scholarly journals Decision-Making of Older Patients in Context of the Doctor-Patient Relationship: A Typology Ranging from “Self-Determined” to “Doctor-Trusting” Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Jennifer Wrede-Sach ◽  
Isabel Voigt ◽  
Heike Diederichs-Egidi ◽  
Eva Hummers-Pradier ◽  
Marie-Luise Dierks ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Seeking ◽  
Older Patients ◽  
Self Determination ◽  
Shared Decision ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Good Doctor ◽  
Patient Decision Making

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.

Doctor–patient relationship mediates the effects of shared decision making on health-related quality of life among women living with breast cancer

2018 ◽  
Vol 49 (3) ◽  
pp. 364-375 ◽  
Author(s):  
Nuworza Kugbey ◽  
Kwaku Oppong Asante ◽  
Anna Meyer-Weitz
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Cross Sectional ◽  
Patient Relationships

Decreased quality of life is a major challenge among women living with breast cancer due to treatment effects and other psychosocial comorbidities. However, shared decision making and doctor–patient relationship have been linked to improved quality of life, but the mechanism linking shared decision making and quality of life is poorly understood. This study therefore examined both the direct and indirect influences of shared decision making on quality of life through doctor–patient relationship among 205 women living with breast cancer in Ghana with a mean age of 52.49 years. Using a cross-sectional design, participants were administered questionnaires which measured quality of life, doctor–patient relationship, and shared decision making. Results showed that shared decision making had significant indirect influence on overall quality of life via doctor–patient relationships ( b = 4.69, 95% confidence interval = [0.006, 9.555]). Shared decision making had a significant effect on doctor–patient relationships ( b = 7.63, t = 6.76, p < .001) but no significant direct effect on quality of life ( b = 2.72, t = 0.510, p = .61). Findings suggest that shared decision making results in improved doctor–patient relationships which probably lead to better quality of life among women living with breast cancer. These findings underscore the need for increased patient involvement in medical decisions to improve interpersonal relationships and consequently quality of life.

scholarly journals Challenges of Shared Decision Making in Older Patients with COVID ‐19

2020 ◽  
Author(s):  
Abhay Dhand ◽  
Leanne Forman ◽  
Rathnamitreyee Vegunta ◽  
Wilbert S. Aronow ◽  
Christopher Nabors
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision

scholarly journals Understanding Behavioral Intent to Participate in Shared Decision-making in Medically Uncertain Situations

2012 ◽  
Vol 51 (04) ◽  
pp. 301-308 ◽  
Author(s):  
K. Dunn ◽  
J. Zhang ◽  
C. E. Hsu ◽  
J. H. Holmes ◽  
R. M. Maffei
Keyword(s):  
Decision Making ◽  
Content Analysis ◽  
Shared Decision Making ◽  
Information Seeking ◽  
Health Informatics ◽  
Qualitative Content Analysis ◽  
Shared Decision ◽  
Behavioral Intent ◽  
Patient Interview ◽  
Medical Uncertainty

SummaryObjective: This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent based on the Theory of Reasoned Action (TRA) and applied to men between the ages of 45 and 70 in the context of their participation in shared decision-making (SDM) in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information that may facilitate greater understanding, efficiency and effectiveness of clinician-patient consultations.Materials and Methods: Twenty-five male subjects from the Philadelphia community participated in this study. Individual semi-structure patient interviews were conducted until data saturation was reached. Based on their review of the patient interview transcripts, researchers conducted a qualitative content analysis to identify prevalent themes and, subsequently, create a category framework. Qualitative indicators were used to evaluate respondents’ experiences, beliefs, and behavioral intent relative to participation in shared decision-making during medical uncertainty.Results: Based on the themes uncovered through the content analysis, a category framework was developed to facilitate understanding and increase the accuracy of predictions related to an individual’s behavioral intent to participate in shared decision-making in medical uncertainty. The emerged themes included past experience with medical uncertainty, individual personality, and the relationship between the patient and his physician. The resulting three main framework categories include 1) an individual’s Foundation for the concept of medical uncertainty, 2) how the individual Copes with medical uncertainty, and 3) the individual’s Behavioral Intent to seek information and participate in shared decision-making during times of medically uncertain situations.Discussion: The theme of Coping (with uncertainty) emerged as a particularly critical behavior/characteristic amongst the subjects. By understanding a subject’s disposition with regard to coping, researchers were better able to make connections between a subject’s prior experiences, their knowledge seeking activities, and their intent to participate in SDM. Despite having information and social support, the subjects still had to cope with the idea of uncertainty before determining how to proceed with regard to shared decision-making. In addition, the coping category reinforced the importance of information seeking behaviors and preferences for shared decision-making.Conclusions: This study applies and extends the field of behavioral and health informatics to assist medical practice and decision-making in situations of medical uncertainty. More specifically, this study led to the development of a category framework that facilitates the identification of an individual’s needs and motivational factors with regard to their intent to participate in shared decision-making in situations of medical uncertainty.

Models of the Doctor-Patient Relationship and the Ethics Committee: Part One

1992 ◽  
Vol 1 (1) ◽  
pp. 11-31 ◽  
Author(s):  
David C. Thomasma
Keyword(s):  
Decision Making ◽  
Ethical Issues ◽  
Ethics Committee ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Patient Decision Making ◽  
Deontological Ethics ◽  
Ethical Discussion ◽  
Patient Decision

Models of the doctor-patient relationship determine which value will predominate in the interaction of the parties. That value then significantly colors and even sometimers alters the nature of the ethical discussion. For example, if an institution predominately prides it-self on its competitive posture, ethical issues arising therein will necessarily be colored by entrepreurial rather than deontological ethics. By contrast, a physician who underlines patient decision making will tend to place autonomy first above all other principles, casting that relationship in a libertarian tone.

Expert and patient consensus on a dynamic model for shared decision-making in frail older patients

2016 ◽  
Vol 99 (6) ◽  
pp. 1069-1077 ◽  
Author(s):  
Marjolein H.J. van de Pol ◽  
Cornelia R.M.G. Fluit ◽  
Joep Lagro ◽  
Yvonne H.P. Slaats ◽  
Marcel G.M. Olde Rikkert ◽  
...  
Keyword(s):  
Decision Making ◽  
Dynamic Model ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision

Older Patients’ Perspectives on Quality of Serious Illness Care in Primary Care

2018 ◽  
Vol 35 (10) ◽  
pp. 1330-1336 ◽  
Author(s):  
Nebras. Abu Al Hamayel ◽  
Sarina R. Isenberg ◽  
Susan M. Hannum ◽  
Joshua Sixon ◽  
Katherine Clegg. Smith ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Quality Improvement ◽  
Access To Care ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision ◽  
Coordination Of Care ◽  
Serious Illness

Background: Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. Objective: To explore older patients’ perspectives on the quality of serious illness care in primary care. Design: Qualitative interview study. Participants: Twenty patients aged 60 or older who were at risk for or living with serious illness and who had participated in the clinic’s quality improvement initiative. Methods: We used a semistructured, open-ended guide focusing on how older patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes. We identified emergent themes using a thematic and constant comparative method. Results: We identified 5 key themes: (1) the importance of patient-centered communication, (2) coordination of care, (3) the shared decision-making process, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between patients and their clinicians, empowered patients for shared decision-making, related to clinicians’ perceived competence, and enabled access to primary and specialty care. Although access to care is not traditionally considered an aspect of quality, patients considered this integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care. Conclusions: Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.

scholarly journals Patient and Cardiologist Perspectives on Shared Decision Making in the Treatment of Older Adults Hospitalized for Acute Myocardial Infarction

2020 ◽  
Vol 40 (3) ◽  
pp. 279-288
Author(s):  
Eleonore V. Grant ◽  
Jenny Summapund ◽  
Daniel D. Matlock ◽  
Victoria Vaughan Dickson ◽  
Sohah Iqbal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Adults ◽  
Acute Myocardial Infarction ◽  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Comparative Method ◽  
Patient Specific ◽  
Shared Decision ◽  
Risks And Benefits

Background. Medical and interventional therapies for older adults with acute myocardial infarction (AMI) reduce mortality and improve outcomes in selected patients, but there are also risks associated with treatments. Shared decision making (SDM) may be useful in the management of such patients, but to date, patients’ and cardiologists’ perspectives on SDM in the setting of AMI remain poorly understood. Accordingly, we performed a qualitative study eliciting patients’ and cardiologists’ perceptions of SDM in this scenario. Methods. We conducted 20 in-depth, semistructured interviews with older patients (age ≥70) post-AMI and 20 interviews with cardiologists. The interviews were transcribed and analyzed using ATLAS.ti. Two investigators independently coded transcripts using the constant comparative method, and an integrative, team-based process was used to identify themes. Results. Six major themes emerged: 1) patients felt their only choice was to undergo an invasive procedure; 2) patients placed a high level of trust and gratitude toward physicians; 3) patients wanted to be more informed about the procedures they underwent; 4) for cardiologists, patients’ age was not a major contraindication to intervention, while cognitive impairment and functional limitation were; 5) while cardiologists intuitively understood the concept of SDM, interpretations varied; and 6) cardiologists considered SDM to be useful in the setting of non-ST elevated myocardial infarction (NSTEMI) but not ST-elevated myocardial infarction (STEMI). Conclusions. Patients viewed intervention as “the only choice,” whereas cardiologists saw a need for balancing risks and benefits in treating older adults post-NSTEMI. This discrepancy implies there is room to improve communication of risks and benefits to older patients. A decision aid informed by the needs of older adults could help to better convey patient-specific risk and increase choice awareness.

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