Abstract 276: A Qualitative Analysis of Shared Decision Making in Cardiac Surgery

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Ryan Gainer ◽  
Karen Buth ◽  
Jennie David ◽  
Rose Garson ◽  
Hani Mufti ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Informed Consent ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Institutional Care ◽  
Consent Process ◽  
Patient Specific ◽  
Shared Decision ◽  
Patient Groups

OBJECTIVES Comprehension of risks, benefits, and alternative treatment options is poor among patients referred for cardiac interventions. We have previously demonstrated that frail, elderly patients undergoing cardiac surgery require complex procedures and are at markedly increased risk of postoperative death and prolonged institutional care. An effective informed consent process is critical in this population. We suggest this vulnerable patient population may benefit from the institution of a formalized shared decision making (SDM) process. METHODS Three focus groups were convened for CABG, Valve, or CABG +Valve patients over 70 who were either within two years post-op, within 4-8 weeks post-op or had had a complicated post-operative course. Two focus groups were convened for the caretaker group: IMCU nurses & ICU nurses and surgeons, anesthesiologists & cardiac intensivists. In a semi-structured interview format, groups were asked questions regarding personal experience with informed consent, comprehension of discussions prior to surgery, potential improvements to the consent process, and SDM in cardiac surgery. Transcribed audio data was analyzed to develop consistent and comprehensive themes. RESULTS Patient groups were supportive of changing standard consent by including patient-specific risk factors through graphics, reduced language complexity and increased font size as means to improve comprehension and discussion. Patient groups felt access to this information earlier on in their care would allow time to identify personal values and desires for treatment. Both care provider groups supported a consent process that would provide patients with information earlier through decisional aids presented in a structured SDM process. All groups were supportive of a dedicated RN employed as a decisional coach to meet with patients and families prior to surgery to discuss their values, concerns, and questions to facilitate SDM with the care team. CONCLUSIONS Data from these groups will aid in the development of decision aids that serve to educate patients about their disease, the procedure proposed, and its risks and alternatives. Utilizing validated risk prediction models from our own experience allows us to provide patient specific risks for in-hospital mortality, major morbidity, and prolonged institutional care as well as long term outcomes freedom from mortality and re-hospitalization for cardiac cause.

Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives

2016 ◽  
Vol 37 (5) ◽  
pp. 600-610 ◽  
Author(s):  
Ryan A. Gainer ◽  
Janet Curran ◽  
Karen J. Buth ◽  
Jennie G. David ◽  
Jean-Francois Légaré ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Consent Process ◽  
Decision Making Process ◽  
Shared Decision ◽  
Provider Perspectives ◽  
Increased Risk ◽  
The Impact

Objectives. Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients’ values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population. Methods. Focus groups were held with both providers and former patients. Three focus groups were convened for Coronary Artery Bypass Graft (CABG), Valve, or CABG +Valve patients ≥ 70 y old (2-y post-op, ≤ 8-wk post-op, complicated post-op course) (n = 15). Three focus groups were convened for Intermediate Medical Care Unit (IMCU) nurses, Intensive Care Unit (ICU) nurses, surgeons, anesthesiologists and cardiac intensivists (n = 20). We used a semi-structured interview format to ask questions surrounding the informed consent process. Transcribed audio data was analyzed to develop consistent and comprehensive themes. Results. We identified 5 main themes that influence the decision making process: educational barriers, educational facilitators, patient autonomy and perceived autonomy, patient and family expectations of care, and decision making advocates. All themes were influenced by time constraints experienced in the current consent process. Patient groups expressed a desire to receive information earlier in their care to allow time to identify personal values and preferences in developing plans for treatment. Both groups strongly supported a formal approach for shared decision making with a decisional coach to provide information and facilitate communication with the care team. Conclusions. Identifying the barriers and facilitators to patient and caretaker engagement in decision making is a key step in the development of a structured, patient-centered SDM approach. Intervention early in the decision process, the use of individualized decision aids that employ graphic risk presentations, and a dedicated decisional coach were identified by patients and providers as approaches with a high potential for success. The impact of such a formalized shared decision making process in cardiac surgery on decisional quality will need to be formally assessed. Given the trend toward older and frail patients referred for complex cardiac procedures, the need for an effective shared decision making process is compelling.

Enhancing the Informed Consent Process Using Shared Decision Making and Consent Refusal Data from the CLEAR III Trial

2019 ◽  
Vol 32 (1) ◽  
pp. 340-347
Author(s):  
Amanda L. Porter ◽  
James Ebot ◽  
Karen Lane ◽  
Lesia H. Mooney ◽  
Amy M. Lannen ◽  
...  
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Informed Consent Process ◽  
Consent Process ◽  
Shared Decision

Abstract TP305: Patient Expectations and Physician Preferences of Informed Consent for tPA

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Scott J Mendelson ◽  
Elisa Gordon ◽  
Christopher Richards ◽  
Jane Holl ◽  
Shyam Prabhakaran
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Patient Expectations ◽  
Informed Consent Process ◽  
Shared Decision ◽  
Stroke Patients ◽  
Risks And Benefits ◽  
Decision Making Model

Objective: To assess the optimal content and contextual parameters, based on patient and physician input, of the informed consent process for tPA in acute ischemic stroke patients. Background: Consent-related delays may contribute to worse outcomes, as any delay in tPA eligible patients is associated with worse outcomes. Informed consent, an under-studied barrier to timely tPA delivery, potentially delays or results in a refusal of therapy in up to 20% of eligible patients. Methods: A mixed-methods qualitative study identified patient and caregiver information expectations and physician preferences in describing risks and benefits of tPA during acute stroke patient evaluations. Through interviews of stroke patients and caregivers who provided informed consent for tPA, and of neurologists and emergency medicine physicians, several themes were identified. These themes as well as strategies to standardize the informed consent process were further explored with mixed focus groups of stroke patients who received tPA, stroke patients who did not receive tPA, and caregivers. Results: Interviewed stroke patients or their surrogates (n=15) who provided informed consent preferred a shared decision-making model of informed consent while recognizing the time urgency of tPA therapy. Interviewed physicians (n=9) expressed a desire to include patients or their surrogates in decision-making and stressed the importance of describing tPA risks, such as intracerebral hemorrhage. Stroke patients and caregivers (n=22) participating in focus groups (n=4) expressed varying information expectations. The majority of focus group participants expressed minimal information needs and preferred a verbal description of risks and benefits as compared with detailed pictographs. A minority desired a greater amount of information regarding the risk, benefits, and indication for tPA when deciding upon treatment. Conclusions: Qualitative analyses of informed consent for tPA suggest that a standardized shared decision-making model which includes descriptions of risks could be developed to meet patient expectations and physician preferences. Optimizing the shared decision-making process for tPA could reduce consent-related delays and refusals of tPA.

scholarly journals Informed Consent for Intraoperative Neural Monitoring in Thyroid and Parathyroid Surgery – Consensus Statement of the International Neural Monitoring Study Group

2021 ◽  
Vol 12 ◽  
Author(s):  
Che-Wei Wu ◽  
Tzu-Yen Huang ◽  
Gregory W. Randolph ◽  
Marcin Barczyński ◽  
Rick Schneider ◽  
...  
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Consensus Statement ◽  
Consent Process ◽  
Study Group ◽  
Shared Decision ◽  
Parathyroid Surgery ◽  
Monitoring Study ◽  
Neural Monitoring

In the past decade, the use of intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery has been widely accepted by surgeons as a useful technology for improving laryngeal nerve identification and voice outcomes, facilitating neurophysiological research, educating and training surgeons, and reducing surgical complications and malpractice litigation. Informing patients about IONM is not only good practice and helpful in promoting the efficient use of IONM resources but is indispensable for effective shared decision making between the patient and surgeon. The International Neural Monitoring Study Group (INMSG) feels complete discussion of IONM in the preoperative planning and patient consent process is important in all patients undergoing thyroid and parathyroid surgery. The purpose of this publication is to evaluate the impact of IONM on the informed consent process before thyroid and parathyroid surgery and to review the current INMSG consensus on evidence-based consent. The objective of this consensus statement, which outlines general and specific considerations as well as recommended criteria for informed consent for the use of IONM, is to assist surgeons and patients in the processes of informed consent and shared decision making before thyroid and parathyroid surgery.

Certified Patient Decision Aids: Solving Persistent Problems with Informed Consent Law

2017 ◽  
Vol 45 (1) ◽  
pp. 12-40 ◽  
Author(s):  
Thaddeus Mason Pope
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Legal Doctrine ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Decision Making Processes

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

Das präoperative anästhesiologische Patientengespräch

2009 ◽  
Vol 66 (7) ◽  
pp. 503-508 ◽  
Author(s):  
Christoph Harms ◽  
Christoph H. Kindler
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Shared Decision

Anästhesisten treffen ihre Patienten häufig in Ausnahmesituationen an, geprägt von Angst und großer Unsicherheit. Selbst zeitlich kurze Kontakte sind daher meist intensiv und bedeutsam. Das persönliche, anästhesiologische Gespräch steht am Beginn der Beziehung von Patient und Anästhesist und soll die geplanten Maßnahmen, welche der Anästhesist durchführen wird, erklären und begleiten. Ein solches Gespräch dauert heute durchschnittlich 20 Minuten. Es beinhaltet die Erhebung der Anamnese, die strukturierte und verständliche Informationsübermittlung zwischen Anästhesist und Patient (inklusive Informationen über die anästhesiologischen Interventionen, Instruktionen zum Verhalten des Patienten und die offene und klare Kommunikation von Vor- und Nachteilen sowie Risiken möglicher Anästhesieverfahren) sowie den professionellen Umgang mit den Emotionen des Patienten, insbesondere seiner präoperativen Angst. Da Patienten heute in der Anästhesiologie vermehrt in den Entscheidungsprozess mit einbezogen werden, entwickelt sich dieses Gespräch zunehmend von einer eher paternalistischen Arzt-Patienten Interaktion zu einer gemeinsamen Entscheidungsfindung, dem so genannten „shared decision making“. Formal sollte das präoperative Gespräch die bekannten Voraussetzungen für eine erfolgreiche Verständigung zwischen Patient und Arzt wie Deutlichkeit, Eindeutigkeit, identische Kodierung, Empathie und Rückmeldung erfüllen und mit dem einholen eines „informed consent“ enden.

Sign in / Sign up

Export Citation Format

Share Document