scholarly journals Shared Decision Making for Surgical Care in the Era of COVID-19

2020 ◽  
pp. 019459982095413
Author(s):  
David Forner ◽  
Christopher W. Noel ◽  
Ryan Densmore ◽  
David P. Goldstein ◽  
Martin Corsten ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Surgical Care ◽  
Health Care Use ◽  
System Capacity ◽  
Shared Decision ◽  
Surgical Practice ◽  
Global Pandemic ◽  
Scientific Expertise ◽  
Patient Values

The global pandemic caused by severe acute respiratory syndrome coronavirus 2 has upended surgical practice. In an effort to preserve resources, mitigate risk, and maintain health system capacity, nonurgent surgeries have been deferred in many jurisdictions, with urgent procedures facing increasing wait times and unpredictability given potential future surges. Shared decision making, a process that integrates patient values and preferences with the scientific expertise of clinicians, may be of particular benefit during these unprecedented times. Aligning patient choices with their values, reducing unnecessary health care use, and promoting consistency between providers are now more critical than ever before. We review important aspects of shared decision making and provide guidance for its perioperative application during the coronavirus disease 2019 pandemic.

The surgical care practitioner seeking consent: An appropriate delegate?

2018 ◽  
Vol 28 (10) ◽  
pp. 273-277
Author(s):  
Michael Nicholas
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Shared Decision Making ◽  
Care Pathway ◽  
Surgical Care ◽  
Recent Case ◽  
Health Board ◽  
Shared Decision ◽  
Surgical Team ◽  
Surgical Practice

Surgical care practitioners (SCPs) have become recognised as integral members of the surgical team in many healthcare establishments. Seeking informed consent either as the operating practitioner or on behalf of the surgeon, as their delegate, has becoming routine for many SCPs. Informed consent is a critical step in the patient’s care pathway and fundamental in fostering shared decision making and safer surgical practice. The relatively recent case of Montgomery v Lanarkshire Health Board has highlighted a need for those practitioners seeking informed consent to critically examine their practice and revisit the founding principles of the process.

Achieving shared treatment decisions

2017 ◽  
Author(s):  
Martin H.N. Tattersall ◽  
David W. Kissane
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Treatment Options ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Shared Decision ◽  
Similar Treatment ◽  
Treatment Benefits ◽  
Patient Values

The respect of a patient’s autonomous rights within the model of patient-centred care has led to shared decision-making, rather than more paternalistic care. Understanding patient needs, preferences, and lifestyle choices are central to developing shared treatment decisions. Patients can be prepared through the use of question prompt sheets and other decision aids. Audio-recording of informative consultations further helps. A variety of factors like the patient’s age, tumour type and stage of disease, an available range of similar treatment options, and their risk-benefit ratios will impact on the use of shared decision-making. Modifiable barriers to shared decision-making can be identified. Teaching shared decision-making includes the practice of agenda setting, use of partnership statements, clarification of patient preferences, varied approaches to explaining potential treatment benefits and risks, review of patient values and lifestyle factors, and checking patient understanding–this sequence helps both clinicians and patients to optimally reach a shared treatment decision.

scholarly journals Shared Decision Making and Choice for Elective Surgical Care

2015 ◽  
Vol 154 (3) ◽  
pp. 405-420 ◽  
Author(s):  
Emily F. Boss ◽  
Nishchay Mehta ◽  
Neeraja Nagarajan ◽  
Anne Links ◽  
James R. Benke ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Surgical Care ◽  
Shared Decision

scholarly journals The Ethic of Responsibility: Max Weber’s Verstehen and Shared Decision-Making in Patient-Centred Care

2019 ◽  
Author(s):  
Ariane Hanemaayer
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Humanities ◽  
Medical Knowledge ◽  
Shared Decision ◽  
Patient Centred Care ◽  
Physician Decision Making ◽  
Patient Values ◽  
Based Medicine ◽  
The Relationship

AbstractWhereas evidence-based medicine (EBM) encourages the translation of medical research into decision-making through clinical practice guidelines (CPGs), patient-centred care (PCC) aims to integrate patient values through shared decision-making. In order to successfully integrate EBM and PCC, I propose a method of orienting physician decision-making to overcome the different obligations set out by a formally-rational EBM and substantively-rational ethics of care. I engage with Weber’s concepts “the ethic of responsibility” and verstehen as a new model of clinical reasoning that reformulates the relationship between medical knowledge and social values, while demonstrating the relevance of the classical sociological cannon to contemporary medical humanities.

Decision dissonance/alignment scale to promote patient-centered decisions about urinary diversion with cystectomy for bladder cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16010-e16010 ◽  
Author(s):  
Scott Michael Gilbert ◽  
Michael C Leo ◽  
Christopher Wendel ◽  
Robert S. Krouse ◽  
Marcia Grant ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Urinary Diversion ◽  
Convergent Validity ◽  
Shared Decision ◽  
Patient Centered ◽  
Kaiser Permanente ◽  
Decision Style ◽  
Patient Goals ◽  
Patient Values

e16010 Background: The choice of urinary diversion (UD) with cystectomy is an opportunity to provide preference-driven care. We adapted a decision dissonance scale to measure concordance of patient goals with choice of ileal conduit (IC) vs. neobladder (NB) UD. Methods: With patient and clinician input, we identified 6 IC- and 4 NB-aligned goals, each rated on an 11-point scale (0 = not at all important to 10 = very important). Kaiser Permanente members rated the importance of these goals in a comprehensive survey mailed 6 months post-op (71% response rate (269/381)). Excluding respondents (n=93) with contraindications to NB and missing data on goals, we examined structural validity with principal axis factor analysis and convergent validity using correlations with other decision-making measures. Results: Items aligned to IC vs. NB factored separately as hypothesized (Table 1). NB patients prioritized (p<.05) NB-aligned goals (M=8.8, SD=1.8) over NB-dissonant goals (M=4.3, SD=2.4). IC patients’ alignment (M=5.4, SD=2.7) and dissonance (M=5.6, SD=2.1) ratings were similar. Dissonance was negatively correlated with informed decision-making (r=-.27) and satisfaction with care (r=-.21), and positively correlated with decision regret (r=.28) (each p<.01), but not correlated with shared decision making or decision style preference. Alignment was not significantly correlated with decision-making measures. Conclusions: Our measure distinguished patient values that could guide shared decision-making about UD choice. Patients who chose a NB had strong preferences for maintaining body integrity and function. [Table: see text]

scholarly journals iValidate: a communication-based clinical intervention in life-limiting illness

2019 ◽  
pp. bmjspcare-2018-001669
Author(s):  
Nicholas Simpson ◽  
Sharyn Milnes ◽  
Peter Martin ◽  
Anita Phillips ◽  
Jonathan Silverman ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Acute Care ◽  
Outcome Measures ◽  
Communication Skills ◽  
Health Professionals ◽  
Demographic Data ◽  
Education Programme ◽  
Shared Decision ◽  
Patient Values

ObjectivesReport the implementation, user evaluation and key outcome measures of an educational intervention—the iValidate educational programme—designed to improve engagement in shared decision-making by health professionals caring for patients with life-limiting illness (LLI).DesignProspective, descriptive, cohort study.ParticipantsHealth professionals working in acute care settings caring for patients with an LLI.Main outcomes measuredParticipant evaluation of learning outcomes for communication skills and shared decision-making; demographic data of participants attending education workshops; and documentation of patients with LLI goals of management, including patient values and care decision based on area in acute care and seniority of doctor.ResultsThe programme was well accepted by participants. Participant evaluations demonstrated self-reported improved confidence in the areas of patient identification, information gathering to ascertain patient values and shared decision-making. There was strong agreement with the course-enhanced knowledge of core communication skills and advanced skills such as discussing mismatched agendas.ConclusionsWe described the educational pedagogy, implementation and key outcome measures of the iValidate education programme, an intervention designed to improve person-centred care for patients with an LLI. A targeted education programme could produce cultural and institutional change for vulnerable populations within a healthcare institution. A concurrent research programme suggests effectiveness within the current service and the potential for transferability.

scholarly journals Personalized outcomes for hip and knee replacement: the patients point of view

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Robin R. Whitebird ◽  
Leif I. Solberg ◽  
Jeanette Y. Ziegenfuss ◽  
Stephen E. Asche ◽  
Christine K. Norton ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Knee Replacement ◽  
Clinical Care ◽  
Surgical Care ◽  
Shared Decision ◽  
Personal Factors ◽  
Knee Replacement Surgery ◽  
Replacement Surgery ◽  
Patient Reported

Abstract Background Patient reported outcome measures (PROMs) are increasingly being incorporated into clinical and surgical care for assessing outcomes. This study examined outcomes important to patients in their decision to have hip or knee replacement surgery, their perspectives on PROMs and shared decision-making, and factors they considered important for postoperative care. Methods A cross-sectional study employing survey methods with a stratified random sample of adult orthopedic patients who were scheduled for or recently had hip or knee replacement surgery. Results In a representative sample of 226 respondents, patients identified personalized outcomes important to them that they wanted from their surgery including the ability to walk without pain/discomfort, pain relief, and returning to an active lifestyle. They preferred a personalized outcome (54%) that they identified, compared to a PROM score, for tracking progress in their care and thought it important that their surgeon know their personal outcomes (63%). Patients also wanted to engage in shared decision-making (79%) about their post-surgical care and identified personal factors important to their aftercare, such as living alone and caring for pets. Conclusions Patients identified unique personalized outcomes they desired from their care and that they wanted their orthopedic surgeons to know about. Asking patients to identify their personalized outcomes could add value for both patients and surgeons in clinical care, facilitating more robust patient involvement in shared decision-making.

Oncology provider perceptions of shared-decision making.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23168-e23168
Author(s):  
Nila Sathe ◽  
Cate Polacek ◽  
Sunnie Fenk ◽  
Wendy Rossi ◽  
Roni Christopher
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Care Delivery ◽  
Shared Decision ◽  
Cultural Meanings ◽  
Provider Attitudes ◽  
Care Experience ◽  
Provider Perceptions ◽  
Patient Values ◽  
Communication Needs

e23168 Background: Adoption of shared decision making (SDM), a key strategy for improving patients’ care experience, may be limited. We explored oncology professionals’ SDM perceptions to understand patient-provider decision-making communication. Methods: Semi-structured phone interviews or web-based surveys with purposively recruited participants from a range of perspectives to increase generalizability. Content analysis to identify overarching themes. Results: Respondents (n = 20) valued SDM but described challenges including: Evolving and variable communication needs. Evolving care trajectories constrain full SDM discussions. Differences in goals in curative or palliative situations dictate different approaches. Communication along care continuum. Providers noted that discussions of elements of care occur with multiple providers and staff, potentially in a piecemeal fashion. Communicating about costs. Costs vary considerably in terms of cost to the patient and to the system. Impact on care is more than a simple higher/lower dichotomy. Directing decisions vs. fostering discussion: Most respondents understood a “literature-based” SDM definition, but some conflated patient education and SDM. Some implied “nudging” patients toward choices vs. open discussion. Balancing clinical imperatives and patient preferences. Respondents noted balancing professional imperatives to share information with patient values. External influences on communication. Families were seen as a help and hindrance to SDM, particularly when care goals differ. Cultural meanings ascribed to cancer also vary. Decision making style. Participants suggested that patients approach decision making from overarching mindsets regarding engagement (e.g., prioritizing provider input). Conclusions: Respondents valued communication and SDM but described challenges in exigencies of care delivery, provider attitudes, and patient influences. Respondents’ discussion of challenges suggests that exploiting communication opportunities across the care trajectory and deliberate consideration of patients’ preferences for decision-making conversations could help to inform/prime communication and potentially improve SDM processes.

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