scholarly journals Varieties of Uncertainty in Health Care

2011 ◽  
Vol 31 (6) ◽  
pp. 828-838 ◽  
Author(s):  
Paul K. J. Han ◽  
William M. P. Klein ◽  
Neeraj K. Arora
Keyword(s):  
Health Care ◽  
Empirical Literature ◽  
Evidence Based ◽  
Shared Decision ◽  
Services Research ◽  
Patient Centered ◽  
3 Dimensional ◽  
Centered Care ◽  
Multiple Meanings ◽  
Based Medicine

Uncertainty is a pervasive and important problem that has attracted increasing attention in health care, given the growing emphasis on evidence-based medicine, shared decision making, and patient-centered care. However, our understanding of this problem is limited, in part because of the absence of a unified, coherent concept of uncertainty. There are multiple meanings and varieties of uncertainty in health care that are not often distinguished or acknowledged although each may have unique effects or warrant different courses of action. The literature on uncertainty in health care is thus fragmented, and existing insights have been incompletely translated to clinical practice. This article addresses this problem by synthesizing diverse theoretical and empirical literature from the fields of communication, decision science, engineering, health services research, and psychology and developing a new integrative conceptual taxonomy of uncertainty. A 3-dimensional taxonomy is proposed that characterizes uncertainty in health care according to its fundamental sources, issues, and locus. It is shown how this new taxonomy facilitates an organized approach to the problem of uncertainty in health care by clarifying its nature and prognosis and suggesting appropriate strategies for its analysis and management.

Comparatively Ineffective? PCORI and the Uphill Battle to Make Evidence Count in US Medicine

2020 ◽  
Vol 45 (5) ◽  
pp. 787-800
Author(s):  
Eric M. Patashnik
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Treatment Options ◽  
Cultural Barriers ◽  
Health Care Spending ◽  
Evidence Based ◽  
Medical Evidence ◽  
Patient Centered ◽  
The Us ◽  
Based Medicine

Abstract The Patient-Centered Outcomes Research Institute (PCORI) was established as part of the Affordable Care Act to promote research on the comparative effectiveness of treatment options. Advocates hoped this information would help reduce wasteful spending by identifying low-value treatments, but many conservatives and industry groups feared PCORI would ration care and threaten physicians' autonomy. PCORI faced three challenges during its first decade of operation: overcoming the controversy of its birth and escaping early termination, shaping medical practice, and building a public reputation for relevance. While PCORI has won reauthorization, it has not yet had a major impact on the decisions of clinicians or payers. PCORI's modest footprint reflects not only the challenges of getting a new organization off the ground but also the larger political, financial, and cultural barriers to the uptake of medical evidence in the US health care system. The growing attention among policymakers and researchers to provider prices (rather than utilization) as the driver of health care spending could be helpful to the political prospects of the evidence-based medicine project by making it appear to be less as rationing driven by costs and more as an effort to improve quality and uphold medical professionalism.

scholarly journals Partnerships to Improve Shared Decision Making for Patients with Hypertension: Health Equity Implications

2019 ◽  
Vol 29 (Suppl 1) ◽  
pp. 97-102
Author(s):  
Aisha T. Langford ◽  
Stephen K. Williams ◽  
Melanie Applegate ◽  
Olugbenga Ogedegbe ◽  
Ronald S. Braithwaite
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Equity ◽  
Clinical Care ◽  
Lifestyle Changes ◽  
Shared Decision ◽  
Patient Centered ◽  
Broad Array ◽  
Centered Care

Shared decision making (SDM) has increas­ingly become appreciated as a method to enhance patient involvement in health care decisions, patient-provider communication, and patient-centered care. Compared with cancer, the literature on SDM for hyperten­sion is more limited. This is notable because hypertension is the leading risk factor for cardiovascular disease and both conditions disproportionately affect certain subgroups of patients. However, SDM holds prom­ise for improving health equity by better engaging patients in their health care. For example, many reasonable options exist for treating uncomplicated stage-1 hyperten­sion. These options include medication and/ or lifestyle changes such as healthy eating, physical activity, and weight management. Deciding on “the best” plan of action for hypertension management can be challeng­ing because patients have different goals and preferences for treatment. As hyper­tension management may be considered a preference-sensitive decision, adherence to treatment plans may be greater if those plans are concordant with patient prefer­ences. SDM can be implemented in a broad array of care contexts, from patient-provider dyads to interprofessional collaborations. In this article, we argue that SDM has the potential to advance health equity and improve clinical care. We also propose a process to evaluate whether SDM has occurred and suggest future directions for research.Ethn Dis. 2019;29(Suppl 1):97- 102; doi:10.18865/ed.29.S1.97.

scholarly journals Medical Concepts with Clinical-Epidemiological Implications that have to be Re-Assessed Since the Coronavirus Disease 2019 (Covid-19) Pandemic

2020 ◽  
Vol 1 (1) ◽  
pp. 17-27
Author(s):  
Jose Luis Turabian
Keyword(s):  
Medical Model ◽  
Big Bang ◽  
Health Centers ◽  
Evidence Based ◽  
Patient Centered ◽  
Centered Care ◽  
Health Model ◽  
Based Medicine ◽  
The Big Bang ◽  
Medical Concepts

The coronavirus disease 2019 (COVID-19) pandemic is something new that baffles us. The dominant health model and the theory that supported it until before COVID-19 are refuted or invalidated by observing the current tragically situation, which also implies lasting changes in that new medical model. Consequently, once the urgency of the epidemic is over, the conceptual and organizational building of medical care can no longer be rebuilt in the same way. Based on the COVID-19 experience, it is necessary to rethink what kind of knowledge can emerge. Some of the concepts with clinical-epidemiological implications that have to be re-evaluated since the COVID-19 pandemic are: 1. Large epidemics or changes do not arise from an event similar to the "Big Bang", but rather they develop slowly and underground, so a surveillance system must be instituted; 2. Re-evaluate what we understand by "evidence-based medicine"; 3. Patient-centered care is inadequate and must be replaced by community-centered care; 4. Telecare and changes in the organization of consultations; 5. Hospitals and health centers are "biological bombs" that act as vectors of disease and must change their architecture, organization and use; 6. The end of the nursing home model; 7. Change of habits; and 8. Social media can democratize information and help communities organize.

scholarly journals Independent and Web-Based Advice for Infertile Patients Using Fertility Consult: Pilot Study (Preprint)

2019 ◽  
Author(s):  
Aleida Gerarda Huppelschoten ◽  
Jan Peter de Bruin ◽  
Jan AM Kremer
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Pilot Study ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Web Based ◽  
Online Platform ◽  
Centered Care

BACKGROUND Patient-centered care—that is, care tailored to personal wishes and needs of patients—has become increasingly important. It is especially relevant in health care areas where patients suffer from a high burden of disease, such as fertility care. At present, both diagnosis and treatment for infertile couples is provided at a single hospital. As a consequence, patients are not likely to receive optimal, independent advice regarding their fertility problems. Internet-based, independent advice could be feasible for large groups of patients because it is not limited by travel distance and overhead costs. OBJECTIVE The aim of this study was to explore the experiences of both patients and professionals with an online platform using video consultations for patients with infertility seeking independent advice for their fertility problem. METHODS This pilot study evaluated an online platform, Fertility Consult, where patients with infertility can get independent advice by a gynecologist through a video consultation, thus eliminating the need of meeting the doctor physically. Semistructured interviews were performed with 2 gynecologists and the chairman of the Dutch patients association. This information was used for a patients’ questionnaire about their first experiences with Fertility Consult, including questions about the level of patient-centeredness and shared decision making, using the Patient-Centered Questionnaire-Infertility (PCQ-Infertility) and the CollaboRATE questionnaire, respectively. RESULTS Of the first 27 patients enrolled at Fertility Consult, 22 responded (82%). Most patients (82%) visited Fertility Consult for a second opinion, seeking more personal attention and independent advice. The mean level of patient-centeredness on the PCQ-Infertility questionnaire was 2.78 (SD 0.58) on a scale of 0 to 3. For the CollaboRATE questionnaire (scale 0-9), patients provided a median score of 8.0 (range 7-9) on all 3 questions about shared decision making. CONCLUSIONS Patients were satisfied with independent, well-prepared, Web-based advice; health care professionals felt they were able to provide patients with proper advice in a manner befitting patients’ needs, without any loss of quality. Future studies should focus more on the separation of advice and treatment and on Web-based consultations compared with face-to-face consultations to ascertain the possibility of increased patient involvement in the process to improve the level of patient-centered care.

Evidence-based medicine offers an optimal starting point for person-centered medicine

2014 ◽  
Vol 2 (1) ◽  
pp. 76 ◽  
Author(s):  
Piet Post ◽  
Gordon Guyatt
Keyword(s):  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Patient Centered Care ◽  
Evidence Based ◽  
Discussion Paper ◽  
Patient Centered ◽  
Starting Point ◽  
Centered Care ◽  
Based Medicine

In their discussion paper, Miles and Mezzich argue that evidence-based medicine (EBM) and patient-centered care have developed in parallel, but rarely have entered into exchange and dialogue. These authors emphasize the need for a rational form of integration to take part between EBM and patient-centered care. We agree wholeheartedly with the desirability of both dialogue and integration. The dialogue will be much less likely to be productive, however, when authors ignore or altogether misconstrue the evolution of evidence-based medicine and the recent work of EBM leaders. Statements claiming “a foundational irreconcilability between the fundamental principles of EBM and those of patient-centered care” are not likely to promote enthusiastic dialogue with the EBM community. In this commentary, we demonstrate that EBM has introduced and aggressively advocated for the integration of patient’s values and preferences in the process of clinical decision-making. Furthermore, EBM has highlighted the need for research into optimal ways of integrating patient values and preferences and, most recently, introduced and studied innovative ways of facilitating shared decision-making.

scholarly journals Caring for patients with kidney disease: shifting the paradigm from evidence-based medicine to patient-centered care

2015 ◽  
Vol 31 (3) ◽  
pp. 368-375 ◽  
Author(s):  
Ann M. O'Hare ◽  
Rudolph A. Rodriguez ◽  
Christopher Barrett Bowling
Keyword(s):  
Kidney Disease ◽  
Evidence Based Medicine ◽  
Patient Centered Care ◽  
Evidence Based ◽  
Patient Centered ◽  
Centered Care ◽  
Based Medicine

scholarly journals Partnerships to Improve Shared Decision Making for Patients with Hypertension: Health Equity Implications

2019 ◽  
Vol 29 (Suppl 1) ◽  
pp. 97-102 ◽  
Author(s):  
Aisha T. Langford ◽  
Stephen K. Williams ◽  
Melanie Applegate ◽  
Olugbenga Ogedegbe ◽  
Ronald S. Braithwaite
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Equity ◽  
Clinical Care ◽  
Lifestyle Changes ◽  
Shared Decision ◽  
Patient Centered ◽  
Broad Array ◽  
Centered Care

Shared decision making (SDM) has increas­ingly become appreciated as a method to enhance patient involvement in health care decisions, patient-provider communication, and patient-centered care. Compared with cancer, the literature on SDM for hyperten­sion is more limited. This is notable because hypertension is the leading risk factor for cardiovascular disease and both conditions disproportionately affect certain subgroups of patients. However, SDM holds prom­ise for improving health equity by better engaging patients in their health care. For example, many reasonable options exist for treating uncomplicated stage-1 hyperten­sion. These options include medication and/ or lifestyle changes such as healthy eating, physical activity, and weight management. Deciding on “the best” plan of action for hypertension management can be challeng­ing because patients have different goals and preferences for treatment. As hyper­tension management may be considered a preference-sensitive decision, adherence to treatment plans may be greater if those plans are concordant with patient prefer­ences. SDM can be implemented in a broad array of care contexts, from patient-provider dyads to interprofessional collaborations. In this article, we argue that SDM has the potential to advance health equity and improve clinical care. We also propose a process to evaluate whether SDM has occurred and suggest future directions for research.Ethn Dis. 2019;29(Suppl 1):97- 102; doi:10.18865/ed.29.S1.97.

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