Autonomous Decision Making and Moral capacities

2009 ◽  
Vol 16 (2) ◽  
pp. 203-218 ◽  
Author(s):  
Albine Moser ◽  
Rob Houtepen ◽  
Harry van der Bruggen ◽  
Cor Spreeuwenberg ◽  
Guy Widdershoven
Keyword(s):  
Type 2 Diabetes ◽  
Decision Making ◽  
Reflective Practice ◽  
Family Care ◽  
Theory Method ◽  
Text Interpretation ◽  
Grounded Theory Method ◽  
Autonomous Decision ◽  
Decision Making Processes

This article examines how people with type 2 diabetes perceive autonomous decision making and which moral capacities they consider important in diabetes nurses' support of autonomous decision making. Fifteen older adults with type 2 diabetes were interviewed in a nurse-led unit. First, the data were analysed using the grounded theory method. The participants described a variety of decision-making processes in the nurse and family care-giver context. Later, descriptions of the decision-making processes were analysed using hermeneutic text interpretation. We suggest first- and second-order moral capacities that nurses specializing in diabetes need to promote the autonomous decision making of their patients. We recommend nurses to engage in ongoing, interactive reflective practice to further develop these moral capacities.

1552-P: Machine Learning Approach to Decision-Making for Initial Insulin Use in Japanese Patients with Type 2 Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1552-P
Author(s):  
KAZUYA FUJIHARA ◽  
MAYUKO H. YAMADA ◽  
YASUHIRO MATSUBAYASHI ◽  
MASAHIKO YAMAMOTO ◽  
TOSHIHIRO IIZUKA ◽  
...  
Keyword(s):  
Machine Learning ◽  
Type 2 Diabetes ◽  
Decision Making ◽  
Japanese Patients ◽  
Learning Approach ◽  
Machine Learning Approach ◽  
Insulin Use

scholarly journals Shared decision making and patient-centeredness for patients with poorly controlled type 2 diabetes mellitus in primary care—results of the cluster-randomised controlled DEBATE trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Anja Wollny ◽  
Christin Löffler ◽  
Eva Drewelow ◽  
Attila Altiner ◽  
Christian Helbig ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Decision Making ◽  
Type 2 Diabetes Mellitus ◽  
Shared Decision Making ◽  
Intervention Group ◽  
Control Group ◽  
Shared Decision ◽  
Patient Centeredness

Abstract Background We investigate whether an educational intervention of GPs increases patient-centeredness and perceived shared decision making in the treatment of patients with poorly controlled type 2 diabetes mellitus? Methods We performed a cluster-randomized controlled trial in German primary care. Patients with type 2 diabetes mellitus defined as HbA1c levels ≥ 8.0% (64 mmol/mol) at the time of recruitment (n = 833) from general practitioners (n = 108) were included. Outcome measures included subjective shared decision making (SDM-Q-9; scale from 0 to 45 (high)) and patient-centeredness (PACIC-D; scale from 1 to 5 (high)) as secondary outcomes. Data collection was performed before intervention (baseline, T0), at 6 months (T1), at 12 months (T2), at 18 months (T3), and at 24 months (T4) after baseline. Results Subjective shared decision making decreased in both groups during the course of the study (intervention group: -3.17 between T0 and T4 (95% CI: -4.66, -1.69; p < 0.0001) control group: -2.80 (95% CI: -4.30, -1.30; p = 0.0003)). There were no significant differences between the two groups (-0.37; 95% CI: -2.20, 1.45; p = 0.6847). The intervention's impact on patient-centeredness was minor. Values increased in both groups, but the increase was not statistically significant, nor was the difference between the groups. Conclusions The intervention did not increase patient perceived subjective shared decision making and patient-centeredness in the intervention group as compared to the control group. Effects in both groups might be partially attributed to the Hawthorne-effect. Future trials should focus on patient-based intervention elements to investigate effects on shared decision making and patient-centeredness. Trial registration The trial was registered on March 10th, 2011 at ISRCTN registry under the reference ISRCTN70713571.

scholarly journals Non-health outcomes affecting self-care behaviors and medical decision-making preference in patients with type 2 diabetes: a cross-sectional study

2020 ◽  
Author(s):  
Ming-Jye Wang ◽  
Hung-Ming Lin ◽  
Li-Chen Hung ◽  
Yi-Ting Lo
Keyword(s):  
Type 2 Diabetes ◽  
Decision Making ◽  
Health Literacy ◽  
Self Efficacy ◽  
Patient Empowerment ◽  
Self Care ◽  
Cross Sectional Study ◽  
Medical Decision ◽  
Cross Sectional

Abstract Background: The effects of patient sustained self-care behaviors on glycemic control are even greater than the effects of medical treatment, indicating the value of identifying the factors that influence self-care behaviors. To date, these factors have not been placed in a single model to clarify the critical path affecting self-care behaviors. The aims of this study were to explore the relationships of these factors and the differences in patient preference for medical decision-making.Methods: A cross-sectional study was conducted among outpatients with type 2 diabetes at a regional teaching hospital. Purposive sampling was adopted to recruit 316 eligible patients via self-administered questionnaires. Partial least squares structural equation modeling was used for analysis.Results: Significant direct pathways were identified from health literacy to self-efficacy, patient empowerment, and self-care behaviors; from self-efficacy to self-care behaviors; and from patient empowerment to self-care behaviors. Indirect pathways were from health literacy to self-care behaviors via self-efficacy or patient empowerment. The pathway from health literacy to self-efficacy was significantly stronger in those preferring shared decision-making than in those who preferred physician decision-making. Conclusions: Health literacy is a critical factor in improving self-care behaviors in patients with type 2 diabetes, and the effect of health literacy on self-efficacy was more significant in the shared decision-making than in the physician decision-making. Therefore, developing an effective health strategy to strengthen health literacy awareness and designing friendly, diverse health literacy materials, and application tools is the most important factor to facilitate self-care behaviors in this population.

Using a patient decision aid about insulin treatment in type 2 diabetes clinics

2021 ◽  
Vol 16 (1) ◽  
pp. 76-108
Author(s):  
Ayeshah Syed
Keyword(s):  
Type 2 Diabetes ◽  
Decision Making ◽  
Decision Aid ◽  
Insulin Treatment ◽  
Treatment Phase ◽  
Activity Analysis ◽  
Patient Decision Aid ◽  
Healthcare Settings ◽  
Patient Decision

The Candlin Researcher AwardThe low uptake of insulin leaves many Malaysians with type 2 diabetes at risk of developing complications. To improve decision making about insulin treatment, a patient decision aid (PDA) was developed for use with patients. However, although it is generally accepted that PDAs can support informed and shared decision making, there is limited discursive data showing how they are used in doctor–patient consultations. This paper reports on activity analysis of clinic consultations in which a PDA about insulin treatment was used. Eleven consultations with diverse participants conducted in three healthcare settings in Malaysia were systematically mapped to identify structural, interactional and thematic patterns. Two main phases of Assessment and Treatment were identified, with doctors generally participating more than patients. Mapping of the Treatment phase showed that structural patterns depended on two main factors: whether patients had read the PDA and whether they responded negatively or positively towards insulin. While mapping is only a preliminary stage of activity analysis, the findings offer insights into structural, interactional and thematic patterns in PDA use at the level of the whole consultation. They also point towards key areas for closer analysis of discursive practices.

Care workers’ ambivalence towards family care partners: informal decision-making processes when older people consider relocation to a residential home

2020 ◽  
Vol 4 (4) ◽  
pp. 513-530
Author(s):  
Maria Söderberg
Keyword(s):  
Decision Making ◽  
Care Management ◽  
Family Care ◽  
Self Determination ◽  
Management Systems ◽  
Residential Home ◽  
Home Help ◽  
Care Partners ◽  
Care Workers ◽  
Decision Making Processes

The aim of this article is to reveal how care workers in the home-help service interpret the influence of family care partners when older people’s relocation to a residential home is considered. Based on interviews with 33 care workers, this article investigates how they use their discretion. The analysis shows that the care workers express ambivalence towards family care workers and that they informally influence decision-making processes despite prevailing care management systems. The conclusion drawn are that welfare ideas in transformation and diffuse areas of responsibility may not benefit either care workers, family care partners or a care receiver’s self-determination.

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