Seeing it clearly: How to use graphics to guide collaborative consultation in pregnancy

2021 ◽  
pp. 103985622110570
Author(s):  
Philip Keightley ◽  
Ilona DiBella ◽  
Anne Sved Williams
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Decision Aids ◽  
Treatment Decision ◽  
Shared Decision ◽  
Collaborative Communication ◽  
Collaborative Consultation ◽  
Treatment Decision Making ◽  
In Pregnancy

Objective This study aims to examine the use of decision aids which may improve shared decision making through an exploration of risk apprehension and modes of collaborative communication. Conclusions Decision aids such as graphics have a key role in facilitating shared treatment decision making, perhaps particularly in perinatal mental health care. They are most useful within a trusting, two-way conversation.

Shared decision-making, decision aids, and the role of values in treatment decision-making

2017 ◽  
Author(s):  
Amiram Gafni ◽  
Cathy Charles
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Conceptual Development ◽  
Decision Aids ◽  
Treatment Decision ◽  
Clinical Encounter ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Key Characteristics

Shared decision-making (SDM) between physicians and patients is often advocated as the ‘best’ approach to treatment decision-making in the clinical encounter. In this chapter we describe: (i) the key characteristics of a SDM approach; (ii) the clinical contexts for SDM; (iii) the definition and use of decision aids (DA), as well as their relationship to SDM; and (iv) the vexing problem of defining the meaning and role of values/preferences in treatment decision-making. Areas for further research and conceptual development are also suggested to help resolve outstanding issues in the above areas. Despite the widespread interest in promoting SDM, there does not seem to be as yet a universally accepted consensus on the meaning of this concept.

scholarly journals Computer knows best? The need for value-flexibility in medical AI

2018 ◽  
Vol 45 (3) ◽  
pp. 156-160 ◽  
Author(s):  
Rosalind J McDougall
Keyword(s):  
Decision Making ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Treatment Decision ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Value Judgements ◽  
The Relationship

Artificial intelligence (AI) is increasingly being developed for use in medicine, including for diagnosis and in treatment decision making. The use of AI in medical treatment raises many ethical issues that are yet to be explored in depth by bioethicists. In this paper, I focus specifically on the relationship between the ethical ideal of shared decision making and AI systems that generate treatment recommendations, using the example of IBM’s Watson for Oncology. I argue that use of this type of system creates both important risks and significant opportunities for promoting shared decision making. If value judgements are fixed and covert in AI systems, then we risk a shift back to more paternalistic medical care. However, if designed and used in an ethically informed way, AI could offer a potentially powerful way of supporting shared decision making. It could be used to incorporate explicit value reflection, promoting patient autonomy. In the context of medical treatment, we need value-flexible AI that can both respond to the values and treatment goals of individual patients and support clinicians to engage in shared decision making.

scholarly journals Patient Decision Aids in Doctor-Patient Consultations: Treatment Decision Making on Starting Insulin

2017 ◽  
Vol 9 (4-2) ◽  
Author(s):  
Zuraidah Mohd Don ◽  
Ayeshah Syed
Keyword(s):  
Decision Making ◽  
Decision Aids ◽  
Treatment Decision ◽  
Information Provision ◽  
Patient Decision Aids ◽  
Demographic Profiles ◽  
Treatment Decision Making ◽  
Healthcare Settings ◽  
Patient Decision

Patient decision aids (PDAs) are increasingly used to support treatment decision making in type 2 diabetes. However, research on PDAs generally involves quantitative analysis or focuses on physicians’ communicative practices, with limited data on how PDAs are used collaboratively in doctor-patient consultations. We apply discourse analytic methods to 11 recorded consultations during which a PDA on starting insulin was used. Purposive sampling was used to select participants from different healthcare settings and demographic profiles. Our analysis first addresses general questions on PDA use in the consultations, such as when it was used or mentioned in the consultation and by whom, before categorising the turns in which the PDA is mentioned or used by doctors and patients, according to the actions being performed. Next, we focus on consultations in which the patients have already read the PDA, and analyse the sequences of talk that occur after the doctor brings the PDA into the conversation. Our analysis shows that doctor talk on the PDA not only facilitated information provision, but also allowed doctors to elicit and explore the patient’s knowledge and perspectives. However, the kinds of questions that doctors asked tend to limit patient participation, and their focus on the PDA at times overshadowed patient contributions. More attention to doctors’ discursive choices can facilitate more patient-centred practices in using PDAs.

scholarly journals Measurement issues of shared decision making in mental health: challenges and opportunities

2017 ◽  
Vol 22 (3) ◽  
pp. 214-232 ◽  
Author(s):  
Lilisbeth Perestelo-Perez ◽  
Amado Rivero-Santana ◽  
Yolanda Alvarez-Perez ◽  
Yaara Zisman-Ilani ◽  
Emma Kaminskiy ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Mental Health Care ◽  
Shared Decision Making ◽  
Self Report ◽  
Psychometric Validation ◽  
Shared Decision ◽  
Deliberative Process ◽  
Content Type

Purpose Shared decision making (SDM) is a model of health care in which patients are involved in the decision-making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The purpose of this paper is to identify the SDM-related measures applied in a mental health context. Design/methodology/approach The authors performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, and outcomes) in the field of mental health were included. Findings The authors included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index, followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce. Research limitations/implications The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care. Originality/value The authors highlight several limitations and challenges for the measurement of SDM in mental health care.

scholarly journals Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care

Medicine ◽  
2020 ◽  
Vol 99 (32) ◽  
pp. e21389
Author(s):  
Valle Coronado-Vázquez ◽  
Carlota Canet-Fajas ◽  
Maria Teresa Delgado-Marroquín ◽  
Rosa Magallón-Botaya ◽  
Macarena Romero-Martín ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Primary Health Care ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Primary Health

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.

Out to Pasture: A Case for the Retirement of Canadian Mental Health Legislation

1993 ◽  
Vol 12 (1) ◽  
pp. 37-55 ◽  
Author(s):  
Robert M. Gordon
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Treatment Strategies ◽  
Treatment Decision ◽  
Legal Framework ◽  
Consumer Involvement ◽  
Treatment Decision Making ◽  
Mental Health Legislation ◽  
Care And Treatment ◽  
Health Legislation

The emergence of new adult guardianship and related legislation and systems in British Columbia, Ontario, and other jurisdictions has generated questions about the utility of separate mental health legislation. Mental health statutes are the descendents of legislation that once created and regulated separate institutions and systems for the insane (later known as the mentally diseased and, more recently, the mentally ill). Such legislation is no longer consistent with the dominant community care and treatment strategies in the mental health field and the growing trend to recognize and respect consumer involvement in care and treatment decision making. Emerging legislation in the guardianship field makes provision for a range of options and mechanisms that can replace separate mental health statutes (e.g., general consent to health care legislation, and provision for enduring powers of attorney of the person and Ulysses agreements) and produce a new and more effective legal framework for the provision of mental health care and treatment.

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