Shared decision making in severe asthma therapy: qualitative study of physician-patient communication

2021 ◽  
Author(s):  
Ember Lu ◽  
Katya Solovyeva ◽  
Zachary Hebert ◽  
Lisa Kietzer ◽  
Simon Griffiths ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Severe Asthma ◽  
Patient Communication ◽  
Shared Decision ◽  
Asthma Therapy ◽  
Physician Patient Communication ◽  
Physician Patient

scholarly journals Variance components of ratings of physician-patient communication: A generalizability theory analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252968
Author(s):  
Nicole Röttele ◽  
Christian Schlett ◽  
Mirjam Körner ◽  
Erik Farin-Glattacker ◽  
Andrea C. Schöpf-Lazzarino ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Variance Components ◽  
Generalizability Theory ◽  
Patient Communication ◽  
Communication Behavior ◽  
Shared Decision ◽  
Open Communication ◽  
Physician Patient Communication ◽  
Physician Patient

Background The ratings of physician-patient communication are an important indicator of the quality of health care delivery and provide guidance for many important decisions in the health care setting and in health research. But there is no gold standard to assess physician-patient communication. Thus, depending on the specific measurement condition, multiple sources of variance may contribute to the total score variance of ratings of physician-patient communication. This may systematically impair the validity of conclusions drawn from rating data. Objective To examine the extent to which different measurement conditions and rater perspectives, respectively contribute to the variance of physician-patient communication ratings. Methods Variance components of ratings of physician-patient communication gained from 32 general practitioners and 252 patients from 25 family practices in Germany were analyzed using generalizability theory. The communication dimensions “shared decision making”, “effective and open communication” and “satisfaction” were considered. Results Physician-patient communication ratings most substantially reflect unique rater-perspective and communication dimension combinations (32.7% interaction effect). The ratings also represented unique physician and rater-perspective combinations (16.3% interaction effect). However, physicians’ communication behavior and the observed communication dimensions revealed only a low extent of score variance (1% physician effect; 3.7% communication dimension effect). Approximately half of the variance remained unexplained (46.2% three-way interaction, confounded with error). Conclusion The ratings of physician-patient communication minimally reflect physician communication skills in general. Instead, these ratings exhibit primarily differences among physicians and patients in their tendency to perceive shared decision making and effective and open communication and to be satisfied with communication, regardless of the communication behavior of physicians. Rater training and assessing low inferential ratings of physician-patient communication dimensions should be considered when subjective aspects of rater perspectives are not of interest.

Prudence in Shared Decision-Making: The Missing Link between the “Technically Correct” and the “Morally Good” in Medical Decision-Making

2020 ◽  
Author(s):  
Paul Muleli Kioko ◽  
Pablo Requena Meana
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Intellectual Ability ◽  
Medical Decision ◽  
Shared Decision ◽  
Physician Patient Relationship ◽  
Good Healing ◽  
The Right ◽  
Physician Patient

Abstract Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be.

scholarly journals Involvement of people with dementia in making decisions about their lives: a qualitative study that appraises shared decision-making concerning daycare

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018337 ◽  
Author(s):  
Leontine Groen-van de Ven ◽  
Carolien Smits ◽  
Fuusje de Graaff ◽  
Marijke Span ◽  
Jan Eefsting ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Critical Points ◽  
Informal Caregivers ◽  
Case Managers ◽  
Shared Decision ◽  
People With Dementia ◽  
Informed Preferences ◽  
Adapted Process

ObjectiveTo explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories.DesignA qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction.SettingCommunity settings and nursing homes in the Netherlands.Participants19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers).ResultsThe participants’ responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare.ConclusionShared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period.

scholarly journals Disparity in Physician-Patient Communication by Ethnicity: Evidence from Bangladesh

2020 ◽  
Author(s):  
Muhammad Zakaria ◽  
Rezaul Karim ◽  
Murshida Rahman ◽  
Feng Cheng ◽  
Junfang Xu
Keyword(s):  
Decision Making ◽  
Linear Regression ◽  
Ethnic Minority ◽  
Health Problem ◽  
Patient Communication ◽  
Medical Consultation ◽  
Medical Decision ◽  
Medical Consultations ◽  
Physician Patient Communication ◽  
Physician Patient

Abstract Background: Physician-patient communication is the primary process by which medical decision-making occurs and health outcome depends. Physician-patient communication differences may partly from the ethnic disparities. To examine this problem, this study aims to explore whether physician-patient communication differs by ethnic in primary care medical consultations. Methods: The study was conducted among the Bengali and ethnic minority patients (N = 850) who visited the physician for medical consultations. Data were collected using a structured post-consultation questionnaire. T-test was conducted to compare the communication between the Bengali and ethnic minority patients. Multiple linear regression analyses were performed to identify the factors associated with favorable communication behavior from the physicians. Results: Bengali patients received more supportive communication behaviors from the Bengali doctors than that of ethnic minority patients including physicians’ cheerful greetings, encouraging patients to express health problems and asking questions, listening carefully, responding to the questions and concerns, explaining the patients about a medical test, medication, and probable side effects, discussing the treatment options, involved the patients in decisions and spending adequate time. Results of linear regression explored that respondents’ education year, internet use, knowledge on the health problem, having a pre-plan about the content of medical consultation, information seeking about the health problem, visiting female doctors, and quiet ambience of the doctor’s room are significantly associated with better PPCB score for the Bengali patients. In contrast, age, being the resident of an urban area, perception of affecting a minor health problem, having a pre-plan about the content of medical consultation, patients’ involvement in physicians’ decision-making about the treatment, and talking time resulted in better physician-patient communication for the ethnic minority patients. Conclusion: This study suggests for reducing the disparity in the socio-economic status of the ethnic minority people through development program and teaching healthcare providers how to use patient-centered communication skills to engage their patients is one solution to improve equity in the delivery of healthcare and make sure patients are receiving high-quality treatment, no matter their race or ethnicity.

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