Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? A cross-sectional survey

Abstract Background: Evidence-based Dentistry (EBD), decision aids, patient preferences and autonomy preferences (AP) play an important role in shared decision making (SDM) and are useful tools in the process of medical and dental decisions as well as in developing of quality criteria for decision making in many fields of health care. However, there aren’t many studies on SDM and AP in the field of dentistry. This study aimed at exploring patients’ autonomy preferences in dentistry in comparison to other medical domains. Methods: As a first step, a consecutive sample of 100 dental patients and 16 dentists was recruited at a university-based prosthodontic clinic to assess and compare patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions using the Control Preference Scale (CPS). This was followed by a cross sectional survey to study autonomy preferences in three cohorts of 100 patients each recruited from general practices, a multiple sclerosis clinic, and a university-based prosthodontic clinic . A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in this process. Results: Dentists were slightly less willing to deliver control than patients willing to enact autonomy. Decisions about management of tooth loss were however considered relevant for a shared decision making by both parties. Highest AP was expressed by people with multiple sclerosis, lowest by patients in dentistry (CPS means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). Patients analysis showed considerable differences in autonomy preferences referring to different decision types (p<.001). More autonomy was needed for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001). Conclusion: The study results showed substantial relevance of patient participation in decision making in dentistry. Furthermore, a need has been discovered to refer to specific medical decisions instead of assessing autonomy preferences in general.

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Patient autonomy in dental medical decision making – is there a need for shared decision making?

10.21203/rs.2.17746/v1 ◽

2019 ◽

Author(s):

Mareike Benecke ◽

Jürgen Kasper ◽

Christoph Heesen ◽

Nina Schäffler ◽

Daniel Reissmann

Keyword(s):

Multiple Sclerosis ◽

Decision Making ◽

General Practice ◽

Shared Decision Making ◽

Treatment Decisions ◽

Medical Decision ◽

Shared Decision ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Study Results

Abstract Background: Evidence-based Dentistry (EBD), decision aids, patient preferences and autonomy preferences (AP) play an important role in shared decision making (SDM) and are useful tools in the process of medical and dental decisions as well as in developing of quality criteria for decision making in many fields of health care. However, there aren’t many studies on SDM and AP in the field of dentistry. This study aimed at exploring patients’ autonomy preferences in dentistry in comparison to other medical domains. Methods: As a first step, a consecutive sample of 100 dental patients and 16 dentists was recruited at a university-based prosthodontic clinic to assess and compare patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions using the Control Preference Scale (CPS). This was followed by a cross sectional survey to study autonomy preferences in three cohorts of 100 patients each recruited from general practices, a multiple sclerosis clinic, and a university-based prosthodontic clinic. A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in this process. Results: Dentists were slightly less willing to deliver control than patients willing to enact autonomy. Decisions about management of tooth loss were however considered relevant for a shared decision making by both parties. Highest AP was expressed by people with multiple sclerosis, lowest by patients in dentistry (CPS means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). Patients analysis showed considerable differences in autonomy preferences referring to different decision types (p<.001). More autonomy was needed for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001). Conclusion: The study results showed substantial relevance of patient participation in decision making in dentistry. Furthermore, a need has been discovered to refer to specific medical decisions instead of assessing autonomy preferences in general.

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The Impact of Pet Care Needs on Medical Decision-Making among Hospitalized Patients: A Cross-Sectional Analysis of Patient Experience

Journal of Patient Experience ◽

10.1177/23743735211046089 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110460

Author(s):

Carri S. Polick ◽

Jennifer W. Applebaum ◽

Caitlin Hanna ◽

Darnysus Jackson ◽

Sophia Tsaras-Schumacher ◽

...

Keyword(s):

Decision Making ◽

Medical Decision Making ◽

Negative Impact ◽

Care Center ◽

Tertiary Care ◽

Hospitalized Patients ◽

Medical Decision ◽

Care Needs ◽

Cross Sectional ◽

The Impact

Hospital-based protocols to support pet care needs for hospitalized patients may have potential to benefit patient health and wellbeing, but must be informed by experiences of hospitalized pet owners. The aim of this study was to determine the scope and need for pet care services among hospitalized patients. A panel of prior inpatients and their family members at a tertiary care center were surveyed about preferences, experiences, and need for assistance with pet care during hospitalization. Respondents (n = 113) expressed interest in a low/no-cost pet-boarding or foster program for adult patients struggling to find pet care assistance. The majority of respondents (n = 71; 63%) reported challenges securing pet care during a prior hospitalization, and/or knew someone who encountered similar challenges. Respondents also indicated that these challenges had a negative impact on health, recovery, or their own decision to receive medical care. Pet care challenges during hospitalization are likely common and have the potential to hamper medical decision-making and health outcomes of inpatients.

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Head, heart or checklist? How self-reported decision-making strategies change according to speciality and grade: a cross-sectional survey of doctors

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-136184 ◽

2019 ◽

Vol 95 (1121) ◽

pp. 148-154

Author(s):

Oliver Pumphrey ◽

Jack Grenville ◽

Matthew Colquhoun ◽

Barry Mullins ◽

Patrick Earls ◽

...

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Clinical Situation ◽

Medical Decision ◽

Cross Sectional Survey ◽

Medical Problems ◽

Cross Sectional ◽

Rule Based ◽

Evidence Based Care

PurposeTo identify and analyse variations in self-reported decision-making strategies between medical professionals of different specialty and grade.Study designWe conducted a cross-sectional survey of doctors of different specialities and grades at St. George’s Hospital, London, UK. We administered 226 questionnaires asking participants to assign proportions of their clinical decision-making behaviour to four strategies: intuitive, analytical, rule-based and creative.ResultsWe found that physicians said they used rule-based decision-making significantly more than did surgeons and anaesthetists (p = 0.025) and analytical decision-making strategies significantly less (p = 0.003). In addition, we found that both intuitive (p = 0.0005) and analytical (p = 0.0005) decision-making had positive associations with increasing experience, whereas rule-based decision-making was negatively associated with greater experience (p = 0.0005).ConclusionsDecision-making strategies may evolve with increasing clinical experience from a predominant use of rule-based approaches towards greater use of intuitive or analytical methods depending on the familiarity and acuity of the clinical situation. Rule-based strategies remain important for delivering evidence-based care, particularly for less experienced clinicians, and for physicians more than surgeons, possibly due to the greater availability and applicability of guidelines for medical problems. Anaesthetists and intensivists tend towards more analytical decision-making than physicians; an observation which might be attributable to the greater availability and use of objective data in the care environment. As part of broader training in non-technical skills and human factors, increasing awareness among trainees of medical decision-making models and their potential pitfalls might contribute to reducing the burden of medical error in terms of morbidity, mortality and litigation.

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