scholarly journals Women’s attitudes, beliefs and values about tests, and management for hypertensive disorders of pregnancy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shenaz Ahmed ◽  
Alina Brewer ◽  
Eleni Z. Tsigas ◽  
Caryn Rogers ◽  
Lucy Chappell ◽  
...  
Keyword(s):  
Decision Making ◽  
Preterm Delivery ◽  
Diagnostic Tests ◽  
Clinical Care ◽  
Preliminary Investigation ◽  
Expectant Management ◽  
Online Questionnaire ◽  
Hypertensive Disorders ◽  
Treatment Risks ◽  
Women’S Views

Abstract Background Advances in research suggest the possibility of improving routine clinical care for preeclampsia using screening (predictive) and diagnostic tests. The views of women should be incorporated into the way in which such tests are used. Therefore, we explored the views of women with experience of preeclampsia and other hypertensive disorders in pregnancy (HDPs) about predictive and diagnostic tests, treatment risks, and expectant management. Method Eight hundred and seven women with experience of preeclampsia or other HDPs completed an online questionnaire. These women were participants in the Preeclampsia Registry (USA). The questionnaire contained 22 items to elicit women’s views about predictive tests (n = 8); diagnostic tests (n = 5); treatment risks (n = 7), and expectant management (n = 2). An optional text box allowed participants to add qualitative open-ended comments. Levels of agreement with the statements were reported descriptively for the sample as a whole, and a preliminary investigation of the role of lived experience in shaping women’s views was conducted by comparing subgroups within the sample based on time of HDP delivery (preterm/term). The qualitative data provided in the optional text box was analysed using inductive thematic analysis to examine participants’ responses. Results Women generally favored predictive and diagnostic testing, although not because they would opt for termination of pregnancy. Participants generally disagreed that taking daily low-dose aspirin (LDA) would make them nervous, with disagreement significantly higher in the preterm delivery subgroup. A high proportion of participants, especially in the preterm delivery subgroup, would take LDA throughout pregnancy. The majority of participants would be more worried about the possibility of preeclampsia than about the risks of treatments to their health (60%), and that proportion was significantly higher in the preterm delivery subgroup. There were no differences between subgroups in the views expressed about expectant management, although opinion was divided in both groups. Overall, most participants opted to put the baby’s interests first. Conclusion Women with experience of hypertensive disorders were enthusiastic about improved predictive and diagnostic tests. However, varied views about treatment options and expectant management suggest the need for a shared decision-making tool to enable healthcare professionals to support pregnant women’s decision-making to maximize the utility of these tests and interventions.

Patient-Centered Care and Autonomy: Shared Decision-Making in Practice and a Suggestion for Practical Application in the Critically Ill

2019 ◽  
Vol 35 (11) ◽  
pp. 1352-1355
Author(s):  
Marianna V. Mapes ◽  
Peter A. DePergola ◽  
William T. McGee
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Critically Ill ◽  
Care Service ◽  
Clinical Care ◽  
Patient Centered Care ◽  
Practical Application ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care

Decision-making for the hospitalized dying and critically ill is often characterized by an understanding of autonomy that leads to clinical care and outcomes that are antithetical to patients’ preferences around suffering and quality of life. A better understanding of autonomy will facilitate the ultimate goal of a patient-centered approach and ensure compassionate, high-quality care that respects our patients’ values. We reviewed the medical literature and our experiences through the ethics service, palliative care service, and critical care service of a large community teaching hospital. The cumulative experience of a senior intensivist was filtered through the lens of a medical ethicist and the palliative care team. The practical application of patient-centered care was discerned from these interactions. We determined that a clearer understanding of patient-centeredness would improve the experience and outcomes of care for our patients as well as our adherence to ethical practice. The practical applications of autonomy and patient-centered care were evaluated by the authors through clinical interactions on the wards to ascertain problems in understanding their meaning. Clarification of autonomy and patient-centeredness is provided using specific examples to enhance understanding and application of these principles in patient-centered care.

scholarly journals Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey

2021 ◽  
Vol 18 (4) ◽  
pp. 2128
Author(s):  
Marta Maes-Carballo ◽  
Manuel Martín-Díaz ◽  
Luciano Mignini ◽  
Khalid Saeed Khan ◽  
Rubén Trigueros ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Cross Sectional Study ◽  
Shared Decision ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Professional Societies ◽  
New Policies

Objectives: To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment. Materials and Methods: A cross-sectional study based on an online questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale. Results: The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36–4.55)) and were in favour of its implementation (mean 4.58 (4.51–4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37–3.55)) and agreed on policies that improved its implementation (3.96 (3.88–4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients’ paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%). Conclusions: New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.

scholarly journals Implementation of Rapid Molecular Diagnostic Tests and Antimicrobial Stewardship Involvement in Acute-Care Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s278-s279
Author(s):  
Maiko Kondo ◽  
Matthew Simon ◽  
Esther Babady ◽  
Angela Loo ◽  
David Calfee
Keyword(s):  
Antimicrobial Stewardship ◽  
Diagnostic Tests ◽  
New Technology ◽  
Clinical Care ◽  
Bloodstream Infections ◽  
Clinical Decision ◽  
Research Network ◽  
Molecular Diagnostic ◽  
Financial Outcomes ◽  
Stewardship Program

Background: In recent years, several rapid molecular diagnostic tests (RMDTs) for infectious diseases diagnostics, such as bloodstream infections (BSIs), have become available for clinical use. The extent to which RMDTs have been adopted and how the results of these tests have been incorporated into clinical care are currently unknown. Methods: We surveyed members of the Society for Healthcare Epidemiology of America Research Network to characterize utilization of RMDT in hospitals and antimicrobial stewardship program (ASP) involvement in result communication and interpretation. The survey was administered using Qualtrics software, and data were analyzed using Stata and Excel software. Results: Overall, 57 responses were received (response rate, 59%), and 72% were from academic hospitals; 50 hospitals (88%) used at least 1 RMDT for BSI (Fig. 1). The factors most commonly reported to have been important in the decision to adopt RMDT were improvements in antimicrobial usage (82%), clinical outcomes (74%), and laboratory efficiency (52%). Among 7 hospitals that did not use RMDT for BSI, the most common reason was cost of new technology. In 50 hospitals with RMDT for BSI, 54% provided written guidelines for optimization or de-escalation of antimicrobials based upon RMDT results. In 40 hospitals (80%), microbiology laboratories directly notified a healthcare worker of the RMDT results: 70% provided results to a physician, nurse practitioner, or physician assistant; 48% to the ASP team; and 33% to a nurse. Furthermore, 11 hospitals (22%) had neither guidelines nor ASP intervention. In addition, 24 hospitals (48%) reported performing postimplementation evaluation of RMDT impact. Reported findings included reduction in time to antibiotic de-escalation (75%), reduction in length of stay (25%), improved laboratory efficiency (20%), and reduction in mortality and overall costs (12%). Among the 47 hospitals with both RMDT and ASP, 79% reported that the ASP team routinely reviewed blood culture RMDT results, and 53.2% used clinical decision support software to do so. Finally, 53 hospitals (93%) used 1 or more RMDT for non–bloodstream infections (Fig. 1). Fewer than half of hospitals provided written guidelines to assist clinicians in interpreting these RMDT results. Conclusions: RMDTs have been widely adopted by participating hospitals and are associated with positive self-reported clinical, logistic, and financial outcomes. However, nearly 1 in 4 hospitals did not have guidelines or ASP interventions to assist clinicians with optimization of antimicrobial prescribing based on RMDT results for BSI. Also, most hospitals did not have guidelines for RMDT results for non-BSI. These findings suggest that opportunities exist to further enhance the potential benefits of RMDT.Funding: NoneDisclosures: None

Making one-sided exercise decisions: The influence of exercise-related cognitive errors

2016 ◽  
Vol 23 (9) ◽  
pp. 1240-1249 ◽  
Author(s):  
Sean R Locke ◽  
Lawrence R Brawley
Keyword(s):  
Decision Making ◽  
Information Processing ◽  
Relevant Information ◽  
Future Research ◽  
Cognitive Errors ◽  
Online Questionnaire ◽  
Cognitive Error ◽  
Biased Processing

Exercise-related cognitive errors reflect biased processing of exercise-relevant information. The purpose of this study was to examine whether differences existed between individuals reporting low and high exercise-related cognitive errors on information processed about a relevant exercise decision-making situation. In all, 138 adults completed an online questionnaire. The high exercise-related cognitive error group primarily focused on negative content about the situation compared to the low exercise-related cognitive error group who focused on both positive and negative content. The high exercise-related cognitive error group displayed biased processing of exercise information, as suggested by the cognitive errors model. Future research should examine whether biasing information processing caused by exercise-related cognitive errors can be modified and attenuated.

scholarly journals Lessons Learned From an Early Hotspot During the COVID-19 Pandemic

2021 ◽  
pp. 000313482199475
Author(s):  
Brett M. Chapman ◽  
George M. Fuhrman
Keyword(s):  
Decision Making ◽  
Surgical Education ◽  
Clinical Care ◽  
Well Being ◽  
Educational Environment ◽  
Lessons Learned ◽  
Residency Programs ◽  
Surgical Residency ◽  
The Impact

The Covid-19 pandemic has provided challenges for surgical residency programs demanding fluid decision making focused on providing care for our patients, maintaining an educational environment, and protecting the well-being of our residents. This brief report summarizes the impact of the impact on our residency programs clinical care and education. We have identified opportunities to improve our program using videoconferencing, managing recruitment, and maintaining a satisfactory caseload to ensure the highest possible quality of surgical education.

scholarly journals Integrating Patient-Generated Health Data Into Clinical Care Settings or Clinical Decision-Making: Lessons Learned From Project HealthDesign

2016 ◽  
Vol 3 (2) ◽  
pp. e26 ◽  
Author(s):  
Deborah J Cohen ◽  
Sara R Keller ◽  
Gillian R Hayes ◽  
David A Dorr ◽  
Joan S Ash ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
Health Data ◽  
Lessons Learned

scholarly journals Dying to divulge: The determinants of, and relationship between, desired and actual disclosure

2020 ◽  
Author(s):  
Erin Carbone ◽  
George Loewenstein
Keyword(s):  
Gender Differences ◽  
Decision Making ◽  
Social Media ◽  
Preliminary Investigation ◽  
Individual Characteristics ◽  
Social Benefits ◽  
Decision Making Process ◽  
Positive Information ◽  
Self Disclosure ◽  
Types Of Information

Studies suggest that sharing thoughts and information with others may be inherently pleasurable and confer health, psychological, and social benefits to the discloser. At the same time, self-disclosure exposes individuals to scrutiny and the risk of rejection and reputational damage, particularly with the advent of digital applications and social media outlets that promote public, and often permanent, disclosing. In an effort to understand the tradeoffs that underlie the decision to disclose, we introduce a distinction between the propensity to disclose and the psychological desire to disclose and present a preliminary investigation into when and why these two constructs diverge. Findings from two exploratory studies reveal the types of information that individuals are most eager to share, as well as the contextual factors and individual characteristics that moderate the desire to share and the circumstances under which this desire is most likely to translate into actual sharing. We replicate findings from prior research that the decision to disclose is a function of content emotionality and valence, but find that the propensity to withhold negative information is most pronounced when the information is about oneself than about others, and that gender differences in disclosure are largely driven by the tendency for men to withhold negative, but not positive, information. Additionally, we capture motives and traits, many of them previously unexplored in the disclosure context, to model the underlying decision-making process that leads to information sharing and distinguish between the act of sharing information and the psychological desire that differentially engender disclosing behavior.

scholarly journals Understanding determinants of illegal e-book downloading behaviour in the UK and Germany

2018 ◽  
Vol 6 (2) ◽  
pp. 79-100 ◽  
Author(s):  
Oliver Jonas ◽  
Ibrahim Sirkeci
Keyword(s):  
Decision Making ◽  
Logistic Regression ◽  
Consumer Choice ◽  
Publishing Industry ◽  
Decision Making Process ◽  
Consumer Decision Making ◽  
Online Questionnaire ◽  
Online Stores ◽  
The Uk ◽  
Book Prices

With the success of e-books in the last decade, e-book piracy has become increasingly prevalent. This is a significant threat to the publishing industry, publishers and authors alike. Despite efforts to inhibit illegal downloading of e-book files, unauthorized download platforms have not lost much popularity. One of the underlying problems is a limited understanding of the determinants that drive consumers in their choice between legal and illegal download options. This article identifies and critically evaluates the key product attributes in the decision-making process of consumers downloading e-books from legal and illegal sources. By providing consumer insights, the publishing industry and e-book sellers can be guided to meet consumer demand better and design marketing plans to attract consumers towards legal download sources and discourage e-book piracy. The consumer choice between legal and illegal e-book download platforms is analysed using the multi-attribute theory for consumer decision making. 23 attributes were tested using an online questionnaire and analysed by logistic regression. Three attributes were found to be significant in determining the choice of download platforms: A low perception of the importance of copyright compliance, dissatisfaction with the security of download platforms and dissatisfaction with e-book prices in online stores.

scholarly journals The “Preparation for Shared Decision-Making” Tool for Women With Advanced Breast Cancer: Qualitative Validation Study

10.2196/16511 ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. e16511
Author(s):  
Domitilla Masi ◽  
Amalia Elvira Gomez-Rexrode ◽  
Rina Bardin ◽  
Joshua Seidman
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Advanced Breast Cancer ◽  
Shared Decision Making ◽  
Validation Study ◽  
Clinical Care ◽  
Advanced Breast ◽  
Future Research ◽  
Shared Decision ◽  
Clinical Workflow

Background The range of decisions and considerations that women with advanced breast cancer (ABC) face can be overwhelming and difficult to manage. Research shows that most patients prefer a shared decision-making (SDM) approach as it provides them with the opportunity to be actively involved in their treatment decisions. The current engagement of these patients in their clinical decisions is suboptimal. Moreover, implementing SDM into routine clinical care can be challenging as patients may not always feel adequately prepared or may not expect to be involved in the decision-making process. Objective Avalere Health developed the Preparation for Shared Decision-Making (PFSDM) tool to help patients with ABC feel prepared to communicate with their clinicians and engage in decision making aligned with their preferences. The goal of this study was to validate the tool for its acceptability and usability among this patient population. Methods We interviewed a diverse group of women with ABC (N=30). Interviews were audiorecorded, transcribed, and double coded by using NVivo. We assessed 8 themes to understand the acceptability and usability of the tool. Results Interviewees expressed that the tool was acceptable for preparing patients for decision making and would be useful for helping patients know what to expect in their care journey. Interviewees also provided useful comments to improve the tool. Conclusions This validation study confirms the acceptability and usability of the PFSDM tool for women with ABC. Future research should assess the feasibility of the tool’s implementation in the clinical workflow and its impact on patient outcomes.

scholarly journals Healthcare professionals’ practice and interactions in older peoples’ cross-sectoral clinical care trajectories when acutely hospitalized - a qualitative observation study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maiken Hjuler Persson ◽  
Christian Backer Mogensen ◽  
Jens Søndergaard ◽  
Helene Skjøt-Arkil ◽  
Pernille Tanggaard Andersen
Keyword(s):  
Decision Making ◽  
Older People ◽  
New Public Management ◽  
Healthcare Professionals ◽  
Clinical Care ◽  
Research Integrity ◽  
Care Practice ◽  
Observation Study ◽  
Person Centered Care ◽  
Centered Care

Abstract Background Healthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals’ identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals’ practice. Aim This study aimed to explore and analyse how healthcare professionals’ interactions and practice influence older peoples’ clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged. Methods This qualitative study arises from a hermeneutical stand within the interpretative paradigm. Focusing on the healthcare professionals’ interactions and practice we followed the clinical care trajectories of seven older people (aged > 65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines. Results The analysis revealed four themes: 1)“The end justifies the means – ‘I know what is best for you’”, 2)“Basic needs of care overruled by system effectiveness”, 3)“Treatment as a bargain”, and 4)“Healthcare professionals as solo detectives”. Conclusion Dissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.

Sign in / Sign up

Export Citation Format

Share Document