Discontinuing chronic medications: Perceptions of patients with life-limiting illness.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 97-97
Author(s):  
Jean Kutner ◽  
Christine Ritchie ◽  
Jon Furuno ◽  
Maryjo Prince-Paul ◽  
Jennifer Tjia ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Functional Decline ◽  
Study Groups ◽  
Shared Decision ◽  
Chi Square ◽  
Patients With Cancer ◽  
Chronic Medications ◽  
Potential Benefits ◽  
Cognitively Intact

97 Background: Optimal management of chronic medications is uncertain in life-limiting illness. To inform shared decision making, we assessed patient perceptions in a trial on the safety of discontinuing statins in life-limiting illness. Methods: Eligible adults (life expectancy 1–12 months, on statin for ≥ 3 months for primary/secondary prevention, recent functional decline, no active cardiovascular disease) were randomized to discontinue or continue statins and were followed monthly for up to 1 year. Cognitively intact participants were asked 9 questions regarding discontinuing statins prior to randomization. We used Pearson chi-square to compare responses between study groups and between those with and without cancer. Of 381 participants, 297 (78%) were cognitively intact (138 discontinued, 159 continued statins). Mean age was 72 years (SD 11) and mean number of medications used was 11.5 (SD 5.0); 58% (N = 173) had cancer. Results: There were no statistically significant differences between the study groups in responses to the medication perception questions. Aggregate findings are presented (Table). Patients with cancer were less likely to think that they may be able to stop other medications (28% vs. 42%, p=0.007) and that statin discontinuation means that the doctor is giving up on them (1% vs. 7%, p=0.013). Conclusions: Few participants expressed concerns about discontinuing statins; many perceived potential benefits. Cancer patients may perceive less impact from stopping statins. Clinicians should inquire about patient concerns when engaging in shared decision making about discontinuing chronic medications in the setting of advanced cancer. Clinical trial information: NCT01415934. [Table: see text]

Shared decision-making preferences and pain characterization in patients with cancer.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 30-30 ◽  
Author(s):  
Jeannine M. Brant ◽  
Carrie Tompkins Stricker ◽  
Alison Petok ◽  
Regina Sih-Meynier ◽  
Debra Wujcik
Keyword(s):  
Decision Making ◽  
Cancer Pain ◽  
Shared Decision Making ◽  
Breakthrough Pain ◽  
Activity Level ◽  
Shared Decision ◽  
Patients With Cancer ◽  
Care Plans ◽  
Pain Outcomes ◽  
Pain Care

30 Background: Cancer pain prevalence is high (52%-77%) with breakthrough pain flares and end-of-dose failure adding to patient suffering and increased health care utilization. Shared decision-making (SDM), incorporating patient-stated preferences, goals, and concerns, can foster comprehensive pain assessment (CPA) and improve pain outcomes. Methods: This study will evaluate SDM and CPA in patients with cancer to manage chronic and breakthrough pain. Eligible patients have pain or are taking opioids to manage chronic cancer pain. Patients complete a tablet-based survey at enrollment to record baseline pain and activity levels, pain flare severity and length, end-of-dose pain, and SDM preferences. Results are presented on an electronic dashboard and the provider and patient collaboratively establish a pain care plan. The effectiveness of SDM on pain outcomes will be measured with the Pain Care Quality Survey. Results: Pain characterization is described for the first 43 patients enrolled, of which 42% (n=18) desire to share decision-making with the provider, while 35% (n=15) prefer to make the final decision after considering provider input. Patients are 57% (n=26) female with a mean age of 56 (range 20-93); baseline mean pain scores were 5.4, and overall distress scores were 5.43, (scale 0-10); 91% had a pain flare in the last seven days with mean severity of 5.53; 72% of flares lasted longer than 30 minutes. All patients had end-of-dose pain. Less than half (42%) have restricted activity and 23% manage self-care but cannot work. Participants reported incident pain associated with certain activity (63%) as well as insidious pain not associated with activity (65%). Enrolled patients selected 143 pain descriptors: burning (16), achy (24), sharp and stabbing (21), pins and needles (15), cramping (14) radiating (14), intermittent (19), and continuous (20). Conclusions: The majority (77%) of patients desire SDM. Although most patients were already taking opioids at presentation, they had moderate pain and distress, frequent flares and end of dose pain, and limitations on activity level due to the pain. Baseline pain characterization with a drill down CPA offers opportunity to use SDM to develop effective pain care plans and measure outcomes. Clinical trial information: NCT03304145.

scholarly journals How to Integrate Predictions in Outcomes in Planning Clinical Care

2015 ◽  
Vol 39 (1-3) ◽  
pp. 65-69 ◽  
Author(s):  
Michael J. Germain
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Current Literature ◽  
Clinical Care ◽  
Functional Decline ◽  
Clinical Approach ◽  
Shared Decision ◽  
Predictive Information

Background: The CKD population is becoming increasingly elderly with multiple comorbidities. For this reason, accurate predictive information related to the progression into ESRD, mortality, and functional decline is critical to allow for optimal shared decision making (SDM). Summary: This review will assess the current literature on the methodologies for the estimation of prognosis and prognostic tools developed for CKD. A practical clinical approach is discussed that involves the estimation of prognosis and integration of prognosis into SDM. Key Message: There are validated, easy-to-use prognostic tools that help clinicians engage in effective shared decision making with their CKD patients and family.

Cognitive Bias: The Downside of Shared Decision Making

2018 ◽  
pp. 1-10 ◽  
Author(s):  
Semra Ozdemir ◽  
Eric Andrew Finkelstein
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Cognitive Bias ◽  
Cognitive Biases ◽  
Patient Treatment ◽  
Shared Decision ◽  
Undue Influence ◽  
Treatment Choices ◽  
Patients With Cancer ◽  
Future Selves

This narrative review presents theoretical and empirical evidence of common cognitive biases that are likely to influence treatment choices of patients with cancer and other illnesses. We present an overview of common cognitive biases that result from how and when information is presented to patients. We supplement these descriptions with cancer-specific examples or those from other health fields if no cancer-specific examples are available. The results provide compelling evidence that patient treatment choices are subconsciously influenced by both known and unknown biases. Shared decision making is ideal in theory, but in reality, it is fraught with risks resulting from cognitive biases and undue influence of even the best-intentioned physicians and family members. Efforts should be made to minimize these concerns and to help patients to make decisions that their future selves are least likely to regret.

scholarly journals Youth-Adult Partnerships in Work with Youth: An Overview

2017 ◽  
Vol 12 (4) ◽  
pp. 38-60 ◽  
Author(s):  
Heather L. Ramey ◽  
Heather L. Lawford ◽  
Wolfgang Vachon
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Current Literature ◽  
Program Planning ◽  
Shared Decision ◽  
Youth Services ◽  
Promising Practices ◽  
Child And Youth Services ◽  
Potential Benefits

Youth-adult partnerships in child and youth services engage the participants in collaborative, shared decision making, in areas such as governance, program planning and implementation, and advocacy. However, these partnerships often occur in isolation, and fail to engage in potentially useful, larger conversations about theory and research. Therefore, in an effort to provide common grounds for understanding and engaging in such partnerships, we offer an overview of current literature. We discuss definitions and discourses, describe models of youth-adult partnerships, and briefly consider current research on potential benefits for youth, adults, organizations, and communities. We also present challenges and promising practices for adult allies engaged in youth-adult partnerships. 

scholarly journals Experiences of bereaved family caregivers with shared decision making in palliative cancer treatment: a qualitative interview study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sanne P. C. van Oosterhout ◽  
Daisy J. M. Ermers ◽  
Floor K. Ploos van Amstel ◽  
Carla M. L. van Herpen ◽  
Yvonne Schoon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Family Caregivers ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Patients With Cancer ◽  
Qualitative Interview Study ◽  
Bereaved Family ◽  
Life Prolongation

Abstract Background Patients with incurable cancer face complex medical decisions. Their family caregivers play a prominent role in shared decision making processes, but we lack insights into their experiences. In this study, we explored how bereaved family caregivers experienced the shared decision making process. Methods We performed a qualitative interview study with in-depth interviews analysed with inductive content analysis. We used a purposive sample of bereaved family caregivers (n = 16) of patients with cancer treated in a tertiary university hospital in the Netherlands. Results Four themes were identified: 1. scenarios of decision making, 2. future death of the patient 3. factors influencing choices when making a treatment decision, and 4. preconditions for the decision making process. Most family caregivers deferred decisions to the patient or physician. Talking about the patient’s future death was not preferred by all family caregivers. All family caregivers reported life prolongation as a significant motivator for treatment, while the quality of life was rarely mentioned. A respectful relationship, close involvement, and open communication with healthcare professionals in the palliative setting were valued by many interviewees. Family caregivers’ experiences and needs seemed to be overlooked during medical encounters. Conclusions Family caregivers of deceased patients with cancer mentioned life prolongation, and not quality of life, as the most important treatment aim. They highly valued interactions with the medical oncologist and being involved in the conversations. We advise medical oncologists to take more effort to involve the family caregiver, and more explicitly address quality of life in the consultations.

scholarly journals Evaluation of the Choosing Wisely Australia 5 Questions resource and a shared decision-making preparation video: protocol for an online experiment

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e033126
Author(s):  
Danielle Marie Muscat ◽  
Edward Hoi-fan Chang ◽  
Rachel Thompson ◽  
Erin Cvejic ◽  
Marguerite Tracy ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Literacy ◽  
Shared Decision Making ◽  
Study Groups ◽  
Outcome Data ◽  
Choosing Wisely ◽  
Secondary Outcome ◽  
Shared Decision ◽  
Intention To Treat ◽  
The Impact

IntroductionChoosing Wisely, an international effort to reduce low value care worldwide, considers communication between clinicians and patients during routine clinical encounters a key mechanism for change. In Australia, Choosing Wisely has developed a 5 Questions resource to facilitate better conversations. The primary aim of this study is to evaluate the impact of the Choosing Wisely Australia 5 Questions resource and a video designed to prepare patients for question-asking and participation in shared decision-making on (a) self-efficacy to ask questions and participate in shared decision-making, (b) intention to participate in shared decision-making and (c) a range of secondary outcomes. The secondary aim of this study is to determine whether participants’ health literacy modifies the effects of the interventions.Methods and analysisWe will use 2×2×2 between-subjects factorial design (preparation video: yes, no × Choosing Wisely 5 Questions resource: yes, no × health literacy: adequate, inadequate). Participants will be recruited by an online market research company, presented with a hypothetical non-specific low back pain scenario, and randomised to study groups stratified by health literacy. Quantitative primary and secondary outcome data will be analysed as intention-to-treat using appropriate regression models (ie, linear regression for continuous outcomes, logistic regression for dichotomous categorical outcomes).Ethics and disseminationEthical approval for this study was obtained from the University of Sydney Human Research Ethics Committee (protocol number: 2018/965). The results from this work will be disseminated through peer-reviewed international journals, conferences and updates with collaborating public health bodies. Resources developed for this study will be made available to patients and clinicians following trial completion.Trial registration numberThis trial has been registered with the Australia New Zealand Clinical Trials Registry (trial number: 376477) and the stage is Pre-results.

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