scholarly journals Differences Between Patient and Provider Perceptions of Informed Decision Making About Epidural Analgesia Use During Childbirth

2014 ◽  
Vol 23 (2) ◽  
pp. 104-112 ◽  
Author(s):  
Holly Bianca Goldberg ◽  
Allison Shorten
Keyword(s):  
Decision Making ◽  
Epidural Analgesia ◽  
Decisional Conflict ◽  
Informed Decision ◽  
Decision Making Process ◽  
Informed Decision Making ◽  
Provider Perceptions ◽  
Legal Principles ◽  
First Time ◽  
Mutual Agreement

The objective of this study was to determine whether differences exist between patient and provider perceptions regarding the decision-making process around use of epidural analgesia during childbirth. The dyadic patient–provider Decisional Conflict Scale was modified to measure first-time mother (n = 35) and maternity care provider (n = 52) perceptions. Providers perceived a greater degree of informed decision making than patients (84.97 vs. 79.41, p = .04) and were more likely to recall they upheld patients’ rights to make informed choices than patients were to perceive their rights had been upheld (85.95 vs. 71.73, p < .01). This incongruity highlights the need to align legal principles with practice to create mutual agreement between stakeholder perceptions of informed decision making.

scholarly journals Knowledge and Informed Decision-Making about Population-Based Colorectal Cancer Screening Participation in Groups with Low and Adequate Health Literacy

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
M. L. Essink-Bot ◽  
E. Dekker ◽  
D. R. M. Timmermans ◽  
E. Uiters ◽  
M. P. Fransen
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Health Literacy ◽  
Decisional Conflict ◽  
Informed Decision ◽  
Informed Decision Making ◽  
Crc Screening ◽  
Adequate Health Literacy ◽  
Screening Participation ◽  
Intention To Participate

Objective. To analyze and compare decision-relevant knowledge, decisional conflict, and informed decision-making about colorectal cancer (CRC) screening participation between potential screening participants with low and adequate health literacy (HL), defined as the skills to access, understand, and apply information to make informed decisions about health.Methods. Survey including 71 individuals with low HL and 70 with adequate HL, all eligible for the Dutch organized CRC screening program. Knowledge, attitude, intention to participate, and decisional conflict were assessed after reading the standard information materials. HL was assessed using the Short Assessment of Health Literacy in Dutch. Informed decision-making was analyzed by the multidimensional measure of informed choice.Results. 64% of the study population had adequate knowledge of CRC and CRC screening (low HL 43/71 (61%), adequate HL 47/70 (67%),p>0.05). 57% were informed decision-makers (low HL 34/71 (55%), adequate HL 39/70 (58%),p>0.05). Intention to participate was 89% (low HL 63/71 (89%), adequate HL 63/70 (90%)). Respondents with low HL experienced significantly more decisional conflict (25.8 versus 16.1;p=0.00).Conclusion. Informed decision-making about CRC screening participation was suboptimal among both individuals with low HL and individuals with adequate HL. Further research is required to develop and implement effective strategies to convey decision-relevant knowledge about CRC screening to all screening invitees.

scholarly journals Many Women and Providers Are Unprepared for an Evidence-Based, Educated Conversation About Birth

2011 ◽  
Vol 20 (4) ◽  
pp. 185-187 ◽  
Author(s):  
Michael C. Klein
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Maternity Care ◽  
Informed Decision ◽  
Current Evidence ◽  
Evidence Based ◽  
Informed Decision Making ◽  
Knowledge And Beliefs ◽  
Canadian Studies ◽  
First Time

Findings from recent Canadian studies on the knowledge and beliefs about birth practices among first-time pregnant women and among obstetricians and other birth providers indicate that many women are inadequately informed and many providers deliver non-evidence-based maternity care. Consequently, informed decision making is problematic for pregnant women and their providers. New strategies are needed to inform pregnant women about key procedures and approaches that might be used in birth so they can have an educated, shared discussion with their provider and successfully advocate for their preferred birth experience. In addition, providers can be encouraged to supplement their knowledge with current, evidence-based maternity care practices. To avoid a lack of informed decision making and to ensure that natural, safe, and healthy birth practices are based on current evidence, pregnant women and providers must work together to inform themselves and to add childbirth to the women’s health agenda.

scholarly journals Mobile Audio Recording Technology to Promote Informed Decision Making in Advanced Prostate Cancer

2021 ◽  
Author(s):  
Daniel H. Kwon ◽  
Sneha Karthikeyan ◽  
Alison Chang ◽  
Hala T. Borno ◽  
Vadim S. Koshkin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Treatment Decision ◽  
Decisional Conflict ◽  
Informed Decision ◽  
Informed Decision Making ◽  
Castration Resistant Prostate Cancer ◽  
Software Application ◽  
Castration Resistant ◽  
Patient Reported

PURPOSE Men with metastatic castration-resistant prostate cancer increasingly encounter complex treatment decisions. Consultation audio recordings and summaries promote patient informed decision making but are underutilized. Mobile recording software applications may increase access. Little is known regarding the feasibility of implementation in clinical encounters. METHODS We conducted a mixed-methods pilot study in men with progressive metastatic castration-resistant prostate cancer. We instructed patients to use a mobile software application to record an oncology visit. Patients could share the recording with our patient scribing program to receive a written summary. We assessed feasibility and acceptability with postvisit surveys. We measured patient-reported helpfulness of the intervention in decision making and change in Decisional Conflict Scale–informed subscale. We conducted semistructured interviews to explore implementation and analyzed transcripts using thematic analysis. RESULTS Across 20 patients, 18 (90%) recorded their visits. Thirteen of 18 (72%) listened to the recording, and 14 of 18 (78%) received a summary. Eighteen of 20 (90%) visits were telehealth. Fourteen patients (70% of all 20; 78% of 18 question respondents) found the application easy to use. Nine patients (50% of 18 recording patients; 90% of 10 question respondents) reported that the recording helped treatment decision making. Decisional conflict decreased from baseline to 1-week postvisit (47.4-28.5, P < .001). Interviews revealed benefits, facilitators, contextual factors, and technology and patient-related barriers to recordings and summaries. CONCLUSION In this single-institution academic setting, a mobile application for patients to record consultations was a feasible, acceptable, and potentially valued intervention that improved decision making in the telehealth setting. Studies in larger, diverse populations are needed.

scholarly journals A Consent Support Resource with Benefits and Harms of Vaccination Does Not Increase Hesitancy in Parents—An Acceptability Study

Vaccines ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 500
Author(s):  
Ciara McDonald ◽  
Julie Leask ◽  
Nina Chad ◽  
Margie Danchin ◽  
Judith Fethney ◽  
...  
Keyword(s):  
Decision Making ◽  
Vaccine Safety ◽  
Decisional Conflict ◽  
Informed Decision ◽  
Childhood Vaccination ◽  
Vaccine Hesitancy ◽  
Informed Decision Making ◽  
Routine Childhood ◽  
Before And After ◽  
Support Resource

It is unclear whether information given about the benefits and risks of routine childhood vaccination during consent may cue parental vaccine hesitancy. Parents were surveyed before and after reading vaccine consent information at a public expo event in Sydney, Australia. We measured vaccine hesitancy with Parent Attitudes about Childhood Vaccine Short Scale (PACV-SS), informed decision-making with Informed Subscale of the Decisional Conflict Scale (DCS-IS), items from Stage of Decision Making, Positive Attitude Assessment, Vaccine Safety and Side Effect Concern, and Vaccine Communication Framework (VCF) tools. Overall, 416 parents showed no change in vaccine hesitancy (mean PACV-SS score pre = 1.97, post = 1.94; diff = −0.02 95% CI −0.10 to 0.15) but were more informed (mean DCS-IS score pre = 29.05, post = 7.41; diff = −21.63 95% CI −24.17 to −18.56), were more positive towards vaccination (pre = 43.8% post = 50.4%; diff = 6.5% 95% CI 3.0% to 10.0%), less concerned about vaccine safety (pre = 28.5%, post = 23.0%, diff = −5.6% 95% CI −2.3% to −8.8%) and side effects (pre = 37.0%, post = 29.0%, diff = −8.0% 95% CI −4.0% to −12.0%) with no change in stage of decision-making or intention to vaccinate. Providing information about the benefits and risks of routine childhood vaccination increases parents’ informed decision-making without increasing vaccine hesitancy.

Prostate cancer care in Canada: Informed decision-making, patterns of care, and treatment trends.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 289-289
Author(s):  
Kim Tran ◽  
Rami Rahal ◽  
Carolyn Sandoval ◽  
Geoff Porter ◽  
Sharon Fung ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Treatment Patterns ◽  
Informed Decision ◽  
Decision Making Process ◽  
Informed Decision Making ◽  
Treatment Decision Making ◽  
Trends Over Time ◽  
Treatment Trends ◽  
Over Time

289 Background: Because treatment options for localized prostate cancer (PCa) have similar survival outcomes but varying side effects, it is important that patients are meaningfully involved in the decision-making process to ensure the chosen treatment aligns with their needs, wants and preferences. Here, we describe PCa patients’ experience with informed decision-making as well as treatment patterns and trends over time. Methods: Focus groups were conducted with 47 men treated for PCa across Canada to understand their cancer journey experience. Thematic analysis was conducted. A subset of this data on informed decision-making is described. Men (≥ 35 years) diagnosed with localized, low-risk PCa from 2011-2013 were identified using data from six provincial cancer registries. Treatment data were identified by linking hospital/cancer centre data with registry data. Descriptive statistics were generated to describe treatment patterns and trends. Results: Focus group participants expressed a desire to be involved in the treatment decision-making process. While many participants felt completely informed about the treatment choices available to them, others felt they had not been properly engaged in the treatment decision-making process. Some participants felt they had opted for surgery or radiation therapy (RT) without full knowledge of the trade-offs between potential benefits and side effects. Others felt they may have made different decisions about their care had they been more informed. From registry data, in 2013 surgery was the most common primary treatment for men with low-risk PCa ranging from 12.0% in New Brunswick to 41.7% in Nova Scotia. RT was the second most common ranging from 6.4% in New Brunswick to 18.3% in Saskatchewan. Varying majorities of men had no record of surgical or radiation treatment, a proxy for active surveillance. Treatment trends over time suggest an increase in the use of non-active treatment approaches from 60.7% in 2011 to 69.9% in 2013. Conclusions: System performance indicators yield useful information about oncology practice patterns and trends. This information is enhanced when combined with patient level information on how men felt about decision-making around their PCa care.

Integrity Risk-Informed Decision Making

2018 ◽  
Author(s):  
Sherif Hassanien ◽  
Doug Langer ◽  
Mona Abdolrazaghi
Keyword(s):  
Decision Making ◽  
Safety Management ◽  
Informed Decision ◽  
Nuclear Industry ◽  
Optimal Decision ◽  
Decision Making Process ◽  
Informed Decision Making ◽  
Safety Critical ◽  
Formal Framework ◽  
Integrity Risk

Over the last three decades, safety-critical industries (e.g. Nuclear, Aviation) have witnessed an evolution from risk-based to risk-informed safety management approaches, in which quantitative risk assessment is only one component of the decision making process. While the oil and gas pipeline industry has recently made several advancements towards safety management processes, their safety performance may still be seen to fall below the expected level achieved by other safety-critical industries. The intent of this paper is to focus on the safety decision making process within pipeline integrity management systems. Pipeline integrity rules, routines, and procedures are commonly based on regulatory requirements, industry best practices, and engineering experience; where they form “programmed” decisions. Non-programmed safety and business decisions are unique and “usually” unstructured, where solutions are worked out as problems arise. Non-programmed decision making requires more activities towards defining decision alternatives and mutual adjustment by stakeholders in order to reach an optimal decision. Theoretically, operators are expected to be at a maturity level where programmed decisions are ready for most, if not all, of their operational problems. However, such expectations might only cover certain types of threats and integrity situations. Herein, a formal framework for non-programmed integrity decisions is introduced. Two common decision making frameworks; namely, risk-based and risk-informed are briefly discussed. In addition, the paper reviews the recent advances in nuclear industry in terms of decision making, introduces a combined technical and management decision making process called integrity risk-informed decision making (IRIDM), and presents a guideline for making integrity decisions.

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