scholarly journals Patient and Provider Perceptions of Decision Making About Use of Epidural Analgesia During Childbirth: A Thematic Analysis

2014 ◽  
Vol 23 (3) ◽  
pp. 142-150 ◽  
Author(s):  
Holly Bianca Goldberg ◽  
Allison Shorten
Keyword(s):  
Decision Making ◽  
Epidural Analgesia ◽  
Shared Decision Making ◽  
Thematic Analysis ◽  
Informed Choice ◽  
Shared Decision ◽  
Provider Perceptions ◽  
Survey Responses

This study examines the nature of differences in perceptions of decision making between patients and providers about use of epidural analgesia during labor. Thematic analysis was used to identify patterns in written survey responses from 14 patients, 13 labor nurses, and 7 obstetrician–gynecologists. Results revealed patients attempted to place themselves in an informed role in decision making and sought respect for their decisions. Some providers demonstrated paternalism and a tendency to steer patients in the direction of their own preferences. Nurses observed various pressures on decision making, reinforcing the importance of patients being supported to make an informed choice. Differences in perceptions suggest need for improvement in communication and shared decision-making practices related to epidural analgesia use in labor.

Shared decision-making and informed choice for the early detection of prostate cancer in primary care

2005 ◽  
Vol 96 (9) ◽  
pp. 1209-1210 ◽  
Author(s):  
Suzanne K. Steginga ◽  
Carole Pinnock ◽  
Claire Jackson ◽  
Tony Gianduzzo
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Decision Making ◽  
Early Detection ◽  
Shared Decision Making ◽  
Informed Choice ◽  
Shared Decision

Health Decisions and Decision Support for Women

2001 ◽  
Vol 19 (1) ◽  
pp. 307-324 ◽  
Author(s):  
MARILYN L. ROTHERT ◽  
ANNETTE M. O’CONNOR
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Cochrane Review ◽  
Informed Choice ◽  
Shared Decision ◽  
Patient Decision ◽  
Key Issues ◽  
Conceptual Overview

Women are more likely to live longer with chronic illness and have a longterm relationship with their health care provider; this requires a situation in which patients and providers have a role in managing illness. In this chapter, the authors provide a conceptual overview of decision making along with key issues: historical concepts related to patients and providers, consumerism, informed choice/consent, patient rights, shared decision making, patient involvement, as well as an overview of models of patient/provider partnerships. This review builds on the work of O’Connor et al. (1999), which resulted in a Cochrane review of decision aids and focuses the examination of patient decision aids that support women’ decisions regarding health treatment or screening. The authors conclude with a look to the future and recommendations for research in the area of shared decision making and health care decision aids.

Decision-Making in Cleft-Related Surgery: A Qualitative Analysis of Patients and Caregivers

2019 ◽  
Vol 57 (2) ◽  
pp. 161-168
Author(s):  
Katelyn G. Bennett ◽  
Annie K. Patterson ◽  
Kylie Schafer ◽  
Madeleine Haase ◽  
Kavitha Ranganathan ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Thematic Analysis ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
Shared Decision ◽  
Surgical Indications ◽  
Facial Difference

Objective: Preference-sensitive surgical decisions merit shared decision-making, as decision engagement can reduce decisional conflict and regret. Elective cleft-related procedures are often preference sensitive, and therefore, we sought to better understand decision-making in this population. Design: Semistructured interviews were conducted to elicit qualitative data. A hierarchical codebook was developed through an iterative process in preparation for thematic analysis. Thematic analysis was performed to examine differences between patients and caregivers. Setting: Multidisciplinary cleft clinic at a tertiary care center. Participants: Patients with cleft lip aged 8 and older (n = 31) and their caregivers (n = 31) were purposively sampled. Inability to converse in English, intellectual disability, or syndromic diagnoses resulted in exclusion. Main Outcome Measures: Preferences surrounding surgical decision-making identified during thematic analysis. Results: Mean patient age was 12.7 (standard deviation: 3.1). Most had unilateral cleft lip and palate (43.8%). Three themes emerged: Insufficient Understanding of Facial Difference and Treatment, Diversity of Surgical Indications, and Barriers to Patient Autonomy. Almost half of caregivers believed their children understood their clefts, but most of these children failed to provide information about their cleft. Although many patients and caregivers acknowledged that surgery addressed function and/or appearance, patients and caregivers exhibited differences regarding the necessity of surgery. Furthermore, a large proportion of patients believed their opinions mattered in decisions, but less than half of caregivers agreed. Conclusions: Patients with clefts desire to participate in surgical decisions but have limited understanding of their facial difference and surgical indications. Cleft surgeons must educate patients and facilitate shared decision-making.

Perceptions and experiences of older patients and healthcare professionals regarding shared decision-making in pulmonary rehabilitation: A qualitative study

2021 ◽  
pp. 026921552110102
Author(s):  
Yuyu Jiang ◽  
Jianlan Guo ◽  
Pingping Sun ◽  
Zhongyi Chen ◽  
Fenglan Liu ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Perceived Stress ◽  
Thematic Analysis ◽  
Pulmonary Rehabilitation ◽  
Older Patients ◽  
Healthcare Professionals ◽  
Knowledge Gap ◽  
Shared Decision

Objective: To understand the perceptions and experiences of older patients with chronic obstructive pulmonary disease (COPD) and healthcare professionals (HCPs) regarding shared decision-making in pulmonary rehabilitation (PR). Design: A qualitative study using single, semi-structured interviews, and thematic analysis. Setting: Face-to-face interviews were conducted in the Jiangnan University, in hospital and in patients’ homes. Participants: Twenty-two older patients with COPD and 29 HCPs. Methods: An initial codebook and semi-structured interview guide were developed based on the shared decision-making 3-circle conceptual model. Thematic analysis was used to analyze data. Results: The study identified 10 themes that describe the perceptions and experiences of patients and HCPs involved in PR decision-making: (1) patients’ confidence, (2) patients’ perceptions of the cost-benefit of decisions, (3) patients’ perceived stress about the consequences of decision-making, (4) HCPs’ perceived stress on shared decision-making, (5) cognitive biases of patients toward illness and rehabilitation, (6) shared decision-making as a knowledge gap, (7) the knowledge gap between patients and HCPs, (8) authority effect, (9) family support, (10) human resources. These themes were then divided into three groups according to their characteristics: (1) the feelings of the participants, (2) knowledge barriers, and (3) support from the social system. Conclusion: Patients and HCPs described their negative perceptions and experiences of participating in decision-making in PR. The implementation of shared decision-making in PR is currently limited; therefore, health education for patients and families should be strengthened and a training system for HCPs in shared decision-making should be established.

scholarly journals Using behavioral theory and shared decision-making to understand clinical trial recruitment: interviews with trial recruiters

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jamie C. Brehaut ◽  
Carolina Lavin Venegas ◽  
Natasha Hudek ◽  
Justin Presseau ◽  
Kelly Carroll ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Decision Making ◽  
Behavior Change ◽  
Shared Decision Making ◽  
Thematic Analysis ◽  
Pilot Trial ◽  
Theoretical Domains Framework ◽  
Shared Decision ◽  
Trial Recruitment ◽  
Clinical Trial Recruitment

Abstract Background Clinical trial recruitment is a continuing challenge for medical researchers. Previous efforts to improve study recruitment have rarely been informed by theories of human decision making and behavior change. We investigate the trial recruitment strategies reported by study recruiters, guided by two influential theoretical frameworks: shared decision-making (SDM) and the Theoretical Domains Framework (TDF) in order to explore the utility of these frameworks in trial recruitment. Methods We interviewed all nine active study recruiters from a multi-site, open-label pilot trial assessing the feasibility of a large-scale randomized trial. Recruiters were primarily nurses or master's-level research assistants with a range of 3 to 30 years of experience. The semi-structured interviews included questions about the typical recruitment encounter, questions concerning the main components of SDM (e.g. verifying understanding, directive vs. non-directive style), and questions investigating the barriers to and drivers of their recruitment activities, based on the TDF. We used directed content analysis to code quotations into TDF domains, followed by inductive thematic analysis to code quotations into sub-themes within domains and overarching themes across TDF domains. Responses to questions related to SDM were aggregated according to level of endorsement and informed the thematic analysis. Results The analysis helped to identify 28 sub-themes across 11 domains. The sub-themes were organized into six overarching themes: coordinating between people, providing guidance to recruiters about challenges, providing resources to recruiters, optimizing study flow, guiding the recruitment decision, and emphasizing the benefits to participation. The SDM analysis revealed recruiters were able to view recruitment interactions as successful even when enrollment did not proceed, and most recruiters took a non-directive (i.e. providing patients with balanced information on available options) or mixed approach over a directive approach (i.e. focus on enrolling patient in study). Most of the core SDM constructs were frequently endorsed. Conclusions Identified sub-themes can be linked to TDF domains for which effective behavior change interventions are known, yielding interventions that can be evaluated as to whether they improve recruitment. Despite having no formal training in shared decision-making, study recruiters reported practices consistent with many elements of SDM. The development of SDM training materials specific to trial recruitment could improve the informed decision-making process for patients.

Oncology provider perceptions of shared-decision making.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23168-e23168
Author(s):  
Nila Sathe ◽  
Cate Polacek ◽  
Sunnie Fenk ◽  
Wendy Rossi ◽  
Roni Christopher
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Care Delivery ◽  
Shared Decision ◽  
Cultural Meanings ◽  
Provider Attitudes ◽  
Care Experience ◽  
Provider Perceptions ◽  
Patient Values ◽  
Communication Needs

e23168 Background: Adoption of shared decision making (SDM), a key strategy for improving patients’ care experience, may be limited. We explored oncology professionals’ SDM perceptions to understand patient-provider decision-making communication. Methods: Semi-structured phone interviews or web-based surveys with purposively recruited participants from a range of perspectives to increase generalizability. Content analysis to identify overarching themes. Results: Respondents (n = 20) valued SDM but described challenges including: Evolving and variable communication needs. Evolving care trajectories constrain full SDM discussions. Differences in goals in curative or palliative situations dictate different approaches. Communication along care continuum. Providers noted that discussions of elements of care occur with multiple providers and staff, potentially in a piecemeal fashion. Communicating about costs. Costs vary considerably in terms of cost to the patient and to the system. Impact on care is more than a simple higher/lower dichotomy. Directing decisions vs. fostering discussion: Most respondents understood a “literature-based” SDM definition, but some conflated patient education and SDM. Some implied “nudging” patients toward choices vs. open discussion. Balancing clinical imperatives and patient preferences. Respondents noted balancing professional imperatives to share information with patient values. External influences on communication. Families were seen as a help and hindrance to SDM, particularly when care goals differ. Cultural meanings ascribed to cancer also vary. Decision making style. Participants suggested that patients approach decision making from overarching mindsets regarding engagement (e.g., prioritizing provider input). Conclusions: Respondents valued communication and SDM but described challenges in exigencies of care delivery, provider attitudes, and patient influences. Respondents’ discussion of challenges suggests that exploiting communication opportunities across the care trajectory and deliberate consideration of patients’ preferences for decision-making conversations could help to inform/prime communication and potentially improve SDM processes.

scholarly journals Medical informed choice: understanding the element of time to meet the standard of care for valid informed consent

2020 ◽  
Vol 96 (1141) ◽  
pp. 708-710
Author(s):  
Zachary R Paterick ◽  
Timothy Edward Paterick ◽  
Barb Block Paterick
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Surgical Outcomes ◽  
Healthcare Providers ◽  
Informed Choice ◽  
Standard Of Care ◽  
Fiduciary Duty ◽  
Shared Decision ◽  
Physician Patient Relationship ◽  
Legal Principles

Medical informed choice is essential for a physician meeting their fiduciary duty when proposing medical and surgical actions, and necessary for a patient to consent or cull the outlined therapeutic approaches. Informed choice, as part of a shared decision-making model, allows widespread give-and-take of ideas between the patient and physician. This sharing of ideas results in a partnership for decision-making and a responsibility for medical and surgical outcomes.Informed choice is indispensible to the patient education process that meets the desired outcome of any covenant—an offer of and acceptance of the proposed treatment. The covenant anchors a true patient–physician partnership with parity and equality in decision-making and medical/surgical outcomes.Medical informed choice flows from ethical and legal principles necessary to meet the acknowledged standard of care. This is codified by statute and fortified in general common law. This espouses a fiduciary relationship where the patient and physician understand and accede to the degree of autonomy the patient requests.The growth of an equal patient–physician relationship requires time. There is no alternative to the time variable when developing a physician–patient relationship. Despite physicians being under pressures to perform more clinical and administrative duties in less time in the corporate model of medicine, time remains the most critical variable when considering informed choice and shared decision-making. Videos, pamphlets and alternate healthcare providers cannot and should not substitute for physician time.

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