scholarly journals Medical choice of chronic patients in a large Russian сity: Situations, practices, factors

2019 ◽  
Vol 25 (2) ◽  
pp. 78-98 ◽  
Author(s):  
Vitaliy L. Lekhtsier ◽  
Anna S. Gotlib ◽  
Irina E. Finkelshtein
Keyword(s):  
Decision Making ◽  
Healthcare System ◽  
Medical Decision ◽  
Chronic Patients ◽  
Medical Decisions ◽  
Institutional Conditions ◽  
Interview Method ◽  
Representation Of Solutions ◽  
Sample Method ◽  
Medical Choice

This article is devoted to the main results of a quantitative empirical study of patients’ choice in a large Russian city. The object of this study was the chronic patients of Samara city, selected using a two-step sample method according to the following criteria: disease type, gender, age (N = 510 p). Research was conducted using the semi-formal interview method. Methodologically the study goes back to an approach which was developed within the framework of cognitive medical anthropology in the theoretical and empirical works of American anthropologists Lynda Garro and James Young, which formulated the principles of the Study of Medical Choice, and the Decision-Making Approach. For this research the problem matter of “remission society”, developed by sociologists and anthropologists Anselm Strauss, Arthur Kleinman and Arthur Frank, is very much relevant. In the article, the results of the choices that chronic patients make out of the alternatives available (appeal to state and non-state biomedicine, to different forms of unconventional medicine, medical and non-medical self-treatment) are structured according to three main situations in an ill patient’s life. These are the following: the situation of first encountering the disease (“the debut of the disease”); the situation of diagnosis and prescription of treatment; the situation of the illness transitioning to a chronic state (exacerbation or control over the disease). It is shown that these situations of choice differ from each other not only by the range of available alternatives for making medical decisions by chronic patients (this conclusion was obtained at the first qualitative stage of the study, brief results of which are also presented in the article), but also by quantitative representation of identical alternatives . Thus, we can observe a significant increase in self-treatment in the third situation, caused by a number of subjective and objective reasons, as well as a significant increase in the proportion of respondents who turned to practitioners of unconventional medicine in a situation after a diagnosis was made. The principles of Study of Medical Choice are adapted in the study to the institutional conditions of the Russian healthcare system, with its inherent range of choices and factors that influence the patient’s medical decision-making. Knowledge of these decisions is necessary in order to understand the direction for reforming the Russian healthcare system and in order to organize medical care which satisfies the needs of patients. This article also presents the results of analyzing certain factors that have seriously affected, based on the respondents’ opinions, a specific solution in the situations studied. A hierarchy of representation of these factors is described for each disease situation. A quantitative representation of solutions inherent to noncompliance was revealed, such as refusing drugs, searching for another doctor, double-checking the diagnosis.

Support for management medical decisions and the nature of uncertainty in them

2021 ◽  
Author(s):  
S.Yu. Zhuleva ◽  
A.V. Kroshilin ◽  
S.V. Kroshilina
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Information ◽  
General Scheme ◽  
The Body ◽  
Medical Decision ◽  
Problem Situation ◽  
Medical Decisions ◽  
Inaccurate Information ◽  
Individual Decisions

The process of making a medical decision is characterized by a lack of knowledge and inconsistency of the available information, the lack of the possibility of attracting competent medical experts, limited time resources, incomplete or inaccurate information about the patient's condition. These aspects may be the causes of medical errors, which lead to further aggravation of the problem situation. Purpose – it is necessary to define and justify managerial medical decisions and types of medical information in conditions of uncertainty, when each variant of the sets of outcomes of the situation (recommendations) has its own unique set of values. The fundamental difference between this process for medical use is the concept of the "best medical solution", in which the key role is given to the patient's state of health in obtaining and evaluating alternatives, as well as the need to take into account the time, adverse reactions of the body and the costs of implementing this solution. In the medical field, support for medical decision-making can be classified as organizational-managerial and therapeutic-diagnostic, but both are determined by the position of the person making the medical decision and are aimed at effective management of the medical institution as a whole. The article describes the causes and factors of the nature of uncertainty in the tasks of supporting medical decision-making in medical-diagnostic and organizational-managerial areas. The analysis of the features of supporting medical decision-making in conditions of uncertainty is carried out. Approaches and directions in this area, as well as the concept of “solution”, are considered. The essence of the management medical decision is reflected. The classification of management medical decisions is given, the requirements that are imposed on them are highlighted. The features of the development of management medical solutions in the conditions of incompleteness and uncertainty, the problems that arise when they are implemented in information systems are presented. The general scheme of the process of creating a management medical solution is shown. The features of making group and individual decisions are reflected. The algorithm of actions of the person making the medical decision in the conditions of uncertainty, incompleteness and risk in medical subject areas is presented.

Prescriptions and Proscriptions

2020 ◽  
pp. 141-161
Author(s):  
Jeff Levin
Keyword(s):  
Decision Making ◽  
Special Reference ◽  
Clinical Setting ◽  
Medical Decision ◽  
Jewish Law ◽  
Controversial Issues ◽  
Medical Decisions ◽  
Faith Traditions ◽  
History Of ◽  
The Life Course

A history of the important contributions of religious and theological scholars to the birth and growth of the field of medical ethics. Religious values influence medical decision-making in the clinical setting and across the life course for many controversial issues, such as abortion and euthanasia. However, conclusions regarding those procedures or courses of action that are proscribed (forbidden or discouraged) or prescribed (mandated or recommended) by respective religious codes (e.g., halachah, or Jewish law) often differ across and among Protestant, Catholic, and Jewish bioethicists and those of other faith traditions. The work of leading scholars in this field is discussed, with special reference to difficult medical decisions at the beginning and end of life.

scholarly journals Medical Decision-Making in Oncology for Patients Lacking Capacity

2020 ◽  
pp. e186-e196
Author(s):  
Jonathan M. Marron ◽  
Kaitlin Kyi ◽  
Paul S. Appelbaum ◽  
Allison Magnuson
Keyword(s):  
Decision Making ◽  
Developmentally Disabled ◽  
Medical Decision ◽  
Decisional Capacity ◽  
Medical Decisions ◽  
Diminished Capacity ◽  
Decision Making Capacity ◽  
Minor Children ◽  
Oncology Practice ◽  
Do So

Modern oncology practice is built upon the idea that a patient with cancer has the legal and ethical right to make decisions about their medical care. There are situations in which patients might no longer be fully able to make decisions on their own behalf, however, and some patients never were able to do so. In such cases, it is critical to be aware of how to determine if a patient has the ability to make medical decisions and what should be done if they do not. In this article, we examine the concept of decision-making capacity in oncology and explore situations in which patients may have altered/diminished capacity (e.g., depression, cognitive impairment, delirium, brain tumor, brain metastases, etc.) or never had decisional capacity (e.g., minor children or developmentally disabled adults). We describe fundamental principles to consider when caring for a patient with cancer who lacks decisional capacity. We then introduce strategies for capacity assessment and discuss how clinicians might navigate scenarios in which their patients could lack capacity to make decisions about their cancer care. Finally, we explore ways in which pediatric and medical oncology can learn from one another with regard to these challenging situations.

scholarly journals The Gray Zone: Adolescent and Young Adult Decision Support Needs for Ulcerative Colitis

2020 ◽  
Vol 5 (2) ◽  
pp. 238146832094070
Author(s):  
Andrea Meisman ◽  
Nancy M. Daraiseh ◽  
Phil Minar ◽  
Marlee Saxe ◽  
Ellen A. Lipstein
Keyword(s):  
Ulcerative Colitis ◽  
Decision Making ◽  
Decision Support ◽  
Focus Groups ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Support Needs ◽  
Final Decision ◽  
Care Providers ◽  
Medical Decisions

Purpose. To understand the medical decision support needs specific to adolescents and young adults (AYAs) with ulcerative colitis (UC) and inform development of a decision support tool addressing AYAs’ preferences. Methods. We conducted focus groups with AYAs with UC and mentors from a pediatric inflammatory bowel disease clinic’s peer mentoring program. Focus groups were led by a single trained facilitator using a semistructured guide aimed at eliciting AYAs’ roles in medical decision making and perceived decision support needs. All focus groups were audio recorded, transcribed, and coded by the research team. Data were analyzed using content analysis and the immersion crystallization method. Results. The facilitator led six focus groups: one group with peer mentors aged 18 to 24 years, three groups with patients aged 14 to 17 years, and two groups with patients aged 18 to 24 years. Decision timing and those involved in decision making were identified as interacting components of treatment decision making. Treatment decisions by AYAs were further based on timing, location (inpatient v. outpatient), and family preference for making decisions during or outside of clinic. AYAs involved parents and health care providers in medical decisions, with older participants describing themselves as “final decision makers.” Knowledge and experience were facilitators identified to participating in medical decision making. Conclusions. AYAs with UC experience changes to their roles in medical decisions over time. The support needs identified will inform the development of strategies, such as decision support tools, to help AYAs with chronic conditions develop and use skills needed for participating in medical decision making.

scholarly journals The role of non-medical factors in physicians’ decision-making process in a pediatric telemedicine service

2019 ◽  
Vol 26 (2) ◽  
pp. 1152-1176 ◽  
Author(s):  
Motti Haimi ◽  
Shuli Brammli-Greenberg ◽  
Yehezkel Waisman ◽  
Nili Stein ◽  
Orna Baron-Epel
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decision Making Process ◽  
Medical Decisions ◽  
Telemedicine Service ◽  
Medical Factors ◽  
Complex Process ◽  
Clinical Scenarios

The complex process of medical decision-making is prone also to medically extraneous influences or “non-medical” factors. We aimed to investigate the possible role of non-medical factors in doctors’ decision-making process in a telemedicine setting. Interviews with 15 physicians who work in a pediatric telemedicine service were conducted. Those included a qualitative section, in which the physicians were asked about the role of non-medical factors in their decisions. Their responses to three clinical scenarios were also analyzed. In an additional quantitative section, a random sample of 339 parent -physician consultations, held during 2014–2017, was analyzed retrospectively. Various non-medical factors were identified with respect to their possible effect on primary and secondary decisions, the accuracy of diagnosis, and “reasonability” of the decisions. Various non-medical factors were found to influence physicians’ decisions. Those factors were related to the child, the applying parent, the physician, the interaction between the doctor and parents, the shift, and to demographic considerations, and were also found to influence the ability to make an accurate diagnosis and “reasonable” decisions. Our conclusion was that non-medical factors have an impact on doctor’s decisions, even in the setting of telemedicine, and should be considered for improving medical decisions in this milieu.

scholarly journals Value Assessment in Healthcare Decision-Making of Ethnically and Cognitively Diverse Older Adults

2019 ◽  
Vol 34 (7) ◽  
pp. 1260-1260
Author(s):  
A Mejia ◽  
G D Smith ◽  
R E Curiel ◽  
W Barker ◽  
R Behar ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Focus Groups ◽  
Family Involvement ◽  
Medical Decision ◽  
Value Assessment ◽  
Healthcare Decision ◽  
Medical Decisions ◽  
Healthcare Decision Making ◽  
Normal Cognition

Abstract Objective Little is known regarding the values that patients with mild cognitive impairment (MCI) incorporate into healthcare decision-making or how culture may affect such values. Even if values overlap across cultures, cultural groups may emphasize the importance of specific values differently since values emanate, at least in part, from cultural and life-long learning. The aim of this study was to explore and compare values that older adults of different ethnicities and cognitive statuses incorporate in their medical decisions. Participants and Method Four focus groups were established by identifying older adults as, a) Hispanic or non-Hispanic, and with b) normal cognition or MCI. Participants were recruited from the 1Florida Alzheimer’s Disease Research Center. Focus groups were audio-recorded and transcribed using a professional transcription service. Results There were a total of 23 participants (Age: M = 70.9, SD = 6.4). MCI groups had briefer discussions (Time M = 44 minutes) than the normal cognition groups (Time M = 62 minutes). Qualitative analysis of discussions was used to explore the values identified across the focus groups. The MCI groups valued spirituality, doctor recommendations, and family involvement when facing medical decisions. Normal cognition groups valued the necessity of proactive involvement as healthcare consumers and the relationship between the quality of patient-clinician interaction and their health care related decisions. Cultural themes involving perceptions of gender and generational differences emerged from the Hispanic normal cognition group. Conclusions This study identified many determinants influencing the medical decision-making process of diverse older adults: including past experiences, family involvement, healthcare barriers, and cultural background. These results have the potential to impact patient-clinician discussions, decisions made by surrogates, and the development of decision aids with a broader range of relevant patient values.

scholarly journals The influence of values in shared (medical) decision making

2019 ◽  
Vol 32 (1) ◽  
pp. 37-47
Author(s):  
Bettina Baldt
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Decision ◽  
Decision Making Process ◽  
Shared Decision ◽  
Medical Decisions ◽  
Teaching Concept ◽  
The Status ◽  
German Speaking ◽  
Definition Of

Abstract Definition of the problem The Shared Decision Making model is becoming increasingly popular also in the German-speaking context, but it only considers values of patients to be relevant for medical decisions. Nevertheless, studies show that the values of physicians are also influential in medical decisions. Moreover, physicians are often unaware of this influence, which makes it impossible to control it. Arguments The influence of both patients’ and physicians’ values is examined from an empirical and normative perspective. The review about the empirical data provides a necessary overview about the status quo, whereas I deduct rules for value-influenced behaviour in the decision making process in the normative approach. Therefore, different scenarios are taken into account to explore in which situations it is acceptable for physicians to let their values be part of the decision making process. The conscious use of values is only possible, when physicians are aware of their influence. To raise awareness, the best option would be to educate future physicians about it in their training. Therefore, this article provides a teaching concept for a unit that could be part of an ethics class for physicians in training. Furthermore, patient’s rights and responsibilities in the decision making process are discussed. Conclusion I conclude that it is necessary to take the influence of values (more) into account and include this knowledge into the training of physicians. Conclusively, recommendations for patients and physicians and their dealing with values in shared decision making processes are suggested.

Importance of Faith on Medical Decisions Regarding Cancer Care

2003 ◽  
Vol 21 (7) ◽  
pp. 1379-1382 ◽  
Author(s):  
Gerard A. Silvestri ◽  
Sommer Knittig ◽  
James S. Zoller ◽  
Paul J. Nietert
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Formal Education ◽  
Treatment Decisions ◽  
Medical Decision ◽  
Advanced Lung Cancer ◽  
Medical Decisions ◽  
Future Studies ◽  
Medical Oncologists ◽  
Individual Decisions

Purpose: Decisions regarding cancer treatment choices can be difficult. Several factors may influence the decision to undergo treatment. One poorly understood factor is the influence of a patient’s faith on how they make medical decisions. We compared the importance of faith on treatment decisions among doctors, patients, and patient caregivers. Methods: One hundred patients with advanced lung cancer, their caregivers, and 257 medical oncologists were interviewed. Participants were asked to rank the importance of the following factors that might influence treatment decisions: cancer doctor’s recommendation, faith in God, ability of treatment to cure disease, side effects, family doctor’s recommendation, spouse’s recommendation, and children’s recommendation. Results: All three groups ranked the oncologist’s recommendation as most important. Patients and caregivers ranked faith in God second, whereas physicians placed it last (P < .0001). Patients who placed a high priority on faith in God had less formal education (P < .0001). Conclusion: Patients and caregivers agree on the factors that are important in deciding treatment for advanced lung cancer but differ substantially from doctors. All agree that the oncologist’s recommendation is most important. This is the first study to demonstrate that, for some, faith is an important factor in medical decision making, more so than even the efficacy of treatment. If faith plays an important role in how some patients decide treatment, and physicians do not account for it, the decision-making process may be unsatisfactory to all involved. Future studies should clarify how faith influences individual decisions regarding treatment.

Decision-Making and Decision Support in Acute Care

2013 ◽  
pp. 1-18
Author(s):  
Brett W. Taylor
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Clinical Decision Support Systems ◽  
Evaluation Process ◽  
Clinical Decision ◽  
Medical Decision ◽  
Information Tools ◽  
Novices And Experts ◽  
And Function ◽  
Medical Choice

Clinical Decision Support Systems (CDSS) are information tools intended to optimize medical choice, promising better patient outcomes, faster care, reduced resource expenditure, or some combination of all three. Clinical trials of CDSS have provided only insipid evidence of benefit to date. This chapter reviews the theory of medical decision-decision making, identifying the different decision support needs of novices and experts, and demonstrates that discipline, objective and setting, and affect of the nature of support that is required. A discussion on categorization attempts to provide metrics by which systems can be compared and evaluated, in particular with regard to decision support mechanics and function. Throughout, the common theme is the placement of clinical decision makers at the center of the design or evaluation process.

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