scholarly journals Family involvement in the context of chronic diseases: The role of social support in treatment decision-making for surgical procedures

2020 ◽  
Vol 32 (1) ◽  
pp. 45-71
Author(s):  
Elena Link ◽  
Doreen Reifegerste ◽  
Christoph Klimmt
Keyword(s):  
Social Support ◽  
Decision Making ◽  
Chronic Diseases ◽  
Family Involvement ◽  
Surgical Procedures ◽  
Qualitative Interviews ◽  
Family Members ◽  
Medical Decision ◽  
Personal Factors

If medical decision-making about complex treatment options (such as surgical procedures) is challenging for patients, family members can provide them with advice and health information. Previous research about family involvement in health communication has largely focused on cancer patients. Thus, it lacks an examination of family involvement in surgery decision-making in the context of non-life-threatening chronic diseases like arthrosis. In particular, we focus on the role of social support for family involvement in these situations. Against this background, we conducted semi-structured qualitative interviews with arthrosis patients and their family members (n = 32 patients; n = 8 relatives). To better understand family involvement in surgery decision-making, three research questions were analyzed: (1) What are the perceived characteristics of the arthroplasty decisional process? (2) Which patterns of family involvement exist with regard to social support? (3) What general circumstances are relevant for family involvement? Our results demonstrate that social support plays an important role in the patterns of family decision-making. Instrumental, emotional, and informational support can indirectly enhance family involvement in decision-making. In addition, relatives are also directly involved in decision-making processes and may instigate the decision. The type of family involvement is influenced by characteristics of the decision-making situation. In addition to personal factors and the relationship with the physician, which is perceived as less supportive, the need for familial decisional support intensifies.

Decision-Making and Holistic Public Defense Post-Montgomery v. Louisiana

2019 ◽  
Vol 31 (6) ◽  
pp. 886-907
Author(s):  
Jeanette Hussemann ◽  
Jonah Siegel
Keyword(s):  
Decision Making ◽  
Supreme Court ◽  
Qualitative Interviews ◽  
Family Members ◽  
Defense Attorneys ◽  
Public Defense ◽  
Emotional Wellness ◽  
The U.S

In 2012, the U.S. Supreme Court ruled in Miller v. Alabama that mandatory sentences of life without the possibility of parole (LWOP) for youth are unconstitutional. In 2016, the Court held in Montgomery v. Louisiana that the ruling in Miller should be applied retroactively. Drawing from qualitative interviews with justice actors, and individuals who were sentenced to LWOP as juveniles and paroled, this article examines the implementation of Miller-Montgomery in Michigan, the factors that influence decisions to release juvenile lifers, and their reentry process. In doing so, we focus specific attention to the role of publicly appointed defense attorneys and the application of holistic defense practices to support Montgomery case mitigation and juvenile lifer reentry. Findings indicate that institutional disciplinary and programming records, emotional wellness, statements by victims’ family members, political considerations, and reentry plans are key considerations when deciding whether a juvenile lifer should be eligible for parole.

scholarly journals 當代中國家庭醫療決策的倫理策略——一個有關家庭醫療決策的案例研究

2017 ◽  
Vol 15 (2) ◽  
pp. 21-41
Author(s):  
Guobin CHENG
Keyword(s):  
Decision Making ◽  
Family Involvement ◽  
Filial Piety ◽  
Medical Information ◽  
Family Members ◽  
Confucian Ethics ◽  
Medical Decision ◽  
Medical Decisions ◽  
The Family ◽  
Family Decision

LANGUAGE NOTE | Document text in Chinese; abstract also in English.在當代中國家庭醫療決策過程存在以下幾個特點：第一，病人的自主權並未完全消失，但其實現程度和方式受到了諸多限制；第二，對病人的行為能力和權利限度的判斷上存在家長主義和後果論的特徵，在一定程度上構成了對病人權利的剝奪；第三，病人的最大利益和個人意願仍然是決策依據的重要方面，但對這兩者的解讀體現出了偏重客觀利益和共用價值觀的特點，又受到家庭具體權力結構的影響。在家人做出最終決策的形式背後隱藏著諸多豐富的細節，家庭醫療決策是一個傳統與現代、家庭與個人價值觀共同作用的複雜過程，用任何一個單一的理論模型都很難說清它的本來面貌。This essay points out that informed consent in China today is often replaced by the “family decision” model, which is designed to embody Confucian family ethics and maximize the benefit of family involvement in medical decision making. The author, a physician, uses a specific case he encountered when treating an elderly woman with late-stage colon cancer. Because the patient did not know the whole truth of her condition, most of the medical decisions regarding her treatment were made by her children. Ideally speaking, a “family decision” means that both the patient and his/her close family members will be involved in the decision-making process. Yet, the author’s experiences show that in most cases, decision-making responsibilities shift from the patient to the family, especially when the patient is an elderly parent. Theoretically speaking, the Confucian ethics of humanness (ren) and filial piety (xiao) support family as the most appropriate authority for medical decisions. However, in reality, the author finds that this could be problematic when family members hide medical information from the patient—sometimes with cooperation from the physician. The essay recommends that more respect and autonomy should be given to the patient if the “family decision” policy is truly implementedDOWNLOAD HISTORY | This article has been downloaded 202 times in Digital Commons before migrating into this platform.

scholarly journals Personalized treatment options for chronic diseases using precision cohort analytics

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kenney Ng ◽  
Uri Kartoun ◽  
Harry Stavropoulos ◽  
John A. Zambrano ◽  
Paul C. Tang
Keyword(s):  
Decision Making ◽  
Chronic Diseases ◽  
Primary Care Physicians ◽  
Treatment Guidelines ◽  
Point Of Care ◽  
Data Extraction ◽  
Treatment Options ◽  
Personalized Treatment ◽  
Medical Decision ◽  
Similarity Model

AbstractTo support point-of-care decision making by presenting outcomes of past treatment choices for cohorts of similar patients based on observational data from electronic health records (EHRs), a machine-learning precision cohort treatment option (PCTO) workflow consisting of (1) data extraction, (2) similarity model training, (3) precision cohort identification, and (4) treatment options analysis was developed. The similarity model is used to dynamically create a cohort of similar patients, to inform clinical decisions about an individual patient. The workflow was implemented using EHR data from a large health care provider for three different highly prevalent chronic diseases: hypertension (HTN), type 2 diabetes mellitus (T2DM), and hyperlipidemia (HL). A retrospective analysis demonstrated that treatment options with better outcomes were available for a majority of cases (75%, 74%, 85% for HTN, T2DM, HL, respectively). The models for HTN and T2DM were deployed in a pilot study with primary care physicians using it during clinic visits. A novel data-analytic workflow was developed to create patient-similarity models that dynamically generate personalized treatment insights at the point-of-care. By leveraging both knowledge-driven treatment guidelines and data-driven EHR data, physicians can incorporate real-world evidence in their medical decision-making process when considering treatment options for individual patients.

基於儒家家庭本位思想的知情同意原則的思考

2013 ◽  
Vol 11 (1) ◽  
pp. 33-44
Author(s):  
Xiangjin KONG ◽  
Mingjie ZHAO
Keyword(s):  
Decision Making ◽  
Filial Piety ◽  
Moral Virtue ◽  
Family Members ◽  
Confucian Ethics ◽  
Medical Decision ◽  
Individual Autonomy ◽  
The Family ◽  
Family Decision ◽  
Opinion Polls

LANGUAGE NOTE | Document text in Chinese; abstract also in English.在具有家庭主義特徵的中國社會文化語境下，儒家家庭本位思想對病人知情同意權的影響是客觀實在。以自由主義和個人主義為理論基礎的個人自主知情同意原則要想在中國本土的醫療實踐中發揮應有作用，突顯家庭在知情同意過程中的主導地位是重要前提。在中國的醫療實踐中，知情同意的模式必須融入中國儒家家庭本位思想，才能更好地發揮其作用。Opinion polls released recently show that the majority of people in China today think that informed consent in medical practice is necessary, with more than half favoring family decision making over individual, autonomous patient decision making. Based on these opinion polls, this essay argues that the liberalism and liberal individualism that emphasize individual autonomy do not square with the Confucian tradition.The essay submits that the “family decision” model is designed to embody Confucian family ethics and maximize the benefit of family involvement in medical decision making. The family model includes both the patient and his or her close family members in the decision making process. The Confucian ethics of humanness (ren) – the highest moral virtue – and filial piety (xiao) – the foundation of all moral virtue – support family as the most appropriate authority for medical decisions. Further, the essay explores how the family as a unit is better positioned to work with the physician at critical moments to protect the interests of the patient. This means that the family, not the patient, is in authority, and that in some cases, it is acceptable for family members to hide “medical information” from the patient with the cooperation of the physician. The essay concludes that the family is, and should be treated as, a significant moral participant in medical decision making.DOWNLOAD HISTORY | This article has been downloaded 99 times in Digital Commons before migrating into this platform.

Augmenting Medical Diagnosis Decisions? An Investigation into Physicians’ Decision-Making Process with Artificial Intelligence

2021 ◽  
Author(s):  
Ekaterina Jussupow ◽  
Kai Spohrer ◽  
Armin Heinzl ◽  
Joshua Gawlitza
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Medical Errors ◽  
Decision Makers ◽  
Medical Decision ◽  
Decision Making Process ◽  
Self Monitoring ◽  
Rule Based ◽  
Human Actors

Systems based on artificial intelligence (AI) increasingly support physicians in diagnostic decisions, but they are not without errors and biases. Failure to detect those may result in wrong diagnoses and medical errors. Compared with rule-based systems, however, these systems are less transparent and their errors less predictable. Thus, it is difficult, yet critical, for physicians to carefully evaluate AI advice. This study uncovers the cognitive challenges that medical decision makers face when they receive potentially incorrect advice from AI-based diagnosis systems and must decide whether to follow or reject it. In experiments with 68 novice and 12 experienced physicians, novice physicians with and without clinical experience as well as experienced radiologists made more inaccurate diagnosis decisions when provided with incorrect AI advice than without advice at all. We elicit five decision-making patterns and show that wrong diagnostic decisions often result from shortcomings in utilizing metacognitions related to decision makers’ own reasoning (self-monitoring) and metacognitions related to the AI-based system (system monitoring). As a result, physicians fall for decisions based on beliefs rather than actual data or engage in unsuitably superficial evaluation of the AI advice. Our study has implications for the training of physicians and spotlights the crucial role of human actors in compensating for AI errors.

scholarly journals Testimonies of Communication in Dementia Care

2019 ◽  
Author(s):  
Grant D. Campbell ◽  
Nicole Dalmer ◽  
Jason Andrews
Keyword(s):  
Significant Role ◽  
Qualitative Interviews ◽  
Family Members ◽  
Dementia Care ◽  
Information Services ◽  
Professional Information

This paper presents a study of recorded conversations, qualitative interviews, and published memoirs to articulate the role of professional information services in answering the needs of persons caring for family members living with dementia. The data from these sources reveals evidence of working naïve classifications based on images of ritual, paradox, contrast, synchrony and stability. The findings suggest that information services need to align with caregivers’ working classifications, and that information, when appropriately delivered, plays a significant role in re-establishing temporary periods of stability in the caregiving relationship.

Reducing overuse by recognising the unintended harms of good intentions

2019 ◽  
pp. bmjebm-2019-111247
Author(s):  
David Slawson ◽  
Allen F Shaughnessy
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Clinical Care ◽  
Critical Role ◽  
Medical Decision ◽  
Wide Acceptance ◽  
Hierarchy Of Evidence ◽  
Healthcare Interventions

Overdiagnosis and overtreatment—overuse—is gaining wide acceptance as a leading nosocomial intervention in medicine. Not only does overuse create anxiety and diminish patients’ quality of life, in some cases it causes harm to both patients and others not directly involved in clinical care. Reducing overuse begins with the recognition and acceptance of the potential for unintended harm of our best intentions. In this paper, we introduce five cases to illustrate where harm can occur as the result of well-intended healthcare interventions. With this insight, clinicians can learn to appreciate the critical role of probability-based, evidence-informed decision-making in medicine and the need to consider the outcomes for all who may be affected by their actions. Likewise, educators need to evolve medical education and medical decision-making so that it focuses on the hierarchy of evidence and that what ‘ought to work’, based on traditional pathophysiological, disease-focused reasoning, should be subordinate to what ‘does work’.

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