scholarly journals “After all, I have to think for myself”: A qualitative study into the perspectives of clients on shared decision-making as a method to support return to work.

2021 ◽  
Author(s):  
Marloes Vooijs ◽  
Drs. Astrid M. Hazelzet ◽  
Nicole M.C. Kesteren ◽  
Drs. Helen Verhoef ◽  
Wilma Otten
Keyword(s):  
Decision Making ◽  
Return To Work ◽  
Shared Decision Making ◽  
Decision Making Process ◽  
Shared Decision ◽  
Structured Interviews ◽  
Unemployed People ◽  
Personal Approach ◽  
Shared Goal ◽  
Legal Restrictions

Abstract Background: Work participation is an important determinant of public health; being unemployed leads to a decline in an individual’s health. In the Netherlands, unemployed people can apply for a disability benefit and receive support from reintegration professionals to return to work (RTW). Since RTW has a significant impact on a client’s life, clients should be involved in the decision-making process of RTW. A method to include the perspectives of both the clients and the professionals in the decision-making process, is shared decision-making (SDM). We explore how clients experience the SDM steps and to what extent they prefer it in their current and in their ideal interaction with professionals. Methods: We performed semi-structured interviews with fourteen clients receiving support in their RTW process from four different municipalities. Results: Clients emphasised the importance of being treated well, meaning: to be treated with respect, to be treated as equals, that professionals take a committed and personal approach, and trust their clients. None of the clients reported discussing a shared goal with a professional, or having been told that they could be part of the decision-making process. Most clients expressed that choice options have been presented either by professionals or by the clients themselves. When choice options were discussed, only the negative aspects of choice options were explained by the professional, such as legal restrictions or being told that the option was not suitable for the client according to the professional. A great number of clients experienced that shared decisions were made thanks to efforts made by both the client and the professional in equal measure. Other clients indicated that decisions were made for them. Conclusions: This study underlines the importance of how clients are treated and how this affects their RTW experience. Clients generally wish to cooperate and participate in the decision-making process, but their ability to do so is limited. Clients lack information, they do not know that they can participate in the decision-making process, and have different views on goals and choice options. This limits a client’s self-management in the RTW process.

scholarly journals Shared decision making from reintegration professionals’ perspectives to support return to work: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marloes Vooijs ◽  
Nicole M. C. van Kesteren ◽  
Astrid M. Hazelzet ◽  
Wilma Otten
Keyword(s):  
Decision Making ◽  
Return To Work ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Structured Interviews ◽  
Knowledge And Skills ◽  
Medical Sector ◽  
Shared Goal ◽  
Axial Coding ◽  
The Individual

Abstract Background Work participation is an important determinant of public health; being unemployed leads to a decrease in an individual’s health. In the Netherlands, people with a work disability can apply for disability benefits, in which people also receive support to return to work (RTW). A method, currently used in the medical sector, that can include both the perspective of the reintegration professional and of the individual in the process of RTW, is shared decision making (SDM). In this article we explore to what extent reintegration professionals currently use SDM, and to what extent they prefer to use SDM in their ideal interaction with clients. Methods We performed semi-structured interviews with fourteen reintegration professionals from four different municipalities. The transcripts were coded according to content analysis, applying open and axial coding. Results Reintegration professionals emphasised the importance of having a good relationship with clients, of building trust and collaborating as a team. They did not inform their clients that they could be part of the decision-making process, or discussed a shared goal. Although professionals did emphasise the importance of aligning their approach with the preferences of the client and though they tried to offer some choice options, they did not mention available options, discussed the pros and cons of these options or evaluated decisions with their clients. Furthermore, they did not mention any of these aspects in their ideal interaction with clients. Conclusions SDM has a potential value, because all professionals underline the importance of having an alliance with clients, collaborating as a team, and striving to align their approach with the preferences of the client. However, professionals currently perform a limited set of SDM steps. Additional knowledge and skills are needed for both reintegration professionals and municipalities so that professionals can consider and reflect on the value of using SDM, or SDM steps, in supporting RTW. Providing clients with knowledge and skills seems necessary to facilitate both self-management and SDM.

The role of a shared decision-making process in paediatric epilepsy surgery

2021 ◽  
Vol 429 ◽  
pp. 119162
Author(s):  
Michelle Gratton ◽  
Bonnie Wooten ◽  
Sandrine Deribaupierre ◽  
Andrea Andrade
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Epilepsy Surgery ◽  
Decision Making Process ◽  
Shared Decision ◽  
Paediatric Epilepsy

scholarly journals Shared decision making for the initiation and continuation of dialysis: a proposal from the Japanese Society for Dialysis Therapy

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kazuyoshi Okada ◽  
Ken Tsuchiya ◽  
Ken Sakai ◽  
Takahiro Kuragano ◽  
Akiko Uchida ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Japanese Society ◽  
Healthcare Management ◽  
Maintenance Hemodialysis ◽  
Decision Making Process ◽  
Healthcare Team ◽  
Shared Decision ◽  
Dialysis Therapy ◽  
Terminal Stage

Abstract Background In Japan, forgoing life-sustaining treatment to respect the will of patients at the terminal stage is not stipulated by law. According to the Guidelines for the Decision-Making Process in Terminal-Stage Healthcare published by the Ministry of Health, Labor and Welfare in 2007, the Japanese Society for Dialysis Therapy (JSDT) developed a proposal that was limited to patients at the terminal stage and did not explicitly cover patients with dementia. This proposal for the shared decision-making process regarding the initiation and continuation of maintenance hemodialysis was published in 2014. Methods and results In response to changes in social conditions, the JSDT revised the proposal in 2020 to provide guidance for the process by which the healthcare team can provide the best healthcare management and care with respect to the patient's will through advance care planning and shared decision making. For all patients with end-stage kidney disease, including those at the nonterminal stage and those with dementia, the decision-making process includes conservative kidney management. Conclusions The proposal is based on consensus rather than evidence-based clinical practice guidelines. The healthcare team is therefore not guaranteed to be legally exempt if the patient dies after the policies in the proposal are implemented and must respond appropriately at the discretion of each institution.

scholarly journals 023 PP: INVOLVING PATIENTS AND CARERS IN RESEARCH: THE EXPERIENCE OF OLDER PEOPLE IN THE SHARED DECISION-MAKING PROCESS IN ADVANCED KIDNEY CARE a

BMJ Open ◽  
2017 ◽  
Vol 7 (Suppl 2) ◽  
pp. bmjopen-2017-016492.41
Author(s):  
N Thomas ◽  
K Jenkins ◽  
S Datta ◽  
R Endacott ◽  
J Kent ◽  
...  
Keyword(s):  
Decision Making ◽  
Older People ◽  
Shared Decision Making ◽  
Decision Making Process ◽  
Shared Decision

Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty

2021 ◽  
Author(s):  
Veena Graff ◽  
Justin T. Clapp ◽  
Sarah J. Heins ◽  
Jamison J. Chung ◽  
Madhavi Muralidharan ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Knee Arthroplasty ◽  
Patient Involvement ◽  
Medical Center ◽  
Academic Medical Center ◽  
Shared Decision ◽  
Structured Interviews ◽  
Primary Knee Arthroplasty

Background Calls to better involve patients in decisions about anesthesia—e.g., through shared decision-making—are intensifying. However, several features of anesthesia consultation make it unclear how patients should participate in decisions. Evaluating the feasibility and desirability of carrying out shared decision-making in anesthesia requires better understanding of preoperative conversations. The objective of this qualitative study was to characterize how preoperative consultations for primary knee arthroplasty arrived at decisions about primary anesthesia. Methods This focused ethnography was performed at a U.S. academic medical center. The authors audio-recorded consultations of 36 primary knee arthroplasty patients with eight anesthesiologists. Patients and anesthesiologists also participated in semi-structured interviews. Consultation and interview transcripts were coded in an iterative process to develop an explanation of how anesthesiologists and patients made decisions about primary anesthesia. Results The authors found variation across accounts of anesthesiologists and patients as to whether the consultation was a collaborative decision-making scenario or simply meant to inform patients. Consultations displayed a number of decision-making patterns, from the anesthesiologist not disclosing options to the anesthesiologist strictly adhering to a position of equipoise; however, most consultations fell between these poles, with the anesthesiologist presenting options, recommending one, and persuading hesitant patients to accept it. Anesthesiologists made patients feel more comfortable with their proposed approach through extensive comparisons to more familiar experiences. Conclusions Anesthesia consultations are multifaceted encounters that serve several functions. In some cases, the involvement of patients in determining the anesthetic approach might not be the most important of these functions. Broad consideration should be given to both the applicability and feasibility of shared decision-making in anesthesia consultation. The potential benefits of interventions designed to enhance patient involvement in decision-making should be weighed against their potential to pull anesthesiologists’ attention away from important humanistic aspects of communication such as decreasing patients’ anxiety. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Depressed Latinx Older Adults’ Shared Decision-Making Preferences

2021 ◽  
Author(s):  
Sara Romero ◽  
Patrick Raue ◽  
Andrew Rasmussen
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Puerto Rican ◽  
Shared Decision Making ◽  
Decision Making Process ◽  
Shared Decision ◽  
Medical Conditions ◽  
Depression Severity ◽  
Related Information ◽  
Health Related

The shared decision-making (SDM) model is the optimal patient-centered approach to reduce racial and ethnic health disparities in primary care settings. This study examined decision-making preferences and the desire to be knowledgeable of health-related information of a multiheritage group of depressed older Latinx primary care patients. The primary aim was to determine differences in treatment preferences for both general medical conditions and depression and desire to be knowledgeable of health-related information between older Puerto Rican adults compared to older non-Puerto Rican Latinx adults. We also examined whether depression severity moderated those relationships. A sample of 178 older Latinx patients were assessed on measures of decision-making preferences, information-seeking desires, and depression severity. Regression models indicated depression severity moderated the relationship between Latinx heritage and decision-making preferences that relate to general medical decisions, but not depression treatment. Specifically, Puerto Ricans with high levels of depression preferred to be more active in making decisions related to general medical conditions compared to non-Puerto Rican patients who preferred less active involvement. There was no difference between groups at low levels of depression as both groups preferred to be similarly active in the decision-making process. This investigation adds to the literature by indicating between-group differences within a Latinx older adult sample regarding decision-making preferences and the desire to be informed of health-related information. Future research is needed to identify other sociocultural characteristics that contribute to this disparity between Latinx heritage groups in their desires to participate in the decision-making process with their primary care provider.

scholarly journals An Exploratory Pilot Study to Describe Shared Decision-Making for PTSD Treatment Planning: The Provider Perspective

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 467-475 ◽  
Author(s):  
Bella Etingen ◽  
Jennifer N Hill ◽  
Laura J Miller ◽  
Alan Schwartz ◽  
Sherri L LaVela ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Planning ◽  
Shared Decision Making ◽  
Treatment Plan ◽  
Treatment Options ◽  
Shared Decision ◽  
Post Traumatic Stress ◽  
Structured Interviews ◽  
Treatment Readiness ◽  
Ptsd Treatment

Abstract Objective To describe current practices used by Veterans Administration (VA) mental health (MH) providers involved in post-traumatic stress disorder (PTSD) treatment planning to support engagement of veterans with PTSD in shared decision-making (SDM). Methods Semi-structured interviews with MH providers (n = 9) were conducted at 1 large VA, audio-recorded, and transcribed verbatim. Transcripts were analyzed deductively, guided by a published account of the integral SDM components for MH care. Results While discussing forming a cohesive team with patients, providers noted the importance of establishing rapport and assessing treatment readiness. Providers’ clinical knowledge/expertise, knowledge of the facility’s treatment options, knowledge of how to navigate the VA MH care system, and patient factors (goals/preferences, factors influencing treatment engagement) were noted as important to consider when patients and providers exchange information. When negotiating the treatment plan, providers indicated that conversations should include treatment recommendations and concurrent opportunities for personalization. They also emphasized the importance of discussions to finalize a mutually agreeable patient- and provider-informed treatment plan and measure treatment impact. Conclusion These results offer a preliminary understanding of VA MH providers’ facilitation of SDM for PTSD care. Findings may provide insights for MH providers who wish to engage patients with PTSD in SDM.

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