scholarly journals The Translation Evidence Mechanism. The Compact between Researcher and Clinician

2010 ◽  
Vol 4 (1) ◽  
pp. 133-139 ◽  
Author(s):  
Janet G Bauer ◽  
Francesco Chiappelli
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Private Practice ◽  
Clinical Decision ◽  
Shared Decision ◽  
Central Database ◽  
Communication Modalities

Currently, best evidence is a concentrated effort by researchers. Researchers produce information and expect that clinicians will implement their advances in improving patient care. However, difficulties exist in maximizing cooperation and coordination between the producers, facilitators, and users (patients) of best evidence outcomes. The Translational Evidence Mechanism is introduced to overcome these difficulties by forming a compact between researcher, clinician and patient. With this compact, best evidence may become an integral part of private practice when uncertainties arise in patient health status, treatments, and therapies. The mechanism is composed of an organization, central database, and decision algorithm. Communication between the translational evidence organization, clinicians and patients is through the electronic chart. Through the chart, clinical inquiries are made, patient data from provider assessments and practice cost schedules are collected and encrypted (HIPAA standards), then inputted into the central database. Outputs are made within a timeframe suitable to private practice and patient flow. The output consists of a clinical practice guideline that responds to the clinical inquiry with decision, utility and cost data (based on the “average patient”) for shared decision-making within informed consent. This shared decision-making allows for patients to “game” treatment scenarios using personal choice inputs. Accompanying the clinical practice guideline is a decision analysis that explains the optimized clinical decision. The resultant clinical decision is returned to the central database using the clinical practice guideline. The result is subsequently used to update current best evidence, indicate the need for new evidence, and analyze the changes made in best evidence implementation. When updates in knowledge occur, these are transmitted to the provider as alerts or flags through patient charts and other communication modalities.

scholarly journals The clinical practice guideline palliative care for children and other strategies to enhance shared decision-making in pediatric palliative care; pediatricians’ critical reflections

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Dunja Dreesens ◽  
Lotte Veul ◽  
Jonne Westermann ◽  
Nicole Wijnands ◽  
Leontien Kremer ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Shared Decision ◽  
Patient Decision

Abstract Background Because of practice variation and new developments in palliative pediatric care, the Dutch Association of Pediatrics decided to develop the clinical practice guideline (CPG) palliative care for children. With this guideline, the association also wanted to precipitate an attitude shift towards shared decision-making (SDM) and therefore integrated SDM in the CPG Palliative care for children. The aim was to gain insight if integrating SDM in CPGs can potentially encourage pediatricians to practice SDM. Its objectives were to explore pediatricians’ attitudes and thoughts regarding (1) recommendations on SDM in CPGs in general and the guideline Palliative care for children specifically; (2) other SDM enhancing strategies or tools linked to CPGs. Methods Semi-structured face-to-face interviews. Pediatricians (15) were recruited through purposive sampling in three university-based pediatric centers in the Netherlands. The interviews were audio-recorded and transcribed verbatim, coded by at least two authors and analyzed with NVivo. Results Some pediatricians considered SDM a skill or attitude that cannot be addressed by clinical practice guidelines. According to others, however, clinical practice guidelines could enhance SDM. In case of the guideline Palliative care for children, the recommendations needed to focus more on how to practice SDM, and offer more detailed recommendations, preferring a recommendation stating multiple options. Most interviewed pediatricians felt that patient decisions aids were beneficial to patients, and could ensure that all topics relevant to the patient are covered, even topics the pediatrician might not consider him or herself, or deems less important. Regardless of the perceived benefit, some pediatricians preferred providing the information themselves instead of using a patient decision aid. Conclusions For clinical practice guidelines to potentially enhance SDM, guideline developers should avoid blanket recommendations in the case of preference sensitive choices, and SDM should not be limited to recommendations on non-treatment decisions. Furthermore, preference sensitive recommendations are preferably linked with patient decision aids.

scholarly journals Shared Decision Making

2021 ◽  
Vol 02 (01) ◽  
pp. 111-117
Author(s):  
Wei Wang
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Emergency Management ◽  
Shared Decision Making ◽  
State Of The Art ◽  
Clinical Decision ◽  
Shared Decision ◽  
Patient Centered ◽  
Significant Potential

Shared decision making (SDM) is a process by which physicians and patients jointly participate in choosing to pursue one of several alternatives in a clinical decision. It is most relevant for decisions that involve significant potential harms and benefits with tradeoffs and uncertainty. This paper provides a state-of-the-art review about SDM covering its concept, value, implementation and application in emergency management and communication. SDM is valuable in the process of making decisions which patients may benefit most from, thus resulting in satisfying patient-centered outcomes. Although SDM can be challenging to incorporate into clinical practice, it is likely to become a useful tool of communication in future.

scholarly journals Physical Therapist Clinical Practice Guideline for the Management of Individuals With Heart Failure

2020 ◽  
Vol 100 (1) ◽  
pp. 14-43
Author(s):  
Michael J Shoemaker ◽  
Konrad J Dias ◽  
Kristin M Lefebvre ◽  
John D Heick ◽  
Sean M Collins
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Clinical Decision Making ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Clinical Decision

Abstract The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular and Pulmonary Section of APTA, have commissioned the development of this clinical practice guideline to assist physical therapists in their clinical decision making when managing patients with heart failure. Physical therapists treat patients with varying degrees of impairments and limitations in activity and participation associated with heart failure pathology across the continuum of care. This document will guide physical therapist practice in the examination and treatment of patients with a known diagnosis of heart failure. The development of this clinical practice guideline followed a structured process and resulted in 9 key action statements to guide physical therapist practice. The level and quality of available evidence were graded based on specific criteria to determine the strength of each action statement. Clinical algorithms were developed to guide the physical therapist in appropriate clinical decision making. Physical therapists are encouraged to work collaboratively with other members of the health care team in implementing these action statements to improve the activity, participation, and quality of life in individuals with heart failure and reduce the incidence of heart failure-related re-admissions.

AHRQ White Paper: Use of Clinical Decision Rules for Point-of-Care Decision Support

2010 ◽  
Vol 30 (6) ◽  
pp. 712-721 ◽  
Author(s):  
Mark Ebell
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Quantitative Data ◽  
Point Of Care ◽  
Decision Rules ◽  
Clinical Decision ◽  
Original Research ◽  
Shared Decision ◽  
Clinical Decision Rules

Translation of research into clinical practice remains a barrier, with inconsistent adoption of effective treatments and useful tests. Clinical decision rules (CDRs) integrate information from several clinical or laboratory findings to provide quantitative estimates of risk for a diagnosis or clinical outcome. They are increasingly reported in the literature and have the potential to provide a bridge that helps translate findings from original research studies into clinical practice. Unlike formal aids for shared decision making, they are pragmatic solutions that provide discrete quantitative data to aid clinicians and patients in decision making. These quantitative data can help inform the informal episodes of shared decision making that frequently take place at the point of care. Methods used to develop CDRs include expert opinion, multivariate models, point scores, and classification and regression trees Desirable CDRs are valid (make accurate predictions of risk), relevant (have been shown to improve patient-oriented outcomes), are easy to use at the point of care, are acceptable (with good face validity and transparency of recommendations), and are situated in the clinical context. The latter means that the rule places patients in risk groups that are clinically useful (i.e., below the test threshold or above the treatment threshold) and does so in adequate numbers to make use of the CDR a worthwhile investment in time. CDRs meeting these criteria should be integrated with electronic health records, populating the point score or decision tree with individual patient data and performing calculations automatically to streamline decision making.

scholarly journals Plain Language Summary: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

2021 ◽  
Vol 164 (4) ◽  
pp. 704-711
Author(s):  
Samantha Anne ◽  
Sandra A. Finestone ◽  
Allison Paisley ◽  
Taskin M. Monjur
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Practice ◽  
Pain Management ◽  
Health Care Providers ◽  
Clinical Practice Guideline ◽  
Shared Decision ◽  
Care Providers ◽  
Plain Language ◽  
Opioid Prescribing

This plain language summary explains pain management and careful use of opioids after common otolaryngology operations. The summary applies to patients of any age who need treatment for pain within 30 days after having a common otolaryngologic operation (having to do with the ear, nose, or throat). It is based on the 2021 “Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations.” This guideline uses available research to best advise health care providers, and it includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to facilitate shared decision making between patients and their health care providers.

scholarly journals A descriptive model of shared decision making derived from routine implementation in clinical practice (‘Implement-SDM’): Qualitative study

2019 ◽  
Vol 102 (10) ◽  
pp. 1774-1785 ◽  
Author(s):  
Natalie Joseph-Williams ◽  
Denitza Williams ◽  
Fiona Wood ◽  
Amy Lloyd ◽  
Katherine Brain ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Descriptive Model
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