scholarly journals Person and Family Centeredness in Ethiopian Cancer Care: Proposal for a Project for Improving Communication, Ethics, Decision Making, and Health (Preprint)

2019 ◽  
Author(s):  
Nataliya Berbyuk Lindström ◽  
Aynalem Abraha Woldemariam ◽  
Abebe Bekele ◽  
Christian Munthe ◽  
Rune Andersson ◽  
...  
Keyword(s):  
Decision Making ◽  
Cancer Care ◽  
Research Collaboration ◽  
Addis Ababa ◽  
Educational Interventions ◽  
Medical Attention ◽  
Health Care Ethics ◽  
Ethical Challenges ◽  
Multiple Sources ◽  
Cancer Awareness

BACKGROUND Cancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital in Addis Ababa is the sole specialist unit for cancer care in the country. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential to help patients as much as possible within such limitations. OBJECTIVE The project has the following three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice; and (3) to plan and evaluate interventions in this area. METHODS This project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making and ethical tension among patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semistructured interviews with Ethiopian staff (n= 16), patients (n= 54), and family caregivers (n= 22); survey data on cancer awareness (n=150) and attitudes toward breaking bad news (n=450); and video recordings of medical consultations (n=45). In addition, we will develop clinical and methodological solutions to formulate educational interventions. RESULTS The project was awarded funding by the Swedish Research Council in December 2017 for the period 2018 to 2021. The research ethics boards in Sweden and Ethiopia approved the project in May 2018. The results of the studies will be published in 2020 and 2021. CONCLUSIONS The project is the first step toward providing unique and seminal knowledge for the specific context of Ethiopia in the areas of physician-patient communication research and ethics. It contributes to the understanding of the complexity of the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low-resource settings in Africa and the Middle East, which share central cultural prerequisites, such as a strong patriarchal family structure, along with strong and devout religiosity. The project will also serve to develop greater understanding about the current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/16493

scholarly journals Person and Family Centeredness in Ethiopian Cancer Care: Proposal for a Project for Improving Communication, Ethics, Decision Making, and Health

10.2196/16493 ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. e16493
Author(s):  
Nataliya Berbyuk Lindström ◽  
Aynalem Abraha Woldemariam ◽  
Abebe Bekele ◽  
Christian Munthe ◽  
Rune Andersson ◽  
...  
Keyword(s):  
Decision Making ◽  
Cancer Care ◽  
Research Collaboration ◽  
Addis Ababa ◽  
Educational Interventions ◽  
Medical Attention ◽  
Health Care Ethics ◽  
Ethical Challenges ◽  
Multiple Sources ◽  
Cancer Awareness

Background Cancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital in Addis Ababa is the sole specialist unit for cancer care in the country. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential to help patients as much as possible within such limitations. Objective The project has the following three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice; and (3) to plan and evaluate interventions in this area. Methods This project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making and ethical tension among patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semistructured interviews with Ethiopian staff (n= 16), patients (n= 54), and family caregivers (n= 22); survey data on cancer awareness (n=150) and attitudes toward breaking bad news (n=450); and video recordings of medical consultations (n=45). In addition, we will develop clinical and methodological solutions to formulate educational interventions. Results The project was awarded funding by the Swedish Research Council in December 2017 for the period 2018 to 2021. The research ethics boards in Sweden and Ethiopia approved the project in May 2018. The results of the studies will be published in 2020 and 2021. Conclusions The project is the first step toward providing unique and seminal knowledge for the specific context of Ethiopia in the areas of physician-patient communication research and ethics. It contributes to the understanding of the complexity of the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low-resource settings in Africa and the Middle East, which share central cultural prerequisites, such as a strong patriarchal family structure, along with strong and devout religiosity. The project will also serve to develop greater understanding about the current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication. International Registered Report Identifier (IRRID) DERR1-10.2196/16493

Achieving the triple aim in cancer care through a tri-part research collaboration.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 52-52
Author(s):  
Manali I. Patel ◽  
David Ramirez ◽  
Andrew Nguyen ◽  
Caroline Hagan ◽  
Steven M Asch ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Plan ◽  
Cancer Care ◽  
Research Collaboration ◽  
Emotional Health ◽  
Care Delivery ◽  
Satisfaction With Care ◽  
Oncology Group ◽  
Gastrointestinal Malignancies ◽  
The Mean

52 Background: Curbing rising cancer care costs require models that safely lower expenditures and improve experience and outcomes. We developed a care delivery model integrating lay health workers to address early goals of care and symptoms (JOP 2015). We then created a research-collaboration with a health plan (which paid for care and processed claims), a contracted oncology group (which implemented the model), and a university research center (which designed the intervention and conducted the evaluation) to test effects on patient satisfaction, utilization, and costs. Methods: All patients newly diagnosed with cancer, referred to the contracted oncology group, and who were beneficiaries of the health plan from 11/17/13 through 9/30/15 were enrolled. We analyzed descriptive statistics and pre-intervention and 5-month post-intervention surveys to assess satisfaction with care and decision-making. Results: There were a total of 412 patients with cancer enrolled over the study period. The mean age of enrollees was 76 years; 53% were women. The mean risk adjustment score was 2.5 (www.CMS.gov). Gastrointestinal malignancies were the highest proportion of cancer diagnoses (26%) followed by breast (23%) and genitourinary cancers (13%). Thirty-one percent of patients were diagnosed with stage IV disease; 22% with stage I; 18% with stages II and III; and 10% with unknown stage. Twenty-two percent of patients died during the study period. In comparison to pre-intervention surveys, there were statistically significant improvements in overall mental and emotional health (p < 0.05) and improvements in satisfaction with care and decision-making (p < 0.05). Conclusions: Research collaborations can help to rapidly implement and test novel strategies of care delivery. These collaborations are needed to align stakeholder priorities to improve cancer care and reduce healthcare spending. Our collaboration demonstrates the feasibility of an all-stakeholder approach to designing and implementing innovative high-value cancer care delivery strategies. Our early findings demonstrate improvements in patient emotional and mental health and satisfaction with care and decision-making.

How multidisciplinary are multidisciplinary case reviews in cancer care? Feasibility analysis of a theory-driven team decision-making fidelity framework

2019 ◽  
Author(s):  
Tayana Soukup ◽  
Ged Murtagh ◽  
Ben W Lamb ◽  
James Green ◽  
Nick Sevdalis
Keyword(s):  
Decision Making ◽  
Cancer Care ◽  
Recent Decade ◽  
Individual Case ◽  
Multidisciplinary Teams ◽  
Final Decision ◽  
Political Climate ◽  
Implementation Framework ◽  
Feasibility Evaluation ◽  
The Uk

Background Multidisciplinary teams (MDTs) are a standard cancer care policy in many countries worldwide. Despite an increase in research in a recent decade on MDTs and their care planning meetings, the implementation of MDT-driven decision-making (fidelity) remains unstudied. We report a feasibility evaluation of a novel method for assessing cancer MDT decision-making fidelity. We used an observational protocol to assess (1) the degree to which MDTs adhere to the stages of group decision-making as per the ‘Orientation-Discussion-Decision-Implementation’ framework, and (2) the degree of multidisciplinarity underpinning individual case reviews in the meetings. MethodsThis is a prospective observational study. Breast, colorectal and gynaecological cancer MDTs in the Greater London and Derbyshire (United Kingdom) areas were video recorded over 12-weekly meetings encompassing 822 case reviews. Data were coded and analysed using frequency counts.Results Eight interaction formats during case reviews were identified. case reviews were not always multi-disciplinary: only 8% of overall reviews involved all five clinical disciplines present, and 38% included four of five. The majority of case reviews (i.e. 54%) took place between two (25%) or three (29%) disciplines only. Surgeons (83%) and oncologists (8%) most consistently engaged in all stages of decision-making. While all patients put forward for MDT review were actually reviewed, a small percentage of them (4%) either bypassed the orientation (case presentation) and went straight into discussing the patient, or they did not articulate the final decision to the entire team (8%). Conclusions Assessing fidelity of MDT decision-making at the point of their weekly meetings is feasible. We found that despite being a set policy, case reviews are not entirely MDT-driven. We discuss implications in relation to the current eco-political climate, and the quality and safety of care. Our findings are in line with the current national initiatives in the UK on streamlining MDT meetings, and could help decide how to re-organise them to be most efficient.

scholarly journals A Finite Mixture Modelling Perspective for Combining Experts’ Opinions with an Application to Quantile-Based Risk Measures

Risks ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 115
Author(s):  
Despoina Makariou ◽  
Pauline Barrieu ◽  
George Tzougas
Keyword(s):  
Decision Making ◽  
Mixture Models ◽  
Finite Mixture Models ◽  
Risk Measures ◽  
Finite Mixture ◽  
Parametric Family ◽  
Collective Decision Making ◽  
Multiple Sources ◽  
Mixture Modelling ◽  
Expert Opinions

The key purpose of this paper is to present an alternative viewpoint for combining expert opinions based on finite mixture models. Moreover, we consider that the components of the mixture are not necessarily assumed to be from the same parametric family. This approach can enable the agent to make informed decisions about the uncertain quantity of interest in a flexible manner that accounts for multiple sources of heterogeneity involved in the opinions expressed by the experts in terms of the parametric family, the parameters of each component density, and also the mixing weights. Finally, the proposed models are employed for numerically computing quantile-based risk measures in a collective decision-making context.

scholarly journals Medical and Nonmedical Information during Multidisciplinary Team Meetings in Cancer Care

2021 ◽  
Vol 28 (1) ◽  
pp. 1008-1016
Author(s):  
Jessica Wihl ◽  
Linn Rosell ◽  
Tobias Carlsson ◽  
Sara Kinhult ◽  
Gert Lindell ◽  
...  
Keyword(s):  
Decision Making ◽  
Multidisciplinary Team ◽  
Cancer Care ◽  
Family Relations ◽  
Patient Characteristics ◽  
Psychological Status ◽  
Treatment Preferences ◽  
Case Discussions ◽  
Case Presentations ◽  
Data Elements

Background: Multidisciplinary team (MDT) meetings provide treatment recommendations based on available information and collective decision-making in teams with complementary professions, disciplines and skills. We aimed to map ancillary medical and nonmedical patient information during case presentations and case discussions in MDT meetings in cancer care. Methods: Through a nonparticipant, observational approach, we mapped verbal information on medical, nonmedical and patient-related characteristics and classified these based on content. Data were collected from 336 case discussions in three MDTs for neuro-oncology, sarcoma and hepato-biliary cancer. Results: Information on physical status was presented in 48.2% of the case discussions, psychological status in 8.9% and comorbidity in 48.5% of the cases. Nonmedical factors, such as family relations, occupation, country of origin and abode were referred to in 3.6–7.7% of the cases, and patient preferences were reported in 4.2%. Conclusions: Provision of information on comorbidities in half of the cases and on patient characteristics and treatment preferences in <10% of case discussions suggest a need to define data elements and develop reporting standards to support robust MDT decision-making.

scholarly journals Using Deliberative Democracy for Better Urban Decision-Making through Integrative Thinking

Urban Science ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 3
Author(s):  
Janette Hartz-Karp ◽  
Dora Marinova
Keyword(s):  
Decision Making ◽  
Case Studies ◽  
Deliberative Democracy ◽  
Decision Makers ◽  
Capital City ◽  
City Region ◽  
Multiple Sources ◽  
Trade Offs ◽  
Urban Issues ◽  
Sustainability Challenges

This article expands the evidence about integrative thinking by analyzing two case studies that applied the collaborative decision-making method of deliberative democracy which encourages representative, deliberative and influential public participation. The four-year case studies took place in Western Australia, (1) in the capital city Perth and surrounds, and (2) in the city-region of Greater Geraldton. Both aimed at resolving complex and wicked urban sustainability challenges as they arose. The analysis suggests that a new way of thinking, namely integrative thinking, emerged during the deliberations to produce operative outcomes for decision-makers. Building on theory and research demonstrating that deliberative designs lead to improved reasoning about complex issues, the two case studies show that through discourse based on deliberative norms, participants developed different mindsets, remaining open-minded, intuitive and representative of ordinary people’s basic common sense. This spontaneous appearance of integrative thinking enabled sound decision-making about complex and wicked sustainability-related urban issues. In both case studies, the participants exhibited all characteristics of integrative thinking to produce outcomes for decision-makers: salience—grasping the problems’ multiple aspects; causality—identifying multiple sources of impacts; sequencing—keeping the whole in view while focusing on specific aspects; and resolution—discovering novel ways that avoided bad choice trade-offs.

scholarly journals Housing Programs for the Poor in Addis Ababa: Urban Commons as a Bridge between Spatial and Social

2021 ◽  
pp. 009614422198997
Author(s):  
Marianna Charitonidou
Keyword(s):  
Decision Making ◽  
Urban Planning ◽  
Low Income ◽  
Addis Ababa ◽  
Low Cost ◽  
Development Program ◽  
Housing Program ◽  
Cultural Aspects ◽  
The Poor ◽  
The Government

The article presents the reasons for which the issue of providing housing to low-income citizens has been a real challenge in Addis Ababa during the recent years and will continue to be, given that its population is growing extremely fast. It examines the tensions between the universal aspirations and the local realities in the case of some of Ethiopia’s most ambitious mass pro-poor housing schemes, such as the “Addis Ababa Grand Housing Program” (AAGHP), which was launched in 2004 and was integrated in the “Integrated Housing Development Program” (IHDP) in 2006. The article argues that the quotidian practices of communities and their socio-economic and cultural characteristics are related to the spatial attributes of co-housing practices. Drawing upon the idea that there is a mutual correspondence between social and spatial structures, it places particular emphasis on the analysis of the IHDP and aims to show that to shape strategies that take into account the social and cultural aspects of daily life of the poor citizens of Addis Ababa, it is pivotal to invite them to take part in the decision-making processes regarding their resettlement. Departing from the fact that a large percentage of the housing supply in Addis Ababa consists of informal unplanned housing, the article also compares the commoning practices in kebele houses and condominium units. The former refers to the legal informal housing units owned by the government and rented to their dwellers, whereas the latter concerns the housing blocks built in the framework of the IHDP for the resettlement of the kebele dwellers. The article analyzes these processes of resettlement, shedding light of the fact that kebele houses were located at the inner city, whereas the condominiums are located in the suburbs. Despite the fact that the living conditions in the condominium units are of a much higher quality than those in the kebele houses, their design underestimated or even neglected the role of the commoning practices. The article highlights the advantages of commoning practices in architecture and urban planning, and how the implementation of participation-oriented solutions can respond to the difficulties of providing housing. It argues that understanding the significance of the endeavors that take into account the opinions of dwellers during the phase of decision-making goes hand in hand with considering commoning practices as a source of architecture and urban planning frameworks for low-cost housing in this specific context. The key argument of the article is that urban planning and architecture solutions in Addis Ababa should be based on the principles of the so-called “negotiated planning” approach, which implies a close analysis of the interconnections between planning, infrastructure, and land.

Medical and Nursing Ethics: Never the Twain?

1995 ◽  
Vol 2 (2) ◽  
pp. 95-101 ◽  
Author(s):  
Ann Gallagher
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Nursing Practice ◽  
Care Ethics ◽  
Ethics Of Care ◽  
Health Care Ethics ◽  
Nursing Ethics ◽  
Nel Noddings ◽  
Shared Learning ◽  
Caring Relationship

Since the publication of Carol Gilligan's In a different voice in 1982, there has been much discussion about masculine and feminine approaches to ethics. It has been suggested that an ethics of care, or a feminine ethics, is more appropriate for nursing practice, which contrasts with the 'traditional, masculine' ethics of medicine. It has been suggested that Nel Noddings' version of an 'ethics of care' (or feminine ethics) is an appropriate model for nursing ethics. The 'four principles' approach has become a popular model for medical or health care ethics. It will be suggested in this article that, whilst Noddings presents an interesting analysis of caring and the caring relationship, this has limitations. Rather than acting as an alternative to the 'four principles' approach, the latter is necessary to provide a framework to structure thinking and decision-making in health care. Further, it will be suggested that ethical separatism (that is, one ethics for nurses and one for doctors) in health care is not a progressive step for nurses or doctors. Three recommendations are made: that we promote a health care ethics that incorporates what is valuable in a 'traditional, masculine ethics', the why (four principles approach) and an 'ethics of care', the 'how' (aspects of Noddings' work and that of Urban Walker); that we encourage nurses and doctors to participate in the 'shared learning' and discussion of ethics; and that our ethical language and concerns are common to all, not split into unhelpful dichotomies.

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