Smartphone-Enabled, Telehealth-Based Family Conferences with Implementation of Shared Decision Making Concepts and Humanistic Communication: A Mixed Method Study (Preprint)

2020 ◽  
Author(s):  
Tzu-Jung Chou ◽  
Yu-Rui Wu ◽  
Jaw-Shiun Tsai ◽  
Shao-Yi Cheng ◽  
Chien-An Yao ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Emotional Distress ◽  
Mixed Method ◽  
Family Members ◽  
Satisfaction Score ◽  
Mixed Method Study ◽  
Shared Decision ◽  
Emotional Cues ◽  
Family Conference

BACKGROUND Smartphone-enabled, telehealth-based family conferences represents an attractive and safe alternative to deliver communication in the COVID-19 pandemic. However, some may fear that the therapeutic relationship might be filtered due to lack of direct human contact. Virtual physician –family interaction and participants’ experience warrant further investigation. OBJECTIVE The study aims to explore whether shared decision making (SDM) model combining VALUE (Value family statements, Acknowledge emotions, Listen, Understand the patient as a person, Elicit questions) and PLACE (Prepare with intention, Listen intently and completely, Agree on what matters most, Connect with the patient’s story, Explore emotional cues) framework can help physicians respond empathetically to emotion cues and foster human connectedness in virtual context. METHODS This is a mixed method study. Participants were recruited from inpatient and outpatient unit in a tertiary medical center in Taiwan from February to May 2020. Family conferences were held if patients or their family required an update of prognosis, a discussion about goal of care, or a potential discharge plan. Smartphone-enabled telehealth-based family conference was arranged if the patient and their family agreed to take part. Those who declined to conduct virtual conference or did not possess the technological skills to participate were excluded. The main outcome was patient and family reported communication satisfaction score with a 10-point Likert scale. Qualitative measures included data from physicians, patients, and family. Physicians’ empathetic statements were classified by VALUE approach. Participants’ emotional cues were categorized into verbal emotional distress, nonverbal emotional distress, and positive emotion. RESULTS Twenty-five telehealth family conferences were conducted. The patients’ mean age was 72.9 (SD 14.3) years; 19 (76%) were married, and the majority of them had Eastern Cooperative Oncology Group (ECOG) score of 3-4. Of the main participating family members, 11 (44%) were patients’ children, 7 (28%) were spouses, and 7 (28%) were other family members. The average length of the family conference was 31.9 ± 11.7 minutes. Expression of verbal emotional distress was noted in 20% of patients and 20% of family members, while nonverbal distress was observed in 24% and 28% respectively. The satisfaction score was 8.7 ± 1.5 toward overall communication and 9.0 ± 1.1 on meeting the family’s needs. CONCLUSIONS Adopting SDM concepts with VALUE and PLACE approaches helps physicians foster connectedness in smartphone-enabled telehealth-based family conferences. The model had high patient and family reported satisfaction scores. It could be adopted worldwide when using telehealth and had implications to governments for policy changing with reimbursement modification.

scholarly journals Understanding the low take-up of home-based dialysis through a shared decision-making lens: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053937
Author(s):  
Jane Noyes ◽  
Gareth Roberts ◽  
Gail Williams ◽  
James Chess ◽  
Leah Mc Laughlin
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Healthcare Professionals ◽  
Family Members ◽  
Shared Decision ◽  
Framework Analysis ◽  
Future Treatment ◽  
Modifiable Factors ◽  
Decision Making Processes

ObjectivesTo explore how people with chronic kidney disease who are pre-dialysis, family members and healthcare professionals together navigate common shared decision-making processes and to assess how this impacts future treatment choice.DesignCoproductive qualitative study, underpinned by the Making Good Decisions in Collaboration shared decision-model. Semistructured interviews with a purposive sample from February 2019 - January 2020. Interview data were analysed using framework analysis. Coproduction of logic models/roadmaps and recommendations.SettingFive Welsh kidney services.Participants95 participants (37 patients, 19 family members and 39 professionals); 44 people supported coproduction (18 patients, 8 family members and 18 professionals).FindingsShared decision-making was too generic and clinically focused and had little impact on people getting onto home dialysis. Preferences of where, when and how to implement shared decision-making varied widely. Apathy experienced by patients, caused by lack of symptoms, denial, social circumstances and health systems issues made future treatment discussions difficult. Families had unmet and unrecognised needs, which significantly influenced patient decisions. Protocols containing treatment hierarchies and standards were understood by professionals but not translated for patients and families. Variation in dialysis treatment was discussed to match individual lifestyles. Patients and professionals were, however, defaulting to the perceived simplest option. It was easy for patients to opt for hospital-based treatments by listing important but easily modifiable factors.ConclusionsShared decision-making processes need to be individually tailored with more attention on patients who could choose a home therapy but select a different option. There are critical points in the decision-making process where changes could benefit patients. Patients need to be better educated and their preconceived ideas and misconceptions gently challenged. Healthcare professionals need to update their knowledge in order to provide the best advice and guidance. There needs to be more awareness of the costs and benefits of the various treatment options when making decisions.

scholarly journals Telehealth-Based Family Conferences with Implementation of Shared Decision Making Concepts and Humanistic Communication Approach: A Mixed-Methods Prospective Cohort Study

2021 ◽  
Vol 18 (20) ◽  
pp. 10801
Author(s):  
Tzu-Jung Chou ◽  
Yu-Rui Wu ◽  
Jaw-Shiun Tsai ◽  
Shao-Yi Cheng ◽  
Chien-An Yao ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Center ◽  
Shared Decision ◽  
Safe Alternative ◽  
Emotional Cues ◽  
Human Contact ◽  
National Medical ◽  
Model Combining ◽  
Communication Approach

Smartphone-enabled, telehealth-based family conferences represent an attractive and safe alternative to deliver communication during the COVID-19 pandemic. However, some may fear that the therapeutic relationship might be filtered due to a lack of direct human contact. The study aims to explore whether shared decision-making model combining VALUE (Value family statements, Acknowledge emotions, Listen, Understand the patient as a person, Elicit questions) and PLACE (Prepare with intention, Listen intently and completely, Agree on what matters most, Connect with the patient’s story, Explore emotional cues) framework can help physicians respond empathetically to emotional cues and foster human connectedness in a virtual context. Twenty-five virtual family conferences were conducted in a national medical center in Taiwan. The expression of verbal emotional distress was noted in 20% of patients and 20% of family members, while nonverbal distress was observed in 24% and 28%, respectively. On 10-point Likert scale, the satisfaction score was 8.7 ± 1.5 toward overall communication and 9.0 ± 1.1 on meeting the family’s needs. Adopting SDM concepts with VALUE and PLACE approaches helps physicians foster connectedness in telehealth family conferences. The model has high participant satisfaction scores and may improve healthcare quality among the pandemic.

A tracheostomy shared decision-making program in respiratory care center patients in Taiwan

2020 ◽  
Author(s):  
Chienhsiu Huang ◽  
Ihung Chen
Keyword(s):  
Decision Making ◽  
Survival Rate ◽  
Endotracheal Tube ◽  
Shared Decision Making ◽  
Care Center ◽  
Family Members ◽  
Optimal Decision ◽  
Respiratory Care ◽  
Shared Decision ◽  
Methods Of Treatment

Abstract Background: We applied tracheostomy shared decision-making program for respiratory care center prolonged mechanical ventilation patients. The purpose of this study is to help patients and family members to have an understanding of both the methods of tracheostomy and endotracheal tube. We can then compare the prognostic differences between patients in the program who receive tracheostomy and who continue to maintain endotracheal tube. Methods: A retrospective cross-sectional study was conducted. The study was performed at the respiratory care center of Dalin Tzu chi hospital from January 2017 to December 2019. We set up a tracheostomy decision-making program. The medical team identified eligible patients. We conduct semi-structured interviews to individual family members. We tracked the survival of each patient and confirmed the satisfaction of the patient or family members with taking part of the tracheostomy shared decision-making program in January 2020. Data of patients who participated in tracheostomy shared decision-making program were collected and analyzed. Results: Fifty-seven respiratory care center patients attended the tracheostomy shared decision-making program. At the end of the study, 37 patients underwent tracheostomy (64.9%), and 20 patients maintained endotracheal tube intubation (35.1%). There was no significant difference in the factors of concern and the degree of concern regarding the methods of treatment in the two groups of patients. Patients or family members of the two groups have a good understanding of the two methods of treatment. The survival rate of patients undergoing tracheostomy was 86.5% and 86.5% of participants believed that they made an optimal decision based on the result of the tracheostomy shared decision-making program. The survival rate of patients who maintained endotracheal tube intubation was 40%, and the all of participants believed that they made an optimal decision based on the result of the tracheostomy shared decision-making program. Patients who underwent tracheostomy have a favorable survival rate. Conclusions: The clinical application of tracheostomy shared decision-making program ensures that patients and family members have a clearer understanding of the methods of tracheostomy and endotracheal tube treatment. Overall, 91.2% of the participants believed that they made an optimal decision despite of the end result.

scholarly journals Developing Family Satisfaction with Care in Adult Critical Care Public Hospital Terengganu, Malaysia

2021 ◽  
pp. 31-35
Author(s):  
Wan Nor Aliza Wan Abdul Rahman ◽  
Abdul Karim Othman ◽  
Yuzana Mohd Yusop ◽  
Asyraf Afthanorhan ◽  
Hasnah Zani ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Shared Decision Making ◽  
Family Members ◽  
Family Satisfaction ◽  
Satisfaction With Care ◽  
Shared Decision ◽  
Cross Sectional ◽  
The Family

In admissions to the intensive care unit (ICU), there is a high possibility of a life-threatening condition and possible emotional distress for family members. When the family is distressed and hospitalized, a significant level of stress and anxiety will be generated among family members, thereby decreasing their ability to make responsible decisions. As a result, the family members need full and up-to-date details, helping them to retain hope, and this contributes to lower stress levels. While there is growing evidence of the effectiveness of shared decision-making for family members who are directly involved in decisions, particularly regarding shared decision-making in the Malaysian context, there is less evidence that supported decisions help overall outcome. This study aims to developing the family satisfaction with decision making in the Intensive Care Unit (FS-ICU)-33 Malay language version of family member’s satisfaction with care and decision making during their stay at the intensive care units. A quantitative, cross-sectional validation study and purposive sampling was conducted from 1st November 2017 and 10 October 2018 to January 2020 among 208 of family members.  The family members of the ICU patients involved in this study had an excellent satisfaction level with service care. Higher satisfaction in ICU care resulting in higher decision-making satisfaction and vice versa.

Shared Decision-Making During Labor and Birth Among Low-Risk, Active Duty Women in the U.S. Military

2021 ◽  
Author(s):  
Stacey E Iobst ◽  
Angela K Phillips ◽  
Candy Wilson
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Family Members ◽  
Hospital Setting ◽  
Active Duty ◽  
Theory Approach ◽  
Labor And Delivery ◽  
Shared Decision ◽  
Cesarean Birth ◽  
The U.S

ABSTRACT Introduction The cesarean birth rate of 24.7% in the Military Health System (MHS) is lower than the national rate of 31.7%. However, the MHS rate remains higher than the 15-19% threshold associated with optimal maternal and neonatal outcomes. For active duty servicewomen, increased morbidity associated with cesarean birth is likely to affect the ability to meet the demands of assigned missions. Several decision-points occur during pregnancy and after the onset of labor that can affect the likelihood of cesarean birth including choice of provider, choice of hospital, timing of admission, and type of fetal monitoring. Evidence suggests the overuse of labor interventions may be associated with cesarean birth. Shared decision-making (SDM) is a strategy that can be used to carefully consider the risks, benefits, and alternatives of each labor intervention and is shown to be associated with positive patient outcomes. Most existing evidence explores SDM as an interaction that occurs between women and their providers. Few studies have explored the role of stakeholders such as spouses, family members, friends, labor and delivery nurses, and doulas. Furthermore, little is known about the process of SDM during labor and childbirth in the hospital setting, particularly for active duty women in the U.S. military. The purpose of this study was to propose a framework that explains the process of SDM during labor and childbirth in the hospital setting for active duty women in the U.S. military. Materials and Methods A qualitatively driven mixed-methods approach was conducted to propose a framework that explains the process of SDM during labor and childbirth in the hospital setting for active duty women in the U.S. military. Servicewomen were recruited from September 2019 to April 2020. Semi-structured interviews were analyzed using a constructivist grounded theory approach. Participants also completed the SDM Questionnaire (SDM-Q-9). Results Interviews were conducted with 14 participants. The sample included servicewomen from the Air Force (n = 7), Army (n = 4), and Navy (n = 3). Two participants were enlisted and the remainder were officers. Ten births occurred at military treatment facilities (MTFs) and six births took place at civilian facilities. The mean score on the SDM Questionnaire was 86.7 (±11.6), indicating a high level of SDM. Various stakeholders (e.g., providers, labor and delivery nurses, doulas, spouses, family members, and friends) were involved in SDM at different points during labor and birth. The four stages of SDM included gathering information, identifying preferences, discussing options, and making decisions. Events that most often involved SDM were deciding when to travel to the hospital, deciding when to be admitted, and selecting a strategy for pain management. Military factors involved in SDM included sources of information, selecting and working with civilian providers, and delaying labor interventions to allow time for an active duty spouse to travel to the hospital. Conclusions SDM during labor and birth in the hospital setting is a multi-stage process that involves a variety of stakeholders, including the woman, members of her social and support network, and healthcare professionals. Future research is needed to explore perspectives of other stakeholders involved in SDM.

scholarly journals Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e050134
Author(s):  
Nina Wubben ◽  
Mark van den Boogaard ◽  
JG van der Hoeven ◽  
Marieke Zegers
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Family Members ◽  
Decision Making Process ◽  
Shared Decision ◽  
Icu Patients ◽  
Qualitative Interview Study ◽  
Icu Physicians ◽  
Close Family

ObjectiveTo identify views, experiences and needs for shared decision-making (SDM) in the intensive care unit (ICU) according to ICU physicians, ICU nurses and former ICU patients and their close family members.DesignQualitative study.SettingTwo Dutch tertiary centres.Participants19 interviews were held with 29 participants: seven with ICU physicians from two tertiary centres, five with ICU nurses from one tertiary centre and nine with former ICU patients, of whom seven brought one or two of their close family members who had been involved in the ICU stay.ResultsThree themes, encompassing a total of 16 categories, were identified pertaining to struggles of ICU physicians, needs of former ICU patients and their family members and the preferred role of ICU nurses. The main struggles ICU physicians encountered with SDM include uncertainty about long-term health outcomes, time constraints, feeling pressure because of having final responsibility and a fear of losing control. Former patients and family members mainly expressed aspects they missed, such as not feeling included in ICU treatment decisions and a lack of information about long-term outcomes and recovery. ICU nurses reported mainly opportunities to strengthen their role in incorporating non-medical information in the ICU decision-making process and as liaison between physicians and patients and family.ConclusionsInterviewed stakeholders reported struggles, needs and an elucidation of their current and preferred role in the SDM process in the ICU. This study signals an essential need for more long-term outcome information, a more informal inclusion of patients and their family members in decision-making processes and a more substantial role for ICU nurses to integrate patients’ values and needs in the decision-making process.

Family and Physicians' Views of Surrogate Decision-Making: The Roles and How to Choose

1996 ◽  
Vol 8 (4) ◽  
pp. 589-596 ◽  
Author(s):  
Michel Silberfeld ◽  
Rivka Grundstein-Amado ◽  
Derek Stephens ◽  
Raisa Deber
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Decision Making ◽  
Shared Decision Making ◽  
Family Members ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Shared Decision ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Physicians and family members were compared on the roles played in surrogate decision-making and their views as to how choices should be made by surrogate decision-makers. Thirty-six family members of patients with Alzheimer's disease, 35 family members of patients with schizophrenia, and 34 physicians from a diversity of specialties were the respondents. There was general agreement that shared decision-making was preferred. Physicians seem to make surrogate decisions in accordance with contemporary views about their roles. Families believed they had a strong subjective appreciation of the patient's overall good. The burden of decision-making was geater for families, but that depended to some degree on the diagnosis of the patient.

scholarly journals Aspects of Shared Decision Making in a Cognitive-Educational Intervention for Family Members of Persons Coping With Severe Mental Illness

2021 ◽  
Vol 12 ◽  
Author(s):  
Penina Weiss ◽  
Dorit Redlich-Amirav ◽  
Sara Daass-Iraqi ◽  
Noami Hadas-Lidor
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Evaluation Studies ◽  
Family Members ◽  
Mental Illnesses ◽  
Communication Model ◽  
Shared Decision ◽  
Prominent Feature ◽  
Mental Health Systems

Background: Partnerships and family inclusion are embedded in mental health policies. Shared Decision Making (SDM) is as an effective health communication model designed to facilitate service users and providers engagement in reaching jointly decisions concerning interventions. Keshet is a 15 bi-weekly academic course for family members of people with mental illnesses that enhances positive family cognitive communication skills.Purpose: To exhibit how SDM is inherently expressed in Keshet.Method: We conducted a secondary analysis of previous Keshet evaluation studies and course protocols that focused on revealing SDM use.Results: SDM was found to be a prominent feature in Keshet interventions in both the structure of the course as well as the process and procedures. Following participation in the program, making decisions jointly was found to be a prominent feature.Conclusions: Interventions such as Keshet that include an SDM approach can contribute to the integration of academic, professional and “lived experience” within a shared perspective, thus promoting an enhanced equality- based SDM model that benefits individuals as well as mental health systems.

Sign in / Sign up

Export Citation Format

Share Document