scholarly journals Patient and Caregiver Priorities for Outcomes in Peritoneal Dialysis

2018 ◽  
Vol 14 (1) ◽  
pp. 74-83 ◽  
Author(s):  
Karine E. Manera ◽  
David W. Johnson ◽  
Jonathan C. Craig ◽  
Jenny I. Shen ◽  
Lorena Ruiz ◽  
...  
Keyword(s):  
United States ◽  
Decision Making ◽  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Shared Decision Making ◽  
The United States ◽  
Nominal Group ◽  
Shared Decision ◽  
Importance Score ◽  
Patient Centered

Background and objectivesThe absence of accepted patient-centered outcomes in research can limit shared decision-making in peritoneal dialysis (PD), particularly because PD-related treatments can be associated with mortality, technique failure, and complications that can impair quality of life. We aimed to identify patient and caregiver priorities for outcomes in PD, and to describe the reasons for their choices.Design, setting, participants, & measurementsPatients on PD and their caregivers were purposively sampled from nine dialysis units across Australia, the United States, and Hong Kong. Using nominal group technique, participants identified and ranked outcomes, and discussed the reasons for their choices. An importance score (scale 0–1) was calculated for each outcome. Qualitative data were analyzed thematically.ResultsAcross 14 groups, 126 participants (81 patients, 45 caregivers), aged 18–84 (mean 54, SD 15) years, identified 56 outcomes. The ten highest ranked outcomes were PD infection (importance score, 0.27), mortality (0.25), fatigue (0.25), flexibility with time (0.18), BP (0.17), PD failure (0.16), ability to travel (0.15), sleep (0.14), ability to work (0.14), and effect on family (0.12). Mortality was ranked first in Australia, second in Hong Kong, and 15th in the United States. The five themes were serious and cascading consequences on health, current and impending relevance, maintaining role and social functioning, requiring constant vigilance, and beyond control and responsibility.ConclusionsFor patients on PD and their caregivers, PD-related infection, mortality, and fatigue were of highest priority, and were focused on health, maintaining lifestyle, and self-management. Reporting these patient-centered outcomes may enhance the relevance of research to inform shared decision-making.

scholarly journals Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions (Preprint)

2020 ◽  
Author(s):  
Yaara Zisman-Ilani ◽  
Rana Obeidat ◽  
Lauren Fang ◽  
Sarah Hsieh ◽  
Zackary Berger
Keyword(s):  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Patient Centered Care ◽  
Survey Study ◽  
Shared Decision ◽  
Patient Centered ◽  
Centered Care ◽  
Comparative Survey

BACKGROUND Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. OBJECTIVE This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. METHODS A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. RESULTS A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. CONCLUSIONS The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.

scholarly journals Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions

10.2196/18223 ◽  
2020 ◽  
Vol 4 (8) ◽  
pp. e18223
Author(s):  
Yaara Zisman-Ilani ◽  
Rana Obeidat ◽  
Lauren Fang ◽  
Sarah Hsieh ◽  
Zackary Berger
Keyword(s):  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Patient Centered Care ◽  
Survey Study ◽  
Shared Decision ◽  
Patient Centered ◽  
Centered Care ◽  
Comparative Survey

Background Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. Objective This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. Methods A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. Results A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. Conclusions The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.

scholarly journals Shared Decision-Making in Patients With Prostate Cancer in Japan: Patient Preferences Versus Physician Perceptions

2018 ◽  
pp. 1-9 ◽  
Author(s):  
Ulrike Schaede ◽  
Jörg Mahlich ◽  
Masahiko Nakayama ◽  
Hisanori Kobayashi ◽  
Yuriko Takahashi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Preferences ◽  
Treatment Decision ◽  
Japanese Patients ◽  
The United States ◽  
Treatment Decisions ◽  
Shared Decision

This article adds the Japanese perspective to our knowledge of shared decision-making (SDM) preferences by surveying patients with prostate cancer (PCA) and physicians in Japan. In 2015, 103 Japanese patients with PCA were asked about their SDM preferences by using an Internet-based 5-point-scale questionnaire. Concurrently, 127 Japanese physicians were surveyed regarding their perceptions of patient preferences on SDM. Drivers of preferences and perceptions were analyzed using univariable ordinal logistic regression and graphing the fitted response probabilities. Although 41% of both patients and physicians expressed and expected a desire for active involvement in treatment decisions (a higher rate than in a similar study for the United States in 2001), almost half the Japanese patients preferred SDM, but only 33% of physicians assumed this was their choice. That is, 29% of Japanese physicians underestimated patients’ preference for involvement in making treatment decisions. Patients with lower health-related quality of life (as measured by the Functional Assessment of Cancer Therapy-Prostate [FACT-P]) expressed a stronger preference for SDM. The study shows that the worse the medical situation, the more patients with PCA prefer to be involved in the treatment decision, yet physicians tend to underestimate the preferences of their patients. Perhaps in contrast to common assumptions, Japanese patients are as interested in being involved in decision making as are patients in the United States.

scholarly journals Patient experiences of shared decision-making are associated with implantable cardioverter defibrillator recipients" openness to discuss device deactivation at end-of-life

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
OJ Oh ◽  
KS Lee ◽  
J Miller ◽  
M Hammash ◽  
DR Thompson ◽  
...  
Keyword(s):  
United States ◽  
Decision Making ◽  
End Of Life ◽  
Shared Decision Making ◽  
The United States ◽  
Public Institution ◽  
Shared Decision ◽  
Icd Implantation ◽  
Life Issues ◽  
End Of Life Issues

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): In Australia, this study received funding from a faculty grand by Australian University Faculty of Health Sciences Research grant. In the United States, the study was funded by a research professor award from University of Kentucky. Background. Shared decision-making is important for ICD recipients to fully contemplate and rationally decide about ICD deactivation at end-of-life. Although discussions about device deactivation at end-of-life are recommended to be held before ICD implantation and throughout the illness trajectory, such discussions rarely occur in clinical practice. Purpose. To identify whether ICD recipients’ experiences of end-of-life discussions with clinicians are associated with openness to discussing ICD deactivation at end-of-life. Methods. This cross-sectional study included 293 ICD recipients living in the United States, Australia, and South Korea (mean age 59, 22.5% female, mean ICD implantation 10 years). Hierarchical logistic regression was used to determine whether patients’ experiences of shared decision-making were associated with openness to discuss device deactivation at end-of-life after controlling for relevant covariates (i.e. age, gender, ICD implantation years, ICD shock experience, general ICD experience, ICD knowledge, and concerns related to the ICD). Results. About half of the participants (57.7%) were open to discussing ICD deactivation at end-of-life with clinicians. Almost one-quarter (23.5%) had no prior experience of discussing any end-of-life issues with clinicians. Patients’ past experiences of end-of-life discussions with clinicians were significantly associated with openness to discuss device deactivation at end-of-life (OR: 1.30) after adjusting for covariates. Conclusion. Our results highlight that clinicians’ willingness to discuss sensitive end-of-life issues such as battery replacement and deactivation of defibrillation therapy empowers patients to actively engage in end-of-life discussions.

scholarly journals Implementation of a Shared Decision-Making Tool for Osteoarthritis Treatment to Reduce Decisional Conflict

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 186-186
Author(s):  
Yashika Watkins ◽  
Rose Gonzalez ◽  
Charla Johnson ◽  
Ravneet Kaur
Keyword(s):  
Physical Activity ◽  
Decision Making ◽  
Shared Decision Making ◽  
Intervention Group ◽  
The United States ◽  
Control Group ◽  
Shared Decision ◽  
Patient Centered ◽  
Chronic Knee Pain ◽  
Co Morbidity

Abstract Shared decision making is a key component of patient centered care where clinical evidence and the patient’s preference and values are considered. Physical activity and weight loss are often recommendations in the treatment plan, especially in mild to moderate stage of osteoarthritis (OA). Movement is Life (MIL) created an innovative SDM tool to provide a framework for patient-centered discussions. The tool leverages an underlying Markov Model and represents the likely pain, activity levels, and lost productivity at three future time points. By comparing the patient’s likely progression depending on treatment choices compared to doing nothing, the patient has an illustration of future state. A pilot of N=108 women, ages 45-64, with chronic knee pain for at least three months and at least one co-morbidity (obesity, hypertension, diabetes) were randomized to a control (n=54) or intervention (n=54) arm of the study at eight centers across the United States. Results showed the demographic profiles were similar between the groups. At one-month, n=47 control and n=50 intervention patients returned for evaluation. Self-reported level of physical activity increased in the intervention group (56% vs 34%, p = 0.0229). Qualitative feedback from the intervention group indicated high satisfaction with use of the tool. Both groups reported a high likeliness to recommend the provider to a friend or family member. Inclusion of the SDM tool added an average of one minute to the patient counseling time over the control group. The quasi script provides a consistent communication pathway and may reduce disparities by addressing unconscious bias.

Clinical Medical Ethics and the Historical Background of Shared Decision Making

2021 ◽  
pp. 27-36
Author(s):  
Mark Siegler
Keyword(s):  
United States ◽  
Decision Making ◽  
Medical Ethics ◽  
Shared Decision Making ◽  
Clinical Medicine ◽  
The United States ◽  
Historical Background ◽  
Shared Decision ◽  
Truth Telling ◽  
Ethical Problems

In 1982, the concept of physician-patient accommodation was renamed shared decision making by the President’s Commission for the Study of Ethical Problems in Medicine. Since then, shared decision making has replaced thousands of years of paternalistic physician-controlled medicine and has emerged as the prevailing model of the doctor-patient relationship in the United States. The President’s Commission’s perspective was closely based on the development of clinical medical ethics (CME) in the early 1970s. CME addresses clinical issues such as truth telling, informed consent, confidentiality, and end-of-life care, and must be practiced by licensed clinicians in their routine, daily encounters with more than 40 million inpatients and about 1.5 billion outpatients in the United States each year. The central goal of CME is to improve the quality of patient care by identifying and contributing to the resolution of ethical problems in the practice of clinical medicine; this goal is frequently achieved by shared decision making.

Shared decision making in the United States: policy and implementation activity on multiple fronts

2011 ◽  
Vol 105 (4) ◽  
pp. 305-312 ◽  
Author(s):  
Dominick L. Frosch ◽  
Benjamin W. Moulton ◽  
Richard M. Wexler ◽  
Margaret Holmes-Rovner ◽  
Robert J. Volk ◽  
...  
Keyword(s):  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Shared Decision ◽  
United States Policy ◽  
Implementation Activity

Community Oncology in an Era of Payment Reform

2014 ◽  
pp. e447-e452 ◽  
Author(s):  
John V. Cox ◽  
Jeffery C. Ward ◽  
John C. Hornberger ◽  
Jennifer S. Temel ◽  
Barbara L. McAneny
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Fee For Service ◽  
Shared Decision ◽  
Payment Reform ◽  
Patient Centered ◽  
Payment Schemes ◽  
Oncology Practice ◽  
Personalized Cancer

Patients and payers (government and private) are frustrated with the fee-for-service system (FFS) of payment for outpatient health services. FFS rewards volume and highly valued services, including expensive diagnostics and therapeutics, over lesser valued cognitive services. Proposed payment schemes would incent collaboration and coordination of care among providers and reward quality. In oncology, new payment schemes must address the high costs of all services, particularly drugs, while preserving the robust distribution of sites of service available to patients in the United States. Information technology and personalized cancer care are changing the practice of oncology. Twenty-first century oncology will require increasing cognitive work and shared decision making, both of which are not well regarded in the FFS model. A high proportion of health care dollars are consumed in the final months of life. Effective delivery of palliative and end-of-life care must be addressed by practice and by new models of payment. Value-based reimbursement schemes will require oncology practices to change how they are structured. Lessons drawn from the principles of primary care's Patient Centered Medical Home (PCMH) will help oncology practice to prepare for new schemes. PCMH principles place a premium on proactively addressing toxicities of therapies, coordinating care with other providers, and engaging patients in shared decision making, supporting the ideal of value defined in the triple aim—to measurably improve patient experience and quality of care at less cost. Payment reform will be disruptive to all. Oncology must be engaged in policy discussions and guide rational shifts in priorities defined by new payment models.

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