An Epistemic Network Analysis of Patient Decision-Making Regarding Choice of Therapy

Background: Patient decision-making concerning therapy choice has been thoroughly investigated in the Push/Pull framework: factors pushing the patient away from biomedicine and those pulling them towards Complementary and Alternative Medicine (CAM). Others have examined lay etiology as a potential factor in CAM use.Methods: We conducted semi-structured interviews with patients employing only biomedicine and those using CAM. The coded and segmented data was quantified and modelled using epistemic network analysis (ENA) to explore what effects push/pull factors and etiology had on the decision-making processes.Results: There was a marked difference between our two subsamples concerning push factors: although both groups exhibited similar scaled relative code frequencies, the CAM network models were more interconnected, indicating that CAM users expressed dissatisfaction with a wider array of phenomena. Among pull factors, a preference for natural therapies accounted for differences between groups but did not retain a strong connection to rejecting conventional treatments. Etiology, particularly adherence to vitalism, was also a critical factor in both choice of therapy and rejection of biomedical treatments.Conclusions: Push factors had a crucial influence on decision-making, not as individual entities, but as a constellation of experienced phenomena. Belief in vitalism affects the patient’s explanatory model of illness, changing the interpretation of other etiological factors and illness itself. Scrutinizing individual push/pull factors or etiology does not explain therapeutic choices; it is from their interplay that decisions arise. Our unified, qualitative-and-quantitative methodological approach offers novel insight into decision-making by displaying connections among codes within patient narratives.

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233 Potential Deprivation of Patient Liberty: A Qualitative Study of Current Practice Amongst Geriatricians in a Tertiary Setting

Age and Ageing ◽

10.1093/ageing/afz103.140 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Michelle O'Brien ◽

Deirdre O'Donnell ◽

Barbara Clyne

Keyword(s):

Decision Making ◽

Perceived Risk ◽

Current Practice ◽

Structured Interview ◽

Structured Interviews ◽

Healthcare Ethics ◽

Patient Decision Making ◽

Acute Setting ◽

Difficult Decision ◽

Patient Decision

Abstract Background The Assisted Decision Making (ADM) Act 2015 was introduced to support decision making and maximise a person’s capacity to make decisions but has not yet commenced. Within this context, medical professionals such as geriatricians must adjust from a best interest’s outlook to that of patient autonomy in response to the changing legislation. The aim of this study is to explore current geriatrician’s practice. In scrutinizing current practice, it will be evident as to what, if any, adaptations are required in order to practice in accordance with the new legislation. Methods Ten semi-structured interviews with individual consultant geriatricians were conducted, each lasting approximately 20 minutes on average in one hospital. Each interview was recorded and transcribed verbatim. The interview involved the geriatrician reading a vignette and answering questions as to how they would manage this situation. Following the vignette, the semi-structured interview proceeded covering topics including; patient decision making in the acute setting, deprivation of patient liberty in the acute setting, thoughts on the ADM (Capacity) Act 2015, and elements learned from experiences in other countries. A thematic analysis was conducted. Results Preliminary themes identified from the interviews include; (a) identification, accessibility and availability of medical and legal colleagues in assisting with difficult decision making, (b) need for clear frameworks, guidance and education in relation to laws applying to medical practice, (c) influence of environment, family, perceived risk and delirium on capacity assessment, (d) paternalism versus autonomy. This work is being conducted as part of a master’s in healthcare ethics and law. Conclusion Preliminary results highlight the need for collaborative communication between medics and the legal profession in order to achieve a structured and supportive framework to inform practice considering the new legislation.

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Exploring Informal Caregivers’ Roles in Medical Tourism through Qualitative Data Triangulation

The Qualitative Report ◽

10.46743/2160-3715/2019.3550 ◽

2019 ◽

Author(s):

Rebecca Whitmore ◽

Valorie Crooks ◽

Jeremy Snyder

Keyword(s):

Decision Making ◽

Information Exchange ◽

Qualitative Data ◽

Medical Tourism ◽

Secondary Analysis ◽

Structured Interviews ◽

Patient Decision Making ◽

Patient Decision ◽

Participant Group ◽

Using Data

When Canadian medical tourists go abroad, they are often accompanied by friends and family, referred to as caregiver-companions, who provide informal care. These individuals play a role in patient decision-making and are stakeholders in medical tourism, yet little is known about their participation in this consumer health practice. To examine the roles that Canadian caregiver-companions play while accompanying medical tourists abroad, and to identify how multi-perspective qualitative data can augment our understanding of these roles, primary and secondary analysis was undertaken on datasets generated from multiple qualitative studies: semi-structured interviews with medical tourists, caregiver-companions, and international patient coordinators, and a survey with medical tourism facilitators. The findings from the triangulated analysis of these qualitative datasets serve to better understand the multiple, overlapping perspectives of different stakeholders in medical tourism. Results show that medical tourism caregivers act as companions, providing physical and emotional care; navigators, providing logistical assistance; and knowledge brokers, participating in decision-making and information exchange between medical tourists and professionals. Using data triangulation to examine the narratives of multiple stakeholders confirmed, altered, and augmented our knowledge of caregiver-companion roles. The unique perspectives offered by each participant group augment our understanding of caregiver roles and the practice of medical tourism.

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