scholarly journals Prenatal counseling for myelomeningocele in the era of fetal surgery: a shared decision-making approach

2020 ◽  
Vol 25 (6) ◽  
pp. 640-647
Author(s):  
Vijay M. Ravindra ◽  
Guillermo Aldave ◽  
Howard L. Weiner ◽  
Timothy Lee ◽  
Michael A. Belfort ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Fetal Surgery ◽  
Uterine Wall ◽  
Shared Decision ◽  
Prenatal Counseling ◽  
Difficult Decision ◽  
Critical Issues ◽  
Care Family ◽  
Expectant Mothers

OBJECTIVEThe Management of Myelomeningocele Study demonstrated that fetal surgery, as compared to postnatal repair, decreases the rate of hydrocephalus and improves expected motor function. However, fetal surgery is associated with significant maternal and neonatal risks including uterine wall dehiscence, prematurity, and fetal or neonatal death. The goal of this study was to provide information about counseling expectant mothers regarding myelomeningocele in the era of fetal surgery.METHODSThe authors conducted an extensive review of topics pertinent to counseling in the setting of myelomeningocele and introduce a new model for shared decision-making to aid practitioners during counseling.RESULTSExpectant mothers must decide in a timely manner among several potential options, namely termination of pregnancy, postnatal surgery, or fetal surgery. Multiple factors influence the decision, including maternal health, fetal heath, financial resources, social support, risk aversion, access to care, family planning, and values. In many cases, it is a difficult decision that benefits from the guidance of a pediatric neurosurgeon.CONCLUSIONSThe authors review critical issues of prenatal counseling for myelomeningocele and discuss the process of shared decision-making as a framework to aid expectant mothers in choosing the treatment option best for them.

scholarly journals Digital decision aid for prenatal counseling in imminent extreme premature labor: development and pilot testing

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Josephus F. M. van den Heuvel ◽  
Marije Hogeveen ◽  
Margo Lutke Holzik ◽  
Arno F. J. van Heijst ◽  
Mireille N. Bekker ◽  
...  
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Treatment Guideline ◽  
Premature Delivery ◽  
Shared Decision ◽  
Premature Labor ◽  
Prenatal Counseling ◽  
Comfort Care

Abstract Background In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options. Prenatal counseling, preferably using shared decision making, is needed to agree on the treatment option in case labor progresses. This article described the development of a digital decision aid (DA) to support pregnant women, partners and clinicians in prenatal counseling for imminent extreme premature labor. Methods This DA is developed following the International Patient Decision Aid Standards. The Dutch treatment guideline and the Dutch recommendations for prenatal counseling in extreme prematurity were used as basis. Development of the first prototype was done by expert clinicians and patients, further improvements were done after alpha testing with involved clinicians, patients and other experts (n = 12), and beta testing with non-involved clinicians and patients (n = 15). Results The final version includes information, probabilities and figures depending on users’ preferences. Furthermore, it elicits patient values and provides guidance to aid parents and professionals in making a decision for either early intensive care or palliative comfort care in threatening extreme premature delivery. Conclusion A decision aid was developed to support prenatal counseling regarding the decision on early intensive care versus palliative comfort care in case of extreme premature delivery at 24 weeks gestation. It was well accepted by parents and healthcare professionals. Our multimedia, digital DA is openly available online to support prenatal counseling and personalized, shared decision-making in imminent extreme premature labor.

scholarly journals Critical Issues for Psychiatric Medication Shared Decision Making with Youth and Families

2011 ◽  
Vol 92 (3) ◽  
pp. 310-316 ◽  
Author(s):  
Megan S. O'Brien ◽  
Elizabeth L. Crickard ◽  
Charles A. Rapp ◽  
Cheryl L. Holmes ◽  
Thomas P. McDonald
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Psychiatric Medication ◽  
Shared Decision ◽  
Critical Issues

The Role of Shared Decision-Making in Audiologic Rehabilitation

2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Helen Pryce ◽  
Amanda Hall
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Behavior Changes ◽  
Shared Decision ◽  
Patient Centered ◽  
Treatment Information ◽  
Centered Care ◽  
Potential Risks ◽  
Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

On the evaluation of shared decision making: The Decision Evaluation Scales

2004 ◽  
Author(s):  
P. F. M. Stalmeier ◽  
M. S. Roosmalen ◽  
L. C. G. Josette Verhoef ◽  
E. H. M. Hoekstra-Weebers ◽  
J. C. Oosterwijk ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision

Shared Decision Making to Increase Family Involvement in the Care of Consumers With SMI

2013 ◽  
Author(s):  
Shirley M. Glynn ◽  
Lisa Dixon ◽  
Amy Cohen ◽  
Amy Drapalski ◽  
Deborah Medoff ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Family Involvement ◽  
Shared Decision

Shared-Decision-Making

2018 ◽  
Vol 09 (06) ◽  
pp. 250-252
Author(s):  
Rainer Bubenzer
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Partizipative Entscheidungsfindung ◽  
Shared Decision ◽  
Sich Eine

Auch in der Onkologie hat das Thema Patientenbeteiligung zunehmend an Bedeutung gewonnen. Ein häufig genanntes Mantra dazu lautet: Viele Patienten wünschen sich eine aktivere Rolle bei der eigenen Gesundheitsversorgung, am besten auf „Augenhöhe“. Ein Ansatz, der solche Wünsche berücksichtigt, ist die partizipative Entscheidungsfindung (PEF, shared-decision-making). Auch auf gesundheitspolitischer Ebene spielt PEF eine wachsende Rolle, wird z. B. im Rahmen des Nationalen Krebsplans spezifisch gefördert (►siehe Kasten). Ob und wieweit diese ambitionierten Ziele in der Onkologie in der Versorgungswirklichkeit angekommen sind, war eines der Themen beim 17. Deutschen Kongress für Versorgungsforschung in Berlin. Es zeigte sich: PEF ist in vielen Bereichen der Onkologie noch längst nicht angekommen.

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