Roles of Trust and Cross-Cultural Miscommunication in Clinical Decision-Making

2003 ◽  
Vol 1 (2) ◽  
pp. 198-207
Author(s):  
H. Mabel Preloran ◽  
Silvia Balzano
Keyword(s):  
Medical Education ◽  
Los Angeles ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Severe Disabilities ◽  
Cross Cultural ◽  
Emotional Engagement ◽  
Test Results ◽  
Clinical Protocol ◽  
Emotional Detachment

This paper explores the emotional world of a recent Mexican immigrant who lives in Los Angeles and is awaiting the results of the amniocentesis she has ambivalently agreed to. She is 45 years old and has given birth to two children with severe disabilities and two who are apparently normal. We focus our analysis on the woman's reactions and feelings during the nine days she spends waiting for the test results. We show that the standard prenatal genetic clinical protocol aimed at providing medical education and requiring professional neutrality and emotional detachment left the woman feeling rejected and subsequently unwilling to seek information or support from her clinicians. We find that while the intent of a protocol of neutrality is to enable patients to make informed decisions without feeling pressure from clinicians, some women want greater emotional engagement. We argue that professional neutrality can inhibit patient-clinician communication, hamper medical education, and ultimately detract from patients' ability to make informed medical choices. / El presente artículo explora el mundo emocional de Rocío, una inmigrante mexicana, quien se encuentra esperando los resultados de una amniocentesis que aceptó hacerse, a pesar de las dudas sobre la credibilidad y utilidad de la misma. Rocío, de 45 años, tenía ya otros hijos, dos con anormalidades severas y dos aparentemente sanos. Centramos nuestro análisis en los sentimientos y reacciones durante los nueve días que transcurren mientras espera el diagnóstico. En este trabajo mostramos cómo la forma de presentar la información médica puede llegar a entorpecer la toma de decisión de un paciente. El protocolo genético tiene por meta proveer información médica manteniendo una cierta distancia profesional y emocional. Estas condiciones hacen que, en nuestro estudio de caso, la paciente se sienta rechazada y sin deseos de acercarse al personal médico, ya sea en busca de apoyo emocional o información que aclararía sus dudas. Creemos que, mientras el objetivo de la neutralidad profesional es asegurar que el paciente decida con los conocimientos adecuados y, a la vez, sin sentirse presionado, algunas mujeres preferirían un mayor acercamiento emocional por parte del personal médico cuando deben decidir sobre pruebas o tratamientos. Creemos que la neutralidad profesional puede llegar a inhibir la comunicación médico-paciente, dificultar la comprensión de la información y, por último, obstaculizar la habilidad de tomar decisiones informadas por parte de los pacientes.

scholarly journals Roles of Trust and Cross-Cultural Miscommunication in Clinical Decision-Making

2003 ◽  
Vol 1 (2) ◽  
pp. 198-207
Author(s):  
H. Mabel Preloran ◽  
Silvia Balzano
Keyword(s):  
Medical Education ◽  
Los Angeles ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Severe Disabilities ◽  
Cross Cultural ◽  
Emotional Engagement ◽  
Test Results ◽  
Clinical Protocol ◽  
Emotional Detachment

This paper explores the emotional world of a recent Mexican immigrant who lives in Los Angeles and is awaiting the results of the amniocentesis she has ambivalently agreed to. She is 45 years old and has given birth to two children with severe disabilities and two who are apparently normal. We focus our analysis on the woman's reactions and feelings during the nine days she spends waiting for the test results. We show that the standard prenatal genetic clinical protocol aimed at providing medical education and requiring professional neutrality and emotional detachment left the woman feeling rejected and subsequently unwilling to seek information or support from her clinicians. We find that while the intent of a protocol of neutrality is to enable patients to make informed decisions without feeling pressure from clinicians, some women want greater emotional engagement. We argue that professional neutrality can inhibit patient-clinician communication, hamper medical education, and ultimately detract from patients' ability to make informed medical choices. / El presente artículo explora el mundo emocional de Rocío, una inmigrante mexicana, quien se encuentra esperando los resultados de una amniocentesis que aceptó hacerse, a pesar de las dudas sobre la credibilidad y utilidad de la misma. Rocío, de 45 años, tenía ya otros hijos, dos con anormalidades severas y dos aparentemente sanos. Centramos nuestro análisis en los sentimientos y reacciones durante los nueve días que transcurren mientras espera el diagnóstico. En este trabajo mostramos cómo la forma de presentar la información médica puede llegar a entorpecer la toma de decisión de un paciente. El protocolo genético tiene por meta proveer información médica manteniendo una cierta distancia profesional y emocional. Estas condiciones hacen que, en nuestro estudio de caso, la paciente se sienta rechazada y sin deseos de acercarse al personal médico, ya sea en busca de apoyo emocional o información que aclararía sus dudas. Creemos que, mientras el objetivo de la neutralidad profesional es asegurar que el paciente decida con los conocimientos adecuados y, a la vez, sin sentirse presionado, algunas mujeres preferirían un mayor acercamiento emocional por parte del personal médico cuando deben decidir sobre pruebas o tratamientos. Creemos que la neutralidad profesional puede llegar a inhibir la comunicación médico-paciente, dificultar la comprensión de la información y, por último, obstaculizar la habilidad de tomar decisiones informadas por parte de los pacientes.

Pediatric reference interval verification for endocrine and fertility hormone assays on the Abbott Alinity system

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Mary Kathryn Bohn ◽  
Siobhan Wilson ◽  
Alexandra Hall ◽  
Khosrow Adeli
Keyword(s):  
Clinical Decision Making ◽  
De Novo ◽  
Reference Interval ◽  
Clinical Decision ◽  
Reference Intervals ◽  
Healthy Children ◽  
Confidence Limits ◽  
Test Results ◽  
Serum Samples ◽  
Abbott Architect

Abstract Objectives The Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) has developed an extensive database of reference intervals (RIs) for several biomarkers on various analytical systems. In this study, pediatric RIs were verified for key immunoassays on the Abbott Alinity system based on the analysis of healthy children samples and comparison to comprehensive RIs previously established for Abbott ARCHITECT assays. Methods Analytical performance of Alinity immunoassays was first assessed. Subsequently, 100 serum samples from healthy children recruited with informed consent were analyzed for 16 Alinity immunoassays. The percentage of test results falling within published CALIPER ARCHITECT reference and confidence limits was determined. If ≥ 90% of test results fell within the confidence limits, they were considered verified based on CLSI guidelines. If <90% of test results fell within the confidence limits, additional samples were analyzed and new Alinity RIs were established. Results Of the 16 immunoassays assessed, 13 met the criteria for verification with test results from ≥ 90% of healthy serum samples falling within the published ARCHITECT confidence limits. New CALIPER RIs were established for free thyroxine and prolactin on the Alinity system. Estradiol required special considerations in early life. Conclusions Our data demonstrate excellent concordance between ARCHITECT and Alinity immunoassays, as well as the robustness of previously established CALIPER RIs for most immunoassays, eliminating the need for de novo RI studies for most parameters. Availability of pediatric RIs for immunoassays on the Alinity system will assist clinical laboratories using this new platform and contribute to improved clinical decision-making.

Cross-cultural Application of Behaviour Therapy

1991 ◽  
Vol 8 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Nick Higginbotham ◽  
Juriko Tanaka-Matsumi
Keyword(s):  
Decision Making ◽  
Behaviour Change ◽  
Potential Application ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cross Cultural ◽  
Cultural Norms ◽  
Behaviour Therapy ◽  
Norms And Values ◽  
Functional Analyses

The potential application of behaviour therapy to cross-cultural situations is explored as societies move to recognise their bicultural or multicultural composition. First reviewed are the moral and epistemological underpinnings of behaviour therapy and questions involving the universality of behaviour principles and technologies. Expected competencies of cross-cultural therapists are next raised. The basic message, told through examples from Australia, North American, and elsewhere, is that cultural norms and values penetrate every facet of client–therapist interaction and clinical decision-making. Competently performed functional analyses can produce culturally accommodating interventions that respond to culture-specific definitions of deviancy, accepted norms of role behaviour, expectations of change techniques, and approved behaviour change practitioners.

scholarly journals Gaitography on lower-limb amputees: Repeatability and between-methods agreement

2018 ◽  
Vol 43 (1) ◽  
pp. 71-79 ◽  
Author(s):  
Celine Timmermans ◽  
Andrea G. Cutti ◽  
Hester van Donkersgoed ◽  
Melvyn Roerdink
Keyword(s):  
Clinical Decision Making ◽  
Center Of Pressure ◽  
Clinical Decision ◽  
Repeated Measurements ◽  
Test Results ◽  
Foot Placement ◽  
Gait Characteristics ◽  
Gait Parameters ◽  
Two Samples ◽  
Systematic Biases

Background: Gaitography is gait parametrization from center-of-pressure trajectories of walking on an instrumented treadmill. Gaitograms may be useful for prosthetic gait analyses, as they can be rapidly and unobtrusively collected over multiple gait cycles without constraining foot placement. However, its reliability must still be established for prosthetic gait. Objectives: To evaluate (a) within-method test–retest repeatability and (b) between-methods agreement for temporal gait events (foot contact, foot off) and gait characteristics (e.g. step times, single-support duration). Study design: Cohort study with repeated measurements. Methods: Ten male proficient prosthetic walkers with a unilateral trans-femoral or trans-tibial amputation were equipped with a pressure-insole system and were invited to walk on separate days on an instrumented treadmill. Results: We found better between-methods reproducibility than within-method repeatability in temporal gait characteristics. Step times, stride times, and foot-contact events matched well between the two methods. In contrast, insole-based foot-off events were detected one-to-two samples earlier. Likewise, a similar bias was observed for temporal gait characteristics that incorporated foot-off events. Conclusion: Notwithstanding small systematic biases, the good between-methods agreement indicates that temporal gait characteristics may be determined interchangeably with gaitograms and insoles in persons with a prosthesis. However, the relatively poorer test–retest repeatability hinders longitudinal assessments with either method. Clinical relevance: Clinical practice could potentially benefit from gaitography as an efficient, unobtrusive, easy to use, automatized, and patient-friendly means to objectively parametrize prosthetic gait, with immediate availability of test results allowing for prompt clinical decision-making. Temporal gait parameters demonstrate good between-methods agreement, but poorer within-method repeatability hinders detecting prosthetic gait changes.

New Insights in Cross-Cultural Communication

2012 ◽  
pp. e85-e88
Author(s):  
Lidia Schapira
Keyword(s):  
Decision Making ◽  
Cultural History ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cross Cultural ◽  
Low Literacy ◽  
Cross Cultural Communication ◽  
Working Definition ◽  
Cross Cultural Education ◽  
Definition Of

Overview: Improving clinician-patient communication, improving clinical decision making, and eliminating mistrust have been identified as three key areas for reducing disparities in care. An important step is the training of cancer professionals to deliver culturally competent care in clinical settings as well as increasing the proportion of underrepresented minorities in the health care workforce. Providing care that is attuned to the patient's cultural preferences begins by talking to the patient about his or her cultural history and identifying the locus of decision making, preferences for disclosure of vital health information, and goals of care. Patients with low literacy and those with poor fluency of the dominant language require additional services. Language interpretation by trained professionals is fundamental to ensure that patients are able to provide informed consent for treatment. A working definition of culture involves multiple dimensions and levels and must be viewed as both dynamic and adaptive, rather than simply as a collection of beliefs and values. Effective cross-cultural education avoids stereotyping and promotes communication and negotiation to solve problems and minimize tension and conflict. Recent research has identified that unconscious biases held by clinicians affect their behavior and recommendations for treatment.

scholarly journals Tendencies of Future Doctors’ Ethical Competence Formation at Medical Universities in Europe and the USA

2017 ◽  
Vol 7 (4) ◽  
pp. 82-88 ◽  
Author(s):  
Larysa Dudikova
Keyword(s):  
Medical Education ◽  
Health Care Professionals ◽  
Clinical Decision Making ◽  
Bologna Process ◽  
Clinical Decision ◽  
The United States ◽  
Educational Process ◽  
Professional Activity ◽  
Ethical Competence ◽  
The Usa

Abstract The materials presented in this article are the result of a documentary-bibliographic study, which is based on the use of methods of analysis, synthesis, comparison and generalization. The results of the study have shown that the problem of professional ethics and culture of health care professionals is of significant interest. Problems of ethics, culture and deontology are the subject of consideration by scholars from the countries of Europe and the United States. There have been defined the main modern tendencies of training doctors for their professional activity in the leading countries of the world in the context of the professional and ethical competence formation. It has been found out that the development of higher medical education is carried out on the basis of the Bologna process principles, which involves introduction of two degrees (Bachelor and Master of Science), implementation of the ECTS system, introduction of the single diploma supplement, etc. It has been estimated that the educational programs for future doctors' training are aimed at the development of the students’ analytical and critical thinking; behavioral and social sciences, medical ethics, bioethics, provide knowledge, skills and abilities in the field of communication, clinical decision making, application of ethical norms, work in the multi-staff teams etc. The integrated programs play an important role in the educational process. Over the last decades studying bioethics is a compulsory component of the medical education. However, not only bioethics is the basis for the formation of future doctors’ professional and ethical competence at medical Universities abroad. The Oath of Hippocrates is of great significance for the students who devote themselves to medicine. In various countries it has been transformed into codes, oaths, etc., and now it is carried out by the students (future physicians) during their studies at higher medical educational institutions.

scholarly journals Introducing Artificial Intelligence Training in Medical Education

10.2196/16048 ◽  
2019 ◽  
Vol 5 (2) ◽  
pp. e16048 ◽  
Author(s):  
Ketan Paranjape ◽  
Michiel Schinkel ◽  
Rishi Nannan Panday ◽  
Josip Car ◽  
Prabath Nanayakkara
Keyword(s):  
Artificial Intelligence ◽  
Health Care ◽  
Medical Education ◽  
Health Care Professionals ◽  
Access To Health Care ◽  
Clinical Decision Making ◽  
New Technology ◽  
Medical Knowledge ◽  
Clinical Decision ◽  
Use Of Data

Health care is evolving and with it the need to reform medical education. As the practice of medicine enters the age of artificial intelligence (AI), the use of data to improve clinical decision making will grow, pushing the need for skillful medicine-machine interaction. As the rate of medical knowledge grows, technologies such as AI are needed to enable health care professionals to effectively use this knowledge to practice medicine. Medical professionals need to be adequately trained in this new technology, its advantages to improve cost, quality, and access to health care, and its shortfalls such as transparency and liability. AI needs to be seamlessly integrated across different aspects of the curriculum. In this paper, we have addressed the state of medical education at present and have recommended a framework on how to evolve the medical education curriculum to include AI.

scholarly journals Genomic screening and genomic diagnostic testing—two very different kettles of fish

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Leslie G. Biesecker
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Diagnostic Testing ◽  
Clinical Decision ◽  
Bayes Theorem ◽  
Genomic Testing ◽  
Test Results ◽  
Correct Interpretation ◽  
Genomic Test ◽  
Genomic Screening

AbstractGenomic testing can be misunderstood as being determinative, when in reality it is the same as all other tests and context is essential for its correct interpretation. Two hypothetical cases of testing for Marfan syndrome demonstrate how clinicians should contextualize genomic test results and the implementation of Bayes theorem in clinical decision-making.

Integration of germline multigene panel testing into breast and gynecologic oncology clinics.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 164-164
Author(s):  
Mariella Tejada ◽  
June YiJuan Hou ◽  
Katherine D. Crew ◽  
Melissa Kate Accordino ◽  
Kevin Kalinsky ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Genetic Testing ◽  
Clinical Decision Making ◽  
Genetic Test ◽  
Gynecologic Oncology ◽  
Clinical Decision ◽  
Test Results ◽  
Panel Testing ◽  
Genetic Test Results

164 Background: Germline genetic testing plays an important role in informing cancer screening and risk-reducing strategies, as well as treatment decisions with PARP inhibitors for BRCA-associated malignancies. Referrals to clinical genetics for pre-test counseling and results disclosure can be delayed due to financial and logistical barriers, which may ultimately delay clinical decision-making. Our study objective was to understand patient attitudes, knowledge, and anxiety/distress with point-of-care (POC) genetic testing in breast and gynecologic oncology clinics. Methods: We enrolled patients with early-stage breast cancer undergoing neoadjuvant treatment, metastatic breast cancer, ovarian cancer, or endometrial cancer undergoing POC multigene panel testing with their primary oncologist, rather than a genetic counselor. Pre-test counseling came from discussion with their primary oncologist. Participants completed a survey at time of genetic testing and one after return of genetic test results. Validated measures of genetic testing knowledge, cancer-related distress, and attitudes towards genetic testing were included. Descriptive statistics were generated for all data collected and paired t-tests were conducted for baseline and follow-up comparisons. Results: We enrolled 106 subjects, of which 97 completed the baseline survey. All participants were female with a mean age of 61.5 years (SD 13.5). The cohort consisted of participants with the following tumor types: 80 breast, 2 ovarian, and 16 endometrial. Almost 44% of women identified as Hispanic/Latina, 55% had highest level of education of community/technical college or less, and 51.2% reported annual incomes of less than $50,000. Forty-seven percent of participants had adequate baseline genetic testing knowledge scores (defined as at least 50% correct responses). A majority of participants (86.6%) had positive attitudes toward undergoing genetic testing. Results of genetic testing revealed 11 participants (11.3%) with pathogenic or likely pathogenic variants (of which 36.3% were in BRCA1/2), 25 (25.8%) with variants of unknown significance (VUS), and 61 (62.9%) with benign or likely benign results. The mean cancer-related distress score (scale from 15 to 60, higher score indicates higher levels of distress) was 32.78 (SD 9.74) at baseline and 26.5 (SD 8.9) after receiving genetic testing results (p = 0.002). Genetic test results informed cancer treatment decisions regarding medications and surgery in 15% and 13% of patients, respectively, the majority of which were breast cancer patients. Conclusions: As genetic testing is more frequently used for clinical decision-making it is important to develop ways to efficiently integrate POC testing in the oncology clinics. We demonstrated that POC genetic testing for breast and gynecologic cancers is feasible and can inform clinical decision-making.

Cross-Cultural Adaptation and Psychometric Evaluation of the Persian Version of the Clinical Decision-Making in Nursing Scale

2021 ◽  
pp. JNM-D-20-00052
Author(s):  
Zhaleh Kouravand ◽  
Fereshteh Aein ◽  
Abbas Ebadi ◽  
Ghasem Yadegarfar
Keyword(s):  
Decision Making ◽  
Cultural Adaptation ◽  
Goodness Of Fit ◽  
Clinical Decision Making ◽  
Psychometric Evaluation ◽  
Clinical Decision ◽  
Cross Cultural ◽  
Cross Cultural Adaptation ◽  
Persian Version ◽  
Fit Index

Background and PurposeThe aim of this study was the cross-cultural adaptation and psychometric evaluation of the Persian version of Clinical Decision Making in Nursing Scale (CDMNS).MethodsThe original CDMNS was translated into Persian using the Beaton's guideline. Its qualitative face validity, qualitative and quantitative content validity, its construct validity, and reliability was assessed.ResultsEleven items out of forty items were deleted due to factor loading values less than 0.3. Subsequently, model fit indices changed as follows: Chi-square value divided by degree of freedom (𝜒2/DF): 2.8, root mean score error of approximation (RMSEA): 0.07, standardized root mean square residual (SRMR): 0.06, comparative fit index (CFI): 0.93, goodness of fit index (GFI): 0.80, and adjusted goodness of fit index (AGFI): 0.77. The Cronbach's alpha values and test.retest intraclass correlation coefficient of the 29-item scale and its subscales also increased afte deleted.ConclusionThe 29-item Persian CDMNS is a valid and reliable instrument for assessing Iranian nurses' perceptions of clinical decision-making.

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