scholarly journals Humanism in global oncology curricula: an emerging priority

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
M. Giuliani ◽  
M.A. Martimianakis ◽  
M. Broadhurst ◽  
J. Papadakos ◽  
R. Fazelad ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Quality Of Care ◽  
Biomedical Model ◽  
Shared Decision ◽  
Medical Expert ◽  
Competency Domains ◽  
Western Perspective ◽  
Over Time

Introduction Training in humanism provides skills important for improving the quality of care received by patients, achieving shared decision-making with patients, and navigating systems-level challenges. However, because of the dominance of the biomedical model, there is potentially a lack of attention to humanistic competencies in global oncology curricula. In the present study, we aimed to explore the incorporation of humanistic competencies into global oncology curricula.Methods This analysis considered 17 global oncology curricula. A curricular item was coded as either humanistic (as defined by the iecares framework) or non-humanistic. If identified as humanistic, the item was coded using an aspect of humanism, such as Altruism, from the iecares framework. All items, humanistic and not, were coded under the canmeds framework using 1 of the 7 canmeds competency domains: Medical Expert, Communicator, Collaborator, Leader, Scholar, Professional, or Health Advocate.Results Of 7792 identified curricular items in 17 curricula, 780 (10%) aligned with the iecares humanism framework. The proportion of humanistic items in individual curricula ranged from 2% to 26%, and the proportion increased from 3% in the oldest curricula to 11% in the most recent curricula. Of the humanistic items, 35% were coded under Respect, 31% under Compassion, 24% under Empathy, 5% under Integrity, 2% under Excellence, 1% under Altruism, and 1% under Service. Within the canmeds domains, the humanistic items aligned mostly with Professional (35%), Medical Expert (31%), or Communicator (25%).Conclusions The proportion of humanistic competencies has been increasing in global oncology curricula over time, but the overall proportion remains low and represents a largely Western perspective on what constitutes humanism in health care. The representation of humanism focuses primarily on the iecares attributes of Respect, Compassion, and Empathy.

scholarly journals A Systematic Literature Review of Shared Decision Making in Cancer Care (Preprint)

2018 ◽  
Author(s):  
Colleen A. McHorney ◽  
Lindsey T. Murray ◽  
Dayo Jagun ◽  
Jennifer Whiteley ◽  
Miriam Kimel ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Quality Of Care ◽  
Shared Decision Making ◽  
Cancer Care ◽  
Quantitative Measure ◽  
Shared Decision ◽  
Care Providers ◽  
Clinician Communication

BACKGROUND Shared decision making (SDM) is a process in which health care providers and patients relate to and influence each other as they collaborate in making decisions about patients’ health care. Hypothesized as a means to improve quality of care, successful applications of SDM in routine cancer care have not been widely documented. OBJECTIVE The objective of this study was to examine the literature to determine if elements of SDM implementation between cancer patients and their clinicians were more or less successful at improving the quality of care and health outcomes. METHODS A systematic literature search of SDM approaches and outcomes in cancer care was conducted using PubMed and EMBASE. An integrative model for SDM was used to classify elements included in SDM intervention studies and the resulting outcomes. RESULTS From 1,018 unique publications, 23 articles meeting eligibility criteria were included. Only three studies addressed elements of patient-clinician interaction as part of the study objectives. Interventions included decision aid (DA) evaluation (n=22) and clinician communication training (n=1). SDM elements commonly included were: defining/explaining the problem (n=23); presenting options (n=19); discussing pros and cons (n=17); assessing patient priorities and preferences (n=17); clinician knowledge and recommendations (n=15); and making or deferring treatment decisions (n=12). The most frequently-measured outcomes were patient-reported outcomes including treatment preference or decision (n=12), decisional conflict (n=10), patient satisfaction (n=10), patient participation (n=9), and patient knowledge (n=7). No clear patterns demonstrating relationships between SDM elements and outcomes were identified. Information on how patients and clinicians utilized DA information to promote SDM was limited. CONCLUSIONS Evaluation of SDM in cancer care has been increasing. However, the term “SDM” was generally applied to studies that focused on the development and/or evaluation of DAs which limited the current analyses to a review of SDM elements as part of the DAs. Most studies did not include a qualitative or quantitative measure of SDM specific to patient-clinician communication and interaction. Instead, there was an underlying assumption that SDM occurred organically with DA implementation. Without a qualitative or quantitative measure of SDM, identification of successful SDM elements and their relationships to patient outcomes remains unclear. Additional research is warranted on SDM implementation and measurement in real-world cancer care settings.

Humanism in global oncology curricula: An emerging priority.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10505-10505
Author(s):  
Meredith Elana Giuliani ◽  
Maria Athina (Tina) Martimianakis ◽  
Janet Papadakos ◽  
Michaela Broadhurst ◽  
Erik Driessen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Curriculum Design ◽  
Descriptive Statistics ◽  
Healthcare Team ◽  
Biomedical Model ◽  
Shared Decision ◽  
Medical Expert ◽  
Cultural Considerations ◽  
Over Time

10505 Background: Training in humanism provides the skills to achieve shared decision making with patients and their families, to navigate systems level challenges and to function positively within the healthcare team. However, there is potentially a lack of attention to humanistic competencies in global oncology curricula due to the dominance of the biomedical model in curriculum design, the challenge of assessing humanistic competencies and global cultural considerations. The aims of this study were to explore to what extent humanistic competencies are included in global oncology curricula and the nature of the humanistic competencies included. Methods: Sixteen global oncology curricula identified in a prior systematic review were analysed. The curricula were coded using the Gold Foundation’s I.E.C.A.R.E.S (Integrity, Excellence, Collaboration & compassion, Altruism, Respect & Resilience, Empathy and Service) humanistic competency framework and the CanMEDS framework. Descriptive statistics were used to describe the proportion of items attributed to each aspect of the framework. Results: 7733 curricular items were identified in the 16 curricula and 729 (9%) aligned with the I.E.C.A.R.E.S framework. The proportion of humanistic items in individual curricula ranged from 2% to 26%. The proportion of humanistic items has been increasing from the curricula published in 1980-1989 (3%) to the curricula published in 2010-2017 with a mean of 11% (4 to 25%). There was a higher proportion of humanistic competencies in curricula from the European region (9%) than in other regions. Of the humanistic items 35% were under respect, 31% under compassion, 24% under empathy, 5% were under integrity, 2% under excellence, 1% under altruism, and 1% under service. The majority of the humanistic items also aligned with the professional (35%), medical expert (31%) or communicator (26%) CanMEDS domains. Conclusions: The proportion of humanistic competencies has been increasing in global oncology curricula over time however the overall proportion remains low. Humanism is largely represented by competencies of respect, compassion and empathy and there exists a conflation between humanism and professionalism. Future global curricular efforts may benefit from attention to incorporating all aspects of humanistic competencies.

Shared decision-making in ovarian cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5549-5549 ◽  
Author(s):  
Lari B. Wenzel ◽  
Dana B Mukamel ◽  
Kathryn Osann ◽  
Lisa Sparks ◽  
Laura Jean Havrilesky ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Treatment Initiation ◽  
Treatment Decision ◽  
Shared Decision ◽  
Decisional Regret ◽  
Over Time

5549 Background: The value of shared decision-making in ovarian cancer is relatively unexplored. The goal of this study was to test a new decision aid, Patient Centered Outcome Aid (PCOA), that facilitates shared decision-making and helps ovarian cancer patients assimilate information and identify quality of life (QOL), toxicity and survival trade-offs between IP/IV therapy and IV therapy alone, based on their preferences and personal clinical characteristics. Methods: Participants were randomized to either PCOA (N=64) or usual care (N=59). Patient characteristics, QOL and shared decision-making data were collected at baseline and treatment initiation. Primary outcomes included satisfaction with treatment decision and decisional regret. Comparisons were made using t-tests and multivariate methods, adjusting for patient covariates. Multivariate linear models were used to investigate predictors of the primary outcomes. Results: Although satisfaction and decisional regret did not differ significantly by arm at any time point, the majority of PCOA patients indicated that the aid helped them understand treatment options and side effects. Notably, low shared decision-making and low QOL, were significant predictors of low satisfaction at treatment initiation (multiple r=0.76), six months (multiple r=0.48) and nine months (r=0.58). They were also significant predictors of decisional regret (multiple r=0.48 and 0.36 at 6 and 9 months). Patient covariates including age, stage, treatment and neoadjuvant status were not associated with differences in satisfaction or decisional regret. Conclusions: There were no clinically meaningful differences in satisfaction with the treatment decision, or decisional regret between the study arms. The absence of a difference may reflect the high degree of shared decision-making in both arms and greater disease severity in PCOA patients, who were more likely to report low baseline QOL and declining QOL over time. Both shared decision-making and quality of life were robust, independent predictors of satisfaction with the treatment decision over time. This implies that women who perceive themselves as less engaged in the decision process, and report poor QOL may benefit from a decision aid, in addition to physician counseling. Clinical trial information: NCT02259699.

Advance care planning: what do patients want?

2019 ◽  
Vol 80 (5) ◽  
pp. 263-267 ◽  
Author(s):  
Lucy Owen ◽  
Anna Steel
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Care Planning ◽  
Care Planning ◽  
Shared Decision ◽  
Future Health ◽  
Final Study ◽  
Future Health Care ◽  
Advance Care

Introduction: Advance care planning is the process by which patients can make decisions about their future health care should they lose capacity. Such conversations are shown to improve quality of life and reduce institutionalization. This article explores the preferences and wishes of patients in terms of advance care planning. Methods: CINAHL, Medline, Embase and Pubmed were searched. Key words included ‘elderly’, ‘advance care planning’, ‘advance directive’, ‘views’ and ‘opinions’. Results: A total of 64 abstracts were screened and 20 full text articles read; 11 articles were included in the final study. Individual and cultural differences influence the level of decision making that patients want. Most studies agreed that conversations should be carried out opportunistically by a trained health-care professional. Patients value honest and open conversations, without which they may make misinformed decisions. Conclusions: The level of shared decision making that individuals personally want should be established. Open and honest conversations should be initiated at the earliest opportunity.

scholarly journals Improving the quality of care in health systems: towards better strategies

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jennifer Dixon
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
New Technologies ◽  
Critical Mass ◽  
National Level ◽  
Short Term ◽  
The Future ◽  
Over Time

AbstractImproving the quality of health care across a nation is complex and hard. Countries often rely on multiple single national level programmes to make progress. But the key is to use a framework to develop a balanced overall strategy, and evaluate the main elements continuously and over time. Achieving that requires having a critical mass of leaders who collectively can see the bigger picture now, envision a roadmap for the future to chart an intelligent course, and course correct regularly. This is a long-term agenda requiring commitment, careful stewardship, different perspectives, trust, and the building of knowledge and experience over time. It is also almost completely at odds with much current policymaking which is short term, reactive and demands hard results. Many countries are making progress. But the rapid introduction of new types of care during the COVID 19 pandemic, such as online and digital, the use of new technologies which could soon revolutionalise the way care is delivered, experienced and evaluated, and the huge pressures on spending on health care in future mean we will have to do better. Achieving system-wide quality of care requires having a critical mass of leaders who collectively can see the bigger picture now, envision a roadmap for the future to chart a balanced intelligent course. For the Israeli health system, the recent IJHPR article by Dreiher et al. will help, but it will be important, in the future, to analyse how Israel measures up on the framework outlined above. This ideally would be supplemented with a survey of key leaders for their assessment, and both would be a regular (say 5 yearly) exercise and would help inform future strategies.

scholarly journals Inpatients’ opinion on quality of health care

Medicina ◽  
2009 ◽  
Vol 45 (3) ◽  
pp. 226 ◽  
Author(s):  
Daiva Brogienė ◽  
Romualdas Gurevičius
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Factor Analysis ◽  
Quality Of Care ◽  
Quality Of Health Care ◽  
Health Care Services ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Care Services

The aim of the study was to assess the inpatients’ opinion on the quality of hospital care based on the factor analysis and to identify the problem-oriented fields in quality of care. Material and methods. A multistage stratified probability sampling was performed in 22 general hospitals in Lithuania. A total of 2060 questionnaires were distributed during November 2006 and February 2007. The response rate was 97.38%; 2006 inpatients responded to the questionnaire; 1917 questionnaires (93.06%) were eligible for analysis. The modified survey instrument of Picker Institute Europe was used for inpatients. The method of survey was follows: each discharged inpatient filled out the questionnaire on the day of his/her discharge. The assessment of quality of care involved such aspects as patients’ communication with medical personnel, organizational issues and coordination of care, patients’ possibility of participation in medical decision-making, physical environment, accessibility to services, and safety of health care. Results. Six dimensions were identified from the factor analysis, explaining 51.48% of the variance. Cronbach alpha was 0.7931 for all dimensions. The majority (91.9%) of respondents evaluated health care services as good and very good. Inpatients were most satisfied with communication with their doctors. Even 91.5% of respondents noted that the doctors provided enough information about their health and treatment. The majority of inpatients gave high positive responses on respect showed to them and confidence with doctors. Correlation analysis confirmed a stronger positive correlation among three items of the global assessment of the quality and patients’ ratings on respect and confidence. Several problems were highlighted in the field of patients’ autonomy. The possibility of participation in medical decision-making was the dimension with the lowest level of patients’ rating. Less than half (42.3%) of inpatients noted that they did not have a possibility of participation in medical decision-making to the extent they were willing. Conclusions. Patients gave highly positive responses on the overall evaluation of the quality of health care services. The priority field in the improvement of health care quality is to create more possibilities for patients’ participation in medical decision-making. Results of the present study indicate that future studies need to include more detailed measurements of patients’ autonomy as dynamic changes are observed today in this field.

Sign in / Sign up

Export Citation Format

Share Document