Talen en spiralen: kennis en besluitvorming in anticonceptieconsultaties met een taalbarrière

Abstract Misconception and contraception: knowledge and decision-making in contraceptive consultations with a language barrier Just like in general medical consultations, different domains of knowledge come together and are negotiated in contraceptive consultations, followed by decision-making on the contraceptive method. Research shows that a language barrier can hamper knowledge negotiation and decision-making in medical consultations. Our paper contributes to those findings by focussing on contraceptive counselling as a specific and underexplored consultation type. We gathered our data in a Belgian abortion clinic, where contraception is discussed during the consultations, and where an important part of the consultations are characterised by a language barrier. We adopt a Bourdieusian view on language as capital, and use a linguistic ethnographic and interactional sociolinguistic approach, complemented with analytical tools from conversation analysis on epistemics and deontics. The analysis of data fragments, ranging from a limited to a double language barrier, shows that this barrier is connected in various ways with how, and how much, knowledge is negotiated. Incomplete renditions, interruptions, epistemic and deontic claims from non-professional interpreters, along with a lack of shared contextualisation, impede clients to gather information and therefore influence decision-making. We conclude that a language barrier involves a potential risk for knowledge negotiation and decision-making in contraceptive consultations. More attention from healthcare professionals to language barriers could empower women in their sexual and reproductive health choices.

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Patients’ practices for taking the initiative in decision-making in outpatient psychiatric consultations

Communication & Medicine ◽

10.1558/cam.27013 ◽

2017 ◽

Vol 13 (2) ◽

pp. 169-184 ◽

Cited By ~ 4

Author(s):

Shuya Kushida ◽

Takeshi Hiramoto ◽

Yuriko Yamakawa

Keyword(s):

Decision Making ◽

Conversation Analysis ◽

Treatment Decision ◽

Close Inspection ◽

Important Resource ◽

Treatment Decision Making ◽

The Way

In spite of increasing advocacy for patients’ participation in psychiatric decision-making, there has been little research on how patients actually participate in decision-making in psychiatric consultations. This study explores how patients take the initiative in decision-making over treatment in outpatient psychiatric consultations in Japan. Using the methodology of conversation analysis, we analyze 85 video-recorded ongoing consultations and find that patients select between two practices for taking the initiative in decision-making: making explicit requests for a treatment and displaying interest in a treatment without explicitly requesting it. A close inspection of transcribed interaction reveals that patients make explicit requests under the circumstances where they believe the candidate treatment is appropriate for their condition, whereas they merely display interest in a treatment when they are not certain about its appropriateness. By fitting practices to take the initiative in decision-making with the way they describe their current condition, patients are optimally managing their desire for particular treatments and the validity of their initiative actions. In conclusion, we argue that the orderly use of the two practices is one important resource for patients’ participation in treatment decision-making.

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Spatially Enabled Pipeline Route Optimization Model

2004 International Pipeline Conference, Volumes 1, 2, and 3 ◽

10.1115/ipc2004-0362 ◽

2004 ◽

Cited By ~ 1

Author(s):

S. Raza Wasi ◽

J. Darren Bender

Keyword(s):

Decision Making ◽

Optimization Problem ◽

Environmental Design ◽

Route Optimization ◽

Design Criteria ◽

Least Cost Path ◽

Ahp Model ◽

Spatial Decision Making ◽

Pipeline Route ◽

Analytical Tools

An interesting, potentially useful, and fully replicable application of a spatially enabled decision model is presented for pipeline route optimization. This paper models the pipeline route optimization problem as a function of engineering and environmental design criteria. The engineering requirements mostly deal with capital, operational and maintenance costs, whereas environmental considerations ensure preservation of nature, natural resources and social integration. Typically, pipelines are routed in straight lines, to the extent possible, to minimize the capital construction costs. In contrast, longer pipelines and relatively higher costs may occur when environmental and social considerations are part of the design criteria. Similarly, much longer pipelines are less attractive in terms of capital costs and the environmental hazard associated with longer construction area. The pipeline route optimization problem is potentially a complex decision that is most often undertaken in an unstructured, qualitative fashion based on human experience and judgement. However, quantitative methods such as spatial analytical techniques, particularly the least-cost path algorithms, have greatly facilitated automation of the pipeline routing process. In the past several interesting studies have been conducted using quantitative spatial analytical tools for finding the best pipeline route or using non-spatial decision making tools to evaluate several alternates derived through conventional route reconnaissance methods. Most of these studies (that the authors are familiar with) have concentrated on integrating multiple sources of spatial data and performing quantitative least-cost path analysis or have attempted to make use of non-spatial decision making tools to select the best route. In this paper, the authors present a new framework that incorporates quantitative spatial analytical tools with an Analytical Hierarchical Process (AHP) model to provide a loosely integrated but efficient spatial Decision Support System (DSS). Specifically, the goal is to introduce a fully replicable spatial DSS that processes both quantitative and qualitative information, balances between lowest-cost and lowest-impact routes. The model presented in this paper is implemented in a four step process: first, integration of multiple source data that provide basis for engineering and environmental design criteria; second, creation of several alternate routes; third, building a comprehensive decision matrix using spatial analysis techniques; and fourth, testing the alternative and opinions of the stakeholder groups on imperatives of AHP model to simplify the route optimization decision. The final output of the model is then used to carry out sensitivity analysis, quantify the risk, generate “several what and if scenarios” and test stability of the route optimization decision.

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Observer Ratings of Shared Decision Making Do Not Match Patient Reports: An Observational Study in 5 Family Medicine Practices

Medical Decision Making ◽

10.1177/0272989x20977885 ◽

2020 ◽

Vol 41 (1) ◽

pp. 51-59

Author(s):

Gisèle Diendéré ◽

Imen Farhat ◽

Holly Witteman ◽

Ruth Ndjaboue

Keyword(s):

Decision Making ◽

Family Medicine ◽

Risk Communication ◽

Shared Decision Making ◽

Cross Sectional Study ◽

Clinical Encounter ◽

Values Clarification ◽

Shared Decision ◽

Cross Sectional ◽

Medical Consultations

Background Measuring shared decision making (SDM) in clinical practice is important to improve the quality of health care. Measurement can be done by trained observers and by people participating in the clinical encounter, namely, patients. This study aimed to describe the correlations between patients’ and observers’ ratings of SDM using 2 validated and 2 nonvalidated SDM measures in clinical consultations. Methods In this cross-sectional study, we recruited 238 complete dyads of health professionals and patients in 5 university-affiliated family medicine clinics in Canada. Participants completed self-administered questionnaires before and after audio-recorded medical consultations. Observers rated the occurrence of SDM during medical consultations using both the validated OPTION-5 (the 5-item “observing patient involvement” score) and binary questions on risk communication and values clarification (RCVC-observer). Patients rated SDM using both the 9-item Shared Decision-Making Questionnaire (SDM-Q9) and binary questions on risk communication and values clarification (RCVC-patient). Results Agreement was low between observers’ and patients’ ratings of SDM using validated OPTION-5 and SDM-Q9, respectively (ρ = 0.07; P = 0.38). Observers’ ratings using RCVC-observer were correlated to patients’ ratings using either SDM-Q9 ( rpb = −0.16; P = 0.01) or RCVC-patients ( rpb = 0.24; P = 0.03). Observers’ OPTION-5 scores and patients’ ratings using RCVC-questions were moderately correlated ( rφ = 0.33; P = 0.04). Conclusion There was moderate to no alignment between observers’ and patients’ ratings of SDM using both validated and nonvalidated measures. This lack of strong correlation emphasizes that observer and patient perspectives are not interchangeable. When assessing the presence, absence, or extent of SDM, it is important to clearly state whose perspectives are reflected.

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Healthcare professionals’ behaviour regarding the implementation of shared decision-making in screening programmes: A systematic review

Patient Education and Counseling ◽

10.1016/j.pec.2021.01.032 ◽

2021 ◽

Author(s):

María José Hernández-Leal ◽

María José Pérez-Lacasta ◽

María Feijoo-Cid ◽

Vanesa Ramos-García ◽

Misericòrdia Carles-Lavila

Keyword(s):

Systematic Review ◽

Decision Making ◽

Shared Decision Making ◽

Healthcare Professionals ◽

Shared Decision

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7 Exploring healthcare professionals’ attitudes to future care planning with older adults in hospital: qualitative research co-design through multi-professional patient and carer involvement

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-mariecurie.7 ◽

2018 ◽

Vol 8 (3) ◽

pp. 362.2-362

Author(s):

Anna-Maria Bielinska ◽

Stephanie Archer ◽

Catherine Urch ◽

Ara Darzi

Keyword(s):

Older Adults ◽

Decision Making ◽

End Of Life Care ◽

Healthcare Professionals ◽

List Type ◽

Care Planning ◽

Life Care ◽

Topic Guide ◽

Future Care ◽

Advance Care

IntroductionDespite evidence that advance care planning in older hospital inpatients improves the quality of end-of-life care (Detering 2010) future care planning (FCP) with older adults remains to be normalised in hospital culture. It is therefore crucial to understand the attitudes of healthcare professionals to FCP in older patients in the hospital setting. Co-design with patients carers and healthcare professionals can generate more detailed meaningful data through better conversations.AimsTo co-design a semi-structured interview (SSI) topic guide to explore healthcare professionals’ attitudes to FCP with older adults in hospital.MethodsA multi-professional research group including a panel of patient and carer representatives co-designed an in-depth topic guide for a SSI exploring healthcare professionals’ attitudes to FCP with older adults in hospital.ResultsThe co-designed topic guide encourages participants to explore personal and system-level factors that may influence attitudes to FCP and practice in hospital amongst healthcare staff. Co-designed topics for inclusion in the SSI schedule include:Potential differences between specialist and generalist approaches to FCPThe influence of perceived hierarchy and emergency–decision making ability in professionals on FCP discussionsThe relevance to transitions of careAttitudes to FCP beyond the biomedical paradigm including perceived well–being and psychosocial aspects of careDigital FCP tools including patient–led FCP.ConclusionCo-designing qualitative research with older people and multi-disciplinary professionals may narrow translational gaps in implementing FCP by setting joint research priorities. Data generated from a co-designed study may expand understanding of hospital-based anticipatory decision-making with older adults.Reference. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ23 March 2010;340:c1345.

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Patient decision aid based on multi-criteria decision analysis for disease-modifying drugs for multiple sclerosis: prototype development

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01479-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

I. E. H. Kremer ◽

P. J. Jongen ◽

S. M. A. A. Evers ◽

E. L. J. Hoogervorst ◽

W. I. M. Verhagen ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Decision Aid ◽

Healthcare Professionals ◽

Treatment Options ◽

Shared Decision ◽

Patient Decision Aid ◽

Disease Modifying Drugs ◽

Patient Decision ◽

Further Development

Abstract Background Since decision making about treatment with disease-modifying drugs (DMDs) for multiple sclerosis (MS) is preference sensitive, shared decision making between patient and healthcare professional should take place. Patient decision aids could support this shared decision making process by providing information about the disease and the treatment options, to elicit the patient’s preference and to support patients and healthcare professionals in discussing these preferences and matching them with a treatment. Therefore, a prototype of a patient decision aid for MS patients in the Netherlands—based on the principles of multi-criteria decision analysis (MCDA) —was developed, following the recommendations of the International Patient Decision Aid Standards. MCDA was chosen as it might reduce cognitive burden of considering treatment options and matching patient preferences with the treatment options. Results After determining the scope to include DMDs labelled for relapsing-remitting MS and clinically isolated syndrome, users’ informational needs were assessed using focus groups (N = 19 patients) and best-worst scaling surveys with patients (N = 185), neurologists and nurses (N = 60) to determine which information about DMDs should be included in the patient decision aid. Next, an online format and computer-based delivery of the patient decision aid was chosen to enable embedding of MCDA. A literature review was conducting to collect evidence on the effectiveness and burden of use of the DMDs. A prototype was developed next, and alpha testing to evaluate its comprehensibility and usability with in total thirteen patients and four healthcare professionals identified several issues regarding content and framing, methods for weighting importance of criteria in the MCDA structure, and the presentation of the conclusions of the patient decision aid ranking the treatment options according to the patient’s preferences. Adaptations were made accordingly, but verification of the rankings provided, validation of the patient decision aid, evaluation of the feasibility of implementation and assessing its value for supporting shared decision making should be addressed in further development of the patient decision aid. Conclusion This paper aimed to provide more transparency regarding the developmental process of an MCDA-based patient decision aid for treatment decisions for MS and the challenges faced during this process. Issues identified in the prototype were resolved as much as possible, though some issues remain. Further development is needed to overcome these issues before beta pilot testing with patients and healthcare professionals at the point of clinical decision-making can take place to ultimately enable making conclusions about the value of the MCDA-based patient decision aid for MS patients, healthcare professionals and the quality of care.

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A multimodal corpus of simulated consultations between a patient and multiple healthcare professionals

Language Resources and Evaluation ◽

10.1007/s10579-020-09526-0 ◽

2021 ◽

Author(s):

Mark Snaith ◽

Nicholas Conway ◽

Tessa Beinema ◽

Dominic De Franco ◽

Alison Pease ◽

...

Keyword(s):

Healthcare Professionals ◽

Ethical Issues ◽

Upper Body ◽

Language Resources ◽

Close Analysis ◽

Medical Consultations ◽

Multimodal Corpus ◽

Clear Identification ◽

Patient Consultation ◽

Design Construction

AbstractLanguage resources for studying doctor–patient interaction are rare, primarily due to the ethical issues related to recording real medical consultations. Rarer still are resources that involve more than one healthcare professional in consultation with a patient, despite many chronic conditions requiring multiple areas of expertise for effective treatment. In this paper, we present the design, construction and output of the Patient Consultation Corpus, a multimodal corpus of simulated consultations between a patient portrayed by an actor, and at least two healthcare professionals with different areas of expertise. As well as the transcribed text from each consultation, the corpus also contains audio and video where for each consultation: the audio consists of individual tracks for each participant, allowing for clear identification of speakers; the video consists of two framings for each participant—upper-body and face—allowing for close analysis of behaviours and gestures. Having presented the design and construction of the corpus, we then go on to briefly describe how the multi-modal nature of the corpus allows it to be analysed from several different perspectives.

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The Role of Healthcare Professionals in Environmental Health and Fertility Decision-Making

NEW SOLUTIONS A Journal of Environmental and Occupational Health Policy ◽

10.1177/1048291117691074 ◽

2017 ◽

Vol 27 (1) ◽

pp. 28-50 ◽

Cited By ~ 2

Author(s):

Ellen Sweeney

Keyword(s):

Decision Making ◽

Healthcare Professionals ◽

Endocrine Disrupting Chemicals ◽

Consumer Products ◽

Professional Organizations ◽

Toxic Substances ◽

Industrial Chemicals ◽

Fertility Decision ◽

Guidelines And Recommendations

There is increasing evidence that raises specific concerns about prenatal exposures to toxic substances which makes it necessary to consider everyday exposures to industrial chemicals and toxic substances in consumer products, including endocrine disrupting chemicals. Pregnant women have measurable levels of numerous toxic substances from exposures in their everyday environments, including those which are associated with adverse developmental and reproductive health outcomes. As a result, environmental contexts have begun to influence the decisions women make related to fertility, as well as the formal guidelines and advice provided by healthcare professionals. This article provides an overview of the potential role for obstetricians and gynecologists in educating their patients about the role of toxic substances in fertility decision-making and pregnancy. It explores the emerging guidelines and recommendations from professional organizations and problematizes the limitations of these approaches.

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