SHARED DECISION MAKING FOR OTHER GENERAL CONDITIONS

2020 ◽  
Author(s):  
Jim Appleyard ◽  
Jón Snaedal
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Common Ground ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Shared Decision ◽  
Confounding Variables ◽  
Empathic Communication ◽  
Informed Preferences

Shared decision making based on clinical evidence and the patient’s informed preferences improves patient knowledge and ability to participate in their care with improvement to those with long-term health problems. A common ground between the patient and the physician is achieved through empathic communication skills with the provision of evidence-based information about options, outcomes, and uncertainties, together with decision support counseling and a systematic approach to recording and implementing patient’s preferences. It is important to recognize that the complexities of the clinical decision-making process with the confounding variables create difficulties in obtaining and measuring reproducible outcomes.

scholarly journals Understanding shared decision-making experience among vulnerable population: Focus group with food bank clients

2020 ◽  
pp. 1-8
Author(s):  
Young Ji Lee ◽  
Tiffany Brazile ◽  
Francesca Galbiati ◽  
Megan Hamm ◽  
Cindy Bryce ◽  
...  
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Vulnerable Populations ◽  
Clinical Decision Making ◽  
Decision Aids ◽  
Clinical Decision ◽  
Therapeutic Options ◽  
Shared Decision ◽  
Food Bank

Abstract Introduction: Shared decision-making (SDM) is a critical component of delivering patient-centered care. Members of vulnerable populations may play a passive role in clinical decision-making; therefore, understanding their prior decision-making experiences is a key step to engaging them in SDM. Objective: To understand the previous healthcare experiences and current expectations of vulnerable populations on clinical decision-making regarding therapeutic options. Methods: Clients of a local food bank were recruited to participate in focus groups. Participants were asked to share prior health decision experiences, explain difficulties they faced when making a therapeutic decision, describe features of previous satisfactory decision-making processes, share factors under consideration when choosing between treatment options, and suggest tools that would help them to communicate with healthcare providers. We used the inductive content analysis to interpret data gathered from the focus groups. Results: Twenty-six food bank clients participated in four focus groups. All participants lived in areas of socioeconomic disadvantage. Four themes emerged: prior negative clinical decision-making experience with providers, patients preparing to engage in SDM, challenges encountered during the decision-making process, and patients’ expectations of decision aids. Participants also reported they were unable to discuss therapeutic options at the time of decision-making. They also expressed financial concerns and the need for sufficiently detailed information to evaluate risks. Conclusion: Our findings suggest the necessity of developing decision aids that would improve the engagement of vulnerable populations in the SDM process, including consideration of affordability, use of patient-friendly language, and incorporation of drug–drug and drug–food interactions information.

Hereditary angioedema and shared decision making

2020 ◽  
Vol 41 (6) ◽  
pp. S55-S60 ◽  
Author(s):  
Russell A. Settipane ◽  
Don A. Bukstein ◽  
Marc A. Riedl
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Hereditary Angioedema ◽  
Clinical Decision Making ◽  
Unmet Need ◽  
Clinical Decision ◽  
Therapeutic Agents ◽  
Shared Decision ◽  
Widespread Implementation ◽  
High Degree

Clinical decision-making in hereditary angioedema (HAE) management involves a high degree of complexity given the number of therapeutic agents that are available and the risk for significant morbidity and potential mortality attributable to the disease. Given this complexity, there is an opportunity to develop shared decision-making (SDM) aids and/or tools that would facilitate the interactive participation of practitioners and patients in the SDM process. This article reviews the general constructs of SDM, the unmet need for SDM in HAE, and the steps necessary to create a SDM tool specific for HAE, and outlines the challenges that must be navigated to guide the establishment and widespread implementation of SDM in the management of HAE.

scholarly journals Downgrade of cardiac defibrillator devices to pacemakers in elderly heart failure patients: clinical considerations and the importance of shared decision-making

2021 ◽  
Vol 29 (5) ◽  
pp. 243-252
Author(s):  
H. F. Groenveld ◽  
J. E. Coster ◽  
D. J. van Veldhuisen ◽  
M. Rienstra ◽  
Y. Blaauw ◽  
...  
Keyword(s):  
Heart Failure ◽  
Decision Making ◽  
Elderly Patients ◽  
Shared Decision Making ◽  
Large Scale ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Short Review ◽  
Implantable Cardioverter Defibrillators ◽  
Shared Decision

AbstractImplantable cardioverter defibrillators are implanted on a large scale in patients with heart failure (HF) for the prevention of sudden cardiac death. There are different scenarios in which defibrillator therapy is no longer desired or indicated, and this is occurring increasingly in elderly patients. Usually device therapy is continued until the device has reached battery depletion. At that time, the decision needs to be made to either replace it or to downgrade to a pacing-only device. This decision is dependent on many factors, including the vitality of the patient and his/her preferences, but may also be influenced by changes in recommendations in guidelines. In the last few years, there has been an increased awareness that discussions around these decisions are important and useful. Advanced care planning and shared decision-making have become important and are increasingly recognised as such. In this short review we describe six elderly patients with HF, in whose cases we discussed these issues, and we aim to provide some scientific and ethical rationale for clinical decision-making in this context. Current guidelines advocate the discussion of end-of-life options at the time of device implantation, and physicians should realise that their choices influence patients’ options in this critical phase of their illness.

Partnerships with Patients: The Pros and Cons of Shared Clinical Decision-Making

1997 ◽  
Vol 2 (2) ◽  
pp. 112-121 ◽  
Author(s):  
Angela Coulter
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Needs ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Treatment Decisions ◽  
Medical Decision ◽  
Shared Decision ◽  
Pros And Cons

The traditional style of medical decision-making in which doctors take sole responsibility for treatment decisions is being challenged. Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources. This article examines the evidence for and against these claims. There is considerable evidence that patients want more information and greater involvement, although knowledge about the circumstances in which shared decision-making should be encouraged, and the effects of doing so, is sparse. There is an urgent need for more research into patients' information needs and preferences and for the development and evaluation of decision-support mechanisms to enable patients to become informed participants in treatment decisions.

Shared Decision-Making and Prevention Recommendations: Evolution, Implications, and Challenges for Public Health

2021 ◽  
Vol 49 (3) ◽  
pp. 444-452
Author(s):  
Juliana C. Lawrence ◽  
Jason L. Schwartz
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Shared Decision ◽  
Advisory Groups

AbstractRecent guidelines and recommen dations from government prevention advisory groups endorsing shared clinical decision-making reflect an emerging trend among public health bodies.

scholarly journals Who knows best? Negotiations of knowledge in clinical decision making

2015 ◽  
Author(s):  
Charlotte Bredahl Jacobsen ◽  
Helle Max Martin ◽  
Vibe Hjelholt Baker
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Patient Involvement ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Shared Decision ◽  
Structured Interviews ◽  
Knowledge Domains ◽  
Clinical Encounters

 This article examines the conflicts which arise when patients with chronic disease engage in decision making with health professionals about their medication. These are conflicts in the sense of discrepancies or incompatibilities between perceptions or opinions of different people engaged in a common endeavour. The paper is based on three qualitative research studies and presents one case from each study to illustrate analytical findings. Data collected in the original studies consisted of observations of clinical encounters and semi-structured interviews; in total 45 interviews with patients and 23 with health professionals. The analysis shows different conflicts, which arise during the process of making decisions about medication. These conflicts arise when: 1) Patients deliberately hold back information about their medication for fear of challenging clinicians’ authority; 2) The decision making process takes place in an environment, which does not support patient involvement; and 3) Patients refer to pharmacological knowledge, but are considered ill-equipped to understand and apply this knowledge by health professionals. The article shows that these conflicts typically revolve around the legitimate access to and use of pharmacological knowledge. These results have important implications for the current discussions of shared decision making. In shared decision making, knowledge about medication is typically regarded as the domain of the doctor. We argue that there is a need for a widening of the concept of partnership, which is central to shared decision making, to encompass breadth of patient knowledge about his/her situation, disease and treatment. Patients with chronic diseases need to be actively invited to disclose the extensive clinical knowledge they acquire over time, thereby creating a legitimate space for this knowledge in clinical consultations, and avoiding that conflicts over knowledge domains lead to unnecessary suffering and wasted resources.

Persons over models: shared decision-making for person-centered medicine

2020 ◽  
Vol 8 (3) ◽  
pp. 355
Author(s):  
Marco Annoni ◽  
Charlotte Blease
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
The Other ◽  
Shared Decision ◽  
Patient Relationship ◽  
New Paradigm ◽  
The Core

In the last decades “shared decision-making” has been hailed as the new paradigm for the doctor-patient relationship. However, different models of clinical decision-making appear to be compatible with the core tenets of “shared decision-making”. Reconsidering Emanuel and Emanuel (1992) classic analysis, in this paper we distinguish five possible models of clinical decision-making: (i) the ‘instrumental’; (ii) the ‘paternalistic’; (iii) the ‘informative’; (iv) the ‘interpretative’; and (v) the ‘persuasive’ models. For each model we present its fundamental assumptions as well as the role that patients and doctors are expected to play with respect to value-laden dilemmas. We argue that, with the exception of the instrumental model, each of the other four models may be appropriate depending on the circumstances. We conclude by highlighting the importance of structuring clinical care around actual persons - and their unique lives and philosophies - rather than around abstract frameworks.

scholarly journals Involvement of people with dementia in making decisions about their lives: a qualitative study that appraises shared decision-making concerning daycare

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018337 ◽  
Author(s):  
Leontine Groen-van de Ven ◽  
Carolien Smits ◽  
Fuusje de Graaff ◽  
Marijke Span ◽  
Jan Eefsting ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Critical Points ◽  
Informal Caregivers ◽  
Case Managers ◽  
Shared Decision ◽  
People With Dementia ◽  
Informed Preferences ◽  
Adapted Process

ObjectiveTo explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories.DesignA qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction.SettingCommunity settings and nursing homes in the Netherlands.Participants19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers).ResultsThe participants’ responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare.ConclusionShared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period.

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