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.

Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty

2021 ◽  
Author(s):  
Veena Graff ◽  
Justin T. Clapp ◽  
Sarah J. Heins ◽  
Jamison J. Chung ◽  
Madhavi Muralidharan ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Knee Arthroplasty ◽  
Patient Involvement ◽  
Medical Center ◽  
Academic Medical Center ◽  
Shared Decision ◽  
Structured Interviews ◽  
Primary Knee Arthroplasty

Background Calls to better involve patients in decisions about anesthesia—e.g., through shared decision-making—are intensifying. However, several features of anesthesia consultation make it unclear how patients should participate in decisions. Evaluating the feasibility and desirability of carrying out shared decision-making in anesthesia requires better understanding of preoperative conversations. The objective of this qualitative study was to characterize how preoperative consultations for primary knee arthroplasty arrived at decisions about primary anesthesia. Methods This focused ethnography was performed at a U.S. academic medical center. The authors audio-recorded consultations of 36 primary knee arthroplasty patients with eight anesthesiologists. Patients and anesthesiologists also participated in semi-structured interviews. Consultation and interview transcripts were coded in an iterative process to develop an explanation of how anesthesiologists and patients made decisions about primary anesthesia. Results The authors found variation across accounts of anesthesiologists and patients as to whether the consultation was a collaborative decision-making scenario or simply meant to inform patients. Consultations displayed a number of decision-making patterns, from the anesthesiologist not disclosing options to the anesthesiologist strictly adhering to a position of equipoise; however, most consultations fell between these poles, with the anesthesiologist presenting options, recommending one, and persuading hesitant patients to accept it. Anesthesiologists made patients feel more comfortable with their proposed approach through extensive comparisons to more familiar experiences. Conclusions Anesthesia consultations are multifaceted encounters that serve several functions. In some cases, the involvement of patients in determining the anesthetic approach might not be the most important of these functions. Broad consideration should be given to both the applicability and feasibility of shared decision-making in anesthesia consultation. The potential benefits of interventions designed to enhance patient involvement in decision-making should be weighed against their potential to pull anesthesiologists’ attention away from important humanistic aspects of communication such as decreasing patients’ anxiety. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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 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.

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.

Understanding relational aspects of shared decision-making in gynaecology: A qualitative analysis of patients’ and physicians’ perspectives as well as clinical consultations

2015 ◽  
Vol 3 (4) ◽  
pp. 456
Author(s):  
Bettina Schwind ◽  
Karin Gross ◽  
Nina Wehner ◽  
Beate Wegener ◽  
Sibil Tschudin ◽  
...  
Keyword(s):  
Decision Making ◽  
Female Patient ◽  
Shared Decision Making ◽  
Medical Knowledge ◽  
Female Physician ◽  
Shared Decision ◽  
Structured Interviews ◽  
Male Physician ◽  
Unequal Distribution ◽  
Clinical Encounters

Rationale, aims and objectives: Following increased interest in the complexity of relational aspects of shared decision-making (SDM), this study traces the meanings and practices of the ways decisions are shared in clinical encounters within gynaecology. Methods: Guided by grounded theory, we analysed semi-structured interviews with 18 patients and 11 physicians as well as 33 observed consultations from 6 gynaecological outpatient care settings, selected by maximum variety sampling in the Basel area of Switzerland. Results: The results show how clinicians and patients co-produce different meanings and practices regarding decision-making across various care settings. Although female and male clinicians equally engaged in reciprocal bonds with patients in the decision-making process, the nature of these bonds differed and patients attributed gendered and different emotional meanings to decision-making. Shared decision-making was only advocated in female physician/female patient constellations, grounded in ‘being in reciprocal exchange’ due to sameness in gender and displayed as a means for creating closeness, empathy and support. In male physician/female patient constellations, the reciprocal bond was constructed upon unequal distribution of medical knowledge with patients favouring direct medical advice. However, whether patients felt supported in decision-making processes rather seemed to depend upon the continuity of clinical relationships than on the decision-making practices or care setting. Conclusion: By integrating different perspectives, insights into the complexity of relational aspects of SDM in gynaecology were obtained. Emotional meanings and practices of SDM differ according to gender constellations, care settings and continuity of clinical relationships.

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