healthcare decision making
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2021 ◽  
Author(s):  
Maria A Pinero De Plaza ◽  
Tiffany Conroy ◽  
Alexandra Mudd ◽  
Alison Kitson

In this study, we drew on methods originating in complex adaptive systems and social network analysis to develop a novel way to quantify fundamental care. Data were obtained from a public statement from the Australian Royal Commission into Aged Care Quality and Safety. Results support the importance of using a systemic approach to assess the multiple dimensions of the fundamentals of care. Our method allows measurement of the problem within its system, providing a detailed quantification of care events and identifying excellence and improvement opportunities. We illustrate the strengths of this approach using principal component analysis and heat mapping. The application of the proposed methodology in healthcare decision-making, planning, and quality improvement is discussed.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 776-776
Author(s):  
Xinran Liu ◽  
Steven Albert

Abstract How does medical and healthcare decision-making among the very old people change in their last year before death? We explored patterns of decision-making in the Health ABC cohort study in 2011-14 (years 15-17), which involved 12 waves of quarterly phone interviews. When the participant was unable to do the interview, a proxy completed it instead. We identified a sample of 291 decedents (aged 90.0±2.9 at death, 35.7% Black, 52.6% female) with at least 1-year follow-up before death. Percentages of decedents who have made medical or healthcare decisions in the last four quarters before death were 32.0%, 31.2%, 32.6%, 41.9%, respectively. Decedents made more healthcare decisions in the last quarter before death (P<0.01), compared to the baseline. Across all quarters, decision-making is most in need for medications (17.6%), hospital admission (13.2%), and ER/urgent care visit (13.2%). We matched a 1:1 sample of survivors at the time of death by race, sex, and age (within ±3 years). In random effects models with multiple imputations of missing data, we found that decedents were more likely to make healthcare decisions than survivors across all four quarters before death or censor (Odds ratio=1.99, 95%CI: 1.49-2.65, P<0.01). The significance still held after adjusting for age, female, race, education, and interview methods. Overall, compared to matched survivors, the frequency of making medical and healthcare decisions among the very old decedents has already been high in the last year before death. This frequency rose sharply in the last quarter before death.


2021 ◽  
pp. bmjspcare-2021-003273
Author(s):  
Julien O Riordan ◽  
P M Kane ◽  
Helen Noble ◽  
Andrew Smyth

ObjectivesLow health literacy among older adults is associated with limited engagement in end-of-life care planning, higher hospitalisation rates and increased mortality. Frequently, older dialysis patients derive no survival benefit from dialysis and their quality of life often deteriorates further on dialysis. Older dialysis patients’ values and wishes are frequently unknown during key healthcare decision making and many endure medically intensive end-of-life scenarios. The objectives of this study were to explore older dialysis patients’ understanding of haemodialysis, to explore their engagement in end-of-life care planning and to explore their satisfaction with life on haemodialysis.Methods15 older dialysis patients participated in qualitative semistructured interviews in two haemodialysis units in Ireland. Thematic saturation was reached. Thematic analysis, applied inductively, was used to distill the data.ResultsThemes identified included disempowerment among participants reflected limited health literacy, poor advance care planning compromised participant well-being, haemodialysis compromised participants’ core values.ConclusionHealth literacy levels among older dialysis patients are poor, patient empowerment is limited and their participation in shared decision making and advance care planning is suboptimal. Consequently, healthcare decision making, including haemodialysis, may jeopardise patients’ core values. Improving health literacy through enhanced patient education and improved communication skills training for clinicians is necessary to promote patient participation in shared decision making. Clinician training to facilitate discussion of patients’ values and wishes will help guide clinicians and patients towards healthcare decisions most concordant with patients’ core values. This approach will optimise the circumstances for patient-centred care.


2021 ◽  
pp. 44-56
Author(s):  
Joseph Tham ◽  
Marie Catherine Letendre

2021 ◽  
Vol 8 ◽  
Author(s):  
Rong Zhang ◽  
Si-yu Yan ◽  
Yun-yun Wang ◽  
Qiao Huang ◽  
Xiang-ying Ren ◽  
...  

Objective: This study aimed to systematically review the status and trends of Chinese clinical practice guidelines (CPGs) during the time period 2010–2020 and explore their methodological characteristics. Then, based on the strengths and weaknesses in development, offer several recommendations for the quality improvement which will serve as a reference for the users and developers of CPG.Introduction: With the development of evidence-based medicine (EBM), the CPGs play an increasingly important role in healthcare decision-making both in China and worldwide.Inclusion criteria: The CPGs that have been used to help the health professionals in the healthcare decision-making were included.Methodology: The China National Knowledge Infrastructure (CNKI) and WanFang databases were searched from 2010 to 2020 for the studies describing the general and methodological characteristics of Chinese CPGs. Comparisons of the methodological characteristics between the groups were conducted using the chi-square test or Fisher's exact test. The M-K test was adopted to identify the monotonically increasing or decreasing trends of methodological characteristics over the timespan.Results: A total of 2,654 CPGs fulfilled the inclusion criteria. The quantity and quality of the guidelines developed in China have improved over the time span. From 2010 to 2020,the guidelines had differing characteristics and covered a wide range of subjects. In total, 2,318(87.34%) guidelines focused on Western Medicine. Eight (0.30%) had been developed for patient versions of guidelines, 10(0.38%) were tentative guidelines, and 16(0.60%) were rapid advice guidelines. Medical specialty societies (including their branches) (71.1%) were the main guideline makers. The most addressed diseases were neoplasms (14.43%). The target population is mainly adults (84.97%). The methodological quality of consensus-based (CB)-CPGs was obviously lower than evidence-based (EB)-CPGs. Except for the item, “recommendations were based on evidence of systematic reviews,” there were statistical differences in all other methodological items between the EB-CPGS and CB-CPGS (P < 0.01). Higher methodological quality has been observed in EB-CPGs. All the data relating to the methodological characteristics indicated that higher methodological quality was present in the guidelines using GRADE (P < 0.01).Conclusion: The quantity and quality of the guidelines developed in China have improved between 2010 and 2020. CB-CPGs have also paid attention to the methodology quality, but obviously, this is lower than that in the EB-CPGs.


2021 ◽  
pp. 193-206
Author(s):  
Nandi Siegfried ◽  
Lawrence Mbuagbaw

Systematic reviews play an important role in healthcare decision-making. When conducted correctly, they provide up-to-date, comprehensive, and replicable summaries of evidence. Authors of systematic reviews are expected to develop a protocol that outlines the research question and key methodological features of their review. A comprehensive and exhaustive search should be conducted, followed by screening to capture studies that meet the prespecified inclusion criteria. Once the relevant studies have been identified, data will be extracted, using a dedicated tool that permits the review authors to confirm the eligibility of the study and collect information on its design, risk of bias, and results. Sufficiently similar data may be pooled using meta-analytic techniques or synthesized narratively. A summary of the overall quality of evidence for each outcome is an essential component of a systematic review. The main concerns with systematic reviews are (1) selection bias: systematic exclusion of relevant studies due to publication status or language; (2) indexing bias: failure to identify relevant studies because they are not indexed accurately; and (3) information bias: missing or inaccurate information in the included studies. Other approaches to evidence synthesis include mapping the evidence with scoping reviews; conducting overviews of systematic reviews; using individual patient data; conducting network meta-analyses for multiple comparisons; conducting rapid reviews when evidence is needed urgently; synthesis of diagnostic accuracy data; and synthesis of qualitative data. Systematic reviews often inform clinical guidelines and require careful planning and execution by teams with content and methodological expertise.


2021 ◽  
pp. bmjspcare-2021-003398
Author(s):  
Julien O Riordan ◽  
P M Kane ◽  
Helen Noble ◽  
Andrew Smyth

ObjectivesLow health literacy among older adults is associated with limited engagement in end-of-life care plans, more hospitalisations and excess mortality. Frequently, older patients derive no survival benefit from dialysis and quality of life often deteriorates with dialysis. Older dialysis patients’ values and wishes are often unknown during key healthcare decision-making and many endure medically intensive end-of-life interventions . The objectives of this study were to examine older dialysis patients’ understanding of haemodialysis, their engagement in end-of-life care planning and their satisfaction with life on haemodialysis.Methods15 older dialysis patients participated in qualitative semi-structured interviews in two haemodialysis units . Thematic saturation was reached. Thematic analysis, applied inductively, distilled the data.ResultsThemes identified included disempowerment which reflected limited health literacy, poor advance care planning compromised well-being and haemodialysis compromised their core values.ConclusionHealth literacy among older dialysis patients appeared poor, patient empowerment was limited and participation in shared decision-making and advance care planning suboptimal. Consequently, complex healthcare decision-making, including haemodialysis may jeopardise patients’ core values. These findings have significant implications for the validity of the informed consent process prior to dialysis initiation. Improved health literacy through enhanced patient education and better communication skills for clinicians are necessary to promote patient participation in shared decision-making. Clinician training to facilitate discussion of patients’ values and wishes will help guide clinicians and patients towards healthcare decisions most concordant with individual core values. This will optimise patient-centred care.


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