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Shared decision making

Katie M Moynihan, Melanie A Jansen, Shih-Ning Liaw, Peta M A Alexander, Robert D Truog
The Declaration of Geneva was recently revised to emphasize patient autonomy and the importance of clinicians sharing medical knowledge. This reflects the welcome evolution of the doctor-patient relationship from one of paternalism to more informed, shared decision-making. Unfortunately, there is an increasing trend for clinicians to avoid making recommendations, instead providing a "menu" of care options from which patients and families must choose. This seems to be underpinned by the belief that it is unacceptably paternalistic to give guidance as to which course of action may be best to take...
June 13, 2018: Pediatric Critical Care Medicine
Alyson M Johnson, Joshua P Spaete, Paul S Jowell, Arif H Kamal, Deborah A Fisher
Patients diagnosed with advanced stages of gastrointestinal (GI) malignancies are often quite symptomatic, with symptoms primarily related to anatomic sites of obstruction. Endoscopic approaches to the palliation of GI malignancies have begun to overtake surgical approaches as first line in interventional management. We brought together a team of interventional gastroenterologists and palliative care experts to collate practical pearls for the types of endoscopic interventions used for symptom management in patients with GI malignancies...
June 15, 2018: Journal of Palliative Medicine
Marc A Probst, Craig F Tschatscher, Christine M Lohse, M Fernanda Bellolio, Erik P Hess
BACKGROUND: Shared decision-making in the Emergency Department (ED) can increase patient engagement for patients presenting with chest pain. However, little is known regarding which factors are associated with actual patient involvement in decision-making or patients' desired involvement in emergency care decisions. We examined which factors were associated with patients' actual and desired involvement in decision-making among ED chest pain patients. METHODS: This is a secondary analysis of data from a randomized trial of a shared decision-making intervention in ED patients with low-risk chest pain...
June 15, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Emma O'Lone, Andrea K Viecelli, Jonathan C Craig, Allison Tong, Benedicte Sautenet, David Roy, William G Herrington, Charles A Herzog, Tazeen Jafar, Meg Jardine, Vera Krane, Adeera Levin, Jolanta Malyszko, Michael V Rocco, Giovanni Strippoli, Marcello Tonelli, Angela Yee Moon Wang, Christoph Wanner, Faiez Zannad, Wolfgang C Winkelmayer, Angela C Webster, David C Wheeler
Patients on long-term hemodialysis are at very high risk for cardiovascular disease but are usually excluded from clinical trials conducted in the general population or in at-risk populations. There are no universally agreed cardiovascular outcomes for trials conducted specifically in the hemodialysis population. In this review, we highlight that trials reporting cardiovascular outcomes in hemodialysis patients are usually of short duration (median 3 to 6 months) and are small (59% of trials have <100 participants)...
June 19, 2018: Journal of the American College of Cardiology
Masoumeh Nazarian, Andrew Price, Peter Demian, Masoud Malekzadeh
OBJECTIVE: The objective is to establish design strategies to help minimize nurse journeys and inform future decision-making. The impact of the ward layout was investigated through a case study ward in a multispecialty hospital in Tehran. BACKGROUND: Nurse teams have the most direct contact with ward patients. Time spent on activities not part of care provision should be minimized. Literature suggests that a significant part of nurses' time is spent moving between different places within wards, which emphasizes the importance of ward layout...
January 1, 2018: HERD
Bernhard Geissler, Gerald Steiner, Michael C Mew
Big Data, blockchains, and cloud computing have become ubiquitous in today's mass media and are universally known terms used in everyday speech. If we look behind these often misused buzzwords, we find at least one common element, namely data. Although we hardly use these terms in the "classic discipline" of mineral economics, we find various similarities. The case of phosphate data bears numerous challenges in multiple forms such as uncertainties, fuzziness, or misunderstandings. Often simulation models are used to support decision-making processes...
June 11, 2018: Science of the Total Environment
Alison E Turnbull, Sarina K Sahetya, Elizabeth Colantuoni, Josephine Kweku, Roozbeh Nikooie, J Randall Curtis
CONTEXT: Goal-concordant care has been identified as an important outcome of advance care planning and shared decision-making initiatives. However validated methods for measuring goal-concordance are needed. OBJECTIVES: To estimate the inter-rater reliability of senior critical care fellows rating the goal-concordance of preference-sensitive interventions performed in intensive care units (ICUs) while considering patient-specific circumstances as described in a previously-proposed methodology...
June 11, 2018: Journal of Pain and Symptom Management
Colleen T Fogarty, Larry B Mauksch
Replies to comments made by B. J. Jacobs (see record 2018-27937-015) on the authors' original editorial (see record 2017-56601-001). While Fogarty and Mauksch agree with Dr. Jacobs that reviving the Doherty and Baird Levels of family involvement would be helpful, as would training clinicians to engage family members as partners in care, Fogarty and Mauksch want to reemphasize that helping trainees recognize systemic thinking and learn systemic problem solving is a necessary precursor to any form of family focused action...
June 2018: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Olga Theou, Emma Squires, Kayla Mallery, Jacques S Lee, Sherri Fay, Judah Goldstein, Joshua J Armstrong, Kenneth Rockwood
BACKGROUND: The ability of acute care providers to cope with the influx of frail older patients is increasingly stressed, and changes need to be made to improve care provided to older adults. Our purpose was to conduct a scoping review to map and synthesize the literature addressing frailty in the acute care setting in order to understand how to tackle this challenge. We also aimed to highlight the current gaps in frailty research. METHODS: This scoping review included original research articles with acutely-ill Emergency Medical Services (EMS) or hospitalized older patients who were identified as frail by the authors...
June 11, 2018: BMC Geriatrics
Elizabeth M Schoenfeld, Hemal K Kanzaria, Denise D Quigley, Peter St Marie, Nikita Nayyar, Sarah H Sabbagh, Kyle L Gress, Marc A Probst
OBJECTIVES: As Shared Decision-Making (SDM) has received increased attention as a method to improve the patient-centeredness of emergency department (ED) care, we sought to determine patients' desired level of involvement in medical decisions and their perceptions of potential barriers and facilitators to SDM in the ED. METHODS: We surveyed a cross-sectional sample of adult ED patients at three academic medical centers across the United States. The survey included 32 items regarding patient involvement in medical decisions including a modified Control Preference Scale (CPS) and questions about barriers and facilitators to SDM in the ED...
June 13, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Melanie Ward, Amy J Schulz, Barbara A Israel, Kristina Rice, Sheena E Martenies, Evan Markarian
Community-based participatory research (CBPR) approaches present strong opportunities to promote health equity by improving health within low-income communities and communities of color. CBPR principles and evaluation frameworks highlight an emphasis on equitable group dynamics (e.g., shared leadership and power, participatory decision-making, two-way open communication) that promote both equitable processes within partnerships and health equity in the communities with whom they engage. The development of an evaluation framework that describes the manner in which equitable group dynamics promote intermediate and long-term equity outcomes can aid partners in assessing their ability to work together effectively and improve health equity in the broader community...
April 30, 2018: Evaluation and Program Planning
David Timbrell, Pradeep Prabhu
Decision making through multidisciplinary teams offers an opportunity to improve perioperative care for high-risk surgical patients. While multidisciplinary team decision making is commonplace in the NHS, involvement of perioperative physicians including anaesthetists and intensivists in this process is not well established. This article presents an exemplar of anaesthetic and intensivist involvement in a joint perioperative upper gastrointestinal cancer multidisciplinary team meeting at the Royal Surrey County Hospital in Guildford, UK...
June 2, 2018: British Journal of Hospital Medicine
Enrique Soto-Perez-de-Celis, Daneng Li, Yuan Yuan, Yat Ming Lau, Arti Hurria
As the worldwide population ages, oncologists are often required to make difficult and complex decisions regarding the treatment of older people (aged 65 years and older) with cancer. Chronological age alone is often a poor indicator of the physiological and functional status of older adults, and thus should not be the main factor guiding treatment decisions in oncology. By contrast, a geriatric assessment can provide a much more comprehensive understanding of the functional and physiological age of an older person with cancer...
June 2018: Lancet Oncology
Marwa El Zein, Valentin Wyart, Julie Grèzes
Facial morphology has been shown to influence perceptual judgments of emotion in a way that is shared across human observers. Here we demonstrate that these shared associations between facial morphology and emotion coexist with strong variations unique to each human observer. Interestingly, a large part of these idiosyncratic associations does not vary on short time scales, emerging from stable inter-individual differences in the way facial morphological features influence emotion recognition. Computational modelling of decision-making and neural recordings of electrical brain activity revealed that both shared and idiosyncratic face-emotion associations operate through a common biasing mechanism rather than an increased sensitivity to face-associated emotions...
June 11, 2018: Scientific Reports
Stijn Van de Velde, Tiina Kortteisto, David Spitaels, Gro Jamtvedt, Pavel Roshanov, Ilkka Kunnamo, Bert Aertgeerts, Per Olav Vandvik, Signe Flottorp
BACKGROUND: Clinical practice patterns greatly diverge from evidence-based recommendations to manage knee osteoarthritis conservatively before resorting to surgery. OBJECTIVE: This study aimed to tailor a guideline-based computerized decision support (CDS) intervention that facilitates the conservative management of knee osteoarthritis. METHODS: Experts with backgrounds in clinical medicine, research, implementation, or health informatics suggested the most important recommendations for implementation, how to develop an implementation strategy, and how to form the CDS algorithms...
June 11, 2018: JMIR Research Protocols
Yuki Nakamura, Bijoy Thattaliyath, Marco Ricci
A combination of hypoplasia of the left side of the heart, a hypoplastic aortic arch, a large patent ductus arteriosus, and valvular pulmonary stenosis is very rare. The severity of the valvular pulmonary stenosis in this setting is difficult to judge preoperatively. Here, we describe a newborn with borderline hypoplasia of the left side of the heart, a hypoplastic aortic arch, a large patent ductus arteriosus, and valvular pulmonary stenosis, who underwent the Norwood procedure successfully. The purpose of this report is to share the perioperative course of the patient and our decision-making process that was not straightforward...
June 8, 2018: Annals of Thoracic Surgery
Alexandru M Rotar, Michael J Van Den Berg, Willemijn Schäfer, Dionne S Kringos, Niek S Klazinga
Primary care faces challenging times in many countries, mainly caused by an ageing population. The GPs' role to match patients' demand with medical need becomes increasingly complex with the growing multiple conditions population. Shared decision-making (SDM) is recognized as ideal to the treatment decision making process. Understanding GPs' perception on SDM about patient referrals and whether patients' preferences are considered, becomes increasingly important for improving health outcomes and patient satisfaction...
2018: PloS One
Joann V Pinkerton
The goal of the 2017 North American Menopause Society Hormone Therapy (HT) Position Statement is to remove fear about HT and encourage individualized shared decision making, using best available evidence. Systemic HT is safe and effective for symptomatic menopausal women aged younger than 60 years and within 10 years of menopause. Special populations of early menopause, high risk for fracture, risk of breast or uterine cancer, and extended duration are discussed. With longer duration of use, periodic evaluation and reassessment of health risks are needed...
June 8, 2018: Clinical Obstetrics and Gynecology
Lucia Guerra-Reyes, Ruth A Iguiñiz-Romero
The long-term management and prevention of Zika virus requires understanding of reproductive and sexual health behaviours, including mechanisms of partnered decision-making. In this article, we report on a qualitative study conducted before the arrival of Zika in Iquitos, Peru. We assessed existing patterns of reproductive decision-making among partnered men and women in a community under threat of Zika and discuss how these may impact Zika prevention in the long-term. We used a rapid qualitative assessment methodology, including in-depth semi-structured interviews with partnered women (28) and men (21)...
June 11, 2018: Culture, Health & Sexuality
Cheryl R Dennison Himmelfarb, Binu Koirala, Lola A Coke
No abstract text is available yet for this article.
July 2018: Journal of Cardiovascular Nursing
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