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Decisional capacity physicians

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https://www.readbyqxmd.com/read/27872409/complexity-analysis-of-decision-making-in-the-critically-ill
#1
Barbara J Daly, Sara L Douglas, Elizabeth O'Toole, James Rowbottom, Alan Hoffer, Amy R Lipson, Christopher Burant
RATIONALE: Despite multiple trials of interventions to improve end-of-life care of the critically ill, there is a persistent lack of understanding of factors associated with barriers to decision-making at the end of life. OBJECTIVE: To apply the principles of complexity science in examining the extent to which transitions to end-of-life care can be predicted by physician, family, or patient characteristics; outcome expectations; and the evaluation of treatment effectiveness...
November 20, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27260552/shared-decision-making-in-the-ed-ethical-considerations
#2
REVIEW
Chadd K Kraus, Catherine A Marco
The process of shared decision making (SDM) is an ethical imperative in the physician-patient relationship, especially in the emergency department (ED), where SDM can present unique challenges because patients and emergency physicians often have no established relationship and decisions about diagnosis, treatment, and disposition are time dependent. SDM should be guided by the ethical principles of autonomy, beneficence, nonmaleficence, and justice and the related principle of stewardship of finite resources...
August 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/26132055/a-justifiable-asymmetry
#3
Daniel Brudney, Mark Siegler
It is a clinician's cliché that a physician only challenges a patient's capacity to make a treatment decision if that decision is not what the physician wants. Agreement is proof of decisional capacity; disagreement is proof or at least evidence of capacity's absence. It is assumed that this asymmetry cannot be justified, that the asymmetry must be a form of physicians' paternalism. Instead what is at issue when patient and physician disagree are usually two laudable impulses. The first is physicians' commitment to patients' well-being: physicians have a professional obligation as well as, ideally, a personal commitment to take care of patients--to do their best to bring about a positive medical outcome...
2015: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/25990137/patient-preferences-and-surrogate-decision-making-in-neuroscience-intensive-care-units
#4
REVIEW
Xuemei Cai, Jennifer Robinson, Susanne Muehlschlegel, Douglas B White, Robert G Holloway, Kevin N Sheth, Liana Fraenkel, David Y Hwang
In the neuroscience intensive care unit (NICU), most patients lack the capacity to make their own preferences known. This fact leads to situations where surrogate decision makers must fill the role of the patient in terms of making preference-based treatment decisions, oftentimes in challenging situations where prognosis is uncertain. The neurointensivist has a large responsibility and role to play in this shared decision-making process. This review covers how NICU patient preferences are determined through existing advance care documentation or surrogate decision makers and how the optimum roles of the physician and surrogate decision maker are addressed...
August 2015: Neurocritical Care
https://www.readbyqxmd.com/read/25523452/perspectives-on-pregnancy-in-women-with-chronic-kidney-disease-systematic-review-of-qualitative-studies
#5
REVIEW
Allison Tong, Shilpa Jesudason, Jonathan C Craig, Wolfgang C Winkelmayer
BACKGROUND: Achieving parenthood in women with chronic kidney disease (CKD) is challenging due to reduced fertility and the risk of adverse outcomes. We aimed to describe women's perspectives of pregnancy in CKD. METHODS: Electronic databases were searched to April 2014. Studies were synthesized thematically. RESULTS: From 15 studies (n = 257) we identified seven themes. 'Pursuing motherhood' was fulfilling an innate or social desire to have a child...
April 2015: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/25317865/medical-decision-making-capacity-knowledge-attitudes-and-assessment-practices-of-physicians-in-switzerland
#6
Helena Hermann, Manuel Trachsel, Christine Mitchell, Nikola Biller-Andorno
OBJECTIVE: Decision-making capacity (DMC) is an indispensable prerequisite for patients' informed consent and therefore directly related to the right to self-determination. In view of this ethical implication, valid and reliable assessment of DMC is essential to best practice. In general, and with particular regard to the Swiss context, little is known about healthcare practitioners' knowledge of and attitudes to the concept of DMC, or about their assessment practice. The present study aims to close this gap...
2014: Swiss Medical Weekly
https://www.readbyqxmd.com/read/25187288/end-of-life-mental-health-assessments-for-older-aged-medically-ill-persons-with-expressed-desire-to-die
#7
Linda E Weinberger, Shoba Sreenivasan, Thomas Garrick
In recent years, assisted suicide has been legalized in four states for those who are terminally ill and wish to end their lives with the assistance of lethal doses of medications prescribed by a physician. The ethics-related and legal questions raised by end-of-life suicide and decisional capacity to refuse treatment assessments are complex. In treating patients with end-stage medical conditions or disorders that severely affect the future quality of their lives, clinicians tend to engage in suicide prevention at all costs...
2014: Journal of the American Academy of Psychiatry and the Law
https://www.readbyqxmd.com/read/25011037/older-persons-and-compromised-decisional-capacity-the-role-of-public-policy-in-defining-and-developing-core-professional-competencies
#8
Marshall B Kapp
Issues frequently arise concerning the cognitive and emotional ability of older individuals to make certain legally significant decisions. In confronting these issues, the professional involvement of both attorneys and physicians (and other health care professionals), acting both individually and collaboratively, is desirable. This article describes the possible contributions of public policy in developing, through fostering innovations in medical and legal education, core competencies for physicians and attorneys that are essential to improving interprofessional collaboration on behalf of older individuals suspected of being compromised in their ability to make certain significant decisions...
2014: Journal of Aging & Social Policy
https://www.readbyqxmd.com/read/24613981/trends-and-perspectives-of-shared-decision-making-in-schizophrenia-and-related-disorders
#9
REVIEW
Romain Beitinger, Werner Kissling, Johannes Hamann
PURPOSE OF REVIEW: Shared decision-making (SDM) is a model of how doctors and patients make medical decisions, which is seen as very applicable to mental health. This review addresses the following issues: Do patients and professionals see the need for SDM? Does SDM actually take place for patients with schizophrenia? What are facilitators and barriers of SDM in schizophrenia treatment? What are the outcomes of SDM? RECENT FINDINGS: Publications in the last 18 months showed the following: Both patients and providers acknowledge the desirability of SDM...
May 2014: Current Opinion in Psychiatry
https://www.readbyqxmd.com/read/24592932/comparison-of-ethical-judgments-exhibited-by-clients-and-ethics-consultants-in-japan
#10
COMPARATIVE STUDY
Noriko Nagao, Yasuhiro Kadooka, Atsushi Asai
BACKGROUND: Healthcare professionals must make decisions for patients based on ethical considerations. However, they rely on clinical ethics consultations (CEC) to review ethical justifications of their decisions. CEC consultants support the cases reviewed and guide medical care. When both healthcare professionals and CEC consultants face ethical problems in medical care, how is their judgment derived? How do medical judgments differ from the ethical considerations of CECs? This study examines CECs in Japan to identify differences in the ethical judgment of clients and CEC consultants...
2014: BMC Medical Ethics
https://www.readbyqxmd.com/read/24445375/scope-and-outcomes-of-surrogate-decision-making-among-hospitalized-older-adults
#11
Alexia M Torke, Greg A Sachs, Paul R Helft, Kianna Montz, Siu L Hui, James E Slaven, Christopher M Callahan
IMPORTANCE: Hospitalized older adults often lack decisional capacity, but outside of the intensive care unit and end-of-life care settings, little is known about the frequency of decision making by family members or other surrogates or its implications for hospital care. OBJECTIVE: To describe the scope of surrogate decision making, the hospital course, and outcomes for older adults. DESIGN, SETTING, AND PARTICIPANTS: Prospective, observational study conducted in medicine and medical intensive care unit services of 2 hospitals in 1 Midwestern city in 1083 hospitalized older adults identified by their physicians as requiring major medical decisions...
March 2014: JAMA Internal Medicine
https://www.readbyqxmd.com/read/24362444/the-influence-of-surrogate-decision-makers-on-clinical-decision-making-for-critically-ill-adults
#12
Raj D Shah, Kenneth A Rasinski, G Caleb Alexander
PURPOSE: Intensive care unit patients rarely have decisional capacity and often surrogates make clinical decisions on their behalf. Little is known about how surrogate characteristics may influence end-of-life decision making for these patients. This study sought to determine how surrogate characteristics impact physicians' approach to end-of-life decision making. METHODS: From March 2011 to August 2011, a survey was fielded to 1000 randomly sampled critical care physicians using a modified Dillman approach...
July 2015: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/23777039/dementia-and-the-law-in-connecticut
#13
REVIEW
Patrick P Coll, Kate McEvoy
Laws pertain to almost every aspect of our lives. How a law applies to a person or one situation is dependent on many variables. One important variable is the capacity of a person to understand the ramifications of their actions. One of the most common reasons for permanent loss of decisional capacity is the development of dementia. Dementia is primarily a disease of old age. As the population of Connecticut ages and the prevalence of dementiaincreases, physicians will be presented with an increasing number of difficult decisions, where the interface between the law and medical practice will have an impact on their approach to the patient and their medical care...
May 2013: Connecticut Medicine
https://www.readbyqxmd.com/read/23158581/depressive-symptoms-among-surrogate-decision-makers-in-lebanese-icus
#14
MULTICENTER STUDY
Fadi Abou-Mrad, Charbel Mourad, Catherine Najem
Surrogate decision making is advocated to protect the vulnerable patient. Family members of patients in intensive care units (ICUs) are prone to develop depressive symptoms which may undermine their decisional capacity. Lebanon is a multicultural country where paternalism still dominates the physician-patient relationship and ethics are far from being the subject of research and studies. This multicenter observational study in the Greater Beirut area attempts to estimate the prevalence of depressive symptoms among surrogates deciding on behalf of ICU patients and to correlate their severity with sociodemographic factors...
April 2012: Functional Neurology
https://www.readbyqxmd.com/read/22558655/advance-directives-as-an-instrument-in-an-ageing-europe
#15
Tom Goffin
Advance directives are written or oral statements that are intended to govern healthcare decision-making for their authors, for both positive and negative decisions, should they lose decisional capacity in the future. In a Europe which is facing an ageing population, advance directives play an increasing role to (help) formulate the wishes from elderly patient once they start losing the capacity to decide independently. Advance directives should not only be used as a formulation of the patients' previously made decision, but can also be used as guidelines to better understand the previous expressed wishes of the patient...
April 2012: European Journal of Health Law
https://www.readbyqxmd.com/read/22325707/coordination-and-resource-related-difficulties-encountered-by-quebec-s-public-health-specialists-and-infectious-diseases-medical-microbiologists-in-the-management-of-a-h1n1-a-mixed-method-exploratory-survey
#16
Charles Nhan, Réjean Laprise, Monique Douville-Fradet, Mary Ellen Macdonald, Caroline Quach
BACKGROUND: In Quebec, the influenza A (H1N1) pandemic was managed using a top-down style that left many involved players with critical views and frustrations. We aimed to describe physicians' perceptions--infectious diseases specialists/medical microbiologists (IDMM) and public health/preventive medicine specialists (PHPMS)--in regards to issues encountered with the pandemics management at the physician level and highlight suggested improvements for future healthcare emergencies. METHODS: In April 2010, Quebec IDMM and PHPMS physicians were invited to anonymously complete a web-based learning needs assessment...
2012: BMC Public Health
https://www.readbyqxmd.com/read/22215831/defining-features-of-advance-directives-in-law-and-clinical-practice
#17
REVIEW
Robert S Olick
In the > 30 years since the New Jersey Supreme Court's seminal opinion in the case of Karen Ann Quinlan, all 50 states and the District of Columbia have enacted legislation to recognize the legal right of competent adults to write advance directives. The purpose of advance directives is to provide direction for health-care decisions near the end of life, when the ravages of illness, disease, or injury have taken the ability to decide for one's self. This article reviews the defining features of advance directives and the governing law, discusses some common practical concerns regarding the use and effectiveness of advance directives, and identifies several significant ethical-legal challenges for honoring advance directives at the bedside...
January 2012: Chest
https://www.readbyqxmd.com/read/22127308/communication-and-informed-consent-in-elderly-people
#18
REVIEW
M Giampieri
Physician-patient relationship is the key-point for an optimal management of any medical procedure. Before performing any diagnostic or therapeutic procedure, clinical communication with patients is necessary. It should regard the nature and purpose of a proposed procedure including potential risks and benefits. During physician-patient communication, alternatives, as well as the risks and benefits of not receiving or undergoing a procedure should also be disclosed. Thus, a complete physician-patient clinical communication is the basis of "shared decision-making" and plays a clinical-therapeutic role in the informed consent process in order to improve patient care...
February 2012: Minerva Anestesiologica
https://www.readbyqxmd.com/read/22092150/patient-participation-in-medical-and-social-decisions-in-alzheimer-s-disease
#19
COMPARATIVE STUDY
Johannes Hamann, Katharina Bronner, Julia Margull, Rosmarie Mendel, Janine Diehl-Schmid, Markus Bühner, Reinhold Klein, Antonius Schneider, Alexander Kurz, Robert Perneczky
OBJECTIVES: To analyze the preferences of people with amnestic mild cognitive impairment (aMCI) and mild dementia in Alzheimer's disease (AD) regarding different aspects of healthcare-related decisions, to correlate these findings with different measures of decision-making capacity, and to explore the views of relatives and referring physicians. DESIGN: Cross-sectional survey. SETTING: University-based memory clinic in Munich, Germany. PARTICIPANTS: One hundred people with aMCI or mild AD, their relatives (N = 99), and their referring physicians (N = 93)...
November 2011: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/22048569/-advance-directives-in-patients-with-mental-disorders-scope-prerequisites-for-validity-and-clinical-implementation
#20
REVIEW
J Vollmann
Since 1 September 2009, advance directives are regulated by law in Germany. This article discusses ethical challenges of advance directives in patients with mental disorders. Besides concrete information on the preferred medical treatment in concrete clinical situations, the mental capacity of the patient at the time of issuing the directive is essential. The "Decisional Competence Assessment Tool for Psychiatric Advance Directives" and empirical studies from the USA on advance directives in patients with mental disorders and the assessment by the treating psychiatrists of these patient directives are discussed...
January 2012: Der Nervenarzt
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