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Shared decision-making

Xiangyu Chang, Jingzhou Shen, Xiaoling Lu, Shuai Huang
The emerging Bicycle Sharing System (BSS) provides a new social microscope that allows us to "photograph" the main aspects of the society and to create a comprehensive picture of human mobility behavior in this new medium. BSS has been deployed in many major cities around the world as a short-distance trip supplement for public transportations and private vehicles. A unique value of the bike flow data generated by these BSSs is to understand the human mobility in a short-distance trip. This understanding of the population on short-distance trip is lacking, limiting our capacity in management and operation of BSSs...
2018: PloS One
Kei Ouchi, Guruprasad D Jambaulikar, Samuel Hohmann, Naomi R George, Emily L Aaronson, Rebecca Sudore, Mara A Schonberg, James A Tulsky, Jeremiah D Schuur, Daniel J Pallin
OBJECTIVES: To inform the shared decision-making process between clinicians and older adults and their surrogates regarding emergency intubation. DESIGN: Retrospective cohort study. SETTING: Multicenter, emergency department (ED)-based cohort. PARTICIPANTS: Adults aged 65 and older intubated in the ED from 2008 to 2015 from 262 hospitals across the United States (>95% of U.S. nonprofit academic medical centers). MEASUREMENTS: Our primary outcome was age-specific in-hospital mortality...
March 15, 2018: Journal of the American Geriatrics Society
Giuliano Tosello, Maria Regina Torloni, Bruna S Mota, Teresa Neeman, Rachel Riera
BACKGROUND: Metastatic breast cancer is not a curable disease, but women with metastatic disease are living longer. Surgery to remove the primary tumour is associated with an increased survival in other types of metastatic cancer. Breast surgery is not standard treatment for metastatic disease, however several recent retrospective studies have suggested that breast surgery could increase the women's survival. These studies have methodological limitations including selection bias. A systematic review mapping all randomised controlled trials addressing the benefits and potential harms of breast surgery is ideal to answer this question...
March 15, 2018: Cochrane Database of Systematic Reviews
Trisha M Prentice, Lynn Gillam
When healthcare professionals feel constrained from acting in a patient's best interests, moral distress ensues. The resulting negative sequelae of burnout, poor retention rates, and ultimately poor patient care are well recognized across healthcare providers. Yet an appreciation of how particular disciplines, including physicians, come to be "constrained" in their actions is still lacking. This paper will examine how the application of shared decision-making may contribute to the experience of moral distress for physicians and why such distress may go under-recognized...
March 14, 2018: Journal of Bioethical Inquiry
Nausheen Bakht
The social contract between medicine and society is being renegotiated and demands the reorientation of healthcare. Neither society nor doctors are happy with the way modern medicine is being practised. An obtuse focus on medical sciences and a myopic view of medical humanities (MH) has been incriminated. MH reflects on healthcare-related topics in the light of shared human experiences. It addresses the genuine concerns of patients and their attendants. It also helps inculcate humanistic values in doctors by enhancing ethical understanding, cultural sensitivity, mutual respect, empathy, communication skills and decision-making...
March 2018: JPMA. the Journal of the Pakistan Medical Association
P Van der Graaf, O Francis, E Doe, E Barrett, M O'Rorke, G Docherty
Background: In 2008, five UKCRC Public Health Research Centres of Excellence were created to develop a coordinated approach to policy and practice engagement and knowledge exchange. The five Centres have developed their own models and practices for achieving these aims, which have not been compared in detail to date. Methods: We applied an extended version of Saner's model for the interface between science and policy to compare five case studies of knowledge exchanges, one from each centre...
March 1, 2018: Journal of Public Health
M Cheetham, A Wiseman, B Khazaeli, E Gibson, P Gray, P Van der Graaf, R Rushmer
Background: Embedded research (ER) is recognized as one way to strengthen the integration of evidence into public health (PH) practice. In this paper, we outline a promising example of the co-production of research evidence between Fuse, the UKCRC Centre for Translational Research in Public Health and a local authority (LA) in north east England. Methods: We critically examine attempts to share and use research findings to influence decision-making in a LA setting, drawing on insights from PH practitioners, managers, commissioners and academic partners involved in this organizational case study...
March 1, 2018: Journal of Public Health
S Kinsinger
Barrett's esophagus is a chronic esophageal condition that is associated with an increased risk of esophageal adenocarcinoma. This chronic condition negatively impacts patients' quality of life and is associated with increased levels of psychological distress. In 'Perceptions of risk and therapy among patients with Barrett's esophagus: a patient survey study,' Stier et al. explored factors associated with esophageal cancer risk perception and management decisions among patients with Barrett's esophagus. The results indicate that patients greatly overestimate their cancer risk and are willing to accept low success rates and high risks of complications to undergo endoscopic therapy...
March 9, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Julia S Anixt, Jareen Meinzen-Derr, Halley Estridge, Laura Smith, William B Brinkman
OBJECTIVE: To describe the characteristics of treatment decisions to address challenging behaviors in children with autism spectrum disorder (ASD). METHODS: Parents of children aged 4 to 15 years with ASD seen in a developmental behavioral pediatric (DBP) clinic completed validated measures to characterize their child's behaviors and their own level of stress. Parents reported their treatment priority before the visit. During the visit, we assessed shared decision making (SDM) using the Observing Patient Involvement (OPTION) scale and alignment of the clinician's treatment plan with the parent's priority...
March 12, 2018: Journal of Developmental and Behavioral Pediatrics: JDBP
Bente T Jensen, Susanne V Lauridsen, Jørgen B Jensen
PURPOSE OF REVIEW: Whether prehabilitation in radical cystectomy adds to the effort of reducing postoperative morbidity and impairments in the survivorship phase has until recently received limited attention. This narrative review aims to summarize the current evidence base on prehabilitaion interventions focusing on the efficacy of procedure-specific interventions and the influence on postoperative outcomes. RECENT FINDINGS: Given the oncological risk, there is a relative short window to intervene and proactively optimize the patient before radical cystectomy...
March 13, 2018: Current Opinion in Urology
Robert A Bailey, Alicia C Shillington, Qing Harshaw, Martha M Funnell, Jeffrey VanWingen, Nananda Col
INTRODUCTION: Failure to intensify treatment for type 2 diabetes mellitus (T2DM) when indicated, or clinical inertia, is a major obstacle to achieving optimal glucose control. This study investigates the impact of a values-focused patient decision aid (PDA) for T2DM antihyperglycemic agent intensification on patient values related to domains important in decision-making and preferred treatments. METHODS: Patients with poorly controlled T2DM who were taking a metformin-containing regimen were recruited through physicians to access a PDA presenting evidence-based information on T2DM and antihyperglycemic agent class options...
March 13, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Anne-Marie Reid, Jeremy M Brown, Julie M Smith, Alexandra C Cope, Susan Jamieson
CONTEXT: For medical education researchers, a key concern may be the practicalities of gaining ethical approval where this is a national or local requirement. However, in qualitative studies, where the dynamics of human interaction pervade, ethical considerations are an ongoing process which continues long after approval has been granted. Responding to ethical dilemmas arising 'in the moment' requires a reflexive approach whereby the researcher questions his/her own motivations, assumptions and interests...
March 13, 2018: Perspectives on Medical Education
O El-Sherif, Z G Jiang, E B Tapper, K C Huang, A Zhong, A Osinusi, M Charlton, M Manns, N H Afdhal, K Mukamal, J McHutchison, D M Brainard, N Terrault, M P Curry
BACKGROUND & AIMS: Treatment with direct-acting antiviral (DAA) agents can reduce model for end-stage liver disease and Child-Pugh-Turcotte (CPT) scores in patients with decompensated cirrhosis caused by hepatitis C virus (HCV). However, many of these patients still die or require liver transplantation. We collected data on baseline features of patients and aimed to develop a scoring system to predict response to DAA therapy. METHODS: We performed a retrospective analysis of data from 4 trials of the effects of sofosbuvir-based therapy in patients with HCV-associated decompensated cirrhosis (502 of CPT class B and 120 of CPT class C)...
March 10, 2018: Gastroenterology
Lindsay J Blazin, Cherilyn Cecchini, Catherine Habashy, Erica C Kaye, Justin N Baker
Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers...
March 11, 2018: Children
Tammy Hoffmann, Jesse Jansen, Paul Glasziou
In a Perspective, Tammy Hoffmann and colleagues discuss medical decision making for elderly patients with multimorbidity.
March 2018: PLoS Medicine
Allison K Ikeda, Paul Hong, Stacey L Ishman, Stephanie A Joe, Gregory W Randolph, Jennifer J Shin
In our previous installment, we introduced shared decision making (SDM) as a collaborative process in which patients, families, and clinicians develop a mutually optimized treatment plan when more than 1 reasonable treatment option exists. In this subsequent installment of our Evidence-Based Medicine in Otolaryngology Series, we expand on the topic of SDM, including the related current state of clinical decision making, the impact of SDM on health care utilization and patient satisfaction, the potential role of system and society changes, the experience with SDM as it relates to race and ethnicity, existing financial incentives, and the validated instruments that assess the extent to which SDM occurs...
March 1, 2018: Otolaryngology—Head and Neck Surgery
John J Sim, Hui Zhou, Jiaxiao Shi, Sally F Shaw, Shayna L Henry, Csaba P Kovesdy, Kamyar Kalantar-Zadeh, Steven J Jacobsen
PURPOSE: The early period after chronic kidney disease (CKD) patients transition to end-stage renal disease (ESRD) represents the highest mortality risk but is variable among different patient populations and clinical circumstances. We compared early mortality outcomes among a diverse CKD population that transitioned to ESRD. METHODS: A retrospective cohort study (1/1/2002 through 12/31/2013) of CKD patients (age ≥ 18 years) who transitioned to peritoneal dialysis (PD), hemodialysis (HD) with arteriovenous fistula/grafts, and HD with catheters was performed...
March 12, 2018: International Urology and Nephrology
Stacey A Fedewa, Ted Gansler, Robert Smith, Ann Goding Sauer, Richard Wender, Otis W Brawley, Ahmedin Jemal
PURPOSE: Previous studies report infrequent use of shared decision making for prostate-specific antigen (PSA) testing. It is unknown whether this pattern has changed recently considering increased emphasis on shared decision making in prostate cancer screening recommendations. Thus, the objective of this study is to examine recent changes in shared decision making. METHODS: We conducted a retrospective cross-sectional study among men aged 50 years and older in the United States using 2010 and 2015 National Health Interview Survey (NHIS) data (n = 9,598)...
March 2018: Annals of Family Medicine
Susan M Smith, Emma Wallace, Chris Salisbury, Maxime Sasseville, Elizabeth Bayliss, Martin Fortin
PURPOSE: We aimed to develop a consensus-based set of core outcomes specifically for studies in multimorbidity. METHODS: We undertook a consensus study following the COS-STAR (Core Outcome Set-STAndards for Reporting) guidelines for the design and reporting of core outcome sets. A Delphi panel of experts completed a web-based survey with 2 rounds. Panelists were presented with a range of outcomes that had been identified in previous workshops and a related systematic review...
March 2018: Annals of Family Medicine
Deanne Wong, Sebastian Morgan-Lynch
Patient portals enable people to access their health information electronically, but concerns about confidentiality and privacy breaches, particularly for young people, may be impeding portal adoption in New Zealand. This paper considers the legal and ethical framework relating to health information privacy and informed consent in New Zealand, and proposes an approach to implementing patient portals for young people. Shared portal access (where both a young person and their parent or guardian have access to the young person's portal) may be appropriate for young children whose parents or guardians are responsible for their health care...
December 2017: Journal of Primary Health Care
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