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Palliative Medicine Apr 2024Shared decision-making is a key element of person-centred care and promoted as the favoured model in preference-sensitive decision-making. Limitations to implementation... (Review)
Review
BACKGROUND
Shared decision-making is a key element of person-centred care and promoted as the favoured model in preference-sensitive decision-making. Limitations to implementation have been observed, and barriers and limitations, both generally and in the palliative setting, have been highlighted. More knowledge about the process of shared decision-making in palliative cancer care would assist in addressing these limitations.
AIM
To identify and synthesise qualitative data on how people with cancer, informal carers and healthcare professionals experience and perceive shared decision-making in palliative cancer care.
DESIGN
A systematic review and metasynthesis of qualitative studies. We analysed data using inductive thematic analysis.
DATA SOURCES
We searched five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus) from inception until June 2023, supplemented by backward searches.
RESULTS
We identified and included 23 studies, reported in 26 papers. Our analysis produced four analytical themes; (1) Overwhelming situation of 'no choice', (2) Processes vary depending on the timings and nature of the decisions involved, (3) Patient-physician dyad is central to decision-making, with surrounding support and (4) Level of involvement depends on interactions between individuals and systems.
CONCLUSION
Shared decision-making in palliative cancer care is a complex process of many decisions in a challenging, multifaceted and evolving situation where equipoise and choice are limited. Implications for practice: Implementing shared decision-making in clinical practice requires (1) clarifying conceptual confusion, (2) including members of the interprofessional team in the shared decision-making process and (3) adapting the approach to the ambiguous, existential situations which arise in palliative cancer care.
Topics: Humans; Physician-Patient Relations; Health Personnel; Caregivers; Palliative Care; Decision Making; Neoplasms
PubMed: 38481012
DOI: 10.1177/02692163241238384 -
Nursing Ethics Feb 2017Despite the growing body of knowledge about surrogate decision making, we know very little about the use of ethical frameworks (including ethical theories, principles,... (Review)
Review
BACKGROUND
Despite the growing body of knowledge about surrogate decision making, we know very little about the use of ethical frameworks (including ethical theories, principles, and concepts) to understand surrogates' day-to-day experiences in end-of-life care planning for incapacitated adults.
OBJECTIVES AND METHODS
This qualitative systematic review was conducted to identify the types of ethical frameworks used to address surrogates' experiences in end-of-life care planning for incapacitated adults as well as the most common themes or patterns found in surrogate decision-making research.
FINDINGS
Seven research papers explicitly identified ethical theories, principles, or concepts, such as autonomy, substituted judgment, and best interest standards as guidelines for the research. Surrogate decision making themes included the responsibilities and goals of being a surrogate, factors influencing surrogates' decision making, outcomes for surrogates, and an overarching theme of "wanting to do the right thing" for their loved one and/or themselves.
DISCUSSION
Understanding the complexity of surrogates' experiences of end-of-life care planning is beyond the scope of conventional ethical frameworks.
CONCLUSION
Ethical frameworks that address individuality and contextual variations related to decision making may more appropriately guide surrogate decision-making research that explores surrogates' end-of-life care planning experiences.
Topics: Decision Making; Ethics, Nursing; Family; Humans; Terminal Care
PubMed: 27005954
DOI: 10.1177/0969733016638145 -
Vaccine Jun 2021This systematic review and meta-analysis aimed to assess the effectiveness of vaccination decision aids compared with usual care on vaccine uptake, vaccine attitudes,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review and meta-analysis aimed to assess the effectiveness of vaccination decision aids compared with usual care on vaccine uptake, vaccine attitudes, decisional conflict, intent to vaccinate and timeliness.
METHODS
Searches were conducted in OVID Medline, OVID Embase, CINAHL, PsycINFO, the Cochrane Library and SCOPUS. Randomised controlled trials were included if they evaluated the impact of decision aids as defined by the International Patient Decision Aids Standards Collaboration. Where possible, meta-analysis was undertaken. Where meta-analysis was not possible, we conducted a narrative synthesis. Risk of bias in included trials was assessed using the Cochrane Collaboration's risk of bias tool. Data were analysed using STATA.
RESULTS
Five RCTs were identified that evaluated the effectiveness of decision aids in the context of vaccination decision making. Meta-analysis of four studies showed that decision aids may have slightly increased vaccination uptake, but this was reduced to no effect once studies with higher risk of bias were excluded. Meta-analysis of three studies showed that decision aids moderately increased intention to vaccinate. Narrative synthesis of two studies suggested that decision aids reduced decisional conflict. One study reported that decision aids decreased perceived risk of vaccination. Content, format and delivery method of the decision aids varied across the studies. It was not clear from the information reported whether these variations affected the effectiveness of the decision aids.
CONCLUSION
Decision aids can assist in vaccine decision making. Future studies of decision aids could provide greater detail of the decision aids themselves, which would enable comparison of the effectiveness of different elements and formats. Standardising decision aids would also allow for easier comparison between decision aids.
Topics: Decision Making; Decision Support Techniques; Humans; Reference Standards; Vaccination
PubMed: 34052064
DOI: 10.1016/j.vaccine.2021.05.021 -
Patient Education and Counseling Feb 20231) determine whether increased levels of Shared Decision-Making (SDM) affect consultation duration, 2) investigate the intervention characteristics involved. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
1) determine whether increased levels of Shared Decision-Making (SDM) affect consultation duration, 2) investigate the intervention characteristics involved.
METHODS
MEDLINE, EMBASE, CINAHL and Cochrane library were systematically searched for experimental and cross-sectional studies up to December 2021. A best-evidence synthesis was performed, and interventions characteristics that increased at least one SDM-outcome, were pooled and descriptively analyzed.
RESULTS
Sixty-three studies were selected: 28 randomized clinical trials, 8 quasi-experimental studies, and 27 cross-sectional studies. Overall, pooling of data was not possible due to substantial heterogeneity. No differences in consultation duration were found more often than increased or decreased durations. . Consultation times (minutes:seconds) were significantly increased only among interventions that: 1) targeted clinicians only (Mean Difference [MD] 1:30, 95% Confidence Interval [CI] 0:24-2:37); 2) were performed in primary care (MD 2:05, 95%CI 0:11-3:59; 3) used a group format (MD 2:25, 95%CI 0:45-4:05); 4) were not theory-based (MD 4:01, 95%CI 0:38-7:23).
CONCLUSION
Applying SDM does not necessarily require longer consultation durations. Theory-based, multilevel implementation approaches possibly lower the risk of increasing consultation durations.
PRACTICE IMPLICATIONS
The commonly heard concern that time hinders SDM implementation can be contradicted, but implementation demands multifaceted approaches and space for training and adapting work processes.
Topics: Humans; Cross-Sectional Studies; Patient Participation; Decision Making, Shared; Referral and Consultation
PubMed: 36434862
DOI: 10.1016/j.pec.2022.11.003 -
Journal of Geriatric Oncology Jul 2023Treatment decision-making in cancer is complex and many patients bring their caregiver to appointments to help them make those decisions. Multiple studies show the... (Review)
Review
INTRODUCTION
Treatment decision-making in cancer is complex and many patients bring their caregiver to appointments to help them make those decisions. Multiple studies show the importance of involving caregivers in the treatment decision-making process. We aimed to explore the preferred and actual involvement of caregivers in the decision-making process of patients with cancer and to see if there are age or cultural background related differences in caregiver involvement.
MATERIALS AND METHODS
A systematic review of Pubmed and Embase was performed on January 2, 2022. Studies containing numerical data regarding caregiver involvement were included, as were studies describing the agreement between patients and caregivers regarding treatment decisions. Studies assessing solely patients aged younger than 18 years old or terminally ill patients, and studies without extractable data were excluded. Risk of bias was assessed by two independent reviewers using an adapted version of the Newcastle-Ottawa scale. Results were analysed in two separate age groups, one <62 years and one ≥62 years.
RESULTS
Twenty-two studies with a total of 11,986 patients and 6,260 caregivers were included in this review. A median of 75% of patients preferred caregivers to be involved in decision-making and a median of 85% of caregivers preferred to be involved. With regards to age groups, the preferred involvement of caregivers was more frequent in the younger study populations. With regards to geographical differences, studies performed in Western countries showed a lower preference for caregiver's involvement compared to studies from Asian countries. A median of 72% of the patients reported the caregiver was actually involved in the treatment decision-making and a median of 78% of the caregivers reported they were actually involved. The most important role of caregivers was to listen and provide emotional support.
DISCUSSION
Patients and caregivers both want caregivers to be involved in the treatment decision-making process and most caregivers are actually involved. An ongoing dialogue between clinicians, patients and caregivers about decision-making is important to meet the individual patient's and caregiver's needs when involved in the decision-making process. Important limitations were a lack of studies in older patients and significant differences in outcome measures among studies.
Topics: Humans; Aged; Caregivers; Decision Making; Neoplasms
PubMed: 37198027
DOI: 10.1016/j.jgo.2023.101525 -
Child Abuse & Neglect Jan 2022Multi-professional approach to child protection decision making is widely promoted by service organisations, although the conditions for this to be effective are little... (Review)
Review
BACKGROUND
Multi-professional approach to child protection decision making is widely promoted by service organisations, although the conditions for this to be effective are little known.
OBJECTIVE
This systematic narrative literature review explored empirical evidence on the implementation of multi-professional child protection decision making in community settings. Of particular interest were the contextual conditions upon which joint working is build (inputs), aspects of interactional functioning (mediators), and the results of working together (outputs).
PARTICIPANTS AND SETTING
Five electronic bibliographic databases were selected for the search. The review was restricted to articles published in peer-reviewed journals, in the English language for ten years, from 1st January 2010 to 31st December 2019. Of the 6934 studies retrieved, 30 studies undertaken in six countries were included.
METHODS
The systematic approach to literature reviewing utilised was 'Systematic Narrative Review'. This approach starts with clearly formulated questions, employs systematic, explicit, and replicable processes for searching the literature to retrieve research, retains quality appraisal limited to publications in peer-reviewed journals, and uses a narrative synthesis.
RESULTS
The analysis outlined key building blocks that form the structure for collaborative decision making and identified cognitive, relational, and behavioural interactional properties that occur when making decisions together. Limitations of the published literature hinder the ability of making robust inferences about outcomes of collaborative decision-making practice.
CONCLUSION
The article discusses the next steps for research and implications for policy and practice for promoting useful multi-professional working in child protection decision making in the community.
Topics: Child; Decision Making; Family; Humans
PubMed: 34922154
DOI: 10.1016/j.chiabu.2021.105432 -
Patient Education and Counseling Feb 2022To assess the extent to which shared decision making (SDM) can take place in telemedicine (remote SDM). (Review)
Review
OBJECTIVES
To assess the extent to which shared decision making (SDM) can take place in telemedicine (remote SDM).
METHODS
We searched Medline, Cochrane, and Scopus from 2010 until August 7th, 2020 for articles on remote SDM in the care of any patient using any technology. We also conducted a search for telemedicine articles citing key reports on SDM outcome measures. Two reviewers independently screened titles and abstracts, reviewed full text eligible studies, and synthesized their content using thematic analysis.
RESULTS
Of the 12 eligible articles, most were European with patients with chronic disease or mental and behavioral health. 8 articles used synchronous remote SDM and 1 used asynchronous remote SDM. Themes related to interactional workability of both telemedicine technologies and SDM emerged, namely access to broadband, digital literacy, and satisfaction with the convenience of remote visits.
CONCLUSIONS
Telemedicine technologies may foster virtual interactions that support remote SDM, which, in turn, may promote productive patient-clinician interactions and patient-centered care.
PRACTICE IMPLICATIONS
Digitally-mediated consultations surged amidst the COVID-19 pandemic. The extent to which SDM frameworks developed for in-person use need any adaptation for remote SDM remains unclear. Investment in innovation, design, implementation, and effectiveness research to advance remote SDM are needed.
Topics: COVID-19; Decision Making; Decision Making, Shared; Humans; Pandemics; Patient Participation; SARS-CoV-2; Telemedicine
PubMed: 34147314
DOI: 10.1016/j.pec.2021.06.012 -
Journal of Clinical Nursing Aug 2023To examine the existing literature on child-parent-nurse relationships (in relation to communication, information, and involvement and decision-making) during... (Review)
Review
AIMS
To examine the existing literature on child-parent-nurse relationships (in relation to communication, information, and involvement and decision-making) during postoperative pain management.
BACKGROUND
Pain in children is under-reported and under-treated in hospitals and research has continued to report high rates of pain among hospitalised children worldwide. The role of child-parent-nurse relationships may be a factor and to date, no review has been identified that focus on these relationships during postoperative pain management.
DESIGN
A systematic scoping review following Arksey and O'Malley with further adaptations based on JBI.
METHODS
A systematic search for published primary studies was conducted using the Medline, CINAHL, British Nursing Index, ASSIA, PsycINFO, Science Direct and Web of Science in English from 2000 to 2022. Two reviewers independently carried out data screening and extraction and any differences were resolved with the assistance of a third reviewer. The data were analysed using thematic analysis and presented descriptively. This study followed the PRISMA-ScR Checklist.
RESULTS
A total of 37 studies met the inclusion criteria. The findings mainly demonstrated a focus on the perspectives of parents and nurses with less on children's perspectives and none of the studies explored child-nurse relationships. The findings were categorised under three themes: communication, information, and involvement and decision making.
CONCLUSION
A prevailing deficiency in child-parent-nurse relationships significantly contributed to suboptimal postoperative pain care, causing prolonged and untreated postoperative pain in children. Children's hesitation in communicating with nurses, the limited communication skills of nurses, and the weak communication position of parents in a hospital setting all hindered the development of strong relationships between children, parents, and nurses. The unclear definition of the roles of children and parents in postoperative pain management resulted in confusion for both parents and nurses. This was exacerbated by parents' lack of knowledge and inadequate guidance from nurses, ultimately leading to a decreased level of parental involvement in their child's postoperative pain management while in the hospital. Unattended requests for pain management caused children to experience prolonged pain and led to a deterioration in the relationship between parents and nurses, as well as a reduction in the parents' ability to provide pain care to their child.
RELEVANCE TO CLINICAL PRACTICE
This study highlights the reasons behind the suboptimal management of postoperative pain in children. The importance of the relationship between children, parents, and nurses in pain management must be acknowledged, and the results of this study may be used to inform improvements in nursing pain management practices.
NO PATIENT OR PUBLIC CONTRIBUTION
Patient or public contribution is not a necessary stage in a systematic scoping review following Arksey and O'Malley's framework.
Topics: Humans; Parent-Child Relations; Pain, Postoperative; Communication; Decision Making; Parents
PubMed: 36841960
DOI: 10.1111/jocn.16655 -
Implementation Science : IS Jul 2021Involving patients in their healthcare using shared decision-making (SDM) is promoted through policy and research, yet its implementation in routine practice remains... (Review)
Review
BACKGROUND
Involving patients in their healthcare using shared decision-making (SDM) is promoted through policy and research, yet its implementation in routine practice remains slow. Research into SDM has stemmed from primary and secondary care contexts, and research into the implementation of SDM in tertiary care settings has not been systematically reviewed. Furthermore, perspectives on SDM beyond those of patients and their treating clinicians may add insights into the implementation of SDM. This systematic review aimed to review literature exploring barriers and facilitators to implementing SDM in hospital settings from multiple stakeholder perspectives.
METHODS
The search strategy focused on peer-reviewed qualitative studies with the primary aim of identifying barriers and facilitators to implementing SDM in hospital (tertiary care) settings. Studies from the perspective of patients, clinicians, health service administrators, and decision makers, government policy makers, and other stakeholders (for example researchers) were eligible for inclusion. Reported qualitative results were mapped to the Theoretical Domains Framework (TDF) to identify behavioural barriers and facilitators to SDM.
RESULTS
Titles and abstracts of 8724 articles were screened and 520 were reviewed in full text. Fourteen articles met inclusion criteria. Most studies (n = 12) were conducted in the last four years; only four reported perspectives in addition to the patient-clinician dyad. In mapping results to the TDF, the dominant themes were Environmental Context and Resources, Social/Professional Role and Identity, Knowledge and Skills, and Beliefs about Capabilities. A wide range of barriers and facilitators across individual, organisational, and system levels were reported. Barriers specific to the hospital setting included noisy and busy ward environments and a lack of private spaces in which to conduct SDM conversations.
CONCLUSIONS
SDM implementation research in hospital settings appears to be a young field. Future research should build on studies examining perspectives beyond the clinician-patient dyad and further consider the role of organisational- and system-level factors. Organisations wishing to implement SDM in hospital settings should also consider factors specific to tertiary care settings in addition to addressing their organisational and individual SDM needs.
TRIAL REGISTRATION
The protocol for the review is registered on the Open Science Framework and can be found at https://osf.io/da645/ , DOI https://doi.org/10.17605/OSF.IO/DA645 .
Topics: Decision Making, Shared; Delivery of Health Care; Hospitals; Humans; Policy; Qualitative Research
PubMed: 34332601
DOI: 10.1186/s13012-021-01142-y -
Psychological Bulletin Jun 2021Visual attention is a fundamental aspect of most everyday decisions, and governments and companies spend vast resources competing for the attention of decision makers.... (Meta-Analysis)
Meta-Analysis
Visual attention is a fundamental aspect of most everyday decisions, and governments and companies spend vast resources competing for the attention of decision makers. In natural environments, choice options differ on a variety of visual factors, such as salience, position, or surface size. However, most decision theories ignore such visual factors, focusing on cognitive factors such as preferences as determinants of attention. To provide a systematic review of how the visual environment guides attention we meta-analyze 122 effect sizes on eye movements in decision making. A psychometric meta-analysis and Top10 sensitivity analysis show that visual factors play a similar or larger role than cognitive factors in determining attention. The visual factors that most influence attention are positioning information centrally, ρ = .43 (Top10 = .67), increasing the surface size, ρ = .35 (Top10 = .43), reducing the set size of competing information elements, ρ = .24 (Top10 = .24), and increasing visual salience, ρ = .13 (Top10 = .24). Cognitive factors include attending more to preferred choice options and attributes, ρ = .36 (Top10 = .31), effects of task instructions on attention, ρ = .35 (Top10 = .21), and attending more to the ultimately chosen option, ρ = .59 (Top10 = .26). Understanding real-world decision making will require the integration of both visual and cognitive factors in future theories of attention and decision making. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Topics: Choice Behavior; Decision Making; Eye Movements; Humans
PubMed: 34843300
DOI: 10.1037/bul0000328