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European Respiratory Review : An... Sep 2023Recent decades have seen an increase in children receiving long-term ventilation. To ensure that long-term ventilation decisions incorporate the perspectives of... (Review)
Review
INTRODUCTION
Recent decades have seen an increase in children receiving long-term ventilation. To ensure that long-term ventilation decisions incorporate the perspectives of stakeholders, it is vital that empirical evidence is gathered to substantiate frameworks and guidance on shared decision-making for long-term ventilation. This systematic review and qualitative evidence synthesis aimed to clarify what shared decision-making constitutes in relation to long-term ventilation initiation for children and young people (<21 years).
METHODS
A systematic review of qualitative research was undertaken. Searches were conducted in MEDLINE, Embase, CINAHL, PsycINFO and Web of Science.
RESULTS
Findings from 13 studies were included representative of 363 caregivers and 143 healthcare professional experiences. Components that support shared decision-making included acknowledging the unique positionality of caregivers and ensuring caregivers were informed about the implications of long-term ventilation. Beneficial qualities of engagement between stakeholders included honest, clear and timely dialogue using lay, tactful and sensitive language.
CONCLUSION
Our findings clarify components and approaches supportive of shared decision-making in discussions about long-term ventilation. This review therefore provides a valuable resource to implement shared decision-making practices in the context of long-term ventilation decisions for children and young people.
Topics: Child; Humans; Adolescent; Respiration; Health Personnel
PubMed: 37611948
DOI: 10.1183/16000617.0098-2023 -
BMC Medical Ethics Aug 2023Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts that can be translated in communication tools to aid the...
BACKGROUND AND AIMS
Shared decision making (SDM) and advance care planning (ACP) are important evidence and ethics based concepts that can be translated in communication tools to aid the treatment decision-making process. Although both have been recommended in the care of patients with risks of complications, they have not yet been described as two components of one single process. In this paper we aim to (1) assess how SDM and ACP is being applied, choosing patients with aortic stenosis with high and moderate treatment complication risks such as bleeding or stroke as an example, and (2) propose a model to best combine the two concepts and integrate them in the care process.
METHODS
In order to assess how SDM and ACP is applied in usual care, we have performed a systematic literature review. The included studies have been analysed by means of thematic analysis as well as abductive reasoning to determine which SDM and ACP steps are applied as well as to propose a model of combining the two concepts into one process.
RESULTS
The search in Medline, Cinahl, Embase, Scopus, Web of science, Psychinfo and Cochrane revealed 15 studies. Eleven describe various steps of SDM while four studies discuss the documentation of goals of care. Based on the review results and existing evidence we propose a model that combines SDM and ACP in one process for a complete patient informed choice.
CONCLUSION
To be able to make informed choices about immediate and future care, patients should be engaged in both SDM and ACP decision-making processes. This allows for an iterative process in which each important decision-maker can share their expertise and concerns regarding the care planning and advance care planning. This would help to better structure and prioritize information while creating a trustful and respectful relationship between the participants. PROSPERO 2019. CRD42019124575.
Topics: Humans; Decision Making; Decision Making, Shared; Advance Care Planning; Records; Documentation; Patient Participation
PubMed: 37580704
DOI: 10.1186/s12910-023-00944-7 -
European Urology Oncology Oct 2023Treatment choice for localised prostate cancer remains a significant challenge for patients and clinicians, with uncertainty over decisions potentially leading to... (Review)
Review
CONTEXT
Treatment choice for localised prostate cancer remains a significant challenge for patients and clinicians, with uncertainty over decisions potentially leading to conflict and regret. There is a need to further understand the prevalence and prognostic factors of decision regret to improve patient quality of life.
OBJECTIVE
To generate the best estimates for the prevalence of significant decision regret localised prostate cancer patients, and to investigate prognostic patient, oncological, and treatment factors associated with regret.
EVIDENCE ACQUISITION
We performed a systematic search of MEDLINE, Embase, and PsychINFO databases including studies evaluating the prevalence or patient, treatment, or oncological prognostic factors in localised prostate cancer patients. A pooled prevalence of significant regret was calculated with the formal prognostic factor evaluation conducted per factor identified.
EVIDENCE SYNTHESIS
Significant decision regret was present in a pooled 20% (95% confidence interval 16-23) of patients across 14 studies and 17883 patients. This was lower in active surveillance (13%), with little difference between those who underwent radiotherapy (19%) and those who underwent prostatectomy (18%). Evaluation of individual prognostic factors demonstrated higher regret in those with poorer post-treatment bowel, sexual, and urinary function; decreased involvement in the decision-making process; and Black ethnicity. However, evidence remains conflicting, with low or moderate certainty of findings.
CONCLUSIONS
A significant proportion of men experience decision regret after a localised prostate cancer diagnosis. Monitoring those with increased functional symptoms and improving patient involvement in the decision-making process through education and decision aids may reduce regret.
PATIENT SUMMARY
We looked at how common regret in treatment decisions is after treatment for early-stage prostate cancer and factors linked with this. We found that one in five regret their decision, with those who had experienced side effects or were less involved in the decision-making process more likely to have regret. By addressing these, clinicians could reduce regret and improve quality of life.
PubMed: 36870852
DOI: 10.1016/j.euo.2023.02.005 -
Heliyon Oct 2023A strong aptitude for making sound decisions on a farm is closely linked to favorable farm outcomes, and this finding has been observed across diverse types of farm... (Review)
Review
A strong aptitude for making sound decisions on a farm is closely linked to favorable farm outcomes, and this finding has been observed across diverse types of farm businesses and geographic locations. Traditionally, research in farm management has addressed the drivers of decision-making and performance as separate entities; however, this article presents novel evidence on the relationship between farmers' decision-making and farm performance. We also examine this association in various contexts of farm decision-making, spanning the past decade. Our comprehensive review encompasses 24 empirical studies conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The analysis focuses on research topics, performance measures, and methodological perspectives. The findings reveal seven key research topics: farmers' management capacity; the influence of management and farm structure; farmers' emotional attachment to their businesses; personal aspects, farm characteristics, and institutional settings; the significance of farm recordkeeping; joint decisions in farm decision-making processes; and rational inefficiencies in farm decisions. Most studies employed conventional farm performance measures, including financial indicators, technical efficiency, and productivity indicators. Existing studies have predominantly used quantitative methodologies. We also identified research gaps and provide suggestions for future investigations in this field. Our results underscore the pivotal role of decision-making ability in shaping farmers' managerial capacity and, consequently, farm performance.
PubMed: 37867840
DOI: 10.1016/j.heliyon.2023.e20820 -
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 -
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 -
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 -
Psychiatry Research Aug 2023We developed and tested a Bayesian network(BN) model to predict ECT remission for depression, with non-response as a secondary outcome.
INTRODUCTION
We developed and tested a Bayesian network(BN) model to predict ECT remission for depression, with non-response as a secondary outcome.
METHODS
We performed a systematic literature search on clinically available predictors. We combined these predictors with variables from a dataset of clinical ECT trajectories (performed in the University Medical Center Utrecht) to create priors and train the BN. Temporal validation was performed in an independent sample.
RESULTS
The systematic literature search yielded three meta-analyses, which provided prior knowledge on outcome predictors. The clinical dataset consisted of 248 treatment trajectories in the training set and 44 trajectories in the test set at the same medical center. The AUC for the primary outcome remission estimated on an independent validation set was 0.686 (95%CI 0.513-0.859) (AUC values of 0.505 - 0.763 observed in 5-fold cross validation of the model within the train set). Accuracy 0.73 (balanced accuracy 0.67), sensitivity 0.55, specificity 0.79, after temporal validation in the independent sample. Prior literature information marginally reduced CI width.
DISCUSSION
A BN model comprised of prior knowledge and clinical data can predict remission of depression after ECT with reasonable performance. This approach can be used to make outcome predictions in psychiatry, and offers a methodological framework to weigh additional information, such as patient characteristics, symptoms and biomarkers. In time, it may be used to improve shared decision-making in clinical practice.
Topics: Humans; Electroconvulsive Therapy; Depression; Bayes Theorem; Prognosis; Biomarkers; Treatment Outcome
PubMed: 37429173
DOI: 10.1016/j.psychres.2023.115328 -
Journal of Clinical Nursing Sep 2023To examine and consolidate literature on the experiences and decision-making of parents following a screen positive result for a potential fetal anomaly and/or diagnosis... (Review)
Review
AIMS AND OBJECTIVES
To examine and consolidate literature on the experiences and decision-making of parents following a screen positive result for a potential fetal anomaly and/or diagnosis of an actual anomaly in a previous pregnancy.
BACKGROUND
Prenatal screening consists of any diagnostic modality that is aimed at acquiring information about a fetus or an embryo; however, the entire process is highly stressful for parents, especially if there was a previous screen positive result, but no abnormality was detected in the final result.
METHODS
Eight electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus, Web of Science, ProQuest Theses and Dissertations and ClinicalTrials.gov) were searched from each database's inception until February 2022. This scoping review was guided by Arksey and O'Malley's framework and was reported in accordance with the PRISMA-ScR checklist. Braun and Clarke's thematic analysis framework was utilised.
RESULTS
Thirty-one studies were eligible for inclusion. Two main themes (reliving the fear while maintaining hope, and bridging the past and future pregnancies) and six subthemes were identified.
CONCLUSIONS
A fetal anomaly diagnosis in pregnancy had a mixed impact on the attitudes of parents toward a future pregnancy. Some parents were fearful of reliving a traumatic experience, while others were determined to have a healthy child and grow their family. Parents generally expressed a greater preference for non-invasive over invasive prenatal testing due to the procedural risks involved.
RELEVANCE TO CLINICAL PRACTICE
There is a need for healthcare professionals to provide psychosocial and emotional support to parents so that they can achieve resolution for their previous pregnancy. Healthcare professionals' ability to provide informational support also enables these parents to make informed decision and understand their reproductive outcomes. Additionally, healthcare administration and policymakers should reconsider current neonatal or pregnancy loss bereavement guidelines to improve the inclusivity of fathers.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Abortion, Induced; Forecasting; Parents; Prenatal Diagnosis; Reproduction
PubMed: 36707923
DOI: 10.1111/jocn.16628 -
PloS One 2023Decision Avoidance (DA) strategies allow people to forego or abandon effortful deliberation by postponing, bypassing, or delegating a decision. DA is thought to reduce... (Meta-Analysis)
Meta-Analysis
Decision Avoidance (DA) strategies allow people to forego or abandon effortful deliberation by postponing, bypassing, or delegating a decision. DA is thought to reduce regret, primarily by allowing decision makers to evade personal responsibility for potential negative outcomes. We tested this relation between DA and post-decision regret in a multilevel meta-analysis of 59 effect estimates coming from 13 papers. Five DA strategies were considered: status quo preservation, action omission, inaction inertia, choice delegation and choice deferral. Across all effects and DA strategies, there was a non-significant trend toward DA reducing regret (Hedges' g = -0.23, p = 0.063). When assessing individual strategies, we found that only status quo preservation reduced regret reliably (Hedges' g = -0.45, p = 0.006). The relationship between DA and regret was unclear for the other DA strategies. We tested a number of moderators for the effect. Only 'previous experience' (i.e., the outcome of a previous decision) influenced the relation between DA and regret reliably. That is, if participants choose the DA option when the same choice previously led to a negative outcome, regret is actually enhanced. Overall, there is clear evidence that status quo preservation can reduce regret, but it is currently unclear whether the same holds for other DA strategies.
Topics: Humans; Decision Making; Emotions; Social Behavior; Apathy; Surveys and Questionnaires
PubMed: 37831709
DOI: 10.1371/journal.pone.0292857