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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 -
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 -
Resuscitation Nov 2019During resuscitation decisions are made frequently and based on limited information in a stressful environment.
BACKGROUND
During resuscitation decisions are made frequently and based on limited information in a stressful environment.
AIM
This systematic review aimed to identify human factors affecting decision-making in challenging or stressful situations in resuscitation. The secondary aim was to identify methods of improving decision-making performance under stress.
METHODS
The databases PubMed, EMBASE and The Cochrane Library were searched from their commencement to the 13th of April 2019. MeSH terms and key words were combined (Stress* OR "human factor") AND Decision. Articles were included if they involved decision makers in medicine where decisions were made under challenging circumstances, with a comparator group and an outcome measure relating to change in decision-making performance.
RESULTS
22,368 records in total were initially identified, from which 82 full text studies were reviewed and 16 finally included. The included studies ranged from 1995 to 2018 and included a total of 570 participants. The studies were conducted in several different countries and settings, with participants of varying experience and backgrounds. Of the 16 studies, 5 were randomised controlled trials, 3 of which were deemed to have a high risk of bias. The stressors identified were (i) illness severity (ii) socio-evaluative, (iii) noise, (iv) fatigue. The mitigators identified were (i) cognitive aids including checklists, (ii) stress management training and (iii) meditation.
CONCLUSIONS
Human factors contributing to decision-making during resuscitation are identified and can be mitigated by tailored stress training and cognitive aids. Understanding these factors may have implications for clinician education and the development of decision-support tools.
Topics: Cardiopulmonary Resuscitation; Decision Making; Decision Support Techniques; Humans; Injury Severity Score; Severity of Illness Index; Stress, Psychological
PubMed: 31562904
DOI: 10.1016/j.resuscitation.2019.09.023 -
BMC Women's Health Dec 2023Although there are calls for women's empowerment and gender equity globally, there are still large disparities regarding women's autonomy in healthcare decision making....
OBJECTIVES
Although there are calls for women's empowerment and gender equity globally, there are still large disparities regarding women's autonomy in healthcare decision making. The autonomy of women is believed to be crucial in improving their health-related outcomes. This review discusses factors that influence autonomy among women in healthcare decision making.
DESIGN
Systematic review.
DATA SOURCES
PubMed, Web of Science and Scopus were searched from 2017-2022.
ELIGIBILITY CRITERIA
The inclusion criteria include original articles, case studies and reports that has been written in the English Language, while manuscripts with no full article, reviews, newspaper reports, grey literatures, and articles that did not answer the review objectives were excluded.
DATA EXTRACTION AND SYNTHESIS
We carried out data extraction using a standardized data extraction form, that has been organized using Microsoft Excel. A narrative synthesis was carried out to combine the findings of all included articles.
RESULTS
A total of 70 records were identified and 18 were reviewed, yielding eight articles to be included in the accepted list of studies. All studies were conducted in developing countries and most of the studies were cross sectional. Factors that were associated with women's autonomy in healthcare decision making were age, women's education and occupation, husbands'/partners' education and occupation, residential location or region of residence, household wealth index as well as culture and religion.
CONCLUSIONS
Identification of these factors may help stakeholders in improving women's autonomy in healthcare decision making. Policymakers play a crucial role in healthcare decision making by enacting laws and policies that protect women's rights, promoting gender-sensitive healthcare services, ensuring access to comprehensive information, promoting health education, and supporting vulnerable populations. These efforts ensure women's autonomy including able to access to unbiased and effective healthcare services.
Topics: Female; Humans; Women's Rights; Socioeconomic Factors; Gender Identity; Decision Making; Delivery of Health Care; Personal Autonomy
PubMed: 38042837
DOI: 10.1186/s12905-023-02792-4 -
Health Expectations : An International... Jun 2023In cancer care, the promotion and implementation of shared decision-making in clinical practice guidelines (CPG) and consensus statements may have potential differences... (Review)
Review
BACKGROUND
In cancer care, the promotion and implementation of shared decision-making in clinical practice guidelines (CPG) and consensus statements may have potential differences by gender.
OBJECTIVE
To systematically analyse recommendations concerning shared decision-making in CPGs and consensus statements for the most frequent cancers exclusively among males (prostate) and females (endometrial).
SEARCH STRATEGY
We prospectively registered the protocol at PROSPERO (ID: RD42021241127). MEDLINE, EMBASE, Web of Science, Scopus and online sources (8 guideline databases and 65 professional society websites) were searched independently by two reviewers, without language restrictions.
INCLUSION CRITERIA
CPGs and consensus statements about the diagnosis or treatment of prostate and endometrial cancers were included from January 2015 to August 2021.
DATA EXTRACTION AND SYNTHESIS
Quality assessment deployed a previously developed 31-item tool and differences between the two cancers analysed.
MAIN RESULTS
A total of 176 documents met inclusion criteria, 97 for prostate cancer (84 CPGs and 13 consensus statements) and 79 for endometrial cancer (67 CPGs and 12 consensus statements). Shared decision-making was recommended more often in prostate cancer guidelines compared to endometrial cancer (46/97 vs. 13/79, 47.4% vs. 16.5%; p < .001). Compared to prostate cancer guidelines (mean 2.14 items, standard deviation 3.45), compliance with the shared-decision-making 31-item tool was lower for endometrial cancer guidelines (mean 0.48 items, standard deviation 1.29) (p < .001). Regarding advice on the implementation of shared decision-making, it was only reported in 3 (3.8%) endometrial cancer guidelines and in 16 (16.5%) prostate cancer guidelines (p < .001).
DISCUSSION AND CONCLUSIONS
We observed a significant gender bias as shared decision-making was systematically more often recommended in the prostate compared to endometrial cancer guidelines. These findings should encourage new CPGs and consensus statements to consider shared decision-making for improving cancer care regardless of the gender affected.
PATIENT OR PUBLIC CONTRIBUTION
The findings may inform future recommendations for professional associations and governments to update and develop high-quality clinical guidelines to consider patients' preferences and shared decision-making in cancer care.
Topics: Humans; Male; Sexism; Decision Making, Shared; Consensus; Endometrial Neoplasms; Prostatic Neoplasms
PubMed: 37016907
DOI: 10.1111/hex.13753 -
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 -
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 -
Patient Education and Counseling May 2023The purpose of this review is to explore the breadth of research conducted on SDM in the care of Black patients. (Review)
Review
OBJECTIVE
The purpose of this review is to explore the breadth of research conducted on SDM in the care of Black patients.
METHODS
We conducted a scoping review following the methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We searched articles related to original research on SDM in the care of Black patients in October 2022 using PubMed, Embase, and Google Scholar databases. Articles of all study designs (quantitative and qualitative), published or translated into English, were included. A standardized data extraction form and thematic analysis were used to facilitate data extraction by two independent reviewers.
RESULTS
After removal of duplicates and screening, 30 articles were included in the final analysis. Black patients and clinician were found to not share the same understanding of SDM, and patients highly valued SDM in their care. Interventions to improve SDM yielded mixed results to enhance intent, participation in SDM, as well as health outcomes. Decision aids were the most effective form of intervention to enhance SDM. The most common barrier to SDM was patient-clinician communication, and was exacerbated by racial discordance, clinician mistrust, past experiences, and paternalistic clinician-patient dynamics.
CONCLUSIONS
SDM has the potential to improve health outcomes in Black patients when implemented contextually within Black patients' experiences and concerns. Significant barriers such as clinician mistrust exist, and the overall perception in the Black community is that SDM does not occur sufficiently. Barriers to SDM seem to be most pronounced when there is patient-clinician racial discordance. Several interventions aimed at improving SDM with Black patients have shown mixed results. Future studies should evaluate larger-scale interventions with longer follow-up. Practice implications Shared decision making (SDM) has been proposed as a useful tool for improving quality and equity in Black patients' care. However, Black patients experience lower rates of SDM compared to other populations. SDM has the potential to improve health outcomes in Black patients when implemented contextually within Black patients' experiences and concerns.
Topics: Humans; Decision Making, Shared; Decision Making; Patient Participation; Black People; Communication
PubMed: 36739706
DOI: 10.1016/j.pec.2023.107646 -
International Journal of Environmental... May 2020The aim of this systematic review conducted in the topic of youth team-sports players was three-fold: (i) Analyze the variations of decision-making processes between...
The aim of this systematic review conducted in the topic of youth team-sports players was three-fold: (i) Analyze the variations of decision-making processes between low- and high-level youth players; (ii) analyze the variations of decision-making processes between different age groups; and (iii) analyze the effects of decision-making training-based programs on youth players. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, this systematic review searched for studies on PubMed, ScienceDirect, Academic Search Complete, SPORTDiscus, and Taylor & Francis Online. The search returned 6215 papers. After screening the records against set criteria, 26 articles were fully reviewed. From the included studies, 9 were focused on comparing the decision-making process between low- and high-level players, 6 compared the decisions made by players from different age categories, and 11 analyzed the effects of decision-making-based training programs on youth players. Comparisons between high- and low-level players suggested that high-level and most talented players present a greater accuracy in the cognitive and executive answers to the game as well as being more adjustable to more complex situations. Considering the comparisons between age groups, a tendency of older players to execute more accurate decisions in the game and to have better tactical knowledge and behavior was observed. Finally, the effects of decision-making training programs suggest a beneficial effect employing practical scenarios (mainly based on small-sided and conditioned games), primarily improving passing decisions and execution. However, the benefits of interventions using videos are not clear.
Topics: Adolescent; Athletic Performance; Child; Decision Making; Humans; Youth Sports
PubMed: 32471126
DOI: 10.3390/ijerph17113803 -
Patient Education and Counseling Jan 2023To identify decision characteristics for which SDM authors deem SDM appropriate or not, and what arguments are used. (Review)
Review
OBJECTIVE
To identify decision characteristics for which SDM authors deem SDM appropriate or not, and what arguments are used.
METHODS
We applied two search strategies: we included SDM models from an earlier review (strategy 1) and conducted a new search in eight databases to include papers other than describing an SDM model, such as original research, opinion papers and reviews (strategy 2).
RESULTS
From the 92 included papers, we identified 18 decision characteristics for which authors deemed SDM appropriate, including preference-sensitive, equipoise and decisions where patient commitment is needed in implementing the decision. SDM authors indicated limits to SDM, especially when there are immediate life-saving measures needed. We identified four decision characteristics on which authors of different papers disagreed on whether or not SDM is appropriate.
CONCLUSION
The findings of this review show the broad range of decision characteristics for which authors deem SDM appropriate, the ambiguity of some, and potential limits of SDM.
PRACTICE IMPLICATIONS
The findings can stimulate clinicians to (re)consider pursuing SDM in situations in which they did not before. Additionally, it can inform SDM campaigns and educational programs as it shows for which decision situations SDM might be more or less challenging to practice.
Topics: Humans; Decision Making, Shared; Patient Participation; Decision Making; Databases, Factual
PubMed: 36220675
DOI: 10.1016/j.pec.2022.09.015