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BMC Women's Health Oct 2022With increasing global availability of medication abortion drugs, a safer option exists for many women to terminate a pregnancy even in legally restrictive settings....
BACKGROUND
With increasing global availability of medication abortion drugs, a safer option exists for many women to terminate a pregnancy even in legally restrictive settings. However, more than 22,000 women die each year from unsafe abortion, most often in developing countries where abortion is highly legally restricted. We conducted a systematic review to compile existing evidence regarding factors that influence women's abortion-related decision making in countries where abortion is highly legally restricted.
METHODS
We searched ten databases in two languages (English and Spanish) for relevant literature published between 2000 and 2019 that address women's decision-making regarding when, where and how to terminate a pregnancy in sub-Saharan African, Latin American and the Caribbean countries where abortion is highly legally restricted.
RESULTS
We identified 46 articles that met the review's inclusion criteria. We found four primary factors that influenced women's abortion-related decision-making processes: (1) the role of knowledge, including of laws, methods and sources; (2) the role of safety, including medical, legal and social safety; (3) the role of social networks and the internet, and; (4) cost affordability and convenience.
CONCLUSIONS
The choices women make after deciding to terminate a pregnancy are shaped by myriad factors, particularly in contexts where abortion is highly legally restricted. Our review catalogued the predominant influences on these decisions of when, where and how to abort. More research is needed to better understand how these factors work in concert to best meet women's abortion needs to the full limit of the law and within a harm reduction framework for abortions outside of legal indications.
Topics: Abortion, Induced; Africa South of the Sahara; Decision Making; Ethnicity; Female; Humans; Latin America; Pregnancy
PubMed: 36217197
DOI: 10.1186/s12905-022-01962-0 -
The British Journal of Surgery Dec 2018Multiple treatment options are generally available for most diseases. Shared decision-making (SDM) helps patients and physicians choose the treatment option that best...
BACKGROUND
Multiple treatment options are generally available for most diseases. Shared decision-making (SDM) helps patients and physicians choose the treatment option that best fits a patient's preferences. This review aimed to assess the extent to which SDM is applied during surgical consultations, and the metrics used to measure SDM and SDM-related outcomes.
METHODS
This was a systematic review of observational studies and clinical trials that measured SDM during consultations in which surgery was a treatment option. Embase, MEDLINE and CENTRAL were searched. Study selection, quality assessment and data extraction were conducted by two investigators independently.
RESULTS
Thirty-two articles were included. SDM was measured using nine different metrics. Thirty-six per cent of 13 176 patients and surgeons perceived their consultation as SDM, as opposed to patient- or surgeon-driven. Surgeons more often perceived the decision-making process as SDM than patients (43·6 versus 29·3 per cent respectively). SDM levels scored objectively using the OPTION and Decision Analysis System for Oncology instruments ranged from 7 to 39 per cent. Subjective SDM levels as perceived by surgeons and patients ranged from 54 to 93 per cent. Patients experienced a higher level of SDM during consultations than surgeons (93 versus 84 per cent). Twenty-five different SDM-related outcomes were reported.
CONCLUSION
At present, SDM in surgery is still in its infancy, although surgeons and patients both think of it favourably. Future studies should evaluate the effect of new interventions to improve SDM during surgical consultations, and its assessment using available standardized and validated metrics.
Topics: Attitude of Health Personnel; Clinical Trials as Topic; Decision Making; Humans; Observational Studies as Topic; Observer Variation; Patient Participation; Physician-Patient Relations; Surgical Procedures, Operative
PubMed: 30357815
DOI: 10.1002/bjs.11009 -
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 -
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 -
Journal of Comparative Effectiveness... Nov 2017For comparative effectiveness research to be effective, patients and providers must collaborate in shared decision making (SDM) to make evidence-based clinical decisions... (Meta-Analysis)
Meta-Analysis
For comparative effectiveness research to be effective, patients and providers must collaborate in shared decision making (SDM) to make evidence-based clinical decisions that align with patient preferences. We conducted a systematic review to examine patient and provider attitudes toward and engagement in SDM in the USA. Searches in PubMed and PsycINFO identified 1585 articles published between July 2006 and December 2016, of which 290 were screened in for coding and analysis. We found that patients and providers have generally positive attitudes toward SDM, but actual engagement in SDM behavior is lagging. Translation of positive attitudes into behavior could be achieved through policies that support key SDM processes of sharing evidence, considering patient preferences and discussing the relative advantages of different clinical options.
Topics: Attitude of Health Personnel; Attitude to Health; Comparative Effectiveness Research; Decision Making; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Patient Preference
PubMed: 29148283
DOI: 10.2217/cer-2017-0045 -
Journal of the American Geriatrics... May 2012To determine to what extent current practice promotes the goals of individuals who did not designate a surrogate while competent with respect to decision-making during... (Review)
Review
OBJECTIVES
To determine to what extent current practice promotes the goals of individuals who did not designate a surrogate while competent with respect to decision-making during periods of decisional incapacity.
DESIGN
Systematic literature search for studies published in English and listed in PubMed, Scopus, Embase, CINAHL, or PsycINFO. Studies were eligible if they provided quantitative or qualitative empirical data on how adults want treatment decisions to be made for them during periods of incapacity.
SETTING
Primarily United States, with six other countries.
PARTICIPANTS
Fourteen qualitative articles, representing 11 distinct data sets, and 26 quantitative articles, representing 25 distinct data sets, providing data on the views of 22,828 individuals, met the inclusion criteria. Most of the respondents were elderly or seriously ill.
MEASUREMENTS
Quantitative surveys and qualitative interview studies assessing individuals' goals.
RESULTS
The majority wanted close family members to act as their surrogate. The most common reason for preferring family members was the belief that they know which treatments the patient would want. Individuals also wanted to reduce the burden on their families. There was significant variation in the extent to which respondents wanted their surrogates to have leeway when making treatment decisions.
CONCLUSION
Individuals have three primary goals with respect to making treatment decisions for them during periods of incapacity: involve their family, treat them consistently with their own treatment preferences, and reduce the burden on their family. Unfortunately, prior systematic reviews have found that family members often are not able to determine which treatment patients want, and family members frequently experience substantial distress when acting as surrogates. These findings suggest that current practice frequently fails to promote individuals' primary goals for treatment decision-making. Future research should evaluate ways to better promote individuals' goals. In the meantime, clinicians should be aware of these findings and should encourage patients to document their own goals, including their treatment preferences and their preferences regarding how they want decisions to be made for them during periods of decisional incapacity.
Topics: Advance Directives; Aged; Decision Making; Goals; Humans; Third-Party Consent
PubMed: 22469395
DOI: 10.1111/j.1532-5415.2012.03937.x -
American Journal of Men's Health 2022Sexual and reproductive health care (SRH) and family planning (FP) services have been primarily female centered. In recent decades, international groups have advocated...
Sexual and reproductive health care (SRH) and family planning (FP) services have been primarily female centered. In recent decades, international groups have advocated for men's involvement in SRH and FP, yet related research remains limited and implementation not fully realized in many countries. This systematic review of literature seeks to summarize the barriers and facilitators to men's involvement in SRH/FP services in the Philippines. It is limited to publications in English from 1994 to 2021 regarding studies conducted in the Philippines whose research questions focused on men's involvement in SRH/FP. Eligible studies were assessed for methodological quality using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Evidence Rating Scale. The Ecological Model for Health Promotion was used as the guiding theoretical framework for analysis and to report findings. Barriers and facilitators were identified at every ecological level except that of policy. The most common barrier identified was men's deficit in knowledge about SRH/FP; the most common facilitator was the positive influence of their social network on men's attitudes, beliefs, and practices pertaining to SRH/FP. A range of factors from the individual to the community level influenced men's involvement, including religious beliefs, economic means, and cultural gender roles. More studies are needed to provide a fuller understanding of the multilevel ecological factors influencing men's involvement in SRH/FP and inform interventions with men that can positively affect their behavior related to SRH/FP decision making.
Topics: Decision Making; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Men; Philippines; Reproductive Health
PubMed: 35815925
DOI: 10.1177/15579883221106052 -
Brain and Cognition Oct 2016The aims of this systematic review were to determine: (a) which brain areas are consistently more active when making (i) moral response decisions, defined as choosing a... (Meta-Analysis)
Meta-Analysis Review
The aims of this systematic review were to determine: (a) which brain areas are consistently more active when making (i) moral response decisions, defined as choosing a response to a moral dilemma, or deciding whether to accept a proposed solution, or (ii) moral evaluations, defined as judging the appropriateness of another's actions in a moral dilemma, rating moral statements as right or wrong, or identifying important moral issues; and (b) shared and significantly different activation patterns for these two types of moral judgements. A systematic search of the literature returned 28 experiments. Activation likelihood estimate analysis identified the brain areas commonly more active for moral response decisions and for moral evaluations. Conjunction analysis revealed shared activation for both types of moral judgement in the left middle temporal gyrus, cingulate gyrus, and medial frontal gyrus. Contrast analyses found no significant clusters of increased activation for the moral evaluations-moral response decisions contrast, but found that moral response decisions additionally activated the left and right middle temporal gyrus and the right precuneus. Making one's own moral decisions involves different brain areas compared to judging the moral actions of others, implying that these judgements may involve different processes.
Topics: Cerebral Cortex; Decision Making; Humans; Morals
PubMed: 27566002
DOI: 10.1016/j.bandc.2016.07.007 -
International Journal of Environmental... Jan 2020The question of how games should be taught is still a controversial subject. There has been a growing number of studies on teaching games and coaching sports since the... (Meta-Analysis)
Meta-Analysis
The question of how games should be taught is still a controversial subject. There has been a growing number of studies on teaching games and coaching sports since the first publication of Bunker and Thorpe on Teaching Games for Understanding (TGfU). In this sense, the present systematic review and meta-analysis aimed to systematically review the scientific literature about the effects of technical and tactical approach interventions on skill execution and decision making, and to examine the influence of the teacher/coach management style. A systematic literature search was carried out in accordance with PRISMA guidelines in Web of Science (WOS), PubMed (Medline), Scopus, and SportDiscus electronic databases. A total of seven and six studies were deemed to meet the inclusion criteria for decision making and skill execution, respectively. Meta-analysis results showed that tactical interventions achieved significant improvements in decision making (effect size = 0.89 with 95% confidence interval (CI) from 0.12 to 1.65), but they did not show significant improvements in skill execution (effect size = 0.89 with 95% CI from -0.45 to 2.23) compared to technical approaches. However, the heterogeneity of interventions was large and the quality of evidence was low according to GRADE. In conclusion, tactical approaches are recommended to teach games and sports in order to develop technique, understanding, tactical knowledge, and decision making, which are demanded in game play. These findings could be useful for teachers and coaches to improve these aspects of their players and students.
Topics: Athletic Performance; Decision Making; Games, Recreational; Humans; Motor Skills; Randomized Controlled Trials as Topic; Sports
PubMed: 31941138
DOI: 10.3390/ijerph17020505 -
BMJ Open Jan 2023Epilepsy treatment decision making is complex and understanding what informs caregiver decision making about treatment for childhood epilepsy is crucial to better...
OBJECTIVES
Epilepsy treatment decision making is complex and understanding what informs caregiver decision making about treatment for childhood epilepsy is crucial to better support caregivers and their children. We synthesised evidence on caregivers' perspectives and experiences of treatments for childhood epilepsy.
DESIGN
Systematic review of qualitative studies using a best-fit framework and Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach.
DATA SOURCES
Searched Embase, PubMed, CINAHL, PsycINFO, SocINDEX and Web of Science from 1 January 1999 to 19 August 2021.
ELIGIBILITY CRITERIA
We included qualitative studies examining caregiver's perspectives on antiseizure medication, diet or surgical treatments for childhood epilepsy. We excluded studies not reported in English.
DATA EXTRACTION AND SYNTHESIS
We extracted qualitative evidence into 1 of 14 domains defined by the Theoretical Domains Framework (TDF). One reviewer extracted study data and methodological characteristics, and two reviewers extracted qualitative findings. The team verified all extractions. We identified themes within TDF domains and synthesised summary statements of these themes. We assessed our confidence in our summary statements using GRADE-CERQual.
RESULTS
We identified five studies (in six reports) of good methodological quality focused on parent perceptions of neurosurgery; we found limited indirect evidence on parents' perceptions of medications or diet. We identified themes within 6 of the 14 TDF domains relevant to treatment decisions: knowledge, emotion; social/professional role and identity; social influence; beliefs about consequences; and environmental context and resources.
CONCLUSIONS
Parents of children with epilepsy navigate a complex process to decide whether to have their child undergo surgery. Educational resources, peer support and patient navigators may help support parents through this process. More qualitative studies are needed on non-surgical treatments for epilepsy and among caregivers from different cultural and socioeconomic backgrounds to fully understand the diversity of perspectives that informs treatment decision making.
Topics: Child; Humans; Emotions; Epilepsy; Knowledge; Parents; Decision Making
PubMed: 36720580
DOI: 10.1136/bmjopen-2022-066872