scholarly journals “What is the right decision for me?” Integrating patient perspectives through shared decision-making for valvular heart disease therapy

2021 ◽  
Author(s):  
Sandra B. Lauck ◽  
Krystina B. Lewis ◽  
Britt Borregaard ◽  
Ismalia de Sousa
Keyword(s):  
Decision Making ◽  
Heart Disease ◽  
Shared Decision Making ◽  
Valvular Heart Disease ◽  
Patient Perspectives ◽  
Shared Decision ◽  
Disease Therapy ◽  
The Right

Prudence in Shared Decision-Making: The Missing Link between the “Technically Correct” and the “Morally Good” in Medical Decision-Making

2020 ◽  
Author(s):  
Paul Muleli Kioko ◽  
Pablo Requena Meana
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Intellectual Ability ◽  
Medical Decision ◽  
Shared Decision ◽  
Physician Patient Relationship ◽  
Good Healing ◽  
The Right ◽  
Physician Patient

Abstract Shared Decision-Making is a widely accepted model of the physician–patient relationship providing an ethical environment in which physician beneficence and patient autonomy are respected. It acknowledges the moral responsibility of physician and patient by promoting a deliberative collaboration in which their individual expertise—complementary in nature, equal in importance—is emphasized, and personal values and preferences respected. Its goal coincides with Pellegrino and Thomasma’s proximate end of medicine, that is, a technically correct and morally good healing decision for and with a particular patient. We argue that by perfecting the intellectual ability to apprehend the complexity of clinical situations, and through a perfection of the application of the first principles of practical reason, prudence is able to point toward the right and good shared medical decision. A prudent shared medical decision is therefore always in keeping with the kind of person the physician and the patient have chosen to be.

Co-Design of an Electronic Dashboard to Support Coproduction of Care in Pediatric Rheumatic Disease (Preprint)

2021 ◽  
Author(s):  
Alysha Taxter ◽  
Lisa Johnson ◽  
Doreen Tabussi ◽  
Yukiko Kimura ◽  
Brittany Donaldson ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Clinical Data ◽  
The United States ◽  
Shared Decision ◽  
Time Data ◽  
Vertical Orientation ◽  
Patient Reported ◽  
Data Elements ◽  
The Right

BACKGROUND Coproduction of care involves patients and families partnering with their clinicians and care teams, with the premise that each brings their own perspective, knowledge, and expertise, as well as their own values, goals, and preferences to the partnership. Dashboards can display meaningful patient and clinical data to assess how a patient is doing and inform shared decision making. Increasing communication between patients and care teams is particularly important for children with chronic conditions, such as juvenile idiopathic arthritis (JIA), which is the most common, chronic rheumatic condition of childhood, and is associated with increased pain, decreased function, and decreased quality of life. OBJECTIVE We aimed to design a dashboard prototype for use in coproducing care for JIA patients. We evaluated the context use and needs of end users, obtained consensus on the necessary dashboard data elements, and constructed display prototypes to inform meaningful discussions for coproduction. METHODS A human-centered design approach involving parents, patients, clinicians, and care team members was used to develop a dashboard to support coproduction of care in four diverse ambulatory pediatric rheumatology clinics across the United States. We engaged a multidisciplinary team (n=18) of patients/parents, clinicians, nurses, and staff during an in-person kick-off meeting, followed by bi-weekly meetings. We also leveraged advisory panels. Teams mapped workflows and patient journeys, created personas, and developed dashboard sketches. Final necessary dashboard components were determined using Delphi consensus voting. Low-tech dashboard testing was completed during clinic visits, and visual display prototypes were iterated using PDSA methodology. Patients and providers were surveyed about their experiences. RESULTS Teams achieved consensus on what data matters most at point-of-care to support JIA patients, families, and clinicians partnering together to make the best possible decisions for better health. Notable themes included: the right data, in the right place, at the right time; data in once for multiple purposes; patient and family self-management components; and opportunity for education and increased transparency. A final set of 11 dashboard data elements were identified which include patient-reported outcomes, clinical data, and medications. Important design considerations include incorporation of real-time data, clearly labeled graphs, and vertical orientation to facilitate review and discussion. Prototype paper testing with 36 patients/families yielded positive feedback about the dashboard’s usefulness during clinic discussions, helped to talk about what mattered most, and informed healthcare decision making. CONCLUSIONS Our study developed a dashboard prototype that displays patient-reported and clinical data over time, along with medications, that can be used during a clinic visit to support meaningful conversations and shared decision making between JIA patients/families and their clinicians and care teams. CLINICALTRIAL N/A

Communicating shared decision-making: Cancer patient perspectives

2013 ◽  
Vol 90 (3) ◽  
pp. 291-296 ◽  
Author(s):  
Sally Thorne ◽  
John L. Oliffe ◽  
Kelli I. Stajduhar
Keyword(s):  
Decision Making ◽  
Cancer Patient ◽  
Shared Decision Making ◽  
Patient Perspectives ◽  
Shared Decision

Abstract 162: Does a Telehealth “Virtual Consult” Including Referring Physicians, Specialist Physicians and Patients Increase Shared Decision Making for Patients With Heart Disease?

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Megan Coylewright ◽  
Ariel Sherman ◽  
Stuart W Grande ◽  
Keren Xu ◽  
John Kirk ◽  
...  
Keyword(s):  
Decision Making ◽  
Heart Disease ◽  
Shared Decision Making ◽  
Decisional Conflict ◽  
Fisher Exact Test ◽  
Shared Decision ◽  
Specialist Physician ◽  
Referring Physicians ◽  
The Impact ◽  
Strong Agreement

Background: Shared decision making (SDM) is highly recommended but difficult to implement for patients with severe heart disease referred for cardiac intervention. This study utilized telehealth (TH) to bring referring physicians and their patients together with a specialist physician to exchange treatment options and patient preferences via a triadic “virtual consult”. This study explores the impact of this innovative approach on SDM and patient decisional conflict. Methods: Two cohorts were included: usual care (UC) and TH. UC patients were seen in a clinic with one of 4 participating physicians, and visits were recorded. Telehealth patients met with their local referring physician in the office, and connected remotely with the specialist physician. One of two decision aids (DA) was used: HealthDecision, an electronic health record-integrated DA for atrial fibrillation, or AS Choice, a paper-based DA for severe aortic stenosis. Patient characteristics were collected via surveys. SDM was measured via Observer OPTION-5, a tool used to rate audio or video-taped clinical encounters, with raters’ agreement being assessed by the Bland-Altman analysis (2-rater pairs). Decisional conflict was measured by a 4-item survey, SURE. Data from two cohorts were compared using the Fisher exact test and the Student’s t test. Results: Twenty UC visits (5 per physician) were compared with 7 telehealth visits from 4 clinical sites. Patient mean age was 84.3 years and 52% were women. UC patients were older than telehealth patients (87.6 vs. 74.9, p=0.002). Patient decisional conflict was significantly different between the two groups (p=0.02). Telehealth visits had higher OPTION-5 scores than UC visits (99.3 vs. 19.0, p<0.001). (Figure) Rater pairs were used for each observation with evidence of lack of strong agreement in 2 pairs (95% limits of agreement in 3 pairs: [-6.0, 8.8], n=7; [-24.3, 20.7], n=11; [-34.2, 18.7], n=9). Conclusions: A combined clinical visit with both the referring and specialist physicians, along with their patient in a “virtual consult,” led to decreased patient decisional conflict. Higher OPTION-5 scores were suggested, indicating improvement in the presence of SDM; lack of strong agreement between raters limits this finding and larger studies are needed.

Perioperative DNR

2019 ◽  
pp. 66-73
Author(s):  
Andrea K. Nagengast ◽  
Karen J. Brasel
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Surgical Intervention ◽  
Advanced Disease ◽  
Disease Process ◽  
Shared Decision ◽  
Do Not Resuscitate ◽  
The Right ◽  
Palliative Phase ◽  
Time Limitations

Despite a diagnosis of a terminal or life-limiting illness, a patient’s do not resuscitate (DNR) status does not preclude the right to surgical intervention. There are many instances when operative intervention is appropriate and warranted. Often a patient is already in the palliative phase of his or her advanced disease process when addressing perioperative DNR status becomes necessary. A standardized framework, rather than rigid policy, not only utilizes shared decision-making to achieve this goal, but also ultimately enables a just process for each individual patient. Such a framework should include requirements for reevaluation; clarification of responsibilities surrounding reevaluation; resuscitation options (full, goal directed, procedure directed, none); documentation requirements; time limitations; and resources.

Cancer Patient Perspectives on the Use of Clinical Pathways and Shared Decision-Making in Cancer Care

2018 ◽  
Vol 4 (11) ◽  
pp. 46-50
Author(s):  
Elizabeth F Franklin ◽  
Helen M Nichols ◽  
Ellyn Charap ◽  
Joanne S Buzaglo ◽  
Shauna McManus ◽  
...  
Keyword(s):  
Decision Making ◽  
Cancer Patient ◽  
Shared Decision Making ◽  
Cancer Care ◽  
Clinical Pathways ◽  
Patient Perspectives ◽  
Shared Decision
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