Educating doctors and patients about how conflicts of interest can affect healthcare decision making

BMJ ◽  
2014 ◽  
Vol 348 (feb05 5) ◽  
pp. g1384-g1384 ◽  
Author(s):  
P. D. P. Pharoah
Keyword(s):  
Decision Making ◽  
Conflicts Of Interest ◽  
Healthcare Decision ◽  
Healthcare Decision Making

scholarly journals Nursing Home Staff’s Perceptions of Healthcare Decision Making for Unbefriended Residents

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 384-384
Author(s):  
Hyejin Kim ◽  
Molly Perkins ◽  
Thaddeus Pope ◽  
Patricia Comer ◽  
Mi-Kyung Song
Keyword(s):  
Decision Making ◽  
Geographic Area ◽  
Care Physician ◽  
Healthcare Decision ◽  
Do Not Resuscitate ◽  
Best Interest ◽  
Care Plans ◽  
Course Of Action ◽  
Healthcare Decision Making ◽  
Facility Level

Abstract ‘Unbefriended’ adults are those who lack decision-making capacity and have no surrogates or advance care plans. Little data exist on nursing homes (NHs)’ healthcare decision-making practices for unbefriended residents. This study aimed to describe NH staff’s perceptions of healthcare decision making on behalf of unbefriended residents. Sixty-six staff including administrators, physicians, nurses, and social workers from three NHs in one geographic area of Georgia, USA participated in a 31-item survey. Their responses were analyzed using descriptive statistics and conventional content analysis. Of 66 participants, eleven had been involved in healthcare decision-making for unbefriended residents. The most common decision was do-not-resuscitate orders. Decisions primarily were made by relying on the resident’s primary care physician and/or discussing within a facility interdisciplinary team. Key considerations in the decision-making process included “evidence that the resident would not have wanted further treatment” and the perception that “further treatment would not be in the resident’s best interest”. Compared with decision making for residents with surrogates, participants perceived decision making for unbefriended residents to be equally-more difficult. Key barriers to making decisions included uncertainty regarding what the resident would have wanted in the given situation and concerns regarding the ethically and legally right course of action. Facilitators (reported by 52 participants) included some information/knowledge about the resident, an understanding regarding decision-making-related law/policy, and facility-level support. The findings highlight the complexity and difficulty of healthcare decision making for unbefriended residents and suggest more discussions among all key stakeholders to develop practical strategies to support decision-making practices in NHs.

Perceived Financial Insecurity Impacts Healthcare Decision‐Making Among Patients With Sinusitis

2021 ◽  
Author(s):  
Vivek C. Pandrangi ◽  
Nyssa Fox Farrell ◽  
Jess C. Mace ◽  
Kara Y. Detwiller ◽  
Timothy L. Smith ◽  
...  
Keyword(s):  
Decision Making ◽  
Healthcare Decision ◽  
Healthcare Decision Making

scholarly journals 307 - Exploratory Study on Healthcare Decision-Making Capacity Assessment

2020 ◽  
Vol 32 (S1) ◽  
pp. 65-65
Author(s):  
Ana Saraiva Amaral ◽  
Rosa Marina Afonso ◽  
Mário R. Simões ◽  
Sandra Freitas
Keyword(s):  
Decision Making ◽  
Content Analysis ◽  
Focus Groups ◽  
Exploratory Study ◽  
Assessment Instrument ◽  
Funding Agency ◽  
Capacity Assessment ◽  
Healthcare Decision ◽  
Healthcare Decision Making ◽  
Decision Making Capacity

Mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) prevalence is expected to continue to increase, due to the population ageing. MCI and AD may impact patients’ decision-making capacities, which should be assessed through the disease course. These medical conditions can affect the various areas of decision-making capacity in different ways. Decision-making capacity in healthcare is particularly relevant among this population. Elders often suffer from multimorbidity and are frequently asked to make healthcare decisions, which can vary from consenting a routine diagnostic procedure to decide receiving highly risk treatments.To assess this capacity in elders with MCI or AD, we developed the Healthcare Decision-Making Capacity Assessment Instrument (IACTD-CS - Instrumento de Avaliação da Capacidade de Tomada de Decisão em Cuidados de Saúde). This project is funded by Portuguese national funding agency for science, research and technology, FCT (SFRH/BD/139344/2018). IACTD-CS was developed based on Appelbaum and Grisso four abilities model, literature review and review of international assessment instruments. After IACTD-CS first version development, an exploratory study with focus groups was conducted. This study included focus groups with healthcare professionals and nursing homes’ professionals.The focus groups main goals were: 1) understand the participants perception regarding healthcare decision-making capacity, 2) distinguish relevant aspects of decision-making, 3) discuss the abilities and items included in IACTD-CS and 4) identify new aspects or items to be added to IACTD-CS. A content analysis of the focus groups results, with resource to MAXQDA, was conducted afterwards. This exploratory study allowed to identify professionals’ perceptions on healthcare decision-making and its results were a significant contribute to IACTD-CS development. The proposed communication aims to describe the methodology used and present the results of content analysis.

scholarly journals Consent to Treatment and Anamnesis as Problem of Communication with Minor Patients in Healthcare Decision-Making

2016 ◽  
Vol 2 (3) ◽  
pp. 57
Author(s):  
Karina Palkova ◽  
Svetlana Semaka
Keyword(s):  
Decision Making ◽  
Medical Professional ◽  
Medical Services ◽  
Medical Professionals ◽  
Healthcare Decision ◽  
Communication Problems ◽  
Legal Relationship ◽  
Healthcare Decision Making ◽  
Consent To Treatment ◽  
Insight Into

Lately lawyers and medical professionals pay more attention too the process of minor patient healthcare. The research shall address the issues of legal relationship between minor patients and medical professionals, consent to treatment of minor patients and communication problems including the scope of information which the doctor can provide to the minor patient’s relatives to protect themselves and patients. Legislation prescribes that the information provided by the medical professional to the minor patient must be not only easy-to-understand, but also be consistent with the patient’s age maturity. However, in Latvia, for example, there are no guidelines that specify how medical professionals can determine the patient’s maturity. In the course of provision of medical services to the minor persons legal disputes involving communiucation failures between the minor patients, their relatives, legal representatives and the doctors arise increasingly frequently. The research will look into issue of communication problems in healthcare. The aim of the research is to provide insight into challenges of legal relations betweem minor patients and medical professionals and communication problems in healthcare.

scholarly journals Taking stock of cost-effectiveness analysis of healthcare in China

2019 ◽  
Vol 4 (3) ◽  
pp. e001418 ◽  
Author(s):  
Thomas Butt ◽  
Gordon G Liu ◽  
David D Kim ◽  
Peter J Neumann
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
English Language ◽  
Mainland China ◽  
Cost Effectiveness Analysis ◽  
Healthcare Decision ◽  
Reporting Practices ◽  
The Past ◽  
Effectiveness Analysis ◽  
Healthcare Decision Making

IntroductionCost-effectiveness analysis (CEA) is playing an increasingly important role in informing healthcare decision-making in China. This study aims to review the published literature on CEA in mainland China and describe its characteristics and evolution. We provide recommendations on the future direction of CEA as a methodology and as a tool to support healthcare decision-making in China.MethodsEnglish-language cost-per-quality-adjusted life-year (QALY) and cost-per-disability-adjusted life-year (DALY) publications relating to mainland China were reviewed using the Tufts Medical Center Cost-Effectiveness Analysis Registry and Global Health Cost-Effectiveness Analysis Registry through 2017. Study features were summarised using descriptive statistics. Changes in study methodology over time were analysed by trend test, and study characteristics influencing the incremental cost-effectiveness ratio (ICER) of cost-per-QALY studies were investigated using logistic regression.Results170 studies were identified reporting CEA for mainland China (cost/QALY=125, cost/DALY=45) since 1998. The number and quality of studies has increased over the past two decades, with significantly more cost-per-QALY studies compared with cost-per-DALY studies (p<0.0001) and more studies with authors affiliated with Chinese institutions (p=0.0002). The average quality score was 5.04 out of 7 for cost-per-QALY and 4.70 for cost-per-DALY studies based on Registry reviewers’ subjective assessment of overall quality (methods, assumptions and reporting practices). The median ICER reported for interventions for oncology patients was higher (US$26 694 per QALY) than the median ICER reported for all interventions (US$11 503 per QALY). Oncology interventions were associated with the likelihood of reporting higher ICERs than the median ICER (p=0.003).ConclusionThe number of English-language published CEA studies relating to China has grown rapidly over the past 20 years. In terms of quality, the China studies compare favourably with international studies, although they remain a small proportion of studies globally.

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