scholarly journals Doing more does not mean doing better: the FADOI contribution to the Slow Medicine program for a sustainable and wise healthcare system

2015 ◽  
Vol 9 (3) ◽  
pp. 281 ◽  
Author(s):  
Luigi Lusiani ◽  
Roberto Frediani ◽  
Roberto Nardi ◽  
Andrea Fontanella ◽  
Mauro Campanini
Keyword(s):  
Internal Medicine ◽  
Decision Making ◽  
Health Professionals ◽  
Choosing Wisely ◽  
Decision Making Process ◽  
Evidence Based ◽  
Shared Decision ◽  
Slow Medicine ◽  
The Usa ◽  
Hospital Doctors

Consistently with its own vision on the necessity to implement a sustainable and frugal medicine, in 2013 the Italian Federation of Associations of Hospital Doctors in Internal Medicine (FADOI) decided to adhere to the Slow Medicine program entitled <em>Doing more does not mean doing better</em>, launched in Italy in late 2012, following the Choosing Wisely® campaign of the American Board of Internal Medicine (ABIM) Foundation started in the USA in 2010. According to the program, FADOI has now produced a list of ten evidence-based recommendations of the <em>do not</em> type, regarding different practices whose benefits for the patients are questionable at least, if not harmful at worst. The list was obtained from a questionnaire submitted to 1175 FADOI members, containing a purposely selected choice of 32 pertinent recommendations already published by Choosing Wisely®, and reflects the qualified opinion of a large number of Italian internists. These recommendations are now endorsed by the FADOI, as a contribution to the discussion among doctors, health professionals, nurses, patients and citizens about what is worth choosing in medicine; they are also meant to promote a shared decision making process in the clinical practice.

scholarly journals Slow Medicine and Choosing Wisely: a synergistic alliance

2022 ◽  
Vol 4 ◽  
pp. e4222
Author(s):  
Marco Bobbio ◽  
Sandra Vernero ◽  
Domenico Colimberti ◽  
Andrea Gardini
Keyword(s):  
Internal Medicine ◽  
Health Professionals ◽  
Choosing Wisely ◽  
New Paradigm ◽  
Professional Societies ◽  
Appropriate Care ◽  
Effective Care ◽  
Slow Medicine ◽  
Quality Principles ◽  
The World

Choosing Wisely® is an initiative of the American Board of Internal Medicine Foundation to help physicians and patients engage in conversations about the overuse of tests and procedures and support physician efforts to help patients make smart and effective care choices. Choosing Wisely campaigns are now active and present in 25 countries around the world, on five continents. Italy is the only country where a Choosing Wisely campaign was launched, and it is currently steered by a Nationwide association (Slow Medicine), creating a synergistic alliance. The Slow Medicine Association was founded in 2011 when a group of health professionals and citizens shared a new paradigm of values, methodology, and interventions and decided to establish an association with the mission of working for a health system driven by ethics and quality principles. Three keywords summarize the philosophy of Slow Medicine: measured because it acts with moderation, gradualness, and without waste; respectful because it is attentive to the dignity of individuals recognizing their values; and equitable because it is committed to ensuring appropriate care based on the best available evidence. Slow Medicine allowed the spread of Choosing Wisely in Italy involving several professional societies and participating at the National meetings of the Societies as well as numerous other meetings, in which the mission of the Association is combined with the principle of the ‘do not’ recommendations. Numerous other initiatives were carried out, and new projects were planned in synergy with Choosing Wisely.

The Effect of Previsit Education in Breast Cancer Patients: A Study of a Shared-decision-making Tool

2016 ◽  
Vol 82 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Victoria Serpico ◽  
Amy E. Liepert ◽  
Kenneth Boucher ◽  
Diane L. Fouts ◽  
Layla Anderson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Cancer Biology ◽  
Decision Making Process ◽  
Evidence Based ◽  
Shared Decision ◽  
Group 2 ◽  
New Diagnosis ◽  
Group 1

To enhance shared decision-making for patients with breast cancer, we developed an evidence-based educational breast cancer video (BCV) providing an overview of breast cancer biology, prognostic indicators, and surgical treatment options while introducing health care choice. By providing patients access to a BCV with information necessary to make informed surgical decisions before seeing a surgeon, we aimed to increase patient participation in the decision-making process, while decreasing distress. Patients with a new diagnosis of breast cancer were provided a link to the BCV. Group 1 participated in online pre- and postvideo questionnaires, with the BCV embedded in between. The questionnaires evaluated self-reported baseline knowledge of breast cancer and perceived distress related to the diagnosis. Changes in self-reported responses were analyzed using the Wilcoxon matched pairs test. Group 2 received a survey collecting demographics, decision-making information, and perceptions of the BCV at the time of clinic visit before meeting the surgeon. Group 1 included 69 subjects with 62 per cent reporting improved knowledge and 30 per cent reporting reduced distress in regard to their breast cancer diagnosis. Group 2 included 87 subjects; 94 to 98 per cent felt the BCV provided information and stimulated thoughts and questions to assist in breast cancer treatment decision-making. The BCV was positively received by participants and feasible to implement into clinical practice. Evidence-based media tools improve knowledge and reduce distress in patients with a new diagnosis of breast cancer as well as contributing to the shared decision-making process.

The Shared Decision-Making Process as the Recommended Standard for Treatment Decisions in Kidney Disease and Requisite Communication Skills to Implement the Process

2020 ◽  
pp. 87-97
Author(s):  
Ernest I. Mandel ◽  
Jane O. Schell ◽  
Robert A. Cohen
Keyword(s):  
Decision Making ◽  
Kidney Disease ◽  
Shared Decision Making ◽  
Treatment Decision ◽  
Standard Of Care ◽  
Healthcare Research ◽  
Choosing Wisely ◽  
Decision Making Process ◽  
Shared Decision ◽  
American Society

Shared decision-making (SDM) is the accepted standard of care paradigm for medical decision making between patient or surrogate and clinician. In its Choosing Wisely campaign, the American Society of Nephrology (ASN) recommended SDM prior to the initiation of dialysis. Evidence suggests that SDM enhances patients’ understanding of their illness and satisfaction with the decision-making process, but at present SDM is poorly integrated into dialysis decision-making. Dialysis patients often describe a passive role in the decision to start dialysis, reinforcing the need for implementation of SDM in decision-making with patients with kidney disease. The hallmark feature of SDM is collaboration between the clinician and the patient or surrogate whereby the patient’s expertise in the realm of values and priorities is elicited while the clinician’s medical expertise is shared. The ultimate treatment decision results from the integration of their respective expertise. The Agency for Healthcare Research and Quality SHARE Approach outlines the components of SDM, and frameworks such as the Serious Illness Conversation Guide, REMAP, and SPIRES are roadmaps for those components. Communication tools and mnemonics also facilitate SDM conversations. With knowledge and application of these frameworks and tools, the nephrology community will be better positioned to fulfill the mandate embodied in the ASN Choosing Wisely campaign to employ the SDM process in renal replacement therapy decisions.

Experiences of involvement in decision-making for patients with breast cancer. A phenomenological-hermeneutical study

2018 ◽  
Vol 6 (2) ◽  
pp. 237 ◽  
Author(s):  
Nausheen Christoffersen ◽  
Karina Olling ◽  
Karina Dahl Steffensen ◽  
Regner Birkelund
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Patient Involvement ◽  
Structured Interview ◽  
Decision Making Process ◽  
Shared Decision ◽  
The Individual ◽  
Cancer Experience

Background: Patient involvement, including shared decision-making (SDM), has become a key topic in the healthcare system. Only a few studies have been conducted in Denmark on how women with breast cancer experience being involved in the decision-making process during their treatment.Aim: The aim of the study was therefore to explore patients’ experiences in the decision-making process during their treatment course and whether or not it was clear to the individual patient that they had a choice.Methods: The study is based on a qualitative semi-structured interview of 7 patients with breast cancer conducted during February 2017 at a regional hospital for cancer treatment. The design is phenomenological-hermeneutic with inspiration from Ricoeur’s interpretation theory.Results: Through analysis and interpretation of the interviews, 2 themes were identified: (1) Real choice or course determined by the health professionals and (2) Treatment efficiency at the expense of time for consideration for options. The patients experienced that there was neither time for consideration in relation to their treatment, nor time to reflect on their situation. In the decision-making situations, most of the patients felt that they gave their consent only to a treatment course organized by the health professionals. They did not feel that they had a choice, but rather that participation was a prerequisite for getting well.Conclusions: The results of this study can contribute to the improvement of person-centered care and treatment by illustrating patient attitudes to the shared decision-making process and indicating where patient education would play a crucial role in increasing patient involvement in decisions about their care.

scholarly journals Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey

2021 ◽  
Vol 18 (4) ◽  
pp. 2128
Author(s):  
Marta Maes-Carballo ◽  
Manuel Martín-Díaz ◽  
Luciano Mignini ◽  
Khalid Saeed Khan ◽  
Rubén Trigueros ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Cross Sectional Study ◽  
Shared Decision ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Professional Societies ◽  
New Policies

Objectives: To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment. Materials and Methods: A cross-sectional study based on an online questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale. Results: The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36–4.55)) and were in favour of its implementation (mean 4.58 (4.51–4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37–3.55)) and agreed on policies that improved its implementation (3.96 (3.88–4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients’ paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%). Conclusions: New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.

The role of a shared decision-making process in paediatric epilepsy surgery

2021 ◽  
Vol 429 ◽  
pp. 119162
Author(s):  
Michelle Gratton ◽  
Bonnie Wooten ◽  
Sandrine Deribaupierre ◽  
Andrea Andrade
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Epilepsy Surgery ◽  
Decision Making Process ◽  
Shared Decision ◽  
Paediatric Epilepsy

scholarly journals Could clustering of comorbidities be useful for better defining the internal medicine patients’ complexity?

2018 ◽  
Vol 12 (2) ◽  
pp. 137 ◽  
Author(s):  
Flavio Tangianu ◽  
Paola Gnerre ◽  
Fabrizio Colombo ◽  
Roberto Frediani ◽  
Giuliano Pinna ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Decision Making ◽  
Cluster Analysis ◽  
Adverse Events ◽  
Decision Making Process ◽  
High Similarity ◽  
High Prevalence ◽  
Clinical Problems ◽  
Index Disease ◽  
Improve Health

Internal medicine patients are mostly elderly with multiple comorbidities, usually chronic. The high prevalence of comorbidity and multimorbidity has a significant impact on both positive responses to treatment and the occurrence of adverse events. Clustering is the process of nosography grouping into meaningful associations with some index disease, so that the objects within a cluster have high similarity in comparison with one another. In the decision-making process it is imperative that, in addition to understanding the immediate clinical problems, we are able to explicit all the contextual factors that have to be taken into account for the best outcome of care. Cluster analysis could be leveraged in developing better interventions targeted to improve health outcomes in subgroups of patients.

scholarly journals Engaging Multidisciplinary Stakeholders to Drive Shared Decision-Making in Oncology

2018 ◽  
Vol 34 (1) ◽  
pp. 29-31 ◽  
Author(s):  
Gabrielle Rocque ◽  
Ellen Miller-Sonnet ◽  
Alan Balch ◽  
Carrie Stricker ◽  
Josh Seidman ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Best Practices ◽  
Shared Decision Making ◽  
Best Practice ◽  
Care Delivery ◽  
Evidence Based ◽  
Shared Decision ◽  
Oncology Practice ◽  
Development And Validation

Although recognized as best practice, regular integration of shared decision-making (SDM) approaches between patients and oncologists remains an elusive goal. It is clear that usable, feasible, and practical tools are needed to drive increased SDM in oncology. To address this goal, we convened a multidisciplinary collaborative inclusive of experts across the health-care delivery ecosystem to identify key principles in designing and testing processes to promote SDM in routine oncology practice. In this commentary, we describe 3 best practices for addressing challenges associated with implementing SDM that emerged from a multidisciplinary collaborative: (1) engagement of diverse stakeholders who have interest in SDM, (2) development and validation of an evidence-based SDM tool grounded within an established conceptual framework, and (3) development of the necessary roadmap and consideration of the infrastructure needed for engendering patient engagement in decision-making. We believe these 3 principles are critical to the success of creating SDM tools to be utilized both within and outside of clinical practice. We are optimistic that shared use across settings will support adoption of this tool and overcome barriers to implementing SDM within busy clinical workflows. Ultimately, we hope that this work will offer new perspectives on what is important to patients and provide an important impetus for leveraging patient preferences and values in decision-making.

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