hared decision-making (SDM) is a formal process of consensus building between health care professionals and patients to select treatment plans based on the best medical evidence and the patient's values. Shared decision-making has been reported to improve patient knowledge, satisfaction, and adherence to treatment. 1 Active collaboration between patient and the clinician is important based on the premises that patients will better adhere to treatment if they understand and agree to its use. Shared decision-making is a measure of high-quality decisionmaking and has been incorporated into reimbursement by payers and legislation of health care models. [2][3][4] Shared decision-making has been broadly applied to medical and surgical specialties since it was first defined in 1982. 5 Shared decisionmaking is particularly relevant in complex, preference-sensitive de-cision-making when there are several medically reasonable alternatives. 6 Fields such as palliative care, oncology, and cardiology have been leaders in the implementation of SDM. [7][8][9][10][11] In addition, the Centers for Medicare & Medicaid Services Innovation Center has developed payment models to encourage clinicians to use patient decision support tools aimed to improve individual understanding of medical options as well as requiring SDM for payment of procedures. 2 Dermatologists and patients co-manage complex chronic conditions with medical, economic, and quality-of-life implications. Decision tools, also known as patient decision aids (PDAs), provide detailed and balanced, evidence-based information about varying treatment options and can therefore be used before, during, or after a clinic visit. 12,13 These tools can be used by the patient before IMPORTANCE Shared decision-making (SDM) can improve the quality of care for patients. The extent to which this tool has been used and the evidence supporting its use in dermatology have not been systematically examined.OBJECTIVE To perform a scoping review of the literature regarding SDM in dermatology.
Background: People who are houseless (also referred to as homeless) perceive high stigma in healthcare settings, and face disproportionate disparities in morbidity and mortality versus people who are housed. Medical students and the training institutions they are a part of play important roles in advocating for the needs of this community. The objective of this study was to understand perceptions of how medical students and institutions can meet needs of the self-identified needs of the houseless community. Methods: Between February and May 2018, medical students conducted mixed-methods surveys with semistructured qualitative interview guides at two community-based organizations that serve people who are houseless in Portland, Oregon. Medical students approach guests at both locations to ascertain interest in participating in the study. Qualitative data were analyzed using thematic analysis rooted in an inductive process. Results: We enrolled 38 participants in this study. Most participants were male (73.7%), white (78.9%), and had been houseless for over a year at the time of interview (65.8%). Qualitative themes describe care experiences among people with mental health and substance use disorders, and roles for medical students and health-care institutions. Specifically, people who are houseless want medical students to 1) listen to and believe them, 2) work to destigmatize houselessness, 3) engage in diverse clinical experiences, and 4) advocate for change at the institutional level. Participants asked healthcare institutions to use their power to change laws that criminalize substance use and houselessness, and build healthcare systems that take better care of people with addiction and mental health conditions. Conclusions: Medical students, and the institutions they are a part of, should seek to reduce stigma against people who are houseless in medical systems. Additionally, institutions should change their approaches to healthcare delivery and advocacy to better support the health of people who are houseless.
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