Ethical Decision Making and Patient Autonomy

Ruhnke, Gregory W.; Wilson, Sandra R.; Akamatsu, Takashi; Kinoue, Takaaki; Takashima, Yutaka; Goldstein, Mary K.; Koenig, Barbara A.; Hornberger, John; Raffin, Thomas A.

doi:10.1378/chest.118.4.1172

Cited by 226 publications

(50 citation statements)

References 45 publications

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“…Ruhnke et al 10 compared the attitudes towards ethical decision-making and autonomy issues in various clinical scenarios among physicians and patients in Japan and the United States and observed that Japanese physicians and patients relied more on the family’s and the physician’s authority and placed less emphasis on the patient’s autonomy, a finding similar to ours. The cultural context seem to shape the relationship between the patient, the physician and the patient’s family in medical decision-making.…”

Section: Discussionsupporting

confidence: 77%

“…The paternalistic attitude of healthcare professionals, although a diminishing problem, still reigns in some situations, particularly, it seems, when it comes to caring for the elderly. While the social framework of decision-making has diminished in significance and Western bioethics now focuses more on ethical decisions that are based on individual autonomy,10 our findings indicate that this situation is more theoretical than real.…”

Section: Discussionmentioning

confidence: 78%

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Elderly patients also have rights

et al. 2007

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Background: Sharing information with relatives of elderly patients in primary care and in hospital has to fit into the complex set of obligations, justifications and pressures concerning the provision of information, and the results of some studies point to the need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day-to-day care of older people. Objectives: To know the frequency with which ''capable'' patients over 65 years of age receive information when admitted to hospital, the information offered to the families concerned, the person who gives consent for medical intervention, and the degree of satisfaction with the information received and the healthcare provided. Method: A descriptive questionnaire given to 200 patients and 200 relatives during the patients' stay in hospital. Results: Only 5% of patients confirmed that they had been asked whether information could be given to their relatives. A significantly higher proportion of relatives received information on the successive stages of the care offered than did patients themselves. As the age of the patients increased, so the number who were given information, understood the information and were asked for their consent for complementary tests decreased. The degree of satisfaction with the information offered was high for both patients and relatives (86.5% and 84%, respectively), despite the irregularities observed. Conclusions: The capacity of elderly patients to participate in the decision-making process is frequently doubted simply because they have reached a certain age and it is thought that relatives should act as their representatives. In Spain, the opinion of the family and doctors appears to play a larger role in making decisions than does the concept of patient autonomy.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 78%

Elderly patients also have rights

et al. 2007

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“…[17] The scale was incorporated into the structured medical decision-making questionnaire. The scale consists of two vignettes concerning a patient with early-stage cancer and a patient with advanced-stage cancer.…”

Section: Methodsmentioning

confidence: 99%

Jordanian physicians' attitudes toward disclosure of cancer information and patient participation in treatment decision-making

Obeidat

Khrais

2016

Asia-Pacific Journal of Oncology Nursing

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Objective:This study aims to determine the attitude of Jordanian physicians toward disclosure of cancer information, comfort and use of different decision-making approaches, and treatment decision making.Methods:A descriptive, comparative research design was used. A convenience sample of 86 Jordanian medical and radiation oncologists and surgeons practicing mainly in oncology was recruited. A modified version of a structured questionnaire was used for data collection. The questionnaire is a valid measure of physicians’ views of shared decision making.Results:Almost 91% of all physicians indicated that the doctor should tell the patient and let him/her decide if the family should know of an early-stage cancer diagnosis. Physicians provide abundant information about the extent of the disease, the side effects and benefits of the treatment, and details of the treatment procedures. They also provided less information on the effects of treatment on the sexuality, mood, and family of the patient. Almost 48% of the participating physicians reported using shared decision making as their usual approach for treatment decision making, and 67% reported that they were comfortable with this approach. The main setting of clinical activity was the only factor associated with physicians’ usual approach to medical decision making. Moreover, age, years of experience, and main setting of clinical activity were associated with physicians’ comfort level with the shared approach.Conclusions:Although Jordanian physicians appreciate patient autonomy, self-determination, and right to information, paternalistic decision making and underuse of the shared decision-making approach persist. Strategies that target both healthcare providers and patients must be employed to promote shared decision making in the Jordanian healthcare system.

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“…Second, utilities estimates from Japanese women are not available. For more than two decades, it has been well-established that attitudes about cancer and its treatments may differ across countries [33]. It would be relevant in the future to have information from studies on patients’ experiences in Japan, especially utility data.…”

Section: Discussionmentioning

confidence: 99%

Societal cost-effectiveness analysis of the 21-gene assay in estrogen-receptor–positive, lymph-node–negative early-stage breast cancer in Japan

Yamauchi

Nakagawa

Yamashige

et al. 2014

BMC Health Serv Res

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BackgroundBreast-cancer incidence and mortality have been increasing in Japan. Japanese-specific clinical validity and utility data for the 21-gene assay (Oncotype DX® Breast Cancer Assay; Genomic Health, Inc., Redwood City, USA) are now available. The objective of this study was to evaluate the cost-effectiveness of the 21-gene assay for the guidance of adjuvant chemotherapy decisions in estrogen-receptor–positive, lymph-node–negative, early-stage breast cancer patients, from the Japanese societal perspective.MethodsThe recurrence risk group distribution by the 21-gene assay result and the assay’s influence on adjuvant chemotherapy recommendations were obtained from a study of 104 patients. A state-transition cohort (Markov) model tracked time from surgery until distant recurrence and from distant recurrence to death. Adjuvant chemotherapy benefit by 21-gene assay risk group was based on published clinical validation studies. Direct and indirect medical costs were obtained from the referral centers. Utilities associated with progression and chemotherapy-related adverse events were extracted from literature. Sensitivity analyses assessed the key drivers and robustness of the primary outcomes.ResultsThe 21-gene assay identified 48% of patients as low-risk, 36% as intermediate-risk, and 16% as high-risk. Total acute chemotherapy-related costs decreased by ¥154,066 due to less adjuvant chemotherapy usage. In the high-risk group, adjuvant chemotherapy use increased 18%, leading to survival benefits. Chemotherapy use overall decreased by 19%. Monitoring costs increased by ¥3,744 but recurrence costs declined by ¥46,113 per patient. Use of the 21-gene assay increased quality-adjusted–life-years (QALYs) by 0.241 per patient on average; the net cost per QALY gained was ¥636,752 ($6,368).ConclusionsThe 21-gene assay for women with estrogen-receptor–positive, lymph-node–negative, early-stage breast cancer is projected to be cost-effective in Japan.

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Ethical Decision Making and Patient Autonomy

Cited by 226 publications

References 45 publications

Elderly patients also have rights

Elderly patients also have rights

Jordanian physicians' attitudes toward disclosure of cancer information and patient participation in treatment decision-making

Societal cost-effectiveness analysis of the 21-gene assay in estrogen-receptor–positive, lymph-node–negative early-stage breast cancer in Japan

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