Not a Humbug: the evolution of patient-centred medical decision-making

Trump, Benjamin D.; Linkov, Faina; Edwards, Robert P.; Linkov, Igor

doi:10.1136/ebmed-2015-110274

Cited by 8 publications

(8 citation statements)

References 14 publications

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“…Some patients might only want basic information when faced with the diagnosis of cancer, whereas others wish for more in-depth information and support during the deliberation process [ 1 , 46 ]. Furthermore, quantitative decision support systems have been described as useful tools that can be helpful for clinicians to offer patients sound information in terms that patients can understand, while engaging them in the decision-making process [ 34 ]. In our study, participants reported that SDM does not take place due to patients not wanting or not being able to decide.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, research on current perceptions on SDM in oncology in Germany is missing. However, to successfully implement SDM in routine cancer care in Germany, it is indispensable to understand the whole process of decision-making from a multidisciplinary perspective [ 26 , 33 , 34 ]. Only if implementation strategies are grounded on the attitudes and experiences of HCPs in a specific setting and health care system, they are likely to be effective [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

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Shared Decision-Making in Oncology – A Qualitative Analysis of Healthcare Providers’ Views on Current Practice

et al. 2016

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BackgroundDespite an increased awareness of shared decision-making (SDM) and its prominent position on the health policy agenda, its implementation in routine care remains a challenge in Germany. In order to overcome this challenge, it is important to understand healthcare providers’ views regarding SDM and to take their perspectives and opinions into account in the development of an implementation program. The present study aimed at exploring a) the attitudes of different healthcare providers regarding SDM in oncology and b) their experiences with treatment decisions in daily practice.Material and MethodsA qualitative study was conducted using focus groups and individual interviews with different healthcare providers at the University Cancer Center Hamburg, Germany. Focus groups and interviews were audio-recorded, transcribed and analyzed using conventional content analysis and descriptive statistics.ResultsN = 4 focus groups with a total of N = 25 participants and N = 17 individual interviews were conducted. Attitudes regarding SDM varied greatly between the different participants, especially concerning the definition of SDM, the attitude towards the degree of patient involvement in decision-making and assumptions about when SDM should take place. Experiences on how treatment decisions are currently made varied. Negative experiences included time and structural constraints, and a lack of (multidisciplinary) communication. Positive experiences comprised informed patients, involvement of relatives and a good physician-patient relationship.ConclusionThe results show that German healthcare providers in oncology have a range of attitudes that currently function as barriers towards the implementation of SDM. Also, their experiences on how decision-making is currently done reveal difficulties in actively involving patients in decision-making processes. It will be crucial to take these attitudes and experiences seriously and to subsequently disentangle existing misconceptions in future implementation programs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Shared Decision-Making in Oncology – A Qualitative Analysis of Healthcare Providers’ Views on Current Practice

et al. 2016

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“…Systematic reviews are being increasingly employed by health policy-makers, researchers and even patients to assist decision-making processes. [1][2][3][4] Cochrane is known as an independent non-for-profit organization that plays a crucial mediating role in creating, evaluating and disseminating reliable, invaluable and practical information in the format of systematic reviews and metaanalyses. With its well-deserved reputation, Cochrane has facilitated the use of applied research for practical purposes for more than two decades, including prevention, treatment and diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Achievements of the Cochrane Iran Associate Centre: Lessons Learned

Mesgarpour¹,

Aghababa²,

Baradaran

et al. 2019

Int J Health Policy Manag

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Healthcare decision-making is a process that mainly depends on evidence and involves increasing numbers of stakeholders, including the consumers. Cochrane evidence responds to this challenge by identifying, appraising, integrating and synthesizing high-quality evidence. Recently, a collaborative effort has been initiated in Iran with Cochrane to establish a representative local entity. A variety of multifaceted interventions were conducted according to Cochrane’s strategy to 2020, such as producing evidence, making Cochrane evidence accessible, advocating for evidence and building an effective and sustainable organization. In this report, the authors present the two and half year performance and achievements of Cochrane Iran based on a comprehensive and systematic approach. This case might be an example of health diplomacy, which is initiated by a successful international collaboration and proceed with recognizing the importance of adherence to the strategic action plans and goals.

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“…Yet, though research has shown that finances lead many patients to stop treatment, no studies have explored how patients actually view and make these decisions, and are affected by these stresses. Needs exist for evidence-based medicine informed by patient values; but various challenges may arise [ 20 ]. Rational decision making models, drawing on multiple criteria, have been applied regarding use of technology in many domains, such as the environment [ 21 ] and various aspects of health care [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…Needs exist for evidence-based medicine informed by patient values; but various challenges may arise [ 20 ]. Rational decision making models, drawing on multiple criteria, have been applied regarding use of technology in many domains, such as the environment [ 21 ] and various aspects of health care [ 20 ]. Such modeling has been applied to one aspect of ARTs—hypothetical decisions, using strictly biological criteria, of whether to transfer one or more than one embryo into the uterus [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

How much is a child worth? Providers’ and patients’ views and responses concerning ethical and policy challenges in paying for ART

Klitzman

2017

PLoS ONE

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Infertility treatments remain expensive and in many countries are covered by little, if any, insurance, raising critical questions concerning how patients and providers view and make decisions regarding these challenges. In-depth semi-structured interviews of approximately 1 hour were conducted with 37 IVF providers and 10 patients (17 physicians, 10 other providers and 10 patients), and were systematically analyzed. These data suggest current insurance policies and legislation pose critical ethical and logistical challenges for both patients and providers. These individuals face multiple uncertainties about costs and insurance, related to unclear causes of fertility, treatment length, costs and outcomes, and odds that insurers will cover expenses. Insurers frequently decline to agree to reimbursement beforehand, and decide only afterwards, case-by-case, generating stress. Patients and providers thus may not be able to predict how best to allocate limited resources. Providers may advocate for patients, but are usually unsuccessful. Patients may adopt several strategies: e.g., moving/seeking treatment elsewhere, switching or feeling “stuck” in jobs because of insurance, seeking “free” medications, going into debt, or using funds intended for other purposes. Patients do not perceive and respond to resource limitations as fixed phenomena—i.e., patients do not see treatment simply as “affordable” or not. Rather, patients face quandaries of how much to keep spending—how much a child is worth—and are forced to make complex risk/benefit calculations. Couples can disagree, straining relationships. In sum, these data, the first to explore how providers and patients struggle, view, and make decisions regarding limited insurance and resources for infertility, raise several critical ethical and policy issues. These data suggest that individuals have difficulty translating profoundly life-altering, deeply personal quests for meaning and fulfillment into purely economic terms. These findings thus have important implications for future policy, practice, research, and patient and provider education.

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Not a Humbug: the evolution of patient-centred medical decision-making

Abstract: This 'Christmas Issue'-type paper uses the framework of

Cited by 8 publications

References 14 publications

Shared Decision-Making in Oncology – A Qualitative Analysis of Healthcare Providers’ Views on Current Practice

Shared Decision-Making in Oncology – A Qualitative Analysis of Healthcare Providers’ Views on Current Practice

Achievements of the Cochrane Iran Associate Centre: Lessons Learned

How much is a child worth? Providers’ and patients’ views and responses concerning ethical and policy challenges in paying for ART

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