What does physicians' clinical expertise contribute to oncologic decision‐making? A qualitative interview study

Salloch, Sabine; Otte, Ina; Reinacher‐Schick, Anke; Vollmann, Jochen

doi:10.1111/jep.12840

Cited by 12 publications

(9 citation statements)

References 28 publications

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“…Despite the ability to register clinical findings correctly, these must be combined with the appropriate imaging and other diagnostic tools to allow a correct diagnosis and treatment plan. Salloch and coworkers [ 29 ] have recently stressed the importance of the physician's expertise to find appropriate diagnoses and treatment plans for each patient in oncologic decision-making. Registration of pathology in the TMJ, including jaw movements, muscle palpation, and TMJ noises, may be seen either independently or in combination with TMDs such as myalgia, disc derangement, or inflammatory joint diseases.…”

Section: Discussionmentioning

confidence: 99%

DC/TMD Examiner Protocol: Longitudinal Evaluation on Interexaminer Reliability

Skeie

Frid

Mustafa

et al. 2018

Pain Research and Management

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Objectives The objectives of this study were to assess the interexaminer agreement between one “reference” (gold standard) and each of two examiners, using the DC/TMD examination method, Axis I and to evaluate whether a recalibration changed reliability values. Methods Participants (4 healthy and 12 TMD patients) in 2013 underwent a clinical examination according to DC/TMDs, Axis I. In 2014, additionally 16 participants (4 healthy and 12 TMD patients) were recruited. Two trainee examiners (one more experienced) and one “reference examiner” (gold standard) at both sessions assessed the participants. Calibration preparation (2013): The clinical protocol was sent to the trainee examiners with a request that its verbal commands should be learned by heart. An eight-hour-course was provided on the day preceding the examination session day. Recalibration preparation (2014): The same examiners in advance to this year's examination session were also asked to recapture the protocol's instructions (verbal commands to be learned by heart) and go through the information from the 2013 course and encouraged to contact by e-mail in case of unclear subjects. At a meeting prior to the examination session, they were also given the opportunities to ask questions. The interexaminer agreements in 2013 and 2014 between the “reference” and each examiner were analysed using Bland–Altman plots, intraclass correlation coefficient, Cohen's kappa, and consistency values. Results For the majority of the gathered data, no clear change of agreement between 2013 and 2014 could be observed, and only one muscle zone in 2014 could show any clear difference in agreement between the examiners. Conclusions No clear and consistent difference in the level of agreement between the two examiners could be observed, although one was more experienced than the other. Likewise, for most components of the DC/TMD tool, recalibration of examiners did not change the reliability findings.

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Section: Discussionmentioning

confidence: 99%

DC/TMD Examiner Protocol: Longitudinal Evaluation on Interexaminer Reliability

Skeie

Frid

Mustafa

et al. 2018

Pain Research and Management

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“…There are some clinical and technical criteria to guide decisions at the EoL, but the patient’s situation around the time of death is so particular to personal circumstances that decisions are mostly guided by clinical judgement and prior expertise [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Decision making in the end-of-life care of patients who are terminally ill with cancer – a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers

et al. 2021

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Background In Colombia, recent legislation regarding end-of-life decisions includes palliative sedation, advance directives and euthanasia. We analysed which aspects influence health professionals´ decisions regarding end-of-life medical decisions and care for cancer patients. Methods Qualitative descriptive–exploratory study based on phenomenology using semi-structured interviews. We interviewed 28 oncologists, palliative care specialists, general practitioners and nurses from three major Colombian institutions, all involved in end-of-life care of cancer patients: Hospital Universitario San Ignacio and Instituto Nacional de Cancerología in Bogotá and Hospital Universitario San José in Popayan. Results When making decisions regarding end-of-life care, professionals consider: 1. Patient’s clinical condition, cultural and social context, in particular treating indigenous patients requires special skills. 2. Professional skills and expertise: training in palliative care and experience in discussing end-of-life options and fear of legal consequences. Physicians indicate that many patients deny their imminent death which hampers shared decision-making and conversations. They mention frequent ambiguity regarding who initiates conversations regarding end-of-life decisions with patients and who finally takes decisions. Patients rarely initiate such conversations and the professionals normally do not ask patients directly for their preferences. Fear of confrontation with family members and lawsuits leads healthcare workers to carry out interventions such as initiating artificial feeding techniques and cardiopulmonary resuscitation, even in the absence of expected benefits. The opinions regarding the acceptability of palliative sedation, euthanasia and use of medications to accelerate death without the patients´ explicit request vary greatly. 3. Conditions of the insurance system: limitations exist in the offer of oncology and palliative care services for important proportions of the Colombian population. Colombians have access to opioid medications, barriers to their application are largely in delivery by the health system, the requirement of trained personnel for intravenous administration and ambulatory and home care plans which in Colombia are rare. Conclusions To improve end-of-life decision making, Colombian healthcare workers and patients need to openly discuss wishes, needs and care options and prepare caregivers. Promotion of palliative care education and development of palliative care centres and home care plans is necessary to facilitate access to end-of-life care. Patients and caregivers’ perspectives are needed to complement physicians’ perceptions and practices.

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“…The literature on diagnostic error provides insight into how clinicians make decisions in relation to patient treatment. It suggests decision makers tend to rely on heuristics, tacit knowledge, and contextual experience when making complex decisions . In the context of intensive care, studies have shown clinicians' predictions of poor outcome for certain patient groups to be unreliable when they rely on their clinical assessment over objective measurements, suggesting an element of cognitive bias .…”

Section: Discussionmentioning

confidence: 99%

Implementing an intervention to improve decision making around referral and admission to intensive care: Results of feasibility testing in three NHS hospitals

Rees

Bassford

Dale

et al. 2019

Evaluation Clinical Practice

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Rationale, aims, and objectives:Decisions about whether to refer or admit a patient to an intensive care unit (ICU) are clinically, organizationally, and ethically challenging. Many explicit and implicit factors influence these decisions, and there is substantial variability in how they are made, leading to concerns about access to appropriate treatment for critically ill patients. There is currently no guidance to support doctors making these decisions.We developed an intervention with the aim of supporting doctors to make more transparent, consistent, patient-centred, and ethically justified decisions. This paper reports on the implementation of the intervention at three NHS hospitals in England and evaluates its feasibility in terms of usage, acceptability, and perceived impact on decision making. Methods:A mixed method study including quantitative assessment of usage and qualitative interviews. Results:There was moderate uptake of the framework (28.2% of referrals to ICU across all sites during the 3-month study period). Organizational structure and culture affected implementation. Concerns about increased workload in the context of limited resources were obstacles to its use. Doctors who used it reported a positive impact on decision making, with better articulation and communication of reasons for decisions, and greater attention to patient wishes. The intervention made explicit the uncertainty inherent in these decisions, and this was sometimes challenging. The patient and family information leaflets were not used. ---This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. 56J Eval Clin Pract. 2020;26:56-65. wileyonlinelibrary.com/journal/jep Conclusions: While it is feasible to implement an intervention to improve decision making around referral and admission to ICU, embedding the intervention into existing organizational culture and practice would likely increase adoption. The doctor-facing elements of the intervention were generally acceptable and were perceived as making ICU decision making more transparent and patient-centred. While there remained difficulties in articulating the clinical reasoning behind some decisions, the intervention offers an important step towards establishing a more clinically and ethically sound approach to ICU admission.

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What does physicians' clinical expertise contribute to oncologic decision‐making? A qualitative interview study

Cited by 12 publications

References 28 publications

DC/TMD Examiner Protocol: Longitudinal Evaluation on Interexaminer Reliability

DC/TMD Examiner Protocol: Longitudinal Evaluation on Interexaminer Reliability

Decision making in the end-of-life care of patients who are terminally ill with cancer – a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers

Implementing an intervention to improve decision making around referral and admission to intensive care: Results of feasibility testing in three NHS hospitals

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