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Radical Sphincter-Sparing Resection in Rectal Cancer
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Decision aids to encourage or facilitate shared decision making have been shown to increase patient satisfaction and knowledge.105 These may provide an overview of the oncological and quality-of-life outcomes in rectal cancer.106 Prediction scores can help to provide evidence that a thorough discussion has taken place with the patient and may inform these discussions. For example, the colorectal-POSSUM79 may help to pre-operatively identify patients who are high risk for an anastomotic leak or who may not survive an anastomotic leak. In addition the internationally validated POLARS score can help to pre-operatively identify patients predicted to have poor bowel function following restorative rectal cancer resection.80 For example, if the patient is high risk, an intersphincteric APE may be the appropriately tailored treatment decision.
Health Literacy
Published in Miranda Thurston, Key Themes in Public Health, 2014
The CSDH (2008) also identifies the responsibility of public and private organizations to communicate information in ways that make it comprehensible. Health care systems in many developed countries are difficult to navigate and made more complex by health professionals through the language and terminology used in clinical encounters (Rudd, 2010). Power relations, including controlling access to information in various ways, have been extensively researched in health care. The conclusion tends to be that clinicians and other health care professionals have made little progress towards more empowering, mediating or enabling models of practice (Anderson and Funnell, 2005; Nugus et al., 2010) as advocated in the Ottawa Charter.Raynor (2012) argues that strengthening health literacy (of any type) has the potential to give rise to actions that diverge from the advice given by health care professionals. ‘Decision-aids’ have been introduced into health care contexts to help people participate in decisions by weighing up harms, benefits and uncertainties relating to treatment and screening. A recent review found that while such ‘aids’ can improve people’s knowledge of options and involvement in decisions, they have a variable effect on their actual choices (Stacey et al., 2012). This underscores the limits to knowledge (or health literacy) in effecting health-related decisions (Peerson and Saunders, 2009).
The Third Component: Finding Common Ground
Published in Moira Stewart, Judith Belle Brown, W Wayne Weston, Ian R McWhinney, Carol L McWilliam, Thomas R Freeman, Patient-Centered Medicine, 2013
Judith Belle Brown, W Wayne Weston, Carol L McWilliam, Thomas R Freeman, Moira Stewart
According to a Cochrane review of decision aids (Stacey et al., 2011), they can be used by patients to improve their understanding of their options, the benefits and harms of each, and the values they place on benefits, harms, and medical uncertainties. This helps to prepare patients to participate more actively in discussions with health care providers. However, Nelson et al. (2007: 615) urge caution in using decision aids: they may interfere with a patient’s implicit decision-making strategies, send the wrong message to patients about the goals of decision making, or lead patients to believe that they can reduce or eliminate uncertainty when confronting decisions that are by their very nature uncertain.
Towards assessing the preferred usage features of upper limb prostheses: most important items regarding prosthesis use in people with major unilateral upper limb absence—a Dutch national survey
Published in Disability and Rehabilitation, 2022
Nienke Kerver, Corry K. van der Sluis, Sacha van Twillert, Paul F. M. Krabbe
The PUF-ULP is a short and practical measurement tool, which can be used in clinical practice or future research, to investigate to what extent features of terminal devices and sockets match the aspects considered most important by the prosthesis users. Although the PUF-ULP was primarily developed to evaluate prosthesis use, the information gathered with the PUF-ULP may be useful for prosthesis selection as well. For instance, this information can be used to develop a decision aid for patients who are considering wearing a prosthesis. Decision aids are tools designed to assist people in choosing between two or more health care options by providing information about the different options and to help by identifying and communicating about personal values that may affect the decision [47]. Literature suggests that people using a decision aid feel more knowledgeable, better informed, more clear about their personal values, and they probably participate more in the decision-making process [48]. Therefore, a decision aid for ULP could help the user and healthcare professional to determine which prosthesis hand fits the users’ values best.
Focusing National Policy on All Patients with Severe Aortic Stenosis: A Paradigm Shift
Published in Structural Heart, 2019
Megan Coylewright, Rakesh M. Suri
How should the heart team clinicians present options to patients with severe AS? The aim would be a high quality discussion in which clinicians provide information on the reasonable alternatives available and meaningfully incorporate patient values and goals into final treatment decisions. This process is referred to as SDM.7 Patient decision aids may further assist the heart team, the patient, and their family in this process by presenting information in a way that is easily understood across a broad range of health literacy levels. Decision aids are shown to improve patient-centered outcomes such as patient knowledge and values-concordant decisions.8 However, the SDM literature is clear that while patient decision aids are helpful, they are not necessary to lead to a SDM process. Rather, clinician skillsets in SDM are even more critical, and favorable clinician attitudes around SDM exceed both skillsets and decision aids for successful implementation of SDM.9 It is likely that clinician attitudes may be shaped by inclusion of SDM in major policy decisions, and the TAVR NCD has an opportunity to encourage SDM within clinical visits for severe AS even as patient decision aids are being refined and made more readily available.
The development of a decision aid for tinnitus
Published in International Journal of Audiology, 2018
Helen Pryce, Marie-Anne Durand, Amanda Hall, Rachel Shaw, Beth-Anne Culhane, Sarah Swift, Jean Straus, Elizabeth Marks, Melanie Ward, Katie Chilvers
We developed a targeted, evidence-based one-page decision aid in the form of a table to summarise treatment options considering the questions most frequently asked by patients. Evidence from previous studies suggests that a simple grid style decision aid is acceptable to clinicians (Health Foundation 2012). Furthermore, simpler paper-based decision aids are as effective as more expensive Digital Video Disks (DVD) decision tools (Shue et al. 2016). The decision aid can enable shared decision making by consistently presenting clear choices, for example, the preference for acoustic and auditory treatments compared to psychological or stress targeted treatments. Comparing treatments will thereby lead to clarity about treatment options and a formalised way of incorporating patient preferences into therapeutic decision-making. A recent Cochrane review of decision aids concluded that there is strong evidence that decision aids improve knowledge of options, help patients feel better informed and enable patients to identify what matters most to them (Stacey et al. 2017). Patients using decision aids had more realistic expectations. There is also moderate evidence that the presence of a decision aid leads to patient engagement with shared decision-making and may achieve decisions which are consistent with patient preferences (Stacey et al. 2017). In a chronic condition such as tinnitus with no single effective treatment, it is important that patient preferences are made explicit through the decision.