China
Africa
Explore chapters and articles related to this topic
Palliative Care and Advanced Directives in Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Melissa I. Owen, Debbie A. Gunter
Shared decision making occurs when the clinician and the patient work together to make health care decisions that are best for the patient. The ideal decision considers evidence-based information about available options, presented in a way that patients can understand, the clinician's knowledge and experience, and the patient's values and preferences. Shared decision making in health care has now been actualized into a model/approach that any clinician can utilize.40 The SHARE approach incorporates these five steps:Seek your patient's participationHelp your patient explore and compare treatment optionsAssess your patient's values and preferencesReach a decision with your patientEvaluate your patient's decision(s)
Digital Therapeutics
Published in Gia Merlo, Kathy Berra, Lifestyle Nursing, 2023
Patricia M. Davidson, Caleb Ferguson, Michelle Patch
Electronic decision support (EDS) or clinical decision support (CDS) software is increasingly popular to guide treatment decisions in clinical practice. Evidence-based clinical decision support tools and algorithms can be integrated into existing electronic platforms such as electronic medical records (EMR) or general practice software at point of care. These tools can guide clinicians with risk assessments and treatment decisions and be applied to optimize evidence-based treatment in practice. eHealth tools like CDS can help to enhance guideline-based prescription of evidence-based therapies, such as anticoagulation (Orchard et al., 2019). These tools are especially useful in assisting anticoagulation decision making when combined with patient decision aides to support shared decision making (Ferguson & Hendriks, 2017).
Medications
Published in Henry J. Woodford, Essential Geriatrics, 2022
Shared decision-making is a communication process where clinicians and patients work together to optimise healthcare decisions in accordance with the patient's own goals. It consists of three components: the medical evidence base, clinician expertise and the individual's values, goals and preferences.
“Everyone needs rehab, but…”: exploring post-stroke rehabilitation referral and acceptance decisions
Published in Disability and Rehabilitation, 2022
Kerry Marnane, Louise Gustafsson, Sally Bennett, Ingrid Rosbergen, Rohan Grimley
Decisions to refer and/or to accept for rehabilitation are examples of clinical decisions. Clinical decision making is a complex process, requiring the clinician to consider the task and information at hand, as well as with the characteristics or interests of the other involved parties, and within a problem space [7]. Thus, decisions are influenced by the nature of the task, the attributes of the decision-maker, and the context in which the decision is made [8]. There is always an element of uncertainty at the point of clinical decision making [9], which brings with it emotional and ethical difficulty [8]. Given that clinical guidelines recommend a multidisciplinary assessment for rehabilitation [3], decisions about post-stroke rehabilitation should be the result of team decision making – a process which is reliant on team members’ prior experiences of collaboration, team procedures, familiarity with each other, and context [10]. Ideally, team decision making would extend to include the patient as a key collaborator (“shared decision making”) [11] however previous research has found that patients are rarely involved in decision making about post-stroke rehabilitation referrals [12].
Ethical and Legal Considerations of Alternative Neurotherapies
Published in AJOB Neuroscience, 2021
Ashwini Nagappan, Louiza Kalokairinou, Anna Wexler
Respecting patients’ autonomy and their right to make decisions about their medical care is a fundamental principle in medical ethics. However, an autonomous decision to choose an experimental therapy rests upon the notion that patients have truthful and accurate information regarding the evidence base for a given therapy and the alternatives available. In this regard, it is important that the information presented to patients through promotional materials and public representation by clinics (e.g., via their websites), as well as during consultations with health care providers, is accurate and complete. However, in previous work examining the websites of neurofeedback providers, we found that many used misleading claims—for example, advertising for indications for which there was little evidence—and exaggerated the benefits of the treatment (Wexler et al. 2020). One neurofeedback company that operates a chain of “brain performance centers”—and is supported by U.S. Education Secretary Betsy DeVos (Boser 2017; Fink, Eder, and Goldstein 2017)— has been the subject of recent investigations by the National Advertising Division (NARB 2018, 2020) and Truth in Advertising (TINA 2019) for misleading claims (see also FTC 2020).
Conceptualizations of consciousness and continuation of care among family members and health professionals caring for patients in a minimally conscious state
Published in Disability and Rehabilitation, 2021
Kristin M. Kostick, Abby Halm, Katherine O'Brien, Sunil Kothari, Jennifer S. Blumenthal-Barby
At least two ethical issues are at stake when considering individuals with minimal states of consciousness in the context of clinical care and decision making. The first concerns implications for continuing or withdrawing care on the basis of understandings about consciousness (its value and indicators), well-being, and suffering. Under the prevailing medical ethics of our day, clinical decisions are premised in part on autonomy, and where patients are unable to communicate their preferences, beneficence and intent of doing no harm. Whether or not decisions are considered to be made in the best interest of a patient often depends on her state of consciousness and on others’ understandings about whether she experiences pain or suffering and has an acceptable quality of life [18]. Greater sentience or pain perception in minimally conscious states could mean greater ability to feel pleasurable states or well-being, calling for specific therapeutic (e.g., palliative) approaches [24] and an argument in favor of maintaining treatments. On the other hand, keeping a sentient individual in a state of pain and suffering indefinitely may be considered morally reprehensible. Our data addresses this question by providing insight into how those with the most intimate experiences with disorders of consciousness patients conceive of their consciousness, as well as how they think about the moral question of whether a patient in a minimally conscious state would be better off dead, meriting consideration of withdrawing life sustaining treatment.