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)
Ethical practice and professional decision-making
Published in Michael Weir, Law and Ethics in Complementary Medicine, 2023
The theories and principles discussed above appear to make decision-making complex but the application of experience and judgement, and a balancing of relevant considerations, is most likely to derive the best option, though people may differ in their views on such matters. Below is a five-step structure that might usefully be applied when determining difficult ethical issues. Note that this incorporates provision for a final justification for the decision reached to deal with the possibility that a personal view may ignore the application of other sound reasons for a particular and perhaps different result. Conscious justification of a conclusion can avoid ethically debatable decisions influenced by prejudice and self-interest and overly influenced by gut feelings, though there may be value in intuitive responses as a possible starting point in considerations.63 Ethical decision-making involves ‘evaluating moral decisions underlying health care, and is thus a conscious activity’.64
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.
Supporting rehabilitation stakeholders in making service delivery decisions: a rapid review of multi-criteria decision analysis methods
Published in Disability and Rehabilitation, 2023
Peter T. Cahill, Meaghan Reitzel, Dana R. Anaby, Chantal Camden, Michelle Phoenix, Shelley Romoff, Wenonah N. Campbell
MCDA methods include discrete choice experiments, best-worst scaling, and the analytic hierarchy/network process, among others [6,7]. To aide readers unfamiliar with these methods, we offer brief, non-technical descriptions of selected MCDA methods in Table 1. All methods entail certain key steps including, defining the decision problem, selecting criteria and alternatives, evaluating the performance of each alternative on the criteria, and interpreting the results to support decision making [5]. Criteria refer to the factors against which a decision is made (e.g., cost, expected outcomes, feasibility) and alternatives refer to the different options being considered in the decision (e.g., individual or group therapy, telerehabilitation, in-person or hybrid services, short, frequent sessions or longer, less frequent sessions). All MCDA methods involve carefully structuring the decision problem, criteria, and alternatives, and systematically evaluating how alternatives perform on each criterion. In doing so, MCDA methods are thought to support decisions that better reflect an informed and values-based decision compared with ad-hoc methods of decision making [5].
“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].
One Goal, Two Roles: Clinicians and Clinical Ethicists Should Approach Patients’ Ambivalence Differently
Published in The American Journal of Bioethics, 2022
Mx Bex L. Forcier, Benny L. Joyner Jr., Arlene M. Davis
Advising clinicians on strategies that can support the patient’s decision-making.Here clinical ethicists might choose to rely on the interventions laid out by Moore et al. (2022) by identifying the type of patient ambivalence at play and then advising clinicians on the corresponding intervention. The “best case/worst case” tool (Kruser et al. 2015) might also be appropriate and likely useful. Of note, clinical ethicists ought not directly enact these clinical interventions themselves; for the reasons we detailed earlier, clinicians are better suited and more properly situated to do so. However, in our experience, clinicians may feel better supported to pursue such interventions when clinical ethicists help them identify salient features of the focal case and tailored strategies that could support the success of planned interventions.