Care Decision Process Research Articles

The impacts of Chinese cultural adherence to filial piety on the dementia care decision processes in East Asian communities

AbstractObjectivesDeveloping knowledge of Chinese cultural adherence to filial piety helps understand Dementia in the Asian Pacific Regions regarding its dementia care practices and medical system cluster around filial piety.BackgroundChinese filial piety has been deeply rooted in East Asian culture for over five thousand years, affecting life choices, including medical treatments decisions and end‐of‐life care decisions for family members. Regardless of their level of westernization, Chinese filial piety continues to play a key role in determining timely diagnosis, and institutionalization of a person with dementia. As characterized by collectivism, filial piety also explicitly directs informal caregivers' careers paths, mental health, and physical health, especially for females. Consequently, dementia care practices and medical system in East Asian communities cluster around the level of practice of filial piety, which directly affects dementia care decision making processes as well as the welfare of a person with dementia and costs to society.MethodsA systematic literature review for the previous decade on filial piety will be employed. Implications: Through developing knowledge of underlying cultural adherence to dementia care practices in East Asian communities, government, social policies, and professionals across the fields as a whole can develop a better supportive environment for persons with dementia and their caregivers.

Evidence 2016--A Health Network Communications Conference (February 24-25, 2016--London, UK).

Defining, standardizing and interpreting are the keys to evidence use throughout healthcare and at each point in the care decision process. The generation of evidence at each step is also critical to define and constitute value from the information gathered, and not gathered, for each stakeholder in the care pathway. Health Network Communications' Evidence 2016 conference provided the opportunity for attendees to consider diverse evidence methodologies globally and their wide-ranging use, from economic modeling initiatives, to framing value assessments in health technology assessments, to leveraging real-world data to support market access.

The Influence of Online Health Information on the Attitude and Behavior of People Aged 50.

E-patients 'empowered' by Web information are much more likely to participate in health care decision processes and take responsibility for their own health. The purpose of the study was to determine the influence of Internet use and online health information on the attitude, behavior, and emotions of Polish citizens aged 50+, with special regard to their attitude towards health professionals and the health care system. A total of 323 citizens, aged 50years and above, who used the Internet for health purposes, were selected from the Polish population by random sampling. The sample collection was carried out by Polish opinion poll agencies in 2005, 2007, and 2012. The Internet was used by 27.8% of Polish citizens aged 50+ for health purposes in the years 2005-2012. 69.7% of respondents were looking for health information that might help them to deal with a consultation, 53.9% turned to the Internet to prepare for a medical appointment, and 63.5% to assess the outcome of a medical consultation and obtain a 'second opinion'. The most likely effects of health related use of the Internet were: willingness to change diet or other life-style habits (48.0% of respondents) and making suggestions or queries on diagnosis or treatment by the doctor (46.1%). Feelings of reassurance or relief after obtaining information on health or illness were reported by a similar number of respondents as feelings of anxiety and fear (31.0% and 31.3% respectively). Online health information can affect the attitudes, emotions, and health behaviors of Polish citizens aged 50+ in different ways.

Toward Patient-Centered, Personalized and Personal Decision Support and Knowledge Management: A Survey

This paper summarizes the recent trends and highlights the challenges and opportunities in decision support and knowledge management for patient-centered, personalized, and personal health care. The discussions are based on a broad survey of related references, focusing on the most recent publications. Major advances are examined in the areas of i) shared decision making paradigms, ii) continuity of care infrastructures and architectures, iii) human factors and system design approaches, iv) knowledge management innovations, and v) practical deployment and change considerations. Many important initiatives, projects, and plans with promising results have been identified. The common themes focus on supporting the individual patients who are playing an increasing central role in their own care decision processes. New collaborative decision making paradigms and information infrastructures are required to ensure effective continuity of care. Human factors and usability are crucial for the successful development and deployment of the relevant systems, tools, and aids. Advances in personalized medicine can be achieved through integrating genomic, phenotypic and other biological, individual, and population level information, and gaining useful insights from building and analyzing biological and other models at multiple levels of abstraction. Therefore, new Information and Communication Technologies and evaluation approaches are needed to effectively manage the scale and complexity of biomedical and health information, and adapt to the changing nature of clinical decision support. Recent research in decision support and knowledge management combines heterogeneous information and personal data to provide cost-effective, calibrated, personalized support in shared decision making at the point of care. Current and emerging efforts concentrate on developing or extending conventional paradigms, techniques, systems, and architectures for the new predictive, preemptive, and participatory health care model for patient-centered, personalized medicine. There is also an increasing emphasis on managing complexity with changing care models, processes, and settings.

Informal caring-time and caregiver satisfaction

This paper examines the role of care decision processes on informal caring-time choices. We focus on three care decisions: the caregiver's own decision, a family decision and a recipient request. Results show that informal caregivers, engaged in care activities as a result of a family decision, are more likely to devote more than 5 h to care activities, even after allowing for endogeneity. Our findings are robust to controlling for a large number of socio-demographic characteristics, including care recipient and caregiver characteristics. Supplemental analysis, developed to explore whether care arrangements are related to informal caregiver's satisfaction, indicates that the family decision heavily penalizes informal caregivers. Given the importance of informal care activities in reducing health care costs, our findings imply that care decision processes should be taken into consideration when formulating health care policies.

Association of stereotypes about physicians to health care satisfaction, help-seeking behavior, and adherence to treatment

The present research consists of three studies examining the role of patients’ stereotypes about health care providers in the health care decision process. Study 1 examined the association of stereotypes to health care satisfaction and help-seeking behavior among a low-income clinic sample; Study 2 examined the relationship of stereotypes to satisfaction and adherence to treatment among low-income individuals living with HIV; and Study 3 examined the association of stereotypes to satisfaction and help-seeking among a sample of homeless individuals. Overall findings indicate that individuals who held more negative stereotypes about physicians sought care less often when sick, were less satisfied with the care that they did obtain, and were less likely to adhere to physician recommendations for treatment. Moreover, African Americans, but not Whites, with more positive stereotypes reported better adherence in Study 2 and were more satisfied with their health care in Study 3. Our findings point to the need to better understand the role of patients’ beliefs about health care in predicting health care satisfaction and health behaviors.

Étude de la participation des patientes au choix thérapeutique en oncologie

The aim of this study is to help patients with breast cancer express their preferences concerning adjuvant chemotherapy and to observe how they perceive and experience the information and the situation of choice. Ten women with breast cancer without axillary extension were observed. We choose to use the decision board method, which consists of both a printed interview guide and a visual aid, designed to inform patients as objectively as possible, to help them choose between two options, chemotherapy or no chemotherapy. Based on interviews with patients we investigated how the patients perceive information given and the situation of choice with which they have been confronted. The results of this study show how patients reached their decision and what factors intervene in the decision process. This study underlies the difficulties of the health care decision process and shows how the patients react when faced with the information and the choice. The most interesting observation is that patients don’t make a rational choice according to the information given by the decision board, but mainly make an irrational choice based on the interpretation of the physician’s intent.

Admission-related migration by older nursing home residents.

To examine recent admissions of older adults to intermediate care facilities in order to identify the factors associated with whether the individual originated in another county, a non-adjacent county, and another state. Employing a conceptual framework based upon migration theory and the long-term care decision process and a data set derived from multiple sources, logistic regression was used to examine whether characteristics of the county of residence prior to admission, the admission facility, and the individual are significant net predictors of the three types of mobility. Separate analyses were conducted for married and unmarried individuals. The analytical models tended to have relatively good fit but only moderate predictive accuracy. In general, persons on Medicaid payment status were more likely to move to another county and to a non-adjacent county, whereas Medicaid payment was associated with a lower likelihood of migrating to Virginia from another state. Individuals originating in counties with higher bed rates had lower rates of migration to another county and non-adjacent county, whereas those from counties with higher occupancy rates were more likely to leave their county of origin. Examination of factors associated with the distance and patterns of nursing home mobility improves our understanding of the nursing home selection process and helps to illuminate the impact of public policy, market forces, and nursing home staff on who goes where to be admitted to a nursing home.

Patients' Views of Family Involvement in Medical Care Decisions and Encounters

This study was designed to examine the role of the third person in the doctor-older patient-companion triad at three points in the medical care decision process of older patients: before the medical encounter, during the medical visit, and subsequent to the medical encounter. Older patients accompanied on the medical visit were compared with older patients who came alone regarding the roles and activities of family and others leading to the older patients' medical visit as well as immediate outcomes upon completion of the medical visit and short-term outcomes 2 months after the initial medical visit. Older patients accompanied to the medical visit also assessed roles and assistance provided by the third-person companion during the medical encounter. Older patients accompanied on the medical visit were usually accompanied by the same person across medical visits. The third person was likely to be a spouse and was viewed as an asset during and after the medical encounter. Older accompanied persons were more likely to have assistance both before and after the medical visit, although there were few differences between groups in terms of immediate and short-term outcomes. Findings suggest that the presence of the third person in the doctor-older patient medical encounter should be viewed as an opportunity for patient education and support for the companion who provides an ongoing role in care of the older patient.