Incorporation Of Patient Values Research Articles

The Use of Artificial Intelligence in Clinical Care: A Values-Based Guide for Shared Decision Making.

Clinical applications of artificial intelligence (AI) in healthcare, including in the field of oncology, have the potential to advance diagnosis and treatment. The literature suggests that patient values should be considered in decision making when using AI in clinical care; however, there is a lack of practical guidance for clinicians on how to approach these conversations and incorporate patient values into clinical decision making. We provide a practical, values-based guide for clinicians to assist in critical reflection and the incorporation of patient values into shared decision making when deciding to use AI in clinical care. Values that are relevant to patients, identified in the literature, include trust, privacy and confidentiality, non-maleficence, safety, accountability, beneficence, autonomy, transparency, compassion, equity, justice, and fairness. The guide offers questions for clinicians to consider when adopting the potential use of AI in their practice; explores illness understanding between the patient and clinician; encourages open dialogue of patient values; reviews all clinically appropriate options; and makes a shared decision of what option best meets the patient's values. The guide can be used for diverse clinical applications of AI.

Review of the 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation—What Has Changed and How Does This Affect Daily Practice

The high prevalence of atrial fibrillation (AF) in the overall population and its association with substantial morbidity, increased mortality and health care cost has instigated significant basic and clinical research efforts over recent years. The publication of multiple new high-quality randomized multi-center trials in the area of AF management and the rapidly evolving technological progress in terms of diagnostic possibilities and catheter ablation in recent years demanded a revision of the previous ESC AF Guidelines from 2016. The 2020 guidelines provide up-to-date, evidence-based guidance for the management of AF. One of the most important innovations is the presentation of a new concept for structural characterization of AF (the “4S AF scheme”) replacing the traditional classification based on its temporal pattern alone (paroxysmal-persistent-permanent). The 4S-AF-scheme highlights the importance of systematic assessment of stroke risk, severity of symptoms, total AF burden and underlying substrate as the foundation for effective and individualized AF treatment for each and every patient. Further novelties relate to the presentation of an easy and intuitive management pathway (“ABC pathway”) and strengthening the recommendations for early rhythm control, in particular the role of first line catheter ablation in heart failure. Another core component of the guidelines is the focus on patient involvement to achieve optimal outcomes. Patient education, shared decision making and incorporation of patient values and patient reported outcome of treatment interventions as well as integrated care by a multidisciplinary team all have a central role in the proposed management pathway for AF.

Evidence-based medicine and precision medicine: Complementary approaches to clinical decision-making.

Evidence-based medicine is widely promoted for decision-making in health care and is associated with improved patient outcomes. Critics have suggested that evidence-based medicine focuses primarily on groups of patients rather than individuals, but often fail to consider subgroup analyses, N-of-1 trials, and the incorporation of patient values and preferences. Precision medicine has been promoted as an approach to individualize diagnosis and treatment of diseases through genetic, biomarker, phenotypic, and psychosocial characteristics. However, there are often high costs associated with personalized medicine, and high-quality evidence is lacking for effectiveness in many applications. For the potential of personalized medicine to be realized, it must adhere to the principles of evidence-based medicine: (1) evidence in isolation is not sufficient to make clinical decisions—patient’s values and preferences as well as resource implications must be considered, and (2) there is a hierarchy of evidence to guide clinical decision-making and studies at lower risk of bias are likely to provide more trustworthy findings.

Guidelines: An Exploration and Discussion

The goal of this article was to explore the structure and evaluation of guidelines and to discuss those features applicable to the librarian serving clinicians, thereby meeting the suggestions for guidelines that the Institute of Medicine (IOM) initially suggested in 1990. A literature search of major biomedical databases was undertaken. In addition, organizations and textbooks were consulted. The search discovered components of guidelines in general, evaluation tools for those components, and a few evaluation tools for the guidelines themselves. A further exploration revealed attributes of guideline formation and development that serve to clarify both their value and limitations. It was determined that GRADE (Grading of Recommendations Assessment, Development, and Evaluation) most nearly meets the IOM’s recommendations. Its widespread acceptance, incorporation of patient values and/or preferences, and its inclusion of studies other than randomized controlled trials make it uniquely suitable to clinical practice.

Evidence‐based care and the curriculum

An evidence-based (EB) approach has been a significant driver in reforming healthcare over the past two decades. This change has extended across a broad range of health professions, including oral healthcare. A key element in achieving an EB approach to oral healthcare is educating our practitioners, both current and future. This involves providing opportunities integrated within simulated and actual clinical settings for practitioners to learn and apply the principles and processes of evidence-based oral healthcare (EBOHC). Therefore, the focus of this discussion will be on ways in which EBOHC and associated research activities can be implemented into curricula, with the aim of improving patient care. This paper will initially define the scope of EBOHC and research, what these involve, why they are important, and issues that we need to manage when implementing EBOHC. This will be followed by a discussion of factors that enable successful implementation of EBOHC and research into curricula. The paper concludes with suggestions on the future of EBOHC and research in curricula. Key recommendations related to curricula include strengthening of the culture of a scientific approach to education and oral healthcare provision; complete integration of EBOHC into the curriculum at all levels; and faculty development to implement EBOHC based on their needs and evidence of effective approaches. Key recommendations to support implementation and maintenance of EBOHC include recognition and funding for high-quality systematic reviews and development of associated methodologies relevant for global environments; building global capacity of EBOHC researchers; research into improving translation of effective interventions into education and healthcare practice, including patient-reported outcomes, safety and harms, understanding and incorporation of patient values into EB decision-making, economic evaluation research specific to oral healthcare and effective methods for changing practitioner (faculty) behaviours; and extend access to synthesized research in 'user friendly' formats and languages tailored to meet users' needs. Realizing these recommendations may help to improve access to effective healthcare as a basic human right.