Participation In Clinical Decision Research Articles

Families’ perspectives on the use of physical restraints

There have been many studies on the use of restraints from health care professionals’ point of view. However, studies that examine the perspective of the patient or the patient’s family are limited. Using a survey approach, the project team investigated the perspectives of families on the use of restraints on their relatives who had been admitted to a rehabilitation facility.Twenty-five families were recruited into this study through convenience sampling. It was found that the majority of them were not aware of alternatives to physical restraints, had no opinions on restraint use, and found restraints useful.The findings highlighted the need for family education and participation in clinical decision making concerning the use of restraints.

User participation in mental health nurse decision‐making: a co‐operative enquiry

This paper is a report of a study to encourage participants to work together to identify strategies for increasing user participation in clinical decisions and to evaluate the value of co-operative inquiry as a vehicle for supporting learning in practice. Service user participation in the clinical practice decisions of mental health nurses is considered essential for good practice. Methods need to be found which enable opportunities for shared learning, facilitate practice development and empower service users. A co-operative inquiry design engaged all participants (n = 17) as co-researchers and involved repeated cycles of action and reflection, using multiple data collection methods. The research was conducted over a two year period in 2004-2005, with mental health nursing students collaborating with service users. Factors inhibiting participation included stigmatizing and paternalistic approaches, where clinical judgments were made solely on the basis of diagnosis. Enhancing factors were a respectful culture which recognized users ''expertise' and communicated belief in individual potential. Inquiry benefits included insight into service users' perspectives, enhanced confidence in decision-making, appreciation of power issues in helping relationships and deconstruction of decision-making within a safe learning environment. Learning from novel approaches which enable nursing students to develop their reflective and reflexive ability is essential to avoid practice which disempowers and potentially harms service users' recovery. Co-operative inquiry is a valuable vehicle for developing professional practice in higher education and practice environments.

¿Quién puede decidir por mí? Una revisión de la legislación española vigente sobre las decisiones de representación y las instrucciones previas

AbstractPatient participation in clinical decision making is at its most problematic when the patient is incompetent. In these cases, decisions must be taken for the patient, which raises issues of great ethical and legal complexity. The quality of a health care organization is also related to its ability to deal with this kind of problem methodically. Therefore, thorough knowledge of the first step of the decision-making process, the legal aspects of these decisions, is essential. The present article aims to review the historical development of the legal aspects of substituted decision making in Spanish law, and to provide a brief overview of the state of the art in current legislation up to January 1st, 2004. Special attention is paid to legal aspects of living wills or advance directives. This will help both health professionals and organizations to develop protocols for the advance planning of these decisions.

The Consultation Style Of Doctors At An Outpatient Clinic In Ibadan, Oyo State, Nigeria, And Nigeria: Are Patients Participating?

Objectives: Family Medicine (FM) training started two decades ago in Nigeria. The influence of FM training on the consultation style of practitioners in Nigeria is not known. This study examined the consultation style of family physicians in an outpatient clinic, the amount of information provided by the physicians to their patients and the level of their patients' participation in the consultation process Methods: A systematic sample of 212 adult patients was interviewed using semi – structured questionnaire. Chi square test was used to test significance of differences in proportions. Result: The consultation style of the physicians was predominantly doctor- centred. Doctors provided information on nature, plan of management, prognosis and prevention of illness to 38.7% 16.5%, 5.5% and 49.5% of the patients respectively. 34.3%, 21.4% and 16.7% of the patients sought information on nature, plan of management and prognosis of illness respectively. The commonest reason for patients not seeking such information from their doctors is that “they did not know they could ask such questions.” Patients who asked doctors about plan of management significantly reported that they had their expectations met. The level of education of the patients determined to a great extent the information sought for and that provided by the doctors (p Conclusion: Patients' participation during consultation is inadequate and there is a suggestion that patients would welcome more involvement in the care of their of their illness practitioners need to be taught the patients centered clinical method, a key distinguishing characteristic of Family Medical, which emphasize patients' expression of their illness experience(s) and participation in clinical decision making KEY WORDS: Patients, participation, consultation, style outpatient, clinic Nigerian Journal of Clinical Practice Vol.6(1) 2003: 10-16

Bridging the gap.: The separate worlds of evidence-based medicine and patient-centered medicine

Modern medical care is influenced by two paradigms: ‘evidence-based medicine’ and ‘patient-centered medicine’. In the last decade, both paradigms rapidly gained in popularity and are now both supposed to affect the process of clinical decision making during the daily practice of physicians. However, careful analysis shows that they focus on different aspects of medical care and have, in fact, little in common. Evidence-based medicine is a rather young concept that entered the scientific literature in the early 1990s. It has basically a positivistic, biomedical perspective. Its focus is on offering clinicians the best available evidence about the most adequate treatment for their patients, considering medicine merely as a cognitive-rational enterprise. In this approach the uniqueness of patients, their individual needs and preferences, and their emotional status are easily neglected as relevant factors in decision-making. Patient-centered medicine, although not a new phenomenon, has recently attracted renewed attention. It has basically a humanistic, biopsychosocial perspective, combining ethical values on ‘the ideal physician’, with psychotherapeutic theories on facilitating patients’ disclosure of real worries, and negotiation theories on decision making. It puts a strong focus on patient participation in clinical decision making by taking into account the patients’ perspective, and tuning medical care to the patients’ needs and preferences. However, in this approach the ideological base is better developed than its evidence base. In modern medicine both paradigms are highly relevant, but yet seem to belong to different worlds. The challenge for the near future is to bring these separate worlds together. The aim of this paper is to give an impulse to this integration. Developments within both paradigms can benefit from interchanging ideas and principles from which eventually medical care will benefit. In this process a key role is foreseen for communication and communication research.

Developing Information Materials to Present the Findings of Technology Assessments to Consumers: The Experience of the NHS Centre for Reviews and Dissemination

We discuss some of the issues that have arisen during the development and introduction into practice of information materials for health professionals and patients that aim to promote clinical effectiveness and informed patient participation in clinical decision making.

Patients' Preferences for Participation in Clinical Decision Making: A Review of Published Surveys

Models of doctor-patient relations vary between “paternalistic” and “informative.” The paternalistic model emphasizes doctors' authority; alternative models allow patients to exercise their rights to autonomy. Published surveys indicate that most patients want to be informed about their diseases, that a proportion of patients want to participate in planning management of their illnesses, and that some patients would rather be completely passive and would avoid any information. The severity of the patients' conditions, and their being older, less well educated, and male are predictors of a preference for the passive role in the doctor-patient relationship, but demographic and situational characteristics explain only 20% or less of the variability in preferences. The only way a physician can gain insight into an individual patient's desire to participate in decision making is through direct enquiry. The ability to communicate health-related information and to determine the patients' desire to participate in medical decisions should be viewed as a basic clinical skill.

Meeting patients' information needs beyond the year 2000.

Advances in information technology, and changing patient expectation in regard to provision of information and participation in clinical decisions are already influencing the cancer consultation. In future, the oncologist's role will evolve further, and the cancer consultation beyond the year 2000 will be an opportunity for information relating to the particular patient's circumstances to be presented according to the patient's wishes. Patients' desired input into clinical decisions will be respected, and consultation audiotapes will be a widely used aid for patients after the consultation.