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Shared Decision Making and Patient Autonomy in Healthcare
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Shared Decision Making and Patient Autonomy in Healthcare

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Communication and Informatics".

Deadline for manuscript submissions: closed (24 March 2023) | Viewed by 13262

Special Issue Editor

Dr. Alessandra Solari

E-Mail Website
Guest Editor
Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milan, Italy
Interests: patient-reported outcome measures; shared decision making; complex interventions
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Shared decision making (SDM) is the bidirectional communication between a patient and healthcare professional (HP) to reach an informed choice. Examples include decisions about screening and diagnostic tests, treatments, and future care (advance care planning). Based on the bioethical principle of patient autonomy, SDM augments the ethical requirement of informed consent. In addition, it enhances the patient–HP relationship and increases patient understanding, trust, and adherence to treatment plans. Despite these advantages, the implementation of SDM in clinical practice can be particularly challenging, e.g., in the intensive care unit or in patients with communication difficulties or reduced decisional capacity.

For this Special Issue, we are interested in all the different components of SDM across disciplines. Interventions include those targeting patient value clarification, risk communication, decision aids, and training programs for patients and HPs. Outcomes include patient and HP self-reported outcomes (e.g., risk knowledge, satisfaction with care, decisional conflict, self-confidence), treatment adherence/persistence, cost-effectiveness and process evaluation. Finally, the implementation of SDM in different countries and cultures is of the utmost importance.

Dr. Alessandra Solari
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • shared decision making
  • informed choice
  • patient autonomy
  • patient empowerment
  • risk communication
  • goals of care
  • outcome measure

Published Papers (5 papers)

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Research

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17 pages, 1474 KiB  
Article
Development of a Patient Decision Aid to Support Shared Decision Making for Patients with Recurrent High-Grade Glioma
by Helle Sorensen von Essen, Frantz Rom Poulsen, Rikke Hedegaard Dahlrot, Karin Piil and Karina Dahl Steffensen
Int. J. Environ. Res. Public Health 2022, 19(12), 7396; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19127396 - 16 Jun 2022
Cited by 5 | Viewed by 1863
Abstract
When high-grade gliomas recur, patients, their families, and clinicians face difficult medical decisions. There is no curable treatment, and the treatment options all come with a risk of complications and adverse effects. The patients are often cognitively affected, and they need tailored decision [...] Read more.
When high-grade gliomas recur, patients, their families, and clinicians face difficult medical decisions. There is no curable treatment, and the treatment options all come with a risk of complications and adverse effects. The patients are often cognitively affected, and they need tailored decision support. The objective of this study was to develop a patient decision aid (PtDA) targeted at patients with recurrent high-grade gliomas. Based on existing knowledge and the International Patient Decision Aids Standards, the PtDA was developed through an iterative process. The PtDA was alpha-tested by potential users to assess its acceptability and usability. The development team comprised three clinicians, two patients, two family members, and a researcher. The fifth version of the PtDA was submitted to the alpha test. Eleven patients, nine family members, and eleven clinicians assessed the PtDA and found it acceptable. Three changes were made during the alpha test. Most participants perceived the PtDA to prepare patients for decision making and improve consultations. The involvement of potential users was emphasized during the development and alpha test process. The PtDA was assessed as useful and acceptable by patients, family members, and clinicians in the decision-making situation of recurrent high-grade glioma. Full article
(This article belongs to the Special Issue Shared Decision Making and Patient Autonomy in Healthcare)
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19 pages, 592 KiB  
Article
Shared Decision Making with Acutely Hospitalized, Older Poly-Medicated Patients: A Mixed-Methods Study in an Emergency Department
by Pia Keinicke Fabricius, Anissa Aharaz, Nina Thórný Stefánsdóttir, Morten Baltzer Houlind, Karina Dahl Steffensen, Ove Andersen and Jeanette Wassar Kirk
Int. J. Environ. Res. Public Health 2022, 19(11), 6429; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116429 - 25 May 2022
Cited by 3 | Viewed by 1946
Abstract
Shared decision making (SDM) about medicine with older poly-medicated patients is vital to improving adherence and preventing medication-related hospital admissions, but it is difficult to achieve in practice. This study’s primary aim was to provide insight into the extent of SDM in medication [...] Read more.
Shared decision making (SDM) about medicine with older poly-medicated patients is vital to improving adherence and preventing medication-related hospital admissions, but it is difficult to achieve in practice. This study’s primary aim was to provide insight into the extent of SDM in medication decisions in the Emergency Department (ED) and to compare how it aligns with older poly-medicated patients’ preferences and needs. We applied a mixed-methods design to investigate SDM in medication decisions from two perspectives: (1) observational measurements with the observing patient involvement (OPTION 5) instrument of healthcare professionals’ SDM behavior in medication decisions and (2) semi-structured interviews with older poly-medicated patients. A convergent parallel analysis was performed. Sixty-five observations and fourteen interviews revealed four overall themes: (1) a low degree of SDM about medication, (2) a variation in the pro-active and non-active patients approach to conversations about medicine, (3) no information on side effects, and (4) a preference for medication reduction. The lack of SDM with older patients in the ED may increase inequality in health. Patients with low health literacy are at risk of safety threats, nonadherence, and preventable re-admissions. Therefore, healthcare professionals should systematically investigate older poly-medicated patients’ preferences and discuss the side effects and the possibility of reducing harmful medicine. Full article
(This article belongs to the Special Issue Shared Decision Making and Patient Autonomy in Healthcare)
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16 pages, 1234 KiB  
Article
Shared Decision Making in the Psychiatric Inpatient Setting: An Ethnographic Study about Interprofessional Psychiatric Consultations
by Caroline Gurtner, Christa Lohrmann, Jos M. G. A. Schols and Sabine Hahn
Int. J. Environ. Res. Public Health 2022, 19(6), 3644; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19063644 - 18 Mar 2022
Cited by 2 | Viewed by 2132
Abstract
Shared decision making is increasingly receiving attention in health care and might improve both the quality of care and patient outcomes. Nevertheless, due to its complexity, implementation of shared decision making in clinical practice seems challenging. This ethnographic study aimed to gain a [...] Read more.
Shared decision making is increasingly receiving attention in health care and might improve both the quality of care and patient outcomes. Nevertheless, due to its complexity, implementation of shared decision making in clinical practice seems challenging. This ethnographic study aimed to gain a better understanding of how psychiatric inpatients and the interprofessional care team interact during regular interprofessional psychiatric consultations. Data were collected through participant observation on two different psychiatric wards in a large psychiatric hospital in Switzerland. The observation focused on the contextual aspects of interprofessional patient consultations, the communication and interaction as well as the extent to which patients were involved in decision making. Participants included patients, psychiatrists, junior physicians, nurses, psychologists, social workers and therapists. We observed 71 interprofessional psychiatric consultations and they differed substantially in both wards in terms of context (place and form) and culture (way of interacting). On the contrary, results showed that the level of patient involvement in decision making was comparable and depended on individual factors, such as the health care professionals’ communication style as well as the patients’ personal initiative to be engaged. The main topics discussed with the patients related to pharmacotherapy and patient reported symptoms. Health care professionals in both wards used a rather unidirectional communication style. Therefore, in order to promote patient involvement in the psychiatric inpatient setting, rather than to focus on contextual factors, consultations should follow a specific agenda and promoting a bidirectional communication style for all parties involved is strongly recommended. Full article
(This article belongs to the Special Issue Shared Decision Making and Patient Autonomy in Healthcare)
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Review

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20 pages, 1050 KiB  
Review
Advance Care Planning in Neurodegenerative Disorders: A Scoping Review
by Andrea Giordano, Ludovica De Panfilis, Marta Perin, Laura Servidio, Marta Cascioli, Maria Grazia Grasso, Alessandra Lugaresi, Eugenio Pucci, Simone Veronese and Alessandra Solari
Int. J. Environ. Res. Public Health 2022, 19(2), 803; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19020803 - 12 Jan 2022
Cited by 12 | Viewed by 3796
Abstract
Advance care planning (ACP) is increasingly acknowledged as a key step to enable patients to define their goals/preferences for future medical care, together with their carers and health professionals. We aimed to map the evidence on ACP in neurodegenerative disorders. We conducted a [...] Read more.
Advance care planning (ACP) is increasingly acknowledged as a key step to enable patients to define their goals/preferences for future medical care, together with their carers and health professionals. We aimed to map the evidence on ACP in neurodegenerative disorders. We conducted a scoping review by searching PubMed (inception-December 28, 2020) in addition to trial, review, and dissertation registers. From 9367 records, we included 53 studies, mostly conducted in Europe (45%) and US-Canada (41%), within the last five years. Twenty-six percent of studies were qualitative, followed by observational (21%), reviews (19%), randomized controlled trials (RCTs, 19%), quasi-experimental (11%), and mixed-methods (4%). Two-thirds of studies addressed dementia, followed by amyotrophic lateral sclerosis (13%), and brain tumors (9%). The RCT interventions (all in dementia) consisted of educational programs, facilitated discussions, or videos for patients and/or carers. In conclusion, more research is needed to investigate barriers and facilitators of ACP uptake, as well as to develop/test interventions in almost all the neurodegenerative disorders. A common set of outcome measures targeting each discrete ACP behavior, and validated across the different diseases and cultures is also needed. Full article
(This article belongs to the Special Issue Shared Decision Making and Patient Autonomy in Healthcare)
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Other

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16 pages, 1196 KiB  
Systematic Review
Factors That Foster Therapeutic Alliance in Pediatric Sports and Orthopedics: A Systematic Review
by Rachel N. Meyers, Robyn B. McHugh and Alissa M. Conde
Int. J. Environ. Res. Public Health 2022, 19(18), 11813; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191811813 - 19 Sep 2022
Viewed by 2482
Abstract
Therapeutic alliance has been defined as building rapport between provider and patient in order to enhance patient motivation to improve outcomes. The purpose of this systematic review was to identify factors that patients look for that help build a strong therapeutic alliance in [...] Read more.
Therapeutic alliance has been defined as building rapport between provider and patient in order to enhance patient motivation to improve outcomes. The purpose of this systematic review was to identify factors that patients look for that help build a strong therapeutic alliance in their pediatric sports or orthopedics healthcare provider, to identify if these factors differ across healthcare professions, and to identify any differences in therapeutic alliance between patients and their provider regarding in-person and telehealth visits. Scientific databases were searched from inception until August 2022. The search strategy resulted in 2195 articles with 11 studies included in the final analysis. The main attributes adolescents look for in their pediatric sports healthcare provider were shared decision making and understanding patients’ sports and goals. These factors were found to differ among parents, sex, race, and socioeconomic status. The top factors improving therapeutic alliance in telehealth were having an already established relationship with the provider, visits lasting longer than 30 min, and having an English-speaking provider for English-speaking patients. The available literature highlights factors that contribute to the development of a stronger therapeutic alliance in the pediatric sports and orthopedics population. As these factors differ among adolescents, parents, sex, race, and socioeconomic status, this review provides insight in what patients and families look for in their provider when seeking care. Full article
(This article belongs to the Special Issue Shared Decision Making and Patient Autonomy in Healthcare)
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