Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper...Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper treatment all contribute to decision-making errors.Clinician-related factors such as fatigue,cognitive overload,and inexperience further interfere with effective decision-making.Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error.This evidence-based review discusses ten common misconceptions regarding critical care decision-making.By understanding how practitioners make clinical decisions and examining how errors occur,strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.展开更多
Purpose:To investigate the preferred and actual participation levels of colorectal cancer patients and their families in treatment decision-making.Methods:A cross-sectional survey was conducted using a questionnaire a...Purpose:To investigate the preferred and actual participation levels of colorectal cancer patients and their families in treatment decision-making.Methods:A cross-sectional survey was conducted using a questionnaire administered to colorectal cancer patients hospitalized in the general surgical wards in two of the upper first-class hospitals in Beijing between February and July 2013.Results:A total of 113 questionnaires were analyzed.For the families of colorectal cancer patients,the concordance rate of their preferred and actual participation levels in treatment decision-making was 60.2%and 62.8%for the patients themselves.Patients with stoma and male patients preferred a passive role compared to those without stoma and female patients(χ^(2)=7.978,p<0.05;χ^(2)=9.854,p<0.05).Conclusions:Over 40%of colorectal cancer patients preferred a passive role in treatment decision-making.We suggest that communication between physicians and patients should be strengthened to accommodate the patient's desired level of involvement.展开更多
Objectives: To describe the communication behaviors of patients and physicians and patient par-ticipation in communication about treatment decision-making during consultation visits for local-ized prostate cancer (LPC...Objectives: To describe the communication behaviors of patients and physicians and patient par-ticipation in communication about treatment decision-making during consultation visits for local-ized prostate cancer (LPCa). Methods: This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed);“low” (patient listening only);“moderate” (patient providing information or asking questions);and “high” (patient providing information and asking questions). Results: Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories;2) “low” in discussing survival/mortality;3) “low and moderate” in discussing treatment options;4) “none and low” in discussing treatment impacts;and 5) “low” in discussing treatment preferences. Conclusions: Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.展开更多
For cancer patients on Phase I trials, one of the most important physician decisions is whether or not patients are deriving benefit from therapy. With an increasing number of cytostatic treatment agents, the criteria...For cancer patients on Phase I trials, one of the most important physician decisions is whether or not patients are deriving benefit from therapy. With an increasing number of cytostatic treatment agents, the criteria to determine patient response to Phase I treatment has become harder to define. Physicians are increasingly looking to patient-reported outcomes (PROs) such as quality of life (QOL) to help evaluate treatment response. Electronic daily diary (EDD) devices can be used by patients to report their QOL over extended periods of time, thereby providing a more accurate picture of how patients are affected by treatment on a daily basis. However, questions remain about how to integrate this patient-reported information into decisions about Phase I treatment. This study investigated how physicians use patients’ daily QOL reports to evaluate patient response to Phase I treatment. Data were collected over a 4-month period from Phase I patients (N = 30) and physicians (N = 3) in an NCI-designated comprehensive cancer center. Patients completed daily QOL reports using EDD devices and physicians were provided with a summary of patients’ QOL before each visit. After the visit, doctors recorded their treatment decision and also rated the importance of four biomedical factors (Toxicity, Imaging, Labs, and Performance Status) and QOL in their treatment decision for that visit. Although physicians rated QOL as being very important in evaluating treatment response, in practice, when predictors of their decisions were analyzed, results showed they relied exclusively on biomedical data (Toxicity, Imaging) to make Phase I treatment decisions. Questions remain about the utility and effective integration of QOL and biomedical data in clinical decision-making processes in Phase I clinical trials.展开更多
In China,there are three basic clinical decision-making modes for patients,namely patients autonomous decision-making mode,family decision-making mode and patient and family codetermination.They were produced under th...In China,there are three basic clinical decision-making modes for patients,namely patients autonomous decision-making mode,family decision-making mode and patient and family codetermination.They were produced under the unique background of Chinese medicine,Confucian philosophy and law in China,l this paper,the concepts,advantages and disadvantages of these three decision-making modes were analyzed In addition,some suggestions were put forward for the improvement.The first is that we suggest to establis standards for choosing decision-making modes;the second is to further learn and publicize relevant laws;thirdly the legal system needs to be further refined;and the last one is to carry out ethical ward round.展开更多
Introduction The success or failure of treatment has long been attributed to the doctors alone,but the role of patients in the medical decision-making(MDM)process has often been ignored.As medical development and heal...Introduction The success or failure of treatment has long been attributed to the doctors alone,but the role of patients in the medical decision-making(MDM)process has often been ignored.As medical development and health needs increase,the desire of patients to participate in MDM continues to grow.This raises the question:should patients be involved in such a highly professional medical activity?How can their involvement bring better clinical benefits?展开更多
文摘Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper treatment all contribute to decision-making errors.Clinician-related factors such as fatigue,cognitive overload,and inexperience further interfere with effective decision-making.Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error.This evidence-based review discusses ten common misconceptions regarding critical care decision-making.By understanding how practitioners make clinical decisions and examining how errors occur,strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.
文摘Purpose:To investigate the preferred and actual participation levels of colorectal cancer patients and their families in treatment decision-making.Methods:A cross-sectional survey was conducted using a questionnaire administered to colorectal cancer patients hospitalized in the general surgical wards in two of the upper first-class hospitals in Beijing between February and July 2013.Results:A total of 113 questionnaires were analyzed.For the families of colorectal cancer patients,the concordance rate of their preferred and actual participation levels in treatment decision-making was 60.2%and 62.8%for the patients themselves.Patients with stoma and male patients preferred a passive role compared to those without stoma and female patients(χ^(2)=7.978,p<0.05;χ^(2)=9.854,p<0.05).Conclusions:Over 40%of colorectal cancer patients preferred a passive role in treatment decision-making.We suggest that communication between physicians and patients should be strengthened to accommodate the patient's desired level of involvement.
文摘Objectives: To describe the communication behaviors of patients and physicians and patient par-ticipation in communication about treatment decision-making during consultation visits for local-ized prostate cancer (LPCa). Methods: This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed);“low” (patient listening only);“moderate” (patient providing information or asking questions);and “high” (patient providing information and asking questions). Results: Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories;2) “low” in discussing survival/mortality;3) “low and moderate” in discussing treatment options;4) “none and low” in discussing treatment impacts;and 5) “low” in discussing treatment preferences. Conclusions: Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.
文摘For cancer patients on Phase I trials, one of the most important physician decisions is whether or not patients are deriving benefit from therapy. With an increasing number of cytostatic treatment agents, the criteria to determine patient response to Phase I treatment has become harder to define. Physicians are increasingly looking to patient-reported outcomes (PROs) such as quality of life (QOL) to help evaluate treatment response. Electronic daily diary (EDD) devices can be used by patients to report their QOL over extended periods of time, thereby providing a more accurate picture of how patients are affected by treatment on a daily basis. However, questions remain about how to integrate this patient-reported information into decisions about Phase I treatment. This study investigated how physicians use patients’ daily QOL reports to evaluate patient response to Phase I treatment. Data were collected over a 4-month period from Phase I patients (N = 30) and physicians (N = 3) in an NCI-designated comprehensive cancer center. Patients completed daily QOL reports using EDD devices and physicians were provided with a summary of patients’ QOL before each visit. After the visit, doctors recorded their treatment decision and also rated the importance of four biomedical factors (Toxicity, Imaging, Labs, and Performance Status) and QOL in their treatment decision for that visit. Although physicians rated QOL as being very important in evaluating treatment response, in practice, when predictors of their decisions were analyzed, results showed they relied exclusively on biomedical data (Toxicity, Imaging) to make Phase I treatment decisions. Questions remain about the utility and effective integration of QOL and biomedical data in clinical decision-making processes in Phase I clinical trials.
文摘In China,there are three basic clinical decision-making modes for patients,namely patients autonomous decision-making mode,family decision-making mode and patient and family codetermination.They were produced under the unique background of Chinese medicine,Confucian philosophy and law in China,l this paper,the concepts,advantages and disadvantages of these three decision-making modes were analyzed In addition,some suggestions were put forward for the improvement.The first is that we suggest to establis standards for choosing decision-making modes;the second is to further learn and publicize relevant laws;thirdly the legal system needs to be further refined;and the last one is to carry out ethical ward round.
文摘Introduction The success or failure of treatment has long been attributed to the doctors alone,but the role of patients in the medical decision-making(MDM)process has often been ignored.As medical development and health needs increase,the desire of patients to participate in MDM continues to grow.This raises the question:should patients be involved in such a highly professional medical activity?How can their involvement bring better clinical benefits?
