519,134 research outputs found

    Ethical decision-making, passivity and pharmacy

    Get PDF
    Background: Increasing interest in empirical ethics has enhanced understanding of healthcare professionals' ethical problems and attendant decision-making. A four-stage decision-making model involving ethical attention, reasoning, intention and action offers further insights into how more than reasoning alone may contribute to decision-making. Aims: To explore how the four-stage model can increase understanding of decision-making in healthcare and describe the decision-making of an under-researched professional group. Methods: 23 purposively sampled UK community pharmacists were asked, in semi-structured interviews, to describe ethical problems in their work and how they were resolved. Framework analysis of transcribed interviews utilised the four decision-making stages, together with constant comparative methods and deviant-case analysis. Results: Pharmacists were often inattentive and constructed problems in legal terms. Ethical reasoning was limited, but examples of appeals to consequences, the golden rule, religious faith and common-sense experience emerged. Ethical intention was compromised by frequent concern about legal prosecution. Ethical inaction was common, typified by pharmacists' failure to report healthcare professionals' bad practices, and ethical passivity emerged to describe these negative examples of the four decision-making stages. Pharmacists occasionally described more ethically active decision-making, but this often involved ethical uncertainty. Discussion: The four decision-making stages are a useful tool in considering how healthcare professionals try to resolve ethical problems in practice. They reveal processes often ignored in normative theories, and their recognition and the emergence of ethical passivity indicates the complexity of decision-making in practice. Ethical passivity may be deleterious to patients' welfare, and concerns emerge about improving pharmacists' ethical training and promoting ethical awareness and responsibility

    Engaging the public in healthcare decision-making: quantifying preferences for healthcare through citizens' juries

    Get PDF
    Introduction The optimal approach to engage the public in healthcare decision-making is unclear. Approaches range from deliberative citizens’ juries to large population surveys using discrete choice experiments. This study promotes public engagement and quantifies preferences in two key areas of relevance to the industry partners to identify which approach is most informative for informing healthcare policy. Methods and analysis The key areas identified are optimising appropriate use of emergency care and prioritising patients for bariatric surgery. Three citizens’ juries will be undertaken—two in Queensland to address each key issue and one in Adelaide to repeat the bariatric surgery deliberations with a different sample. Jurors will be given a choice experiment before the jury, immediately following the jury and at approximately 1 month following the jury. Control groups for each jury will be given the choice experiment at the same time points to test for convergence. Samples of healthcare decision-makers will be given the choice experiment as will two large samples of the population. Jury and control group participants will be recruited from the Queensland electoral roll and newspaper advertisements in Adelaide. Population samples will be recruited from a large research panel. Jury processes will be analysed qualitatively and choice experiments will be analysed using multinomial logit models and its more generalised forms. Comparisons between preferences across jurors predeliberation and postdeliberation, control participants, healthcare decision-makers and the general public will be undertaken for each key issue

    Evidence Based Decision Making in Healthcare

    Get PDF

    Data Mining in Health-Care: Issues and a Research Agenda

    Get PDF
    While data mining has become a much-lauded tool in business and related fields, its role in the healthcare arena is still being explored. Currently, most applications of data mining in healthcare can be categorized into two areas: decision support for clinical practice, and policy planning/decision making. However, it is challenging to find empirical literature in this area since a substantial amount of existing work in data mining for health care is conceptual in nature. In this paper, we review the challenges that limit the progress made in this area and present considerations for the future of data mining in healthcare

    Collaborative Documentation for Behavioral Healthcare Providers: An Emerging Practice

    Get PDF
    This article considers the practice of collaborative documentation (CD) for behavioral healthcare providers; the legislative, technological, and philosophical milieu in which it developed; the attributed benefits for providers and clients; and the peer-reviewed research supporting its use. Collaborative documentation has emerged following significant legislative and technological changes in healthcare delivery and shifts toward client-centered healthcare practices including more shared decision-making between clients and practitioners

    Competent children?: minors’ consent to health care treatment and research

    Get PDF
    This paper concentrates on controversies about children's consent, and reviews how children's changing status as competent decision makers about healthcare and research has gradually gained greater respect. Criteria for competence have moved from age towards individual children's experience and understanding. Uncertain and shifting concepts of competence and its identification with adulthood and childhood are examined, together with levels of decision-making and models for assessing children's competence. Risks and uncertainties, methods of calculating the frequency and severity of risks, the concept of 'therapeutic research' and problems of expanding consent beyond its remit are considered. The paper ends by considering how strengths and limitations in children's status and capacities to consent can be mirrored in researchers' and practitioners' own status and capacities. Examples are drawn from empirical research studies about decision-making in healthcare and research involving children in the UK

    Patient and health care professional decision-making to commence and withdraw from renal dialysis: A systematic review of qualitative research

    Get PDF
    Background and objectives. To ensure decisions to start and stop dialysis in end stage kidney disease are shared, the factors that affect patients and healthcare professionals in making such decisions need to be understood. This systematic review aims to explore how and why different factors mediate the choices about dialysis treatment. Design, setting, participants, and measurements. Medline, Embase, CINAHL and PsychINFO were searched for qualitative studies of factors that affect patients’ and/or healthcare professionals’ decisions to commence or withdraw from dialysis. A thematic synthesis was conducted. Results. Of 494 articles screened, 12 studies (conducted: 1985-2014) were included. These involved 206 predominantly haemodialysis patients and 64 healthcare professionals (age range: patients 26-93; professionals 26-61 years). (i) Commencing dialysis: patients based their choice on ‘gut-instinct’ as well as deliberating the impact of treatment on quality-of-life and survival. How individuals coped with decision-making was influential, some tried to take control of the problem of progressive renal failure, whilst others focussed on controlling their emotions. Healthcare professionals weighed-up biomedical factors and were led by an instinct to prolong life. Both patients and healthcare professionals described feeling powerless. (ii) Dialysis withdrawal: Only after prolonged periods of time on dialysis, were the realities of life on dialysis fully appreciated and past choice questioned. By this stage however patients were physically treatment dependent. Similar to commencing dialysis, individuals coped with treatment withdrawal in a problem or emotion-controlling way. Families struggled to differentiate choosing versus allowing death. Healthcare teams avoided and queried discussions regarding dialysis withdrawal. Patients however missed the dialogue they experienced during pre-dialysis education. Conclusions. Decision-making in end stage kidney disease is complex, dynamic, and evolves over time and towards death. The factors at work are multi-faceted and operate differently for patients and health professionals. More training and research on open-communication and shared decision-making is needed

    Giving Children a Voice: Investigation of children's participation in consultation and decision making in Irish hospitals

    Get PDF
    The purpose of this study was to investigate sick children’s experiences of participation in consultation and decision-making within the healthcare setting. The specific objectives were: to describe children’s experiences of consultation in the healthcare setting; to identify the factors that enhance children’s involvement in consultation and the decisionmaking process; to identify the factors that hinder children from involvement in consultation and the decisionmaking process; to explore strategies that will empower children to participate in their own healthcare decisions

    The Challenges of Capacity Building in the Aligning Forces for Quality Alliances

    Get PDF
    Summarizes the challenges and trade-offs in infrastructure and governance as well as stakeholder relations and participation, such as inclusive versus efficient decision making, in an alliance to coordinate regional healthcare improvement activities
    • 

    corecore