Decision-Making Dilemmas within Integrated Care Service Networks: A Systematic Literature Review

Introduction: The diverse nature of people’s care needs requires collaboration between different organisations and sectors. One way of achieving such collaboration is through integrated care service networks. Decision-making is considered an important aspect of network governance and key to achieve further integration of care services. As integrated care scholars only implicitly seem to touch upon the issue of decision-making, we aimed to identify multiple decision-making dilemmas. Theory and Methods: A systematic literature review was conducted of eighteen empirical studies in which decision-making dilemmas in integrated care service networks were inductively identified. To frame and understand these dilemmas, we partly drew on Provan and Kenis’ governance models and their hypothesised decision-making dilemma for service networks. Results: Identified decision-making dilemmas included 1) autonomy versus inter-dependence, 2) diversity versus coherence, and 3) self-interest versus common goals. In line with Provan and Kenis’ hypothesis, we highlight a cross-cutting dilemma of inclusiveness (all viewpoints are considered hence widely supported decisions) vs. efficiency (reaching timely decisions). Discussion and conclusion: We believe that network- and ‘systemic’ stakeholders both need to reflect upon and learn from decision-making dilemmas to work towards widely supported and adequate decisions. This is important for achieving aligned and holistic care services that many people desire

Persuasive communication in medical decision-making during consultations with patients with limited health literacy in hospital-based palliative care

OBJECTIVE: Both patients in the palliative phase of their disease and patients with limited health literacy (LHL) have an increased risk of being influenced by healthcare providers (HCPs) when making decisions. This study aims to explore to what extent persuasive communication occurs during shared decision-making (SDM) by (1) providing an overview of persuasive communication behaviours relevant for medical decision-making and (2) exemplifying these using real-life outpatient consultations. METHODS: An exploratory qualitative design was applied: (1) brief literature review; (2) analysis of verbatim extracts from outpatient consultations and stimulated recall sessions with HCPs; and (3) stakeholder meetings. RESULTS: 24 different persuasive communication behaviours were identified, which can be divided in seven categories: biased presentation of information, authoritative framing, probability framing, illusion of decisional control, normative framing, making assumptions and using emotions or feelings. CONCLUSIONS: Persuasive communication is multi-faceted in outpatient consultations. Although undesirable, it may prove useful in specific situations making it necessary to study the phenomenon more in depth and deepen our understanding of its mechanisms and impact. PRACTICE IMPLICATIONS: Awareness among HCPs about the use of persuasive communication needs to be created through training and education. Also, HCPs need help in providing balanced information

Fun, engaging and easily shareable? Exploring the value of co-creating vlogs with citizens from disadvantaged neighbourhoods

The use of vlogs is promising in participatory action research (PAR) that aims to enhance the health and well-being of citizens. Vlogs have the potential to reach a wide audience, transcending the local scale of PAR. This article aims to explore the value of co-creating vlogs by investigating two exploratory studies involving adolescents and women from disadvantaged neighbourhoods. We reflected on the co-creation of vlogs by community members and professionals. The results show that co-creating vlogs enabled meaningful engagement of citizens living in vulnerable circumstances and promoted shared learning. Community members who were not involved in the vlog creation were critical of the vlogs. However, watching the vlogs stimulated discussion and reflection. Therefore, dissemination of vlogs in a setting guided by a professional seems to have the potential to facilitate shared learning. Despite the popularity of vlogs, this study highlights the need to carefully consider the use of vlogs in relation to a study’s aims and to respond to (ethical) concerns

Fun, engaging and easily shareable? Exploring the value of co-creating vlogs with citizens from disadvantaged neighbourhoods

The use of vlogs is promising in participatory action research (PAR) that aims to enhance the health and well-being of citizens. Vlogs have the potential to reach a wide audience, transcending the local scale of PAR. This article aims to explore the value of co-creating vlogs by investigating two exploratory studies involving adolescents and women from disadvantaged neighbourhoods. We reflected on the co-creation of vlogs by community members and professionals. The results show that co-creating vlogs enabled meaningful engagement of citizens living in vulnerable circumstances and promoted shared learning. Community members who were not involved in the vlog creation were critical of the vlogs. However, watching the vlogs stimulated discussion and reflection. Therefore, dissemination of vlogs in a setting guided by a professional seems to have the potential to facilitate shared learning. Despite the popularity of vlogs, this study highlights the need to carefully consider the use of vlogs in relation to a study’s aims and to respond to (ethical) concerns

Setting Priorities for Optimizing Vascular Access Decision Making--An International Survey of Patients and Clinicians.

Many decisions around vascular access for haemodialysis warrant a collaborative treatment decision-making process, involving both clinician and patient. Yet, patients' experiences in this regard have been suboptimal. Although clinical practice guidelines could facilitate collaborative decision making, they often focus on the clinicians' side of the process, while failing to address the patients' perspective. The objective of this study was to explore and compare kidney patients' and clinicians' views on what vascular access-related decisions deserved priority for developing guidelines that will contribute to optimizing collaborative decision making.In the context of updating their vascular access guideline, European Renal Best Practice surveyed an international panel of 85 kidney patients, 687 nephrologists, 194 nurses, and 140 surgeons/radiologists. In an electronic questionnaire, respondents rated 42 vascular access-related topics on a 5-point Likert scale. Based on mean standardized ratings, we compared priority ratings between patients and each clinician group.Selection of access type and site, as well as prevention of access infections received top priority across all respondent groups. Patients generally assigned higher priority to decisions regarding managing adverse effects of arteriovenous access and patient involvement in care, while clinicians more often prioritized decisions around sustaining patients' access options, technical aspects of access creation, and optimizing fistula maturation and patency.Apart from identifying the most pressing knowledge gaps, our study provides pointers for developing guidelines that may improve healthcare professionals' understanding of when to involve patients along the vascular access pathway

Flow chart of process of identifying and prioritizing treatment decisions (i.e., topics) around permanent vascular access

<p>Flow chart of process of identifying and prioritizing treatment decisions (i.e., topics) around permanent vascular access</p

Participants’ characteristics.^a)

<p>Participants’ characteristics.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0128228#t001fn001" target="_blank">^a)</a></p

Comparing priority ratings between kidney patients and clinicians for topics to which <i>clinicians</i> assigned high priority, but that were absent in patients’ top 10.

<p>Abbreviations: N, number of respondents who rated the importance of a topic; SD, standard deviation</p