Strategic Maneuvering in Treatment Decision-Making Discussions: Two Cases in Point

Over the past decade, the ideal model of shared decision-making has been increasingly promoted as the preferred standard of doctor-patient communication in medical consultation. The model advocates a treatment decision-making process in which the doctor and his patient are considered coequal partners that carefully negotiate the treatment options available in order to ultimately reach a treatment decision that is mutually shared. Thereby, the model notably leaves room for—and stimulates—argumentative discussions to arise in the context of medical consultation. A paradigm example of a discussion that often emerges between doctors and their patients concerns antibiotics as a method of treatment for what is presumed to be a viral infection. Whereas the doctor will generally not encourage treatment with antibiotics, patients oftentimes prefer the medicine to other methods of treatment. In this paper, two cases of such antibiotic-related discussions in consultation are studied using insights gained in the extended pragma-dialectical theory to argumentation. It is examined how patient and physician maneuver strategically in order to maintain a balance between dialectical reasonableness and rhetorical effectiveness, as well as an equilibrium between patient participation and evidence-based medication, while arguing a case for and against antibiotics respectivel

Conflict and consultation: Strategic manoeuvring in response to an antibiotic request

In recent years, the model of shared decision-making has become increasingly promoted as the preferred standard in doctor-patient communication. As the model considers doctor and patient as coe-qual partners that negotiate their preferred treatment options in order to reach a shared decision, shared de-cision-making notably leaves room for the usage of argumentation in the context of medical consultation. A paradigm example of argumentative conflict in consultation is the discussion that emerges between doctors and their patients concerning antibiotics as a method of treatment for what is presumed to be a viral infec-tion. In this paper, a case of such argumentative conflict is studied, using the extended pragma-dialectical theory to argumentation. It is examined how a patient and her physician manoeuvre strategically in order to maintain a balance between dialectical reasonableness and rhetorical effectiveness, as well as an equilibri-um between patient participation and evidence-based medication, while arguing their case for and against antibiotics respectively

Pengaruh Lingkungan Kerja, Disiplin Kerja dan Loyalitas Kerja Terhadap Peningkatan Kinerja Karyawan Pada PT. Cipta Kurnia Maju Sejahtera

Penelitian ini dilakukan untuk mengukur besaran pengaruh Lingkngan Krja, Displin Krja dan Lyalitas Krja Terhdap peningkatan Kinrja Karyawn pada PT. Cipta Kurnia Maju Sejahtera. Pengumpulan data diambil melalui penyebaran kuesioner kepada 104 orang responden. Analisis data dilakukan dengan menggunakan program SPSS 25. metode penngkajian hasil yang pakai pada hal ini diantaranya berupa Uji reliabilitas serta validitas menggunakan nilai cornbach alpha, serta dengan analisis regresi untuk mengetahui penjabaran hasil pengujian. Nilai analisis regresi  Ialah y = 9.449 + 0.146 + 0.318 + 0.338, Untuk thitung, lingkungan kerja memiliki thitung sebesar 3.120 lebih tinggi dari nilai ttabel 1.66023 dengan sig. dibawah 0.05 yakni 0.002. disiplin kerja memiliki thitung sebesar 5.329 lebih tinggi dari ttabel 1.66023 sig. dibawah 0.05 yakni 0.000. loyalitas kerja memiliki t-hitung sebesar 5.989 lebih tinggi dari nilai ttabel 1.66023 sig. dibwah 0.05 yakni 0.000. untuk fhitung memiliki nilai sebnyak 19.507 lebih tinggi dari ftabel 2.70 dengan sig. sejumlah 0.000 lebih kecil dari sig. yng diterapkan 0.05 maka hipotesis ini disimpulkan terbukti berpengaruh H0 Ditolak dan Ha Diterima. dalam saat bersamaan ketiga variable tersebut menjabarkan pengaruh yang signifikans Teerhadap kinrja kryawan

Eliciting preferences of persons with dementia and informal caregivers to support ageing in place in the Netherlands:a protocol for a discrete choice experiment

Introduction:Ageing in place (AIP) for persons with dementia is encouraged by European governments and societies. Healthcare packages may need reassessment to account for the preferences of care funders, patients and informal caregivers. By providing insight into people's preferences, discrete choice experiments (DCEs) can help develop consensus between stakeholders. This protocol paper outlines the development of a Dutch national study to cocreate a healthcare package design methodology built on DCEs that is person-centred and helps support informal caregivers and persons with dementia to AIP. A subpopulation analysis of persons with dementia with a migration background is planned due to their high risk for dementia and under-representation in research and care. Methods and analysis:The DCE is designed to understand how persons with dementia and informal caregivers choose between different healthcare packages. Qualitative methods are used to identify and prioritise important care components for persons with dementia to AIP. This will provide a list of care components that will be included in the DCE, to quantify the care needs and preferences of persons with dementia and informal caregivers. The DCE will identify individual and joint preferences to AIP. The relative importance of each attribute will be calculated. The DCE data will be analysed with the use of a random parameters logit model. Ethics and dissemination:Ethics approval was waived by the Amsterdam University Medical Center (W23_112 #23.137). A study summary will be available on the websites of Alzheimer Nederland, Pharos and Amsterdam Public Health institute. Results are expected to be presented at (inter)national conferences, peer-reviewed papers will be submitted, and a dissemination meeting will be held to bring stakeholders together. The study results will help improve healthcare package design for all stakeholders.</p

Strategic Maneuvering in Treatment Decision-Making Discussions:Two Cases in Point

Over the past decade, the ideal model of shared decision-making has been increasingly promoted as the preferred standard of doctor-patient communication in medical consultation. The model advocates a treatment decision-making process in which the doctor and his patient are considered coequal partners that carefully negotiate the treatment options available in order to ultimately reach a treatment decision that is mutually shared. Thereby, the model notably leaves room for-and stimulates-argumentative discussions to arise in the context of medical consultation. A paradigm example of a discussion that often emerges between doctors and their patients concerns antibiotics as a method of treatment for what is presumed to be a viral infection. Whereas the doctor will generally not encourage treatment with antibiotics, patients oftentimes prefer the medicine to other methods of treatment. In this paper, two cases of such antibiotic-related discussions in consultation are studied using insights gained in the extended pragma-dialectical theory to argumentation. It is examined how patient and physician maneuver strategically in order to maintain a balance between dialectical reasonableness and rhetorical effectiveness, as well as an equilibrium between patient participation and evidence-based medication, while arguing a case for and against antibiotics respectively

For the sake of argument: considering the role, characteristics, and effects of argumentation in general practice consultation

In general practice consultation, the doctor characteristically gives the patient advice concerning the patient’s medical situation. Such advice may, for instance, pertain to a diagnosis or prognosis of the patient’s health condition, the recommended treatment plan, or the prevention of an illness. Bound by the legal rules (e.g., informed consent), ethical standards (e.g., patient centered and evidence-based medicine), and social discursive conventions (e.g., obligation-to-defend rule) that apply in the institutionalized context of medical consultation, the general practitioner is inherently obliged to support his medical advice with argumentation. By doing so, the general practitioner can simultaneously justify his medical recommendations while encouraging the patient to actively take part in the treatment decision-making discussion. This dissertation project sets out to critically examine the precise role, characteristics, and effects of doctors’ provision of argumentation to support their medical advice during general practice consultation. In a series of five research articles, both qualitative and quantitative methods are applied to explore to what extent the study of doctor- patient communication can benefit from insights gained in argumentation theory. The (extended) pragma-dialectical theory of argumentation (van Eemeren & Grootendorst, 1984; 1992; 2004; van Eemeren & Houtlosser, 2002; 2006) is used as the theoretical point of departure in this dissertation. The findings of a systematic literature review (Chapter II) demonstrate that while the use of argumentation in medical consultation is increasingly investigated by scholars from a variety scientific backgrounds, interdisciplinary, theory-driven and empirically-grounded research that takes a quantitative approach has thus far been lacking. This project aims to bridge this gap. Using qualitative methods, it studies how general practitioners can strategically use argumentation to create common ground with their patients and, as such, start the treatment decision-making discussion in a reasonable, yet favorable way (Chapter III). Furthermore, this dissertation addresses the merits of observational content analysis as a method for the quantitative examination of argumentative in context (Chapter IV). It shows that content analysis can be used to enrich the characterization of medical consultation as an argumentative activity type, to justify the exploration of certain argumentative phenomena in consultation practice, and to lay bare the correlation between general practitioners’ use of argumentation and several aspects of the communicative context (e.g., visit duration, physician gender, and communication style) (Chapter V). Lastly, by means of a randomized-controlled experiment, this dissertation establishes the causal relationships between general practitioners’ provision of reasonable argumentation to support their treatment advice and outcomes of the consultation (Chapter VI). The findings of the vignette-based study demonstrate that doctors’ use of reasonable arguments positively affects patients’ perceptions of their doctor as a credible medical expert and a participatory decision-maker. Moreover, general practitioners’ provision of reasonable argumentation has a positive effect on patients’ acceptance of, and intended adherence to, doctors’ medical recommendations. On the basis of the findings, this dissertation contributes to endeavors in the field of health communication that aim to analyze, understand, and ultimately improve the interaction between doctors and their patients. Moreover, it provides new insights to argumentation theoretical research that seeks to study the use of argumentation in context. Finally, the results have the potential to significantly influence medical consultation practice. The dissertation lays bare the importance of general practitioners’ argumentation, not only in light of legal, ethical, and social discursive standards, but also in view of consultation outcomes and, thus, pragmatic considerations