Medical treatment decision-making in rural cancer patients: A qualitative systematic review and meta-synthesis

ObjectiveRural cancer patients have unique care needs which may impact upon treatment decision-making. Our aim was to conduct a qualitative systematic review and meta-synthesis to understand their perspectives and experiences of making treatment decisions.MethodsA systematic search of MEDLINE, PsycINFO, CINAHL and RURAL was conducted for qualitative studies in rural cancer patients regarding treatment decision-making. Articles were screened for relevance, and data from the included articles were extracted and analysed using meta-thematic synthesis.ResultsTwelve studies were included, with 4 themes and 9 subthemes identified. Many studies reported patients were not given a choice regarding their treatment. Choice, if given, was influenced by personal factors such as finances, proximity to social supports, convenience, and their personal values. Patients were also influenced by the opinions of others and cultural norms. Finally, it was reported that patients made choices in the context of seeking the best possible medical care and the patient-clinician relationship.ConclusionsIn the rural context, there are universal and unique factors that influence the treatment decisions of cancer patients.Practical implicationsOur findings are an important consideration for clinicians when engaging in shared decision-making, as well as for policymakers, to understand and accommodate the unique rural perspective.     

Anodal transcranial direct current stimulation over the right dorsolateral prefrontal cortex enhances reflective judgment and decision-making

Background

Accounts of cognitive processes in judgment and decision-making are frequently based on a dual-process framework, which reflects two qualitatively different types of processing: intuitive (Type 1) and analytical (Type 2) processes.

Education and training methods for healthcare professionals to lead conversations concerning deceased organ donation: An integrative review

ObjectivesTo determine which training methods positively influenced healthcare professionals’ communication skills and families’ deceased organ donation decision-making.MethodsAn integrative review using systematic methods and narrative synthesis for data analysis. Electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (EBSCO), Embase (OVID) and ProQuest Dissertations & Theses Global, were searched between August 1997 and March 2020, retrieving 1019 papers. Included papers (n = 14) were appraised using the Medical Education Research Study Quality Instrument.ResultsTraining programmes offered theory, experiential learning, feedback and debriefing including self-reflection, the opportunity to role-play and interact with simulated participants within realistic case scenarios. Programmes reported observed and self-rated improvements in communication learning and confidence. The methodological quality score averaged 13, (72% of maximum); few studies used an experimental design, examined behavioural change or families’ perspectives. Weak evidence suggested training could increase organ donation authorisation/consent rates.ConclusionsMultiple training strategies are effective in improving interprofessional healthcare professionals’ confidence and learning of specialised communication. Methodological limitations restricted the ability to present definitive recommendations and further research is warranted, inclusive of family decision-making experiences.Practice implicationsLearning of specialised communication skills is enhanced by using multiple training strategies, including role-play and debriefing.     

Ethics of uncertainty

Uncertainty is inherent in clinical medicine. However, just because absolute certainty is unachievable does not mean that rational and optimal decisions cannot be made. It is argued that we need to distinguish legitimate from illegitimate scientific uncertainties that are generated by manufacturing doubts aiming to create mis- and disinformation. The attempt to create doubts implies that actions under uncertainties are impossible. Such a belief ultimately harms public, which requires reasoned actions within a context of genuine scientific and medical uncertainties. The latter indicates that rational decisions, even in the absence of guaranteed absolute certainty, are not only possible but, on average, beneficial both for society and individuals.     

大小便失禁病人尊严丧失感与社会支持和应对方式的相关性研究

目的:探讨大小便失禁病人尊严丧失感现状及其与社会支持和应对方式的相关性。方法:采用一般资料调查表、病人尊严量表(PDI)、社会支持评定量表(SSRS)、应对方式量表(MCMQ)对山东省3所三级甲等医院119例大小便失禁病人进行调查。结果:病人尊严丧失感程度不一,不同大小便失禁时间病人尊严丧失感得分比较差异有统计学意义(P<0.05)。多元回归分析显示,大小便失禁后不同时间、主观支持、对社会支持的利用度以及屈服的应对方式是导致大小便失禁病人尊严丧失的重要因素。结论:大小便失禁病人尊严丧失感与社会支持和应对方式密切相关,加强社会支持以及积极有效的应对方式能减轻病人的尊严丧失感。     

Ethical,legal and professional accountability in emergency nursing practice: An ethnographic observational study

IntroductionAccountability in nursing practice is a concept that influences quality care, decision-making, safety standards and staff values. Therefore, understanding accountability and how it affects nursing practice could improve patient care and nurses’ working conditions.AimThe aim of this study was to find factors that influenced ethical, legal and professional accountability in emergency nursing practice.MethodsA qualitative ethnographic approach using participant observation through convenience sampling was employed as the data collection method, while ethnographic content analysis was used for data analysis.ResultsThe factors linked to nursing accountability found were classified into four main themes: daily dynamics, work environment evolution, customs and routines and bioethics principles’ application.DiscussionThe long-term effect of chronic high workload and crowding, which affects nursing accountability, could promote burnout in a junior ED workforce. Changes in the nurses’ working conditions need to be implemented to limit the workload to which an ED nurse is subjected to.ConclusionED nurses have to manage their accountability in difficult situations regularly, which followed patterns of four main themes across the majority of situations. Nonetheless, all those factors were influenced by nursing workload, an ever-present factor that was always considered by ED nurses during decision-making.     

Feasibility,acceptability, and effectiveness of a decision aid versus an informational website to promote clinical trial decision-making among cancer patients: A pilot randomized controlled trial

ObjectiveTo assess intervention feasibility and acceptability, and compare the effectiveness of the CHOICES Decision Aid (DA) versus the National Cancer Institute (NCI) Cancer Clinical Trials (CCT) website to improve knowledge about CCTs and preparedness to make an informed decision.MethodsOncology patients (n = 101) with a scheduled clinic visit were enrolled and randomized. Decision-making variables were collected at two timepoints. Post-intervention scores were examined via paired t-tests and multivariate regression analyses. Predictors of the magnitudes of the change in scores were examined in multivariable regression analyses.ResultsThe interventions were feasible to implement and acceptable to participants. Both interventions increased objective and subjective knowledge, improved clarity of opinions, and reduced decisional conflict (p-values < 0.01). Improvements in the belief that one could find out about CCTs were observed in the CHOICES DA arm (p < 0.001). Multivariable analyses controlling for educational attainment showed no significant differences in the magnitude of change in outcome variables between intervention arms, but did find that improvements in some variables in the NCI arm – but not CHOICES DA arm – were associated with previous educational attainment.ConclusionsInterventions were feasible to implement and acceptable. Improvements in knowledge and decision-making outcomes were observed in both arms, supporting the view that interventions to improve CCT decision making are effective and feasible. Our results suggest that the CHOICES DA may be more effective than an informational website in improving decision-making outcomes regardless of participants’ educational attainment.Practice implicationsCCT resources should support informed decision-making among all cancer survivors, regardless of educational attainment.     

The communication of uncertainty in health: A scoping review

ObjectiveTo conduct a scoping review of existing studies that examine communication strategies that address uncertainty in health and categorize them using the taxonomy of uncertainty.MethodsRelevant articles retrieved from ten databases were categorized according to the dimensions of the taxonomy of uncertainty, and study characteristics were extracted from each article.ResultsAll articles (n = 63) explored uncertainty in the context of probabilistic risk and related to scientific issues (n = 63; 100%). The majority focused on complexity (n = 24; 38.1%) and uncertainty experienced by patients (n = 52; 82.5%). Most utilized quantitative methods (n = 46; 73.0%), hypothetical scenarios (n = 49; 77.8%), and focused on cancer (n = 20; 31.7%). Theory guided messages and study design in fewer than half (n = 27; 42.9%).ConclusionsHeterogeneity in terminology used to refer to different types of uncertainties preclude a unified research agenda on uncertainty communication. Research predominately focuses on probability as the source of uncertainty, uncertainties related to scientific issues, and uncertainty experienced by patients.Practice implicationsAdditional efforts are needed to understand providers’ experience of uncertainty, and to identify strategies to address ambiguity. Future studies should use consistent terminology to allow for coherence and advancement of uncertainty communication scholarship. Continued efforts to refine the existing taxonomy should be undertaken.