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Robles-Sanchez MA, Moharra M, Bosch-Farré C, Hernández-Leal MJ, Montalban X, Sastre-Garriga J, Ramió-Torrentà L, Bertran-Noguer C. Views of Multiple Sclerosis Patients About Key Elements for a Decision Aid: A Qualitative Study. J Neurosci Nurs 2023; 55:164-170. [PMID: 37527935 DOI: 10.1097/jnn.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
ABSTRACT BACKGROUND: Patients with multiple sclerosis (MS) may experience decisional conflict during treatment choice. Shared decision making (SDM), whereby patients and health professionals, primarily nurses, collaborate in making decisions, reduces this decisional conflict. It requires understanding large amounts of information and may be complex, especially when decisions affect patients' autonomy and quality and prolongation of life. Patient decision aids are tools in facilitating SDM. This study aimed to identify the key elements from the perspective of patients with relapsing-remitting MS to create a patient decision aid in the Spanish sociocultural context. METHODS: This is a qualitative study using focus groups led by a clinical nurse specialist. Semistructured interviews included healthcare needs and demands, the SDM process, and general characteristics of a peer support program. After the transcription of interview recordings, data were analyzed by thematic analysis and a constructivist naturalistic approach. RESULTS: Patients with MS (27) from Spain participated in 4 focus groups of 90 to 120 minutes each. Three overarching themes were identified: information access to sufficient high-quality data; knowledge of available treatment options, including efficacy, adverse effects, frequency, administration route, and the impact on daily life; decision-making role, engaged versus nonengaged patients. The former require support in facilitating their active involvement in decisions, whereas the latter prefer more passive health models. CONCLUSION: The needs identified by patients with relapsing-remitting MS regarding treatment choice in the Spanish setting align with those reported by other studies. The identified themes provide valuable information to design and develop a virtual patient decision aid jointly by clinical MS nurses and patients according to the International Patient Decision Aid Standards Collaboration criteria. This aid will help improve understanding between nurses and patients during SDM and facilitate the process.
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Ankeambom TJ, Motah M, Ewane M, Shlobin NA, Mbangtang CB, Dada OE, Kabulo KDM, Tetinou F, Endalle G, Kanmounye US, Jokonya L, Esene IN. Identifying Barriers and Facilitators to the Improvement of Healthcare Delivery and Ethics in Two Cameroonian Neurosurgical Centers. Front Surg 2022; 8:703867. [PMID: 35242801 PMCID: PMC8887806 DOI: 10.3389/fsurg.2021.703867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/31/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Low-and middle-income countries (LMICs) are disproportionately affected by neurosurgical burden of disease. This health inequity causes constraints in decision-making. Neurosurgical ethics helps us to assess the moral acceptability and effectiveness of clinical decisions. We aimed to assess ethical neurosurgical care and its effect on patient satisfaction in Cameroon. METHODS Two questionnaires hosted on Google Forms were administered among inpatients and staff at two Cameroonian neurosurgery centers. The questionnaires covered the factors influencing health outcomes and ethics. Data were collected from November 11, 2020, to March 11, 2021 and analyzed with SPSS v 26 to generate non-parametric tests with a threshold of significance at 0.05. RESULTS Seventy patients and twenty healthcare providers responded to the survey. Most patients faced financial hardship (57.1%; 95% CI = 45.7-68.6%), and felt that this affected the care they received (P = 0.02). Patients noticed changes in the care plan and care delivery attributable to the neurosurgical units' lack of resources. According to the patients and caregivers, these changes happened 31.0-50.0% of the time (42.9%, 95% CI = 5.7-21.4%). The majority of patients were pleased with their involvement in the decision-making process (58.6%; 95% CI = 47.1-70.0%) and felt their autonomy was respected (87.1%; 95% CI = 78.6-94.3%). CONCLUSION Multiple challenges to neurosurgical ethical care were seen in our study. Multimodal interventions based on the four ethical principles discussed are necessary to improve ethical neurosurgical decision-making in this low resource setting.
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Affiliation(s)
- Tutuwan J. Ankeambom
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Neurosurgery Unit, Surgery Department, Douala General Hospital, Douala, Cameroon
| | - Mathieu Motah
- Neurosurgery Unit, Surgery Department, Douala General Hospital, Douala, Cameroon
| | - Mfouapon Ewane
- Neurosurgery Unit, Surgery Department, Laquintinie Hospital, Douala, Cameroon
| | - Nathan A. Shlobin
- Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Celestin Bilong Mbangtang
- Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon
| | - Olaoluwa Ezekiel Dada
- Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kantenga Dieu Merci Kabulo
- Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Neurosurgery Unit, Surgery Department, Jason Sendwe General Provincial Hospital, Lubumbashi, Democratic Republic of Congo
| | - Francklin Tetinou
- Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Geneviève Endalle
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Luxwell Jokonya
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Ignatius N. Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
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