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Tawfik HE, Cascio MA, Gomaa N. Recommendations for implementing value-based practice in medicine. CLINICAL TEACHER 2022; 19:192-196. [PMID: 35315218 DOI: 10.1111/tct.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/21/2021] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Huda E Tawfik
- Department of Foundational Science, Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
| | - M Ariel Cascio
- Medicine & Society, Department of Foundational Science, Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
| | - Nahla Gomaa
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Serrano-Zamago AB, Altamirano-Bustamante MM. Appealing to Tacit Knowledge and Axiology to Enhance Medical Practice in the COVID-19 Pandemic: A Systematic Review and Hermeneutic Bioethical Analysis. Front Public Health 2021; 9:686773. [PMID: 34956997 PMCID: PMC8692268 DOI: 10.3389/fpubh.2021.686773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The pressure of coronavirus disease 2019 (COVID-19) pandemic, epidemiological and demographic changes, personnel-patient relationship in healthcare, and the development of biotechnologies do not go unnoticed by the healthcare professional. Changes are so wide and at a high rate that guidelines and mere scientific knowledge, which are represented by evidence-based medicine, are not sufficient to lead actions, thus the experiential aspects in the configuration of an ethos present as a fundamental part of the resources to deal with critical scenarios, such as a pandemic. In this regard, the recognition of tacit knowledge as a way of teaching and learning skills related to ethical aspects such as principles, virtues, and values, revealed as a fundamental part of the clinical field. The challenge is to strengthen binomial evidence-based medicine and values-based in order to achieve excellence in the health care of the patients and the well-being of the clinical personnel. Method: A 2-fold analysis was conducted taking pediatric endocrinology as an example. First, a systematic review was carried out in electronic databases BIREME, PubMed, and PhilPapers following PEO and PRISMA approaches. A total of 132 articles were garnered. After reading their title and abstract, 30 articles were obtained. Quantitative information was arranged in an Excel database according to three themes: ethics, axiology, and tacit knowledge. A quality criterion that meets our research question was assigned to each article and those which had a quality criterion of 3 (9) were taken to carry out the hermeneutic bioethical analysis, which consisted of three stages, namely naïve reading, codification, and interpretation. The results were analyzed in Atlas.ti. to elucidate the relations between the three main themes in accordance with the objective. Results: Although there was no difference in the frequency of tacit knowledge skills, including cognitive, social, and technical, for medical practice, there is an intrinsic relationship between epistemic and ethical values with cognitive skills, this means that professionals who practice honesty, authenticity and self-control are capable of seeing patients as persons and thus respect their dignity. This suggested that there is a strong partnership between evidence-based medicine and value-based medicine, which reinforced this binomial as the two feet on which medical practice decisions rested. With regard to tacit knowledge in terms of the context of the COVID-19 pandemic, the challenges refer to (1) adapting and learning a new way of establishing trust with the patient and (2) how to capitalize on the new knowledge that new experiences have posed. Discussion: The analysis of ethical-tacit knowledge in medicine is a recent phenomenon and is in full development. Although no references were found that dealt with any of the main topics in pediatric endocrinology, there is an interest in pediatrics to explore and discuss educational strategies in ethics related to its tacit dimension as a vector of enhancement in the clinical practice. Educational strategies ought to take into consideration the development of skills that promote reflection and discussion of experiences, even more vigorously in the context of the COVID-19 pandemic.
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Affiliation(s)
- Ana-Beatriz Serrano-Zamago
- Grupo Transfuncional en Bioética, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.,Master and Doctorate Program in Medical and Health Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
| | - Myriam M Altamirano-Bustamante
- Grupo Transfuncional en Bioética, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.,Unidad de Investigación en Enfermedades Metabólicas, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Chia MS, Wong JYY, Chan IPM, Ng KC. What matters to patients: Parental and caregiver opinions on International Consortium for Health Outcomes Measurements overall health outcomes for children in Singapore. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/2010105820979324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Health in children is multifaceted. More than just the absence of disease, good child health also comprises psychological well-being and social functioning. In paediatrics, optimal health care is a partnership between caregivers and doctors. Value-based medicine strengthens this partnership. Monitoring and tracking these patient-reported outcomes using validated measurement tools in a life-course manner helps us to understand and ultimately improve overall child health better. Objectives: This study aimed to assess parental opinions in Singapore on recommended outcome measures and approach recommended by the International Consortium for Health Outcomes Measurements (ICHOM) Overall Pediatric Health (OPH) working group. Methods: An international working group comprising 25 experts in paediatric health was formed under the auspices of ICHOM. Through a series of literature reviews, patient focus groups and open review periods, a set of health outcomes and case-mix variables was proposed, with the aim of improving paediatric care globally. Parents and caregivers were invited to participate in this survey from around the world, including from the USA, UK, Colombia and Singapore. The survey covered domains that were included in the ICHOM OPH Standard Set. An international anonymised online patient validation survey tool online survey was initiated to evaluate caregiver opinions of these proposed ICHOM OPH outcomes, and this was conducted from November 2019 to January 2020. Singapore participated in this caregiver survey on overall paediatric health outcomes. Of the 270 respondents in this ICHOM OPH consumer international open review online survey, 160 were from Singapore. We report here a cross-sectional study with data from the Singapore group of respondents. Results: Of the 160 responses from Singapore, 73.8% had no more than two children, and 38.8% of caregivers had children between 0 and 5 years old. In general, 76.9% of caregivers were satisfied with the health care that they received, and 60% of caregivers had had between one and four health-care appointments in the last 12 months. Assessment was done on a scale of 1 to 9, with importance defined as a score of ⩾7. All outcome measures were ranked to be important, with an overall mean score of 7.9 on a scale ranging from 1 to 9. Development was assessed as being the most important ( M=8.34±0.93), and sexual health was assessed as being the least important ( M=7.09±1.71). Almost all respondents felt that the list of ICHOM-recommended outcomes proposed was complete. Parents and caregivers in Singapore placed development and mental health as the most important across all age groups surveyed. They felt that the framework provided by the ICHOM OPH working group was adequate in addressing their concerns. Most parents and caregivers were satisfied with the health care they had received. Conclusion: Child health is a continuum that requires longitudinal attention from both the family and the clinician, and should take a life-course approach, utilising validated measurement tools to monitor and track key parameters. Parents and caregivers in Singapore place high importance on their child’s development and mental functioning. While there has been much community effort on development and mental functioning in children, more can be done in these two areas and to increase the emphasis and awareness on sex education both within the home and in schools. A framework for evaluating children during follow-up clinic visits would be helpful in continuing longitudinal care of children to provide holistic care and to improve adult health in the long term, guided by the framework set down by the ICHOM OPH standard set. As we recognise and embrace the importance not just of health care but the health of the next generation, we will need to use validated measurement tools to monitor and track these importance parameters in the journey of our children, so that we can identify and improve these outcomes in a timely manner.
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Affiliation(s)
- Moira Suyin Chia
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
| | | | | | - Kee Chong Ng
- Division of Medicine, KK Women’s and Children’s Hospital, Singapore
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Juárez-Villegas LE, Altamirano-Bustamante MM, Zapata-Tarrés MM. Decision-Making at End-of-Life for Children With Cancer: A Systematic Review and Meta-Bioethical Analysis. Front Oncol 2021; 11:739092. [PMID: 34722289 PMCID: PMC8554195 DOI: 10.3389/fonc.2021.739092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background Evidence shows that medical education includes a variety of basic and clinical skills. Ethical and human values are not typically considered in medical school curricula, and this is evident in medical practice in certain scenarios such as decision-making at pediatric cancer patients' end of life. Methods This study explores a bioethical approach to address complex decision-making at the end of life in children and adolescents with cancer. We are a cross-functional group of scientists from several academic disciplines who conducted a systematic review of the literature using our newly developed meta-bioethical analysis and synthesis of findings. The search was carried out in five databases, resulting in 10 research papers. Following quality screening, seven articles were ultimately selected for further analysis. Results Our focus is on the state of the art to better understand the bioethical deliberation at the end of life in pediatric oncology. Here, we report a systematic review that includes (i) classification of the screened articles by the type of decision-making they use, ii) the system values that are at the core of the decision-making at the end of life, and iii) bioethical and ethical discernment queries. We conclude with a discussion regarding the best practices of ethical discernment and decision-making at the end of life.This study highlights the need to develop more research to better understand the influence and origin of these multidimensional factors determining critical decisions that define the quality of life of patients in a highly sensitive moment. Conclusion We conclude that personal aspects of the physician define their actions more than knowledge or organized structure. It is thus necessary that pediatric oncologists receive ethics and humanistic education.
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Affiliation(s)
- Luis Enrique Juárez-Villegas
- Department of Hematology-Oncology, Hospital Infantil de Mexico Federico Gómez, Mexico City, Mexico.,Master and Doctorate Program in Medical and Health Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Myriam M Altamirano-Bustamante
- Master and Doctorate Program in Medical and Health Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Metabolic Diseases Research Unit, Cross-functional Bioethics Group, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Sinclair S, Kondejewski J, Jaggi P, Roze des Ordons AL, Kassam A, Hayden KA, Harris D, Hack TF. What works for whom in compassion training programs offered to practicing healthcare providers: a realist review. BMC MEDICAL EDUCATION 2021; 21:455. [PMID: 34454489 PMCID: PMC8403363 DOI: 10.1186/s12909-021-02863-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Patients and families want their healthcare to be delivered by healthcare providers that are both competent and compassionate. While compassion training has begun to emerge in healthcare education, there may be factors that facilitate or inhibit the uptake and implementation of training into practice. This review identified the attributes that explain the successes and/or failures of compassion training programs offered to practicing healthcare providers. METHODS Realist review methodology for knowledge synthesis was used to consider the contexts, mechanisms (resources and reasoning), and outcomes of compassion training for practicing healthcare providers to determine what works, for whom, and in what contexts. RESULTS Two thousand nine hundred ninety-one articles underwent title and abstract screening, 53 articles underwent full text review, and data that contributed to the development of a program theory were extracted from 45 articles. Contexts included the clinical setting, healthcare provider characteristics, current state of the healthcare system, and personal factors relevant to individual healthcare providers. Mechanisms included workplace-based programs and participatory interventions that impacted teaching, learning, and the healthcare organization. Contexts were associated with certain mechanisms to effect change in learners' attitudes, knowledge, skills and behaviors and the clinical process. CONCLUSIONS In conclusion this realist review determined that compassion training may engender compassionate healthcare practice if it becomes a key component of the infrastructure and vision of healthcare organizations, engages institutional participation, improves leadership at all levels, adopts a multimodal approach, and uses valid measures to assess outcomes.
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Affiliation(s)
- Shane Sinclair
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
- Division of Palliative Medicine Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Jane Kondejewski
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Priya Jaggi
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Amanda L Roze des Ordons
- Department of Critical Care Medicine and Division of Palliative Medicine Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliya Kassam
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Office of Postgraduate Medical Education, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Daranne Harris
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Thomas F Hack
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 99 Curry Place, Winnipeg, Manitoba, R3T 2M6, Canada
- Psychosocial Oncology & Cancer Nursing Research, St. Boniface Hospital Research Centre, Room CR3018, 369 Taché Ave, Winnipeg, Manitoba, R2H 2A6, Canada
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Páez G, Forte DN, Gabeiras MDPL. Exploring the Relationship between Shared Decision-Making, Patient-Centered Medicine, and Evidence-Based Medicine. LINACRE QUARTERLY 2021; 88:272-280. [PMID: 34565903 PMCID: PMC8375370 DOI: 10.1177/00243639211018355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shared decision-making is a possible link between the best of patient-centered medicine and evidence-based medicine. This article seeks to describe the link between them. It discusses to what extent the integration of such perspectives is successful in assuring respect for the patient's autonomy. From the evidence herein, we conclude that if the doctor-patient relationship and communication are strengthened to cover all issues relevant to the patient's health and values, is it possible for him or her to achieve more autonomous decisions by this linkage of shared decision-making and patient-centered medicine? SUMMARY Shared decision-making is a possible link between the best of patient-centered medicine and evidence-based medicine. This article seeks to describe the link between them.
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Affiliation(s)
- Gustavo Páez
- University of Navarra, Pamplona, Spain
- Bioethics Department, Austral University, Buenos Aires, Argentina
| | - Daniel Neves Forte
- Palliative Care Program, Hospital Sírio-Libanês, São Paulo, Brazil
- Medicine School, University of São Paulo, Brazil
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Sinclair S, Kondejewski J, Jaggi P, Dennett L, Roze des Ordons AL, Hack TF. What Is the State of Compassion Education? A Systematic Review of Compassion Training in Health Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1057-1070. [PMID: 33830949 PMCID: PMC8231671 DOI: 10.1097/acm.0000000000004114] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE To investigate the current state and quality of compassion education interventions offered to health care providers during training or practice, determine how the components of each education intervention map onto the domains of an empirically based clinical model of compassion, and identify the most common approaches to compassion education. METHOD The MEDLINE, Embase, CINAHL Plus with Full Text, Sociological Abstracts, Web of Science, ERIC, and Education Research Complete databases were searched from inception to March 2020 in this systematic review. Studies that evaluated a compassion education intervention for health care providers or those in training to enhance compassion toward patients and/or families were included. A narrative synthesis of the included studies was performed. The components of each intervention were mapped onto the domains of compassion described in the Patient Compassion Model. RESULTS One hundred eight peer-reviewed publications describing 103 interventions were included. Modalities ranged from establishing curricula and interventions in clinical settings to programs that used humanities-based reflective practices, clinical simulation, role modeling, and contemplative practices, with many education interventions adopting a multimodal approach. Most interventions mapped to the virtuous response domain of the Patient Compassion Model; very few mapped to the other domains of this model. CONCLUSIONS Most interventions were limited as they focused on a single domain of compassion; did not adequately define compassion; were assessed exclusively by self-report; were devoid of a comparator/control group; and did not evaluate retention, sustainability, and translation to clinical practice over time. The authors suggest that compassion education interventions be grounded in an empirically based definition of compassion; use a competency-based approach; employ multimodal teaching methods that address the requisite attitudes, skills, behaviors, and knowledge within the multiple domains of compassion; evaluate learning over time; and incorporate patient, preceptor, and peer evaluations.
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Affiliation(s)
- Shane Sinclair
- S. Sinclair is associate professor and director, Compassion Research Lab, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Jane Kondejewski
- J. Kondejewski is research assistant, Compassion Research Lab, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Priya Jaggi
- P. Jaggi is research coordinator, Compassion Research Lab, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Liz Dennett
- L. Dennett is librarian, Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda L. Roze des Ordons
- A.L. Roze des Ordons is clinical associate professor, Department of Critical Care Medicine and Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thomas F. Hack
- T.F. Hack is professor, College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, and director, Psychosocial Oncology & Cancer Nursing Research, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
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Walter S, Keinki C, Hübner J. Therapieentscheidungen in der Onkologie. HNO 2020; 68:492-497. [DOI: 10.1007/s00106-020-00842-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sampaio SGDSM, Motta LBD, Caldas CP. Value-based medicine and palliative care: how do they converge? Expert Rev Pharmacoecon Outcomes Res 2019; 19:509-515. [PMID: 31370715 DOI: 10.1080/14737167.2019.1651645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Sick persons need doctors who understand their pathology, know how to treat their problem, and accompany them through their illness. This study aimed to synthesize the state of knowledge regarding the concept of value-based medicine (VBM) through an integrative literature review, and establish how VBM can be applied in palliative care. Areas covered: An integrative review was conducted with the keywords 'value-based medicine,' 'patient-centered care,' and 'medicina baseada em valor' (Portuguese for VBM) in PubMed and Virtual Health Library, identifying 17,189 articles in total. Of these, 10 articles met the eligibility criteria. VBM combines the highest level of technical-scientific data with patients' values. It is defined as the combination of evidence-based medicine, patient-centered care, and cost-effectiveness. Patients' values are a set of preferences, concerns, and expectations that contribute toward accommodating their needs in the treatment clinic. Expert opinion: Like VBM, palliative care focuses on patients' values and quality of life, respecting natural limits. The early development of a care plan with active participation of the patient in the face of life-threatening diseases should be encouraged and can bring peace and comfort in a person's final moments.
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Karimi-Dehkordi M, Spiers J, Clark AM. An evolutionary concept analysis of "patients' values". Nurs Outlook 2019; 67:523-539. [PMID: 31072646 DOI: 10.1016/j.outlook.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients' values are everywhere and nowhere in nursing: frequently invoked and associated with effective nursing care but seldom explicitly defined or subject to dedicated analysis. Clarification of the concept of patients' values is pivotal because respecting and supporting patients' values are widely recognized as crucial for ethical nursing care. Despite this and the pervasive employment of the term patients' values in theories, approaches, and clinical guidelines, the concept remains ambiguous. PURPOSE We sought to understand the key elements of the concept by investigating its use in theoretical and empirical literature. METHOD This study used Rodgers' evolutionary concept analysis approach. FINDINGS We found that values are core individual beliefs that function in hierarchical systems; however, in the context of disease, the priority assigned to values by the individual may change. This is important, given that values play a foundational role in health-related decisions, such as in the context of chronic diseases. DISCUSSION Values are influenced by both individual intrinsic needs and the social context, but importantly, are involved in guiding decision-making. The attributes of the values may vary according to the context of the disease, the type of disease, and the decision at hand.
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Affiliation(s)
| | - Jude Spiers
- University of Alberta, Faculty of Nursing, Edmonton, AB, Canada
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Bentwich ME, Dickman N, Oberman A, Bokek-Cohen Y. "I Treat Him as a Normal Patient": Unveiling the Normalization Coping Strategy Among Formal Caregivers of Persons With Dementia and Its Implications for Person-Centered Care. J Transcult Nurs 2018; 29:420-428. [PMID: 29308708 DOI: 10.1177/1043659617745137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Currently, 47 million people have dementia, worldwide, often requiring paid care by formal caregivers. Research regarding family caregivers suggests normalization as a model for coping with negative emotional outcomes in caring for a person with dementia (PWD). The study aims to explore whether normalization coping mechanism exists among formal caregivers, reveal differences in its application among cross-cultural caregivers, and examine how this coping mechanism may be related to implementing person-centered care for PWDs. METHOD Content analysis of interviews with 20 formal caregivers from three cultural groups (Jews born in Israel [JI], Arabs born in Israel [AI], Russian immigrants [RI]), attending to PWDs. RESULTS We extracted five normalization modes, revealing AI caregivers had substantially more utterances of normalization expressions than their colleagues. DISCUSSION The normalization modes most commonly expressed by AI caregivers relate to the personhood of PWDs. These normalization modes may enhance formal caregivers' ability to employ person-centered care.
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Affiliation(s)
| | - Nomy Dickman
- 1 Faculty of Medicine, Bar-Ilan University, Tzfat, Israel
| | - Amitai Oberman
- 1 Faculty of Medicine, Bar-Ilan University, Tzfat, Israel
| | - Ya'arit Bokek-Cohen
- 1 Faculty of Medicine, Bar-Ilan University, Tzfat, Israel.,2 Mofet Institute, Tel Aviv-Yafo, Israel
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Sueiras P, Romano-Betech V, Vergil-Salgado A, de Hoyos A, Quintana-Vargas S, Ruddick W, Castro-Santana A, Islas-Andrade S, Altamirano-Bustamante NF, Altamirano-Bustamante MM. Today´s medical self and the other: Challenges and evolving solutions for enhanced humanization and quality of care. PLoS One 2017; 12:e0181514. [PMID: 28759585 PMCID: PMC5536364 DOI: 10.1371/journal.pone.0181514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
Background Recent scientific developments, along with growing awareness of cultural and social diversity, have led to a continuously growing range of available treatment options; however, such developments occasionally lead to an undesirable imbalance between science, technology and humanism in clinical practice. This study explores the understanding and practice of values and value clusters in real-life clinical settings, as well as their role in the humanization of medicine and its institutions. The research focuses on the values of clinical practice as a means of finding ways to enhance the pairing of Evidence-Based Medicine (EBM) with Values-based Medicine (VBM) in daily practice. Methods and findings The views and representations of clinical practice in 15 pre-CME and 15 post-CME interviews were obtained from a random sampling of active healthcare professionals. These views were then identified and qualitatively analyzed using a three-step hermeneutical approach. A clinical values space was identified in which ethical and epistemic values emerge, grow and develop within the biomedical, ethical, and socio-economic dimensions of everyday health care. Three main values—as well as the dynamic clusters and networks that they tend to form—were recognized: healthcare personnel-patient relationships, empathy, and respect. An examination of the interviews suggested that an adequate conceptualization of values leads to the formation of a wider axiological system. The role of clinician-as-consociate emerged as an ideal for achieving medical excellence. Conclusions By showing the intricate clusters and networks into which values are interwoven, our analysis suggests methods for fine-tuning educational interventions so they can lead to demonstrable changes in attitudes and practices.
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Affiliation(s)
- Perla Sueiras
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Victoria Romano-Betech
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Alejandro Vergil-Salgado
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Adalberto de Hoyos
- CIECAS, Instituto Politécnico Nacional, Lauro Aguirre 120, Agricultura, Miguel Hidalgo, Ciudad de México, México
| | - Silvia Quintana-Vargas
- Instituto de Salud Pública del Estado de Guanajuato, Tamazuca 4, Centro, Guanajuato, México
| | - William Ruddick
- Center for Bioethics, New York University, New York, NY, United States of America
| | - Anaclara Castro-Santana
- National Research Council for Science and Technology (CONACYT), Ciudad de México, México
- Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México, México
| | - Sergio Islas-Andrade
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, México
| | - Nelly F. Altamirano-Bustamante
- Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México, México
- * E-mail: (NFAB); (MMAB)
| | - Myriam M. Altamirano-Bustamante
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, México
- * E-mail: (NFAB); (MMAB)
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Marzorati C, Pravettoni G. Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes. J Multidiscip Healthc 2017; 10:101-106. [PMID: 28356752 PMCID: PMC5367583 DOI: 10.2147/jmdh.s122383] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of "value" is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on "value" and new paradigms such as patient-centered system (PCS), patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care.
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Affiliation(s)
- Chiara Marzorati
- Foundations of the Life Sciences, Bioethics and Cognitive Science, European School of Molecular Medicine (SEMM)
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Grace S, Innes E, Joffe B, East L, Coutts R, Nancarrow S. Identifying common values among seven health professions: An interprofessional analysis. J Interprof Care 2017; 31:325-334. [DOI: 10.1080/13561820.2017.1288091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sandra Grace
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Ev Innes
- School of Health and Human Sciences, Southern Cross University, Coolangatta, Queensland, Australia
| | - Beverly Joffe
- School of Health and Human Sciences, Southern Cross University, Coolangatta, Queensland, Australia
| | - Leah East
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Rosanne Coutts
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Susan Nancarrow
- School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
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Gschmeidler B, Flatscher-Thöni M, Knitel-Grabher E. Genetics in the medical and psychosocial practice: on the role of value hierarchies in counselling. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0719-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Issues on Luck Egalitarianism, Responsibility, and Intercultural Healthcare Policies. Camb Q Healthc Ethics 2016; 25:186-96. [DOI: 10.1017/s0963180115000493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract:This article analyzes the criteria for the distribution of healthcare services through different justice theories such as utilitarianism and liberalism, pointing out the problems that arise when providing services to a culturally diverse population. The international epidemiological setting is a favorable one for discussing personal responsibility and luck egalitarianism; however, some provisions have to be made so that healthcare institutions do not treat ethnic, cultural, religious, and linguistic minorities unfairly. The article concludes by proposing that accommodations and culturally sensible attention should be provided when possible, without affecting the equal opportunity of others to access these services.
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Calleja-Sordo EC, de Hoyos A, Méndez-Jiménez J, Altamirano-Bustamante NF, Islas-Andrade S, Valderrama A, García-Peña C, Altamirano-Bustamante MM. Novel ethical dilemmas arising in geriatric clinical practice. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:229-236. [PMID: 25185872 DOI: 10.1007/s11019-014-9593-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel-patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients' life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population.
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Affiliation(s)
- Elisa Constanza Calleja-Sordo
- Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Col. Doctores, 06720, Mexico, D.F., Mexico
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18
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Guevara-López U, Altamirano-Bustamante MM, Viesca-Treviño C. New frontiers in the future of palliative care: real-world bioethical dilemmas and axiology of clinical practice. BMC Med Ethics 2015; 16:11. [PMID: 25890355 PMCID: PMC4351938 DOI: 10.1186/s12910-015-0003-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 02/05/2015] [Indexed: 12/04/2022] Open
Abstract
Background In our time there is growing interest in developing a systematic approach to oncologic patients and end-of-life care. An important goal within this domain is to identify the values and ethical norms that guide physicians’ decisions and their recourse to technological aids to preserve life. Though crucial, this objective is not easy to achieve. The purpose of this study is to evaluate empirically the real-life bioethical dilemmas with which palliative physicians are confronted when treating terminal cancer patients. Methods A quasi-experimental, observational, comparative, prospective and mixed (qualitative and quantitative) study was conducted in order to analyse the correlation between the palliative doctor-patient relationship and ethical judgments regarding everyday bioethical dilemmas that arise in palliative clinical practice. The values at stake in decision-making on a daily basis were also explored. From February 2012 to march 2014, palliative healthcare personnel were invited to participate in a research project on axiology of clinical practice in palliative medicine. Each participant answered to a set of survey instruments focusing on ethical dilemmas, views, and representations of clinical practice. For this analysis we selected a convenience sample of 30 physicians specialized in pain medicine and palliative care (algologists and palliativists), with two or more years of experience with oncologic patients and end-of-life care. Results 113 dilemmas were obtained, the most frequent of which were those regarding sedation, home administration of opioids, and institutional regulations. We observed that the ethical nucleus of palliative medicine is truth-telling, implying bidirectional trust between patients and healthcare providers. The two most prominent virtues among the participants in our study were justice and professional humility. The outstanding roles of the physician in palliative medicine are as educator and as adviser, followed by that of provider of medical assistance. Conclusions This investigation opens up new horizons in a career path where professional wearing is rampant. The rediscovery of values and virtues in palliative clinical practice will renew and replenish the motivation of healthcare providers who carry out these duties, giving them a new professional and personal perspective of growth.
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Affiliation(s)
- Uría Guevara-López
- Facultad de Medicina y Cirugía de la Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca, Mexico. .,Centro Interdisciplinario para el Estudio y Tratamiento del Dolor y Cuidados Paliativos del UMAE "Dr. Victorio de la Fuente Narvaez", México, DF, Mexico. .,Grupo Transfuncional en Ética Clínica, Centro Médico Nacional Siglo XXI, IMSS, México, DF, Mexico.
| | - Myriam M Altamirano-Bustamante
- Grupo Transfuncional en Ética Clínica, Centro Médico Nacional Siglo XXI, IMSS, México, DF, Mexico. .,Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, México, DF, Mexico.
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Abstract
On 24 November 2003, BMC Medicine published its first article. Ten years and over 900 articles later we look back at some of the most notable milestones for the journal and discuss advances and innovations in medicine over the last decade. Our editorial board members, Leslie Biesecker, Thomas Powles, Chris Del Mar, Robert Snow and David Moher, also comment on the changes they expect to see in their fields over the coming years.
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Affiliation(s)
- Sabina Alam
- BioMed Central Ltd, 236 Gray’s Inn Road, London WC1X 8HB, UK
| | - Jigisha Patel
- BioMed Central Ltd, 236 Gray’s Inn Road, London WC1X 8HB, UK
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20
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Terndrup C. A student's perspective on medical ethics education. JOURNAL OF RELIGION AND HEALTH 2013; 52:1073-1078. [PMID: 23793349 DOI: 10.1007/s10943-013-9747-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Despite many efforts to increase ethics education in US medical schools, barriers continue to arise that impede the production of morally driven physicians who practice medicine with ideal empathy. Research has shown that, particularly during the clinical years, medical students lose the ability both to recognize ethical dilemmas and to approach such situations with compassionate reasoning. This article summarizes the current status of ethics education in US medical schools, described through the eyes of and alongside the story of a graduating medical student.
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de Hoyos A, Nava-Diosdado R, Mendez J, Ricco S, Serrano A, Flores Cisneros C, Macías-Ojeda C, Cisneros H, Bialostozky D, Altamirano-Bustamante N, Altamirano-Bustamante MM. Cardiovascular medicine at face value: a qualitative pilot study on clinical axiology. Philos Ethics Humanit Med 2013; 8:3. [PMID: 23531271 PMCID: PMC3620706 DOI: 10.1186/1747-5341-8-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/17/2013] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Cardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in which they have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter. RESULTS We point out the need for strengthening the roles of healthcare personnel as educators and guidance counselors in order to meet the ends of medicine, as well as the need for an ethical discernment that is compatible with our results, namely, that the ethical values developed by healthcare professionals stem from their life history as well as their professional education. CONCLUSION We establish the kind of actions, communication skills and empathy that are required to build a stronger patient-healthcare professional relationship, which at the same time improves prognosis, treatment efficiency and therapeutic adhesion.
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Affiliation(s)
- Adalberto de Hoyos
- Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330 Col. Doctores, México, 06720, D.F Mexico
- FES Acatlán, Universidad Nacional Autónoma de México, Av. Cuauhtémoc 330 Col. Doctores, México, 06720, D.F. Mexico
| | - Rodrigo Nava-Diosdado
- Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330 Col. Doctores, México, 06720, D.F Mexico
| | - Jorge Mendez
- Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330 Col. Doctores, México, 06720, D.F Mexico
| | | | - Ana Serrano
- Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330 Col. Doctores, México, 06720, D.F Mexico
| | | | - Carlos Macías-Ojeda
- Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330 Col. Doctores, México, 06720, D.F Mexico
- Universidad Anáhuac, Mexico, Mexico
| | | | - David Bialostozky
- Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330 Col. Doctores, México, 06720, D.F Mexico
- Instituto Nacional de Cardiología, Ignacio Chávez, Mexico, Mexico
| | - Nelly Altamirano-Bustamante
- Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330 Col. Doctores, México, 06720, D.F Mexico
- Instituto Nacional de Pediatría, Secretaría de Salud, Mexico, Mexico
| | - Myriam M Altamirano-Bustamante
- Grupo transfuncional en ética clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330 Col. Doctores, México, 06720, D.F Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Av. Insurgentes 3300. Copilco Universidad, México, 04530, D.F. Mexico
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Peile E. Evidence-based medicine and values-based medicine: partners in clinical education as well as in clinical practice. BMC Med 2013; 11:40. [PMID: 23414247 PMCID: PMC3626674 DOI: 10.1186/1741-7015-11-40] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/15/2013] [Indexed: 11/10/2022] Open
Abstract
The best clinical decisions are based on both evidence and values in what is known as the 'two-feet principle'. Anecdotally, educationalists find teaching clinicians to become more evidence based is relatively simple in comparison to encouraging them to become more values based. One reason is likely to be the importance of values awareness. As values-based practice is premised on a mutual respect for the diversity of values, clinicians need to develop the skills to ascertain patient values and to get in touch with their own beliefs and preferences in order to understand those at play in any consultation. Only then can shared decision-making processes take place within a shared framework of values. In a research article published in BMC Medicine, Altamirano-Bustamante and colleagues highlight difficulties that clinicians face in getting in touch with their own values. Despite finding that healthcare personnel's core values were honesty and respect, autonomy was initially low ranked by participants. One significant aspect of this work is that this group has demonstrated that the extent to which clinicians value 'autonomy' and 'openness to change' can both be positively influenced by well designed education.
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Affiliation(s)
- Ed Peile
- Warwick Medical School, The University of Warwick, Coventry, UK.
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