Patients' Involvement in Decision-Making During Healthcare in a Developing Country: A Cross-Sectional Study

Implementation suggestions for shared decision-making: results from a comparative study of inpatients and outpatients experience surveys

BACKGROUND

Shared decision-making (SDM) is crucial in patient-centered healthcare services, but its integration into routine medical care remains limited. This study aimed to investigate patients' experience with SDM in both outpatient and inpatient settings, exploring how the quality of care provided by doctors and patient's trust in doctors influence SDM across different contexts.

METHODS

This study utilized data from the regional cross-sectional surveys, including the 2019 Inpatient Experience and the 2021 Specialist Outpatient Experience survey in Hong Kong. Multivariable logistic regression and path analysis were conducted.

RESULTS

A total of 20,675 participants were included (inpatients: n = 8,275; outpatients: n = 12, 400) in this study. The results indicated that inpatients perceiving better quality of doctor's care were significantly more likely to participate in SDM (OR = 1.29, 95%CI = 1.26-1.47, p < 0.001), with trust in doctors significantly moderating this association. Conversely, among outpatients, a higher quality of doctor's care was significantly associated with decreased SDM involvement (OR = 0.91, 95% CI = 0.88-1.00, p = 0.04), with trust in doctors serving as a mediator in suppressing this association. Additionally, both subsets indicated that females, the elderly, individuals with good health status, less-educated people, and those living alone were less likely to engage in SDM.

CONCLUSION

These findings underscore the importance of tailoring SDM implementation to specific contexts, acknowledging the different challenges within outpatient and inpatient settings. Building trust is key to promoting SDM, with added support for vulnerable groups to ensure their involvement in decision-making.

Decision-making and role preferences for receiving individual pharmacogenomic research results among participants at a Ugandan HIV research institute

Little is known about how people living with HIV should be engaged in the decision-making process for returning individual pharmacogenomic research results. This study explored the role people living with HIV want to play in making decisions about whether and how individual results of pharmacogenomic research should be presented to them. A convergent parallel mixed methods study was conducted, comprising a survey of 221 research participants and five deliberative focus group discussions with 30 purposively selected research participants. Most participants (122, 55.2%) preferred the collaborative role, 67 (30.3%) preferred the active role and 32 (14.5%) preferred the passive role. Factors that significantly influenced preference for an active role compared with a collaborative role were marital status (OR: 0.282, p = 0.013), research experience (OR: 4.37, p = 0.028), and religion (OR: 2.346, p = 0.041). The reasons proffered for the active role included prior experience with antiretroviral treatment and increased exposure to research activities. The reasons given for preferring the passive role included limited level of awareness about the interaction between patients' genes and drugs, trust in researchers to make the right decision, and fear of making decisions with harmful implications. Overall, findings from our study show that participants want to be engaged in the decision-making process. Research teams ought to provide adequate and simple information about the pharmacogenomic research and implications of the results to support participants' informed decisions.

Shared decision-making between patients and healthcare providers at rural health facilities in Eastern Uganda: an exploratory qualitative study

BACKGROUND

Shared decision-making in healthcare is a collaborative process where patients are supported to make informed decisions according to their preferences. Healthcare decisions affect patients' lives which necessitates patients to participate in decisions concerning their health. This study explored experiences and ethical issues related to shared decision-making in a rural healthcare setting.

METHODS

An exploratory qualitative study was conducted at Budumba Health Centre III and Butaleja Health Centre III in rural Eastern Uganda. In this study, 23 in-depth interviews were conducted among 12 healthcare providers and 11 patients. Data was analyzed thematically using NVivo-12 plus software.

RESULTS

Four themes emerged which included: Paternalistic cultures of care, challenges, strategies for improvement, and ethical issues. Patients at both facilities expressed the need to be involved in decision-making processes. However, many stressed that they are not engaged in decision-making about their health. Many healthcare providers noted that shared decision-making could improve patient prognosis but are faced with challenges related to low male involvement and the influence of cultural and religious practices, including myths and patriarchal attitudes which impact effective patient engagement. Ethical issues identified include concerns about informed consent, privacy and confidentiality, deception, and harm.

CONCLUSIONS

This study highlighted the need for better sensitization of patients and comprehensive training for healthcare providers to minimize and resolve ethical issues that emerge during shared decision-making processes. Therefore, targeted interventions are needed to enhance decision-making processes in rural healthcare including but not limited to developing shared decision-making manual and continuous training of healthcare providers to ethically engage patients. Further research is needed to explore larger facilities with a bigger scope including patients under 18 years of age and and their surrogates.

Patients' perceived involvement in clinical decision-making and associated factors among adult patients admitted at Jimma Medical Center, Oromia, Ethiopia: a cross-sectional study

OBJECTIVE

To assess patients' perceived involvement in clinical decision-making and associated factors among adult patients admitted at Jimma Medical Center, Oromia, Ethiopia, 2022.

DESIGN

An institution-based cross-sectional study was employed.

SETTING

A study was conducted at a governmental tertiary teaching and referral hospital located in Jimma Zone, Oromia region, southwestern part of Ethiopia. The study was conducted between 15 July and 7 September 2022.

PARTICIPANTS

A total of 422 randomly selected adult patients admitted at Jimma Medical Center were enrolled, after excluding those who were acutely ill during the study period.

METHODS

Data were collected via a structured, interviewer-administered tool, entered into EpiData V.4.6 and exported to SPSS V.26 for analysis. Bivariable and multivariable logistic regression analyses were used to identify factors associated with the outcome variable. Significant factors were declared at p<0.05.

MAIN OUTCOME MEASURE

Patients' perceived involvement in clinical decision-making (adequate involvement/poor involvement).

RESULTS

A total of 51.4% (95% CI: 46.4 to 56.3) of respondents had adequate perceived involvement in clinical decision-making. Participants who were aged >60 years (adjusted OR (AOR): 2.01 (95% CI: 1.44 to 5.65)), college and above the level of education (AOR: 4.6 (95% CI: 1.6 to 13.26)), length of hospital stay >15 days (AOR: 2.8 (95% CI: 1.41 to 5.5)) and high health literacy level (AOR: 2.04 (95% CI: 1.34 to 4.21)) were more likely to be associated with adequate perceived involvement in clinical decision-making whereas non-prior hospitalisation (AOR: 0.493 (95% CI: 0.3 to 0.82)) and passive autonomy preference (AOR: 0.22 (95% CI: 0.13 to 0.37)) were less likely to be associated with adequate perceived involvement in clinical decision-making than each of their corresponding counterparts.

CONCLUSION

Only nearly half of the respondents had adequate perceived involvement in clinical decision-making. Collaborative autonomy preferences, high educational levels, long length of hospital stay, high health literacy level and patients in the older age group were among the factors significantly associated with respondents' adequate perceived involvement in clinical decision-making. Healthcare professionals have to consider empowering patients' perceived involvement in clinical decision-making, and hospital management has to reinforce healthcare professionals' efforts to promote patients' perceived involvement in clinical decision-making.

Patient experience and satisfaction with shared decision-making: A cross-sectional study among outpatients

OBJECTIVES

This study aimed to investigate how doctor-patient communication, trust in doctors impacted patients' experience and satisfaction in shared decision-making (SDM).

METHODS

This study is based on the data from a cross-sectional survey (n = 12,401) conducted in 27 public specialist outpatient clinics in Hong Kong.

RESULTS

The multivariable regression models revealed that doctors' better communication skills were associated with lower decision-making involvement (odd ratio, 0.75 [95 % CI, 0.88-0.94], P < .001) but higher satisfaction with involvement (odd ratio, 6.88 [95 % CI, 5.99-7.93], P < .001). Similarly, longer consultation durations were associated with reduced involvement in decision-making (odd ratio, 0.71 [95 % CI, 0.66-0.73], P < .001) but increased satisfaction with involvement (odd ratio, 1.91 [95 % CI, 1.80-2.04], P < .001). Trust in doctors significantly mediated these associations, except for the association between consultation duration and patients' satisfaction with decision-making involvement.

CONCLUSION

Doctors' better communication skills and longer consultations might not necessarily increase patient involvement in SDM but correlated with increased satisfaction with involvement. Trust in doctors emerged as a mediator for participation and satisfaction in decision-making.

PRACTICE IMPLICATIONS

Clinics should consider patients' preferences and capabilities when tailoring communication strategies about decision-making and optimizing patient satisfaction.

An international environmental scan of the scope and characteristics of patient decision aids which are freely available online

OBJECTIVE

To analyse the scope and characteristics of freely available online patient decision aids.

METHODS

An international environmental scan of online decision aids, with no language restriction, was conducted by searching aids in the recent Cochrane review and 35 online sources. Aid characteristics were extracted and analysed.

RESULTS

Of 1555 decision aids identified, there were 1222 unique aids after removing duplicates. Of these, 785 met eligibility criteria. The aids were from 17 countries (30 % from the Netherlands, 20 % from the US) and 44 % in English. Nearly all had a downloadable PDF or were printable and 32 % were interactive web-based. Many aids (72 %) were about a treatment decision. Most common diseases addressed were cancer (23 %), especially breast cancer, musculoskeletal diseases (11 %), and genitourinary system diseases (10 %).

CONCLUSIONS

There are many freely available decision aids, with most addressing treatment decisions and particular health conditions. Many (21 %) of the aids identified were duplicates, some topics are covered by multiple versions of decision aids, and other topics have few decision aids.

PRACTICE IMPLICATIONS

While many decision aids exist online, initiatives are needed to minimise aid duplication, achieve better distribution of aids across health decisions/topics, encourage greater collaboration between developers, and adaption of existing aids.

Empowering diabetes management: The impact of patient-provider collaboration on type 2 diabetes outcomes through autonomy support and shared decision-making

OBJECTIVES

Through the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision-making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes.

METHODS

We sampled 474 individuals over 18 years old who self-identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8.

RESULTS

Patient-provider collaboration through autonomy support improved treatment satisfaction (β = .16, ρ < .05) and self-management adherence (β = .43, ρ < .001). While collaboration through SDM improved treatment satisfaction (β = .25, ρ < .01), it worsened SM adherence (β = -.31, ρ < .001). The negative impact of SDM on self-management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided.

CONCLUSIONS

Autonomy support increases treatment satisfaction and self-management adherence. SDM enhances treatment satisfaction but may adversely affect self-management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self-management adherence, although its influence is limited when autonomy support is provided by the provider.

PRACTICAL IMPLICATIONS

For providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self-management tasks. Providers should evaluate patients' coping ability and adapt their approach to care based on the patient's coping capacity.

The medical librarian's roles in the patient education process: A scoping review protocol

BACKGROUND

The presence of medical librarians in the patient education team can greatly facilitate the patient education process. Expanding the role of medical librarians in patient education and using them in this process requires understanding the roles and services they can provide. This scoping review aims to identify different traditional and modern services and roles that medical librarians provide specifically in the patient education process.

MATERIALS AND METHODS

A scoping review protocol is reported, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and guided by The Joanna Briggs Institute. PubMed, Scopus, Web of Science, and LISTA (Library, Information Science & Technology Abstracts) will be searched. A grey literature search and hand-searching of citations and reference lists of the included studies will also be undertaken. Studies with their full text are not available and are in languages other than English will be excluded. Two independent reviewers will screen titles/abstracts and full text of retrieved articles and eligibility disagreements within a pair will resolve by discussion or a third reviewer. Data charting will be done in accordance with the data extraction tool made in Excel. Findings will be presented as a narrative summary supported by tables and diagrams.

CONCLUSIONS

Identifying the different services that medical librarians provide in the patient education process leads medical librarians to inform about the different services they can provide in the patient education process and to expand their roles as well as policymakers and hospital managers to be aware of these roles and use medical librarians in the patient education process appropriately. It also helps the general public and patients to learn about the services that medical librarians can provide them in this process.

Hospital Managers' Decision-Making Puzzle

Background

Decision-making is choosing one option from among different options. Most decision-making models were developed in the general industry. Specific decision-making models are needed due to the special nature of the hospital and its services. We aimed to propose and validate a decision-making model for hospital managers.

Methods

This research used the modified Delphi technique to develop and validate a decision-making model for hospital managers. A data collection form was used to collect data. The search of English databases covered the period from 1990 to 2020. The first draft of the model was introduced through a scoping review and semi-structured interviews. Two rounds of Delphi were conducted with 33 experts to verify the proposed model.

Results

Many factors affect the quality and outcome of a hospital manager's decision. The decision-making model developed in this study has 10 constructs grouped into three components (i.e., inputs, processes, and outputs). These constructs include decision maker, decision implementer, organization, client, subject, analysis, identification, evaluation & selection, implementation and control. This model provides a guide for each decision stage and determines the conditions necessary for a good decision.

Conclusion

Using the decision-making puzzle and considering the set of inputs, processes, and outcomes of the decision making together alongside with specifying the details of each decision-making stage make it easy for hospital managers to decide. Such a scientific, objective and systematic approach in decision-making will result in desired results for staff, patients, managers and the hospital. This puzzle is also a good tool for pathology of hospital managers' decisions.

A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients

OBJECTIVES

In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees.

METHODS

A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels.

RESULTS

The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals.

CONCLUSIONS

SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels.

PRACTICE IMPLICATIONS

This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.

Strategies to improve the care of older adults 50 years and above living with HIV in Uganda

INTRODUCTION

With effective antiretroviral therapy (ART), many persons living with HIV (PLHIV) live to old age. Caring for aged PLHIV necessitates the engagement of caregivers and patients to establish agreed-upon goals of treatment. However, there is limited literature on friendly and centered models of care for elderly PLHIV. We explored strategies to improve care in HIV clinics among PLHIV aged 50 years and above in Uganda.

METHODS

We conducted 40 in-depth interviews in two hospitals with elderly PLHIV aged 50 years and above who had lived with HIV for more than ten years. We explored strategies for improving care of elderly PLHIV at both health facility and community levels. The in-depth interviews were audio-recorded and transcribed verbatim. The thematic approach guided data analysis.

RESULTS

The elderly PLHIV suggested the following strategies to improve their care: creating geriatric clinics; increasing screening tests for non-communicable diseases in the ART clinics; community and home-based ART delivery; workshops at health facilities to provide health education on aging effectively; creating community support groups; financial assistance for the elderly PLHIV and advances in science.

CONCLUSIONS

There is need to improve community HIV care especially for the elderly and social and economic support in the community. Involving the elderly PLHIV in developing strategies to improve their health goes a long way to improve the patients' quality of care. There is a need to incorporate the raised strategies in HIV care or older adults.

Pattern of anti-epileptic medications nonadherence and associated factors at ambulatory clinic of Jimma Medical Center, Southwestern Ethiopia: A prospective observational study

Objective:

This study is designed to assess the pattern of nonadherence, and associated factors among ambulatory patients with epilepsy at Jimma Medical Center, Southwestern Ethiopia, from November 2020 to April 2021.

Methods:

A hospital-based prospective observational study was employed. A consecutive sampling method was used to recruit study participants. Nonadherence was assessed by the Hill–Bone compliance to the high blood pressure therapy scale. A threshold of 18 scores was used to classify adherence status. Epi-Data manager version 4.6 was used for data entry and all statistical analysis was performed by Statistical Package for Social Science 25.0. Multivariable logistic regression was performed to explore associated factors.

Results:

A survey included 334 patients with epilepsy. One hundred twenty-two (36.52%) of the study participants were found to be non-adherent. The factors associated with nonadherence were poor involvement of the patient in the therapeutic decision (adjusted odds ratio = 1.74; 95% confidence interval: 1.04–2.90; p = 0.034), per month income of lesser than1000 Ethiopian birr (adjusted odds ratio = 2.66; 95% confidence interval: 1.03–6.84; p = 0.042), recent seizure episodes (adjusted odds ratio = 1.97; 95% confidence interval: 1.20–3.23; p = 0.007), adverse drug reaction (AOR = 2.13; 95% confidence interval: 1.31–3.47; p = 0.002), and negative medication belief (adjusted odds ratio = 1.28; 95% confidence interval: 1.53–2.25; p = 0.043).

Conclusions:

In our setting, the magnitude of nonadherence was substantially high. Hence, providing regular health-related information about the disease and treatment, supplying free antiepileptic drugs, routine assessment of adverse drug reactions, and a multidisciplinary approach involving patients may improve adherence.

A trend of Medical Negligence in Laser Therapy in the Capital City: A Nine-Year Survey

Introduction: The purpose of the present study is to investigate the common causes of injuries, claims, and decisions related to laser therapy medical malpractice during a nine-year survey. Methods: The legal documents in the Coroner's Office of Forensic Medicine were investigated in a national database from 2012 to 2020 in Tehran, Iran. The frequency and nature of the cases, including the year of litigation, the location and certificate of the provider, the injury sustained, and the cause of legal action and judgment were collected. Results: Three hundred and eighty-three cases related to injury from laser therapy were registered in the coroner's Office of Forensic Medicine during the study period. The incidence of litigation related to laser surgery showed an increasing trend, with a peak occurrence in 2020. Laser hair removal was the most common (51.2%) litigated procedure. General practice operators (48%) recorded the highest rate of laser-related medical complaints. Lack of skill was the most common reason for failure. Among 383 cases with public decisions, 62.4% of them were fault liability in paid judgment. Conclusion: Medical claims related to laser application are increasing. However, as it is clear, the growth of laser technology and the increasing demand for lasers in medical science require more surveillance to avoid probable injuries and improve patient safety, especially surveillance of the physicians who work outside the scope of their specialty.