Medical decision making : an international journal of the Society for Medical Decision Making
-
When waiting lists are used to ration treatments for nonemergency procedures, a prioritization rule is required to ensure that urgent patients are admitted first. This study investigates how the introduction of an explicit prioritization guideline affected the prioritization behavior of doctors, who previously had full discretion for assigning patients. ⋯ The presence of a simple clinical priority guideline at the procedural level has not produced systematic, clinically based prioritization behaviors among doctors. The New South Wales priority guideline has curtailed assignments to the highest priority. This result raises a question concerning the usefulness of such a guideline in improving timely and equitable access to health care.
-
Randomized Controlled Trial
Decision aid influences on factors associated with patient empowerment prior to cancer treatment decision making.
Despite progress, models that incorporate antecedent and mediating factors associated with shared decision making (SDM)-related outcomes remain limited. An experimental study tests patient decision aid (DA) effects on a network of antecedents and mediators associated with patient empowerment prior to a medical decision-making consultation regarding cancer treatment. ⋯ Evidence from this research indicates that experiencing a DA prior to treatment decision making affects patient empowerment through a network that includes desire for information, life satisfaction, and multiple mediators. The studies also demonstrate the role that theory-based, multigroup structural equation modeling (SEM) can play in increasing understanding of DA effects. Such understanding is critical to improving SDM between patients and their physicians.
-
Linking patient-reported back pain outcomes with health utility measures is valuable for informing economic evaluations. ⋯ An empirical algorithm predicting EQ-5D weights from RMDQ scores provides a currently unavailable link for conducting economic evaluations in low back pain studies.
-
Multicenter Study
The Understanding of Terminal Cancer and Its Relationship with Attitudes toward End-of-Life Care Issues.
Although terminal cancer is a widely used term, its meaning varies, which may lead to different attitudes toward end-of-life issues. The study was conducted to investigate differences in the understanding of terminal cancer and determine the relationship between this understanding and attitudes toward end-of-life issues. ⋯ The understanding of terminal cancer varied among the 4 participant groups. It was associated with different preferences regarding end-of-life issues. Standardization of these terms is needed to better understand end-of-life care.
-
The trend for terminally ill patients to receive much of their end-of-life care at home necessitates the design of services to facilitate this. Care at home also requires that informal care be provided by family members and friends. This study investigated informal carers' preferences for support services to aid the development of end-of-life health care services. ⋯ The most valued services are those that support carers in their caregiving role; however, supportive care preferences vary with the different circumstances of patients and carers.