Medical decision making : an international journal of the Society for Medical Decision Making
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Multicenter Study Clinical Trial
Informed Decision Making: Assessment of the Quality of Physician Communication about Prostate Cancer Diagnosis and Treatment.
Little is known about how physicians present diagnosis and treatment planning in routine practice in preference-sensitive treatment decisions. We evaluated completeness and quality of informed decision making in localized prostate cancer post biopsy encounters. ⋯ Physicians informed patients of options and risks and benefits, but infrequently engaged patients in core shared decision-making processes. Despite patients having received DAs, physicians rarely provided an opportunity for preference-driven decision making. More attention to the underused patient decision-making and engagement elements could result in improved shared decision making.
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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.
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Multicenter Study
Advance care planning norms may contribute to hospital variation in end-of-life ICU use: a simulation study.
There is wide variation in end-of-life (EOL) intensive care unit (ICU) use among academic medical centers (AMCs). Our objective was to develop hypotheses regarding medical decision-making factors underlying this variation. ⋯ In this simulation study of 2 AMCs, hospital-based physicians had different perceptions of an identical case. We hypothesize that different advance care planning norms may have influenced their decision-making heuristics.
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Multicenter Study
The language of prognostication in intensive care units.
Rationale. Although misunderstandings about prognosis are common in intensive care units (ICUs), little is known about how physicians actually communicate prognostic information. ⋯ There is considerable variability in the language used by physicians to disclose prognosis, with only 20% of physicians using quantitative terms. Very few physicians checked whether families understood prognostic information. These findings may provide potential targets for interventions to improve communication about prognosis in ICUs.
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Multicenter Study Clinical Trial
The impact of unstable angina guidelines in the triage of emergency department patients with possible acute coronary syndrome.
The primary aim of this study is to determine whether implementing the Agency for Health Care Policy and Research (AHCPR) Unstable Angina Practice Guideline improves emergency physician's decision making in patients with symptoms of possible acute coronary syndrome (ACS), including those for whom the diagnosis of unstable angina is uncertain. ⋯ Implementation of the AHCPR guideline did not improve triage decisions in emergency department patients with possible ACS. Assessing physician triage solely based on concordance with the AHCPR guideline may not accurately reflect the quality of patient care.