Journal of evaluation in clinical practice
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Evidence of mechanisms plays an important role in medical decision-making, but this role is less well articulated than that of clinical trial evidence. A new book, Evaluating Evidence of Mechanisms in Medicine: Principles and Procedures, provides a framework and resources for explicitly evaluating evidence of mechanisms when assessing claims of efficacy and external validity. This review outlines the overall approach of the book, the contribution it makes to evidence evaluation in medicine and makes some suggestions for further work that will aid implementation of the framework into clinical decision-making.
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Multicenter Study
Characteristics of shared decision making in Romania from the patient perspective: A cross-sectional multicentric study.
Shared decision making (SDM) is very important from patients' perspective. This process has not yet been evaluated in Romania. The study aims to evaluate SDM from the patients' perspective and to evaluate patients' characteristics that associate with SDM. ⋯ In our study, full anonymity was associated with significantly lower scores for the SDM process. The patients with higher education were most influenced by this condition, while those with the lowest education were the most critical.
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Elements of shared decision-making (ie, collaboration, patient preferences, and working alliance) have long been discussed and studied in the field of clinical psychology; however, research indicates that shared decision-making is not typically used in clinical practice. Instead, clinicians often rely on a paternalistic approach. In this article, we provide a narrative review of the existing research supporting shared decision-making for mental and behavioural health concerns, we discuss several barriers that impede its use in actual clinical practice, and we provide recommendations for increasing shared decision-making when working with patients.
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Shared decision-making (SDM) is a collaborative process through which patients and clinicians work together to arrive at a mutually agreed-upon treatment plan. The use of SDM has gathered momentum, with it being legally mandated in some areas; however, despite being a ubiquitously applicable intervention, its maturity in use varies across the specialties and requires an appreciation of the nuanced and different challenges they each present. It is therefore our aim in this paper to review the current and potential use of SDM across a wide variety of specialties in order to understand its value and the challenges in its implementation. ⋯ SDM has been demonstrated to improve decision quality in many scenarios across all of these specialties. There are, however, many challenges to its successful implementation, including the need for high-quality decision aids, cultural shift, and adequate training. SDM represents a paradigm shift towards more patient-centred care but must be implemented with continued people centricity in order to realize its full potential.
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Clinical guidelines are an increasingly common part of medical practice. The desire to standardize practices may seem a noble one, but overzealous application can make guidelines seem restrictive, leading to resentment or, worse, disregard. ⋯ Or where guidelines restrict access to services, utilitarianism might seem a better fit. Here, clinical practice guidelines are examined in terms of these theories of normative ethics, and it is argued that in fact, the process of writing and implementing guidelines is more accurately modelled through the lens of virtue ethics.