Journal of evaluation in clinical practice
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Some philosophers have argued that evidence of underlying mechanisms does not provide evidence for the effectiveness of a medical intervention. One such argument appeals to the unreliability of mechanistic reasoning. However, mechanistic reasoning is not the only way that evidence of mechanisms might provide evidence of effectiveness. ⋯ A case study from virology provides an example of this so-called reinforced reasoning in medicine. It is argued that in this case study, the available evidence of underlying mechanisms did in fact play a role in providing evidence in favour of a medical intervention. This paper therefore adds a novel and recent case study to the literature in support of evidential pluralism in medicine.
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User participation is nowadays a desirable feature of social services work. The International Federation of Social Workers states that staff shall promote the participation of clients so as to "enable them to be empowered in all aspects of decisions and actions affecting their lives." The statement is codified in various national ethical codes; the Swedish Code of Conduct and Ethical Behaviour for Social Workers specifies that interventions shall build on client participation and common agreement. However, a 2012 Swedish governmental report noted that among 16 methods for user participation in the social services, psychiatry, and abuse and addiction care, only one, shared decision making (SDM), had been evaluated in randomized controlled trials (RCTs). ⋯ Social workers do have good reasons for choosing certain methods for user participation rather than others. These methods can be found by looking at specific justificatory reasons. The case for SDM is strengthened by its having been evaluated in RCTs and also because the SDM components harmonize with relevant components in the presented (Swedish) legislation.
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Review Meta Analysis
Strategies for implementing shared decision making in elective surgery by health care practitioners: A systematic review.
To summarize relevant international scientific evidence on strategies aimed at facilitating or improving health care practitioners' adoption of shared decision making in elective surgery. The review evaluated the effectiveness of these strategies and described the characteristics of identified strategies. ⋯ The use of well-developed educational information provided through interactive multimedia, computer or DVD based, may enhance the decision-making process. The evidence suggests that such multimedia can be used prior to the surgical consultation, presenting medical and surgical information relevant to the upcoming consultation. A decision and communication aid also appears to be an effective method to support the surgeon in patient participation and involvement in the decision-making process.
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In shared decision making, health care professionals and patients collaborate in making health-related choices. This process is based on autonomy and constitutes one to the elements of patient-centered care. However, there are situations where shared decision making is more difficult, if not impossible, due to barriers, which may be related to language, culture, education, or mental capacity and external factors like the state of emergency or the availability of alternative sources of information. ⋯ The implementation of the shared decision making approach at an organization-wide level improves its quality and effectiveness.