Journal of evaluation in clinical practice
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In order for patients to make autonomous decisions in a healthcare setting, they must understand relevant information. There is, however, a lack of consensus on how understanding should be defined or assessed in this context, despite the fact that in practice doctors are regularly required to judge whether a patient has understood medical information. Current accounts of patient decision-making often focus on the information which needs to be disclosed to the patient to support their autonomous decision-making. ⋯ In this paper, I use a number of hypothetical clinical situations to explore the conditions that are required for a patient to adequately understand information in medical decision-making. Drawing upon the wider philosophical literature, I propose a number of criteria which are necessary for understanding in a medical context: patients must (1) grasp a body of information which (2) reasonably reflects a responsible body of medical professionals' best estimate of the truth, (3) to a degree which meets a context-specific threshold. These criteria may be helpful in guiding assessments of patient understanding in clinical practice.
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Three interrelated topics are examined in this paper. These are (1) the study of shame and the other moral emotions (guilt, regret, remorse) as it relates to clinical approaches in cross-cultural psychiatry; (2) the examination of methodological problems and choices in researching and treating shame in persons who have experienced forced departure from their country of origin and immigration into ambivalent host countries, in which shame experienced as part of the power differentials between host and refugee is added to whatever shaming experiences the person endured within the violence of the country of origin; and (3) an examination of the suitability of evidence-based psychiatry (EBP) and narrative psychiatry as vehicles for providing clinical assessment and care that is scientifically rigorous and also establishes a reciprocally respectful relationship between two humans working on a single task of developing and understanding the life story of the person who has experienced the stresses of life as a refugee. ⋯ We present two case vignettes as illustrations of how shame or respect arises and is responded to in the context of a psychiatry session.
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Shared decision making has been widely advocated and evaluated in diverse ways for 4 decades. ⋯ It is a broader concept than providing information regarding treatment alternatives in the office.
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Assessments of treatments for 'subjective symptoms' are problematic and potentially contentious. These are symptoms without ascertainable pathophysiology, also referred to as 'medically unexplained.' Treatments of them may be assessed from different perspectives, and an assessment as seen from one perspective may be discrepant with an assessment as seen from another perspective. The observational study described in the paper represents one perspective. ⋯ This is notable, because the population of China, the indigenous context of acupuncture, is greater than populations of WEIRD countries combined. Patients' expectations of a treatment such as acupuncture and their prior familiarity with it vary among contexts, and patients' experiences of treatment outcomes may vary accordingly. In short, although clinical trials constitute a test of truth in biomedicine and inform authoritative assessments in WEIRD countries, they do not necessarily represent the truth from the perspective of those experiencing outcomes of especially indigenous treatments for subjective symptoms in non-WEIRD contexts.
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Morita therapy is one of the leading alternative psychotherapeutic approaches that has emerged from Japan and has adapted with notable success to the mores and demands of the Western medical establishment. Although still on the margin, Morita therapy has the potential to offer a viable option for those who seek therapeutic assistance for various neuroses and psychosomatic illnesses that culminate in psychiatric symptoms such as generalized anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder. Diverging considerably from conventional Western psychiatric approaches, Morita therapy has its own modes of conceiving mental illness and offers distinct curative methods that are in some ways akin to the techniques of meaning-centred psychotherapies, but in many other ways are rather different. In this paper, the meaning-formation and the building of a constant sense of purpose in Morita therapy is explored, with a special focus on how these relate to creating a stable psychological framework for the client.