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Showing results for tags 'Decision making'.
Found 333 results
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Content ArticleFew previous studies evaluating the benefits of diagnostic decision support systems have simultaneously measured changes in diagnostic quality and clinical management prompted by use of the system. This report describes a reliable and valid scoring technique to measure the quality of clinical decision plans in an acute medical setting, where diagnostic decision support tools might prove most useful.
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Content ArticleIn this opinion piece for The Guardian, Adrian Chiles describes how his father was unnecessarily transferred from a community hospital to an A&E department by a locum GP. This caused his father—who was largely alone, confused and without his hearing aids—great distress, and should have been avoided, as healthcare professionals said the transfer had been unnecessary. Adrian describes his father's rapid deterioration following the incident and his regret that some of his father's last days were spent—avoidably—in distress. He says, "The process, the system, the protocols, the whatever, take hold and the wrong thing happens even though everyone can see it’s wrong but is powerless to put a stop to it."
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Content ArticleThe relentless increase in administrative responsibilities, amplified by electronic health record (EHR) systems, has diverted clinician attention from direct patient care, fuelling burnout. In response, large language models (LLMs) are being adopted to streamline clinical and administrative tasks. Notably, Epic is currently leveraging OpenAI's ChatGPT models, including GPT-4, for electronic messaging via online portals. The volume of patient portal messaging has escalated in the past 5–10 years, and general-purpose LLMs are being deployed to manage this burden. Their use in drafting responses to patient messages is one of the earliest applications of LLMs in EHRs. Previous works have evaluated the quality of LLMs responses to biomedical and clinical knowledge questions; however, the ability of LLMs to improve efficiency and reduce cognitive burden has not been established, and the effect of LLMs on clinical decision making is unknown. To begin to bridge this knowledge gap, the authors of this study, published in the Lancet, carried out a proof-of-concept end-user study assessing the effect and safety of LLM-assisted patient messaging.
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Content ArticleThe National Academies of Sciences, Engineering, and Medicine (NASEM) report Improving Diagnosis in Health Care calls for healthcare professionals to engage patients in diagnostic decision making. Patient engagement refers to the concept of patients being actively involved in their healthcare, including but not limited to engaging with medical providers and the health system in diagnosis, treatment, and overall disease management decisions. The emergency department (ED) presents unique challenges to engage patients in the diagnostic process. Patients evaluated in the ED typically have no prior relationship with the care team. Engagement is further challenged in the unpredictable, chaotic environment where clinicians operate in time-constrained situations and care for multiple patients simultaneously. Finally, patients presenting to the ED may be critically ill, emotionally distressed, intoxicated, or otherwise unable to fully participate in their own care. Health information technology (IT) is increasingly used to promote patient engagement by enhancing patient-provider communication, ensuring shared decision making, and enabling positive behavioural changes. Health IT tools such as electronic patient portals, mobile text messaging, health apps, and recent advancements in virtual environments offer new opportunities for patient engagement in the ED. This Agency for Healthcare Research and Quality (AHRQ) brief reviews the current state of health IT-based methods for engaging patients in the diagnostic process in the ED and outlines opportunities for further development.
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Content ArticleAccurate and accessible medical information is key to successful patient-centred care, which can be supported by the availability of easy-to-understand summaries of articles published in medical journals. In this short Lancet article, Mohamed Seghier of Khalifa University of Science and Technology, makes the case for plain language summaries that enable clinically useful research to be understood by the general public.
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Content ArticleThis study in Surgery aimed to investigate the accuracy of ChatGPT-4’s surgical decision-making compared with general surgery residents and attending surgeons. Five clinical scenarios were created from actual patient data based on common general surgery diagnoses. Scripts were developed to sequentially provide clinical information and ask decision-making questions. Responses to the prompts were scored based on a standardised rubric for a total of 50 points. Each clinical scenario was run through Chat GPT-4 and sent electronically to all general surgery residents and attendings at a single institution. Scores were compared using Wilcoxon rank sum tests. The results showed that, when faced with surgical patient scenarios, ChatGPT-4 performed superior to junior residents and equivalent to senior residents and attendings. The authors argue that large language models, such as ChatGPT, may have the potential to be an educational resource for junior residents to develop surgical decision-making skills.
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Content ArticleWomen with learning disabilities are less likely to access cervical and breast cancer screening when compared to the general population. In this study, the Social Ecological Model (SEM) was used to examine the inequalities faced by women with learning disabilities in accessing cervical and breast cancer screening in England. The study highlighted the following barriers to access for women with learning disabilities:Women with learning disabilities may lack knowledge of cancer symptoms and cancer screening, as well as being scared about the process and getting the results. The attitudes of family and paid carers towards screening may influence women with learning disabilities' decisions as to whether screening is seen as favourable; support and training may ensure unbiased perspectives. Barriers associated with how cancer screening programmes are designed, such as postal invitations which assumes an ability to read. Screening staff need to be aware of the general needs of people with learning disabilities, such as the benefits of easy-to-read documents. Multidisciplinary working is required so reasonable adjustments can be embedded into cancer screening pathways.The authors suggest that multiple methods to reduce the inequalities faced by women with learning disabilities are needed, and that these can be achieved through reasonable adjustments. Embedding reasonable adjustments can support women with learning disabilities in making an informed decision and accessing screening if they choose to. This may result in women with learning disabilities getting a timely cancer diagnosis.
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News Article
New crackdown on ICSs that ‘discourage’ referrals to private hospitals
Patient-Safety-Learning posted a news article in News
NHS England will begin monitoring and benchmarking systems on the extent to which patients are given the option to be treated by a private provider. The move follows the government today endorsing the recommendations of a review by the chair of the newly created Independent Patient Choice and Procurement Panel, which has highlighted how some local areas are restricting patient choice. It highlighted significant variation in choice between some systems, which it said was driven by factors including messaging from commissioners to GPs that discourages choice and/or encourages referrals to local NHS trusts, financial incentives for referrals to particular providers and difficulties in securing accreditation from commissioners. It cited one example where the operator of an independent sector hospital that is co-located with an NHS hospital was contractually prevented by the NHS trust from accepting certain referrals. Health and social care secretary Victoria Atkins said: “Empowering patients to take control of their own healthcare decisions is a key part of my missions to make the NHS faster, simpler and fairer for everyone that uses it.” Read full story (paywalled) Source: HSJ, 15 May 2024 -
Content ArticleIn this Guardian article. Palliative Care doctor Rachel Clarke examines the debate around legalising assisted dying, focusing on the need to ensure patients do not want to end their lives due to lack of adequate health and social care. She highlights the risk that if assisted dying were legalised, patients might be coerced into choosing death "not by some rightwing politician or avaricious family member, but by the woeful inadequacy of their care." She goes on to look at wider attitudes to the dying in the NHS, pointing out that hospice care is mostly funded by charities, not the NHS, and that last year in England, almost 14,000 people died in A&E while waiting more than 12 hours for a bed.
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Content Article
A growing number of patients with eating disorders are reporting having treatment withdrawn by services, often without notice and without their consent. We spoke to eating disorder campaigner Hope Virgo about how pressures on services, enduring stigma around eating disorders and dangerous new narratives are leading to the practice of treatment withdrawal. Hope explains how this is affecting vulnerable patients and highlights that as the number of people developing eating disorders increases, the risks to patient safety will only get worse. -
Content ArticleThe debate about fairness of artificial intelligence (AI) in health care is gaining momentum. At present, the focus of the debate is on identifying unfair outcomes resulting from biased algorithmic decision making. This article in The Lancet Digital Health looks at the ethical principles guiding outcome fairness in AI algorithms.
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Content ArticleHow we talk about health is important, and even those with the best intentions don't always do it well. Krista Lamb is an author and science communicator in Toronto. For years she has helped scientists, physicians, advocates and others share their healthcare stories effectively. Along the way, some of them have taught her how we can and should talk about health in ways that are empathetic, understandable and accurate. In this podcast she asks those people to share their tips and tricks to help everyone communicate better.
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Content ArticleLots of helpful information about health and medical science is available on the internet, often found via search engines and social media. However, some online health information is false and misleading—this is called health misinformation. Health misinformation can be harmful and can be hard to recognise, as the information may appear to come from an official or safe source. This article by US-based doctor Kelly Johnson-Arbor provides advice on how to recognise health misinformation, where misinformation comes from and why it can be harmful. The author goes on to explain ways to look for reliable health information.
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Content ArticleThere is a growing momentum around the world to foster greater opportunities for the involvement of mental health service users in their care and treatment planning. In-principle support for this aim is widespread across mental healthcare professionals. Yet, progress in mental health services towards this objective has lagged in practice. Francis et al. conducted a systematic review of quantitative, qualitative and mixed-method research on interventions to improve opportunities for the involvement of mental healthcare service users in treatment planning, to understand the current research evidence and the barriers to implementation. Overarching barriers to shared and supported decision-making in mental health treatment planning were: (1) Organisational (resource limitations, culture barriers, risk management priorities and structure); (2) Process (lack of knowledge, time constraints, health-related concerns, problems completing and using plans); and (3) Relationship barriers (fear and distrust for both service users and clinicians). On the basis of the barriers identified, recommendations are made to enable the implementation of new policies and programmes, the designing of new tools and for clinicians seeking to practice shared and supported decision-making in the healthcare they offer.
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Content ArticleThis study aimed to find out whether using an artificial intelligence (AI) deterioration model decreased the risk of escalations in care during hospitalisation. The study's findings suggest that use of an AI model is associated with a decreased risk of escalations in care.
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Content ArticleThis systematic review in JAMA Network Open explored how much shared decision-making (SDM) is used in interventions aimed at improving cardiovascular risk management, and how it affects decisional outcomes, cardiovascular risk factors and health behaviours. The review looked at 57 randomised clinical trials that included 88,578 patients on SDM interventions for cardiovascular risk management and 1341 clinicians, SDM interventions were associated with a slight decrease in decisional conflict and an improvement in haemoglobin A1c levels.
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Content ArticleEvidence-informed decision-making (EIDM) entails identifying, appraising, and mobilising the best available evidence for safe and effective health policy and programmes. EIDM is a mainstay of the World Health Organization’s science-based mandate, and a pivotal steppingstone towards achieving the Triple WHO’s triple billion targets and the 2030 Agenda for Sustainable Development. This guide and associated tool repository provide WHO staff, Member States and partner organisations with vetted methods and tools to better leverage diverse forms of evidence for more effective policy and practice in the clinical, public health and health system fields. Introducing a comprehensive, multidisciplinary framework to plan and implement evidence-to-policy processes, the guide also aims to foster better collaboration and create synergies among actors and workstreams of the evidence ecosystem.
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Content ArticleImproving maternity care is a key Government and National Institute for Health and Care Research (NIHR) priority. In March 2024, an NIHR Evidence webinar showcased research from their recent Collection, Maternity services: evidence to support improvement. This summary includes videos of researchers’ presentations and captures some of the points raised in the webinar Q&A. It highlights seven features of safety in the maternity units, kind and compassionate care around the induction of labour, and the role of hospital boards in improving maternity care.
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Content ArticleThis Medscape article looks at misconceptions about the impact of diet on cancer progression that are being spread on social media platforms such as TikTok. Examples of these ideas include the idea that you can 'starve' cancer by cutting out carbohydrates, or that an alkaline diet will stop cancer by neutralising the acid environment around a tumour. The author, John Kerr, asks whether there should be a rallying call for cancer health professionals to do more to "push these scientifically illiterate concepts away." He suggests, "Rather than just shrugging our shoulders, perhaps we should be thinking more about it?"
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Event
Medical treatment decisions and the law
Sam posted an event in Community Calendar
This course will offer an overview of the law relating to medical treatment decisions, both children and adults, and both for patients able to make a decision for themselves, and where best interests decisions must be made for those who cannot, and how to tell the difference. We will also look at how, and when, it may be necessary to involve the court to resolve disputes and – better – how to avoid disputes altogether. Decisions about medical treatment can be about life and death, such as withdrawal of treatment or (not) providing CPR. Or about quality of life, liberty and independence, which can be just as important. But the legal (and ethical) framework around these decisions is often misunderstood, leading to distress and disputes at the very worst of times, as we have seen in a few very high-profile cases. It can also cause uncertainty and doubt in clinicians, where the law is misunderstood as a stick to beat them with, rather than a shield to protect their reasonable decision-making. We will cover whether a patient should always get what they want, or does “doctor know best”? When a patient cannot make a decision for themselves, who gets to decide, and how should these decisions be made? What is the role of so-called “next of kin” (and did you know that there’s actually no such thing)? Can parents insist on treatment for a child when doctors think it futile? How are disputes in this context resolved and, better yet, how are they avoided? Throughout, we will talk in particular about the importance of good communication, and managing expectations, and how to ensure that clinicians are doing the right thing for the patient, as well as avoiding getting sued. Key learning objectives: To understand and apply in practice the fundamental legal framework around decisions about medical treatment, including: Rationing and resource allocation The limits of choice and autonomy The relationship between law and ethics The importance of good communication, and how to not get sued The law on consent Mental capacity and best interests decision for adults Decisions about children – Gillick competence, parental responsibility and disputes Restraint and deprivation of liberty Going to court Register -
Content Article
The trend towards health system mergers and acquisitions in the US is likely to continue in 2024. Mergers can be beneficial. However, post-merger integration can take years to complete and can have an adverse effect on patient safety, care culture and care quality. Some healthcare researchers have dubbed mergers as 'life events' for health systems.[1] Health system mergers and acquisition projects need to include a special task force to assess the risks to patient safety management practices.- Posted
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Content ArticleA change in how British people and health professionals talk about death is needed to avoid delays in crucial conversations about end-of-life care, resulting in traumatic consequences for patients and their families, the Parliamentary and Health Service Ombudsman (PHSO) has warned. In a new report, End of life care: improving ‘do not attempt CPR’ conversations for everyone, PHSO has called for urgent improvements to the process and communication surrounding do not attempt cardiopulmonary resuscitation (DNACPR), so doctors, patients, and their loved ones can make informed choices about their care.
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Content ArticleThis article looks at US study showing that the simple act of a doctor sitting in a chair during hospital bedside discussions improves the experience for both doctors and patients. The research team examined whether educating internal medicine residents on the value of sitting and adding a wall-mounted folding chair in plain sight to hospital rooms would motivate doctors to use chairs. The study also measured the impact of whether this physician behaviour impacted patient perceptions. The results showed that: Education alone improved sitting frequency to 15%, but adding dedicated chairs for the clinicians in addition to any patient or visitor chairs improved sitting to 45%. In units where residents were given only education on the value of sitting, patients reported 49% of the time residents always spent enough time by the bedside with them, compared to 73% when a chair was available. In units with education only, 67% of the time residents always checked to ensure the patient understood everything, compared to 87% when a chair was present.
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Content ArticleThe Patients Association has been working with the Health and Care Professions Council (HCPC) to understand the impact the English language proficiency of health and care professionals has on patient and carer experiences. The HPCP is proposing changes to its English language proficiency requirements for applicants and this blog outlines key issues that were raised in an online focus group with patients, including: The impact of English language proficiency on patient experience Creating a fair system Partnering with patients and carers
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Content ArticleThis US study looked at how critical care doctors approach shared decision-making with Black compared with White caregivers of critically ill patients. The authors found that racial disparities exist in critical care clinicians' approaches to shared decision-making and suggest potential areas for future interventions aimed at promoting equity.
