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Negotiating treatment preferences: Physicians' formulations of patients' stance.

https://arctichealth.org/en/permalink/ahliterature275921
Source
Soc Sci Med. 2016 Jan;149:26-36
Publication Type
Article
Date
Jan-2016
Author
Anne Marie Dalby Landmark
Jan Svennevig
Pål Gulbrandsen
Source
Soc Sci Med. 2016 Jan;149:26-36
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Decision Making
Humans
Negotiating - methods
Norway
Patient Preference
Physician-Patient Relations
Physicians - psychology
Abstract
Eliciting patients' values and treatment preferences is an essential element in models of shared decision making, yet few studies have investigated the interactional realizations of how physicians do this in authentic encounters. Drawing on video-recorded encounters from Norwegian secondary care, the present study uses the fine-grained empirical methodology of conversation analysis (CA) to identify one conversational practice physicians use, namely, formulations of patients' stance, in which physicians summarize or paraphrase their understanding of the patient's stance towards treatment. The purpose of this study is twofold: (1) to explore what objectives formulations of patients' stance achieve while negotiating treatment and (2) to discuss these objectives in relation to core requirements in shared decision making. Our analysis demonstrates that formulating the patient's stance is a practice physicians use in order to elicit, check, and establish patients' attitudes towards treatment. This practice is in line with general recommendations for making shared decisions, such as exploring and checking patients' preferences and values. However, the formulations may function as a device for doing more than merely checking and establishing common ground and bringing up patients' preferences and views: Accompanied by subtle deprecating expressions, they work to delegitimize the patients' stances and indirectly convey the physicians' opposing stance. Once established, these positions can be used as a basis for challenging and potentially altering the patient's attitude towards the decision, thereby making it more congruent with the physician's view. Therefore, in addition to bringing up patients' views towards treatment, we argue that physicians may use formulations of patients' stance as a resource for directing the patient towards decisions that are congruent with the physician's stance in situations with potential disagreement, whilst (ostensibly) avoiding a more authoritarian or paternalistic approach.
PubMed ID
26699275 View in PubMed
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Customer interest in and experience with various types of pharmacy counselling - a qualitative study.

https://arctichealth.org/en/permalink/ahliterature264351
Source
Health Expect. 2014 Dec;17(6):852-62
Publication Type
Article
Date
Dec-2014
Author
Susanne Kaae
Janine M Traulsen
Lotte S Nørgaard
Source
Health Expect. 2014 Dec;17(6):852-62
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Counseling - methods
Denmark
Humans
Interviews as Topic
Patient Preference
Pharmaceutical Services
Qualitative Research
Abstract
Despite pharmacists' extensive knowledge in the optimization of patients' medical treatments, community pharmacies are still fighting to earn patients' trust with respect to medicinal counselling at the counter.
The aim was to investigate how patients perceive pharmacy counselling at the present time, in order to develop the patient-pharmacy relationship for the benefit of both patients and pharmacies.
Short semi-structured interviews were carried out with pharmacy customers by pharmacy internship students.
One hundred and eight customers in 35 independent pharmacies across Denmark were interviewed during the spring of 2011.
Customers were interviewed about their expectations of pharmacies in general and their experiences with medical counselling in particular.
Customers perceive community pharmacies very differently in terms of both expectations of and positive experiences with counselling. They appear to be in favour of pharmacy counselling with respect to over-the-counter medicine and first-time prescription medicine in contrast to refills. Customers find it difficult to express the health-care role of pharmacies even when experiencing and appreciating it.
Lack of appreciation of pharmacy counselling for refill prescription medicine and the difficulty in defining the role of pharmacies might stem from the difficulties that customers have in understanding medicine and thus the role of counselling services with respect to medicine. The pharmacy staff does not seem to realize these barriers.
For pharmacies to encourage customer interest in pharmacy counselling, the staff should start taking the identified barriers into account when planning communication strategies.
PubMed ID
23020683 View in PubMed
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Motivation and experience of nulliparous women using intrauterine contraceptive devices.

https://arctichealth.org/en/permalink/ahliterature143309
Source
J Obstet Gynaecol Can. 2010 Apr;32(4):335-8
Publication Type
Article
Date
Apr-2010
Author
Ellen Ruth Wiebe
Konia Jane Trouton
Jennifer Dicus
Author Affiliation
Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver BC.
Source
J Obstet Gynaecol Can. 2010 Apr;32(4):335-8
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adult
Canada
Female
Humans
Intrauterine Devices
Motivation
Parity
Patient Preference
Patient satisfaction
Pregnancy
Questionnaires
Abstract
Use of an intrauterine contraceptive device (IUD) has not been recommended to nulliparous women in the past. There is now good evidence that there is no increased risk of pelvic inflammatory disease or infertility in nulliparas who use IUDs and the recommendations have changed. Our objective was to understand more about the motivations and experience of nulliparous women using IUDs.
This was a mixed method study. First, we asked 44 nulliparous women who had had an IUD inserted within the previous six months about their reasons for seeking the IUD, their history with other forms of contraception, their perception of the insertion experience, and their feelings after insertion. Questionnaires were then distributed to 154 nulliparous women presenting for IUDs, asking about their past experience with hormonal contraception.
The main theme arising from the interviews was a desire to avoid hormonal contraception. Other reasons for choosing the IUD were greater contraceptive effectiveness than other methods, convenience of use, and lower cost. Responses to the questionnaire indicated that 138 women (89.7%) had used hormonal contraception in the past and, of those, 98 (63.0%) complained of mood side effects, 64 (41.6%) of sexual side effects, and 64 (41.6%) of physical side effects.
The most important motivation for nulliparous women in this study to choose IUDs was to avoid the potential or actual side effects of hormonal contraception. Despite experiencing some discomfort at the time of insertion, this group of nulliparous women was very positive about using IUDs for contraception.
PubMed ID
20500940 View in PubMed
Less detail
Source
CMAJ. 2012 Apr 3;184(6):E299-300
Publication Type
Article
Date
Apr-3-2012

[Municipalities actions for people with back issues is risky].

https://arctichealth.org/en/permalink/ahliterature271627
Source
Ugeskr Laeger. 2013 Dec 2;175(49):3049
Publication Type
Article
Date
Dec-2-2013

Enhancing the quality of end-of-life care in Canada.

https://arctichealth.org/en/permalink/ahliterature107076
Source
CMAJ. 2013 Nov 5;185(16):1383-4
Publication Type
Article
Date
Nov-5-2013
Author
Deborah Cook
Graeme Rocker
Daren Heyland
Source
CMAJ. 2013 Nov 5;185(16):1383-4
Date
Nov-5-2013
Language
English
Publication Type
Article
Keywords
Advance Care Planning
Canada
Humans
Patient Participation
Patient Preference
Physician-Patient Relations
Quality Improvement
Terminal Care - standards
Notes
Comment In: CMAJ. 2014 Feb 18;186(3):21324549710
PubMed ID
24062171 View in PubMed
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Preference for place-of-death among terminally ill cancer patients in Denmark.

https://arctichealth.org/en/permalink/ahliterature136622
Source
Scand J Caring Sci. 2011 Dec;25(4):627-36
Publication Type
Article
Date
Dec-2011
Author
Mette Asbjoern Neergaard
Anders Bonde Jensen
Jens Sondergaard
Ineta Sokolowski
Frede Olesen
Peter Vedsted
Author Affiliation
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark. man@alm.au.dk
Source
Scand J Caring Sci. 2011 Dec;25(4):627-36
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Aged
Cross-Sectional Studies
Death
Denmark
Female
Humans
Male
Middle Aged
Neoplasms - psychology
Patient Preference
Terminally ill
Abstract
Achieving home death is often seen as an important endpoint in palliative care, but no studies of the preferred place-of-death have yet been conducted in Scandinavia. Furthermore, we do not know if professionals' report on deceased patients' preference of place-of-death is a valid information. The aim of this study was to describe where terminally ill Danish cancer patients prefer to die and to determine if their preference changed during the palliative period, as reported retrospectively by bereaved relatives, general practitioners (GPs) and community nurses (CNs) and to assess the agreement of their accounts. The study was a population-based, cross-sectional combined register and questionnaire study in Aarhus County, Denmark. The population comprised 599 deceased adult cancer patients who had died from 1 March to 30 November 2006 and were identified through merging of health registers. Relatives returned 198 questionnaires about patients' preferred place-of-death, GPs 333 and CNs 201. The study showed that most terminally ill cancer patients preferred home death (up to 80.7%). The reported preference for home death weakened as death approached (down to 64.4%). A better congruence was seen between relatives' and GPs' accounts of preference for place of death at the end of the palliative period (? 0.71) than between relatives' and CNs' accounts (? 0.37). In conclusion, bereaved relatives (and GPs and CNs) report retrospectively that most terminally ill cancer patients wish to die at home. The preference weakened significantly as death approached. The agreement between relatives' and GPs' accounts on patients' preferences at the end of the palliative period was 'substantial', whereas the agreement between relatives' and CNs' accounts at the same time was significantly less outspoken. This indicates that CNs may be facing a problem in assessing their patients' wishes retrospectively.
PubMed ID
21362004 View in PubMed
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Hospice residents' interest in complementary and alternative medicine (CAM) at end of life: a pilot study in hospice residences in British Columbia.

https://arctichealth.org/en/permalink/ahliterature132575
Source
J Palliat Care. 2011;27(2):134-40
Publication Type
Article
Date
2011
Author
Sherin Rahim-Jamal
Ann Sarte
Jean Kozak
Kathy Bodell
Maria Cristina Barroetavena
Romayne Gallagher
Anne Leis
Author Affiliation
Centre for Healthy Aging at Providence, 4865 Heather Street, Vancouver, British Columbia, Canada. srahimjamal@providencehealth.bc.ca
Source
J Palliat Care. 2011;27(2):134-40
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
British Columbia
Complementary Therapies - utilization
Female
Hospices
Humans
Male
Middle Aged
Needs Assessment
Patient Preference
Pilot Projects
Abstract
While complementary and alternative medicine (CAM) can improve quality of life at end of life, little research exists on hospice residents' interest in using and sharing CAM experiences with a partner/friend/other family member. A pilot study conducted in British Columbia, Canada explored the extent of hospice residents' interest and openness to CAM use. A convenience sample of 48 hospice residents from 9 hospice sites completed questionnaire-based interviews. The majority of participants were Caucasian women over 60 years old. 81 percent expressed interest in receiving CAM; 79 percent used CAM prior to entering the hospice setting. 50 percent of those interested in using CAM felt their partner/friend/other family member would also be interested in receiving CAM, and half of that 50 percent reported personal interest in sharing the experience. Reasons reported for CAM interest were to enhance well-being, relaxation, and for pain relief. Further research could explore how resident-caregiver dyads may benefit from shared CAM experiences over the illness trajectory.
PubMed ID
21805948 View in PubMed
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Maternal preference for cesarean delivery: do women get what they want?

https://arctichealth.org/en/permalink/ahliterature122361
Source
Obstet Gynecol. 2012 Aug;120(2 Pt 1):252-60
Publication Type
Article
Date
Aug-2012
Author
Dorthe Fuglenes
Eline Aas
Grete Botten
Pål Øian
Ivar Sønbø Kristiansen
Author Affiliation
Department of Health Management and Health Economics, University of Oslo, Oslo, Norway. dorthe.fuglenes@medisin.uio.no
Source
Obstet Gynecol. 2012 Aug;120(2 Pt 1):252-60
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Adult
Cesarean Section - psychology - statistics & numerical data
Female
Humans
Norway
Patient Preference - statistics & numerical data
Pregnancy
Prospective Studies
Abstract
To estimate the association between delivery preferences during pregnancy and actual delivery mode.
This was a prospective cohort study using data from the Norwegian Mother and Child Cohort Study (N=65,959). We analyzed predictors of birth outcome by means of women's preferences for mode or delivery and a range of medical and socioeconomic factors with multivariable logistic regression models. The term "elective" cesarean delivery includes cesarean deliveries planned 8 hours or more before delivery and performed as planned.
When asked about delivery preference at 30 weeks of gestation, 5% of the women reported a preference for a cesarean delivery, 84% had a preference for vaginal delivery, and 11% were neutral. Among those with a cesarean delivery preference, 48% subsequently had a cesarean delivery (12% acute and 36% elective), and of those with a vaginal preference 12% delivered by cesarean (8.7% acute and 3.1% elective). When adjusting for maternal characteristics and medical indications, the odds for an acute cesarean delivery among nulliparous women with a cesarean delivery preference was almost two times higher (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.49-2.62) and for elective cesarean delivery the preference was 12 times higher (OR 12.61, 95% CI 9.69-16.42) than for women with a vaginal preference. For multiparous women, the corresponding figures were OR 3.13 (95% CI 1.39-7.05) and OR 10.04 (95% CI 4.59-21.99). When multiparous women with previous cesarean deliveries were excluded, the OR for an elective cesarean delivery was 26 times higher given a cesarean delivery preference compared with a vaginal delivery preference (OR 25.78, 95% CI 7.89-84.28). Based on a small subset of women with planned cesarean delivery on maternal request (n=560), we estimated a predicted probability of 16% for nulliparous women (25% for multiparous women) for such cesarean delivery.
Pregnant women's expressed preferences for delivery mode were associated with both elective and acute cesarean deliveries.
II.
PubMed ID
22825082 View in PubMed
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Opportunities and limitations of patient choice: the case of the Russian Federation.

https://arctichealth.org/en/permalink/ahliterature262278
Source
Health Policy Plan. 2014 Jan;29(1):106-14
Publication Type
Article
Date
Jan-2014
Author
Igor Sheiman
Sergey Shishkin
Helen Markelova
Source
Health Policy Plan. 2014 Jan;29(1):106-14
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Competitive Medical Plans - organization & administration
Delivery of Health Care - organization & administration
Financing, Personal
Health Policy
Humans
Patient Preference
Russia
Abstract
While many countries have increased the opportunities for patient choice of provider, there is debate to what extent this has had positive effects on efficiency and quality of healthcare provision. First, some conditions should be met to exercise such choice, of which the most important is the provision of reliable data on providers' performance to both patients and physicians as their agents, as well as increasing primary health care (PHC) providers' involvement in realization of patient choice. Second, expanding patient choice does not always lead to efficient allocation of resources in a healthcare system. This article explores these controversial developments by using empirical evidence from the Russian Federation. It shows that choice indeed has value for patients, but there are many areas of inefficient choice, which leads to misallocation of healthcare recourses. Thus, health policy in this area should be designed to ensure a reasonable balance between objectives of expanding choice and promoting more efficient organization of healthcare provision. Political rhetoric about unlimited patient choice may be useless and even risky unless supported by well-balanced programmes of supporting and managing choice.
PubMed ID
23619777 View in PubMed
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205 records – page 1 of 21.