Musculoskeletal Health Disparities: Health Literacy, Cultural Competency, Informed Consent, and Shared Decision Making

McClellan, Frank M.; Wood, James E.; Fahmy, Sherin M.; Jones, Lynne C.

doi:10.1615/jlongtermeffmedimplants.2014010918

Cited by 4 publications

(3 citation statements)

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“…As a concept and a set of practices and methods, HL emerged from two very different roots; one being from medical care with its patient education focus and the other one from the broader public health field with its health promotion perspective [7]. It is a strategy that addresses not only the shortfalls of the individuals in terms of skills and knowledge but also the deficits health services may display in answering the needs of the population (for instance by increasing the readability of consent forms and improving communication skills of health care providers) [8][9][10]. This dual purpose lead to numerous investigations to better capture the scope of HL and also to devise better strategies to improve people's HL, particularly in the clinical context [11][12][13][14][15][16][17].…”

Section: Resultsmentioning

confidence: 99%

Health Literacy: From a Property of Individuals to One of Communities

Kendir

Breton

2020

IJERPH

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Health literacy (HL) is increasingly hailed as a strategy to improve the control individuals have over their health. A central critic of HL intervention is its overemphasis on individual level factors, something recognised in the 2008 report of the Commission of Social Determinants of Health (SDoH) that recommended expanding the scope of HL to cover the SDoH. The objective of our study was to assess the extent to which recent progress on HL captures the need for collective action on the SDoH. We conducted a scoping review on PubMed looking for review papers published between 2013–2018 in English and French. Definitions of HL were analysed against two main dimensions (i.e., locus of change of HL strategies and foreseen outcome of HL improvements). Despite a number of authors calling for more research on HL interventions at the community level and an expansion of the definition to cover the SDoH, we found that the recommendation of the Commission has yet to be implemented. Even when the definitions include the capacities of individuals on distal determinants, both the locus of change and outcomes of HL improvement do not go beyond intra individual factors (knowledge, skills, etc.). It is noteworthy that communities were either framed as a setting outside of health care services or as an aggregate of individuals. We found no instance of HL intervention regarding communities as complex systems of actors sharing a common space and dynamic. We conclude by suggesting a new definition of HL and by drawing attention to the research gap in addressing the upstream SDoH through HL actions.

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Section: Resultsmentioning

confidence: 99%

Health Literacy: From a Property of Individuals to One of Communities

Kendir

Breton

2020

IJERPH

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“…It would be beneficial to discuss potential biases in treatment at the beginning of an SDM conversation. Previous research has found that a patient’s prior knowledge compounds the complexity of the decision-making process, especially for patients with lower literacy rates or those lacking access to high-quality information (McClellan et al., 2014). Furthermore, we found that the discussion of cost is a point of weakness within the process and often overlooked.…”

Section: Discussionmentioning

confidence: 99%

Dupuytren contracture: using qualitative data to inform a conceptual framework for shared decision-making

Cichocki

Chung

Kane

et al. 2022

J Hand Surg Eur Vol

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Multiple treatment options are available to patients with Dupuytren contracture, making shared decision-making complex. Our rigorous qualitative analysis sought to understand patient perceptions of shared decision-making in Dupuytren contracture treatment and create a conceptual framework to optimize patient-physician communication. We interviewed 30 patients with Dupuytren contracture to learn about their experience with treatment selection. The following themes were integral to shared decision-making for Dupuytren contracture treatment: discussing disease progression and treatment initiation, presenting all available treatment options, assessing patients’ pre-existing biases towards treatment, patient values and preferences for treatment trade-offs, treatment risks and benefits, physician recommendation and active patient participation. This model can optimize communication about treatment options and expectations for relevant outcomes including, recovery time, contracture recurrence, complications, and treatment-related expenses. Level of evidence: V

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“…The effectiveness of these treatment modalities hinges on the engagement and compliance of the patient with their own treatment. Shared decision‐making is a first step in this engagement . This communication can be enhanced with the use of a shared decision‐making tool .…”

Section: Discussionmentioning

confidence: 99%

Potential Role of Cost and Quality of Life in Treatment Decisions for Arthritis‐Related Knee Pain in African American and Latina Women

Gaskin

Karmarkar

Maurer

et al. 2020

Arthritis Care & Research

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Objective. The present study was undertaken to investigate whether Latina and African American women with arthritis-related knee pain and primary care providers who treat them believe their treatment decisions would benefit from having more information about the impact of treatment on their quality of life, medical care costs, and work productivity.Methods. We conducted 4 focus groups of Latina and African American women over age 45 years who had knee pain. We also conducted 2 focus groups with primary care providers who treated Latina and African American women for knee pain. The participants were recruited from the community. They were asked their opinions about a decision tool that presented information on a range of treatment options and their impacts on quality of life, medical care costs, and work productivity. They were asked whether providing this information would help them make better treatment decisions. We analyzed the focus group transcripts using ATLAS.ti.Results. We found that minority women and primary care providers endorsed the use of a decision-making tool that provided information of the impact of treatment on quality of life, medical care costs, and work productivity. Providers felt that patients would benefit from having the additional information but were concerned about its complexity and some patients' ability to comprehend the information.Conclusion. Latina and African American women could make more informed treatment decisions for their knee pain using a decision-making tool that provides them with significant information about how various treatment options may impact their quality of life, medical care costs, and workforce productivity.

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Musculoskeletal Health Disparities: Health Literacy, Cultural Competency, Informed Consent, and Shared Decision Making

Cited by 4 publications

References 0 publications

Health Literacy: From a Property of Individuals to One of Communities

Health Literacy: From a Property of Individuals to One of Communities

Dupuytren contracture: using qualitative data to inform a conceptual framework for shared decision-making

Potential Role of Cost and Quality of Life in Treatment Decisions for Arthritis‐Related Knee Pain in African American and Latina Women

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