Overview of the main challenges in shared decision making in a multicultural and diverse society in the intensive and critical care setting

Abstract

Background 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. Aim The aim of this paper is to identify some of the main obstacles to the adoption of shared decision making in an intensive and critical care scenario and discuss potential ways to facilitate its implementation. Methods We conducted a literature review on shared decision making from the perspective of intensive and critical care specialists. Discussion Although the health care context is complex and the variety of situation that can arise makes it impossible to prepare professionals for every occurrence, shared decision making process should be structured at an organization level, engaging health care professionals, experts of communication, and patient representatives coming from different cultural backgrounds, languages, and education to assemble for all the main procedures, where shared decision making is involved, the specific information packages health care professionals will use in order to guide them through the process and ensuring all patients receive a comparable level of engagement. Shared decision making should not become a hindrance for the health care professional but on the contrary a way to strengthen their relationship with the patient. Conclusion The implementation of the shared decision making approach at an organization‐wide level improves its quality and effectiveness.

How Artificial Intelligence and New Technologies Can Help the Management of the COVID-19 Pandemic

“…In many cases, social distancing is the only measure applicable: the consequent isolation and personal protective equipment can hinder the communication process, so it becomes important to develop specific guidelines to assist healthcare workers in delivering effective shared decision-making (SDM) in order to customize the treatments of patients [ 25 ]. SDM is a management model that allows a two-way exchange of information between patient and doctor, in to optimize and personalize the provided care.…”

“…New technologies may be used to spread medical information and knowledge, while physicians can play a role similar to that of influencers during the pandemic (some doctors have become very popular as opinion leaders) [ 52 ]. It would be interesting to exploit these possibilities, in order to spread healthy habits, disseminate medical culture, improve the understanding of medical decisions, and share the decision-making process [ 25 ]. The availability of open and big data gives scientists the possibility to perform studies reducing data collection time to a minimum, to assess the impact of new strategies, and to test new instruments to control the outbreak, including new applications.…”

Fine-Tuning Convolutional Neural Networks for COVID-19 Detection from Chest X-ray Images

“…This will allow us to further refine the models in future works. Deep learning techniques should be considered when creating information packages by organizations for the procedures where shared decision making [52] is used as a tool to help health care professionals effectively communicate all relevant information to the patient or their next of kin to reach an informed decision.…”

Editorial introduction: Decision making, reasoning, context, and perspective

“…[15][16][17] These papers are followed by articles identifying barriers to the implementation of SDM (again, in a diverse range of social and cultural contexts) and proposing ways of overcoming these barriers. [18][19][20] The edition concludes with a number of papers proposing innovative methods for implementing and evaluating the impact of PCC and SDM. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Again, the core concepts of PCC and SDM are explored across a very diverse set of contexts.…”

“…The edition contains several research papers aimed at getting a clearer picture of the patient decision‐making process in a number of areas, in different national contexts . These papers are followed by articles identifying barriers to the implementation of SDM (again, in a diverse range of social and cultural contexts) and proposing ways of overcoming these barriers …”