‘Trust me, I’m a doctor’: a qualitative study of the role of paternalism and older people in decision-making when they have lost their capacity

Cole, Joanne; Kiriaev, Oleg; Malpas, Phillipa; Cheung, Gary

doi:10.1177/1039856217734741

Cited by 6 publications

(9 citation statements)

References 11 publications

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“…In older physicians, a rational decision‐making style showed a stronger positive effect on patient involvement in protocols. This could be seen as contrary to studies reported previously that older physicians are more intuitive (heuristic) in decision making and more paternalistic when interacting with patients . Female physicians utilizing slow/DMR showed a stronger positive effect on patient involvement in decision‐making tools than male physicians utilizing this form of decision making.…”

Section: Discussioncontrasting

confidence: 99%

“…This could be seen as contrary to studies reported previously that older physicians are more intuitive (heuristic) in decision making and more paternalistic when interacting with patients. 64,65 Female physicians utilizing slow/DMR showed a stronger positive effect on patient involvement in decision-making tools than male physicians utilizing this form of decision making. This is consistent with several earlier studies showing that female physicians are more participatory in terms of empathy and information sharing.…”

Section: Multi-groupmentioning

confidence: 97%

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Shared decision making: Does a physician's decision‐making style affect patient participation in treatment choices for primary immunodeficiency?

Lamb

Wang

Lyytinen

2019

Evaluation Clinical Practice

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Overall health care spending in the United States is equivalent to more than 15% of GDP, yet outcomes rank below the top 25 in most quality categories when compared with other Organization for Economic Cooperation and Development (OECD) countries. The majority of spending is consumed by small patient populations with chronic diseases. Experts believe increased patient‐physician shared decision making (SDM) should result in better overall longitudinal care but understanding the physician's role in facilitating SDM is limited. Structural equation modelling was applied to results of a 2016 questionnaire‐based survey of 330 US physicians who treat approximately 55% of primary immune deficiency requiring immune globulin therapy; it tested the relationship between slow/rational vs fast/intuitive decision‐making styles and SDM as mediated by patient‐centric care and moderated by physician's trust in the patient. The results showed a statistically significant relationship between slow/rational decision making and SDM. The results also suggest differences related to age, gender, education, and race but no differences related to trust.

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Section: Discussioncontrasting

confidence: 99%

Section: Multi-groupmentioning

confidence: 97%

Shared decision making: Does a physician's decision‐making style affect patient participation in treatment choices for primary immunodeficiency?

Lamb

Wang

Lyytinen

2019

Evaluation Clinical Practice

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“…The lack of training of health professionals not only refers to theoretical-practical knowledge and geriatric clinical skills, but also to the poor establishment of an appropriate relationship with older adults. Oftentimes, a paternalistic model is employed in medical care, which may be desired by some older adults who prefer to place trust and decision-making regarding the management of their disease in the attending physician 16…”

Section: Introductionmentioning

confidence: 99%

<p>Decreased Autonomy In Community-Dwelling Older Adults</p>

Sánchez-García¹,

García-Peña²,

Ramírez-García³

et al. 2019

CIA

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PurposeThe present study aims to explore characteristics associated with low perception of autonomy among community-dwelling older adults.Patients and methodsThis original research was derived from a cross-sectional study based on the study COSFOMA with information from 1,252 (60 years and older) community-dwelling older adults whose data was obtained through a questionnaire that included sociodemographic characteristics, as well as different scales of geriatric assessment. The perception of autonomy was evaluated with the autonomy sub-scale of the Quality of Life Scale of Older Adults from the World Health Organization (World Health Organization Quality of Life of Older Adults, WHOQOL-OLD).ResultsThe mean (SD) age of the 1,252 community-dwelling older adults participating in the study was 68.5 (7.2) years. The average perception of autonomy was 65.3 (18.2) points out of 100. In the final logistic regression model, schooling <6 years (Odds Ratio, OR = 2.1, 95% Confidence Interval, CI = 1.5–2.9), low social support (OR = 1.6, 1.2–2.2), low spirituality (OR = 2.6, 95% CI = 1.9–3.4), presence of cognitive impairment (OR = 1.9, 95% CI = 1.4–2.5), anxiety (OR = 1.7, 95% CI = 1.2–2.5), and limitation in activities of daily living (ADL) (OR = 1.6, 95% CI = 1.1–2.2) were statistically associated with the presence of low autonomy in older adults.ConclusionThe perception of autonomy among community-dwelling older adults is moderate. Social support and spirituality, as well as cognitive impairment, anxiety, and limitations in ADL, play a significant role for degree of perceived autonomy in this population. Health professionals can use this information to promote participation in decision-making processes through programs that improve quality of life.

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“…The authors argued that the paternalistic model within health care can be applicable especially in the older population and that we should not underestimate its relevance. 26 Various practitioners also share this notion. Surveys of doctors and nurses revealed that though they felt it was important to offer autonomous decision making, they were concerned that the full impact of the decision may not be understood by patients or surrogates.…”

Section: Problems With Futilitymentioning

confidence: 96%

“…A survey of 37 elderly patients found that 73% of them would want their doctors to make treatment decisions on their behalf if they lacked capacity to do so. 26 This study identified trust in the doctorpatient relationship and physician professionalism and knowledge as important factors when making this decision. The authors argued that the paternalistic model within health care can be applicable especially in the older population and that we should not underestimate its relevance.…”

Section: Problems With Futilitymentioning

confidence: 99%

Futility and Patients Who Insist on Medically Ineffective Therapy

Cifrese

Rincón

2018

Semin Neurol

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As medical decisions fall under more scrutiny and society demands increasing transparency of care, it is likely that more opportunities for conflicts will emerge. Similarly, with increasing demand and a static supply, the issue of who receives treatment and for how long naturally will arise. This mismatch leads to discussions of resource utilization and limitation of care in light of patients' values and rights. Clinicians should always be forthcoming with the uncertainty of prognostication while also articulating the severity of a patient's disease in relation to the risk and benefits of an intervention. However, dispute over treatment course and the idea of futile care can arise for in a variety of reasons, both from the clinician and the patient. Without identifying the cause of these conflicts, it is impossible to have effective communication. At times, it is important to utilize various negotiating skills when resolving these disagreements. Regardless of the approach, practitioners need more training in and exposure to these types of conflicts. In this review, we provide a framework for the origins and current state of futility, challenges in the application of the term, and recommendations on how to approach conflict in these situations.

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‘Trust me, I’m a doctor’: a qualitative study of the role of paternalism and older people in decision-making when they have lost their capacity

Abstract: Our findings suggest that the paternalistic model within medical care can be an expectation of some older patients and if taking a paternalistic approach we should not underestimate the trust and power that is imparted to us.

Cited by 6 publications

References 11 publications

Shared decision making: Does a physician's decision‐making style affect patient participation in treatment choices for primary immunodeficiency?

Shared decision making: Does a physician's decision‐making style affect patient participation in treatment choices for primary immunodeficiency?

<p>Decreased Autonomy In Community-Dwelling Older Adults</p>

Futility and Patients Who Insist on Medically Ineffective Therapy

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