What should educators teach to improve preventive health care?

Grad, Roland; Antao, Viola; Bell, Neil R.; Dickinson, James A; Rezkallah, Raphael; Singh, Harminder; Szafran, Olga; Waugh, Earle H.; Thériault, Guylène

doi:10.46747/cfp.6808583

Cited by 21 publications

(28 citation statements)

References 11 publications

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“…31 SDM entails (1) communicating the benefits and risks of treatment options based on clinical protocols and the best available evidence, and ( 2) eliciting what is most relevant for patients and their families. 32 Multiple studies have emphasized that SDM is the most desirable and ethical model for decision making in transplant clinical practice. 14,16,23,33,34 In the specific context of decision making, the criterion of proportionality enables the balance of the patient's clinical conditions with the patient's interest.…”

Section: Conceptualizing Informed Consentmentioning

confidence: 99%

The 3-T Model of Informed Consent for Nonstandard Risk Donors: A Proposal for Transplant Clinical Practice

Grossi

Nicoli

Feo

et al. 2021

Transplantation Direct

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Background. The risk of disease transmission from nonstandard risk donors (NSRDs) is low, and outcomes are similar or better relative to transplants performed with standard criteria donors. However, NSRDs have posed new ethical challenges to the informed consent (IC) process. Based on the shared decision-making model, coinciding with the 3 main timings of the IC process ([1] pretransplant assessments and waiting list registration, [2] time on the waiting list, and [3] time of the organ offer), we put forward a model (3-T Model) to summarize the knowledge on IC for NSRDs and to deliver conceptual and practical support to transplant providers on this emergent issue. Methods. We searched PubMed and analyzed data from our area to provide evidence and ethical arguments to promote standardization of the timing of patient information, degree of patient participation, and disclosure of donor risk factors throughout the 3 stages of the time continuum leading to the potential acceptance of NSRDs. Results. Each of the 3 timings carries special ethical significance and entails well-defined duties for transplant providers relative to patient involvement and information of the benefits and risks associated with NSRDs. Based on our framework, experience, and interpretation of the literature, we put forward a list of recommendations to combine standardization (ie, timing, content, and degree of patient participation) and individualization of IC. Conclusions. The 3-T Model may enable the prevention of physicians’ arbitrariness and the promotion of patient-centered care. Future studies will assess the effectiveness of the 3-T Model in transplant clinical practice.

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Section: Conceptualizing Informed Consentmentioning

confidence: 99%

The 3-T Model of Informed Consent for Nonstandard Risk Donors: A Proposal for Transplant Clinical Practice

Grossi

Nicoli

Feo

et al. 2021

Transplantation Direct

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“…Acknowledging that approximately 85% of anticoagulant therapies are prescribed by family physicians, and their longitudinal doctor-patient relationships make them ideal for delivering patient-centered approaches to stroke prevention in AF, 14 , 16 the management practices and perspectives of family physicians are of particular interest. Further, this will enable exploration of a key facet of patient-centered care known as shared decision-making (SDM), that has shown value in situations where the benefit-to-harm risks are subtle, 17 such as in stroke prevention in older patients with AF. SDM involves collaboration between clinicians and patients to make decisions that are both informed by evidence, and in line with the patients’ values.…”

Section: Introductionmentioning

confidence: 99%

Family Physician Prescribing Practices and Perspectives on Shared Decision-Making Regarding the Use of Oral Anticoagulants for Stroke Prevention in Patients 75 Years or Older With Atrial Fibrillation

Ali

Abbasi-Dezfouly

Khera

et al. 2023

J Prim Care Community Health

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Introduction: Atrial Fibrillation (AF) is common in older adults, yet guideline-recommended oral anti-coagulants (OACs) for stroke prevention are underused in this population. With a growing population of older adults at risk of AF seeking primary care, the objective of the study was to determine the management practices and perspectives of family physicians on the initiation of OACs for stroke prevention in AF patients 75 years or older, including their engagement of patients in shared decision-making. Methods: This was an online survey of family physicians affiliated with a Primary Care Network in Alberta, Canada. Results: Patient’s risk (of falls, bleeding, or stroke) was the most common factor (17/20, 85%) physicians considered when deciding to initiate OAC in older adult patients with AF. Physicians used the CHADS2VASC (13/14, 93%) and HASBLED (11/15, 73%) tools to determine stroke and bleeding risks, respectively. Majority (11/15, 73%) of the physicians agreed that they feel confident initiating OAC for AF patients ≥75, while 20% (3/15) were neutral. All physicians agreed that their patients participated in shared decision-making to initiate OAC for stroke prevention. Conclusion: Family physicians strongly consider patient risks and utilize risk-assessment tools when initiating OAC in older adults with AF. Despite all physicians reporting the use of shared decision-making and that their patients were educated on the indications for OAC, confidence in initiating treatment was variable. Further exploration into factors impacting physician confidence is needed.

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“…21 Respect for autonomy is also important in shared decisionmaking process that is central to the provider-patient interaction and patient-centered care. [23][24][25][26] Shared decisionmaking is grounded in the principles of self-determination in that it is an approach that supports patients in their decisionmaking process. 23 It involves the clinician sharing the best available evidence so the patients can consider their options and make an informed choice in light of their values and preferences.…”

Section: Introductionmentioning

confidence: 99%

“…23 It involves the clinician sharing the best available evidence so the patients can consider their options and make an informed choice in light of their values and preferences. 23,26 Thus, shared decision-making is one way of addressing the three preconditions of respect for autonomy by enhancing the patient's understanding. 17 Before surgery, the performing surgeon must obtain consent from the patient.…”

Section: Introductionmentioning

confidence: 99%

“…The informed consent process must include the following: (a) assessment of the patient's competence to understand and make decisions; (b) full disclosure about the nature of the surgery verbally or with information pamphlets by the surgeon; (c) assessment of comprehension of the disclosure; (d) the ability of the patient to act voluntarily; and (e) give consent, authorizing the surgeon to carry out the surgery. 26 The practice of attaining informed consent is fundamental to assuring respect for autonomy, but it also assures the healthcare provider abides by the principles of nonmaleficence, beneficence, and justice that are the cornerstone bioethics principles of modern medicine. 18,27 How much information should be disclosed during the consenting process is debatable.…”

Section: Introductionmentioning

confidence: 99%

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The lived experiences of metal hypersensitivity

Dordunoo,

Doane,

Carey

et al. 2023

Journal of Patient Safety and Risk Management

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Background Immunological responses to metal ions can occur in people with metal implantable devices. Nevertheless, patients are not routinely asked about metal hypersensitivity nor tested for it prior to surgical procedures. Moreover, we have not identified any published literature on patients’ experiences with this condition. We undertook this study to better understand the experiences of patients with metal hypersensitivity and to determine what information would help them make an informed decision about implantable medical devices with metal compositions. Methods This is a patient-oriented research using an interpretative phenomenological methodology. We enrolled 16 people from five countries (Canada, New Zealand, Spain, the UK, and the USA) who experienced metal hypersensitivity following implantable medical device. We collected data from in-depth, semi-structured interviews focused on pre-procedural patient education and postoperative experiences to elucidate the barriers and opportunities related to metal hypersensitivity. We analyzed the data using interpretative phenomenological analysis. Results The majority were white biological women between the ages of 34 and 65. None of the participants were informed about immunological responses to metals in implants during the consenting process. They encountered many challenges when symptoms of metal hypersensitivity occurred. The outcomes for the few who had the implants removed were mixed. Conclusion Hypersensitivity reactions to metal need to be discussed as part of the consenting process, and addition strategies are needed to mitigate this issue in the health system.

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What should educators teach to improve preventive health care?

Cited by 21 publications

References 11 publications

The 3-T Model of Informed Consent for Nonstandard Risk Donors: A Proposal for Transplant Clinical Practice

The 3-T Model of Informed Consent for Nonstandard Risk Donors: A Proposal for Transplant Clinical Practice

Family Physician Prescribing Practices and Perspectives on Shared Decision-Making Regarding the Use of Oral Anticoagulants for Stroke Prevention in Patients 75 Years or Older With Atrial Fibrillation

The lived experiences of metal hypersensitivity

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