Purpose. To systematically develop and field test an intervention to engage families and healthcare teams in the decision-making process about life support for critically ill patients in the Intensive Care Unit (ICU). Setting. Adult medical-surgical ICU at a Canadian academic teaching hospital. Methods. The International Patient Decision Aid Standards (IPDAS) criteria and the Interprofessional Shared Decision Making (SDM) model guided the study of families facing decisions about life support for their relative in ICU that involved:1) systematic review; 2) qualitative descriptive study; 3) mixed methods field test of a novel patient decision aid (DA). Systematic review findings. Of 3162 citations, four trials evaluated interventions to improve communication between health professionals and patients/families. One intervention met eight of nine criteria for SDM but did not evaluate its effect on the benefit to communication. Qualitative study findings. Six family members and nine health professionals identified two options (life support or comfort care) and values associated with these options. Values included maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, giving the family enough time to adapt emotionally to the patient’s health situation, and the judicious use of healthcare resources. Families were unlikely to become engaged without healthcare professionals making the decision explicit and minimizing other barriers across the decision-making process. Field test findings. Family members and health professionals for eight patients indicated that the DA was feasible to use, acceptable to users, had the potential to do what was intended, and did not seem to present adverse consequences to users. An enhanced delivery strategy is needed for future evaluation of its effect on facilitating patient/family involvement in decisions. Conclusions. Limited involvement of families in the process of decision-making about life support in the ICU reinforced the need for effective interventions to facilitate SDM. These studies validated the operationalization of the IPDAS criteria, as part of a systematic process for developing and field testing DAs. However, IPDAS criteria stop short of elements necessary to consider when implementing the DA in the processes of care.

Background: Management of atrial fibrillation (AF) is complex and requires active patient engagement in shared decision making to achieve better clinical outcomes, greater medication adherence, and increased treatment satisfaction. Efficacy in patient-physician interactions is a critical component of patient engagement, but factors associated with efficacy in older AF patients have not been well-characterized. Methods: We performed a cross-sectional analysis of baseline data from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) study, a cohort study of older adults (age ≥ 65) with non-valvular AF and CHA2DS2-VASc score ≥ 2. Participants were classified according to their Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) score (lower: 0-44; higher: 45-50). Logistic regression analysis was used to identify sociodemographic, clinical (AF type, AF treatment, medical comorbidities), and geriatric (cognitive impairment, sensory impairment, frailty, independent functioning) factors associated with lower reported efficacy. Results: Participants (n = 1209; 49% female) had a mean age of 75. A majority (66%) reported higher efficacy in their interactions with physicians. Lower efficacy was associated with persistent AF (adjusted odds ratio [aOR] = 1.52; 95% confidence interval [CI] = 1.13-2.04) and with symptoms of depression (aOR = 1.67; CI = 1.20-2.33) or anxiety (aOR = 1.40; CI = 1.01-1.94). Decreased odds of lower efficacy were observed in participants with chronic kidney disease (aOR = 0.68; CI = 0.50-0.92) and those classified as pre-frail compared to those classified as not frail (aOR = 0.71; CI = 0.53-0.95). Conclusion: Older patients with persistent AF or symptoms of depression or anxiety have decreased efficacy in patient-physician interactions. These individuals merit greater attention from physicians when engaged in shared decision making.

Le dépistage du cancer de la prostate est largement controversé de par l’équilibre de la balance bénéfices-risques de cette procédure. L’enjeu de santé publique est alors d’accompagner au mieux les hommes susceptibles de se faire dépister pour qu’ils puissent être informés et participer au choix. L’objectif de ce doctorat est de contribuer à comprendre pourquoi les hommes participent au dépistage du cancer de la prostate, pour pouvoir améliorer dans un second temps leur accompagnement. Nous avons tout d’abord interrogé des hommes sur leurs connaissances, leurs sources d’informations et leur rôle dans le choix de participer au dépistage du cancer de la prostate. Ces entretiens ont abouti à la nécessité de concevoir un nouvel outil d’information pour améliorer les connaissances des hommes, en particulier sur les risques de la procédure de dépistage. Enfin, nous avons estimé comment les bénéfices et les risques étaient intégrés dans le choix des individus selon si ces derniers avaient eu accès à notre outil d’information. Les résultats de ce travail montrent que les hommes semblent moins favorables à une proposition de dépistage après avoir eu accès à notre outil d’information. Cependant, cela ne modifie pas leur appréciation des bénéfices et des risques du dépistage. Il est nécessaire de poursuivre les efforts pour permettre aux hommes de faire un choix éclairé. / Prostate cancer screening is highly controversial because of the benefit risk ratio. An issue is to support men susceptible to perform this screening towards informed choice and shared decision-making. The aim of this doctorate is to understand why men adhere to prostate cancer screening, and in a second time to improve their support. We interviewed men about their knowledge, their information seeking behaviour, and their implication in prostate cancer screening decision. This highlighted the necessity to create a new information tool to improve men’s knowledge, in particular regarding risks of the screening procedure. Finally, we investigate benefit risk trade-off with and without our information tool access. Results of this work shows that men are less favourable to a screening option after taking into account our information tool. However, benefit and risk of this screening appreciation was not changed. We need to continue efforts to allow men to make an informed choice.

Each year millions of people face the medical decision-making cycle that comes with a diagnosis of cancer. For patients and their families, this can be a rollercoaster of confusion and fear. Researchers have indicated that the complexity of the decision-making process is underrepresented in the current approach of informed decision-making. The purpose of this study was to add to scientifically-validated research expanding the identification of factors that influence decision-making for individuals diagnosed with cancer. Fuzzy trace theory (FTT) is the dual process memory theory used as the framework for this study. Qualitative data were collected using semistructured interviews with 10 participants. The sampling strategy included purposeful sampling and snowball or chain sampling. The audio-recorded interviews were transcribed and analyzed. Software tools were used to aid in the creation of word mapping and clusters and a naming structure emerged. A comprehensive thematic analysis was completed. Participants detailed experiences with family and social dynamics, psychological or emotional stress, external influencing factors to the decision-making process, and experiences with cancer advertising. This research can create positive social change through the advancement of scientifically-validated research to support patients during the decision-making process.

Cancer incidence is high for aging minority and underserved populations, yet research is limited about patient-provider communications with aging racial and ethnic minority populations. Achieving high-quality cancer care is crucial to reducing health disparities for this population. However, potential shortages in professional health personnel, the cost to treat cancer, a strained health care system, and large aging populations contribute to the problem. The purpose of this qualitative study was to understand the personal experiences of aging minorities during cancer treatment decision making when communicating with their cancer care providers. Purposive sampling methods were used to recruit 10 minority women and men born between 1946 and 1964 who had experienced communicating with providers and making cancer treatment decisions. In-depth semi-structured interviews and thematic analysis of qualitative data was conducted. Important findings were barriers related to miscommunication with providers, the need for more time with the cancer doctor, and mistrust of the medical profession. Participants perceived poor interpersonal communication with providers as causing a lack of understanding regarding their cancer treatment options, which affected their decision making regarding their treatment. Barriers to communication included long wait times at public or teaching health care systems for follow up cancer care services. The findings of this study could be useful to assist health care providers in improving communication with their cancer patients, reducing cancer health disparities, and increasing the quality of cancer care for this population.

No description available.

No description available.

Les situations de crise sont fréquentes chez les personnes ayant des troubles de santé mentale. Plusieurs interventions ont été développées pour agir en prévention, dont les plans de crise reconnus comme particulièrement efficaces pour diminuer le recours aux mesures coercitives. Dans la littérature, plusieurs modèles de plans de crise sont proposés et incluent entre autres le plan de sécurité, le plan de crise conjoint et les directives anticipées. Un examen de ces différents plans permet de constater qu’ils ont des buts et des contenus très semblables. Basé sur la méthodologie proposée par le Johanna Briggs Institute (2020), une revue de la portée a été conduite dans l’objectif de dresser l’état des connaissances sur les plans de crise en santé mentale adulte. Une stratégie de recherche documentaire a été conduite sur six bases de données (CINAHL, PubMed, Medline, EMBASE, PsychINFO, and Cochrane) et a permis d’identifier 2435 articles. Parmi ces derniers, 122 textes complets ont été évalués et 78 ont répondu aux critères d’inclusion de l’étude. Ensuite, la qualité méthodologique des articles sélectionnés a été évaluée et les données ont été extraites de façon indépendante par deux étudiantes à la maitrise. L’analyse de contenu a été réalisée, puis les résultats préliminaires ont été présentés, discutés et validés avec un patient partenaire ayant vécu des crises en santé mentale. Une typologie des plans de crise a été identifiée selon 1) les plans de crise légaux et 2) les plans de crise formels. Également, cinq modalités pour la complétion des plans de crise ont été identifiées : les sections, le moment, les étapes de complétion, les personnes impliquées et la formation des acteurs.trices clés. Les retombées de l’intervention sont concordantes avec le but principal des plans de crise, soit la prévention de la crise. Or, les retombées les plus identifiées dans la littérature sont davantage liées au rétablissement de l’usager.ère et semblent indiquer que les plans de crise pourraient représenter une intervention permettant d’opérationnaliser le rétablissement dans les soins en santé mentale. Les futures recherches empiriques devraient cibler le développement des connaissances sur les modalités à privilégier dans l’objectif de guider les milieux cliniques dans l’implantation des plans de crise. / Crisis situations are frequent among people with mental health disorders. Several interventions have been developed to act in prevention, including crisis plans, which are recognized as particularly effective in reducing coercive measures. In the literature, several types of crisis plans have been proposed, including the safety plan, the joint crisis plan and advance directives. A review of these plans suggests that they are very similar in purpose and content. Based on the methodology proposed by the Johanna Briggs Institute, a scoping review was conducted with the objective of mapping the state of knowledge on crisis plans in adult mental health services. A literature search strategy was conducted on six databases (CINAHL, PubMed, Medline, EMBASE, PsychINFO, and Cochrane) and yielded 2435 articles. Of these, 122 full text articles were assessed for eligibility, and 78 met the inclusion criteria. Studies were then critically appraised using the Johanna Briggs Institute appraisal tools, and date were extracted my two master’s students. Content analysis was performed, and preliminary results were presented, discussed, and validated with a patient partner who has experienced mental health crises. A typology of crisis plans was identified according to 1) the legal crisis plan, 2) the formal crisis plan. Five modalities were identified for its completion: sections, timing, creation steps, people involved, and training of key actors in writing a crisis plan. The outcomes of the intervention are consistent with the main objective of crisis plans, which is to prevent a crisis. However, the most identified outcomes focused on the service user’s recovery and indicated that crisis plans could provide an opportunity to operationalize recovery in mental healthcare, thus suggesting an evolution in the aim of the intervention. Future research should further focus on the modalities of crisis plans to guide the implementation in clinical practice.

No description available.

Patientdelaktighet är ett begrepp med flera dimensioner, vilket gör det svårdefinierat. Idag är det en lagstadgad rättighet att patienten ska få möjlighet att vara delaktig i sin vård. Det innebär att patienterna har en självklar plats i vården, en plats som medskapare till sin vård. Sjuksköterskan har ansvar att ge patienten möjligheter för att bli delaktig, genom att arbeta personcentrerat där patienten och sjuksköterskan samarbetar i ett partnerskap. Partnerskapet ska genomsyras av ömsesidig kommunikation, där båda parterna bidrar. Det är viktigt att sjuksköterskan tar del av patientens livsvärld och ser varje patient som en unik individ. Forskning visar att det finns barriärer för delaktighet. Dessa barriärer kan bero på brister i kommunikationen, avdelningsspecifika hinder och föråldrade hierarkiska strukturer i sjukvården som lever kvar. Utifrån dessa barriärer och kunskapen om hur det borde arbetas med delaktighet är frågan hur patienterna upplever delaktighet när de blir sjuka. Syftet med denna kandidatuppsats är att belysa patienternas upplevelse av delaktighet. Litteraturöversikten är utformad för att ge en bredare översikt och är därför baserad på både kvantitativ och kvalitativ forskning. Resultatet visar att patienterna är nöjda när de deltar i vården på en önskad nivå, genom ett partnerskap med ömsesidig kommunikation och där de blir sedda. Det visar också att patienterna upplever hinder för att känna sig delaktiga. De upplever en maktobalans samt kommunikationsbrister. Det här visar på vikten av ett partnerskap mellan patient och sjuksköterska, där delaktighet skapas. / Patient participation is a concept with several dimensions, which makes it hard to define. Today patients have a legal right to have the ability to participate in their own healthcare. This means that the patients have a natural place in healthcare, as co-creators of their care. The nurse has a responsibility to give the patient the opportunity to participate by adopting a person centred approach where the patient and the nurse cooperates in a partnership. The partnership is characterized by mutual communication where both parties contribute. The nurse needs to take part of the patient’s lifeworld and see every patient as a unique individual. Research shows that there are hindrances for participation. The hindrances may be a result of a lack of communication, ward specific barriers and outdated hierarchical structures that still exists. With these hindrances and the knowledge about how participation should be incorporated, the question is how the patients experience participation when they become ill. The aim of this bachelor’s thesis is to illustrate the patients experiences of participation. This literature review is designed to give a wide overview and is therefore based on both quantitative and qualitative research. The results show that the patients are satisfied when they participate in care at a desired level, through a partnership with mutual communication and where they are seen. It also shows that the patients experience hindrances to the feeling of being a participant in their care. They experience a power imbalance as well as a lack of communication. This shows the importance of a partnership between the patient and the nurse, where participation is created.