"Existe o espaço, mas ao mesmo tempo não existe": análise do processo de cuidado no tratamento psicofarmacológico na saúde mental / "Existe el espacio, pero al mismo tiempo no existe": análisis del proceso de cuidado en el tratamiento psicofarmacéutico en la salud mental / "There is space, but at the same time there isn't": the care process analysis in psychopharmacological treatment in mental health

Considerando os desafios à reabilitação psicossocial, objetivou-se compreender a perspectiva de usuários e trabalhadores no tratamento psicofarmacológico. Trata-se de um estudo qualitativo que entrevistou seis profissionais e dez usuários do Centro de Atenção Psicossocial de um município da região norte de Minas Gerais. As transcrições foram tratadas em Ciclos de Codificação e examinadas pela Análise de Discurso. Definiram-se três categorias relativas à dimensão micropolítica do cuidado: o fluxograma institucional, os espaços intercessores e a produção subjetiva dos agentes. Revelaram-se dissonâncias entre enunciados alusivos à política da atenção psicossocial, com a concorrência de concepções e tecnologias de cuidado emancipatórias e restritivas. Constatou-se a importância da análise micropolítica do cuidado no tratamento psicofarmacológico, favorecendo os processos de contratualidade, protagonismo e autonomia do usuário.

Considerando los desafíos para la rehabilitación psicosocial, el objetivo fue comprender la perspectiva de usuarios y trabajadores en el tratamiento psicofarmacéutico. Se trata de un estudio cualitativo que entrevistó a seis profesionales y a diez usuarios del Centro de Atención Psicosocial de un municipio de la región norte de Minas Gerais. Las transcripciones fueron tratadas en Ciclos de Codificación y examinadas por el Análisis del Discurso. Se definieron tres categorías relativas a la dimensión micropolítica del cuidado: el diagrama de flujo institucional, los espacios intercesores y la producción subjetiva de los agentes. Se revelaron disonancias entre enunciados alusivos a la política de la atención psicosocial, con la concurrencia de concepciones y tecnologías de cuidado emancipatorias y restrictivas. Se constató la importancia del análisis micropolítico del cuidado en el tratamiento psicofarmacéutico, favoreciendo los procesos de contractualidad, protagonismo y autonomía del usuario.

Considering the challenges to psychosocial rehabilitation, this study was aimed at understanding the perspective of users and workers regarding psychopharmacological treatment. This is a qualitative study, which interviewed six providers and ten users of the Psychosocial Care Center of a municipality in the north of Minas Gerais. The transcripts were treated in Coding Cycles and examined by Discourse Analysis. Three categories related to the micropolitical dimension of care were defined: the institutional flowchart; the intercessory spaces; and the subjective production of the agents. Dissonances were revealed between statements alluding to the psychosocial care policy, with the competition of emancipatory and restrictive conceptions and technologies of care. The importance of the micropolitical analysis of care in psychopharmacological treatment was verified, favoring the processes of contractuality, protagonism, and user autonomy.

Study on the status and influencing factors of treatment and nursing decision making in patients with chronic obstructive pulmonary disease / 中国实用护理杂志

Objective:To investigate the status of participation in treatment and nursing decision-making in patients with chronic obstructive pulmonary disease (COPD), and analyze its influencing factors.Methods:A cross-sectional survey was conducted on 230 COPD patients hospitalized in the Affiliated Hospital of Hangzhou Normal University from October 2021 to May 2022 by using the general situation questionnaire, questionnaire of patients′ decision-making regarding treatment and care, Patient Doctor Relationship Questionnaire, 13-Item Version, Nursing-Patient Relationship Trust Scale and Chronic Obstructive Pulmonary Disease knowledge Questionnaire, Logistic regression was used to analyze the influencing factors of patients′ participation in treatment and nursing decision-making.Results:The participation attitude score of COPD patients′ treatment decision-making was (1.93 ± 0.55) points, the participation degree score of COPD patients′ treatment decision-making was (2.29 ± 0.46) points, the participation attitude score of COPD patients′nursing decision-making was (1.84 ± 0.42) points, and the participation degree score of COPD patients′ nursing decision-making was (2.03 ± 0.35) points. Gender, education level, occupation or occupation before retirement, the number of hospitalizations due to acute exacerbation of COPD in the past year, modified medical research council, doctor-patient relationship, and nurse-patient relationship were the influencing factors for patients to participate in treatment and nursing decision-making ( OR values were 0.070 to 18.368, all P<0.05). Conclusions:The participation attitude of COPD patients in treatment and nursing decision-making is negative and the degree of participation is low. Medical staff should correctly assess the reasons for the low participation of patients, and take targeted individualized measures to support patients to actively participate in treatment and nursing decision-making.

Analysis of potential categories and influencing factors of prostate cancer patients' participation in shared decision making / 中国实用护理杂志

Objective:To explore the potential categories of prostate cancer patients′ participation in shared decision making, and analyze the characteristics and influencing factors of different categories of prostate cancer patients′ participation, so as to provide theoretical support for improving prostate cancer patients′ participation in shared decision making.Methods:This was a cross-sectional study. A total of 292 patients with a first diagnosis of prostate cancer without metastasis from three tertiary grade A hospitals in Zhengzhou were selected from October 2019 to October 2020 (Henan Provincial People′s Hospital, the First Affiliated Hospital of Zhengzhou University, the First Affiliated Hospital of Henan University of Chinese Medicine). The general data questionnaire, the Decisional Engagement Scale, Perceived Social Support Scale and Disease Uncertainty Scale were used. Latent class analysis was used to classify prostate cancer patients according to shared decision making participation, and Logistic regression was used to analyze the influencing factors of the potential category.Results:The total scores of the Decisional Engagement Scale, Perceived Social Support Scale and Disease Uncertainty Scale in prostate cancer patients were (67.28 ± 20.77), (62.34 ± 15.39), (95.06 ± 8.05) points, respectively. The shared decision making participation of prostate cancer patients was divided into three potential categories: high participation group 76.4%(223/292), moderate participation group 12.7%(37/292), and low participation group 11.0%(32/292). Taking high participation group as reference, age( OR=1.088, 95% CI 1.161-1.231, P<0.05) and illness uncertainty( OR=1.480, 95% CI 1.414-1.919, P<0.05) were the risk factors for the low participation group; perceived social support was the protective factor ( OR=0.857, 95% CI 0.775-0.946, P<0.05). Illness uncertainty was the risk factor( OR=1.525, 95% CI 1.316-1.767, P<0.05), and perceived social support was the protective factor ( OR=0.829, 95% CI 0.838-0.949, P<0.05) for the moderate participation group. Conclusions:There were obvious classification characteristics of shared decision making participation for prostate cancer patients. Age, perceived social support and illness uncertainty were the influencing factors of it. Interventions should be taken according to the characteristics of each category, to improve the level of shared decision making of prostate cancer patients.

Shared decision-making and specific informed consent in patients with aortic aneurysms

ABSTRACT Objective To analyze the refusal rate of elective aortic aneurysm surgery in asymptomatic patients after the presentation of a detailed informed consent form followed by a meeting where patient and their families can analyze each item. Methods We conducted a retrospective analysis of 49 patients who had aneurysms and were offered surgical treatment between June 2017 and February 2019. The patients were divided into two groups: the Rejected Surgery Group, which was composed of patients who refused the proposed surgical treatment, and the Accepted Surgery Group, comprising patients who accepted the proposed surgeries and subsequently underwent them. Results Of the 49 patients, 13 (26.5%) refused surgery after reading the informed consent and attending the comprehensive meeting. We observed that patients who refused surgery had statistically smaller aneurysms than those who accepted surgery (9% versus 26%). These smaller aneurysms were above the indication size, according to the literature. Conclusion One-quarter of patients who were indicated for elective surgical repair of aortic aneurysms rejected surgery after shared decision-making, which involved presenting patients with an informed consent form followed by a clarification meeting for them and their families to analyze each item. The only factor that significantly influenced a rejection of the procedure was the size of the aneurysm; patients who rejected surgery had smaller aneurysms than those who accepted surgery.

Tomada de decisão compartilhada enquanto estratégia para vulnerabilidade em saúde / Shared decision making as a strategy for vulnerability in health / La toma de decisiones compartida como estrategia para la vulnerabilidad sanitaria

Resumo A premissa de que todo ser humano é vulnerável por natureza advém da noção de vulnerabilidade enquanto suscetibilidade ao dano, assim como da inter-relação e interdependência intrínseca do ser humano com seu contexto socioambiental, cabendo à sociedade estabelecer instituições capazes de promover tanto a proteção quanto a autonomia das pessoas, em equidade de condições. Para além do dever profissional de informar benefícios e malefícios das intervenções possíveis, incluindo as consequências de negar qualquer intervenção, o cuidado centrado no paciente integra uma abordagem colaborativa que considera fundamental a tomada de decisão compartilhada. A partir de uma revisão teórica, neste artigo analisa-se o conceito de vulnerabilidade e sua relação com o respeito e a promoção dos direitos humanos dos pacientes, propondo e justificando a tomada de decisão compartilhada no que se refere a uma boa estratégia de mitigação de vulnerabilidades acrescidas.

Abstract The premise that every human being is vulnerable by nature stems from the notion of vulnerability as susceptibility to harm, as well as the interrelations and intrinsic interdependence of human beings with their socio-environmental context. It is up to society to establish institutions capable of promoting both the protection and autonomy, under equal conditions. Besides the professional duty to inform patients of the benefits and harms from possible interventions, including the consequences of denying any intervention, patient-centered care integrates a collaborative approach that considers shared decision-making essential. This theoretical review analyzes the concept of vulnerability and its relations with respect for and promotion of patient rights, proposing and justifying shared decision-making as a good strategy for mitigating increased vulnerabilities.

Resumen La premisa de que todo ser humano es vulnerable por naturaleza parte de la noción de vulnerabilidad como susceptibilidad al daño, así como de la interrelación e interdependencia intrínseca del ser humano con su contexto socioambiental, y a la sociedad le corresponde establecer instituciones capaces de promover tanto la protección como la autonomía de las personas en igualdad de condiciones. Además del deber profesional de informar de los beneficios y perjuicios de las posibles intervenciones, incluyendo las consecuencias de negar cualquier intervención, la atención centrada en el paciente integra un enfoque colaborativo que considera fundamental la toma de decisiones compartida. A partir de una revisión teórica, este artículo analiza el concepto de vulnerabilidad y su relación con el respeto y la promoción de los derechos humanos de los pacientes, proponiendo y justificando la toma de decisiones compartida como una buena estrategia para mitigar el aumento de las vulnerabilidades.

Avaliação da educação interprofissional para a tomada de decisão compartilhada em farmacoterapia: uma revisão de escopo sobre métodos e instrumentos / Evaluación de la educación interprofesional para la toma de decisionescompartida en farmacoterapia: una revisión del alcance sobre métodos einstrumentos / Evaluation of interprofessional education for shared decision making in drug therapy: a scoping review on methods and instruments

Resumo Este estudo teve como objetivo descrever os métodos de pesquisa e instrumentos utilizados na avaliação de estratégias de educação interprofissional para a tomada de decisão compartilhada em farmacoterapia. Os tipos de avaliação empregados foram categorizados segundo o modelo adaptado de Kirkpatrick. Foi conduzida uma revisão de escopo, seguindo as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (Prisma-ScR). Entre os 21 estudos selecionados, houve predomínio dos métodos quantitativos na avaliação das experiências educacionais (n=18). Destes, o aspecto mais comum avaliado foi "atitudes e percepções dos estudantes em relação à educação e à prática interprofissional", por meio de instrumentos validados (n=13). Foram identificados dez diferentes instrumentos, que se mostraram em conformidade com as competências colaborativas do Interprofessional Education Collaborative. A variedade de instrumentos sinaliza a crescente produção de conhecimento acerca do assunto, mas aponta o desafio de realizar análises comparativas entre experiências educacionais ao redor do mundo. (AU)

Resumen El objetivo de este estudio es describir los métodos de investigación e instrumentos utilizados en la evaluación de estrategias de educación interprofesional para la toma de decisiones compartida en farmacoterapia. Los tipos de evaluación empleados se caracterizaron según el modelo adaptado de Kirkpatrick. Se realizó una revisión de alcance, siguiendo las recomendaciones del PRISMA-ScR. Entre los 21 estudios seleccionados, predominaron los métodos cuantitativos en la evaluación de las experiencias educativas (n=18). De ellos, el aspecto más común evaluado fue el de "actitudes y percepciones de los alumnos con relación a la educación y a la práctica interprofesional", por medio de instrumentos validados (n=13). Se identificaron diez diferentes instrumentos, que se mostraron en conformidad con las competencias colaborativas del Interprofessional Education Collaborative . La variedad de instrumentos señala la creciente producción de conocimiento sobre el asunto, pero muestra el desafío de realizar análisis comparativos entre experiencias educativas alrededor del mundo. (AU)

Abstract This study aimed to describe the research methods and instruments used in the evaluation of interprofessional education strategies for shared decision making in drug therapy. The types of evaluation employed were categorized according to Kirkpatrick's adapted model. A scoping review was conducted, following the PRISMA-ScR recommendations. Among the 21 selected studies, there was a predominance of quantitative methods in the evaluation of educational experiences (n=18). Of these, the most common aspect evaluated was "students' attitudes and perceptions towards interprofessional education and practice" by means of validated instruments (n=13). Ten different instruments were identified and found to be in line with the Interprofessional Education Collaborative competencies. The variety of instruments signals the growing production of knowledge about this topic, but points to the challenge of conducting comparative analyses between educational experiences around the world. (AU)

Mamografia de rastreamento, atenção primária e decisão compartilhada: a voz das mulheres / Screening mammography, primary care, and shared decision-making: the voice of women

Em relação à última diretriz brasileira do Instituto Nacional do Câncer/Ministério da Saúde sobre a detecção precoce do câncer de mama, destacamos as incertezas sobre a tomada de decisão compartilhada relativas a benefícios e riscos do rastreamento mamográfico. Este artigo expressa as percepções de usuárias de serviços de Atenção Primária à Saúde sobre a decisão compartilhada nesse cenário, sendo resultado de uma pesquisa qualitativa que utilizou grupos focais, como instrumentos de produção de dados, e análise de conteúdo temática, para a sistematização de resultados. As participantes revelaram não participarem dedecisão compartilhada no rastreamento mamográfico, o que nos leva a ressaltar a importância de nortear os cuidados em saúde com base em tecnologias leves, ou seja, tecnologias relacionais, e a valorizar, também, a necessidade de implementação de certos aspectos conceituais e de princípios fundamentais, que precisam ser discutidos e realçados para que a decisão compartilhada seja implementada.

According to the latest Brazilian guidelines from the National Cancer Institute/Ministry of Health on early detection of breast cancer, we highlight the uncertainties about shared decision-making concerning the benefits and risks of mammographic screening. This article expresses the perceptions of users of Primary Health Care services concerning shared decision-making in this scenario. As a result of qualitative research, it used focus groups as an instrument for data production and thematic content analysis to systematize the results. The participants revealed that there is no shared decision-making concerning mammographic screening, which leads us to emphasize that health care guidelines should be based on light technologies,that is, relational technologies. They should also discuss and highlight related conceptual aspects and fundamental principles so that shared decision-making can be implemented.

Adequação terapêutica: apresentação de um protocolo hospitalar / Therapeutic adequacy: presentation of a hospital protocol / Adecuación terapéutica: presentación de un protocolo de hospital

Resumo A adequação terapêutica é definida como uma decisão médica compartilhada, com pacientes e familiares, que busca ajustar recursos terapêuticos e diagnósticos adequados a cada plano de cuidados. Este artigo objetiva apresentar um protocolo sobre adequação terapêutica implementado em um hospital universitário. Tal protocolo visa nortear práticas de profissionais da saúde sob a luz dos princípios bioéticos, legais e clínicos pertinentes a cada caso. Conclui-se que o protocolo pode auxiliar nas decisões de abstenção ou suspensão de determinado tratamento de pacientes com doença grave, progressiva e irreversível.

Abstract Therapeutic adequacy is defined as a medical decision shared with patients and family members and that seeks to adjust therapeutic and diagnostic resources appropriate to each care plan. This article aims to present a protocol on therapeutic adequacy implemented in a university hospital. This protocol aims to guide practices of health professionals in the light of the bioethical, legal and clinical principles relevant to each case. It is concluded that the protocol can assist in the decisions to abstain or suspend certain treatment procedures of patients with severe, progressive and irreversible diseases.

Resumen La adecuación terapéutica se define como una decisión médica, compartida con pacientes y familiares, que busca ajustar los recursos terapéuticos y diagnósticos a cada plan de cuidado. Este artículo tiene como objetivo presentar un protocolo de adecuación terapéutica desarrollado en un hospital universitario. El protocolo buscó orientar las prácticas de los profesionales de la salud a la luz de los principios bioéticos, legales y clínicos pertinentes a cada caso. Se concluye que el protocolo puede auxiliar en las decisiones de abstención o suspensión de un tratamiento en pacientes con enfermedad grave, progresiva e irreversible.

Consideraciones para comunicar riesgos y beneficios de la mamografía a mujeres desde la perspectiva de los expertos / Experts' views on the communication of risks and benefits of mammography to detect breast cancer

Background: Breast cancer (BC) has a high mortality rate in developing countries due to a scarcity of early detection. Risk communication is critical to support women who face the decision to undertake BC screening. Thus, they can balance their perceived and real risk, and make informed choices. Aim: To describe experts' views on how the provision of information related to BC screening should be made. Material and Methods: A qualitative study with focus groups with national experts was conducted. Open coding was performed. Results: Four categories on the way information about BC screening should be provided emerged: to communicate about the need of the exam; the pros and cons of the test; fear as a barrier for understanding; and involving women in the decision-making process. Conclusions: These findings emphasize the need to include risk communication strategies in the patient-provider relationship and encourage and respect women's autonomy when facing the BC screening decision.