Stepping into the Cancer Patients: Qualitative Study on Elements of Patients’ Participation in Medical Decision-making and their Health Outcomes / 中国医学伦理学

In order to understand the actual needs and influencing factors of cancer patients to participate in medical decision-making, 29 cancer patients were selected for semi-structured interviews by purpose sampling from September 2020 to February 2021, and the data were analyzed by substantive coding step by step according to interview method. The results showed that the quality of patient-clinician interaction was an important factor influencing the decision quality. The elements for cancer patients to participate in medical decision-making include: patients’ disease knowledge, awareness of choice, communication duration, support from family members and doctors, and mutual trust between doctors and patients. Medical staff should respect patients’ preference to participate in medical decision-making, break the medical-centered system arrangement, help patients obtain services matching their preferences for participating in decision-making, and achieve a pattern that is beneficial to both patients and the medical system.

Act like a warrior to defeat medication counselling barriers: A cross sectional study.

BACKGROUND: In the previous literature, patients' perceptions of medication consultation provided by pharmacists was found to poor, depending upon various factors, which may lead to poor compliance with medication instructions and, therefore, poor health outcomes. In the Kingdom of Saudi Arabia (KSA), this specific area has been overlooked to date, so this study aims to examine patients' perceptions of medication counselling and the factors that influence their likelihood of participating in medication counselling as well as determine the predictors of patients' likelihood to take part in medication counselling delivered by pharmacists in KSA. MATERIALS AND METHODS: A cross-sectional survey was conducted involving people over 18 years of age, who had purchased or collected medicine for their own use from community and/or hospital pharmacies within the past two years and who lived in Saudi Arabia. The data were analysed using IBM SPSS Statistics version 24. Descriptive statistics were applied to each item as well as linear regression and Pearson's correlation. RESULTS: Five hundred and eleven participants (male (n = 101), female (n = 410), the majority of whom were aged 18-24-years-old) were included. Almost an equal number of participants had accessed either community (CP) (n = 228: 45%) or hospital pharmacies (HP) (n = 283: 55%) within the past two years in regards to their condition and/or medication. The perceived susceptibility construct had weak positive correlations with all of the constructs being measured (r < 0.3). Perceived barriers had a weak negative relationship with likelihood (r < 0.3), which means that, as the perceived barriers increase, the perceived benefits and future likelihood to participate in medication counselling decrease. Linear regression analysis found that age (ß = -0.06; P =˃0.05), gender (ß = 0.14; P =˃0.05), education level (ß = -0.01; P =˃0.05) and type of pharmacies accessed (ß = -0.05; P =˃0.05) were non-significant predictors of the participants' likelihood of participating in medication counselling. CONCLUSION: In order to improve the medication consultation provided by pharmacists and, therefore, enhance the patients' experience and care, it is important to understand the public's views, concerns and demands regarding medication consultation, in order to provide the proper interventions and serve as a platform for developing a plan of action for good pharmacy practice.

Microdecisions instead of coercion: patient participation and self-perceived discrimination in a psychiatric ward.

Aims: Patients may experience unfair reception when in contact with psychiatric services. The aims are to illuminate these perceptions, and the extent of inpatients' involvement in their care, and if degree of involvement depends on compulsory or voluntary care. Furthermore, we sought to determine if an educational intervention for staff members, including systematic listening and offering the inpatients involvement using microdecisions, affects the inpatients' experiences and the use of coercion. Materials and methods: We used a naturalistic setting case control design in two psychiatric wards for one year, including all inpatients (n = 685) of which 458 took part of the microdecision intervention. Structured direct interviews were carried out with inpatients based on the Discrimination and Stigma Scale (DISC), Dyadic OPTION, and CollaboRATE instruments before (n = 19) and after (n = 46) the intervention. Frequencies of coercive measures before and after the intervention were compared (n = 685). Results: Respondents subjected to the intervention experienced less discrimination related to psychiatric care compared to responders not subjected. Tendencies of improvements post intervention were found for some aspects of involvement, as attention to concerns and possibilities to ask questions. A decrease in the use of coercive measures at three and six months after the start of the intervention was observed. Conclusion: Results suggest that the intervention could decrease the inpatients' experiences of discrimination during psychiatric care as well as the use of coercion in the service. The Dyadic OPTION instrument showed a mixed picture with results implying improvements in some areas and impairments in others.

Patients participation in pharmaceutical care consultations in Brazil.

Background The effectiveness of pharmaceutical care has already been evidenced in several studies and scenarios; the lack of patient's consultation has been little explored in the literature. Unprovided care is a missed opportunity to offer care to another individual who needs attention to their health. The need for investigation of missed consultations in a Brazilian pharmaceutical care service arises. Objective To evaluate the participation and characteristics of patients in pharmaceutical care consultations in a university outpatient unit in the Brazilian city of Divinópolis. Methods A descriptive study was carried out from a secondary source of information. The socio-demographic profile of the patients who were absent from the pharmacy consultations from January to December 2017 was outlined. Results Of the 832 scheduled appointments from January to December 2017, 501 were not attended by patients, revealing 60.2% missed consultations. The female gender was predominant, corresponding to 67.8% of the patients. A total of 63.8% of the absentees were over 60 years of age. Most of the patients had two comorbidities (32.5%) and came from an active identification by the Outpatient unit pharmacists (86.60%). Furthermore, the patients who were more absent from the consultations had their primary health care units farther away from the outpatient unit, and this could be one of the causes of the high number of absent patients from the pharmaceutical consultations. Conclusion The lack of participation in patient's consultations is high. It is necessary to articulate new strategies aimed at reducing absences from consultations, since this is a source of waste of financial resources and opportunities to improve the patients' health and quality of life.

The significance of patient participation in nursing care - a concept analysis.

OBJECTIVE: The purpose of this study was to report on a concept analysis of the meaning of patients' participation. Participation is commonplace in many areas of health care and has become an important issue in healthcare services. Participation is essential when giving nursing care. Challenges exist throughout clinical practice to make the patient a participant in their own care. The study had a caring science perspective. METHOD: A literature study based on Walker and Avant's method was used with eight steps. Data were collected using several databases covering the years 1995-2017. The analysis covered fifteen articles, dissertations, reports and textbooks. FINDINGS: Patients' participation may be defined as a concept that relates to and includes the three caring science concepts: learning, caring relationship and reciprocity (defining attributes). CONCLUSION: Participation is a concept with vague meaning that is prevalent in nursing practice. Patients' participation is a complex concept. By using the attributes, it could be more visible in nursing care. The next question for research in this area is how these three attributes can best practically be achieved in a clinical context.

The attitude and actual participation of decision making regarding nursing care among patients with breast cancer / 中国实用护理杂志

Objective To describe and compare the attitude and actual participation of decision-making regarding nursing care of patients with breast cancer, and to identify the related factors. Methods To investigate 480 cases of inpatients with breast cancer in 3 Grade ⅢA hospitals in Wuhan through questionnaire and self-designed general information questionnaire. Results There were significant differences (χ2=28.3, P<0.01) between the attitude and actual participation of decision making regarding of nursing care. The results of Logistic regression analysis showed that patients with higher education level (B=1.574, P=0.002), less children (B=-2.716, P<0.01) and higher income (B=0.323, P<0.01) , had a more active attitude to participate decision making; patients who were younger (B=-6.001, P=0.015), with higher education level (B=1.643, P=0.000), shorter duration of disease (B=-2.413, P=0.022), and lower degree of TNM stage (B=0.618, P=0.012), actually participated more often in decision making. Conclusions The actual participation was inconsistent with the attitude of decision-making regarding nursing care among patients with breast cancer. And patients′ demographic characters were related to their participation of decision making, which suggested that nurses should make a comprehensive assessment of willingness and capacity of patients′decision-making participation, identify the facilitators and barriers, and take measures to support patients to take an active part in the decision making to improve the quality of nursing care.

Older patients with late-stage COPD: Their illness experiences and involvement in decision-making regarding mechanical ventilation and noninvasive ventilation.

AIMS AND OBJECTIVES: To explore the illness experiences of older patients with late-stage chronic obstructive pulmonary disease and to develop knowledge about how patients perceive their preferences to be taken into account in decision-making processes concerning mechanical ventilation and/or noninvasive ventilation. BACKGROUND: Decisions about whether older patients with late-stage chronic obstructive pulmonary disease will benefit from noninvasive ventilation treatment or whether the time has come for palliative treatment are complicated, both medically and ethically. Knowledge regarding patients' values and preferences concerning ventilation support is crucial yet often lacking. DESIGN: Qualitative design with a hermeneutic-phenomenological approach. METHODS: The data consist of qualitative in-depth interviews with 12 patients from Norway diagnosed with late-stage chronic obstructive pulmonary disease. The data were analysed within the three interpretative contexts described by Kvale and Brinkmann. RESULTS: The participants described their lives as fragile and burdensome, frequently interrupted by unpredictable and frightening exacerbations. They lacked information about their diagnosis and prognosis and were often not included in decisions about noninvasive ventilation or mechanical ventilation. CONCLUSION: Findings indicate that these patients are highly vulnerable and have complex needs in terms of nursing care and medical treatment. Moreover, they need access to proactive advanced care planning and an opportunity to discuss their wishes for treatment and care. RELEVANCE TO CLINICAL PRACTICE: To provide competent care for these patients, healthcare personnel must be aware of how patients experience being seriously ill. Advanced care planning and shared decision-making should be initiated alongside the curative treatment.

The level and influencing facts of PICC catheter patients′ willingness to participate in patient safety / 中国实用护理杂志

Objective To investigate the level and influencing factors of PICC catheter patients' willingness to participate in patient safety. Methods A total of 198 PICC catheter patients were sampled from the targeted hospital by convenience sampling,and investigated by the Patient Participate Patient Safety Willingness and Behavior Scale ( PSWBS). Results The PSWBS score of PICC catheter patients was 3.73 ± 0.52 , including initiative willingness 4.13 ± 0.54, initiative tendency 3.82 ± 0.49, attention for technique level 3.70 ± 0.50, attention for environmental safety 3.27 ± 0.48. Among these factors, age(F=14.75, P<0.01), education degree(F=9.588, P<0.01), occupation(25.070, P<0.01), residence(t=8.570, P<0.01)and complications(t=8.880, P<0.01)were the influencing facts with statistical difference (P<0.05) . Conclusions Most of the patients have a high willingness to participate in patient safety , the distribution of impact factors have certain characteristics. Clinical nurses should take targeted nursing measures according to these different characteristics.