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Book part
Publication date: 10 May 2017

Leslie Joan Harris

Legal standards that allow teens to make health care decisions, or any important decisions, must account for the contingency and variability of minors’ capacity…

Abstract

Legal standards that allow teens to make health care decisions, or any important decisions, must account for the contingency and variability of minors’ capacity. Traditional law denied minors’ legal authority to make any decisions, giving all power to parents. This rule goes too far; the Supreme Court has held that minors have constitutionally protected autonomy-based rights, and modern views about adolescence are inconsistent with the rule. The question is how and where to draw lines.

Legal standards are based on minors’ evolving maturity, policy favoring decisions that follow medical advice, and policy supporting parental authority. This paper uses four hard cases to show how these considerations factor into legal rules.

Details

Studies in Law, Politics, and Society
Type: Book
ISBN: 978-1-78714-344-9

Keywords

Book part
Publication date: 23 April 2013

Ronald J. Berger, Carla Corroto, Jennifer Flad and Richard Quinney

Medical uncertainty is recognized as a critical issue in the sociology of diagnosis and medical sociology more generally, but a neglected focus of this concern is the…

Abstract

Medical uncertainty is recognized as a critical issue in the sociology of diagnosis and medical sociology more generally, but a neglected focus of this concern is the question of patient decision making. Using a mixed methods approach that draws upon autoethnographic accounts and third-party interviews, we aim to illuminate the dilemmas of patient decision making in the face of uncertainty. How do patients and supportive caregivers go about navigating this state of affairs? What types of patient–doctor/healthcare professional relationships hinder or enhance effective patient decision making? These are the themes we explore in this study by following patients through the sequence of experiencing symptoms, seeking a diagnosis, evaluating treatment protocols, and receiving treatments. In general, three genres of culturally available narratives are revealed in the data: strategic, technoluxe, and unbearable health narratives.

Details

40th Anniversary of Studies in Symbolic Interaction
Type: Book
ISBN: 978-1-78190-783-2

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Article
Publication date: 12 October 2012

Policarpo C. deMattos, Daniel M. Miller and Eui H. Park

This paper aims to examine complex clinical decisionmaking processes in trauma center units of hospitals in terms of the immediate impact of complexity on the medical

Abstract

Purpose

This paper aims to examine complex clinical decisionmaking processes in trauma center units of hospitals in terms of the immediate impact of complexity on the medical team involved in the trauma event.

Design/methodology/approach

It is proposed to develop a model of decisionmaking processes in trauma events that uses a Bayesian classifier model with convolution and deconvolution operators to study real‐time observed trauma data for the decisionmaking process under tremendous stress. The objective is to explore and explain physicians' decisionmaking processes under stress and time constraints during actual trauma events from the perspective of complexity.

Findings

Because physicians have blurred information and cues that are tainted by random environmental noise during injury‐related events, they must de‐blur (de‐convolute) the collected data to find a best approximation of the real data for decisionmaking processes.

Research limitations/implications

The data collection and analysis is innovative and the permission to access raw audio and video data from an active trauma center will differentiate this study from similar studies that rely on simulations, self report and case study approaches.

Practical implications

Clinical decision makers in trauma centers are placed in situations that are increasingly complex, making decisionmaking and problem‐solving processes multifaceted.

Originality/value

The science of complex adaptive systems, together with human judgment theories, provide important concepts and tools for responding to the challenges of healthcare this century and beyond.

Details

Management Decision, vol. 50 no. 9
Type: Research Article
ISSN: 0025-1747

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Article
Publication date: 13 May 2019

Ulla Hellström Muhli, Jan Trost and Eleni Siouta

The purpose of this paper is to analyse the accounts of Swedish cardiologists concerning patient involvement in consultations for atrial fibrillation (AF). The questions…

Abstract

Purpose

The purpose of this paper is to analyse the accounts of Swedish cardiologists concerning patient involvement in consultations for atrial fibrillation (AF). The questions were: how cardiologists handle and provide scope for patient involvement in medical consultations regarding AF treatment and how cardiologists describe their familiarity with shared decision-making.

Design/methodology/approach

A descriptive study was designed. Ten interviews with cardiologists at four Swedish hospitals were held, and a qualitative content analysis was performed on the collected data.

Findings

The analysis shows cardiologists’ accounts of persuasive practice, protective practice, professional role and medical craftsmanship when it comes to patient involvement and shared decision-making. The term “shared decision-making” implies a concept of not only making one decision but also ensuring that it is finalised with a satisfactory agreement between both parties involved, the patient as well as the cardiologist. In order for the idea of patient involvement to be fulfilled, the two parties involved must have equal power, which can never actually be guaranteed.

Research limitations/implications

Methodologically, this paper reflects the special contribution that can be made by the research design of descriptive qualitative content analysis (Krippendorff, 2004) to reveal and understand cardiologists’ perspectives on patient involvement and participation in medical consultation and shared decision-making. The utility of this kind of analysis is to find what cardiologists said and how they arrived at their understanding about patient involvement. Accordingly, there is no quantification in this type of research.

Practical implications

Cardiologists should prioritise patient involvement and participation in decision-making regarding AF treatment decisions in consultations when trying to meet the request of patient involvement.

Originality/value

Theoretically, the authors have learned that the patient involvement and shared decision-making requires the ability to see patients as active participants in the medical consultation process.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 4
Type: Research Article
ISSN: 0952-6862

Keywords

Book part
Publication date: 15 January 2021

stef m. shuster and Grayson Bodenheimer

Purpose: We analyze how medical providers use accountability processes or the regulatory means through which individuals hold themselves or others accountable to social…

Abstract

Purpose: We analyze how medical providers use accountability processes or the regulatory means through which individuals hold themselves or others accountable to social norms, to uphold their medical authority. We use the case of trans medicine because in this medical domain, providers often have little to no expertise and few are trained specifically in delivering trans medicine or working with trans patients. As a result, providers experience uncertainty and are left without the typical tools and expertise on which they depend in most other areas of medical decision-making.

Design/methodology/approach: We conducted in-depth interviews with 23 medical providers and observations of transgender healthcare conferences in the United States between 2012 and 2015.

Findings: Our work offers insight into the provider side of patient-provider encounters and medical decision-making in gender minority health. The first accountability strategy providers employed was to invoke the language of evidence as a method to maintain their authority, in spite of the paucity of scientific evidence that undergirds this emergent medical domain. The second strategy was to mandate compliance by holding trans people accountable to the expectation of acquiescing to medical authority.

Originality/value: We contribute to the scholarship on gender minority health by examining how high power actors use accountability processes to restore order in interactions with trans and nonbinary patients. We demonstrate how enforcement to expectations through accountability processes is a plausible, though oft-overlooked, dimension of health inequalities.

Details

Sexual and Gender Minority Health
Type: Book
ISBN: 978-1-83867-147-1

Keywords

Article
Publication date: 27 December 2021

Victoria Helmly, Marisol Garica, Brie Williams and Benjamin A. Howell

With a rapidly growing population of older adults with chronic illness in US prisons, the number of people who die while incarcerated is increasing. Support for patients…

Abstract

Purpose

With a rapidly growing population of older adults with chronic illness in US prisons, the number of people who die while incarcerated is increasing. Support for patients’ medical decision-making is a cornerstone of quality care for people at the end of life (EOL). This study aims to identify, describe, and analyze existing policies regarding EOL decision-making in U.S. Departments of Corrections.

Design/methodology/approach

This study performed an iterative content analysis on all available EOL decision-making policies in US state departments of corrections and the Federal Bureau of Prisons.

Findings

This study collected and reviewed available policies from 37 of 51 prison systems (73%). Some areas of commonality included the importance of establishing health-care proxies and how to transfer EOL decision documents, although policies differed in terms of which patients can complete advance care planning documents, and who can serve as their surrogate decision-makers.

Practical implications

Many prison systems have an opportunity to enhance their patient medical decision-making policies to bring them in line with community standard quality of care. In addition, this study was unable to locate policies regarding patient decision-making at the EOL in one quarter of US prison systems, suggesting there may be quality-of-care challenges around formalized approaches to documenting patient medical wishes in some of those prison systems.

Originality/value

To the best of the authors’ knowledge, this is the first content analysis of EOL decision-making policies in US prison systems.

Details

International Journal of Prisoner Health, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1744-9200

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Article
Publication date: 1 April 2014

Anothai Ngamvichaikit and Rian Beise-Zee

The aim of this paper is to contribute a conceptualization of the information and communication needs of medical tourists from Western countries in an Asian health care…

1181

Abstract

Purpose

The aim of this paper is to contribute a conceptualization of the information and communication needs of medical tourists from Western countries in an Asian health care context.

Design/methodology/approach

Multi-phase, semi-structured, in-depth interviews and observations were conducted with 27 multi-source informants who have communication experience in the international healthcare setting.

Findings

Multi-level information provision should be used to address communicative incongruence in Asian healthcare provider – Western patient encounters as was self-reported by the participants and observed by authors. The use of an informative communication model is proposed in order to facilitate interaction and the effective transfer of information with Western patients to overcome negative, underlying emotions and enable autonomous decision making by the patients.

Research limitations/implications

This exploratory study is focused on Western patients and Asian practitioners in Thailand. Future research in other countries and with patients from other geographical areas could expand to generalize findings.

Practical implications

Fostering information sharing with Western patients by using an integrative communication model can improve patient satisfaction and health outcomes. The need for developing and implementing these improved practices for communicating with Western patients is reflected by the healthcare industry's current developmental trends helping to lead to a future of health service internationalization.

Originality/value

This is the first empirical study to provide insights concerning the communication needs and coping strategies of Western patients with Asian doctors in developing countries.

Details

International Journal of Pharmaceutical and Healthcare Marketing, vol. 8 no. 1
Type: Research Article
ISSN: 1750-6123

Keywords

Book part
Publication date: 6 December 2018

Pablo Hernández-Marrero, Sandra Martins Pereira, Joana Araújo and Ana Sofia Carvalho

This chapter aims to provide an overview of the ethical framework and decision-making in clinical dementia research, and to analyze and discuss the ethical challenges and…

Abstract

This chapter aims to provide an overview of the ethical framework and decision-making in clinical dementia research, and to analyze and discuss the ethical challenges and issues that can arise when conducting clinical dementia research.

Informed consent is the most scrutinized and controversial aspect of clinical research ethics. In clinical dementia research, assessing decision-making capacity may be challenging as the nature and progress of each disease influences decision-making capacity in diverse ways. Persons with dementia represent a vulnerable population deserving special attention when developing, implementing, and evaluating the informed consent process. In this chapter, particular attention will be given to vulnerability categories and how these influence decision-making capacity. Ethical frameworks with a pragmatic contour and implication are needed to protect vulnerable patients from potential harms and ensure their optimal participation in clinical dementia research.

In addition, this chapter analyses important ethical challenges and issues in clinical dementia research. If handled thoughtfully, they would not pose insuperable barriers to research. But if they are ignored, they could slow the research process, alienate potential study subjects and cause harm to research participants. Ethical considerations in research involving persons with dementia primarily concern the representation of the interests of the participants with dementia and protection of their vulnerabilities and rights.

A core set of ethical questions and recommendations are drawn to aid researchers, institutional review boards and potential research participants in the process of participating in clinical dementia research.

Details

Ethics and Integrity in Health and Life Sciences Research
Type: Book
ISBN: 978-1-78743-572-8

Keywords

Book part
Publication date: 18 September 2018

DaJuan Ferrell

Procedures can be categorized as certain surgeries based on their necessity and outcomes while others are classified as uncertain surgeries based on these areas. To…

Abstract

Purpose

Procedures can be categorized as certain surgeries based on their necessity and outcomes while others are classified as uncertain surgeries based on these areas. To account for this variance, policies such as the Affordable Care Act (ACA) call for health care providers to engage in shared decision making (SDM) with patients to ensure they are informed of treatment options and asked their preferences. Yet, gender may influence the decision-making process. Thus, this project examines the decision process and how gender impacts patients’ participation in decisions to undergo certain surgeries compared to uncertain surgeries.

Methodology/approach

This research project analyzed data from the National Survey of Medical Decisions 2006–2007 which surveyed the medical decisions of US residents 40 and older.

Findings

First, the data reveals that women felt more informed having uncertain surgeries compared to men. Second, patients were less likely asked their preference for surgery when undergoing certain surgeries compared to uncertain surgeries. Third, compared to men, women having uncertain surgeries were less likely to make the final decision to have surgery, compared to sharing the final decision with health care providers.

Limitations

Due to the sample size, this project could not perform three-way interactions between gender, race, and surgery type.

Originality/value

Gender influences the level patients feel informed having uncertain surgeries. Though policy calls for SDM, health care providers are less likely to ask patients their preference for surgery regarding certain surgeries, relative to uncertain surgeries. Gender impacts the final decision-making process regarding whether patients should have uncertain surgeries.

Details

Gender, Women’s Health Care Concerns and Other Social Factors in Health and Health Care
Type: Book
ISBN: 978-1-78756-175-5

Keywords

Article
Publication date: 15 June 2015

Krystyna Adams, Jeremy Snyder, Valorie Crooks and Rory Johnston

This paper aims to respond to a knowledge gap regarding the motivations of medical tourists, the term used to describe persons that travel across borders with the…

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Abstract

Purpose

This paper aims to respond to a knowledge gap regarding the motivations of medical tourists, the term used to describe persons that travel across borders with the intention of accessing medical care. Commonly cited motivations for engaging in medical tourism are typically based on speculation and provide generalizations for what is a contextualized practice. This research paper aims to complicate the commonly discussed motivations of medical tourists to provide a richer understanding of these motivations and the various contexts in which medical tourists may choose to travel for medical care.

Design/methodology/approach

Drawing on semi-structured interviews with 32 former Canadian medical tourists, this study uses the Iso-Ahola’s motivation theory to analyze tourists’ motivations. Quotations from participants were used to highlight core themes relevant to critical theories of tourism.

Findings

Participants’ discussions illuminated motivations to travel related to personal and interpersonal seeking as well as personal and interpersonal escaping. These motivations demonstrate the appropriateness of applying critical theories of tourism to the medical tourism industry.

Research limitations/implications

This research is limited in its ability to link various motivations with particular contexts such as medical procedure and personal demographics. However, this study demonstrates that the three commonly cited motivations of medical tourists might oversimplify this phenomenon.

Originality/value

By providing new insight into medical tourists’ motivations, this paper expands the conversation about medical tourists’ decision-making and how this is informed by tourism discourse. This insight may contribute to improved guidance for medical tourism stakeholders for more ethical and safe practices.

Details

Tourism Review, vol. 70 no. 2
Type: Research Article
ISSN: 1660-5373

Keywords

1 – 10 of over 45000