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

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

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 decision‐making processes.

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.

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

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.

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.

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.

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.

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.

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.

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.

The purpose of this study is to examine the rostering practices and work experiences of medical scientists at four health services in the Australian public healthcare sector. There are over 16,000 medical scientists (AIHW, 2019) in Australia responsible for carrying out pathology testing to help save the lives of thousands of patients every day. However, there are systemic shortages of medical scientists largely due to erratic rostering practices and workload issues. The purpose of this paper is to integrate evidence-based human resource management (EBHRM), the LAMP model and HR analytics to enhance line manager decision-making on rostering to support the wellbeing of medical scientists.

Using a qualitative methodological approach, the authors conducted 21 semi-structured interviews with managers/directors and nine focus groups with 53 medical scientists, making a total 74 participants from four large public hospitals in Australia.

Across four health services, manual systems of rostering and management decisions do not meet the requirements of the enterprise agreement (EA) and impact negatively on the wellbeing of medical scientists in pathology services. The authors found no evidence of the systematic approach of the organisations and line managers to implement the LAMP model to understand the root causes of rostering challenges and negative impact on employees. Moreover, there was no evidence of sophisticated use of HR analytics or EBHRM to support line managers' decision-making regarding mitigation of rostering related challenges such as absenteeism and employee turnover.

The authors contribute to HRM theory by integrating EBHRM, the LAMP model (Boudreau and Ramstad, 2007) and HR analytics to inform line management decision-making. The authors advance understandings of how EBHRM incorporating the LAMP model and HR analytics can provide a systematic and robust process for line managers to make informed decisions underpinned by data.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

The greater availability of life‐sustaining technology, such as cardiopulmonary resuscitation, and the medical, legal and moral pressures to use them, often enable the prolongation of lives of older people. The dying process can be extended regardless of quality of life. Further, there is much public debate on the increasing emphasis on individual rights and personal autonomy in the dying process. This qualitative study examined older people's perspectives on end‐of‐life decision‐making and advance care planning. A sample of 12 older people living in the community was recruited and studied in‐depth. A semi‐structured interview explored patients' conceptualisations of decision‐making in the later stages of life and the significant others they would like involved in the process. The data were analysed using ‘content analysis’. The resulting broad categories, themes and sub‐themes formed the foundation of an emerging model of older people talking about end‐of‐life care. Finally, results were discussed with regard to practice and policy development.

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.

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.

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.

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.

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.

The purpose of this paper is to demonstrate that the common and statutory law governing children's capacity or competence to consent to and to refuse medical treatment is unsatisfactory and to suggest solutions.

Critical legal analysis of the law on assessing minors’ decision-making capacity in relation to legal recognition of their consent to and refusal of medical treatment.

Without legal mechanisms which protect both children and their rights, all children and young people are effectively disabled from exercising age and capacity-related autonomy and participation in decisions affecting their lives. Yet in English law, inconsistencies between legal and clinical measures of decision-making capacity, situations where compulsory medical or mental health treatment is lawful, and tensions between rights and duties associated with human rights, autonomy, best interests and protections for the vulnerable create difficulties for clinicians, lawyers and patients.

As the paper acknowledges in its recommendations, the views of stakeholders are needed to enrich and inform legal reforms in this area.

The paper makes suggestions to amend the law and clinical practice which are original and far reaching. The paper suggests that in order to observe children's rights while protecting them appropriately, the Mental Capacity Act 2005 and Deprivations of Liberty Safeguards should be applied to minors. The paper recommends the establishment of Mental Capacity Tribunals, similar in nature and purpose to Mental Health Tribunals, to provide legal safeguards and mechanisms to foster the supported decision-making envisaged in recent United Nations Conventions.

Managing risk and making decisions presents an increasing challenge to doctors as they are encouraged to adopt a partnership approach with patients to dealing with risk, within a “risk society” constructed around individuality, uncertainty, blame and responsibility. In‐depth interviews, stimulated by clinical vignettes, were used to explore the key position of doctors within this risk society. Analysis, sensitised through contemporary texts, revealed unexpected findings that portrayed doctors as reflexive jugglers of risk. Discourses in this study revealed indecision and uncertainty, balanced against needs to preserve professional roles and engage patients in addressing risk, whilst preventing widespread harm and conflict. In concluding, the alternative approaches to risk with older people will suggest a more trusting and positive process that presents a real opportunity for truly sharing risk and decisions that benefit both doctor and patient.

Assessing the capacity of individuals with learning disabilities to make decisions about treatment is problematic. This field has received little attention in the United Kingdom, the concept of capacity proving difficult to define. There are no commonly agreed standards, English law in this area is still developing and there are few guidelines to instruct health professionals. This paper reviews the diagnostic, outcome and functional approaches to examining the issue of capacity and outlines a number of tests that have been developed for use in the clinical setting, though not adapted for use with people with a learning disability. Issues to be addressed in the adaptation of tests are explored and areas for practitioners to consider are discussed.