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Results for “Making Health Care Decisions”

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PubMed1989

Health-care decision making. Part I: Legal and ethical principles.

The growing elderly population and the acquired immunodeficiency syndrome (AIDS) epidemic have focused attention on ethical and legal issues surrounding health-care decision making. It is becoming increasingly critical to involve patients in the decisions that affect their care. Legal frameworks are evolving to protect the rights of both "competent" and "incompetent" patients. By writing instructions in advance, patients can increase their control and autonomy over health-care decisions. Physician assistants can facilitate the process by incorporating a patient value history into the chart and explaining legally recognized documents. Living wills generally apply in the context of terminal illness or irreversible coma; however, definitions of terminal conditions, imminent death, or life-sustaining procedures can be problematic. A number of states recognize the health-care durable power of attorney, which establishes a surrogate decision maker to act with specific instructions and limitations should the patient become incompetent or incapacitated.

Decision Making↗
PubMed1994

Voting and priorities in health care decision making, portrayed through a group decision support system, using analytic hierarchy process.

Within the health care industry many decision making approaches and tools are used. This paper explores a new tool, the Analytic Hierarchy Process (AHP), which permits both subjective and objective information to be considered in a decision. AHP has tremendous potential to solve both traditional and non-traditional health care problems. Its strength as a decision-making tool is its ability to combine both subjective and objective data. Application of AHP is discussed within the context of a Group Decision Support System (GDSS) model developed by Hatcher. The model is reviewed in limited detail, and readers are referred to the original article that defined and discussed the uniqueness and level of sophistication of GDSS applications in the health care industry. Health and medical delivery problems are discussed to highlight AHP requirements and the complexity of AHP applications. Health care applications are unique in that they lend themselves ideally to the use of computer data, image, voice, text, and multimedia concepts.

Decision Making, Organizational↗
PubMed1995

Involving consumers in health care decision making.

This paper considers ways of involving consumers in decisions regarding the allocation of scarce health service resources. Specifically, two levels of consumer participation are highlighted and discussed. These are: (1) at the level of deciding whether or not a particular service should be introduced or its scale changed; and (2) at the level of deciding how best to provide a service once it has been decided that the service will be provided. The limitations of the current methods of involving consumers are outlined and two alternative approaches discussed. These are willingness to pay and conjoint analysis.

Community Participation↗
PubMed2006

Whither trial-based economic evaluation for health care decision making?

The randomised controlled trial (RCT) has developed a central role in applied cost-effectiveness studies in health care as the vehicle for analysis. This paper considers the role of trial-based economic evaluation in this era of explicit decision making. It is argued that any framework for economic analysis can only be judged insofar as it can inform two key decisions and be consistent with the objectives of a health care system subject to its resource constraints. The two decisions are, firstly, whether to adopt a health technology given existing evidence and, secondly, an assessment of whether more evidence is required to support this decision in the future. It is argued that a framework of economic analysis is needed which can estimate costs and effects, based on all the available evidence, relating to the full range of possible alternative interventions and clinical strategies, over an appropriate time horizon and for specific patient groups. It must also enable the accumulated evidence to be synthesised in an explicit and transparent way in order to fully represent the decision uncertainty. These requirements suggest that, in most circumstances, the use of a single RCT as a vehicle for economic analysis will be an inadequate and partial basis for decision making. It is argued that RCT evidence, with or without economic content, should be viewed as simply one of the sources of evidence, which must be placed in a broader framework of evidence synthesis and decision analysis.

Cost-Benefit Analysis↗
PubMed2005

An approach to develop effective health care decision making for women in prison.

BACKGROUND: Decision making about medical treatment, advance care planning and end-of-life care often is limited or influenced by a patient's capacity to read or comprehend crucial information. Ineffective communication between patient and physician, and the complex nature of serious illness and dying also affect these decisions. America's incarcerated have virtually no autonomy in decision making, especially with regard to medical care and treatment. For the nearly 100,000 incarcerated women in the United States, medical issues differ significantly from those of male prisoners. Many women enter prison with chronic illnesses or are diagnosed with such illnesses while in prison. In addition, America's prison population reflects our country's unsolved literacy problems with almost two thirds of aging inmates lacking basic literacy skills. Maintaining a balance between the Eighth Amendment rights of prisoners and their status as wards of the state is a concern for inmates and for those responsible for their care. OBJECTIVE: The purpose of this study was to identify informational barriers to people making medical care and treatment decisions, particularly those with low literacy. Findings were used to in the development of a tool to assist patients to initiate discussion and become active participants in their own care. DESIGN: Female inmates of diverse ethnicity and literacy levels were recruited through self-selection from the Central California Women's Facility near Sacramento to participate in focus group discussions. The focus groups were guided by a set of research questions and were facilitated by the first author to identify informational barriers to medical care needs. SETTING: The female prison setting was identified as an appropriate setting for the development of a new approach to stimulate effective decision making by introducing basic information on medical care and treatment, advance care planning, and end-of-life care. A total of 113 inmates participated in 16 focus group, each 2 hours in length. RESULTS: Findings were used to develop a handbook to assist low literacy populations in general, and female inmates in particular, to obtain appropriate medical care and treatment and to make advance care decisions regarding the end of life. CONCLUSION: Those who face chronic, potentially life-limiting illness cannot make meaningful decisions regarding medical care and treatment without having a basic foundation of health information. Acquiring knowledge and improving communication skills reduce stress and vulnerability, assuring individuals of some control over decision making.

Communication Barriers↗
PubMed1999

Rationing care in the community: engaging citizens in health care decision making.

This article examines the theoretical and practical logics of community engagement exercises in health care rationing. To evaluate such exercises in Canada, it is necessary to compare suspected rationing exercises (such as those in Nova Scotia and Saskatchewan) with clear examples of rationing. The Oregon Medicaid reform process is considered an important example of transparent and community-level rationing from which Canadian executive-driven governments can learn a few valuable lessons. While the Oregon experiment seems to have been a (qualified) success, in the Canadian context, formal citizen participation in decision making might be incompatible with social rights and present an incongruous and antagonistic pairing of executive and popular sources of authority.

Community Participation↗
PubMed1999

Decision analytic modeling in health care decision making. Oversimplifying a complex world?

The need to choose among alternatives instead of allowing the market to make choices has led health care professionals to rely on scientific information as an aid in decision making. Mathematical modeling is one of the increasingly common tools used over the past three decades to produce new information. But we have used almost exclusively noncomplex models to help analyze complex systems problems. The need to integrate the complexity of the interactions of clinical, quality of life, and economic attributes into such models can no longer be ignored. The opportunity is available to use existing complex systems modeling techniques for health care questions to improve the quality of study outputs, which can, in turn, help produce more rational decisions.

Decision Support Techniques↗
PubMed2000

Making health care decisions without a prognosis: life in a brain trauma unit.

When the author's daughter was hit by a car and remained unconscious for seven months, she found that there were certain factors where traditional ethical theory was not sufficiently nuanced to guide her practical decision making in regard to her daughter's health care. This article concentrates on three of those factors. They are: (1) no reliable prognosis can be offered for many brain-injured individuals; (2) a patient's age and the relationship between the patient and the caregiver affect the context of caring; and (3) there are severe difficulties in obtaining and sustaining chronic care and accessing scarce resources.

Adult↗
PubMed1978

Health care decision making in Southern County.

We combine two standard approaches to analyze power and influence in health policy formulation within a moderately large county in the south. Intrinsic methodologic weaknesses are discussed and several conclusions are drawn regarding power in the health care sector of that community. The most significant finding is the shift in power over time, away from the individuals to committees and health care organizations. The ignorance of most physicians about the broader health care issues that affect the community was reflected in their lack of recognition by others in the community as influential decision makers. The insular relationship of the university to the rest of the community was also noted. Past racial politics had a continuing effect on later health policy formulation. These findings are discussed in light of current and past issues. Because we had promised confidentiality to the persons we interviewed, fictitious names were given to the county, the institutions, and the interviewees.

Decision Making↗
PubMed2005

Misimagining the unimaginable: the disability paradox and health care decision making.

Good decision making often requires accurate predictions about how potential outcomes will make one feel. However, people often mispredict the emotional impact of unfamiliar circumstances. For example, they often overestimate the emotional impact that chronic illnesses and disability will have on their lives. In the present article, the authors look at possible sources of error in both the happiness reports of patients with chronic illness or disability and the happiness predictions of healthy people asked to imagine the same illnesses and disabilities. On balance, the available evidence suggests that, whereas patients misreport their well-being, healthy people also mispredict the emotional impact that chronic illness and disability will have on their lives.

Adaptation, Psychological↗