Allocating health resources.
Explore the source record for details and available documents.
Costs and Cost Analysis↗
SEARCH · PubMed Health
Results for “Making Difficult Health Care Decisions”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Health care social workers' views of ethical issues, practice, and policy in end-of-life care.
End-of-life care decision making is perhaps the most difficult practice situation faced by health care social workers. Complex ethical issues arise from decisions regarding use of advancing medical technologies and/or other artificial treatments that may prolong life and/or compromise its quality. NASW has set forth a policy to help guide social workers dealing with end-of-life care decisions and the preservation of client self-determination in these situations. However, the present study (N = 63) revealed that a majority (57%) of social workers were not aware of the existence of, or were only somewhat familiar with the policy. Ethical dilemmas most often faced in end-of-life care situations related primarily to issues of communication between and among patients, families, and professionals. Practitioners indicated that more specific practice guidelines and increased education regarding bioethics and issues of end-of-life care are needed to be effective in assisting patients and families in end-of-life decision making.
Adult↗
The effects of structures on decision-making policies in health care.
BACKGROUND: There is plenty of evidence in the literature indicating how difficult it is to recognize, question and eventually change our current mental models of the structures and decision-making processes in health care. The citizens of western countries are offered more health care services than ever and report themselves to be somatically healthier than ever. Paradoxically, many health care systems claim to be in a state of crisis, for which the cure is believed to more services and more money. Growth is a major feature of modern medicine and most people assume that more medical care must lead to improved health and wellbeing. However, adding more resources and more health care may also have counterintuitive effects. OBJECTIVE: This perspective describes common phenomena seen in our health care structures and searches for reports and results that may challenge some of the 'self-evident' solutions to these problems. RESULTS AND DISCUSSION: Most organizations and systems learn poorly and it is difficult to recognize how we contribute to our own problems and crisis. Even if the evidence has been apparent for decades, it may simply be ignored or rejected when it is inconsistent with the underlying beliefs. Learning seems to be associated more with attitudes and mental models than with evidence. As we are part of the health care structure, we share responsibility for problems generated by the system. It is time for health care professionals to study and question the efficacy of our current paradigms and practices.
Decision Making↗
Making interactive decision support for patients a reality.
Interactive decision support applications might help patients to make difficult decisions about their health care. They lie in the context of traditional decision aids, which are known to have effects on a number of patient outcomes, including knowledge and decisional conflict. The problem of restricted uptake with decision aids may be addressed by interactive applications, particularly if associated with health information websites. We suggest that there may be an impact on the doctor-patient relationship and that this presents a number of opportunities. However, there are ethical challenges such as information bias and commercialisation.
Decision Support Systems, Clinical↗
Patient autonomy in care: a theoretical framework for nursing.
Patient autonomy has increasingly become an issue in a health care system that often promotes dependence in decision making. The complex technology of health care creates situations in which difficult decisions need to be made by patients and their families. Nurses are important participants in that decision-making process. Models available for developing a theoretical approach to patient autonomy traditionally have been limited to ethics literature. A more recent approach to personal autonomy is Meyer's philosophical feminist perspective. Any philosophical approach to patient autonomy must be congruent with other critical nursing concepts. In addition, a model of patient autonomy for nursing must be useful for persons who operate at various functional levels. The model, Patient-Autonomy in Care, based on the Meyer's model, was developed to incorporate the special vulnerability and functional needs of patients in the health care system.
Decision Making↗
Living wills and health care proxies. Advance directives help families and loved ones make difficult decisions.
Explore the source record for details and available documents.
Advance Directives↗
Is quality of health care a meaningful guide?
Health care consumers are beginning to learn that "what you don't know can hurt you." Though consumers consistently rank quality of care as an important attribute, "quality of care" does not appear to be particularly useful in decision making. The quality of health care is difficult to measure, communicate, and interpret. Yet if consumers are to make efficient choices including both value and cost in their decisions, quality information must be available to them. This paper outlines a scheme to conceptualize quality of care and suggests some ways to operationalize measures of quality that could provide empirically based indices of quality of care to facilitate health care consumer decision-making.
Consumer Behavior↗
Informing the elderly. A comparison of four methods.
Providing elderly persons with understandable information with which they can make informed health care decisions is a difficult, yet critical, task. Four methods of enhancing understanding of the Resident's Bill of Rights were evaluated in residents of the board and care section of a long-term care facility. The methods included the use of large print and simplified language, a storybook, and a videotape. There was no significant improvement for performance on the comprehension test after any of the methods of presentation of the Bill of Rights. A number of subjects were found to be very deficient in short term memory or in verbal knowledge. When these subjects were eliminated from the analyses, significant improvement was demonstrated with the simplified version of the Bill of Rights yielding the most improvement. These findings indicate that many elderly people can benefit from an informed consent procedure that provides information clearly and simply. Furthermore, with relatively simple cognitive screening procedures, it should be possible to identify those unable to process the information necessary to participate in common health care decisions.
Aged↗
Ethically defensible decision-making in health care: challenges to traditional practice.
The concept of paternalism is deeply entrenched in health care. Decision-making about health care can be extremely difficult at times, and many competing interests may influence the outcomes. However, ethically defensible practice aligns itself with acknowledging the patient's prima facie right to be treated as an autonomous individual. This includes the patient's right to make informed decisions or to decide that other(s), such as the close family, should make decisions on his or her behalf.
Australia↗
Reforming home health care.
The Balanced Budget Act of 1997 currently limits Medicare payments to home health agencies through an interim payment system and authorizes future implementation of a prospective payment system. These new payment systems and the growing influence of managed care are forcing home health agencies to make difficult decisions about restructuring their organizational philosophies and operations to create a more cost-conscious environment.
Aged↗
[The role of models in economic evaluation of healthcare].
INTRODUCTION: The information on which decision-making in healthcare is based --especially information on new drugs or technologies-- comes mainly from phase III clinical trials, which are carried out according to clinical efficacy criteria. Placebos are frequently used as comparators. Therefore, no clinical or economic evidence is usually available to assess the new product or technology in real-life practice (effectiveness). Efficiency is seldom evaluated either. METHODS: The clinical evidence generated by clinical trials usually evaluates intermediate, not final clinical variables. This makes decision-making difficult, both for clinicians or health-care managers in areas as varied as financing drugs or technology, inclusion of these in a therapeutic formulary or in clinical pathways. CONCLUSION: To obtain clinical and economic information, modelling techniques have been developed in the field of health economics. This study reviews the justification of the use of models, their characteristics, methodological requirements and steps followed for their construction and resolution, while Markov models are explained.
Clinical Trials, Phase III as Topic↗
Health services pricing in Turkey.
One of the most important and complex decisions that public services managers have to make is pricing. This is especially difficult within public health care because pricing decisions are influenced by a myriad of ideological, political, economic and professional arguments. In Turkey the majority of health care services are provided under public auspice; however, recent changes in governmental policy have led to increased competition among hospitals in both the public and private sector. Therefore, all institutions are being watched and remain open to government scrutiny and regulation. The aim of the study is to analyze how the private and governmental hospitals determine pricing or the actual cost of services in Turkey. Also, comparisons are made between health services expenditures and the Consumer Price Index with suggestions provided for public and private hospital managers in regard to the general cost of health services.
Economic Competition↗
Quality of life and the right to die: an ethical dilemma.
In an increasingly 'patient-centred' health service individuals are demanding to make independent judgements about their own fate. In keeping with this trend there is now a growing drive to review the current laws on euthanasia and assisted suicide. The issues in the euthanasia debate usually revolve around patients who are terminally ill and/or suffering intractable pain. However, pain is not the only determinant of an intolerable existence and the problems become more complex when existential quality of life issues are the focus. This can lead to difficult decision making for the health workers involved in care. The paper uses a case study approach to examine the ethical and legal issues surrounding euthanasia. The dilemma under discussion involves a quadriplegic patient who wished to commit suicide by refusing nutrition. The discussion offered centres around the principles of beneficence, non-maleficence and autonomy in relation to whether it was morally or legally appropriate to intervene with this patient's wishes by artificial feeding. Conclusions and recommendations are offered.
Adult↗
Making decisions about end-stage renal disease treatment: a review of theories and issues.
Multiple theories and models of decision-making have been reported in the popular and scientific literature. Decisions and choices about health care are some of the most dramatic and difficult that humans make. The interactive role of patient and health care professional in circumstances of urgency, stress, and possible unpredictability is complex. This article reviews some of the theories of decision-making and their implementation or usefulness in the end-stage renal disease setting. In caring for patients, health professionals need to identify their approach to the decision-making process with special concern for the patient role in this process.
Decision Making↗
A procedure for evaluating primary health care software.
Managers in health care often find themselves in the difficult position of having to make decisions regarding the purchasing of software and hardware which they are not qualified to make. The aim of this paper is to support health managers in their decision making by means of a procedure and an instrument that can be used to evaluate primary health care software. A seven step approach to the evaluation process is proposed and each step is discussed in detail. The paper concludes with a proposed software evaluation instrument that is suitable for application in the health care environment.
Decision Making↗
Communicating with families of rehabilitation patients about "do not resuscitate" decisions.
Resuscitation discussions can elicit potent emotional reactions from both health care providers and consumers. In rehabilitation settings, decision making grows more difficult if decisions must be sought from family members or proxies of incompetent patients. There is ample room for emotions and lack of clarity to lead to dissatisfaction and heightened distress. This paper outlines legal, ethical, and psychological factors that must be managed if clear communication between health care providers and families is to occur. Issues are discussed that can clarify thinking at each stage of the communication process.
Beneficence↗
Do not resuscitate orders in different countries.
Health care decision making in severely ill patients presents many difficult medical, ethical and legal problems. Physicians, including anaesthesiologists, are frequently confronted with dilemmas regarding the appropriateness of risky interventions and the balance of potential benefits versus risks. The risks include not only death and the pain and suffering that are related to the interventions, but also (and arguably more importantly) the burdens of lingering disability, loss of independence and poor quality of life. This review presents recent findings (focusing on papers published between 1999 and March 2001), and explores the background for the introduction of do not resuscitate policies and their use in clinical practice in different countries. Problems with auditing and implementing do not resuscitate policies are highlighted.
Journal Article↗
A network flow approach to optimizing hospital bed capacity decisions.
The delivery of cost-effective and quality hospital-based health care remains an important and ongoing challenge for the American health care industry. Despite numerous advances in medical procedures and technologies, a growing array of outpatient health care options, limits on inpatient reimbursements, and almost two decades of hospital contraction and consolidation, annual inpatient admissions in the United States are currently at levels not seen since the early 1980s. This combination of increased demand and diminished resources makes planning for hospital bed capacity a difficult problem for health care decision makers. We examine this problem by developing a network flow model that incorporates facility performance and budget constraints to determine optimal hospital bed capacity over a finite planning horizon. Under modest assumptions, we demonstrate that for realistic sized capacity planning problems, our network formulation is not computationally intensive, and allows us to obtain optimal bed capacity plans quickly.
Decision Making, Organizational↗