Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants-physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.

Shared Decision-making in the Medical Encounter: What Does It Mean? (Or, It Takes at Least Two to Tango)

Assumptions are our taken for granted interpretation of the world. They are identified as important in reasoning, sense making, behaviour and action. Anecdotal evidence from users of neurological rehabilitation services suggest that assumptions influence how they are perceived and related to, impacting on their experiences of inclusion. This study investigates the assumptions held by service users and staff about neurological rehabilitation, examines their influence on inclusion and explores the conditions influencing change in assumptions.

This doctoral study drew largely on data generated as part of a funded research project, which investigated perceptions of inclusion and inclusive practice in neurological rehabilitation. Both the funded research project and this study adopted a participatory action research approach, using photography, mapping, diaries, interviews and focus groups to generate data. Additional data was generated for this doctoral study through a workshop and reflective questionnaire which focussed specifically on assumptions. Data analysis and sense making used framework analysis and a thematic approach. Research participants and critical friends contributed to validation of findings.

The findings identified that assumptions do form the basis for interactions and practices that influence whether neurological rehabilitation is inclusive and/or effective. Addressing assumptions requires that specific attention and scrutiny are given to situations where taken for granted thought has been disrupted, therefore, creating opportunities for critical dialogue and new understanding to be developed. Importantly, when service users and staff work collaboratively to ask the question “how do we do this together” assumptions of role, knowledge and expertise can be challenged and inclusion facilitated.

The study recognises that addressing assumptions in practice requires a change in the way of working in neurological rehabilitation. A re-framing of practice is called for and a critical relational ontology proposed to replace the currently advocated person centred approach, with the acknowledgement that this is likely to radically challenge current principles and practices in neurological rehabilitation.

Investigating service user and staff assumptions about neurological rehabilitation practice, their influence on inclusion and examining conditions for change

Menschen, die unter chronischen Einschrankungen leiden, sind dauerhaft auf die Unterstutzung von Gesundheitsdiensten und sozialen Pflege- bzw. Gemeinschaftsdiensten angewiesen. In Grosbritannien hat das Department of Health die Erarbeitung inklusiver Ansatze vorgeschlagen, um sowohl den Betroffenen besser helfen als auch finanzielle Einsparungen aufseiten der Dienstleistungserbringer sicherstellen zu konnen. Vor diesem Hintergrund wurden Personen mit unterschiedlicher Gruppenzugehorigkeit (Nutzer/innen neuro-rehabilitativer Dienstleitungen, Dienstleistungsanbieter/innen, Personen, die in weiteren Unterstutzungsdiensten tatig sind sowie universitare Forscher/innen) zur Teilnahme in einem partizipativen Forschungsprojekt eingeladen, um gemeinsam herauszufinden, was Inklusion fur Menschen bedeuten konnte, die dauerhaft Gesundheitsdienste in Anspruch nehmen mussen. Die folgenden Prozesse liefen herkommlichen Vorstellungen von Inklusion und inklusiver Praxis tlw. zuwider: Es wurde deutlich, dass oft diskutierte Elemente wie Vertrauen, Respekt und geteilte Verantwortung fur eine inklusive Praxis zwar erforderlich, aber nicht ausreichend sind. Inklusion ist vielmehr ein komplexer und herausfordernder Prozess, der der aktiven Konstruktion und Bereitstellung kritischer Kommunikationsraume bedarf mit dem Ziel einer wechselseitigen und demokratischen Konzeption von Unterstutzungsleistungen.

/pdf/participatory-research-into-inclusive-practice-improving-ihnox47xjh.pdf

Participatory Research Into Inclusive Practice: Improving Services for People With Long Term Neurological Conditions

Objectives The multifaceted nature of the problems faced by someone with motor neuron disease requires a knowledgeable multidisciplinary team approach. Where available, generally, such services are only provided on an outpatient basis, meaning that hospitalised patients are frequently admitted to non-specialist wards where understanding of their needs is limited. Little is known regarding the inpatient care received by patients. Our objective was to address this by exploring the experience of hospitalisation following a diagnosis of motor neuron disease from the perspective of family carers of those diagnosed with the illness. Method This was a qualitative secondary analysis of pre-existing data from two previously published, separately conducted, qualitative studies. The study involved interview data from 18 bereaved carers and 3 current carers of family members diagnosed with motor neuron disease in Northwest England. Results The findings reveal dissatisfaction with the inpatient care received, which impacted negatively not only on patient and carer enthusiasm for future hospital admissions but also on carer bereavement. Conclusions Patients with motor neuron disease have specialist needs that are not always met during hospital admission, particularly to non-specialist units. The inpatient care provided for these patients must be improved as must the knowledge and understanding of the illness among healthcare professionals who treat them.

/pdf/family-carer-perspectives-of-acute-hospital-care-following-a-3ozqia2god.pdf

Family carer perspectives of acute hospital care following a diagnosis of motor neuron disease: a qualitative secondary analysis

Several studies have examined how the lockdown restrictions enforced to halt the spread of COVID-19 have affected adults’ movement behaviors; however, there is limited information regarding the effects on youth. This study aimed to report on the lifestyle habits of adolescents during COVID-19 pandemic remote learning and explore associations between the participants’ bodyweight and lifestyle behaviors. We used a cross-sectional study applied to 285 students studying in the gymnasium. The response rate was 74.21%. They completed an online questionnaire regarding lifestyle, eating habits, and nutritional status (assessed by the Body Mass Index—BMI). The study was conducted in January–February 2021. The percentage of overweight and obese was higher among boys (p = 0.001). The mean sleep duration was 8.12 (SD:1.284) hours per night, and was higher in boys than in girls. The respondents met the physical activity (PA) recommendation for their age, based mainly on unorganized PA. The screen time was 4–6 h or more for the majority of the respondents. Dietary habits included a high consumption of comfort food, like cereals, sweets, soft drinks, snacks, and fried food, but a lower consumption of vegetables and fast food. The regression analyses showed that the BMI was correlated with the BMI of the parents and the number of hours spent in front of the computers in free time. The study identified behavioral and environmental factors that can be modified with effective strategies to reduce overweight and obesity among school students and to promote a healthy lifestyle.

/pdf/adolescents-lifestyle-determinants-in-relation-to-their-240ljz47.pdf

Adolescents’ Lifestyle Determinants in Relation to Their Nutritional Status during COVID-19 Pandemic Distance Learning in the North-Western Part of Romania—A Cross-Sectional Study

Sleep in childhood is affected by behavioral, environmental, and parental factors. We propose that these factors were altered during the COVID-19 pandemic. This study investigates sleep habit changes during the pandemic in 528 children 4-12 years old in the US, leveraging data from the Environmental Influences on Child Health Outcomes (ECHO) Program.Data collection occurred in July 2019-March 2020 (pre-pandemic) and two pandemic periods: December 2020-April 2021 and May-August 2021. Qualitative interviews were performed in 38 participants.We found no changes in sleep duration, but a shift to later sleep midpoint during the pandemic periods. There was an increase in latency at the first pandemic collection period but no increase in the frequency of bedtime resistance, and a reduced frequency of naps during the pandemic. Qualitative interviews revealed that parents prioritized routines to maintain sleep duration but were more flexible regarding timing. Children from racial/ethnic minoritized communities slept less at night, had later sleep midpoint, and napped more frequently across all collection periods, warranting in-depth investigation to examine and address root causes.The COVID-19 pandemic significantly impacted children sleep, but parental knowledge of the importance of sleep might have played a significant protective role.During the COVID-19 pandemic, US children changed their sleep habits, going to bed and waking up later, but their sleep duration did not change. Sleep latency was longer. Parental knowledge of sleep importance might have played a protective role. Regardless of data collection periods, children from racial/ethnic minoritized communities slept less and went to bed later. This is one of the first study on this topic in the US, including prospective pre-pandemic qualitative and quantitative data on sleep habits. Our findings highlight the pandemic long-term impact on childhood sleep. Results warrants further investigations on implications for overall childhood health. 

https://www.nature.com/articles/s41390-022-02309-z.pdf

Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO study

Towards Inclusive Living: a case study of the impact of inclusive practice in neuro-rehabilitation/neuro-psychiatry services (Department of Health Policy Research Programme LTNC Reference Number 530010)

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Phil Moore

Author Tools

Chat about Author

Papers

Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO study

Towards Inclusive Living: a case study of the impact of inclusive practice in neuro-rehabilitation/neuro-psychiatry services (Department of Health Policy Research Programme LTNC Reference Number 530010)