Journal of evaluation in clinical practice
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Elements of shared decision-making (ie, collaboration, patient preferences, and working alliance) have long been discussed and studied in the field of clinical psychology; however, research indicates that shared decision-making is not typically used in clinical practice. Instead, clinicians often rely on a paternalistic approach. In this article, we provide a narrative review of the existing research supporting shared decision-making for mental and behavioural health concerns, we discuss several barriers that impede its use in actual clinical practice, and we provide recommendations for increasing shared decision-making when working with patients.
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The move towards evidence-based medicine has generated rapid growth in reviews of research literature. The scoping review is one of the new literature reviews that has emerged from traditional systematic reviews. A scoping review aims to map the literature on a particular topic or research area. ⋯ Second, the contextual constraints of scoping reviews such as time, resources, and the jurisdiction of the commissioning agency need to be made explicit in the reporting of scoping reviews. Third, the findings in this paper indicate that the evolving emphasis on formalization in both the methods the reporting practices of scoping reviews could benefit if complemented with a more pronounced role for informalities. In addition, highlighting the informalities in scoping review methods may serve to create more realistic expectations of the methods, the validity, and the potentials of scoping reviews.
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Evidence of mechanisms plays an important role in medical decision-making, but this role is less well articulated than that of clinical trial evidence. A new book, Evaluating Evidence of Mechanisms in Medicine: Principles and Procedures, provides a framework and resources for explicitly evaluating evidence of mechanisms when assessing claims of efficacy and external validity. This review outlines the overall approach of the book, the contribution it makes to evidence evaluation in medicine and makes some suggestions for further work that will aid implementation of the framework into clinical decision-making.
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Motor neurone disease (MND) is a neurodegenerative disease presenting with progressive weakness of voluntary muscles. For any condition, person-centred health care relies on the sharing of information and a mutual understanding of the person's needs and preferences. Decision making in MND becomes more complex as there is no cure and a high prevalence of co-morbid communication and/or cognitive difficulties. ⋯ This review highlights that the current body of literature exploring decision making within the MND population presents us with extremely limited insights into the impact of communication and/or cognitive impairments on health care decision making. Extant literature focuses on interventions (namely, ventilation and gastrostomy), the broad process of decision making, or cognitive assessment of decision-making ability. Whilst most studies acknowledge that deficits in communication or cognition impact the decision-making process, this issue is not the focus of any study.
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The aim of this review was to evaluate the implementation of shared decision-making (SDM) in dentistry and the roles of informed consent and patient decision-making aids (PDAs) as part of this process. ⋯ SDM is applied in dentistry and is influenced by many factors. Informed consent is an important part of this process. PDAs in more dental fields need to be further developed, in order to ensure a satisfactory integration of patients in the SDM process.