Journal of evaluation in clinical practice
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An increasing number of patients are on sick leave from work due to fatigue- and pain-related symptoms that could indicate burnout. The aetiology is unknown, and recently, it has been considered whether burnout should be a distinct medical diagnosis or "just" a form of depression. Little attention has been given to these individuals' experiences. Therefore, we conducted a phenomenological study to explore burnout from a first person perspective. The aim of the study was to obtain a deeper understanding of burnout as phenomenon. ⋯ The findings indicate that lack of recognition of the interviewees' illness may have affected the healing process. When understanding burnout as an intersubjective, lived, contextual, and temporal experience, it is important to take the implications of such factors into consideration for both medical theory and clinical practice. On the basis of our findings, we argue that reducing burnout to a form of depression will neither solve the problem of its unknown aetiology nor provide for meaningful individual health care.
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While shared decision-making (SDM) training programmes for health professionals have been developed in several countries, few have been evaluated. In Norway, a comprehensive curriculum, "klar for samvalg" (ready for SDM), for interprofessional health-care teams was created using generic didactic methods and guidance to tailor training to various contexts. The programmes adapted didactic methods from an evidence-based German training programmes (doktormitSDM). The overall aim was to evaluate two particular SDM modules on facilitating SDM implementation into clinical practice. ⋯ The two SDM training modules met the basic requirements for use in a broader SDM implementation strategy and can even improve knowledge.
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Some philosophers have argued that evidence of underlying mechanisms does not provide evidence for the effectiveness of a medical intervention. One such argument appeals to the unreliability of mechanistic reasoning. However, mechanistic reasoning is not the only way that evidence of mechanisms might provide evidence of effectiveness. ⋯ A case study from virology provides an example of this so-called reinforced reasoning in medicine. It is argued that in this case study, the available evidence of underlying mechanisms did in fact play a role in providing evidence in favour of a medical intervention. This paper therefore adds a novel and recent case study to the literature in support of evidential pluralism in medicine.
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People worldwide are affected by psychiatric disorders that lack a "best" treatment option. The role of shared decision-making (SDM) in psychiatric care seems evident, yet remains limited. Research on SDM in specialized mental health is scarce, concentrating on patients with depressive disorder or psychiatric disorders in general and less on patients with anxiety and obsessive-compulsive disorder (OCD). Furthermore, recent research concentrates on the evaluation of interventions to promote and measure SDM rather than on the feasibility of SDM in routine practice. This study investigated patients' and clinicians' perspectives on SDM to treat depression, anxiety disorders, and OCD as to better understand SDM in specialized psychiatric care and its challenges in clinical practice. ⋯ Patients and clinicians in specialized psychiatric care value SDM, but adapting it to daily practice remains challenging. Clinicians are vital to the implementation of SDM and should become versed in how to involve patients in the decision-making process, even when this is difficult.
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In this article, we evaluate and compare the frailties of two different standards of disclosure of information regarding the risks of medical procedures applied in recent judicial decisions in the United Kingdom. As an alternative, we present the tenets and philosophical grounds of an agency model of consent and a person-based standard of disclosure. ⋯ We conclude that in order to know how to obtain valid informed consent, doctors need to engage in real conversations with their patients, revealing as much information as they, taken as real persons, need to be part of a genuine shared and respectful decision-making process.