Articles: professional-patient-relationship.
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Randomized Controlled Trial Clinical Trial
High rates of advance care planning in New York City's elderly population.
Previous studies have demonstrated low rates of advance care planning (ACP), particularly among nonwhite populations, raising questions about the generalizability of this decision-making process. ⋯ African American, Hispanic, and white community-dwelling, older adults had similarly high rates of advance directive completion. The primary predictors of advance directive completion involved modifiable factors such as established primary care physicians, personal experience with mechanical ventilation, knowledge about the process of ACP, and physicians' willingness to effectively initiate such discussions. Some of the racial/ethnic differences in desire for collective family-based decision making that were observed in this study have implications for the evolution of ACP policy that respects and operationalizes these preferences.
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Randomized Controlled Trial Clinical Trial
Involving patients in decision making and communicating risk: a longitudinal evaluation of doctors' attitudes and confidence during a randomized trial.
Important barriers to the wider implementation of shared decision making (SDM) and risk communication in practice remain. The attitudes of professionals undergoing training in these approaches may inform how to overcome these barriers, but there are few such data yet available. ⋯ Professionals appear receptive to patient involvement, and willing to acquire the relevant skills. SDM and risk communication training did not appear to contribute differentially to this. Practical barriers such as time constraints should probably be addressed with greater priority than the precise content of training or continuing professional development initiatives if 'involvement' is to become a commoner experience for patients in primary care.
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Randomized Controlled Trial Clinical Trial
Health plan members' views about disclosure of medical errors.
Various authorities and national organizations encourage disclosing medical errors, but there is little information on how patients respond to disclosure. ⋯ Patients will probably respond more favorably to physicians who fully disclose medical errors than to physicians who are less forthright, but the specifics of the case and the severity of the clinical outcome also affect patients' responses. In some circumstances, the desire to seek legal advice may not diminish despite full disclosure.
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Randomized Controlled Trial Clinical Trial
Patient-centered advance care planning in special patient populations: a pilot study.
The purpose of this study was to assess the feasibility of a patient-centered advance care planning (PC-ACP) approach to patients with chronic illnesses and their surrogates with respect to promotion of shared decision-making outcomes-congruence between patient and surrogate, patient's decisional conflict, and knowledge of advance care planning. An experimental design was used. The settings were the heart failure, renal dialysis, and cardiovascular surgery clinics at Gundersen Lutheran Medical Center in La Crosse, WI. ⋯ Comparison of the composite scores of a Statement of Treatment Preferences indicated that congruence in decision-making for future medical treatment in patient-surrogate pairs in the treatment group was significantly higher than in the control group. Greater satisfaction with the decision-making process and less decisional conflict were demonstrated in the treatment group. The PC-ACP interview can be effective in promoting shared decision-making between patients and their surrogates and in producing greater satisfaction with the process of decision-making and less decisional conflict.
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Randomized Controlled Trial Clinical Trial
Informed consent in otologic surgery: prospective study of risk recall by patients and impact of written summaries of risk.
To evaluate how much patients remember of the risks discussed with them about their otologic surgery and to evaluate whether a simple intervention, the addition of an information handout, improves recall. ⋯ The addition of a handout did not significantly alter recall of potential complications of otologic surgery with the exception of facial nerve paralysis.