RESUMEN
Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process.
Asunto(s)
Consenso , Toma de Decisiones , Atención Dirigida al Paciente/organización & administración , Guías como Asunto , Personal de Salud , Humanos , Participación del PacienteRESUMEN
Community-based participatory (CBP) strategies are considered important to efforts to eliminate disparities. This paper outlines how the Program for the Elimination of Cancer Disparities (PECaD) uses CBP strategies as a part of a long-term cancer education, prevention, and control strategy in an urban community. Community partnerships have proved to be vital resources to inform PECaD's agenda and the research practice of academic partners. We begin with a description of PECaD governance and partnership structures. The paper then describes programmatic activities and successes, including efforts to monitor clinical trials, deployment of mammography resources, anti-smoking, and prostate and colorectal cancer (CRC) screening education. The influence of changes in funding priorities, preventive screening policy, and community partner development on the partnership process over time is discussed. PECaD community partners have grown and expanded beyond the Program's mission and developed additional partnerships, resulting in a reevaluation of relationships. The impact of these external and internal changes and pressures on the partnerships are noted. The evolution of the evaluation process and what it has revealed about needed improvements in PECaD activities and operations is presented. A summary of the lessons learned and their implications for CBP practice are provided.
Asunto(s)
Redes Comunitarias , Investigación Participativa Basada en la Comunidad/métodos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Neoplasias/prevención & control , Educación en Salud , HumanosRESUMEN
Across North America and in other parts of the world, there has been a growing recognition that a large gap exists between public health knowledge generated through scientific discovery and its application in individual, community, organizational, and policy innovation. An academic-funder partnership sought to identify potential actions to improve the translation of public health research to practice in Missouri. Concept mapping, a structured conceptualization process, was used to develop information to support a local action planning effort to improve research translation to practice in Missouri. Nine conceptual clusters emerged: (1) provide education and training; (2) enhance capacity; (3) change incentives and accountability; (4) shift funding toward community needs; (5) support practice-based research; (6) engage and collaborate with the community; (7) share knowledge; (8) engage influentials; and (9) sustain momentum; action plans were drafted to address priorities in each cluster. The project connected the ideas of a wide-ranging set of stakeholders, identified areas of high-level agreement among stakeholders, and supported shared agenda setting.