Factors influencing the implementation of shared decision-making in breast cancer care: protocol for a mixed-methods study.

INTRODUCTION: Chile is committed to actively involving patients in their healthcare. However, little is known about how this is translated into clinical encounters. Breast cancer (BC) is the first cause of cancer-related death in Chilean women. National policy guarantees standard care, and treatment decisions should be made along this process that can have long-term consequences for women. So, BC is a particularly well-suited case study to understand the complexity of patient participation in decision-making. OBJECTIVE: To identify the factors that affect the active involvement of patients in the BC treatment decision-making process, considering the perspectives and practices of health professionals and women facing the disease. METHOD AND ANALYSIS: We will conduct a mixed-method study through a convergent parallel design in three stages: (1) A qualitative study: non-participant observation of the tumour board (TB) meetings; semi-structured interviews with key informants from TBs; documentary analyses; semi-structured interviews with women facing BC; and non-participant observations of clinical encounters; (2) a cross-sectional study with 445 women facing BC stages I-III from three hospitals in Santiago, Chile. We will measure the level of expected participation, experienced participation, decisional conflict, quality of life (QoL) and satisfaction with healthcare. Descriptive analysis will be performed, and multivariable binary logistic regression models will be adjusted to identify factors associated with high levels of QoL or satisfaction; (3) an integration study will bring together the data through a joint display technique. ETHICS AND DISSEMINATION: The study has been conceived and will be conducted according to international and local agreements for ethical research. Ethical approval has been granted by two Ethics Committees in Chile.The results will be disseminated to scientific and lay audiences (publications in scientific journals and conferences, seminars and a website for plain language dissemination).

What is needed to effectively communicate risk during a health crisis? A qualitative study with international experts based on the COVID-19 pandemic.

OBJECTIVE: To identify a framework for risk communication during health crises by using the current pandemic as a case study. DESIGN: A qualitative study based on individual interviews. SETTING: Different countries with diverse levels of perceived success on risk communication during the COVID-19 health crisis. PARTICIPANTS: International experts with experience in health crisis management or risk communication. ANALYSIS: A thematic analysis was performed supported by Atlas.ti. RESULTS: Four men and six women took part in the study (three from Europe, two from Latin America, two from North America, one from Asia and two from Oceania). Three major themes emerged from the data: (1) institutionalising the communication strategy; (2) defining the problem that needs to be faced; (3) developing an effective communication strategy. CONCLUSION: Risk communication during a health crisis requires preparation of governments and of health teams in order to produce and deliver effective messages as well as to help communities to make informed and healthy decisions. This is particularly relevant for slow disasters, such as COVID-19, as the strategy must innovate to avoid information fatigue of the audience. The findings of this article could inform guidelines to best equip countries for a clear communication strategy for future crises. PROSPERO REGISTRATION NUMBER: CRD42021234443.

[The significance of menopause for Chilean women attending primary health care centers]. / El significado de la menopausia para un grupo de mujeres chilenas atendidas en el sistema público de salud.

BACKGROUND: Menopause connects a biological event with social representations related to aging Aim: To assess the meaning of menopause in a group of Chilean women attending primary health care. MATERIAL AND METHODS: Secondary analysis of a descriptive qualitative study of in-depth interviews to explore the meaning of menopause in fifteen women aged 55 to 71 years who experienced menopause between 2 and 29 years before. Data were collected using the method proposed by the Grounded Theory. Guba's criteria of scientific rigor were used. RESULTS: Relational analysis shows that menopause divides the life cycle of women into two stages related with the possibility of having children, which is heavily influenced by the cultural significance of menopause. CONCLUSIONS: Women perceive that menopause is a natural stage and that it is the end of a period focused on tasks related to reproduction and motherhood. However, that "normality" includes a suffering process, loaded with negative cultural beliefs about menopause passed down for generations.

Participación en el proceso reproductivo: toma de decisiones durante el embarazo y parto

Introducción: Potenciar la participación de las mujeres durante el embarazo y el parto se alinea con el llamado de la Organización Mundial de la Salud y se vincula con efectos en la satisfacción usuaria, resultados clínicos de salud y una mejor gestión de los prestadores de salud. Objetivo : Descubrir las necesidades de participación en la toma de decisiones de las mujeres durante el proceso del embarazo y parto. Método : Análisis secundario de un estudio cualitativo descriptivo con mujeres hospitalizadas del servicio de puerperio de dos hospitales en Santiago de Chile. El análisis de los datos se realizó utilizando el método propuesto por la Grounded Theory. Resultados : Participaron doce mujeres en dos grupos focales. Del análisis relacional se desprende que la participación en el proceso reproductivo es interferida por dos grupos de factores vinculados a significados culturales y a la vulneración de los derechos de las mujeres. Conclusiones. La participación de las mujeres en las decisiones clínicas durante el proceso de embarazo y parto es aún escasa y el poder sigue manteniéndose en los profesionales de la salud, perpetuándose prácticas de violencia institucional. Para avanzar en una práctica obstétrica centrada en las mujeres, es importante reconocer el papel activo que ellas quieren y pueden cumplir para vivir una experiencia positiva y satisfactoria.

Introduction : Enhancing women's participation during pregnancy and childbirth is in line with the call of the World Health Organization and is linked to effects on user satisfaction, clinical health outcomes and better management of health care providers. Objective : To discover women's needs for participation in decision making during pregnancy and childbirth. Methods : Secondary analysis of a descriptive qualitative study with hospitalized women from the puerperium service of two hospitals in Santiago, Chile. The data analysis was carried out using the method proposed by Grounded Theory. Results : Twelve women participated in two focus groups. The relational analysis showed that participation in the reproductive process is interfered by two groups of factors linked to cultural meanings and to the violation of women's rights. Conclusions: Women's participation in clinical decisions during pregnancy and childbirth is still scarce and power is still held by health professionals, perpetuating practices of institutional violence. To advance in obstetric practice centered on women, it is important to recognize the active role that women want and can play in order to have a positive and satisfactory experience.

Advancing towards the implementation of patient-centred care in Chile: An opportunity to effectively practice shared decision-making.

In Chile, local normative and guidelines place patient-centred care (PCC) as a desirable means and outcome for each level of health care. Thus, a definition of PCC is provided, and for the first time shared decision-making (SDM) is included as an intended practice. During the past five years the country has shown progress on the implementation of PCC. A large pilot study was conducted in one of the Metropolitan Health Services, and now the health authority is committed to escalate a PCC strategy nationwide. From the practice domain, most of the work is being placed on the training of health professionals. Patients' preparation for the clinical encounter is scarce, thereby limiting their potential to participate in their care. At the research domain, the country shows a strengthened agenda that has advanced from a diagnostic phase (including the exploration from social sciences) to a purposeful stage which involves the development of training programs, patient decision aids, international collaborations, and other PCC interventions. The country is now positioned to secure new initiatives to empower patients and allow them to take an active role, as a key component of PCC and SDM.

El significado de la menopausia para un grupo de mujeres chilenas atendidas en el sistema público de salud / The significance of menopause for Chilean women attending primary health care centers

BACKGROUND: Menopause connects a biological event with social representations related to aging AIM: To assess the meaning of menopause in a group of Chilean women attending primary health care. MATERIALS AND METHODS: Secondary analysis of a descriptive qualitative study of in-depth interviews to explore the meaning of menopause in fifteen women aged 55 to 71 years who experienced menopause between 2 and 29 years before. Data were collected using the method proposed by the Grounded Theory. Guba's criteria of scientific rigor were used. RESULTS: Relational analysis shows that menopause divides the life cycle of women into two stages related with the possibility of having children, which is heavily influenced by the cultural significance of menopause. CONCLUSIONS: Women perceive that menopause is a natural stage and that it is the end of a period focused on tasks related to reproduction and motherhood. However, that "normality" includes a suffering process, loaded with negative cultural beliefs about menopause passed down for generations.

[Experts' views on the communication of risks and benefits of mammography to detect breast cancer]. / Consideraciones para comunicar riesgos y beneficios de la mamografía a mujeres desde la perspectiva de los expertos.

BACKGROUND: Breast cancer (BC) has a high mortality rate in developing countries due to a scarcity of early detection. Risk communication is critical to support women who face the decision to undertake BC screening. Thus, they can balance their perceived and real risk, and make informed choices. AIM: To describe experts' views on how the provision of information related to BC screening should be made. MATERIAL AND METHODS: A qualitative study with focus groups with national experts was conducted. Open coding was performed. RESULTS: Four categories on the way information about BC screening should be provided emerged: to communicate about the need of the exam; the pros and cons of the test; fear as a barrier for understanding; and involving women in the decision-making process. CONCLUSIONS: These findings emphasize the need to include risk communication strategies in the patient-provider relationship and encourage and respect women's autonomy when facing the BC screening decision.

Validación del instrumento Informed Choice para medir la decisión informada de mamografía en mujeres chilenas usuarias de atención primaria / Validation of the Informed Choice instrument for Chilean women facing a mammography decision in primary care

Objetivo: Adaptar y validar el instrumento Informed Choice (IC) para la decisión de mamografía al contexto chileno. Diseño: Estudio transversal, analítico, de adaptación y validación psicométrica. Emplazamiento: Centro de atención primaria del sector sur oriente de Santiago de Chile. Métodos: 1) traducir y contra-traducir IC; 2) realizar un grupo focal para la relevancia cultural/lingüística; 3) examinar la validez del contenido; 4) pilotar el instrumento; 5) aplicar para validación. Para la consistencia interna se usó el alfa de Cronbach, prueba de esfericidad de Bartlett y la medida de Kaiser-Meyer-Olkin para determinar correlaciones entre las variables y análisis factorial. Resultados: Se construyeron 3 versiones del IC, modificándose según la opinión de usuarios y expertos. La validación se llevó a cabo en una muestra de 70 mujeres. La edad media fue de 54,4 años, el 47,1% de educación secundaria completa y el 92,9% al menos se había realizado alguna vez una mamografía. Se realizó análisis factorial del IC y se eliminó uno de sus ítems. El alfa de Cronbach final fue 0,79. Conclusión: El uso de instrumentos de medición requiere de su validación previa ya que la versión original puede variar de acuerdo al contexto cultural donde será aplicado y las necesidades locales particulares. El proceso de validación del IC permite contar con un instrumento confiable para medir la decisión de las mujeres que deben realizarse la mamografía en la dimensión conocimiento, actitud e intención hacia el examen.(AU)

Objective: To adapt and validate for the Chilean context the instrument Informed Choice (IC) to measure informed decision for mammography. Location: Primary Health Care Center in southeast Santiago, Chile. Design: Individual, transversal, analytical and psychometric adaptation and validation study. Methods: We 1) translated and back-translated IC; 2) conducted a focus group for cultural/linguistic relevance; 3) reviewed content validity; 4) piloted the instrument; 5) applied IC for validation. Analysis was performed by using Cronbach alpha, correlation, Bartlett's test of sphericity, Kaiser-Meyer-Olkin measure and factor analysis. Results: Three versions of the IC were developed, which included changes according to the views of users and experts. Validation was conducted in a sample of 70 women. Mean age was 54,4 years, 47,1% had completed secondary school and 92,9% have had at least one mammography. After factor analysis item 1 was removed and the final Cronbach Alpha was 0,79. Conclusions: The Chilean IC is reliable to measure decision women for mammography, this evaluate knowledge, attitude and intention towards the screening. The validation of an instrument to the cultural context is necessary and may have any variations to the original version according to local needs.(AU)

[Validation of the Informed Choice instrument for Chilean women facing a mammography decision in primary care]. / Validación del instrumento Informed Choice para medir la decisión informada de mamografía en mujeres chilenas usuarias de atención primaria.

OBJECTIVE: To adapt and validate for the Chilean context the instrument Informed Choice (IC) to measure informed decision for mammography. LOCATION: Primary Health Care Center in southeast Santiago, Chile. DESIGN: Individual, transversal, analytical and psychometric adaptation and validation study. METHODS: We 1) translated and back-translated IC; 2) conducted a focus group for cultural/linguistic relevance; 3) reviewed content validity; 4) piloted the instrument; 5) applied IC for validation. Analysis was performed by using Cronbach alpha, correlation, Bartlett's test of sphericity, Kaiser-Meyer-Olkin measure and factor analysis. RESULTS: Three versions of the IC were developed, which included changes according to the views of users and experts. Validation was conducted in a sample of 70 women. Mean age was 54,4 years, 47,1% had completed secondary school and 92,9% have had at least one mammography. After factor analysis item 1 was removed and the final Cronbach Alpha was 0,79. CONCLUSIONS: The Chilean IC is reliable to measure decision women for mammography, this evaluate knowledge, attitude and intention towards the screening. The validation of an instrument to the cultural context is necessary and may have any variations to the original version according to local needs.

Consideraciones para comunicar riesgos y beneficios de la mamografía a mujeres desde la perspectiva de los expertos / Experts' views on the communication of risks and benefits of mammography to detect breast cancer

Background: Breast cancer (BC) has a high mortality rate in developing countries due to a scarcity of early detection. Risk communication is critical to support women who face the decision to undertake BC screening. Thus, they can balance their perceived and real risk, and make informed choices. Aim: To describe experts' views on how the provision of information related to BC screening should be made. Material and Methods: A qualitative study with focus groups with national experts was conducted. Open coding was performed. Results: Four categories on the way information about BC screening should be provided emerged: to communicate about the need of the exam; the pros and cons of the test; fear as a barrier for understanding; and involving women in the decision-making process. Conclusions: These findings emphasize the need to include risk communication strategies in the patient-provider relationship and encourage and respect women's autonomy when facing the BC screening decision.

Perfil de competencias del tutor clínico de enfermería desde la perspectiva del personal de enfermería experto / Competencies of clinical nursing preceptors from the perspective of expert nurses

INTRODUCCIÓN: La figura del tutor clínico es esencial en la formación de los estudiantes de enfermería, dado que es modelo y guía en los procesos de aproximación al quehacer profesional y se transforma en facilitador del aprendizaje y en un nexo entre la teoría y la práctica. Pese a ello, en Chile no se han establecido las competencias del tutor clínico de enferme-ría para estudiantes de pregrado, por lo que el objetivo del manuscrito es describir sus competencias para la formación de estudiantes de pregrado de enfermería chilenos desde la perspectiva del personal de enfermería experto. Sujetos y métodos. Es un estudio de diseño cualitativo. Para la construcción del perfil de competencias se realizó un Del-phi electrónico con 22 enfermeros expertos y luego se realizó la validación de contenido con la participación de jueces. RESULTADOS: Participaron 12-14 enfermeros expertos y 11 jueces. Se construyó el perfil de competencias para el tutor clínico de enfermería, compuesto de cinco dimensiones: profesional, docencia clínica, pensamiento crítico, habilidades interpersonales y trabajo en equipo. CONCLUSIÓN: El perfil brinda orientación y estándares que aseguran la calidad de la docencia y de la formación de futuros enfermeros en un marco que profesionaliza la labor de los tutores clínicos

INTRODUCTION: The clinical preceptor is essential in the training of nursing students. They are a model and guide in the approach to professional work, facilitate learning and link theory and practice. In Chile, the competencies of the nursing clinical preceptor for undergraduate students have not been established. So the purpose of the manuscript is to describe the competencies of the clinical nursing preceptor for the training of Chilean nursing undergraduate students from the perspective of expert nurses. Subjects and methods. Qualitative design study. For the construction of the competency profi le, an electronic Delphi was conducted with 22 expert nurses, then the content was validated with the participation of judges. RESULTS: 12-14 nurses and 11 judges participated. The Profi le of competencies for the clinical nursing preceptor composed of fi ve dimensions: professional, clinical teaching, critical thinking, interpersonal skills and teamwork. CONCLUSION: The profile provides guidance and standards that ensure the quality of teaching and the training of future nurses in a framework that professionalizes the work of clinical preceptor

[Development of a tool to conduct family studies in primary health care]. / Estudio de familia en Atención Primaria: construcción y validación de una herramienta para la valoración familiar.

BACKGROUND: The Family and Community Health Model (MAIS) establishes the continuity of care as an essential principle. The Family Study, as a clinical strategy, allows to have sufficient and timely information and knowledge about users of health care services, facilitates their accompaniment and is a source of information to improve the quality of care and the management of health centers. AIM: To develop a tool to conduct family studies, devised by experts in Primary Health Care. MATERIAL AND METHODS: Using a qualitative method, an electronic Delphi was conducted on 24 experts on primary health care. Afterwards, the content validation was carried out with the participation of judges. RESULTS: The resulting tool considers two levels of family assessment. It allows to distinguish those families that would benefit from interventions of greater complexity than those derived from the usual care of health centers. CONCLUSIONS: The tool to perform family studies responds to the informational and continuity component of Continuity of Patient Care principle. It may be a proposal for the continuous improvement of Chilean primary care.

Estudio de familia en Atención Primaria: construcción y validación de una herramienta para la valoración familiar / Development of a tool to conduct family studies in primary health care

Background: The Family and Community Health Model (MAIS) establishes the continuity of care as an essential principle. The Family Study, as a clinical strategy, allows to have sufficient and timely information and knowledge about users of health care services, facilitates their accompaniment and is a source of information to improve the quality of care and the management of health centers. Aim: To develop a tool to conduct family studies, devised by experts in Primary Health Care. Material and Methods: Using a qualitative method, an electronic Delphi was conducted on 24 experts on primary health care. Afterwards, the content validation was carried out with the participation of judges. Results: The resulting tool considers two levels of family assessment. It allows to distinguish those families that would benefit from interventions of greater complexity than those derived from the usual care of health centers. Conclusions: The tool to perform family studies responds to the informational and continuity component of Continuity of Patient Care principle. It may be a proposal for the continuous improvement of Chilean primary care.

Conflicto decisional en personas con diabetes mellitus e hipertensión arterial usuarias del nivel primario de atención de salud de Chile / Decisional conflict among people with diabetes mellitus or hypertension attending primary care

Background: Decisional conflict refers to the personal uncertainty about which course of action to take when the choice involves risk, regret, or challenge to personal life values. Aim: To determine the level of decisional conflict (DC) of people with Diabetes Mellitus (DM) or High Blood Pressure (HBP) attending primary care centers (PCC) in Chile. Patients and Methods: A Spanish version of the Decisional Conflict Scale (DCS) was applied to patients who were recruited if they had DM or HBP, were 18 years old or older, and had an appointment at the PCC the day of the recruitment. The scale was self-administered. Analysis of covariance (ANCOVA) was used to determine association between DC and other variables of interest while controlling confounding variables. Results: The scale was answered by 1075 participants from 24 PCC aged 62 ± 14 years (74% female). Average score for the DCS scale was 16.8 ± 12.9 of a maximum of 100 points indicating a higher DC. The sub-scale "information" had the highest score (19.9 ± 20.0). Low educational level and older age were significantly associated with higher DCS scores (p < 0.05). Having a bad health perception, deciding to initiate a medical treatment and being attended by a doctor were significantly associated with higher DC. These associations persisted when confounding variables such as sex, age and education were controlled. Conclusions: People with DM or HBP who have a poor health perception, who initiated their treatment and were attended by a doctor had higher levels of DC, independent of their age and educational level.

Participación de los usuarios en las decisiones clínicas en la atención primaria de salud en Chile

[RESUMEN]. Objetivo. Describir la experiencia de participación en las decisiones clínicas desde la perspectiva de usuarios de Centros de Salud Familiar (CESFAM) de la Atención Primaria de Salud (APS). Métodos. Estudio de diseño cualitativo descriptivo; se realizaron grupos focales con usuarios de CESFAM del área sudeste de Santiago, Chile, y análisis temático de la información utilizando el programa Atlas.ti versión 6. Resultados. Se realizaron cinco grupos focales (n = 41). Los principales temas emergentes fueron el rol pasivo de los usuarios en las decisiones y la toma de decisión delegada, basada en la confianza en el profesional. El rol pasivo de los usuarios limita las oportunidades de participación en las decisiones clínicas y mantiene el poder en los profesionales de la salud. A pesar de ello, el establecimiento de una alianza terapéutica les permita sentirse tratados como personas únicas, escuchados y respetados por los profesionales, lo que asegura que las decisiones tomadas por el equipo de salud son confiables, pues velan por sus reales intereses. Conclusión. La participación de los usuarios en los encuentros clínicos es aún escasa en el país. Sin embargo, potenciar esta participación es esencial para aumentar la satisfacción usuaria y promover un cuidado centrado en la persona.

[ABSTRACT]. Objective. Describe users’ experience with participation in clinical decision-making at Family Health Centers (CESFAM) in the Primary Health Care (PHC) system. Methods. Qualitative descriptive study. Focus groups made up of CESFAM users were held in southeastern Santiago, Chile, and the information was thematically analyzed using Atlas.ti version 6® software. Results. Five focus groups were held (n = 41). The main themes that emerged from the discussions were the passive role of users in decisions and delegated decision-making, based on their trust in the health professional. Users’ passive role limits their opportunities for participation in clinical decision-making, ceding power to the health professional. However, establishing a therapeutic partnership allows users to feel that they are being treated as unique individuals whom the professional listens to and respects, ensuring that the decisions of the health team can be trusted, since they look out for the users’ real interests. Conclusion. Users’ participation in clinical encounters is still limited in Chile. However, bolstering that participation is essential for increasing user satisfaction and promoting people-centered care.

[RESUMO]. Objetivo. Descrever a experiência de participação nas decisões clínicas dos usuários dos Centros de Saúde Familiar (CESFAM) de atenção primária à saúde. Métodos. Estudo qualitativo descritivo conduzido em grupos de discussão formados por usuários dos CESFAM da região sudeste da cidade de Santiago, no Chile. Foi realizada uma análise temática das informações com o uso do programa de software ATLAS.ti versão 6. Resultados. Foram formados cinco grupos de discussão (n = 41). Os principais tópicos abordados foram o papel passivo dos usuários nas decisões e a tomada de decisão delegada aos profissionais na base da confiança. O papel passivo restringe as oportunidades de participação dos usuários nas decisões clínicas e mantém o poder nas mãos dos profissionais da saúde. Apesar disso, ao ser criada uma aliança terapêutica, os usuários se sentem tratados como indivíduos únicos que são ouvidos e respeitados pelos profissionais, o que assegura que as decisões tomadas pela equipe de saúde sejam confiáveis porque protegem os reais interesses dos usuários. Conclusão. Os usuários ainda têm pouca participação nas interações clínicas no Chile. Porém, é fundamental reforçar esta participação para melhorar a satisfação do usuário e promover uma atenção mais centrada na pessoa.

Formación y competencias para los equipos de atención primaria desde la mirada de expertos chilenos

[RESUMEN]. Objetivo. Describir las competencias para equipos de atención primaria en salud (APS) en distintos tópicos vinculados a la atención directa del usuario y a la gestión de los centros de salud primarios, de acuerdo a la percepción de expertos chilenos en APS. Métodos. Estudio de diseño mixto. Se realizó un Delphi electrónico con 29 expertos nacionales en APS. Resultados. Se propone una matriz de competencias específicas vinculada al trabajo directo con familias y a la gestión del centro de salud priorizados en tres niveles. Los expertos concuerdan que se requiere una masa crítica de profesionales que cuenten con competencias que le conciernen a la APS. Conclusiones. El reto de reorganizar los sistemas de salud en torno a una APS fuerte y de calidad solo puede lograrse con la participación de profesionales que comprendan y practiquen los atributos y principios fundamentales de la APS. Los resultados de este estudio dan cuenta de un perfil de competencias para profesionales de APS alineado con recomendaciones internacionales alcanzable a través de estrategias de educación continua.

[ABSTRACT]. Objective. To describe the competencies for primary health care teams (PHC) in different topics related to the direct care of the user and the management of primary health centers, according to the perception of Chilean experts in PHC. Methods. Mixed design studio. An electronic Delphi method was conducted with 29 national experts in APS. Results. A matrix of specific competences related to direct work with families and to the management of the health center prioritized in three levels is proposed. Experts agreed that a critical mass of professionals with competencies in PHC is required. Conclusions. The challenge of reorganizing health systems around a strong and quality PHC can only be achieved with the participation of professionals who understand and practice the attributes and fundamental principles of PHC. The results of this study show a competency profile for PHC professionals aligned with international recommendations achievable through continuous education strategies.

[RESUMO]. Objetivo. Descrever as habilidades para equipes de atenção primária à saúde (APS) sobre vários tópicos vinculados com a atenção direta do usuário e gestão de centros de saúde, de acordo com a percepção de especialistas chilenos na APS. Métodos. Estudo de desenho misto. Foi realizado um Delphi eletrônico com 29 especialistas nacionais em APS. Resultados. É proposta uma matriz de competências específicas vinculada ao trabalho direto com famílias e à gestão do centro de saúde priorizados em três níveis. Os especialistas concordam que se requer uma massa crítica de profissionais que contem com competências em APS. Conclusões. O desafio de reorganizar os sistemas de saúde em torno de uma APS forte e de qualidade só se pode conseguir com a participação de profissionais que entendem e pratiquem os atributos e os princípios fundamentais da APS. Os resultados deste estudo mostram um perfil de competências para profissionais de APS alinhados com recomendações internacionais que podem ser alcançadas através de estratégias de educação contínua.

Adaptación y validación del instrumento genérico CollaboRATE(TM) para medir la participación de mujeres en la toma de decisiones en salud durante el proceso reproductivo / Adapting and validating the generic instrument CollaboRATE(TM) to measure women's participation in health related decision-making during the reproductive process

Introducción: La participación en la toma de decisiones en salud (TDS) responde a un interés global por involucrar a las personas como actores activos en la búsqueda de alternativas terapéuticas y la elección de cursos de acción que les permitan mantener una mejor calidad de vida y bienestar. La mayoría de los instrumentos disponibles para evaluar el grado de participación han sido desarrollados en inglés y para países de altos ingresos. Objetivo: Adaptar y validar a la realidad chilena el instrumento CollaboRATE(TM) para medir la participación de las mujeres en decisiones vinculadas al periodo reproductivo. Diseño: Estudio transversal de adaptación y validación psicométrica del instrumento CollaboRATE(TM). Emplazamiento: Maternidades del Servicio de Salud de Santiago, Chile. Participantes: Puérperas usuarias del servicio de maternidad de tres hospitales públicos. Método: Se usó la técnica de traducción y contra traducción, seguida de evaluación de la pertinencia cultural y lingüística con grupos de usuarios y la revisión de la versión final por un grupo de expertos. Seguido de un estudio con 90 usuarias del servicio público de salud. Resultados: La versión chilena de CollaboRATE(TM) es un instrumento validado que demostró ser confiable (alfa de Cronbach ≥ 0,89) para medir el grado de participación de mujeres en la TDS relativas al proceso reproductivo. Conclusiones: Este estudio proporciona el primer instrumento para evaluar la TDS en un país de América Latina, que puede ser fundamental en futuros esfuerzos de investigación que exploren la participación de las personas en las decisiones relacionadas con su salud

Introduction: There is a worldwide interest in involving patients in health related decisions, so patients can actively search for therapeutic options and choose course of action that allows them to have better quality of life and wellbeing. The majority of the instruments available to capture the degree of participation in medical decision-making are in English and have been developed in high income countries. Objective: To adapt and validate for the Chilean context the instrument CollaboRATE(TM), to measure women's participation in medical decisions during the reproductive process. Design: Cross-sectional study to adapt and validate the instrument CollaboRATE(TM). Location: Maternity units in Santiago, Chile. Participants: Puerperal women in maternity units of three public hospitals. Method: Translation and back-translation, cultural and linguistic relevance with service users and final revision by experts. Study for validation with 90 puerperal women. Results: The Chilean version of CollaboRAT(TM) demonstrated to be a reliable instrument to capture the degree of patients' participation in medical decision-making. Cronbach alpha was above 0.89. Conclusions: This study provides the first instrument to capture the prevalence of SDM in a Latin American country. This instrument will be critical in future research efforts that seek to explore to what extent people are being involved in the decisions related to their healthcare

[User Participation in Clinical Decision-making in Primary Health Care in ChileParticipação dos usuários nas decisões clínicas na atenção primária à saúde no Chile]. / Participación de los usuarios en las decisiones clínicas en la atención primaria de salud en Chile.

OBJECTIVE: Describe users' experience with participation in clinical decision-making at Family Health Centers (CESFAM) in the Primary Health Care (PHC) system. METHODS: Qualitative descriptive study. Focus groups made up of CESFAM users were held in southeastern Santiago, Chile, and the information was thematically analyzed using Atlas.ti version 6® software. RESULTS: Five focus groups were held (n = 41). The main themes that emerged from the discussions were the passive role of users in decisions and delegated decision-making, based on their trust in the health professional. Users' passive role limits their opportunities for participation in clinical decision-making, ceding power to the health professional. However, establishing a therapeutic partnership allows users to feel that they are being treated as unique individuals whom the professional listens to and respects, ensuring that the decisions of the health team can be trusted, since they look out for the users' real interests. CONCLUSION: Users' participation in clinical encounters is still limited in Chile. However, bolstering that participation is essential for increasing user satisfaction and promoting people-centered care.

OBJETIVO: Descrever a experiência de participação nas decisões clínicas dos usuários dos Centros de Saúde Familiar (CESFAM) de atenção primária à saúde. MÉTODOS: Estudo qualitativo descritivo conduzido em grupos de discussão formados por usuários dos CESFAM da região sudeste da cidade de Santiago, no Chile. Foi realizada uma análise temática das informações com o uso do programa de software ATLAS.ti® versão 6. RESULTADOS: Foram formados cinco grupos de discussão (n = 41). Os principais tópicos abordados foram o papel passivo dos usuários nas decisões e a tomada de decisão delegada aos profissionais na base da confiança. O papel passivo restringe as oportunidades de participação dos usuários nas decisões clínicas e mantém o poder nas mãos dos profissionais da saúde. Apesar disso, ao ser criada uma aliança terapêutica, os usuários se sentem tratados como indivíduos únicos que são ouvidos e respeitados pelos profissionais, o que assegura que as decisões tomadas pela equipe de saúde sejam confiáveis porque protegem os reais interesses dos usuários. CONCLUSÃO: Os usuários ainda têm pouca participação nas interações clínicas no Chile. Porém, é fundamental reforçar esta participação para melhorar a satisfação do usuário e promover uma atenção mais centrada na pessoa.

[Training and competencies for primary care teams from the perspective of Chilean expertsTreinamento e competências para equipes de atenção primária na perspectiva de especialistas chilenos]. / Formación y competencias para los equipos de atención primaria desde la mirada de expertos chilenos.

OBJECTIVE: To describe the competencies for primary health care teams (PHC) in different topics related to the direct care of the user and the management of primary health centers, according to the perception of Chilean experts in PHC. METHODS: Mixed design studio. An electronic Delphi method was conducted with 29 national experts in APS. RESULTS: A matrix of specific competences related to direct work with families and to the management of the health center prioritized in three levels is proposed. Experts agreed that a critical mass of professionals with competencies in PHC is required. CONCLUSIONS: The challenge of reorganizing health systems around a strong and quality PHC can only be achieved with the participation of professionals who understand and practice the attributes and fundamental principles of PHC. The results of this study show a competency profile for PHC professionals aligned with international recommendations achievable through continuous education strategies.

OBJETIVO: Descrever as habilidades para equipes de atenção primária à saúde (APS) sobre vários tópicos vinculados com a atenção direta do usuário e gestão de centros de saúde, de acordo com a percepção de especialistas chilenos na APS. MÉTODOS: Estudo de desenho misto. Foi realizado um Delphi eletrônico com 29 especialistas nacionais em APS. RESULTADOS: É proposta uma matriz de competências específicas vinculada ao trabalho direto com famílias e à gestão do centro de saúde priorizados em três níveis. Os especialistas concordam que se requer uma massa crítica de profissionais que contem com competências em APS. CONCLUSÕES: O desafio de reorganizar os sistemas de saúde em torno de uma APS forte e de qualidade só se pode conseguir com a participação de profissionais que entendem e pratiquem os atributos e os princípios fundamentais da APS. Os resultados deste estudo mostram um perfil de competências para profissionais de APS alinhados com recomendações internacionais que podem ser alcançadas através de estratégias de educação contínua.

[Decisional conflict among people with diabetes mellitus or hypertension attending primary care]. / Conflicto decisional en personas con diabetes mellitus e hipertensión arterial usuarias del nivel primario de atención de salud de Chile.

BACKGROUND: Decisional conflict refers to the personal uncertainty about which course of action to take when the choice involves risk, regret, or challenge to personal life values. AIM: To determine the level of decisional conflict (DC) of people with Diabetes Mellitus (DM) or High Blood Pressure (HBP) attending primary care centers (PCC) in Chile. PATIENTS AND METHODS: A Spanish version of the Decisional Conflict Scale (DCS) was applied to patients who were recruited if they had DM or HBP, were 18 years old or older, and had an appointment at the PCC the day of the recruitment. The scale was self-administered. Analysis of covariance (ANCOVA) was used to determine association between DC and other variables of interest while controlling confounding variables. RESULTS: The scale was answered by 1075 participants from 24 PCC aged 62 ± 14 years (74% female). Average score for the DCS scale was 16.8 ± 12.9 of a maximum of 100 points indicating a higher DC. The sub-scale "information" had the highest score (19.9 ± 20.0). Low educational level and older age were significantly associated with higher DCS scores (p < 0.05). Having a bad health perception, deciding to initiate a medical treatment and being attended by a doctor were significantly associated with higher DC. These associations persisted when confounding variables such as sex, age and education were controlled. CONCLUSIONS: People with DM or HBP who have a poor health perception, who initiated their treatment and were attended by a doctor had higher levels of DC, independent of their age and educational level.