Social determinants of health influencing the choice of dialysis modality in advanced chronic kidney disease: Need of an interdisciplinary approach.

INTRODUCTION: The influence of socioeconomic and cultural barriers in the choice of renal replacement therapy (RRT) techniques in advanced chronic kidney disease (ACKD) has been scarcely explored, which can generate problems of inequity, frequently unnoticed in health care. The aim of this study is to identify the "non-medical" barriers that influence the choice of RRT in an advanced chronic kidney disease (ACKD) consultation in Spain. MATERIAL AND METHODS: Retrospective analysis including the total number of patients seen in the ACKD consultation in a tertiary hospital from 2009 to 2020. Inclusion in the ACKD consultation began with an eligibility test and a decision-making process, conducted by a specifically trained nurse. The variables considered for the study were: age, sex, etiology of CKD, level of dependence for basic activities of daily living (Barthel Scale) and instrumental activities of daily living (Lawton and Brody Scale), Spanish versus foreign nationality, socioeconomic level and language barrier. The socioeconomic level was extrapolated according to home and health district by primary care center to which the patients belonged. RESULTS: A total of 673 persons were seen in the ACKD consultation during the study period, of whom 400 (59.4%) opted for hemodialysis (HD), 156 (23.1%) for peritoneal dialysis (PD), 4 (0.5%) for early living donor renal transplantation (LDRT) and 113 (16.7%) chose conservative care (CC). The choice of PD as the chosen RRT technique (vs. HD) was associated with people with a high socioeconomic level (38.7% vs. 22.5%) (p = 0.002), Spanish nationality (91% vs. 77.7%) (p < 0.001), to a lower language barrier (0.6% vs 10.5%) (p < 0.001), and to a higher score on the Barthel scale (97.4 vs 92.9) and on the Lawton and Brody scale (7 vs 6.1) (p < 0.001). Neither age nor sex showed significant differences in the choice of both techniques. Patients who opted for CC were significantly older (81.1 vs 67.7 years; p < 0.001), more dependent (p < 0.001), with a higher proportion of women (49.6% vs 35.2%; p = 0.006) and a higher proportion of Spaniards (94.7% vs 81%, p = 0.001) in relation to the choice of other techniques (PD and HD). Socioeconomic level did not influence the choice of CC. CONCLUSION: Despite a regulated decision-making process, there are factors such as socioeconomic status, migration, language barrier and dependency of the population that influence the type of RRT chosen. To address these aspects that may cause inequity, an intersectoral and multilevel intervention is required with interdisciplinary teams that include, among others, social workers, to provide a more holistic and person-centered assessment.

Do consentimento informado à tomada de decisão compartilhada e a urgência de sua implementação no contexto brasileiro / Del consentimiento informado a la toma de decisiones compartida y la urgencia de su implementación en el contexto brasileño / Del consentiment informat a la presa de decisions compartides i la urgència de la seva implementació en el context brasiler / From informed consent to shared decision making and the urgency of its implementation in Braziliancontext

O presente artigo expõe um panorama geral da Tomada de Decisão Compartilhada (TDC), considerada cada vez mais como a melhor forma para envolver os pacientes no processo de decisão sobre seus cuidados em saúde. Contudo, a despeito do amplo reconhecimento internacional, a TDC ainda não se encontra amplamente implementada na prática clínica brasileira, sendo o consentimento informado o modelo de tomada de decisão mais comumente adotado pelos profissionais de saúde. Assim, este trabalho, após esclarecer as definições em torno da TDC, apresenta instrumentos para sua aplicação e as razões pelas quais essa nova forma de tomar decisões deve ser preferível ao consentimento informado.(AU)

L'actual article exposa una visió general de la Presa de Decisions Compartides (PDC), cada vegada més considerada com la millor manera d'involucrar els pacients en el procés de decisió sobre la seva cura sanitària. No obstant això, malgrat el reconeixement internacional ampli, la PDC encara no està àmpliament implementada en la pràctica clínica brasilera, essent el consentiment informat el model de presa de decisions més comunament adoptatpels professionals de la salut. Així, aquest treball, després de clarificar les definicions al voltant de la PDC, presenta instruments per a la seva aplicació i les raons per les quals aquesta nova forma de prendre decisions ha de ser preferible al consentiment informat.(AU)

Este artículo presenta una visión general de la Toma de Decisiones Compartida (TDC), considerada cada vez más como la mejor manera de involucrar a los pacientes en el proceso de toma de decisiones sobre su atencion de salud. Sin embargo, a pesar del amplio reconocimiento internacional, la TDC aún no está ampliamente implementada en la práctica clínica brasileña, siendo el consentimiento informado el modelo de toma de decisiones más comúnmente adoptado por los profesionales de la salud. Así, este trabajo, tras aclarar las definiciones en torno a la TDC, presenta instrumentos para su aplicación y las razones por las que esta nueva forma de tomar decisiones debe ser preferible al consentimiento informado.(AU)

This article presents an overview of Shared Decision Making (SDM), increasingly considered the best way to involve patients in the decision-making process about their health care. However, despite wide international recognition, SDM is still not widely implemented in brazilian clinical practice, with informed consent being the decision-making model most commonly adopted by health professionals. Thus, this work, after clarifying the definitions around SDM, presents instruments for its application and the reasons why this new way of making decisions should be preferable to informed consent.(AU)

Evaluación de la madurez del menor en el ámbito sanitario: la perspectiva de padres y pediatras / Assessment of the maturity of the minor in the health field: the perspective of parents and pediatricians

Introducción: el modelo de respeto a la autonomía y de participación progresiva en el contexto pediátrico requiere que el pediatra que atiende al paciente menor sea capaz de evaluar y decidir si este presenta suficiente madurez y es competente para tomar una decisión sanitaria, o en qué grado participa en la misma. El objetivo es determinar la correlación entre la valoración de la madurez del menor realizada por parte de pediatras y de padres de forma subjetiva, con la realizada mediante una prueba objetiva, la Escala de Valoración de la Madurez de Lleida, MadurTest. Material y métodos: estudio prospectivo, observacional y transversal; 199 adolescentes de entre 12 y 16 años, con patología aguda y crónica. Se evaluó la madurez de los pacientes con la escala MadurTest, y los pediatras y los padres valoraron la madurez del menor con preguntas de la escala Likert para madurez. Resultados: la media de la puntuación de MadurTest fue de 6,39, presentando las niñas un nivel de madurez superior a los niños en la mayoría de las franjas de edad. La valoración de madurez por parte de los pediatras fue de 3,18 de media y por parte de los padres de 3,18. No se observa correlación entre la puntuación obtenida en el MadurTest con la valoración por parte de los profesionales ni por parte de los padres. No obstante, se observa una correlación entre las valoraciones efectuadas por los padres y los profesionales (r = 0,73; p <0,00001). Conclusiones: la madurez de los menores valorada de forma subjetiva por pediatras y padres no se correlaciona con la madurez evaluada de forma objetiva mediante el test MadurTest (AU)

Introduction: the model of respect for autonomy and progressive participation in the pediatric context requires that attending pediatricians be able to assess minor maturity, and decide the degree of participation. The objective of this study is to determine the correlation between the assessment made subjectively by paediatricians and parents, with the maturity of the minor carried out by means of an objective test, the Lleida Maturity Assessment Scale, MadurTest.Material and methods: prospective, observational and cross-sectional study. 199 adolescents between 12 and 16 years old, affected by acute and chronic pathology. The maturity of the patients was evaluated with the MadurTest scale and pediatricians and parents assessed the maturity of the minor in the form of the Likert maturity scale.Results: the mean of the MadurTest score is 6.39, girls present a higher level of maturity than boys in most age groups. The maturity assessment by pediatricians is 3.18 on average and by parents 3.18. No correlation is observed between the score obtained with the MadurTest and the assessment by professionals or by parents. However, a correlation is observed between the assessments made by parents and professionals (r = 0.73, p <0.00001)Conclusions: the maturity of minors assessed subjectively by paediatricians and parents does not correlate with the maturity assessed objectively using the MadurTest. (AU)

Avaliação da educação interprofissional para a tomada de decisão compartilhada em farmacoterapia: uma revisão de escopo sobre métodos e instrumentos / Evaluación de la educación interprofesional para la toma de decisionescompartida en farmacoterapia: una revisión del alcance sobre métodos einstrumentos / Evaluation of interprofessional education for shared decision making in drug therapy: a scoping review on methods and instruments

Resumo Este estudo teve como objetivo descrever os métodos de pesquisa e instrumentos utilizados na avaliação de estratégias de educação interprofissional para a tomada de decisão compartilhada em farmacoterapia. Os tipos de avaliação empregados foram categorizados segundo o modelo adaptado de Kirkpatrick. Foi conduzida uma revisão de escopo, seguindo as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (Prisma-ScR). Entre os 21 estudos selecionados, houve predomínio dos métodos quantitativos na avaliação das experiências educacionais (n=18). Destes, o aspecto mais comum avaliado foi "atitudes e percepções dos estudantes em relação à educação e à prática interprofissional", por meio de instrumentos validados (n=13). Foram identificados dez diferentes instrumentos, que se mostraram em conformidade com as competências colaborativas do Interprofessional Education Collaborative. A variedade de instrumentos sinaliza a crescente produção de conhecimento acerca do assunto, mas aponta o desafio de realizar análises comparativas entre experiências educacionais ao redor do mundo. (AU)

Resumen El objetivo de este estudio es describir los métodos de investigación e instrumentos utilizados en la evaluación de estrategias de educación interprofesional para la toma de decisiones compartida en farmacoterapia. Los tipos de evaluación empleados se caracterizaron según el modelo adaptado de Kirkpatrick. Se realizó una revisión de alcance, siguiendo las recomendaciones del PRISMA-ScR. Entre los 21 estudios seleccionados, predominaron los métodos cuantitativos en la evaluación de las experiencias educativas (n=18). De ellos, el aspecto más común evaluado fue el de "actitudes y percepciones de los alumnos con relación a la educación y a la práctica interprofesional", por medio de instrumentos validados (n=13). Se identificaron diez diferentes instrumentos, que se mostraron en conformidad con las competencias colaborativas del Interprofessional Education Collaborative . La variedad de instrumentos señala la creciente producción de conocimiento sobre el asunto, pero muestra el desafío de realizar análisis comparativos entre experiencias educativas alrededor del mundo. (AU)

Abstract This study aimed to describe the research methods and instruments used in the evaluation of interprofessional education strategies for shared decision making in drug therapy. The types of evaluation employed were categorized according to Kirkpatrick's adapted model. A scoping review was conducted, following the PRISMA-ScR recommendations. Among the 21 selected studies, there was a predominance of quantitative methods in the evaluation of educational experiences (n=18). Of these, the most common aspect evaluated was "students' attitudes and perceptions towards interprofessional education and practice" by means of validated instruments (n=13). Ten different instruments were identified and found to be in line with the Interprofessional Education Collaborative competencies. The variety of instruments signals the growing production of knowledge about this topic, but points to the challenge of conducting comparative analyses between educational experiences around the world. (AU)

Shared decision-making in genetic counseling: A scoping review / La toma de decisiones compartida en el asesoramiento genético: una revisión del ámbito de aplicación / Tomada de decisão compartilhada em aconselhamento genético: uma revisão de propósito

Abstract: Background: It is challenging to make informed decision in genetic counseling. Shared decision-making provides a chance in balancing the information and preferences between counselors and counselees. However, the status and prescriptions of shared decision-making have not been extensively studied in genetic counseling. Aim: To develop an up-to-date literature review of the shared decision-making in genetic counseling, identify knowledge gaps, and provide inspiration and suggestions for the development and practice of genetic counseling. Methods: "Genetic Counseling" and "Shared decision-making" were used to search in PubMed, Web of Science, Embase, Wanfang, CNKI and CBM databases. The search deadline was March 26, 2021. Results: A total of 22 articles were included, and four themes were identified: how people involved in genetic counseling, different stakeholders involved in SDM, multiple facilitators and barriers to SDM and the effectiveness of SDM in genetic counseling. Conclusion: Each participant needs to recognize their boundaries and make the best effort to involve in the shared decision-making. In the future, multinational studies should be considered for bringing shared decision-making to the global scale and well-designed studies are required to explore the long-term impact of shared decision-making in genetic counseling.

Resumen: Antecedentes: Es un reto tomar una decisión informada en el asesoramiento genético. La toma de decisiones compartida ofrece una oportunidad para equilibrar la información y las preferencias entre los asesores y los pacientes. Sin embargo, el estado y las prescripciones de la toma de decisiones compartida no se han estudiado ampliamente en el asesoramiento genético. Objetivo: Desarrollar una revisión bibliográfica actualizada de la toma de decisiones compartida en el asesoramiento genético, identificar las lagunas de conocimiento y proporcionar inspiración y sugerencias para el desarrollo y la práctica del asesoramiento genético. Métodos: "Genetic Counseling" y "Shared decision-making" se utilizaron para buscar en las bases de datos PubMed, Web of Science, Embase, Wanfang, CNKI y CBM. La fecha límite de búsqueda fue el 26 de marzo de 2021. Resultados: Se incluyó un total de 22 artículos y se identificó cuatro temas: cómo se involucran las personas en el asesoramiento genético, las diferentes partes interesadas involucradas en la GDS, los múltiples facilitadores y barreras para la GDS y la efectividad de la GDS en el asesoramiento genético. Conclusión: Cada participante necesita reconocer sus límites y hacer el mejor esfuerzo para involucrarse en la toma de decisiones compartida. En el futuro, se debe considerar la realización de estudios multinacionales para llevar la toma de decisiones compartida a la escala global y se requieren estudios bien diseñados para explorar el impacto a largo plazo de la toma de decisiones compartida en el asesoramiento genético.

Resumo Antecedentes: Tomar uma decisão informada em aconselhamento genético é um desafio. A tomada de decisão compartilhada (SDM) fornece uma oportunidade para contrabalançar a informação e preferências entre conselheiros e aconselhados. Entretanto, o status e prescrições da tomada de decisão compartilhada não têm sido extensivamente estudados em aconselhamento genético. Objetivo: Desenvolver uma revisão de literatura atualizada sobre a tomada de decisão compartilhada em aconselhamento genético, identificar lacunas no conhecimento e fornecer inspiração e sugestões para o desenvolvimento e prática do aconselhamento genético. Métodos: "Genetic Counseling" e "Shared decision-making" foram usados para pesquisar nos bancos de dados PubMed, Web of Science, Embase, Wanfang, CNKI e CBM. A data limite para a pesquisa foi 26 de março de 2021. Resultados: Um total de 22 artigos foram incluídos e quatro temas foram identificados: como pessoas se envolveram em aconselhamento genético, diferentes interessados envolvidos em SDM, facilitadores e barreiras múltiplas à SDM e efetividade da SDM em aconselhamento genético. Conclusão: Cada participante necessita reconhecer seus limites e fazer os melhores esforços para se envolver em tomada de decisão compartilhada. No futuro, estudos multinacionais devem ser considerados para trazer a tomada de decisão compartilhada a uma escala global e estudos bem desenhados são requeridos para explorar o impacto a longo prazo da tomada de decisão compartilhada em aconselhamento genético.

Centering the Voice of the Client: On Becoming a Collaborative Practitioner with Low-Income Individuals and Families.

Despite current interest in collaborative practices, few investigations document the ways practitioners can facilitate collaboration during in-session interactions. This investigation explores verbatim psychotherapy transcripts to describe and illustrate therapist's communications that facilitate or hinder centering client's voice in work with socioeconomically disadvantaged populations. Four exemplar cases were selected from a large intervention trial aimed at improving shared decision making (SDM) skills of psychotherapists working with low-income clients. The exemplar cases were selected because they showed therapist's different degrees of success in facilitating SDM. Therapist's verbalizations were grouped into five distinct communicative practices that centered or de-centered the voice of clients. Communication practices were examined through the lens of collaborative approaches in family therapy. The analysis suggests that cross-fertilization between SDM and family-oriented collaborative and critical approaches shows promise to illuminate and enhance the challenging road from clinician-led to client-led interactions. This paper also stresses the importance of incorporating relational intersectionality with individuals and families who may not feel entitled to express their expectations or raise questions when interacting with authority figures.

A pesar del interés actual en las prácticas colaborativas, pocas investigaciones documentan las maneras en las que los profesionales pueden facilitar la colaboración durante las interacciones dentro de las sesiones. Esta investigación analiza transcripciones textuales de la psicoterapia para describir e ilustrar las comunicaciones de los terapeutas que facilitan u obstaculizan la centralización de la voz del paciente en el trabajo con poblaciones desfavorecidas socioeconómicamente. Se eligieron cuatro casos ejemplares de un ensayo grande de intervención orientado a mejorar las habilidades para la toma de decisiones compartidas de psicoterapeutas que trabajan con pacientes de bajos recursos. Los casos ejemplares se eligieron porque demostraban los diferentes grados de éxito de los terapeutas a la hora de facilitar la toma de decisiones compartidas. Las verbalizaciones del terapeuta se agruparon en cinco prácticas comunicativas diferentes que centralizaban o descentralizaban la voz de los pacientes. Se examinaron las prácticas de comunicación desde la perspectiva de los enfoques colaborativos en la terapia familiar. El análisis sugiere que la fertilización entre el esquema de decisiones compartidas y los enfoques teóricos críticos y colaborativos orientados a la familia promete iluminar y mejorar el difícil camino desde las interacciones dirigidas por el clínico a las dirigidas por los clientes. Este artículo también acentúa la importancia de incorporar la interseccionalidad relacional con personas y familias que posiblemente no se sientan con derecho a expresar sus expectativas o a hacer preguntas cuando interactúan con figuras de autoridad.

Tomada de decisão compartilhada no contexto do paciente adolescente em programa de reabilitação / Shared decision-making in the context of adolescent patient in rehabilitation program / Toma de decisiones compartida en el contexto del paciente adolescente en programa de rehabilitación

Objetivo: analisar a aplicação da tomada de decisão compartilhada no contexto do paciente adolescente, com base no referencial dos Direitos Humanos dos Pacientes (DHP). Metodologia: baseia-se em pesquisa teórica, que se fundamenta no marco teórico dos DHP, desenvolvido por Albuquerque e Eler e nos estudos sobre a tomada de decisão compartilhada, de acordo com Sullivan. A aplicação do proposto neste artigo foi exemplificada pelo relato de experiência de enfermeiros em hospital de referência em reabilitação no Distrito Federal. Resultados: os Direitos Humanos dos Pacientes como referencial normativo e teórico, bem como a tomada de decisão compartilhada aplicada ao paciente adolescente, asseguram o direito à participação no programa de reabilitação, impactando positivamente nos resultados dos cuidados. Considerações finais: o reconhecimento do adolescente enquanto protagonista do seu cuidado em saúde, além de efetivar as determinações de direitos humanos, produz resultados positivos para o tratamento, contribuindo para a adesão, o bem-estar, do paciente, e reduz efeitos adversos e ansiedades.

Objective: to discuss, based on the Patient Human Rights principles, shared decision-making applied to adolescent patients. Methods: it is a theoretical research which application was exemplified by the experience of nurses from a rehabilitation hospital in Federal District, Brazil. Results: Patient Human Rights, as a normative and theoretical principle as well as shared decision-making applied to adolescent patients, ensure the right to participate in the rehabilitation program, with positive impacts to health care outcomes. Conclusion: the recognition of adolescents as protagonists of their own health care, in addition to complying to human rights determinations, produces positive results, contributing to patient compliance, well-being, and reducing adverse effects and anxieties.

Objetivo: discutir la toma de decisiones compartidas en el contexto de pacientes adolescentes, en base al marco de Derechos Humanos de los Pacientes, basado en un programa de rehabilitación. Metodología: se basa en la investigación teórica, basada en el marco teórico de Derechos Humanos de los Pacientes desarrollado por Albuquerque y Eler, e en estudios sobre la toma de decisiones compartidas, según Sullivan. La aplicación de lo que se propuso en este artículo fue ejemplificada por la experiencia de enfermería en un hospital de referencia en rehabilitación en el Distrito Federal. Resultados: los derechos humanos de los pacientes como referencia normativa y teórica, así como la toma de decisiones compartidas aplicadas a pacientes adolescentes, aseguran el derecho a participar en el programa de rehabilitación, impactando positivamente los resultados de la atención. Consideraciones finales: el reconocimiento de los adolescentes como protagonistas de su atención médica, además de hacer determinaciones de derechos humanos, produce resultados positivos para el tratamiento, lo que contribuye al cumplimiento del paciente, el bienestar y reduce los efectos adversos y las ansiedades.

Shared decision-making in advanced chronic kidney disease in the elderly. / Toma de decisiones compartida en la enfermedad renal crónica avanzada del anciano.

Chronic kidney disease is common in people >65years of age. The development and improvement of dialysis techniques has allowed its generalisation to the entire population, when there is a situation of terminal nephropathy, without limit of use due to chronological age. Decision making in elderly patients with advanced chronic kidney disease is complex: in addition to renal parameters, both comorbidity and the presence of geriatric syndromes must be considered. This review addresses the management of information, the decision making of different treatment modalities that can be offered to these patients, and the time of initiation and/or withdrawal of dialysis.

[Improving shared decision-making for hospital patients: Description and evaluation of a treatment intensity assessment tool]. / Innovando en la toma de decisiones compartida con pacientes hospitalizados: descripción y evaluación de una herramienta de registro de nivel de intensidad terapéutica.

BACKGROUND AND AIM: Shared decision-making between patients and healthcare professionals is crucial to guarantee adequate coherence between patient values and preferences, caring aims and treatment intensity, which is key for the provision of patient-centred healthcare. The assessment of such interventions are essential for caring continuity purposes. To do this, reliable and easy-to-use assessment systems are required. This study describes the results of the implementation of a hospital treatment intensity assessment tool. MATERIAL AND METHODS: The pre-implementation and post-implementation results were compared between two cohorts of patients assessed for one month. RESULTS: Some record of care was registered in 6.1% of patients in the pre-implementation group (n=673) compared to 31.6% of patients in the post-implementation group (n=832) (P<.01), with differences between services. Hospital mortality in both cohorts is 1.9%; in the pre-implementation group, 93.75% of deceased patients had treatment intensity assessment. CONCLUSIONS: In hospital settings, the availability of a specific tool seems to encourage very significantly shared decision-making processes between patients and healthcare professionals -multiplying by more than 5 times the treatment intensity assessment. Moreover, such tools help in the caring continuity processes between different teams and the personalisation of caring interventions to be monitored. More research is needed to continue improving shared decision-making for hospital patients.