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1.
Int. j. clin. health psychol. (Internet) ; 24(1): [100417], Ene-Mar, 2024. ilus, tab, graf
Artículo en Inglés | IBECS | ID: ibc-230361

RESUMEN

Background: Individuals with major depressive disorder (MDD) are usually observed making inappropriate risky decisions. However, whether and to what extent MDD is associated with impairments in risky decision-making remains unclear. We performed a three-level meta-analysis to explore the relationship between risky decision-making and MDD. Method: We searched the Web of Science, PubMed, Scopus, and PsycINFO databases up to February 7, 2023, and calculated Hedges' g to demonstrate the difference in risky decision-making between MDD patients and healthy controls (HCs). The moderating effect of sample and task characteristics were also revealed. Results: Across 73 effect sizes in 39 cross-sectional studies, MDD patients exhibited greater risk-seeking than HCs (Hedges' g = 0.187, p = .030). Furthermore, age (p = .068), region (p = .005), and task type (p < .001) were found to have moderating effects. Specifically, patients preferred risk-seeking over HCs as age increased. European patients showed significantly increased risk-seeking compared to American and Asian patients. Patients in the Iowa Gambling Task (IGT) exhibited a notable rise in risk-seeking compared to other tasks, along with an increased risk aversion in the Balloon Analogue Risk Task (BART). The multiple-moderator analysis showed that only task type had significant effects, which may be explained by a tentative framework of "operationalization-mechanism-measure" specificity. Conclusions: MDD patients generally exhibit higher risk-seeking than HCs. It implies that impaired risky decision-making might be a noteworthy symptom of depression, which should be placed more emphasis for clinical management and psycho-education.(AU)


Asunto(s)
Humanos , Masculino , Femenino , Toma de Decisiones , Trastorno Depresivo Mayor , Psicología , Asunción de Riesgos , Conducta Peligrosa , Estudios de Casos y Controles , Psicología Clínica
2.
Eur. j. psychiatry ; 38(1): [100216], Jan.-Mar. 2024.
Artículo en Inglés | IBECS | ID: ibc-229237

RESUMEN

Background and objectives People with psychotic disorders can experience a lack of active involvement in their decisional process. Clinical decision aids are shared decision-making tools which are currently rarely used in mental healthcare. We examined the effects of Treatment E-Assist (TREAT), a computerized clinical decision aid in psychosis care, on shared decision-making and satisfaction with consultations as assessed by patients. Methods A total of 187 patients with a psychotic disorder participated. They received either treatment as usual in the first phase (TAU1), TREAT in the second phase or treatment as usual in the third phase of the trial (TAU2). The Decisional Conflict Scale was used as primary outcome measure for shared decision-making and patient satisfaction as secondary outcome. Results A linear mixed model analysis found no significant effects between TAU 1 (β = −0.54, SE = 2.01, p = 0.80) and TAU 2 (β = −1.66, SE = 2.63, p = 0.53) compared to TREAT on shared decision-making. High patient rated satisfaction with the consultations was found with no significant differences between TAU 1 (β = 1.48, SE = 1.14, p = 0.20) and TAU 2 (β = 2.26, SE = 1.33, p = 0.09) compared to TREAT. Conclusion We expected TREAT to enhance shared decision-making without decreasing satisfaction with consultations. However, no significant differences on shared decision-making or satisfaction with consultations were found. Our findings suggest that TREAT is safe to implement in psychosis care, but more research is needed to fully understand its effects on the decisional process. (AU)


Asunto(s)
Humanos , Toma de Decisiones Asistida por Computador , Técnicas de Apoyo para la Decisión , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/terapia , Toma de Decisiones
3.
Sci Rep ; 14(1): 3002, 2024 02 06.
Artículo en Inglés | MEDLINE | ID: mdl-38321195

RESUMEN

This study aimed to evaluate the relationship between the speed of performing a complex motor task carried out under conditions requiring decision-making and the sports level of the kickboxers being studied. The authors constructed a test involving a complex author's kickboxing task that mirrored the competitive conditions during a sports fight. Forty-seven K-1 kickboxing Polish National Team members (37 men and 10 women) performed a specific series of strikes across three variants. The relationship between the speed of these complex movement tasks, performed under decision-making conditions, and the sports level of the kickboxers, was evaluated. Deciding to start or change an action in reaction to external stimuli significantly (p < 0.001) increased the total task completion time in the male and female subject groups. The time spent deciding to take action and the time spent on deciding on the action were not significantly different. Quick execution of complex tasks under decision-making conditions, such as selecting the appropriate technical and tactical action, can become a decisive factor in determining a sports result. Making decisions to start or change an action as a reaction to external stimuli significantly (p < 0.001) extended the total time of task execution in the studied group. However, the time spent deciding to start the action and the time devoted to deciding during the action did not differ significantly. Therefore, the tactical solution an athlete uses makes no difference, though they must perform it confidently and with minimal time loss.


Asunto(s)
Deportes , Humanos , Masculino , Femenino , Movimiento , Atletas , Destreza Motora , Toma de Decisiones
4.
Behav Brain Sci ; 47: e57, 2024 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-38311464

RESUMEN

Dominant paradigms in science foster integration of research findings, but at what cost? Forcing convergence requires centralizing decision-making authority, and risks reducing the diversity of methods and contributors, both of which are essential for the breakthrough ideas that advance science.


Asunto(s)
Toma de Decisiones
5.
BMC Womens Health ; 24(1): 89, 2024 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-38311740

RESUMEN

PURPOSE: Women diagnosed with ductal carcinoma in situ (DCIS) face confusion and uncertainty about treatment options. The objective of this study was to determine whether there are differences in decisional conflict about treatment by age and race/ethnicity. METHODS: A cross-sectional survey was conducted of women (age ≥ 18) diagnosed with DCIS enrolled at Kaiser Permanente of Southern California. The Decisional Conflict Scale (DCS) measured personal perceptions of decision uncertainty, values clarity, and effective decision-making. We used a multivariable regression to study whether age, race, and ethnicity were associated with patient-reported DCS. RESULTS: 45% (N = 1395) of women who received the online survey, participated. The mean age was 56 (± 9.6) years, the majority were white. Compared to women younger than 50, women aged 60-69 reported lower overall DCS scores (-5.4; 95% CI -1.5 to -9.3). Women > 70 had lower values clarity scores (-9.0; 95% CI -2.8 to -15.2) about their treatment compared to women aged 50-59 and 60-69 (-7.1; 95% CI -2.9 to -11.3 and - 7.2; 95% CI -2.9 to -11.5) and likewise, lower effective decision-making scores (-5.4; 95% CI -1.7 to -9.2 and - 5.2; 95% CI -1.4 to -9.0) compared to women < 50. Compared to whites, blacks reported lower decision conflict (-4.4; 95% CI 0.04 to -8.8) and lower informed decision (-5.2; 95% CI -0.18 to -10.3) about DCIS treatment. CONCLUSION: Younger women reported higher decisional conflict about DCIS treatment, compared to older women (> 70). Age based tailored discussions about treatment options, health education, and supportive decision-making interventions/tools may reduce decision conflict in future DCIS patients. TRADE REGISTRATION: The IRB number is 10678.


Asunto(s)
Carcinoma Intraductal no Infiltrante , Toma de Decisiones , Humanos , Femenino , Anciano , Persona de Mediana Edad , Carcinoma Intraductal no Infiltrante/terapia , Etnicidad , Estudios Transversales , Encuestas y Cuestionarios
6.
Curr Sports Med Rep ; 23(2): 45-52, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-38315432

RESUMEN

ABSTRACT: Legg-Calvé-Perthes disease (LCPD), or idiopathic avascular necrosis of the proximal capital femoral epiphysis in children, has a variable presentation and can result in significant femoral head deformity that can lead to long-term functional deficits. Plain radiographic imaging is crucial in diagnosing LCPD and guiding treatment. Although the etiology of LCPD remains unknown, the evolution of the disease has been well characterized to include the phases of ischemia, revascularization, and reossification. The mechanical weakening during these phases of healing place the femoral head at high risk of deformity. Treatment of LCPD, therefore, focuses on minimizing deformity through operative and nonoperative strategies to reduce the risk of premature osteoarthritis. Advanced imaging using perfusion MRI may refine surgical decision making in the future, and biological treatments to improve femoral head healing are on the horizon.


Asunto(s)
Enfermedad de Legg-Calve-Perthes , Niño , Humanos , Enfermedad de Legg-Calve-Perthes/terapia , Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Cabeza Femoral/diagnóstico por imagen , Radiografía , Imagen por Resonancia Magnética , Toma de Decisiones
7.
Sci Rep ; 14(1): 2735, 2024 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-38302540

RESUMEN

We analyze the visual perception task that home plate umpires (N = 121) perform calling balls and strikes (N = 3,001,019) in baseball games, focusing on the topics of perceptual learning and bias in decision-making. In the context of perceptual learning, our results show that monitoring, training, and feedback improve skill over time. In addition, we document two other aspects of umpires' improvement that are revealing with respect to the nature of their perceptual expertise. First, we show that biases in umpires' decision-making persist even as their overall accuracy improves. This suggests that bias and accuracy are orthogonal and that reduction of bias in decision-making requires interventions aimed specifically at this goal. Second, we measure a distinct difference in the rate of skill improvement between older and younger umpires. Younger umpires improve more quickly, suggesting that the decision task umpires engage in becomes routinized over time.


Asunto(s)
Béisbol , Percepción Visual , Visión Ocular , Aprendizaje , Psicofísica , Toma de Decisiones
8.
Sci Data ; 11(1): 158, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-38302470

RESUMEN

Behavioural and neuroimaging research has shown that older adults are less sensitive to financial losses compared to younger adults. Yet relatively less is known about age-related differences in social decisions and social reward processing. As part of a pilot study, we collected behavioural and functional magnetic resonance imaging (fMRI) data from 50 participants (Younger: N = 26, ages 18-34 years; Older: N = 24, ages 63-80 years) who completed three tasks in the scanner: an economic trust game as the investor with three partners (computer, stranger, friend) as the investee; a card-guessing task with monetary gains and losses shared with three partners (computer, stranger, friend); and an ultimatum game as responder to three anonymous proposers (computer, age-similar adults, age-dissimilar adults). We also collected B0 field maps and high-resolution structural images (T1-weighted and T2-weighted images). These data could be reused to answer questions about moment-to-moment variability in fMRI signal, representational similarity between tasks, and brain structure.


Asunto(s)
Encéfalo , Toma de Decisiones , Imagen por Resonancia Magnética , Anciano , Humanos , Encéfalo/diagnóstico por imagen , Toma de Decisiones/fisiología , Proyectos Piloto , Recompensa , Adulto Joven , Adulto
10.
BMC Med Inform Decis Mak ; 24(1): 32, 2024 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-38308286

RESUMEN

BACKGROUND: Patients with advanced cancer who no longer have standard treatment options available may decide to participate in early phase clinical trials (i.e. experimental treatments with uncertain outcomes). Shared decision-making (SDM) models help to understand considerations that influence patients' decision. Discussion of patient values is essential to SDM, but such communication is often limited in this context and may require new interventions. The OnVaCT intervention, consisting of a preparatory online value clarification tool (OnVaCT) for patients and communication training for oncologists, was previously developed to support SDM. This study aimed to qualitatively explore associations between patient values that are discussed between patients and oncologists during consultations about potential participation in early phase clinical trials before and after implementation of the OnVaCT intervention. METHODS: This study is part of a prospective multicentre nonrandomized controlled clinical trial and had a between-subjects design: pre-intervention patients received usual care, while post-intervention patients additionally received the OnVaCT. Oncologists participated in the communication training between study phases. Patients' initial consultation on potential early phase clinical trial participation was recorded and transcribed verbatim. Applying a directed approach, two independent coders analysed the transcripts using an initial codebook based on previous studies. Steps of continuous evaluation and revision were repeated until data saturation was reached. RESULTS: Data saturation was reached after 32 patient-oncologist consultations (i.e. 17 pre-intervention and 15 post-intervention). The analysis revealed the values: hope, perseverance, quality or quantity of life, risk tolerance, trust in the healthcare system/professionals, autonomy, social adherence, altruism, corporeality, acceptance of one's fate, and humanity. Patients in the pre-intervention phase tended to express values briefly and spontaneously. Oncologists acknowledged the importance of patients' values, but generally only gave 'contrasting' examples of why some accept and others refuse to participate in trials. In the post-intervention phase, many oncologists referred to the OnVaCT and/or asked follow-up questions, while patients used longer phrases that combined multiple values, sometimes clearly indicating their weighing. CONCLUSIONS: While all values were recognized in both study phases, our results have highlighted the different communication patterns around patient values in SDM for potential early phase clinical trial participation before and after implementation of the OnVaCT intervention. This study therefore provides a first (qualitative) indication that the OnVaCT intervention may support patients and oncologists in discussing their values. TRIAL REGISTRATION: Netherlands Trial Registry: NL7335, registered on July 17, 2018.


Asunto(s)
Toma de Decisiones , Neoplasias , Humanos , Estudios Prospectivos , Neoplasias/terapia , Toma de Decisiones Conjunta , Comunicación , Participación del Paciente
11.
Reprod Health ; 21(1): 16, 2024 Feb 02.
Artículo en Inglés | MEDLINE | ID: mdl-38308322

RESUMEN

BACKGROUND: Women in Mozambique are often disempowered when it comes to making decisions concerning their lives, including their bodies and reproductive options. This study aimed to explore the views of women in Mozambique about key elements of empowerment for reproductive decisions and the meanings they attach to these elements. METHODS: Qualitative in-depth interviews were undertaken with 64 women of reproductive age (18-49 years) in two provinces in Mozambique. Participants were recruited through convenience sampling. Data collection took place between February and March 2020 in Maputo city and Province, and during August 2020 in Nampula Province. A thematic analysis was performed. RESULTS: Women described crucial elements of how power is exerted for reproductive choices. These choices include the ability to plan the number and timing of pregnancies and the ability either to negotiate with sexual partners by voicing choice and influencing decisions, or to exercise their right to make decisions independently. They considered that women with empowerment had characteristics such as independence, active participation and being free. These characteristics are recognized key enablers for the process of women's empowerment. CONCLUSIONS: This study's findings contribute to an expanded conceptualization and operationalization of women's sexual and reproductive empowerment by unveiling key elements that need to be considered in future research and approaches to women's empowerment. Furthermore, it gave women the central role and voice in the research of empowerment's conceptualization and measurement where women's views and meanings are seldom considered.


Women who are empowered seem to make better health decisions for themselves. Nevertheless, women's views about and understanding of empowerment are seldom considered in the study of empowerment and its definitions. In this study we explore how women in Mozambique view, understand and experience empowerment, i.e., gaining power and control in the household, and specifically around decision-making processes concerning their reproductive lives. A total of 64 adult women were interviewed in rural and urban areas within two provinces of Mozambique. Through the data analysis, we identified key characteristics of the empowerment process that Mozambican women perceived to be of relevance in their context. Women who have power were perceived as financially and socially independent, free to choose their own pathway, and be active participants in the household decision-making process. In reproductive decisions, women show power through the ability to negotiate with their partner, or by making sole decisions and by planning the number of pregnancies and the size of the family. The elements identified provide important information for improving the definition and the measurement of empowerment in Mozambique, as well as for the support of women in their pathways to empowerment within this context.


Asunto(s)
Toma de Decisiones , Reproducción , Embarazo , Femenino , Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Mozambique , Empoderamiento , Investigación Cualitativa , Derechos de la Mujer
13.
BMJ Open ; 14(2): e075693, 2024 02 02.
Artículo en Inglés | MEDLINE | ID: mdl-38309751

RESUMEN

OBJECTIVES: Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan. DESIGN: In-depth interviews and thematic analysis. SETTING: Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022. PARTICIPANTS: 21 outpatients with at least three visits for DJD and who were aware of SDM. RESULTS: Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations. CONCLUSIONS: In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.


Asunto(s)
Toma de Decisiones , Artropatías , Humanos , Relaciones Médico-Paciente , Pacientes Ambulatorios , Taiwán , Participación del Paciente , Hospitales de Enseñanza
15.
BMC Public Health ; 24(1): 404, 2024 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-38326802

RESUMEN

BACKGROUND: To inform the development of an online tool to be potentially used in shared decision-making about breast cancer screening, French women were questioned about participation in breast cancer screening, the health professional's role, and their perceptions of the proposed tool. METHODS: We organised focus group discussions with 55 French women. Two different strategies were used to recruit women from high and low socioeconomic backgrounds. We applied both inductive and deductive approaches to conduct a thematic analysis of the discussions. We analysed the responses by using the main determinants from different health behaviour models and compared the two groups. RESULTS: Independently of socioeconomic status, the most important determinant for a woman's participation in breast cancer screening was the perceived severity of breast cancer and the perceived benefits of its early detection by screening. Cues to action reported by both groups were invitation letters; recommendations by health professionals, or group/community activities and public events were reported by women from high and low socioeconomic backgrounds, respectively. Among other positive determinants, women from high socioeconomic backgrounds reported making informed decisions and receiving peer support whereas women from low socioeconomic backgrounds reported community empowerment through group/community events. Fear of cancer was reported as a barrier in both groups. Among other barriers, language issues were reported only by women from low socioeconomic backgrounds; women from high socioeconomic backgrounds reported breast cancer screening-related risks other than overdiagnosis and/or overtreatment. Barriers to accessing the online tool to be developed were mainly reported by women from high socioeconomic backgrounds. CONCLUSION: Limitations in implementing shared decision-making for women from low socioeconomic backgrounds were highlighted. An online tool that is suitable for all women, regardless of socioeconomic status, would provide "on-demand" reliable and tailored information about breast cancer screening and improve access to health professionals and social exchanges.


Asunto(s)
Neoplasias de la Mama , Femenino , Humanos , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/prevención & control , Grupos Focales , Detección Precoz del Cáncer , Investigación Cualitativa , Clase Social , Toma de Decisiones , Tamizaje Masivo
17.
Scand J Urol ; 59: 26-30, 2024 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-38358280

RESUMEN

BACKGROUND: Surgical strategy in renal cell carcinoma (RCC) is considered based on the renal function. Partial nephrectomy (PN) preserves kidney function better than radical nephrectomy (RN), lowering risk of chronic kidney disease (CKD). The aim was to evaluate whether renal function and other clinical variables were important for surgical treatment selection. METHODS: Patients with RCC, surgically treated between 1994 and 2018 were included. There were 663 patients in all stages, 265 women and 398 men, mean age 66 years. CLINICAL DATA: estimated glomerular filtration rate (eGFR), WHO performance status (WHO-PS), Charlson comorbidity index (CCI), surgery, T-stage, M-stage, RCC type, tumor size, age, and gender were extracted from the medical records. Statistical analysis included Mann-Whitney U, X2-test, and logistic regression analysis. RESULTS: Of 663 patients, 455 were treated with RN and 208 with PN. In all patients, preoperative eGFR was significantly higher in PN (80.8) than in RN (77.1, p = 0.015). Using logistic regression tumor size (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.95-0.98, T-stage (OR: 0.46; 95% CI: 0.33-0.65), WHO-PS (OR: 0.39; 95% CI: 0.04-0.57), and CCI (OR: 1.23; 95% CI: 1.05-1.44), associated to treatment selection, while eGFR, M-stage, age, and gender did not. In cTa subgroup, eGFR was also higher in PN (84.6) than in RN (75.0, p = 0.007). Using logistic regression, tumor size (OR: 0.93; 95% CI: 0.83-0.98) and WHO-PS (OR: 0.36; 95% CI: 0.20-0.66) associated to treatment selection, while eGFR, CCI, age, and gender did not. CONCLUSION: Tumor size, CCI scores, T-stage, and WHO-PS, all had an impact on the surgical strategy for all RCC patients. In patients with T1a RCC, tumor size and WHO-PS associated independently with treatment decision. After adjusted analysis, renal function lost its independent association with the treatment strategy in RCC patients.


Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Insuficiencia Renal Crónica , Masculino , Humanos , Femenino , Anciano , Carcinoma de Células Renales/cirugía , Carcinoma de Células Renales/patología , Neoplasias Renales/patología , Nefrectomía/efectos adversos , Tasa de Filtración Glomerular , Toma de Decisiones , Estudios Retrospectivos
18.
BMC Med Ethics ; 25(1): 20, 2024 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-38374022

RESUMEN

BACKGROUND: There is considerable variation in the functionality of bioethical services in different institutions and countries for children in hospital, despite new challenges due to increasing technology supports for children with serious illness and medical complexity. We aimed to understand how bioethics services address bioethical concerns that are increasingly encountered in paediatric intensive care. METHODS: A qualitative descriptive design was used to describe clinician's perspectives on the functionality of clinical bioethics services for paediatric intensive care units. Clinicians who were members of formal or informal clinical bioethics groups, or who were closely involved with the process of working through ethically challenging decisions, were interviewed. Interviews took place online. Resulting transcripts were analysed using thematic analysis. RESULTS: From 33 interviews, we identified four themes that described the functionality of bioethics services when a child requires technology to sustain life: striving for consensus; the importance of guidelines; a structure that facilitates a time-sensitive and relevant response; and strong leadership and teamwork. CONCLUSIONS: Clinical bioethics services have the potential to expand their role due to the challenges brought by advancing medical technology and the increasing options it brings for treatment. Further work is needed to identify where and how bioethics services can evolve and adapt to fully address the needs of the decision-makers in PICU.


Asunto(s)
Bioética , Niño , Humanos , Investigación Cualitativa , Unidades de Cuidado Intensivo Pediátrico , Toma de Decisiones , Consenso
19.
Hastings Cent Rep ; 54 Suppl 1: S33-S39, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38382035

RESUMEN

When people lose capacity to make a medical decision, the standard is to assess what their preferences would have been and try to honor their wishes. Dementia raises a special case in such situations, given its long, progressive trajectory during which others must make substituted judgments. The question of how to help surrogates make better-informed decisions has led to the development of dementia-specific advance directives, in which people are given tools to help them communicate what their preferences are while they are still able. Such directives allow the perspective of the person to play a clearer role in guiding decisions about their care. Dementia directives can never serve as rigid algorithms. Rather, they can be used to help inform conversations, to help surrogates make decisions that are better aligned with the preferences the person would have had. This essay lays out the proposed utility of dementia-specific directives and addresses some of the criticisms raised about them.


Asunto(s)
Toma de Decisiones , Demencia , Humanos , Directivas Anticipadas , Comunicación , Juicio , Demencia/terapia
20.
Hastings Cent Rep ; 54 Suppl 1: S29-S32, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38382036

RESUMEN

Cultural narratives shape how we think about the world, including how we decide when the end of life begins. Hospice care has become an integral part of the end-of-life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the "six-month rule" that the majority of the end of life takes place in the final six months of life. This idea is embedded in policies for a range of care practices and reimbursement processes, even though six months is not always a meaningful marker. In the case of people living with advanced dementia, six months is both too early in the trajectory to facilitate conversations and too late in the trajectory to ensure decision-making capacity. This essay encourages scholars and policy-makers to consider how cultural narratives may limit what they think is possible in care for people living with dementia.


Asunto(s)
Demencia , Cuidado Terminal , Humanos , Estados Unidos , Demencia/diagnóstico , Toma de Decisiones , Muerte , Políticas
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