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1.
Med Clin North Am ; 105(1): 107-116, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246513

RESUMO

Insomnia is a common condition affecting approximately 50% of people at some point. Physicians must be equipped to diagnose and treat it as part of outpatient practice. Chronic insomnia is a common complaint that has potentially dangerous short-term and long-term effects, but effective treatments are available. The 2 methods of treatment are psychological, which is preferred, and pharmacologic, for when behavioral therapies are not effective. It is important to understand the various behavioral interventions and risks and benefits of the medications available to engage patients in a shared decision-making model to find the best treatment for each patient.


Assuntos
Distúrbios do Início e da Manutenção do Sono/terapia , Doença Crônica , Terapia Cognitivo-Comportamental , Tomada de Decisão Compartilhada , Humanos , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Resultado do Tratamento
4.
J Clin Psychiatry ; (6)2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33147657

RESUMO

​​​​​​ Many patients who are at risk for tardive dyskinesia fear that they might develop the involuntary neurological movement disorder, yet it is possible for clinicians to convey a realistic assessment of the benefits and risks of medications that might induce TD. Clinicians need to be aware of the importance of communicating reasonable risk in a way that will not alarm patients, using tools such as probabilities and phronesis in discussions with their patients.


Assuntos
Antipsicóticos/efeitos adversos , Tomada de Decisão Compartilhada , Comunicação em Saúde , Transtornos Mentais/tratamento farmacológico , Relações Médico-Paciente , Medição de Risco , Discinesia Tardia/induzido quimicamente , Adulto , Comunicação em Saúde/normas , Humanos
5.
Acute Med ; 19(4): 230-234, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33215176

RESUMO

IMPORTANCE: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. OBJECTIVE: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. DESIGN, SETTING AND PARTICIPANTS: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. RESULTS: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.


Assuntos
Infecções por Coronavirus , Dispneia/virologia , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez/virologia , Betacoronavirus , Tomada de Decisão Compartilhada , Dispneia/diagnóstico , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico
6.
Medicine (Baltimore) ; 99(45): e23031, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157953

RESUMO

RATIONALE: The evidence for outpatient pulmonary embolism (PE) management apart from hospitalization is expanding. The availability and ease of direct oral anticoagulants have facilitated this transition. The literature, however, is sparse on the topic of comprehensive management of pulmonary embolism in the primary care clinic setting. As such, the role of the primary care physician in the complete diagnosis, risk stratification for outpatient eligibility, and initiation of treatment is unclear. CASE PRESENTATIONS: Case 1: A 33-year-old man with known heterozygous Factor V Leiden mutation and a remote history of deep vein thrombosis presented to his primary care physician's office with 2 days of mild pleuritic chest pain and a dry cough after a recent transcontinental flight. Case 2: A 48-year-old man with a complex medical history including recent transverse myelitis presented to his primary care family physician with dyspnea and pleuritic chest pain for 6 days. DIAGNOSIS: Case 1: Computed tomographic pulmonary angiography that same afternoon showed multiple bilateral segmental and subsegmental emboli as well as several small pulmonary infarcts. Case 2: The patient's D-dimer was elevated at 1148 ng/mL. His physician ordered a computed tomographic pulmonary angiography, performed that evening, which showed segmental and subsegmental PE. INTERVENTIONS: Both patients were contacted by their respective physicians shortly after their diagnoses and, in shared decision-making, opted for treatment at home with 5 days of enoxaparin followed by dabigatran. OUTCOMES: Neither patient developed recurrence nor complications in the subsequent 3 months. LESSONS: These cases, stratified as low risk using the American College of Chest Physicians criteria and the PE Severity Index, are among the first in the literature to illustrate comprehensive primary care-based outpatient PE management. Care was provided within an integrated delivery system with ready, timely access to laboratory, advanced radiology, and allied health services. This report sets the stage for investigating the public health implications of comprehensive primary care-based PE management, including cost-savings as well as enhanced patient follow-up and patient satisfaction.


Assuntos
Dor no Peito/etiologia , Dispneia/etiologia , Transferência de Pacientes/métodos , Médicos de Atenção Primária/normas , Embolia Pulmonar/tratamento farmacológico , Doença Aguda , Adulto , Assistência Ambulatorial , Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Dor no Peito/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Dabigatrana/uso terapêutico , Tomada de Decisão Compartilhada , Dispneia/diagnóstico , Enoxaparina/uso terapêutico , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Mielite Transversa/complicações , Mielite Transversa/diagnóstico , Transferência de Pacientes/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Embolia Pulmonar/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico
7.
Am Surg ; 86(11): 1445-1449, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135421

RESUMO

Early goal-oriented conversations at the end of life can help alleviate suffering and anxiety for surgical patients with cancer and their loved ones. This is especially important in the young adult population in whom there are limited patient-reported perspectives about their experiences at the end of life. We report the illustrative case of a 29-year-old woman who underwent palliative surgery for widely metastatic renal cell carcinoma. Her postoperative course was complicated by a proximal anastomotic stricture, bilateral pulmonary emboli, and delayed gastric emptying, ultimately leading to a functional decline in health and quality of life. Several wide-ranging palliative care needs arose during our patient's surgery, discharge, and subsequent readmissions. In addition to our patient's case, we discuss 3 fundamental surgical palliative care principles, and broad considerations for end-of-life management of young adults with advanced malignancies.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Cuidados Paliativos/métodos , Adulto , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/terapia , Tomada de Decisão Compartilhada , Feminino , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Assistência Terminal/métodos
8.
Am Surg ; 86(11): 1441-1444, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33153269

RESUMO

A 55-year-old man undergoes emergent exploratory laparotomy and splenectomy following a motorcycle collision. Following surgery, he is found to have a traumatic brain injury requiring decompressive craniectomy and intracranial pressure monitoring. The patient then continues to have complications throughout his hospital course. Using the American College of Surgeons Trauma Quality Improvement Program guidelines, the surgical team has early and ongoing primary palliative care discussions to foster communication and determine goals of care for the patient. As the patient deteriorates, the surgical team continues meeting with the patient's surrogate decision makers to discuss the best case and worst case scenarios regarding the patient's prognosis and expected quality of life.


Assuntos
Traumatismo Múltiplo/cirurgia , Cuidados Paliativos/métodos , Tomada de Decisão Clínica , Deterioração Clínica , Comunicação , Tomada de Decisão Compartilhada , Família , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/terapia , Planejamento de Assistência ao Paciente , Traumatologia/métodos
9.
Am Surg ; 86(11): 1467-1472, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33153284

RESUMO

Seriously ill surgical patients require complex and integrated surgical, interventional, and medical management to balance the risks and benefits that complicate decision-making. Palliative care principles can aid surgeons in these cases. To illustrate this, we describe a scenario of a patient with unresectable hepatocellular carcinoma with portal vein tumor thrombus causing portal hypertension. We discuss options for managing the sequelae of portal hypertension, including varices and ascites. We explore the interventional and surgical options for mitigating or palliating the underlying portal hypertension. Advances in interventional radiological techniques can facilitate the creation of transjugular intrahepatic portosystemic shunts (TIPSs), even with extensive portal vein thrombus. If interventional approaches are not possible, surgical shunts can be considered but carry significant risks that must be weighed against the benefits. To communicate effectively, we outline key steps to breaking bad news. To make shared decisions in challenging cases, we describe how to elicit a patient's hopes, expectations, concerns, and preferences; how to synthesize goals of care from these stated values; and how to use those goals to guide decision-making.


Assuntos
Hipertensão Portal/cirurgia , Cuidados Paliativos/métodos , Planejamento Antecipado de Cuidados , Carcinoma Hepatocelular/complicações , Tomada de Decisão Clínica , Comunicação , Tomada de Decisão Compartilhada , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/terapia , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Derivação Portossistêmica Cirúrgica , Medição de Risco
10.
Am Surg ; 86(11): 1482-1484, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33155825

RESUMO

Evaluating a high-risk patient for a high-risk operation is complicated. Discussing the benefits and burdens with your patient is only a part of the process. Should the decision be not to operate, explaining and planning the nonoperative path forward with all of its inherent challenges is crucial. Because the inevitable is likely to happen, the patient as well as their family must be prepared. If they are not, then the result may be exactly what the patient was hoping to avoid in the first place by declining the operation. Critical to this conversation is understanding the nuances of "doing everything" when dealing with a patient facing a life-limiting condition.


Assuntos
Cuidados Paliativos , Planejamento de Assistência ao Paciente , Procedimentos Cirúrgicos Operatórios , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Tomada de Decisão Compartilhada , Família , Evolução Fatal , Humanos , Masculino , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Medição de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/ética , Procedimentos Cirúrgicos Operatórios/métodos
11.
BMJ Glob Health ; 5(11)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33208314

RESUMO

Diagnostics, including those that work at point-of-care, are an essential part of successful public health responses to infectious diseases and pandemics. Yet, they are not always used or fit intended use settings. This paper reports on key insights from a qualitative study on how those engaged with developing and implementing new point-of-care (POC) diagnostics for tuberculosis (TB) and HIV ensure these technologies work at POC. Ethnographic fieldwork between 2015 and 2017 consisting of 53 semistructured interviews with global stakeholders and visits to workshops, companies, and conferences was combined with 15 semistructured interviews with stakeholders in India including providers, decision-makers, scientists and developers and visits to companies, clinics and laboratories. Our results show how developers and implementer of HIV and TB POC diagnostics aim to know and align their diagnostics to elements in more settings than just intended use, but also the setting of the developer, the global intermediaries, the bug/disease and the competitor. Actors and elements across these five settings define what a good diagnostic is, yet their needs might conflict or change and they are difficult to access. Aligning diagnostics to the POC requires continuous needs assessment throughout development and implementation phases as well as substantive, ongoing investment in relationships with users. The flexibility required for such continuous realigning and iteration clashes with established evaluation procedures and business models in global health and risks favouring certain products over others. The paper concludes with suggestions to strengthen this alignment work and applies this framework to research needs in the wake of COVID-19.


Assuntos
Infecções por HIV/diagnóstico , Testes Imediatos , Kit de Reagentes para Diagnóstico , Tuberculose/diagnóstico , /diagnóstico , Tomada de Decisão Compartilhada , Humanos , Invenções , Pesquisa
12.
Am Surg ; 86(11): 1456-1461, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33167706

RESUMO

Surgeons care deeply about their patients, their patient's surgical outcomes, and their fund of knowledge as it relates to disease, treatment options, and risk is remarkable. Unfortunately, surgical patients' values, hopes, fears, and unacceptable levels of suffering are rarely elicited and addressed while constructing surgical treatment plans, even when the stakes are high. How can surgeons bring all their experience, education, and expertise to bear in a patient-centered manner amidst uncertainty? Surgeons typically emulate mentors who either employed a solely informative, facilitative, or directive/paternalistic approach to decision-making. These 3 styles fail to simultaneously address: (1) what matters most to patients and (2) the surgeon's expertise. Since communication in each of these 3 approaches is unidirectional, and the decisional power locus is imbalanced, they are unshared, nonpartnering, and-perhaps surprisingly-not patient-centered. Patient-centered, collaborative shared decision-making (SDM) approaches align with palliative care principles and are rarely employed, taught, or modeled. Furthermore, nonpartnering approaches to surgical decision-making are often laden with unintended consequences, such as patient and family suffering and the suffering of surgeons. We present the high-risk case of an abdominal gunshot wound in a morbidly obese man, which was complicated by 3 enterocutaneous fistulae and a loss of abdominal wall integrity, where ongoing empathic, partnering SDM dialogue is enabling a patient-centered and value-concordant care plan. The authors invite you to virtually journey with us as this case unfolds, as the impending surgical decisions are substantial and weighty. Uncertainty and risks appear at every turn-providing additional challenges to overcome.


Assuntos
Traumatismos Abdominais/cirurgia , Tomada de Decisão Compartilhada , Fístula Intestinal/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/terapia , Comunicação , Humanos , Fístula Intestinal/etiologia , Fístula Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Relações Médico-Paciente/ética , Incerteza , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/terapia
13.
Methodist Debakey Cardiovasc J ; 16(3): 220-224, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133358

RESUMO

Improving patient experience is a fundamental component of patient-centered care and one of the key strategies for improving health care quality, delivery, and outcomes. Several studies have described the association between improved patient experience and better health outcomes among individuals with cardiovascular disease. These findings are important given that cardiovascular disease is a leading cause of morbidity and mortality in the United States and globally. This review summarizes the findings on patient-reported health care experiences and discusses how optimizing these experiences may be a tool to improve health outcomes among individuals with cardiovascular disease.


Assuntos
Doenças Cardiovasculares/terapia , Participação do Paciente , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Assistência Centrada no Paciente , Doenças Cardiovasculares/diagnóstico , Tomada de Decisão Compartilhada , Humanos , Assistência Centrada no Paciente/normas , Relações Médico-Paciente , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde
14.
Prim Dent J ; 9(4): 31-36, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33225852

RESUMO

Engaging patients in shared decision making (SDM) is a professional requirement since the Montgomery ruling in 2015. Endodontic treatments present a specific challenge to achieving SDM, both for the clinician and the patient. The treatments are often perceived as more challenging to complete by the clinician, and the assessment of risk and likely outcome requires a deep understanding of the (limited) evidence base. For the patient, decisions can be required at a time of acute symptoms and prolonged treatments. There are health literacy demands in comparison to some less complex dental treatments. Treatment decisions may be based more on inherent biases and prior experiences than objective probabilities. This article discusses options and supports effective shared decision making in endodontic treatment.


Assuntos
Tomada de Decisão Compartilhada , Endodontia , Tomada de Decisões , Assistência Odontológica , Humanos , Participação do Paciente
16.
Am J Respir Crit Care Med ; 202(7): e95-e112, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33000953

RESUMO

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.


Assuntos
Tomada de Decisão Compartilhada , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Neoplasias Pulmonares/diagnóstico , Fumar/etnologia , Definição da Elegibilidade , Grupos Étnicos/estatística & dados numéricos , Custos de Cuidados de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Ciência da Implementação , Cobertura do Seguro , Marketing de Serviços de Saúde/métodos , Medicaid , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Sexuais , Fumar/epidemiologia , Fumar/terapia , Abandono do Hábito de Fumar/estatística & dados numéricos , Classe Social , Estados Unidos
17.
BMC Geriatr ; 20(1): 381, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008335

RESUMO

BACKGROUND: Shared decision-making provides an approach to discuss advance care planning in a participative and informed manner, embodying the principles of person-centered care. A number of guided approaches to achieve shared decision-making already exist, such as the three-talk model. However, it is uncertain whether daily practice methods in nursing home wards for persons with dementia comply with the underpinnings of this model. It is also uncertain whether professionals consider shared decision-making to be important in this context, and whether they perceive themselves sufficiently competent to practice this approach frequently. METHODS: The study has a cross-sectional design, with 65 wards (46 Belgian nursing homes) participating in the study. We compared nursing home professionals' and residents' perspectives on the level of shared decision-making during advance care planning conversations with ratings from external raters. Residents and professionals rated the level of shared decision-making by means of a questionnaire, which included the topic of the conversation. External raters assessed audio recordings of the conversations. Professionals filled in an additional self-report questionnaire on the importance of shared decision-making, their competence in practicing the approach, and with what frequency. RESULTS: At ward level, professionals and residents rated the average achieved level of shared decision-making 71.53/100 (σ = 16.09) and 81.11/100 (σ = 19.18) respectively. Meanwhile, raters gave average scores of 26.97/100 (σ = 10.45). Only 23.8% of residents referred to advance care planning as the topic of the conversation. Professionals considered shared decision-making to be important (x̄=4.48/5, σ = 0.26). This result contrasted significantly with the frequency (x̄=3.48/5, σ = 0.51) and competence (x̄=3.76/5, σ = 0.27) with which these skills were practiced (P < 0.001). CONCLUSIONS: Residents with dementia are grateful when involved in discussing their care, but find it difficult to report what is discussed during these conversations. Receiving more information about advance care planning could provide them with the knowledge needed to prepare for such a conversation. External raters observe a discrepancy between the three-talk model and daily practice methods. Training programs should focus on providing professionals with better knowledge of and skills for shared decision-making. They should also promote team-based collaboration to increase the level of person-centered care in nursing home wards for persons with dementia.


Assuntos
Planejamento Antecipado de Cuidados , Tomada de Decisão Compartilhada , Demência , Idoso , Idoso de 80 Anos ou mais , Bélgica , Comunicação , Estudos Transversais , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Masculino , Casas de Saúde
18.
Nat Commun ; 11(1): 5161, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-33057001

RESUMO

Humans establish public goods to provide for shared needs like safety or healthcare. Yet, public goods rely on cooperation which can break down because of free-riding incentives. Previous research extensively investigated how groups solve this free-rider problem but ignored another challenge to public goods provision. Namely, some individuals do not need public goods to solve the problems they share with others. We investigate how such self-reliance influences cooperation by confronting groups in a laboratory experiment with a safety problem that could be solved either cooperatively or individually. We show that self-reliance leads to a decline in cooperation. Moreover, asymmetries in self-reliance undermine social welfare and increase wealth inequality between group members. Less dependent group members often choose to solve the shared problem individually, while more dependent members frequently fail to solve the problem, leaving them increasingly poor. While self-reliance circumvents the free-rider problem, it complicates the governing of the commons.


Assuntos
Comportamento Cooperativo , Tomada de Decisão Compartilhada , Processos Grupais , Fatores Socioeconômicos , Tomada de Decisões , Feminino , Teoria do Jogo , Humanos , Masculino , Motivação
20.
PLoS One ; 15(10): e0240371, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031475

RESUMO

BACKGROUND: Shared decision making (SDM) in healthcare is an approach in which health professionals support patients in making decisions based on best evidence and their values and preferences. Considering sex and gender in SDM research is necessary to produce precisely-targeted interventions, improve evidence quality and redress health inequities. A first step is correct use of terms. We therefore assessed sex and gender terminology in SDM intervention studies. MATERIALS AND METHODS: We performed a secondary analysis of a Cochrane review of SDM interventions. We extracted study characteristics and their use of sex, gender or related terms (mention; number of categories). We assessed correct use of sex and gender terms using three criteria: "non-binary use", "use of appropriate categories" and "non-interchangeable use of sex and gender". We computed the proportion of studies that met all, any or no criteria, and explored associations between criteria met and study characteristics. RESULTS: Of 87 included studies, 58 (66.7%) mentioned sex and/or gender. The most mentioned related terms were "female" (60.9%) and "male" (59.8%). Of the 58 studies, authors used sex and gender as binary variables respectively in 36 (62%) and in 34 (58.6%) studies. No study met the criterion "non-binary use". Authors used appropriate categories to describe sex and gender respectively in 28 (48.3%) and in 8 (13.8%) studies. Of the 83 (95.4%) studies in which sex and/or gender, and/or related terms were mentioned, authors used sex and gender non-interchangeably in 16 (19.3%). No study met all three criteria. Criteria met did not vary according to study characteristics (p>.05). CONCLUSIONS: In SDM implementation studies, sex and gender terms and concepts are in a state of confusion. Our results suggest the urgency of adopting a standardized use of sex and gender terms and concepts before these considerations can be properly integrated into implementation research.


Assuntos
Tomada de Decisão Compartilhada , Assistência à Saúde , Feminino , Humanos , Masculino , Caracteres Sexuais
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