Adolescent Shared Decision-Making: A Concept Analysis.

The aim of this study was to identify potential implementation interventions to increase the uptake of shared decision making (SDM) in clinical practice in New South Wales (NSW) Health. The Agency for Clinical Innovation hosted a full-day SDM masterclass in May 2017 and 53 attendees completed a survey to identify barriers to implementing SDM. The Theoretical Domains Framework, COM-B ('capability', 'opportunity', motivation' and 'behaviour') Model and Behaviour Change Wheel were used to conduct a theoretical analysis of the barriers and identify potential interventions to increase the uptake of SDM. This was supplemented by a purposive review of articles about current international efforts to facilitate SDM. From the theoretical analysis, 9 of the 14 theoretical domains were considered relevant to implementing SDM in the NSW Health context. Multi-faceted interventions including education, training, enablement, modelling, incentivisation, persuasion and environmental restructuring were identified as potential ways to increase SDM. The review of international articles identified communication and marketing, patient and public involvement, research, training, legislation, patient decision aids, service provision, clinical champions, financial incentives and policy as interventions being used to increase the uptake of SDM internationally. Based on current perceptions about barriers for SDM implementation in NSW Health, initial efforts should focus on workforce skills development, motivation, communication and marketing, service provision and creating receptive work environments. Investments into facilitating SDM will require an ongoing commitment to enhancing patient experience, evidence translation and reducing unwarranted variations in care.

The purpose of this article was to analyze the concept of "the fighter in the intensive care unit (ICU)" per the scientific literature and the impact this mentality has on care administered in the ICU. A literature review and a concept analysis based on Rodger's evolutionary method were performed to identify surrogate terms, antecedents, attributes, and consequences pertaining to the "fighter" in the ICU. Thirteen articles with a focus on "the fighter" were included in this analysis. There is a strong desire to remain optimistic and maintain high spirits as a coping mechanism in the face of extreme prognostic uncertainty. Themes that emerged from the literature were the need to find inner strength and persist in the face of adversity. The concept of "the fighter in the ICU" can serve as either adaptive or maladaptive coping, depending on the larger clinical picture. Patient experiences in the ICU are fraught with physical and psychological distress. How the patient and family unit cope during this anxiety-provoking time is based on the individual. Maintaining optimism and identifying as a fighter can be healthy ways to adapt to the circumstances. This concept analysis highlights the importance of holistic care and instilling hope particularly as patients may be nearing the end of life.

Although the concept of suicide in children and adolescents is widely present in the literature, its conceptual definition varies according to context, discipline, and time. How this concept is defined impacts the delivery of care to children and adolescents regarding suicide prevention in mental health settings and in the community. Using Rodgers's evolutionary method, we examined the antecedents, attributes, and consequences of "suicide in children"through temporal trends, and geographic locations. In total, 106 articles were included. Searches were performed using CINAHL, PsycINFO, and Medline, as well as Google Scholar as a complementary tool. Through a thematic analysis, we identified three themes: (1) developmental perspectives, (2) factors predicting suicide in children, and (3) the emancipation of children as active agents in society. Recent literature shows a movement toward acknowledging the voice of children and adolescents regarding suicide. We address clinical and future implications for the development of this concept.

WHAT IS KNOWN ON THE SUBJECT?: Several studies describe barriers and facilitators for implementing shared decision-making in mental care, yet a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care. Mental care is intended to empower the patients by increasing their responsibility and self-awareness and helping them to use their own resources. Too much focus on the patients' independence, responsibility and choice may hinder the patients getting the help they need. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The meaning of SDM can be understood as a continuous relational process between the patients and MHCPs in search of dignified care. Practising shared decision-making is a challenging process which requires the MHCPs to possess high professional competence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental healthcare professionals should be conscious of their own role in the asymmetrical power relationship in decision-making and use their professional competence for their patients' benefit. Clinical supervision can be a tool for developing professional competence and is considered important when assisting mental healthcare professionals practising shared decision-making for dignified care. Abstract Introduction Several studies describe barriers and facilitators for implementing shared decision-making in mental care. However, a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care by placing them at the centre of care. Too much focus on the patients' autonomy may hinder them getting the help they need. A comprehensive understanding of shared decision-making is needed for its implementation. Aim/research question To interpret the meaning of shared decision-making in mental care as perceived by patients and mental healthcare professionals. The research question was: What is the meaning of shared decision-making in mental care? Method A hermeneutic inductive design with a thematic interpretative analysis of data was performed from in-depth interviews with 16 patients and multistage focus group interviews with eight mental healthcare professionals. Results The overall theme being in a space of sharing decision-making for dignified mental care was described by the three themes engaging in a mental room of values and knowledge, relating in a process of awareness and comprehension and responding anchored in acknowledgement. Discussion Balancing the patients' need for assistance with autonomy, while safeguarding their dignity, is a challenging process requiring mental healthcare professionals to possess professional competence. Implications for practice Organized professional development of the carers' professional competence is important to facilitate shared decision-making.

Introduction: Total knee arthroplasty (TKA) is a treatment for knee pain, but some patients are not satisfied with their outcomes. Utilizing shared decision making (SDM) can lead to better decisions, satisfaction, and fewer regrets. However, healthcare professionals have little knowledge of risk factors for regret. The aim of this study is to evaluate decisional regret using the Decision Regret Scale (DRS) after primary TKA among patients who engaged in SDM. Method: A total of 118 patients who underwent TKA surgery between March 2020 and May 2022 participated in this study, and they were able to reflect on their outcomes. The primary outcome was decisional regret assessed using the DRS, and the secondary outcome was post-operative pain at a three-month follow-up, measured using the Lequesne Index. Result: The study found that 49% of the patients reported no regret, 25% reported mild regret, and 26% reported moderate-to-severe regret. There was a significant correlation between greater levels of decision regret and a higher three-month Lequesne Index. Post-operative pain and post-operative mobility status and the range of motion of the knee joint were also strongly correlated. Conclusion: The study found that more than half of the patients undergoing primary TKAs experienced regret even following SDM counseling. Regret levels were associated with higher post-operative pain and poorer mobility. This underscores the importance of informing patients about potential adverse effects of TKA to manage their expectations and reduce regret in future SDM interviews. Practice implications: This study incorporated patient perspectives through their direct engagement in the SDM process prior to surgery. Patients participated in the design of the SDM framework, which included educational pamphlets and structured interviews to assess their values and preferences. Their involvement ensured that the SDM procedure was tailored to patient-centered outcomes. Furthermore, the follow-up assessments were conducted with patients to evaluate decisional regret and post-operative outcomes, providing valuable insights into the effectiveness of the SDM process. By actively participating in the research through decision making and outcome reflection, the patients contributed to the understanding of factors influencing decisional regret after undergoing TKA.

Legal implications surrounding adolescent health care decision-making in matters of sex, reproduction, and gender

Shared decision-making implies that patients and healthcare professionals make decisions together about clinical exams, available treatments, choice of options, and the benefit or downside of every choice. Patients involved in the shared decision-making process are more compliant with treatments and have a reduced risk of complications related to the pathology. In Italy, patient involvement in caring processes is still barely investigated. To investigate patients' perceptions about shared decision-making with physicians and nurses, respectively, and to examine the relationship between shared decision-making and patient satisfaction and perceived quality of care/treatment. The study was performed between March and June 2019 in two wards of one Italian hospital. A questionnaire was administered to inpatients at the time of admission and again at discharge, including demographic information and measurement scales regarding patient involvement in shared decision-making, patient satisfaction, and perceived quality of treatment/care. A total of 151 out of 301 patients completed questionnaires at both admission and discharge. Patients' scores for shared decision-making (information, patient needs, treatment planning) were significantly different for physicians and nurses. At both admission and discharge, patients rated shared decision-making significantly higher for physicians compared to nurses, while there were no differences in their satisfaction ratings. Patient ratings of physicians did not change from admission (information: mean (M) = 3.50, standard deviation (SD) = 0.81; patient need: M = 3.05, SD = 1.05; treatment planning: M = 2.75, SD = 1.23) to discharge (information: M = 3.50, SD = 0.79; patient need: M = 3.17, SD = 1.02; treatment planning: M = 2.66, SD = 1.23) (p = 0.924, p = 0.098, p = 0.293, respectively), but patients' ratings of nurses' behavior increased significantly from admission (information: M = 2.44, SD = 1.23; patient need: M = 2.27, SD = 1.17; treatment planning: M = 2.12, SD = 1.19) to discharge (information: M = 2.62, SD = 1.22; patient need: M = 2.53, SD = 1.24; treatment planning: M = 2.35, SD = 1.21) (p = 0.019, p = 0.001, p = 0.003, respectively). Attention to patients' needs was the key determinant of both satisfaction with nurses (OR = 3.65, 95% CI = 1.31-10.14, p = 0.013) and perceived quality of care (OR = 3.97, 95% CI = 1.49-10.55, p = 0.006). Providing appropriate information about disease progress and treatments was a key determinant of both satisfaction with physicians (OR = 19.75, 95% CI = 7.29-53.55, p < 0.001) and perceived quality of treatment (OR = 8.03, 95% CI = 3.25-19.81, p < 0.001). Nurses should be sensitized to involving patients in the decision-making process, especially upon hospital admission. Specific training about effective communication techniques can be implemented to manage relationships with patients in different caring situations. Practical implications and future directions are discussed.

This article revamps the work of Ward and Reingen (1990) to examine adolescent normative behaviour in a social collective decision-making group. This is of particular importance as it will enhance an understanding of the youth market both through the social context employed here as well as the social interaction that occurs when adolescent decisions are made. Employing a diachronic qualitative methodology, this research explores collective decisions made by adolescents on a high school prom organizing committee and reveals influencing strategies (e.g., coalition formation, bargaining) as well as approaches to managing conflict and conflict resolution. A model is proposed, which examines the role of both intra- and intercoalition formation and subsequent influence on decision making. Identification of conflict resolution strategies (e.g., yielding, dominating, and disassociation), employed at different stages of preparation for this event, are recognized as having both theoretical and practical marketing managerial implications.

Pediatric Fertility Counseling

Development of a scale to measure shared problem-solving and decision-making in mental healthcare

Patient decision aids (PDAs) are evidence-based tools that facilitate shared decision-making (SDM) between patients and healthcare professionals. These tools are used when multiple treatment options exist, no clear choice prevails regarding risks versus benefits, and the best option may vary depending on patient values. A 2024 Cochrane review of 209 randomized controlled trials involving over 107,000 participants identified the substantial benefits of PDAs,1 including improved patient knowledge, increased SDM and enhanced accuracy of risk perceptions and alignment of decisions with patient values. Given these benefits, SDM tools are more widely used. However, their quality remains inconsistent, potentially limiting their benefit.2-4 Dermatology is particularly suited to SDM, given the wide-ranging and ever-evolving treatment options for conditions that often convey a significant psychological burden. A literature review was conducted to assess dermatologic PDAs for adherence with reporting the development process according to the International Patient Decision Aids Standards (IPDAS) Collaboration.5-8 A comprehensive search using MEDLINE (via PubMed) and EMBASE identified articles on dermatological PDA development from 2014 to 2024. After screening 509 publications, 11 studies describing 14 PDAs across eight conditions, psoriasis (2), acne (1), superficial, low and high-risk basal cell carcinoma (4), vitiligo (1), actinic keratoses (3), metastatic malignant melanoma (1), lentigo maligna (1) and hidradenitis suppurativa (1), were included. Data extraction followed Coulter et al.'s9 template for documenting PDA development, focusing on adherence to IPDAS reporting standards. Most studies (10/11) were published in the last 5 years (2020–2024). All PDAs aimed to support patients with a treatment decision (Table 1). Clinical guidelines (5/14) and literature reviews (4/14) were the most common information sources. Five studies did not report this step. Digital PDAs were most common (6/14), although 4 studies only provided images of the PDA, without stating the format. While most PDAs (10/14) reported adhering to the IPDAS framework with an iterative process, only three included all the required development steps (Figure 1). Clinician needs assessments were infrequently conducted (4/14), with just three specifying numbers involved. In contrast, patient needs assessments were more consistently reported (9/14), although only six provided details on patient numbers. Alpha testing with patients was reported in nearly all studies (12/14), reflecting strong patient engagement, but 4 of these did not provide participant numbers, limiting insight into testing scope. Across the PDAs, patient involvement was nearly double that of clinicians, with a median of 20 (IQR = 33) versus 13 (IQR = 38). Patient participation ranged widely from 7 to 322 individuals, while clinician numbers ranged from 8 to 51. Notably, no patient or clinician numbers were reported for any step in the development of PDAs that did not use the IPDAS development framework. This review of dermatologic PDAs reveals that many lack key elements of the IPDAS development process, such as expert panel involvement, needs assessments and usability testing. While most PDAs were reported to align with the IPDAS framework, a substantial number lacked transparency in their development process which may explain the previously reported variations in dermatologic PDA quality.4 For PDAs to effectively support patient-centred SDM, they must undergo a thorough development process with broad user engagement as demonstrated by our research group's development of a PDA for multiple AKs.10 We suggest developers follow the streamlined IPDAS development framework outlined by Witteman et al.7 and Coulter et al.9 which emphasizes iterative development, evidence-based content and stakeholder engagement through minimal, medium and maximal approaches. These approaches ensure both patients and clinicians are included in all development phases and define a minimum required number for user involvement. Future research should prioritize adherence to these standardized development frameworks. The study was completed in partial fulfillment of a doctorate of medicine funded by a research grant from The City of Dublin Skin and Cancer Hospital Charity. The funders were not involved in the study design, data collection, data analysis or manuscript preparation. The authors declare no conflicts of interest. Not applicable. Not applicable. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Objective: Shared decision making (SDM) is an approach adapted from the health care field for use in mental health treatment because SDM promotes collaborative decision making of providers and consumers regarding treatment options and goals. Personal medicine, defined as “self-initiated, non-pharmaceutical self-care activities that serve to decrease symptoms, avoid undesirable outcomes such as hospitalization, and improve mood, thoughts, behaviors, and overall sense of well-being” (Deegan, 2005, p. 31), has been incorporated into SDM when applied in mental health settings. This exploratory, qualitative study investigates how mental health consumers define and use personal medicine. Method: A sample of 14 consumers with severe and persistent mental illness were selected from a local community mental health agency using purposeful sampling. Participants used Common Ground, a software program that formalizes SDM and uses the concept of personal medicine. Participants were interviewed using a naturalistic inquiry approach and a semi-structured interview protocol of open-ended questions. Interviews were transcribed and coded, and findings were corroborated with consultant panels. Comprehensive member checks ensured trustworthiness. Results: Personal medicine might be a larger concept than can be explained by any single modality. Several factors contribute to the use of personal medicine, including the individualization of personal medicine by consumers, how consumers define the concept of personal medicine, and the purposes and benefits of personal medicine. Conclusions: Participants report personal medicine to have benefit, value, and purpose that impact recovery. These findings support current literature and practical implications that might inform the ways in which professionals use personal medicine.

Creating a treatment plan (TP) through shared decision-making (SDM) with healthcare professionals is of paramount importance for patients with multimorbidity (MM). This study aims to estimate the prevalence of SDM and TP in patients with MM and study the association between SDM/TP with patients' confidence to manage their diseases and hospitalization within the previous 1year. This cross-sectional study used an internationally recognized survey. A total of 1032 patients aged 60 or above with MM were recruited from a specialist outpatient clinic, general outpatient clinic (GOPC) and a geriatric day hospital. The proportion of patients reported to have SDM and TP was estimated. Associations between the presence of SDM/TP and patients' demographic data, the confidence level to manage their illnesses and hospitalization in previous 1year were then studied using logistic regression. The prevalence of SDM and TP was 35.8% and 82.1%, respectively. The presence of TP was associated with receiving healthcare from the same doctor or in the same facilities and being recruited from GOPC. The presence of SDM (OR=1.352, P=.089) and TP (OR=2.384, P<.001) was associated with enhanced confidence in dealing with diseases. Most people with MM had TP in Hong Kong, but fewer patients had SDM. Ways to promote SDM in HK are needed.

To identify the core components of acute pain management in children, re-conceptualise the process and update the existing model to inform nursing research and clinical practice. Acute pain in hospitalised children remains suboptimal, despite extensive nursing research and education. Improvements require a patient-centred approach and a conceptual model which includes the role of parents and partnership. Using Rodgers' Evolutionary method, a concept analysis was conducted to define the core components for effective acute pain management in children. A scoping review of peer-reviewed literature from 1990 through 2020 was conducted using the terms "pain management," "pain control," "pain treatment," "multi modal," and "concept*". Abstracts from 85 articles were initially reviewed with 30 articles retained for analysis. Core concepts were identified, defined and synthesised. The PRISMA 2020 checklist was used. A new model was developed from a synthesis of past work which incorporates the role of parents, the complexity of the process and definitions for shared decision-making. Trust, safety, collaborative communication and genuine partnership were identified as the core components for effective pain management in children, with the triadic relationship of nurses, patients and parents in genuine partnership foundational to the nursing process. The new model for acute pain management in children transforms the nurse's role from gatekeeper to facilitator, shifting the process from nurse driven to patient-centred. The new collaborative model will promote shared decision-making for individualised pain assessments, interventions and evaluations. Establishing the nurse, child, parent partnership as an essential foundation to pain management has the potential to expand pain assessments, optimise treatment selections, advancing clinical practice, patient outcomes and nursing science. No Patient or Public Contributions were included in this paper as this was a concept analysis pulling from past works.

To conduct a concept analysis of evidence-based leadership in a nursing context. Rodgers' evolutionary method was employed to identify attributes, antecedents, consequences, definitions and surrogate and related terms. We systematically searched three databases (PubMed, Cumulative Index to Nursing and Allied Health Literature and Scopus) for relevant publications. The databases were searched from their inception to 4 February 2024. We included 12 papers published between 2005 and 2022. The attributes include leadership attributes (personality, developing common goals and visions and influencing others) and evidence-based attributes (valuing evidence-based practice, integrating evidence and adapting evidence). The antecedents include individual internal factors (commitment to growth and proficiency in implementation science) and individual external factors (growing need for evidence-based practice, training support and available resources), while the consequences are personal growth, organisational benefit and disciplinary development. Based on the concept analysis, evidence-based leadership can be defined as a process whereby individuals, based on their personality and values towards evidence-based practices, integrate the best evidence into practice, adapt the evidence integration process based on evaluations and influence others towards achieving a common goal and vision. This concept analysis enhances our understanding of evidence-based leadership, guiding nurses to integrate evidence into their leadership practices to achieve specific goals and visions within the healthcare context. Future studies could consider developing instruments to evaluate evidence-based leadership based on this refined concept, ultimately promoting nurses' leadership competencies in real-world settings. This concept analysis not only raises awareness of the responsibilities of nurses as healthcare professionals, including the provision of evidence-based practice, but also facilitates their effective execution of these responsibilities. Empowering nurses to actively incorporate evidence into their leadership practices can further enhance the quality of healthcare delivery. Not applicable. Not applicable.