Attitudes on cost-effectiveness and equity: viewpoints of medical professionals

The aim of this study is to determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making | BMJ Open

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Cost-effectiveness analysis does not accurately reflect the importance that medical professionals place on equity. Among medical professionals, practising physicians appear to be more egalitarian than residents-in-training, while medical students appear to be most utilitarian and cost-effective. Meanwhile, female respondents in all three cohorts favoured the more equitable option to a greater degree than their male counterparts. Healthcare policies that trade off equity in favour of cost-effectiveness may be unacceptable to many medical professionals, especially practising physicians and women.

Full reference: Li, D.G. et al. (2017) Attitudes on cost-effectiveness and equity: a cross-sectional study examining the viewpoints of medical professionals. BMJ Open 7:e017251.

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Implementing shared decision making in the NHS

Shared decision making requires a shift in attitudes at all levels but can become part of routine practice with the right support, say Natalie Joseph-Williams and colleagues | BMJ

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Adoption of shared decision making into routine practice has been remarkably slow, despite 40 years of research and considerable policy support. In 2010, the Health Foundation in the UK commissioned the MAGIC (Making Good Decisions in Collaboration) programme to design, test, and identify the best ways to embed shared decision making into routine primary and secondary care using quality improvement methods

The learning from MAGIC derives from a variety of sources, including facilitated shared learning events, clinic and consultation observations, interviews with clinicians and patients, patient and public involvement panels, focus groups, and questionnaires. We assessed progress using “plan do study act” data collection tools,monthly project team meetings (including researchers, clinical teams, healthcare organisations, and patient representatives), and an independent evaluation report of phase 1. Here, we draw on our learning from the three year programme and subsequent experience to summarise the key challenges of implementing shared decision making and to offer some practical solutions

Read the full article here

Increasing Compassion in Medical Decision-Making: Can a Brief Mindfulness Intervention Help?

Fernando, A.T. et al. (2017) Mindfulness. 8(2) pp. 276–285

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Compassion is an essential component of medical practice but is difficult to sustain over time. This problem is increasingly recognized in medical curricula.

Mindfulness-based interventions have the potential to enhance compassion in medicine but this has not yet been tested. This study evaluated whether a brief mindfulness induction increased compassionate responding to difficult patients among medical students and assessed whether trait self-compassion moderated the impact of this experimental manipulation.

Read the full abstract here

Qualitative evidence synthesis to improve implementation of clinical guidelines

Christopher Carroll argues that generic advice to share decision making is insufficient and that successful clinical guidelines need to reflect disease specific insights into patients’ experiences, views, beliefs, and priorities | BMJ

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As Sackett and colleagues wrote 20 years ago, evidence based practice involves the use of the “best external evidence” to inform clinical decision making. The published evidence used to underpin clinical guidelines, including those produced by the National Institute for Health and Care Excellence (NICE) in the UK, is almost exclusively quantitative. This is understandable as the principal focus is efficacy and safety: the aim is to establish what works. However, Sackett and colleagues were also clear that clinical practice should take account of patients’ preferences.

This is currently achieved by patient involvement in the process and by using primary qualitative research, which uses techniques such as interviews to explore how and why patients make the decisions they do. But a synthesis of such qualitative research studies paints a rich, subtle, and useful picture of patients’ experience, views, beliefs, and priorities, and could improve the implementation of clinical guidelines.

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Study on Hospital Administrators’ Beliefs and Attitudes toward the Practice of Evidence-Based Management

Guo, R. et al. (2016) Hospital Topics. 94(3-4) pp. 62-66

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The authors’ purpose was to explore hospital administrators’ beliefs and attitudes toward the practice of evidence-based management (EBMgt) and to identify the needs for EBMgt training programs. A cross-sectional, nonexperimental design was utilized. Survey data were analyzed using descriptive statistics and Spearman’s correlation. The results showed that hospital administrators had positive attitudes toward the practice of EBMgt. There was a significant correlation between attitudes and percentage of healthcare management decisions made using an evidence-based practice approach (p < .01). The study findings suggest EBMgt educational training programs would likely help hospital administrators adopt evidence-based practice in management decision-making.

Read the full abstract here