Sierra Leone ranks last with a life expectancy of just over 50 years.
Sepucha and colleaguesp. Health researchers, advocacy organizations, and the Agency for Healthcare Research and Quality AHRQ have also encouraged patients to play a larger role in making medical decisions.
Research indicates that when patients are involved in their own care, they are more satisfied with the care they receive and often experience better health outcomes Alston et al. Patients with cancer and their families are often required to manage greater portions of their cancer care due to advances in cancer treatment, as well as changes in the practice of health care, such as earlier discharge from the hospital CFAH, ; McCorkle et al.
These duties may include drug management, wound care, rehabilitation, and lifestyle changes CFAH, Clinicians help patients engage in self-management, which involves managing the medical and psychological aspects of cancer care, as well as adapting to changes in roles that result from cancer diagnosis McCorkle et al.
Promoting patient self-management can facilitate shared decision making and improve cancer care. Each of these factors is discussed below. Complexity of Cancer Care Cancer care is complex.
It may involve multiple treatment modalities, including chemotherapy, radiation, and surgery, all of which need to be coordinated among different cancer care specialists. Treatment regimens can also be time intensive, debilitating, and often result in serious and sometimes long-term complications IOM, a.
In addition, patients must often choose from multiple cancer treatment options, requiring patients and their families to decide on the goals of treatment e.
These decisions often need to be revisited at various points along the cancer care continuum. Limitations in the Evidence Base As described in Chapter 5the committee recommends that researchers improve the breadth and depth of information collected in clinical research.
Studies indicate that there is a lack of evidence to support many medical decisions El Dib et al. While comparative effectiveness research CER and learning health care systems aim to fill these evidence gaps, they have limitations.
Clinicians should fully communicate gaps in the evidence base to their patients during the medical decision-making process. When evidence is sparse, patient preferences should be a particularly important consideration in the health care decision-making process.
Preference-Sensitive Decisions Some decisions in cancer care are particularly sensitive to patient preferences. For example, women with breast cancer can often choose from different courses of treatment—mastectomy versus lumpectomy followed by radiation—and expect equivalent survival outcomes Fisher et al.
Women may choose mastectomy, or the removal of the entire breast, for peace of mind or to avoid radiation therapy, while women who choose lumpectomy followed by radiation may do so to conserve their breasts Collins et al.
Women with BRCA 1 and 2 gene mutations are at higher risk for developing breast and ovarian cancer, and may face difficult decisions about breast cancer screening, as well as consideration of prophylactic mastectomy or oophorectomy to reduce the risk of cancer 3 Jolie, ; Schwartz et al.
Preferences may also change over time and clinicians need to revisit these throughout the cancer care continuum.
For example, women considering second line chemotherapy may prefer to take a more active role in decision making compared to women who are considering first line chemotherapy Grunfeld et al. This section discusses patient, clinician, and health care system challenges.
Challenges for Patients A cancer diagnosis can lead to a state of crisis for an individual and his or her family because most people are not immediately equipped to understand their diagnosis or how to identify options for moving forward NCCS, a.
Because treatment and its side effects, as well as recovery and the worry about recurrence, can result in a series of crises for a patient, the crisis does not end once the shock of initial diagnosis wears off NCCS, a.Assessment is an integral part of instruction, as it determines whether or not the goals of education are being met.
Assessment affects decisions about grades, placement, advancement, instructional needs, curriculum, and, in some cases, funding. The author of Being Mortal: Medicine and What Matters in the End is Atul Gawande.
He is an eminent American surgeon and author, who conducts research into public h I read this book a fortnight ago, by my brother's bedside, at a time when both he and I knew he was dying/5.
The foundation of ethical decision-making involves choice and balance; it is a guide to discard bad choices in favor of good ones. Therefore, in making ethical decisions, one of the first questions to consider is 'what a reasonable man would do in this situation?'For tougher decisions, advisors may find three rules of management helpful.
Apr 01, · Do The Right Thing: Making Ethical Decisions in Everyday Life. By Tom Marshall April 1, pm April 1, pm. Neither one has been at all shy about speaking out, even though he is speaking in nearly complete isolation from fellow lawmakers. 11 Understands the role of diversity in American life and the importance.
These all contain implied "shoulds" about how people interact and behave toward one another in groups, organizations, and societies. These "shoulds" define collective effort because they are fundamental to trust and to team relationships that entail risk.
The greater the potential risk, the more important ethical practices become. Learn about decision-making, and some ideas about how to do it. In particular, learn why it can be difficult and how to overcome these problems.
Unfortunately we all have to make decisions all the time, ranging from trivial issues like what to have for lunch, right up to life-changing decisions like where and what to study, and who to marry.