Supporting adults with intellectual and developmental disabilities to participate in health care decision making.
Bibliographic record
Abstract
OBJECTIVE: To discuss what is new in the revised guideline 3 of the "Primary care of adults with intellectual and developmental disabilities [IDD]. 2018 Canadian consensus guidelines" on decision-making capacity, and how to implement the recommendations. QUALITY OF EVIDENCE: Integrative review based on a literature search, the framework of the United Nations Convention on the Rights of Persons with Disabilities, and the experience of the authors. MAIN MESSAGE: Person-centred health care of adults with IDD should include all possible contributions from the patient in decision making. At present, legal criteria do not address the relational aspects of decision making that are important for adults with IDD. The revised guideline 3 incorporates recent thinking regarding supported and shared decision making. It envisages decision making as a collaborative exercise in which the patient, trusted caregivers, and the family physician all are involved in deciding on medically appropriate interventions that promote the patient's goals or values. CONCLUSION: Family physicians and caregivers both play an important role in supporting adults with IDD so that they can participate in health care decision making. Communication, mediation, and advocacy skills, plus the use of tools adapted for adults with IDD, can facilitate the family physician's role.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.061 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".