Shared Decision Making in Routine Childhood Vaccination: What do Parents Want?
Bibliographic record
Abstract
BackgroundIn order to enhance implementation of shared decision making (SDM) in older patients with multiple chronic conditions (MCC), we conducted a review on barriers and limitations that older patients with MCC, their informal caregivers and health professionals.Methods Medline, Embase, Psycinfo, Cinahl and Cochrane Central Register of Controlled Trials (Central) were searched covering the period from 1980 to April 2016.We used both keywords and MESH terms for 'shared decision making', 'older people', 'comorbidities', 'barriers' and 'facilitators'.Studies were included if they had an original data collection, both qualitative and quantitative studies were included.Two researchers independently reviewed all data, including a quality assessment.Barriers and facilitators were reported according to an existing taxonomy for predisposing factors, interactional context factors, the SDM encounter, organisational, social and policy factors.We described from which perspective (patient, informal caregiver, health professional) which barriers and facilitators were reported. ResultsWe reported only those barriers (b) and facilitators (f) that were not previously reported in reviews about b&f in a general population.Patient reported b & f were mainly about: hectic environment (b), not really allowed to decide (b), bad communication skills professional (b), individual approach (f), forming partnership with professional (f) and feeling invited (f).Health professional reported barriers and facilitators concerned: patient not wanting to participate, thus having to guess (b), organisational constraints (b) and working in a multidisciplinary team (f).Informal caregivers reported barriers and facilitators addressed: having to deal with complex and multiple health organisations (b), stress between own values and interests and patients values and interests (b), being extra eye and ear for both patient as well as health professional (f).The major part of barriers and facilitators was experienced by both patients as professionals. ConclusionsOlder people with MCC, informal caregivers and health professionals caring for them experience particular barriers as facilitators in the SDM process, in addition to general and well known barriers and facilitators.There is consensus between patients and health professionals about most barriers and facilitators, which is a fertile starting point for enhanced implementation of SDM.
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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 | 0.031 | 0.142 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.006 | 0.007 |
| Open science | 0.001 | 0.005 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.006 | 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".