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Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters

Shared decision‐making involves health professionals and patients/clients working together to achieve true person‐centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting th...

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Autores principales: Begley, Keith, Daly, Deirdre, Panda, Sunita, Begley, Cecily
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899916/
https://www.ncbi.nlm.nih.gov/pubmed/31338953
http://dx.doi.org/10.1111/jep.13243
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author Begley, Keith
Daly, Deirdre
Panda, Sunita
Begley, Cecily
author_facet Begley, Keith
Daly, Deirdre
Panda, Sunita
Begley, Cecily
author_sort Begley, Keith
collection PubMed
description Shared decision‐making involves health professionals and patients/clients working together to achieve true person‐centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision‐making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision‐making for caesarean section. The team concluded that shared decision‐making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision‐making (defeaters) are disclosed. Informed consent is not shared decision‐making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision‐making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required.
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spelling pubmed-68999162019-12-19 Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters Begley, Keith Daly, Deirdre Panda, Sunita Begley, Cecily J Eval Clin Pract Original Papers Shared decision‐making involves health professionals and patients/clients working together to achieve true person‐centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision‐making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision‐making for caesarean section. The team concluded that shared decision‐making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision‐making (defeaters) are disclosed. Informed consent is not shared decision‐making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision‐making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. John Wiley and Sons Inc. 2019-07-23 2019-12 /pmc/articles/PMC6899916/ /pubmed/31338953 http://dx.doi.org/10.1111/jep.13243 Text en © 2019 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Papers
Begley, Keith
Daly, Deirdre
Panda, Sunita
Begley, Cecily
Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters
title Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters
title_full Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters
title_fullStr Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters
title_full_unstemmed Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters
title_short Shared decision‐making in maternity care: Acknowledging and overcoming epistemic defeaters
title_sort shared decision‐making in maternity care: acknowledging and overcoming epistemic defeaters
topic Original Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899916/
https://www.ncbi.nlm.nih.gov/pubmed/31338953
http://dx.doi.org/10.1111/jep.13243
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