Joseph F Griffith, Rhonda Wilson, Heather C Cimino, Mayme Patthoff, Daniel F Martin, Elias I Traboulsi
The Use of a Mobile Van for School Vision Screening: Results of 63 841 Evaluations
American journal of ophthalmology
shared decisionmaking sdm patients clinicians increasingly considered important treament escalation plans tep individualised documents outlining lifesaving interventions considered event clinical deterioration sdm inform subjective goals care tep remains unclear much considered beneficial patients clinicians aimed synthesise existing knowledge clinician older patient generally aged 65 years perspectives patient involvement tep acute setting systematic database search performed medline embase psycinfo cinahl databases well grey literature database inception june 8 2023 using sample older patients clinicians acute setting studies relating patients whose main diagnosis cancer single organ failure excluded conditions may specific tep considerations phenomenon interest treatment escalation planning design including interview observational survey evaluation shared decisionmaking research type qualitative quantitative mixed methods tool primary data published participant quotations field notes survey results descriptive author comments extracted qualitative thematic synthesis performed generate analytic themes quality assessment made using critical appraisal skills programme mixed methods appraisal tools gradecerqual grading recommendations assessment development evaluationconfidence evidence reviews qualitative research approach used assess overall confidence thematic finding according methodology coherence adequacy relevance contributing studies study protocol registered prospero crd42022361593 following duplicate exclusion 1916 studies screened ultimately 13 studies included european north american settings clinicianorientated themes treatment escalation medical decision high confidence clinicians want best patients amidst uncertainty high confidence involving patients families decisions always meaningful involve conflict high confidence treatment escalation planning exists within clinical environment organisation society moderate confidence patientorientated themes patients relationships treatment escalation planning complex low confidence interactions doctors important communication always easy moderate confidence patients highly aware families considering tep moderate confidence based current evidence tep decisions appear dominated clinicians perspectives motivated achieving best patients challenged complex decisions communication environmental factors older patients perspectives seldom explored input decisions may modest presenting context challenge sdm professional education may allow reflection nuanced approach future research seek understand approach tep decisionmaking patients clinicians consider optimum acute setting mutually acceptable standard defined policy hca international nihr imperial biomedical research centre