• Clinical holding: ethical guidance for children's nurses working in the UK.

      Page, Andrea; Hejlskov Elvén, Bo; Seabra, Suzanne; Warren, Alison; McDonnell, Andrew; Lucy Mortiboys, Imogen; Vanes, Nicola (2019-07-09)
      This article explores ethical decision-making surrounding clinical holding of children and young people in healthcare environments with the aim of enhancing autonomy and engagement on their behalf. A considerable body of evidence, published over the last 20 years, suggests that this complex and challenging area of practice is not always well managed, with mixed messages about the nature of consent, choice and negotiated practice countered by best interests decisions taking precedence ahead of the child's wishes. An ethical framework is proposed comprising four levels of value-based interventions and how they may be applied in clinical practice, allowing for increased engagement, empowerment and support on behalf of children and young people in relation to clinical holding decisions. [Abstract copyright: ©2019 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.]
    • Decision making in the management of adults with malignant colorectal polyps: An exploration of the experiences of patients and clinicians

      Westwood, Clare; Lee, Tom; McSherry, Robert; Bettany-Saltikov, Josette; Catlow, Jamie; University Hospital North Tees and Hartlepool NHS Foundation Trust; North Tyneside General Hospital; University of Chester; Teesside University (Wiley, 2021-05-18)
      Aim: A diagnosis of colorectal polyp cancer presents a treatment dilemma. The decision between segmental resection versus endoscopic surveillance is difficult due to lack of good quality clinical evidence for either option. The aim of this study was to understand the decision-making experiences of both clinicians and patients when faced with such a diagnosis. Methods: Qualitative, semi-structured interviews were undertaken with ten clinicians involved in the care of patients diagnosed with polyp cancer and five patients who had experience of a diagnosis of polyp cancer. All clinicians and patients were from four hospital Trusts across the North of England. Interviews were audio recorded, transcribed verbatim and analysed using the principles of Interpretative Phenomenological Analysis. Results: Analysis of the interview transcripts evidenced the difficulties faced by both groups when faced with treatment decisions following a diagnosis of colorectal polyp cancer. Some of these difficulties were specific to either the clinician or patient group. Themes which were common to both groups included: complexity of risk information; external influences, unexpected diagnosis; and time. In addition, hospital system factors were disclosed which also influenced clinician and patient experiences. Conclusion: This research study has evidenced several factors such as uncertainty, complexity of risk information and influences on decisions which are preventing patients being fully involved in treatment decisions following a diagnosis of colorectal polyp cancer. Recommendations for improvements in practice, including a framework to assist treatment decision making in the future have been highlighted. What does this paper add to the literature? This qualitative study is, to the authors knowledge, the first exploring clinician and patient experiences of treatment decision making following a colorectal polyp cancer diagnosis. Key factors influencing how treatment decisions are made have been identified. As a result, a framework is proposed highlighting critical factors for consideration to deliver patient centred care.