Brain health and value diversity: A new implementation field for values-based practice?

Q3 Medicine
Psychiatrike = Psychiatriki Pub Date : 2024-03-28 Epub Date: 2024-01-22 DOI:10.22365/jpsych.2024.001
Panagiotis Alexopoulos, Alison Canty, Jayashree Dasgupta, Joyla A Furlano, Aline Nogueira Haas
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引用次数: 0

Abstract

Brain health has recently emerged as an overarching concept encompassing cognitive, sensory, social-emotional, behavioural and motor aspects of brain functioning, enabling individuals to achieve their potential for both health and wellbeing over their life course, independent of the presence or absence of disease.1 It is contingent on a continuous, complex interplay between interconnected determinants related to physical health, healthy environments, safety and security, learning and social connection, and access to quality services. Even though responsibility for optimizing brain health can be taken at an individual level, brain health is in fact heavily influenced by determinants far beyond the control of individuals and their families. For instance, protection from abuse and maltreatment or equitable access to health services depend on interacting social, financial, and political factors that can often only be minimally influenced by individual or small group initiatives.2,3 In addition, the voice of many people, including the very young, the very old, the sick, the disadvantaged, and those who live in poverty, may not be sufficiently influential, even though the decision-making process crucially affects the brain health and quality of life for these individuals. The breadth of determinants of brain health makes brain health a terrain that is justifiably shaped by a plethora of stakeholders with highly diverse values and hence potentially conflicting interests and albeit different degrees of power. Consequently, decision-making in such contexts embodies a thorny process that may render the negligence of the values, viewpoints, and perspectives of those directly involved in a given decision, particularly when the individual capacity to advocate for oneself and the willingness of society and governments to act on behalf of their citizens, are low. Values-based practice (VBP) is a toolkit for balancing interests, wishes, and values in contexts characterized by diverse values, which may be valuable in decision-making related to brain health.4 The implementation of this toolkit in different fields of healthcare (e.g., occupational therapy, orthopedics, primary care, psychiatry, psychology, radiotherapy) has been proposed, and training materials for healthcare professionals have been developed.5 VBP aims to include the differences in values, viewpoints, and perspectives of those directly concerned with a given decision so that communication and shared decision-making are facilitated. Based on the legacy of the Popperian open society,5 VBP treats values in the same way that democracy treats ideas and human voices. Hence, this decision-making toolkit is neither restricted to ethical codes nor prioritizes one value over others. It also does not endorse certain values while excluding others, provided that the values in play are compatible with legal, regulatory, and bioethical frameworks. The emphasis of VBP is on good process rather than predetermined 'correct' outcomes.6,7 Respect for differences between stakeholders results in the creation of a culture of mutual responsibility and in building up a positive relationship between all those concerned, so that everyone feels a sense of ownership of the decision made.4,6 Of note, according to VBP, the perspective of the health service user or of the individuals or community seeking to protect their brain health is the ideal starting point for any decision. This approach minimizes the negligence of the views, needs, values, competencies, resources, and aspirations of those trying to optimize their brain health in contexts where powerful socioeconomic and further interests may be at stake. The 'good process' of VBP is safeguarded by ten principles.4 Four of them pertain to clinical skills and practice - awareness raising regarding the involvement of values in a given decision-making process; use of a clear reasoning strategy to explore value diversity; knowledge about the values and facts that may be relevant to different contexts; and good communication skills. Two further principles underscore the importance of person-centred and multidisciplinary health service delivery. Other principles focus on the fact that all decisions are based on both values and facts, where the former become noticeable particularly when they are diverse or conflicting, especially in environments where variable choices are at the disposal of service users. The last principle of VBP is based on partnership in decision-making, including both service users and providers. In conclusion, VBP may become a valuable tool for making balanced decisions in the broad terrain of brain health. Its protective focus on the perspectives of service users and its democratic character may pave the way towards achieving equity in and optimization of brain health.

大脑健康与价值多样性:价值观实践的新实施领域?
1 脑健康取决于与身体健康、健康环境、安全和保障、学习和社会联系以及获得优质 服务有关的相互关联的决定因素之间持续、复杂的相互作用。尽管优化大脑健康的责任可以在个人层面上承担,但大脑健康实际上在很大程度上受到远非个人及其家庭所能控制的决定因素的影响。2,3 此外,许多人,包括年幼者、年长者、病人、弱势群体和生活贫困者的声音可能没有足够的影响力,尽管决策过程对这些人的大脑健康和生活质量有着至关重要的影响。大脑健康决定因素的广泛性使得大脑健康理所当然地成为由众多利益相关者共同决定的领域,这些利益相关者的价值观千差万别,因此可能存在利益冲突,尽管权力程度不同。因此,在这种情况下,决策是一个棘手的过程,可能会忽视直接参与特定决策的人的价值观、观点和看法,特别是当个人为自己辩护的能力以及社会和政府代表公民采取行动的意愿都很低的时候。以价值观为基础的实践(VBP)是一种在具有不同价值观的环境中平衡利益、愿望和价值观的工具包,在与脑健康有关的决策中可能很有价值。4 有人提出在不同的医疗保健领域(如职业治疗、整形外科、初级保健、精神病学、心理学、放射治疗)实施这种工具包,并为医疗保健专业人员编写了培训材料。基于波普尔开放社会的遗产5 ,VBP 以民主对待思想和人的声音的方式对待价值观。因此,本决策工具包既不局限于道德规范,也不将某一价值观置于其他价值观之上。它也不会在认可某些价值观的同时排斥其他价值观,前提是这些价值观与法律、监管和 生物伦理框架相一致。6,7尊重利益相关者之间的差异可以创造一种相互负责的文化,并在所有相关者之间建立一种积极的关系,从而使每个人都对所做的决定有一种主人翁感。4,6 值得注意的是,根据 VBP,医疗服务使用者或寻求保护其大脑健康的个人或社区的观点是任何决定的理想出发点。在强大的社会经济利益和更多利益可能受到威胁的情况下,这种方法最大限度地减少了对那些试图优化大脑健康的人的观点、需求、价值观、能力、资源和愿望的忽视。4 其中四项原则与临床技能和实践有关--提高对特定决策过程中价值参与的认识;使用清晰的推理策略探索价值多样性;了解可能与不同情况相关的价值和事实;以及良好的沟通技巧。还有两项原则强调了以人为本和提供多学科医疗服务的重要性。其他原则则强调,所有决策都要以价值观和事实为基础,尤其是当价值观和事实各不相同或相互冲突时,前者就显得尤为重要,特别是在服务使用者可以做出多种选择的环境中。VBP 的最后一项原则是基于决策中的伙伴关系,包括服务使用者和提供者。总之,VBP 可以成为在脑健康的广阔领域做出平衡决策的宝贵工具。它对服务使用者视角的保护性关注及其民主特性,可为实现脑健康的公平和优化铺平道路。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Psychiatrike = Psychiatriki
Psychiatrike = Psychiatriki Medicine-Medicine (all)
CiteScore
2.60
自引率
0.00%
发文量
37
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