UNASSIGNED: The aim of the study was to test the effect of a meta-disciplinary intervention based on the motivational style of autonomy support on the development of competencies in secondary school students. It was carried out by means of a quasi-experimental design and lasted for three months.
UNASSIGNED: A total of 62 students between the ages of 12 and 16 (M = 13.61; SD = 1.16) participated, with 33 in the experimental group and 29 in the control group, along with 12 teachers (7 in the intervention group and 5 in the control group). The study measured teaching motivational style, satisfaction of basic psychological needs, motivation, and key competencies.
UNASSIGNED: The results demonstrate improvements in the autonomy-supportive motivational style, satisfaction of the basic psychological need for autonomy, autonomous motivation, and competencies in the experimental group, while the control group exhibited an increase in the chaos style.
UNASSIGNED: These findings reveal the positive impact of the supportive motivational style on the development of key competencies establishing it as an active, valid, and reliable methodology to motivate secondary school students.

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In most self-determination theory (SDT) research, improving (de)motivating teaching styles provides numerous benefits for students and teachers, although there is less evidence of the latter. Although the recent circumplex model provides a fine-grained picture of the different (de)motivating teaching styles (i.e., autonomy support, structure, control, and chaos) that physical education (PE) teachers can use in their lessons, no previous motivational training programs have been based on this model. Moreover, all SDT-training programs have been implemented through different group sessions, but individual sessions have not been delivered. This study outlines the protocol of a motivational training program, derived from the circumplex model, designed to enhance motivating teaching styles (and prevent or decrease demotivating teaching styles) among PE teachers. Consequently, this program seeks to improve motivational variables and influence (mal)adaptive outcomes in both teachers and students. A randomised controlled trial design with a mixed-method approach. At least 16 secondary PE teachers will be assigned to either an experimental group or a control group, together with some of their students. The training program comprises four face-to-face group sessions and two follow-up sessions (one individual and one group session). PE teachers will learn how to support autonomy and provide structure, as well as to be less controlling and chaotic towards students. Over approximately five months, teachers will implement these motivational strategies during their PE classes. Different (de)motivating teaching styles, motivational variables, and (mal)adaptive outcomes will be assessed in both PE teachers and their students at three distinct points: before the training program (T1), during the intervention (T2), and at the end of the intervention (T3). Additionally, two discussion groups involving all experimental PE teachers will be held (one following the training program and another at the end of the intervention). The results from this study could be useful for developing motivational training programs for in-service PE teachers. Clinical trial registration: ClinicalTrials.gov, identifier [NTC06479369].

OBJECTIVE: Timely detection and diagnosis of dementia are beneficial for providing appropriate, anticipatory care and preventing acute situations. However, initiating diagnostic testing is a complex and dynamic process that requires general practitioners (GPs) to balance competing priorities. Previously identified barriers, such as a lack of time, knowledge, and resources, may not fully represent the challenges involved in this process. Therefore, this study aimed to examine GPs\' more implicit considerations on starting the diagnostic trajectory for dementia.
METHODS: A qualitative study was conducted using semi-structured interviews with 14 Dutch GPs who were purposively selected through maximum variation sampling. The interview transcripts were inductively analyzed in multiple rounds by a multidisciplinary research team using thematic analysis.
RESULTS: GPs\' considerations on starting the diagnostic trajectory for dementia can be summarized in three main themes that are interconnected: (1) \'the presumed patient\'s willingness\', that is, facing a dilemma of wanting to respect patient autonomy in cases of denial or an absence of a diagnostic request, while at the same time identifying a problem and feeling the urgency to act; (2) \'the GP\'s attempt not to harm\', that is, balancing between not wanting to harm the patient and/or relatives with the burdensome label of dementia and with the possible negative consequences of a late diagnosis; and (3) \'time, trust, and interprofessional collaboration influence timeliness of diagnostic work-up\', that is, time available for consultations, time as a diagnostic factor, GP\'s diagnostic confidence, and trustful physician-patient relationship.
CONCLUSIONS: This study revealed that important ethical dilemmas regarding patient autonomy and the principle of doing no harm lie behind practical GP barriers to initiating diagnostic testing for dementia. Time, trust, and interprofessional collaboration were found to facilitate GPs in determining the right decision and timing with each individual patient and their relatives. Future research could explore the value of diagnostic decision aids that explicitly involve patients and their relatives in this balancing act.

BACKGROUND: The principles of dynamic consent are based on the idea of safeguarding the autonomy of individuals by providing them with personalized options to choose from regarding the sharing and utilization of personal health data. To facilitate the widespread introduction of dynamic consent concepts in practice, individuals must perceive these procedures as useful and easy to use. This study examines the user experience of a dynamic consent-based application, in particular focusing on personalized options, and explores whether this approach may be useful in terms of ensuring the autonomy of data subjects in personal health data usage.
METHODS: This study investigated the user experience of MyHealthHub, a dynamic consent-based application, among adults aged 18 years or older living in South Korea. Eight tasks exploring the primary aspects of dynamic consent principles-including providing consent, monitoring consent history, and managing personalized options were provided to participants. Feedback on the experiences of testing MyHealthHub was gathered via multiple-choice and open-ended questionnaire items.
RESULTS: A total of 30 participants provided dynamic consent through the MyHealthHub application. Most participants successfully completed all the provided tasks without assistance and regarded the personalized options favourably. Concerns about the security and reliability of the digital-based consent system were raised, in contrast to positive responses elicited in other aspects, such as perceived usefulness and ease of use.
CONCLUSIONS: Dynamic consent is an ethically advantageous approach for the sharing and utilization of personal health data. Personalized options have the potential to serve as pragmatic safeguards for the autonomy of individuals in the sharing and utilization of personal health data. Incorporating the principles of dynamic consent into real-world scenarios requires remaining issues, such as the need for powerful authentication mechanisms that bolster privacy and security, to be addressed. This would enhance the trustworthiness of dynamic consent-based applications while preserving their ethical advantages.

BACKGROUND: Patient autonomy is central to the provision of respectful maternity care. Enabling women to make decisions free of discrimination and coercion, and respecting their privacy and confidentiality can contribute to positive childbirth experiences. This study aimed to deepen the understanding of how patient autonomy is reflected through social practices during intrapartum care in Benin.
METHODS: Semi-structured interviews with women and midwives, a focus-group discussion with women\'s birth companions, and non-participant observations in the delivery room were conducted within the frame of the ALERT research project. This study analysed data through a reflexive thematic analysis approach, in line with Braun and Clarke.
RESULTS: We identified two themes and five sub-themes. Patient autonomy was systemically suppressed over the course of birth as a result of the conditions of care provision, various forms of coercion and women\'s surrendering of their autonomy. Women used other care practices, such as alternative medicine and spiritual care, to counteract experiences of limited autonomy during intrapartum care.
CONCLUSIONS: The results pointed to women\'s experiences of limited patient autonomy and their use of alternative and spiritual care practices to reclaim their patient autonomy. This study identified spiritual autonomy as an emergent dimension of patient autonomy. Increasing women\'s autonomy during childbirth may improve their experiences of childbirth, and the provision of quality and respectful maternity care.

The experience of serious illness or injury frequently results in increased vulnerability. In cases in which decision-making capacity is compromised, this vulnerability is compounded by threats to a patient\'s autonomy. This case report presents an opportunity to explore the elaborately entwined relationship between autonomy and vulnerability in patients with severe impairment who are reliant on surrogate decision-makers. Expanded views of autonomy and vulnerability are applied to the case of a young woman with a severe and life-altering spinal cord injury and iatrogenic loss of decisional capacity to illustrate how one can experience enhanced autonomy despite special vulnerability and can be made less vulnerable through surrogate-mediated autonomy. Also revealed is how attitudes and actions of surrogates can potentiate pathogenic vulnerability and disturb the balance between patient autonomy and vulnerability. Through methodical review and robust deliberation, clinical ethics committees can play a stabilizing role in helping distressed care teams reconcile the two.

OBJECTIVE: Medical assistance in dying (MAiD) in Canada places the medical provider at the centre of the process. The MAiD provider holds primary responsibility for determining eligibility and becomes acquainted with patients\' inner desires and expressions of suffering. This is followed by the MAiD procedure of administering the lethal agent and being present at the death of eligible patients. We report participants\' perceptions of the emotional and moral impacts of this role.
METHODS: Two years after MAiD was legalised in Canada, 22 early-adopting physician providers were interviewed. Data were examined using both phenomenological analysis and a novel ChatGPT-enhanced analysis of an anonymised subset of interview excerpts.
RESULTS: Participants described MAiD as emotionally provocative with both challenges and rewards. Providers expressed a positive moral impact when helping to optimise a patient\'s autonomy and moral comfort with their role in relieving suffering. Providers experienced tensions around professional duty and balancing self with service to others. Personal choice and patient gratitude enhanced the provider experience, while uncertainty and conflict added difficulty.
CONCLUSIONS: Participants described MAiD provision as strongly aligned with a patient-centred ethos of practice. This study suggests that, despite challenges, providing MAiD can be a meaningful and satisfying practice for physicians. Understanding the emotional and moral impact and factors that enhance or detract from the providers\' experience allows future stakeholders to design and regulate assisted dying in ways congruent with the interests of patients, providers, families and society.

This study explores psychological well-being in adolescence through a multidimensional perspective using the Adolescent Students\' Basic Psychological Needs at School Scale, derived from the Self-Determination Theory. The ASBPNSS focuses on three basic psychological needs (Competence, Autonomy, and Relatedness) in adolescence and has not yet been used within the school context in Italy. This study\'s main objectives are: (1) to validate a preliminary Italian version of the ASBPNSS; (2) to analyze the association between well-being at school and self-efficacy for self-regulated learning; and (3) to verify whether there are differences by gender. A sample of 395 students (mean age = 17.5; SD = 0.75) completed the ASBPNSS and the Self-Efficacy for Self-Regulated Learning Scale. The factorial structure, composite reliability, and gender invariance of the ASBPNSS were examined. Associations between well-being at school and self-efficacy were tested with structural equation models (CFI = 0.935, TLI = 0.925; RMSEA = 0.054). Measures of well-being were associated with school self-efficacy for self-regulated learning, which predicted Competence (beta = 0.639), Relatedness (beta = 0.350), and Autonomy (beta = 0.309). These relationships were invariant over gender, although girls reported lower latent means in the Relatedness factor. This study highlights the importance of promoting school self-efficacy and well-being in adolescence.

The field of disabilities is being challenged to adopt a paradigm that can be used to guide the transformation of services, supports, and research practices to ensure and enhance the personal autonomy, rights, and community inclusion of people with disabilities. This article describes strategies associated with the systematic diffusion and sustainability of an innovation such as the emerging Shared Citizenship Paradigm (SCP), which has the potential to guide the transformation. The systematic diffusion process incorporates five components: knowledge, persuasion, decision, implementation, and confirmation. The systematic process also addresses the risks of dissonance, backlash, unintended consequences, and backsliding that can emerge when the sustainability of a paradigm is not supported. Throughout the article, we stress that meaningful change in organizations and systems requires use of a paradigm such as the SCP and its principles and foundation pillars to guide the change, and a systematic process such as that described in this article to bring about and sustain the change.