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Staehelin D, Dolata M, Stöckli L, Schwabe G. How Patient-Generated Data Enhance Patient-Provider Communication in Chronic Care: Field Study in Design Science Research. JMIR Med Inform 2024; 12:e57406. [PMID: 39255481 DOI: 10.2196/57406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/25/2024] [Accepted: 07/21/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Modern approaches such as patient-centered care ask health care providers (eg, nurses, physicians, and dietitians) to activate and include patients to participate in their health care. Mobile health (mHealth) is integral in this endeavor to be more patient centric. However, structural and regulatory barriers have hindered its adoption. Existing mHealth apps often fail to activate and engage patients sufficiently. Moreover, such systems seldom integrate well with health care providers' workflow. OBJECTIVE This study investigated how patient-provider communication behaviors change when introducing patient-generated data into patient-provider communication. METHODS We adopted the design science approach to design PatientHub, an integrated digital health system that engages patients and providers in patient-centered care for weight management. PatientHub was developed in 4 iterations and was evaluated in a 3-week field study with 27 patients and 6 physicians. We analyzed 54 video recordings of PatientHub-supported consultations and interviews with patients and physicians. RESULTS PatientHub introduces patient-generated data into patient-provider communication. We observed 3 emerging behaviors when introducing patient-generated data into consultations. We named these behaviors emotion labeling, expectation decelerating, and decision ping-pong. Our findings show how these behaviors enhance patient-provider communication and facilitate patient-centered care. Introducing patient-generated data leads to behaviors that make consultations more personal, actionable, trustworthy, and equal. CONCLUSIONS The results of this study indicate that patient-generated data facilitate patient-centered care by activating and engaging patients and providers. We propose 3 design principles for patient-centered communication. Patient-centered communication informs the design of future mHealth systems and offers insights into the inner workings of mHealth-supported patient-provider communication in chronic care.
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Affiliation(s)
- Dario Staehelin
- Department of Informatics, University of Zurich, Zurich, Switzerland
- Department for Information and Process Management, Eastern Switzerland University of Applied Sciences, St Gallen, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Livia Stöckli
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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Belay YA, Yitayal M, Atnafu A, Taye FA. Barriers and Facilitators for Implementing Shared Decision Making in Differentiated Antiretroviral Therapy Service in Northwest Ethiopia: Implications for Policy and Practice. MDM Policy Pract 2024; 9:23814683241281385. [PMID: 39301043 PMCID: PMC11412211 DOI: 10.1177/23814683241281385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 08/18/2024] [Indexed: 09/22/2024] Open
Abstract
Background. Shared decision making (SDM) for patients enrolling in differentiated antiretroviral therapy (DART) is crucial. Empirical evidence is lacking regarding factors promoting or hindering SDM implementation in DART provision in Ethiopia. Hence, this study aimed to explore the barriers and facilitators to implementing SDM for patients enrolled in DART in Northwest Ethiopia. Methods. A qualitative descriptive study using semi-structured interviews among 17 patients and 15 providers at health facilities providing DART service was conducted. The MAXQDA version 20 software was used for inductive coding. Interviews were analyzed using thematic analysis. Results. Ten themes emerged at 4 levels related to SDM in the provision of DART: patient, provider, organizational, and health system. At the patient level, 1) trust in providers (facilitator) and 2) patient's level of education (barrier) emerged as themes. At the provider level, 3) lack of familiarity with DART models (barrier) and 4) patient-provider relationship (barrier and facilitator) were emerged themes. At the organizational level, 5) workload (barrier) and 6) resources (barrier and facilitator) emerged as themes. At the health system level, 7) availability of DART models (facilitator), 8) not involving providers while initiating DART models (barrier), 9) other providers' involvement (facilitator), and 10) presence of other implementing partners (barrier) emerged as themes. Conclusions. Numerous barriers and facilitators influence the implementation of SDM in the provision of DART. Based on these findings, the following steps are recommended. Providing access to patient decision aids shall be in place to assist patients in making decisions about their preferred DART models. Health care workers shall be trained, and patients shall be given education to enhance the SDM process. Policy makers and program managers shall consider the resource context (training and size of human resources and convenience of rooms) for the delivery of ART service to have an appropriate implementation of SDM in clinical practice. Highlights Shared decision making in DART is influenced by various barriers and facilitators present at the patient, provider, organizational, and health system levels.Patients need education, and health care staff need regular training to improve SDM in DART service provision.Patient access to decision support tools that aid in the selection of the preferred DART model in health facilities is critical.Policy makers and program managers shall consider the availability of adequate and trained human resources as well as provide adequate space and private rooms for SDM in the implementation of DART.
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Affiliation(s)
- Yihalem Abebe Belay
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fitalew Agimass Taye
- Department of Accounting, Finance, and Economics, Griffith University, Brisbane, Australia
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Wilson L, Dohan D, Garibaldi M, Szeto D, Timmerman M, Matheny J. Prosthesis preferences for those with upper limb loss: Discrete choice study of PULLTY® for use in regulatory decisions. J Rehabil Assist Technol Eng 2023; 10:20556683231152418. [PMID: 36698551 PMCID: PMC9869218 DOI: 10.1177/20556683231152418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction The patient's voice in shared decision-making has progressed from physician's office to regulatory decision-making for medical devices with FDA's Patient Preference Initiative. A discrete-choice preference measure for upper limb prosthetic devices was developed to investigate patient's risk/benefit preference choices for regulatory decision making. Methods Rapid ethnographic procedures were used to design a discrete-choice measure describing risk and benefits of osseointegration with myoelectric control and test in a pilot preference study in adults with upper limb loss. Primary outcome is utility of each choice based conjoint (CBC) attribute using mixed-effects regression. Utilities with and without video, and between genders were compared. Results Strongest negative preference was for avoiding infection risk (B = -1.77, p < 0.001) and chance of daily pain (B = -1.22, p, 0.001). Strongest positive preference was for attaining complete independence when cooking dinner (B = 1.62, p < 0.001) and smooth grip patterns at all levels (B = 1.62, B = 1.28, B = 1.26, p < 0.001). Trade-offs showed a 1% increase in risk of serious/treatable infection resulted in a 1.77 decrease in relative preference. There were gender differences, and where video was used, preferences were stronger. Conclusions Strongest preferences were for attributes of functionality and independence versus connectedness and sensation but showed willingness to make risk-benefit trade-offs. Findings provide valuable information for regulatory benefit-risk decisions for prosthetic device innovations. Trial Registration This study is not a clinical trial reporting results of a health care intervention so is not registered.
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Affiliation(s)
- Leslie Wilson
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA,Leslie Wilson, Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, 480 16th street Office 32f, Box 0613, San Francisco, CA 94143-3402, USA.
| | - Dan Dohan
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Garibaldi
- Director, Orthotics Prosthetics, University of California San Francisco, San Francisco, CA, USA
| | - David Szeto
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA
| | - Molly Timmerman
- General Physical Medicine & Rehabilitation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Johnny Matheny
- Department of Cllinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA
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Rendell S, Schmidt H, Neergaard R, Nkwihoreze H, Barbati Z, Short WR, Rana AI, Sheth AN, Scott RK, Sethi S, Momplaisir FM. Integrating ART adherence support technologies in the care of pregnant and postpartum people with HIV: a qualitative study. Implement Sci Commun 2022; 3:85. [PMID: 35918738 PMCID: PMC9344442 DOI: 10.1186/s43058-022-00331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background We have a limited understanding on how to best integrate technologies to support antiretroviral therapy (ART) adherence in routine HIV care. Methods We conducted semi-structured interviews with multidisciplinary providers caring for pregnant and postpartum people with HIV and asked providers about their perspectives on utilizing adherence support technologies such as text messages, video check-ins with providers or automated with facial recognition for directly-observed-therapy, signaling pill bottle, and signaling pill to support ART adherence. Each approach generated an adherence report. The interview instrument was guided by the Consolidated Framework for Implementation Research and included questions on the implementation climate, barriers, and facilitators to the clinical integration of the adherence approach and strategies that could be used to maximize this integration. The order of adherence support technologies was randomized to minimize bias. We used a modified grounded theory to develop the coding structure and two coders applied the codebook to the transcripts after establishing strong inter-rater reliability with 20% of interviews (kappa = 0.82). Results Between March and December 2020, we conducted 26 in-depth, semi-structured interviews with providers who weighed several factors when considering each approach, including the approach’s effect on patient-provider interaction in and outside of the clinic visit, timing for and duration of the approach’s utility, threat of disclosing status, and added burden to providers (e.g., needing to act on generated information) or to patients (e.g., needing to hide the signaling pills, responding to text messages). Providers’ most preferred approach was text-messages, and the least preferred was the signaling pill. Barriers to acceptability varied by approach and included perceived surveillance, violation of privacy, added time demand for providers, potential inaccuracy of the adherence data generated, and negative impact on the patient-provider relationship, particularly if the approach was perceived as coercive. Payers anticipated regulatory hurdles with unfamiliar approaches, particularly the signaling pill and signaling pill bottle. Facilitators included strengthened therapeutic alliance, predictable reminder mechanisms, and options for customization according to patient preference. Conclusions Our study elucidates barriers and facilitators to integrating technology-based adherence support approaches in clinical care to support adherence of pregnant and postpartum people with HIV.
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Hill LM, Golin CE, Saidi F, Phanga T, Tseka J, Young A, Pearce LD, Maman S, Chi BH, Mutale W. Understanding PrEP decision making among pregnant women in Lilongwe, Malawi: A mixed-methods study. J Int AIDS Soc 2022; 25:e26007. [PMID: 36074034 PMCID: PMC9454413 DOI: 10.1002/jia2.26007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/23/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is a promising tool for HIV prevention during pregnancy. With increasing rollout in antenatal settings, counselling strategies to help pregnant women make appropriate decisions about PrEP use are needed. Understanding women's motivations and concerns for PrEP use-and how these inform their decision making and feelings about the decision to start PrEP-are critical to inform these strategies. METHODS We conducted a convergent mixed-methods study from June 2020 to June 2021 in the context of a PrEP adherence support trial among HIV-negative pregnant women in Lilongwe, Malawi. Two hundred women completed a survey reporting their motivations and concerns about PrEP use, and their feelings about the decision to start PrEP (Decisional Regret Scale). Thirty women completed in-depth interviews to better understand the decision-making process, including motivations and concerns weighed in women's decision to use PrEP. Analyses comprised descriptive and bivariate statistics, thematic qualitative analysis, and integration of quantitative and qualitative results. RESULTS Women initiating PrEP during pregnancy were highly motivated to obtain HIV protection for themselves and their unborn child, often due to perceived HIV risk connoted by a recent sexually transmitted infection and/or concerns about partner non-monogamy. These motivations prevailed despite some concerns about safety and side effects, anticipated stigmatization, and concerns about adherence burden and pill attributes. Many women had informed their partner of their decision to use PrEP yet few felt their decision was contingent upon partner approval. Most women felt positively about the decision to start PrEP (mean decisional regret = 1.2 out of 5), but those with a greater number of concerns reported greater decisional regret (B = 0.036; p = 0.005). Furthermore, women who were specifically concerned about partner disclosure, who disliked pills or who had no perceived HIV risk reported greater decisional regret. CONCLUSIONS Pregnant women were strongly motivated by the promise of HIV protection offered by PrEP and accepted it despite diverse concerns. A shared decision-making approach that centres pregnant women and offers partner involvement may help identify and address initial concerns about PrEP use and support prevention-effective use of PrEP during this important period.
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Affiliation(s)
- Lauren M. Hill
- Department of Health BehaviorUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Carol E. Golin
- Department of Health BehaviorUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Friday Saidi
- UNC Project‐MalawiLilongweMalawi
- Department of Obstetrics and GynecologySchool of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | | | - Alinda Young
- Department of Maternal and Child HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Lisa D. Pearce
- Department of SociologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Suzanne Maman
- Department of Health BehaviorUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Benjamin H. Chi
- Department of Obstetrics and GynecologySchool of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Wilbroad Mutale
- Department of Health PolicyUniversity of Zambia School of Public HealthLusakaZambia
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Belay YA, Yitayal M, Atnafu A, Taye FA. Patient experiences and preferences for antiretroviral therapy service provision: implications for differentiated service delivery in Northwest Ethiopia. AIDS Res Ther 2022; 19:30. [PMID: 35761352 PMCID: PMC9237972 DOI: 10.1186/s12981-022-00452-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Understanding the experiences, needs, preferences, and behaviors of people living with HIV (PLHIV) are critical to tailor HIV treatment. However, there is limited empirical evidence in Ethiopia on the views of PLHIV regarding their experiences with current antiretroviral therapy (ART) services and preferred models of HIV treatment. Hence, this study aimed to explore the patients’ experiences of taking medications and preferences for ART service provision in Northwest Ethiopia. Methods A phenomenological study design was employed. In this study, stable and 18 years old and above PLHIVs, who had been using ART service at four public hospitals and two health centers in East Gojjam, West Gojjam and Awi zones, and Bahir Dar city administration of Amhara National Regional State, Northwest Ethiopia, were purposively selected. Fifteen in-depth interviews were conducted from July 2021 to September 2021 to collect data. ATLAS.ti version 9 software was used for coding translated transcripts. A thematic analysis approach was employed. Findings Participants in this study had reported positive and negative experiences in receiving ART services and also varied preferences toward ART service features. The study identified five themes on experiences for ART service and 15 attributes of ART service characteristics. The identified themes were stigma, time, availability of drugs and providers, costs for clinic visits, and provider-patient interaction. The fifteen attributes were buddy system, ART refill (individualized or group), ART packaging and labeling, drug formulation and administration, ART room labeling, distance, location of service, preferences on involvement in treatment decision-making, the person providing ART refills, provider’s attitude, spatial arrangement of ART room, time of health facility operation, time spent at clinics, and total cost of the visit. Conclusions The results raise awareness for the positive and negative experiences of patients informing us about barriers and supporting factors in ART service provision. They open up the potential for HIV treatment service improvement. The preferences of PLHIVs toward ART service delivery features were heterogeneous. Policy and program efforts should tailor ART services that suit patients’ needs and priorities in Ethiopia. Future research should further assess the reasons for patients’ distrust of the community ART delivery models. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-022-00452-5.
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Affiliation(s)
- Yihalem Abebe Belay
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia. .,Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mezgebu Yitayal
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fitalew Agimass Taye
- Department of Accounting, Finance, and Economics, Griffith University, Brisbane, Australia
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Cervical Cancer Prevention and High-Risk HPV Self-Sampling Awareness and Acceptability among Women Living with HIV: A Qualitative Investigation from the Patients’ and Providers’ Perspectives. Curr Oncol 2022; 29:516-533. [PMID: 35200547 PMCID: PMC8870184 DOI: 10.3390/curroncol29020047] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Routine cervical cancer screening is important for women living with HIV (WLH) due to the greater incidence and persistence of high-risk HPV (HR-HPV) infection. HR-HPV self-sampling has been proposed to overcome barriers to in-office cervical cancer screening in underserved populations. However, little is known about baseline knowledge of HR-HPV and the acceptability of HR-HPV self-sampling among WLH. This paper describes WLH’s experiences and needs regarding cervical cancer screening, specifically HR-HPV self-sampling, and seeks to reconcile their experiences with the views of their providers. In total, 10 providers and 39 WLH participated in semi-structured interviews and group discussions, respectively. Knowledge of cervical cancer and HR-HPV was generally limited among WLH; when present, it was often due to personal experience of or proximity to someone affected by cervical cancer. Most WLH were not familiar with HR-HPV self-sampling but, despite some of the providers’ skepticism, expressed their willingness to participate in a mail-based HR-HPV self-sampling intervention and highlighted convenience, ease of use, and affordability as facilitators to the uptake of HR-HPV self-sampling. The experiences identified can be used to guide patient-centered communication aimed at improving cervical cancer knowledge and to inform interventions, such as HR-HPV self-sampling, designed to increase cervical cancer screening among under-screened WLH.
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Sevelius JM, Neilands TB, Reback CJ, Castro D, Dilworth SE, Kaplan RL, Johnson MO. An Intervention by and for Transgender Women Living With HIV: Study Protocol for a Two-Arm Randomized Controlled Trial Testing the Efficacy of “Healthy Divas” to Improve HIV Care Outcomes. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:665723. [PMID: 36304034 PMCID: PMC9580739 DOI: 10.3389/frph.2021.665723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/16/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction: Transgender women (assigned “male” at birth but who do not identify as male) are disproportionately impacted by HIV and experience unique barriers and facilitators to HIV care engagement. In formative work, we identified culturally specific and modifiable barriers to HIV treatment engagement among transgender women living with HIV (TWH), including prioritizing transition-related healthcare over HIV treatment, avoiding HIV care settings due to gender-related and HIV stigma, concerns about potential drug interactions with hormones, and inadequate social support. Grounded in the investigators' Models of Gender Affirmation and Health Care Empowerment, we developed the Healthy Divas intervention to optimize engagement in HIV care among TWH at risk for treatment failure and consequential morbidity, mortality, and onward transmission of HIV. Methods and Analysis: We conducted a 2-arm randomized controlled trial (RCT) of the intervention's efficacy in Los Angeles and San Francisco to improve engagement in care among TWH (N = 278). The primary outcome was virologic control indicated by undetectable HIV-1 level (undetectability = < 20 copies/mL), at baseline and follow-up assessment for 12 months at 3-month intervals. Ethics and Dissemination: This study was approved by University of California, San Francisco Institutional Review Board (15-17910) and Western Institutional Review Board (20181370). Participants provided informed consent before enrolment in the study. We are committed to collaboration with National Institutes of Health officials, other researchers, and health and social services communities for rapid dissemination of data and sharing of materials. The results will be published in peer-reviewed academic journals and scientific presentations. We will make our results available to researchers interested in transgender health to avoid unintentional duplication of research, as well as to others in health and social services communities, including HIV clinics, LGBT community-based organizations, and AIDS service organizations. Clinical Trial Registration:Clinicaltrials.gov, identifier NCT03081559.
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Affiliation(s)
- Jae M. Sevelius
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
- Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Jae M. Sevelius
| | - Torsten B. Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Cathy J. Reback
- Friends Research Institute, Los Angeles, CA, United States
- Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, CA, United States
| | - Danielle Castro
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
- Department of Medicine, Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, CA, United States
| | - Samantha E. Dilworth
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Rachel L. Kaplan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, United States
| | - Mallory O. Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, United States
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Creasy SL, Olaniyan A, Davis D, Hawk M. "Support People the Way in Which They Want to Be Supported": Best Practices for Incorporating Client-Centeredness in Representative Payee Programs. Community Ment Health J 2021; 57:1065-1072. [PMID: 33128098 PMCID: PMC8085172 DOI: 10.1007/s10597-020-00733-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 10/21/2020] [Indexed: 12/01/2022]
Abstract
Nearly 1 million Social Security beneficiaries have representative payees to manage their funds. Although coercion and paternalism are historically associated with payee services, a recent study showed high satisfaction in a payee program incorporating client-centered practices. Separately we reported ways organizations align payee services with their missions to empower clients and improve outcomes. Here we share results from nine provider qualitative interviews describing client-centered best practices and exploring beliefs regarding their value. We identified four best practices: Shared Decision-Making on Bills and Spending, Non-Paternalistic Substance Use Policies, Client Advocacy, and Additional Service Policies, (changing fee structures, termination policies, incorporating opting in or out, and "graduation"). Results indicate prioritizing clients' goals and agency may improve the quality of life of beneficiaries and reduce the paternalism and coercion historically associated with payee. Creating a client-centered payee toolkit and a payee collaborative may empower organizations to refine their services and provide opportunities for shared learning and support.
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Affiliation(s)
- Stephanie L Creasy
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
| | - Abisola Olaniyan
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
| | - Dana Davis
- Youngstown State University, Cushwa Hall 3379, One University Plaza, Youngstown, OH, 44555, USA
| | - Mary Hawk
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA.
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Links AR, Callon W, Wasserman C, Beach MC, Ryan MA, Leu GR, Tunkel D, Boss EF. Treatment recommendations to parents during pediatric tonsillectomy consultations: A mixed methods analysis of surgeon language. PATIENT EDUCATION AND COUNSELING 2021; 104:1371-1379. [PMID: 33342578 DOI: 10.1016/j.pec.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/19/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. We characterize how otolaryngologists provide treatment recommendations and suggest a classification framework. METHODS We qualitatively analyzed surgeon recommendations from 55 encounters between otolaryngologists and parents of children evaluated for tonsillectomy, and classified recommendation types by phrasing. Multilevel logistic regression identified predictors of recommendation phrasing. RESULTS Clinicians provided 183 recommendations (mean/visit = 3.3). We identified four domains of recommendation-phrasing (direct, passive, acceptable, parent-oriented). Direct recommendations (n = 68, 37%) included presumptive statements phrasing intentions as inevitable. Passive recommendations (n = 65, 36%) included practice-based recommendations utilizing general statements. Acceptable recommendations (n = 29, 16%) included speaking positively about treatment options. Parent-oriented recommendations (n = 21, 11%) included parent choice statements. Clinicians more commonly made direct recommendations to parents who were racial minorities (OR = 2.7, p = .02, 95% CI [1.7, 5.9]) or had an annual income <$50,000 (OR = 2.2, p = .03, 95% CI [1.1, 4.4]). CONCLUSION Clinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions. PRACTICE IMPLICATIONS Findings may be implemented into training which increases clinician awareness of dialogue use when recommending treatment alternatives to patients.
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Affiliation(s)
- Anne R Links
- Johns Hopkins University School of Medicine, Department of Otolaryngology, Baltimore, USA.
| | - Wynne Callon
- Harvard Medical School, Boston Children's Hospital, Boston, USA
| | - Carly Wasserman
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, USA
| | - Mary Catherine Beach
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, USA
| | - Marisa A Ryan
- Johns Hopkins University School of Medicine, Department of Otolaryngology, Baltimore, USA
| | - Grace R Leu
- Johns Hopkins University School of Medicine, Department of Otolaryngology, Baltimore, USA
| | - David Tunkel
- Johns Hopkins University School of Medicine, Department of Otolaryngology, Baltimore, USA
| | - Emily F Boss
- Johns Hopkins University School of Medicine, Department of Otolaryngology, Baltimore, USA
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Leu GR, Links AR, Ryan MA, Walsh JM, Tunkel DE, Beach MC, Boss EF. Assessment of Parental Choice Predisposition for Tonsillectomy in Children. JAMA Otolaryngol Head Neck Surg 2021; 147:263-270. [PMID: 33377933 DOI: 10.1001/jamaoto.2020.5031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance The decision to proceed with tonsillectomy to treat pediatric obstructive sleep-disordered breathing (OSDB) often falls on individual families. Despite emphasis on shared decision-making between parents and surgeons about tonsillectomy for OSDB, the extent to which parents have already decided about surgery prior to the child's consultation is not known. Objective To identify predictors of parent choice predisposition for surgical treatment of OSDB with tonsillectomy and describe its association with parent-clinician communication. Design, Setting, and Participants Observational cohort study conducted at 3 outpatient clinical sites (urban-based outpatient center, suburban off-site outpatient center, and community-based medical center) associated with a large academic center. A total of 149 parents of children undergoing their initial otolaryngology consultation for OSDB were identified through clinic scheduling records and deemed eligible for participation in this study. Of the 149 parents, a volunteer sample of 64 parents (42.9%) agreed to participate and have their consultation audiorecorded. Of these 64 participants, 12 parents were excluded because their child had previously been evaluated for OSDB by a specialist. Main Outcomes and Measures The primary outcomes and measures were treatment choice predisposition scale (a measure of the strength of a patient's treatment decision prior to entering a medical consultation), parent communication behaviors coded in consultation audiorecordings (substantive questions asked, introduced medical jargon, expression of treatment preference, and scores on the OSDB and Adenotonsillectomy Knowledge Scale for parents). Results A total of 52 parent participants were included in the final analysis. Most parent participants were female (n = 48; 92%); 50% (n = 26) of parents were non-Hispanic White, 37% (n = 19) were Black, 10% (n = 5) were Hispanic/Latino, and 4% (n = 2) self-reported race/ethnicity as "Other." Mean (range) choice predisposition was 6.84 (2-10), with 22 parents (42%) more predisposed to choose tonsillectomy. Parents more predisposed to choose tonsillectomy used more medical jargon during the consultation (odds ratio [OR], 3.95; 95% CI, 1.16-15.15) and were less likely to ask questions (OR, 0.22; 95% CI, 0.05-0.87). Parental predictors of greater predisposition toward choosing surgery were White race (OR, 7.31; 95% CI, 1.77-39.33) and prior evaluation by a pediatrician for OSDB (OR, 6.10; 95% CI, 1.44-33.34). Conclusions and Relevance In this cohort study of parents of children with OSDB, many parents were predisposed to choose treatment with tonsillectomy prior to initial surgical consultation, which may lessen engagement and influence 2-way communication. In this cohort, greater predisposition for tonsillectomy was observed in non-Hispanic White parents and parents of patients who had been previously evaluated by a pediatrician for OSDB. Understanding parent choice predisposition for surgery may promote improved communication and parental engagement during surgical consultations. It may also help direct education about sleep and tonsillectomy to nonsurgical forums.
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Affiliation(s)
- Grace R Leu
- Tufts University School of Medicine, Boston, Massachusetts
| | - Anne R Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marisa A Ryan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Catherine Beach
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Olaniyan A, Creasy SL, Batey DS, Brooks MM, Maulsby C, Musgrove K, Hagan E, Martin D, Sashin C, Farmartino C, Hawk M. Protocol of a randomized controlled trial to test the effects of client-centered Representative Payee Services on antiretroviral therapy adherence among marginalized people living with HIV. BMC Public Health 2020; 20:1443. [PMID: 32967646 PMCID: PMC7509495 DOI: 10.1186/s12889-020-09500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Client-Centered Representative Payee (CCRP) is an intervention modifying implementation of a current policy of the US Social Security Administration, which appoints organizations to serve as financial payees on behalf of vulnerable individuals receiving Social Security benefits. By ensuring beneficiaries' bills are paid while supporting their self-determination, this structural intervention may mitigate the effects of economic disadvantage to improve housing and financial stability, enabling self-efficacy for health outcomes and improved antiretroviral therapy adherence. This randomized controlled trial will test the impact of CCRP on marginalized people living with HIV (PLWH). We hypothesize that helping participants to pay their rent and other bills on time will improve housing stability and decrease financial stress. METHODS PLWH (n = 160) receiving services at community-based organizations will be randomly assigned to the CCRP intervention or the standard of care for 12 months. Fifty additional participants will be enrolled into a non-randomized ("choice") study allowing participant selection of the CCRP intervention or control. The primary outcome is HIV medication adherence, assessed via the CASE adherence index, viral load, and CD4 counts. Self-assessment data for ART adherence, housing instability, self-efficacy for health behaviors, financial stress, and retention in care will be collected at baseline, 3, 6, and 12 months. Viral load, CD4, and appointment adherence data will be collected at baseline, 6, 12, 18, and 24 months from medical records. Outcomes will be compared by treatment group in the randomized trial, in the non-randomized cohort, and in the combined cohort. Qualitative data will be collected from study participants, eligible non-participants, and providers to explore underlying mechanisms of adherence, subjective responses to the intervention, and implementation barriers and facilitators. DISCUSSION The aim of this study is to determine if CCRP improves health outcomes for vulnerable PLWH. Study outcomes may provide information about supports needed to help economically fragile PLWH improve health outcomes and ultimately improve HIV health disparities. In addition, findings may help to refine service delivery including the provision of representative payee to this often-marginalized population. This protocol was prospectively registered on May 22, 2018 with ClinicalTrials.gov (NCT03561103) .
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Affiliation(s)
- Abisola Olaniyan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
| | - Stephanie L Creasy
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
| | - D Scott Batey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Mori Brooks
- Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Catherine Maulsby
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Deborah Martin
- Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Courtenay Sashin
- Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Mary Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA.
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Links AR, Callon W, Wasserman C, Walsh J, Tunkel DE, Beach MC, Boss EF. Parental role in decision-making for pediatric surgery: Perceptions of involvement in consultations for tonsillectomy. PATIENT EDUCATION AND COUNSELING 2020; 103:944-951. [PMID: 31866196 DOI: 10.1016/j.pec.2019.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/20/2019] [Accepted: 12/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Parental role in decision-making has implications for quality of care. We describe roles of parent participation in decision-making for tonsillectomy. METHODS Parents reported preferred role in decision-making before consultations for tonsillectomy and the role they experienced after their consult. Parents completed questionnaires, including items evaluating clinician/parent communication. Clinicians rated perception of parents' preferred role in decision-making. Congruence between parent and clinician responses was evaluated via kappa analysis. Logistic regression identified associations between decision-making roles and socioemotional and communication factors. RESULTS Consults between 63 parents and 8 otolaryngologists were analyzed.There was inadequate agreement between clinician and parent ratings of preferred roles (37%, p = 0.6, 95% CI [-0.09, 0.001]). Parents perceived greater involvement when clinicians discussed reasons to have (OR = 4.3, p = 0.03) or not have (OR = 4.1, p = 0.005) surgery. Parents perceived less involvement when clinicians used jargon (OR = 0.1, p = 0.03), and when parents trusted clinicians (OR = 0.4, p = 0.049), or experienced greater decisional conflict (OR = 0.9, p = 0.03). CONCLUSIONS Parents and clinicians perceived parental preference for decision-making involvement differently during consultations for tonsillectomy. Clinician information-sharing, jargon use, and parent trust in clinician predicted extent of perceived engagement. PRACTICE IMPLICATIONS Findings may enhance understanding of strategies to effectively communicate and engage parents in shared decision-making for pediatric surgical care.
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Affiliation(s)
- Anne R Links
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA.
| | - Wynne Callon
- Harvard Medical School, Boston Children's Hospital, Boston, USA
| | - Carly Wasserman
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, USA
| | - Jonathan Walsh
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA
| | - David E Tunkel
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA
| | - Mary Catherine Beach
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, USA
| | - Emily F Boss
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA
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Feijoo-Cid M, Rivero-Santana A, Moriña D, Cesar C, Fink V, Sued O. Decision-making in HIV clinical trials: a study with patients enrolled in antiretroviral trials. GACETA SANITARIA 2020; 35:264-269. [PMID: 32197784 DOI: 10.1016/j.gaceta.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore the decisional process of people living with human immunodeficiency virus (HIV) currently enrolled in antiretroviral clinical trials. METHOD Cross-sectional retrospective study. Outcome variables were reasons to participate, perceived decisional role (Control Preference Scale), the Decisional Conflict Scale and the Decisional Regret Scale. Descriptive statistics were calculated, and associations among these variables and with sociodemographic and clinical characteristics were analyzed with non-parametric techniques. RESULTS Main reasons to participate were gratitude towards Fundación Huesped (47%), the doctor's recommendation (32%), and perceived difficulty to access treatment in a public hospital (28%). Most patients thought that they made their decision alone (54.8%) or collaboratively with the physician (43%). Decisional conflict was low, with only some conflict in the support subscale (median=16.67). Education was the only significant correlate of the total decisional conflict score (higher in less educated patients; p=0.018), whereas education, recent diagnosis, living alone, lower age, being man and doctor's recommendation to go to Fundación Huésped related to higher conflict in different subscales. Nobody regretted to participate. CONCLUSIONS The decision making regarding participation in HIV trials, from the perspective of participants, was made respecting their autonomy and with very low decisional conflict. Currently, patients show no signs of regret. However, even in this favorable context, results highlight the necessity of enhancing the decision support in more vulnerable patients (e.g., less educated, recently diagnosed or with less social support), thus warranting equity in the quality of the decision making process.
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Affiliation(s)
- Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Grup de REcerca Multidisciplinar en SAlut i Societat (GREMSAS) (2017 SGR 917), Spain
| | - Amado Rivero-Santana
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Las Palmas de Gran Canaria, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
| | - David Moriña
- Barcelona Graduate School of Mathematics (BGSMath), Bellaterra, Cerdanyola del Vallès, Barcelona, Spain; Departament de Matemàtiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
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Freytag J, Jiang ZJ, Giordano TP, Westbrook RA, McCurdy SA, Njue-Marendes S, Dang BN. What patient involvement means to new patients at two HIV clinics: A longitudinal, qualitative study. PATIENT EDUCATION AND COUNSELING 2019; 102:1535-1540. [PMID: 30948202 PMCID: PMC6565493 DOI: 10.1016/j.pec.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This study 1) defines patient involvement from the perspective of patients new to a provider, 2) describes provider communication that patients perceive as promoting involvement, and 3) examines changes in patient definitions of involvement over time. METHODS We enrolled 56 patients at two HIV clinics in Houston, Texas, from August 2013 until March 2015. We interviewed patients three times during the first year of care and analyzed interviews using content analysis. RESULTS The mean age was 45 years; 54% were men. Patient definitions of involvement ranged from adherence- to decision-oriented. Analysis revealed three provider communication behaviors that patients perceive as promoting involvement: 1) soliciting patient feedback, 2) discussing treatment options and trade-offs, 3) narrating the decision-making process. Definitions of involvement can change over time as providers reframe the patient's illness as manageable and through perceived partnerships with the provider. CONCLUSION Provider communication plays a critical role in shaping new patients' perception of involvement and can make patients feel involved even when patients do not actively make medical decisions. PRACTICAL IMPLICATIONS Finding strategies to make patients feel involved in their care is important, particularly for new patients, even if those strategies do not necessarily promote more talk from the patient.
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Affiliation(s)
- Jennifer Freytag
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
| | - Zhixin J Jiang
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States.
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
| | - Robert A Westbrook
- Jesse H. Jones Graduate School of Business, Rice University, Houston, TX, United States.
| | - Sheryl A McCurdy
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States.
| | - Sarah Njue-Marendes
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
| | - Bich N Dang
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
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Links AR, Callon W, Wasserman C, Walsh J, Beach MC, Boss EF. Surgeon use of medical jargon with parents in the outpatient setting. PATIENT EDUCATION AND COUNSELING 2019; 102:1111-1118. [PMID: 30744965 PMCID: PMC6525640 DOI: 10.1016/j.pec.2019.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/13/2018] [Accepted: 02/01/2019] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Unexplained medical terminology impedes clinician/parent communication. We describe jargon use in a pediatric surgical setting. METHODS We evaluated encounters between parents of children with sleep-disordered breathing (SDB; n = 64) and otolaryngologists (n = 8). Participants completed questionnaires evaluating demographics, clinical features, and parental role in decision-making via a 4-point categorical item. Two coders reviewed consultations for occurrence of clinician and parent utterance of medical jargon. Descriptive statistics established a profile of jargon use, and logistic regression evaluated associations between communication factors with jargon use. RESULTS Unexplained medical jargon was common (mean total utterances per visit = 28.9,SD = 19.5,Range = 5-100), including SDB-specific jargon (M = 8.3,SD = 8.8), other medical terminology (M = 13.9,SD = 12) and contextual terms (M = 3.8,SD = 4). Parents used jargon a mean of 4.3 times (SD = 4.6). Clinicians used more jargon in consults where they perceived parents as having greater involvement in decision-making (OR = 3.4,p < 0.05) and when parents used more jargon (OR = 1.2,p < 0.05). CONCLUSIONS Jargon use in pediatric surgical consultations is common and could serve as a barrier to informed or shared parent decision-making. This study provides a foundation for further research into patterns of jargon use across surgical populations. PRACTICE IMPLICATIONS Results will be integrated into communication training to enhance clinician communication, foster self-awareness in language use, and create strategies to evaluate parental understanding.
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Affiliation(s)
- A R Links
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, United States
| | - W Callon
- Johns Hopkins School of Medicine, Department of Medicine, Baltimore, MD, United States
| | - C Wasserman
- Johns Hopkins School of Medicine, Department of Medicine, Baltimore, MD, United States
| | - J Walsh
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, United States
| | - M C Beach
- Johns Hopkins School of Medicine, Department of Medicine, Baltimore, MD, United States
| | - E F Boss
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD, United States.
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Campbell AR, Kinvig K, Côté HC, Lester RT, Qiu AQ, Maan EJ, Alimenti A, Pick N, Murray MC. Health Care Provider Utilization and Cost of an mHealth Intervention in Vulnerable People Living With HIV in Vancouver, Canada: Prospective Study. JMIR Mhealth Uhealth 2018; 6:e152. [PMID: 29986845 PMCID: PMC6056738 DOI: 10.2196/mhealth.9493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/25/2018] [Accepted: 06/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Improving adherence to combined antiretroviral therapy (cART) can be challenging, especially among vulnerable populations living with HIV. Even where cART is available free of charge, social determinants of health act as barriers to optimal adherence rates. Patient-centered approaches exploiting mobile phone communications (mHealth) have been shown to improve adherence to cART and promote achievement of suppressed HIV plasma viral loads. However, data are scarce on the health care provider (HCP) time commitments and health care costs associated with such interventions. This knowledge is needed to inform policy and programmatic implementation. OBJECTIVE The purpose of this study was to approximate the resources required and to provide an estimate of the costs associated with running an mHealth intervention program to improve medication adherence in people living with HIV (PLWH). METHODS This prospective study of HCP utilization and costs was embedded within a repeated measures effectiveness study of the WelTel short-message service (SMS) mHealth program. The study included 85 vulnerable, nonadherent PLWH in Vancouver, Canada, and resulted in improved medication adherence and HIV plasma viral load among participants. Study participants were provided mobile phones with unlimited texting (where required) and received weekly bidirectional text messages to inquire on their status for one year. A clinic nurse triaged and managed participants' responses, immediately logging all patient interactions by topic, HCP involvement, and time dedicated to addressing issues raised by participants. Interaction costs were determined in Canadian dollars based on HCP type, median salary within our health authority, and their time utilized as part of the intervention. RESULTS Participant-identified problems within text responses included health-related, social, and logistical issues. Taken together, management of problems required a median of 43 minutes (interquartile range, IQR 17-99) of HCP time per participant per year, for a median yearly cost of Can $36.72 (IQR 15.50-81.60) per participant who responded with at least one problem. The clinic nurse who monitored the texts solved or managed 65% of these issues, and the remaining were referred to a variety of other HCPs. The total intervention costs, including mobile phones, plans, and staffing were a median Can $347.74/highly vulnerable participant per year for all participants or Can $383.18/highly vulnerable participant per year for those who responded with at least one problem. CONCLUSIONS Bidirectional mHealth programs improve HIV care and treatment outcomes for PLWH. Knowledge about the HCP cost associated, here less than Can $50/year, provides stakeholders and decision makers with information relevant to determining the feasibility and sustainability of mHealth programs in a real-world setting. TRIAL REGISTRATION ClinicalTrials.gov NCT02603536; https://clinicaltrials.gov/ct2/show/NCT02603536 (Archived by WebCite at http://www.webcitation.org/70IYqKUjV).
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Affiliation(s)
- Amber R Campbell
- Division of Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Karen Kinvig
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Hélène Cf Côté
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Richard T Lester
- Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Annie Q Qiu
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Evelyn J Maan
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Ariane Alimenti
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Neora Pick
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada
- Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melanie Cm Murray
- Oak Tree Clinic, British Columbia Women's Hospital, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital, Vancouver, BC, Canada
- Division of Infectious Disease, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Johnson MO, Koester KA, Wood T, Neilands TB, Pomeranz JL, Christopoulos KA. Development of an Index of Engagement in HIV Care: An Adapted Internet-Based Delphi Process. JMIR Res Protoc 2017; 6:e224. [PMID: 29208589 PMCID: PMC5736874 DOI: 10.2196/resprot.8520] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/08/2017] [Accepted: 10/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background Improving engagement in medical care among persons living with human immunodeficiency virus (HIV) is critical to optimizing clinical outcomes and reducing onward transmission of HIV. However, a clear conceptualization of what it means to be engaged in HIV care is lacking, and thus efforts to measure and enhance engagement in care are limited. Objective This paper describes the use of a modified online Delphi process of consensus building to solicit input from a range of HIV and non-HIV researchers and providers, and to integrate that input with focus group data conducted with HIV-infected patients. The overarching goal was to generate items for a patient-centered measure of engagement in HIV care for use in future research and clinical practice. Methods We recruited 66 expert panelists from around the United States. Starting with six open-ended questions, we used four rounds of online Delphi data collection in tandem with 12 in-person focus groups with patients and cognitive interviews with 25 patients. Results We recruited 66 expert panelists from around the United States and 64 (97%) were retained for four rounds of data collection. Starting with six open-ended questions, we used four rounds of online Delphi data collection in tandem with 12 in-person focus groups with patients and cognitive interviews with 25 patients. The process resulted in an expansion to 120 topics that were subsequently reduced to 13 candidate items for the planned assessment measure. Conclusions The process was an efficient method of soliciting input from geographically separated and busy experts across a range of disciplines and professional roles with the aim of arriving at a coherent definition of engagement in HIV care and a manageable set of survey items to assess it. Next steps are to validate the utility of the new measure in predicting retention in care, adherence to treatment, and clinical outcomes among patients living with HIV.
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Affiliation(s)
- Mallory O Johnson
- University of California, San Francisco, San Francisco, CA, United States
| | - Kimberly A Koester
- University of California, San Francisco, San Francisco, CA, United States
| | - Troy Wood
- University of California, San Francisco, San Francisco, CA, United States
| | - Torsten B Neilands
- University of California, San Francisco, San Francisco, CA, United States
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Hawk M, Coulter RW, Egan JE, Friedman MR, Meanley S, Fisk S, Watson C, Kinsky S. Exploring the Healthcare Environment and Associations with Clinical Outcomes of People Living with HIV/AIDS. AIDS Patient Care STDS 2017; 31:495-503. [PMID: 29148966 PMCID: PMC5724582 DOI: 10.1089/apc.2017.0124] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite three decades of dramatic treatment breakthroughs in antiretroviral regimens, clinical outcomes for people living with HIV vary greatly. The HIV treatment cascade models the stages of care that people living with HIV go through toward the goal of viral suppression and demonstrates that <30% of those living with HIV/AIDS in the United States have met this goal. Although some research has focused on the ways that patient characteristics and patient-provider relationships contribute to clinical adherence and treatment success, few studies to date have examined the ways that contextual factors of care and the healthcare environment contribute to patient outcomes. Here, we present qualitative findings from a mixed-methods study to describe contextual and healthcare environment factors in a Ryan White Part C clinic that are associated with patients' abilities to achieve viral suppression. We propose a modification of Andersen's Behavioral Model of Health Services Utilization, and its more recent adaptation developed by Ulett et al., to describe the ways that clinic, system, and provider factors merge to create a system of care in which more than 86% of the patient population is virally suppressed.
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Affiliation(s)
- Mary Hawk
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - James E. Egan
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mackey Reuel Friedman
- Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven Meanley
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stuart Fisk
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Courtney Watson
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Suzanne Kinsky
- UPMC Center for High-Value Health Care, Pittsburgh, Pennsylvania
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Callon W, Saha S, Wilson IB, Laws MB, Massa M, Korthuis PT, Sharp V, Cohn J, Moore RD, Beach MC. How does decision complexity affect shared decision making? An analysis of patient-provider antiretroviral initiation dialogue. PATIENT EDUCATION AND COUNSELING 2017; 100:919-926. [PMID: 28012679 PMCID: PMC5400677 DOI: 10.1016/j.pec.2016.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 05/25/2023]
Abstract
OBJECTIVES This study analyzed patient-provider dialogue regarding anti-retroviral therapy (ART) initiation, assessing the degree to which shared decision making (SDM) occurred. METHODS We analyzed 24 audio-recorded dialogues between 14 HIV providers and their patients regarding ART initiation. We coded transcribed dialogues for seven SDM elements. We stratified dialogues into three levels of decision complexity (basic, intermediate, complex) based on patient CD4 counts and evaluated SDM criteria fulfillment at each level of decision complexity. RESULTS There were five basic, twelve intermediate, and seven complex decisions in our sample. While only two met the defined criteria for SDM, the mean number of SDM elements present increased with each level of decision complexity. Discussion of the clinical issue requiring the decision occurred most frequently (88%), while discussion of pros/cons (13%), patient's understanding (21%), and decision alternatives (29%) occurred least frequently. CONCLUSION/PRACTICE IMPLICATIONS While few dialogues met the defined SDM criteria, providers are having conversations that respond to decision complexity. Clinicians should be aware that discussion of pros/cons, alternatives, and uncertainties are frequently skipped, even when these elements are clearly relevant, as in complex decisions. In addition, rhetorical questions to assess patient preferences and understanding are insufficient to fully engage patients in SDM.
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Affiliation(s)
- Wynne Callon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Somnath Saha
- Portland VA Medical Center, Portland, OR, USA; Department of Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Ira B Wilson
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Michael Barton Laws
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Michele Massa
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - P Todd Korthuis
- Department of Medicine, Oregon Health Sciences University, Portland, OR, USA
| | | | - Jonathan Cohn
- Department of Medicine, Wayne State University, Detroit, MI, USA
| | - Richard D Moore
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Moise N, Ye S, Alcántara C, Davidson KW, Kronish I. Depressive symptoms and decision-making preferences in patients with comorbid illnesses. J Psychosom Res 2017; 92:63-66. [PMID: 26682488 PMCID: PMC4889561 DOI: 10.1016/j.jpsychores.2015.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Shared decision-making (SDM) is increasingly promoted in the primary care setting, but depressive symptoms, which are associated with cognitive changes, may influence decision-making preferences. We sought to assess whether elevated depressive symptoms are associated with decision-making preference in patients with comorbid chronic illness. METHODS We enrolled 195 patients ≥18years old with uncontrolled hypertension from two urban, academic primary care clinics. Depressive symptoms were assessed using the 8-item Patient Health Questionnaire. Clinician-directed decision-making preference was assessed according to the Control Preference Scale. The impact of depressive symptoms on decision-making preference was assessed using generalized linear mixed models adjusted for age, gender, race, ethnicity, education, Medicaid status, Charlson Comorbidity Index, partner status, and clustering within clinicians. RESULTS The mean age was 64.2years; 72% were women, 77% Hispanic, 38% Black, and 33% had elevated depressive symptoms. Overall, 35% of patients preferred clinician-directed decision-making, 19% mostly clinician-directed, 39% shared, and 7% some or little clinician-input. Patients with (vs. without) elevated depressive symptoms were more likely to prefer clinician-directed decision-making (46% versus 29%; p=0.02; AOR 2.51, 95% CI 1.30-4.85, p=0.005). Remitted depressive symptoms (vs. never depressed) were not associated with preference. CONCLUSIONS Elevated depressive symptoms are associated with preference for clinician-directed decision-making. We suggest that clinicians should be aware of this effect when incorporating preference into their communication styles and take an active role in eliciting patient values and exchanging information about treatment choice, all important components of shared decision-making, particularly when patients are depressed.
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Affiliation(s)
- Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States
| | - Carmela Alcántara
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States; Columbia University School of Social Work, New York, NY, United States
| | - Karina W Davidson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States; Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Ian Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States.
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Fuller SM, Koester KA, Guinness RR, Steward WT. Patients' Perceptions and Experiences of Shared Decision-Making in Primary HIV Care Clinics. J Assoc Nurses AIDS Care 2016; 28:75-84. [PMID: 27712863 DOI: 10.1016/j.jana.2016.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/26/2016] [Indexed: 11/15/2022]
Abstract
Shared decision-making (SDM) is considered best practice in health care. Prior studies have explored attitudes and barriers/facilitators to SDM, with few specific to HIV care. We interviewed 53 patients in HIV primary care clinics in California to understand the factors and situations that may promote or hinder engagement in SDM. Studies in other populations have found that patients' knowledge about their diseases and their trust in providers facilitated SDM. We found these features to be more nuanced for HIV. Perceptions of personal agency, knowledge about one's disease, and trust in provider were factors that could work for or against SDM. Overall, we found that participants described few experiences of SDM, especially among those with no comorbidities. Opportunities for SDM in routine HIV care (e.g., determining antiretroviral therapy) may arise infrequently because of treatment advances. These findings yield considerations for adapting SDM to fit the context of HIV care.
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Murray MCM, O’Shaughnessy S, Smillie K, Van Borek N, Graham R, Maan EJ, van der Kop ML, Friesen K, Albert A, Levine S, Pick N, Ogilvie G, Money D, Lester R. Health care providers' perspectives on a weekly text-messaging intervention to engage HIV-positive persons in care (WelTel BC1). AIDS Behav 2015; 19:1875-87. [PMID: 26297567 DOI: 10.1007/s10461-015-1151-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Though evidence shows that Mobile health (mHealth) interventions can improve adherence and viral load in HIV-positive persons, few have studied the health care providers' (HCP) perspective. We conducted a prospective mixed methods pilot study using the WelTel intervention wherein HIV-positive participants (n = 25) received weekly interactive text messages for 6 months. Text message response rate and topic data were collected to illustrate the HCP experience. The aim of this study is to explore intervention acceptability and feasibility from the HCP perspective through a baseline focus group and end of study interviews with HCP impacted by the intervention. Interview data were thematically coded using the Technology Acceptance Model. HCPs identified that the WelTel intervention engaged patients in building relationships, while organizing and streamlining existing mHealth efforts and dealing with privacy issues. HCPs recognized that although workload would augment initially, intervention benefits were many, and went beyond simply improving HIV viral load.
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Ferron P, Asfour SS, Metsch LR, Antoni MH, Rodriguez AE, Duncan R, Findlay SM. Impact of a Multifaceted Intervention on Promoting Adherence to Screening Colonoscopy Among Persons in HIV Primary Care: A Pilot Study. Clin Transl Sci 2015; 8:290-7. [PMID: 25996255 DOI: 10.1111/cts.12276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
HIV-positive patients have lower colon cancer screening rates and are at increased risk for colon adenocarcinoma. We tested a transdisciplinary prevention model to increase provider and patient adherence to screening colonoscopy. Of 1,339 HIV-positive patients with scheduled clinic appointments during the period September to November 2009, we identified 400 records of eligible patients ≥50 years and retrospectively reviewed for screening colonoscopy referral; if never referred, flagged for referral at next visit. Providers referred 43.5% (174/400) patients and 36.2% (63/174) kept appointment. Within 6 months before the study, 337 patients attended clinic and providers referred 18%. Note that 211/226 patients with flagged records attended clinic at least once during the study 6-month period and providers referred (43.6%). The referral rate for flagged records was significantly different from that for the prior 6 months (p < 0.0001). A randomized trial compared the efficacy of patient decision support versus usual care on screening adherence. Among patients randomized to intervention 17 (51.5%) compared to usual care only 16 (48.5%), intervention group showed significant adherence of 70.6% (12/17) versus 29.4% (5/16), (p = 0.024). In addition, intervention patients had good bowel preparation of 76.9% (10/13) versus usual care 23.1% (3/13), (p = 0.05). This transdisciplinary intervention model significantly increased provider and patient screening colonoscopy behavior.
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Affiliation(s)
- Pansy Ferron
- University of Miami, Miller School of Medicine, Miami, Florida, USA
| | | | - Lisa R Metsch
- University of Miami, Miller School of Medicine, Miami, Florida, USA.,Columbia University, New York, USA
| | - Michael H Antoni
- University of Miami, Miller School of Medicine, Miami, Florida, USA
| | | | - Robert Duncan
- University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Sheila M Findlay
- University of Miami, Miller School of Medicine, Miami, Florida, USA
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25
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Factors influencing combination antiretroviral therapy choice: Do doctors really know best? J Infect 2015; 71:269-71. [PMID: 25818533 DOI: 10.1016/j.jinf.2015.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 11/22/2022]
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26
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Schoenthaler A, Kalet A, Nicholson J, Lipkin M. Does improving patient-practitioner communication improve clinical outcomes in patients with cardiovascular diseases? A systematic review of the evidence. PATIENT EDUCATION AND COUNSELING 2014; 96:3-12. [PMID: 24795073 PMCID: PMC4091848 DOI: 10.1016/j.pec.2014.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/27/2014] [Accepted: 04/06/2014] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To conduct a systematic literature review appraising the effects of interventions to improve patient-practitioner communication on cardiovascular-related clinical outcomes. METHODS Databases were searched up to March 27, 2013 to identify eligible studies that included interventions to improve patient and/or practitioner communication skills and assessment of a cardiovascular-related clinical outcome in adults ≥18 years of age. RESULTS Fifteen papers were reviewed: the primary focus in seven studies was the patient; seven included a practitioner-focused intervention and one targeted both. Two patient-focused and two practitioner-focused studies demonstrated a beneficial effect of the intervention compared to a control group. Patient-focused studies were designed to improve patients' information-seeking and question-asking skills with their practitioner. Practitioner-focused studies were designed to either improve practitioner's general patient-centered communication or risk communication skills. CONCLUSION Few interventions targeting patient-practitioner communication have assessed the impact on cardiovascular-related clinical outcomes, limiting the ability to determine effectiveness. Additional rigorous research supported by theoretical frameworks and validated measurement is needed to understand the potential of patient-practitioner communication to improve cardiovascular-related clinical outcomes. PRACTICE IMPLICATIONS Investments in communication skills trainings in medical education and practice are needed in order to attain the full potential of patient-centered care on cardiovascular-related clinical outcomes.
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Affiliation(s)
- Antoinette Schoenthaler
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, USA.
| | - Adina Kalet
- Section of Primary Care, Division of General Internal Medicine, Department of Medicine, NYU School of Medicine, New York, USA
| | - Joseph Nicholson
- NYU Health Sciences Libraries, Department of Medical Library, NYU School of Medicine, New York, USA
| | - Mack Lipkin
- Section of Primary Care, Division of General Internal Medicine, Department of Medicine, NYU School of Medicine, New York, USA
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27
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Chiegil RJ, Zungu LI, Jooste K. Quality of antiretroviral therapy in public health facilities in Nigeria and perceptions of end users. J Nurs Manag 2014; 22:373-82. [DOI: 10.1111/jonm.12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Robert J. Chiegil
- Department of Health Studies; College of Human Sciences; University of South Africa; Pretoria South Africa
| | - Lindiwe I. Zungu
- Department of Health Studies; College of Human Sciences; University of South Africa; Pretoria South Africa
| | - Karien Jooste
- Faculty of Community and Health Sciences; School of Nursing; University of the Western Cape; Cape Town South Africa
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Chiegil RJ, Zungu LI, Jooste K. End-user centeredness in antiretroviral therapy services in Nigerian public health facilities. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2014.10855352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- RJ Chiegil
- Department of Health Studies, University of South Africa
| | - LI Zungu
- Department of Health Studies, University of South Africa
| | - K Jooste
- School of Nursing, University of Western Cape
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29
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Hooper LM, Huffman LE. Associations among depressive symptoms, well-being, patient involvement, provider cultural competency, and treatment nonadherence: An exploratory study among university student-patients. COUNSELLING PSYCHOLOGY QUARTERLY 2014. [DOI: 10.1080/09515070.2014.880046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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30
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Down I, Prestage G, Triffitt K, Brown G, Bradley J, Ellard J. Recently diagnosed gay men talk about HIV treatment decisions. Sex Health 2014; 11:200-6. [DOI: 10.1071/sh13100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/30/2013] [Indexed: 11/23/2022]
Abstract
Background
In recent years, there has been increasing evidence that early initiation of antiretroviral therapy (ART) may provide health benefits for those infected with HIV. There has also been significant discussion about the role of HIV treatment in preventing onward transmission of the virus. Early provision and uptake of ART to people recently diagnosed with HIV could achieve both individual and public health outcomes. The success of such an initiative relies, in part, on the preparedness of those recently diagnosed with HIV to engage with the therapy. Methods: The HIV Seroconversion Study collects both quantitative and qualitative data from people in Australia who have recently been diagnosed with HIV. During 2011–2012, 53 gay or bisexual men recruited across Australia took part in semistructured interviews as part of the study. The men were asked about their knowledge and experience of, and their decisions about whether or not to commence, HIV treatment. Results: The interviews identified differing levels of knowledge about HIV treatments and divergent views about the health and prevention benefits of ART. For some, treatments provided a sense of control over the virus; others were apprehensive and distrustful, and preferred to resist commencing treatments for as long as possible. Conclusions: If early initiation of treatment is to be encouraged, appropriate measures must be in place to ensure recently diagnosed individuals have access to the appropriate information and the support they need to enable them to make informed choices and, if necessary, to address their fears.
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31
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Nokes KM, Verkuilen J, Hickey DE, James-Borga JC, Shan J. Developing a personal health record self-efficacy tool. Appl Nurs Res 2013; 26:32-9. [PMID: 23332014 DOI: 10.1016/j.apnr.2012.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 02/20/2012] [Accepted: 06/01/2012] [Indexed: 10/27/2022]
Abstract
The purpose of this preliminary work was to develop a new short tool to assess personal health records (PHRs) self-efficacy. Prior work had found 4 distinct skills related to creating, updating, tracking symptoms, and sharing information with health care providers using PHR. Although PHRs have great promise, their uptake has been rather limited, especially in economically limited populations. A convenience sample of community-living persons with HIV/AIDS (N = 100) was asked to complete the new tool along with other self-efficacy measures. Preliminary work indicated more confidence about paper-based PHRs compared with computer-based PHRs. The paper-based subscale was significantly correlated to chronic illness and HIV treatment self-efficacy scales as expected, but there were no relationships for the computer-based subscale. This simple screening tool could identify interested clients and their preference either for a paper-based or computer-based PHR. Further research is needed with larger sample sizes and different chronically ill populations to further explore the psychometrics of the instrument.
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Affiliation(s)
- Kathleen M Nokes
- Hunter College, CUNY, Hunter-Bellevue School of Nursing, New York, NY 10010, USA.
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32
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Higher quality communication and relationships are associated with improved patient engagement in HIV care. J Acquir Immune Defic Syndr 2013; 63:362-6. [PMID: 23591637 DOI: 10.1097/qai.0b013e318295b86a] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient retention in HIV care may be influenced by patient-provider interactions. In an urban, academic HIV clinic, 1363 patients rated the quality of communication and relationships with their providers on 5 domains. We used linear regressions to investigate associations between these 5 domains and appointment adherence. In multivariate analysis, patients kept more appointments if providers treated them with dignity and respect, listened carefully to them, explained in ways they could understand, and knew them as persons. Being involved in decisions was not significantly associated with appointment adherence. Enhancing providers' skills in effective communication and relationship building may improve patient retention in HIV care.
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Addo-Atuah J, Gourley D, Gourley G, White-Means SI, Womeodu RJ, Faris RJ, Addo NA. Accessibility of antiretroviral therapy in Ghana: convenience of access. SAHARA J 2013; 9:74-87. [PMID: 23237042 DOI: 10.1080/17290376.2012.683581] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The convenience of accessing antiretroviral therapy (ART) is important for initial access to care and subsequent adherence to ART. We conducted a qualitative study of people living with HIV/AIDS (PLWHA) and ART healthcare providers in Ghana in 2005. The objective of this study was to explore the participants' perceived convenience of accessing ART by PLWHA in Ghana. The convenience of accessing ART was evaluated from the reported travel and waiting times to receive care, the availability, or otherwise, of special considerations, with respect to the waiting time to receive care, for those PLWHA who were in active employment in the formal sector, the frequency of clinic visits before and after initiating ART, and whether the PLWHA saw the same or different providers at each clinic visit (continuity of care). This qualitative study used in-depth interviews based on Yin's case-study research design to collect data from 20 PLWHA and 24 ART healthcare providers as study participants. • Reported travel time to receive ART services ranged from 2 to 12 h for 30% of the PLWHA. • Waiting time to receive care was from 4 to 9 h. • While known government workers, such as teachers, were attended to earlier in some of the centres, this was not a consistent practice in all the four ART centres studied. • The PLWHA corroborated the providers' description of the procedure for initiating and monitoring ART in Ghana. • PLWHA did not see the same provider every time, but they were assured that this did not compromise the continuity of their care. Our study suggests that convenience of accessing ART is important to both PLWHA and ART healthcare providers, but the participants alluded to other factors, including open provider-patient communication, which might explain the PLWHA's understanding of the constraints under which they were receiving care. The current nation-wide coverage of the ART programme in Ghana, however, calls for the replication of this study to identify possible perception changes over time that may need attention. Our study findings can inform interventions to promote access to ART, especially in Africa.
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Laws MB, Taubin T, Bezreh T, Lee Y, Beach MC, Wilson IB. Problems and processes in medical encounters: the cases method of dialogue analysis. PATIENT EDUCATION AND COUNSELING 2013; 91:192-9. [PMID: 23391684 PMCID: PMC3622168 DOI: 10.1016/j.pec.2012.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 12/21/2012] [Accepted: 12/28/2012] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To develop methods to reliably capture structural and dynamic temporal features of clinical interactions. METHODS Observational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The comprehensive analysis of the structure of encounters system (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads--the problems or issues addressed; and processes within threads--basic tasks of clinical care labeled presentation, information, resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution. RESULTS 61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare. CONCLUSIONS In this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation. PRACTICE IMPLICATIONS Awareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective.
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Affiliation(s)
- M Barton Laws
- Brown University, Department of Health Services, Policy & Practice, USA.
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Gaston GB, Alleyne-Green B. The impact of African Americans' beliefs about HIV medical care on treatment adherence: a systematic review and recommendations for interventions. AIDS Behav 2013; 17:31-40. [PMID: 23010941 DOI: 10.1007/s10461-012-0323-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Disparities in access to and retention of regular HIV medical treatment persist among African Americans living with HIV. Many scholars believe that the mistrust of health care held by many African Americans stems from a legacy of abuse, from medical experimentation on slaves to the unethical practices with patients in the Tuskegee Syphilis study. We performed a systematic appraisal of the literature, using several key terms, in order to understand how attitudes about HIV-related health care influence African Americans' engagement in care. We examined peer-reviewed studies published during the period January 2001 through May 2012. An initial search generated 326 studies. Sixteen descriptive studies met our inclusion criteria. Experiences of racism, conspiracy beliefs and the quality of provider relationships appeared to impact engagement. Providers should openly investigate personal beliefs that adversely affect their treatment decisions, listen to patient narratives, and share treatment decisions in order to create a transparent environment.
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Affiliation(s)
- Gina B Gaston
- Jane Addams College of Social Work, University of Illinois at Chicago, 1040 West Harrison Street (MC 309), Chicago, IL 60607, USA.
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36
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Korthuis PT, Gregg J, Rogers WE, McCarty D, Nicolaidis C, Boverman J. Patients' Reasons for Choosing Office-based Buprenorphine: Preference for Patient-Centered Care. J Addict Med 2012; 4:204-10. [PMID: 21170143 DOI: 10.1097/adm.0b013e3181cc9610] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To explore HIV-infected patients' attitudes about buprenorphine treatment in office-based and opioid treatment program (OTP) settings. METHODS We conducted in-depth qualitative interviews with 29 patients with co-existing HIV infection and opioid dependence seeking buprenorphine maintenance therapy in office-based and OTP settings. We used thematic analysis of transcribed audiorecorded interviews to identify themes. RESULTS Patients voiced a strong preference for office-based treatment. Four themes emerged to explain this preference. First, patients perceived the greater convenience of office-based treatment as improving their ability to address HIV and other healthcare issues. Second, they perceived a strong patient-focused orientation in patient-provider relationships underpinning their preference for office-based care. This was manifest as increased trust, listening, empathy, and respect from office-based staff and providers. Third, they perceived shared power and responsibility in office-based settings. Finally, patients viewed office-based treatment as a more supportive environment for sobriety and relapse prevention. This was partly due to strong therapeutic alliances with office-based staff and providers who prioritized a harm reduction approach, but also due to the perception that the office-based settings were "safer" for sobriety, compared with increased opportunities for purchasing and using illicit opiates in OTP settings. CONCLUSIONS HIV-infected patients with opioid dependence preferred office-based buprenorphine because they perceived it as offering a more patient-centered approach to care compared with OTP referral. Office-based buprenorphine may facilitate engagement in care for patients with co-existing opioid dependence and HIV infection.
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Affiliation(s)
- P Todd Korthuis
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
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Johnson MO, Rose CD, Dilworth SE, Neilands TB. Advances in the conceptualization and measurement of Health Care Empowerment: development and validation of the Health Care Empowerment inventory. PLoS One 2012; 7:e45692. [PMID: 23029184 PMCID: PMC3446922 DOI: 10.1371/journal.pone.0045692] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/21/2012] [Indexed: 11/30/2022] Open
Abstract
The Health Care Empowerment Model offers direction for the investigation of patient-controlled engagement and involvement in health care. At the core of the model is the construct of Health Care Empowerment (HCE), for which there exist no validated measures. A set of 27 candidate self-report survey items was constructed to capture five hypothesized inter-related facets of HCE (informed, engaged, committed, collaborative, and tolerant of uncertainty). The full item set was administered to 644 HIV-infected persons enrolled in three ongoing research studies. Exploratory and confirmatory factor analyses resulted in a two factor solution comprising four items each on two subscales: (1) HCE: Informed, Committed, Collaborative, and Engaged HCE ICCE) and (2) HCE Tolerance of Uncertainty (HCE TU). Subscale scores were evaluated for relationships with relevant constructs measured in the three studies, including depression, provider relationships, medication adherence, and HIV-1 viral load. Findings suggest the utility of this 8-item Health Care Empowerment Inventory (HCEI) in efforts to measure, understand, and track changes in the ways in which individuals engage in health care.
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Affiliation(s)
- Mallory O Johnson
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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Schoenthaler A, Allegrante JP, Chaplin W, Ogedegbe G. The effect of patient-provider communication on medication adherence in hypertensive black patients: does race concordance matter? Ann Behav Med 2012; 43:372-82. [PMID: 22270266 DOI: 10.1007/s12160-011-9342-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite evidence of a positive effect of collaborative patient-provider communication on patient outcomes, our understanding of this relationship is unclear. PURPOSE The purpose of this paper is to determine whether racial composition of the relationship modified the association between ratings of provider communication and medication adherence. METHODS Effect modification of the communication-adherence association, by racial composition of the relationship, was evaluated using general linear mixed models while adjusting for selected covariates. RESULTS Three hundred ninety patients were in race-concordant (black patient, black provider) relationships, while 207 were in race-discordant (black patient, white provider) relationships. The communication-adherence association was significantly modified in race-discordant relationships (p = 0.04). Communication rated as more collaborative in race-discordant relationships was associated with better adherence, while communication rated as less collaborative was associated with poor adherence. There was no significant association between adherence and communication in race-concordant relationships (p = 0.24). CONCLUSIONS Collaborative patient-provider communication may play an influential role in black patients' adherence behaviors when receiving care from white providers.
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Affiliation(s)
- Antoinette Schoenthaler
- Center for Healthful Behavior Change, Department of Medicine, New York University School of Medicine, NY 10016, USA.
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Street RL, Elwyn G, Epstein RM. Patient preferences and healthcare outcomes: an ecological perspective. Expert Rev Pharmacoecon Outcomes Res 2012; 12:167-80. [PMID: 22458618 DOI: 10.1586/erp.12.3] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This article examines the nature of patients' preferences for healthcare and whether clinician accommodation of patient preferences influences health outcomes. First, we provide a conceptualization of patient preferences along with their key attributes. Second, we review research on the relationship between health outcomes and patient preferences for treatments and for the process of care (e.g., preferred involvement in decision-making). Third, following a critique of this literature, we present an ecological model of patient preferences that, while acknowledging that patient preferences may emerge from various contexts (e.g., family or media exposure), we focus on the important role that clinical encounters and patients' health-related experiences play in the elicitation and construction of patient preferences. Fourth, we propose two pathways, one behavioral (adherence) and the other psychological (sense of autonomy or satisfaction with decision), through which meeting patient preferences could lead to better health outcomes. Fifth, we discuss how preferences can be elicited and clarified through patient-centered conversations. We conclude with implications for future research and clinical practice.
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Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, TX 77843-74234, USA.
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Johnson MO, Sevelius JM, Dilworth SE, Saberi P, Neilands TB. Preliminary support for the construct of health care empowerment in the context of treatment for human immunodeficiency virus. Patient Prefer Adherence 2012; 6:395-404. [PMID: 22654510 PMCID: PMC3363300 DOI: 10.2147/ppa.s30040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Model of Health Care Empowerment (HCE) defines HCE as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. We examined the hypothesized antecedents and clinical outcomes of this model using data from ongoing human immunodeficiency virus (HIV)-related research. The purpose of this paper is to explore whether a new measure of HCE offers direction for understanding patient engagement in HIV medical care. Using data from two ongoing trials of social and behavioral aspects of HIV treatment, we examined preliminary support for hypothesized clinical outcomes and antecedents of HCE in the context of HIV treatment. METHODS This was a cross-sectional analysis of 12-month data from study 1 (a longitudinal cohort study of male couples in which one or both partners are HIV-seropositive and taking HIV medications) and 6-month data from study 2, a randomized controlled trial of HIV-seropositive persons not on antiretroviral therapy at baseline despite meeting guidelines for treatment. From studies 1 and 2, 254 and 148 participants were included, respectively. Hypothesized antecedents included cultural/social/environmental factors (demographics, HIV-related stigma), personal resources (social problem-solving, treatment knowledge and beliefs, treatment decision-making, shared decision-making, decisional balance, assertive communication, trust in providers, personal knowledge by provider, social support), and intrapersonal factors (depressive symptoms, positive/negative affect, and perceived stress). Hypothesized clinical outcomes of HCE included primary care appointment attendance, antiretroviral therapy use, adherence self-efficacy, medication adherence, CD4+ cell count, and HIV viral load. RESULTS Although there was no association observed between HCE and HIV viral load and CD4+ cell count, there were significant positive associations of HCE scores with likelihood of reporting a recent primary care visit, greater treatment adherence self-efficacy, and higher adherence to antiretroviral therapy. Hypothesized antecedents of HCE included higher beliefs in the necessity of treatment and positive provider relationships.
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Affiliation(s)
- Mallory O Johnson
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Jeanne M Sevelius
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Parya Saberi
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, CA, USA
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Turner-Bowker DM, Saris-Baglama RN, DeRosa MA, Giovannetti ER, Jensen RE, Wu AW. A computerized adaptive version of the SF-36 is feasible for clinic and Internet administration in adults with HIV. AIDS Care 2012; 24:886-96. [PMID: 22348336 DOI: 10.1080/09540121.2012.656573] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
DYNHA SF-36 is a computerized adaptive test version of the SF-36 Health Survey. The feasibility of administering a modified DYNHA SF-36 to adults with HIV was evaluated with Johns Hopkins University Moore (HIV) Clinic patients (N=100) and Internet consumer health panel members (N=101). Participants completed the DYNHA SF-36, modified to capture seven health domains [(physical function (PF), role function (RF, without physical or emotional attribution), bodily pain (BP), general health, vitality (VT), social function (SF), mental health (MH)], and scored to produce two summary components [Physical Component Summary (PCS), Mental Component Summary (MCS)]. Item-response theory-based response consistency, precision, mean scores, and discriminant validity were examined. A higher percentage of Internet participants responded consistently to the DYNHA SF-36. For each domain, three standard deviations were covered with five items (90% reliability); however, RF and SF scores were less precise at the upper end of measurement (better functioning). Mean scores were slightly higher for the Internet sample, with the exception of VT and MCS. Clinic and Internet participants reporting an AIDS diagnosis had significantly lower mean PCS and PF scores than those without a diagnosis. Additionally, significantly lower RF and BP scores were found for Internet participants reporting an AIDS diagnosis. The measure was well accepted by the majority of participants, although Internet respondents provided lower ratings for the tool's usefulness. The DYNHA SF-36 has promise for measuring the impact of HIV and its treatment in both the clinic setting and through telemonitoring.
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Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep 2012; 8:277-87. [PMID: 21989672 DOI: 10.1007/s11904-011-0098-0] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A literature review of original research articles on adherence to antiretroviral therapy (ART) in developed countries, covering January 2000 to June 2011, was conducted to determine if gender differences exist in the prevalence of nonadherence to ART. Of the 1,255 articles reviewed, only 189 included data on the proportion of the study population that was adherent and only 57 (30.2%) of these reported proportional adherence values by gender. While comparing articles was challenging because of varied reporting strategies, women generally exhibit poorer adherence than men. Thirty of the 44 articles (68.2%) that reported comparative data on adherence by gender found women to be less adherent than men. Ten articles (17.5%) reported significant differences in proportional adherence by gender, nine of which showed women to be less adherent than men. These findings suggest that in multiple studies from developed countries, female gender often predicts lower adherence. The unique circumstances of HIV-positive women require specialized care to increase adherence to ART.
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Chewning B, Bylund CL, Shah B, Arora NK, Gueguen JA, Makoul G. Patient preferences for shared decisions: a systematic review. PATIENT EDUCATION AND COUNSELING 2012; 86:9-18. [PMID: 21474265 PMCID: PMC4530615 DOI: 10.1016/j.pec.2011.02.004] [Citation(s) in RCA: 539] [Impact Index Per Article: 44.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Revised: 02/07/2011] [Accepted: 02/07/2011] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Empirical literature on patient decision role preferences regarding treatment and screening was reviewed to summarize patients' role preferences across measures, time and patient population. METHODS Five databases were searched from January 1980 to December 2007 (1980-2007 Ovid MEDLINE, Cochrane Database of Systematic Reviews, PsychInfo, Web of Science and PubMed (2005-2007)). Eligible studies measured patient decision role preferences, described measures, presented findings as percentages or mean scores and were published in English from any country. Studies were compared by patient population, time of publication, and measure. RESULTS 115 studies were eligible. The majority of patients preferred sharing decisions with physicians in 63% of the studies. A time trend appeared. The majority of respondents preferred sharing decision roles in 71% of the studies from 2000 and later, compared to 50% of studies before 2000. Measures themselves, in addition to patient population, influenced the preferred decision roles reported. CONCLUSION Findings appear to vary with the measure of preferred decision making used, time of the publication and characteristics of the population. PRACTICE IMPLICATIONS The role preference measure itself must be considered when interpreting patient responses to a measure or question about a patient's preference for decision roles.
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Affiliation(s)
- Betty Chewning
- Sonderegger Research Center, University of Wisconsin School of Pharmacy, Madison, WI 53705-2222, USA.
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Lee YY, Lin JL. How much does trust really matter? A study of the longitudinal effects of trust and decision-making preferences on diabetic patient outcomes. PATIENT EDUCATION AND COUNSELING 2011; 85:406-412. [PMID: 21269794 DOI: 10.1016/j.pec.2010.12.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 11/15/2010] [Accepted: 12/06/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To examine the impact of trust on patient outcomes (satisfaction, HbA(1C), physical and mental health-related quality of life (HRQoL)) and to investigate the role of decision-making preferences in the trust-outcome relationship. METHODS We conducted a one-year longitudinal analysis of 614 type 2 diabetic patients (mean age: 59.3 years; mean disease duration: 6.7 years). Patients' self-administered questionnaires and medical record were used for the research. Multiple regression analyses were conducted to investigate the relationship among variables during a 12-month follow-up. Further, we used latent growth modeling (LGM) to assess changes in health outcomes and to examine how these changes were related to trust. RESULTS Regression analyses revealed that trust was positively related to glycemic control, physical HRQoL, and satisfaction at 12 months. Patients with higher decision-making preferences experienced a greater increase in subsequent satisfaction. The results of LGM showed that higher levels of trust were associated with greater increases in physical HRQoL. CONCLUSION Trust contributes to improvements in health outcomes. The relationship between trust and satisfaction may be stronger among patients with higher decision-making preferences. PRACTICE IMPLICATIONS For healthcare providers, efforts should be made to cultivate patients' trust and enhance their decision-making preferences to maximize satisfaction and improve outcomes.
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Affiliation(s)
- Yin-Yang Lee
- Department of Health Management, I-Shou University, Taiwan
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Combination Antiretroviral Therapy Toxicities: A Comparison Between Patients and Health Care Professionals. J Acquir Immune Defic Syndr 2011; 56:e120-1. [DOI: 10.1097/qai.0b013e31820967d9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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A comparison of patients' attitudes to antiretroviral toxicities between the UK and Uganda. AIDS 2011; 25:392-3. [PMID: 21239896 DOI: 10.1097/qad.0b013e3283428c68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Johnson MO. The shifting landscape of health care: toward a model of health care empowerment. Am J Public Health 2010; 101:265-70. [PMID: 21164096 DOI: 10.2105/ajph.2009.189829] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In a rapidly changing world of health care information access and patients' rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities.
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Affiliation(s)
- Mallory O Johnson
- Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA.
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Lee YY, Lin JL. Do patient autonomy preferences matter? Linking patient-centered care to patient-physician relationships and health outcomes. Soc Sci Med 2010; 71:1811-8. [PMID: 20933316 DOI: 10.1016/j.socscimed.2010.08.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 06/02/2010] [Accepted: 08/16/2010] [Indexed: 11/26/2022]
Abstract
As health care systems seek to provide patient-centered care as a cornerstone of quality, the link between patient-centeredness and patient outcomes is a concern. Past research reveals inconsistent findings regarding the impact of patient-centeredness on patient outcomes, and few studies have investigated the factors that moderate this relationship. Most studies have used self-rated outcomes on a cross-sectional basis, even though most patient care is inherently longitudinal. The current study extends past research by examining the theoretical and empirical relationships between patients' perceptions of autonomy support and autonomy preferences with regard to their health outcomes. We hypothesized that autonomy preferences moderate the positive relationships between perceived autonomy support and patient-physician relationships, and on self-rated and objective health outcomes such that the relationships are more positive when patient autonomy preferences are high. Data were collected 3 times over a one-year period from a sample of 614 patients with type 2 diabetes in Taiwan. The results revealed strong support for the hypothesized relationships between perceived autonomy support and patient trust, satisfaction, and mental health-related quality of life (HRQoL) after adjusting for baseline scores; however, the direct link between autonomy support and patients' glycemic control was not significant. Specifically, patients with high decisional preference experienced a greater increase in subsequent trust and satisfaction than patients with low decisional preference. Further, patients with high information preference had a higher level of satisfaction over time than patients with low information preference. In addition, it was found that perceived autonomy support improved both physical and mental HRQoL but only if combined with high levels of information preference. This study provides evidence of a contingency perspective of the relationship between patient autonomy support and outcomes. By recognizing the uniqueness of each patient's autonomy preferences, healthcare practitioners can increase the efficiency of patient-centered care and improve patient outcomes.
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Affiliation(s)
- Yin-Yang Lee
- Department of Health Management, I-Shou University, No1, Sec 1, Syuecheng Rd, Dashu Township, Kaohsiung County 840, Taiwan.
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Kumar R, Korthuis PT, Saha S, Chander G, Sharp V, Cohn J, Moore R, Beach MC. Decision-making role preferences among patients with HIV: associations with patient and provider characteristics and communication behaviors. J Gen Intern Med 2010; 25:517-23. [PMID: 20180157 PMCID: PMC2869417 DOI: 10.1007/s11606-010-1275-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 12/29/2009] [Accepted: 01/20/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND A preference for shared decision-making among patients with HIV has been associated with better health outcomes. One possible explanation for this association is that patients who prefer a more active role in decision-making are more engaged in the communication process during encounters with their providers. Little is known, however, about patient and provider characteristics or communication behaviors associated with patient decision-making preferences in HIV settings. OBJECTIVE We examined patient and provider characteristics and patient-provider communication behaviors associated with the decision-making role preferences of patients with HIV. DESIGN Cross-sectional analysis of patient and provider questionnaires and audio recorded clinical encounters from four sites. PARTICIPANTS A total of 45 providers and 434 of their patients with HIV. MEASURES Patients were asked how they prefer to be involved in the decision-making process (doctor makes all/most decisions, patients and doctors share decisions, or patients make decisions alone). Measures of provider and patient communication behaviors were coded from audio recordings using the Roter Interaction Analysis System. MAIN RESULTS Overall, 72% of patients preferred to share decisions with their provider, 23% wanted their provider to make decisions, and 5% wanted to make decisions themselves. Compared to patients who preferred to share decisions with their provider, patients who preferred their provider make decisions were less likely to be above the age of 60 (ARR 0.09, 95% CI 0.01-0.89) and perceive high quality provider communication about decision-making (ARR 0.41, 95% CI 0.23-0.73), and more likely to have depressive symptoms (ARR 1.92, 95% CI 1.07-3.44). There was no significant association between patient preferences and measures of provider or patient communication behavior. CONCLUSION Observed measures of patient and provider communication behavior were similar across all patient decision-making role preferences, indicating that it may be difficult for providers to determine these preferences based solely on communication behavior. Engaging patients in open discussion about decision-making preferences may be a more effective approach.
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Affiliation(s)
- Rashmi Kumar
- Johns Hopkins University, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205, USA.
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Atkinson MJ, Petrozzino JJ. An evidence-based review of treatment-related determinants of patients' nonadherence to HIV medications. AIDS Patient Care STDS 2009; 23:903-14. [PMID: 19642921 DOI: 10.1089/apc.2009.0024] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Patients' adherence to antiretroviral medications is a primary determinant of both the effectiveness of treatment and the clinical course of HIV/AIDS. This empirical review is intended to compare the relative importance of patient and treatment characteristics on nonadherence behavior and the impact of nonadherence on treatment failure. Articles cited in PubMed and published between 2006 and June 2008 (n = 200) were reviewed to select those that address patient or treatment characteristics associated with nonadherence. Twenty-two articles were selected that provided odds ratio or hazard ratio statistics that quantified predictors of patients' level of nonadherence (e.g., <80%, 80%-95% and >95%). Results were summarized using random effects meta-analytic models. Predictors of nonadherence were divided into four predictive clusters (clinical predictors, comorbid predictors, treatment competence predictors, and dosing predictors). The summary odds ratios (ORs) of nonadherence for each cluster (in order of strength) were treatment competence 2.0 (95% confidence interval [CI]: 1.6-2.6), clinical predictors 1.6 (95% CI: 1.4-1.8), comorbid predictors 1.6 (95% CI: 1.4-1.8), and dosing predictors 1.5 (95% CI: 1.3-1.7). The effect of nonadherence on treatment failure supported the findings of two prior empirical reviews (OR 2.0, 95% CI: 1.6-2.5). Within dosing predictors, a pill burden of more versus less than 10 pills per day was associated with a much higher odds of nonadherence than twice versus once daily dosing or small differences in the number of types of antiretroviral treatments in a regimen. These results provide insight into the relative importance of various determinants of patient nonadherence that may inform the design of patient educational initiatives and initiatives to simplify treatment regimens.
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Affiliation(s)
- Mark J. Atkinson
- PRO-Spectus LLC, San Diego, California
- Health Services Research Center, University of California at San Diego, San Diego, California
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