Involving Patients in Their Care

Scoping Review of the Literature on Smart Healthcare for Older Adults

Smart healthcare systems are being designed to provide medical services to and improve the daily lives of older adults. However, most research has been focused on technical issues, despite a need to conduct in-depth studies on related ethical issues. Therefore, this study aimed to examine ethical issues in smart healthcare for older adults. We reviewed published literature using PubMed. In total, 292 documents were analyzed by applying the scoping review method. Finally, 29 articles were selected from the 292 articles. Ethical issues in smart healthcare for older adults were analyzed in terms of the themes of responsibility/autonomy (n=10), privacy (n=9), and digital divide (n=10). Technical help provided by smart healthcare may infringe on the autonomy of tacit choice for older adults. This pose a potential ethical issue as the subject of responsibility here is unclear. Privacy is a concern as smart technology may intrude the personal life of the user. The digital divide is a challenge because of low responsiveness from older adults to technological changes. The future development and application of smart healthcare systems must take these ethical aspects into account to enable their efficient and effective use in supplementing healthcare for older adults. Critical discussions to identify ethical issues and customize ethical requirements for specific user needs are necessary among smart healthcare providers.

Perceived problems with involvement in decision making about breast cancer treatment and care: A cross-sectional study

OBJECTIVE

To examine perceived problems with involvement in medical decision making among people with breast cancer from various phases of the cancer care trajectory.

METHODS

Breast cancer outpatients (n = 663) from 13 treatment centres completed a survey of perceived involvement in treatment and care decisions in the last month, psychological distress, demographic and clinical factors. A subsample (n = 98) from three centres completed a follow-up survey on preferred and perceived treatment decision making roles.

RESULTS

Overall, 112 (17 %) of 663 respondents from 13 oncology centres had experienced problems with involvement in decision making about their treatment and care in the last month, and of these, 36 (32 %) reported an unmet need for help with this problem. Elevated psychological distress was associated with 5.7 times the odds of reporting this problem and 6.6 times the odds of reporting this unmet need in the last month. Among the follow-up subsample (n = 98), 39% (n = 38) reported discordance between preferred and perceived role in a major treatment decision. Psychological distress was not associated with this outcome.

CONCLUSION

Psychological distress was significantly associated with recently experiencing problems with involvement in treatment and care decisions, but not with misalignment of preferred and perceived roles in prior major treatment decisions.

PRACTICE IMPLICATIONS

There is a need to maintain support for patient involvement in healthcare decisions across the cancer care continuum.

The Patient-Professional Interaction Questionnaire (PPIQ) to assess patient centered care from the patient's perspective

OBJECTIVE

To investigate how patients evaluate the provision of patient-centered care (PCC) by healthcare professionals and psychometrically test a questionnaire to assess it. A tool previously developed for self-assessment of professionals' provision of PCC was adapted into a patient-rated form, named Patient-Professional Interaction Questionnaire (PPIQ).

METHODS

A sample of 1139 patients from six hospitals completed the 16-item PPIQ and the questionnaire structure, reliability, susceptibility to social desirability, and associations with other variables were tested.

RESULTS

The PPIQ confirmed the original four-factor structure (effective communication, interest in the patient's agenda, empathy, and patient involvement in care) and showed acceptable reliability and measurement invariance across both in-/out-patients and first/non-first encounter with the evaluated professional. Associations with patients' social desirability were negligible and effective communication was rated the highest among the PPIQ dimensions. PPIQ scores varied according to patients' educational level and type of professional evaluated, while associations between first/non-first encounter and PPIQ scores varied according to in-/out-patient.

CONCLUSION

The PPIQ is a psychometrically sound patient-rated measure of the provision of PCC by healthcare professionals.

PRACTICE IMPLICATIONS

The PPIQ has potential value in promoting quality patient-professional interactions in the hospital setting, as patients' reported experience is an important dimension of the clinician's performance.

Leaving patients to their own devices? Smart technology, safety and therapeutic relationships

BACKGROUND

This debate article explores how smart technologies may create a double-edged sword for patient safety and effective therapeutic relationships. Increasing utilization of health monitoring devices by patients will likely become an important aspect of self-care and preventive medicine. It may also help to enhance accurate symptom reports, diagnoses, and prompt referral to specialist care where appropriate. However, the development, marketing, and use of such technology raise significant ethical implications for therapeutic relationships and patient safety.

MAIN TEXT

Drawing on lessons learned from other direct-to-consumer health products such as genetic testing, this article explores how smart technology can also pose regulatory challenges and encourage overutilization of healthcare services. In order for smart technology to promote safer care and effective therapeutic encounters, the technology and its utilization must be safe.

CONCLUSION

This article argues for unified regulatory guidelines and better education for both healthcare providers and patients regarding the benefits and risks of these devices.

Improving the Transition From Oncology to Primary Care Teams: A Case for Shared Leadership

This article discusses the case of a 47-year-old woman who underwent primary therapy with curative intent for breast cancer. The case illustrates a number of failure events in transferring information and responsibility from oncology to primary care teams. The article emphasizes the importance of shared leadership, as multiple team members, dispersed in time and space, pursue their own objectives while achieving the common goal of coordinating care for survivors of cancer transitioning across settings. Shared leadership is defined as a team property comprising shared responsibility and mutual influence between the patient and the patient’s family, primary care providers, and oncology teams, whereby they lead each other toward quality and safety of care. Teams, including the patient-family, should achieve leadership when their contribution is relevant in managing task interdependence during transition. Shared leadership fosters coordinated actions to enable functioning as an integrated team-of-teams. This article illustrates how shared leadership can make a difference to coordinate interfaces and pathways, from therapy with curative intent to the follow-up and management of survivors of breast cancer. The detailed case is elaborated as a clinical vignette. It can be used by care providers and researchers to consider the need for new models of care for survivors of cancer by addressing the following questions. Who accepts shared leadership, how, with whom, and under what conditions? What is the evidence that supports the answers to these questions? The detailed case is also valuable for medical and allied health professional education.