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Gomes F, Khatoon B, Sawyer C, Punnett G, Farrington N, Yorke J. Patient-reported outcomes and experiences from a prospective cohort study of older patients with cancer on checkpoint inhibitors: The ELDERS study. J Geriatr Oncol 2024; 15:101777. [PMID: 38704912 DOI: 10.1016/j.jgo.2024.101777] [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: 01/06/2024] [Revised: 03/15/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Checkpoint inhibitors (CPI) are widely used across different tumour types in older cancer patients. The ELDERS study investigated primarily the safety of CPI in older patients, and secondarily its impact on health-related quality of life (HRQoL), comparing older and younger patients. Here we describe the results from its secondary aim. MATERIALS AND METHODS This was an observational, mixed methods study, consisting of questionnaires and qualitative interviews. Patients completed the EORTC QLQ-C30 at baseline and at three-monthly reviews (up to four over the planned 12 months on study). RESULTS One hundred and forty patients, 70 in each age cohort (older: ≥70 years of age, younger: <70 years of age), were recruited. Twenty-four patients, 12 in each age cohort, were interviewed. The mean baseline EORTC QLQ-C30 score was 65/100 for both cohorts combined, and the score for the full QLQ-C30 assessment was 78/100 and 75/100 for older and younger, respectively. The physical functioning score was the only subscale to change significantly between baseline and the first and second reviews (p = 0.03 and 0.04, respectively), resulting from some improvement in the mean score (from baseline) within the younger cohort and some decline within the older cohort. However, when focusing on each cohort separately, the change over time was not statistically significant for either. Two main themes from the interviews were 'expectations' (thoughts about treatment before commencing) and 'experience' (lived experience during treatment). DISCUSSION Quantitatively, there was no difference in the effect of CPIs on HRQoL between the cohorts, although qualitative data from interviews suggested that there were some experiential differences. People in the older cohort were less likely to seek additional information about CPIs and were more likely to report side effects. In terms of both 'expectations' and 'experience,' the older cohort was a heterogenous group, highlighting that an individualised approach is needed when supporting this group. This study shows that older patients can be reassured that immunotherapy is unlikely to negatively impact their HRQoL more than younger patients, and it should be considered a viable treatment option.
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Affiliation(s)
- Fabio Gomes
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK; Senior Adult Oncology Service, The Christie NHS Foundation Trust, Manchester, UK.
| | - Binish Khatoon
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK; Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Chelsea Sawyer
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK; Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - Grant Punnett
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Naomi Farrington
- Senior Adult Oncology Service, The Christie NHS Foundation Trust, Manchester, UK
| | - Janelle Yorke
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK; Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
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Beiner C, Qureshi MM, Zhao J, Hu B, Jimenez R, Hirsch AE. Depression and Anxiety Among English- and Spanish-Speaking Patients With Breast Cancer Receiving Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 119:185-192. [PMID: 38070714 DOI: 10.1016/j.ijrobp.2023.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE An estimated 30% and 40% of patients with breast cancer experience depression and anxiety, respectively. However, distress experienced by patients with breast cancer receiving radiation therapy may vary among patients and vary at different time points. This study sought to describe the changes in levels of depression and anxiety experienced by English- and Spanish-speaking patients throughout a course of radiation therapy for breast cancer, along with the effect of different variables to better understand potential gaps. METHODS AND MATERIALS Eligibility criteria included English- and Spanish-speaking females, aged 18 or older, undergoing radiation therapy treatment for breast cancer at 2 institutions. Pre- and posttreatment surveys were completed before and after delivery of radiation therapy. Sociodemographic characteristics collected included race, ethnicity, marital status, education level, longest residency location, religion, housing, and food insecurity. The survey ended with the standardized PHQ-4 questionnaire to assess anxiety and depression. Results were analyzed using the analysis of covariance procedure. RESULTS A total of 160 participants completed pre- and posttreatment surveys, with an initial response rate of 100% (169 patients), though 9 were lost to follow-up. Most of the participants were nonwhite (50%), primarily married (42.5%), and had a high school or associate's level education (46.9%). The total baseline distress mean (BDM) was 2.96 and the final distress mean was 2.78. English-speaking patients comprised 82.5% (n = 132) of the sample and had a BDM of 2.91 with an adjusted change mean decrease of 0.45. Spanish-speaking patients comprised 17.5% (n = 28) of the sample, with a baseline distress mean of 3.21 and an adjusted change mean increase of 1.03 (P = .002). Housing (P = .017) and food insecurity (P = .0002) also showed increasing distress with increased insecurity at baseline. CONCLUSIONS Patients who speak Spanish, identify as Hispanic, or are experiencing food and housing insecurity are at an increased risk for depression and anxiety, and could benefit from more support during their course of radiation therapy to minimize distress.
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Affiliation(s)
- Corina Beiner
- Boston University Chobanian & Avedisian School of Medicine.
| | | | - Jenny Zhao
- Boston University Chobanian & Avedisian School of Medicine
| | - Bonnie Hu
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rachel Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ariel E Hirsch
- Boston University Chobanian & Avedisian School of Medicine; Department of Radiation Oncology, Boston Medical Center
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Yalamanchili A, Sengupta B, Song J, Lim S, Thomas TO, Mittal BB, Abazeed ME, Teo PT. Quality of Large Language Model Responses to Radiation Oncology Patient Care Questions. JAMA Netw Open 2024; 7:e244630. [PMID: 38564215 PMCID: PMC10988356 DOI: 10.1001/jamanetworkopen.2024.4630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/04/2024] [Indexed: 04/04/2024] Open
Abstract
Importance Artificial intelligence (AI) large language models (LLMs) demonstrate potential in simulating human-like dialogue. Their efficacy in accurate patient-clinician communication within radiation oncology has yet to be explored. Objective To determine an LLM's quality of responses to radiation oncology patient care questions using both domain-specific expertise and domain-agnostic metrics. Design, Setting, and Participants This cross-sectional study retrieved questions and answers from websites (accessed February 1 to March 20, 2023) affiliated with the National Cancer Institute and the Radiological Society of North America. These questions were used as queries for an AI LLM, ChatGPT version 3.5 (accessed February 20 to April 20, 2023), to prompt LLM-generated responses. Three radiation oncologists and 3 radiation physicists ranked the LLM-generated responses for relative factual correctness, relative completeness, and relative conciseness compared with online expert answers. Statistical analysis was performed from July to October 2023. Main Outcomes and Measures The LLM's responses were ranked by experts using domain-specific metrics such as relative correctness, conciseness, completeness, and potential harm compared with online expert answers on a 5-point Likert scale. Domain-agnostic metrics encompassing cosine similarity scores, readability scores, word count, lexicon, and syllable counts were computed as independent quality checks for LLM-generated responses. Results Of the 115 radiation oncology questions retrieved from 4 professional society websites, the LLM performed the same or better in 108 responses (94%) for relative correctness, 89 responses (77%) for completeness, and 105 responses (91%) for conciseness compared with expert answers. Only 2 LLM responses were ranked as having potential harm. The mean (SD) readability consensus score for expert answers was 10.63 (3.17) vs 13.64 (2.22) for LLM answers (P < .001), indicating 10th grade and college reading levels, respectively. The mean (SD) number of syllables was 327.35 (277.15) for expert vs 376.21 (107.89) for LLM answers (P = .07), the mean (SD) word count was 226.33 (191.92) for expert vs 246.26 (69.36) for LLM answers (P = .27), and the mean (SD) lexicon score was 200.15 (171.28) for expert vs 219.10 (61.59) for LLM answers (P = .24). Conclusions and Relevance In this cross-sectional study, the LLM generated accurate, comprehensive, and concise responses with minimal risk of harm, using language similar to human experts but at a higher reading level. These findings suggest the LLM's potential, with some retraining, as a valuable resource for patient queries in radiation oncology and other medical fields.
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Affiliation(s)
- Amulya Yalamanchili
- Robert H. Lurie Comprehensive Cancer Center, Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bishwambhar Sengupta
- Robert H. Lurie Comprehensive Cancer Center, Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joshua Song
- Robert H. Lurie Comprehensive Cancer Center, Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sara Lim
- Robert H. Lurie Comprehensive Cancer Center, Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tarita O. Thomas
- Robert H. Lurie Comprehensive Cancer Center, Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bharat B. Mittal
- Robert H. Lurie Comprehensive Cancer Center, Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mohamed E. Abazeed
- Robert H. Lurie Comprehensive Cancer Center, Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - P. Troy Teo
- Robert H. Lurie Comprehensive Cancer Center, Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Chen JJ, Brown AM, Garda AE, Kim E, McAvoy SA, Perni S, Rooney MK, Shiue K, Tonning KL, Warren LE, Golden DW, Croke JM. Patient Education Practices and Preferences of Radiation Oncologists and Interprofessional Radiation Therapy Care Teams: A Mixed-Methods Study Exploring Strategies for Effective Patient Education Delivery. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00332-8. [PMID: 38437924 DOI: 10.1016/j.ijrobp.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/02/2024] [Accepted: 02/07/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE Patients' understanding of radiation therapy (RT) and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. We aimed to evaluate PE practices of radiation oncologists and interprofessional RT care team members to inform recommendations for delivering inclusive and accessible PE. METHODS AND MATERIALS An anonymous survey was administered to all Radiation Oncology Education Collaborative Study Group members (10/5/22-11/23/22). Respondent demographics, individual practices/preferences, and institutional practices were collected. Qualitative items explored strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. The Fisher exact test compared PE practices by respondent role and PE timing. Thematic analysis was used for qualitative responses. RESULTS One hundred thirteen Radiation Oncology Education Collaborative Study Group members completed the survey (28.2% response rate); RO attendings comprised 68.1% of respondents. Most practiced in an academic setting (85.8%) in North America (80.5%). Institution-specific materials were the most common PE resource used by radiation oncologists (67.6%). Almost half (40.2%) reported that their PE practices differed based on clinical encounter type, with paper handouts commonly used for in-person and multimedia for telehealth visits. Only 57.7% reported access to non-English PE materials. PE practices among radiation oncologists differed according to RT clinical workflow timing (consultation versus simulation versus first RT, respectively): one-on-one teaching: 88.5% versus 49.4% versus 56.3%, P < .01, and paper handouts: 69.0% versus 28.7% versus 16.1%, P < .01. Identified challenges for PE delivery included limited time, administrative barriers to the development or implementation of new materials or practices, and a lack of customized resources for tailored PE. Effective strategies for PE included utilization of visual diagrams, multimedia, and innovative education techniques to personalize PE delivery/resources for a diverse patient population, as well as fostering interprofessional collaboration to reinforce educational content. CONCLUSIONS Radiation oncologists and interprofessional RO team members engage in PE, with most using institution-specific materials often available only in English. PE practices differ according to clinical encounter type and RT workflow timing. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources are needed to foster high-quality, patient-centered PE delivery.
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Affiliation(s)
- Jie Jane Chen
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Anna M Brown
- Aspirus Regional Cancer Center, Wausau, Wisconsin
| | - Allison E Garda
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Ellen Kim
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sarah A McAvoy
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Subha Perni
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael K Rooney
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kevin Shiue
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kristi L Tonning
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
| | - Laura E Warren
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Daniel W Golden
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Jennifer M Croke
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Kaliszewski K, Makles S, Frątczak A, Kisiel M, Lipska P, Stebel A. Patient Perceptions of Medical Students' Involvement in Clinical Classes: A Cross-Sectional Survey. Patient Prefer Adherence 2024; 18:301-313. [PMID: 38327727 PMCID: PMC10849151 DOI: 10.2147/ppa.s444797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/22/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction A crucial aspect of the education of prospective medical professionals is their interaction with patients. The study aimed to explore patients' perspectives on the interaction between medical students and themselves. It sought to understand how patients perceive this dynamic within clinical classes. The goal was to gather insights into the most favorable behavior and demeanor of medical students during these sessions, with the overarching objective of enhancing patient comfort. Material and Methods The authors collected a total of 403 surveys from patients of a teaching hospital, regarding their perception of students as healthcare providers. The participants ranged in age from 18 to 92. 53.83% of the participants were female, and 46.17% were male. The surveys were collected between April 8th, 2022, and August 10th, 2022. The results of the anonymous survey undergone statistical analyses using the Mann‒Whitney U-test for comparing two groups and the Kruskal‒Wallis test for comparing more than two groups, because the Shapiro‒Wilk test indicated that the data did not follow a normal distribution. Results The study delved into patients' assessments of students' external presentation, adherence to behavioral norms, empathetic qualities, consideration during intimate examinations, and preferences for the organization of clinical classes. Our research indicates notable differences in responses based on age. Specifically, the senior demographic prioritizes students' external presentation, communication and the utilization of courteous language more often than younger individuals (p<0.05). Attendees exhibit varying levels of interest in participating in educational sessions with students based on the ward. Significantly, individuals in the gynecology ward display the least enthusiasm for engagement (p<0.05). Notably, the majority of patients perceive their involvement in the education of future healthcare professionals to be essential (83.38%). Conclusion The study found that generally, patients voluntarily engage in educational classes with students. The relationship between patients and students is amicable, and the majority of students display a respectful demeanor toward patients. Nonetheless, preserving patient confidentiality and ensuring the proper management of classes remain persistent issues. This is particularly crucial, especially when the clinical classes pertain to intimate and personal health matters of a patient. Upholding and enriching the organization of such sessions, along with the attentiveness and knowledge of medical students regarding patient comfort, assumes heightened significance.
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Affiliation(s)
- Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, 50-556, Poland
| | - Szymon Makles
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, 50-556, Poland
| | - Agnieszka Frątczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, 50-556, Poland
| | - Michał Kisiel
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, 50-556, Poland
| | - Patrycja Lipska
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, 50-556, Poland
| | - Agata Stebel
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, 50-556, Poland
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Liao D, Yan J, Wilson SR. How Does Physician (Non)accommodation Affect Patient Behavioral Intention? Using a Web-Based Experiment to Examine Indirect Effects of Language Type on Behavioral Intention Through Goal Inferences and Source Appraisals. JOURNAL OF HEALTH COMMUNICATION 2023; 28:585-594. [PMID: 37470681 DOI: 10.1080/10810730.2023.2237435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Drawing on communication accommodation theory (CAT), we investigated how physician (non)accommodation indirectly affects participants' intention to engage in advocated health behaviors through participant goal inferences and source appraisals. We conducted a 3 (language type: medical jargon, analogies, literal language) × 2 (health topic: coronary artery disease, influenza vaccine) web-based experiment. Participants recruited from an online research panel (N = 545) were randomly assigned to a condition and watched a video featuring a physician explaining medical information and providing health recommendations. In a serial mediation analysis, results suggested two parallel indirect effects (relational vs. informational). Relative to underaccommodation (i.e. medical jargon), physician accommodation (i.e. literal language, analogies) had positive, indirect effects on participant health behavioral intention through goal inferences and assessment of physicians (i.e. warmth, expertise). Compared to the use of literal language, physician use of analogies had a positive, indirect effect on participant behavioral intention solely through the relational path, not the informational path. These findings extend CAT by explicating a mechanism underlying physician (non)accommodation and patient outcomes, offering practical implications for physicians to foster relationships with patients and facilitate patient comprehension.
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Affiliation(s)
- Danni Liao
- Department of Communication, University of Health Sciences and Pharmacy in St Louis, St Louis, MO, USA
| | - Jia Yan
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Sam R Wilson
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Medical Misinformation and Healthy Information Environment: A Call to Action. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Grilo AM, Almeida B, Rodrigues C, Isabel Gomes A, Caetano M. Using virtual reality to prepare patients for radiotherapy: A systematic review of interventional studies with educational sessions. Tech Innov Patient Support Radiat Oncol 2023; 25:100203. [PMID: 36873800 PMCID: PMC9982317 DOI: 10.1016/j.tipsro.2023.100203] [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: 10/17/2022] [Revised: 02/06/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
Purpose To understand the impact of radiotherapy educational sessions with virtual reality on oncologic adult patients' psychological and cognitive outcomes related to the treatment experience. Methods This review was performed according to the Preferred Reporting Items for Systematic Reviews guidelines. A systematic electronic search in three databases, MEDLINE, Scopus, and Web of Science, was conducted in December 2021 to find interventional studies with adult patients undergoing external radiotherapy who received an educational session with virtual reality before or during the treatment. The studies that provided qualitative or quantitative information about the impact of educational sessions on patients' psychological and cognitive dimensions related to RT experience were retained for analysis. Results Of the 25 records found, eight articles about seven studies were analysed that involved 376 patients with different oncological pathologies. Most studies evaluated knowledge and treatment-related anxiety, mainly through self-reported questionnaires. The analysis showed a significant improvement in patients' knowledge and comprehension of radiotherapy treatment. Anxiety levels also decreased with virtual reality educational sessions and throughout the treatment in almost all the studies, although with less homogeneous results. Conclusion Virtual reality methods in standard educational sessions can enhance cancer patients' preparation for radiation therapy by increasing their understanding of treatment and reducing anxiety.
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Affiliation(s)
- Ana Monteiro Grilo
- H&TRC − Health & Technology Research Center, ESTeSL − Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Av. D. João II, Lote 4.69.01, 1990-096 Lisboa, Portugal
- CICPSI − Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
- Corresponding author.
| | - Bárbara Almeida
- ESTeSL − ESTeSL – Escola Superior de Tecnologia da Saúde de Lisboa, Av. D. João II, Lote 4.69.01, 1990-096 Lisboa, Portugal
| | - Carolina Rodrigues
- ESTeSL − ESTeSL – Escola Superior de Tecnologia da Saúde de Lisboa, Av. D. João II, Lote 4.69.01, 1990-096 Lisboa, Portugal
| | - Ana Isabel Gomes
- CICPSI − Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
| | - Marco Caetano
- ESTeSL − ESTeSL – Escola Superior de Tecnologia da Saúde de Lisboa, Av. D. João II, Lote 4.69.01, 1990-096 Lisboa, Portugal
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Darley A, Coughlan B, Maguire R, McCann L, Furlong E. A bridge from uncertainty to understanding: The meaning of symptom management digital health technology during cancer treatment. Digit Health 2023; 9:20552076231152163. [PMID: 36714543 PMCID: PMC9880573 DOI: 10.1177/20552076231152163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Objective Digital health technology is valued as a tool to provide person-centred care and improve health outcomes amongst people with cancer and their family caregivers. Although the evidence to date shows encouraging effectiveness, there is limited knowledge regarding the lived experience and personal meaning of using supportive technology during cancer treatment. The aim of this study was to explore the lived experiences of people with colorectal cancer receiving chemotherapy using digital health symptom management technology and their family caregivers. Methods A longitudinal and multi-perspective interpretative phenomenological analytical approach was adopted including three people with newly diagnosed colorectal cancer and four family caregivers. Findings Three superordinate themes and related subthemes were identified. The first theme (The 3 Cs of symptom management technology) centred on the continuity of care that participants felt while using the technology. The second theme (Digital health technology as a psychosocial support) offered insights into the psychological benefits using technology incurred as they navigated their cancer diagnosis including sense of control and psychological safety. The final theme (Impact of digital health technology on family caregivers) details the supportive effect the technology had on family caregivers' role, responsibilities and well-being during the cancer experience. Conclusion Digital health technology can act as a bridge from uncertainty to an understanding regarding a cancer diagnosis and its treatment. Digital health technology can support peoples' understanding of cancer and enhance self-management practices, while being a psychological support in navigating the uncertain and often worrying period of receiving cancer treatment.
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Affiliation(s)
- Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland,Andrew Darley, School of Medicine,
University College Dublin, Belfield, Dublin 4, Ireland.
| | - Barbara Coughlan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Roma Maguire
- Digital Health and Wellness Group, Department of Computing and
Information Sciences, University of Strathclyde, Glasgow, UK
| | - Lisa McCann
- Digital Health and Wellness Group, Department of Computing and
Information Sciences, University of Strathclyde, Glasgow, UK
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Liu Y, Medlar A, Głowacka D. Lexical ambiguity detection in professional discourse. Inf Process Manag 2022. [DOI: 10.1016/j.ipm.2022.103000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Development and Evaluation of the Clinical Trial HEalth Knowledge and Beliefs Scale (CHEKS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148660. [PMID: 35886512 PMCID: PMC9315756 DOI: 10.3390/ijerph19148660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
Patient health literacy is vital to clinical trial engagement. Knowledge and beliefs about clinical trials may contribute to patient literacy of clinical trials, influencing engagement, enrollment and retention. We developed and assessed a survey that measures clinical trial health knowledge and beliefs, known as the Clinical trial HEalth Knowledge and belief Scale (CHEKS). The 31 survey items in CHEKS represent knowledge and beliefs about clinical trial research (n = 409) in 2017. We examined item-scale correlations for the 31 items, eliminated items with item-scale correlations less than 0.30, and then estimated internal consistency reliability for the remaining 25 items. We used the comparative fit index (CFI) and the root mean squared error of approximation (RMSEA) to evaluate model fit. The average age of the sample was 34 (SD = 15.7) and 48% female. We identified 6 of the 31 items that had item-scale correlations (corrected for overlap) lower than 0.30. Coefficient alpha for the remaining 25 items was 0.93 A one-factor categorical confirmatory factor analytic model with 16 correlated errors was not statistically significant (chi-square = 10011.994, df = 300, p < 0.001) but fit the data well (CFI = 0.95 and RMSEA = 0.07). CHEKS can assess clinical trial knowledge and beliefs.
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Miller AN, Bharathan A, Duvuuri VNS, Navas V, Luceno L, Zraick R, Atmakuri S, Schmidt-Owens M, Deichen M, Ayers T, Thrash K. Use of seven types of medical jargon by male and female primary care providers at a university health center. PATIENT EDUCATION AND COUNSELING 2022; 105:1261-1267. [PMID: 34489148 DOI: 10.1016/j.pec.2021.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The purposes of this study were to investigate extent and type of jargon use among primary care providers at a university health center, to evaluate the association of jargon use with patient outcomes, and to identify differences in jargon use between male and female providers. METHOD The study employed a causal comparative design. Audio recordings of 87 primary care interviews were transcribed and coded using Pitt and Hendrickson's seven-category medical jargon classification framework. RESULTS Nearly 80% of appointments included at least one instance of unexplained jargon, with an average of more than four uses of jargon per visit. The most frequently used types of jargon were technical terminology and medical vernacular. Acronyms and abbreviations, medicalized English, and unnecessary synonyms were also regularly used. Just under half of distinct jargon terms were explained. Male providers used nearly 50% more jargon per minute than female providers, and they used more technical jargon than did their female colleagues. However, they explained that jargon just as frequently as female providers. CONCLUSIONS Whereas previous studies have frequently limited the operational definition of jargon to two or three types, the comprehensive typology proposed by Pitt and Hendrickson provides a useful tool for identifying a wide range of jargon usage. Future research should examine the outcomes of this range of jargon types in more varied, less educated patient populations, and across different types of healthcare providers. PRACTICE IMPLICATIONS With jargon used on average more than once every four minutes in our sample, and only half of jargon terms explained, medical jargon may be more of a problem even in primary care contexts than providers themselves realize. Male providers especially may want to make efforts to become more conscious of their jargon use and take care to explain terms, in an effort to facilitate more effective patient-provider communication and improved patient outcomes.
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Affiliation(s)
- Ann Neville Miller
- University of Central Florida, 12405 Aquarius Agora Drive, Orlando, FL 32816, United States.
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13
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Man A, van Ballegooie C. Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study. JMIR Pediatr Parent 2022; 5:e31820. [PMID: 35293875 PMCID: PMC8968558 DOI: 10.2196/31820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/20/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Web-based patient education materials (PEMs) are frequently written above the recommended reading level in North America. Poor PEM readability limits the accessibility of medical information for individuals with average literacy levels or lower. Pediatric hospital and association websites have not only been shown to be a preferred source of information among caregivers but have also become a necessity during the COVID-19 pandemic. The readability of Canadian pediatric association websites has not yet been assessed. OBJECTIVE The aim of this study is to determine if the content of PEMs from Canadian pediatric associations is written at a reading level that the majority of Canadians can understand. METHODS A total of 258 PEMs were extracted from 10 Canadian pediatric associations and evaluated for their reading level using 10 validated readability scales. The PEMs underwent a difficult word analysis and comparisons between PEMs from different associations were conducted. RESULTS Web-based PEMs were identified from 3 pediatric association websites, where the reading level (calculated as a grade level) was found to be an average of 8.8 (SD 1.8) for the Caring for Kids website, 9.5 (SD 2.2) for the Pediatric Endocrine Group website, and 13.1 (SD 2.1) for the Atlantic Pediatric Society website. The difficult word analysis identified that 19.9% (SD 6.6%) of words were unfamiliar, with 13.3% (SD 5.3%) and 31.9% (SD 6.1%) of words being considered complex (≥3 syllables) and long (≥6 letters), respectively. CONCLUSIONS The web-based PEMs were found to be written above the recommended seventh-grade reading level for Canadians. Consideration should be made to create PEMs at an appropriate reading level for both patients and their caregivers to encourage health literacy and ultimately promote preventative health behaviors and improve child health outcomes.
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Affiliation(s)
- Alice Man
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Courtney van Ballegooie
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Experimental Therapeutics, British Columbia Cancer Research Institute, Vancouver, BC, Canada
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14
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Kelly T, Thompson JD, Surjan Y, Rinks M, Warren‐Forward H. Lived experiences of radiation therapists using health literacy strategies with patients—A qualitative review using interpretative phenomenological analysis. J Med Radiat Sci 2022; 69:318-326. [PMID: 35289107 PMCID: PMC9442295 DOI: 10.1002/jmrs.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Toni Kelly
- School of Health Sciences University of Newcastle Callaghan New South Wales Australia
- Illawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Jennifer D Thompson
- BreastScreen New South Wales, Hunter New England Newcastle New South Wales Australia
| | - Yolanda Surjan
- School of Health Sciences University of Newcastle Callaghan New South Wales Australia
| | - Marianne Rinks
- Illawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Helen Warren‐Forward
- School of Health Sciences University of Newcastle Callaghan New South Wales Australia
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15
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Blee S, Rosenberg B, Switchenko JM, Hianik R, Thomson MC, Dixon M, Bilen MA, Pentz RD. Understanding Immunotherapy Terminology: An Analysis of Provider-Patient Conversations. IMMUNOMEDICINE 2021; 1:e1028. [PMID: 34901734 PMCID: PMC8659848 DOI: 10.1002/imed.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Immunotherapy terminology is complex and can be difficult for patients to understand, threatening informed consent. The aims of this exploratory study are to determine whether patients understand immunotherapy terminology and if the provider defining the term improves patient understanding. METHODS Conversations between oncology providers and patients discussing immunotherapy were observed(n=39), and technical terms used were noted. With consent, patients were interviewed post-conversation to assess their understanding of these terms(n=39). Comparisons of the terms were conducted using chi-square tests, Fisher's exact tests, or ANOVA where appropriate. RESULTS 'Immunotherapy' was the most difficult for participants to understand with 48.7% (19/39) correctly defining immunotherapy. 'Immunotherapy agents' was understood 53.8% (14/26) of the time. 'Immune system' was well understood (88.5%;23/26). Providers defined immunotherapy in 97.4% of conversations. There was no correlation between having immunotherapy defined in the conversation, and the likelihood of a correct definition (p=0.487). 'Immune system' was defined in 92.3% of conversations (n=26), and defining it in the conversation was correlated with increased patient understanding (p=0.009). CONCLUSION Our results indicate that patients have difficulty understanding some immunotherapy terminology. Since patient understanding of key terminology is crucial for informed consent and patient care, it is essential to implement interventions to improve understanding.
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Affiliation(s)
| | | | | | | | | | | | - Mehmet Asim Bilen
- Winship Cancer Institute, Emory University
- Emory University School of Medicine
| | - Rebecca D Pentz
- Winship Cancer Institute, Emory University
- Emory University School of Medicine
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16
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Hildenbrand GM. Healthcare Provider Analogies as Memorable Messages. JOURNAL OF HEALTH COMMUNICATION 2021; 26:764-772. [PMID: 34779337 DOI: 10.1080/10810730.2021.2002982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Healthcare providers must explain medical information to patients in a way that patients can understand. Provider use of analogies is one strategy that may help patients better understand medical information. The present study, guided by a memorable message framework, investigated whether participants remembered any analogies used by their healthcare providers, and included a content analysis of the function the analogies served, the types of analogies participants remembered, and the body systems associated with the health issues that were described. Almost one-quarter of participants recalled an analogy used by a provider. The most frequently recalled analogies functioned to describe health conditions or phenomena, followed by elements of the body, and treatments or something external to the body. Analogies were most frequently used to describe health issues associated with the cardiovascular system, musculoskeletal system, digestive system, dental, eye, or skin issues, or the nervous system. The analogies were categorized as mechanical, a feeling or experience, random object, structure, food, nature, war/battle, or medical/body. Provider analogies may be a type of memorable message for some patients. Providers could consider using suitable analogies to explain health issues when communicating with patients, and be trained in effective use of analogies.
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Affiliation(s)
- Grace M Hildenbrand
- Brian Lamb School of Communication, Purdue University, West Lafayette, Indiana, USA
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17
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Zhang J, Zhang J, Wang K, Yan W. Should doctors use or avoid medical terms? The influence of medical terms on service quality of E-health. ELECTRONIC COMMERCE RESEARCH 2021. [PMCID: PMC8546201 DOI: 10.1007/s10660-021-09516-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 06/12/2023]
Abstract
With epidemics and pandemics like COVID-19, many offline healthcare services have been suspended and shifted to online, where patients and doctors typically communicate by typing texts. The limited communication poses a threat to the service quality of E-health, and also raises higher demand on the language skills of doctors, in which medical terms are a common concern. Traditional studies of offline healthcare mostly hold a negative attitude towards the use of medical terms by doctors. However, should we still advise doctors to avoid using medical terms in E-health? To answer this question, this paper conducts a study combining technical and empirical analyses based on real data. In this paper, a novel unsupervised text-mining method is proposed to automatically identify medical terms with crowd wisdom from large-scale doctor-patient communication texts. Then, a TREC-type experiment is carried out to validate the proposed method in terms of Precision, Recall, and \documentclass[12pt]{minimal}
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\begin{document}$$F_1$$\end{document}F1-measure, demonstrating that it can identify accurate and comprehensive medical terms. Based on the identified medical terms, an empirical analysis is conducted to verify the influence of medical terms used by doctors on the service quality of E-health. The analysis results show that for patients with low health literacy, the use of medical terms by doctors would decrease their service quality. However, for patients with high health literacy, the use of medical terms by doctors can significantly increase their service quality, revealing that doctors could improve their service quality in E-health by adjusting their medical term usage according to the health literacy of patients.
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Affiliation(s)
- Jilong Zhang
- Department of Management Science and Engineering, School of Business, Renmin University of China, Beijing, 100872 China
| | - Jin Zhang
- Department of Management Science and Engineering, School of Business, Renmin University of China, Beijing, 100872 China
| | - Kanliang Wang
- Department of Management Science and Engineering, School of Business, Renmin University of China, Beijing, 100872 China
| | - Wei Yan
- State Key Laboratory of Media Convergence and Communication, Communication University of China, Beijing, 100024 China
- School of Economics and Management, Communication University of China, Beijing, 100024 China
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18
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Watermeyer J, Thwala Z, Beukes J. Medical Terminology in Intercultural Health Interactions. HEALTH COMMUNICATION 2021; 36:1115-1124. [PMID: 32202159 DOI: 10.1080/10410236.2020.1735700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The terminology and jargon used in medical interactions can pose particular challenges to understanding for patients, healthcare providers, and mediators in cases where a language barrier is present. Common medical words used in the interactional space may mean different things to each party present. This study focuses on 79 mediated and nonmediated South African and Italian recorded healthcare interactions in which a language barrier was present. Using a hybrid sociolinguistic approach, we examined how patients, mediators, and healthcare providers orient to the use of medical terminology and how both parties demonstrate understanding of terminology used in the interactional space. Talk-extrinsic data in the form of interviews with South African patients revealed a frequent lack of understanding of key terminology, yet we found few displays of a lack of understanding in the interactional data nor explicit requests by patients for clarification of terminology not understood. In both data sets, patients made use of medical terminology infrequently and usually when describing their symptoms. Healthcare providers used medical terminology quite regularly. We found limited evidence of explicit verification of patients' understanding of medical terminology by healthcare providers or mediators. Given the additional communication complexities inherent in health interactions where a language barrier is present and patients' tendency not to request clarification, the healthcare provider has a special responsibility to ensure that all parties understand the terminology brought into the interactional space. Direct checks of patient understanding of terminology can provide an effective and efficient way of revealing comprehension and establishing shared membership.
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Affiliation(s)
- Jennifer Watermeyer
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand
| | - Zamokuhle Thwala
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand
| | - Johanna Beukes
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand
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19
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Berg MN, Ngune I, Schofield P, Grech L, Juraskova I, Strasser M, Butt Z, Halkett GKB. Effectiveness of online communication skills training for cancer and palliative care health professionals: A systematic review. Psychooncology 2021; 30:1405-1419. [PMID: 33909328 DOI: 10.1002/pon.5702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the reported effect of online communication skills training (CST) on health professional (HP) communication skills and patient care outcomes in cancer and palliative care. METHODS Primary research published in English between January 2003 and April 2019 was identified in bibliographic databases including Medline, Embase and Proquest (Prospero: CRD42018088681). An integrated mixed-method approach included studies describing a CST intervention and its effect, for cancer or palliative care HPs, delivered online or blended with an online component. Included studies' outcomes were categorised then findings were stratified by an evaluation framework and synthesised in an effect direction plot. Risk of bias was assessed using Joanna Briggs Institute's tools. RESULTS Nineteen included studies (five randomised controlled trials, 11 pre-post, two post-test and one qualitative study) evaluated a CST intervention (median duration = 3.75 h; range 0.66-96 h) involving 1116 HPs, 422 students and 732 patients. Most interventions taught communication skills for specific scenarios and approximately half were delivered solely online and did not involve role plays. Online CST improved HPs' self-assessed communication skills (three studies, 215 participants), confidence (four studies, 533 participants), and objective knowledge (five studies, 753 participants). While few studies evaluated patient outcomes, CST may benefit observed communication skills in care settings (two studies, 595 participants). CONCLUSIONS Online CST benefits oncology HPs' subjectively-reported communication skills and confidence, and objective knowledge. Translation to patient outcomes requires further investigation. The quality of research varied and few studies had a control group. We recommend improvements to study design, evaluation and implementation.
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Affiliation(s)
- Melissa N Berg
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Irene Ngune
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Penelope Schofield
- Behavioural Science Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Psychology, and Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Lisa Grech
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Ilona Juraskova
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Strasser
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Zoe Butt
- The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making, Sydney, New South Wales, Australia
| | - Georgia K B Halkett
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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20
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Loh KP, Abdallah M, Kadambi S, Wells M, Kumar AJ, Mendler J, Liesveld J, Wittink M, O’Dwyer K, Becker MW, McHugh C, Stock W, Majhail NS, Wildes TM, Duberstein P, Mohile SG, Klepin HD. Treatment decision-making in acute myeloid leukemia: a qualitative study of older adults and community oncologists. Leuk Lymphoma 2021; 62:387-398. [PMID: 33040623 PMCID: PMC7878016 DOI: 10.1080/10428194.2020.1832662] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/13/2020] [Accepted: 09/29/2020] [Indexed: 01/19/2023]
Abstract
Little is known about the characteristics of patients, physicians, and organizations that influence treatment decisions in older patients with AML. We conducted qualitative interviews with community oncologists and older patients with AML to elicit factors that influence their treatment decision-making. Recruitment was done via purposive sampling and continued until theoretical saturation was reached, resulting in the inclusion of 15 patients and 15 oncologists. Participants' responses were analyzed using directed content analysis. Oncologists and patients considered comorbidities, functional status, emotional health, cognition, and social factors when deciding treatment; most oncologists evaluated these using clinical gestalt. Sixty-seven percent of patients perceived that treatment was their only option and that they had not been offered a choice. In conclusion, treatment decision-making is complex and influenced by patient-related factors. These factors can be assessed as part of a geriatric assessment which can help oncologists better determine fitness and guide treatment decision-making.
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Affiliation(s)
- Kah Poh Loh
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Maya Abdallah
- Department of Medicine, Sections of Geriatrics and Hematology/Oncology, Boston University School of Medicine, Boston, , Massachusetts
| | - Sindhuja Kadambi
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Megan Wells
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | | | - Jason Mendler
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Jane Liesveld
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Marsha Wittink
- Department of Psychiatry, University of Rochester Medical Center
| | - Kristen O’Dwyer
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Michael W. Becker
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Colin McHugh
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Wendy Stock
- The University of Chicago Medicine Comprehensive Cancer Center, Chicago, Illinois
| | - Navneet S. Majhail
- Blood and Marrow Transplant Program, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Tanya M. Wildes
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | | | - Supriya Gupta Mohile
- James P. Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center
| | - Heidi D. Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Medical Center Blvd, Winston-Salem, NC
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21
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van Ballegooie C, Hoang P. Health Services: A Mixed Methods Assessment of Canadian Cancer Patient Education Materials Related to the 2019 Novel Coronavirus. Cancer Control 2021; 28:1073274821989709. [PMID: 33563050 PMCID: PMC8482715 DOI: 10.1177/1073274821989709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The 2019 novel coronavirus (COVID-19) pandemic has prompted the reorganization in the scheduling and method of care for many patients, including patients diagnosed with cancer. Cancer patients, who have an immunocompromised status, may be at a higher risk of severe symptoms from infection with COVID-19. While information is rapidly evolving regarding COVID-19, Canada, both nationally and provincially, has been conveying new information to patients online. We assessed the content and readability of COVID-19-related online Canadian patient education material (PEM) for cancer patients to determine if the content of the material was written at a grade reading level that the majority of Canadians can understand. PEMs were extracted from provincial cancer agencies and the national Canadian Cancer Society, evaluated using 10 readability scales, qualitatively analyzed to identify their themes and difficult word content. Thirty-eight PEMs from both national and provincial cancers associations were, on average, written above the recommended 7th grade level. Each of the associations' average grade levels were: BC Cancer (11.00 95% confidence interval [CI] 8.27-13.38), CancerControl Alberta (10.46 95% CI 8.29-12.62), Saskatchewan Cancer Agency (11.08 95% CI 9.37-12.80), Cancer Care Manitoba (9.55 95% CI 6.02-13.01), Cancer Care Ontario (9.35 95% CI 6.80-11.90), Cancer Care Nova Scotia (10.95 95% CI 9.86-12.04), Cancer Care Eastern Health Newfoundland and Labrador (10.14 95% CI 6.87-13.41), and the Canadian Cancer Society (10.06 95% CI 8.07-12.05). Thematic analysis identified 4 themes: public health strategy, information about COVID-19, patient instructions during COVID-19, and resources. Fifty-three percent of the complex words identified were medical jargon. This represents an opportunity to improve PEM readability, to allow for greater comprehension amongst a wider target audience.
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Affiliation(s)
- Courtney van Ballegooie
- Experimental Therapeutics, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Courtney van Ballegooie, Department of Experimental Therapeutics, BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 1L3.
| | - Peter Hoang
- Department of Internal Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
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22
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O'Connor M, Watts KJ, Kilburn WD, Vivekananda K, Johnson CE, Keesing S, Halkett GKB, Shaw J, Colgan V, Yuen K, Jolly R, Towler SC, Chauhan A, Nicoletti M, Leonard AD. A Qualitative Exploration of Seriously Ill Patients' Experiences of Goals of Care Discussions in Australian Hospital Settings. J Gen Intern Med 2020; 35:3572-3580. [PMID: 33037591 PMCID: PMC7546390 DOI: 10.1007/s11606-020-06233-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Goals of care (GOC) is a communication and decision-making process that occurs between a clinician and a patient (or surrogate decision-maker) during an episode of care to facilitate a plan of care that is consistent with the patient's preferences and values. Little is known about patients' experiences of these discussions. OBJECTIVE This study explored patients' perspectives of the GOC discussion in the hospital setting. DESIGN An explorative qualitative design was used within a social constructionist framework. PARTICIPANTS Adult patients were recruited from six Australian hospitals across two states. Eligible patients had had a GOC discussion and they were identified by the senior nurse or their doctor for informed consent and interview. APPROACH Semi-structured individual or dyadic interviews (with the carer/family member present) were conducted at the bedside or at the patient's home (for recently discharged patients). Interviews were audio-recorded and transcribed verbatim. Data were analysed for themes. KEY RESULTS Thirty-eight patient interviews were completed. The key themes identified were (1) values and expectations, and (2) communication (sub-themes: (i) facilitators of the conversation, (ii) barriers to the conversation, and (iii) influence of the environment). Most patients viewed the conversation as necessary and valued having their preferences heard. Effective communication strategies and a safe, private setting were facilitators of the GOC discussion. Deficits in any of these key elements functioned as a barrier to the process. CONCLUSIONS Effective communication, and patients' values and expectations set the stage for goals of care discussions; however, the environment plays a significant role. Communication skills training and education designed to equip clinicians to negotiate GOC interactions effectively are essential. These interventions must also be accompanied by systemic changes including building a culture supportive of GOC, clear policies and guidelines, and champions who facilitate uptake of GOC discussions.
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Affiliation(s)
- Moira O'Connor
- WA Cancer Prevention Research Unit, School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Kaaren J Watts
- WA Cancer Prevention Research Unit, School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Warren D Kilburn
- School of Psychological Sciences, Faculty of Education, Monash University, Melbourne, VIC, Australia
| | - Kitty Vivekananda
- Counselling & Psychology Programs, Faculty of Education, Monash University, Melbourne, VIC, Australia
| | - Claire E Johnson
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Eastern Health, Melbourne, VIC, Australia
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Sharon Keesing
- School of Occupational Therapy, Social Work, and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Georgia K B Halkett
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Josephine Shaw
- WA Cancer Prevention Research Unit, School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Valerie Colgan
- WA Cancer and Palliative Care Network, WA Department of Health, Perth, WA, Australia
| | - Kevin Yuen
- Palliative Care Department, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA, Australia
| | - Renate Jolly
- Respiratory Medicine, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA, Australia
| | - Simon C Towler
- Intensive Care Unit, Fiona Stanley Hospital, South Metropolitan Health Service, Perth, WA, Australia
- DonateLife, WA, MHPHDS Division, North Metropolitan Health Service, Perth, WA, Australia
- End-of-Life Care, WA Department of Health, Perth, WA, Australia
| | - Anupam Chauhan
- Department of Intensive Care Medicine, Rockingham Hospital, South Metropolitan Health Service, Perth, WA, Australia
| | - Margherita Nicoletti
- Palliative Care, Rockingham Hospital, South Metropolitan Health Service, Perth, WA, Australia
| | - Anton D Leonard
- Intensive Care, Royal Perth Bentley Group, East Metropolitan Health Service, Perth, WA, Australia
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23
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Ihrig A, Richter J, Grüllich C, Apostolidis L, Horak P, Villalobos M, Grapp M, Friederich HC, Maatouk I. Patient expectations are better for immunotherapy than traditional chemotherapy for cancer. J Cancer Res Clin Oncol 2020; 146:3189-3198. [PMID: 32813113 PMCID: PMC7679331 DOI: 10.1007/s00432-020-03336-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022]
Abstract
Purpose The main aim of the study was to explore the expectations and knowledge of advanced-stage cancer patients about immunotherapy. Methods This mixed methods study included 53 cancer patients on immune checkpoint inhibitors (ICIs), 55 cancer patients undergoing chemotherapy (CT), and 53 non-cancer patients. Participants’ expectations about ICIs and CT were compared. Additional qualitative data were derived from semi-structured interviews. Results Among patients who did not receive ICIs, 63 (58%) had never heard of ICIs and 94 (87%) had large gaps in their knowledge of ICIs. Among ICI patients, 33 (62%) simply described ICIs without errors. ICI perception was positive, regardless of whether respondents received or had heard of ICIs, which became particularly evident when compared to CT. ICIs were rated as more promising, and all adverse effects were expected to be significantly lower than those of CT. Knowledge about ICIs was also limited in the interviewed ICI patients. Some patients reported adverse effects of ICIs that were mostly mild and well-tolerated or easily treated. Conclusions The lack of understanding of ICIs should be improved by activities to increase the knowledge of ICI patients and the general population. In contrast to CT, ICIs invoked fewer negative associations with efficacy and toxicity. Therefore, attention should be paid to risk awareness when educating patients. (Clinical trial registration number: DRKS00011868) Trial Registration: German clinical trials register, www.germanctr.de, number DRKS00011868.
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Affiliation(s)
- Andreas Ihrig
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany
| | - Jenniffer Richter
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Grüllich
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Leonidas Apostolidis
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Horak
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Villalobos
- Department of Thoracic Oncology, University Hospital Heidelberg and Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Miriam Grapp
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Division of Psychooncology, Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany.
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Halkett GK, Merchant S, Smith SK, O’Connor M, Jefford M, Aranda S, Schofield P. Supporting and preparing patients for radiotherapy: Patients’ and radiation therapists’ perspectives on their one‐to‐one consultations. Eur J Cancer Care (Engl) 2020; 29:e13284. [DOI: 10.1111/ecc.13284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/16/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Georgia K.B. Halkett
- School of Nursing, Midwifery and Paramedicine Faculty of Health Sciences Curtin University Perth WA Australia
| | - Susan Merchant
- School of Nursing, Midwifery and Paramedicine Faculty of Health Sciences Curtin University Perth WA Australia
- Department of Radiation Oncology Royal Adelaide Hospital Adelaide SA Australia
| | - Sian K. Smith
- Psychosocial Research Group Prince of Wales Clinical School Faculty of Medicine UNSW Sydney Sydney NSW Australia
- Bath Centre for Healthcare Innovation and Improvement Information, Decisions and Operations School of Management University of Bath Somerset UK
| | - Moira O’Connor
- School of Psychology Faculty of Health Sciences Curtin University Perth WA Australia
| | - Michael Jefford
- Department of Cancer Experiences Research Peter MacCallum Cancer Centre Melbourne Vic. Australia
- Sir Peter MacCallum Department of Oncology The University of Melbourne Melbourne Vic. Australia
| | - Sanchia Aranda
- Cancer Council Australia Sydney NSW Australia
- Department of Nursing The University of Melbourne Melbourne Vic. Australia
| | - Penelope Schofield
- Department of Cancer Experiences Research Peter MacCallum Cancer Centre Melbourne Vic. Australia
- Sir Peter MacCallum Department of Oncology The University of Melbourne Melbourne Vic. Australia
- Department of Psychology Swinburne University of Technology Hawthorn Vic. Australia
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Observing the Implementation of Shared Decision-making in Routine Radiotherapy Cancer Nursing: An Explorative Longitudinal Questionnaire Study. Cancer Nurs 2020; 44:369-377. [PMID: 32541208 DOI: 10.1097/ncc.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Healthcare professionals have driven decision-making in the past. However, shared decision-making has the potential to increase quality of care. OBJECTIVE To determine to what degree patients undergoing routine pelvic radiotherapy care perceive decision-making as being shared between patient and healthcare professionals. METHODS This exploratory longitudinal study covered 193 patients undergoing pelvic radiotherapy, mostly women (n = 161 [84%]) treated for a gynecological (n = 132 [68%]) or colorectal (n = 54 [28%]) cancer. We collected data regarding self-perceived level of shared decision-making at the start of radiotherapy and quality of life (QoL) (91%-95% response rate per week) during the radiotherapy period. RESULTS The patients reported that they shared the decision-making with the healthcare professionals much (n = 137 [71%]), moderately (n = 33 [17%]), a little (n = 12 [6%]), or not at all (n = 11 [6%]). Male patients (P = .048), patients who did not live with their partner (P = .034), patients with higher education (P = .043), and patients with low functional capacity (P = .018) perceived lower levels of shared decision-making. A higher level of shared decision-making was related to higher QoL at baseline and during the first to third weeks of radiotherapy (P ranged from .001 to .044). CONCLUSIONS Almost 9 of 10 patients reported that they shared the decision-making moderately or much with the healthcare professionals. The study identified subgroups perceiving lower levels of shared decision-making and found that a higher level of shared decision-making was related to better QoL. IMPLICATIONS Healthcare professionals may need to pay extra attention to patients who may perceive that they share decision-making to a low extent.
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Chau M. Cultural Diversity and the Importance of Communication, Cultural Competence, and Uncertainty in Radiography. J Med Imaging Radiat Sci 2020; 51:S17-S22. [PMID: 32439284 DOI: 10.1016/j.jmir.2020.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
Cultural diversity has been well-recognized as a challenge for health care providers in many countries, thereby stressing the importance of effective and sufficient communications between patients and health care staff. Culturally competent care is a key to day-to-day practice, and we must strive to provide optimum care despite personal differences. If the health care service is to provide culturally competent care, our radiographers are vulnerable and prone to errors because effective communication requires both cultural competence and knowledge of the language. An understanding in effective communication, cultural competence, and uncertainty is important in the profession of radiographers.
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Affiliation(s)
- Minh Chau
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
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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: 6] [Impact Index Per Article: 1.5] [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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Kelly T, Arnold B, Surjan Y, Rinks M, Warren-Forward H. Radiation therapist health literacy training: A qualitative study exploring perceived barriers and attitudes. Radiography (Lond) 2020; 26:294-301. [PMID: 32169311 DOI: 10.1016/j.radi.2020.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/02/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Health literacy (HL) is a universal issue in healthcare. While difficult to assess an individual's HL status, the onus is on the health provider to empower patients to seek understanding of health information provided to them. Universal HL training techniques include implementing plain language and the teach-back method. The research aims to explore the perceptions of Australian radiation therapists (RTTs) learning and implementation of these tools with patients. METHODS RTTs attended two communication and HL workshops one week apart. Participants completed three anonymous surveys (before the first workshop, immediately after the second and three months post workshops) and a workshop evaluation was administered after the second workshop. Participants had the opportunity to provide written comments on all surveys and the evaluation form. A thematic analysis was performed on the written comments by two independent researchers. RESULTS Five themes were revealed after the thematic analysis of the surveys. These themes were: improved patient understanding, impact on professional credibility, practice and timing of using methods, appearing to be condescending to educated patients and increased patient anxiety. The workshop evaluation assessment indicated the success of and improvement for future workshops and revealed seven themes. These were: learning from others, providing a safe environment to share experiences, to be open to learning new methods, more time for learning, role-play aversion, group sizing and thinking beyond the workshops. CONCLUSION While strong evidence of using HL tools for improved patient understanding exists, this qualitative review revealed unexpected barriers with implementing both the plain language and teach-back method. IMPLICATIONS FOR PRACTICE Barriers revealed during HL training could have patient flow on effects when checking for understanding. These challenges need further exploration, to inform all health professionals.
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Affiliation(s)
- T Kelly
- School of Health Sciences, University of Newcastle, Australia; Illawarra Shoalhaven Local Health District, Australia.
| | - B Arnold
- Illawarra Shoalhaven Local Health District, Australia
| | - Y Surjan
- School of Health Sciences, University of Newcastle, Australia
| | - M Rinks
- Illawarra Shoalhaven Local Health District, Australia
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Jager M, de Zeeuw J, Tullius J, Papa R, Giammarchi C, Whittal A, de Winter AF. Patient Perspectives to Inform a Health Literacy Educational Program: A Systematic Review and Thematic Synthesis of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4300. [PMID: 31694299 PMCID: PMC6862529 DOI: 10.3390/ijerph16214300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 01/22/2023]
Abstract
Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with LHL within the curricula of (future) healthcare providers (HCP). This systematic review aimed to explore and synthesize evidence on the needs, experiences and preferences of patients with LHL and to inform an existing educational framework. We searched three databases: PsychInfo, Medline and Cinahl, and extracted 798 articles. One-hundred and three articles met the inclusion criteria. After data extraction and thematic synthesis, key themes were identified. Patients with LHL and chronic diseases encounter multiple problems in the care process, which are often related to a lack of person-centeredness. Patient perspectives were categorized into four key themes: (1) Support system; (2) Patient self-management; (3) Capacities of HCPs; (4) Barriers in healthcare systems. "Cultural sensitivity" and "eHealth" were identified as recurring themes. A set of learning outcomes for (future) HCPs was developed based on our findings. The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for (future) HCPs, and contribute to better person-centred care for patients with LHL.
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Affiliation(s)
- Margot Jager
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
| | - Janine de Zeeuw
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
- Department of Medical Sciences, Educational Institute, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | - Janne Tullius
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
| | - Roberta Papa
- Regional Health Agency Marche Region, 60125 Ancona, Italy; (R.P.); (C.G.)
- IRCCS INRCA, 60124 Ancona, Italy
| | - Cinzia Giammarchi
- Regional Health Agency Marche Region, 60125 Ancona, Italy; (R.P.); (C.G.)
- IRCCS INRCA, 60124 Ancona, Italy
| | - Amanda Whittal
- Department of Psychology & Methods, Jacobs University, 28759 Bremen, Germany;
| | - Andrea F. de Winter
- Department of Health Sciences, University Medical Center Groningen and University of Groningen, 9700 AD Groningen, The Netherlands; (J.T.); (A.F.d.W.)
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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: 12] [Impact Index Per Article: 2.4] [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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Williams R, Moeller L, Willis S. Barriers and enablers to improved access to health information for patients with low health literacy in the radiotherapy department. Radiography (Lond) 2018; 24 Suppl 1:S11-S15. [DOI: 10.1016/j.radi.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/24/2018] [Accepted: 06/28/2018] [Indexed: 11/26/2022]
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Smith SK, Cabrera-Aguas M, Shaw J, Shepherd H, Naehrig D, Meiser B, Jackson M, Saade G, Bucci J, Halkett GKB, Turner RM, Milross C, Dhillon HM. A low literacy targeted talking book about radiation therapy for cancer: development and acceptability. Support Care Cancer 2018; 27:2057-2067. [PMID: 30225574 DOI: 10.1007/s00520-018-4446-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/26/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To develop a low literacy talking book (written book with accompanying audio-recording) about radiation therapy and explore its acceptability with patients and caregivers. METHOD The talking book was developed iteratively using low literacy design principles and a multidisciplinary committee comprising consumers and experts in radiation oncology, nursing, behavioural sciences, and linguistics. It contained illustrations, photos, and information on: treatment planning, daily treatment, side effects, psychosocial health, and a glossary of medical terms. Semi-structured interviews were conducted with patients who self-reported low functional health literacy and caregivers to explore their views on the resource. Thematic analysis using a framework approach informed the analysis. RESULTS Participants were very satisfied with the content, illustrations, and language in the resource. Most were unfamiliar with the term 'talking book', but liked the option of different media (text and audio). The resource was seen as facilitating communication with the cancer care team by prompting question-asking and equipping patients and their families with knowledge to communicate confidently. CONCLUSIONS The low literacy talking book was well accepted by patients and their caregivers. The next step is to examine the effect of the resource on patients' knowledge, anxiety, concerns, and communication with the cancer care team.
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Affiliation(s)
- Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Lowy Cancer Research Centre C25 Level 4, Cnr High Street and Botany Street, Kensington, NSW, 2033, Australia.
| | - Maria Cabrera-Aguas
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Lowy Cancer Research Centre C25 Level 4, Cnr High Street and Botany Street, Kensington, NSW, 2033, Australia
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Heather Shepherd
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Diana Naehrig
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Chris O'Brien Lifehouse, Integrative Oncology & Supportive Care, Sydney, NSW, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Lowy Cancer Research Centre C25 Level 4, Cnr High Street and Botany Street, Kensington, NSW, 2033, Australia
| | - Michael Jackson
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - George Saade
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Joseph Bucci
- St George Hospital Cancer Care, Radiation Oncology Unit, Sydney, NSW, Australia
| | - Georgia K B Halkett
- Faculty of Health Sciences, School of Nursing School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - Robin M Turner
- Biostatistics Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Christopher Milross
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Chris O'Brien Lifehouse, Radiation Oncology and Medical Services, Sydney, NSW, Australia
| | - Haryana M Dhillon
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
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Schnitzler L, Smith SK, Shepherd HL, Shaw JM, Dong S, Turner RM, Sørensen K, Dhillon HM. What information is communicated by radiation therapists to patients during education sessions on the first day of treatment? Eur J Cancer Care (Engl) 2018; 28:e12911. [PMID: 30204270 DOI: 10.1111/ecc.12911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 05/19/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022]
Abstract
This study examined the content covered by radiation therapists (RTs) during education sessions; the frequency and types of questions asked by patients; and the relationship between patient characteristics and the number of questions asked. Fifty-eight education sessions were audio-recorded and transcribed verbatim. A coding scheme was developed to examine the frequency of topics covered. It comprised 16 topics under four themes: (a) treatment schedule, (b) procedural information, (c) treatment-related side effects and (d) who will be involved in treatment provision. All education sessions covered information about the treatment plan (n = 58, 100%), and the majority described procedural information about what happens in the treatment room (n = 56, 97%). Least information was given about who will be providing treatment. On average, patients asked a mean of 6 questions (SD = 4.95; range = 0-28). Most frequently asked questions concerned the general treatment (logistics, schedule), accounting for 67% of all questions asked. The least common types of questions were related to the impact of treatment (6%). There were no statistically significant differences in the total number of questions and patient demographics. Patients are provided with most, but not all, of the recommended information. Tailoring of information by RTs was enabled in response to questions asked.
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Affiliation(s)
- Lena Schnitzler
- Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands.,Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Heather L Shepherd
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, New South Wales, Australia
| | - Joanne M Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, New South Wales, Australia
| | - Skye Dong
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney, New South Wales, Australia
| | - Robin M Turner
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
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RT Prepare: a radiation therapist-delivered intervention reduces psychological distress in women with breast cancer referred for radiotherapy. Br J Cancer 2018; 118:1549-1558. [PMID: 29855611 PMCID: PMC6008448 DOI: 10.1038/s41416-018-0112-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/11/2018] [Accepted: 04/17/2018] [Indexed: 12/17/2022] Open
Abstract
Background The aims of this study were to determine whether a radiation therapist-led patient education intervention (RT Prepare) reduced breasts cancer patients’ psychological distress (primary endpoint); anxiety, depression and concerns about radiotherapy, and increased knowledge of radiotherapy and preparedness (secondary endpoints). Patient health system usage and costs were also assessed. Methods A multiple-baseline study across three sites. The RT Prepare intervention comprised two consultations with a radiation therapist: prior to treatment planning and on the first day of treatment. Radiation therapists focused on providing sensory and procedural information and addressing patients’ pre-treatment anxiety. Usual care data were collected prior to intervention commencement. Data collection occurred: after meeting their radiation oncologist, prior to treatment planning, first day of treatment and after treatment completion. Multilevel mixed effects regression models were used. Results In total, 218 usual care and 190 intervention patients participated. Compared with usual care, intervention participants reported lower psychological distress at treatment commencement (p = 0.01); lower concerns about radiotherapy (p < 0.01); higher patient knowledge (p < 0.001); higher preparedness for procedural concerns (p < 0.001) and higher preparedness for sensory-psychological concerns at treatment planning (p < 0.001). Mean within-trial costs per patient were estimated at $AU159 (US$120); mean ongoing costs at $AU35 (US$26). Conclusion The RT Prepare intervention was effective in reducing breast cancer patients’ psychological distress and preparing patients for treatment. This intervention provides an opportunity for radiation therapists to extend their role into providing patients with information and support prior to treatment to reduce psychological distress.
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The term “seropositive” to qualify polyarthritis/rheumatoid arthritis should be banned. Joint Bone Spine 2018; 85:123. [DOI: 10.1016/j.jbspin.2016.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 11/18/2022]
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Walser SA, Werner-Lin A, Mueller R, Miller VA, Biswas S, Bernhardt BA. How do providers discuss the results of pediatric exome sequencing with families? Per Med 2017; 14:409-422. [PMID: 28966657 DOI: 10.2217/pme-2017-0015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM This study provides preliminary data on the process and content of returning results from exome sequencing offered to children through one of the Clinical Sequencing Exploratory Research (CSER) projects. MATERIALS & METHODS We recorded 25 sessions where providers returned diagnostic and secondary sequencing results to families. Data interpretation utilized inductive thematic analysis. RESULTS Typically, providers followed a results report and discussed diagnostic findings using technical genomic and sequencing concepts. We identified four provider processes for returning results: teaching genetic concepts; assessing family response; personalizing findings; and strengthening patient-provider relationships. CONCLUSION Sessions should reflect family interest in medical management and next steps, and minimize detailed genomic concepts. As the scope and complexity of sequencing increase, the traditional information-laden counseling model requires revision.
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Affiliation(s)
- Sarah A Walser
- Translational Medicine & Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Allison Werner-Lin
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rebecca Mueller
- Department of History & Sociology of Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Victoria A Miller
- Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 9104, USA
| | - Sawona Biswas
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Barbara A Bernhardt
- Translational Medicine & Human Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
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