Information provision to cancer patients: a practical example of identifying the need for changes in practice from the Dorset Cancer Centre

A new model for investigating the factors influencing the innovation in medical services

Purpose

This paper tries to examine attitude toward knowledge sharing (KS) for improving the innovation in medical services. So, this paper aims to analyze the influence of information technology (IT), staff, hospital cultures and patients and their families on the attitude toward KS and also examine the influence of attitude toward KS on innovation in medical services.

Design/methodology/approach

This paper presented a project plan that contains five research hypotheses, with attitude toward KS as a mediating construct. In this paper, Smart PLS 3.0 is implemented to study the calculation. The hypotheses are tested on data collected using structural equation modeling. Data was collected using questionnaires from a hospital in Iran. The statistical population of this research is unlimited. Through using the sample measurement method, the sample size for structural equations has come to be 384.

Findings

The results showed that all theories of the project are proved. Also, they indicated the importance of IT as an important factor in attitude toward KS and the latter's influence on the innovation in medical services. Furthermore, the attitude toward KS influences positively on innovation in medical services. As a general result, the managers of health organizations should empower employees to participate in decision-making and encourage them to resolve problems together and share medical information to promote innovation in medical services.

Research limitations/implications

This research must be carefully defined and accepted because the study information had special restrictions. At first, a prejudice was created, because the sample was self-selected. Second, the participants were living in Iran. There were different cultures and lifestyles among countries. Third, this research sample consisted only of hospital staff and managers. Moreover, little empirical research has been conducted on this topic in Iran. Iran’s culture is considerably different from Western culture, and it is unknown whether the same questionnaire that is used in the Iran context can be used in the Western context. In further studies, this research could be extended to contain other psychosocial elements that permit KS in institutions and increase innovation.

Practical implications

The medical industry is knowledge-intensive, remains a competitive advantage and accumulates knowledge, and the hospitals are the main subject. The role of this research according to providing a functional-theoretical plan enables authorities and practitioners to access thoughts about efficient stimulation attitude toward KS on innovation in medical services in the health sector. Also, the findings of this study at the same time are implemented to study relations between knowledge-sharing elements such as enablers, processes and firm innovation capability.

Originality/value

Modern study design enables the relations between IT and other influential elements on attitude toward KS and innovation in medical services to be analyzed. This design determines the coexistence of the participation and contest relations among participants, which is not studied in past researches. From a management point of view, this research determined various elements essential to a successful attitude toward KS and investigated the usage of these elements for improving innovation in medical services.

Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making

BACKGROUND

The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice.

METHODS

Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician. This was assessed by multiple-choice, 1-5 Likert Scale, and open questions. The Decisional Conflict Scale was used to assess the decisional conflict. Health related quality of life (HRQoL) was measured with SF-36 questionnaire.

RESULTS

In 19% of patients, there was self-reported perceived lack of knowledge about the advantages and disadvantages of the treatment options. Seventy-four percent of patients felt that they were sufficiently involved in decision-making by their physician, and 81% found it important to be involved in decision making. Forty percent experienced decisional conflict, and one-in-five patients to such an extent that it made them feel unsure about the decision. Subscores with regard to feeling uninformed and on uncertainty, contributed the most to decisional conflict, as 36% felt uninformed and 17% of patients were not satisfied with their decision. HRQoL was not influenced by patient experience with decision-making or patient preferences for shared decision making.

CONCLUSIONS

Dutch early-stage NSCLC patients find it important to be involved in treatment decision making. Yet a substantial proportion experiences decisional conflict and feels uninformed. Better patient information and/or involvement in treatment-decision-making is needed in order to improve patient knowledge and hopefully reduce decisional conflict.

Information needs of cancer patients: a comparison of nurses' and patients' perceptions

This study aimed to identify nurses' and patients' perceptions and compare them in terms of the information needs of cancer patients. Another aim is to identify the association between the demographic and situational characteristics of patients'/nurses' and information needs. A total of 305 patients and 130 nurses participated in this descriptive and comparative study. Data was collected with a study-specific questionnaire developed for this study. Descriptive statistics, Pearson Chi-square and RIDIT analyses were used to analyze the data. Results indicated that there was incongruence between patients' and nurses' perceptions regarding information provision (p < 0.05), both congruence regarding how much information was needed (eight out of 16 information items), but also significant incongruence on the remaining items(p < 0.05). The other finding was that patients residing out of Ankara city needed to obtain more information rather than the others. No relationship was found between demographic and situational characteristics and nurses' perceptions regarding information need of patients.

A critical review of the evidence for nurses as information providers to cancer patients

AIMS

To review evidence on the role of oncology nurses in the provision of information to cancer patients and to delineate evidence-based implications for clinical practice and research.

BACKGROUND

Provision of information is central for the empowerment of patients to participate in their care. There is not enough evidence regarding the nursing role in the information delivery process in cancer patients.

DESIGN

Descriptive literature review.

METHODS

From January 1990-2008, databases searched included Medline, CINAHL, PubMed, CancerLit and the Cochrane Library. Original research articles addressing the role of nurses in information delivery were included. We explored evidence on: (1) the effectiveness of nurses as information providers, (2) the way patients evaluate nurses' input to information delivery, (3) the extent to which nurses contribute to information delivery to cancer patients and (4) the types of information provided by nurses.

RESULTS

The most important findings were: (1) nurses' role as information providers for cancer patients is prominent, especially after the initiation of treatment, (2) specialist nurses are very effective in providing information, (3) no clear evidence exists on how nurses compare with other health-care professionals as information providers and (4) some evidence exists that patients may prefer nurses as information providers at specific times in their treatment and especially in regards to symptom management.

CONCLUSION

Well-designed studies provide some evidence that nurses are effective as information providers to cancer patients. Specifically, oncology nurses are able to provide information of both high quality and of appropriate quantity and to assist individuals to interpret information provided by others.

RELEVANCE TO CLINICAL PRACTICE

Oncology nurses should be specifically educated and prepared to offer explicit, practical and timely information and they should be trained in interpersonal communication skills, which will increase their ability to comprehend patient information needs.

Developing a self-rating measure of patient competence in the context of oncology: a multi-center study

OBJECTIVE

Concepts of patient competence (PC) are being increasingly used, but seldom clearly defined in the context of shared medical treatment decision making and coping with cancer. The meaning of such concepts should therefore be clarified, and measures developed that permit the assessment of different facets of this patient characteristic. Consequently, this study attempted to contribute to the definition and measurement of PC.

METHODS

Employing literature reviews and qualitative interviews, we developed a working definition of PC in the context of cancer from which we designed a self-rating measure of this patient characteristic that was then tested for validity and reliability in a sample of N=536 patients with cancer.

RESULTS

Using factor analyses, we developed five problem- and three emotion-focused subscales that measure distinct facets of PC with satisfactory reliability. Additional analyses provide preliminary evidence of the instruments' validity.

CONCLUSIONS

This study represents an essential first step in developing a reliable self-rating measure of PC in the context of cancer. Although further refinement of this measure is clearly required, it provides a preliminary methodological basis for empirically investigating the determinants and potential health effects of PC.

Subjective dimensions of patient competence: relationships with selected healthcare usage behaviors and general features of self-rated competence

OBJECTIVE

To introduce the concept of patient competence and provide additional information on the concurrent validity of a new self-rating measure of patient competence in the context of cancer employing healthcare usage behaviors and more general self-rated features of patient competence as criteria.

METHODS

Based on a multi-center sample of n=536 patients with cancer, bivariate correlations and multiple regressions were computed.

RESULTS

The competence subscale of striving for autonomous decisions emerged as significant, albeit weak predictor of having used professional psycho-social support (r=.31, beta=.28) and employing other complementary medicines (r=.28; B=.65) in relation to one's cancer. Problem-focused and emotion-focused competencies relate differently to different general features of self-rated competence like feeling informed and assertive or adapting well.

CONCLUSION

Additional support for the concurrent validity of the new self-rating measure of patient competence in the context of cancer has been found. Viewed in perspective, this measure may therefore provide a methodological basis to examine determinants and health effects of patient competence empirically. Nevertheless, further research on the conceptualization and measurement of patient competence appears necessary.

PRACTICE IMPLICATIONS

Having available measures of patients' specific competencies in the context of cancer will help identify their strength and weaknesses in dealing with life-threatening disease and enhance their coping resources.

An Evaluation of Internet Websites Provided by Radiotherapy Departments

The research identifies and evaluates the content and readability of Websites of all radiotherapy departments that provide a Website. As more patients are being referred for radiotherapy treatment each year, the information needs of the public on this subject is growing. Fifty-two per cent of radiotherapy departments within the United Kingdom (UK) and Ireland were identified as providing a Website. These Websites were evaluated, over a period of 2 weeks, using an adapted Website evaluation tool. Five criteria – content, authority, navigation, design and technical aspects – were identified as important aspects of a Website. For each criterion a number of statements were listed and using a Likert scale were marked. Flesch–Kincaid readability tests were used to analyse the readability level of the Websites. Data analysis resulted in the ranking of the Websites. Evaluation scores varied greatly and the readability tests showed 92% of the Websites were written at a level too high for the public. This shows the varying quality of radiotherapy department Websites with scores ranging from 48 to 115, and the varying readability level of these Websites. The research makes suggestions for the improvement of radiotherapy department Websites including the provision of a dedicated Website team within the department, educated in Website design.

EORTC QLQ-INFO26: a questionnaire to assess information given to cancer patients a preliminary analysis in eight countries

Information disclosure is a key factor in the support for cancer patients. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group has developed a questionnaire to evaluate the level of information received by cancer patients at different stages of their disease and treatment: the EORTC QLQ-INFO26. It can be used in clinical practice and research, including clinical trials. The questionnaire was developed following EORTC Quality of Life Group guidelines. The paper presents the data on 133 patients from eight countries. The resulting EORTC QLQ-INFO26 questionnaire includes four sub-scales on information regarding their cancer, medical tests, treatment and other services and several single items.

Web‐based Resources for Health Care Providers and Women Following Pregnancy Loss

Experiencing perinatal loss can leave women and families feeling distressed, overwhelmed, and with many questions, while health care providers often lack time and may not be prepared to provide all the answers. This paper highlights the rationale for use and benefits of the Internet with this population and outlines an effort to review and select reliable Internet resources containing valid and substantial content specific to pregnancy loss. A summary table is included for distribution to women and providers.

Psychometric assessment and application of a questionnaire measuring patient satisfaction with information on cancer treatment

OBJECTIVE

Pharmaceutical care follows a needs-based approach. Cancer patients form a group with particular needs. Information about cancer treatment plays an important role in terms of coping strategies, initiation of self-care behaviour, and quality of life. In order to develop pharmaceutical care strategies for cancer patients, it is important to assess patients' information needs. This survey aims at providing a suitable instrument to measure patient satisfaction with information on cancer treatment and to reveal the present situation in Germany.

METHODS

Since there was no suitable German measure available, the Canadian 'Patient Satisfaction with Cancer Treatment Education (PS-CaTE) questionnaire' was translated into German and its test quality criteria were examined. Selected socio-demographic variables were added to the original version of the questionnaire to facilitate subgroup analysis. A pre-test was performed to assess the reliability of the adapted instrument. The questionnaire was distributed among patients of cooperating hospitals, oncology practices, and self-aid groups over Germany.

RESULTS

The pre-test established a good reliability of the instrument. In the main survey, overall satisfaction, on a 5-point Likert scale, showed a median score of 3.5, where 5 represented the highest degree of satisfaction. A subscale analysis revealed that satisfaction with information provided on adverse events and complementary treatment options was lower compared to the information provided on cancer treatment. A stepwise multiple-regression analysis identified three significant predictors of satisfaction: a) diagnosis of a mammary carcinoma; b) recent diagnosis; and c) treatment by a primary-care oncologist. Patients with a mammary carcinoma and patients treated by a primary-care oncologist were less satisfied, and patients with a recent diagnosis were more satisfied compared to other patients. In comparison to other information sources, pharmacists still seem to play a minor role as a source of information for patients.

CONCLUSIONS

The version of the questionnaire with a total of 14 items seems to be suitable for measuring patient satisfaction with information. Additional research is needed to further verify the validity of the instrument. The questionnaire may help pharmaceutical-care providers to develop needs-based information strategies. The assessment of patient satisfaction can contribute to the outcome evaluation of pharmaceutical care. The fact that pharmacists are not yet being recognised by most patients as a source of information should support an intensified and more active offer of care by the pharmacist.

The information needs of women who have undergone breast reconstruction. Part II: Information giving and content of information

Women diagnosed with breast cancer treated by mastectomy can choose breast reconstruction. The information needs of women undergoing this procedure have only been addressed in the research literature to a limited extent. A qualitative approach was used to explore the experiences of women who had undergone breast reconstruction with a specific focus on their views on how they considered their information needs could best be met. A purposeful sample of eight women was recruited to participate in two focus groups, each lasting 2 hours. Framework analysis was used to develop an index of key themes and sub themes which transformed the data into a structured record which facilitated systematic analysis. This paper will present the emergent key themes regarding information giving and the content of information that women perceive as important when preparing for breast reconstruction. Process, delivery and patient factors are presented in the category of information giving. Several sub themes are discussed concerning the content of information considered to be relevant. Those involved in imparting information to women about such surgery should be aware of the type of information that is considered relevant, the manner in which it should be delivered and timing factors that implicate on the process.

Multicomponent psychosocial support for newly diagnosed cancer patients: participants’ views

The diagnosis and treatment of cancer carries a heavy psychological burden, particularly in the first year after diagnosis. The purpose of this study was to investigate and report qualitatively on patients who had completed a 10-session programme consisting of education, social interaction, psychological support, exercise and complementary therapies for newly diagnosed cancer patients. A thematic analysis of data obtained from purposefully selected focus groups revealed that peer support was the most highly valued aspect of the service and that a variety of needs were being met. The relaxed atmosphere, sensitivity of staff and complementary therapies were particularly appreciated. The findings also indicated that patients would like the option of diversional activities and a period of structured group therapy in addition to the services offered and that the revision of information-giving procedures would enhance psychological support. Opportunities for staff development are identified.

Provider-sponsored virtual communities for chronic patients: improving health outcomes through organizational patient-centred knowledge management

Patients with long-term chronic disease experience numerous illness patterns and disease trends over time, resulting in different sets of knowledge needs than patients who intermittently seek medical care for acute or short-term problems. Health-care organizations can promote knowledge creation and utilization by chronic patients through the introduction of a virtual, private, disease-specific patient community. This virtual socialization alters the role of chronic disease patients from external consumers of health-care services to a 'community of practice' of internal customers so that, with the tacit support of their health-care organization, they have a forum supporting the integration of knowledge gained from the experiences of living with chronic disease in their self-management. Patient-centred health-care organizations can employ the virtual community to direct and support the empowerment of chronic patients in their care.