Information sessions for outpatients referred to a hospital Nutrition and Dietetic Service for cholesterol lowering advice

Japanese women's reasons for accompaniment status to hereditary breast and ovarian cancer-focused genetic counseling

Genetic counselors routinely assess and understand clients' needs at the beginning of a session. Attending a genetic counseling session with or without companions is an objective sign that genetic counselors can easily notice. This study focused on clients' reasons for their accompaniment status for genetic counseling, which we categorize into attending with or without a companion(s). A questionnaire survey and interviews were conducted using snowball sampling, starting with the chief executive officer (CEO) of the Japanese hereditary breast and ovarian cancer (HBOC) support group. Of 32 participants, 19 continued with an in-depth interview after answering the questionnaire. Five themes were identified from the interview: (1) personal confidence, (2) decision-making style, (3) family members' habits and time availability, (4) considerations and conflicts with family members, and (5) healthcare provider's suggestion. Our data suggested that the clients expected their companion(s) to play certain roles. This indicates that the reasons of accompaniment status will be helpful for genetic counselors to understand both clients' and their families' motivations, personalities, habits, and psychosocial backgrounds. In a high-context culture such as that of Japan, accompaniment status may be a helpful sign to understand clients' true worries. In addition, some companions may be future clients in genetic counseling, due to the genetic nature of the disease. In conclusion, our study indicated that it is important for genetic counselors to record accompaniment status before the initial genetic counseling and to pay attention to its reasons at the beginning of the session, which may lead them to understand the client's psychosocial background to facilitate better client-centered genetic counseling.

Direct Interactive Public Education by Breast Radiologists About Screening Mammography: Impact on Anxiety and Empowerment

PURPOSE

Anxiety has been called a "harm" of screening mammography. The authors provided direct, interactive education to lay audiences and measured these sessions' impact on anxiety and any increased understanding of breast cancer screening.

METHODS

Academic breast radiologist provided seven 1-hour sessions of structured lectures and question-and-answer periods. Lay language and radiologic images were used to discuss disease background, screening guidelines, and areas of debate. One hundred seventeen participants (mean age, 45 ± 15 years) completed voluntary, anonymous, institutional review board-approved pre and postsession questionnaires relaying their attitudes regarding screening and the impact of the sessions. Results are summarized descriptively.

RESULTS

Mean reported anxiety regarding screening (on a scale ranging from 1-5; 1 = no anxiety) was 2.5 ± 1.3. Anxiety was attributed to unknown results (56.4%), anticipation of pain (21.8%), known risk factors (14.5%), general uncertainty (12.7%), waiting for results (9.1%), possibility of more procedures (3.6%), and personal breast cancer history (3.6%). Ninety-seven percent reported that immediate results would lower anxiety (78% of those women indicated a 75%-100% decrease in anxiety); 93% reported that radiologist consultation with images would lower anxiety (75.6% indicated a 75%-100% decrease in anxiety). After the lecture, women reported (on a scale ranging from 1-5) increased understanding of the topic (4.7 ± 0.6), encouragement to screen (4.6 ± 0.7), and reduced anxiety (4.0 ± 1.1). Ninety-seven percent to 100% provided correct responses to these questions: rationale for screening in the absence of family history, recall does not equate to cancer diagnosis, benefit of prior films, and continued importance of physical examination.

CONCLUSION

Attendees of radiologist-provided direct public lectures reported decreased anxiety and improved knowledge regarding screening mammography. The resultant reduced anxiety ("harm") and educational empowerment help enable informed decision making and may promote screening attendance.

The Radiologist as Direct Public Educator: Impact of Sessions Demystifying Select Cancer Screening Imaging Examinations

PURPOSE

The aim of this report is to describe our early experience with radiologist-led direct public education about imaging-based cancer screening examinations, with a focus on the level of satisfaction and the educational impact reported by session participants.

METHODS

Subspecialty radiologists provided 1-hour educational sessions to small lay public audiences covering breast, prostate, and lung cancer screening, focusing on key radiologic screening tests. Subsequently, session participants completed a survey pertaining to their levels of satisfaction and the perceived impact of the sessions on knowledge of the diseases and relevant screening tests; results from all topic sessions were pooled for analysis.

RESULTS

One hundred nineteen participants attended a total of 144 sessions. The large majority of respondents agreed or strongly agreed that the sessions increased their understanding (95.4%), they gained information not obtained from clinic visit (88.1%), seeing radiology images helped their understanding (92.6%), they felt more involved in their own care (85.8%), they felt more prepared to undergo screening tests (87.4%), they were satisfied with the sessions' format (93.3%) and content (96.2%), their main questions were answered (88.3%), they would be interested in similar future radiologist-led sessions (88.5%), and they would recommend the sessions to friends (93.9%). The provided information (43.1%) and images (34.7%) were identified as the most helpful aspects of the sessions.

CONCLUSION

Radiologist-led direct public education sessions about imaging-based cancer screening examinations yield high levels of audience satisfaction and add value to the public's understanding of the role of radiology and radiologists. Our experience may provide an encouraging model for other radiology practices in pursuing similar endeavors.

Effect of an educational program (PEGASE) on cardiovascular risk in hypercholesterolaemic patients

BACKGROUND

Many studies have demonstrated a gap between guidelines for the prevention of cardiovascular disease (CVD) and their implementation in clinical practice.

AIM

The PEGASE education program has been devised with an aim to improve the management of patients at high risk of CVD.

METHODS

In a multicentre study carried out from 2001-2004 in France, 96 participating physicians were randomized into a "trained" group, which included 398 "educated" patients, and a "non-trained" group, which included 242 "non-educated" patients. Educated patients received six hospital-based educational sessions, four collective and two individual. Framingham score, smoking, lipid levels, glycaemia, blood pressure, dietary intake and drug compliance, as well as quality of life, were evaluated at baseline (M0) and 6 months (M6). The primary endpoint of the study was the efficacy of the PEGASE program in reducing global CVD risk in high-risk patients.

RESULTS

The Framingham score was calculated for 473 patients. The Framingham score improved significantly at M6 vs M0 in the educated group (13.0 +/- 8.21 vs 13.6 +/- 8.48, d = -0.658, p = 0.016), but not in the non-educated group (12.5 +/- 8.19 vs 12.4 +/- 7.81, d = +0.064, p = 0.836); the mean change between the two groups did not reach significance. Quality of life, LDL-c level and diet scores improved in the "educated" group only.

CONCLUSIONS

The PEGASE education program improved risk factors for CVD, although global assessment by Framingham score was not significantly different between groups. This program, aimed at meeting needs and expectations of patients and physicians, was easily implemented in all hospital centres.

Measuring patient assessments of the quality of outpatient care: a systematic review

RATIONALE, AIMS AND OBJECTIVES

The aim of the study was to answer three questions: first, what methods have been used to measure patient assessments of the quality of care? Second, how do outpatients rate their care? And third, what needs to be taken into account in measuring patient assessments of the quality of care?

METHODS

Systematic review of the literature. Electronic searches were conducted on Medline, CINAHL and the Cochrane Database of Systematic Reviews. To be included, articles were to deal with patients' assessments of health care in ambulatory units for somatic adult patients. They were to have been published between January 2000 and May 2005, written in English, Swedish or Finnish with an English abstract, and the research was to have been conducted in Europe. The search terms used were: ambulatory care, ambulatory care facilities, outpatient, outpatients, patient satisfaction and quality of health care. The articles were screened by two independent reviewers in three phases.

RESULTS

Thirty-five articles were included. The quality of care was measured using both quantitative and qualitative methods. Only a few studies relied on the single criterion of patient satisfaction for quality measurements. It is easy to identify common sources of dissatisfaction in different studies. Sources of satisfaction are more closely dependent on the target population, the context and research design.

CONCLUSION

Patient satisfaction is widely used as one indicator among others in assessing the quality of outpatient care. However, there is no single, universally accepted method for measuring this.