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von der Warth R, Körner M, Farin-Glattacker E. Trans-Inclusive Communication and Self-Perceived Barriers to It, as Reported by Doctors-A Mixed-Methods Survey in Germany. Healthcare (Basel) 2024; 12:707. [PMID: 38610132 PMCID: PMC11012201 DOI: 10.3390/healthcare12070707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The majority of transgender and gender-nonconforming people (TGNC) report negative experiences with doctors in the healthcare system. As there is little knowledge about the communication behaviour of doctors towards TGNC, this survey aimed to assess the self-reported trans-inclusive communication of doctors and their willingness to communicate trans-inclusively, as well as their self-perceived barriers to it. A mixed-methods survey was applied for this. Firstly, we measured self-reported trans-inclusive communication behaviour based on the CommTrans questionnaire. Based on this, the overall willingness, as well as self-perceived barriers (qualitative) to communication, were assessed. In total, N = 57 doctors took part in the survey. Most participants reported not introducing themselves using pronouns (79.4%). Of these, 61.4% said that they would not be able to do this in the future either. Perceived barriers were classified into the following eight categories: necessity, sample-dependency, habit, structural barriers in practice, uncertainties in dealing with the topic, limits of patient-centredness, gender as a binary concept, and transphobia. In summary, doctors in Germany show different degrees of trans-inclusive communication. It is likely that this has a negative effect on TGNC, their health and access to the healthcare system.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, 79104 Freiburg, Germany;
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
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Vestala H, Bendtsen M, Midlöv P, Kjellgren K, Eldh AC. Effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients living with hypertension - a randomized controlled trial in primary care. Scand J Prim Health Care 2024; 42:225-233. [PMID: 38214748 PMCID: PMC10851821 DOI: 10.1080/02813432.2023.2301567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE To estimate the effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only). DESIGN A parallel group, non-blinded, randomized controlled trial, conducted October 2018-February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support via mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement. SETTING 31 primary healthcare centers in Sweden. SUBJECTS 949 patients treated for hypertension. MAIN OUTCOME MEASURES The effects on preference-based patient participation, that is, the match between a patient's preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression. RESULTS At baseline, 43-51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for 'managing treatment myself' at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months. CONCLUSION The interactive web-based support system via mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care.
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Affiliation(s)
- Hanna Vestala
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Patrik Midlöv
- Center for Primary Healthcare Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Karin Kjellgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- University of Gothenburg Centre for Person-Centered Care, University of Gothenburg, Gothenburg
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
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3
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von der Warth R, Horstmeier LM, Körner M, Farin-Glattacker E. Health Communication Preferences of Transgender and Gender-Diverse Individuals - Development and First Psychometric Evaluation of the CommTrans Questionnaire. JOURNAL OF HOMOSEXUALITY 2024:1-16. [PMID: 38421283 DOI: 10.1080/00918369.2024.2320246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Patient-doctor communication is an important component of patient-centered care and should be adapted to the target group. Adapting communication to transgender and gender-diverse individuals is particularly difficult, as little is known about the preferences of this group. Thus, the aim of the study was to develop a questionnaire to assess the communication preferences of the target group. Based on a qualitative study, an item pool was created, which was tested in a survey in September 2022. An item analysis was conducted and items with unacceptable characteristics were removed. The remaining item pool was examined with an explorative factor analysis. The sample consisted of N = 264 individuals. Of the initial k = 43 items, k = 9 items remained in the final factor analysis. The final two factor solution explained 60.7% of the variance. The factors describe the emotional resonance in communication (Cronbach's α = .74; e.g. "My medical doctors should be happy for me when my treatment progresses positively.") as well as gender-related communication (Cronbach's α = .85; e.g. "My medical doctors should introduce themselves with pronouns."). Overall, the questionnaire captures the communication preferences of transgender and gender-diverse individuals in medical conversations. It covers two important topics for the target group, but further validation is necessary.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
| | - Lukas M Horstmeier
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Freiburg, Germany
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van Til JA, Pearce A, Ozdemir S, Hollin IL, Peay HL, Wu AW, Ostermann J, Deal K, Craig BM. Role Preferences in Medical Decision Making: Relevance and Implications for Health Preference Research. THE PATIENT 2024; 17:3-12. [PMID: 37874464 PMCID: PMC10769916 DOI: 10.1007/s40271-023-00649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
Health preference research (HPR) is being increasingly conducted to better understand patient preferences for medical decisions. However, patients vary in their desire to play an active role in medical decisions. Until now, few studies have considered patients' preferred roles in decision making. In this opinion paper, we advocate for HPR researchers to assess and account for role preferences in their studies, to increase the relevance of their work for medical and shared decision making. We provide recommendations on how role preferences can be elicited and integrated with health preferences: (1) in formative research prior to a health preference study that aims to inform medical decisions or decision makers, (2a) in the development of health preference instruments, for instance by incorporating a role preference instrument and (2b) by clarifying the respondent's role in the decision prior to the preference elicitation task or by including role preferences as an attribute in the task itself, and (3) in statistical analysis by including random parameters or latent classes to raise awareness of heterogeneity in role preferences and how it relates to health preferences. Finally, we suggest redefining the decision process as a model that integrates the role and health preferences of the different parties that are involved. We believe that the field of HPR would benefit from learning more about the extent to which role preferences relate to health preferences, within the context of medical and shared decision making.
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Affiliation(s)
- Janine A van Til
- Department of Health Technology and Services Research, Technical Medical Center, Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, Technohal, Room 3304, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Alison Pearce
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Semra Ozdemir
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Ilene L Hollin
- Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Holly L Peay
- Genomics and Translational Research Center, RTI International, Research Triangle Park, NC, USA
| | - Albert W Wu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jan Ostermann
- Department of Health Services, Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ken Deal
- DeGroote School of Business, McMaster University, Hamilton, ON, Canada
| | - Benjamin M Craig
- Department of Economics, University of South Florida, Tampa, FL, USA
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Hurtig C, Bendtsen M, Årestedt L, Uhlin F, Eldh AC. Patient participation in end-stage kidney disease care: variation over time and effects of staff-directed interventions - a quasi-experimental study. BMC Nephrol 2023; 24:265. [PMID: 37691126 PMCID: PMC10494352 DOI: 10.1186/s12882-023-03313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Among those elements establishing decent quality of care from a patient perspective, opportunities to participate in accord with one's individual needs and preferences are central. To date, little is known the extent of preference-based patient participation in kidney care, and what facilitates optimal conditions. This study investigated i) preference-based patient participation in kidney care over time, and ii) the effects of interventions designed to enhance person-centred patient participation. METHODS A quasi-experimental study was conducted across nine kidney care sites in southeast Sweden. A cohort of 358 patients with stage IV chronic kidney disease (eGRF 15-19 ml/min) or V (eGRF < 15 mL/min) entered the study. Of these, 245 patients (with kidney replacement therapy or intermittent outpatient visits only) completed a survey on patient participation at four time points: every six months from August 2019 to May 2021, patients reported their preferences for and experiences of participation using the validated Patient Preferences for Patient Participation tool, the 4Ps. Between the first and second data collection points, interventions were provided for designated staff to facilitate person-centred participation, using two strategies for two subgroups at three sites each: the managers receiving a bundle of information via e-mail on patient participation in a standard dissemination procedure (three sites), or an additional half-year support program for implementation offered to 1-2 staff per site (three sites), with no intervention for a control group (three sites). The differences in 4Ps data between groups were analysed using multilevel ordinal regression. RESULTS Over time and across all sites, most patients' experiences of participation fully or almost fully matched their engagement preferences (57%-90%). Still, up to 12% of patient reports indicated that their preferences and experiences were insufficiently matched: in these cases, the patients had preferred to be more involved than they had experienced, for example, in making healthcare plans and setting health-related goals. The interventions did not affect the levels of preference-based participation, but patients in the control group sites had slightly more consistent matches. CONCLUSIONS Living with kidney failure necessitates patient engagement, but opportunities to participate in accordance with one's preferences are not fully provided for all patients. Additional efforts to support a common understanding and to ensure person-centred patient participation is still needed.
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Affiliation(s)
- Caroline Hurtig
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Liselott Årestedt
- Department of Health and Caring Sciences, Linnaeus University, 391 82, Kalmar, Sweden
| | - Fredrik Uhlin
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Nephrology, Region Östergötland, 581 85, Linköping, Sweden
- Department of Health Technologies, Tallinn University of Technology (TalTech), 19086, Tallinn, Estonia
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, 751 22, Uppsala, Sweden
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Büdenbender B, Köther AK, Kriegmair MC, Grüne B, Michel MS, Alpers GW. Getting specific: participation preference in urooncological decision-making. BMC Med Inform Decis Mak 2023; 23:114. [PMID: 37407999 DOI: 10.1186/s12911-023-02201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/23/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Shared decision-making is the gold standard for good clinical practice, and thus, psychometric instruments have been established to assess patients' generic preference for participation (e.g., the Autonomy Preference Index, API). However, patients' preferences may vary depending on the specific disease and with respect to the specific decision context. With a modified preference index (API-Uro), we assessed patients' specific participation preference in preference-sensitive decisions pertaining to urological cancer treatments and compared this with their generic participation preference. METHODS In Study 1, we recruited (N = 469) urological outpatients (43.1% urooncological) at a large university hospital. Participation preference was assessed with generic measures (API and API case vignettes) and with the disease-specific API-Uro (urooncological case vignettes describing medical decisions of variable difficulty). A polychoric exploratory factor analysis was used to establish factorial validity and reduce items. In Study 2, we collected data from N = 204 bladder cancer patients in a multicenter study to validate the factorial structure with confirmatory factor analysis. Differences between the participation preference for different decision contexts were analyzed. RESULTS Study 1: Scores on the specific urooncological case vignettes (API-Uro) correlated with the generic measure (r = .44) but also provided incremental information. Among the disease-specific vignettes of the API-Uro, there were two factors with good internal consistency (α ≥ .8): treatment versus diagnostic decisions. Patients desired more participation for treatment decisions (77.8%) than for diagnostic decisions (22%), χ2(1) = 245.1, p ≤ .001. Study 2: Replicated the correlation of the API-Uro with the API (r = .39) and its factorial structure (SRMR = .08; CFI = .974). Bladder cancer patients also desired more participation for treatment decisions (57.4%) than for diagnostic decisions (13.3%), χ²(1) =84, p ≤ .001. CONCLUSIONS The desire to participate varies between treatment versus diagnostic decisions among urological patients. This underscores the importance of assessing participation preference for specific contexts. Overall, the new API-Uro has good psychometric properties and is well suited to assess patients' preferences. In routine care, measures of participation preference for specific decision contexts may provide incremental, allowing clinicians to better address their patients' individual needs.
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Affiliation(s)
- Björn Büdenbender
- Department of Psychology, School of Social Sciences, University of Mannheim, L 15-17, 68131, Mannheim, Germany
| | - Anja K Köther
- Department of Psychology, School of Social Sciences, University of Mannheim, L 15-17, 68131, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Britta Grüne
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice S Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, L 15-17, 68131, Mannheim, Germany.
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Jerofke-Owen TA, Tobiano G, Eldh AC. Patient engagement, involvement, or participation - entrapping concepts in nurse-patient interactions: A critical discussion. Nurs Inq 2023; 30:e12513. [PMID: 35871476 DOI: 10.1111/nin.12513] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 01/25/2023]
Abstract
The importance of patients taking an active role in their healthcare is recognized internationally, to improve safety and effectiveness in practice. There is still, however, some ambiguity about the conceptualization of that patient role; it is referred to interchangeably in the literature as engagement, involvement, and participation. The aim of this discussion paper is to examine and conceptualize the concepts of patient engagement, involvement, and participation within healthcare, particularly nursing. The concepts were found to have semantic differences and similarities, although, from a nursing perspective, they can be summoned to illustrate the establishment of a mutual partnership between a patient and a nurse. The individualization of such processes requires the joint effort of engagement, involvement, or participation, represented by interactive actions of both the patient (asking questions, telling/speaking up, knowledge acquisition, learning, and decision-making) and the nurse (recognizing, responding, information sharing, teaching, and collaborating). Suggesting that the concepts can be used interchangeably comes with some caution, requiring that nurses embrace patients playing a role in their health and healthcare. Further research and practice development should focus on how patients and nurses receive and respond to each other to establish patient engagement, involvement, and participation.
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Affiliation(s)
| | - Georgia Tobiano
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia.,Gold Coast Health, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Ann C Eldh
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Drott J, Fomichov V, Nordén M, Larsson AL, Sandström P, Björnsson B, Eldh AC. Patient preferences and experiences of participation in surgical cancer care. Worldviews Evid Based Nurs 2022; 19:405-414. [PMID: 35607906 PMCID: PMC10946456 DOI: 10.1111/wvn.12589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/11/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Quality cancer care necessitates opportunities for patient participation, supposedly recognizing the individual's preferences and experiences for being involved in their health and healthcare issues. Previous research shows that surgical cancer patients wish to be more involved, requiring professionals to be sensitive of patients' needs. AIMS To explore preference-based patient participation in surgical cancer care. METHODS A cross-sectional study was conducted. The Patient Preferences for Patient Participation tool (4Ps) was used, which includes 12 attributes of preferences for and experiences of patient participation. Data were analyzed with descriptive and comparative statistical methods. RESULTS The results are based on a total of 101 questionnaires. Having reciprocal communication and being listened to by healthcare staff were commonly deemed crucial for patient participation. While 60% of the patients suggested that taking part in planning was crucial for their participation, they had experienced this only to some extent. Learning to manage symptoms and phrasing personal goals were items most often representing insufficient conditions for preference-based patient participation. LINKING EVIDENCE TO ACTION To support person-centered surgical care, further efforts to suffice preference-based participation are needed, including opportunities for patients to share their experiences and engage in the planning of healthcare activities.
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Affiliation(s)
- Jenny Drott
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- Department of Surgery in Linköping, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Victoria Fomichov
- Unit for Public Health and Statistics, County Council of ÖstergötlandLinköping UniversityLinköpingSweden
| | - Maria Nordén
- Department of Urology in Linköping, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Anna Lindhoff Larsson
- Department of Surgery in Linköping, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Per Sandström
- Department of Surgery in Linköping, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Bergthor Björnsson
- Department of Surgery in Linköping, Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
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Jerofke-Owen TA, McAndrew NS, Gralton KS, Totka JP, Weiss ME, Fial AV, Sawin KJ. Engagement of Families in the Care of Hospitalized Pediatric Patients: A Scoping Review. JOURNAL OF FAMILY NURSING 2022; 28:151-171. [PMID: 34605283 DOI: 10.1177/10748407211048894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This scoping review was conducted to examine the range, nature, and extent of the published family engagement literature specific to the pediatric acute care setting to highlight future research and practice development opportunities. Included studies (N = 247) revealed global relevance. Engagement strategies ranged from more passive such as allowing/encouraging families to be present at the bedside to more active strategies aimed at promoting mutual and reciprocal nurse-patient interactions. Family engagement is distinguished by a mutually beneficial partnership of families with health care team members and care organizations. Future research in the area of family engagement in pediatric nursing should focus on determining the core engaging health professional behaviors and engaged parent outcomes; extending the knowledge base related to mutually beneficial partnerships between families and health care teams; developing effectiveness studies to determine the optimal engaging actions by teams to achieve parent engagement; and measuring the influence of engagement on parent and infant/child outcomes.
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Affiliation(s)
| | - Natalie S McAndrew
- University of Wisconsin-Milwaukee, USA
- Froedtert Hospital & the Medical College of Wisconsin, Milwaukee, USA
| | | | - Joan P Totka
- Marquette University, Milwaukee, WI, USA
- Children's Wisconsin, Milwaukee, USA
| | | | | | - Kathleen J Sawin
- University of Wisconsin-Milwaukee, USA
- Children's Wisconsin, Milwaukee, USA
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Clavel N, Paquette J, Dumez V, Del Grande C, Ghadiri DP(S, Pomey M, Normandin L. Patient engagement in care: A scoping review of recently validated tools assessing patients' and healthcare professionals' preferences and experience. Health Expect 2021; 24:1924-1935. [PMID: 34399008 PMCID: PMC8628592 DOI: 10.1111/hex.13344] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/04/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patient engagement in care is a priority and a key component of clinical practice. Different approaches to care have been introduced to foster patient engagement. There is a lack of a recent review on tools for assessing the main concepts and dimensions related to patient engagement in care. OBJECTIVE Our scoping review sought to map and summarize recently validated tools for assessing various concepts and dimensions of patient engagement in care. SEARCH STRATEGY A scoping review of recent peer-reviewed articles describing tools that assess preferences in and experience with patient engagement in care was conducted in four databases (Ovid Medline, Ovid EMBASE, Cochrane Database of Systematic Reviews, CINAHL-EBSCO). We adopted a broad definition based on the main concepts of patient engagement in care: patient-centredness, empowerment, shared decision-making and partnership in care. MAIN RESULTS Of 2161 articles found, 16, each describing a different tool, were included and analysed. Shared decision-making and patient-centredness are the two main concepts evaluated, often simultaneously in most of the tools. Only four scales measure patient-centredness, empowerment and shared decision-making at the same time, but no tool measures the core dimensions of partnership in care. Most of the tools did not include patients in their development or validation or just consulted them during the validation phase. DISCUSSION AND CONCLUSION There is no tool coconstructed with patients from development to validation, which can be used to assess the main concepts and dimensions of patient engagement in care at the same time. PATIENT AND PUBLIC CONTRIBUTION This manuscript was prepared with a patient expert who is one of the authors. Vincent Dumez, who is a patient expert and codirector of the Center of Excellence on Partnership with Patients and the Public, has contributed to the preparation of the manuscript.
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Affiliation(s)
- Nathalie Clavel
- Ingram School of NursingMcGill UniversityMontrealQuebecCanada
| | - Jesseca Paquette
- Health Innovation and Evaluation HubUniversity of Montreal Hospital CenterMontrealQuebecCanada
| | - Vincent Dumez
- Center of Excellence on Partnership with Patients and the PublicUniversity of MontrealMontrealQuebecCanada
| | - Claudio Del Grande
- Health Innovation and Evaluation HubUniversity of Montreal Hospital CenterMontrealQuebecCanada
- Department of Health Management, Evaluation and Policy, School of Public HealthUniversity of MontrealMontrealQuebecCanada
| | | | - Marie‐Pascale Pomey
- Health Innovation and Evaluation HubUniversity of Montreal Hospital CenterMontrealQuebecCanada
- Center of Excellence on Partnership with Patients and the PublicUniversity of MontrealMontrealQuebecCanada
- Department of Health Management, Evaluation and Policy, School of Public HealthUniversity of MontrealMontrealQuebecCanada
| | - Louise Normandin
- Health Innovation and Evaluation HubUniversity of Montreal Hospital CenterMontrealQuebecCanada
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Winners and Losers in Palliative Care Service Delivery: Time for a Public Health Approach to Palliative and End of Life Care. Healthcare (Basel) 2021; 9:healthcare9121615. [PMID: 34946341 PMCID: PMC8702146 DOI: 10.3390/healthcare9121615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/09/2021] [Accepted: 11/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Consumer experience of palliative care has been inconsistently and selectively investigated. Methods: People in Western Australia who had experienced a life limiting illness in the past five years were recruited via social media and care organisations (2020) and invited to complete a cross sectional consumer survey on their experiences of the care they received. Results: 353 bereaved carers, current carers and patients responded. The winners, those who received the best quality end-of-life care, were those who were aware of palliative care as an end-of-life care (EOLC) option, qualified for admission to and were able to access a specialist palliative care program, and with mainly a cancer diagnosis. The losers, those who received end-of-life care that was adequate rather than best practice, were those who were unaware of palliative care as an EOLC option or did not qualify for or were unable to access specialist palliative care and had mainly a non-cancer diagnosis. Both groups were well supported throughout their illness by family and a wider social network. However, their family carers were not adequately supported by health services during caregiving and bereavement. Conclusions: A public health approach to palliative and end of life care is proposed to integrate tertiary, primary, and community services through active consumer engagement in the design and delivery of care. Therefore, suggested strategies may also have relevance in many other international settings.
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