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Oueslati R, Woudstra AJ, Alkirawan R, Reis R, van Zaalen Y, Slager MT, Stiggelbout AM, Touwen DP. What value structure underlies shared decision making? A qualitative synthesis of models of shared decision making. PATIENT EDUCATION AND COUNSELING 2024; 124:108284. [PMID: 38583353 DOI: 10.1016/j.pec.2024.108284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/06/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To construct the underlying value structure of shared decision making (SDM) models. METHOD We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz's value theory to define values in SDM and to investigate value relations. RESULTS We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals' (HCPs) and patients' skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients' autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. CONCLUSION SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients' Self-Direction. PRACTICE IMPLICATIONS This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients' values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
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Affiliation(s)
- Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Nursing and Research Group Oncological Care, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands.
| | - Anke J Woudstra
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Rima Alkirawan
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands; Children's Institute, University of Cape Town, Cape Town, South Africa
| | - Yvonne van Zaalen
- Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - Meralda T Slager
- Centre of Expertise Perspective in Health, Avans University of Applied Sciences, Breda, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Dorothea P Touwen
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
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2
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van der Veen R, van der Burgt S, Königs M, Oosterlaan J, Peerdeman S. Team functioning in Neurorehabilitation: a mixed methods study. J Interprof Care 2024; 38:621-631. [PMID: 38470835 DOI: 10.1080/13561820.2024.2325694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
The objective of this study was to enhance understanding of team functioning in a neurorehabilitation team by identifying the factors that impede and facilitate effective interprofessional team collaboration. We focused on team identification, psychological safety, and team learning, and conducted the research at a neurorehabilitation center treating young patients with severe acquired brain injury in the Netherlands. A mixed-methods approach was employed, integrating quantitative data from questionnaires (N = 40) with qualitative insights from a focus group (n = 6) and in-depth interviews (n = 5) to provide a comprehensive perspective on team dynamics. Findings revealed strong team identification among participants, denoting a shared sense of belonging and commitment. However, limited psychological safety was observed, which negatively affected constructive conflict and team learning. Qualitative analysis further identified deficiencies in shared mental models, especially in shared decision-making and integrated care. These results highlight the crucial role of psychological safety in team learning and the development of shared mental models in neurorehabilitation settings. Although specific to neurorehabilitation, the insights gained may be applicable to enhancing team collaboration in various healthcare environments. The study forms a basis for future research to investigate the impact of improvements in team functioning on patient outcomes in similar settings.
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Affiliation(s)
- Ruud van der Veen
- Department of Pediatrics, Emma Children's Hospital, Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Stéphanie van der Burgt
- Teaching and Learning Center (TLC), Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Quality of Care Group, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Marsh Königs
- Department of Pediatrics, Emma Children's Hospital, Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Children's Hospital, Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Saskia Peerdeman
- Teaching and Learning Center (TLC), Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Quality of Care Group, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Neurosurgery, De Boelelaan, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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3
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Noordam D, Noordman J, van den Braak G, Visee H, Bakker A, Batenburg R, Olde Hartman TC, van Dulmen S. Shared decision-making in undergraduate nursing and medical education: An explorative dual-method study. PATIENT EDUCATION AND COUNSELING 2024; 123:108246. [PMID: 38480111 DOI: 10.1016/j.pec.2024.108246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE This study explores how shared decision-making (SDM) is integrated in undergraduate nursing and medical education. METHODS A dual-method design was applied. The integration of SDM in medicine and nursing education programs (i.e. SDM on paper) was explored through document analyses; the integration of SDM in curricula (i.e. SDM in class) through interviews with teachers and curriculum coordinators (N = 19). RESULTS A majority of the education programs featured SDM, mostly non-explicit. In curricula SDM was generally implicitly featured in compulsory courses across all study years. SDM was often integrated into preexisting theories and models and taught through various methods and materials. Generally, teachers and supervisors were not trained in SDM themselves. They assessed students' competence in SDM in a summative manner. CONCLUSION Overall, SDM was featured in undergraduate nursing and medical education, however, very implicitly.
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Affiliation(s)
- Désanne Noordam
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands.
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | | | - Hetty Visee
- Regioplan Beleidsonderzoek, Amsterdam, Netherlands
| | - Alice Bakker
- V&VN (Verpleegkundigen & Verzorgenden Nederland), Utrecht, Netherlands
| | - Ronald Batenburg
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | - Tim C Olde Hartman
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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4
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Salmi L, Hubbard J, McFarland DC. When Bad News Comes Through the Portal: Strengthening Trust and Guiding Patients When They Receive Bad Results Before Their Clinicians. Am Soc Clin Oncol Educ Book 2024; 44:e433944. [PMID: 38848509 DOI: 10.1200/edbk_433944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Communication in oncology was challenging long before the emergence of the US 21st Century Cures Act. Before 2021, a growing body of evidence had demonstrated the benefits of patients' access to and review of the clinical notes in their charts (open notes); however, studies examining the benefits of immediate access to test results were scarce until the implementation of the Cures Act's Information Blocking Rule. Individuals grappling with cancer today now possess immediate access to their laboratory results, imaging scans, diagnostic tests, and progress notes as mandated by law. To many clinicians, the implementation of the Cures Act felt sudden and presented new challenges and concerns for oncologists surrounding patients' potential emotional reactions to medical notes or lack of control over the careful delivery of potentially life-changing information. Despite data that show most patients want immediate access to information in their records before it is communicated directly by a health care professional, surveys of oncologists showed trepidation. In this chapter, perspectives from a patient with cancer, an oncologist, and a cancer psychiatrist (in that order) are shared to illuminate the adjustments made in clinician-patient communication amid the era of nearly instantaneous results within the electronic health record.
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Affiliation(s)
- Liz Salmi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Daniel C McFarland
- Department of Psychiatry/Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
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5
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Hampton J, Alam A, Zdenkowski N, Rowe C, Fradgley E, O'Neill CJ. Fear of Cancer Recurrence in Differentiated Thyroid Cancer Survivors: A Systematic Review. Thyroid 2024; 34:541-558. [PMID: 38368547 DOI: 10.1089/thy.2023.0642] [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] [Indexed: 02/19/2024]
Abstract
Background: Despite excellent survival rates, health-related quality of life detriments are common in differentiated thyroid cancer survivors and can be driven by fear of cancer recurrence (FCR). This review aims to report the incidence of FCR in thyroid cancer survivors and synthesize evidence regarding contributing factors. An overview and appraisal of the range of tools used to measure FCR is presented. Methods: A systematic review of the English literature was performed. The search across six electronic databases generated 3414 studies. Two reviewers independently screened the citations and full-text articles, of which 31 were included. The data were extracted independently by two reviewers. Results: The incidence of FCR was reported in 27/31 studies and ranged from 15% to 91%. Direct comparisons regarding incidence and severity of FCR were not possible due to heterogeneity in cut-points used to define FCR. A total of eight validated tools were used to measure FCR across all studies, with five studies using self-developed nonvalidated items. There was minimal repetition of validated tools and no clear consensus as to a preferred survey tool. Factors influencing FCR were reported in 11 studies. There was minimal overlap of factors influencing FCR. Risk factors contributing to increased FCR reported in more than one study included young age and an upcoming clinical appointment. Male gender and higher education levels were reported in more than one article as protective. No literature evaluating interventions to address FCR in thyroid cancer survivors was found. Conclusion: FCR is common in thyroid cancer survivors, but significant heterogeneity in the current evidence base limits assessment of incidence, severity, or risk factors. There is a need to use validated tools to assess FCR in both research and clinical contexts. Reliable assessment of FCR may permit routine assessment of FCR in clinical practice and allow interventions to be prospectively evaluated to optimize the holistic well-being of thyroid cancer survivors.
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Affiliation(s)
- Jacob Hampton
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Ahmad Alam
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Nicholas Zdenkowski
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Christopher Rowe
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Department of Endocrinology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Elizabeth Fradgley
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christine J O'Neill
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Doctor JN, Meeker D, Fox CR, Persell SD, Wagner Z, Bouskill KE, Zanocco KA, Romanelli RJ, Brummett CM, Kirkegaard A, Watkins KE. A call for community-shared decisions. BMJ Evid Based Med 2024:bmjebm-2023-112641. [PMID: 38604618 DOI: 10.1136/bmjebm-2023-112641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Jason N Doctor
- University of Southern California Sol Price School of Public Policy, Los Angeles, California, USA
| | | | - Craig R Fox
- University of California Los Angeles Anderson School of Management, Los Angeles, California, USA
| | - Stephen D Persell
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Kyle A Zanocco
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Chad M Brummett
- University of Michigan Medical School, Ann Arbor, Michigan, USA
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Pillen H, Attrill S, Fisher A, Forte S, Brebner C, Robinson S. Educating for supported decision making and shared decision making: a scoping review of educational design and outcomes for education and training interventions. Disabil Rehabil 2024:1-12. [PMID: 38591714 DOI: 10.1080/09638288.2024.2337099] [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: 02/16/2023] [Accepted: 03/24/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To characterise existing knowledge about the design and learning outcomes of education and training programs for supported or shared decision making. MATERIALS AND METHODS A scoping review was performed to identify academic and grey literature, published between January 2006 and February 2022, that reported on the design and/or learning outcomes of supported or shared decision making education or training programs. Eligible literature was mapped across domains of educational design and Kirkpatrick's hierarchy of learning effectiveness, and then qualitatively synthesised using cross-case analysis. RESULTS A total of 33 articles were identified (n = 7 for supported decision making and n = 26 for shared decision making) that provided education or training to supporters of persons with mental illness or substance use disorders (n = 14), dementia or neurocognitive disorders (n = 6), cognitive disability (n = 5), mixed populations (n = 1), and those receiving end-of-life care (n = 7). In their design, most programs sought specific changes in practice (behaviour) via experiential learning. Reported educational outcomes also focused on supporter behaviour, with limited evidence for how changes in learner attitudes, skills, or knowledge might be contributing to changes in supporter behaviour. CONCLUSIONS Future education and training would benefit from a closer engagement with theories of teaching and learning, particularly those oriented towards co-design.
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Affiliation(s)
- Heath Pillen
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Stacie Attrill
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Alinka Fisher
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sabrina Forte
- Council for Intellectual Disability, Surry Hills, Australia
| | - Chris Brebner
- Office of the Deputy Vice-Chancellor, Flinders University, Adelaide, Australia
| | - Sally Robinson
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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8
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Bui M, Nijmeijer WS, Hegeman JH, Witteveen A, Groothuis-Oudshoorn CGM. Systematic review and meta-analysis of preoperative predictors for early mortality following hip fracture surgery. Osteoporos Int 2024; 35:561-574. [PMID: 37996546 PMCID: PMC10957669 DOI: 10.1007/s00198-023-06942-0] [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: 04/13/2023] [Accepted: 10/04/2023] [Indexed: 11/25/2023]
Abstract
Hip fractures are a global health problem with a high postoperative mortality rate. Preoperative predictors for early mortality could be used to optimise and personalise healthcare strategies. This study aimed to identify predictors for early mortality following hip fracture surgery. Cohort studies examining independent preoperative predictors for mortality following hip fracture surgery were identified through a systematic search on Scopus and PubMed. Predictors for 30-day mortality were the primary outcome, and predictors for mortality within 1 year were secondary outcomes. Primary outcomes were analysed with random-effects meta-analyses. Confidence in the cumulative evidence was assessed using the GRADE criteria. Secondary outcomes were synthesised narratively. Thirty-three cohort studies involving 462,699 patients were meta-analysed. Five high-quality evidence predictors for 30-day mortality were identified: age per year (OR: 1.06, 95% CI: 1.04-1.07), ASA score ≥ 3 (OR: 2.69, 95% CI: 2.12-3.42), male gender (OR: 2.00, 95% CI: 1.85-2.18), institutional residence (OR: 1.81, 95% CI: 1.31-2.49), and metastatic cancer (OR: 2.83, 95% CI: 2.58-3.10). Additionally, six moderate-quality evidence predictors were identified: chronic renal failure, dementia, diabetes, low haemoglobin, heart failures, and a history of any malignancy. Weak evidence was found for non-metastatic cancer. This review found relevant preoperative predictors which could be used to identify patients who are at high risk of 30-day mortality following hip fracture surgery. For some predictors, the prognostic value could be increased by further subcategorising the conditions by severity.
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Affiliation(s)
- Michael Bui
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands.
| | - Wieke S Nijmeijer
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609, PP, Almelo, The Netherlands
| | - Johannes H Hegeman
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
- Department of Surgery, Ziekenhuisgroep Twente, Zilvermeeuw 1, 7609, PP, Almelo, The Netherlands
| | - Annemieke Witteveen
- Biomedical Signals and Systems Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
| | - Catharina G M Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522, NB, Enschede, The Netherlands
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9
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Ghomrawi HMK, Golladay GJ, Riddle DL. A Proposed Conceptual Framework for Patient Selection for Knee Arthroplasty. J Bone Joint Surg Am 2024:00004623-990000000-01032. [PMID: 38442197 DOI: 10.2106/jbjs.23.00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Hassan M K Ghomrawi
- Departments of Surgery, Medicine (Rheumatology), and Pediatrics, and Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia
| | - Daniel L Riddle
- Departments of Physical Therapy, Orthopaedic Surgery, and Rheumatology, Virginia Commonwealth University, Richmond, Virginia
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Ten Haaft BHEA, Furumaya A, Nooijen LE, Kazemier G, Ubbink DT, Erdmann JI. Current level of shared decision-making in hepatobiliary surgical oncology (SAPACHA). HPB (Oxford) 2024; 26:451-460. [PMID: 38161079 DOI: 10.1016/j.hpb.2023.12.009] [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: 04/21/2023] [Revised: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Shared decision-making (SDM) may improve patient autonomy and health outcomes. This study assessed the level of SDM at both ends of the spectrum of hepatobiliary surgery to identify needs and opportunities for improvement. METHODS A mixed-methods study was performed. Consultations regarding surgery for perihilar cholangiocarcinoma (pCCA) or hepatocellular adenoma (HCA) were prospectively included between September 2020 and December 2022. The level of patient involvement in treatment decision-making was assessed objectively by analysis of audio-recorded consultations using the OPTION-5 instrument. The perceived level of SDM was appreciated by patients (SDM-Q-9) and surgeons (SDM-Q-doc) through questionnaires. Higher scores indicated higher levels of SDM. Outcomes were compared between patient groups and two focus groups were held. RESULTS Ten pCCA- and nine HCA-patients were included in the quantitative part of the study. Median OPTION-5, SDM-Q-9 and SDM-Q-doc scores were 35% (IQR: 25-45%), 86% (IQR: 76-96%), and 73% (IQR: 71-78%), respectively. SDM-Q-9 scores among HCA-patients (79% [IQR: 71-82%]) were significantly lower than in pCCA-patients (96% [IQR: 93-100%], p < 0.001). In focus groups, patients reported a lack of information, support, and expressed positive attitudes towards decision support tools (DSTs). CONCLUSION Patient involvement and information provision among HPB-surgical patients show room for improvement, particularly for HCA-patients. DSTs may be helpful for this purpose.
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Affiliation(s)
- Britte H E A Ten Haaft
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Alicia Furumaya
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Lynn E Nooijen
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Geert Kazemier
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
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Geurtzen R, Wilkinson DJC. Incorporating parental values in complex paediatric and perinatal decisions. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:225-235. [PMID: 38219752 DOI: 10.1016/s2352-4642(23)00267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 01/16/2024]
Abstract
Incorporating parental values in complex medical decisions for young children is important but challenging. In this Review, we explore what it means to incorporate parental values in complex paediatric and perinatal decisions. We provide a narrative overview of the paediatric, ethics, and medical decision-making literature, focusing on value-based and ethically complex decisions for children who are too young to express their own preferences. We explain key concepts and definitions, discuss paediatric-specific features, reflect on challenges in learning and expressing values for both parents and health-care providers, and provide recommendations for clinical practice. Decisional values are informed by global and external values and could relate to the child, the parents, and the whole family. These values should inform preferences and assure value-congruent choices. Additionally, parents might hold various meta values on the process of decision making itself. Complex decisions for young children are emotionally taxing, ethically difficult, and often surrounded by uncertainty. These contextual factors make it more likely that values and preferences are initially absent or unstable and need to be constructed or stabilised. Health-care professionals and parents should work together to construct and clarify values and incorporate them into personalised decisions for the child. An open communication style, with unbiased and tailored information in a supportive environment, is helpful. Dedicated training in communication and shared decision making could help to improve the incorporation of parental values in complex decisions for young children.
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Affiliation(s)
- Rosa Geurtzen
- Amalia Children's Hospital, Radboud Institute of Healthcare Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Dominic J C Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; Oxford Newborn Care Unit, John Radcliffe Hospital, Oxford University, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore
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12
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Baghus A, Giroldi E, van Geel J, Leferink A, van de Pol MHJ, Sanders A, Dielissen PW, Bisschop I, Pieterse AH, Muris JWM, Timmerman AA, van der Weijden T. Shared decision-making performance of general practice residents: an observational study combining observer, resident, and patient perspectives. Fam Pract 2024; 41:50-59. [PMID: 38206317 PMCID: PMC10901472 DOI: 10.1093/fampra/cmad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Shared decision making (SDM) is considered fundamental to person-centred care. However, applying SDM may be a challenge for residents in general practice, since it is a complex competence that requires the integration of knowledge and skills from several competency domains. OBJECTIVE To support learning of SDM during medical residency, we aimed to gain insight in Dutch residents' observed and perceived SDM performance in general practice. METHODS We evaluated residents' SDM performance from an observer, resident, and patient perspective. Consultations of first- and third-year residents were recorded. Trained observers used the validated Observing Patient Involvement (OPTION5) scale to assess observed SDM performance of residents in 98 actual recorded consultations. Perceived SDM performance was evaluated by residents and patients completing validated SDM questionnaires, supplemented with questions about (the context of) the consultation and perceived relevance of SDM immediately after the consultation. The data were analysed using descriptive statistics (mean, SD, minimums, and maximums) and explorative bivariate analyses. RESULTS The residents' observed mean SDM performance was 19.1 (range, 0-100, SD = 10.9), mean resident self-reported SDM performance was 56.9 (range, 0-100, SD = 18.5), and mean patient-reported SDM performance was 73.3 (range, 0-100, SD = 26.8). We found a significant and positive correlation between observed SDM performance and residents' perceived relevance of SDM for the consultation (t = 4.571, P ≤ 0.001) and the duration of the consultation (r = 0.390, P ≤ 0.001). CONCLUSIONS This study showed that there is room for increasing awareness of the potential incongruence between observed and perceived SDM performance during medical residency, in order to facilitate the implementation of SDM in clinical practice.
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Affiliation(s)
- Anouk Baghus
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Professional Education, Maastricht University, Maastricht, The Netherlands
| | - Jasper van Geel
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Arthur Leferink
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Marjolein H J van de Pol
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ariëtte Sanders
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Patrick W Dielissen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Isabella Bisschop
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Angelique A Timmerman
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Ebeling AE, Maschke SK, Holthausen-Markou S, Steinkasserer L, Klapdor R, Renz D, Meier N, von Kaisenberg C, Hillemanns P, Brodowski L. The influence of MRI-based pelvimetric measurements in mother's choice of delivery in fetal breech position. Arch Gynecol Obstet 2024:10.1007/s00404-023-07348-3. [PMID: 38334820 DOI: 10.1007/s00404-023-07348-3] [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: 09/06/2023] [Accepted: 12/14/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION At term, about 3-4% of all singleton pregnancies present as breech. MRI-based pelvimetry is a valuable tool to support selection of adequate candidates for a trial-of-labor in women expecting term breech babies. Shared decision-making is playing an increasingly important role in obstetrics. Since the divergent existing knowledge of breech term delivery needs to be discussed with the pregnant woman, we examined the influence of MRI results on the shared decision-making process in women with term breech presentation. METHODS Between 08/2021 and 12/2022, anamnestic and clinical parameters were collected from singleton pregnancies expecting term breech babies resulting in birth at the Hanover Medical School. After information, written consent and inclusion, clinical parameters, the course of birth and the maternal and fetal outcome were collected retrospectively. 32 women participated in a postpartum questionnaire study on inquiry. The subsequent acquisition of information and the arguments in the decision-making process were determined. In addition, the sense of security and self-determination was asked both before and during birth. RESULTS 50% of the respondents had not decided for a mode of delivery before having MRI pelvimetry. After imaging and information, about the own pelvic dimensions and predictors for a successful vaginal birth, 80% of this subgroup decided to give birth vaginally. Over 40% of the collective descripted that they made a decision based on the result of MRI pelvimetry. None of the women felt to be insecure after having talked about the MRI results. The elective cesarean section group and the group of those who delivered vaginally were approximately equally highly satisfied with their feeling of self-determination of the birth mode. Overall, the study population had a very positive birth experience. The group of women who had delivered by elective cesarean showed a wider range in their assessment and appeared to perceive the experience more negative than the group of women who had a vaginal birth or emergency cesarean. Fetal and maternal outcomes did not differ between the groups. DISCUSSION MRT pelvimetry measurements can be used as a predictor for a successful vaginal breech delivery. The additional information obtained from the MRI measurements can be used in the shared decision-making process to decide more easily on the mode of delivery while improving women's awareness and safety. A balanced education on rare and frequently adverse events of vaginal delivery and cesarean section and patient expectations about labor processes must be taken into account.
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Affiliation(s)
- Anna Elisabeth Ebeling
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sabine Katharina Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Sophia Holthausen-Markou
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lena Steinkasserer
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Rüdiger Klapdor
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Diane Renz
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Nina Meier
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Constantin von Kaisenberg
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Peter Hillemanns
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lars Brodowski
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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van Lent LGG, van der Ham M, de Jonge MJA, Gort EH, van Mil M, Hasselaar J, van der Rijt CCD, van Gurp J, van Weert JCM. Patient values in patient-provider communication about participation in early phase clinical cancer trials: a qualitative analysis before and after implementation of an online value clarification tool intervention. BMC Med Inform Decis Mak 2024; 24:32. [PMID: 38308286 PMCID: PMC10835819 DOI: 10.1186/s12911-024-02434-1] [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: 06/06/2023] [Accepted: 01/22/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Patients with advanced cancer who no longer have standard treatment options available may decide to participate in early phase clinical trials (i.e. experimental treatments with uncertain outcomes). Shared decision-making (SDM) models help to understand considerations that influence patients' decision. Discussion of patient values is essential to SDM, but such communication is often limited in this context and may require new interventions. The OnVaCT intervention, consisting of a preparatory online value clarification tool (OnVaCT) for patients and communication training for oncologists, was previously developed to support SDM. This study aimed to qualitatively explore associations between patient values that are discussed between patients and oncologists during consultations about potential participation in early phase clinical trials before and after implementation of the OnVaCT intervention. METHODS This study is part of a prospective multicentre nonrandomized controlled clinical trial and had a between-subjects design: pre-intervention patients received usual care, while post-intervention patients additionally received the OnVaCT. Oncologists participated in the communication training between study phases. Patients' initial consultation on potential early phase clinical trial participation was recorded and transcribed verbatim. Applying a directed approach, two independent coders analysed the transcripts using an initial codebook based on previous studies. Steps of continuous evaluation and revision were repeated until data saturation was reached. RESULTS Data saturation was reached after 32 patient-oncologist consultations (i.e. 17 pre-intervention and 15 post-intervention). The analysis revealed the values: hope, perseverance, quality or quantity of life, risk tolerance, trust in the healthcare system/professionals, autonomy, social adherence, altruism, corporeality, acceptance of one's fate, and humanity. Patients in the pre-intervention phase tended to express values briefly and spontaneously. Oncologists acknowledged the importance of patients' values, but generally only gave 'contrasting' examples of why some accept and others refuse to participate in trials. In the post-intervention phase, many oncologists referred to the OnVaCT and/or asked follow-up questions, while patients used longer phrases that combined multiple values, sometimes clearly indicating their weighing. CONCLUSIONS While all values were recognized in both study phases, our results have highlighted the different communication patterns around patient values in SDM for potential early phase clinical trial participation before and after implementation of the OnVaCT intervention. This study therefore provides a first (qualitative) indication that the OnVaCT intervention may support patients and oncologists in discussing their values. TRIAL REGISTRATION Netherlands Trial Registry: NL7335, registered on July 17, 2018.
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Affiliation(s)
- Liza G G van Lent
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Mirte van der Ham
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Maja J A de Jonge
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Eelke H Gort
- Department of Medical Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - Marjolein van Mil
- Department of Medical Oncology and Clinical Pharmacology, Antoni Van Leeuwenhoek, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jeroen Hasselaar
- Department of Pain, Anaesthesiology and Palliative Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carin C D van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jelle van Gurp
- Department of IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research (ASCoR) and University of Amsterdam, Amsterdam, the Netherlands
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Pichler T, Mumm F, Dehar N, Dickman E, Díez de Los Ríos de la Serna C, Dinkel A, Heinrich K, Hennink M, Parviainen AD, Raske V, Wicki N, Moore AC. Understanding communication between patients and healthcare professionals regarding comprehensive biomarker testing in precision oncology: A scoping review. Cancer Med 2024; 13:e6913. [PMID: 38298115 PMCID: PMC10905543 DOI: 10.1002/cam4.6913] [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: 08/03/2023] [Revised: 11/15/2023] [Accepted: 12/23/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Precision oncology, using comprehensive biomarker testing (cBT) to inform individual cancer diagnosis, prognosis and treatment, includes increasingly complex technology and clinical data sets. People impacted by cancer (patients and caregivers) and healthcare professionals (HCPs) face distinct challenges in navigating the cBT and personalized treatment landscape. This review summarizes evidence regarding cBT-related communication between people impacted by cancer and HCPs and identifies important avenues for future research in precision oncology. METHODS A scoping review was conducted using records published in PubMed during January 2017-August 2022, focusing on the breadth of topics on patient-HCP communication and knowledge resources used by HCPs as guidance in cBT-related communication. Data were extracted from records meeting inclusion criteria, and findings were summarized according to main topics. RESULTS The search identified 287 unique records and data were extracted from 42 records, including nine from expert input. Most records originated from the United States included patients with different types of cancer, and oncologists were the main HCPs. Patients' motivation for undergoing cBT and receiving results was generally high in different settings. However, patients' understanding of cBT-related concepts was limited, and their knowledge and information preferences changed based on cBT implications and significance to family members. HCPs were valued by patients as a trusted source of information. Limited evidence was available on HCPs' information-seeking behavior and factors influencing cBT-related knowledge and confidence, often self-reported as insufficient. CONCLUSIONS Patient education by knowledgeable and confident HCPs, information management and a caring patient-HCP relationship communicating continuity of care regardless of cBT results are crucial to empower patients and shared decision-making in precision oncology. More data on the process and structure of cBT-related communication, distinction between and characterization of different timepoints of patient-HCP interactions are needed.
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Affiliation(s)
- Theresia Pichler
- Department of Internal Medicine III, University HospitalLMU MunichMunichGermany
- Comprehensive Cancer Center Munich LMU (CCC Munich)MunichGermany
| | - Friederike Mumm
- Department of Internal Medicine III, University HospitalLMU MunichMunichGermany
- Comprehensive Cancer Center Munich LMU (CCC Munich)MunichGermany
| | - Navdeep Dehar
- Department of Medical OncologyQueen's UniversityKingstonOntarioCanada
| | - Erin Dickman
- Oncology Nursing SocietyPittsburghPennsylvaniaUSA
| | - Celia Díez de Los Ríos de la Serna
- European Oncology Nursing SocietyBrusselsBelgium
- Faculty of Medicine and Health Sciences, School of NursingBarcelona UniversityBarcelonaCataloniaSpain
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine and HealthTechnical University of MunichMunichGermany
- Comprehensive Cancer Center Munich TUM (CCC Munich)MunichGermany
| | - Kathrin Heinrich
- Comprehensive Cancer Center Munich LMU (CCC Munich)MunichGermany
| | | | - Anndra D. Parviainen
- Department of Nursing Science, Faculty of Health SciencesUniversity of Eastern FinlandKuopioFinland
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Jenkins LC, Summers SJ, Nasser A, Verhagen A. Dry needling perceptions and experiences: A survey of Australian physiotherapists. Musculoskelet Sci Pract 2024; 69:102895. [PMID: 38081107 DOI: 10.1016/j.msksp.2023.102895] [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: 08/07/2023] [Revised: 10/30/2023] [Accepted: 12/04/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND There is a lack of information on the use of dry needling in Australian physiotherapy practice. OBJECTIVES Our primary aim was to enhance the understanding of why Australian physiotherapists use dry needling in clinical practice. The secondary aim was to explore Australian physiotherapists experiences with adverse events caused by dry needling. DESIGN Cross-sectional online survey. METHOD We developed a survey and disseminated it through email to physiotherapists from all states and territories in Australia. Participant demographics and responses were reported as frequencies and percentages. RESULTS/FINDINGS We invited 1006 Australian physiotherapists, of which 232 (23%) viewed the online survey and 203 (20%) consented to participate, of which nearly all completed the survey (n = 198, 98%). Most respondents worked in private practice (n = 164, 83%), with 127 (64%) reporting using dry needling as an intervention within the previous 12 months. Physiotherapists typically used dry needling to decrease pain intensity (n = 105, 85%) and reduce muscle tension (n = 100, 81%). Reports of minor adverse events were common and included discomfort during the treatment (n = 77, 62%) and bruising (n = 69, 56%). Some respondents reported experiencing major adverse events including prolonged aggravation of symptoms (n = 10, 8%) and syncope (n = 16, 13%). CONCLUSIONS We found that many Australian physiotherapists in private practice use dry needling, usually to decrease pain intensity and muscle tension. Minor adverse events were experienced by more than half the respondents and between 8 and 13% of the Australian physiotherapists surveyed reported experiencing a major adverse event due to dry needling.
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Affiliation(s)
- Luke C Jenkins
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia.
| | - Simon J Summers
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, New South Wales, Australia
| | - Anthony Nasser
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia
| | - Arianne Verhagen
- University of Technology Sydney, Graduate School of Health, Faculty of Health, Australia
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Waddell A, Goodwin D, Spassova G, Sampson L, Candy A, Bragge P. "We will be the ones bearing the consequences": A qualitative study of barriers and facilitators to shared decision-making in hospital-based maternity care. Birth 2024. [PMID: 38270268 DOI: 10.1111/birt.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Pregnant women involved in decisions about their care report better health outcomes for themselves and their children. Shared decision-making (SDM) is a priority for health services; however, there is limited research on factors that help and hinder SDM in hospital-based maternity settings. The purpose of this study was to explore barriers and facilitators to SDM in a large tertiary maternity care service from the perspectives of multiple stakeholders. METHODS Qualitative semi-structured interviews were undertaken with 39 participants including women, clinicians, health service administrators and decision-makers, and government policymakers. The interview guide and thematic analysis were based on the Theoretical Domains Framework to identify barriers and facilitators to SDM. RESULTS Women expect to be included in decisions about their care. Health service administrators and decision-makers, government policymakers, and most clinicians want to include them in decisions. Key barriers to SDM included lack of care continuity, knowledge, and clinician skills, as well as professional role and decision-making factors. Key facilitators pertained to policy and guideline changes, increased knowledge, professional role factors, and social influences. CONCLUSION This study revealed common barriers and facilitators to SDM and highlighted the need to consider perspectives outside the patient-clinician dyad. It adds to the limited literature on barriers and facilitators to SDM in hospital care settings. Organizational- and system-wide changes to service delivery are necessary to facilitate SDM. These changes may be enabled by education and training, changes to policies and guidelines to include and support SDM, and adequately timed information provision to enable SDM conversations.
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Affiliation(s)
- Alex Waddell
- Safer Care Victoria, Victorian Department of Health, Melbourne, Victoria, Australia
- Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Denise Goodwin
- BehaviourWorks Australia, Monash University, Clayton, Victoria, Australia
| | - Gerri Spassova
- Department of Marketing, Monash Business School, Caulfield East, Victoria, Australia
| | | | - Alix Candy
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Peter Bragge
- Monash Sustainable Development Institute Evidence Review Service, Monash University, Clayton, Victoria, Australia
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Matsubara S. Old doctors: Still useful as clinicians and researchers. J Obstet Gynaecol Res 2024; 50:139-140. [PMID: 37935437 DOI: 10.1111/jog.15827] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan
- Department of Obstetrics and Gynecology, Koga Red Cross Hospital, Ibaraki, Japan
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Gans EA, Pieterse AH, Klapwijk MS, van Stiphout F, van Steenbergen IJ, Portielje JEA, de Groot JF, van Munster BC, van den Bos F. Shared decision-making with older adults with cancer: Adaptation of a model through literature review and expert opinion. Psychooncology 2024; 33:e6291. [PMID: 38282224 DOI: 10.1002/pon.6291] [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: 07/14/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To provide a literature overview of characteristics of Shared Decision Making (SDM) with specific importance to the older adult population with cancer and to tailor an existing model of SDM in patients with cancer to the needs of older adults. METHODS A systematic search of several databases was conducted. Eligible studies described factors influencing SDM concerning cancer treatment with adults aged 65 years or above, with any type of cancer. We included qualitative or mixed-methods studies. Themes were identified and discussed in an expert panel, including a patient-representative, until consensus was reached on an adjusted model. RESULTS Overall 29 studies were included and nine themes were identified from the literature. The themes related to the importance of goal setting, need for tailored information provision, the role of significant others, uncertainty of evidence, the importance of time during and outside of consultations, the possible ill-informed preconceptions that health care professionals (HCPs) might have about older adults and the specific competencies they need to engage in the SDM process with older adults. No new themes emerged from discussion with expert panel. This study presents a visual model of SDM with older patients with cancer based on the identified themes. CONCLUSIONS Our model shows key elements that are specific to SDM with older adults. Further research needs to focus on how to educate HCPs on the competencies needed to engage in SDM with older patients, and how to implement the model into everyday practice.
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Affiliation(s)
- Emma A Gans
- University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Maartje S Klapwijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Feikje van Stiphout
- Department of Geriatric Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Irma J van Steenbergen
- Department of Gerontology and Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Janke F de Groot
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Barbara C van Munster
- University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederiek van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
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20
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Zagt AC, Bos N, Bakker M, de Boer D, Friele RD, de Jong JD. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients. PATIENT EDUCATION AND COUNSELING 2024; 118:108030. [PMID: 37897867 DOI: 10.1016/j.pec.2023.108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. METHODS A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. RESULTS The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. CONCLUSIONS SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. PRACTICE IMPLICATIONS This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.
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Affiliation(s)
- Anne C Zagt
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | - Nanne Bos
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Max Bakker
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dolf de Boer
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Roland D Friele
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; Tranzo Scientifc Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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21
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Noorlandt HW, Korfage IJ, Felet FMAJ, Aarts K, Festen DAM, Vrijmoeth C, Van Der Heide A, Echteld MA. Shared decision making with frail people with intellectual disabilities in the palliative phase: A process evaluation of the use of the In-Dialogue conversation aid in practice. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13158. [PMID: 37715512 DOI: 10.1111/jar.13158] [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: 06/22/2022] [Revised: 07/20/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND This study reports the process evaluation of the In-Dialogue conversation aid to facilitate shared decision-making with people with intellectual disabilities in the palliative phase. METHODS Training for In-Dialogue was evaluated by 53 support staff members through questionnaires. The use of In-Dialogue in four residential care facilities for frail people with mild to severe intellectual disabilities was evaluated with semi-structured interviews with five relatives, nine support staff and three people with intellectual disabilities. RESULTS Most participants considered the training helpful to apply shared decision-making. Sixty-three people with intellectual disabilities participated in In-Dialogue conversations. Almost all interviewees stated that these conversations provided additional insight into people's concerns and preferences. Involvement of people with profound intellectual disabilities and their relatives appeared to be challenging. CONCLUSION Conversations about illness and the end of life appeared to be feasible with the In-Dialogue conversation aid and provided insight into people's experiences and preferences.
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Affiliation(s)
- H W Noorlandt
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - I J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - F M A J Felet
- Expert by Experience, Breda, Noord-Brabant, The Netherlands
| | - K Aarts
- Care facility for people with intellectual disabilities, Amarant, Breda, Noord-Brabant, The Netherlands
| | - D A M Festen
- Department of General Practice, Intellectual Disability Medicine, Rotterdam, Erasmus MC, University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - C Vrijmoeth
- Centre for Research and Innovation in Christian Mental Health Care, Eleos/De Hoop GGZ, Hoevelaken, Utrecht, The Netherlands
| | - A Van Der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - M A Echteld
- Palliative care project director, Prisma Foundation, Waalwijk, Noord Brabant, Netherlands
- Avans University of Applied Science, Expertise Centre Caring Society, Breda, Noord-Brabant, The Netherlands
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Gessesse AG, Haile JM, Woldearegay AG. Exploring Effective Communication Strategies Employed by Physicians in Delivering Bad News in Ethiopian State Hospitals. Patient Relat Outcome Meas 2023; 14:409-425. [PMID: 38144389 PMCID: PMC10749095 DOI: 10.2147/prom.s390164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/12/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Delivering Bad News (DBN) presents a highly challenging situation in physician-patient communication. This study aims to gain insight into the various communication strategies employed by physicians when DBN. Methods This qualitative study conducted thematic analysis of in-depth interviews. Physicians from two comprehensive hospitals with large patient populations were selected purposively based on their engagement in delivering bad news to patients. Thematic analysis was made. Results Thematic analysis of the data revealed several communication strategies physicians use when delivering bad news. These communication strategies include. Jointly Initiated Physician-Patient Communication Strategies: ((i) Discussing with patient family/caregivers, (ii) Collaborating with other physicians and specialists), Patient-Engaged/Led Communication Strategies: ((iii) Investigating with adolescents alone or without the family, (iv) Helping patients predict what the news is, (v) Identifying patients' emotions related to bad news, (vi) Assessing patients' level of understanding, (vii) Minimizing patient anxiety), Physician-Related Communication Strategies: ((viii) Making sure diagnostic results are accurate, (xi) Identifying causes for rejection, (x) deliveringbad news using clear and simple communication). Conclusion Delivering bad news to patients can be challenging for physicians. It is important to be clear and accurate, and to prepare patients for the news. Patients may feel more comfortable and open when they are unaccompanied and with their healthcare provider. The study concluded that physicians need to be prepared to deliver bad news in a sensitive and effective manner.
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Affiliation(s)
| | - Jemal Mohammed Haile
- Departments of Journalism and Communication, Bahir Dar University, Bahir Dar, Ethiopia
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Lloyd KE, Hall LH, Ziegler L, Foy R, Green SMC, MacKenzie M, Taylor DG, Smith SG. Acceptability of aspirin for cancer preventive therapy: a survey and qualitative study exploring the views of the UK general population. BMJ Open 2023; 13:e078703. [PMID: 38110374 DOI: 10.1136/bmjopen-2023-078703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVES Aspirin could be offered for colorectal cancer prevention for the UK general population. To ensure the views of the general population are considered in future guidance, we explored public perceptions of aspirin for preventive therapy. DESIGN We conducted an online survey to investigate aspirin use, and awareness of aspirin for cancer prevention among the UK general population. We conducted semistructured interviews with a subsample of survey respondents to explore participants' acceptability towards aspirin for cancer preventive therapy. We analysed the interview data using reflexive thematic analysis and mapped the themes onto the Theoretical Domains Framework, and the Necessity and Concerns Framework. SETTING Online survey and remote interviews. PARTICIPANTS We recruited 400 UK respondents aged 50-70 years through a market research company to the survey. We purposefully sampled, recruited and interviewed 20 survey respondents. RESULTS In the survey, 19.0% (76/400) of respondents were aware that aspirin can be used to prevent cancer. Among those who had previously taken aspirin, 1.9% (4/216) had taken it for cancer prevention. The interviews generated three themes: (1) perceived necessity of aspirin; (2) concerns about side effects; and (3) preferred information sources. Participants with a personal or family history of cancer were more likely to perceive aspirin as necessary for cancer prevention. Concerns about taking aspirin at higher doses and its side effects, such as gastrointestinal bleeding, were common. Many described wanting guidance and advice on aspirin to be communicated from sources perceived as trustworthy, such as healthcare professionals. CONCLUSIONS Among the general population, those with a personal or family history of cancer may be more receptive towards taking aspirin for preventive therapy. Future policies and campaigns recommending aspirin may be of particular interest to these groups. Multiple considerations about the benefits and risks of aspirin highlight the need to support informed decisions on the medication.
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Affiliation(s)
- Kelly E Lloyd
- Leeds Institute of Health Sciences, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Louise H Hall
- Leeds Institute of Health Sciences, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Lucy Ziegler
- Leeds Institute of Health Sciences, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Sophie M C Green
- Leeds Institute of Health Sciences, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | | | - David G Taylor
- School of Pharmacy, University College London, London, UK
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds Faculty of Medicine and Health, Leeds, UK
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Spinnewijn L, Aarts J, Braat D, Baranov N, Sijtsma K, Ellis J, Scheele F. Is it fun or is it hard? Studying physician-related attributes of shared decision-making by ranking case vignettes. PEC INNOVATION 2023; 3:100208. [PMID: 37727700 PMCID: PMC10506089 DOI: 10.1016/j.pecinn.2023.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Abstract
Objective This study investigated provider-related attributes of shared decision-making (SDM). It studied how physicians rank SDM cases compared to other cases, taking 'job satisfaction' and 'complexity' as ranking criteria. Methods Ten vignettes representing three cases of SDM, three cases dealing with patients' emotions and four with technical problems were designed to conduct a modified ordinal preference elicitation study. Gynaecologists and trainees ranked the vignettes for 'job satisfaction' or 'complexity'. Results were analysed by comparing the top three and down three ranked cases for each type of case using exact p-values obtained with custom-made randomisation tests. Results Participants experienced more satisfaction significantly from performing technical cases than cases dealing with emotions or SDM. Moreover, technical cases were perceived as less complex than those dealing with emotions. However, results were inconclusive about whether gynaecologists find SDM complex. Conclusion Findings suggest gynaecologists experience lower satisfaction with SDM tasks, possibly due to them falling outside their comfort zone. Integrating SDM into daily routines and promoting culture change favouring dealing with non-technical problems might help mitigate issues in SDM implementation. Innovation Our novel study assesses SDM in the context of task appraisal, illuminating the psychology of health professionals and providing valuable insights for implementation science.
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Affiliation(s)
- Laura Spinnewijn
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
- VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands
| | - Johanna Aarts
- Amsterdam University Medical Centers, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
| | - Didi Braat
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Nikolaj Baranov
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Klaas Sijtsma
- Tilburg University, Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
| | - Jules Ellis
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands
| | - Fedde Scheele
- VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands
- Amsterdam University Medical Centers, School of Medical Sciences, Amsterdam, the Netherlands
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Cancelliere C, Hincapié CA. Management of Adults with Chronic Primary Low Back Pain: Introduction to the Special Series of Systematic Reviews to Inform a World Health Organization (WHO) Clinical Guideline. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:615-617. [PMID: 37991650 DOI: 10.1007/s10926-023-10126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Carol Cancelliere
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich, Balgrist University Hospital, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland
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Rucinski K, Leary E, Royse LA. Factors Important to Patients when Making Treatment Decisions for Knee Osteoarthritis. J Knee Surg 2023; 36:1413-1421. [PMID: 37072026 DOI: 10.1055/s-0043-56998] [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] [Indexed: 04/20/2023]
Abstract
Patient treatment decisions for knee osteoarthritis (OA) are driven largely by the patient's physical examination and radiograph findings. Because multiple treatment options may be medically appropriate, it is imperative that the patient's voice be considered to better facilitate patient-centered treatment decisions. Concordance between physicians and patients on optimal treatment can vary, with few studies identifying the factors important to patients when making treatment decisions for knee OA. The goal of this analysis is to identify and synthesize subjective factors in the literature found to influence patient decision-making in a presurgical knee OA population, such that physicians and health care teams can become better equipped to help patients realize their specific treatment goals. This review was registered with PROSPERO and conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. A systematic search was completed in four databases for search terms related to knee OA and decision-making. Articles were eligible for inclusion when they discussed (1) patients' thoughts, feelings, goals, and perceptions that factored into treatment deliberation and decision-making; and (2) related to knee OA. Twenty-four articles were identified, 11 qualitative studies and 13 quantitative studies. Synthesis of the included articles revealed three main themes that drive patient treatment decisions: (1) individual catalysts to pursue treatment including pain and mobility limitations, (2) interpersonal factors including social networks and clinician trust, and (3) risks versus benefits assessment including patients' beliefs and expectations. Only a few studies looked at nonoperative treatment decisions, and no studies looked at cohorts considering knee preservation surgeries. This study was completed to synthesize literature related to patient treatment decisions for nonoperative and surgical management of knee OA, finding that patients consider multiple subjective factors when choosing whether to move forward with treatment. Understanding how patients' beliefs determine their preferences for treatment can improve shared decision-making.
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Affiliation(s)
- Kylee Rucinski
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Emily Leary
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Lisa A Royse
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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O'Brien E, Walsh A, Boland F, Collins C, Harkins V, Smith SM, O'Herlihy N, Clyne B, Wallace E. GP preferences for, access to, and use of evidence in clinical practice: a mixed-methods study. BJGP Open 2023; 7:BJGPO.2023.0107. [PMID: 37442591 PMCID: PMC11176671 DOI: 10.3399/bjgpo.2023.0107] [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: 06/11/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND GPs aim to provide patient-centred care combining clinical evidence, clinical judgement, and patient priorities. Despite a recognition of the need to translate evidence to support patient care, barriers exist to the use of evidence in practice. AIM To ascertain the needs and preferences of GPs regarding evidence-based guidance to support patient care. The study also aimed to prioritise content and optimise structure and dissemination of future evidence-based guidance. DESIGN & SETTING This was a convergent parallel mixed-methods study in collaboration with the national GP professional body in the Republic of Ireland (Irish College of General Practitioners [ICGP]). Quantitative and qualitative findings were integrated at the interpretive level. METHOD A national GP survey was administered via the ICGP (December 2020) and seven GP focus groups were undertaken (April-May 2021). RESULTS Of 3496 GPs, a total of 509 responders (14.6%) completed the survey and 40 GP participants took part in focus groups. Prescribing updates, interpretation of test results, chronic disease management, and older person care were the preferred topics for future evidence-based guidance. GPs reported that they required rapid access to up-to-date and relevant evidence summaries online for use in clinical practice. Access to more comprehensive reviews for the purposes of continuing education and teaching was also a priority. Multimodal forms of dissemination were preferred to increase uptake of evidence in practice. CONCLUSION GPs indicated that rapid access to up-to-date, summarised evidence-based resources, available from their professional organisation, is preferred. Evidence should reflect the disease burden of the population and involve multifaceted dissemination approaches.
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Affiliation(s)
- Emer O'Brien
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, School of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Velma Harkins
- Irish College of General Practitioners, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | | | - Barbara Clyne
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Emma Wallace
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Department of General Practice, University College Cork, Cork, Ireland
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van der Padt-Pruijsten A, Leys MB, Oomen-de Hoop E, van der Rijt CCD, van der Heide A. Quality of cancer treatment care before and after a palliative care pathway: bereaved relatives' perspectives. BMJ Support Palliat Care 2023:spcare-2023-004495. [PMID: 37973203 DOI: 10.1136/spcare-2023-004495] [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: 07/18/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Appropriate communication between healthcare providers and patients and their families is an essential part of good (palliative) care. We investigated whether implementation of a standardised palliative care pathway (PCP) facilitated communication, that is, aspects of shared decision-making (SDM), including advance care planning (ACP) conversations and satisfaction with care as experienced by bereaved relatives of patients with advanced cancer. METHODS We conducted a prospective preintervention and postintervention study in a hospital. Questionnaires were sent to relatives of patients who died between February 2014 and February 2015 (pre-PCP period) or between November 2015 and November 2016 (post-PCP period). Relatives' perceptions on communication and satisfaction with care were assessed using parts of the Views of Informal Carers-Evaluation of Services and IN-PATSAT32 Questionnaires. RESULTS 195 (46%) and 180 (42%) bereaved relatives completed the questionnaire in the pre-PCP and post-PCP period, respectively. The majority of all patients in both the pre-PCP period and the post-PCP period had been told they had an incurable illness (92% and 89%, respectively, p=0.544), mostly in the presence of a relative (88% and 85%, respectively, p=0.865) and had discussed their preferences for end-of-life (EOL) treatment (82% and 76%, respectively, p=0.426). Bereaved relatives were reasonably satisfied with the received hospital care in both groups. CONCLUSIONS We found no overall effect of the PCP on the communication process and satisfaction with EOL care of bereaved relatives. Before the use of the PCP bereaved relatives already reported favourably about the EOL care provided.
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Affiliation(s)
- Annemieke van der Padt-Pruijsten
- Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
- Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maria Bl Leys
- Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Hussain S, Wilkes C, Dhanda N. Shared decision making: audiology student perspectives. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1254836. [PMID: 38035185 PMCID: PMC10682730 DOI: 10.3389/fresc.2023.1254836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023]
Abstract
Introduction Shared decision making is a concept in healthcare that actively involves patients in the management of their condition. The process of shared decision making is taught in clinical training programmes, including Audiology, where there are several options for the management of hearing loss. This study sought to explore the perception of Healthcare Science (Audiology) student views on shared decision making. Methods Twelve students across all years of the BSc Healthcare Science degree took part in three semi-structured focus groups. Four students were work-based learners, and eight students were enrolled on the standard pathway. Data were analysed using Thematic Analysis. Results Students' definition and understanding of shared decision making was influenced by three key factors that were based on using a range of resources, implementation of a decision aid, and recognising Ida Institute as a pinnacle of shared decision making. Students also identified their roles as the future of healthcare workforce and the importance of disseminating best practice. Conclusion Shared decision making is valued by students in their roles as healthcare trainees. This study data will enhance teaching practices for healthcare science students in audiology training. Future research involving patient views in clinical training is vital.
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Affiliation(s)
- S. Hussain
- Department of Audiology, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - C. Wilkes
- Department of Audiology, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - N. Dhanda
- College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Kvæl LAH, Bergland A, Eldh AC. Preference-based patient participation in intermediate care: Translation, validation and piloting of the 4Ps in Norway. Health Expect 2023; 27:e13899. [PMID: 37934200 PMCID: PMC10726279 DOI: 10.1111/hex.13899] [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: 06/30/2023] [Revised: 09/09/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION The implementation and evaluation of patient participation to obtain high-quality transitional care for older people is an international priority. Intermediate care (IC) services are regarded as an important part of the patient's pathway from the specialist to the primary care levels, bridging the gap between the hospital and the home. Patients may experience varying capacities and conditions for patient participation. Yet, few tools for evaluating patients' preferences for patient participation within IC services are at hand. Accordingly, further knowledge is needed to understand and scaffold processes for patient participation in IC. Therefore, the aim of this project was to translate, validate and pilot test the Patient Preferences for Patient Participation (the 4Ps) with patients in IC services in Norway. METHODS This project comprised two phases: (1) a careful translation and cultural adaptation process, followed by a content validity trial among 15 patients and staff in Norwegian IC and (2) a cross-sectional survey of the instrument with 60 patients admitted to IC. RESULTS The translation between Swedish and Norwegian required no conceptual or contextual adaptations. The subsequent cross-sectional study, designed as a dialogue between the patients and staff, revealed that only 50% of the participants received a sufficient level of patient participation based on their preferences, mostly indicating that patients were receiving less-than-preferred conditions for engaging in their health and healthcare issues. CONCLUSION The 4Ps instrument was deemed suitable for measuring patient participation based on patient preferences in the IC context and was feasible for both healthcare professionals and patients to complete in an interview when arriving at and leaving services. This may support person-centred communication and collaboration, calling for further research on what facilitates patient participation and the implementation of person-centred services for patients in IC. PATIENT OR PUBLIC CONTRIBUTION First, the current paper is part of the IPIC study (i.e., the implementation of patient participation in IC). Influenced by a James Lind Alliance process, the study addresses research uncertainties identified by patients, next of kin, staff and researchers in the cocreation process. Second, cognitive interviewing was conducted with 15 representatives of the target population: seven patients receiving IC services, one home-dwelling previous IC patient (altogether four women and four men, most of them 80 years or older) and seven healthcare staff working in IC services. The interviews determined the relevance, comprehensiveness and clarity of the 4Ps. Finally, 60 patients admitted to IC took part in the cross-sectional study.
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Affiliation(s)
- Linda A. H. Kvæl
- Department of Rehabilitation Science and Health TechnologyFaculty of Health Sciences, Oslo Metropolitan UniversityOsloNorway
- Norwegian Social Research—NOVAOslo Metropolitan UniversityOsloNorway
| | - Astrid Bergland
- Department of Rehabilitation Science and Health TechnologyFaculty of Health Sciences, Oslo Metropolitan UniversityOsloNorway
| | - Ann C. Eldh
- Department of Health, Medicine and Caring SciencesFaculty of Medicine and Health Sciences, Linköping UniversityLinköpingSweden
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
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Conroy S, Evans T, Butler-Moburg D, Beuttler R, Robinson J, Huebert M, O Mahony E, Grant-Beuttler M. Clinical application and feasibility of utilizing the PEDI-CAT to assess activity and participation among children receiving physical therapy incorporating hippotherapy. Physiother Theory Pract 2023; 39:2300-2313. [PMID: 35594061 DOI: 10.1080/09593985.2022.2072250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hippotherapy (HPOT) is a physical therapy (PT) treatment tool using equine movement to improve mobility for children with movement impairments. Although research suggests HPOT improves body structure and function, there is limited evidence regarding its impact on activity and participation outcomes in a clinical setting. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) may be useful in HPOT settings to highlight changes in activity and participation. PURPOSE 1) Evaluate the PEDI-CAT's sensitivity to changes in activity and participation among children receiving PT using HPOT; 2) determine feasibility of administering the PEDI-CAT in a HPOT setting; and 3) examine how PEDI-CAT scores influence clinical decision-making. METHODS Participants (N = 34) were children who attended weekly PT using HPOT for 6 months. The PEDI-CAT was completed for all participants by a parent or caregiver at initial treatment (T1) and 6 months later (T2). A linear mixed effects model was used to evaluate changes in scores over time. Team meetings occurred monthly to discuss how PEDI-CAT scores impacted treatment. RESULTS There were significant improvements across 3 PEDI-CAT domains between T1 and T2 for all children with small effect sizes and nonsignificant changes noted within two diagnostic subgroups with small-to-medium effect sizes. The PEDI-CAT was completed by all participants without interrupting treatment flow. PEDI-CAT score reports enriched therapist-client conversations increasing shared decision-making. CONCLUSION PTs who treat children using HPOT may feasibly use the PEDI-CAT to assess changes in activity level outcomes and to assist clinical decision-making.
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Affiliation(s)
- Susan Conroy
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
| | - Trish Evans
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
| | - Dana Butler-Moburg
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
| | | | - Janelle Robinson
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
| | - Matt Huebert
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
| | - Erin O Mahony
- Therapy services, Shea Center for Therapeutic Riding, San Juan Capistrano, CA, USA
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Avci E. Co-production as a resolution to authoritarian attitudes in healthcare. Nurs Ethics 2023; 30:1003-1010. [PMID: 37159933 DOI: 10.1177/09697330231169931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Healthcare services should be provided according to contemporary ethical norms that require patients' active engagement in all the relevant processes. However, authoritarian attitudes and behaviors in healthcare, one of which is paternalism, put patients in a passive role. But, as Avedis Donabedian emphasizes, patients are co-producers of care, reformers of healthcare, informants, and definers and evaluators of quality. Overlooking these significant functions and merely focusing on physicians' benevolence due to their medical knowledge and skills in the production of healthcare services would leave the fate of patients in the hands of clinicians and impose physicians' hegemony on patients and their choices. Nevertheless, the concept of co-production is a practical and effective mechanism to redefine the language used in healthcare by recognizing patients as co-producers and equal partners. The application of co-production in healthcare would improve the therapeutic relationship, decrease ethical violations, and promote the patient's dignity.
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Affiliation(s)
- Ercan Avci
- Grefenstette Center for Ethics, Duquesne University, Pittsburgh, PA, USA
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Morris M, Atterbury E, Minichetti C, Santos N, Farrell A, Hanel A, Porras M, Leak K, Tepper L, Whalen S, Kunzel C. Patient-dental student provider communication in an academic dental clinic setting: A dyadic data analysis. J Dent Educ 2023; 87:1585-1593. [PMID: 37539451 DOI: 10.1002/jdd.13343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/05/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Patient-dentist communication is an inherently dyadic social process; however, it is rarely regarded as such in research and pedagogy. This study utilizes a dyadic data analysis approach to study patient-dental student provider communication in an academic dental clinic. PROCEDURES Using pairwise data collected from patient-dental student provider dyads, we conducted unadjusted and adjusted actor-partner interdependence models to examine the association of intrapersonal (actor) and interpersonal (partner) effects of three communication skills on the assessment of appointment interaction among patient-dental student provider dyads in a pre-doctoral comprehensive care academic dental clinic setting. MAIN FINDINGS Actor effects were most evident among the associations in the study. Dental student providers' assessment of their own shared decision-making predicted positive changes in their overall interaction assessment in both unadjusted and fully adjusted models. Patients' ratings of their dental student provider's capability/confidence predicted positive changes in their overall interaction assessment in both unadjusted and adjusted models. CONCLUSIONS This study suggests that dental students and their patients are primarily impacted by actor perspectives regarding dental student communication and its impact on the assessment of their respective overall appointment interaction. Findings suggest a need for the incorporation of interpersonal skill building in collaboration with patients to strengthen the communication skills and practice of dental students.
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Affiliation(s)
- Melanie Morris
- Dental Community Health, Columbia University College of Dental Medicine, New York, New York, USA
- Boston University School of Social Work, Boston, Massachusetts, USA
| | - Elizabeth Atterbury
- Dental Community Health, Columbia University College of Dental Medicine, New York, New York, USA
| | - Cara Minichetti
- Dental Community Health, Columbia University College of Dental Medicine, New York, New York, USA
| | - Noemy Santos
- Columbia University School of Social Work, New York, New York, USA
| | - Alexandria Farrell
- Dental Community Health, Columbia University College of Dental Medicine, New York, New York, USA
| | - Alyssa Hanel
- Dental Community Health, Columbia University College of Dental Medicine, New York, New York, USA
| | - Mariana Porras
- Columbia University School of Social Work, New York, New York, USA
| | - Kathryne Leak
- Columbia University School of Social Work, New York, New York, USA
| | - Lynn Tepper
- Dental Community Health, Columbia University College of Dental Medicine, New York, New York, USA
| | - Stacey Whalen
- Dental Community Health, Columbia University College of Dental Medicine, New York, New York, USA
- Columbia University School of Social Work, New York, New York, USA
| | - Carol Kunzel
- Dental Community Health, Columbia University College of Dental Medicine, New York, New York, USA
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Blom JMC, Rivi V, Tascedda F, Pani L. The nexus of social alliances and diverse moral domains: a bedrock for participatory clinical research. Front Med (Lausanne) 2023; 10:1250247. [PMID: 37849486 PMCID: PMC10577180 DOI: 10.3389/fmed.2023.1250247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Johanna M. C. Blom
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Veronica Rivi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Tascedda
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Consorzio Interuniversitario per le Biotecnologie, Trieste, Italy
| | - Luca Pani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, United States
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Barber S, Jones A, Abigale Patel V, P Ashley M. Involving young people and parents in decision-making for hypodontia. Br Dent J 2023; 235:529-534. [PMID: 37828196 PMCID: PMC10570137 DOI: 10.1038/s41415-023-6328-1] [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: 03/29/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 10/14/2023]
Abstract
Involving young people and their parents in decisions about their health care is ethically and professionally the right thing to do. Good decision-making relies on informed, value-based deliberation. Providing the right treatment for people with hypodontia is complex, both technically, in terms of the range of options available, and from a communication perspective. Treatment decisions faced by young people with hypodontia can have lifelong implications and the weight of this is felt both by the patient, who may have limited experience of dental treatment and decision-making, and their parents, who act as advocates. It is important that clinicians understand how they can best share the available evidence and their expertise in a way that can be understood and applied. Clinicians also have an important role in facilitating young people to recognise and communicate their own values, expectations, and ultimately, preferences for treatment. This paper outlines the challenges of navigating information sharing and engaging in shared decision-making specific to hypodontia. A scoping review of the literature by the authors was conducted to identify evidence-based advice for discussing uncertainties, risks and increasing engagement in decision-making. This may be useful to both primary and secondary care practitioners involved in decision-making with people with hypodontia.
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Affiliation(s)
- Sophy Barber
- Clinical Lecturer, University of Leeds, UK; Honorary Consultant Orthodontist, Mid Yorkshire NHS Hospitals Trust, UK.
| | - Adam Jones
- Academic Clinical Fellow in Oral Surgery, Leeds Dental Institute, UK
| | | | - Martin P Ashley
- Consultant and Honorary Professor in Restorative Dentistry and Oral Health, University Dental Hospital of Manchester, UK
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de Veer MR, Hermus M, van der Zijden CJ, van der Wilk BJ, Wijnhoven BPL, Stiggelbout AM, Dekker JWT, Coene PPLO, Busschbach JJ, van Lanschot JJB, Lagarde SM, Kranenburg LW. Surgeon's steering behaviour towards patients to participate in a cluster randomised trial on active surveillance for oesophageal cancer: A qualitative study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106935. [PMID: 37210275 DOI: 10.1016/j.ejso.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Few studies have been conducted into how physicians use steering behaviour that may persuade patients to choose for a particular treatment, let alone to participate in a randomised trial. The aim of this study is to assess if and how surgeons use steering behaviour in their information provision to patients in their choice to participate in a stepped-wedge cluster randomised trial investigating an organ sparing treatment in (curable) oesophageal cancer (SANO trial). MATERIALS AND METHODS A qualitative study was performed. Thematic content analysis was applied to audiotaped and transcribed consultations of twenty patients with eight different oncological surgeons in three Dutch hospitals. Patients could choose to participate in a clinical trial in which an experimental treatment of 'active surveillance' (AS) was offered. Patients who did not want to participate underwent standard treatment: neoadjuvant chemoradiotherapy followed by oesophagectomy. RESULTS Surgeons used various techniques to steer patients towards one of the two options, mostly towards AS. The presentation of pros and cons of treatment options was imbalanced: positive framing of AS was used to steer patients towards the choice for AS, and negative framing of AS to make the choice for surgery more attractive. Further, steering language, i.e. suggestive language, was used, and surgeons seemed to use the timing of the introduction of the different treatment options, to put more focus on one of the treatment options. CONCLUSION Awareness of steering behaviour can help to guide physicians in more objectively informing patients on participation in future clinical trials.
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Affiliation(s)
- Mathijs R de Veer
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Merel Hermus
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Berend J van der Wilk
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | - Jan J Busschbach
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jan J B van Lanschot
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Lound A, Bruton J, Jones K, Shah N, Williams B, Gross J, Post B, Day S, Brett SJ, Ward H. "I'd rather wait and see what's around the corner": A multi-perspective qualitative study of treatment escalation planning in frailty. PLoS One 2023; 18:e0291984. [PMID: 37733669 PMCID: PMC10513333 DOI: 10.1371/journal.pone.0291984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION People living with frailty risk adverse outcomes following even minor illnesses. Admission to hospital or the intensive care unit is associated with potentially burdensome interventions and poor outcomes. Decision-making during an emergency is fraught with complexity and potential for conflict between patients, carers and clinicians. Advance care planning is a process of shared decision-making which aims to ensure patients are treated in line with their wishes. However, planning for future care is challenging and those living with frailty are rarely given the opportunity to discuss their preferences. The aim of the ProsPECT (Prospective Planning for Escalation of Care and Treatment) study was to explore perspectives on planning for treatment escalation in the context of frailty. We spoke to people living with frailty, their carers and clinicians across primary and secondary care. METHODS In-depth online or telephone interviews and online focus groups. The topic guide explored frailty, acute decision-making and planning for the future. Data were thematically analysed using the Framework Method. Preliminary findings were presented to a sample of study participants for feedback in two online workshops. RESULTS We spoke to 44 participants (9 patients, 11 carers and 24 clinicians). Four main themes were identified: frailty is absent from treatment escalation discussions, planning for an uncertain future, escalation in an acute crisis is 'the path of least resistance', and approaches to facilitating treatment escalation planning in frailty. CONCLUSION Barriers to treatment escalation planning include a lack of shared understanding of frailty and uncertainty about the future. Emergency decision-making is focussed on survival or risk aversion and patient preferences are rarely considered. To improve planning discussions, we recommend frailty training for non-specialist clinicians, multi-disciplinary support, collaborative working between patients, carers and clinicians as well as broader public engagement.
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Affiliation(s)
- Adam Lound
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Jane Bruton
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Kathryn Jones
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Nira Shah
- ProsPECT Study Public Advisor, Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Barry Williams
- ProsPECT Study Public Advisor, Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Jamie Gross
- London North West University Healthcare NHS Trust, London, United Kingdom
| | - Benjamin Post
- Department of Bioengineering and Department of Computing, Imperial College London, London, United Kingdom
- UKRI Centre in AI for Healthcare, Imperial College London, London, United Kingdom
| | - Sophie Day
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
| | - Stephen J. Brett
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Helen Ward
- Patient Experience Research Centre, School of Public Health, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- National Institute for Health Research Imperial Biomedical Research Centre, London, United Kingdom
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Kao MJ, Wang JY, Hu HY. Bidirectional referral system between National Taiwan University Hospital medical center and Zhongxiao Branch community hospital of Taipei City Hospital: focus on patient satisfaction. Sci Rep 2023; 13:14759. [PMID: 37679483 PMCID: PMC10484964 DOI: 10.1038/s41598-023-39794-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: 07/23/2022] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
The policy of bidirectional referral between National Taiwan University Hospital and Taipei City Hospital has been launched due to the over-crowding of the emergency department at National Taiwan University Hospital. This research aims to evaluate patient satisfaction with the bidirectional referral. Sixty-six patients have been referred from the emergency department of National Taiwan University Hospital to Taipei City Hospital, Zhongxiao campus from April 2015 to December 2017. The selection criteria of the subjects for bidirectional referral include the management of patients classified as triage classification 2 or 3. Exclusion criteria are as follows: incomplete patient records and patients who chose hospice care. Sixty-six patients completed the questionnaires. Multivariate regression was used to evaluate the determinants of overall satisfaction scores of the bidirectional referral. The two overall satisfaction scores of patients were high (> 7). Three independent variables, (1) overall satisfaction scores of medical care at Taipei City Hospital, Zhongxiao campus, (2) waiting times for examination, treatment, and test, and (3) a positive question regarding quality improvement of delivered care for patients and family explained 69.3% adjusted variability of the overall satisfaction scores of bidirectional referrals. Therefore, the policy of bidirectional referrals and direct admission into the wards of Taipei City Hospital, Zhongxiao campus, from the emergency department of National Taiwan University Hospital met the criteria for patient satisfaction and public accountability.
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Affiliation(s)
- Mu-Jung Kao
- University of Taipei, Taipei City, Taiwan
- China Medical University, Taichung, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Hsinchu, Taiwan
| | - Jenn Yeu Wang
- Division of Nephrology and Division of Occupational Medicine, Department of Medicine, Taipei City Hospital, Zhongxiao Branch, No.87, Tongde Rd., Nangang Dist., Taipei City, 115006, Taiwan.
- University of Taipei, Taipei City, Taiwan.
- Taipei Medical University, Taipei City, Taiwan.
- School of Medicine, Fu Jen Catholic University, Taipei City, Taiwan.
- School of Medicine, National Yang-Ming Chiao Tung University, Hsinchu, Taiwan.
| | - Hsiao-Yun Hu
- University of Taipei, Taipei City, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei City, Taiwan
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Fares MY, Singh J, Vadhera AS, Koa J, Boufadel P, Abboud JA. Online resources for information on shoulder arthroplasty: an assessment of quality and readability. Clin Shoulder Elb 2023; 26:238-244. [PMID: 37607858 PMCID: PMC10497924 DOI: 10.5397/cise.2023.00290] [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: 04/19/2023] [Revised: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Many patients use online resources to educate themselves on surgical procedures and make well-informed healthcare decisions. The aim of our study was to evaluate the quality and readability of online resources exploring shoulder arthroplasty. METHODS An internet search pertaining to shoulder arthroplasty (partial, anatomic, and reverse) was conducted using the three most popular online search engines. The top 25 results generated from each term in each search engine were included. Webpages were excluded if they were duplicates, advertised by search engines, subpages of other pages, required payments or subscription, or were irrelevant to our scope. Webpages were classified into different source categories. Quality of information was assessed by HONcode certification, Journal of the American Medical Association (JAMA) criteria, and DISCERN benchmark criteria. Webpage readability was assessed using the Flesch reading ease score (FRES). RESULTS Our final dataset included 125 web pages. Academic sources were the most common with 45 web pages (36.0%) followed by physician/private practice with 39 web pages (31.2%). The mean JAMA and DISCERN scores for all web pages were 1.96±1.31 and 51.4±10.7, respectively. The total mean FRES score was 44.0±11.0. Only nine web pages (7.2%) were HONcode certified. Websites specified for healthcare professionals had the highest JAMA and DISCERN scores with means of 2.92±0.90 and 57.96±8.91, respectively (P<0.001). HONcode-certified webpages had higher quality and readability scores than other web pages. CONCLUSIONS Web-based patient resources for shoulder arthroplasty information did not show high-quality scores and easy readability. When presenting medical information, sources should maintain a balance between readability and quality and should seek HONcode certification as it helps establish the reliability and accessibility of the presented information. Level of evidence: IV.
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Affiliation(s)
- Mohamad Y. Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Jaspal Singh
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Amar S. Vadhera
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Jonathan Koa
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Peter Boufadel
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopedic Institute, Philadelphia, PA, USA
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van Kooten RT, Algie JPA, Tollenaar RAEM, Wouters MWJM, Putter H, Peeters KCMJ, Dekker JWT. The impact on health-related quality of a stoma or poor functional outcomes after rectal cancer surgery in Dutch patients: A prospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106914. [PMID: 37105868 DOI: 10.1016/j.ejso.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/01/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND As the survival of patients with rectal cancer has improved in recent decades, more and more patients have to live with the consequences of rectal cancer surgery. An influential factor in long-term Health-related Quality of Life (HRQoL) is the presence of a stoma. This study aimed to better understand the long-term consequences of a stoma and poor functional outcomes. METHODS Patients who underwent curative surgery for a primary tumor located in the rectosigmoid and rectum between 2013 and 2020 were identified from the nationwide Prospective Dutch Colorectal Cancer (PLCRC) cohort study. Patients received the following questionnaires: EORTC-QLQ-CR29, EORTC-QLQ-C30, and the LARS-score at 12 months, 24 months and 36 months after surgery. RESULTS A total of 1,170 patients were included of whom 751 (64.2%) had no stoma, 122 (10.4%) had a stoma at primary surgery, 45 (3.8%) had a stoma at secondary surgery and 252 (21.5%) patients that underwent abdominoperineal resection (APR). Of all patients without a stoma, 41.4% reported major low-anterior resection syndrome (LARS). Patients without a stoma reported significantly better HRQoL. Moreover, patients without a stoma significantly reported an overall better HRQoL. CONCLUSION The presence of a stoma and poor functional outcomes were both associated with reduced HRQoL. Patients with poor functional outcomes, defined as major LARS, reported a similar level of HRQoL compared to patients with a stoma. In addition, the HRQoL after rectal cancer surgery does not change significantly after the first year after surgery.
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Affiliation(s)
- Robert T van Kooten
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - Jelle P A Algie
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Michel W J M Wouters
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Hein Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Nieuwenhuyzen-de Boer GM, Aamran H, van den Berg CB, Willemsen S, Piek JMJ, Reesink-Peters N, Maliepaard M, van Doorn HC, Polinder S, van Beekhuizen HJ. Cytoreductive Surgery with the PlasmaJet Improved Quality-of-Life for Advanced Stage Ovarian Cancer Patients. Cancers (Basel) 2023; 15:3947. [PMID: 37568763 PMCID: PMC10416900 DOI: 10.3390/cancers15153947] [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: 06/29/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Knowledge of quality-of-life after cytoreductive surgery is important to counsel patients with advanced-stage epithelial ovarian cancer prior to surgery. The aim of this study was to determine whether the use of the PlasmaJet Surgical device during cytoreductive surgery has an effect on the quality-of-life of patients with advanced epithelial ovarian cancer. METHODS Data included in this prospective observational study were derived from the PlaComOv study, in which patients with advanced epithelial ovarian cancer were randomly assigned to have cytoreductive surgery with or without adjuvant use of the PlasmaJet. Quality-of-life was measured before surgery and one, six, 12, and 24 months after surgery with three questionnaires: the EORTC QLQ-C30, QLQ-OV28, and EQ-5D-5L. RESULTS Between 2018 and 2020, 326 patients were enrolled in the trial. The overall response rate was high, with the lowest response rate at 24 months of 77%. At 6 months, quality-of-life was higher in the intervention group (95%CI 0.009; 0.081, p = 0.045). At 12 months, quality-of-life was higher in the intervention group with fewer symptoms of fatigue, appetite loss, and diarrhea (95%CI 0.6; 10,0, p = 0.027); similarly, patients in the intervention group reported a better body image (95%CI -14.2; -3.0, p = 0.003) and a higher score on the visual analog scale (95%CI 1.99; 11.15, p = 0.005). At 24 months postoperatively, no further difference was found between the two groups except for pain (95%CI -12.9; -0.8, p = 0.027) and body image (95%CI -13.808; -0.733, p = 0.029). A higher quality-of-life in the intervention group was partially explained by the mediator 'surgery outcome'. CONCLUSIONS This study demonstrated knowledge of patients' quality-of-life until two years after cytoreductive surgery. The use of the PlasmaJet Surgical device during cytoreductive surgery leads to a higher quality-of-life than conventional surgery with electrocoagulation alone. Even after adjustment for the mediator of surgical outcome, a higher quality-of-life was seen in patients who had surgery with the use of the PlasmaJet device.
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Affiliation(s)
- Gatske M. Nieuwenhuyzen-de Boer
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
- Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Hanane Aamran
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
| | - Caroline B. van den Berg
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
- Department of Obstetrics and Gynecology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Sten Willemsen
- Department of Epidemiology, Erasmus MC, 3015 GD Rotterdam, The Netherlands;
- Department of Biostatistics, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Jurgen M. J. Piek
- Department of Obstetrics and Gynecology, Catharina Cancer Institute, 5623 EJ Eindhoven, The Netherlands;
| | - Nathalie Reesink-Peters
- Department of Obstetrics and Gynecology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands;
| | - Marianne Maliepaard
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
| | - Helena C. van Doorn
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands;
| | - Heleen J. van Beekhuizen
- Department of Gynecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.A.); (C.B.v.d.B.); (M.M.); (H.C.v.D.); (H.J.v.B.)
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van Kooten RT, Schutte BAM, van Staalduinen DJ, Hoeksema JHL, Holman FA, van Dorp C, Peeters KCMJ, Tollenaar RAEM, Wouters MWJM. Patient perspectives on consequences of resection for colorectal cancer: A qualitative study. Colorectal Dis 2023; 25:1578-1587. [PMID: 37329241 DOI: 10.1111/codi.16637] [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: 01/15/2023] [Revised: 04/30/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Colorectal cancer is diagnosed in approximately 500,000 patients each year in Europe, leading to a high number of patients having to cope with the consequences of resection for colorectal cancer. As treatment options tend to grow, more information on the effects of these treatments is needed to engage in shared decision-making. This study aims to explore the impact of resection for colorectal cancer on patients' daily life. METHODS Patients (≥18 years of age) who underwent an oncological colorectal resection between 2018 and 2021 were selected. Purposeful sampling was used to include patients who differed in age, comorbidity conditions, types of (neo)adjuvant therapy, postoperative complications and the presence/absence of a stoma. Semi-structured interviews were conducted, guided by a topic guide. Interviews were fully transcribed and subsequently thematically analysed using the framework approach. Analyses were carried out using the following predefined themes: (1) daily life and activities; (2) psychological functioning; (3) social functioning; (4) sexual functioning; and (5) healthcare experiences. RESULTS Sixteen patients with a follow-up period of between 0.6 and 4.4 years after surgery were included in this study. Participants reported several challenges experienced because of poor bowel function, a stoma, chemotherapy-induced neuropathy, fear of recurrence and sexual dysfunction. However, they reported these as not interfering much with daily life. CONCLUSION Colorectal cancer treatment leads to several challenges and treatment-related health deficits. This is often not recognized by generic patient-reported outcome measures, but the findings on treatment-related health deficits presented in this study contain valuable insights which might contribute to improving colorectal cancer care, shared decision making and value-based health care.
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Affiliation(s)
- Robert T van Kooten
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Bianca A M Schutte
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorine J van Staalduinen
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jetty H L Hoeksema
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Fabian A Holman
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Chantal van Dorp
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Michel W J M Wouters
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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Montori VM, Ruissen MM, Hargraves IG, Brito JP, Kunneman M. Shared decision-making as a method of care. BMJ Evid Based Med 2023; 28:213-217. [PMID: 36460328 PMCID: PMC10423463 DOI: 10.1136/bmjebm-2022-112068] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Merel M Ruissen
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
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Chan HY, Wang CC, Jeng W, Huang YM. Strengthening scientific credibility in the face of misinformation and disinformation: Viable solutions. J Control Release 2023; 360:163-168. [PMID: 37301268 DOI: 10.1016/j.jconrel.2023.05.036] [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: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
Despite numerous attempts to mitigate their spread, misinformation and disinformation are rampant on social media and other public networks, posing a substantial risk to public health and individual well-being. A concerted, multi-channel approach is required to effectively tackle this evolving problem. This paper outlines potential strategies and actionable plans to improve the response to misinformation and disinformation by stakeholders from various healthcare ecosystems.
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Affiliation(s)
- Hsun-Yu Chan
- Department of Industrial Education, National Taiwan Normal University, Taipei, Taiwan
| | - Chi-Chuan Wang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei Jeng
- Department of Library and Information Science, National Taiwan University, Taipei, Taiwan; National Institute of Cyber Security, Taipei, Taiwan
| | - Yen-Ming Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
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Drummond L, Guiney S, Connolly D, Foley C, O'Connor L, O'Carroll T, Flynn R, Rohde D. Experiences of shared decision making in acute hospitals: A mixed methods secondary analysis of the Irish National Inpatient Experience Survey. PATIENT EDUCATION AND COUNSELING 2023; 113:107755. [PMID: 37099839 DOI: 10.1016/j.pec.2023.107755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/04/2023] [Accepted: 04/12/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION This study explored patient experiences of shared decision making (SDM) in public acute hospitals in Ireland. METHODS Quantitative and qualitative data from three years of the Irish National Inpatient Experience Survey were analysed. Survey questions were mapped to definitions of SDM and subjected to principal components analysis. Three SDM subscales (care on the ward; treatments; discharge) and one overall SDM scale were created. Differences in experiences of SDM by aspects of care and patient group were assessed. Thematic analysis of qualitative responses was undertaken. RESULTS 39,453 patients participated in the survey. The mean SDM experience score was 7.60 ± 2.43. Experience scores were highest on the treatments sub-scale, and lowest during discharge. Patients who had a non-emergency admission, those aged 51-80 years and men had more positive experiences than other groups. Patient comments highlighted that opportunities to clarify information and facilitation of families/caregivers in SDM were found to be lacking. CONCLUSION There were differences in experiences of SDM by aspects of care and patient group. PRACTICE IMPLICATIONS Efforts to improve SDM in acute hospitals are required, particularly at the time of discharge. SDM may be improved by facilitation of more time for discussion between clinicians and patients and/or their families/caregivers.
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Affiliation(s)
- Linda Drummond
- Health Information and Quality Authority, Dublin, Ireland.
| | | | | | - Conor Foley
- Health Information and Quality Authority, Dublin, Ireland
| | - Laura O'Connor
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Rachel Flynn
- Health Information and Quality Authority, Dublin, Ireland
| | - Daniela Rohde
- Health Information and Quality Authority, Dublin, Ireland
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Gerritse MB, de Swart E, de Vries M, Kluivers KB. Identifying Womens' Needs in Making a Treatment Decision for Stress Urinary Incontinence: A Qualitative Study. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:358-366. [PMID: 37476608 PMCID: PMC10354721 DOI: 10.1089/whr.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/22/2023]
Abstract
Background Choosing a treatment option for female stress urinary incontinence (SUI) is a preference-sensitive decision. Nowadays, shared decision making (SDM) is the preferred way of decision making. SDM considers the needs patients have regarding the decision-making process. The aim of this study was to identify decisional needs of women who are making a treatment decision for SUI. Materials and Methods Semistructured interviews were planned with women who had been seeking treatment for SUI. Patients were recruited in two teaching hospitals in the Netherlands. Interviewers used a topic list based on the Ottawa decision support framework. The interviews were transcribed and coded. Themes and subthemes of factors relating to the treatment decision-making process were identified and described. Results We interviewed a total of 16 women. Four major themes of SUI patients' needs were identified: information on disorder and treatment, SDM, personalized health care, and consideration for social context. Within these themes, specific needs varied between individuals. In addition to the provision of objective information, other important identified needs were subjective, such as acknowledgment of symptoms and feeling understood by a physician. It was important for patients that they had a sufficient amount of time to make their decision. Conclusions To ensure a good quality treatment decision in female SUI, several topics need to be addressed in an SDM process. The themes of decisional needs identified in this study can help improve the decision-making process.
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Affiliation(s)
- Maria B.E. Gerritse
- Department of Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Obstetrics and Gynecology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Ellis de Swart
- Department of Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marieke de Vries
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, the Netherlands
| | - Kirsten B. Kluivers
- Department of Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
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Chen DR, Weng HC. Associations of health literacy, personality traits, and pro-individualism with the willingness to complete advance directives in Taiwan. BMC Palliat Care 2023; 22:91. [PMID: 37424005 DOI: 10.1186/s12904-023-01215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Studies indicated that patients with advance directives (ADs) have a generally better quality of life near death. Yet, the concept of ADs is relatively new in East Asian countries. This study examined the associations between health literacy, pro-individualism in end-of-life (EOL) decisions (i.e., EOL pro-individualism), and master-persistence personality traits with the willingness to complete ADs. METHODS The data is from a representative data of 1478 respondents from the 2022 Taiwan Social Change Survey. Generalized structural equation modeling (GSEM) was used to conduct path analysis. RESULTS Nearly half of the respondents (48.7%) were willing to complete ADs. Health literacy has direct and indirect effects through EOL pro-individualism values on the willingness to complete ADs. Noncognitive factors such as mastery-persistence personality traits and EOL pro-individualism values enhanced the willingness to complete ADs. CONCLUSION A personalized communication strategy, mindful of personality dimensions and cultural values, can address individual fears and concerns, promoting the benefits of advance care planning (ACP). These influences can provide a roadmap for healthcare providers to customize their approach to ACP discussions, improving patient engagement in AD completion.
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Affiliation(s)
- Duan-Rung Chen
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Population Health Research Center, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Hui-Ching Weng
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Jamy OH, Dudley WN, Dudley LS, Scott JM, Wujcik D. Goals, preferences, and concerns of patients with acute myeloid leukemia at time of treatment decision. J Geriatr Oncol 2023; 14:101555. [PMID: 37327759 DOI: 10.1016/j.jgo.2023.101555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Current cancer value-based models require documentation of patient goals of care and an evidence-based treatment course commensurate with patient goals. This feasibility study assessed the utility of an electronic tablet-based questionnaire to elicit patient goals, preferences, and concerns at a treatment decision making time point in patients with acute myeloid leukemia. MATERIALS AND METHODS Seventy-seven patients were recruited from three institutions prior to seeing the physician for treatment decision-making visit. Questionnaires included demographics, patient beliefs, and decision-making preferences. Analyses included standard descriptive statistics appropriate for the level of measurement. RESULTS Median age was 71 (range = 61-88), 64.9% female, 87.0% white, and 48.6% college educated. On average, patients completed the surveys unassisted in 16.24 min and providers reviewed the dashboard in 3.5 min. All but one patient completed the survey prior to starting treatment (98.7%). Providers reviewed the survey results prior to seeing the patient 97.4% of the time. When asked their goals of care, 57 (74.0%) patients agreed with the statement "my cancer is curable" and 75 (97.4%) agreed that the treatment goal was to get rid of all cancer. Seventy-seven (100%) agreed the goal of care is to feel better and 76 (98.7%) agreed the goal of care is live longer. Forty-one (53.9%) indicated they wanted to make treatment decisions together with the provider. The top two concerns were understanding treatment options (n = 24; 31.2%) and making the right decision (n = 22; 28.6%). DISCUSSION This pilot demonstrated the feasibility of using technology for decision-making at the point of care. Eliciting patient goals of care, treatment outcomes expectations, decision-making preferences, and top concerns may provide clinicians with information to inform the treatment discussion. A simple electronic tool may provide valuable insight into patient understanding of disease to better tailor patient-provider discussion and treatment decision-making.
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Affiliation(s)
- Omer Hassan Jamy
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - William N Dudley
- Piedmont Research Strategies, Inc, Greensboro, NC, United States of America.
| | - Leah S Dudley
- Piedmont Research Strategies, Inc, Greensboro, NC, United States of America
| | - Julie M Scott
- Carevive Systems, Inc, Miami, FL, United States of America.
| | - Debra Wujcik
- Carevive Systems, Inc, Miami, FL, United States of America.
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Waddell A, Goodwin D, Spassova G, Bragge P. "The Terminology Might Be Ahead of Practice": Embedding Shared Decision Making in Practice-Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care. MDM Policy Pract 2023; 8:23814683231199943. [PMID: 37743932 PMCID: PMC10517621 DOI: 10.1177/23814683231199943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/20/2023] [Indexed: 09/26/2023] Open
Abstract
Background. It is a patient's right to be included in decisions about their health care. Implementing shared decision making (SDM) is important to enable active communication between clinicians and patients. Although health policy makers are increasingly mandating SDM implementation, SDM adoption has been slow. This study explored stakeholders' organizational- and system-level barriers and facilitators to implementing policy mandated SDM in maternity care in Victoria, Australia. Method. Twenty-four semi-structured interviews were conducted with participants including clinicians, health service administrators and decision makers, and government policy makers. Data were mapped to the Theoretical Domains Framework to identify barriers and facilitators to SDM implementation. Results. Factors identified as facilitating SDM implementation included using a whole-of-system approach, providing additional implementation resources, correct documentation facilitated by electronic medical records, and including patient outcomes in measurement. Barriers included health service lack of capacity, unclear policy definitions of SDM, and policy makers' lack of resources to track implementation. Conclusion. This is the first study to our knowledge to explore barriers and facilitators to SDM implementation from the perspective of multiple actors following policy mandating SDM in tertiary health services in Australia. The primary finding was that there are concerns that SDM implementation policy is outpacing practice. Nonclinical staff play a crucial role translating policy to practice. Addressing organizational- and system-level barriers and facilitators to SDM implementation should be a key concern of health policy makers, health services, and staff. Highlights New government policies require shared decision making (SDM) implementation in hospitals.There is limited evidence for how to implement SDM in hospital settings.There are concerns SDM implementation policy is outpacing practice.Understanding and capacity for SDM varies considerably among stakeholders.Whole of system approaches and electronic medical records are seen to facilitate SDM.
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Affiliation(s)
- Alex Waddell
- Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
- Safer Care Victoria, Victorian Department of Health, Melbourne, VIC, Australia
| | - Denise Goodwin
- Behaviour Works Australia Health Programs, Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | - Gerri Spassova
- Department of Marketing, Monash Business School, Caulfield East, VIC, Australia
| | - Peter Bragge
- Monash Sustainable Evidence Review Service, Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
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Koehler A, Strauss B, Briken P, Fisch M, Soave A, Riechardt S, Nieder TO. Exploring the Relationship between (De-)Centralized Health Care Delivery, Client-Centeredness, and Health Outcomes-Results of a Retrospective, Single-Center Study of Transgender People Undergoing Vaginoplasty. Healthcare (Basel) 2023; 11:1746. [PMID: 37372864 DOI: 10.3390/healthcare11121746] [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: 03/31/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction: Transgender health care interventions (e.g., gender-affirming surgery) support transgender and gender-diverse people to transition to their gender and are delivered in both centralized (by one interdisciplinary institution) and decentralized settings (by different institutions spread over several locations). In this exploratory study, we investigated the relationship between centralized and decentralized delivery of transgender health care, client-centeredness, and psychosocial outcomes. Methods: A retrospective analysis of 45 clients undergoing vaginoplasty at one medical center was conducted. Mann-Whitney U tests assessed differences regarding five dimensions of client-centeredness and psychosocial outcomes between the health care delivery groups. To address shortcomings regarding the small sample size, we applied a rigorous statistical approach (e.g., Bonferroni correction) to ensure that we only identified predictors that were actually related to the outcomes. Results: All aspects of client-centered care were scored average or high. Decentralized delivery of care was more client-centered in terms of involvement in care/shared decision-making and empowerment. However, participants from decentralized health care delivery settings scored lower on psychosocial health (p = 0.038-0.005). Conclusions: The factor of (de-)centralized health care delivery appears to have a significant impact on the provision of transgender health care and should be investigated by future research.
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Affiliation(s)
- Andreas Koehler
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, University Hospital Jena, Stoystrasse 3, 07740 Jena, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Margit Fisch
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Armin Soave
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Silke Riechardt
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Interdisciplinary Transgender Health Care Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Timo O Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
- Department for Urology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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