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Coakley M, Drohan M, Bruce E, Hughes S, Jackson N, Holmes S. COPD Self-Management: A Patient-Physician Perspective. Pulm Ther 2024:10.1007/s41030-024-00258-y. [PMID: 38758408 DOI: 10.1007/s41030-024-00258-y] [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: 12/22/2023] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
This article is co-authored by five patients living with chronic obstructive pulmonary disease (COPD), and a primary care physician who has over 30 years of clinical experience and is involved in educating healthcare professionals. The first section of this article is authored by the patients, who describe their experiences of living with COPD. The section that follows is authored by the physician, who discusses the management of COPD in the context of the patients' experiences.
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Chuang YH, Wang CC, Hsiao CY, Lu CY, Wu JC, Hou WH. Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study. BMJ Open 2024; 14:e075693. [PMID: 38309751 PMCID: PMC10840022 DOI: 10.1136/bmjopen-2023-075693] [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] [Received: 05/16/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan. DESIGN In-depth interviews and thematic analysis. SETTING Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022. PARTICIPANTS 21 outpatients with at least three visits for DJD and who were aware of SDM. RESULTS Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations. CONCLUSIONS In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.
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Affiliation(s)
- Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei, Taiwan
| | - Chih-Chien Wang
- College of Management, Da-Yeh University, Changhua, Taiwan
- Graduate Institute of Information Management, National Taipei University, Taipei, Taiwan
| | - Chih-Yin Hsiao
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yeh Lu
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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Ninković M, Ilić S, Damnjanović K. Women's trust in the healthcare system in Serbia: Validation of the Women's Trust and Confidence in Healthcare System scale. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241249864. [PMID: 38770772 PMCID: PMC11127576 DOI: 10.1177/17455057241249864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Women's role as patients is associated with power relationships embedded in society. Although trust in the health care system is a general prerequisite for positive health outcomes, practices regarding women's agency in healthcare systems in Southeastern Europe reinforce women's passivity. Most of the current psychological measures of trust have been constructed and validated in "WEIRD" (samples that are drawn from populations that are White, Educated, Industrialized, Rich, and Democratic) countries, thus having a limited application in other social contexts. OBJECTIVES We aimed to construct an instrument for assessing women's trust in healthcare systems to describe the structure of trust: Women's Trust and Confidence in the Healthcare System scale. DESIGN Two independent samples (N1 = 329; N2 = 333) of adult women in Serbia voluntarily completed an online questionnaire. The questionnaire comprised 20 trust-related items which were selected from an extensive collection of women's experiences in the healthcare system and evaluated by experts on a 5-point Likert-type scale. METHODS We used exploratory factor analysis of the Women's Trust and Confidence in the Healthcare System scale to analyze the structure of trust in the first sample data set and validated it with the second sample using confirmatory factor analysis. We tested concurrent validity by exploring how women's trust in the healthcare system predicts health-related behaviors (multigroup structural equation modeling). All analyses were conducted using R statistical software. RESULTS The Women's Trust and Confidence in the Healthcare System scale (Cronbach's alpha = 0.86) indicated a three-factor structure of trust in the healthcare system: trust in healthcare professionals, distrust in the public healthcare system, and confidence in healthcare system. This was validated using an independent sample. Interpersonal trust positively predicted women's desirable health behaviors, while trust in the system had a negative impact. CONCLUSION The Women's Trust and Confidence in the Healthcare System scale captures women's trust in a paternalistic healthcare system, is reliable, and has a stable three-factor structure. The study's findings reveal the relationship between women's trust and health-related behavior: in paternalistic environments, trust reinforces women's passivity.
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Affiliation(s)
- Milica Ninković
- Laboratory for Research of Individual Differences, Department of Psychology and Institute of Philosophy, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Sandra Ilić
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Kaja Damnjanović
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
- Institute of Philosophy, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
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Vanholder R, Annemans L, Braks M, Brown EA, Pais P, Purnell TS, Sawhney S, Scholes-Robertson N, Stengel B, Tannor EK, Tesar V, van der Tol A, Luyckx VA. Inequities in kidney health and kidney care. Nat Rev Nephrol 2023; 19:694-708. [PMID: 37580571 DOI: 10.1038/s41581-023-00745-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/16/2023]
Abstract
Health inequity refers to the existence of unnecessary and unfair differences in the ability of an individual or community to achieve optimal health and access appropriate care. Kidney diseases, including acute kidney injury and chronic kidney disease, are the epitome of health inequity. Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of disease. Insufficient investment across the spectrum of kidney health and kidney care is a fundamental source of inequity. In addition, social and structural inequities, including inequities in access to primary health care, education and preventative strategies, are major risk factors for, and contribute to, poorer outcomes for individuals living with kidney diseases. Access to affordable kidney care is also highly inequitable, resulting in financial hardship and catastrophic health expenditure for the most vulnerable. Solutions to these injustices require leadership and political will. The nephrology community has an important role in advocacy and in identifying and implementing solutions to dismantle inequities that affect kidney health.
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Affiliation(s)
- Raymond Vanholder
- European Kidney Health Alliance, Brussels, Belgium.
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium.
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marion Braks
- European Kidney Health Alliance, Brussels, Belgium
- Association Renaloo, Paris, France
| | - Edwina A Brown
- Imperial College Healthcare NHS Trust, Imperial College Renal and Transplant Center, London, UK
| | - Priya Pais
- Department of Paediatric Nephrology, St John's Medical College, Bengaluru, India
| | - Tanjala S Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Simon Sawhney
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | | | - Bénédicte Stengel
- Clinical Epidemiology Team, Center for Research in Epidemiology and Population Health (CESP), University Paris-Saclay, UVSQ, Inserm, Villejuif, France
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Directorate of Medicine, Komfo Anokye, Teaching Hospital, Kumasi, Ghana
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Arjan van der Tol
- Nephrology Section, Department of Internal Medicine and Paediatrics, University Hospital Ghent, Ghent, Belgium
| | - Valérie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
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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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Byrne A, Jones K, Backhouse M, Rose F, Moatt E, van der Feltz-Cornelis C. Patient and primary care practitioners' perspectives on consultations for fibromyalgia: a qualitative evidence synthesis. Prim Health Care Res Dev 2023; 24:e58. [PMID: 37750736 PMCID: PMC10540196 DOI: 10.1017/s1463423623000506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Fibromyalgia presents a challenge to both the patients experiencing symptoms and the staff aiming to treat them. This qualitative review aimed to synthesise how patients and practitioners experience primary care consultations, develop a rounded picture of how they perceive each other, the challenges to primary care consultation and how they might be tackled. METHODS CINAHL, Embase, CENTRAL and Medline were searched from inception to November 2021. Qualitative studies were included if they explored the perspectives and experiences of either fibromyalgia patients or primary care practitioners. Quantitative data, studies not published in English, not set in primary care or that did not distinguish the type of patient or clinician were excluded. Included studies were analysed using thematic synthesis and their quality assessed. RESULTS In total, 30 studies met the inclusion criteria. Thematic synthesis identified three overarching themes: (1) life turned upside down - exploring the chaos experienced by patients as they seek help; (2) negative cycle - highlighting how patient and practitioner factors can create a detrimental cycle; and (3) breaking the cycle - validating patient-doctor relationships underpinned by clear communication can help break the negative cycle. CONCLUSIONS Fibromyalgia patients experience uncertainty and chaos that can clash with the attitudes of GPs and the help they can feasibly provide. Difficult consultations in which neither the GP nor patient are satisfied can easily occur. Promoting supportive, reciprocal and open patient-doctor relationships is essential. Future research is required to further explore GP attitudes and to develop an intervention that could improve consultations, patient outcomes and GP satisfaction.
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Affiliation(s)
- Ailish Byrne
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, UK
| | - Katherine Jones
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Fiona Rose
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, UK
| | - Emma Moatt
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, UK
| | - Christina van der Feltz-Cornelis
- Mental Health and Addictions Research Group, Department of Health Sciences, Hull York Medical School, University of York, Heslington, York, UK
- Institute of Health Informatics, University College London, London, UK
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Horton A, Flenady T, Massey D. The factors impacting sepsis recognition in older adults in non-clinical environments - a scoping review. Int Emerg Nurs 2023; 70:101323. [PMID: 37597281 DOI: 10.1016/j.ienj.2023.101323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Annette Horton
- Rockhampton Hospital, Central Queensland Hospital Health Service, Rockhampton 4700, Australia.
| | - Tracy Flenady
- Central Queensland University, School of Nursing & Midwifery, Rockhampton 4701, Australia
| | - Deb Massey
- Edith Cowan University, School of Nursing & Midwifery, Joondalup 6027, Australia
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Szabó RM, Buzás N, Braunitzer G, Shedlin MG, Antal MÁ. Factors Influencing Patient Satisfaction and Loyalty as Perceived by Dentists and Their Patients. Dent J (Basel) 2023; 11:203. [PMID: 37754323 PMCID: PMC10529870 DOI: 10.3390/dj11090203] [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: 07/27/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE This study aimed to identify the key aspects of patients' dental care experience that influenced their self-perceived satisfaction and loyalty. Also examined was the agreement between patients and dentists regarding these factors. METHODS Questionnaires were administered to 1121 patients and 77 dentists, focusing on demographic information and 15 selected items related to the patients' last dental visit. Descriptive and linear regression analyses were conducted. RESULTS The study included participants from 41 practices. Factors significantly influencing satisfaction and loyalty included location convenience, treatment quality, trust in dentists' decisions, visit frequency satisfaction, clear treatment explanations, dentist's interest in symptoms, patient-dental personnel attachment, and dentist's knowledge of the patient and their medical records. While overall agreement between patients and dentists was high, some areas exhibited notable disagreement. CONCLUSIONS The findings mostly align with existing literature, underscoring the importance of communication, trust, and a personal patient-dentist relationship in promoting satisfaction and loyalty. However, they also show that local, generally not reported factors might be at play, which necessitates dentists' awareness and consideration of the local context for optimal outcomes.
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Affiliation(s)
- Réka Magdolna Szabó
- Department of Health Economics, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary; (R.M.S.); (N.B.)
| | - Norbert Buzás
- Department of Health Economics, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary; (R.M.S.); (N.B.)
| | | | | | - Mark Ádám Antal
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, University of Szeged, 6720 Szeged, Hungary
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Power A, Tuteja A, Mascarenhas L, Temple-Smith M. A qualitative exploration of obtaining informed consent in medical consultations with Burma-born women. Aust J Prim Health 2023; 29:284-291. [PMID: 36442078 DOI: 10.1071/py22138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/07/2022] [Indexed: 07/20/2023]
Abstract
BACKGROUND Conciliatory attitudes, respect for medical professionals and avoidance of being direct can make health consultations with Burma-born patients difficult to navigate. Coupled with linguistic barriers, this may make the sensitive nature of many women's health consultations challenging. Little is known about current practices for obtaining informed consent in this context. The objectives of this study were to explore current practices, barriers and strategies to obtaining informed consent in medical consultations with women born in Burma. METHODS Purposive and snowball sampling was used to recruit health practitioners (n =15, 2 male, 13 female) of different ages, years of professional experience, and country of origin, from clinics in Victoria that see a high volume of Burma-born patients. Thirty to sixty minute semi-structured interviews were conducted with four general practitioners, eight nurses and three interpreters, and de-identified audio recordings were transcribed for inductive thematic analysis. RESULTS Five key themes were generated: (1) cultural cognisance; (2) influence of community; (3) skilful navigation of communication; (4) favourable consultation attributes; and (5) individual tailoring of consent conversations. Differing cultural expectations, and linguistic and educational barriers, were highlighted as challenges to obtaining informed consent, whereas thoughtful utilisation of non-verbal communication, and intentional customisation of consent conversations were identified as facilitators. CONCLUSION The findings of this study provide practical ways to optimise the informed consent process within the Australian primary healthcare context, and reinforce that accepted Western-based practices for obtaining informed consent are not a 'one-size-fits-all' process.
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Affiliation(s)
- Anna Power
- Department of General Practice, University of Melbourne, Parkville, Vic. 3010, Australia; and The Royal Australian College of General Practitioners, East Melbourne, Vic. 3002, Australia
| | - Amita Tuteja
- Department of General Practice, University of Melbourne, Parkville, Vic. 3010, Australia
| | - Lester Mascarenhas
- Department of General Practice, University of Melbourne, Parkville, Vic. 3010, Australia; and Utopia Refugee and Asylum Seeker Health, Hoppers Crossing, Vic. 3029, Australia
| | - Meredith Temple-Smith
- Department of General Practice, University of Melbourne, Parkville, Vic. 3010, Australia
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Panahi S, Spearman B, Sundrud J, Lunceford M, Kamimura A. The Impact of Patient Autonomy Among Uninsured Free Clinic Patients. J Patient Exp 2023; 10:23743735231179041. [PMID: 37323759 PMCID: PMC10265317 DOI: 10.1177/23743735231179041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Uninsured primary care patients tend to experience barriers to autonomy in clinical decision-making due to limited choices of healthcare facilities and low health literacy. This study examined whether certain factors, including the component of patient-centeredness, are associated with patient autonomy among these populations and contribute to reducing disparities in healthcare. This was a cross-sectional study using a convenience sample of free clinic patients aged 18 years and older who spoke English and/or Spanish. Multiple regression analyses were performed to understand factors associated with Ideal Patient's Autonomy. Data were collected from September to December 2019. Findings conclude that Spanish-speaking patients at the free clinic have a stronger belief in a paternalist model of the provider-patient relationship (P < .01). Better communication between patients and providers results in higher levels of autonomy (P < .01). Higher levels of educational attainment and better communication partnership were associated with higher levels of a free clinic patient's understanding of treatment risks (P < .01). This research study found that components of patient-centeredness are important considerations for improving patient autonomy among free clinic patients.
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Affiliation(s)
- Samin Panahi
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Akiko Kamimura
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
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Melhem SJ, Nabhani-Gebara S, Kayyali R. Cancer literacy among Jordanian colorectal cancer survivors and informal carers: Qualitative explorations. Front Public Health 2023; 11:1116882. [PMID: 37020817 PMCID: PMC10067669 DOI: 10.3389/fpubh.2023.1116882] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/01/2023] [Indexed: 03/22/2023] Open
Abstract
IntroductionCancer patients face a variety of challenges in understanding their diagnosis and treatment options. Making informed decisions requires health literacy. There is scant research on how colorectal cancer (CRC) survivors and their caregivers engage with healthcare systems and obtain cancer-related knowledge to maintain proper health literacy, which is crucial for enhancing their outcomes.Materials and methodsIn-depth semi-structured interviews (IDIs) with CRC survivors (n = 15) and online focus groups (FG) with informal caregivers (ICs) were held in Amman between Jan-June 2020. In-depth interviews were conducted using semi-structured interview protocol that addressed the healthcare experience of CRC cancer survivors. FGs evaluated ICs' perspectives of e-health for cancer care support. IDIs and FGs were done in the local Jordanian Arabic dialect, which was then translated into English. Transcribed audio-recordings were thematically coded and framework analysis was used.ResultsThe findings are organized around a central concept of “exploring the level of literacy and its impact.” From the overarching theme, three themes and subthemes emerged, including: (1) The current state of counseling and information provision, (2) The impact of lack of information, awareness, and literacy and (3) The health system's influence on literacy.ConclusionsPoor cancer literacy hinders patients throughout their cancer journey. Empowering cancer patients is crucial for a more timely and positive patient experience. Increased cancer literacy together with the creation of health-literate organizations and systems have the potential to improve patients' treatment throughout the continuum of care.
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[Public mental health and patient autonomy-an area of conflict?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:410-415. [PMID: 36862213 DOI: 10.1007/s00103-023-03676-6] [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: 09/30/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023]
Abstract
Public mental health (PMH) interventions aim to promote and improve the well-being of members of a society. PMH is based on a normative understanding of what well-being is and what factors contribute to it. Without necessarily disclosing it, measures of a PMH program may affect the autonomy of individuals if their personal perceptions regarding their own individual well-being differ from PMH's prescriptions for well-being oriented toward societal goals. In this paper, we discuss this potential tension between the possible goals of PMH and those of the addressees.
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Nanu CA, Plaiasu MC, Edu A. Geographic and Specialty-Specific Disparities in Physicians' Legal Compliance: A National-Scale Assessment of Romanian Medical Practice. Healthcare (Basel) 2023; 11:healthcare11040499. [PMID: 36833032 PMCID: PMC9957268 DOI: 10.3390/healthcare11040499] [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: 12/31/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Physicians must respect their patients' rights to informed consent, privacy, access to medical records, non-discrimination, treatment by a qualified doctor, and a second medical opinion. Compliance with patients' rights is mandatory, and legal breaches are considered medical malpractice under Romanian law. This is the first study to assess physicians' practices nationally and create a geographical map of legal compliance. RESULTS We examined survey responses of 2978 physicians, including 1587 general practitioners and 1391 attending physicians from high-risk specialties. According to the findings, 46.67% of physicians' practices adhered to the law. Physicians' practices were homogenous across the country's regions. General practitioners were significantly more legally compliant than attending physicians were. Additionally, 94.02% of the physicians acknowledged malpractice anxiety, whereas only 17.67% had been accused of malpractice. CONCLUSIONS Our findings emphasize the need for further research and to voice issues about Romanian physicians' low level of legal compliance. This study provides a starting point for future studies to evaluate the benefits of interventional strategies in this field. Healthcare facilities should provide physicians with easily available resources when they are unsure about their legal obligations, and establish an observer organization that can detect unlawful conduct. Interventions should concentrate on education programs and expert guidance.
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Affiliation(s)
- Codrut Andrei Nanu
- Department No. 14 of Orthopedics, Anesthesia and Intensive Care, University of Medicine and Pharmacy “Carol Davila” Bucharest, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Maria Cristina Plaiasu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St, 200349 Craiova, Romania
- Correspondence: ; Tel.: +40-770-112-453
| | - Antoine Edu
- Department No. 14 of Obstetrics and Gynecology, University of Medicine and Pharmacy “Carol Davila” Bucharest, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
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Shiao YC, Lu ZYJ, Fu CP, Lin JY, Chang YW, Chen WT, Wang CC. A novel curriculum for the Same-Sex Marriage Act and Patient Right to Autonomy Act (SMPRA) module based on two new laws in Taiwan: a mixed-methods study. BMC MEDICAL EDUCATION 2023; 23:91. [PMID: 36739384 PMCID: PMC9899378 DOI: 10.1186/s12909-023-04076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/01/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The establishment of laws has had a tremendous impact on holistic medical care. The Patient Right to Autonomy (PRA) Act and the Same-Sex Marriage Act have been passed in Taiwan, and both have sparked intense societal debate. The Same-Sex Marriage Act and PRA Act (SMPRA) teaching module was created for the Gender, Medicine, and Law (GML) course of the medical curriculum. This video trigger-assisted problem-based learning (VTA-PBL) software has integrated content on the aforementioned legislative proclamations. It upends conventional beliefs and fosters reflective practices on sexual rights and the right to representation among medical students. This study examined how the SMPRA module affected the knowledge and attitudes of medical students taking up the GML course. METHODS A simple pre-/post-test design evaluated the outcomes of the PBL module to examine the changes in knowledge and attitudes of medical students toward same-sex marriage rights. In 2019 and 2020, 126 and 49 5th-year medical students took up the GML course, respectively. The GML components included a video scenario representing advanced decision-making and a healthcare agency with a same-sex couple, a PBL discussion, and student feedback presentations. The mechanisms of feedback collection and measuring student knowledge and attitudes toward sexual rights differed between one cohort in 2019 and the other in 2020. Pre- and post-lecture tests were used in the first school year, whereas a post-lecture open-ended questionnaire survey was used in the second school year. RESULTS In total, 90 and 39 eligible questionnaires were received in the first and second school years, respectively, which corresponded to response rates of 71% and 80%. Students showed a better understanding of and positive enhancement of proficiency in legal and ethical content and relevant clinical practice. Qualitative analysis revealed that students viewed healthcare providers as checkpoints for conflicts of interest; medical ethics as the cornerstone of clinical practice; cultural background as a significant influence on decision-making; and empathetic communication as the cornerstone of relationships between patients, family members, and doctors. CONCLUSION The GML course of the SMPRA module fosters reflective practices on ethical and legal sexual rights issues.
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Affiliation(s)
- Yi-Chih Shiao
- School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, Taipei City, 11490, Taiwan
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist, Taipei City, 11490, Taiwan
- College of Law, National Chengchi University, No.64, Sec.2, ZhiNan Rd., Wenshan District, Taipei City, 11605, Taiwan
| | - Zxy-Yann Jane Lu
- Department of Bioscience Technology, Chung Yuan Christian University, No. 200, Zhongbei Rd., Zhongli Dist, Taoyuan City, 320314, Taiwan
| | - Chung-Pei Fu
- Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, No.510, Zhongzheng Rd., Xinzhuang Dist, New Taipei City, 24205, Taiwan
| | - Jing-Yi Lin
- School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, Taipei City, 11490, Taiwan
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist, Taipei City, 11490, Taiwan
| | - Yaw-Wen Chang
- School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, Taipei City, 11490, Taiwan
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist, Taipei City, 11490, Taiwan
| | - Wan-Ting Chen
- School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, Taipei City, 11490, Taiwan
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist, Taipei City, 11490, Taiwan
| | - Chih-Chia Wang
- School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, Taipei City, 11490, Taiwan.
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist, Taipei City, 11490, Taiwan.
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15
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Lee PY, Cheong AT, Ghazali SS, Rashid AA, Ong SC, Ong SY, Alip A, Sylvia M, Chen MF, Taib NA, Jaganathan M, Ng CJ, Teo SH. Barriers of and strategies for shared decision-making implementation in the care of metastatic breast cancer: A qualitative study among patients and healthcare professionals in an Asian country. Health Expect 2022; 25:2837-2850. [PMID: 36098241 DOI: 10.1111/hex.13590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/16/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Shared decision-making has been shown to improve the quality of life in metastatic breast cancer patients in high-literacy and high-resource settings. However, limited studies have examined the cultural preferences of metastatic breast cancer patients with shared decision-making implementation and the barriers encountered in an Asian setting where societal norms predominate and physician decision-making is at the forefront. This paper aims to identify (1) barriers to practising shared decision-making faced by healthcare professionals and patients and (2) strategies for implementing shared decision-making in the context of metastatic breast cancer management in Malaysia. METHODS We conducted a qualitative study involving 12 patients diagnosed with metastatic breast cancer, 16 healthcare professionals and 5 policymakers from surgical and oncology departments at public healthcare centres in Malaysia. Semi-structured in-depth interviews and focus group discussions were conducted. The interviews were recorded, transcribed verbatim and analysed using the thematic approach. Nvivo software was used to manage and analyse the data. RESULTS Five main themes emerged from the study: healthcare provider-patient communication, workforce availability, cultural and belief systems, goals of care and paternalism versus autonomy. Other strategies proposed to overcome barriers to implementing shared decision-making were training of healthcare professionals and empowering nurses to manage patients' psychosocial issues. CONCLUSION This study found that practising shared decision-making in the public health sector remains challenging when managing patients with metastatic breast cancer. The utilization of decision-making tools, patient empowerment and healthcare provider training may help address the system and healthcare provider-patient barriers identified in this study. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the study design, recruitment and analysis.
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Affiliation(s)
- Ping Yein Lee
- UMeHealth Unit, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia.,Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Aneesa Abdul Rashid
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Siu Ching Ong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia.,Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
| | - Soo Ying Ong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia.,Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
| | - Adlinda Alip
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - McCarthy Sylvia
- Clinical Service Department, Hospis Malaysia, Kuala Lumpur, Malaysia
| | - May Feng Chen
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Universiti Malaya Cancer Research Institute, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | | | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia.,Health Services & Systems Research, Duke NUS Medical School, Singapore, Singapore.,SingHealth Polyclinics, Singapore, Singapore
| | - Soo-Hwang Teo
- Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
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16
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Surendran S, Castro-Sánchez E, Nampoothiri V, Joseph S, Singh S, Tarrant C, Holmes A, Charani E. Indispensable yet invisible: A qualitative study of the roles of carers in infection prevention in a South Indian hospital. Int J Infect Dis 2022; 123:84-91. [PMID: 35988864 DOI: 10.1016/j.ijid.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/21/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVES We investigated the roles of patient carers in infection-related care on surgical wards in a South Indian hospital from the perspective of healthcare workers (HCWs), patients, and their carers. METHODS Ethnographic study included ward-round observations (138 hours) and face-to-face interviews (44 HCWs, 6 patients/carers). Data (field notes, interview transcripts) were coded in NVivo 12 and thematically analyzed. Data collection and analysis were iterative, recursive, and continued until thematic saturation. RESULTS Carers have important, unrecognized roles. At the study site, institutional expectations are formalized in policies, demanding a carer to always accompany in-patients. Such intense presence embeds families in the patient care environment, as demonstrated by their high engagement in direct personal (bathing patients) and clinical care (wound care). Carers actively participate in discussions on patient progress with HCWs, including therapeutic options. There is a misalignment between how carers are positioned by the organization (through policy mandates, institutional practices, and HCWs expectations), and the role that they play in practice, resulting in their role, though indispensable, remaining unrecognized. CONCLUSION Current models of patient and carer involvement in infection prevention and control are poorly aligned with sociocultural and contextual aspects of care. Culture-sensitive infection prevention and control policies which embrace the roles that carers play are urgently needed.
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Affiliation(s)
- Surya Surendran
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, India; Health System and Equity, The George Institute for Global Health, New Delhi, India
| | - Enrique Castro-Sánchez
- Department of Medicine, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom; School of Health Sciences, University of West London, London, United Kingdom
| | - Vrinda Nampoothiri
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Shiny Joseph
- Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | - Sanjeev Singh
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Alison Holmes
- Department of Medicine, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom
| | - Esmita Charani
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, India; Department of Medicine, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom; Centre for Excellence in Infectious Diseases Research, University of Liverpool, Liverpool, United Kingdom; Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, South Africa.
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17
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Difficult Conversations. Plast Reconstr Surg 2022; 150:237-241. [PMID: 35895519 DOI: 10.1097/prs.0000000000009087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Is Teleaudiology Achieving Person-Centered Care: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127436. [PMID: 35742684 PMCID: PMC9224155 DOI: 10.3390/ijerph19127436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023]
Abstract
Digital health and person-centered care are unquestionably linked in today’s Australian healthcare landscape. Teleaudiology is the application of digital health in the field of audiology, and it has become a popular component of standard audiological care. Behavior modification is essential in audiology intervention. Guidance on achieving behavior change, which is dependent on digitally enabled intervention, is a valuable resource when used in tandem to achieve person-centered care. The aim of this review is to determine whether teleaudiology achieves person-centered care. A qualitative review was conducted, followed by mapping and analysis. Analysis identified evidence of teleaudiology use, and ascertained guiding principles are appropriate to behavior change dependent digital intervention supported or enabled person-centered care. In conclusion, teleaudiology will continue to be a promising technology for promoting relatedness, a positive user experience, confidence and capability, and appropriate levels of autonomy for the user to choose from among the person-centered care options available.
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19
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Riegel M, Randall S, Buckley T. Factors associated with the decision to offer memory making in end-of-life: A survey of healthcare professionals in adult intensive care. J Clin Nurs 2022; 32:2627-2641. [PMID: 35415864 DOI: 10.1111/jocn.16323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
AIM Report experiences and behaviour influences with healthcare professionals' decision to and experiences of offering memory making during end-of-life care in the adult acute population. BACKGROUND Little is known about healthcare professionals' experiences offering memory making during adult acute end-of-life care. DESIGN Survey. METHODS Registered nurses, medical practitioners and social workers employed at a single tertiary referral adult intensive care, where memory making had been implemented nearly two years prior were invited to participate between June and August 2017. Reporting adheres to the STROBE checklist. RESULTS Ninety-six valid surveys (75% response rate: 75 registered nurses, 19 medical practitioners, and 2 social workers) were analysed with 67 participants reporting experience offering memory making. Highest overall agreement scores included believing families value memory making and the offer of memory making being beneficial. Enablers were described as organisational supports, personal qualities and good interpersonal relationships. Barriers identified included the intensive care environment, workload, inexperience offering/facilitating memory making, being afraid to offer, lack of resources and legality concerns. Compared with non-experienced participants, experienced participants reported higher level of confidence and comfort offering memory making, pride in their ability, ability to spend time supporting families and had observed colleagues offering memory making. Experienced participants were less likely to be afraid to offer, be limited by the family's behaviours, report lack of resources or be time limited to offer memory making. CONCLUSION Findings identify elements needed for the development and support for offering memory making to assist bereaved families in adult acute care including role modelling, support to reduce negative emotions, workload assistance and leadership/organisational support. RELEVANCE TO CLINICAL PRACTICE Discoveries have important implications in addressing evidence gaps regarding behaviour influences linked to the decision to offer memory making. Findings inform development and sustainability to integrate memory making as routine end-of-life care intervention in adult acute care.
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Affiliation(s)
- Melissa Riegel
- Adult Intensive Care Unit, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Sue Randall
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Thomas Buckley
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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20
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Shemesh B, Opie J, Tsiamis E, Ayton D, Satasivam P, Wilton P, Gough K, Lewis K, O'Brien C, Shub M, Pomery A, Mac Manus C, Millar J, Evans S. Codesigning a patient support portal with health professionals and men with prostate cancer: An action research study. Health Expect 2022; 25:1319-1331. [PMID: 35411697 PMCID: PMC9327875 DOI: 10.1111/hex.13444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/02/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The supportive care needs of men with prostate cancer (PCa) have been well documented, but little is known about how an online portal may address these. This study sought to determine priority issues facing men with PCa, barriers and enablers to accessing care and whether health professionals (HPs) and men would support the inclusion of a patient-reported outcome (PRO) comparator tool. METHODS We conducted four online focus groups with HPs recruited from healthcare services in Victoria, followed by seven online codesign workshops with men with PCa, recruited through the Victorian Prostate Cancer Outcomes Registry, Prostate Cancer Foundation Australia and the Cancer Council Victoria. Men were eligible to participate if they had lived experience of PCa and access to the internet. We analysed focus groups thematically. Workshops were analysed using descriptive-content analysis. RESULTS HPs (n = 39) highlighted that men had shifting priorities over time, but noted the importance of providing information to men in lay terms to assist in treatment decision-making and side-effect management. HPs identified key enablers to men accessing support services such as practice nurses, partners and having men share their stories with each other. HPs raised financial, cultural, geographic and emotional barriers to accessing supportive care. Inclusion of a PRO comparator tool received mixed support from HPs, with 41% (n = 16) supportive, 49% (n = 19) unsure and 10% (n = 4) not supportive. Men involved in workshops (n = 28) identified informational needs to assist in treatment decision-making and side-effect management as the top priority throughout care. Men described support groups and practice nurses as key enablers. Short consultation times and complex information were described as barriers. Unlike HPs, all men supported the inclusion of a PRO comparator tool in a portal. CONCLUSIONS Our findings suggest that a patient support portal should provide information in lay terms that address the shifting priorities of men with PCa. Men with PCa would welcome the development of a portal to centralize support information and a PRO comparator tool to prompt health-seeking behaviour. Future research will implement these findings in the development of a portal, and pilot and evaluate the portal within a population-based sample. PATIENT OR PUBLIC CONTRIBUTION This project adopted a codesign approach including both men with PCa and HPs involved in PCa care. Men with PCa also formed part of the study's steering committee and consumer advisory groups. HPs were consulted in a serious of online focus groups. Subsequently, men with PCa and their support persons participated in workshops. Men with PCa were also involved in the preparation of this manuscript.
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Affiliation(s)
- Benjamin Shemesh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jacinta Opie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ellie Tsiamis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Prassannah Satasivam
- Department of Surgery, Northern Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paula Wilton
- The Victorian Agency for Health Information (VAHI), Melbourne, Victoria, Australia
| | - Karla Gough
- Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Katrina Lewis
- Patient Experience and Consumer Participation, Alfred Health, Melbourne, Victoria, Australia
| | - Colin O'Brien
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Max Shub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | | | - Jeremy Millar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Susan Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Cancer Council Victoria, Melbourne, Victoria, Australia
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21
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Maples NJ, Velligan DI, Jones EC, Espinosa EM, Morgan RO, Valerio-Shewmaker MA. Perspectives of Patients and Providers in Using Shared Decision Making in Psychiatry. Community Ment Health J 2022; 58:578-588. [PMID: 34176054 PMCID: PMC8860777 DOI: 10.1007/s10597-021-00856-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
There is increased interest over the last decade in the use of Shared Decision Making with individuals with serious mental illness to improve engagement in treatment and clinical outcomes. We conducted semi-structured qualitative interviews with 15 individuals with serious mental illness treated in an outpatient transitional care clinic serving people immediately after discharge from a psychiatric hospitalization. Parallel interviews were conducted with a variety of clinical providers (n = 9). Using latent thematic analysis, six themes were identified including: (1) Differences in the Use of SDM, (2) Consideration of Past Experiences, (3) Decisional Power Preferences, (4) Use of SDM in Psychiatry Versus Other Areas of Medicine, (5) Dignity and Disengagement, and (6) External Forces Impacting SDM. Implications for clinical practice and research using a shared decision-making approach within this treatment setting are further discussed.
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Affiliation(s)
- Natalie J Maples
- Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, San Antonio, TX, USA.
- Department of Psychiatry and Behavioral Sciences, MS7797, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA.
| | - Dawn I Velligan
- Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, San Antonio, TX, USA
| | - Eric C Jones
- Department of Epidemiology, Human Genetics and Environmental Sciences, UT School of Public Health, El Paso, TX, USA
| | | | - Robert O Morgan
- Department of Management, Policy, and Community Health, UT School of Public Health, Houston, TX, USA
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22
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Chang DS, Chen WL, Wang R. Impact of the bidirectional relationship between communication and cognitive efficacy on orthopedic patient adherence behavior. BMC Health Serv Res 2022; 22:199. [PMID: 35164761 PMCID: PMC8845262 DOI: 10.1186/s12913-022-07575-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
Background There is growing interest in patient autonomy, and communication between physicians and patients has become the essential cornerstone for improving the quality of healthcare services. Previous research has concentrated on the direct effect of physician-patient communication on service outcomes. In the present study, we examined the influence among constructs in the service process and the impact on healthcare outcomes. The present study used behavioral theory to expand the process aspect of the Donabedian healthcare service quality structure-process-outcome model to examine the impact of cognitive changes and communication feedback on patients’ adherence behavior. In addition, the moderating effect of hospital facility levels is examined. Methods A conceptual model was developed and tested using a questionnaire administered to patients in eight hospitals. A total of 397 respondents returned usable surveys, with a response rate of 92.11%. Structural equation modeling was used to analyze the data in two steps that involved a measurement model and a structural model. The former was applied to estimate the Cronbach’s alphas, intercorrelations of factors, and descriptive statistics; the latter was used to test the hypothesized relationships of the constructs. Results The results identified three mediators of the healthcare process within the healthcare services framework: physician-patient communication, cognitive efficacy, and adherence behavior. Physician-patient communication influenced cognitive efficacy (β = 0.16, p < 0.001), and cognitive efficacy influenced physician-patient communication (β = 0.18, p < 0.001). The effect of this bidirectional relationship on adherence behavior was positive (β = 0.38, p < 0.001). The healthcare structure influenced healthcare outcomes via these three healthcare process constructs. The adherence behavior of patients who were treated in the medical center has greater influences by the structure and physician-patient communication than it was treated in the regional hospitals. Conclusions This study revealed a complex pattern in relationships among process constructs for healthcare services. The findings of this study acknowledge the important potential interrelationships among the healthcare service constructs to improve the quality of healthcare outcomes. Trial registration CRREC104107. Date: 22/01/2016. Prospectively Registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07575-5.
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Affiliation(s)
- Dong-Shang Chang
- Department of Business Administration, National Central University, Taoyuan, Taiwan
| | - Wil-Lie Chen
- School of Nursing, China Medical University, Taichung, Taiwan.
| | - Rouwen Wang
- Department of Business Administration, National Central University, Taoyuan, Taiwan
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23
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Airola E. Learning and Use of eHealth Among Older Adults Living at Home in Rural and Nonrural Settings: Systematic Review. J Med Internet Res 2021; 23:e23804. [PMID: 34860664 PMCID: PMC8686468 DOI: 10.2196/23804] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/23/2020] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
Background Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim. However, there is a need to better understand older adults’ needs for eHealth services, and thus, these health solutions require further exploration. Objective The purpose of this systematic literature review is to appraise, synthesize, and summarize the literature on older adults’ (aged ≥60 years) eHealth learning and use in real home settings, particularly in rural and remote areas, with a focus on the social and cultural context. Methods A systematic search was conducted in January 2020 using 4 academic databases. The studies by means of qualitative thematic analysis to identify the barriers, enablers, and support practices involved in the domestication process were examined. In addition, we identified the various meanings attached to eHealth technologies for older adults living in rural and remote areas. Results In total, 31 empirical studies published between 2010 and 2020 were included in this review. A total of 17 articles included participants from rural and remote areas. The most regularly reported barriers related to older adults’ learning to use and use of eHealth were health-related difficulties, such as cognitive impairment or impaired hearing. The most reported enabler was the support provided for older adults in learning and use of eHealth. Support mainly comprised older adults’ own digital competences, which were distributed with their social network. It was found that eHealth technology is needed for rural and remote areas to facilitate access and reduce logistical barriers to health care services. Conclusions The literature review provided information and practical implications for designers, health care providers, and policy makers. On the basis of these findings, eHealth technologies should be easy to use, and adequate support should be provided to older adults for use.
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Affiliation(s)
- Ella Airola
- Media Education Hub, Faculty of Education, University of Lapland, Rovaniemi, Finland
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24
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Provencal Levesque O, Vandyk A, Vanderspank-Wright B, Kaluzienski M, Jacob JD. Engaging in resuscitation status conversations in psychiatry: A qualitative study of nurses' perspectives. J Psychiatr Ment Health Nurs 2021; 28:995-1004. [PMID: 34322957 DOI: 10.1111/jpm.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/30/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Discussion and documentation of a patient's resuscitation status are essential aspects of any hospital admission, and yet, they seldomly occur in psychiatry. Nurses play an important role in resuscitation status determination by being an information broker, supporter and advocate. Persons with mental illness may be competent to engage in the determination of their resuscitation status and deserve the same respect and autonomy as other patients during this process. There are no published qualitative studies exploring healthcare providers experiences in initiating resuscitation status conversations in the psychiatric setting. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: An in-depth qualitative understanding of the complexity of resuscitation status determination in psychiatry. The shared experiences of nurses enacting their role in resuscitation status determination with patients admitted to psychiatry. The challenges of implementing a 'one-size fits all' approach to resuscitation status policies, and the ways in which depression and/or suicidal ideation influence the process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Role clarity and improved communication between providers about resuscitation status determination in psychiatry are needed. Hospital policies for resuscitation status determination must account for the psychiatric context to ensure patients' goals of care are known and upheld. Nurses working in psychiatry should initiate and more readily engage in resuscitation status conversations. ABSTRACT: Introduction Patients with mental illness experience stigma and marginalization, which affects the quality of their health care. In most settings, end-of-life decisions, including goals of care, must be discussed with all patients upon hospital admission, including determining cardiopulmonary resuscitation preferences in the event of a medical emergency. Despite this requirement, these conversations do not routinely occur in inpatient psychiatry. By default, patients become a 'full code status', mandating life-sustaining interventions. Aim To explore how and why resuscitation status conversations occur, or do not occur, in inpatient psychiatry from the perspectives of healthcare providers. Method Qualitative descriptive study using focus groups with nurses working in psychiatry. Results Nurses' experiences with initiating and engaging in resuscitation status conversations related to Working in Psychiatry, which represents the current practices and the participants' views of the nursing role; Caring for Psychiatric Patients, which describes how fluctuating competency and suicidality influence determination; and The Influence of Physical Health Status, which details how differences in physical health status affect how healthcare providers engage in resuscitation status determination. Discussion Although the importance of completing resuscitation status conversations with patients admitted to psychiatry was expressed by participants, they seldomly occur. There is ambiguity about when and how to determine patient wishes. Implications for practice Tailored strategies are needed to ensure patients' rights to self-determination are upheld when they are admitted to psychiatry. Nurses working in this setting would benefit from education, training and support to adequately initiate and engage in these conversations.
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Affiliation(s)
| | - Amanda Vandyk
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Mark Kaluzienski
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jean Daniel Jacob
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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St John A, Carlisle K, Kligman M, Kavic SM. What's Nissen on the net? the quality of information regarding Nissen fundoplication on the internet. Surg Endosc 2021; 36:5198-5206. [PMID: 34845552 DOI: 10.1007/s00464-021-08895-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND More patients are turning to the internet for their health information than ever before. This is a growing problem as it is well recognized that medical information on the internet is highly variable. We assessed the quality of information on the internet regarding the anti-reflux procedure, Nissen Fundoplication. Three commonly used measures of website quality are the Health On the Net code, the Journal of the American Medical Association Benchmark criteria, and the DISCERN tool. The HON code is a seal of approval awarded by an independent organization where the JAMA Benchmark and DISCERN Tool are a set of standards that can be utilized by an internet user or webpage creator. METHODS We performed a Google search using the term "Nissen Fundoplication", where we analyzed the top 75 websites. We included English language websites and excluded advertisements, websites for medical professionals, duplicates, and requiring a login. Each website included was evaluated for presence of the HON seal and scored with the JAMA Benchmark and DISCERN criteria to determine quality. RESULTS Only 16.28% of websites were found to be HON code certified. The average JAMA benchmark score was 1.23, with 9.3% websites scoring the maximum 4 points and 39.53% receiving a score of 0. The average DISCERN score was 34.65 out of a total possible score of 75, where the mean score for the overall quality of the website (question 16) was 2.19 out of a maximal score of 5. CONCLUSION This study, using 3 commonly used validated measures, has found that the quality of online information pertaining to Nissen Fundoplication is sorely lacking. The implications of these results are twofold as an important reference for institutions to update their source material and a guide when providing patients with adequate resources.
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Affiliation(s)
- Ace St John
- Department of Surgery, University of Maryland Medical Center, 29 South Greene Street, GS 631, Baltimore, MD, 21201, USA
| | - Kendyl Carlisle
- Department of Surgery, University of Maryland Medical Center, 29 South Greene Street, GS 631, Baltimore, MD, 21201, USA
| | - Mark Kligman
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen M Kavic
- University of Maryland School of Medicine, Baltimore, MD, USA.
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Karačić J, Viđak M, Marušić A. Reporting violations of European Charter of Patients' Rights: analysis of patient complaints in Croatia. BMC Med Ethics 2021; 22:148. [PMID: 34749721 PMCID: PMC8573760 DOI: 10.1186/s12910-021-00714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background The European Charter of Patients' Rights (ECPR) presents basic patients' rights in health care. We analysed the characteristics of patients' complaints about their rights submitted through the official complaints system and to a non-governmental organization in Croatia. Methods The official system for patients’complaints in Croatia does not have a common pathway but offers different modes for addressing patient complaints. In this cross-sectional study, we analysed the reports about patients’ complaints from the official regional committees sent to the Ministry of Health. We also analysed the complaints received by the Croatian Association for the Protection of Patient’s Rights (CAPR) and mapped them to the ECPR. Results The aggregated official data from the Ministry of Health in 2017 and 2018 covered only 289 individual complaints from 10 out of 21 counties. Complaints were most frequently related to secondary and tertiary healthcare institutions and details were not provided. CAPR received a total of 440 letters, out of which 207 contained 301 complaints about violations of patients’ rights in 2017–2018. The most common complaint was the Right of Access to health care (35.3%) from the ECPR, followed by the Right to Information (29.9%) and the Right to Safety (21.7%). The fewest complaints were about the Right to Complain (1.9%), Right to Innovation (1.4%), Right to Compensation (1.4%), and Right to Preventive Measures (1.0%). Conclusions Reporting and dealing with patients’ complaints about violations of their patients’ rights does not appear to be effective in a system with parallel but uncoordinated complaints pathways. Mapping patient's complaints to the ECPR is a useful tool to assess the perception of patients’ rights and to plan actions to improve the complaints system for effective health care.
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Affiliation(s)
- Jasna Karačić
- Cochrane Croatia, University of Split School of Medicine, Split, Croatia.
| | - Marin Viđak
- Cochrane Croatia, University of Split School of Medicine, Split, Croatia.,Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Ana Marušić
- Cochrane Croatia, University of Split School of Medicine, Split, Croatia.,Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
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Amirian A, Amini M, Sagheb MM, Ghahartars M, Neshatavar R, Tabari P, Moosavi M. Study of patients' satisfaction toward photographing their skin lesions for educational purposes. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:308. [PMID: 34667808 PMCID: PMC8459852 DOI: 10.4103/jehp.jehp_526_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 02/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Medical images have been widely used for various aims, especially for the educational purposes. Patient confidentiality and consent should be deemed crucial. In this study, we sought to assess patients' satisfaction with taking medical photos of their skin lesions and giving their physicians consent to use them for educational purposes. MATERIALS AND METHODS This multi-method study included quantitative and qualitative phases and was performed from April to November 2018 in the Dermatology Department of Shiraz Faghihi Hospital in South Iran. Demographic information was analyzed using the descriptive statistics. To resolve the simultaneous effect of demographic variables on patient satisfaction, we conducted linear regression. All the tests were analyzed at the 0.05 significance level. RESULTS In this study, all the patients except one (99.5%) preferred that only a physician who had a direct role in their care can access their digital photos. Of 200 patients, 134 patients (62.33%) preferred the utilization of hospital cameras in photographing their skin lesions (P = 0.002). On the other hand, 131 patients (49.81%) did not gave consent about using a personal phone camera for photographing their skin lesions (P = 0.001). In the qualitative phase, two major themes (trusting attending physician and paying attention to patient confidentiality) and five sub-themes (considering their physicians as professional people who always do the right thing, allowing physicians to use their images for educational purposes, covering patient's face, using hospital cameras, and obtaining informed consent from patients) were derived from qualitative semi-structured interviews. CONCLUSION The results showed that there is a need for developing international and national photography guidelines in the era of technology development.
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Affiliation(s)
- Ali Amirian
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Amini
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Sagheb
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Ghahartars
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Razieh Neshatavar
- Education Development Office, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parinaz Tabari
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahsa Moosavi
- Clinical Education Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Siau CS, Wee LH, Wahab S, Visvalingam U, Yeoh SH, Halim NAA, Ibrahim N. The influence of religious/spiritual beliefs on Malaysian hospital healthcare workers’ attitudes towards suicide and suicidal patients: a qualitative study. J Res Nurs 2021; 26:723-740. [DOI: 10.1177/17449871211008520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background There has been mixed findings on whether a healthcare workers’ religious beliefs contribute positively or negatively to their attitudes towards suicidal patients. Aims This study aims to explore qualitatively the influence of religious/spiritual beliefs on healthcare workers’ attitudes towards suicide and suicidal patients in the culturally heterogeneous Malaysian population. Methods Thirty-one healthcare workers from diverse religious backgrounds, professions and medical disciplines were interviewed. Thematic analysis revealed the centrality of religion in determining healthcare workers’ acceptability of suicide, specific religious beliefs that influenced their views on the right-to-die issue, perceptions of the suicidal patient’s religiousness/spirituality, and the aspects and extent of religious relevance in professional philosophy and practice. Results Healthcare workers who could perceive the multifactorial nature of suicide causation had a more empathetic response. There were high levels of paternalism in the care of suicidal patients, involving unsolicited religious/spiritual advice practised as a form of suicide deterrent and social support. Conclusions The formal integration of religious/spiritual practices into the professional care of suicidal patients was indicated.
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Affiliation(s)
- Ching Sin Siau
- Senior Lecturer, Center for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
| | - Lei-Hum Wee
- Professor, Center for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
| | - Suzaily Wahab
- Associate Professor, Department of Psychiatry, UKM Medical Centre, Malaysia
| | - Uma Visvalingam
- Consultant Psychiatrist, Department of Psychiatry and Mental Health, Putrajaya Hospital, Malaysia
| | - Seen Heng Yeoh
- Assistant Professor, Faculty of Medicine, Universiti Tunku Abdul Rahman, Malaysia
| | - Nur Atikah Abdul Halim
- Health Education PhD Candidate, Health Education Programme, Universiti Kebangsaan Malaysia, Malaysia
| | - Norhayati Ibrahim
- Associate Professor, Faculty of Health Sciences, Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Malaysia
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Bashkin O, Dopelt K, Asna N, Davidovitch N. Recommending Unfunded Innovative Cancer Therapies: Ethical vs. Clinical Perspectives among Oncologists on a Public Healthcare System-A Mixed-Methods Study. Curr Oncol 2021; 28:2902-2913. [PMID: 34436020 PMCID: PMC8395438 DOI: 10.3390/curroncol28040254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 11/26/2022] Open
Abstract
Over the past decade, there has been a growing development of innovative technologies to treat cancer. Many of these technologies are expensive and not funded by health funds. The present study examined physicians' perceptions of the ethical and clinical aspects of the recommendation and use of unfunded technologies for cancer treatment. This mixed-methods study surveyed 127 oncologists regarding their perceptions toward using unfunded innovative cancer treatment technologies, followed by in-depth interviews with 16 oncologists. Most respondents believed that patients should be offered all treatment alternatives, regardless of their financial situation. However, 59% indicated that they often face dilemmas regarding recommending new unfunded treatments to patients with financial difficulties and without private health insurance. Over a third (38%) stated that they felt uncomfortable discussing the cost of treatment with patients. A predictive model found that physicians facing patients whose medical condition worsened due to an inability to access new treatments, and who expressed the opinion that physicians can assist in locating funding for patients who cannot afford treatments, were more likely to recommend unfunded innovative therapies to patients (F = 5.22, R2 = 0.15, p < 0.001). Subsequent in-depth interviews revealed four key themes: economic considerations in choosing therapy, patient-physician communication, the public healthcare fund, and discussion of treatment costs. Physicians feel a professional commitment to offer patients the best medical care and a moral duty to discuss costs and minimize patients' financial difficulty. There is a need for careful and balanced use of innovative life-prolonging technologies while putting patients at the center of discourse on this complex and controversial issue. It is essential to develop a psychosocial support program for physicians and patients dealing with ethical and psychosocial dilemmas and to set guidelines for oncologists to conduct a comprehensive and collaborative physician-patient discourse regarding all aspects of treatment.
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Affiliation(s)
- Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel;
| | - Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel;
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel;
| | - Noam Asna
- Oncology Institute, Ziv Medical Center, Safed 13100, Israel;
| | - Nadav Davidovitch
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel;
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Žaliauskaitė M. Role of ruler or intruder? Patient’s right to autonomy in the age of innovation and technologies. AI & SOCIETY 2021. [DOI: 10.1007/s00146-020-01034-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Effect of Biomedical Materials in the Implementation of a Long and Healthy Life Policy. Processes (Basel) 2021. [DOI: 10.3390/pr9050865] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This paper is divided into seven main parts. Its purpose is to review the literature to demonstrate the importance of developing bioengineering and global production of biomaterials to care for the level of healthcare in the world. First, the general description of health as a universal human value and assumptions of a long and healthy life policy is presented. The ethical aspects of the mission of medical doctors and dentists were emphasized. The coronavirus, COVID-19, pandemic has had a significant impact on health issues, determining the world’s health situation. The scope of the diseases is given, and specific methods of their prevention are discussed. The next part focuses on bioengineering issues, mainly medical engineering and dental engineering, and the need for doctors to use technical solutions supporting medicine and dentistry, taking into account the current stage Industry 4.0 of the industrial revolution. The concept of Dentistry 4.0 was generally presented, and a general Bioengineering 4.0 approach was suggested. The basics of production management and the quality loop of the product life cycle were analyzed. The general classification of medical devices and biomedical materials necessary for their production was presented. The paper contains an analysis of the synthesis and characterization of biomedical materials supporting medicine and dentistry, emphasizing additive manufacturing methods. Numerous examples of clinical applications supported considerations regarding biomedical materials. The economic conditions for implementing various biomedical materials groups were supported by forecasts for developing global markets for biomaterials, regenerative medicine, and tissue engineering. In the seventh part, recapitulation and final remarks against the background of historical retrospection, it was emphasized that the technological processes of production and processing of biomedical materials and the systematic increase in their global production are a determinant of the implementation of a long and healthy policy.
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Nguyen TL, Annoussamy LSC, Krakauer EL. Creation and validation of a Vietnamese version of the Frommelt Attitudes Toward Care of the Dying Scale. Int J Palliat Nurs 2021; 27:147-156. [PMID: 34038177 DOI: 10.12968/ijpn.2021.27.3.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study aims to develop a valid measurement of the Frommel Attitudes Toward Care of the Dying (FATCOD) scale to address some of the gaps in the existing knowledge of this field in Vietnam. METHODS The FATCOD scale was translated and culturally adapted to make it suitable for use in Vietnam. Following this, the FATCOD_VN scale was assessed for content validity. The construct validity of the instrument was then determined by exploratory factor analysis (n=237), and confirmatory factor analysis (n=245), based on the combined data from two cross-sectional studies. The internal consistency reliability and background factors associated with the FATCOD_VN were examined to further support the validity of the Vietnamese version. RESULTS The exploratory factor analysis of the FATCOD_VN yielded a three-factor structure that presents the most plausible goodness of fit, supported by confirmatory factor analysis. The Cronbach's alpha of the FATCOD_VN was 0.74 for overall scale and ranges from 0.56 to 0.81 for each sub-scale. CONCLUSIONS The study results indicate that the FATCOD_VN is acceptable and appropriate to use in the Vietnamese context.
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Affiliation(s)
- Thuy Ly Nguyen
- Nursing Research Centre, Hanoi Medical University, Vietnam
| | | | - Eric L Krakauer
- Massachusetts General Hospital, Harvard Medical School, USA and University of Medicine and Pharmacy
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Kherbache A, Mertens E, Denier Y. Moral distress in medicine: An ethical analysis. J Health Psychol 2021; 27:1971-1990. [PMID: 33938314 DOI: 10.1177/13591053211014586] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Moral distress is a negative emotional response that occurs when physicians know the morally correct action but are prevented from taking it because of internal or external constraints. Moral distress undermines a physician's ethical integrity, leading to anger, poor job satisfaction, reduced quality of care and burnout. Scarce literature exists on the ethical aspects of moral distress in medicine. We conducted an ethical analysis of moral distress as experienced by physicians and analysed it from the literature using two predominant ethical theories: principlism and care ethics. Finally, we consider the emergence of moral distress in medicine during the COVID-19 pandemic.
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Klinovszky A, Papp-Zipernovszky O, Buzás N. Building a House of Skills-A Study of Functional Health Literacy and Numeracy among Patients with Type 2 Diabetes in Hungary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041547. [PMID: 33561956 PMCID: PMC7915100 DOI: 10.3390/ijerph18041547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/23/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022]
Abstract
The purpose of this study is to explore functional health literacy (FHL) and numeracy skills in an insulin-treated, type 2 diabetes mellitus (T2DM) patient population, and their impact on diabetes self-care activities. A non-experimental, cross-sectional quantitative design was used for this study. The sample consisted of 102 T2DM patients on insulin therapy, including 42 males and 60 females, with a mean age of 64.75 years (SD = 9.180) and an average diabetes duration of 10.76 years (SD = 6.702). Independent variables were sociodemographic variables (e.g., age, educational level, etc.) and diabetes and health-related factors (e.g., duration of diabetes (years), the frequency of blood glucose testing/day, etc.). For this study, the participants completed the reading comprehension exercise from the Short Test of Functional Health Literacy (S-TOFHLA) and the Shortened Version of the Diabetes Numeracy Test (DNT-15), which specifically evaluates the numeracy skills of patients living with diabetes. The associations between the variables were examined with Spearman’s rank correlation. Multivariate regression analysis was performed to examine whether measured FHL skills impact diabetes self-care activities. We found that DNT-15 test (β = 0.174, t(96) = 2.412, p < 0.018) had significant effect on the frequency of blood glucose testing/day. Moreover, the problem areas for patients with T2DM mostly included multi-step calculations according to food label interpretations, and adequate insulin dosage based on current blood glucose levels and carbohydrate intake. The results of regression analyses and Spearman’s rank correlation indicated that limited FHL and diabetes numeracy skills not only influenced the participants’ behaviors related to self-management, but they also affected their health outcomes. Thus, besides the personalization of insulin treatment, it is indispensable to provide more precise information on different types of insulin administration and more refined educational materials based on medical nutrition therapy.
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Affiliation(s)
- Andrea Klinovszky
- Department of Health Economics, University of Szeged, 6724 Szeged, Hungary;
- Correspondence:
| | | | - Norbert Buzás
- Department of Health Economics, University of Szeged, 6724 Szeged, Hungary;
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Bužančić I, Dragović P, Pejaković TI, Markulin L, Ortner-Hadžiabdić M. Exploring Patients' Attitudes Toward Deprescribing and Their Perception of Pharmacist Involvement in a European Country: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:2197-2208. [PMID: 34588769 PMCID: PMC8476111 DOI: 10.2147/ppa.s323846] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/14/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To explore how adult patients perceive deprescribing in a country with developing pharmaceutical care. PATIENTS AND METHODS This was a multicenter cross-sectional study conducted in ten community pharmacies across Croatia. Community-dwelling adults 40 years and older, taking at least one prescription medication long term, were invited to participate. The revised and validated Patients' Attitude Towards Deprescribing Questionnaire was used to investigate community-dwelling adults' opinions on potential medication discontinuation. Questions regarding the patients' perception of pharmacist competences and involvement as well as patients' preferences in deprescribing were added. Collected data were analyzed using IBM SPSS Statistics using descriptive and inferential statistical analysis. Binary logistic regression was used to explore potential predictive factors of willingness to have medication deprescribed. All tests were performed as two-tailed and a p < 0.05 was considered statistically significant. RESULTS A total of 315 adults aged 40 years and older completed the questionnaire. Majority of participants, 83.81% (95% CI, 79.72% to 87.90%) stated that they were satisfied with their medications, and 83.81% (95% CI, 79.72% to 87.90%) would be willing to deprescribe one or more medications. Participants expressed a positive attitude toward pharmacists' competences (68.89%, 95% CI, 63.75% to 74.03%) and involvement in deprescribing (71.11%, 95% CI, 66.08% to 76.14%). Participants who stated specific medication as deprescribing preference were more likely show dissatisfaction with current medication and show greater willingness to have medication deprescribed. Three factors were found to be associated with a positive attitude towards deprescribing: low concerns about stopping factor score (aOR 0.54, 95% CU=0.35-0.84; p=0.006), low appropriateness factor score (aOR 0.62, 95% CI=0.39-0.98; p=0.039), and a positive opinion on pharmacist involvement (aOR 2.35, 95% CI=1.18-4.70; p= 0.016). CONCLUSION This study showed the patient's willingness for deprescription as well as their positive attitude towards pharmacists being involved in the process. Results favour transition to a patient-centred care and shared-decision making model.
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Affiliation(s)
- Iva Bužančić
- City Pharmacies Zagreb, Zagreb, 10 000, Croatia
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, 10 000, Croatia
| | | | | | - Luka Markulin
- Pharmacy Unit, Psychiatric Hospital Ugljan, Ugljan, 23275, Ugljan Island, Croatia
| | - Maja Ortner-Hadžiabdić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, 10 000, Croatia
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Lazcano-Ponce E, Angeles-Llerenas A, Rodríguez-Valentín R, Salvador-Carulla L, Domínguez-Esponda R, Astudillo-García CI, Madrigal-de León E, Katz G. Communication patterns in the doctor-patient relationship: evaluating determinants associated with low paternalism in Mexico. BMC Med Ethics 2020; 21:125. [PMID: 33302932 PMCID: PMC7731770 DOI: 10.1186/s12910-020-00566-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paternalism/overprotection limits communication between healthcare professionals and patients and does not promote shared therapeutic decision-making. In the global north, communication patterns have been regulated to promote autonomy, whereas in the global south, they reflect the physician's personal choices. The goal of this study was to contribute to knowledge on the communication patterns used in clinical practice in Mexico and to identify the determinants that favour a doctor-patient relationship characterized by low paternalism/autonomy. METHODS A self-report study on communication patterns in a sample of 761 mental healthcare professionals in Central and Western Mexico was conducted. Multiple ordinal logistic regression models were used to analyse paternalism and associated factors. RESULTS A high prevalence (68.7% [95% CI 60.0-70.5]) of paternalism was observed among mental health professionals in Mexico. The main determinants of low paternalism/autonomy were medical specialty (OR 1.67 [95% CI 1.16-2.40]) and gender, with female physicians being more likely to explicitly share diagnoses and therapeutic strategies with patients and their families (OR 1.57 [95% CI 1.11-2.22]). A pattern of highly explicit communication was strongly associated with low paternalism/autonomy (OR 12.13 [95% CI 7.71-19.05]). Finally, a modifying effect of age strata on the association between communication pattern or specialty and low paternalism/autonomy was observed. CONCLUSIONS Among mental health professionals in Mexico, high paternalism prevailed. Gender, specialty, and a pattern of open communication were closely associated with low paternalism/autonomy. Strengthening health professionals' competencies and promoting explicit communication could contribute to the transition towards more autonomist communication in clinical practice in Mexico. The ethical implications will need to be resolved in the near future.
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Affiliation(s)
- Eduardo Lazcano-Ponce
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico.,Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Angelica Angeles-Llerenas
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico. .,Research Ethics Committee, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Rocío Rodríguez-Valentín
- Population Health Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | | | | | - Eduardo Madrigal-de León
- Hospital Director at the National Institute of Psychiatry Ramón de La Fuente Muñiz, Mexico City, Mexico
| | - Gregorio Katz
- Department of Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Abstract
This paper concerns the assessment of the current state of dentistry in the world and the prospects of its sustainable development. A traditional Chinese censer was adopted as the pattern, with a strong and stable support on three legs. The dominant diseases of the oral cavity are caries and periodontal diseases, with the inevitable consequence of toothlessness. From the caries 3.5–5 billion people suffer. Moreover, each of these diseases has a wide influence on the development of systemic complications. The territorial range of these diseases and their significant differentiation in severity in different countries and their impact on disability-adjusted life years index are presented (DALY). Edentulousness has a significant impact on the oral health-related quality of life (OHRQoL). The etiology of these diseases is presented, as well as the preventive and therapeutic strategies undertaken as a result of modifying the Deming circle through the fives’ rules idea. The state of development of Dentistry 4.0 is an element of the current stage of the industrial revolution Industry 4.0 and the great achievements of modern dental engineering. Dental treatment examples from the authors’ own clinical practice are given. The systemic safety of a huge number of dentists in the world is discussed, in place of the passive strategy of using more and more advanced personal protective equipment (PPE), introducing our own strategy for the active prevention of the spread of pathogenic microorganisms, including SARS-CoV-2. The ethical aspects of dentists’ activity towards their own patients and the ethical obligations of the dentist community towards society are discussed in detail. This paper is a polemic arguing against the view presented by a group of eminent specialists in the middle of last year in The Lancet. It is impossible to disagree with these views when it comes to waiting for egalitarianism in dental care, increasing the scope of prevention and eliminating discrimination in this area on the basis of scarcity and poverty. The views on the discrimination of dentistry in relation to other branches of medicine are far more debatable. Therefore, relevant world statistics for other branches of medicine are presented. The authors of this paper do not agree with the thesis that interventional dental treatment can be replaced with properly implemented prophylaxis. The final remarks, therefore, present a discussion of the prospects for the development of dentistry based on three pillars, analogous to the traditional Chinese censer obtaining a stable balance thanks to its three legs. The Dentistry Sustainable Development (DSD) > 2020 model, consisting of Global Dental Prevention (GDP), Advanced Interventionist Dentistry 4.0 (AID 4.0), and Dentistry Safety System (DSS), is presented.
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Fino LB, Basheti IA, Chaar BB. Exploring Ethical Pharmacy Practice in Jordan. SCIENCE AND ENGINEERING ETHICS 2020; 26:2809-2834. [PMID: 32533448 DOI: 10.1007/s11948-020-00231-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
Patient-centered pharmacy practice involves increased pharmacist engagement in patient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists' practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with 30 Jordanian registered pharmacists. The transcribed interviews were thematically analysed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious values; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists' personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists' understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternalism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists' literacy in professional ethics.
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Affiliation(s)
- Leen B Fino
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Iman A Basheti
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Betty B Chaar
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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AlRuthia Y, Alwhaibi M, Almalag H, Almosabhi L, Almuhaya M, Sales I, Albassam AA, Alharbi FA, Mansy W, Bashatah AS, Asiri Y. The relationship between trust in primary healthcare providers among patients with diabetes and levels of depression and anxiety. PLoS One 2020; 15:e0239035. [PMID: 32915906 PMCID: PMC7485844 DOI: 10.1371/journal.pone.0239035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 08/30/2020] [Indexed: 01/14/2023] Open
Abstract
Background Trust in healthcare providers has been shown to improve several clinical and patient-reported outcomes. However, its relationship with depression and anxiety has not been investigated among patients with chronic health conditions, such as diabetes. Therefore, the aim of this study was to examine whether trust in primary care physicians among patients with diabetes is associated with their levels of depression and/or anxiety. Method Adult patients (≥18 years) with a diagnosis of diabetes, confirmed through their electronic health records, were recruited and interviewed from the primary care clinics of three public hospitals. Patient trust in primary care physicians was assessed using the Health Care Relationship (HCR) Trust scale. Depression and anxiety were assessed using the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7), respectively. Two multiple linear regression analyses were conducted to examine the association of HCR-Trust scores with PHQ-9 and GAD-7 scores controlling for age, sex, Charlson comorbidity index score, education, health literacy, annual income, nationality, duration of illness, and research site. Results The number of patients who agreed to be interviewed was 367. Most of the participants were female (61.54%) and Saudi (92.86%). High HCR-Trust scores were negatively associated with PHQ-9 scores (β = -0.18; 95% CI: -0.23 –-0.13; P = < .0001), and GAD-7 scores (β = -0.17; 95% CI: -0.22– -0.12; P = < .0001). Conclusions Trust in primary care physicians among patients with diabetes was associated with lower levels of depression and anxiety. Therefore, healthcare providers should adopt a patient-centered care approach that fosters trust in the relationship between their patients and themselves. Further research should explore whether interventions that foster shared decision-making and trust in healthcare providers might also improve the health outcomes of patients with diabetes.
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Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- * E-mail:
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Haya Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Latifa Almosabhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Majed Almuhaya
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Sales
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Abdulrahman Albassam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | - Wael Mansy
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Adel S. Bashatah
- Department of Nursing Education and Administration, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Yousif Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Coronado-Vázquez V, Museros-Sos D, Oliván-Blázquez B, Magallón-Botaya R, Gómez-Salgado J, Sánchez-Calavera MA, Masluk B, Gil-de-Gómez MJ, Rodríguez-Eguizábal E. Mental Health Patients' Expectations about the Non-Medical Care They Receive in Primary Care: A Cross-Sectional Descriptive Study. Healthcare (Basel) 2020; 8:healthcare8030235. [PMID: 32726908 PMCID: PMC7551225 DOI: 10.3390/healthcare8030235] [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: 06/16/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/18/2022] Open
Abstract
A health system’s responsiveness is the result of patient expectations for the non-medical care they receive. The objective of this study was to assess mental patients’ responsiveness to the health system in primary care, as related to the domains of dignity, autonomy, confidentiality, and communication. Data were collected from 215 people over the age of 18 with mental disorders, using the Multi-Country Survey Study (MCSS) developed by the World Health Organization. Of them, 95% reported a good experience regarding the dignity, confidentiality, communication, and autonomy domains. Regarding responsiveness, patients valued the dignity domain as the most important one (25.1%). Among the patients who experienced poor confidentiality, five out of seven earned less than 900 euros per month (Χ2 = 10.8, p = 0.004). Among those who experienced good autonomy, 85 out of 156 belonged to the working social class (90.4%), and among those who valued it as poor (16.1%), the highest proportion was for middle class people (Χ2 = 13.1, p = 0.028). The two students and 87.5% of retirees experienced this dimension as good, and most patients who valued it as poor were unemployed (43.5%) (Χ2 = 13.0, p = 0.011). Patients with a household income higher than 900 euros more frequently valued responsiveness as good, regarding those domains related to communication, with OR = 3.84, 95% CI = 1.05–14.09, and confidentiality, with OR = 10.48, 95% CI = 1.94–56.59. To conclude, as regards responsiveness in primary care, the dignity domain always obtained the best scores by people with mental disorders. Low economic income is related to a poor assessment of confidentiality. Working class patients, students, and retirees value autonomy as good.
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Affiliation(s)
- Valle Coronado-Vázquez
- Instituto Aragonés de Ciencias de la Salud (IACS), 50009 Zaragoza, Spain; (V.C.-V.); (D.M.-S.); (B.M.); (M.J.G.-d.-G.); (E.R.-E.)
- Castilla-La Mancha Health Service, Illescas Primary Care Health Center, 45200 Toledo, Spain
- Department of Nursing, Universidad Católica de Ávila, 05005 Ávila, Spain
- Health Research Institute of Aragon (IIS), Group B21-20R, 50009 Zaragoza, Spain; (B.O.-B.); (R.M.-B.); (M.A.S.-C.)
- Aragonese Primary Care Research Group, redIAPP Group 016/07/01, 50009 Zaragoza, Spain
| | - Dolores Museros-Sos
- Instituto Aragonés de Ciencias de la Salud (IACS), 50009 Zaragoza, Spain; (V.C.-V.); (D.M.-S.); (B.M.); (M.J.G.-d.-G.); (E.R.-E.)
- Emergency Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Health Research Institute of Aragon (IIS), Group B21-20R, 50009 Zaragoza, Spain; (B.O.-B.); (R.M.-B.); (M.A.S.-C.)
- Aragonese Primary Care Research Group, redIAPP Group 016/07/01, 50009 Zaragoza, Spain
- University of Zaragoza, 50009 Zaragoza, Spain
| | - Rosa Magallón-Botaya
- Health Research Institute of Aragon (IIS), Group B21-20R, 50009 Zaragoza, Spain; (B.O.-B.); (R.M.-B.); (M.A.S.-C.)
- Aragonese Primary Care Research Group, redIAPP Group 016/07/01, 50009 Zaragoza, Spain
- University of Zaragoza, 50009 Zaragoza, Spain
- Aragon Health Service, Arrabal Primary Care Health Center, 50009 Zaragoza, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain
- Safety and Health Posgraduate Program, Universidad Espíritu Santo, 092301 Guayaquil, Ecuador
- Correspondence: ; Tel.: +34-95-921-9700
| | - María Antonia Sánchez-Calavera
- Health Research Institute of Aragon (IIS), Group B21-20R, 50009 Zaragoza, Spain; (B.O.-B.); (R.M.-B.); (M.A.S.-C.)
- Aragonese Primary Care Research Group, redIAPP Group 016/07/01, 50009 Zaragoza, Spain
- University of Zaragoza, 50009 Zaragoza, Spain
- Aragon Health Service, Fuentes Norte Primary Care Health Center, 50002 Zaragoza, Spain
| | - Bárbara Masluk
- Instituto Aragonés de Ciencias de la Salud (IACS), 50009 Zaragoza, Spain; (V.C.-V.); (D.M.-S.); (B.M.); (M.J.G.-d.-G.); (E.R.-E.)
- Aragonese Primary Care Research Group, redIAPP Group 016/07/01, 50009 Zaragoza, Spain
- University of Zaragoza, 50009 Zaragoza, Spain
| | - María Josefa Gil-de-Gómez
- Instituto Aragonés de Ciencias de la Salud (IACS), 50009 Zaragoza, Spain; (V.C.-V.); (D.M.-S.); (B.M.); (M.J.G.-d.-G.); (E.R.-E.)
- La Rioja Health Service, San Pedro Hospital, 26006 Logroño, Spain
| | - Eva Rodríguez-Eguizábal
- Instituto Aragonés de Ciencias de la Salud (IACS), 50009 Zaragoza, Spain; (V.C.-V.); (D.M.-S.); (B.M.); (M.J.G.-d.-G.); (E.R.-E.)
- La Rioja Health Service, Puerta de Arnedo Primary Care Health Center, 26580 Arnedo, Spain
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Sawhill C, Fipps DC, Palomo JV, Miller M. End-Stage Anorexia Nervosa: When to Say "When"-A Literature Review of an Ethically Complicated Case. PSYCHOSOMATICS 2020; 61:779-786. [PMID: 32674855 DOI: 10.1016/j.psym.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Christine Sawhill
- University of South Carolina, Greenville, Prisma Health, Upstate, Greenville, SC.
| | - David C Fipps
- University of South Carolina, Greenville, Prisma Health, Upstate, Greenville, SC
| | - Jennifer V Palomo
- University of South Carolina, Greenville, Prisma Health, Upstate, Greenville, SC
| | - Melanie Miller
- Consult Liaison Division, Department of Psychiatry, Prisma Health, Upstate, Greenville, SC
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Kaya C, Bezyak J, Chan F, Bengtson K, Hsu S. Autonomy Support, Life Satisfaction, and Quality of Life of Cancer Patients. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2020. [DOI: 10.1027/2512-8442/a000054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Abstract. Previous research shows that perceived autonomy support is significantly associated with positive health outcomes for different clinical populations. However, there is not a standardized measurement tool that assesses perceived autonomy support for the Turkish population. This study translated the Health Care Climate Questionnaire (HCCQ), a perceived autonomy support measurement tool, into Turkish and investigated the factorial structure of the questionnaire with a group of patients with cancer. This study used a convenience-sampling method with 192 people with cancer. The participants were recruited from a major cancer institute and a non-profit organization in Turkey by research partners. Volunteer participants either filled out a hard copy of a survey packet or completed the survey packet through a secured online survey tool website (i.e., https://www.surveymonkey.com ). In addition, a closed Facebook group for cancer survivors in Turkey was used to advertise the study’s link. The results indicated the participants perceived a moderate level of autonomy support. In comparison to German and US populations, perceived autonomy support was low among Turkish cancer patients. The results also indicated that the HCCQ has a two-factor measurement structure. Correlations with external variables indicated that the scores of HCCQ were significantly positively associated with life satisfaction and quality of life of cancer patients and negatively associated with cancer related symptoms (e.g., fatigue).
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Affiliation(s)
- Cahit Kaya
- Department of Educational Sciences, Giresun University, Giresun, Turkey
| | - Jill Bezyak
- Department of Rehabilitation Counseling and Sciences, University of Northern Colorado, Greeley, CO, USA
| | - Fong Chan
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, WI, USA
| | - Kevin Bengtson
- Department of Health and Community Studies, Western Washington University, Bellingham, WA, USA
| | - Sharon Hsu
- Institute on Disability, University of Memphis, TN, USA
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Mithas S, Hofacker CF, Bilgihan A, Dogru T, Bogicevic V, Sharma A. Information technology and Baumol's cost disease in healthcare services: a research agenda. JOURNAL OF SERVICE MANAGEMENT 2020. [DOI: 10.1108/josm-11-2019-0339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper advances a research agenda for service researchers at the intersection of healthcare and information technologies to improve access to quality healthcare at affordable prices. The article reviews key trends to provide an agenda for research focusing on strategies, governance and management of key service processes.Design/methodology/approachThis paper synthesizes literature in information systems, service management, marketing and healthcare operations to suggest a research agenda. The authors draw on frameworks such as the interpretive model of technology, technology acceptance model, assemblage theories and Baumol's cost disease to develop their arguments.FindingsThe paper situates strategy-related service management questions that service providers and consumers face in the context of emerging healthcare and technology trends. It also derives implications for governance choices and questions related to that.Research limitations/implicationsThe paper discusses service management challenges and concludes with an agenda for future research that touches on governance and service management issues.Practical implicationsThis paper provides implications for healthcare service providers and policymakers to understand new trends in healthcare delivery, technologies and facilities management to meet evolving customer needs.Social implicationsThis paper provides implications for managing healthcare services that touch on many social and societal concerns.Originality/valueThis conceptual paper provides background and review of the work at the intersections of information systems, marketing and healthcare operations to draw implications for future research.
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Nebeker C, Weisberg B, Hekler E, Kurisu M. Using Self-Study and Peer-to-Peer Support to Change "Sick" Care to "Health" Care: The Patient Perspective. Front Digit Health 2020; 2:2. [PMID: 34713016 PMCID: PMC8522003 DOI: 10.3389/fdgth.2020.00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Access to digital health technologies is contributing to a paradigm shift where sickcare may become authentic healthcare. Individuals can now access personal health data through wearable sensors, affordable lab screenings, genetic and genomic sequencing, and real-time health tracking apps. Personal health data access creates opportunities to study health indicators 24/7 and in real time. This is especially useful for patients with hard-to-diagnose or treat diseases, which led to a self-formed patient group called Project Apollo. Project Apollo is composed of highly motivated patients with common experiences of undiagnosed conditions, a lack of clear treatment options, and shared frustrations with navigating the U.S. healthcare system. These experiences have led the Apollo cohort to supplement their health knowledge through self-study research. Objective: To qualify the experience and expectations of patients affiliated with Project Apollo. Methods: A qualitative approach involved record review and semi-structured interviews. One-hour semi-structured interviews were conducted to solicit motivations, expectations, and potential barriers and facilitators to self-study followed by a brief survey on digital tool use. Interviews were digitally recorded, transcribed, and analyzed to identify themes and patterns. Results: Participants included six females and three males ranging in age from 30 to 70+ years. Responses were organized under five key themes including: frustration with healthcare system; community support; self-study/N-of-1 research; access to experts; moving from sick to healthcare. Facilitators include motivation, albeit stemming from frustration, a safe community where patients derive support, and access to experts for guidance. Increasing awareness of clinicians about the potential value of partnering with patients who are advancing health knowledge through self-study is critical. Conclusions: N-of-1 self-study research, coupled with community support and digital health tools, appears to be one plausible pathway to shifting the paradigm from sickcare toward patient-partnered healthcare.
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Affiliation(s)
- Camille Nebeker
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States.,Center for Wireless and Population Health Systems, UC San Diego, La Jolla, CA, United States.,The Design Lab, UC San Diego, La Jolla, CA, United States
| | - Bethany Weisberg
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Eric Hekler
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States.,Center for Wireless and Population Health Systems, UC San Diego, La Jolla, CA, United States.,The Design Lab, UC San Diego, La Jolla, CA, United States
| | - Michael Kurisu
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States.,Center for Wireless and Population Health Systems, UC San Diego, La Jolla, CA, United States.,The Design Lab, UC San Diego, La Jolla, CA, United States
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Lin CY, Renwick L, Lovell K. Patients' perspectives on shared decision making in secondary mental healthcare in Taiwan: A qualitative study. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30316-5. [PMID: 32487469 DOI: 10.1016/j.pec.2020.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this study is to explore patient perspectives on shared decision making in secondary mental healthcare in Taiwan. METHODS Qualitative semi-structured interviews were used to explore patient perspectives on shared decision making in secondary mental healthcare in Taiwan. Individual semi-structured interviews were conducted from July to August 2017 with a purposive sample of twenty patients using halfway houses. Data were analysed using thematic analysis. RESULTS Analysis of the interviews identified two themes: barriers to shared decision making; facilitators of shared decision making. Patients perceived that they were not involved in decision making due to: the professional status of health professionals; negative perception of making decisions; and limited time resources. However, patients reported a desire to be involved and felt sufficient information exchange would be a necessary step towards collaboration/sharing decisions about treatment with clinicians. CONCLUSION The findings provided an understanding of significant barriers to and facilitators of implementing shared decision making to aid further professional training and the development of national policies. PRACTICE IMPLICATIONS The findings could be the basis for developing effective strategies to overcome barriers to shared decision making and improve the process quality of delivering shared decision making.
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Affiliation(s)
- Chiu-Yi Lin
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom.
| | - Laoise Renwick
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom
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Cerit K, Karataş T, Ekici D. Behaviours of healthcare professionals towards difficult patients: A structural equation modelling study. Nurs Ethics 2019; 27:554-566. [PMID: 31315514 DOI: 10.1177/0969733019858694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Some patients are stigmatised as difficult patients by healthcare professionals. This phenomenon has great many negative consequences. The behaviours of healthcare professionals towards difficult patients are important. OBJECTIVE To explore the behaviours of all healthcare professionals towards difficult patients. RESEARCH DESIGN This study was based on a cross-sectional research design using structural equation modelling. PARTICIPANTS AND RESEARCH CONTEXT Two hundred and fifty-four healthcare professionals were involved in the study in Turkey. 'Participant Information Form' and the 'Healthcare Professionals Behaviour Assessment Questionnaire For Difficult Patient' were used to collect data from participants. ETHICAL CONSIDERATION Ethical approval was obtained from Gazi University Ethics Committee for the study. Informed consent of the participants in the study was taken and the confidentiality of the participants was ensured. FINDINGS It was explored that the behaviours of healthcare professionals towards difficult patients were categorised into ethical, supportive and negative. The highest mean score was supportive behaviour and the least mean score was negative. According to structural equation modelling, the most important predictor of difficult encounters was an ethical dimension. One-unit increase in ethical behaviour contributed to 0.92 unit increase in positive patient behaviour. DISCUSSION Patients generally are perceived as 'difficult patient' by the healthcare professionals, so the patients' treatment and care services are affected negatively due to healthcare professionals' negative beliefs and attitudes. The healthcare professionals should behave supportively towards difficult patients. CONCLUSION Healthcare professionals should be aware of management strategies in dealing with difficult encounters. The behaviours of healthcare professionals should be improved in a positive way and awareness of ethical dimension of difficult encounters should be increased.
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Moeini S, Shahriari M, Shamali M. Ethical challenges of obtaining informed consent from surgical patients. Nurs Ethics 2019; 27:527-536. [PMID: 31296111 DOI: 10.1177/0969733019857781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Informed consent can be obtained by various methods, by various people, and with use of various types of consent forms. Persistent effort is necessary to reveal the practical realities of informed consent to improve ethical and legal standards. OBJECTIVE To determine the ethical challenges of obtaining informed consent from surgical patients. METHODS The present study was a descriptive cross-sectional study using two researcher-made questionnaires and a checklist for data collection. Data were collected from nursing personnel (n = 95) and surgical patients (n = 203) on the surgical wards of three university hospitals in Isfahan, Iran. Data were analyzed using descriptive statistics, Spearman's rank correlation, Pearson's correlation coefficient, and the t-test. ETHICAL CONSIDERATIONS The study was approved by the Ethics Committee of Isfahan University of Medical Sciences (No: 396478). RESULTS The mean scores (maximum 100) of awareness, competency, and authority were 36.3, 67.7, and 57.6, respectively. The overall quality of the informed consent was poor (score 53.9 of 100). The higher educational level in patients was correlated with lower awareness of and less authority to give informed consent. Only 12.6% of the nurses stated that patients were given sufficient information to assure informed consent. In 89.2% of the consent forms, the risks of the treatment were mentioned. However, alternative methods and risks and advantages of rejecting the treatment were not mentioned in any of the forms. CONCLUSION Ethical challenges to obtaining informed consent include patients' poor awareness of their rights, a failure to provide adequate information to patients, absence of consideration of patients' educational level, an unclear definition of who is responsible for obtaining informed consent from the patients, time constraints, and use of unclear language and medical jargon. Constructing an ethical framework may guide nursing staff in dealing with the ethical challenges involved in obtaining informed consent.
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Fernández-Ballesteros R, Sánchez-Izquierdo M, Olmos R, Huici C, Caprara MG, Santacreu M, Ribera Casado JM, Cruz-Jentoft A. Development and validation of a paternalism and autonomist care assessment. J Adv Nurs 2019; 75:3166-3178. [PMID: 31287167 DOI: 10.1111/jan.14154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/28/2019] [Accepted: 07/03/2019] [Indexed: 11/30/2022]
Abstract
AIM There is a need for a validated instrument to measure the type of care (paternalism or person-centred) provided for older adults. Since paternalism and person-centred care are the most important caregiving styles in the field of care and as they are usually opposed, the study aims to develop and establish psychometrics data of an instrument to identify paternalistic and autonomist behaviours in older adults care contexts, which can help to enhance care practice. DESIGN Instrument development. METHODS After observing and standardizing behaviours in formal care contexts in 2016, an instrument was developed and proceeding to a first validation using standard validation techniques among caregivers in two care settings during 2016-2017: senior citizen centres and older adult day care centres. RESULTS The Paternalist/Autonomist Care Assessment (PACA) is a 30-item, behaviour-based instrument which measures both the appraisal of caregivers on elements of care (Care Appraisal Scale- PACA-Appraisal) and the occurrence of behaviours (Occurrence of Care in Context- PACA-Occurrence). The Paternalist/Autonomist Care Assessment (PACA) was validated in 160 professional caregivers and was able to discriminate two factors: paternalistic or overprotective behaviours and autonomist behaviours. However, these factors were not fully dichotomous and were shown to coexist to some degree. CONCLUSION The instrument displayed good psychometric properties to measure paternalism and autonomy in older adult care. Moreover, it showed that the two types of care are not antagonistic and can coexist, with overprotective behaviours being more frequent in contexts of care for more dependent persons. IMPACT There are no validated instruments to measure paternalism and person-centred behaviour in care contexts. The two measures yielded by the PACA show good construct and concurrent empirical validity, internal consistency, and convergent and discriminant validity. Family caregiver, professional caregivers, nurses, older adults.
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Affiliation(s)
| | | | - Ricardo Olmos
- Department of Methodology, Autonomous University of Madrid, Madrid, Spain
| | - Carmen Huici
- Department of Social Psychology and Organizations, National University of Distance Education (UNED), Madrid, Spain
| | - María Giovanna Caprara
- Department of Personality, Evaluation and Psychological Treatments, National University of Distance Education (UNED), Madrid, Spain
| | - Marta Santacreu
- Department Psychology, Universidad Europea Madrid, Madrid, Spain
| | | | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
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Arab-Zozani M, Pezeshki MZ, Khodayari-Zarnaq R, Janati A. Balancing Overuse and Underuse in the Iranian Healthcare System: A Force Field Theory Analysis. Ethiop J Health Sci 2019; 29:231-238. [PMID: 31011271 PMCID: PMC6460443 DOI: 10.4314/ejhs.v29i2.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Overuse and underuse of healthcare services occure within population, organizations and even patients around the world. Producing a balance between these two can increase efficiency, service quality and patient satisfaction. It also decrease extra costs. The aim of this study was to identify forces for change and forces against change for generating balance between overuse and underuse to achieve right care. Methods This study was conducted in five steps: 1) describe our plan or proposal for change; 2) identify forces for change; 3) identify forces against change; 4) assign forces; and 5) analyze and apply. We used purposive sampling strategy. The number of participants in the expert panel were eight. Each participant signed informed consent form before starting the study (Ethical code: IR.TBZMED.REC.1396.908). Results The driving factors for balancing overuse and underuse were education, preparing clinical guideline and standard protocols, resource allocation, using evidence-based medicine, evidence-based management and evidence-informed policy making approaches and social prescribing. The restraining factors for balancing overuse and underuse were conflict of interest issues, payment systems, paternalism and medicalization, patients and physicians' side problems and culture of consumerism in the community. The total scores for and against change were 14 and 17, respectively. Conclusion It seems that the emphasis on education and training in this field is essential for physicians, patients and all people in the community. Also, making reforms in payment systems and changing the rules and regulations in this area could be major drivers.
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Affiliation(s)
- Morteza Arab-Zozani
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Zakaria Pezeshki
- Social Determinants of Health Research Center, Department of Community and Family Medicine, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Janati
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Samaranayake UMJE, Mathangasinghe Y, Banagala ASK. Are predominantly western standards and expectations of informed consent in surgery applicable to all? A qualitative study in a tertiary care hospital in Sri Lanka. BMJ Open 2019; 9:e025299. [PMID: 30813111 PMCID: PMC6347869 DOI: 10.1136/bmjopen-2018-025299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the different perceptions on informed surgical consent in a group of Sri Lankan patients. METHODS A qualitative study was conducted in a single surgical unit at a tertiary care hospital from January to May 2018. The protocol conformed to the Declaration of Helsinki. Patients undergoing elective major surgeries were recruited using initial purposive and later theoretical sampling. In-depth interviews were conducted in their native language based on the grounded theory. Initial codes were generated after analysing the transcripts. Constant comparative method was employed during intermediate and advanced coding. Data collection and analyses were conducted simultaneously, until the saturation of the themes. Finally, advanced coding was used for theoretical integrations. RESULTS Thirty patients (male:female=12:18) were assessed. The mean age was 41±9 years. Sinhalese predominated (50.0%, n=15). Majority underwent thyroidectomy (36.7%, n=11). The generated theory categorises the process of obtaining informed consent in four phases: initial interaction phase, reasoning phase, convincing phase and decision-making phase. Giving consent for surgery was a dependent role between patient, family members and the surgeon, as opposed to an individual decision by the patient. Some patients abstained from asking questions from doctors since doctors were 'busy', 'short-tempered' or 'stressed out'. Some found nurses to be more approachable than doctors. Patients admitted that having a bystander while obtaining consent would relieve their stress. They needed doctors to emphasise more on postoperative lifestyle changes and preprocedure counselling at the clinic level. To educate patients about their procedure, some suggested leaflets or booklets to be distributed at the clinic before ward admission. The majority disliked watching educational videos because they were 'scared' to look at surgical dissections and blood. CONCLUSION The informed consent process should include key elements that are non-culture specific along with elements or practices that consider the cultural norms of the society.
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Affiliation(s)
| | - Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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