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Sievert EDC, Korn L, Gross M, Santana AP, Böhm R, Betsch C. Communicating diagnostic uncertainty reduces expectations of receiving antibiotics: Two online experiments with hypothetical patients. Appl Psychol Health Well Being 2024. [PMID: 38500005 DOI: 10.1111/aphw.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/13/2024] [Indexed: 03/20/2024]
Abstract
The overprescription of antibiotics due to diagnostic uncertainty and inappropriate patient expectations influence antimicrobial resistance. This research assesses (i) whether communicating diagnostic uncertainty reduces expectations of receiving antibiotics and (ii) which communication strategies minimise unintended consequences of such communication. In two experimental online studies conducted in January and April 2023, participants read a vignette describing a doctor consultation for an ear infection and expressed their expectations of receiving antibiotics, trust in their doctor, rated the doctor's reputation and provided their intention to get a second doctor's opinion. Study 1 (N = 2213) investigated whether communicating diagnostic uncertainty and social externalities of antibiotic use (the negative social impacts of developing antibiotic resistance) decreases expectations for antibiotics and explores potential unintended consequences on the doctor-patient relationship. In Study 2 (N = 527), we aimed to replicate and extend the findings by adding specific treatment recommendations. Disclosing diagnostic uncertainty (vs. certainty) and communicating (vs. not communicating) the social externalities of antibiotic overuse reduced patients' expectations of receiving antibiotics. Yet, communicating uncertainty impaired trust in the doctor and the doctor's reputation. Combining the communication of uncertainty with specific treatment recommendations-particularly delayed antibiotic prescriptions-showed important to prevent these unintended consequences.
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Affiliation(s)
- Elisabeth D C Sievert
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Lars Korn
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Marina Gross
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Ana Paula Santana
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Robert Böhm
- Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark
| | - Cornelia Betsch
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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2
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Omondi MP, Mwangi JC, Sitati FC, Onga’ngo H. Patterns of facility and patient related factors to the orthopedic and trauma admissions at the Kenyatta National Hospital: A qualitative assessment. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002323. [PMID: 38271345 PMCID: PMC10810445 DOI: 10.1371/journal.pgph.0002323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024]
Abstract
Inappropriate utilization of higher-level health facilities and ineffective management of the referral processes in resource-limited settings is increasingly becoming a concern in health care management in developing countries. This is characterized by self-referrals and frequent bypassing of nearest health facilities coupled with low formal referral mechanisms. This scenario lends itself to a situation where uncomplicated medical conditions are unnecessarily managed in a high-cost health facility. This situation compromises the ability and capacity of Kenyatta National Hospital (KNH) to function as a tertiary referral health facility as envisioned by Kenya Health Sector Referral Implementation Guidelines of 2014, Kenya 201 constitution and KNH legal statue of 1987. The study objective was to assess the patterns of facility and patient related factors to the orthopaedic and trauma admissions at the KNH. This was a descriptive qualitative study design. The study was conducted amongst the orthopaedic and trauma admission caseload for 2021. Data collection was done through a) data abstraction from 905 patients charts admitted during February to December 2021 and b) 10 (ten) semi-structured interviews with 10 major health facilities that refer to KNH to understand the reasons for referral to KNH. Quantitative data was analysed using Statistical Package for Social Science version 21.0 to calculate the frequency distribution. Qualitative data from the data abstraction and transcripts from the KIIs were analysed using NVivo version 12. The major facility and patient related factors to the orthopaedic and trauma admissions at KNH were inadequate human resource capacity and availability (42.7%), financial constraints (23.3%), inadequate Orthopaedic equipment's and implants availability (20.0%) and inadequate health facility infrastructure (6.3%) while the major patient related factor was patient's preference (23.4%). In conclusion, to decongest KNH requires that the lower-level health facilities need to be better equipped and resourced to handle essential orthopaedic and trauma care.
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Affiliation(s)
- Maxwell Philip Omondi
- Department of Surgery, Thematic Unit–Orthopedic Surgery, University of Nairobi, Nairobi, Kenya
| | - Joseph Chege Mwangi
- Department of Surgery, Thematic Unit–Orthopedic Surgery, University of Nairobi, Nairobi, Kenya
| | - Fred Chuma Sitati
- Department of Surgery, Thematic Unit–Orthopedic Surgery, University of Nairobi, Nairobi, Kenya
| | - Herbert Onga’ngo
- Department of Orthopedics, Kenyatta National Hospital, Nairobi, Kenya
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3
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Wish J, Villena-Vargas J, Harrison S, Lee B, Chow O, Port J, Altorki N, Stiles BM. Surgical Treatment at an Academic Medical Center is Associated with Statistically Insignificant Lung Cancer Survival Outcome Differences Related to ZIP Code. World J Surg 2023; 47:2052-2064. [PMID: 37046063 DOI: 10.1007/s00268-023-07006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Low socioeconomic status is a well-characterized adverse prognostic factor in large lung cancer databases. However, such characterizations may be confounded as patients of lower socioeconomic status are more often treated at low-volume, non-academic centers. We evaluated whether socioeconomic status, as defined by ZIP code median income, was associated with differences in lung cancer resection outcomes within a high-volume academic medical center. METHODS Consecutive patients undergoing resection for non-small cell lung cancer were identified from a prospectively maintained database (2011-18). Patients were assigned an income value based on the median income of their ZIP code as determined by census-based geographic data. We stratified the population into income quintiles representative of SES and compared demographics (chi-square), surgical outcomes, and survival (Kaplan-Meier). RESULTS We identified 1,693 patients, representing 516 ZIP codes. Income quintiles were Q1: $24,421-53,151; Q2:$53,152-73,982; Q3:$73,983-99,063; Q4:$99,064-123,842; and Q5:$123,843-250,001. Compared to Q5 patients, Q1 patients were younger (median 69 vs. 73, p < 0.001), more likely male (44 vs. 36%, p = 0.035), and more likely Asian, Black, or self-identified as other than white, Asian, or Black. (67 vs. 11%, p = < 0.001). We found minor differences in surgical outcomes and no significant difference in 5-year survival between Q1 and Q5 patients (5-year: 86 vs. 85%, p = 0.886). CONCLUSIONS Surgical care patterns at a high-volume academic medical center are similar among patients from varying ZIP codes. Surgical treatment at such a center is associated with no survival differences based upon socioeconomic status as determined by ZIP code. Centralization of lung cancer surgical care to high-volume centers may reduce socioeconomic outcome disparities.
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Affiliation(s)
- Jack Wish
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA.
| | - Jonathan Villena-Vargas
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Ben Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Oliver Chow
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Jeffrey Port
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Brendon M Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, 111 East 210th Street, New York, NY, 10467, USA
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4
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Schreidah CM, Fahmy LM, Lapolla BA, Geskin LJ. Decision Paralysis: Recognition and Patient-Centered Discourse. Dermatol Ther (Heidelb) 2023; 13:1211-1217. [PMID: 37046111 PMCID: PMC10149428 DOI: 10.1007/s13555-023-00921-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Decision paralysis (DP) can be defined as a patient's inability to commit to a physician and/or initiate appropriate treatment for their condition. An incessant search for greater physician opinions often leads to treatment delay, disease progression, and initiation of care at more advanced stages. Despite the harms associated with DP, a dearth of research on the issue remains. There are no guidelines that assist in both recognition and rectification of DP, leaving patients with chronic illnesses and diagnoses without well-characterized treatment algorithms especially vulnerable. This paper analyzes why patients are inclined toward DP and the clinical implications. Review of the literature affirms that the patient-physician relationship holds considerable influence; physicians identifying DP can improve therapeutic outcomes for their patients. Using these findings, we then propose a framework for broaching this topic with a method that supports patients while respecting their autonomy. A practical approach to both recognition and patient-centered discourse is introduced, providing a foundation for physicians to host these conversations and understand their patients' perspectives. This approach toward recognition and discourse on DP holds clinical importance, given that there is a paucity of established guidance. A future uniform approach may generate optimal patient care recommendations, which will hold far-reaching impact on both the patient-physician relationship and overall patient outcomes.
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Affiliation(s)
- Celine M Schreidah
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lauren M Fahmy
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Brigit A Lapolla
- Department of Dermatology, Columbia University Irving Medical Center, 161 Fort Washington Ave., New York, NY, 10032, USA
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, 161 Fort Washington Ave., New York, NY, 10032, USA.
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5
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Benaim E, Dudley S, Grande P, Gillespie MB. The value of second opinions on thyroid nodule management provided via direct-to-consumer telemedicine service. Am J Otolaryngol 2023; 44:103732. [PMID: 36682146 DOI: 10.1016/j.amjoto.2022.103732] [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: 05/10/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Second medical opinions (SMO) can improve patient outcomes and change medical decision-making. The purpose was to determine the concordance of initial management of thyroid nodules for patients seeking SMO to established management guidelines. MATERIALS AND METHODS Cases of patients consulting a single provider via telemedicine for SMO on the workup and management of thyroid nodule(s) were reviewed from September 2011 to February 2022. The primary outcome was the overall rate of adherence to 2015 ATA guidelines (correct/incorrect) and complete agreement (yes/no) between SMO and initial treatment team. RESULTS Most sought a second opinion for treatment options. Only 14 (29.2 %) cases had followed all the guidelines correctly. Living in North America compared to Asia (10/18 vs. 4/25, p = 0.004) and consulting endocrinology (11/21 vs. 3/26, p = 0.004) was associated with correct following of all guidelines. The most common violations of the guidelines were a lack of Bethesda scoring in pathology reports (31.8 %) and inappropriate initial FNA (25.5 %). The SMO was in complete agreement with the initial treatment recommendation in 31 cases (64.6 %), in partial agreement in 12 cases (25 %), and in disagreement in 5 cases (10.4 %). CONCLUSIONS In our study, adherence to guidelines was low. However, the SMO agreed with the workup and management of most patients, as most of this discordance with guidelines did not affect the overall treatment. The virtual second opinion consult was valuable in addressing patient-specific concerns, explaining additional treatment options, and, in a few cases, recommending against inappropriate surgical intervention.
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Affiliation(s)
- Ezer Benaim
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 430, Memphis, TN, United States.
| | - Samuel Dudley
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 430, Memphis, TN, United States.
| | - Payton Grande
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 430, Memphis, TN, United States.
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 430, Memphis, TN, United States.
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Rosenberg D. Ethnic differences in utilization of online health information sources: A test of the social inequality hypotheses. JOURNAL OF LIBRARIANSHIP AND INFORMATION SCIENCE 2023. [DOI: 10.1177/09610006221146843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The goal of the current study was to understand ethnic differences in use of online health information sources. Social stratification and social diversification hypotheses were used as study’s theoretical framework. The data were obtained from the 2017 Israel Social Survey (N = 2166). Multinomial and logistic regression techniques were used for the multivariate analysis. The results suggest that Israeli Arab respondents were less likely than Israeli-born Jewish respondents to seek health information using the Health Funds’ call centers or websites, other websites, and to utilize any number of the online health information sources. The findings provide a strong support for the social stratification hypothesis. The findings imply that members of minority population should be more encouraged to use (public) online health information sources as a means of taking greater responsibility for their health as well as for the health of their communities.
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May S, Bruch D, Muehlensiepen F, Ignatyev Y, Neugebauer E, Ronckers C, von Peter S. Physicians' Perspectives on the Implementation of the Second Opinion Directive in Germany-An Exploratory Sequential Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127426. [PMID: 35742675 PMCID: PMC9224158 DOI: 10.3390/ijerph19127426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 02/01/2023]
Abstract
A new Second Opinion Directive (SOD) was introduced in Germany in December 2018 for hysterectomy, tonsillotomy, and tonsillectomy to support shared decision making and to avoid unnecessary surgeries. Owing to its recent implementation, evidence and insights regarding outcomes and challenges encountered with the SOD are lacking, notably from the physicians' perspective. To assess this, we undertook an exploratory sequential mixed-methods design with an initial qualitative phase followed by a quantitative evaluation. A qualitative analysis of 22 interviews with specialists in gynecology and otorhinolaryngology was followed by a statistical analysis of a survey of 136 physicians in those disciplines. The specialists expressed a generally positive opinion of the new SOD, emphasizing the aspects of patient orientation, support in decision making, and patient safety. However, they also highlighted the following structural problems regarding the SOD implementation: In addition to an increased organisational effort, the specialists criticised the SOD with regard to its implementation in rural regions with a low availability of specialists for referral. Barriers that impede the implementation of the current directive, such as the adaptation of the qualifying requirements for authorized second opinion physicians, as well as the inclusion of relevant indications, need focused consideration to obtain better alignment with everyday practice.
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Affiliation(s)
- Susann May
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany; (D.B.); (F.M.); (Y.I.); (E.N.)
- Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany; (C.R.); (S.v.P.)
- Correspondence: ; Tel.: +49-3391-39-145-91
| | - Dunja Bruch
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany; (D.B.); (F.M.); (Y.I.); (E.N.)
- Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany; (C.R.); (S.v.P.)
- Faculty for Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany
| | - Felix Muehlensiepen
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany; (D.B.); (F.M.); (Y.I.); (E.N.)
- Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany; (C.R.); (S.v.P.)
- Faculty for Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany
| | - Yuriy Ignatyev
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany; (D.B.); (F.M.); (Y.I.); (E.N.)
| | - Edmund Neugebauer
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), 15562 Rüdersdorf, Germany; (D.B.); (F.M.); (Y.I.); (E.N.)
| | - Cecile Ronckers
- Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany; (C.R.); (S.v.P.)
- Department of Health Services Research, Carl Von Ossietzky Universität Oldenburg, 26129 Oldenburg, Germany
| | - Sebastian von Peter
- Brandenburg Medical School (Theodor Fontane), 16816 Neuruppin, Germany; (C.R.); (S.v.P.)
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Hostiuc S, Isailă OM, Curcă GC. Perceptions of Dental Medicine Students on Equity within Healthcare Systems in Romania: A Pilot Study. Healthcare (Basel) 2022; 10:857. [PMID: 35627993 PMCID: PMC9141564 DOI: 10.3390/healthcare10050857] [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: 03/28/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022] Open
Abstract
The scope of this paper is to evaluate the opinion of future dentists on equity within healthcare systems from a social and medical perspective. MATERIAL AND METHODS We conducted an observational study based on a survey among year five students from the "Carol Davila" Faculty of Dental Medicine Bucharest using an online questionnaire composed of graded answers to 14 statements on the theme of equity within healthcare systems before taking this course. RESULTS The questionnaire was sent to 300 students, of whom 151 (50.3%) responded; 79.47% of these were female and 20.53% were male; 9.3% had a rural background and 90.7% had an urban background. The majority of respondents expressed strong agreement that equity in public healthcare and acknowledging disadvantaged populations was important. The majority of students also strongly agreed that inequity came about from a lack of accessibility to medical care, lack of financial resources, and the absence of a second medical opinion. There were no statistically significant differences specific to the gender and background environment of the respondents. CONCLUSIONS The notion of equity is known to future dentists. However, contextual clarifications of the concept itself and its adequate quantification are necessary.
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Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Mina Minovici” National Institute of Legal Medicine, 042122 Bucharest, Romania;
| | - Oana-Maria Isailă
- Department of Legal Medicine and Bioethics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Mina Minovici” National Institute of Legal Medicine, 042122 Bucharest, Romania;
| | - George-Cristian Curcă
- “Mina Minovici” National Institute of Legal Medicine, 042122 Bucharest, Romania;
- Department of Legal Medicine and Bioethics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Rosenberg D. Searched and found? The association between use of health information sources and success in getting the desired information. Health Info Libr J 2022. [PMID: 35506593 DOI: 10.1111/hir.12434] [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: 10/04/2020] [Revised: 02/22/2022] [Accepted: 04/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although many health information seeking studies are concerned with longer range outcomes (e.g. patient-provider communication) the immediate outcomes for the searchers are whether they found the desired information, for whom and how successfully. OBJECTIVES To examine the association between health information seeking via various sources and the reported extent of success in getting the desired information the information needs perspective. METHODS Data were obtained from the 2017 Israel Social Survey and analysed using multinomial regression models. The sample included individuals who reported engaging in seeking health information prior to the survey and mentioned the extent of success in obtaining the desired health information (fully, partially, or not-at-all) (N = 2197). Multinominal regression technique served for the multivariable analysis. DISCUSSION Engagement in health information seeking via friends, family and using various websites (excluding those by Ministry of Health and Health Funds) was associated with the increased likelihood of partial success in getting the desired information. Education level and population group, affected level of success. CONCLUSIONS The (partial) success in meeting health consumers' information needs is associated with the turn to particular sources. Public health professionals and health provider institutions should improve provision and delivery of health information to meet consumer health information needs.
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Affiliation(s)
- Dennis Rosenberg
- University of Jyvaskyla, Jyvaskyla, Finland
- University of Haifa, Haifa, Israel
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10
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Könsgen N, Prediger B, Schlimbach A, Bora AM, Weißflog V, Loh JC, Bruch D, Pieper D. Telemedical Second Opinions in Germany: A Customer Survey of an Online Portal. Telemed J E Health 2022; 28:1664-1671. [PMID: 35394825 DOI: 10.1089/tmj.2022.0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Second medical opinions (SOs) can strengthen patients' certainty in decision making. In Germany, both personally delivered and telemedical SOs (often based on documents only) are provided. Our aim was to analyze the experiences of people who obtained telemedical SOs. We also investigated different routes of SO delivery (personally/by phone/documents only). Materials and Methods: German residents who obtained a telemedical SO via an online portal between January 2016 and February 2019 (n = 1,247) were contacted by post between August and November 2019 up to three times. The results were analyzed descriptively. Results: The 368 participants (response rate 30%) were 54% male, 95% statutory health insured, and 61 years old (median; interquartile range 51-72). Approximately 75% were (rather) satisfied with obtaining the SO via the online portal. The most preferred route of SO delivery was a personally delivered SO, which 80% would (rather) consider, followed by 70% (rather) considering SOs based on documents only and 48% (rather) considering SOs by phone. The most often mentioned advantage of telemedical SOs was independence of time and place, while the most important disadvantage was the standardized process resulting in a lack of direct and personal contact between the patient and the physician. Discussion: Although our results show that SOs (based on documents only) support patients and that patient satisfaction was high, personally delivered SOs were still preferred. Future research on the use of SOs based on documents only (in which patient population and in what situations) is needed.
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Affiliation(s)
- Nadja Könsgen
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Barbara Prediger
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Anna Schlimbach
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Ana-Mihaela Bora
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | | | | | - Dunja Bruch
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Brandenburg, Germany
- Center for Health Services Research, and Institute for Health Services and Health System Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
- Center for Health Services Research, and Institute for Health Services and Health System Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Institute for Health Services and Health System Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
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Kempt H, Nagel SK. Responsibility, second opinions and peer-disagreement: ethical and epistemological challenges of using AI in clinical diagnostic contexts. JOURNAL OF MEDICAL ETHICS 2022; 48:222-229. [PMID: 34907006 DOI: 10.1136/medethics-2021-107440] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
In this paper, we first classify different types of second opinions and evaluate the ethical and epistemological implications of providing those in a clinical context. Second, we discuss the issue of how artificial intelligent (AI) could replace the human cognitive labour of providing such second opinion and find that several AI reach the levels of accuracy and efficiency needed to clarify their use an urgent ethical issue. Third, we outline the normative conditions of how AI may be used as second opinion in clinical processes, weighing the benefits of its efficiency against concerns of responsibility attribution. Fourth, we provide a 'rule of disagreement' that fulfils these conditions while retaining some of the benefits of expanding the use of AI-based decision support systems (AI-DSS) in clinical contexts. This is because the rule of disagreement proposes to use AI as much as possible, but retain the ability to use human second opinions to resolve disagreements between AI and physician-in-charge. Fifth, we discuss some counterarguments.
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Affiliation(s)
- Hendrik Kempt
- Applied Ethics Group, RWTH Aachen University, Aachen, Germany
| | - Saskia K Nagel
- Applied Ethics Group, RWTH Aachen University, Aachen, Germany
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12
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Könsgen N, Prediger B, Schlimbach A, Bora AM, Hess S, Caspers M, Pieper D. Attitude toward second opinions in Germany - a survey of the general population. BMC Health Serv Res 2022; 22:76. [PMID: 35033078 PMCID: PMC8760563 DOI: 10.1186/s12913-021-07422-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/15/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Second medical opinions (SOs) can assist patients in making informed treatment decisions and improve the understanding of their diagnosis. In Germany, there are different approaches to obtain a structured SO procedure: SO programs by health insurers and SOs according to the SO Directive. Through a direct survey of the population, we aimed to assess how structured SOs should be provided to fulfil patients' needs. METHODS A stratified sample of 9990 adults (≥18 years) living in the federal states of Berlin and Brandenburg (Germany) were initially contacted by post in April and sent a reminder in May 2020. The survey results were analyzed descriptively. RESULTS Among 1349 participants (response rate 14%), 56% were female and the median age was 58 years (interquartile range (IQR) 44-69). Participants wanted to be informed directly and personally about the possibility of obtaining an SO (89%; 1201/1349). They preferred to be informed by their physician (93%; 1249/1349). A majority of participants would consider it important to obtain an SO for oncological indications (78%; 1049/1349). Only a subset of the participants would seek an SO via their health insurer or via an online portal (43%; 577/1349 and 16%; 221/1349). A personally delivered SO was the preferred route of SO delivery, as 97% (1305/1349) would (tend to) consider this way of obtaining an SO. Participants were asked to imagine having moderate knee pain for years, resulting in a treatment recommendation for knee joint replacement. They were requested to rate potential qualification criteria for a physician providing the SO. The criteria rated to be most important were experience with the recommended diagnosis/treatment (criterion (very) important for 93%; 1257/1349) and knowledge of the current state of research (criterion (very) important for 86%; 1158/1349). Participants were willing to travel 60 min (median; IQR 60-120) and wait 4 weeks (median; IQR 2-4) for their SO in the hypothetical case of knee pain. CONCLUSION In general, SOs were viewed positively. We found that participants have clear preferences regarding SOs. We propose that these preferences should be taken into account in the future design and development of SO programs.
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Affiliation(s)
- Nadja Könsgen
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany.
| | - Barbara Prediger
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Anna Schlimbach
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Ana-Mihaela Bora
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Michael Caspers
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Institute for Health Services and Health System Research, Neuruppin, Germany
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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Kassouf V, Sagherian BH, Yassin K, Antoun J. Effect of a discordant opinion offered by a second opinion physician on the patient's decision for management of spinal disc disease. PATIENT EDUCATION AND COUNSELING 2022; 105:228-232. [PMID: 33985847 DOI: 10.1016/j.pec.2021.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Factors that influence a patient's decision for spinal surgery and selection of the spine surgeon have not been studied in the context of a Second Opinion (SO). Providing insight into these factors will guide surgeons in their discussion of treatment options with patients. OBJECTIVE This study aims to assess the impact of a discordant SO on the final decision of patients as compared to their initial preference regarding spinal disc disease treatment for chronic neck and low back pain. PATIENT INVOLVEMENT Patients in this study engage in clinical vignettes designed to induce decisional conflict. METHODS A cross-sectional study using clinical vignette-based questionnaires was presented to patients at the Family Medicine, Orthopedic, and Neurosurgery clinics at a university-based tertiary academic medical center. RESULTS A total of 246 patients participated in the study (response rate, 66.8%). Irrespective of the initial offered treatment, most patients wanted to consult a SO (64.2%). Most patients preferred conservative treatment to surgery after getting the initial recommendation (78.5%) and after getting a discordant SO (56.5%). There was an association between the agreement of the patient with the initial recommendation and the effect of the SO on the final decision of patients (p < 0.001). Patients who disagreed with the initially offered treatment were more likely to abide by their initial decision after the SO (80.8%) as compared to those who were in agreement (17.7%), while those who agreed with the initially offered treatment were more likely to change their decision (39.5%) or to take a third opinion (42.9%). DISCUSSION A discordant SO may validate patients' wishes when they disagree with the initially offered treatment and may lead to confusion when they agree with the initial physicians' recommendations. PRACTICAL VALUE As patients tend to abide by their initial preference, physicians should explicitly consider patients' wishes when discussing options for management of spinal disc disease.
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Affiliation(s)
- Vicky Kassouf
- Department of Family Medicine, American University of Beirut, Lebanon
| | - Bernard H Sagherian
- Division of Orthopedic Surgery / Department of Surgery, American University of Beirut, Lebanon
| | - Koumail Yassin
- Department of Arts and Science, American University of Beirut, Lebanon
| | - Jumana Antoun
- Department of Family Medicine, American University of Beirut, Lebanon.
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14
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Parental motivations for seeking second medical opinions for their child’s HPV vaccine. Prev Med Rep 2021; 24:101550. [PMID: 34976620 PMCID: PMC8683845 DOI: 10.1016/j.pmedr.2021.101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 11/22/2022] Open
Abstract
We sought to characterize parents who look for second medical opinions to get human papillomavirus (HPV) vaccine for their children and whether second opinions influenced acceptance of HPV vaccine. Between July and August 2019, we conducted an online survey with a national sample of 906 parents of adolescents ages 11–17. We used multivariable logistic regression to assess correlates of looking for second opinions on HPV vaccination. For those who looked for second opinions, the survey assessed their HPV vaccine information needs and whether their child ultimately received the vaccine. Overall, 15% of parents reported looking for second opinions. Parents were more likely to look for second opinions if their self-reported knowledge about HPV vaccine was the same (Odds ratio [OR] = 1.94; 95% confidence interval [CI]:1.13, 3.30) or more (OR = 3.97; 95% CI:2.35, 6.73) than their child’s provider, or if they reported seeing HPV vaccine information on social media (OR = 2.50; 95% CI:1.69, 3.69). Parents were also more likely to look for second opinions if they were male, reported low vaccine confidence, disagreed with social norms favoring HPV vaccination, or had a young child (all p < .05). Among parents who looked for second opinions, 32% wanted the most information about safety and side effects, and 40% decided not to get their child vaccinated or were still undecided. In conclusion, a considerable number of parents look for second opinions to obtain information about HPV vaccine yet many still decline vaccination. Evidence-based messaging addressing parents’ HPV vaccine information needs may avoid delayed vaccine initiation in search of second opinions.
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15
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Meyer AND, Giardina TD, Khawaja L, Singh H. Patient and clinician experiences of uncertainty in the diagnostic process: Current understanding and future directions. PATIENT EDUCATION AND COUNSELING 2021; 104:2606-2615. [PMID: 34312032 DOI: 10.1016/j.pec.2021.07.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Uncertainty occurs throughout the diagnostic process and must be managed to facilitate accurate and timely diagnoses and treatments. Better characterization of uncertainty can inform strategies to manage it more effectively in clinical practice. We provide a comprehensive overview of current literature on diagnosis-related uncertainty describing (1) where patients and clinicians experience uncertainty within the diagnostic process, (2) how uncertainty affects the diagnostic process, (3) roots of uncertainty related to probability/risk, ambiguity, or complexity, and (4) strategies to manage uncertainty. DISCUSSION Each diagnostic process step involves uncertainty, including patient engagement with the healthcare system; information gathering, interpretation, and integration; formulating working diagnoses; and communicating diagnoses to patients. General management strategies include acknowledging uncertainty, obtaining more contextual information from patients (e.g., gathering occupations and family histories), creating diagnostic safety nets (e.g., informing patients what red flags to look for), engaging in worst case/best case scenario planning, and communicating diagnostic uncertainty to patients, families, and colleagues. Potential strategies tailored to various aspects of diagnostic uncertainty are also outlined. CONCLUSION Scientific knowledge on diagnostic uncertainty, while previously elusive, is now becoming more clearly defined. Next steps include research to evaluate relationships between management and communication of diagnostic uncertainty and improved patient outcomes.
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Affiliation(s)
- Ashley N D Meyer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard (152), Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Traber D Giardina
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard (152), Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Lubna Khawaja
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard (152), Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
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16
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Greenfield G, Shmueli L, Harvey A, Quezada-Yamamoto H, Davidovitch N, Pliskin JS, Rawaf S, Majeed A, Hayhoe B. Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review. BMJ Open 2021; 11:e044033. [PMID: 34561250 PMCID: PMC8475134 DOI: 10.1136/bmjopen-2020-044033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To review the characteristics and motivations of patients seeking second opinions, and the impact of such opinions on patient management, satisfaction and cost effectiveness. DATA SOURCES Embase, Medline, PsycINFO and Health Management Information Consortium (HMIC) databases. STUDY DESIGN A systematic literature search was performed for terms related to second opinion and patient characteristics. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. DATA COLLECTION/EXTRACTION METHODS We included articles focused on patient-initiated second opinions, which provided quantitative data on their impact on diagnosis, treatment, prognosis or patient satisfaction, described the characteristics or motivating factors of patients who initiated a second opinion, or the cost-effectiveness of patient-initiated second opinions. PRINCIPAL FINDINGS Thirty-three articles were included in the review. 29 studies considered patient characteristics, 19 patient motivating factors, 10 patient satisfaction and 17 clinical agreement between the first and second opinion. Seeking a second opinion was more common in women, middle-age patients, more educated patients; and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment. While many second opinions confirm the original diagnosis or treatment, discrepancies in opinions had a potential major impact on patient outcomes in up to 58% of cases. No studies reported on the cost effectiveness of patient initiated second opinions. CONCLUSIONS This review identified several demographic factors associated with seeking a second opinion, including age, gender, health status, and socioeconomic status. Differences in opinion received, and in the impact of change in opinion, varies significantly between medical specialties. More research is needed to understand the cost effectiveness of second opinions and identify patient groups most likely to benefit from second opinions.
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Affiliation(s)
- Geva Greenfield
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
| | - Liora Shmueli
- Department of Management, Bar-Ilan University, Ramat-Gan, Israel
| | - Amy Harvey
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
| | - Harumi Quezada-Yamamoto
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
| | - Nadav Davidovitch
- Health Policy and Management, School of Public Health, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Joseph S Pliskin
- Health Policy and Management, School of Public Health, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Salman Rawaf
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
| | - Azeem Majeed
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
| | - Benedict Hayhoe
- Primary Care and Public Health, School of Public Health, Imperial College London Department of Life Sciences, London, UK
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17
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Gattas S, Fote GM, Brown NJ, Lien BV, Choi EH, Chan AY, Rosen CD, Oh MY. Second opinion in spine surgery: A scoping review. Surg Neurol Int 2021; 12:436. [PMID: 34513199 PMCID: PMC8422531 DOI: 10.25259/sni_399_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/05/2021] [Indexed: 01/13/2023] Open
Abstract
Background: As a growing number of patients seek consultations for increasingly complex and costly spinal surgery, it is of both clinical and economic value to investigate the role for second opinions (SOs). Here, we summarized and focused on the shortcomings of 14 studies regarding the role and value of SOs before proceeding with spine surgery. Methods: Utilizing PubMed, Google Scholar, and Scopus, we identified 14 studies that met the inclusion criteria that included: English, primary articles, and studies published in the past 20 years. Results: We identified the following findings regarding SO for spine surgery: (1) about 40.6% of spine consultations are SO cases; (2) 61.3% of those received a discordant SO; (3) 75% of discordant SOs recommended conservative management; and (4) SO discordance applied to a variety of procedures. Conclusion: The 14 studies reviewed regarding SOs in spine surgery showed that half of the SOs differed from those given in the initial consultation and that SOs in spine surgery can have a substantial impact on patient care. Absent are prospective studies investigating the impact of following a first versus second opinion. These studies are needed to inform the potential benefit of universal implementation of SOs before major spine operations to potentially reduce the frequency and type/extent of surgery.
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Affiliation(s)
- Sandra Gattas
- Department of Neurological Surgery, University of California Irvine Medical Center, Irvine, CA, United States.,Department of Electrical Engineering and Computer Science, University of California Irvine Medical Center, Irvine, CA, United States.,Department of Medical Scientist Training Program, University of California Irvine Medical Center, Irvine, CA, United States
| | - Gianna M Fote
- Department of Neurological Surgery, University of California Irvine Medical Center, Irvine, CA, United States.,Department of Medical Scientist Training Program, University of California Irvine Medical Center, Irvine, CA, United States.,Department of Biological Chemistry, University of California Irvine Medical Center, Irvine, CA, United States
| | - Nolan J Brown
- Department of Neurological Surgery, University of California Irvine Medical Center, Irvine, CA, United States
| | - Brian V Lien
- Department of Neurological Surgery, University of California Irvine Medical Center, Irvine, CA, United States
| | - Elliot H Choi
- Department of Neurological Surgery, University of California Irvine Medical Center, Irvine, CA, United States
| | - Alvin Y Chan
- Department of Neurological Surgery, University of California Irvine Medical Center, Irvine, CA, United States
| | - Charles D Rosen
- Orthopedic Surgery, University of California Irvine Medical Center, Irvine, CA, United States
| | - Michael Y Oh
- Department of Neurological Surgery, University of California Irvine Medical Center, Irvine, CA, United States
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18
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Sanchez S, Adamowicz I, Chrusciel J, Denormandie P, Denys P, Degos L. Predictive factors of diagnostic and therapeutic divergence in a nationwide cohort of patients seeking second medical opinion. BMC Health Serv Res 2021; 21:902. [PMID: 34470642 PMCID: PMC8408960 DOI: 10.1186/s12913-021-06936-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe the profile of patients who sought a second medical opinion (SMO) on their therapeutic or diagnostic strategy using nationwide data from a French physician network dedicated to SMOs. METHODS An observational cohort study was conducted and the study population consisted of patients residing in France or in the French overseas territories who submitted a request for an SMO through a dedicated platform between January 2016 and October 2020. Patient characteristics were compared between convergent and divergent SMOs. The divergent rate for all patients excluding those with mental diseases were described. Logistic regression was used to estimate the probability of a divergent SMO according to patient characteristics. RESULTS AND DISCUSSION In total, 1,552 adult patients over several French regions were included. The divergence rate was 32.3 % (n = 502 patients). Gynecological [Odds Ratio (OR) and 95 % CI: 5.176 (3.154 to 8.494)], urological [OR 4.246 (2.053 to 8.782)] and respiratory diseases [OR 3.639 (1.357 to 9.758)] had the highest probability of a divergent SMO. Complex cases were also associated with a significantly higher risk of a divergent opinion [OR 2.78 (2.16 to 3.59)]. Age, sex, region and profession were not found to be predictive of a divergent second opinion. CONCLUSIONS Policymakers should encourage new research on patient outcomes such as mortality and hospitalization rates after a SMO. When proven effective, SMO networks will have the potential to benefit from specific public funding or even play a key role in national healthcare quality improvement programs.
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Affiliation(s)
- Stéphane Sanchez
- Public Health and Performance Department, Champagne Sud Hospitals, 101 avenue Anatole France, 10000, Troyes, France.
| | | | - Jan Chrusciel
- Public Health and Performance Department, Champagne Sud Hospitals, 101 avenue Anatole France, 10000, Troyes, France
| | | | - Pierre Denys
- Urology and Neurology Rehabilitation Department, Raimond Poincaré Hospital, APHP, Garches, France
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van Someren JL, Lehmann V, Stouthard JM, Stiggelbout AM, Smets EMA, Hillen MA. Oncologists' Communication About Uncertain Information in Second Opinion Consultations: A Focused Qualitative Analysis. Front Psychol 2021; 12:635422. [PMID: 34135806 PMCID: PMC8201772 DOI: 10.3389/fpsyg.2021.635422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Uncertainty is omnipresent in cancer care, including the ambiguity of diagnostic tests, efficacy and side effects of treatments, and/or patients' long-term prognosis. During second opinion consultations, uncertainty may be particularly tangible: doubts and uncertainty may drive patients to seek more information and request a second opinion, whereas the second opinion in turn may also affect patients' level of uncertainty. Providers are tasked to clearly discuss all of these uncertainties with patients who may feel overwhelmed by it. The aim of this study was to explore how oncologists communicate about uncertainty during second opinion consultations in medical oncology. Methods: We performed a secondary qualitative analysis of audio-recorded consultations collected in a prospective study among cancer patients (N = 69) who sought a second opinion in medical oncology. We purposively selected 12 audio-recorded second opinion consultations. Any communication about uncertainty by the oncologist was double coded by two researchers and an inductive analytic approach was chosen to allow for novel insights to arise. Results: Seven approaches in which oncologists conveyed or addressed uncertainty were identified: (1) specifying the degree of uncertainty, (2) explaining reasons of uncertainty, (3) providing personalized estimates of uncertainty to patients, (4) downplaying or magnifying uncertainty, (5) reducing or counterbalancing uncertainty, and (6) providing support to facilitate patients in coping with uncertainty. Moreover, oncologists varied in their (7) choice of words/language to convey uncertainty (i.e., "I" vs. "we"; level of explicitness). Discussion: This study identified various approaches of how oncologists communicated uncertain issues during second opinion consultations. These different approaches could affect patients' perception of uncertainty, emotions provoked by it, and possibly even patients' behavior. For example, by minimizing uncertainty, oncologists may (un)consciously steer patients toward specific medical decisions). Future research is needed to examine how these different ways of communicating about uncertainty affect patients. This could also facilitate a discussion about the desirability of certain communication strategies. Eventually, practical and evidence-based guidance needs to be developed for clinicians to optimally inform patients about uncertain issues and support patients in dealing with these.
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Affiliation(s)
- Jamie L van Someren
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Vicky Lehmann
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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20
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Könsgen N, Prediger B, Bora AM, Glatt A, Hess S, Weißflog V, Pieper D. Analysis of second opinion programs provided by German statutory and private health insurance - a survey of statutory and private health insurers. BMC Health Serv Res 2021; 21:209. [PMID: 33750368 PMCID: PMC7941885 DOI: 10.1186/s12913-021-06207-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/22/2021] [Indexed: 01/12/2023] Open
Abstract
Background Second medical opinions can give patients confidence when choosing among treatment options and help them understand their diagnosis. Health insurers in several countries, including Germany, offer formal second opinion programs (SecOPs). We systematically collected and analyzed information on German health insurers’ approach to SecOPs, how the SecOPs are structured, and to what extent they are evaluated. Methods In April 2019, we sent a questionnaire by post to all German statutory (n = 109) and private health insurers (n = 52). In September 2019, we contacted the nonresponders by email. The results were analyzed descriptively. They are presented overall and grouped by type of insurance (statutory/private health insurer). Results Thirty one of One hundred sixty one health insurers (response rate 19%) agreed to participate. The participating insurers covered approximately 40% of the statutory and 34% of the private health insured people. A total of 44 SecOPs were identified with a median of 1 SecOP (interquartile range (IQR) 1–2) offered by a health insurer. SecOPs were in place mainly for orthopedic (21/28 insurers with SecOPs; 75%) and oncologic indications (20/28; 71%). Indications were chosen principally based on their potential impact on a patient (22/28; 79%). The key qualification criterion for second opinion providers was their expertise (30/44 SecOPs; 68%). Second opinions were usually provided based on submitted documents only (21/44; 48%) or on direct contact between a patient and a doctor (20/44; 45%). They were delivered after a median of 9 days (IQR 5–15). A median of 31 (IQR 7–85) insured persons per year used SecOPs. Only 12 of 44 SecOPs were confirmed to have conducted a formal evaluation process (27%) or, if not, plan such a process in the future (10/22; 45%). Conclusion Health insurers’ SecOPs focus on orthopedic and oncologic indications and are based on submitted documents or on direct patient-physician contact. The formal evaluation of SecOPs needs to be expanded and the results should be published. This can allow the evaluation of the impact of SecOPs on insured persons’ health status and satisfaction, as well as on the number of interventions performed. Our results should be interpreted with caution due to the low participation rate. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06207-8.
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Affiliation(s)
- Nadja Könsgen
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany.
| | - Barbara Prediger
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Ana-Mihaela Bora
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Angelina Glatt
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
| | | | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne, Germany
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Burger PM, Westerink J, Vrijsen BEL. Outcomes of second opinions in general internal medicine. PLoS One 2020; 15:e0236048. [PMID: 32645107 PMCID: PMC7347190 DOI: 10.1371/journal.pone.0236048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/26/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To date, the outcomes of second opinions in internal medicine in terms of diagnostic yield and patient benefit have not been studied extensively. This retrospective study explores the outcomes of second opinions at a general internal medicine outpatient clinic in an academic hospital. METHODS A register of all patients referred to the general internal medicine outpatient clinic of the University Medical Center in Utrecht for a second opinion, was kept. All 173 patients referred between June 2016 and August 2018 were selected. Case records were analyzed for patient characteristics, referring doctor, chief complaint, performed investigations, follow-up time and, established diagnosis, additional diagnoses, initiated treatment and reported benefit. RESULTS A new diagnosis was established in 13% of all patients. A new treatment was initiated in 56% of all patients: 91% and 51% of patients with and without a new diagnosis respectively (p < 0.001). Of all patients, 19% received an effective treatment (52% vs 14% of patients with vs without a new diagnosis, p < 0.001). Regardless of treatment, resolution or improvement of the chief complaint was achieved in 28% of all patients (52% vs 25% of patients with vs without a new diagnosis, p = 0.006). Regarding diagnostics, 23-33% of radiology, endoscopy and pathology tests performed during second opinion were a repetition of previously conducted investigations. Conventional blood tests were a repetition in 89% of cases. Median time to diagnosis was 64 days (IQR: 25-128 days) and median time to discharge was 75 days (IQR: 31-144 days). CONCLUSION Second opinions in general internal medicine lead to the establishment of a new diagnosis in a small proportion of patients. However, the value of second opinions may not be limited to the establishment of diagnoses, as new treatments are often initiated and overall patients report improved symptomatology in 28% of cases.
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Affiliation(s)
- Pascal M. Burger
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bram E. L. Vrijsen
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
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22
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West S, Kornhaber R, Visentin DC, Thapa DK, Cleary M. The role of the health professional supporting consumers who use ‘Dr Google’. J Adv Nurs 2020; 76:2217-2219. [DOI: 10.1111/jan.14419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Sancia West
- Faculty of Health and Medicine University of Newcastle Newcastle NSW Australia
| | - Rachel Kornhaber
- College of Health and Medicine University of Tasmania Sydney NSW Australia
| | - Denis C. Visentin
- College of Health and Medicine University of Tasmania Sydney NSW Australia
| | - Deependra K. Thapa
- College of Health and Medicine University of Tasmania Sydney NSW Australia
| | - Michelle Cleary
- College of Health and Medicine University of Tasmania Sydney NSW Australia
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Weyerstraß J, Prediger B, Neugebauer E, Pieper D. Results of a patient-oriented second opinion program in Germany shows a high discrepancy between initial therapy recommendation and second opinion. BMC Health Serv Res 2020; 20:237. [PMID: 32192450 PMCID: PMC7083019 DOI: 10.1186/s12913-020-5060-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 02/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background As of 2015, second opinions are legally implemented in Germany. However, empirical results from German second opinion programs are lacking. The aim of this study was to examine several aspects within a population of a German second opinion program. Methods Study population consisted of patients who sought a second opinion in the period from August 2011 to December 2016. Multivariate logistic regression and ANOVA were used to examine differences in patient characteristics, differentiated by agreement of initial therapy recommendation and second opinion. Follow-up points for patient satisfaction and HRQoL were defined at 1, 3 and 6 months after obtaining the second opinion. Results Total number of patients who sought a second opinion was 1414. Most common indications concerned the knee (37.3%), spine (27.3%), hip (11.5%) and shoulder (10.1%). The independent specialists did not confirm the initial therapy recommendations in two out of three cases. The type of indication influenced the agreement between initial therapy recommendation and the second opinion significantly (p = 0.035). The second opinion and the offered service was highly valued by the patients (89%). Conclusions The second opinion offers patients the possibility to confirm a medical indication independently and support patients in their decision making process. Reasons for the large discrepancy between initial therapy recommendation and second opinion should be addressed in future research.
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Affiliation(s)
- Jan Weyerstraß
- University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany.
| | - Barbara Prediger
- Institute for Research in Operative Medicine (IFOM), Interim Head: Prof. Dr. Rolf Lefering, Chair of Surgical Research, Faculty of Health, School of Medicine, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Edmund Neugebauer
- Institute for Research in Operative Medicine (IFOM), Interim Head: Prof. Dr. Rolf Lefering, Chair of Surgical Research, Faculty of Health, School of Medicine, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany.,Brandenburg Medical School Theodor Fontane (MHB), Brandenburg, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine (IFOM), Interim Head: Prof. Dr. Rolf Lefering, Chair of Surgical Research, Faculty of Health, School of Medicine, University of Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany.
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Larcher V, Brierley J. Second medical opinions in paediatric practice; proposals for a framework for best practice. Arch Dis Child 2020; 105:213-215. [PMID: 31320359 DOI: 10.1136/archdischild-2019-317223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Vic Larcher
- Paediatric Bioethics Centre, National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Joe Brierley
- Paediatric Bioethics Centre, National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
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25
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Herrmann-Werner A, Weber H, Loda T, Keifenheim KE, Erschens R, Mölbert SC, Nikendei C, Zipfel S, Masters K. "But Dr Google said…" - Training medical students how to communicate with E-patients. MEDICAL TEACHER 2019; 41:1434-1440. [PMID: 30707847 DOI: 10.1080/0142159x.2018.1555639] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose: Patients who have access to information online may feel empowered and also confront their physicians with more detailed questions. Medical students are not well-prepared for dealing with so-called "e-patients." We created a teaching module to deal with this, and evaluate its effectiveness.Method: Senior medical students had to manage encounters with standardized patients (SPE) in a cross-over design. They received blended-learning teaching on e-patients and a control intervention according to their randomization group (EI/LI = early/late intervention). Each SPE was rated by two blinded video raters, the SP and the student.Results: N = 46 students could be included. After the intervention, each group (EI, LI) significantly improved their competency in dealing with e-patients as judged by expert video raters (EI: MT0 = 9.75 (2.51) versus MT1 = 16.60 (2.80); LI: MT0 = 8.70 (2.14) versus MT2 = 15.20 (2.84); both p < 0.001) and SP (EI: MT0 = 24.13 (4.83) versus MT1 = 26.52 (3.06); LI: MT0 = 23.37 (3.10) versus MT2 = 27.47 (4.38); both p < 0.001). Students' rating showed a similar non-significant trend.Conclusions: Students, SP and expert video raters determined that blended-learning teaching can improve students' competencies when dealing with e-patients. Within the study period, this effect was lasting; however, further studies should look at long-term outcomes.
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Affiliation(s)
- A Herrmann-Werner
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - H Weber
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - T Loda
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - K E Keifenheim
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - R Erschens
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - S C Mölbert
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - C Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - S Zipfel
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - K Masters
- Medical Education & Informatics Unit, College of Medicine & Health Sciences SQU, Alkoudh, Sultanate of Oman
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26
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Blanch-Hartigan D, van Eeden M, Verdam MGE, Han PKJ, Smets EMA, Hillen MA. Effects of communication about uncertainty and oncologist gender on the physician-patient relationship. PATIENT EDUCATION AND COUNSELING 2019; 102:1613-1620. [PMID: 31101428 DOI: 10.1016/j.pec.2019.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/15/2019] [Accepted: 05/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Physicians are increasingly expected to share uncertain information, yet there is concern about possible negative effects on patients. How uncertainty is conveyed and by whom may influence patients' response. We tested the effects of verbally and non-verbally communicating uncertainty by a male vs. female oncologist on patients' trust and intention to seek a second opinion. METHODS In an experimental video vignettes study conducted in The Netherlands, oncologist communication behavior (verbal vs. non-verbal and high vs. low uncertainty) and gender (male vs. female) were systematically manipulated. Former cancer patients viewed one video variant and reported trust, intention to seek a second opinion, and experience of uncertainty. RESULTS Non-verbal communication of high uncertainty by the oncologist led to reduced trust (β = -0.72 (SE = 0.15), p < .001) and increased intention to seek a second opinion (β = 0.67 (SE = 0.16), p < .001). These effects were partly explained by patients' increased experience of uncertainty (β = -0.48 (SE = 0.12), p < .001; and β = 0.34 (SE = 0.09), p < .001 respectively). Neither verbal uncertainty nor oncologists' gender influenced trust or intention to seek a second opinion. CONCLUSION Non-verbal communication of uncertainty by oncologists may affect patient trust and intention to seek a second-opinion more than verbal communication. PRACTICE IMPLICATIONS Further research to understand and improve oncologists' non-verbal uncertainty behavior is warranted.
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Affiliation(s)
| | - Marceline van Eeden
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Mathilde G E Verdam
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health, Amsterdam, The Netherlands; Leiden University, Institute of Psychology, Leiden, The Netherlands
| | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, USA
| | - Ellen M A Smets
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Marij A Hillen
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health, Amsterdam, The Netherlands.
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Shmueli L, Shmueli E, Pliskin JS, Balicer RD, Davidovitch N, Hekselman I, Greenfield G. Second opinion utilization by healthcare insurance type in a mixed private-public healthcare system: a population-based study. BMJ Open 2019; 9:e025673. [PMID: 31352409 PMCID: PMC6661653 DOI: 10.1136/bmjopen-2018-025673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To evaluate the utilisation (overall and by specialty) and the characteristics of second-opinion seekers by insurance type (either health fund or supplementary insurance) in a mixed private-public healthcare. DESIGN An observational study. SETTING Secondary care visits provided by a large public health fund and a large supplementary health insurance in Israel. PARTICIPANTS The entire sample included 1 392 907 patients aged 21 years and above who visited at least one specialist over an 18 months period, either in the secondary care or privately via the supplementary insurance. OUTCOMES MEASURES An algorithm was developed to identify potential second-opinion instances in the dataset using visits and claims data. Multivariate logistic regression was used to identify characteristics of second-opinion seekers by the type of insurance they used. RESULTS 143 371 (13%) out of 1 080 892 patients who had supplementary insurance sought a single second opinion, mostly from orthopaedic surgeons. Relatively to patients who sought second opinion via the supplementary insurance, second-opinion seekers via the health fund tended to be females (OR=1.2, 95% CI 1.17 to 1.23), of age 40-59 years (OR=1.36, 95% CI 1.31 to 1.42) and with chronic conditions (OR=1.13, 95% CI 1.08 to 1.18). In contrast, second-opinion seekers via the supplementary insurance tended to be native-born and established immigrants (OR=0.79, 95% CI 0.76 to 0.84), in a high socioeconomic level (OR=0.39, 95% CI 0.37 to 0. 4) and living in central areas (OR=0.88, 95% CI 0.85 to 0.9). CONCLUSIONS Certain patient profiles tended to seek second opinions via the supplementary insurance more than others. People from the centre of the country and with a high socioeconomic status tended to do so, as medical specialists tend to reside in central urban areas. Further research is recommended to examine the availability of medical specialists by specialty and residence.
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Affiliation(s)
- Liora Shmueli
- Department of Management, Bar Ilan University, Ramat Gan, Israel
| | - Erez Shmueli
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Joseph S Pliskin
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ran D Balicer
- Epidemiology, Ben-Gurion University, Tel Aviv, Israel
- Clalit Research Institute, Tel Aviv, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Igal Hekselman
- Clalit Mushlam Health Insurance, Bnei Brak, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Geva Greenfield
- Department of Primary Care & Public Health, Imperial College London, London, UK
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Shmueli L, Davidovitch N, Pliskin JS, Hekselman I, Balicer RD, Greenfield G. Reasons, perceived outcomes and characteristics of second-opinion seekers: are there differences in private vs. public settings? BMC Health Serv Res 2019; 19:238. [PMID: 31014323 PMCID: PMC6480844 DOI: 10.1186/s12913-019-4067-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/05/2019] [Indexed: 01/29/2023] Open
Abstract
Background In most countries, patients can get a second opinion (SO) through public or private healthcare systems. There is lack of data on SO utilization in private vs. public settings. We aim to evaluate the characteristics of people seeking SOs in private vs. public settings, to evaluate their reasons for seeking a SO from a private physician and to compare the perceived outcomes of SOs given in a private system vs. a public system. Methods A cross-sectional national telephone survey, using representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, on the same medical concern. We modeled SO utilization in a public system vs. a private system by patient characteristics using a multivariate logistic regression model. Results 214 of 339 respondents who obtained a SO during the study period, did so in a private practice (63.1%). The main reason for seeking a SO from a private physician rather than a physician in the public system was the assumption that private physicians are more professional (45.7%). However, respondents who obtained a private SO were neither more satisfied from the SO (p = 0.45), nor felt improvement in their perceived clinical outcomes after the SO (p = 0.37). Low self-reported income group, immigrants (immigrated to Israel after 1989) and religious people tended to seek SOs from the public system more than others. Conclusions The main reason for seeking a SO from private physicians was the assumption that they are more professional. However, there were no differences in satisfaction from the SO nor perceived clinical improvement. As most of SOs are sought in the private system, patient misconceptions about the private market superiority may lead to ineffective resource usage and increase inequalities in access to SOs. Ways to improve public services should be considered to reduce health inequalities.
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Affiliation(s)
- Liora Shmueli
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Joseph S Pliskin
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel.,Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Igal Hekselman
- Clalit Mushlam Health Insurance Systems, Clalit Health Services, 1 Ben Gurion, 5120149, Bnei Brak, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, 101 Arlozorov, 62098, Tel-Aviv, Israel
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St. Dunstan's Road, London, W6 8RP, UK.
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29
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Benbassat J. Obtaining a second opinion is a neglected source of health care inequalities. Isr J Health Policy Res 2019; 8:12. [PMID: 30651143 PMCID: PMC6335699 DOI: 10.1186/s13584-019-0289-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/10/2019] [Indexed: 11/25/2022] Open
Abstract
Observational studies have detected discrepancies between two expert interpreters of imaging and histopathological studies. Furthermore, in a substantial proportion of patients, an independent second opinion disagreed with the first one. Therefore, it is widely accepted that patients have a right to obtain a second opinion and, in case of divergent opinions, to deliberate and choose the option that they believe is most consistent with their individual circumstances. However, doctors are less likely to inform old and poorly educated patients about the possibility of seeking a second opinion, and this may contribute to healthcare inequalities. Hence the importance of (a) promoting doctors’ self-awareness of a possible tendency to discriminate against old and poorly educated patients, and (b) creating programs within the healthcare system that would help patients in seeking a second opinion, suggest specialists for the specific problem of the patient, and provide tools to reconcile between discrepant opinions.
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Affiliation(s)
- Jochanan Benbassat
- Myers-JDC-Brookdale Institute, Department of Health Policy Research, PO Box 3886, 91037, Jerusalem, Israel.
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Abstract
BACKGROUND Although second opinions are rather restricted to the surgical disciplines, they have become more and more important to the health system in the last 20 years. The demand has been triggered by rising health costs and the economization of the field. The Internet has also made a considerable contribution to the demand for patient-initiated second opinions. Given these developments, it is surprising that second opinions have not become more important in the field of psychiatry. This article highlights the special situation of second opinions in psychiatry, discusses possible barriers to the adoption of second opinions in psychiatry, and the potential for greater use of second opinions in this field. OBJECTIVE In psychiatry, second opinions have been neglected by the typical drivers of innovations in health care, including insurers and other commercial drivers as well as psychiatrists and patients themselves. This review identifies current barriers to widespread adoption of second opinions in psychiatric practice, discusses the benefits of second opinions that have been demonstrated in other disciplines, and outlines the potential gains to be realized through use of second opinions in psychiatry. METHODS Literature in the area was reviewed through a search of the main medical databases. This literature review was supported by in-depth interviews with health care personnel and insurers. CONCLUSIONS Second opinions are rarely obtained in psychiatry and there is little literature on this subject. The stigmatization of psychiatric disorders and patients and the uniqueness of the patient-doctor relationship in psychiatry, especially in psychotherapeutic care, may pose considerable obstacles to the use of second opinions in this field. In addition, more stakeholders, such as social workers, government agencies and regulators, health care and disability insurers, and social security agencies, are involved in the mental health compared with the somatic health sector, which may make it more difficult to achieve a coordinated approach in psychiatric care. However, we have found no convincingly good reason why second opinions have not been at least discussed in psychiatry. Psychiatry could benefit from ongoing discussions concerning the outcomes of second opinions in other medical disciplines.
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