1
|
Aijaz M, Lewis VA, Murray GF. Advancing equity in challenging times: A qualitative study of telehealth expansion and changing patient-provider relationships in primary care settings during the COVID-19 pandemic. Digit Health 2024; 10:20552076241233148. [PMID: 38434791 PMCID: PMC10906055 DOI: 10.1177/20552076241233148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Objective The patient-provider relationship is critical for achieving high-quality care and better health outcomes. During the COVID-19 pandemic, primary care practices rapidly transitioned to telehealth. While telehealth provided critical access to services for many, not all patients could optimally utilize it, raising concerns about its potential to exacerbate inequities in patient-provider relationships. We investigated technical and workforce-related barriers to accessing telehealth and the impacts on patient-provider relationships for vulnerable populations. Methods Qualitative, semi-structured interviews from May 2021 to August 2021 with 31 individuals (medical directors, physicians, and medical assistants) working at 20 primary care practices in Massachusetts, North Carolina, and Texas. Thematic analysis to better understand how barriers to using telehealth complicated patient-provider relationships. Results Interviewees shared challenges for providers and patients that had a negative effect on patient-provider relationships, particularly for vulnerable patients, including older adults, lower socio-economic status patients, and those with limited English proficiency. Providers faced logistical challenges and disruptions in team-based care, reducing care coordination. Patients experienced technological challenges that made accessing and engaging in telehealth difficult. Interviewees shared challenges for patient-provider relationships as commonly used telephone-only telehealth reduced channels for non-verbal communication. Conclusion This study indicates that barriers to virtual interaction with patients compared to in-person care likely led to weaker personal relationships that may have longer-term effects on engagement with and trust in the healthcare system, particularly among vulnerable patient groups. Additional support and resources should be available to primary care providers to optimize telehealth utilization.
Collapse
Affiliation(s)
- Monisa Aijaz
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valerie A Lewis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Genevra F Murray
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| |
Collapse
|
2
|
Bunce AE, Morrissey S, Kaufmann J, Krancari M, Bowen M, Gold R. Finding meaning: a realist-informed perspective on social risk screening and relationships as mechanisms of change. FRONTIERS IN HEALTH SERVICES 2023; 3:1282292. [PMID: 37936880 PMCID: PMC10626542 DOI: 10.3389/frhs.2023.1282292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023]
Abstract
Background Social risk screening rates in many US primary care settings remain low. This realist-informed evaluation explored the mechanisms through which a tailored coaching and technical training intervention impacted social risk screening uptake in 26 community clinics across the United States. Methods Evaluation data sources included the documented content of interactions between the clinics and implementation support team and electronic health record (EHR) data. Following the realist approach, analysis was composed of iterative cycles of developing, testing and refining program theories about how the intervention did-or didn't-work, for whom, under what circumstances. Normalization Process Theory was applied to the realist program theories to enhance the explanatory power and transferability of the results. Results Analysis identified three overarching realist program theories. First, clinic staff perceptions about the role of standardized social risk screening in person-centered care-considered "good" care and highly valued-strongly impacted receptivity to the intervention. Second, the physicality of the intervention materials facilitated collaboration and impacted clinic leaders' perception of the legitimacy of the social risk screening implementation work. Third, positive relationships between the implementation support team members, between the support team and clinic champions, and between clinic champions and staff motivated and inspired clinic staff to engage with the intervention and to tailor workflows to their settings' needs. Study clinics did not always exhibit the social risk screening patterns anticipated by the program theories due to discrepant definitions of success between clinic staff (improved ability to provide contextualized, person-centered care) and the trial (increased rates of EHR-documented social risk screening). Aligning the realist program theories with Normalization Process Theory constructs clarified that the intervention as implemented emphasized preparation over operationalization and appraisal, providing insight into why the intervention did not successfully embed sustained systematic social risk screening in participating clinics. Conclusion The realist program theories highlighted the effectiveness and importance of intervention components and implementation strategies that support trusting relationships as mechanisms of change. This may be particularly important in social determinants of health work, which requires commitment and humility from health care providers and vulnerability on the part of patients.
Collapse
Affiliation(s)
- Arwen E. Bunce
- Research Department, OCHIN Inc., Portland, OR, United States
| | | | - Jorge Kaufmann
- Oregon Health & Science University, Portland, OR, United States
| | - Molly Krancari
- Research Department, OCHIN Inc., Portland, OR, United States
| | - Megan Bowen
- Research Department, OCHIN Inc., Portland, OR, United States
| | - Rachel Gold
- Research Department, OCHIN Inc., Portland, OR, United States
- Kaiser Center for Health Research, Portland, OR, United States
| |
Collapse
|
3
|
Chung C, McKenna L, Cooper SJ. Contextual factors influencing patients' experiences of acute deterioration and medical emergency team (MET) encounter: A grounded theory study. J Adv Nurs 2022; 78:4062-4070. [PMID: 35822295 PMCID: PMC9796959 DOI: 10.1111/jan.15336] [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: 03/16/2022] [Revised: 05/28/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
AIM This paper explores the personal, social and structural factors that influence patients' experiences of acute deterioration and medical emergency team (MET) encounter. BACKGROUND Patient experience is recognized as a means of assessing healthcare delivery with a positive experience being linked to high-quality healthcare, improved patient safety and reduced length of stay. The experience of acute deterioration is unique, extensive and complex. However, little is known about this experience from the patient's perspective. DESIGN Constructivist grounded theory, informed by Kathy Charmaz, was used to explore the personal, social and structural factors that influence patients' experiences of acute deterioration and MET encounter. METHODS Using a semi-structured interview guide, in-depth individual interviews were conducted with 27 patients from three healthcare services in Victoria, Australia. Data were collected over a 12-month period from 2018 to 2019. Interview data were analysed using grounded theory processes. FINDINGS Contextual factors exert a powerful influence on patients' experiences of acute deterioration and MET encounter. The most significant factors identified include patients' expectations and illness perception, relationship with healthcare professionals during MET call and past experiences of acute illness. The expectations and perceptions patients had about their disease can condition their overall experience. Healthcare professional-patient interactions can significantly impact quality of care, patient experience and recovery. Patients' experiences of illness and healthcare can impact a person's future health-seeking behaviour and health status. CONCLUSION Patients' actions and processes about their experiences of acute deterioration and MET encounter are the result of the complex interface of contextual factors. IMPACT The findings from this study have highlighted the need for revised protocols for screening and management of patients who experience acute deterioration.
Collapse
Affiliation(s)
- Catherine Chung
- Institute of Health and WellbeingFederation University AustraliaChurchillVictoriaAustralia
| | - Lisa McKenna
- Institute of Health and WellbeingFederation University AustraliaChurchillVictoriaAustralia,School of Nursing and MidwiferyLa Trobe UniversityBundooraAustralia
| | - Simon J. Cooper
- Institute of Health and WellbeingFederation University AustraliaChurchillVictoriaAustralia
| |
Collapse
|
4
|
Cox CE, Ashana DC, Khandelwal N, Kamal AH, Engelberg RA. Improving Outcomes Measurement in Palliative Care: The Lasting Impact of Randy Curtis and his Collaborators. J Pain Symptom Manage 2022; 63:e579-e586. [PMID: 35595371 PMCID: PMC9173670 DOI: 10.1016/j.jpainsymman.2022.03.012] [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: 02/21/2022] [Revised: 02/24/2022] [Accepted: 03/09/2022] [Indexed: 11/24/2022]
Abstract
Palliative care research is deeply challenging for many reasons, not the least of which is the conceptual and operational difficulty of measuring outcomes within a seriously ill population such as critically ill patients and their family members. This manuscript describes how Randy Curtis and his network of collaborators successfully confronted some of the most vexing outcomes measurement problems in the field, and by so doing, have enhanced clinical care and research alike. Beginning with a discussion of the clinical challenges of measurement in palliative care, we then discuss a selection of the novel measures developed by Randy and his collaborators and conclude with a look toward the future evolution of these concepts. Randy and his foundational work, including both successes as well as the occasional near miss, have enriched and advanced the field as well as (immeasurably) impacted the work of so many others-including this manuscript's authors.
Collapse
Affiliation(s)
- Christopher E Cox
- Duke University School of Medicine (C.E.C., D.C.A.), Division of Pulmonary and Critical Care Medicine, Durham, North Carolina, USA; Program to Support People and Enhance Recovery (ProSPER) (C.E.C., D.C.A.), Duke University, Duke University School of Medicine, Duke Cancer Institute, Durham North Carolina, USA.
| | - Deepshikha Charan Ashana
- Duke University School of Medicine (C.E.C., D.C.A.), Division of Pulmonary and Critical Care Medicine, Durham, North Carolina, USA; Program to Support People and Enhance Recovery (ProSPER) (C.E.C., D.C.A.), Duke University, Duke University School of Medicine, Duke Cancer Institute, Durham North Carolina, USA
| | - Nita Khandelwal
- Department of Anesthesiology and Pain Medicine (N.K.), University of Washington, Harborview Medical Center, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (N.K., R.A.E.), University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Arif H Kamal
- Duke University School of Medicine (A.H.K.), Duke Cancer Institute, Durham, North Carolina, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence (N.K., R.A.E.), University of Washington, Harborview Medical Center, Seattle, Washington, USA; University of Washington, Department of Medicine (R.A.E.), Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, Washington, USA
| |
Collapse
|
5
|
Fisher KA, Kennedy K, Bloomstone S, Fukunaga MI, Bell SK, Mazor KM. Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD. PATIENT EDUCATION AND COUNSELING 2022; 105:726-733. [PMID: 34175167 PMCID: PMC8651798 DOI: 10.1016/j.pec.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 05/20/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To understand the impact of sharing clinic notes on communication and self-management among patients with COPD and to develop recommendations for writing patient-centered notes. METHODS Thirty patients with COPD participated in 'think-aloud' interviews in which they reviewed their COPD-specific clinic note. Interviews were coded using conventional content analysis, organized by the six-function communication framework. RESULTS Participants were predominantly White (93.3%), with a mean age of 65.5 years. More than half had a high school degree or less, half reported difficulty understanding spoken information, and nearly half sometimes need help reading medical materials. Patients indicated notes provided an opportunity to learn details of their condition and facilitated information sharing - strengthening information exchange. Reading notes enabled self-management through motivation, prompting information seeking, and reminding them of action steps. Patients reacted positively to statements suggesting the provider listened to them, saw them as a person, and was attentive to details, which fostered the relationship. Most patients reacted negatively to medical terminology, incorrect information, and wording that was perceived as disparaging. CONCLUSIONS Sharing clinic notes with patients can promote information exchange, enable self-management, and strengthen the patient-provider relationship. PRACTICE IMPLICATIONS Incorporating patients' recommendations for writing notes could strengthen the benefits of sharing notes.
Collapse
Affiliation(s)
- Kimberly A Fisher
- Department of Medicine, University of Massachusetts Medical School, Worcester, USA; Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA.
| | - Kara Kennedy
- University of Massachusetts Medical School, Worcester, USA.
| | - Sarah Bloomstone
- Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA.
| | - Mayuko Ito Fukunaga
- Department of Medicine, University of Massachusetts Medical School, Worcester, USA; Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA; Department of Population and Quantitative Health Sciences University of Massachusetts Medical School, Worcester, USA.
| | | | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Medical School, Worcester, USA; Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA.
| |
Collapse
|
6
|
Gender Gap in Healthcare Worker—Patient Communication during the COVID-19 Pandemic: An Italian Observational Study. PSYCH 2022. [DOI: 10.3390/psych4010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The value of the healthcare worker–patient communication has been well demonstrated and validated in several studies evidencing its relation to positive patient health outcomes, including better care response, simpler decision-making, better patient psychological well-being, and, therefore, considerable patient care satisfaction. The present study purposed to assess how patients perceived healthcare worker–patient communication during the COVID-19 pandemic and whether there were any gender-related differences among participants. From March 2020 to April 2020, an online questionnaire was administered to those who declared a patient’s condition in this period. The data considered included data on gender and a Quality of Communication questionnaire (QOC). A total of 120 patients were recruited online. Of these, 52 (43.33%) were females and 68 (56.67%) were males. Significant differences were recorded between females and males in the QOC questionnaire as regards Item no.2 (p = 0.033), Item no.6 (p = 0.007), Item no.11 (p = 0.013), Item no.12 (p = 0.003), Item no.13 (p = 0.002), Item no.15 (p = 0.008), and Item no.16 (p = 0.037), respectively. The potentially different elements between the two sexes considered were assessed in: Component 1: the need to be completely informed about their own health condition, and Component 2: the need to receive authentic and sincere communication from the healthcare worker involved. In light of the present findings, it has emerged that male patients seemed to be more active and positive in effective healthcare worker–patient communication.
Collapse
|
7
|
Ngui K, Lam P, Materne M, Hilmer S. Patient-reported Experience Measures in Deprescribing for Hospitalised Older Patients: A Prospective, Multicentre, Observational Study. Intern Med J 2022. [PMID: 35112777 DOI: 10.1111/imj.15707] [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: 06/28/2021] [Revised: 09/18/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalisation provides an opportunity for medication review and deprescribing. Patient-reported experience measures (PREM) for deprescribing in older patients in-hospital are not well-described. AIM To pilot test and describe PREM for deprescribing in older patients, compare PREM by patient characteristics, and investigate patients' awareness of medication changes on hospital discharge. METHODS This prospective, multicentre, observational cohort study at two tertiary hospitals in Sydney, Australia, evaluated the PREM questionnaire developed by the NSW Therapeutic Advisory Group. It was completed by patients (or their next of kin) recruited from acute geriatric medicine and orthogeriatric services. Association with nine patient characteristics was analysed using the chi-square test and multivariable regression. Awareness of medication changes and test-retest reliability were analysed using descriptive statistics. RESULTS Overall, 201 participants completed the questionnaire, with 170 eligible for analysis; 34/170 (20%) were aware of reduction or cessation of their usual medications on discharge and reported involvement in decision making and receiving enough information to reduce or stop one or more of their usual medications (positive PREM). Independent predictors of positive PREM included respondent (next of kin), hospital (Hospital 1), language (English), and specialty (acute geriatric medicine). Overall, 92 of 155 (59.4%) patients with medication changes were aware of those changes on hospital discharge. CONCLUSIONS These PREMs are a feasible tool to examine older patients' experiences of deprescribing in-hospital and may be applied to evaluate interventions to improve awareness, shared decision making, and provision of information when deprescribing for older patients. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Keat Ngui
- Department of General & Acute Medicine, Liverpool Hospital, Liverpool NSW 2170, Australia. Faculty of Health and Medicine, University of Newcastle
| | - Patrick Lam
- Orthopaedic Research Institute, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, Australia, Level 2, 4-10 South Street, Kogarah, Sydney, New South Wales, 2217, Australia
| | | | - Sarah Hilmer
- Departments of Clinical Pharmacology and Aged Care, Kolling Institute, Royal North Shore Hospital and Faculty of Medicine and Health, University of Sydney, St Leonards, New South Wales, 2065, Australia
| |
Collapse
|
8
|
Schattner A. An antidote to burnout? Developing broad-spectrum curiosity as a prevailing attitude. QJM 2022; 114:770-772. [PMID: 31868899 DOI: 10.1093/qjmed/hcz322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Schattner
- From the Faculty of Medicine, Hebrew University and Hadassah Medical School, Ein Kerem, Jerusalem 91120, Israel
| |
Collapse
|
9
|
Corrêa M, Castanhel FD, Grosseman S. Patients' perception of medical communication and their needs during the stay in the intensive care unit. Rev Bras Ter Intensiva 2021; 33:401-411. [PMID: 35107551 PMCID: PMC8555396 DOI: 10.5935/0103-507x.20210050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/20/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To understand the perception of patients about medical communication as well as their needs during hospitalization in the intensive care unit. METHODS This study was cross-sectional descriptive and qualitative exploratory including 103 patients admitted to or recently discharged from the intensive care units of four hospitals in Greater Florianópolis, Santa Catarina state, Brazil. The patients' sociodemographic and clinical variables were studied, as were the score they gave to the quality of medical communication through the Quality of Communication Questionnaire and their spontaneous comments with reflections or justifications for the scores given, and their responses on how they felt and what complementary help they would have liked to receive. The quantitative data were analyzed by descriptive and analytical statistics, and the qualitative data were analyzed by thematic content analysis. RESULTS The mean Quality of Communication Questionnaire score was 5.1 (standard deviation - SD = 1.3), with 8.6 (SD = 1.3) on the general communication subscale and 2.1 (SD = 1.8) on the end-of-life communication subscale. The patients had a variable understanding of medical language. Some physicians seemed to be "rushed", according to some patients. Other patients would like to receive more frequent and detailed information and/or be respected and taken "more seriously" when they reported pain. Anxiety, sadness, and fear were among the reported feelings. Other needs included silence, more time for visits, the presence of a companion, psychological and social-work care, a bathroom that they could use, and better food in the intensive care unit. CONCLUSION The quality of medical communication with patients is good but could improve if physicians and the healthcare team had more time for patients. Other felt needs included respect, pain relief, and adjustments in the intensive care unit dynamics and environment.
Collapse
Affiliation(s)
- Marlon Corrêa
- Curso de Medicina, Centro de Ciências da Saúde,
Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Flávia Del Castanhel
- Programa de Pós-Graduação em Ciências
Médicas, Universidade Federal de Santa Catarina - Florianópolis (SC),
Brasil
| | - Suely Grosseman
- Curso de Medicina, Centro de Ciências da Saúde,
Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
- Programa de Pós-Graduação em Ciências
Médicas, Universidade Federal de Santa Catarina - Florianópolis (SC),
Brasil
| |
Collapse
|
10
|
District nurses' experiences of using a clinical decision support system and an assessment tool at elderly care units in primary health care: a qualitative study. Prim Health Care Res Dev 2021; 22:e45. [PMID: 34521503 PMCID: PMC8444460 DOI: 10.1017/s1463423621000530] [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: 11/06/2022] Open
Abstract
AIM The present study aimed to describe the experience of district nurses (DNs) in using a clinical decision support system (CDSS) and the safe medication assessment (SMA) tool during patient visits to elderly care units at primary health care centres. BACKGROUND In Swedish primary health care, general practitioners (GPs) prescribe and have the responsibility to regularly review older adults' medications, while DN (nurses specialised in primary health care) play an important role in assessing older adults' ability to manage their medications, detecting potential drug-related problems and communicating with patients and GPs about such problems. In a previous feasibility study, we found that DNs who use a combination of a CDSS and the SMA tool identified numerous potentially harmful or dangerous factors and took a number of nursing care actions to improve the safety and quality of patients' medication use. In telephone interviews, patients indicated that they were positive towards the assessment and interventions. METHODS Individual interviews with seven DNs who worked at six different primary health care centres in Region Stockholm were carried out in 2018. In 2019, an additional group interview was conducted with two of the seven DNs so they could discuss and comment on preliminary findings. Qualitative content analysis was used to analyse the interview transcripts.Findings: Using the tools, the DNs could have a natural conversation about medication use with older adults. They could get a clear picture of the older adults' medication use and thus obtain information that could facilitate collaboration with GPs about this important component of health care for older adults. However, for the tools to be used in clinical practice, some barriers would have to be overcome, such as the time-consuming nature of using the tools and the lack of established routines for interprofessional collaboration regarding medication discussions.
Collapse
|
11
|
Demissie BN, Mengesha AT, Habte BM. Illness and Treatment Perceptions of Patients with Epilepsy Attending Treatment at a Tertiary Hospital in Addis Ababa - A Qualitative Exploration. Ethiop J Health Sci 2021; 31:581-588. [PMID: 34483615 PMCID: PMC8365480 DOI: 10.4314/ejhs.v31i3.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022] Open
Abstract
Background Epilepsy can be a large economic burden in countries where appropriate treatment is not taken due to religious and psychosocial beliefs. The objective of this study was to explore the perceptions and experiences of patients with epilepsy attending their treatment at Tikur Anbessa Specialized Hospital about their illness and treatment. Methods A qualitative exploratory design with an in-depth interview was followed. Fourteen purposively selected patients were used until saturation of key emerging themes was achieved. Results The finding showed that study participants expressed perceptions towards their illness including about its cause, timeline, severity and psychosocial consequences which at times may be considered different from the biomedical version. They also expressed concerns about their treatment, reported about social and psychological issues and in certain cases dissatisfaction with their healthcare providers. Such issues may have led to delays in treatment-seeking and non-adherence to recommended treatment regimens and as well use of traditional medicine and spiritual healing. On the other hand, reasons that were reported to positively influence their treatment experiences include necessity perceptions about their medications, family support and use of spiritual healing alongside their biomedical treatment. Conclusion The healthcare provision should improve to cater to these groups of patients including instituting chronic care management and appropriate health education provision.
Collapse
Affiliation(s)
- Bezawit N Demissie
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Abenet T Mengesha
- School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Bruck M Habte
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Ethiopia
| |
Collapse
|
12
|
Del Castanhel F, Burg L, Nogueira LM, Filho GRDO, Grosseman S. Quality of Communication Questionnaire for Patients Hospitalized in Intensive and Palliative Care: Validity Evidence for Use in Brazil. Am J Hosp Palliat Care 2021; 39:535-541. [PMID: 34427122 DOI: 10.1177/10499091211041347] [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: 11/16/2022] Open
Abstract
The Quality of Communication Questionnaire (QoC) was culturally adapted for Brazil due to its importance and use in several studies and different scenarios. The objective of this study was to evaluate the validity evidence of the Brazilian version of the QoC. A validation study was carried out involving 253 patients admitted to five public hospitals in Southern Brazil. Data were analyzed using descriptive analysis, Cronbach's alpha (α) to assess internal consistency, exploratory factor analysis, and goodness-of-fit index. One hundred and three patients were in intensive care (IC), and 150 were in palliative care (PC). The participants' mean age was 51 years (SD = 14.2). QoC,and its general communication subscale, and end-of-life communication subscale means were 5.5 (SD = 1.6), 8.8 (SD = 1.5), and 5.5 (SD = 1.6) respectively. Among patients in IC, QoC Cronbach's alpha was .75, and .84 in the general communication subscale and .51 in the end-of-life communication subscale. Among patients in PC, QoC Cronbach's alpha was .83, and .88 in the general communication subscale, and .71 in the end-of-life communication subscale. The root mean square error of approximation was .07 (90% CI: .04 - .08); Tucker-Lewis index was .97 (95% CI: .95 - .98); comparative fit index was .98 (95% CI: .97 - .99), and χ2/df ratio was 1.33 (χ2[53] = 70.858, p = .05). The authors conclude that the general communication subscale of QoC Brazilian version has good validity evidence for patients in IC and PC, whereas the end-of-life communication subscale is only valid for patient in PC.
Collapse
Affiliation(s)
- Flávia Del Castanhel
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina, Brazil
| | - Luciana Burg
- Hospital Universitário Professor Polydoro Ernani de São Thiago, Florianópolis, State of Santa Catarina, Brazil
| | | | | | - Suely Grosseman
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina, Brazil
| |
Collapse
|
13
|
Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. A qualitative study of clinician perceptions regarding the potential role for digital health interventions for the management of COPD. Health Informatics J 2021; 27:1460458221994888. [PMID: 33653189 DOI: 10.1177/1460458221994888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Effective self-management of chronic obstructive pulmonary disease (COPD) can lead to increased patient control and reduced health care costs. However, both patients and healthcare professionals encounter significant challenges. Digital health interventions, such as smart oximeters and COPD self-management applications, promise to enhance the management of COPD, yet, there is little evidence to support their use and user-experience issues are still common. Understanding the needs of healthcare professionals is central for increasing adoption and engagement with digital health interventions but little is known about their perceptions of digital health interventions in COPD. This paper explored the perceptions of healthcare professionals regarding the potential role for DHI in the management of COPD. Snowball sampling was used to recruit the participants (n = 32). Each participant underwent a semi-structured interview. Using NVivo 12 software, thematic analysis was completed. Healthcare professionals perceive digital health interventions providing several potential benefits to the management of COPD including the capture of patient status indicators during the interappointment period, providing new patient data to support the consultation process and perceived digital health interventions as a potential means to improve patient engagement. The findings offer new insights regarding potential future use-cases for digital health interventions in COPD, which can help ease user-experience issues as they align with the needs of healthcare professionals.
Collapse
Affiliation(s)
| | | | - John Cullen
- Tallaght University Hospital, Ireland.,Trinity College Dublin, Ireland
| | - Marcus W Butler
- University College Dublin, Ireland.,St. Vincent's University Hospital, Ireland
| | - Seamas C Donnelly
- Tallaght University Hospital, Ireland.,Trinity College Dublin, Ireland
| | | |
Collapse
|
14
|
Vitale E, Giammarinaro MP, Lupo R, Archetta V, Fortunato RS, Caldararo C, Germini F. The quality of patient-nurse communication perceived before and during the COVID-19 pandemic: an Italian pilot study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021035. [PMID: 34328139 PMCID: PMC8383229 DOI: 10.23750/abm.v92is2.11300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023]
Abstract
Background and Aim of the work. Therapeutic communication is essential for assessing the quality of patients’ care. The present study aimed to assess how the forced use of the mask influenced the communication before and during the Covid-19 pandemic. Methods. An online questionnaire was administered including two socio-demographic items, such as sex, as male and female, and role, as nurse or patient, and the Quality of Communication Questionnaire (QOC) for twice, referring to the period before and during the pandemic. Results. 178 subjects participated in the study, of which 60 (33.7%) were patients and 118 (66.3%) were nurses. During the pandemic, patients reported no significant differences in the perception of the quality of nurse-patient communication. While nurses recorded a lower perception of communication quality during the pandemic period than before. Conclusions. The patient willingly accepted the use of the face mask unlike nurses considered it a further obstacle to an effective communication between nurse-patient. However, it could be considered the emotional and caring overload that each nurse had stored during the Covid-19 pandemic, in addition to the fear of contagion that had gripped the lives of nurses on a daily basis.
Collapse
Affiliation(s)
- Elsa Vitale
- Department of Mental Health, Local Health Authority Bari, Italy.
| | | | - Roberto Lupo
- San Giuseppe da Copertino hospital, Lecce, Italy.
| | | | | | | | - Francesco Germini
- Direction of Health Professions, Local Healthcare Company Bari, Italy.
| |
Collapse
|
15
|
Hamel LM, Moulder R, Harper FWK, Penner LA, Albrecht TL, Eggly S. Examining the dynamic nature of nonverbal communication between Black patients with cancer and their oncologists. Cancer 2020; 127:1080-1090. [PMID: 33290592 DOI: 10.1002/cncr.33352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/29/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although communication quality is associated with patient outcomes, racial disparities in communication exist, disproportionately burdening Black patients. However, most communication research focuses on verbal behaviors in predominantly White patient populations. We used a newly developed and theory-guided network analysis that examines the dynamic interplay and behavioral convergence and divergence between Black patients with cancer and their oncologists during cancer treatment discussions. METHODS We applied a nonverbal behavioral coding system to thin slices of video recordings of Black patients and their oncologists discussing treatment. We then estimated 3 networks: 1) a temporal network to determine whether a nonverbal behavior predicts another nonverbal behavior at the next time point in an interaction, and how much each nonverbal behavior influences other nonverbal behaviors and is influenced by other nonverbal behaviors; 2) a contemporaneous network to determine whether a nonverbal behavior co-occurs with other nonverbal behaviors at the same time point in an interaction; and 3) a between-dyads network to examine the covariation between nonverbal behaviors across all dyads. RESULTS Black patients (n = 74) and their non-Black physicians (n = 15) showed a mix of convergence and divergence in their nonverbal behaviors at the same points in time, from one time point to the next, and across dyads. Across analyses, convergence was most likely to occur when physicians matched their behaviors to their patients; especially with smiling, gaze, leaning, and laughter behaviors. CONCLUSION Our findings reveal patterns of modifiable behaviors that can potentially inform interventions to reduce disparities in clinical communication and, in turn, treatment and mortality disparities.
Collapse
Affiliation(s)
- Lauren M Hamel
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Robert Moulder
- Department of Psychology, University of Virginia, Charlottesville, Virginia
| | - Felicity W K Harper
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Louis A Penner
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Terrance L Albrecht
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Susan Eggly
- Department of Oncology, Wayne State University School of Medicine & Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| |
Collapse
|
16
|
Shersher V, Haines TP, Williams C, Willoughby L, Sturgiss E, Weller C. Developing a Taxonomy of Communication Techniques and Aids Used By Healthcare Providers During Patient Consultations: Protocol for a Systematic Review. JMIR Res Protoc 2020; 9:e16801. [PMID: 32673277 PMCID: PMC7388054 DOI: 10.2196/16801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 03/06/2020] [Accepted: 04/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background Currently, there is no available standardized taxonomy of defined communication techniques and aids used by healthcare providers during patient consultations. It is challenging to identify communication techniques that contribute to effective healthcare provider and patient consultations and to replicate communication interventions in research. Objective The aim of this paper is to describe a protocol for the development and pilot of a taxonomy of communication techniques and aids used by healthcare providers during patient consultations. Methods A systematic review will be completed to identify eligible studies. Extracted techniques and aids will be organized into a preliminary taxonomy by a multidisciplinary team. The preliminary taxonomy will be piloted by two groups: research assistants trained in taxonomy application and healthcare providers and healthcare professional students not trained in taxonomy use. The pilot will use custom developed video footage of health provider and patient interactions. Interrater validity and interview feedback will be used to inform a Delphi panel of multidisciplinary healthcare providers and patient experts when they convene to finalize the preliminary taxonomy. Results This study was funded in November 2017 by the Monash University Interdisciplinary Research Seed Funding Scheme. Data collection commenced in March 2018, and data analysis is in progress. We expect the results to be published in 2021. Conclusions This is the first known attempt to develop a defined and standardized taxonomy of communication techniques and aids used by healthcare providers in patient consultations. The findings will be used to inform future research by providing a detailed taxonomy of healthcare providers’ communication techniques and standardized definitions. International Registered Report Identifier (IRRID) DERR1-10.2196/16801
Collapse
Affiliation(s)
- Violetta Shersher
- School of Primary and Allied Health, Monash University, Frankston, Australia
| | - Terry P Haines
- School of Primary and Allied Health, Monash University, Frankston, Australia
| | - Cylie Williams
- School of Primary and Allied Health, Monash University, Frankston, Australia
| | - Louisa Willoughby
- School of Languages, Literatures, Cultures and Linguistics, Monash University, Clayton, Victoria, Australia
| | - Elizabeth Sturgiss
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Carolina Weller
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
17
|
Links MJ, Watterson L, Martin P, O'Regan S, Molloy E. Finding common ground: meta-synthesis of communication frameworks found in patient communication, supervision and simulation literature. BMC MEDICAL EDUCATION 2020; 20:45. [PMID: 32046704 PMCID: PMC7014645 DOI: 10.1186/s12909-019-1922-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Effective communication between patients-clinicians, supervisors-learners and facilitators-participants within a simulation is a key priority in health profession education. There is a plethora of frameworks and recommendations to guide communication in each of these contexts, and they represent separate discourses with separate communities of practice and literature. Finding common ground within these frameworks has the potential to minimise cognitive load and maximise efficiency, which presents an opportunity to consolidate messages, strategies and skills throughout a communication curriculum and the possibility of expanding the research agenda regarding communication, feedback and debriefing in productive ways. METHODS A meta-synthesis of the feedback, debriefing and clinical communication literature was conducted to achieve these objectives. RESULTS Our analysis revealed that the concepts underlying the framework can be usefully categorised as stages, goals, strategies, micro-skills and meta-skills. Guidelines for conversations typically shared a common structure, and strategies aligned with a stage. Core transferrable communication skills (i.e., micro-skills) were identified across various types of conversation, and the major differences between frameworks were related to the way that power was distributed in the conversation and the evolution of conversations along the along the path of redistributing power. As part of the synthesis, an overarching framework "prepare-EMPOWER enact" was developed to capture these shared principles across discourses. CONCLUSIONS Adopting frameworks for work-based communication that promote dialogue and empower individuals to contribute may represent an important step towards learner-centred education and person-centred care for patients.
Collapse
Affiliation(s)
- Matthew Jon Links
- Gold Coast University Hospital and Health Service, Southport, Australia.
- Griffith University Institute of Educational Research and School of Medicine, Brisbane, Australia.
- Medical Oncology, 1 Hospital Boulevarde, Southport, QLD, 4215, Australia.
| | - Leonie Watterson
- Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital Sydney, Sydney, New South Wales, Australia
| | - Peter Martin
- Deakin University Faculty of Health, School of Medicine, Geelong, Australia
| | - Stephanie O'Regan
- Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Molloy
- Department of Medical Education, University of Melbourne, Melbourne, Australia
| |
Collapse
|
18
|
Stellefson M, Paige SR, Alber JM, Chaney BH, Chaney D, Apperson A, Mohan A. Association Between Health Literacy, Electronic Health Literacy, Disease-Specific Knowledge, and Health-Related Quality of Life Among Adults With Chronic Obstructive Pulmonary Disease: Cross-Sectional Study. J Med Internet Res 2019; 21:e12165. [PMID: 31172962 PMCID: PMC6592488 DOI: 10.2196/12165] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/01/2019] [Accepted: 04/12/2019] [Indexed: 12/11/2022] Open
Abstract
Background Despite the relatively high prevalence of low health literacy among individuals living with chronic obstructive pulmonary disease (COPD), limited empirical attention has been paid to the cognitive and health literacy–related skills that can uniquely influence patients’ health-related quality of life (HRQoL) outcomes. Objective The aim of this study was to examine how health literacy, electronic health (eHealth) literacy, and COPD knowledge are associated with both generic and lung-specific HRQoL in people living with COPD. Methods Adults from the COPD Foundation’s National Research Registry (n=174) completed a cross-sectional Web-based survey that assessed sociodemographic characteristics, comorbidity status, COPD knowledge, health literacy, eHealth literacy, and generic/lung-specific HRQoL. Hierarchical linear regression models were tested to examine the roles of health literacy and eHealth literacy on generic (model 1) and lung-specific (model 2) HRQoL, after accounting for socioeconomic and comorbidity covariates. Spearman rank correlations examined associations between ordinal HRQoL items and statistically significant hierarchical predictor variables. Results After adjusting for confounding factors, health literacy, eHealth literacy, and COPD knowledge accounted for an additional 9% of variance in generic HRQoL (total adjusted R2=21%; F9,164=6.09, P<.001). Health literacy (b=.08, SE 0.02, 95% CI 0.04-0.12) was the only predictor positively associated with generic HRQoL (P<.001). Adding health literacy, eHealth literacy, and COPD knowledge as predictors explained an additional 7.40% of variance in lung-specific HRQoL (total adjusted R2=26.4%; F8,161=8.59, P<.001). Following adjustment for covariates, both health literacy (b=2.63, SE 0.84, 95% CI 0.96-4.29, P<.001) and eHealth literacy (b=1.41, SE 0.67, 95% CI 0.09-2.73, P<.001) were positively associated with lung-specific HRQoL. Health literacy was positively associated with most lung-specific HRQoL indicators (ie, cough frequency, chest tightness, activity limitation at home, confidence leaving home, sleep quality, and energy level), whereas eHealth literacy was positively associated with 5 of 8 (60%) lung-specific HRQoL indicators. Upon controlling for confounders, COPD knowledge (b=−.56, SE 0.29, 95% CI −1.22 to −0.004, P<.05) was inversely associated with lung-specific HRQoL. Conclusions Health literacy, but not eHealth literacy, was positively associated with generic HRQoL. However, both health literacy and eHealth literacy were positively associated with lung-specific HRQoL, with higher COPD knowledge indicative of lower lung-specific HRQoL. These results confirm the importance of considering health and eHealth literacy levels when designing patient education programs for people living with COPD. Future research should explore the impact of delivering interventions aimed at improving eHealth and health literacy among patients with COPD, particularly when disease self-management goals are to enhance HRQoL.
Collapse
Affiliation(s)
- Michael Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - Samantha R Paige
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | - Julia M Alber
- Department of Kinesiology and Public Health, College of Science & Mathematics, California Polytechnic State University, San Luis Obispo, CA, United States
| | - Beth H Chaney
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - Don Chaney
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - Avery Apperson
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - Arjun Mohan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, East Carolina University Brody School of Medicine, Greenville, NC, United States
| |
Collapse
|
19
|
Shah A, Bailey CR. Outcomes following surgery: are we measuring what really matters? Anaesthesia 2019; 74:696-699. [DOI: 10.1111/anae.14562] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 12/01/2022]
Affiliation(s)
- A. Shah
- Nuffield Department of Anaesthesia John Radcliffe Hospital OxfordUK
- Radcliffe Department of Medicine University of OxfordUK
| | - C. R. Bailey
- Department of Anaesthesia Guys and St. Thomas’ NHS Foundation Trust London UK
| |
Collapse
|
20
|
Stoilkova-Hartmann A, Franssen FME, Augustin IML, Wouters EFM, Barnard KD. COPD patient education and support - Achieving patient-centredness. PATIENT EDUCATION AND COUNSELING 2018; 101:2031-2036. [PMID: 29884533 DOI: 10.1016/j.pec.2018.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The art of medicine is undergoing a dramatic shift in focus, evolving to focus on patient involvement as partners in care, transforming the traditional, prescriptive, reactive practice of healthcare into a proactive discipline. The personal and societal burden of chronic diseases is burgeoning and unsustainable in current systems, novel approaches are required to address this. DISCUSSION Although considerable progress has been made in the development of diagnostics, therapeutics and care guidelines for patients with chronic obstructive pulmonary disease (COPD), questions remain surrounding the implementation of best practice education and support. Current educational programmes, personal limitations and preferences and patient-clinician communication in modification of coping styles and behaviour are discussed. A novel holistic model, the Kaleidoscope Model of Care is proposed to address the barriers to optimal self-care behaviours. CONCLUSION AND PRACTICE IMPLICATIONS Holistic approaches are essential for optimal self-management and improved outcomes. Guidance on personalised goals for patients to help meeting their therapy priorities is needed to aid healthcare professionals (HCPs) and funders to minimise healthcare burden and costs. The novel KALMOD approach may optimise patient empowerment, exploring whole-life factors that impact COPD care and improve interactions between patients and HCPs for optimised outcomes.
Collapse
Affiliation(s)
- Ana Stoilkova-Hartmann
- Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.
| | - Frits M E Franssen
- Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands; Department of Research & Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Ingrid M L Augustin
- Department of Research & Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands; Department of Research & Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | | |
Collapse
|
21
|
Poelstra R, Selles RW, Slijper HP, van der Oest MJ, Feitz R, Hovius SE, Porsius JT. Better patients' treatment experiences are associated with better postoperative results in Dupuytren's disease. J Hand Surg Eur Vol 2018; 43:848-854. [PMID: 29911473 PMCID: PMC6139991 DOI: 10.1177/1753193418780187] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This prospective study investigates the extent to which a better experience with healthcare delivery is associated with better postoperative treatment outcomes after surgery for Dupuytren's contracture. Patients undergoing limited fasciectomy or percutaneous needle fasciotomy for Dupuytren's contractures completed the Michigan Hand Outcomes Questionnaire before and 3 months after surgery, together with a patient reported experience measure, while hand therapists assessed the straightness of the finger with a goniometer. Regression analyses were used to examine associations. We found that a better experience with healthcare delivery was associated with better patient-reported outcomes, while association with residual extension deficit was minimal. Strongest associations were seen with communication of the physician, postoperative care and information about the treatment. Experience with the treatment explained up to 12% of the variance in treatment outcome. These findings suggest that patient reported treatment outcomes in Dupuytren's disease can be improved by improving the treatment context. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Ralph Poelstra
- Department of Plastic,
Reconstructive and Hand Surgery, Erasmus University Medical Centre,
Rotterdam, The Netherlands,Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands,Department of Rehabilitation
Medicine, Erasmus University Medical Centre, Rotterdam, The
Netherlands,Ralph Poelstra, Department of
Plastic, Reconstructive and Hand Surgery, Erasmus University Medical
Centre, Room EE 15.91b, Dr. Molewaterplein 50, 3015 GE Rotterdam, The
Netherlands.
| | - Ruud W. Selles
- Department of Plastic,
Reconstructive and Hand Surgery, Erasmus University Medical Centre,
Rotterdam, The Netherlands,Department of Rehabilitation
Medicine, Erasmus University Medical Centre, Rotterdam, The
Netherlands
| | - Harm P. Slijper
- Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands
| | - Mark J.W. van der Oest
- Department of Plastic,
Reconstructive and Hand Surgery, Erasmus University Medical Centre,
Rotterdam, The Netherlands,Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands,Department of Rehabilitation
Medicine, Erasmus University Medical Centre, Rotterdam, The
Netherlands
| | - Reinier Feitz
- Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands
| | - Steven E.R. Hovius
- Department of Plastic,
Reconstructive and Hand Surgery, Erasmus University Medical Centre,
Rotterdam, The Netherlands,Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands
| | - Jarry T. Porsius
- Department of Plastic,
Reconstructive and Hand Surgery, Erasmus University Medical Centre,
Rotterdam, The Netherlands,Hand and Wrist Centre, Xpert
Clinic, Hilversum, The Netherlands,Department of Rehabilitation
Medicine, Erasmus University Medical Centre, Rotterdam, The
Netherlands
| | | |
Collapse
|
22
|
Lacy BE. Review article: an analysis of safety profiles of treatments for diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2018; 48:817-830. [PMID: 30194692 PMCID: PMC6667996 DOI: 10.1111/apt.14948] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/27/2018] [Accepted: 07/28/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is multifactorial in nature, and a wide range of therapies is available to manage symptoms of this common disorder. AIM To provide an overview of the safety of interventions that may be used to manage patients with diarrhoea-predominant IBS (IBS-D). METHODS Medline and Embase database searches (through 02 May 2018) to identify clinical studies that evaluated treatment safety and/or efficacy in adults with IBS-D. RESULTS IBS-D treatments include dietary modification, probiotics, serotonin receptor antagonists, opioid receptor agonists and antagonists, nonsystemic antibiotics, bile acid sequestrants, antidepressants, and complementary and alternative therapies. These treatments vary in administration frequency (eg, daily; short-course therapy) and target various pathophysiologic factors. Safety profiles vary considerably by treatment among IBS-D therapies. The number needed to harm (defined as the number of patients treated to encounter an adverse event) was lowest (worse) for antidepressants (8.5) and highest (best) for probiotics (35), and the number needed to harm (defined as the number of patients who discontinued due to an adverse event) was lowest for tricyclic antidepressants (9) and highest for rifaximin (8971). Notable safety concerns with IBS-D treatments include pancreatitis with eluxadoline, ischaemic colitis and serious complications of constipation with alosetron, and cardiac adverse events with loperamide and tricyclic antidepressants. Treatment decisions need to account for medication risks and adverse events for each patient. CONCLUSIONS Multiple treatment options are now available for patients with IBS-D. However, the safety profiles of these agents vary widely by number needed to harm value. Providers should consider both safety and efficacy of a specific intervention when determining how best to manage patients' IBS-D symptoms.
Collapse
Affiliation(s)
- Brian E. Lacy
- Section of GastroenterologyMayo ClinicJacksonvilleFlorida
| |
Collapse
|
23
|
Bastas-Bratkic D, Weismuller PC, Brady M. Assessing Clinicians' Endorsement of Patient Activation in Health Management. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
24
|
Castanhel FD, Grosseman S. Quality of Communication Questionnaire for COPD patients receiving palliative care: translation and cross-cultural adaptation for use in Brazil. J Bras Pneumol 2018; 43:357-362. [PMID: 29160381 PMCID: PMC5790653 DOI: 10.1590/s1806-37562016000000199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 05/04/2017] [Indexed: 11/21/2022] Open
Abstract
Objective: To translate the Quality of Communication Questionnaire (QOC) to Portuguese and adapt it for use in Brazil in COPD patients receiving palliative care. Methods: After approval from the first author of the original QOC and the local research ethics committee, the original, 13-item version of the questionnaire was independently translated to Brazilian Portuguese by two Brazilian translators fluent in English. The two translations were analyzed by a bilingual physician and the two Brazilian translators, who reached a consensus and produced another Portuguese version of the QOC. That version was back-translated to English by two translators originally from English-speaking countries and fluent in Portuguese. In order to resolve any discrepancies, an expert panel compared the original version of the QOC with all five versions produced up to that point, the “prefinal” version of the QOC for use in Brazil being thus arrived at. A total of 32 patients admitted to any of three public hospital ICUs in the greater metropolitan area of Florianopolis, in southern Brazil, participated in the pretesting phase of the study, which was aimed at assessing the clarity and cultural acceptability of the prefinal version of the QOC for use in Brazil. Results: Mean patient age was 48.5 ± 18.8 years. Most of the items were well understood and accepted, being rated 8 or higher. One item, regarding death, was considered difficult to understand by the participants in the pretesting phase. After analyzing the back-translated version of the QOC, the first author of the original questionnaire requested that the items “Caring about you as a human being” and “Talking about what death might be like” be changed to “Caring about you as a person” and “Talking about how dying might be”, respectively. The final version of the QOC for use in Brazil was thus arrived at. Conclusions: The QOC was successfully translated to Portuguese and adapted for use in Brazil.
Collapse
Affiliation(s)
- Flávia Del Castanhel
- . Programa de Pós-Graduação em Ciências Médicas - PPGCM - Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| | - Suely Grosseman
- . Departamento de Pediatria, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| |
Collapse
|
25
|
Gilligan T, Bohlke K, Baile WF. Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline Summary. J Oncol Pract 2018; 14:42-46. [DOI: 10.1200/jop.2017.027144] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Timothy Gilligan
- Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kari Bohlke
- Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Walter F. Baile
- Cleveland Clinic, Cleveland, OH; American Society of Clinical Oncology, Alexandria, VA; The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
26
|
Rationale and Design of the Lung Cancer Screening Implementation. Evaluation of Patient-Centered Care Study. Ann Am Thorac Soc 2017. [DOI: 10.1513/annalsats.201705-378sd] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
27
|
Gilligan T, Coyle N, Frankel RM, Berry DL, Bohlke K, Epstein RM, Finlay E, Jackson VA, Lathan CS, Loprinzi CL, Nguyen LH, Seigel C, Baile WF. Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline. J Clin Oncol 2017; 35:3618-3632. [PMID: 28892432 DOI: 10.1200/jco.2017.75.2311] [Citation(s) in RCA: 304] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose To provide guidance to oncology clinicians on how to use effective communication to optimize the patient-clinician relationship, patient and clinician well-being, and family well-being. Methods ASCO convened a multidisciplinary panel of medical oncology, psychiatry, nursing, hospice and palliative medicine, communication skills, health disparities, and advocacy experts to produce recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. The systematic review focused on guidelines, systematic reviews and meta-analyses, and randomized controlled trials published from 2006 through October 1, 2016. Results The systematic review included 47 publications. With the exception of clinician training in communication skills, evidence for many of the clinical questions was limited. Draft recommendations underwent two rounds of consensus voting before being finalized. Recommendations In addition to providing guidance regarding core communication skills and tasks that apply across the continuum of cancer care, recommendations address specific topics, such as discussion of goals of care and prognosis, treatment selection, end-of-life care, facilitating family involvement in care, and clinician training in communication skills. Recommendations are accompanied by suggested strategies for implementation. Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki .
Collapse
Affiliation(s)
- Timothy Gilligan
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nessa Coyle
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard M Frankel
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Donna L Berry
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kari Bohlke
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ronald M Epstein
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Esme Finlay
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vicki A Jackson
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher S Lathan
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles L Loprinzi
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lynne H Nguyen
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carole Seigel
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Walter F Baile
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
28
|
Mgbere O, Khuwaja S, Bell TK, Rodriguez-Barradas MC, Arafat R, Blair JM, Essien EJ. Managing the Personal Side of Health Care among Patients with HIV/AIDS. J Int Assoc Provid AIDS Care 2016; 16:149-160. [PMID: 25331218 PMCID: PMC10877399 DOI: 10.1177/2325957414555229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The study describes the HIV care providers' sociodemographic and medical practice characteristics and the health care services offered to patients during medical care encounters in Houston/Harris County, Texas. We used data from the pilot cycle of the Centers for Disease Control and Prevention Medical Monitoring Project Provider Survey conducted in June to September 2009. The average age and HIV care experience of the providers were 46.7 and 11.7 years, respectively, and they provided care to an average of 113 patients monthly. The average proportion of HIV-infected patients seen per month by race/ethnicity was 43.3% for blacks, 28.5% for whites, 26.6% for Hispanics, 1.3% for Asians, and 0.6% for other races. A total of 67% of providers offered HIV testing to all patients 13 to 64 years of age. Most HIV care providers (73.9%) reported that patients in their practices sought HIV care only after experiencing symptoms. Understanding the HIV care delivery system from providers' perspectives may help enhance support services, patients' ongoing care and retention, leading to improved health outcomes.
Collapse
Affiliation(s)
- Osaro Mgbere
- Bureau of Epidemiology, Office of Surveillance and Public Health Preparedness, Houston Department of Health and Human Services, Houston, TX, USA
| | - Salma Khuwaja
- Bureau of Epidemiology, Office of Surveillance and Public Health Preparedness, Houston Department of Health and Human Services, Houston, TX, USA
| | - Tanvir K. Bell
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Health Science Center–Houston, Houston, TX, USA
| | - Maria C. Rodriguez-Barradas
- Department of Medicine, Infectious Diseases Section, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Raouf Arafat
- Bureau of Epidemiology, Office of Surveillance and Public Health Preparedness, Houston Department of Health and Human Services, Houston, TX, USA
| | - Janet M. Blair
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Ekere James Essien
- Institute of Community Health, Texas Medical Center, University of Houston College of Pharmacy, Houston, TX, USA
| |
Collapse
|
29
|
Tobiano G, Bucknall T, Marshall A, Guinane J, Chaboyer W. Nurses' views of patient participation in nursing care. J Adv Nurs 2015. [DOI: 10.1111/jan.12740] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Georgia Tobiano
- Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Gold Coast Queensland Australia
| | - Tracey Bucknall
- Centre for Quality and Patient Safety; School of Nursing and Midwifery; Deakin University; Melbourne Victoria Australia
- Alfred Health; Melbourne Victoria Australia
| | - Andrea Marshall
- National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients; Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Southport Queensland Australia
- Gold Coast Health; Southport Queensland Australia
| | - Jessica Guinane
- School of Nursing and Midwifery; Deakin University; Melbourne Victoria Australia
| | - Wendy Chaboyer
- National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients; Centre for Health Practice Innovation; Menzies Health Institute Queensland; Griffith University; Southport Queensland Australia
| |
Collapse
|
30
|
Houben CHM, Spruit MA, Schols JMGA, Wouters EFM, Janssen DJA. Patient-Clinician Communication About End-of-Life Care in Patients With Advanced Chronic Organ Failure During One Year. J Pain Symptom Manage 2015; 49:1109-15. [PMID: 25623920 DOI: 10.1016/j.jpainsymman.2014.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 11/24/2014] [Accepted: 12/20/2014] [Indexed: 01/24/2023]
Abstract
CONTEXT Patient-clinician communication is an important prerequisite to delivering high-quality end-of-life care. However, discussions about end-of-life care are uncommon in patients with advanced chronic organ failure. OBJECTIVES The aim was to examine the quality of end-of-life care communication during one year follow-up of patients with advanced chronic organ failure. In addition, we aimed to explore whether and to what extent quality of communication about end-of-life care changes toward the end of life and whether end-of-life care communication is related to patient-perceived quality of medical care. METHODS Clinically stable outpatients (n = 265) with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure were visited at home at baseline and four, eight, and 12 months after baseline to assess quality of end-of-life care communication (Quality of Communication questionnaire). Two years after baseline, survival status was assessed, and if patients died during the study period, a bereavement interview was done with the closest relative. RESULTS One year follow-up was completed by 77.7% of the patients. Quality of end-of-life care communication was rated low at baseline and did not change over one year. Quality of end-of-life care communication was comparable for patients who completed two year follow-up and patients who died during the study. The correlation between quality of end-of-life care communication and satisfaction with medical treatment was weak. CONCLUSION End-of-life care communication is poor in patients with chronic organ failure and does not change toward the end of life. Future studies should develop an intervention aiming at initiating high-quality end-of-life care communication between patients with advanced chronic organ failure and their clinicians.
Collapse
Affiliation(s)
- Carmen H M Houben
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
| | - Martijn A Spruit
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Jos M G A Schols
- Departments of Family Medicine and Health Services Research, Faculty of Health, Medicine and Life Sciences/CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht UMC+, Maastricht, The Netherlands
| | - Daisy J A Janssen
- Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands; Centre of Expertise for Palliative Care, Maastricht UMC+, Maastricht, The Netherlands
| |
Collapse
|
31
|
Tobiano G, Marshall A, Bucknall T, Chaboyer W. Patient participation in nursing care on medical wards: An integrative review. Int J Nurs Stud 2015; 52:1107-20. [PMID: 25769475 DOI: 10.1016/j.ijnurstu.2015.02.010] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 12/19/2014] [Accepted: 02/12/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patient participation is a way for patients to engage in their nursing care. In view of the possible link between patient participation and safety, there is a need for an updated review to assess patient participation in nursing care. OBJECTIVES To investigate patients' and nurses' perceptions of and behaviours towards patient participation in nursing care in the context of hospital medical wards. DESIGN Integrative review. DATA SOURCES Three search strategies were employed in August 2013; a computerised database search of Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Medline and PsychINFO; reference lists were hand-searched; and forward citation searching was executed. REVIEW METHODS After reviewing the studies, extracting study data and completing summary tables the methodological quality was assessed using the Mixed-Methods Assessment Tool by two reviewers. Reviewers met then to discuss discrepancies as well as the overall strengths and limitations of the studies. Discrepancies were overcome through consensus or a third reviewer adjudicated the issue. Within and across study analysis and synthesis of the findings sections was undertaken using thematic synthesis. RESULTS Eight studies met inclusion criteria. Four themes were identified - enacting participation, challenges to participation, promoting participation and types of participation. Most studies included were conducted in Europe. The majority of studies used qualitative methodologies, with all studies sampling patients; nurses were included in three studies. Data were largely collected using self-reported perceptions; two studies included observational data. Methodological issues included a lack of reflexivity, un-validated data collection tools, sampling issues and low response rates. CONCLUSIONS On medical wards, patients and nurses desire, perceive or enact patient participation passively. Challenging factors for patient participation include patients' willingness, nurses' approach and confusion around expectations and roles. Information-sharing was identified as an activity that promotes patient participation, suggesting nurses encourage active communication with patients in practice. Involving patients in assessment and care planning may also enhance patient participation. For education, enhancing nurses' understanding of the attributes of patient participation, as well as patient-centred care approaches may be beneficial for medical ward nurses. From here, researchers need to examine ways to overcome the barriers to patient participation; further nurse participants and observational data is required on medical wards.
Collapse
Affiliation(s)
- Georgia Tobiano
- Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia.
| | - Andrea Marshall
- Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; The Gold Coast University Hospital, Queensland, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Alfred Health, Victoria, Australia
| | - Wendy Chaboyer
- Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Queensland, Australia; National Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| |
Collapse
|
32
|
Stellefson M, Chaney B, Chaney D, Paige S, Payne-Purvis C, Tennant B, Walsh-Childers K, Sriram P, Alber J. Engaging community stakeholders to evaluate the design, usability, and acceptability of a chronic obstructive pulmonary disease social media resource center. JMIR Res Protoc 2015; 4:e17. [PMID: 25630449 PMCID: PMC4336200 DOI: 10.2196/resprot.3959] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/05/2014] [Accepted: 01/05/2015] [Indexed: 12/31/2022] Open
Abstract
Background Patients with chronic obstructive pulmonary disease (COPD) often report inadequate access to comprehensive patient education resources. Objective The purpose of this study was to incorporate community-engagement principles within a mixed-method research design to evaluate the usability and acceptability of a self-tailored social media resource center for medically underserved patients with COPD. Methods A multiphase sequential design (qual → QUANT → quant + QUAL) was incorporated into the current study, whereby a small-scale qualitative (qual) study informed the design of a social media website prototype that was tested with patients during a computer-based usability study (QUANT). To identify usability violations and determine whether or not patients found the website prototype acceptable for use, each patient was asked to complete an 18-item website usability and acceptability questionnaire, as well as a retrospective, in-depth, semistructured interview (quant + QUAL). Results The majority of medically underserved patients with COPD (n=8, mean 56 years, SD 7) found the social media website prototype to be easy to navigate and relevant to their self-management information needs. Mean responses on the 18-item website usability and acceptability questionnaire were very high on a scale of 1 (strongly disagree) to 5 (strongly agree) (mean 4.72, SD 0.33). However, the majority of patients identified several usability violations related to the prototype’s information design, interactive capabilities, and navigational structure. Specifically, 6 out of 8 (75%) patients struggled to create a log-in account to access the prototype, and 7 out of 8 patients (88%) experienced difficulty posting and replying to comments on an interactive discussion forum. Conclusions Patient perceptions of most social media website prototype features (eg, clickable picture-based screenshots of videos, comment tools) were largely positive. Mixed-method stakeholder feedback was used to make design recommendations, categorize usability violations, and prioritize potential solutions for improving the usability of a social media resource center for COPD patient education.
Collapse
Affiliation(s)
- Michael Stellefson
- Center for Digital Health and Wellness, Department of Health Education and Behavior, University of Florida, Gainesville, FL, United States.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Schmidt M, Demoule A, Deslandes-Boutmy E, Chaize M, de Miranda S, Bèle N, Roche N, Azoulay E, Similowski T. Intensive care unit admission in chronic obstructive pulmonary disease: patient information and the physician's decision-making process. Crit Care 2014; 18:R115. [PMID: 24898342 PMCID: PMC4229873 DOI: 10.1186/cc13906] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 05/20/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION ICU admission is required in more than 25% of patients with chronic obstructive pulmonary disease (COPD) at some time during the course of the disease. However, only limited information is available on how physicians communicate with COPD patients about ICU admission. METHODS COPD patients and relatives from 19 French ICUs were interviewed at ICU discharge about their knowledge of COPD. French pulmonologists self-reported their practices for informing and discussing intensive care treatment preferences with COPD patients. Finally, pulmonologists and ICU physicians reported barriers and facilitators for transfer of COPD patients to the ICU and to propose invasive mechanical ventilation. RESULTS Self-report questionnaires were filled in by 126 COPD patients and 102 relatives, and 173 pulmonologists and 135 ICU physicians were interviewed. For 41% (n = 39) of patients and 54% (n = 51) of relatives, ICU admission had never been expected prior to admission. One half of patients were not routinely informed by their pulmonologist about possible ICU admission at some time during the course of COPD. Moreover, treatment options (that is, non-invasive ventilation, intubation and mechanical ventilation or tracheotomy) were not explained to COPD patients during regular pulmonologist visits. Pulmonologists and ICU physician have different perceptions of the decision-making process pertaining to ICU admission and intubation. CONCLUSIONS The information provided by pulmonologists to patients and families concerning the prognosis of COPD, the risks of ICU admission and specific care could be improved in order to deliver ICU care in accordance with the patient's personal values and preferences. Given the discrepancies in the decision-making process between pulmonologists and intensivists, a more collaborative approach should probably be discussed.
Collapse
Affiliation(s)
- Matthieu Schmidt
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 ‘Neurophysiologie Respiratoire Expérimentale et Clinique’, 47-83 boulevard de l'Hôpital, 75013 Paris, France
- INSERM, UMR_S 1158 ‘Neurophysiologie Respiratoire Expérimentale et Clinique’, 47-83 boulevard de l'Hôpital, 75013 Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘R3S’), 47 boulevard de l'Hôpital, F-75013 Paris, France
| | - Alexandre Demoule
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘R3S’), 47 boulevard de l'Hôpital, F-75013 Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 974, 47-83 boulevard de l'Hôpital, 75013 Paris, France
- INSERM, UMR_S 974, F-75005 Paris, France
| | - Emmanuelle Deslandes-Boutmy
- Hôpitaux de Paris, Hôpital Saint Louis, Service de Biostatistique, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Marine Chaize
- Hôpitaux de Paris, Hôpital Saint Louis, Service de Réanimation Médicale, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Sandra de Miranda
- Hôpitaux de Paris, Hôpital Saint Louis, Service de Réanimation Médicale, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Nicolas Bèle
- Hôpitaux de Paris, Hôpital Saint Louis, Service de Réanimation Médicale, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Nicolas Roche
- Hôpitaux de Paris, Hôpital Cochin – Site Val de Grâce, Service de Pneumologie et Soins Intensifs Respiratoires, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, F-75014 Paris, France
| | - Elie Azoulay
- Hôpitaux de Paris, Hôpital Saint Louis, Service de Réanimation Médicale, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Thomas Similowski
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 ‘Neurophysiologie Respiratoire Expérimentale et Clinique’, 47-83 boulevard de l'Hôpital, 75013 Paris, France
- INSERM, UMR_S 1158 ‘Neurophysiologie Respiratoire Expérimentale et Clinique’, 47-83 boulevard de l'Hôpital, 75013 Paris, France
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département ‘R3S’), 47 boulevard de l'Hôpital, F-75013 Paris, France
| |
Collapse
|
35
|
Grande SW, Faber MJ, Durand MA, Thompson R, Elwyn G. A classification model of patient engagement methods and assessment of their feasibility in real-world settings. PATIENT EDUCATION AND COUNSELING 2014; 95:281-287. [PMID: 24582473 DOI: 10.1016/j.pec.2014.01.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 12/19/2013] [Accepted: 01/26/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Examine existing reviews of patient engagement methods to propose a model where the focus is on engaging patients in clinical workflows, and to assess the feasibility of advocated patient engagement methods. METHODS A literature search of reviews of patient engagement methods was conducted. Included reviews were peer-reviewed, written in English, and focused on methods that targeted patients or patient-provider dyads. Methods were categorized to propose a conceptual model. The feasibility of methods was assessed using an adapted rating system. RESULTS We observed that we could categorize patient engagement methods based on information provision, patient activation, and patient-provider collaboration. Methods could be divided by high and low feasibility, predicated on the extent of extra work required by the patient or clinical system. Methods that have good fit with existing workflows and that require proportional amounts of work by patients are likely to be the most feasible. CONCLUSION Implementation of patient engagement methods is likely to depend on finding a "sweet-spot" where demands required by patients generate improved knowledge and motivate active participation. PRACTICE IMPLICATIONS Attention should be given to those interventions and methods that advocate feasibility with patients, providers, and organizational workflows.
Collapse
Affiliation(s)
- Stuart W Grande
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, USA
| | - Marjan J Faber
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Rachel Thompson
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, USA
| | - Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, USA; The Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, USA.
| |
Collapse
|
36
|
What the heck is a "nodule"? A qualitative study of veterans with pulmonary nodules. Ann Am Thorac Soc 2014; 10:330-5. [PMID: 23952851 DOI: 10.1513/annalsats.201304-080oc] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE Every year, hundreds of thousands of patients are diagnosed with incidentally detected pulmonary nodules, and if lung cancer screening is widely implemented, thousands more will be identified. The psychosocial outcomes associated with incidental nodule detection in general practice settings are virtually unknown. OBJECTIVES The purpose of this study was to explore the experiences of patients with incidentally diagnosed pulmonary nodules. METHODS We conducted qualitative interviews of 19 veterans with incidentally detected pulmonary nodules. We used qualitative description for the analysis, focusing on patients' information exchange and other communication behaviors with their clinicians. MEASUREMENTS AND MAIN RESULTS The patients were cared for by primary care clinicians and had small nodules that were unlikely to be malignant. Patients did not understand the term "nodule" although they knew it was related to cancer. They also did not understand the follow-up plan and most were unable to obtain better information from their clinician or other sources. Most patients experienced nodule-related distress that was usually mild, although sometimes severe. This distress was sometimes mitigated by patients' confidence in their clinician. Most patients wanted more and better information about their nodule. CONCLUSIONS Veterans from one hospital have little understanding of what nodules are, the likelihood of malignancy, and the follow-up plan. Their reaction to this knowledge deficit is variable and is likely related to preferred communication behaviors with their clinician. Evaluating communication in other settings is important to confirm these findings and to refine mechanisms to improve patient-centered care for those with incidentally detected pulmonary nodules.
Collapse
|
37
|
Slatore CG, Feemster LC, Au DH, Engelberg RA, Curtis JR, Uman J, Reinke LF. Which patient and clinician characteristics are associated with high-quality communication among veterans with chronic obstructive pulmonary disease? JOURNAL OF HEALTH COMMUNICATION 2014; 19:907-921. [PMID: 24558957 DOI: 10.1080/10810730.2013.864732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The authors evaluated associations of patient and clinician characteristics with high-quality communication among patients with chronic obstructive pulmonary disease. Using a cross-sectional analysis from patients with chronic obstructive pulmonary disease enrolled in a clinical trial, the authors evaluated the association of patient and clinician characteristics with patient-reported communication quality. The authors measured these associations using general estimating equations and adjusted odds ratios for best imagined communication quality. Most patient and clinician characteristics, including age, race/ethnicity, mental health attributes, and clinician specialty, were not associated with communication quality. Patient-reported clinician expertise (OR = 2.10, 95% CI [1.52, 2.88], p < .001) was associated with increased communication quality, while the patient not being married was associated with decreased quality (OR = 0.52, 95% CI [0.27, 0.99], p = .047). Only one modifiable characteristic, patient-reported clinician expertise, was associated with best imagined communication quality. This characteristic may be important to include as a potential intermediate outcome in future communication intervention studies. Predictors and outcomes of communication quality are not uniform across patient populations and settings. To maximize the effectiveness of communication interventions, it is important to have a thorough understanding of which patient, clinician, and system factors are associated with communication quality.
Collapse
Affiliation(s)
- Christopher G Slatore
- a Health Services Research and Development, and the Section of Pulmonary and Critical Care Medicine, Portland VA Medical Center, and the Division of Pulmonary and Critical Care Medicine , Oregon Health and Science University , Portland , Oregon , USA
| | | | | | | | | | | | | |
Collapse
|
38
|
Black N, Varaganum M, Hutchings A. Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery. BMJ Qual Saf 2014; 23:534-42. [DOI: 10.1136/bmjqs-2013-002707] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
39
|
Abstract
PURPOSE Medical home care has been identified as a model for improving primary care delivery and population-specific quality and safety outcomes. Questions remain how this model affects older adult quality. This systematic review addresses 2 important questions: Are quality and safety outcomes associated with medical home and patient-centered interventions, and how is quality studied in older adult primary care research? METHODS The authors searched MEDLINE for articles that examined interventions that were associated with medical home principles. Each article was evaluated using a standardized data abstraction form. Studies were categorized according to how interventions influenced specific quality and safety outcomes-improved clinical and treatment measures and care delivery processes-for older adults. RESULTS Thirteen research studies were identified by the authors. A great deal of variety exists in both research design and how quality and safety outcomes for older adults are operationalized in primary care. In general, studies indicate potentially beneficial relationships between 3 types of medical home interventions targeting health care utilization, disease management, and patient-provider communication to improved quality outcomes. CONCLUSION It would be advantageous for practices looking to align with patient-centered medical home quality and safety goals to consider the needs of older adults when redesigning care delivery.
Collapse
|
40
|
Miravitlles M, Ferrer J, Baró E, Lleonart M, Galera J. Differences between physician and patient in the perception of symptoms and their severity in COPD. Respir Med 2013; 107:1977-85. [PMID: 23890959 DOI: 10.1016/j.rmed.2013.06.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/10/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) impairs quality of life and presents symptoms that affect the lives of patients. Our study analysed the degree of concordance between the patients and their pulmonologists in the perception of the severity of symptoms. A cross-sectional, descriptive, multicentre study was conducted in patients with COPD. From a list of 10 symptoms (cough, dry mouth, chest pain, expectoration, wheezing/whistling in the lungs, depression/sadness/discouragement, fatigue/tiredness/general lack of energy, anxiety/nervousness, breathlessness/shortness of breath upon exertion and difficulty sleeping/sleep disorders) each investigator and patient assessed those which, in their opinion, most concerned or affected the patient. A total of 450 patients were included in the study (91.3% males, 66.7 years old (SD = 10.2), FEV1(%) 51.7% (SD = 12.7%)). At an aggregate level, breathlessness/shortness of breath, fatigue/tiredness and coughing were identified by patients and physicians as being the most relevant symptoms. However, according to the concordance analysis conducted with individual pairs (each pulmonologist with his/her patient), only 52.8% coincided when identifying the symptom that most concerned or affected the life of the patient. The concordance analysed by the Kappa index between patients and physicians was poor (<0.42). The degree of physician-patient concordance was greater in patients with more severe COPD. The patients and their pulmonologists identified the same three main symptoms of COPD but showed low concordance when assessing the impact of the symptoms of the illness.
Collapse
Affiliation(s)
- Marc Miravitlles
- Servei de Pneumologia, Hospital General Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
| | | | | | | | | |
Collapse
|
41
|
Downey L, Au DH, Curtis JR, Engelberg RA. Life-sustaining treatment preferences: matches and mismatches between patients' preferences and clinicians' perceptions. J Pain Symptom Manage 2013; 46:9-19. [PMID: 23017611 PMCID: PMC3534846 DOI: 10.1016/j.jpainsymman.2012.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 07/04/2012] [Accepted: 07/11/2012] [Indexed: 12/23/2022]
Abstract
CONTEXT Better clinician understanding of patients' end-of-life treatment preferences has the potential for reducing unwanted treatment, decreasing health care costs, and improving end-of-life care. OBJECTIVES To investigate patient preferences for life-sustaining therapies, clinicians' accuracy in understanding those preferences, and predictors of patient preference and clinician error. METHODS This was an observational study of 196 male veterans with chronic obstructive pulmonary disease who participated in a randomized trial. Measures included patients' preferences for mechanical ventilation (MV) and cardiopulmonary resuscitation (CPR) if needed in their current state of health, and outpatient clinicians' beliefs about those preferences. RESULTS Analyses were based on 54% of participants in the trial who had complete patient/clinician data on treatment preferences. Patients were more receptive to CPR than MV (76% vs. 61%; P<0.001). Preferences for both treatments were significantly associated with the importance patients assigned to avoiding life-sustaining therapies during the final week of life (MV: b=-0.11, P<0.001; CPR: b=-0.09, P=0.001). When responses were dichotomized (would/would not want treatment), clinicians' perceptions matched patient preferences in 75% of CPR cases and 61% of MV cases. Clinician errors increased as patients preferred less aggressive treatment (MV: b=-0.28, P<0.001; CPR: b=-0.32, P<0.001). CONCLUSION Clinicians erred more often about patients' wishes when patients did not want treatment than when they wanted it. Treatment decisions based on clinicians' perceptions could result in costly and unwanted treatments. End-of-life care could benefit from increased clinician-patient discussion about end-of-life care, particularly if discussions included patient education about risks of treatment and allowed clinicians to form and maintain accurate impressions of patients' preferences.
Collapse
Affiliation(s)
- Lois Downey
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA.
| | | | | | | |
Collapse
|
42
|
M van Es J, Wieringa-de Waard M, Visser MRM. Differential growth in doctor-patient communications skills. MEDICAL EDUCATION 2013; 47:691-700. [PMID: 23746158 DOI: 10.1111/medu.12175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 01/04/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT Although doctor-patient communication is considered a core competency for medical doctors, the effect of training has not been unequivocally established. Moreover, knowledge about the variance in the growth of different skills and whether certain patterns in growth can be detected could help us to develop more efficient programmes. We therefore investigated the growth in general practitioner (GP) trainees' doctor-patient communication skills in their first year and whether the growth was different for distinct categories of skills. METHODS Seventy-one first-year GP trainees were invited to participate in a study aimed at measuring their consultation skills at the beginning (baseline) and at the end of their first year (follow-up). Consultation skills were assessed with the MAAS-Global rating list for consultation skills. RESULTS Data on 29 general practitioner trainees were collected. MAAS-Global scores showed a significant growth on all items but one. Patient-oriented skills showed significantly more growth than task-oriented skills. Empathy as a separate skill seems to be mastered predominantly before the start of training. CONCLUSIONS Three patterns in the growth in skills were distinguished: (i) low baseline, relatively high follow-up, (ii) moderate baseline, moderate growth and (iii) high baseline, hardly any growth. Patient-oriented skills follow either pattern (i) or (iii), whereas task-oriented skills follow pattern (ii). These findings may help to define where the focus should lie in the training of doctor-patient communication skills.
Collapse
Affiliation(s)
- Judith M van Es
- Academic Medical Center, Department of General Practice, Amsterdam, the Netherlands.
| | | | | |
Collapse
|
43
|
Wortz K, Cade A, Menard JR, Lurie S, Lykens K, Bae S, Jackson B, Su F, Singh K, Coultas D. A qualitative study of patients' goals and expectations for self-management of COPD. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 21:384-91. [PMID: 23138844 DOI: 10.4104/pcrj.2012.00070] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is an illness that affects patients on multiple levels, both physically and psychologically. While there is a growing body of evidence for the efficacy of self-management among patients with COPD, little evidence is available on the optimal content and methods for delivering self-management support. AIMS The purpose of this study was to address gaps in the literature on self-management support by examining patients' responses to questions about goals, needs, and expectations regarding self-management using qualitative methods in a broadly representative sample of patients with moderate to severe COPD. By focusing on patients' perceptions of their needs, we hoped to guide development of cognitive-behavioural interventions for self-management support. METHODS Patients >45 years of age with a physician diagnosis of COPD were recruited as part of a larger randomised controlled trial designed to determine the effectiveness of a lifestyle behavioural intervention to increase physical activity. In-depth interviews were conducted at baseline data collection using 10 standardised open-ended questions tailored to examine factors relevant to self-management support including concerns, fears, learning needs, barriers, facilitators, and goals. All interviews were audio recorded and analysed using qualitative methods. Responses were coded by three raters into thematic categories. RESULTS A sample of 47 interviews with patients of mean age 68.4 years, 53% male, 87% white were used in the analysis. The distribution of spirometric impairment based on percent predicted forced expiratory volume in 1 second (FEV1) was moderate (57.5%), severe (31.9%), and very severe (10.6%). In response to questions targeting needs and goals for care, three main themes (loss, fear, and desire for improved care) and seven associated sub-themes were identified. Because of breathlessness and fatigue as well as symptoms from conditions other than COPD, patients reported the loss of ability to participate in pleasurable and necessary activities of daily living and the desire to recover at least some of their functioning. They expressed problems with social isolation and uncertainty about their prognosis, as well as the hope to improve. In addition, fearful experiences associated with uncontrolled breathlessness and a wish for greater understanding and knowledge about treatment were major concerns. CONCLUSIONS These qualitative results suggest that the content of self-management support for patients with COPD should focus on addressing patients' fears associated with the uncertainty, progression, and suffering of their disease, their expectations about overcoming or replacing losses, their needs for improved health literacy and their desire for improved care. These responses indicate areas where cognitive-behavioural intervention should focus in order to enhance patient self-efficacy, motivation, and behavioural change for improved self-management.
Collapse
Affiliation(s)
- Kathryn Wortz
- University of Texas Health Science Center at Tyler, Department of Family Medicine, Tyler, Texas 75708, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Affiliation(s)
- Ami Schattner
- />Kaplan Medical Centre, Rehovot, Israel
- />Hebrew University and Hadassah Medical School, Jerusalem, Israel
| |
Collapse
|
45
|
Philip J, Gold M, Brand C, Douglass J, Miller B, Sundararajan V. Negotiating hope with chronic obstructive pulmonary disease patients: a qualitative study of patients and healthcare professionals. Intern Med J 2013; 42:816-22. [PMID: 22152049 DOI: 10.1111/j.1445-5994.2011.02641.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The information needs of patients with chronic obstructive pulmonary disease (COPD) towards the end of life are poorly understood. AIM This study explored the views of patients with COPD and healthcare professionals, focusing upon information needs and treatment preferences. METHOD In-depth, semi-structured interviews were held with patients with COPD following admission to hospital with respiratory failure, and focus groups held with healthcare professionals from hospital and community settings. RESULTS Ten patients were interviewed, who had a median 4 previous hospital admissions, and had smoked for median 47 years. Five focus groups were held with 31 healthcare professionals (18 nurses, 7 doctors, 6 allied health). The theme underpinning all discussions was of tension between maintaining hope and negotiating the reality of the illness and its consequences. Within this theme, patients tended to be optimistic, viewed acute exacerbations as separate from their underlying chronic illness, and were keen for intensive treatments, including intubation if acutely unwell. They had little understanding of the complexities of decision-making around treatment escalation. Both patients and health workers believed that information around end of life should be offered routinely, but delivered in a manner that recognises and maintains a form of hope. CONCLUSION Patients and healthcare professionals believe information around illness course, future goals and treatment is important to care. An expanded view of hope may assist when providing such information, including when discussing goals of care in the setting of advanced illness.
Collapse
Affiliation(s)
- J Philip
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, Victoria, Australia.
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Out of an exhaustive review of the literature on the essential attributes of exemplary clinicians, five main characteristics were derived. Summarized by a useful acronym-SOAPS, these attributes include maintaining a Systematic method; employing Observation and listening; Accessing databases; emphasizing a Personal empathic attitude and Sharing information and decisions with the patient and family. Universally lauded as these concepts are, the evidence demonstrates that they are often neglected, with a negative impact on the quality of care and patient outcomes. The article focuses on using the SOAPS acronym as a mental checklist in teaching sessions and patient encounters to improve adherence to these key concepts.
Collapse
Affiliation(s)
- Ami Schattner
- Department of Medicine, Kaplan Medical Center, Rehovot, Israel.
| |
Collapse
|
47
|
Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 2013; 3:e001570. [PMID: 23293244 PMCID: PMC3549241 DOI: 10.1136/bmjopen-2012-001570] [Citation(s) in RCA: 1207] [Impact Index Per Article: 109.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/02/2012] [Accepted: 11/12/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. DESIGN Systematic review. SETTING A wide range of settings within primary and secondary care including hospitals and primary care centres. PARTICIPANTS A wide range of demographic groups and age groups. PRIMARY AND SECONDARY OUTCOME MEASURES A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. RESULTS This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. CONCLUSIONS The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the 'real' clinical work of measuring safety and effectiveness.
Collapse
Affiliation(s)
- Cathal Doyle
- NIHR CLAHRC for North West London, Chelsea and Westminster Hospital, London, UK
| | - Laura Lennox
- NIHR CLAHRC for North West London, Chelsea and Westminster Hospital, London, UK
- Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Derek Bell
- NIHR CLAHRC for North West London, Chelsea and Westminster Hospital, London, UK
- Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| |
Collapse
|
48
|
Janssen DJA, Spruit MA, Schols JMGA, van der Sande FM, Frenken LA, Wouters EFM. Insight into advance care planning for patients on dialysis. J Pain Symptom Manage 2013; 45:104-13. [PMID: 22841410 DOI: 10.1016/j.jpainsymman.2012.01.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 01/15/2012] [Accepted: 01/19/2012] [Indexed: 11/23/2022]
Abstract
CONTEXT Advance care planning is not included in regular clinical care for patients on dialysis. Insight into life-sustaining treatment preferences and communication about end-of-life care is necessary to develop interventions to improve advance care planning for patients on dialysis. OBJECTIVES This cross-sectional observational study aimed to understand the preferences for life-sustaining treatments of outpatients on dialysis and to study the quality of patient-physician communication about end-of-life care and barriers and facilitators to this communication. METHODS The following outcomes were assessed in 80 clinically stable dialysis patients: demographics, clinical characteristics, life-sustaining treatment preferences (cardiopulmonary resuscitation and mechanical ventilation, and Willingness to Accept Life-Sustaining Treatment instrument), preference for site of death, quality of communication (Quality of Communication Questionnaire), and barriers and facilitators to communication about end-of-life care (Barriers and Facilitators Questionnaire). RESULTS Patients were able to indicate their preferences for life-sustaining treatments and site of death. Preferences for life-sustaining treatments depend on the specific treatment, the expected outcome of treatment, and likelihood of an adverse outcome. Life-sustaining preferences were discussed with the nephrologist by 30.3% of the patients. Quality of the patient-physician communication about end-of-life care was rated poor. This study identified several barriers and facilitators to end-of-life care communication. CONCLUSION Patients should receive information about treatment burden, expected outcome, and the likelihood of an adverse outcome when discussing life-sustaining treatments. Quality of patient-physician communication about end-of-life care needs to improve. Barriers and facilitators to communication about end-of-life care provide direction for future interventions to facilitate advance care planning for patients on dialysis.
Collapse
Affiliation(s)
- Daisy J A Janssen
- Program Development Centre, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.
| | | | | | | | | | | |
Collapse
|
49
|
Houle J, Beaulieu MD, Lussier MT, Del Grande C, Pellerin JP, Authier M, Duplain R, Tran TM, Allison F. Patients' experience of chronic illness care in a network of teaching settings. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2012; 58:1366-73. [PMID: 23242897 PMCID: PMC3520666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate chronic illness care delivery from the patient's perspective and to examine its main correlates. DESIGN Cross-sectional, descriptive study using questionnaires and medical chart review. SETTING Nine teaching family practices in Quebec. PARTICIPANTS A total of 364 patients with diabetes, hypertension, or chronic obstructive pulmonary disease. MAIN OUTCOMES MEASURES Score on the Patient Assessment of Chronic Illness Care (PACIC) questionnaire, which evaluates the patient's perspective on the care received based on the chronic care model (CCM); patients characteristics (sex, level of education, number of chronic illnesses); patient-physician relationship (relational continuity, interpersonal communication assessed from the patient's perspective); and interdisciplinary care and technical quality of care abstracted from patients' medical charts. RESULTS The mean PACIC score obtained (2.8 out of 5) indicates that, on average, CCM-concordant care "generally did not occur" or occurred only "sometimes" in this network of teaching practices. However, with a mean technical quality-of-care score of nearly 80%, physicians in this network showed a high degree of adherence to clinical guidelines for the chronic illnesses under study. Patient education level lower than high school was negatively associated with PACIC scores, while positive associations were found with male sex, number of chronic illnesses, relational continuity, interpersonal communication, interdisciplinary care, and technical quality of care. CONCLUSION Patients with less education reported receiving less CCM-concordant care. The patient-physician relationship was the strongest correlate of PACIC scores, while interdisciplinary care and technical quality of care had modest contributions.
Collapse
Affiliation(s)
- Janie Houle
- Department of Psychology, Université du Québec à Montréal, PO Box 8888, Station Centre-ville, Montreal, QC H3C 3P8.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
|