1
|
Edwards M, Holland‐Hart D, Mann M, Seddon K, Buckle P, Longo M, Byrne A, Nelson A. Understanding how shared decision-making approaches and patient aids influence patients with advanced cancer when deciding on palliative treatments and care: A realist review. Health Expect 2023; 26:2109-2126. [PMID: 37448166 PMCID: PMC10632651 DOI: 10.1111/hex.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/09/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Patients with advanced incurable cancer face difficult decisions about palliative treatment options towards their end of life. However, they are often not provided with the appropriate information and support that is needed to make informed decisions. This review aimed to identify contexts and mechanisms associated with communication tools, patient decision-aids and shared decision-making (SDM) approaches that influence patient outcomes. METHODS We used a realist review method to search for published studies of patients (adults > 18) with advanced cancer who were expected to make a decision about palliative treatment and/or supportive care in consultation with healthcare practitioners. We appraised and synthesised literature describing the contexts of (when and how) decision aids and SDM approaches are used, and how these contexts interact with mechanisms (resources and reasoning) which impact patient outcomes. Stakeholders including academics, palliative healthcare professionals (HCPs) and people with lived experience of supporting people with advanced incurable cancer contributed to identifying explanatory accounts. These accounts were documented, analysed and consolidated to contribute to the development of a programme theory. RESULTS From the 33 included papers, we consolidated findings into 20 explanatory accounts to develop a programme theory that explains key contexts and mechanisms that influence patient and SDM. Contexts include underlying patients' and HCPs' attitudes and approaches. These need to be understood in relation to key mechanisms, including presenting information in multiple formats and providing adequate time and opportunities to prepare for and revisit decisions. Contexts influenced mechanisms which then influence the levels of patient decisional satisfaction, conflict and regret. CONCLUSIONS Our programme theory highlights mechanisms that are important in supporting shared treatment decisions for advanced noncurative cancer. The findings are informative for developing and evaluating interventions to improve understanding and involvement in SDM for patients with advanced incurable cancer. PATIENT AND PUBLIC CONTRIBUTION We included patient and public involvement (PPI) representatives in four stakeholder meetings. PPI helped to define the scope of the review, identify their unique experiences and perspectives, synthesise their perspectives with our review findings, make decisions about which theories we included in our programme theory and develop recommendations for policy and practice and future research.
Collapse
Affiliation(s)
- Michelle Edwards
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Daniella Holland‐Hart
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Mala Mann
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Kathy Seddon
- Marie Curie Palliative Care Research CentreWales Cancer Research CentreCardiffWalesUK
| | - Peter Buckle
- Marie Curie Palliative Care Research CentreWales Cancer Research CentreCardiffWalesUK
| | - Mirella Longo
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Anthony Byrne
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| | - Annmarie Nelson
- Division of Population Medicine, Marie Curie Palliative Care Research CentreCardiff UniversityCardiffWalesUK
| |
Collapse
|
2
|
Alshamrani K, Alshamrani HA, Alqahtani FF, Almutairi BS. Enhancement of Mammographic Images Using Histogram-Based Techniques for Their Classification Using CNN. Sensors (Basel) 2022; 23:235. [PMID: 36616832 PMCID: PMC9824687 DOI: 10.3390/s23010235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
In the world, one in eight women will develop breast cancer. Men can also develop it, but less frequently. This condition starts with uncontrolled cell division brought on by a change in the genes that regulate cell division and growth, which leads to the development of a nodule or tumour. These tumours can be either benign, which poses no health risk, or malignant, also known as cancerous, which puts patients' lives in jeopardy and has the potential to spread. The most common way to diagnose this problem is via mammograms. This kind of examination enables the detection of abnormalities in breast tissue, such as masses and microcalcifications, which are thought to be indicators of the presence of disease. This study aims to determine how histogram-based image enhancement methods affect the classification of mammograms into five groups: benign calcifications, benign masses, malignant calcifications, malignant masses, and healthy tissue, as determined by a CAD system of automatic mammography classification using convolutional neural networks. Both Contrast-limited Adaptive Histogram Equalization (CAHE) and Histogram Intensity Windowing (HIW) will be used (CLAHE). By improving the contrast between the image's background, fibrous tissue, dense tissue, and sick tissue, which includes microcalcifications and masses, the mammography histogram is modified using these procedures. In order to help neural networks, learn, the contrast has been increased to make it easier to distinguish between various types of tissue. The proportion of correctly classified images could rise with this technique. Using Deep Convolutional Neural Networks, a model was developed that allows classifying different types of lesions. The model achieved an accuracy of 62%, based on mini-MIAS data. The final goal of the project is the creation of an update algorithm that will be incorporated into the CAD system and will enhance the automatic identification and categorization of microcalcifications and masses. As a result, it would be possible to increase the possibility of early disease identification, which is important because early discovery increases the likelihood of a cure to almost 100%.
Collapse
Affiliation(s)
- Khalaf Alshamrani
- PhD Radiological Sciences Department, College of Applied Medical Sciences, Najran University, Najran 6641, Saudi Arabia
| | - Hassan A. Alshamrani
- PhD Radiological Sciences Department, College of Applied Medical Sciences, Najran University, Najran 6641, Saudi Arabia
| | - Fawaz F. Alqahtani
- PhD Radiological Sciences Department, College of Applied Medical Sciences, Najran University, Najran 6641, Saudi Arabia
| | - Bander S. Almutairi
- Radiology Department, King Abdulaziz University Hospital, Jeddah 3646, Saudi Arabia
| |
Collapse
|
3
|
Lowe D, Ryan R, Schonfeld L, Merner B, Walsh L, Graham-Wisener L, Hill S. Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. Cochrane Database Syst Rev 2021; 9:CD013373. [PMID: 34523117 PMCID: PMC8440158 DOI: 10.1002/14651858.cd013373.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health services have traditionally been developed to focus on specific diseases or medical specialties. Involving consumers as partners in planning, delivering and evaluating health services may lead to services that are person-centred and so better able to meet the needs of and provide care for individuals. Globally, governments recommend consumer involvement in healthcare decision-making at the systems level, as a strategy for promoting person-centred health services. However, the effects of this 'working in partnership' approach to healthcare decision-making are unclear. Working in partnership is defined here as collaborative relationships between at least one consumer and health provider, meeting jointly and regularly in formal group formats, to equally contribute to and collaborate on health service-related decision-making in real time. In this review, the terms 'consumer' and 'health provider' refer to partnership participants, and 'health service user' and 'health service provider' refer to trial participants. This review of effects of partnership interventions was undertaken concurrently with a Cochrane Qualitative Evidence Synthesis (QES) entitled Consumers and health providers working in partnership for the promotion of person-centred health services: a co-produced qualitative evidence synthesis. OBJECTIVES To assess the effects of consumers and health providers working in partnership, as an intervention to promote person-centred health services. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2000 to April 2019; PROQUEST Dissertations and Theses Global from 2016 to April 2019; and grey literature and online trial registries from 2000 until September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs of 'working in partnership' interventions meeting these three criteria: both consumer and provider participants meet; they meet jointly and regularly in formal group formats; and they make actual decisions that relate to the person-centredness of health service(s). DATA COLLECTION AND ANALYSIS Two review authors independently screened most titles and abstracts. One review author screened a subset of titles and abstracts (i.e. those identified through clinical trials registries searches, those classified by the Cochrane RCT Classifier as unlikely to be an RCT, and those identified through other sources). Two review authors independently screened all full texts of potentially eligible articles for inclusion. In case of disagreement, they consulted a third review author to reach consensus. One review author extracted data and assessed risk of bias for all included studies and a second review author independently cross-checked all data and assessments. Any discrepancies were resolved by discussion, or by consulting a third review author to reach consensus. Meta-analysis was not possible due to the small number of included trials and their heterogeneity; we synthesised results descriptively by comparison and outcome. We reported the following outcomes in GRADE 'Summary of findings' tables: health service alterations; the degree to which changed service reflects health service user priorities; health service users' ratings of health service performance; health service users' health service utilisation patterns; resources associated with the decision-making process; resources associated with implementing decisions; and adverse events. MAIN RESULTS We included five trials (one RCT and four cluster-RCTs), with 16,257 health service users and more than 469 health service providers as trial participants. For two trials, the aims of the partnerships were to directly improve the person-centredness of health services (via health service planning, and discharge co-ordination). In the remaining trials, the aims were indirect (training first-year medical doctors on patient safety) or broader in focus (which could include person-centredness of health services that targeted the public/community, households or health service delivery to improve maternal and neonatal mortality). Three trials were conducted in high income-countries, one was in a middle-income country and one was in a low-income country. Two studies evaluated working in partnership interventions, compared to usual practice without partnership (Comparison 1); and three studies evaluated working in partnership as part of a multi-component intervention, compared to the same intervention without partnership (Comparison 2). No studies evaluated one form of working in partnership compared to another (Comparison 3). The effects of consumers and health providers working in partnership compared to usual practice without partnership are uncertain: only one of the two studies that assessed this comparison measured health service alteration outcomes, and data were not usable, as only intervention group data were reported. Additionally, none of the included studies evaluating this comparison measured the other primary or secondary outcomes we sought for the 'Summary of findings' table. We are also unsure about the effects of consumers and health providers working in partnership as part of a multi-component intervention compared to the same intervention without partnership. Very low-certainty evidence indicated there may be little or no difference on health service alterations or health service user health service performance ratings (two studies); or on health service user health service utilisation patterns and adverse events (one study each). No studies evaluating this comparison reported the degree to which health service alterations reflect health service user priorities, or resource use. Overall, our confidence in the findings about the effects of working in partnership interventions was very low due to indirectness, imprecision and publication bias, and serious concerns about risk of selection bias; performance bias, detection bias and reporting bias in most studies. AUTHORS' CONCLUSIONS The effects of consumers and providers working in partnership as an intervention, or as part of a multi-component intervention, are uncertain, due to a lack of high-quality evidence and/or due to a lack of studies. Further well-designed RCTs with a clear focus on assessing outcomes directly related to partnerships for patient-centred health services are needed in this area, which may also benefit from mixed-methods and qualitative research to build the evidence base.
Collapse
Affiliation(s)
- Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| |
Collapse
|
4
|
Balneaves LG, Watling CZ, Hayward EN, Ross B, Taylor-Brown J, Porcino A, Truant TLO. Addressing Complementary and Alternative Medicine Use Among Individuals With Cancer: an Integrative Review and Clinical Practice Guideline. J Natl Cancer Inst 2021; 114:25-37. [PMID: 33769512 DOI: 10.1093/jnci/djab048] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 01/07/2023] Open
Abstract
Complementary and alternative medicine (CAM) use is common among individuals with cancer, but many choose not to discuss CAM with healthcare providers (HCPs). Moreover, there is variability in the provision of evidence-informed decision making about CAM use. A clinical practice guideline was developed to standardize how oncology HCPs address CAM use as well as to inform how individuals with cancer can be supported in making evidence-informed decisions about CAM. An integrative review of the literature, from inception to December 31st, 2018, was conducted in MEDLINE, EMBASE, PsychINFO, CINAHL, and AMED databases. Eligible articles included oncology HCPs' practice related to discussing, assessing, documenting, providing decision support, or offering information about CAM. Two authors independently searched the literature and selected articles were summarised. Recommendations for clinical practice were formulated from the appraised evidence and clinical experiences of the research team. An expert panel reviewed the guideline for usability and appropriateness and recommendations were finalised. The majority of the 30 studies eligible for inclusion were either observational or qualitative, with only three being reviews and three being experimental. From the literature, seven practice recommendations were formulated for oncology HCPs regarding how to address CAM use by individuals with cancer, including communicating, assessing, educating, decision-coaching, documenting, active monitoring, and adverse event reporting. It is imperative for safe and comprehensive care that oncology HCPs address CAM use as part of standard practice. This clinical practice guideline offers directions on how to support evidence-informed decision making about CAM among individuals with cancer.
Collapse
Affiliation(s)
- Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Cody Z Watling
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Emilie N Hayward
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | - Antony Porcino
- BC Cancer, Vancouver, Canada.,School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada
| | - Tracy L O Truant
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada
| |
Collapse
|
5
|
Overby CL, Chung WK, Hripcsak G, Kukafka R. Cancer genetic counselor information needs for risk communication: a qualitative evaluation of interview transcripts. J Pers Med 2013; 3. [PMID: 24358447 DOI: 10.3390/jpm3030238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Personalized medicine is a model of healthcare that is predictive, personalized, preventive and participatory (“P4 Medicine”). Genetic counselors are an ideal group to study when designing tools to support cancer P4 Medicine activities more broadly. The goal for this work was to gain a better understanding of the information cancer genetic counselors seek from their patients to facilitate effective information exchange for discussing risk. This was an analysis of a qualitative data set from interviews of eight cancer genetic counselors, recruited from three institutions. Genetic counselors at each site were interviewed using a semi-structured, open-ended questionnaire. A selective coding approach was used to determine major themes associated with genetic counseling information needs for communicating risk. We generated a model for understanding categories of genetic counseling information needs to support risk communication activities. Common activities for risk communication included risk assessment and tailoring communication. Categories of information needs included: (a) clinical patient characteristics, (b) social and cognitive patient characteristics and (c) patient motivation and goals for the genetic counseling session. A logical next step is for this model to inform the design of software systems for pre-visit patient planning and delivering just-in-time educational information to facilitate cancer risk communication activities.
Collapse
|
6
|
Presutti R, D'Alimonte L, McGuffin M, Chen H, Chow E, Pignol JP, Di Prospero L, Doherty M, Kiss A, Wong J, Lee J, Liu S, Warner E, Trudeau M, Feldman-Stewart D, Harth T, Szumacher E. Decisional support throughout the cancer journey for older women diagnosed with early stage breast cancer: a single institutional study. J Cancer Educ 2014; 29:129-135. [PMID: 24092532 DOI: 10.1007/s13187-013-0558-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
To determine if older women with early stage breast cancer have sufficient decisional support during their breast cancer journey, a questionnaire-based study was conducted at the Sunnybrook Odette Cancer Centre, in Toronto, Ontario, Canada. Women with stages I and II breast cancer, ≥60 years, were contacted upon completion of their adjuvant treatment. A questionnaire was developed based on focus groups, the literature, and consultation with patients and a multidisciplinary team of experts. The questionnaire was divided into six domains as follows: (1) information support surrounding diagnosis, (2) impact of cancer diagnosis on the patient, (3) quality of interaction with healthcare team, (4) decisional support from the healthcare team, (5) additional information needs surrounding treatment decision, and (6) information support during radiation treatment. Ninety-two of 137 patients approached were included in the analysis. Ninety percent were > 60 years at the time of diagnosis and 65% had stage I invasive breast cancer. The majority of women received adequate decisional support during their cancer journey. Approximately 90% of women indicated that they received a high level of support during their cancer diagnosis. We found no significant differences in overall decisional support based on age at diagnosis, education level, ethnicity, or the presence of co-morbidities. However, participants desired additional educational resources such as a worksheet, consultation summary, or workbook to assist in making a treatment decision. The majority of participants felt that they had sufficient support while making a treatment decision for breast cancer.
Collapse
Affiliation(s)
- Roseanna Presutti
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Henselmans I, de Haes HCJM, Smets EMA. Enhancing patient participation in oncology consultations: a best evidence synthesis of patient-targeted interventions. Psychooncology 2012; 22:961-77. [DOI: 10.1002/pon.3099] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/16/2012] [Accepted: 04/06/2012] [Indexed: 01/08/2023]
Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Hanneke C. J. M. de Haes
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Ellen M. A. Smets
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| |
Collapse
|
8
|
Lacovara JE, Arzouman J, Kim CJ, Degan JA, Horner M. Are Patients With Breast Cancer Satisfied With Their Decision Making? Clin J Oncol Nurs 2011; 15:320-3. [DOI: 10.1188/11.cjon.320-323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
9
|
Hendren S, Griggs JJ, Epstein RM, Humiston S, Rousseau S, Jean-Pierre P, Carroll J, Yosha AM, Loader S, Fiscella K. Study protocol: a randomized controlled trial of patient navigation-activation to reduce cancer health disparities. BMC Cancer 2010; 10:551. [PMID: 20939928 PMCID: PMC2964637 DOI: 10.1186/1471-2407-10-551] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 10/13/2010] [Indexed: 11/23/2022] Open
Abstract
Background Cancer health disparities affecting low-income and minority patients are well documented. Root-causes are multifactorial, including diagnostic and treatment delays, social and financial barriers, and poor communication. Patient navigation and communication coaching (activation) are potential interventions to address disparities in cancer treatment. The purpose of this clinical trial is to test the effectiveness of an intervention combining patient navigation and activation to improve cancer treatment. Methods/Design The Rochester Patient Navigation Research Program (PNRP) is a National Cancer Institute-sponsored, patient-level randomized trial (RCT) of patient navigation and activation, targeting newly-diagnosed breast and colorectal cancer patients in Rochester, NY. The goal of the program is to decrease cancer health disparities by addressing barriers to receipt of cancer care and promoting patient self-efficacy. The intervention uses trained, paraprofessional patient navigators recruited from the target community, and a detailed training and supervisory program. Recruited patients are randomly assigned to receive either usual care (except for baseline and follow-up questionnaires and interviews) or intervention. The intervention patients receive tailored assistance from their patient navigators, including phone calls, in-person meetings, and behind-the-scenes coordination of care. A total of 344 patients have been recruited. Outcomes measured at three month intervals include timeliness of care, patient adherence, patient satisfaction, quality of life, self-efficacy, health literacy, and cancer knowledge. Discussion This unique intervention combining patient navigation and patient activation is designed to address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of patient navigation programs. Trials Registration clinicaltrials.gov identifier NCT00496678
Collapse
Affiliation(s)
- Samantha Hendren
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Belkora JK, Loth MK, Chen DF, Chen JY, Volz S, Esserman LJ. Monitoring the implementation of Consultation Planning, Recording, and Summarizing in a breast care center. Patient Educ Couns 2008; 73:536-43. [PMID: 18755564 PMCID: PMC2622737 DOI: 10.1016/j.pec.2008.07.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2008] [Revised: 06/16/2008] [Accepted: 07/04/2008] [Indexed: 05/23/2023]
Abstract
OBJECTIVE We implemented and monitored a clinical service, Consultation Planning, Recording and Summarizing (CPRS), in which trained facilitators elicit patient questions for doctors, and then audio-record, and summarize the doctor-patient consultations. METHODS We trained 8 schedulers to offer CPRS to breast cancer patients making treatment decisions, and trained 14 premedical interns to provide the service. We surveyed a convenience sample of patients regarding their self-efficacy and decisional conflict. We solicited feedback from physicians, schedulers, and CPRS staff on our implementation of CPRS. RESULTS 278 patients used CPRS over the 22-month study period, an exploitation rate of 32% compared to our capacity. 37 patients responded to surveys, providing pilot data showing improvements in self-efficacy and decisional conflict. Physicians, schedulers, and premedical interns recommended changes in the program's locations; delivery; products; and screening, recruitment and scheduling processes. CONCLUSION Our monitoring of this implementation found elements of success while surfacing recommendations for improvement. PRACTICE IMPLICATIONS We made changes based on study findings. We moved Consultation Planning to conference rooms or telephone sessions; shortened the documents produced by CPRS staff; diverted slack resources to increase recruitment efforts; and obtained a waiver of consent in order to streamline and improve ongoing evaluation.
Collapse
|
11
|
Abstract
BACKGROUND Many people find it difficult to remember information provided during medical consultations. One way of improving this may be to provide a record of the conversation. OBJECTIVES This review examined the effects of providing recordings or summaries of their consultations to people with cancer and their families. SEARCH STRATEGY We searched the following sources: The Cochrane Library (issue 2 2007); MEDLINE (1966 to 29 May 2007); CINAHL (1982 to 29 May 2007); Dissertation Abstracts (1861 to 29 May 2007; Index to Theses 29 May 2007; EMBASE (1985 to 29 May 2007); PsycINFO (1967 to 29 May 2007); AMED (1985 to 29 May 2007); British Nursing Index (1985 to May 2007); SCI-EXPANDED, SSCI (1986 to 3 June 2007); and Sociological Abstracts (1998 to 29 May 2007). For the initial (1999) publication of this review we also searched the following databases: Sociofile; Cancerlit; IAC Health & Wellness; JICST; Pascal; ERIC; ASSIA; Linguistics and Language Behavior Abstracts; Mental Health Abstracts; CAB Health; DHSS-Data; MANTIS. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that evaluate the effects of providing recordings (for example, audiotapes) or summaries (for example, a letter with reminders of key points) of consultations to people with cancer or their families. DATA COLLECTION AND ANALYSIS Two authors assessed studies for inclusion. Data were extracted by one author and checked by another author. We assessed study quality on seven criteria. We used a systematic approach to data extraction to produce a descriptive summary of studies, and present a narrative synthesis of the results. MAIN RESULTS We included sixteen controlled trials involving 2318 adult participants. The studies measured diverse outcomes. Many of the participants found recordings or summaries of their consultations valuable, with between 60% and 100% of participants (across twelve studies) reading the summary or listening to the recording at least once. The recordings were used to help inform family and friends (range 41.5% to 94.4% of participants in nine studies). Five out of nine studies reported better recall of information for those receiving recordings or summaries. Three out of ten studies found that participants provided with a recording or summary were more satisfied. No studies (out of ten) found any statistically significant difference between groups in terms of anxiety or depression. Three studies evaluated the effects on quality of life, but found no main effects. No study evaluated the intervention's effects on survival. AUTHORS' CONCLUSIONS The provision of recordings or summaries of key consultations may benefit most adults with cancer. Although more research is needed to improve our understanding of these interventions, most patients find them very useful. Practitioners should consider offering people recordings or written summaries of their consultations.
Collapse
Affiliation(s)
- Marie Pitkethly
- Tayside Centre for General Practice, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, Tayside, UK, DD2 4BF.
| | | | | |
Collapse
|
12
|
Belkora J, Edlow B, Aviv C, Sepucha K, Esserman L. Training community resource center and clinic personnel to prompt patients in listing questions for doctors: follow-up interviews about barriers and facilitators to the implementation of consultation planning. Implement Sci 2008; 3:6. [PMID: 18237380 PMCID: PMC2270865 DOI: 10.1186/1748-5908-3-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Accepted: 01/31/2008] [Indexed: 11/23/2022] Open
Abstract
Background Visit preparation interventions help patients prepare to meet with a medical provider. Systematic reviews have found some positive effects, but there are no reports describing implementation experiences. Consultation Planning (CP) is a visit preparation technique in which a trained coach or facilitator elicits and documents patient questions for an upcoming medical appointment. We integrated CP into a university breast cancer clinic beginning in 1998. Representatives of other organizations expressed interest in CP, so we invited them to training workshops in 2000, 2001, and 2002. Objectives In order to learn from experience and generate hypotheses, we asked: 1) How many trainees implemented CP? 2) What facilitated implementation? 3) How have trainees, patients, physicians, and administrative leaders of implementing organizations reacted to CP? 4) What were the barriers to implementation? Methods We attempted to contact 32 trainees and scheduled follow-up, semi-structured, audio-recorded telephone interviews with 18. We analyzed quantitative data by tabulating frequencies and qualitative data by coding transcripts and identifying themes. Results Trainees came from two different types of organizations, clinics (which provide medical care) versus resource centers (which provide patient support services but not medical care). We found that: 1) Fourteen of 21 respondents, from five of eight resource centers, implemented CP. Four of the five implementing resource centers were rural. 2) Implementers identified the championing of CP by an internal staff member as a critical success factor. 3) Implementers reported that modified CP has been productive. 4) Four respondents, from two resource centers and two clinics, did not implement CP, reporting resource limitations or conflicting priorities as the critical barriers. Conclusion CP training workshops have been associated with subsequent CP implementations at resource centers but not clinics. We hypothesize that CP workshops combined with an internal champion and adequate program resources may be sufficient for some patient support organizations to implement CP.
Collapse
Affiliation(s)
- Jeffrey Belkora
- Department of Surgery, University of California, San Francisco, San Francisco, USA.
| | | | | | | | | |
Collapse
|
13
|
Kinnersley P, Edwards A, Hood K, Cadbury N, Ryan R, Prout H, Owen D, Macbeth F, Butow P, Butler C. Interventions before consultations for helping patients address their information needs. Cochrane Database Syst Rev 2007; 2007:CD004565. [PMID: 17636767 PMCID: PMC9036848 DOI: 10.1002/14651858.cd004565.pub2] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients often do not get the information they require from doctors and nurses. To address this problem, interventions directed at patients to help them gather information in their healthcare consultations have been proposed and tested. OBJECTIVES To assess the effects on patients, clinicians and the healthcare system of interventions which are delivered before consultations, and which have been designed to help patients (and/or their representatives) address their information needs within consultations. SEARCH STRATEGY We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library (issue 3 2006); MEDLINE (1966 to September 2006); EMBASE (1980 to September 2006); PsycINFO (1985 to September 2006); and other databases, with no language restriction. We also searched reference lists of articles and related reviews, and handsearched Patient Education and Counseling (1986 to September 2006). SELECTION CRITERIA Randomised controlled trials of interventions before consultations designed to encourage question asking and information gathering by the patient. DATA COLLECTION AND ANALYSIS Two researchers assessed the search output independently to identify potentially-relevant studies, selected studies for inclusion, and extracted data. We conducted a narrative synthesis of the included trials, and meta-analyses of five outcomes. MAIN RESULTS We identified 33 randomised controlled trials, from 6 countries and in a range of settings. A total of 8244 patients was randomised and entered into studies. The most common interventions were question checklists and patient coaching. Most interventions were delivered immediately before the consultations.Commonly-occurring outcomes were: question asking, patient participation, patient anxiety, knowledge, satisfaction and consultation length. A minority of studies showed positive effects for these outcomes. Meta-analyses, however, showed small and statistically significant increases for question asking (standardised mean difference (SMD) 0.27 (95% confidence interval (CI) 0.19 to 0.36)) and patient satisfaction (SMD 0.09 (95% CI 0.03 to 0.16)). There was a notable but not statistically significant decrease in patient anxiety before consultations (weighted mean difference (WMD) -1.56 (95% CI -7.10 to 3.97)). There were small and not statistically significant changes in patient anxiety after consultations (reduced) (SMD -0.08 (95%CI -0.22 to 0.06)), patient knowledge (reduced) (SMD -0.34 (95% CI -0.94 to 0.25)), and consultation length (increased) (SMD 0.10 (95% CI -0.05 to 0.25)). Further analyses showed that both coaching and written materials produced similar effects on question asking but that coaching produced a smaller increase in consultation length and a larger increase in patient satisfaction. Interventions immediately before consultations led to a small and statistically significant increase in consultation length, whereas those implemented some time before the consultation had no effect. Both interventions immediately before the consultation and those some time before it led to small increases in patient satisfaction, but this was only statistically significant for those immediately before the consultation. There appear to be no clear benefits from clinician training in addition to patient interventions, although the evidence is limited. AUTHORS' CONCLUSIONS Interventions before consultations designed to help patients address their information needs within consultations produce limited benefits to patients. Further research could explore whether the quality of questions is increased, whether anxiety before consultations is reduced, the effects on other outcomes and the impact of training and the timing of interventions. More studies need to consider the timing of interventions and possibly the type of training provided to clinicians.
Collapse
Affiliation(s)
- P Kinnersley
- School of Medicine, Cardiff University, Department of Primary Care and Public Health, Centre for Health Sciences Research, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, UK, CF14 4XN.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Belkora J, Katapodi M, Moore D, Franklin L, Hopper K, Esserman L. Evaluation of a visit preparation intervention implemented in two rural, underserved counties of Northern California. Patient Educ Couns 2006; 64:350-9. [PMID: 16904859 DOI: 10.1016/j.pec.2006.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 03/03/2006] [Accepted: 03/25/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Evaluate satisfaction with visit preparation at three rural resource center sites. METHODS The resource centers sent eight employees and two volunteers for training at UCSF in Consultation Planning (CP). CP is a service to help patients make a list of questions before seeing their doctors. Researchers used multivariate ordered logistic regression analysis to investigate the variation in satisfaction among 99 CP Clients served by the resource centers in 2003. RESULTS Sixty-seven CP Clients who completed surveys were highly satisfied (mean=8.67, standard deviation (S.D.)=1.85, range=5-10). Variation in satisfaction was associated only with whether or not the CP Provider was a breast cancer survivor serving a breast patient (p=0.005). Satisfaction was not associated with CP Client demographics; type of upcoming medical visit; or CP Provider age, remuneration status, nursing background, and volume of CP Clients. CONCLUSION Community-based resource centers have implemented CP to the satisfaction of their clients. Further research should expand the delivery of CP to more underserved members of the community and evaluate its acceptability and impact. There may be a therapeutic alliance formed when survivors provide CP to newly diagnosed patients. PRACTICE IMPLICATIONS CP should be considered by patient support programs wishing to expand their client services to include visit preparation.
Collapse
Affiliation(s)
- Jeffrey Belkora
- University of California, San Francisco School of Medicine, CA 94115, USA.
| | | | | | | | | | | |
Collapse
|