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Görig T, Eichinger M, Georg S, Hoffmann D, Philippi H, König J, Urschitz MS, De Bock F. Correlates of perceived shared decision making with parents of children with special healthcare needs: Findings from the PART-CHILD study. Patient Educ Couns 2024; 124:108252. [PMID: 38503036 DOI: 10.1016/j.pec.2024.108252] [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] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/20/2024] [Accepted: 03/13/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To assess the extent of perceived shared decision making (SDM) with parents of pediatric patients and to examine its association with characteristics of patients, professionals, and healthcare facilities. METHODS Parents of pediatric patients (n = 4383) were recruited in 15 social pediatric centers in Germany and provided information on perceived SDM (binary CollaboRATEpediatric score: optimal versus suboptimal extent of SDM), child age and sex, type of impairment, appointment, and healthcare professional present at the appointment. Organizational characteristics were assessed in a cross-sectional survey of staff at the study sites. RESULTS Overall, 58.4% of parents reported an optimal extent of SDM. The optimal extent of SDM was more likely reported by parents of girls (OR=1.27, p < 0.001) and children with physical (as opposed to cognitive and combined) impairments (OR=1.30, p = 0.006), and after appointments attended by allied health professionals (OR=1.28, p = 0.004). In addition, parents in facilities receiving financing in addition to compensation by statutory health insurance funds were less likely to report an optimal extent of perceived SDM. CONCLUSION While SDM with parents was mostly related to individual characteristics of children and professionals at appointments, organizational characteristics seemed less relevant in our study. PRACTICE IMPLICATIONS Staff should be made aware of lower SDM with parents of boys, older children, and those with cognitive impairments, and trained to improve the SDM in these groups.
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Affiliation(s)
- Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Professorship of Epidemiology and Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Michael Eichinger
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sabine Georg
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dorle Hoffmann
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Jochem König
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michael S Urschitz
- Division of Pediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Freia De Bock
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Oueslati R, Woudstra AJ, Alkirawan R, Reis R, van Zaalen Y, Slager MT, Stiggelbout AM, Touwen DP. What value structure underlies shared decision making? A qualitative synthesis of models of shared decision making. Patient Educ Couns 2024; 124:108284. [PMID: 38583353 DOI: 10.1016/j.pec.2024.108284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/06/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To construct the underlying value structure of shared decision making (SDM) models. METHOD We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz's value theory to define values in SDM and to investigate value relations. RESULTS We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals' (HCPs) and patients' skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients' autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. CONCLUSION SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients' Self-Direction. PRACTICE IMPLICATIONS This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients' values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
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Affiliation(s)
- Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Nursing and Research Group Oncological Care, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands.
| | - Anke J Woudstra
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Rima Alkirawan
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands; Children's Institute, University of Cape Town, Cape Town, South Africa
| | - Yvonne van Zaalen
- Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - Meralda T Slager
- Centre of Expertise Perspective in Health, Avans University of Applied Sciences, Breda, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Dorothea P Touwen
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
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Vaseur RME, Te Braake E, Beinema T, d'Hollosy WON, Tabak M. Technology-supported shared decision-making in chronic conditions: A systematic review of randomized controlled trials. Patient Educ Couns 2024; 124:108267. [PMID: 38547638 DOI: 10.1016/j.pec.2024.108267] [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] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To describe the role of patients with a chronic disease, healthcare professionals (HCPs) and technology in shared decision making (SDM) and the use of clinical decision support systems (CDSSs), and to evaluate the effectiveness of SDM and CDSSs interventions. METHODS Randomized controlled studies published between 2011 and 2021 were identified and screened independently by two reviewers, followed by data extraction and analysis. SDM elements and interactive styles were identified to shape the roles of patients, HCPs and technology. RESULTS Forty-three articles were identified and reported on 21 SDM-studies, 15 CDSS-studies, 2 studies containing both an SDM-tool and a CDSS, and 5 studies with other decision support components. SDM elements were mostly identified in SDM-tools and interactions styles were least common in the other decision support components. CONCLUSIONS Patients within the included RCTs mainly received information from SDM-tools and occasionally CDSSs when it concerns treatment strategies. HCPs provide and clarify information using SDM-tools and CDSSs. Technology provides interactions, which can support more active SDM. SDM-tools mostly showed evidence for positive effects on SDM outcomes, while CDSSs mostly demonstrated positive effects on clinical outcomes. PRACTICE IMPLICATIONS Technology-supported SDM has potential to optimize SDM when patients, HCPs and technology collaborate well together.
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Affiliation(s)
- Roswita M E Vaseur
- Department of Biomedical Signals and Systems; University of Twente, Enschede, The Netherlands.
| | - Eline Te Braake
- Department of Biomedical Signals and Systems; University of Twente, Enschede, The Netherlands; Roessingh Research and Development, Enschede, The Netherlands
| | - Tessa Beinema
- Department of Human-Media Interaction; University of Twente, Enschede, The Netherlands
| | | | - Monique Tabak
- Department of Biomedical Signals and Systems; University of Twente, Enschede, The Netherlands
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Mat Lazim NH, Syed A, Lee C, Ahmed Abousheishaa A, Chong Guan N. Using decision support tools for treatment decision making about antidepressants in outpatient psychiatric consultations. Patient Educ Couns 2024; 124:108266. [PMID: 38565074 DOI: 10.1016/j.pec.2024.108266] [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] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To examine the use of decision support tools in decision making about antidepressants during conversations between patients with major depressive disorder (MDD) and their psychiatrists. METHODS Theme-oriented discourse analysis of two psychiatric consultation groups: control (n = 17) and intervention (n = 16). In the control group, only a doctor's conversation guide was used; in the intervention group, the conversation guide and a patient decision aid (PDA) were used. RESULTS Psychiatrists mainly dominated conversations in both consultation groups. They were less likely to elicit patient treatment-related perspectives in the intervention group as they focused more on delivering the information than obtaining patient perspectives. However, using PDA in the intervention group slightly encouraged patients to participate in decisional talk. CONCLUSION The decision support tools did promote SDM performance. Using the conversation guide in both consultation groups encouraged the elicitation of patient perspectives, which helped the psychiatrists in tailoring their recommendations of options based on patient preferences and concerns. Using the PDA in the intervention group created space for treatment discussion and fostered active collaboration in treatment decision making. PRACTICE IMPLICATIONS Our findings have implications for SDM communication skills training and critical reflection on SDM practice.
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Affiliation(s)
- Nor Hazila Mat Lazim
- Department of English Language, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ayeshah Syed
- Department of English Language, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Charity Lee
- Department of Asian and European Languages, Faculty of Languages and Linguistics, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Aya Ahmed Abousheishaa
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Valentine KD, Leavitt L, Sepucha KR, Atlas SJ, Simmons L, Siegel L, Richter JM, Han PKJ. Uncertainty tolerance among primary care physicians: Relationship to shared decision making-related perceptions, practices, and physician characteristics. Patient Educ Couns 2024; 123:108232. [PMID: 38458091 PMCID: PMC10997439 DOI: 10.1016/j.pec.2024.108232] [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] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Understand how physicians' uncertainty tolerance (UT) in clinical care relates to their personal characteristics, perceptions and practices regarding shared decision making (SDM). METHODS As part of a trial of SDM training about colorectal cancer screening, primary care physicians (n = 67) completed measures of their uncertainty tolerance in medical practice (Anxiety subscale of the Physician's Reactions to Uncertainty Scale, PRUS-A), and their SDM self-efficacy (confidence in SDM skills). Patients (N = 466) completed measures of SDM (SDM Process scale) after a clinical visit. Bivariate regression analyses and multilevel regression analyses examined relationships. RESULTS Higher UT was associated with greater physician age (p = .01) and years in practice (p = 0.015), but not sex or race. Higher UT was associated with greater SDM self-efficacy (p < 0.001), but not patient-reported SDM. CONCLUSION Greater age and practice experience predict greater physician UT, suggesting that UT might be improved through training, while UT is associated with greater confidence in SDM, suggesting that improving UT might improve SDM. However, UT was unassociated with patient-reported SDM, raising the need for further studies of these relationships. PRACTICE IMPLICATIONS Developing and implementing training interventions aimed at increasing physician UT may be a promising way to promote SDM in clinical care.
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Affiliation(s)
- K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lauren Leavitt
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Leigh Simmons
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lydia Siegel
- Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - James M Richter
- Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Paul K J Han
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
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Aref HAT, Turk T, Dhanani R, Xiao A, Olson J, Paul P, Dennett L, Yacyshyn E, Sadowski CA. Development and evaluation of shared decision-making tools in rheumatology: A scoping review. Semin Arthritis Rheum 2024; 66:152432. [PMID: 38554593 DOI: 10.1016/j.semarthrit.2024.152432] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Shared decision-making (SDM) tools are facilitators of decision-making through a collaborative process between patients/caregivers and clinicians. These tools help clinicians understand patient's perspectives and help patients in making informed decisions based on their preferences. Despite their usefulness for both patients and clinicians, SDM tools are not widely implemented in everyday practice. One barrier is the lack of clarity on the development and evaluation processes of these tools. Such processes have not been previously described in the field of rheumatology. OBJECTIVE To describe the development and evaluation processes of shared decision-making (SDM) tools used in rheumatology. METHODS Bibliographic databases (e.g., EMBASE and CINAHL) were searched for relevant articles. Guidelines for the PRISMA extension for scoping reviews were followed. Studies included were: addressing SDM among adults in rheumatology, focusing on development and/or evaluation of SDM tool, full texts, empirical research, and in the English language. RESULTS Of the 2030 records screened, forty-six reports addressing 36 SDM tools were included. Development basis and evaluation measures varied across the studies. The most commonly reported development basis was the International Patient Decision Aids Standards (IPDAS) criteria (19/36, 53 %). Other developmental foundations reported were: The Ottawa Decision Support Framework (ODSF) (6/36, 16 %), Informed Medical Decision Foundation elements (3/36, 8 %), edutainment principles (2/36, 5.5 %), and others (e.g. DISCERN and MARKOV Model) (9/31,29 %). The most commonly used evaluation measures were the Decisional Conflict Scale (18/46, 39 %), acceptability and knowledge (7/46, 15 %), and the preparation for decision-making scale (5/46,11 %). CONCLUSION For better quality and wider implementation of such tools, there is a need for detailed, transparent, systematic, and consistent reporting of development methods and evaluation measures. Using established checklists for reporting development and evaluation is encouraged.
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Affiliation(s)
- Heba A T Aref
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Tarek Turk
- Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Ruhee Dhanani
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Andrew Xiao
- Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Joanne Olson
- Faculty of Nursing, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Pauline Paul
- Faculty of Nursing, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Liz Dennett
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Alberta, Canada
| | - Elaine Yacyshyn
- Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Cheryl A Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Alberta, Canada.
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Xiao L, Huang C, Bai Y, Ding J. Shared decision-making training embedded in undergraduate and postgraduate medical education: A scoping review. Patient Educ Couns 2024; 123:108186. [PMID: 38331626 DOI: 10.1016/j.pec.2024.108186] [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] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/20/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This review mapped the published literature on shared decision-making (SDM) training embedded in undergraduate and/or postgraduate medical education. METHODS We conducted a scoping review following the framework proposed by Arksey and O'Malley. We searched ten databases and Google Scholar and manual searched reference list in included articles. Two researchers independently screened articles and extracted data. A narrative synthesis was used for data analysis. RESULTS This review identified 27 studies describing 25 unique SDM programs. Most programs integrated SDM training in undergraduate education, encompassing an overview of SDM theories and enhancing skills through role-plays. The programs duration ranged from one to 24 h. Overall, they improved students' SDM knowledge, attitude, confidence and skills, but the impact for students on patients is unclear due to lack of long-term follow-up. CONCLUSION The current SDM programs appear to be effectiveness in achieving short-term SDM-related outcomes. These programs were heterogeneous in their content, duration and delivery. Future research should concentrate on exploring the long-term impact of SDM programs, particularly students' application of SDM practices and patient outcomes. PRACTICE IMPLICATIONS Embedding SDM training in undergraduate and/or postgraduate medical education may be a practical and effective solution for current barriers to the widespread adoption of SDM.
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Affiliation(s)
- Lin Xiao
- School of nursing, Southern Medical University, Guangzhou, China
| | - Chongmei Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yang Bai
- School of Nursing, Sun Yat-Sen University, Guangzhou, China.
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China.
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Haidet P, Melro CM, Fecile MLE, Jarecke JLT, Moniz T, Cooper AB. Shared decision making reimagined. Patient Educ Couns 2024; 123:108249. [PMID: 38508885 DOI: 10.1016/j.pec.2024.108249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Paul Haidet
- The Woodward Center for Excellence in Health Sciences Education and the Departments of Medicine, Humanities, and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| | - Carolyn M Melro
- The Department of Communication Studies, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | | | | | - Tracy Moniz
- The Department of Communication Studies, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Amanda B Cooper
- The Departments of Surgery and Humanities, Penn State College of Medicine, Hershey, PA, USA
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Debrabander J. On subjective measures of decision quality. Bioethics 2024; 38:438-444. [PMID: 38655819 DOI: 10.1111/bioe.13291] [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] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 02/28/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
In times of person-centered care, it is all the more important to support patients in making good decisions about their care. One way to offer such support to patients is by way of Patient Decision Aids (PDAs). Ranging from patient brochures to web-based tools, PDAs explicitly state the decisions patients face, inform them about their medical options, help them to clarify and discuss their values, and ultimately make a decision. However, lingering discussions surround effectiveness research on PDAs. In this article, I focus on two subjective measures of decision quality that are widely used as outcome measures in effectiveness research on PDAs (i.e., the Decisional Conflict Scale (DCS) and measures of regret). Although these measurement instruments have attracted critical attention in the scientific literature, bioethicists have hardly engaged with them. Therefore, I set myself to analyze the relationship between (the different subscales of) the DCS and measures of regret, on the one hand, and ethical principles such as beneficence and autonomy, on the other hand. In light of that analysis, I will clarify some discussions regarding the use of these measures of decision quality in effectiveness research on PDAs. This should help us to align the way we evaluate PDAs with ethical principles and avoid that our attempts to support patients in making good decisions about their care that is so central to person-centered care point in unethical directions.
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Affiliation(s)
- Jasper Debrabander
- Department of Philosophy and Moral Sciences, Ghent University, Ghent, Belgium
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Noordam D, Noordman J, van den Braak G, Visee H, Bakker A, Batenburg R, Olde Hartman TC, van Dulmen S. Shared decision-making in undergraduate nursing and medical education: An explorative dual-method study. Patient Educ Couns 2024; 123:108246. [PMID: 38480111 DOI: 10.1016/j.pec.2024.108246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE This study explores how shared decision-making (SDM) is integrated in undergraduate nursing and medical education. METHODS A dual-method design was applied. The integration of SDM in medicine and nursing education programs (i.e. SDM on paper) was explored through document analyses; the integration of SDM in curricula (i.e. SDM in class) through interviews with teachers and curriculum coordinators (N = 19). RESULTS A majority of the education programs featured SDM, mostly non-explicit. In curricula SDM was generally implicitly featured in compulsory courses across all study years. SDM was often integrated into preexisting theories and models and taught through various methods and materials. Generally, teachers and supervisors were not trained in SDM themselves. They assessed students' competence in SDM in a summative manner. CONCLUSION Overall, SDM was featured in undergraduate nursing and medical education, however, very implicitly.
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Affiliation(s)
- Désanne Noordam
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands.
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | | | - Hetty Visee
- Regioplan Beleidsonderzoek, Amsterdam, Netherlands
| | - Alice Bakker
- V&VN (Verpleegkundigen & Verzorgenden Nederland), Utrecht, Netherlands
| | - Ronald Batenburg
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | - Tim C Olde Hartman
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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Xie T, Meng J, Feng Z, Gao Y, Chen T, Chen Y, Geng J. Assessing patient information needs for new antidiabetic medications to inform shared decision-making: A best-worst scaling experiment in China. Health Expect 2024; 27:e14059. [PMID: 38689509 PMCID: PMC11061543 DOI: 10.1111/hex.14059] [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: 01/06/2024] [Revised: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Shared decision-making (SDM) is a patient-centred approach to improve the quality of care. An essential requirement for the SDM process is to be fully aware of patient information needs. OBJECTIVES Our study aimed to assess patient information needs for new antidiabetic medications using the best-worst scaling (BWS) experiment. METHODS BWS tasks were developed according to a literature review and the focus group discussion. We used a balanced incomplete block design and blocking techniques to generate choice sets. The final BWS contains 11 attributes, with 6-choice scenarios in each block. The one-to-one, face-to-face BWS survey was conducted among type 2 diabetic patients in Jiangsu Province. Results were analyzed using count-based analysis and modelling approaches. We also conducted a subgroup analysis to observe preference heterogeneity. RESULTS Data from 539 patients were available for analysis. The most desired information domain was the comparative effectiveness of new antidiabetic medications. It consists of the incidence of macrovascular complications, the length of extended life years, changes in health-related quality of life, the incidence of microvascular complications, and the control of glycated haemoglobin. Of all the attributes, the incidence of macrovascular complications was the primary concern. Patients' glycemic control and whether they had diabetes complications exerted a significant influence on their information needs. CONCLUSIONS Information on health benefits is of critical significance for diabetic patients. Patients have different information needs as their disease progresses. Personalized patient decision aids that integrate patient information needs and provide evidence of new antidiabetic medications are worthy of being established. PATIENT OR PUBLIC CONTRIBUTION Before data collection, a pilot survey was carried out among diabetic patients to provide feedback on the acceptability and intelligibility of the attributes.
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Affiliation(s)
- Tongling Xie
- Center for Evidence‐Based MedicineNantong University Medical SchoolNantongChina
- Information CenterThe People's Hospital of RugaoNantongChina
| | - Jingyi Meng
- Center for Evidence‐Based MedicineNantong University Medical SchoolNantongChina
| | - Zhe Feng
- Center for Evidence‐Based MedicineNantong University Medical SchoolNantongChina
| | - Yue Gao
- Hepatobiliary CenterThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Tian Chen
- Department of Rehabilitation Medicine and Clinical MedicineMedical Institute of Taizhou Polytechnic CollegeTaizhouChina
| | - Yalan Chen
- Center for Evidence‐Based MedicineNantong University Medical SchoolNantongChina
| | - Jinsong Geng
- Center for Evidence‐Based MedicineNantong University Medical SchoolNantongChina
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Tennant BL, Tesfaye CL, Chansky MC, Lappin B, Weinberg J, Ritchey ME, MacLennan L, Tarver ME. Communicating medical device recalls: A rapid review of the literature. Patient Educ Couns 2024; 123:108244. [PMID: 38484598 DOI: 10.1016/j.pec.2024.108244] [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] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES The U.S. Food and Drug Administration (FDA) currently regulates more than 190,000 different medical devices. Like all products, these devices may be subject to manufacturing problems, flawed designs, or new and unexpected risks, which in some cases require devices to be recalled. In 2021, the FDA's Patient Engagement Advisory Committee (PEAC) recommended that the FDA consider changes to the communication approach used for medical device recalls to make them more patient-focused, timely, and action-oriented. METHODS To support this recommendation, we conducted a rapid review of literature published from 2008-2022 to capture and examine information on risk communication approaches, methods, and best practices for recall-related communications about medical products. RESULTS We identified 23 articles to include in our review. CONCLUSION Our review found a lack of research-based studies as well as gaps in understanding about consumer perspectives, comprehension, and communication preferences related to recalls. Despite these limitations, we identified current communication approaches, numerous challenges, and recommendations for communicating medical products recall information to consumers. PRACTICE IMPLICATIONS Further research is needed to assess consumer attitudes, understanding, and preferences and to reach consensus on best practices for effectively communicating recall information to consumers of medical products.
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Affiliation(s)
| | | | | | - Brian Lappin
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Jessica Weinberg
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Mary E Ritchey
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Lori MacLennan
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
| | - Michelle E Tarver
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, USA
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13
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Smith-Turchyn J, Mukherjee SD. Factors Influencing the Decision of Individuals with Breast Cancer to Join an Exercise Oncology Trial. J Cancer Educ 2024; 39:244-252. [PMID: 38418705 DOI: 10.1007/s13187-024-02403-2] [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] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
Exercise has been found to have numerous benefits for individuals with cancer undergoing treatment. The primary objective of this study was to explore factors that influence the decision to join an exercise trial for individuals with a current diagnosis of breast cancer. A theory-informed survey was administered exploring factors (i.e., attitudes, subjective norms, perceived behavioral control) that influenced participants' decision to join the "NEXT-BRCA" exercise trial. Eligible participants included self-reported females over 18 years, diagnosed with stage 1-3 breast cancer undergoing treatment and cleared for exercise by their oncologist. Survey questions were analyzed using descriptive statistics and exploratory analysis was performed to determine if associations existed between personal characteristics (age, physical activity level, co-morbid conditions) and cancer characteristics (treatment received). Seventy-four participants completed the survey. Most participants (85% of respondents) were interested in increasing their level of physical activity. The most common attitudes contributing to participant's decision to participate in the trial included feelings that exercise was beneficial for improving physical (91%) and mental health (89%). Advice from the treating oncologist was ranked as the most important factor influencing their decision to join the trial (73%). Respondents hoped to gain exercise knowledge through educational materials (72%) and a structured exercise program (70%). Findings explore why individuals with breast cancer participate in exercise trials during treatment. This knowledge will enhance recruitment of future studies using similar interventions and assist clinicians to maximize education regarding exercise and access to exercise programs for individuals with breast cancer in the future.
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Affiliation(s)
- Jenna Smith-Turchyn
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, IAHS Rm 436, Hamilton, ON, L8S 1C7, Canada.
| | - Som D Mukherjee
- Department of Oncology, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 35, Canada
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14
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Gulati A, Abdulbaki H, Callander JK, Cai Y, Chang JL. Video-Based Decision Aids Improve Sleep Surgery Decision-Making: A Randomized Controlled Trial. Laryngoscope 2024; 134:2958-2963. [PMID: 37965946 DOI: 10.1002/lary.31156] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/19/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Decisional conflict (DC) is high in obstructive sleep apnea (OSA) surgical candidates interested in positive airway pressure (PAP) alternatives. We evaluated the impact of pre-consultation video decision aids on patient DC and decision readiness. METHODS Prior to consultation for PAP alternatives, adult OSA patients were enrolled and completed a questionnaire querying DC (scored 0 [no conflict]-100 [high conflict]) and decision readiness. Those considering ≥3 treatment options were categorized as "high-conflict." Patients were randomized to either an intervention group with video review about PAP and surgical options prior to their visit or to a control group that received no video review. Audio recordings of clinic visits were analyzed for patient engagement. RESULTS Twenty-five participants (control: n = 12, intervention: n = 13) were found to have comparably high DC (mean score: 40.0). Both groups experienced post-visit improvements in DC scores (post-consult: 25.2, p = 0.003) which did not differ between the two groups (intervention: 20.5 ± 15.1 vs. control: 11.7 ± 12.1 points, p = 0.13). The intervention group showed significant improvement in decision-making stage after the visit, with 72.7% "close to selecting an option" (p = 0.04) versus 41.7% in the control group. Use of videos was not associated with any differences in patient satisfaction, engagement, or decision to pursue surgery (all p > 0.05). High-conflict patients (n = 5) who reviewed pre-visit videos (intervention sub-group) spoke fewer words during the visit (687 ± 139 vs. 1120 ± 389 words, p = 0.047) and had shorter visit times (18.7 ± 2.9 vs. 24.3 ± 3.1 min, p = 0.02) than high-conflict control patients. CONCLUSIONS Patients have high levels of DC when considering PAP alternatives. Use of video decision aids prior to sleep surgery consultation may improve the treatment decision-making process. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2958-2963, 2024.
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Affiliation(s)
- Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Hasan Abdulbaki
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Jacquelyn K Callander
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Yi Cai
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, California, U.S.A
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15
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Nisius K, Hoffmann D, Görig T, Georg S, Krug K, De Bock F, Eichinger M. Perceived shared decision making and satisfaction with care among children and adolescents with special healthcare needs and their parents: Cross-sectional evidence from the PART-CHILD Study. Patient Educ Couns 2024; 123:108175. [PMID: 38492427 DOI: 10.1016/j.pec.2024.108175] [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] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/28/2023] [Accepted: 01/24/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES To compare shared decision making (SDM) and satisfaction with care (SWC), an indicator of care quality, between children with special healthcare needs (CSHCN) and parents and to assess the association between SDM and SWC in both groups. METHODS We recruited CSHCN ≥ 7 years and parents from 15 outpatient facilities that completed a paper questionnaire assessing SDM (highest vs. lower levels of SDM) and SWC. Differences in SDM and SWC were assessed with McNemar and paired t-tests. We used adjusted linear mixed models to investigate cross-sectional associations between SDM and SWC. RESULTS Based on data from 275 CSHCN and 858 parents, 39% and 64% of CSHCN and parents reported the highest level of SDM (p < 0.0001). No difference in SWC was observed (p = 0.36). Perceived SDM was associated with SWC in both groups (both p < 0.0001). CONCLUSION Associations between SDM and SWC reinforce the role of SDM for care quality. Large proportions of CSHCN and parents reporting suboptimal levels of SDM highlight the need for effective programs to promote SDM in the target population. PRACTICE IMPLICATIONS Until effective programs become available, healthcare professionals can use existing opportunities to involve CSHCN and parents in consultations (e.g., provide sufficient opportunities to ask questions).
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Affiliation(s)
- Katja Nisius
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dorle Hoffmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tatiana Görig
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Georg
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Freia De Bock
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michael Eichinger
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
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16
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Zogas A, Sitter KE, Barker AM, Fix GM, Khanna A, Herbst AN, Vimalananda VG. Strategies for engaging patients in co-design of an intervention. Patient Educ Couns 2024; 123:108191. [PMID: 38367306 DOI: 10.1016/j.pec.2024.108191] [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] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE We provide practical guidance about using co-design methods to collaborate with patients to create patient-facing interventions, which others can use when undertaking similar projects. METHODS This is a narrative review synthesizing co-design principles and published literature with our experience working alongside five Veteran patients of the U.S. Department of Veterans Affairs in New England to co-design a portfolio of patient-facing materials to improve patient-centered care coordination. Our process took 12 weeks (April - June 2022) and was conducted entirely via video conference. RESULTS Co-design is a participatory research method. Its principles include sharing power over the research process and products, agency for all participants, embracing a plurality of forms of knowledge, and mutual and reciprocal benefit. We describe three stages of the co-design process (preparatory work; design and development; feedback and closure), strategies and techniques we used at each stage, challenges we faced, and considerations for addressing them. CONCLUSION Co-designing patient-facing interventions blends different forms of knowledge to produce practical, contextually specific interventions with ownership by the people who will use them. PRACTICE IMPLICATIONS Co-design is a feasible methodology for most health services research teams whose goal is to intensify patient engagement in research.
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Affiliation(s)
- Anna Zogas
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA; Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Kailyn E Sitter
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Anna M Barker
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Gemmae M Fix
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Aishwarya Khanna
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA; University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Abigail N Herbst
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA; Section of Endocrinology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Holden C, Keen A, Harle A, Boon IS. Shared Decision Making in Oncology Care: Translating to Clinical Practice. Clin Oncol (R Coll Radiol) 2024; 36:e168. [PMID: 38565458 DOI: 10.1016/j.clon.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Affiliation(s)
- C Holden
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - A Keen
- Department of Cancer Nursing, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - A Harle
- Department of Medical Oncology, University Hospitals Dorset NHS Foundation Trust, Dorset, United Kingdom
| | - I S Boon
- Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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18
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Li M, Pai RA, Gomel R, Vyas M, Callif SC, Hatchett J, Bowlus CL, Lai JC. Patient-focused drug development in primary sclerosing cholangitis: Insights on patient priorities and involvement in clinical trials. Hepatol Commun 2024; 8:e0433. [PMID: 38727680 PMCID: PMC11093571 DOI: 10.1097/hc9.0000000000000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/16/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND According to the new AASLD Practice Guidance, all patients with primary sclerosing cholangitis (PSC) should be considered for participation in clinical trials. However, PSC's rarity has posed challenges to characterizing patient interest in trial participation and identifying predictors of patient willingness to participate in drug trials. METHODS PSC Partners Seeking a Cure developed the "Our Voices" survey to inform the development of the Externally-Led Patient-Focused Drug Development Forum, an FDA initiative to capture patient experiences and perspectives on drug development. RESULTS Of 797 survey respondents from over 30 countries, 536 (67%) identified slowing disease progression as the most important outcome. Eighty-nine percent identified their hepatologist/gastroenterologist as someone they would approach for advice about trials. Although 61% reported being willing to participate in drug trials, only 26% had ever been asked to participate. Notable barriers to trial involvement included unknown long-term risks (71%), long travel times to the study center (32%), and a liver biopsy requirement (27%). On multivariable logistic regression, pruritus (OR 1.62, 95% CI: 1.09-2.40, p = 0.017) was positively associated with willingness to participate in disease-modifying therapy trials, while jaundice (OR 0.34, 95% CI: 0.19-0.61, p < 0.001) and inflammatory bowel disease (OR 0.64, 95% CI: 0.42-0.98, p = 0.038) were negatively associated. Pruritus (OR 2.25, 95% CI: 1.50-3.39, p < 0.001) was also independently associated with willingness to participate in symptom treatment trials. CONCLUSIONS Most patients with PSC report interest in participating in clinical trials, but few have been asked to participate. Referral of patients with PSC by their hepatologist/gastroenterologist to clinical trials and patient education on trial participation are vital to closing the gap between trial interest and participation. Pruritus may serve as a key indicator of patient interest in trial participation.
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Affiliation(s)
- Michael Li
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA
| | - Ruth-Anne Pai
- PSC Partners Seeking a Cure, Greenwood Village, Colorado, USA
| | - Rachel Gomel
- PSC Partners Seeking a Cure, Greenwood Village, Colorado, USA
| | - Mary Vyas
- PSC Partners Seeking a Cure Canada, Toronto, ON, Canada
| | | | - Joanne Hatchett
- PSC Partners Seeking a Cure, Greenwood Village, Colorado, USA
| | - Christopher L. Bowlus
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California Davis Health, Sacramento, California, USA
| | - Jennifer C. Lai
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, California, USA
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19
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Wiertz CMH, Hemmen B, Sep SJS, Verbunt JA. Caregiver burden and impact on COVID-19 patient participation and quality of life one year after ICU discharge - A prospective cohort study. Patient Educ Couns 2024; 123:108221. [PMID: 38460347 DOI: 10.1016/j.pec.2024.108221] [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] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES to investigate changes in caregiver strain, mental health complaints and QoL in caregivers of COVID-19 ICU survivors in the first year after discharge, and their associations with patients' participation and quality of life. METHODS Post-ICU COVID-19 survivors, needing inpatient rehabilitation and their informal caregivers were included. Caregiver self-administered questionnaires included quality of life, self-rated health, caregiver strain, anxiety and depression symptoms, post-traumatic stress and coping style. Patients' participation in society was assessed and quality of life. RESULTS 67 patients (78% male) and 57 caregivers (23.6% male) were included. Three months post-ICU, caregivers experienced caregiver strain (32%), anxiety (41%), depressive symptoms (16%) and PTSD (24%). One year post-ICU, rates decreased, still being 11%, 26%, 10% and 5%, respectively. Caregiver anxiety symptoms and self-rated health at three months were associated with worse patient levels of participation and quality of life one year after ICU discharge (p < 0.05). CONCLUSIONS COVID-19 caregivers experience high levels of mental health complaints one year after a patient's ICU discharge. Furthermore, our results indicate that patient participation levels and quality of life one year after ICU discharge may be negatively associated by caregiver complaints. PRACTICAL IMPLICATIONS Counselling and routine assessment of emotional complaints and unmet needs of the informal caregiver should be incorporated and addressed in the rehabilitation treatment of (COVID-19) post-ICU patients.
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Affiliation(s)
- Carolina M H Wiertz
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Bena Hemmen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Department of Rehabilitation Medicine, Zuyderland, Heerlen, the Netherlands
| | - Simone J S Sep
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Jeanine A Verbunt
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
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20
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Lammons W, Nobility L, Markham S, Saloniki E. PPIE in a technical research study: Using public involvement to refine the concept and understanding and move towards a multidimensional concept of disability. Health Expect 2024; 27:e14072. [PMID: 38747318 PMCID: PMC11094671 DOI: 10.1111/hex.14072] [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: 02/19/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Disability is often an essentialised and oversimplified concept. We propose refining this while incorporating the multidimensional nature of disability by increasing the use of existing survey questions and their corresponding data to enrich, broaden and inform understandings of disability. METHODS We combined patient and public involvement and engagement (PPIE) with focus groups and concept mapping to collaboratively map disability survey questions into conceptual models of disability with six members of the public with lived experiences of disability. RESULTS Using reflexive thematic analysis, we identified three qualitative themes and eight subthemes through a series of four PPIE activities: (1) understanding concepts of disability based on individual experience, subthemes: 1.1-preference for the biopsychosocial model, 1.2-'Reviewing' instead of mapping survey questions and 1.3-comparing questions to real life; (2) consistency between understanding needs and implementing adjustments, subthemes: 2.1-connecting preparation and operation, 2.2-inclusivity and adjustments in activities and 2.3-feedback for improving activities and (3) real-world applications-targeted awareness raising, subthemes: 3.1-who, where, what and how to share activity findings and results, 3.2-sharing with human resource and equality, diversity and inclusion professionals. CONCLUSION Members of the public who collaborated in these activities felt empowered, engaged and supported throughout this study. This approach offers a model for other researchers to cede power to the public over the research aspects typically reserved for researchers. PATIENT OR PUBLIC CONTRIBUTION We involved members of the public with lived experience throughout this study-co-design, co-facilitation, collaboratively mapping the disability or disability-related survey questions into conceptual models of disability, evaluation of the activities, co-analysis and co-authorship.
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Affiliation(s)
- William Lammons
- National Institute of Health and Care Research Applied Research Collaboration (NIHR ARC), North ThamesLondonUK
- Department of Primary Care and Population Health, Institute of Epidemiology and Health CareUniversity College LondonLondonUK
| | - Lucky Nobility
- National Institute of Health and Care Research Applied Research Collaboration (NIHR ARC), North ThamesLondonUK
| | - Sarah Markham
- National Institute of Health and Care Research Applied Research Collaboration (NIHR ARC), North ThamesLondonUK
- Department of Biostatistics and Health InformaticsKing's College LondonLondonUK
| | - Eirini‐Christina Saloniki
- National Institute of Health and Care Research Applied Research Collaboration (NIHR ARC), North ThamesLondonUK
- Department of Primary Care and Population Health, Institute of Epidemiology and Health CareUniversity College LondonLondonUK
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21
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Punnett G, Eastwood C, Green L, Yorke J. A systematic review of the effectiveness of decision making interventions on increasing perceptions of shared decision making occurring in advanced cancer consultations. Patient Educ Couns 2024; 123:108235. [PMID: 38492428 DOI: 10.1016/j.pec.2024.108235] [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] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To determine how decision making interventions for use in advanced cancer treatment consultations function and whether they increase perceptions of shared decision making (SDM) behaviours within consultations. METHODS A systematic search of five literature databases was conducted. Evaluations of decision making interventions where participants faced active treatment decisions for stage 4 or otherwise incurable cancer were included. Intervention descriptions were coded using Behaviour Change Techniques (BCTs) to provide a narrative of how the interventions function. A narrative synthesis of interventions effect on perceptions of SDM behaviours compared to usual care was conducted. RESULTS Four studies presenting different interventions were included. Education, training, modelling and enablement intervention functions were identified. Oncologist SDM training alone and combined with a patient communication aid demonstrated the only significant effect (p < 0.05) on SDM behaviours in advanced cancer consultations. CONCLUSION Healthcare professional (HCP) SDM training which includes modelling and enablement functions may be effective in increasing clinician motivation, capability and opportunity to facilitate SDM in advanced cancer consultations. PRACTICE IMPLICATIONS Implementing HCP SDM training into practice may encourage greater uptake of SDM which may lead to treatment decisions concordant with the goals of care of people with advanced cancer.
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Affiliation(s)
- Grant Punnett
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK; University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK.
| | - Charlotte Eastwood
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK
| | - Laura Green
- University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK
| | - Janelle Yorke
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK; University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK
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22
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Rake EA, Meinders MJ, Brand G, Dreesens D, Kremer JAM, Elwyn G, Aarts JWM. Explorative observational study of Dutch patient-clinician interactions: operationalisation of personal perspective elicitation as part of shared decision-making in real-life audio-recorded consultations. BMJ Open 2024; 14:e079540. [PMID: 38760032 DOI: 10.1136/bmjopen-2023-079540] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES Patients' preferences, values and contexts are important elements of the shared decision-making (SDM) process. We captured those elements into the concept of 'personal perspective elicitation' (PPE), which reflects the need to elicit patients' preferences, values and contexts in patient-clinician conversations. We defined PPE as: 'the disclosure (either elicited by the clinician or spontaneously expressed by the patient) of information related to the patient's personal preferences, values and/or contexts potentially relevant to decision-making'. Our goal was to operationalise the concept of PPE through the evaluation of preferences, values and contexts and explore how PPE occurs in clinical encounters. DESIGN Cross-sectional study: observational coding based on a novel coding scheme of audio-recorded outpatient clinical encounters where encounter patient decision aids were applied. SETTING We audio-recorded patient-clinician interactions at three Dutch outpatient clinics. PPE was analysed using a novel observational coding scheme, distinguishing preferences, contexts and four Armstrong taxonomy value types (global, decisional, external and situational). We measured SDM using the Observer OPTION5. PARTICIPANTS Twenty patients who suffered from psoriasis or ovarian cysts; four clinicians. RESULTS We included 20 audio-recordings. The mean Observer OPTION5 score was 57.5 (SD:10.1). The audio-recordings gave a rich illustration of preferences, values and contexts that were discussed in the patient-clinician interactions. Examples of identified global values: appearance, beliefs, personality traits. Decisional values were related to the process of decision-making. External values related to asking advice from for example, the clinician or significant others. An identified situational value: a new job ahead. Contexts related to how the illness impacted the life (eg, sexuality, family, sports, work life) of patients. CONCLUSIONS The operationalisation of PPE, an important aspect of SDM, explores which preferences, values and contexts were discussed during patient-clinician interactions where an ePDA was used. The coding scheme appeared feasible to apply but needs further refinement.
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Affiliation(s)
- Ester A Rake
- IQ Health, Radboudumc, Nijmegen, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | | | - Guus Brand
- Radboudumc IQ Healthcare, Nijmegen, The Netherlands
| | - Dunja Dreesens
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | | | - Glyn Elwyn
- Radboudumc IQ Healthcare, Nijmegen, The Netherlands
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Johanna W M Aarts
- Department of Gynecology and Obstetrics, Amsterdam UMC University Medical Center, Amsterdam, The Netherlands
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Goldfarb MJ, Saylor MA, Bozkurt B, Code J, Di Palo KE, Durante A, Flanary K, Masterson Creber R, Ogunniyi MO, Rodriguez F, Gulati M. Patient-Centered Adult Cardiovascular Care: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1176-e1188. [PMID: 38602110 DOI: 10.1161/cir.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Patient-centered care is gaining widespread acceptance by the medical and lay communities and is increasingly recognized as a goal of high-quality health care delivery. Patient-centered care is based on ethical principles and aims at establishing a partnership between the health care team and patient, family member, or both in the care planning and decision-making process. Patient-centered care involves providing respectful care by tailoring management decisions to patients' beliefs, preferences, and values. A collaborative care approach can enhance patient engagement, foster shared decision-making that aligns with patient values and goals, promote more personalized and effective cardiovascular care, and potentially improve patient outcomes. The objective of this scientific statement is to inform health care professionals and stakeholders about the role and impact of patient-centered care in adult cardiovascular medicine. This scientific statement describes the background and rationale for patient-centered care in cardiovascular medicine, provides insight into patient-oriented medication management and patient-reported outcome measures, highlights opportunities and strategies to overcome challenges in patient-centered care, and outlines knowledge gaps and future directions.
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Riganti P, Ruiz Yanzi MV, Escobar Liquitay CM, Sgarbossa NJ, Alarcon-Ruiz CA, Kopitowski KS, Franco JV. Shared decision-making for supporting women's decisions about breast cancer screening. Cochrane Database Syst Rev 2024; 5:CD013822. [PMID: 38726892 PMCID: PMC11082933 DOI: 10.1002/14651858.cd013822.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/13/2024]
Abstract
BACKGROUND In breast cancer screening programmes, women may have discussions with a healthcare provider to help them decide whether or not they wish to join the breast cancer screening programme. This process is called shared decision-making (SDM) and involves discussions and decisions based on the evidence and the person's values and preferences. SDM is becoming a recommended approach in clinical guidelines, extending beyond decision aids. However, the overall effect of SDM in women deciding to participate in breast cancer screening remains uncertain. OBJECTIVES To assess the effect of SDM on women's satisfaction, confidence, and knowledge when deciding whether to participate in breast cancer screening. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 8 August 2023. We also screened abstracts from two relevant conferences from 2020 to 2023. SELECTION CRITERIA We included parallel randomised controlled trials (RCTs) and cluster-RCTs assessing interventions targeting various components of SDM. The focus was on supporting women aged 40 to 75 at average or above-average risk of breast cancer in their decision to participate in breast cancer screening. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and conducted data extraction, risk of bias assessment, and GRADE assessment of the certainty of the evidence. Review outcomes included satisfaction with the decision-making process, confidence in the decision made, knowledge of all options, adherence to the chosen option, women's involvement in SDM, woman-clinician communication, and mental health. MAIN RESULTS We identified 19 studies with 64,215 randomised women, mostly with an average to moderate risk of breast cancer. Two studies covered all aspects of SDM; six examined shortened forms of SDM involving communication on risks and personal values; and 11 focused on enhanced communication of risk without other SDM aspects. SDM involving all components compared to control The two eligible studies did not assess satisfaction with the SDM process or confidence in the decision. Based on a single study, SDM showed uncertain effects on participant knowledge regarding the age to start screening (risk ratio (RR) 1.18, 95% confidence interval (CI) 0.61 to 2.28; 133 women; very low certainty evidence) and frequency of testing (RR 0.84, 95% CI 0.68 to 1.04; 133 women; very low certainty evidence). Other review outcomes were not measured. Abbreviated forms of SDM with clarification of values and preferences compared to control Of the six included studies, none evaluated satisfaction with the SDM process. These interventions may reduce conflict in the decision made, based on two measures, Decisional Conflict Scale scores (mean difference (MD) -1.60, 95% CI -4.21 to 0.87; conflict scale from 0 to 100; 4 studies; 1714 women; very low certainty evidence) and the proportion of women with residual conflict compared to control at one to three months' follow-up (rate of women with a conflicted decision, RR 0.75, 95% CI 0.56 to 0.99; 1 study; 1001 women, very low certainty evidence). Knowledge of all options was assessed through knowledge scores and informed choice. The effect of SDM may enhance knowledge (MDs ranged from 0.47 to 1.44 higher scores on a scale from 0 to 10; 5 studies; 2114 women; low certainty evidence) and may lead to higher rates of informed choice (RR 1.24, 95% CI 0.95 to 1.63; 4 studies; 2449 women; low certainty evidence) compared to control at one to three months' follow-up. These interventions may result in little to no difference in anxiety (MD 0.54, 95% -0.96 to 2.14; scale from 20 to 80; 2 studies; 749 women; low certainty evidence) and the number of women with worries about cancer compared to control at four to six weeks' follow-up (RR 0.88, 95% CI 0.73 to 1.06; 1 study, 639 women; low certainty evidence). Other review outcomes were not measured. Enhanced communication about risks without other SDM aspects compared to control Of 11 studies, three did not report relevant outcomes for this review, and none assessed satisfaction with the SDM process. Confidence in the decision made was measured by decisional conflict and anticipated regret of participating in screening or not. These interventions, without addressing values and preferences, may result in lower confidence in the decision compared to regular communication strategies at two weeks' follow-up (MD 2.89, 95% CI -2.35 to 8.14; Decisional Conflict Scale from 0 to 100; 2 studies; 1191 women; low certainty evidence). They may result in higher anticipated regret if participating in screening (MD 0.28, 95% CI 0.15 to 0.41) and lower anticipated regret if not participating in screening (MD -0.28, 95% CI -0.42 to -0.14). These interventions increase knowledge (MD 1.14, 95% CI 0.61 to 1.62; scale from 0 to 10; 4 studies; 2510 women; high certainty evidence), while it is unclear if there is a higher rate of informed choice compared to regular communication strategies at two to four weeks' follow-up (RR 1.27, 95% CI 0.83 to 1.92; 2 studies; 1805 women; low certainty evidence). These interventions result in little to no difference in anxiety (MD 0.33, 95% CI -1.55 to 0.99; scale from 20 to 80) and depression (MD 0.02, 95% CI -0.41 to 0.45; scale from 0 to 21; 2 studies; 1193 women; high certainty evidence) and lower cancer worry compared to control (MD -0.17, 95% CI -0.26 to -0.08; scale from 1 to 4; 1 study; 838 women; high certainty evidence). Other review outcomes were not measured. AUTHORS' CONCLUSIONS Studies using abbreviated forms of SDM and other forms of enhanced communications indicated improvements in knowledge and reduced decisional conflict. However, uncertainty remains about the effect of SDM on supporting women's decisions. Most studies did not evaluate outcomes considered important for this review topic, and those that did measured different concepts. High-quality randomised trials are needed to evaluate SDM in diverse cultural settings with a focus on outcomes such as women's satisfaction with choices aligned to their values.
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Affiliation(s)
- Paula Riganti
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Victoria Ruiz Yanzi
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Nadia J Sgarbossa
- Health Department, Universidad Nacional de La Matanza, Buenos Aires, Argentina
| | - Christoper A Alarcon-Ruiz
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Karin S Kopitowski
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Va Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Ndjaboue R, Beaudoin C, Comeau S, Dagnault A, Dogba MJ, Numainville S, Racine C, Straus S, Tremblay MC, Witteman HO. Patients as teachers: a within-subjects randomized pilot experiment of patient-led online learning modules for health professionals. BMC Med Educ 2024; 24:525. [PMID: 38730313 PMCID: PMC11087246 DOI: 10.1186/s12909-024-05473-4] [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] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE Many health professions education programs involve people with lived experience as expert speakers. Such presentations may help learners better understand the realities of living with chronic illness or experiencing an acute health problem. However, lectures from only one or a small number of people may not adequately illustrate the perspectives and experiences of a diverse patient cohort. Additionally, logistical constraints such as public health restrictions or travel barriers may impede in-person presentations, particularly among people who have more restrictions on their time. Health professions education programs may benefit from understanding the potential effects of online patient-led presentations with a diverse set of speakers. We aimed to explore whether patient-led online learning modules about diabetes care would influence learners' responses to clinical scenarios and to collect learners' feedback about the modules. METHOD This within-subjects randomized experiment involved 26 third-year medical students at Université Laval in Quebec, Canada. Participation in the experiment was an optional component within a required course. Prior to the intervention, participating learners responded to three clinical scenarios randomly selected from a set of six such scenarios. Each participant responded to the other three scenarios after the intervention. The intervention consisted of patient-led online learning modules incorporating segments of narratives from 21 patient partners (11 racialized or Indigenous) describing why and how clinicians could provide patient-centered care. Working with clinical teachers and psychometric experts, we developed a scoring grid based on the biopsychosocial model and set 0.6 as a passing score. Independent evaluators, blinded to whether each response was collected before or after the intervention, then scored learners' responses to scenarios using the grid. We used Fisher's Exact test to compare proportions of passing scores before and after the intervention. RESULTS Learners' overall percentage of passing scores prior to the intervention was 66%. Following the intervention, the percentage of passing scores was 76% (p = 0.002). Overall, learners expressed appreciation and other positive feedback regarding the patient-led online learning modules. DISCUSSION Findings from this experiment suggest that learners can learn to provide better patient-centered care by watching patient-led online learning modules created in collaboration with a diversity of patient partners.
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Kikuchi R, Kingston P, Hao A, Sadrolashrafi K, Yamamoto RK, Tolson H, Bilimoria SN, Guo L, Yee D, Ochoa MT, Armstrong AW. Shared decision-making in psoriasis care: Evaluation of how patients' perception of clinicians' delivery of care changes by age and sex. PLoS One 2024; 19:e0303058. [PMID: 38728289 PMCID: PMC11086864 DOI: 10.1371/journal.pone.0303058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Shared decision-making (SDM) refers to a collaborative process in which clinicians assist patients in making medically informed, evidence-based decisions that align with their values and preferences. There is a paucity of literature on SDM in dermatology. OBJECTIVE We aim to assess whether male and female psoriasis patients evaluate their clinicians' engagement in SDM differently across different age groups. METHODS Cross-sectional study using data from the 2014-2017 and 2019 Medical Expenditure Panel Surveys (MEPS). RESULTS A weighted total of 7,795,608 psoriasis patients were identified. SDM Scores ranged from 1 to 4, with 4 representing the most favorable patient evaluation of their clinicians' engagement in SDM. We conducted multivariate linear regression to compare mean SDM Scores in male psoriasis patients versus female psoriasis patients across different patient age groups. Female patients ages 60-69 perceived significantly greater clinician engagement in SDM compared to age-matched male patients (female patient perception of SDM 3.65 [95%CI:3.61-3.69] vs. male patient perception of SDM 3.50 [95%CI:3.43-3.58], p<0.005). The same trend of older female patients evaluating their clinicians' engagement in SDM significantly higher than their age-matched male counterparts exists for the age group >70 (p<0.005). No significant differences between male and female patients' evaluations of their clinicians' engagement in SDM were demonstrated in subjects younger than 60. All calculations were adjusted for demographic and clinical factors. CONCLUSIONS Compared to older male psoriasis patients, older female psoriasis patients evaluated their clinicians to be more engaged in shared decision-making.
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Affiliation(s)
- Robin Kikuchi
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Paige Kingston
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Audrey Hao
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Kaviyon Sadrolashrafi
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, Nevada, United States of America
| | - Rebecca K. Yamamoto
- Georgetown University School of Medicine, Washington, DC, United States of America
| | - Hannah Tolson
- University of Arizona College of Medicine, Phoenix, Arizona, United States of America
| | - Sara N. Bilimoria
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Lily Guo
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Danielle Yee
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Maria T. Ochoa
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - April W. Armstrong
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
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Davidson AR, Morgan M, Ball L, Reidlinger DP. Patients' experiences of and roles in interprofessional collaborative practice in primary care: a constructivist grounded theory study. Prim Health Care Res Dev 2024; 25:e24. [PMID: 38721698 DOI: 10.1017/s1463423624000148] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
AIM This constructivist grounded theory study aimed to (1) explore patients' experiences of and roles in interprofessional collaborative practice for chronic conditions in primary care and (2) consider the relevance and alignment of an existing theoretical framework on patients' roles and based on the experiences of patient advocates. BACKGROUND High-quality management of chronic conditions requires an interprofessional collaborative practice model of care considering an individual's mental, physical, and social health situation. Patients' experiences of this model in the primary care setting are relatively unknown. METHODS A constructivist grounded theory approach was taken. Interview data were collected from primary care patients with chronic conditions across Australia in August 2020 - February 2022. Interviews were recorded, transcribed verbatim, and thematically analysed by (1) initial line-by-line coding, (2) focused coding, (3) memo writing, (4) categorisation, and (5) theme and sub-theme development. Themes and sub-themes were mapped against an existing theoretical framework to expand and confirm the results from a previous study with a similar research aim. FINDINGS Twenty adults with chronic conditions spanning physical disability, diabetes, heart disease, cancer, autoimmune, and mental health conditions participated. Two themes were developed: (1) Adapting to Change with two sub-themes describing how patients adapt to interprofessional team care and (2) Shifting across the spectrum of roles, with five sub-themes outlining the roles patients enact while receiving care. The findings suggest that patients' roles are highly variable and fluid in interprofessional collaborative practice, and further work is recommended to develop a resource to support greater patient engagement in interprofessional collaborative practice.
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Affiliation(s)
- Alexandra R Davidson
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, Brisbane, Queensland, Australia
| | - Dianne P Reidlinger
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Munce SEP, Wong E, Luong D, Rao J, Cunningham J, Bailey K, John T, Barber C, Batthish M, Chambers K, Cleverley K, Crabtree M, Diaz S, Dimitropoulos G, Gorter JW, Grahovac D, Grimes R, Guttman B, Hébert ML, Henze M, Higgins A, Khodyakov D, Li E, Lo L, Macgregor L, Mooney S, Severino SM, Mukerji G, Penner M, Pidduck J, Shulman R, Stromquist L, Trbovich P, Wan M, Williams L, Yates D, Toulany A. Patient, caregiver and other knowledge user engagement in consensus-building healthcare initiatives: a scoping review protocol. BMJ Open 2024; 14:e080822. [PMID: 38719333 PMCID: PMC11086512 DOI: 10.1136/bmjopen-2023-080822] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Patient engagement and integrated knowledge translation (iKT) processes improve health outcomes and care experiences through meaningful partnerships in consensus-building initiatives and research. Consensus-building is essential for engaging a diverse group of experienced knowledge users in co-developing and supporting a solution where none readily exists or is less optimal. Patients and caregivers provide invaluable insights for building consensus in decision-making around healthcare, policy and research. However, despite emerging evidence, patient engagement remains sparse within consensus-building initiatives. Specifically, our research has identified a lack of opportunity for youth living with chronic health conditions and their caregivers to participate in developing consensus on indicators/benchmarks for transition into adult care. To bridge this gap and inform our consensus-building approach with youth/caregivers, this scoping review will synthesise the extent of the literature on patient and other knowledge user engagement in consensus-building healthcare initiatives. METHODS AND ANALYSIS Following the scoping review methodology from Joanna Briggs Institute, published literature will be searched in MEDLINE, EMBASE, CINAHL and PsycINFO databases from inception to July 2023. Grey literature will be hand-searched. Two independent reviewers will determine the eligibility of articles in a two-stage process, with disagreements resolved by a third reviewer. Included studies must be consensus-building studies within the healthcare context that involve patient engagement strategies. Data from eligible studies will be extracted and charted on a standardised form. Abstracted data will be analysed quantitatively and descriptively, according to specific consensus methodologies, and patient engagement models and/or strategies. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review protocol. The review process and findings will be shared with and informed by relevant knowledge users. Dissemination of findings will also include peer-reviewed publications and conference presentations. The results will offer new insights for supporting patient engagement in consensus-building healthcare initiatives. PROTOCOL REGISTRATION https://osf.io/beqjr.
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Affiliation(s)
- Sarah E P Munce
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Elliott Wong
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dorothy Luong
- KITE Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Justin Rao
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Jessie Cunningham
- Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Katherine Bailey
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Tomisin John
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claire Barber
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Kyle Chambers
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health Queen Street Site, Toronto, Ontario, Canada
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Marilyn Crabtree
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Sanober Diaz
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Gina Dimitropoulos
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Southern Ontario, Canada
- Department of Rehabilitation, Physical Therapy Science & Sports, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Danijela Grahovac
- National Health Hub in Transition, Children's Healthcare Canada, Hamilton, Southern Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Southern Ontario, Canada
| | - Ruth Grimes
- Canadian Pediatric Society, Winnipeg, Manitoba, Canada
| | - Beverly Guttman
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Michèle L Hébert
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Henze
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Surrey Place Centre, Toronto, Ontario, Canada
| | - Amanda Higgins
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Elaine Li
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Lisha Lo
- University of Toronto Centre for Quality Improvement and Patient Safety, Toronto, Ontario, Canada
| | - Laura Macgregor
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Martin Luther University College, Waterloo, Ontario, Canada
| | - Sarah Mooney
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Samadhi Mora Severino
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Melanie Penner
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Jacklynn Pidduck
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Rayzel Shulman
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Endocrinology and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Stromquist
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- National Health Hub in Transition, Children's Healthcare Canada, Ottawa, Ontario, Canada
| | - Patricia Trbovich
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
- Patient Safety and Quality Improvement, North York General Hospital, Toronto, Ontario, Canada
| | - Michelle Wan
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Laura Williams
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Darryl Yates
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Integrated Knowledge Translation Panel Member, Toronto, Ontario, Canada
| | - Alene Toulany
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Birkeland S, Bismark M, Barry MJ, Möller S. Associations between knowledge of health issues and health care satisfaction and propensity to complain: a cross-sectional survey of adult men in Denmark. BMJ Open 2024; 14:e076257. [PMID: 38719305 PMCID: PMC11086498 DOI: 10.1136/bmjopen-2023-076257] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES The objective of this study was to investigate associations between knowledge of health issues and healthcare satisfaction and propensity to complain including the association between knowledge and greater patient involvement. DESIGN The present study is a secondary analysis of a larger cross-sectional case vignette survey. SETTING Survey conducted in adult Danish men. PARTICIPANTS Participants included 6755 men aged 45-70 years. INTERVENTIONS Participants responded to a survey with scenarios illustrating prostate-specific antigen (PSA) testing and different information provision. PRIMARY AND SECONDARY OUTCOME MEASURES Using Likert scales (scored 1-5), participants rated their satisfaction with the care described and their inclination to complain and responded to a short quiz (scored 0-3) assessing their knowledge about the PSA test. RESULTS Satisfaction with healthcare increased with better quiz performance (Likert difference 0.13 (95% CI .07 to 0.20), p <0.001, totally correct vs totally incorrect responders) and correspondingly, the desire to complain significantly decreased (Likert difference -0.34 (95% CI 0.40 to -0.27), p <0.001). Respondents with higher education performed better (mean quiz score difference 0.59 (95% CI 0.50 to 0.67), p <0.001, most educated vs least educated). Responders who received information about the PSA test generally performed better (quiz score difference 0.41 (95% CI 0.35 to 0.47), p<0.001, neutral vs no information). Overestimation of PSA merits was more common than underestimation (7.9% vs 3.8%). CONCLUSIONS Mens' knowledge of the benefits of screening varies with education, predicts satisfaction with care and the desire to complain, and may be improved through greater involvement in decision-making.
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Affiliation(s)
- Søren Birkeland
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- OPEN, Odense University Hospital, Odense, Denmark
| | - Marie Bismark
- Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Sören Möller
- OPEN, Odense University Hospital, Odense, Denmark
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
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30
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Stinissen L, Bouma S, Böhm J, van Tienen J, Fischer H, Hughes Z, Lennox A, Ward E, Wood M, Foley AR, Oortwijn W, Jungbluth H, Voermans NC. The experience of clinical study and trial participation in rare diseases: A scoping review of centronuclear myopathy and other neuromuscular disorders. Neuromuscul Disord 2024; 38:1-7. [PMID: 38290938 DOI: 10.1016/j.nmd.2023.12.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/09/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024]
Abstract
The design of a clinical trial for a rare disease can be challenging. An optimal study design is required to effectively study the clinical outcomes for possible therapies for these types of disorders. Understanding the study participants' experiences as well as barriers and facilitators of participation are important to optimize future research and to inform clinical trial management. Centronuclear myopathies (CNMs) including X-linked myotubular myopathy (XLMTM) are a group of rare congenital myopathies for which there is no cure currently. Since 2014, a number of natural history studies and clinical trials have been conducted in CNMs. Two trials have been prematurely terminated because of severe adverse events. Since no research has been conducted regarding trial experience in CNM, we performed a scoping literature research on clinical trial experience of patients with neuromuscular disorders in general. The most common barriers to trial participation of patients comprise concerns about potential harmful effects, opportunity loss and the expected burden on daily life. The most common facilitators were an expected benefit on the disease course, altruism and collateral benefit. While several results are in line with trial experiences of other types of patients, for example oncological patients, distinctions can be made for patients with CNM and other neuromuscular disorders. However, the limited availability of relevant literature suggests that future (qualitative) research should focus on trial experiences in CNM patients.
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Affiliation(s)
- Lizan Stinissen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Sietse Bouma
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Johann Böhm
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Inserm U 1258, CNRS UMR 7104, Université de Strasbourg, Illkirch, France
| | | | | | | | | | | | | | - A Reghan Foley
- Neuromuscular & Neurogenetic Diseases of Childhood, Neurogenetics Branch (NGB), NIH, USA
| | - Wija Oortwijn
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College, London, United Kingdom
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
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Oehrlein EM, Schoch S, Majercak K, Gressler LE, Costantino RC, Love TR, Perfetto EM. Development and Testing of a Chronic-Disease Patient Experience Mapping Toolbox. Patient 2024; 17:263-274. [PMID: 38172406 DOI: 10.1007/s40271-023-00658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Stakeholders increasingly expect research and care delivery to be guided by and to optimize patient experiences. However, standardized tools to engage patients to gather high-quality data about their experiences, priorities, and desired outcomes are not publicly available. The objective of this study was to develop and test a Toolbox with a disease-agnostic interview guide template and accompanying resources to assist researchers in engaging patients living with chronic disease in a dialogue about their experiences. METHODS Guided by a multidisciplinary workgroup, a targeted literature review (PubMed) was conducted, followed by group discussions to identify/thematically organize patient experience concepts, development of a conceptual model, and drafting of an interview guide template and patient-facing visual. Materials were tested/refined via cognitive (n = 5) and pilot (n = 30) interviews conducted virtually with US patients diagnosed with chronic/potentially disabling conditions from December 2020 to April 2021. Patient-facing tools were reviewed by health literacy experts for applicability/accessibility. English-speaking adults who self-reported receiving a chronic condition diagnosis at least 6 months prior participated in a 60-90 min interview. RESULTS Patient experience concepts were organized thematically under three domains: (1) life before a diagnosis, (2) experiences getting a diagnosis, and (3) experiences living with a diagnosis. A plain language consent sheet template, interview guide template, and patient experience conceptual model were developed and revised based on input from interviewees, interviewers, and the workgroup. CONCLUSIONS A disease-agnostic patient-engagement Toolbox was developed and tested to capture patient experience data. These materials can be customized based on study objectives and leveraged by various stakeholders to identify opportunities to enhance the patient centricity of healthcare delivery and research.
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Affiliation(s)
- Elisabeth M Oehrlein
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA.
- Applied Patient Experience, LLC, 2201 Wisconsin Ave NW, Suite 200, Washington, DC, 20007, USA.
| | - Silke Schoch
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Kelsie Majercak
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
| | - Laura Elisabeth Gressler
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Ryan C Costantino
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
| | - T Rosie Love
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
- Enterprise Intelligence and Data Solutions Program Management Office, Program Executive Office, Defense Healthcare Management Systems, 1700 North Moore Street, Suite 2300, Arlington, VA, 22209, USA
| | - Eleanor M Perfetto
- National Health Council, 1730 M St. NW Suite 650, Washington, DC, 20036, USA
- School of Pharmacy, University of Maryland, 20 N. Pine St, Baltimore, MD, 21201, USA
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Jiang S, Wu Z, Zhang X, Ji Y, Xu J, Liu P, Liu Y, Zheng J, Zhao L, Chen J. How does patient-centered communication influence patient trust?: The roles of patient participation and patient preference. Patient Educ Couns 2024; 122:108161. [PMID: 38308973 DOI: 10.1016/j.pec.2024.108161] [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] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE The aim of this study was to examine the effects of patient-centered communication, patient participation, and patient preference on patient trust in the context of China. METHODS A cross-sectional survey was conducted involving 217 cancer patients in China. Mediation and moderation analyses were performed to examine the relationships among the study variables. RESULTS First, patient-centered communication increased patient participation in decision-making, which, in turn, enhanced patient trust. Second, patient-centered communication did not have a direct effect on patient trust. Third, patient preference for a passive role in decision-making weakened the relationship between patient participation and patient trust. CONCLUSION The results underscore the significant effect of facilitating patient participation in linking patient-centered communication to patient trust. However, medical communication should also respond to patients' preferred roles in the decision-making process. PRACTICE IMPLICATIONS Doctors should provide patients with opportunities to ask questions and express their concerns. In addition, they should evaluate patients' preferred degree of involvement before inviting them to contribute so as to respect their preferences and values.
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Affiliation(s)
- Shaohai Jiang
- Department of Communications and New Media, National University of Singapore, Singapore 999002, Singapore
| | - Zhengyu Wu
- School of Public Affairs, Xiamen University, Xiamen 361000, China
| | - Xiaoyu Zhang
- China Agricultural Film and Television Center, Beijing 100020, China
| | - Ying Ji
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | | | - Peng Liu
- Beijing Hospital, Beijing 100020, China
| | - Yan Liu
- Cancer Hospital Chinese Academy of Medical Science, Beijing 100020, China
| | - Jie Zheng
- Department of neurosurgery, Huashan Hospital, Fudan University, Shanghai 200000, China
| | - Liang Zhao
- Cancer Hospital Chinese Academy of Medical Science, Beijing 100020, China
| | - Jingxi Chen
- College of Arts and Media, Tongji University, Weixin Building, No.4800 Cao'an Road, Jiading District, Shanghai 201801, China.
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Carter-Bawa L, Slaven JE, Monahan PO, Brandzel S, Gao H, Wernli KJ, Lafata JE, Rawl SM. Unpacking the relationship between shared decision-making and decisional quality, decision to screen, and screening completion in lung cancer screening. Patient Educ Couns 2024; 122:108143. [PMID: 38237528 PMCID: PMC10922311 DOI: 10.1016/j.pec.2024.108143] [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] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/09/2023] [Accepted: 01/08/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES Lung cancer screening is a complex and individualized decision. To understand how best to support patients in this decision, we must understand how shared decision-making is associated with both decisional and behavioral outcomes. METHODS Observational cohort study combining patient survey data with electronic health record data of lung screening-eligible patients who recently engaged in a shared decision-making discussion about screening with a primary care clinician. RESULTS Using multivariable analysis (n = 529), factors associated with higher lung cancer screening decisional quality include higher knowledge (OR = 1.33, p < .0001), lower perceived benefits (OR = 0.90, p = .0004), higher perceived barriers (OR = 1.07, p < .0001), higher self-efficacy (OR = 1.13, p < .0001), and higher levels of perceiving the discussion was shared (OR = 1.04, p < .0001). Factors associated with the patient's decision to screen include older age (OR = 1.12, p = .0050) and higher self-efficacy (OR = 1.11, p = .0407). Factors associated with screening completion included older age (OR = 1.05, p = .0050), higher knowledge (OR = 1.24, p = .0045), and higher self-efficacy (OR = 1.12, p = .0003). CONCLUSIONS Shared decision-making in lung cancer screening is a dyadic process between patient and clinician. As we continue to strive for high-quality patient-centered care, patient decision quality may be enhanced by targeting key factors such as high-quality knowledge, self-efficacy, and fostering a shared discussion to support patient engagement in lung cancer screening decisions.
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Affiliation(s)
- Lisa Carter-Bawa
- Center for Discovery & Innovation at Hackensack Meridian Health, Nutley, NJ, USA; Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - James E Slaven
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN, USA
| | - Patrick O Monahan
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, Indianapolis, IN, USA
| | - Susan Brandzel
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer Elston Lafata
- UNC Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA
| | - Susan M Rawl
- Indiana University School of Nursing, Indianapolis, IN, USA; Indiana University Melvin & Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
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Baldt B. ["He does not know it yet"-Triadic communication and its pitfalls exemplified by an oncological ward round consultation]. Wien Med Wochenschr 2024; 174:153-160. [PMID: 35386061 PMCID: PMC11060969 DOI: 10.1007/s10354-022-00924-3] [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: 07/12/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
Medical communication is an effective instrument for the medical practice. Due to the low status that medical communication still has within medicine and medical education, many physicians do not know how to use this instrument professionally. Using medical communication in a way that patients are well informed and involved is a prerequisite for them to make self-determined decisions. In this paper I analyze a consultation in an oncology ward to show the pitfalls of medical communication, especially in triadic communication, based on a case study to work out suggestions for optimization from the transcript. Mistakes in conducting conversations, which can be recognized as such in theory, unfortunately still happen in practice, which is why this case study is intended as an invitation to critically reflect on one's own conduct of conversations. The conclusion contains suggestions for the preparation as well as the conduct of the consultation during medical rounds.
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Affiliation(s)
- Bettina Baldt
- Institut für Systematische Theologie und Ethik, Universität Wien, Schenkenstr. 8-10, 1010, Wien, Österreich.
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35
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Kiernan E, Wong SPY. Challenges to Informed, Patient-Centered, and Shared Decision Making for Treatment of Kidney Failure in Older Adults. Am J Kidney Dis 2024; 83:561-563. [PMID: 38206253 DOI: 10.1053/j.ajkd.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Elizabeth Kiernan
- Department of Medicine, University of Washington, Seattle, Washington
| | - Susan P Y Wong
- Department of Medicine, University of Washington, Seattle, Washington; VA Puget Sound Health Care System, Seattle, Washington.
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Jung OS, Kyle MA, McCree P, Nadel HM. Patient-Centered Innovation: Involving Patients in Open Social Innovation. Med Care 2024; 62:314-318. [PMID: 38498871 PMCID: PMC10990018 DOI: 10.1097/mlr.0000000000001987] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Involving patients in the health-care delivery innovation has many benefits. Open social innovation (OSI) presents a fitting lens to examine and advance patient engagement in innovation. OSI offers a participatory approach to innovation, in which diverse groups of participants collaboratively generate ideas and scale solutions on complex social challenges. PURPOSE This study: (1) describes a pilot application of OSI, in which individuals serving on a hospital's patients and family advisory councils (PFACs) were invited to participate in an innovation contest; and (2) explores the extent to which patients' beliefs about their role in innovation relate to their participation in the contest. METHODOLOGY/APPROACH We conducted an innovation contest that invited PFAC members to share ideas that would improve patient experiences and then vote on and select the ideas that they wanted to see move forward. We measured patients' beliefs about their role in innovation in a survey before the contest. RESULTS Twenty individuals submitted 27 ideas. Patients who expressed preference for more involvement in innovation were more likely to participate. CONCLUSIONS Using OSI may help expand patient engagement in innovation, particularly among those who want to be more involved but do not feel authorized to voice ideas in traditional advisory committees. PRACTICAL IMPLICATIONS OSI spurred collaboration among patients, clinicians, quality improvement staff, hospital administrators, and other stakeholders in idea generation, elaboration, and implementation. More experimentation and research are needed to understand how OSI can be leveraged to capture patients' voice and incorporate them in care delivery innovation.
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Affiliation(s)
- Olivia S. Jung
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Michael Anne Kyle
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston MA
| | - Paula McCree
- Healthcare Transformation Lab, Massachusetts General Hospital, Boston, MA
| | - Hiyam M. Nadel
- Center for Innovations in Care Delivery, Massachusetts General Hospital, Boston, MA
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Kabbes N, Bugra A, Wissanji H, Osmanlliu E. Telehealth for Indigenous Children Worldwide: A Scoping Review. J Pediatr Surg 2024; 59:908-917. [PMID: 38413263 DOI: 10.1016/j.jpedsurg.2024.01.041] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Indigenous children worldwide face healthcare disparities due, in part, to resource scarcity in remote settings which may be mitigated with technology. This study aims to determine the use of telehealth for this population, with respect to feasibility, acceptability, and the degree of patient/family involvement in reported interventions. We focused on the use of telehealth to support perioperative care. METHODS To identify relevant studies, five databases were searched to find articles that focused on the role of telehealth in caring for Indigenous populations worldwide, with an emphasis on the pediatric population. Studies that lacked insight into those themes, as well as protocols and review articles, were excluded. Analysis was done according to the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework, the Montreal Model (patient involvement), and the theoretical framework of acceptability (TFA). RESULTS Of the 1690 articles screened, 34 met the eligibility criteria. The most frequent uses of telehealth for Indigenous children were in ENT and psychiatry. Most of those had a low degree of complexity across the NASSS framework domains, suggesting greater feasibility. In 13 articles, the patient involvement was limited to information (lowest level of involvement in the Montreal Model). Only 11 articles directly assessed patient/family-perceived acceptability. Finally, two articles addressed telehealth in the surgical context. CONCLUSIONS The relative simplicity of the proposed telehealth applications may support their sustained impact and use in other settings such as for perioperative care. Early and longitudinal involvement of communities is essential for responsible telehealth development that addresses local needs. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Nour Kabbes
- McGill Faculty of Medicine, Montreal, QC, Canada
| | - Adalet Bugra
- McGill Faculty of Medicine, Montreal, QC, Canada
| | - Hussein Wissanji
- Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Esli Osmanlliu
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
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Newton L, Dimopoulos-Bick TL. Assessing early feasibility of a novel innovation to increase consumer partnership capability within an Australian health innovation organisation using a mixed-method approach. BMJ Open 2024; 14:e080495. [PMID: 38692723 PMCID: PMC11086460 DOI: 10.1136/bmjopen-2023-080495] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/16/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE Engagement-capable health organisations recognise that consumer engagement (also known as patient engagement, consumer engagement, patient and public involvement) must occur at every level of the organisation if it is to be meaningful and genuine. Despite this aspiration, health organisations struggle to adopt, implement, and embody consumer engagement capability in a way that has yielded impact. The Partner Ring (PR) is an embedded model for building staff capability for consumer partnerships. It is hosted by an employed Patient Partner. PR was implemented at the Agency for Clinical Innovation in New South Wales, Australia. The aim of this study was to assess the feasibility (acceptability, demand and practicality) of this innovation to increase consumer engagement capability. DESIGN One-group post-intervention mixed methods approach to assess feasibility. PARTICIPANTS ACI staff engaged in the PR (n=40 of 89 members). DATA COLLECTION AND ANALYSIS Qualitative data was collected through an artificial intelligence (AI)-driven interactive interview, with 40 responses received between 29 June and 12 July 2023. A framework analysis and Generative AI causal mapping were conducted to identify and visualise causal claims within the texts. Cost and session attendance collected from the same point in time supplemented the analysis. FINDINGS Findings were categorised by the following feasibility constructs: acceptability, demand and practicality. Almost all the respondents indicated their intent to continue using the PR and outlined personal benefits and professional benefits. For example, (n=23, 57%) reacted positively to the psychological safety of the PR, and professionally people identified attendance increased their knowledge and skills (n=23, 57%). CONCLUSION The PR is feasible and likely to be an acceptable innovation for building staff capability and consumer engagement skills across a large health system or organisation. It could be adopted or adapted by other jurisdictions.
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Affiliation(s)
- Liz Newton
- New South Wales Agency for Clinical Innovation, St Leonards, New South Wales, Australia
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Kangasjarvi E, Forsey J, Simpson JS, Ng SL. "We're back in control of the story and we're not letting anyone take that away from us": patient teacher programs as means for patient emancipation. Adv Health Sci Educ Theory Pract 2024; 29:487-505. [PMID: 37455294 DOI: 10.1007/s10459-023-10255-6] [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] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/04/2023] [Indexed: 07/18/2023]
Abstract
While patient engagement in healthcare professions education (HPE) has significantly increased in the past decades, a theoretical gap remains. What are the varied reasons as to why patients get involved with HPE programs? With a focus on understanding what drives patient involvement with HPE programs, this study examined how a patient as teacher (PAT) program was experienced by medical students, patient teachers, and faculty within a medical school. Through a phenomenographic approach, this study captures and describes the different ways our study participants experienced a PAT program (the 'phenomenon'). 24 semi-structured interviews were conducted in total, comprised of interviews with patient teachers (N = 10), medical students (N = 10) and program facilitators (N = 4) who participated in a PAT program. Our focus was on participants' description of the program and was grounded in their experiences of as well as their beliefs about it. Our findings captured 4 layers representing the qualitatively different (yet interrelated) ways in which participants experienced/perceived and conceptualized the various aspects of their experience with the PAT program: (1) A productive disruption of the learning space (2) A re-humanization within healthcare (3) A means of empowerment and agency (4) A catalyst for change and emancipation. Our outcome space results can be visually illustrated by a nesting "Matryoshka" doll, representing the four layers and depicting the process of uncovering the less conscious layers of sense-making within this phenomenon. HPE programs that are co-produced with patients and actively involve patients as teachers have the potential, but not guarantee, to be emancipatory. To engage in PAT programs that exhibit an emancipatory potential, we need to consider transformative paradigms of education, which are aligned with social change, and disrupt the traditional teacher-learner hierarchy.
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Affiliation(s)
- E Kangasjarvi
- Li Ka Shing Knowledge Institute, Applied Education Research Operatives (AERO), Faculty of Medicine, University of Toronto at St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B1W8, Canada.
| | - J Forsey
- University of Toronto, Rehabilitation Sciences Institute, Toronto, ON, Canada
| | - J S Simpson
- Division of General Surgery, St. Michael's Hospital, Unity Health Toronto, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - S L Ng
- University of Toronto, Centre for Interprofessional Education, University Health Network Toronto, Toronto, ON, Canada
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Walker L, Sillence E. Examining Healthcare Professionals' Communication Around Decision-Making with Internet-Informed Patients. Health Commun 2024; 39:1094-1101. [PMID: 37150845 DOI: 10.1080/10410236.2023.2204580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
In the last ten years the use of the internet as a health resource has transformed, and while patients increasingly consult online resources for health decision-making, less is known about how healthcare professionals (HCPs) currently discuss decision-making with internet informed patients (IIPs). In this paper we examine how HCPs perceive IIPs and specifically how bringing online information into appointments can prompt different communicative strategies around decision-making. Ten HCPs with experience working across different healthcare roles, took part in semi-structured interviews and discussed their interactions with IIPs around decision-making. Vignettes based on descriptions of real patients bringing online health information to their HCPs were used to prompt further discussion. The analysis identified two themes in relation to communication: (i) being honest about information sources and (ii) from compliance to co-construction: improving communication around decision-making. HCPs were overwhelmingly positive toward IIPs and encouraged patients to be transparent about their online searching to understand their motivations, priorities, and concerns. Although compliance remains part of the narrative, HCPs recognized practical ways in which discussing online health information could improve HCP-patient communication around shared decision-making. We discuss the findings in relation to early work on communicative strategies between HCP's and patients bringing resources to their consultations. We argue that for HCPs the concept of the internet as a provider of health information is no longer seen as inherently damaging or risky. There is growing acceptance of pre-consultation internet searching with the caveat that any information sourced online should inform rather than dictate decision-making with HCPs.
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Affiliation(s)
- Lauren Walker
- School of Social Sciences, Humanities and Law, Teesside University
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MacDonald BJ, McCormack JP, Turgeon RD. Shared decision-making approach to type 2 diabetes management. Can Fam Physician 2024; 70:310-315. [PMID: 38744513 DOI: 10.46747/cfp.7005310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To provide an online interactive decision aid to facilitate shared decision making in the context of medication choices for patients with type 2 diabetes mellitus (T2DM). SOURCES OF INFORMATION The best available clinical prediction model for patients with T2DM was selected based on a review of guidelines, DynaMed, and UpToDate and a search of PubMed. A list of pharmacotherapeutic options for T2DM was compiled based on a review of guidelines, narrative reviews, and expert opinion. To determine the benefits and harms of each treatment, federated search engines were searched for meta-analyses of randomized controlled trials, supplemented by individual randomized controlled trials for outcomes not reported in meta-analyses. MAIN MESSAGE Approximately 2.1 million Canadians have T2DM, with a resulting increased risk of death, cardiovascular disease, and microvascular outcomes. While more than a dozen medication options are available, decisions regarding these medications are challenging, as patients vary in their preferences. Shared decision making has the potential to individualize these difficult decisions, but the number of diabetes-related outcomes and available treatment options have made this historically impractical. It is within this context that the PEER Diabetes Medication Decision Aid was developed. This decision aid provides patients with personalized 10-year risk estimates for 6 clinically important diabetes-related outcomes. The tool also allows patients to focus on the outcome that matters most to them and to compare the benefits and harms of up to 12 different treatment options. This information is displayed in personalized absolute numbers, along with practical considerations such as cost. CONCLUSION The PEER Diabetes Medication Decision Aid provides a practical tool that can enable patients with T2DM to come to autonomous and well-informed medication decisions.
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Affiliation(s)
- Blair J MacDonald
- Doctoral candidate in the Faculty of Pharmaceutical Sciences at the University of British Columbia in Vancouver
| | - James P McCormack
- Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia
| | - Ricky D Turgeon
- Assistant Professor at the University of British Columbia and Clinical Pharmacy Specialist at St Paul's Hospital in Vancouver
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Lipinski S, Sünkel U, Totzeck C, Dresler T, Baskow I, Bea M, Hannig R, Dziobek I. [Patient and public involvement at the German Center for Mental Health: achievements and challenges]. Nervenarzt 2024; 95:458-466. [PMID: 38506976 PMCID: PMC11068695 DOI: 10.1007/s00115-024-01630-8] [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] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Patient and public involvement (PPI) describes the participation of patients and relatives, i.e., experts by experience (EE), in the research process. The PPI has not been widely adopted in the fields of medicine and clinical psychology in Germany and there is a notable absence of institutional support. The German Center for Mental Health (DZPG), which has been under construction since May 2023, aims to achieve nationwide and cross-center implementation of PPI, constituting one of its primary objectives. Participation of EE is to be implemented in the DZPG at all levels of decision-making. OBJECTIVES The article describes the origins, development and challenges associated with the implementation of participation structures and projects in the DZPG. The central political PPI committee in the DZPG, the Trilogue Center Council (TZR), developed a comprehensive PPI strategy for the DZPG in almost 3 years of work, before the beginning of the financial support of the DZPG. Among various measures, the strategy entails establishing a far-reaching representation for EE in all decision-making bodies of the DZPG, to involve EE as reviewers in evaluating research proposals, to integrate participatory elements into all studies of the DZGG and to foster user-initiated research endeavors. The implementation of the strategy is ensured by a cross-center PPI infrastructure, the Center for PPI, and scientific PPI consultants. The Center for PPI's tasks include supporting the voice of the EE and developing instruments and guidelines for participatory research, bringing together EE and researchers for joint DZPG projects as well as the documentation and quality assurance for participatory research. One of the particular challenges for the successful implementation of the PPI strategy is the limited experience with PPI in Germany in the field of mental health research and the widespread lack of structural implementation. Currently developed solution strategies include training for researchers and EE to communicate the benefits and pathways in the realization of PPI and thus enable shared decision-making and research. In addition, extensive access to knowledge and resources for EE will be created and uniform remuneration regulations for EE will be developed. CONCLUSION A PPI strategy at the DZPG has been successfully developed and is currently being implemented by the cross-center infrastructure Center for PPI.
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Affiliation(s)
- Silke Lipinski
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Klinische Psychologie Sozialer Interaktion, Institut für Psychologie, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Deutschland
- Aspies e. V., Berlin, Deutschland
| | - Ulrike Sünkel
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Aspies e. V., Berlin, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Christina Totzeck
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Forschungs- und Behandlungszentrum für psychische Gesundheit (FBZ), Ruhr-Universität Bochum, Bochum, Deutschland
| | - Thomas Dresler
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
- LEAD Graduate School & Research Network, Universität Tübingen, Tübingen, Deutschland
| | - Irina Baskow
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Myriam Bea
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- ADHS Deutschland e. V., Berlin, Deutschland
| | - Rüdiger Hannig
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG)
- Bundesverband der Angehörigen psychisch erkrankter Menschen e. V., Bonn, Deutschland
| | - Isabel Dziobek
- Trialogischer Zentrumsrat des DZPG, German Center for Mental Health (DZPG), .
- Klinische Psychologie Sozialer Interaktion, Institut für Psychologie, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Deutschland.
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He Y, Tan X, Wang J, Wiley J, Huang Y, Ding H, Wang Q, Huang T, Sun M. Trust, discrimination and preference for shared decision-making in adolescents diagnosed with depression: Implications from Chinese mental health professionals. Patient Educ Couns 2024; 122:108137. [PMID: 38232674 DOI: 10.1016/j.pec.2024.108137] [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] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/02/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND While evidence suggests that the attitudes of healthcare providers toward medical decision-making in adolescents diagnosed with depression merit exploration, research on their preferences for Shared Decision-Making (SDM) and the factors affecting these preferences remains limited. OBJECTIVE To investigate Chinese mental health professionals' (MHPs) preferences for SDM in adolescents with depression and identify the relationships between their preference for SDM and trust and discrimination. METHODS A cross-sectional design was used in this study. Clinical Decision-making Style-Staff (CDMS-S) was applied to evaluate their preferences for SDM. Physician Trust in the Patient Scale (PTPS) was utilised to assess their trust in consumers. Social Distance Scale to Mental Illness (SDSMI) was utilised to measure their discrimination against people with mental illness. RESULTS A total of 581 MHPs were identified in China. MHPs rated their preference for participation in decision making (PD) as shared (1.89 ± 0.472), information (IN) as moderate (2.62 ± 0.682), and family involvement (FI) as high (3.13 ± 0.840). The preferences for three decision topics ranked from the highest to the lowest score were working-related decision (2.35 ± 0.681), general preferences in decision (1.82 ± 0.581) and medication-related decision (1.74 ± 0.826). The mean score of PTPS and SDSMI were 34.71 (SD=9.709) and 15.17 (SD=4.299), respectively. Logistic regression indicated that the preference for PD was associated with discrimination; the preference for IN was associated with trust, discrimination and SDM-related training experience; and the preference for FI was associated with both trust and discrimination. CONCLUSIONS While MHPs generally exhibit a favourable attitude toward SDM, this positivity is not universally observed across all contexts. There remains room for improvement in the willingness to co-develop medication regimens and share health information. Rational recognition of depression, and building trusting and friendly therapeutic relationships are key to promoting MHPs' preferences for SDM. PRACTICAL VALUE MHPs' preferences for SDM have a significant impact on SDM implementation, which will be promoted by implementing SDM-related training.
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Affiliation(s)
- Yuqing He
- Xiangya School of Nursing, Central South University, Changsha, China.
| | - Xiangmin Tan
- Xiangya School of Nursing, Central South University, Changsha, China.
| | - Jianjian Wang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - James Wiley
- School of Nursing, University of California, San Francisco.
| | - Yuxin Huang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Hui Ding
- The second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Qian Wang
- The second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Tianhui Huang
- Lanzhou University Second Hospital, Lanzhou, Gansu, China.
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, China; School of Nursing, Changsha Medical University, 1501 Leifeng Avenue, Wangcheng district, Changsha, Hunan 410219, China.
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Sebri V, Marzorati C, Dorangricchia P, Monzani D, Grasso R, Prelaj A, Provenzano L, Mazzeo L, Dumitrascu AD, Sonnek J, Szewczyk M, Watermann I, Trovò F, Dollis N, Sarris E, Garassino MC, Bestvina CM, Pedrocchi A, Ambrosini E, Kosta S, Felip E, Soleda M, Roca AA, Rodríguez‐Morató J, Nuara A, Lourie Y, Fernandez‐Pinto M, Aguaron A, Pravettoni G. The impact of decision tools during oncological consultation with lung cancer patients: A systematic review within the I3LUNG project. Cancer Med 2024; 13:e7159. [PMID: 38741546 PMCID: PMC11091486 DOI: 10.1002/cam4.7159] [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: 11/10/2023] [Revised: 03/17/2024] [Accepted: 03/22/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION To date, lung cancer is one of the most lethal diagnoses worldwide. A variety of lung cancer treatments and modalities are available, which are generally presented during the patient and doctor consultation. The implementation of decision tools to facilitate patient's decision-making and the management of their healthcare process during medical consultation is fundamental. Studies have demonstrated that decision tools are helpful to promote health management and decision-making of lung cancer patients during consultations. The main aim of the present work within the I3LUNG project is to systematically review the implementation of decision tools to facilitate medical consultation about oncological treatments for lung cancer patients. METHODS In the present study, we conducted a systematic review following the PRISMA guidelines. We used an electronic computer-based search involving three databases, as follows: Embase, PubMed, and Scopus. 10 articles met the inclusion criteria and were included. They explicitly refer to decision tools in the oncological context, with lung cancer patients. RESULTS The discussion highlights the most encouraging results about the positive role of decision aids during medical consultations about oncological treatments, especially regarding anxiety, decision-making, and patient knowledge. However, no one main decision aid tool emerged as essential. Opting for a more recent timeframe to select eligible articles might shed light on the current array of decision aid tools available. CONCLUSION Future review efforts could utilize alternative search strategies to explore other lung cancer-specific outcomes during medical consultations for treatment decisions and the implementation of decision aid tools. Engaging with experts in the fields of oncology, patient decision-making, or health communication could provide valuable insights and recommendations for relevant literature or research directions that may not be readily accessible through traditional search methods. The development of guidelines for future research were provided with the aim to promote decision aids focused on patients' needs.
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Affiliation(s)
- Valeria Sebri
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
| | - Patrizia Dorangricchia
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
| | - Dario Monzani
- Laboratory of Behavioral Observation and Research on Human Development, Department of Psychology, Educational Science and Human MovementUniversity of PalermoPalermoItaly
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Arsela Prelaj
- Thoracic Oncology Unit, Medical Oncology Department 1Fondazione IRCCS Istituto Nazionale TumoriMilanItaly
- Department of Electronics, Information, and BioengineeringPolitecnico di MilanoMilanItaly
| | - Leonardo Provenzano
- Medical Oncology DepartmentFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Laura Mazzeo
- Thoracic Oncology Unit, Medical Oncology Department 1Fondazione IRCCS Istituto Nazionale TumoriMilanItaly
- Department of Electronics, Information, and BioengineeringPolitecnico di MilanoMilanItaly
| | - Andra Diana Dumitrascu
- Thoracic Oncology Unit, Medical Oncology Department 1Fondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Jana Sonnek
- Lungen Clinic Grosshansdorf, Airway Research Center NorthGerman Center for Lung ResearchGrosshansdorfGermany
| | - Marlen Szewczyk
- Lungen Clinic Grosshansdorf, Airway Research Center NorthGerman Center for Lung ResearchGrosshansdorfGermany
| | - Iris Watermann
- Lungen Clinic Grosshansdorf, Airway Research Center NorthGerman Center for Lung ResearchGrosshansdorfGermany
| | | | | | | | - Marina Chiara Garassino
- Knapp Center for Biomedical DiscoveryUniversity of Chicago Medicine & Biological SciencesChicagoIllinoisUSA
| | - Christine M. Bestvina
- Knapp Center for Biomedical DiscoveryUniversity of Chicago Medicine & Biological SciencesChicagoIllinoisUSA
| | - Alessandra Pedrocchi
- Department of Electronics, Information and BioengineeringNeuroengineering and Medical Robotics Laboratory NearLabMilanItaly
| | - Emilia Ambrosini
- Department of Electronics, Information and BioengineeringNeuroengineering and Medical Robotics Laboratory NearLabMilanItaly
| | - Sokol Kosta
- Department of Electronic SystemsAalborg UniversityCopenhagenDenmark
| | - Enriqueta Felip
- Vall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Institute of OncologyBarcelonaSpain
| | | | | | | | | | | | | | | | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
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Ödemiş E, Baysal CV. Clinical evaluation of a patient participation assessment system for upper extremity rehabilitation exercises. Med Biol Eng Comput 2024; 62:1441-1457. [PMID: 38231343 PMCID: PMC11021326 DOI: 10.1007/s11517-023-03014-7] [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: 09/13/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024]
Abstract
In conventional and robotic rehabilitation, the patient's active participation in exercises is essential for the maximum functional output to be received from therapy. In rehabilitation exercises performed with robotic devices, the difficulty levels of therapy tasks and the device assistance are adjusted based on the patient's therapy performance to improve active participation. However, the existing therapy performance evaluation methods are based on either some specific device designs or certain therapy tasks, which limits their widespread use. In this paper, the effectiveness of a participation assessment system, which can evaluate patients' therapy performance, tiredness, and slacking independent of any device design and therapy exercise, was clinically tested on ten patients diagnosed with frozen shoulder syndrome. The patients performed exercises using the system once a week throughout their 4-week treatment period. Multiple clinical measurements and scales were employed during the clinical study to assess patients' progress and status, such as tiredness throughout the therapy process. The clinical data, along with the patient findings obtained from the participation assessment system, were statistically analyzed and compared. The findings revealed that the patients' improvements and progress during the therapy process clinically coincide with the variations in the performance evaluation results of the system, and the implemented method successfully assesses the patients' participation during the rehabilitation exercises.
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Affiliation(s)
- Erkan Ödemiş
- Department of Biomedical Engineering, Çukurova University, 01330, Saricam, Adana, Turkey.
| | - Cabbar Veysel Baysal
- Department of Biomedical Engineering, Çukurova University, 01330, Saricam, Adana, Turkey
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Serna MK, Yoon C, Fiskio J, Lakin JR, Schnipper JL, Dalal AK. The Association of Standardized Documentation of Serious Illness Conversations With Healthcare Utilization in Hospitalized Patients: A Propensity Score Matched Cohort Analysis. Am J Hosp Palliat Care 2024; 41:479-485. [PMID: 37385609 PMCID: PMC10983774 DOI: 10.1177/10499091231186818] [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] [Indexed: 07/01/2023] Open
Abstract
Background: Serious Illness Conversations (SICs) conducted during hospitalization can lead to meaningful patient participation in the decision-making process affecting medical management. The aim of this study is to determine if standardized documentation of a SIC within an institutionally approved EHR module during hospitalization is associated with palliative care consultation, change in code status, hospice enrollment prior to discharge, and 90-day readmissions. Methods: We conducted retrospective analyses of hospital encounters of general medicine patients at a community teaching hospital affiliated with an academic medical center from October 2018 to August 2019. Encounters with standardized documentation of a SIC were identified and matched by propensity score to control encounters without a SIC in a ratio of 1:3. We used multivariable, paired logistic regression and Cox proportional-hazards modeling to assess key outcomes. Results: Of 6853 encounters (5143 patients), 59 (.86%) encounters (59 patients) had standardized documentation of a SIC, and 58 (.85%) were matched to 167 control encounters (167 patients). Encounters with standardized documentation of a SIC had greater odds of palliative care consultation (odds ratio [OR] 60.10, 95% confidence interval [CI] 12.45-290.08, P < .01), a documented code status change (OR 8.04, 95% CI 1.54-42.05, P = .01), and discharge with hospice services (OR 35.07, 95% CI 5.80-212.08, P < .01) compared to matched controls. There was no significant association with 90-day readmissions (adjusted hazard ratio [HR] .88, standard error [SE] .37, P = .73). Conclusions: Standardized documentation of a SIC during hospitalization is associated with palliative care consultation, change in code status, and hospice enrollment.
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Affiliation(s)
- Myrna K. Serna
- Division of General Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Catherine Yoon
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
| | - Julie Fiskio
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
| | - Joshua R. Lakin
- Harvard Medical School, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jeffrey L. Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anuj K. Dalal
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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47
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Bacorro W, Short M, Baldivia K, Mariano J, Bautista A, Amparo G, Tagayuna I, Jainar CJ, Antonio L, Dancel E, Ortin TS, Gonzalez G, Canlas R. Shared Decision Making in Oncology and Its Implementation in Cervical Cancer Management in the Philippines: A Narrative Review. JCO Glob Oncol 2024; 10:e2300486. [PMID: 38754049 DOI: 10.1200/go.23.00486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/21/2024] [Accepted: 03/12/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE Shared decision making (SDM) is an approach where clinicians and patients make decisions together using the best available evidence. Although much studied, recognized to be ethically imperative, and recommended in international health policies, it remains poorly implemented. In the Philippines, there are limited studies on patient decision making preferences and SDM. Practical guidance on the implementation of SDM or use of patient decision aids (PtDAs) is often not detailed in existing national clinical practice guidelines in oncology. METHODS We performed a systematic search of Philippine literature on SDM in oncology and an iterative review of international literature on the philosophy and methods of SDM, the utility and effectiveness of PtDAs, and the facilitators and barriers to implementation or usage. We contextualized our review to the cervical cancer management and health service delivery in the Philippines. RESULTS Local literature is limited to five scientific publications and two registered studies. International literature encompasses patient decisional preferences, the role of PtDAs and the standards for their development and evaluation, their effectiveness, and barriers and facilitators to their use in cancer-related decision making. We discussed the implications on the management of cervical cancer in the Philippines, challenges in health service delivery and standards, and SDM research. CONCLUSION Local SDM research is limited. Our preliminary experience in a multicenter clinical trial in Manila on PtDA use in the framework of SDM in cervical cancer suggest good patient and clinician acceptability. Challenges to implementation such as unfavorable financial situations, urgency of clinical decisions, low patient or caregiver educational attainment, and poor integration of multidisciplinary and SDM in organizational workflows will be important when implementing SDM in different settings.
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Affiliation(s)
- Warren Bacorro
- Graduate School, University of Santo Tomas, Manila, Philippines
- Department of Clinical Epidemiology, University of Santo Tomas-Faculty of Medicine and Surgery, Manila, Philippines
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Michala Short
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Kathleen Baldivia
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Jocelyn Mariano
- Department of Obstetrics and Gynecology, University of Santo Tomas-Faculty of Medicine and Surgery, Manila, Philippines
- Department of Obstetrics and Gynecology, University of Santo Tomas Hospital, Manila, Philippines
| | - Aida Bautista
- Department of Obstetrics and Gynecology, Manila Doctors Hospital, Manila, Philippines
| | - Genalin Amparo
- Department of Obstetrics and Gynecology, Our Lady of Lourdes Hospital, Manila, Philippines
| | - Irene Tagayuna
- Department of Obstetrics and Gynecology, De Los Santos Medical Center, Quezon City, Philippines
| | - Carl Jay Jainar
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Linda Antonio
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Evelyn Dancel
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Teresa Sy Ortin
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Gil Gonzalez
- Department of Obstetrics and Gynecology, University of Santo Tomas-Faculty of Medicine and Surgery, Manila, Philippines
- Department of Obstetrics and Gynecology, University of Santo Tomas Hospital, Manila, Philippines
| | - Rodel Canlas
- Graduate School, University of Santo Tomas, Manila, Philippines
- Department of Psychology, University of Santo Tomas-College of Science, Manila, Philippines
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Haroutounian S, Holzer KJ, Kerns RD, Veasley C, Dworkin RH, Turk DC, Carman KL, Chambers CT, Cowan P, Edwards RR, Eisenach JC, Farrar JT, Ferguson M, Forsythe LP, Freeman R, Gewandter JS, Gilron I, Goertz C, Grol-Prokopczyk H, Iyengar S, Jordan I, Kamp C, Kleykamp BA, Knowles RL, Langford DJ, Mackey S, Malamut R, Markman J, Martin KR, McNicol E, Patel KV, Rice AS, Rowbotham M, Sandbrink F, Simon LS, Steiner DJ, Vollert J. Patient engagement in designing, conducting, and disseminating clinical pain research: IMMPACT recommended considerations. Pain 2024; 165:1013-1028. [PMID: 38198239 PMCID: PMC11017749 DOI: 10.1097/j.pain.0000000000003121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/27/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 01/12/2024]
Abstract
ABSTRACT In the traditional clinical research model, patients are typically involved only as participants. However, there has been a shift in recent years highlighting the value and contributions that patients bring as members of the research team, across the clinical research lifecycle. It is becoming increasingly evident that to develop research that is both meaningful to people who have the targeted condition and is feasible, there are important benefits of involving patients in the planning, conduct, and dissemination of research from its earliest stages. In fact, research funders and regulatory agencies are now explicitly encouraging, and sometimes requiring, that patients are engaged as partners in research. Although this approach has become commonplace in some fields of clinical research, it remains the exception in clinical pain research. As such, the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials convened a meeting with patient partners and international representatives from academia, patient advocacy groups, government regulatory agencies, research funding organizations, academic journals, and the biopharmaceutical industry to develop consensus recommendations for advancing patient engagement in all stages of clinical pain research in an effective and purposeful manner. This article summarizes the results of this meeting and offers considerations for meaningful and authentic engagement of patient partners in clinical pain research, including recommendations for representation, timing, continuous engagement, measurement, reporting, and research dissemination.
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Affiliation(s)
- Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Katherine J. Holzer
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Robert D. Kerns
- Departments of Psychiatry, Neurology, and Psychology, Yale University, New Haven, CT, United States
| | - Christin Veasley
- Chronic Pain Research Alliance, North Kingstown, RI, United States
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Dennis C. Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
| | - Kristin L. Carman
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, United States
| | - Christine T. Chambers
- Departments of Psychology & Neuroscience and Pediatrics, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, CA, United States
| | - Robert R. Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - James C. Eisenach
- Departments of Anesthesiology, Physiology and Pharmacology, Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - John T. Farrar
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - McKenzie Ferguson
- Southern Illinois University Edwardsville, School of Pharmacy, Edwardsville, IL, United States
| | - Laura P. Forsythe
- Patient-Centered Outcomes Research Institute (PCORI), Washington, DC, United States
| | - Roy Freeman
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jennifer S. Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Christine Goertz
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
| | | | - Smriti Iyengar
- Division of Translational Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Isabel Jordan
- Departments of Psychology & Neuroscience and Pediatrics, Dalhousie University, and Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Cornelia Kamp
- Center for Health and Technology/Clinical Materials Services Unit, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Bethea A. Kleykamp
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Rachel L. Knowles
- Medical Research Council (part of UK Research and Innovation), London, United Kingdom
| | - Dale J. Langford
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, United States
| | - Sean Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, Stanford, CA, United States
| | | | - John Markman
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Kathryn R. Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Ewan McNicol
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA, United States
| | - Kushang V. Patel
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Michael Rowbotham
- Departments of Anesthesia and Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Friedhelm Sandbrink
- National Pain Management, Opioid Safety, and Prescription Drug Monitoring Program, Specialty Care Program Office, Veterans Health Administration, Washington, DC, United States
| | | | - Deborah J. Steiner
- Global Pain, Pain & Neurodegeneration, Eli Lilly and Company, Indianapolis, IN, United States
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
- Department of Neurophysiology, Mannheim Center for Translational Neuroscience MCTN, Medical Faculty Mannheim, Ruprecht Karls University, Heidelberg, Germany
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Staguhn ED, Kirkhart T, Allen L, Campbell CM, Wegener ST, Castillo RC. Predictors of participation in online self-management programs: A longitudinal observational study. Rehabil Psychol 2024; 69:102-109. [PMID: 37956087 PMCID: PMC11059776 DOI: 10.1037/rep0000521] [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] [Indexed: 11/15/2023]
Abstract
PURPOSE/OBJECTIVE Lack of patient participation and engagement remains a barrier to implementing effective online self-management and behavioral health interventions. Identifying patient characteristics associated with engagement rates may lead to interventions that improve engagement in traditional and online self-management programs. In this study, two online self-management and recovery programs were evaluated to identify factors that predict patient engagement. RESEARCH METHOD/DESIGN Predictors were collected in a questionnaire at baseline before 435 participants started either of the two interventions. One or two online lessons were completed per week with seven or eight total lessons to complete in each program, and each lesson took about 20-30 min to finish. Full patient engagement was defined as completing all lessons and assessments in the program and partial engagement as attempting at least one lesson or assessment. RESULTS Predictors of full patient engagement were self-rated confidence in completing the program or being over 60 years of age. Predictors of at least partial patient engagement were experienced ordering online or being over 50 years of age. CONCLUSIONS/IMPLICATIONS Identifying profiles of individuals who predict poor engagement may improve implementation and the health outcomes of intervention programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Elena D. Staguhn
- Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health
- Physical Medicine and Rehabilitation, Johns Hopkins
Medicine
| | - Tricia Kirkhart
- Physical Medicine and Rehabilitation, Johns Hopkins
Medicine
| | - Lauren Allen
- Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health
| | | | | | - Renan C. Castillo
- Department of Health Policy and Management, Johns Hopkins
Bloomberg School of Public Health
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Delfing D, Chin K, Hentrich L, Rachwani J, Friel KM, Santamaria V, Imms C, Gordon AM. Assessing engagement in rehabilitation: development, validity, reliability, and responsiveness to change of the Rehabilitation Observation Measure of Engagement (ROME). Disabil Rehabil 2024; 46:1888-1897. [PMID: 37161867 DOI: 10.1080/09638288.2023.2208379] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE We describe the development of an observational video coding tool, the Rehabilitation Observation Measure of Engagement (ROME), to quantify engagement in rehabilitative settings at the person (internal state of an individual) and between-system (interaction between individuals) level. METHODS Forty-nine children with unilateral spastic cerebral palsy (29 males; Age: M = 9.28 yrs, SD = 3.08 yrs) and their interventionists were videotaped during different activities. Construct validity was examined by correlating the ROME with the Engagement vs. Disaffection with Learning Survey and the Pediatric Rehabilitation Intervention Measure of Engagement - Observation questionnaire. Inter- and intra-rater reliability were examined using two independent raters. The ROME's responsiveness to change was examined by comparing scores across activities. RESULTS For construct validity, results showed a positive correlation for person-level engagement (r = 0.444, p = 0.003). No relationship was found between-system-level engagement. High intrarater (91.8%) and interrater (96.1%) reliability was found. The ROME's responsiveness to change was supported by children exhibiting lower engagement scores during repetitive shaping activities. CONCLUSION These findings provide evidence that the ROME is a reliable tool to objectively examine the construct of engagement within rehabilitation and is valid for quantifying person-level engagement. It provides information that cannot be extracted from questionnaires and can help guide intervention decisions.
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Affiliation(s)
- Dalina Delfing
- Department of Biobehavioral Sciences, Teachers College, Columbia University, NY, NY, United States
| | - Karen Chin
- Department of Biobehavioral Sciences, Teachers College, Columbia University, NY, NY, United States
| | - Larissa Hentrich
- Department of Biobehavioral Sciences, Teachers College, Columbia University, NY, NY, United States
| | - Jaya Rachwani
- Department of Physical Therapy, Hunter College, City University of New York, New York, NY, United States
| | - Kathleen M Friel
- Burke Neurological Institute, Weill Cornell Medicine, White Plains, NY, United States
| | - Victor Santamaria
- Department of Physical Therapy, New York Medical College, NY, United States
| | - Christine Imms
- Healthy Trajectories: A Child and Youth Disability Research Hub, Department of Pediatrics, The University of Melbourne, Melbourne, Australia
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, NY, NY, United States
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