Preferences for health care and self-management among Dutch adolescents with chronic conditions: A Q-methodological investigation

Provision of personalized genomic diagnostic technologies for breast and colorectal cancer: an analysis of patient needs, expectations and priorities

AIM

Several novel pharmacogenomic diagnostic tests are commercially available for breast and colorectal cancer, and are increasingly being used in clinical practice for improving treatment decisions. However, there is little evidence evaluating the value of these new genomic technologies from the perspective of patients. As part of an ongoing effort to understand the continuum of the process of adoption of genomic diagnostics, our aim in this study was to examine the value of genomic diagnostics to breast and colorectal cancer patients, and their willingness to adopt and use genomic diagnostics.

PATIENTS & METHODS

We conducted six focus groups of breast and colorectal cancer patients from the oncology clinics at The Methodist Hospital, Houston, TX, USA. An adapted Q-sort instrument was also administered to focus group participants.

RESULTS

The majority of breast and colorectal cancer patients are interested in using novel genomic diagnostics for deciding about treatment options. Most participants in our study expressed a willingness to pay out-of-pocket for genomic testing (z = 0.736). Reliability and validity of genomic testing were of significant concern (z = 1.32) for the majority of breast and colorectal cancer patients. Participants identified several facilitators and barriers within health systems that might either facilitate or impede the widespread adoption and use of genomic diagnostics in healthcare delivery.

CONCLUSION

This study demonstrates breast and colorectal cancer patients' willingness to adopt and pay for novel genomic diagnostics, as well as identifies several salient factors associated with patient preferences for genomic diagnostics.

Perceptions of team workers in youth care of what makes teamwork effective

In youth care, little is known about what makes teamwork effective. What is known mostly reflects the view of managers in care organisations, as objective outcome measures are lacking. The objective of this article was to explore the views of youth care workers in different types of teams on the relative importance of characteristics of teamwork for its effectiveness. Q methodology was used. Fifty-one respondents rank-order 34 opinion statements regarding characteristics of teamwork. Individual Q sorts were analysed using by-person factor analysis. The resulting factors, which represented team workers' views of what is important for effective teamwork, were interpreted and described using composite rankings of the statements for each factor and corresponding team workers' explanations. We found three views of what makes teamwork effective. One view emphasised interaction between team members as most important for team effectiveness. A second view pointed to team characteristics that help sustain communication within teams as being most important. In the third view, the team characteristics that facilitate individuals to perform as a team member were put forward as most important for teamwork to be effective. In conclusion, different views exist on what makes a team effective in youth care. These views correspond with the different types of teams active in youth care as well as in other social care settings.

Unraveling triadic communication in hospital consultations with adolescents with chronic conditions: the added value of mixed methods research

OBJECTIVE

To integrate findings of a mixed methods research (MMR) into adolescents' preferences and competencies for communication during consultations, in order to demonstrate the added value of MMR for health communication research.

METHODS

Sequential MMR with adolescents (12-19 years) with various chronic conditions in a university hospital. Methods comprised: (1) 31 face-to-face interviews; (2) Q-methodology; (3) 39 observations of outpatient consultations; (4) three focus groups with 27 healthcare providers; (5) web-based questionnaire in 960 adolescents.

RESULTS

Adolescents had different preferences regarding health communication, but all wished to be involved as partners. Yet, their actual participation during consultations was low. They often acted as bystanders rather than main characters because their participation was neither requested nor encouraged. Parents filled the gap, to healthcare providers' frustration. The questionnaire confirmed the discrepancy between self-efficacy and self-reported independent behavior during consultations.

CONCLUSION

Triadic communication was all but multi-party-talk and adolescents did not act and were not considered as main partners. MMR was of pivotal importance for our understanding.

PRACTICE IMPLICATIONS

As chronically ill adolescents need to prepare themselves for transition to adult care, healthcare providers should encourage them to take the lead in communication by initiating independent visits and changing the parents' roles.

"What we want": chronically ill adolescents' preferences and priorities for improving health care

BACKGROUND

As important users of health care, adolescents with chronic conditions deserve to be consulted about their experiences and expectations. This study aimed to explore chronically ill adolescents' preferences regarding providers' qualities, and outpatient and inpatient care. Furthermore, suggestions for improvement of service delivery were collected.

METHODS

This research was a sequential mixed methods study in adolescents aged 12-19 years with various chronic conditions treated in a university children's hospital. Methods comprised 31 face-to-face interviews at home, a hospital-based peer research project in which nine adolescents interviewed 34 fellow patients, and a web-based questionnaire (n = 990). Emerging qualitative themes were transformed into questionnaire items.

RESULTS

Having "a feeling of trust" and "voice and choice" in the hospital were central to these adolescents. Regarding providers' qualities, "being an expert" and "being trustworthy and honest" were ranked highest, followed by "being caring and understanding", "listening and showing respect", and "being focused on me". Regarding outpatient consultations, preferences were ranked as follows: "answering all questions"; "attending to my and my parents' needs"; and "clear communication", while "limited waiting times" and "attractive outpatient surroundings" scored lowest. Regarding hospitalization, adolescents most preferred to "avoid pain and discomfort", "keep in touch with home", and "be entertained", while "being hospitalized with peers" and "being heard" were least important. Regarding priorities for improvement, 52% of the respondents felt that more attention should be paid to older children, followed by enabling more contact with family and friends (45%), shorter waiting times (43%), and more activities to meet fellow patients (35%).

CONCLUSION

Adolescents prefer technically competent providers, who are honest and trustworthy, and attend to their needs. As they gradually grow out of the pediatric environment, they desire staff attitudes to become less childish and more age-appropriate, and welcome being treated as an equal partner in care. Health care professionals should inquire into preferences and adjust their communication style accordingly.

[Friendly hospitals for adolescents: patients' preferences]

OBJECTIVE

To determine the preferences and priorities of a sample of hospitalized adolescents on potential ways to improve their stay in the hospital.

METHOD

We performed a prospective, cross-sectional, descriptive study. The participants completed a questionnaire on their preferences and priorities regarding hospitalization, which included data about age, sex, and hospitalization experience. There were 15 questions (Likert-type scale) to score from 1 to 5 the importance they gave to different aspects of the hospital stay, 6 questions with various response options on their preferences concerning roommates and accompanying person at night in the hospital, and 5 open questions to indicate positive and negative aspects on hospitalization and suggestions to improve it.

RESULTS

A total of 96 adolescents completed the questionnaire, which was 76% of the eligible sample. The importance of friendliness of clinical staff and medical tests not to suffer any delay were the aspects that were considered most important to improve adolescents' hospitalization. If they had to share the hospital room, 86.4% (95% CI: 77.9-92.5) preferred to share with someone of the same age. Among the noteworthy suggestions to improve hospitalization were those involving leisure services in the hospital for adolescent patients (56.2% of the references). As a positive aspect of hospitalization, half (50.0%) referred to the relationship with the clinical staff.

CONCLUSIONS

Adolescents express a hospital user perspective that should be taken into account in developing improvements in the health care they receive.