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Ladegaard Grønkjær L, Berg K, Søndergaard R, Møller M. Assessment of Written Patient Information Pertaining to Cirrhosis and Its Complications: A Pilot Study. J Patient Exp 2020; 7:499-506. [PMID: 33062870 PMCID: PMC7534118 DOI: 10.1177/2374373519858025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Written patient information may play an important role in the compliance of the cirrhosis disease, but little is known on the quality and patients' understanding of them. OBJECTIVES To assess the written patient information leaflet pertaining to cirrhosis and its complications. METHODS The Baker Able Leaflet Design (BALD) criteria and the Ensuring Quality Information for Patients (EQIP) questionnaire were applied to assess design, layout characteristics, and information quality. Readability was calculated using the Læsbarhedsindex (LIX) and the Simple Measure of Gobbledygook (SMOG). A cross-sectional study with a mixed methods design was carried out, using a questionnaire consisting of closed- and open-ended questions. RESULTS The BALD score was 24 and the EQIP score 70%. The LIX score was 46 and the SMOG score 15.8. Sixteen phrases from the leaflet were selected to explore patients' understanding. Four phrases were understood by 100% of the patients, 6 phrases by more than 50% of the patients, and 6 phrases were understood by less than 50% of the patients. The meaning condensation showed that knowledge and understanding of cirrhosis and its complications were not enhanced by the availability of the leaflet. CONCLUSION The leaflet had a good design, layout, and information quality but was difficult to read. Patients appeared to relate poorly to the leaflet and demonstrated limited health literacy. These results suggest that an assessment of written patient information ought to be made in an effort to improve readability. Further studies on intervention to improve patients' health literacy are recommended.
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Affiliation(s)
- Lea Ladegaard Grønkjær
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Gastroenterology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Kirsten Berg
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Søndergaard
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
| | - Majbritt Møller
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
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Sherman MD, Hooker SA, Swanson K. Bring back the notepads: Drawing as an underutilized approach to improving patient comprehension and recall. PATIENT EDUCATION AND COUNSELING 2020; 103:1662-1663. [PMID: 32127232 DOI: 10.1016/j.pec.2020.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Michelle D Sherman
- Department of Family Medicine and Community Health, University of Minnesota, MMC 381; 420 Delaware St. SE, Minneapolis, MN, USA.
| | | | - Katherine Swanson
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
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Ector GICG, Hermens RPMG, Blijlevens NMA. Filling the gaps of patient information and comprehension. Curr Opin Oncol 2020; 32:262-268. [PMID: 32541311 DOI: 10.1097/cco.0000000000000633] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review describes the gaps in cancer patient information and comprehension and provides examples of interventions aimed at filling the gaps. RECENT FINDINGS Despite the technologically advanced era, unmet information needs remain a challenge in current cancer care, even though the beneficial effects of adequate information provision are well described.It starts with the basics of patient-physician communication and information exchange. Barriers are described both patient and physician-specific. For patients to comprehend and recall information correctly, information provision should be tailored to the specific patient in content, as well as in readability level. Tailored content based on bidirectional and iterative information exchange (i.e., patients reported outcomes, followed by specific/personalized feedback) is of focus in the current development of interventions aimed at meeting the gaps. However, the effects of such interventions are not overwhelming and the explanation could be multifactorial. SUMMARY Unmet informational needs are still a gap in current cancer care. The effect of eHealth interventions is not yet well established. Key is to educate patients and (future) healthcare professionals in eHealth. Future research should focus on identifying what kind of interventions are able to fill the gaps.
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Affiliation(s)
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
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Richards HS, Portal A, Absolom K, Blazeby JM, Velikova G, Avery KNL. Patient experiences of an electronic PRO tailored feedback system for symptom management following upper gastrointestinal cancer surgery. Qual Life Res 2020; 30:3229-3239. [PMID: 32535864 PMCID: PMC8528794 DOI: 10.1007/s11136-020-02539-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 11/26/2022]
Abstract
Purpose Complications following upper gastrointestinal (UGI) surgery are common. Symptom-monitoring following discharge is not standardized. An electronic patient-reported outcome (ePRO) system providing feedback to patients and clinicians could support patients and improve outcomes. Little is known about patients’ experiences of using such systems. This qualitative sub-study explored patients’ perspectives of the benefits of using a novel ePRO system, developed as part of the mixed methods eRAPID pilot study, to support recovery following discharge after UGI surgery. Methods Patients completed the online ePRO symptom-report system post-discharge. Weekly interviews explored patients’ experiences of using ePRO, the acceptability of feedback generated and its value for supporting their recovery. Interviews were audio-recorded and targeted transcriptions were thematically analysed. Results Thirty-five interviews with 16 participants (11 men, mean age 63 years) were analysed. Two main themes were identified: (1) reassurance and (2) empowerment. Feelings of isolation were common; many patients felt uninformed regarding their expectations of recovery and whether their symptoms warranted clinical investigation. Participants were reassured by tailored feedback advising them to contact their care team, alleviating their anxiety. Patients reported feeling empowered by the ePRO system and in control of their symptoms and recovery. Conclusion Patients recovering at home following major cancer surgery regarded electronic symptom-monitoring and feedback as acceptable and beneficial. Patients perceived that the system enhanced information provision and provided a direct link to their care team. Patients felt that the system provided reassurance at a time of uncertainty and isolation, enabling them to feel in control of their symptoms and recovery. Electronic supplementary material The online version of this article (10.1007/s11136-020-02539-w) contains supplementary material, which is available to authorised users.
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Affiliation(s)
- H S Richards
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - A Portal
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - K Absolom
- Leeds Institute of Medical Research at St James, St James's Hospital, University of Leeds, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK
| | - J M Blazeby
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - G Velikova
- Leeds Institute of Medical Research at St James, St James's Hospital, University of Leeds, Bexley Wing, Beckett Street, Leeds, LS9 7TF, UK
| | - K N L Avery
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research, Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Hoek AE, Anker SC, van Beeck EF, Burdorf A, Rood PP, Haagsma JA. Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Discharge Instructions: A Systematic Review and Meta-analysis. Ann Emerg Med 2020; 75:435-444. [DOI: 10.1016/j.annemergmed.2019.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/10/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
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Lee C, Jafari M, Brownbridge R, Phillips C, Vanstone JR. The viral prescription pad - a mixed methods study to determine the need for and utility of an educational tool for antimicrobial stewardship in primary health care. BMC FAMILY PRACTICE 2020; 21:42. [PMID: 32087685 PMCID: PMC7035666 DOI: 10.1186/s12875-020-01114-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/18/2020] [Indexed: 12/17/2022]
Abstract
Background In order to combat rising rates of antimicrobial resistant infections, it is vital that antimicrobial stewardship become embedded in primary health care (PHC). Despite the high use of antimicrobials in PHC settings, there is a lack of data regarding the integration of antimicrobial stewardship programs (ASP) in non-hospital settings. Our research aimed to determine which antimicrobial stewardship interventions are optimal to introduce into PHC clinics beginning to engage with an ASP, as well as how to optimize those interventions. This work became focused specifically around management of viral upper respiratory tract infections (URTIs), as these infections are one of the main sources of inappropriate antibiotic use. Methods This mixed methods study of sequential explanatory design was developed through three research projects over 3 years in Regina, Saskatchewan, Canada. First, a survey of PHC providers was performed to determine their perceived needs from a PHC-based ASP. From this work, a “viral prescription pad” was developed to provide a tool to help PHC providers engage in patient education regarding appropriate antimicrobial use, specifically for URTIs. Next, interviews were performed with family physicians to discuss their perceived utility of this tool. Finally, we performed a public survey to determine preferences for the medium by which information is received regarding symptom management for viral URTIs. Results The majority of PHC providers responding to the initial survey indicated they were improperly equipped with tools to aid in promoting conversations with patients and providing education about the appropriate use of antimicrobials. Following dissemination of the viral prescription pad and semi-structured interviews with family physicians, the viral prescription pad was deemed to be a useful educational tool. However, about half of the physicians interviewed indicated they did not actually provide a viral prescription to patients when providing advice on symptom management for viral URTIs. When asked about their preferences, 76% of respondents to the public survey indicated they would prefer to receive written or a combination of verbal and written information in this circumstance. Conclusions PHC providers indicated a need for educational tools to promote conversations with patients and provide education about the appropriate use of antimicrobials. Viral prescription pads were regarded by family physicians and patients as useful tools in facilitating discussion on the appropriate use of antimicrobials. PHC providers should exercise caution in opting out of providing written forms of information, as many respondents to the general public survey indicated their preference in receiving both verbal and written information.
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Affiliation(s)
- Christine Lee
- College of Pharmacy and Nutrition, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada
| | - Maryam Jafari
- Dr. T. Bhanu Prasad Medical Professional Corporation, 3401B Pasqua St., Regina, SK, S4S 7K9, Canada
| | - Regan Brownbridge
- College of Medicine, University of Saskatchewan, 107 Wiggins Rd., Saskatoon, SK, S7N 5E5, Canada
| | - Casey Phillips
- Antimicrobial Stewardship Program, Saskatchewan Health Authority - Regina Area, 4B35, 1440 - 14th Ave., Regina, SK, S4P 0W5, Canada
| | - Jason R Vanstone
- Stewardship and Clinical Appropriateness, Saskatchewan Health Authority - Regina Area, 4B35, 1440 - 14th Ave., Regina, SK, S4P 0W5, Canada.
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Lehmann V, Labrie NHM, van Weert JCM, van Dulmen S, de Haes HJCJM, Kersten MJ, Pieterse AH, Smets EMA. Provider caring and structuring treatment information to improve cancer patients' recall: Does it help? PATIENT EDUCATION AND COUNSELING 2020; 103:55-62. [PMID: 31349965 DOI: 10.1016/j.pec.2019.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Patient recall of medical information is usually poor. Healthcare providers can employ affect-oriented (i.e., showing care) or cognition-oriented communication styles (i.e., structuring information) to enhance recall, but research evidence is limited especially among clinical and/or older patient populations. This video-vignette study manipulated provider caring and information structuring to examine effects on recall and trust among cancer patients/survivors. METHODS In an online survey, 148 participants (Mage = 62) were randomized to one of four video conditions in a two (standard communication vs. enhanced caring) by two (standard vs. enhanced structuring) design, and completed measures of active recall, recognition, and trust. RESULTS Increased caring or structuring did not enhance active recall or recognition, instead both were higher among younger, female, or highly educated participants. The caring condition induced higher perceived trust in the provider within the whole sample, but trust was significantly correlated with decreased recall (r = -.268) among younger participants. CONCLUSIONS Provider caring can strengthen the patient-provider relationship by enhancing trust. Yet, increased trust may impair recall among younger patients. Structuring treatment information did not enhance recall and recognition, but additional research is needed. PRACTICE IMPLICATIONS Providers may use additional ways of structuring/organizing information to help enhance recall (e.g., written information).
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Nanon H M Labrie
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands; Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hanneke J C J M de Haes
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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Wolderslund M, Kofoed PE, Holst R, Waidtløw K, Ammentorp J. Outpatients' recall of information when provided with an audio recording: A mixed-methods study. PATIENT EDUCATION AND COUNSELING 2020; 103:63-70. [PMID: 31473043 DOI: 10.1016/j.pec.2019.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE While the ability to recall medical information is crucial, it is known to be a considerable challenge for many patients. Consequently, we aimed to investigate whether replay could enhance information recall and to explore the extent of information recall in a group of Danish outpatients. METHODS This study utilized a mixed-methods approach and evaluated patients' recall by comparing seven key themes between the interviews and the recordings. A total of 33 patients were included from three outpatient clinics. RESULTS Overall, 61% of the information was recalled. However, the study could not confirm an effect of replay on patients' information recall. Information recall was associated with age and information load. Accordingly, patients younger than 70 years had a 2.46 higher probability of recall (95%CI: 1.1-5.5, p = 0.027), whereas an increase in information load negatively influenced recall. CONCLUSION The study power is insufficient to provide a definite answer to the hypothesis regarding a positive association between replay and recall. Patients' information recall depended on the information theme, their age, and amount of information provided in the consultation. PRACTICE IMPLICATIONS The critical consequences of information overload necessitate an increased awareness of how to prioritise information, particularly when communicating with older patients.
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Affiliation(s)
- Maiken Wolderslund
- Health Services Research Unit, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Poul-Erik Kofoed
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Paediatrics, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark.
| | - René Holst
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway.
| | - Karin Waidtløw
- Health Services Research Unit, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark.
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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Stevenson W, Bryant J, Watson R, Sanson-Fisher R, Oldmeadow C, Henskens F, Brown C, Ramanathan S, Tiley C, Enjeti A, Guest J, Tzelepis F, Paul C, D'Este C. A multi-center randomized controlled trial to reduce unmet needs, depression, and anxiety among hematological cancer patients and their support persons. J Psychosoc Oncol 2019; 38:272-292. [PMID: 31833452 DOI: 10.1080/07347332.2019.1692991] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Individuals diagnosed with a high-grade hematological malignancy are at high risk for psychosocial distress. This study aimed to examine the effectiveness of a web-based information tool and nurse delivered telephone support in reducing: (i) unmet information needs; (ii) depression; and (iii) anxiety, among hematological cancer patients and their support persons (SPs).Methods: Patients with a new diagnosis of acute myeloid leukemia, acute lymphoblastic leukemia, Burkitt lymphoma, or lymphoblastic lymphoma and their SPs were enrolled in a prospective multi-site randomized trial. Participants received either access to an online information tool and telephone support from a hematology nurse, or usual care. Outcome data were collected 2, 4, 8, and 12 weeks post-recruitment. The primary endpoint was unmet information needs.Results: Data from 60 patients and 15 SPs were included in the analysis. There were no statistically significant differences in unmet information needs, depression or anxiety between intervention and control groups for patients. Patients in both groups demonstrated a decrease in information needs over the intervention period. Post hoc analyses revealed that patients who did not achieve remission with the first cycle of treatment experienced increased anxiety from 4 weeks until the end of the study (p = 0.008).Conclusions: A web-based information tool and nurse delivered telephone support did not reduce unmet information needs, depression or anxiety among hematological cancer patients, however this finding is inconclusive given the low power of the study.Implications for Psychosocial Providers or Policy: Patients who do not achieve remission are at high risk of anxiety, and may benefit from targeted psychological intervention.
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Affiliation(s)
- William Stevenson
- Department of Haematology, Royal North Shore Hospital, Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, Australia
| | - Jamie Bryant
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Rochelle Watson
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Rob Sanson-Fisher
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Clinical Research Design, IT and Statistical Support Unit, Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Frans Henskens
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Christina Brown
- Department of Haematology, Royal Prince Alfred Hospital, University of Sydney, Camperdown, New South Wales, Australia
| | - Sundra Ramanathan
- Department of Haematology, St George Hospital, Kogarah, New South Wales, Australia
| | - Campbell Tiley
- Department of Haematology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Anoop Enjeti
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Haematology Unit, Calvary Mater Newcastle, Waratah, New South Wales, Australia.,NSW Health Pathology North-Hunter, New Lambton Heights, New South Wales, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Johanna Guest
- Department of Haematology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Flora Tzelepis
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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Sprague S, Holschuh C. Telemedicine Versus Clinic Visit: A Pilot Study of Patient Satisfaction and Recall of Diet and Exercise Recommendations From Survivorship Care Plans. Clin J Oncol Nurs 2019; 23:639-646. [DOI: 10.1188/19.cjon.639-646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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61
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Comparing written and verbal delivery of a treatment regimen to women with overactive bladder: a randomized controlled trial. ACTA ACUST UNITED AC 2019; 27:76-81. [PMID: 31663980 DOI: 10.1097/gme.0000000000001430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Overactive bladder is a common condition among aging women requiring a multifaceted treatment approach, which is usually communicated by physician to the patient in the clinic setting. The objective of this two-center, randomized controlled trial was to determine if a transcribed list of six management strategies for overactive bladder improves immediate and delayed retention of these recommendations compared with a traditional verbal discussion. METHODS Between March, 2015 and February, 2019, women newly diagnosed with overactive bladder were randomized to either the intervention group, where they received a transcribed list of six treatment recommendations, or to the control group, where the same six recommendations were communicated verbally by their physician. Participants in both groups were asked to recall treatment recommendations immediately after their appointment and 2 weeks later. A score out of 6 was assigned at each time point based on the number of recommendations participants could list. Scores at each point of recall were compared between groups. RESULTS Seventy-two women were recruited and randomized to either the written instruction (n = 34) or verbal discussion group (n = 38). Immediate total retention score was significantly better for women who received the transcribed list compared with those receiving verbal communication (P = 0.002). There was no difference in 2-week total information retention scores between groups. CONCLUSIONS A written list of recommendations is a quality improvement initiative that can improve overactive bladder participants' immediate retention of a suggested treatment regimen, but lacks impact 2 weeks later.
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Brusco NK, Tilley L, Walpole B, Kugler H, Li R, Kennedy E, Morris ME. Feasibility of increasing the dosage of inpatient occupational therapy and physiotherapy rehabilitation via independent tasks and exercises: 'My Therapy'. Aust Occup Ther J 2019; 66:739-752. [PMID: 31602693 DOI: 10.1111/1440-1630.12614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The dosage of occupational therapy and physiotherapy positively correlates with rehabilitation patient and health service outcomes. Nevertheless, increasing the dosage during inpatient rehabilitation without additional resources can be challenging. This study aimed to determine feasibility of increasing the dosage of inpatient occupational therapy and physiotherapy rehabilitation with independent tasks and exercises outside of supervised sessions, the 'My Therapy' programme. METHODS A two-group, quasi-experimental, pre-post-design examined feasibility of delivering My Therapy in addition to usual care, compared to usual care alone, for hospitalised musculoskeletal and frail older rehabilitation patients. My Therapy was prescribed by the occupational therapist and physiotherapist. A booklet was provided with an individually tailored set of tasks and exercises that were a sub-set of routine therapy, to be practised safely, effectively and independently outside of supervised sessions. The primary outcome was feasibility of My Therapy implementation to achieve at least 70% adherence. Secondary outcomes were self-reported daily My Therapy participation (minutes), total daily rehabilitation participation (minutes), adverse events, length of stay, 10-metre walk speed, FIM scores and discharge destination. RESULTS Participation in My Therapy was achieved by 72% (83/116) of the My Therapy group, who averaged 14 min (SD 14) of daily practice outside of supervised sessions. Total daily rehabilitation participation was 177 min (SD 47) for My Therapy participants (n = 116) and 148 min (SD 88) for usual care participants (n = 89); mean difference 30 min (p = .00). A minimal clinically important difference in FIM was achieved for a significantly higher portion of the My Therapy group (22%, n = 26) compared to usual care (10%, n = 9; p = .02). There were no adverse events, safety concerns or group differences for other secondary outcomes. CONCLUSION My Therapy was a feasible and safe way to increase the dosage of inpatient occupational therapy and physiotherapy rehabilitation via independent practice. Clinical Trial Registry: ACTRN12616000691448.
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Affiliation(s)
- Natasha K Brusco
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia.,Alpha Crucis Group, Senior Associate and Health Economist, Melbourne, Victoria, Australia.,Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Louise Tilley
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia
| | - Brianna Walpole
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia
| | - Helen Kugler
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia
| | - Ran Li
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia
| | - Emma Kennedy
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia
| | - Meg E Morris
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Victoria, Australia
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Hung KS, Paulsen MJ, Wang H, Hironaka C, Woo YJ. Custom Patient-Specific Three-Dimensional Printed Mitral Valve Models for Pre-Operative Patient Education Enhance Patient Satisfaction and Understanding. J Med Device 2019. [DOI: 10.1115/1.4043737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In recent years, advances in medical imaging and three-dimensional (3D) additive manufacturing techniques have increased the use of 3D-printed anatomical models for surgical planning, device design and testing, customization of prostheses, and medical education. Using 3D-printing technology, we generated patient-specific models of mitral valves from their pre-operative cardiac imaging data and utilized these custom models to educate patients about their anatomy, disease, and treatment. Clinical 3D transthoracic and transesophageal echocardiography images were acquired from patients referred for mitral valve repair surgery and segmented using 3D modeling software. Patient-specific mitral valves were 3D-printed using a flexible polymer material to mimic the precise geometry and tissue texture of the relevant anatomy. 3D models were presented to patients at their pre-operative clinic visit and patient education was performed using either the 3D model or the standard anatomic illustrations. Afterward, patients completed questionnaires assessing knowledge and satisfaction. Responses were calculated based on a 1–5 Likert scale and analyzed using a nonparametric Mann–Whitney test. Twelve patients were presented with a patient-specific 3D-printed mitral valve model in addition to standard education materials and twelve patients were presented with only standard educational materials. The mean survey scores were 64.2 (±1.7) and 60.1 (±5.9), respectively (p = 0.008). The use of patient-specific anatomical models positively impacts patient education and satisfaction, and is a feasible method to open new opportunities in precision medicine.
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Affiliation(s)
- Kay S. Hung
- Department of Cardiothoracic Surgery, Stanford University, 870 Quarry Road Extension, Palo Alto, CA 94304 e-mail:
| | - Michael J. Paulsen
- Department of Cardiothoracic Surgery, Stanford University, 870 Quarry Road Extension, Palo Alto, CA 94304 e-mail:
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, 870 Quarry Road Extension, Palo Alto, CA 94304 e-mail:
| | - Camille Hironaka
- Department of Cardiothoracic Surgery, Stanford University, 870 Quarry Road Extension, Palo Alto, CA 94304 e-mail:
| | - Y. Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, 870 Quarry Road Extension, Palo Alto, CA 94304 e-mail:
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Rozenberg G, Petersiel N, Korytny A, Bishop B, Mousa A, Fried C, Maister A, Neuberger A. Standard pre-travel consultation versus shorter consultation combined with smartphone support: a randomized controlled trial. J Travel Med 2019; 26:5424971. [PMID: 30937447 DOI: 10.1093/jtm/taz025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 11/12/2022]
Abstract
Immediate and long-term recalls of a pre-travel consultation are suboptimal. We aimed to assess the role of online consultation for travellers. We randomized travellers into two study groups. In the intervention arm, each traveller was given a short pre-travel consultation of 8-12 minutes, combined with the option of smartphone support before and during the trip. In the control arm, each traveller was given a standard length pre-travel consultation of 18-22 minutes. Endpoints included knowledge about potential risks, travellers' satisfaction, time allocated to each traveller and clinical events. We enrolled 75 patients in the intervention group and 74 patients in the control group. Online consultation was used 33 times, by 24 travellers, both before and during the trip. Important health hazards that were addressed included animal and insect bites (8), treatment of diarrhea (4), malaria prophylaxis (2) and altitude sickness prophylaxis (5). Other consultations consisted mainly of reassurances of worried travellers and provision of data. Knowledge about travel-related risks was higher in the control group before travelling (8.86 ± 1.12 vs 8.34 ± 1.32, P = 0.014), and there was a trend towards higher levels of knowledge also during the trip (8.29 ± 1.35 vs 7.89 ± 1.39, P = 0.06). Travellers' satisfaction before and during the trip was similar in both groups: median 10 (10, 10) in both groups before traveling (P = 0.51) and median 9 (8, 10) in both groups during the trip (P = 0.71). In the intervention group, time allocated to each traveller was <12 minutes. There were no differences in the number of clinical events (P > 0.2 for all comparisons). Online WhatsApp support addressed several important travel-related hazards but, when combined with a shortened pre-travel consultation, was associated with a lower level of knowledge about health risks. Therefore, such smartphone support should augment, rather than replace, pre-travel consultation.
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Affiliation(s)
- Gilad Rozenberg
- Travel Medicine and Tropical Diseases Clinic, Division of Infectious Diseases, Rambam Medical Center, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Neta Petersiel
- Travel Medicine and Tropical Diseases Clinic, Division of Infectious Diseases, Rambam Medical Center, Haifa, Israel.,Internal Medicine H, Rambam Medical Center, Haifa, Israel
| | - Alexander Korytny
- Travel Medicine and Tropical Diseases Clinic, Division of Infectious Diseases, Rambam Medical Center, Haifa, Israel.,Internal Medicine H, Rambam Medical Center, Haifa, Israel
| | - Boaz Bishop
- Travel Medicine and Tropical Diseases Clinic, Division of Infectious Diseases, Rambam Medical Center, Haifa, Israel.,Internal Medicine B, Rambam Medical Center, Haifa, Israel.,Department of Nephrology, Rambam Medical Center, Haifa, Israel
| | - Amjad Mousa
- Travel Medicine and Tropical Diseases Clinic, Division of Infectious Diseases, Rambam Medical Center, Haifa, Israel.,Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - Carmit Fried
- Travel Medicine and Tropical Diseases Clinic, Division of Infectious Diseases, Rambam Medical Center, Haifa, Israel.,Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - Alina Maister
- Travel Medicine and Tropical Diseases Clinic, Division of Infectious Diseases, Rambam Medical Center, Haifa, Israel.,Internal Medicine B, Rambam Medical Center, Haifa, Israel
| | - Ami Neuberger
- Travel Medicine and Tropical Diseases Clinic, Division of Infectious Diseases, Rambam Medical Center, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Internal Medicine B, Rambam Medical Center, Haifa, Israel
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65
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Bhattarai P, Newton-John TRO, Phillips JL. Quality and Usability of Arthritic Pain Self-Management Apps for Older Adults: A Systematic Review. PAIN MEDICINE 2019; 19:471-484. [PMID: 28541464 DOI: 10.1093/pm/pnx090] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective To appraise the quality and usability of currently available pain applications that could be used by community-dwelling older adults to self-manage their arthritic pain. Methods A systematic review. Searches were conducted in App Store and Google Play to identify pain self-management apps relevant to arthritic pain management. English language pain management apps providing pain assessment and documentation function and pain management education were considered for inclusion. A quality evaluation audit tool based on the Stanford Arthritis Self-Management Program was developed a priori to evaluate app content quality. The usability of included apps was assessed using an established usability evaluation tool. Results Out of the 373 apps that were identified, four met the inclusion criteria. The included apps all included a pain assessment and documentation function and instructions on medication use, communication with health professionals, cognitive behavioral therapy-based pain management, and physical exercise. Management of mood, depression, anxiety, and sleep were featured in most apps (N = 3). Three-quarters (N = 3) of the apps fell below the acceptable moderate usability score (≥3), while one app obtained a moderate score (3.2). Conclusions Few of the currently available pain apps offer a comprehensive pain self-management approach incorporating evidence-based strategies in accordance with the Stanford Arthritis Self-Management Program. The moderate-level usability across the included apps indicates a need to consider the usability needs of the older population in future pain self-management app development endeavors.
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Affiliation(s)
- Priyanka Bhattarai
- The University of Notre Dame Australia, School of Nursing, Darlinghurst, NSW, Australia
| | | | - Jane L Phillips
- Center for Cardiovascular and Chronic Care, University of Technology Sydney, Sydney, NSW, Australia
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Barchi F, Winter SC, Ketshogile FM, Ramogola-Masire D. Adherence to screening appointments in a cervical cancer clinic serving HIV-positive women in Botswana. BMC Public Health 2019; 19:318. [PMID: 30885175 PMCID: PMC6423763 DOI: 10.1186/s12889-019-6638-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 03/08/2019] [Indexed: 11/24/2022] Open
Abstract
Background The link between human immunodeficiency virus (HIV) and cervical cancer is of particular concern in Botswana, where one in four women at risk for cervical cancer is HIV-positive. In settings where co-occurrence of these diseases is high, adherence to screening appointments is essential to ensure detection and early treatment. Methods This study took place in a cervical cancer-screening program in an HIV clinic in Botswana. Data for this analysis came from 1789 patient records and 257 semi-structured surveys about the screening consent process that were completed by a subset of patients. Results Forty percent of women kept their scheduled follow-up appointments. Findings suggest that women treated at first visit or referred for additional treatment due to the presence of more advanced disease had more than double the odds of adhering to follow-up appointments compared to women with negative screens. Women who completed the 35-min surveys in the embedded consent study were found to have 3.7 times greater odds of adhering to follow-up appointment schedules than women who did not. Factors such as age, education, income and marital status that have been shown elsewhere to be important predictors of adherence were not found to be significant predictors in this study. Conclusions HIV-positive women in Botswana who are symptom free at initial screening may be lost to essential future screening and follow-up care without greater targeted communication regarding cervical cancer and the importance of regular screening. Strategies to reinforce health messages using cell phone reminders, appointment prompts at time of anti-retroviral drug (ARV) refills, and use of trained community workers to review cervical cancer risks may be effective tools in reducing the burden of cervical cancer disease in HIV-positive women in this setting. Electronic supplementary material The online version of this article (10.1186/s12889-019-6638-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francis Barchi
- Edward J. Bloustein School of Planning & Public Policy, Rutgers, The State University of New Jersey, 33 Livingston Avenue, New Brunswick, NJ, 08901, USA.
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Khrystolubova N, Shieh M, Patel AJ, Bailey R. Pharmacist-led patient education and adverse event management in patients with non-small cell lung cancer receiving afatinib in a community-based, real-world clinical setting. J Oncol Pharm Pract 2019; 26:13-22. [PMID: 30832554 PMCID: PMC6886115 DOI: 10.1177/1078155219833441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose To describe the outcomes of a pharmacist-led multi-center, collaborative patient education and proactive adverse event management program in a community-based oncology setting. Methods Patients with EGFR mutation-positive (EGFRm+) non-small cell lung cancer, newly prescribed with oral afatinib, and monitored as part of the Florida Cancer Specialists patient management program, were included in a retrospective, observational analysis. During follow-up, data were collected on adverse event frequency, and changes in afatinib dosing. Data analyses were descriptive and exploratory in nature. Results The mean age of the 123 patients included in the analysis was 69 years, and 78% were female. At the time of the analysis, 3 patients had discontinued before receiving treatment, 89 patients had discontinued afatinib treatment, and 31 patients were continuing to receive afatinib treatment. The most common afatinib-related adverse events were diarrhea (85%), rash/skin reactions (58%), stomatitis/mucositis (19%), and paronychia (16%). Overall, 13% of patients discontinued due to afatinib-related adverse events. The median duration of treatment was 4 months in patients who discontinued due to adverse events, 6 months in those who discontinued for other reasons, and 18 months in those who were continuing to receive therapy. Afatinib dose-reductions were more frequent in patients continuing treatment versus those who discontinued due to adverse events (77% vs. 42%, respectively). Conclusions Findings suggest that adverse events in patients with EGFRm + non-small cell lung cancer receiving afatinib can be successfully managed in a community-based, real-world setting with the help of collaborative pharmacist-led patient education, adverse event monitoring, and continuous support.
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Affiliation(s)
| | - Monica Shieh
- Rx To Go, Florida Cancer Specialists, Fort Myers, FL, USA
| | - Anjan J Patel
- Florida Cancer Specialists & Research Institute, Sarasota, FL, USA
| | - Ray Bailey
- Rx To Go, Florida Cancer Specialists, Fort Myers, FL, USA
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Noble N, Paul C, Walsh J, Wyndham K, Wilson S, Stewart J. Concordance between self-report and medical records of preventive healthcare delivery among a sample of disadvantaged patients from four aboriginal community controlled health services. BMC Health Serv Res 2019; 19:111. [PMID: 30736763 PMCID: PMC6368754 DOI: 10.1186/s12913-019-3930-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This cross-sectional study aimed to explore, among a sample of patients attending one of four Aboriginal Health Services (ACCHSs), the degree of concordance between self-report and medical records for whether screening for key healthcare items had ever been undertaken, or had been undertaken within the recommended timeframe. METHODS Across the four ACCHSs, a convenience sample of 109 patients was recruited. Patients completed a self-report computer survey assessing when they last had preventive care items undertaken at the service. ACCHS staff completed a medical record audit for matching items. The degree of concordance (i.e. the percentage of cases in which self-reports matched responses from the medical record) was calculated. RESULTS Concordance was relatively high for items including assessment of Body Mass Index and blood pressure, but was substantially lower for items including assessment of waist circumference, alcohol intake, physical activity, and diet. CONCLUSIONS Reliance on either patient self-report or medical record data for assessing the level of preventive care service delivery by ACCHSs requires caution. Efforts to improve documentation of some preventive care delivery in medical records are needed. These findings are likely to also apply to patients in other general practice settings.
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Affiliation(s)
- Natasha Noble
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,The Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Christine Paul
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,The Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Justin Walsh
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,The Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Kylie Wyndham
- Bulgarr Ngaru Medical Aboriginal Corporation, Richmond Valley Clinic, 153 - 157 Canterbury St, Casino, NSW, 2470, Australia
| | - Sue Wilson
- Durri Aboriginal Corporation Medical Service, 15-19 York Lane, Kempsey, NSW, 2440, Australia
| | - Jessica Stewart
- NSW Department of Family & Community Services- Business Services, 219-241 Cleveland Street, Redfern, NSW, 2016, Australia
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Noordman J, Driesenaar JA, van Bruinessen IR, Portielje JE, van Dulmen S. Evaluation and Implementation of ListeningTime: A Web-Based Preparatory Communication Tool for Elderly Patients With Cancer and Their Health Care Providers. JMIR Cancer 2019; 5:e11556. [PMID: 30698525 PMCID: PMC6372931 DOI: 10.2196/11556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/04/2018] [Accepted: 09/25/2018] [Indexed: 01/14/2023] Open
Abstract
Background Effective patient-provider communication is an important condition to deliver optimal care and it supports patients in coping with their disease. The complex and emotionally loaded setting of oncology care challenges both health care providers (HCPs) and patients in reaching effective communication. ListeningTime is developed for elderly patients with cancer and their oncological HCPs to help them (better) prepare the clinical encounter and overcome communication barriers. ListeningTime is a Web-based preparatory communication tool including modeling videos and has an audio-facility to listen back to recorded encounters. Objective This study aims to evaluate the usability, perceived usefulness, and actual use of ListeningTime, through the eyes of elderly patients with cancer and their oncological HCPs. If highly rated, the ultimate goal is to make ListeningTime publicly available. Methods First, members of a panel of elderly cancer survivors and patients (age ≥65 years) were approached to evaluate ListeningTime through a Web-based questionnaire. The usability and perceived usefulness were assessed. Second, ListeningTime was evaluated in real-life practice through a pilot study in 3 Dutch hospitals. In these hospitals, elderly patients with cancer and their oncological HCPs were approached to evaluate ListeningTime through a similar Web-based questionnaire, measuring the perceived usefulness. In addition, we examined log files and user statistics to get insight into how the program was used. Results A total of 30 cancer survivors or patients from the patient panel, and 17 patients and 8 HCPs from the hospitals, evaluated ListeningTime. Overall, both panel members and hospital patients were positive about the ListeningTime website, audio-facility, and video fragments. Some patients suggested improvements with respect to the actors’ performances in the video fragments and believed that ListeningTime is mainly suitable for non experienced patients. HCPs were also positive about ListeningTime; they valued the video fragments for patients and the audio-facility for patients and themselves. However, providers did not relisten their own recorded encounters. Patients did use the audio-facility to relisten their encounters. Conclusions ListeningTime was highly rated, both by patients and their oncological HCPs. As a result, the video fragments of ListeningTime are now made publicly available for elderly patients with cancer through the Dutch website “kanker.nl.”
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Affiliation(s)
- Janneke Noordman
- Nivel: Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | | | | | - Johanneke Ea Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands.,Department of Oncology, Hagaziekenhuis, Den Haag, Netherlands
| | - Sandra van Dulmen
- Nivel: Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Federman A, Sarzynski E, Brach C, Francaviglia P, Jacques J, Jandorf L, Munoz AS, Wolf M, Kannry J. Challenges optimizing the after visit summary. Int J Med Inform 2018; 120:14-19. [PMID: 30409339 PMCID: PMC6326571 DOI: 10.1016/j.ijmedinf.2018.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 06/18/2018] [Accepted: 09/08/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The after visit summary (AVS) is a paper or electronic document given to patients after a medical appointment, which is intended to summarize patients' health and guide future care, including self-management tasks. OBJECTIVE To describe experiences of health systems implementing a redesigned outpatient AVS in commercially available electronic health record (EHR) systems to inform future optimization. MATERIALS AND METHODS We conducted semi-structured interviews with information technology and clinical leaders at 12 hospital and community-based healthcare institutions across the continental United States focusing on the process of AVS redesign and implementation. We also report our experience implementing a redesigned AVS in the Epic EHR at the Mount Sinai Hospital in New York City, NY. RESULTS Health systems experienced many challenges implementing the redesigned AVS. While many IT leaders noted that the redesigned AVS is easier to understand and the document is better organized, they claim the effort is time-consuming, Epic system upgrades render AVS modifications non-functional, and primary care and specialty practices have different needs in regards to content and formatting. Our team was able to modify the document by changing the order of print groups, modifying the font size, bolding section headers, and inserting page breaks. Similar to other health systems, our team found that it is difficult to achieve some desired features due to limitations in the EHR platform. CONCLUSION Health IT leaders view the AVS as a valuable source of information for patients. However, limitations to AVS modifications in EHR systems present challenges to optimizing the tool. EHR vendors should incorporate learning from healthcare systems innovation efforts and consider building more flexibility into their product development.
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Affiliation(s)
- Alex Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Erin Sarzynski
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Cindy Brach
- Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Paul Francaviglia
- Epic Clinical Transformation Group, Information Technology Department, Mount Sinai Health System, New York, NY, USA
| | - Jessica Jacques
- Epic Clinical Transformation Group, Information Technology Department, Mount Sinai Health System, New York, NY, USA
| | - Lina Jandorf
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Angela Sanchez Munoz
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Wolf
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joseph Kannry
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Watson R, Bryant J, Sanson-Fisher R, Turon H, Hyde L, Herrmann A. Do haematological cancer patients get the information they need about their cancer and its treatment? Results of a cross-sectional survey. Support Care Cancer 2018; 27:1509-1517. [DOI: 10.1007/s00520-018-4525-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 10/19/2018] [Indexed: 01/06/2023]
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Smith SK, Cabrera-Aguas M, Shaw J, Shepherd H, Naehrig D, Meiser B, Jackson M, Saade G, Bucci J, Halkett GKB, Turner RM, Milross C, Dhillon HM. A low literacy targeted talking book about radiation therapy for cancer: development and acceptability. Support Care Cancer 2018; 27:2057-2067. [PMID: 30225574 DOI: 10.1007/s00520-018-4446-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/26/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To develop a low literacy talking book (written book with accompanying audio-recording) about radiation therapy and explore its acceptability with patients and caregivers. METHOD The talking book was developed iteratively using low literacy design principles and a multidisciplinary committee comprising consumers and experts in radiation oncology, nursing, behavioural sciences, and linguistics. It contained illustrations, photos, and information on: treatment planning, daily treatment, side effects, psychosocial health, and a glossary of medical terms. Semi-structured interviews were conducted with patients who self-reported low functional health literacy and caregivers to explore their views on the resource. Thematic analysis using a framework approach informed the analysis. RESULTS Participants were very satisfied with the content, illustrations, and language in the resource. Most were unfamiliar with the term 'talking book', but liked the option of different media (text and audio). The resource was seen as facilitating communication with the cancer care team by prompting question-asking and equipping patients and their families with knowledge to communicate confidently. CONCLUSIONS The low literacy talking book was well accepted by patients and their caregivers. The next step is to examine the effect of the resource on patients' knowledge, anxiety, concerns, and communication with the cancer care team.
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Affiliation(s)
- Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Lowy Cancer Research Centre C25 Level 4, Cnr High Street and Botany Street, Kensington, NSW, 2033, Australia.
| | - Maria Cabrera-Aguas
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Lowy Cancer Research Centre C25 Level 4, Cnr High Street and Botany Street, Kensington, NSW, 2033, Australia
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Heather Shepherd
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Diana Naehrig
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Chris O'Brien Lifehouse, Integrative Oncology & Supportive Care, Sydney, NSW, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Lowy Cancer Research Centre C25 Level 4, Cnr High Street and Botany Street, Kensington, NSW, 2033, Australia
| | - Michael Jackson
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - George Saade
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Joseph Bucci
- St George Hospital Cancer Care, Radiation Oncology Unit, Sydney, NSW, Australia
| | - Georgia K B Halkett
- Faculty of Health Sciences, School of Nursing School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - Robin M Turner
- Biostatistics Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Christopher Milross
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Chris O'Brien Lifehouse, Radiation Oncology and Medical Services, Sydney, NSW, Australia
| | - Haryana M Dhillon
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
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Barr PJ, Bonasia K, Verma K, Dannenberg MD, Yi C, Andrews E, Palm M, Cavanaugh KL, Masel M, Durand MA. Audio-/Videorecording Clinic Visits for Patient's Personal Use in the United States: Cross-Sectional Survey. J Med Internet Res 2018; 20:e11308. [PMID: 30209029 PMCID: PMC6231772 DOI: 10.2196/11308] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 11/19/2022] Open
Abstract
Background Few clinics in the United States routinely offer patients audio or video recordings of their clinic visits. While interest in this practice has increased, to date, there are no data on the prevalence of recording clinic visits in the United States. Objective Our objectives were to (1) determine the prevalence of audiorecording clinic visits for patients’ personal use in the United States, (2) assess the attitudes of clinicians and public toward recording, and (3) identify whether policies exist to guide recording practices in 49 of the largest health systems in the United States. Methods We administered 2 parallel cross-sectional surveys in July 2017 to the internet panels of US-based clinicians (SERMO Panel) and the US public (Qualtrics Panel). To ensure a diverse range of perspectives, we set quotas to capture clinicians from 8 specialties. Quotas were also applied to the public survey based on US census data (gender, race, ethnicity, and language other than English spoken at home) to approximate the US adult population. We contacted 49 of the largest health systems (by clinician number) in the United States by email and telephone to determine the existence, or absence, of policies to guide audiorecordings of clinic visits for patients’ personal use. Multiple logistic regression models were used to determine factors associated with recording. Results In total, 456 clinicians and 524 public respondents completed the surveys. More than one-quarter of clinicians (129/456, 28.3%) reported that they had recorded a clinic visit for patients’ personal use, while 18.7% (98/524) of the public reported doing so, including 2.7% (14/524) who recorded visits without the clinician’s permission. Amongst clinicians who had not recorded a clinic visit, 49.5% (162/327) would be willing to do so in the future, while 66.0% (346/524) of the public would be willing to record in the future. Clinician specialty was associated with prior recording: specifically oncology (odds ratio [OR] 5.1, 95% CI 1.9-14.9; P=.002) and physical rehabilitation (OR 3.9, 95% CI 1.4-11.6; P=.01). Public respondents who were male (OR 2.11, 95% CI 1.26-3.61; P=.005), younger (OR 0.73 for a 10-year increase in age, 95% CI 0.60-0.89; P=.002), or spoke a language other than English at home (OR 1.99; 95% CI 1.09-3.59; P=.02) were more likely to have recorded a clinic visit. None of the large health systems we contacted reported a dedicated policy; however, 2 of the 49 health systems did report an existing policy that would cover the recording of clinic visits for patient use. The perceived benefits of recording included improved patient understanding and recall. Privacy and medicolegal concerns were raised. Conclusions Policy guidance from health systems and further examination of the impact of recordings—positive or negative—on care delivery, clinician-related outcomes, and patients’ behavioral and health-related outcomes is urgently required.
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Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Kyra Bonasia
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, United States
| | - Kanak Verma
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, United States
| | - Michelle D Dannenberg
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Cameron Yi
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, United States
| | | | - Marisha Palm
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
| | - Kerri L Cavanaugh
- Vanderbilt Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, United States.,Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Meredith Masel
- Oliver Center for Patient Safety & Quality Healthcare, University of Texas Medical Branch, Galveston, TX, United States
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, United States
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Cavan D, Makaroff LE, da Rocha Fernandes J, Karuranga S, Sylvanowicz M, Conlon J, Chaney D, Malhi A, Barratt J. Global perspectives on the provision of diabetic retinopathy screening and treatment: Survey of health care professionals in 41 countries. Diabetes Res Clin Pract 2018; 143:170-178. [PMID: 30003940 DOI: 10.1016/j.diabres.2018.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/08/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
AIM To assess the level of awareness and provision of screening and treatment for Diabetic Eye Disease (DED) comprising Diabetic Retinopathy (DR) and Diabetic Macular Edema (DME) among health care professionals. METHODS The study was conducted in two phases. The first phase consisted of a qualitative study, based on semi-structured face-to-face and telephone interviews in 8 countries. The second phase used a quantitative approach utilising online surveys in 41 countries. The survey for health care professionals comprised of 43 questions covering provider information, practice characteristics, management of adults with diabetes and specific information from ophthalmologists on screening and treatments for DR. RESULTS There were 2329 health care professionals who participated in the online survey. More than one third of diabetes specialists surveyed reported that they did not discuss eye care with their diabetes patients. Nearly two-thirds of all health care professionals surveyed reported that they had written information about diabetes for patients available in their practice. Only one in five (22%, n = 58) primary care providers reported they had material that contained sufficient information on eye complications, and 37% (n = 252) of ophthalmologists reported that they had sufficient information on eye complications. Sixty-five percent (n = 378) of ophthalmologists reported that most of their patients presented when visual problems had already occurred. Six percent (n = 36) stated that most of their patients presented when it was already too late for effective treatment. The most substantial barriers to eye health mentioned by health care professionals responding to the survey were: a patients' lack of knowledge and/or awareness about eye complications (43%), followed by lack of importance given to eye examinations by patients (33%), and the high cost of care (32%). Ophthalmologists also reported late screening (66%), and lack of patient education materials (55%) as obstacles for improving eye health outcomes. CONCLUSION Health care professionals need to be appropriately supported and trained so they can provide adults with diabetes with information about the risks of DR, support them in reducing their risk, and advocate for the provision of affordable DR screening and treatment as required.
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Affiliation(s)
- D Cavan
- International Diabetes Federation, Chaussée de la Hulpe 166, Brussels, Belgium
| | - L E Makaroff
- Department of Microbiology and Immunology, University of Leuven, Herestraat 49, Leuven, Belgium.
| | | | - S Karuranga
- International Diabetes Federation, Chaussée de la Hulpe 166, Brussels, Belgium.
| | | | - J Conlon
- The International Agency for the Prevention of Blindness, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom.
| | - D Chaney
- Diabetes UK Northern Ireland, Bridgewood House, Newforge Business Park, Newforge Lane, Belfast, United Kingdom.
| | - A Malhi
- International Diabetes Federation, Chaussée de la Hulpe 166, Brussels, Belgium
| | - J Barratt
- International Federation on Ageing, 351 Christie Street, Toronto, Ontario, Canada.
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Abstract
AIM To explore the demands for different disease-related information and the acceptance of various information sources in patients with Crohn's disease (CD). METHODS This study included 159 patients with CD and was conducted from April 2017 to December 2017 in our hospital. We obtained the demographic characteristics of the patients and used the modified information demands questionnaire to assess patients' disease information demands, covering 4 aspects which include general knowledge, fertility, clinical treatment, and daily management. Then, we analyzed the factors associated with the information demand. In addition, we studied the patients' acceptance of different information sources. RESULTS The disease-related information demands of patients with CD are generally high. Female patients, young patients, and patients with plans to have children have significantly higher information demands concerning fertility. The information demands in clinical treatment are higher in young patients. Patients living in the countryside and patients with a short disease duration have high information demands concerning life management. The patients' acceptance of different information sources is variable. Doctor-mediated guidance, brochures, and videos are the top 3 patient choices for information sources. CONCLUSION Patients' information demands concerning many aspects of CD are generally high. Certain demands are significantly associated with the demographic characteristics of the patients. Doctor-mediated guidance, brochures, and videos are the top 3 patient choices for information sources. Therefore, corresponding education programs can be developed to improve the physical and psychological health of CD patients in the future.
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Affiliation(s)
- Qiangqiang Wu
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China,
| | - Jie Zhong
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China,
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Hyatt A, Lipson-Smith R, Gough K, Butow P, Jefford M, Hack TF, Hale S, Zucchi E, White S, Ozolins U, Schofield P. Culturally and linguistically diverse oncology patients' perspectives of consultation audio-recordings and question prompt lists. Psychooncology 2018; 27:2180-2188. [DOI: 10.1002/pon.4789] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Amelia Hyatt
- Cancer Experiences Research; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Ruby Lipson-Smith
- Cancer Experiences Research; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Karla Gough
- Cancer Experiences Research; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Parkville Australia
| | - Phyllis Butow
- Centre of Medical Psychology and Evidence-Based Decision-Making; University of Sydney; Sydney Australia
- Psycho-Oncology Cooperative Research Group; University of Sydney; Sydney Australia
| | - Michael Jefford
- Cancer Experiences Research; Peter MacCallum Cancer Centre; Melbourne Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Australia
| | - Thomas F. Hack
- College of Nursing, Rady Faculty of Health Sciences; University of Manitoba; Winnipeg Canada
- Research Institute in Haematology and Oncology at CancerCare Manitoba; Winnipeg Manitoba Canada
| | - Sandra Hale
- School of Humanities and Languages; University of New South Wales; Sydney Australia
| | - Emiliano Zucchi
- Transcultural & Language Services; Northern Health; Melbourne Australia
| | - Shane White
- Department of Medicine; Northern Health; Melbourne Australia
| | - Uldis Ozolins
- School of Humanities and Languages; University of New South Wales; Sydney Australia
| | - Penelope Schofield
- Cancer Experiences Research; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Psychological Sciences; Swinburne University of Technology; Melbourne Australia
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Lipson‐Smith R, Hyatt A, Murray A, Butow P, Hack TF, Jefford M, Ozolins U, Hale S, Schofield P. Measuring recall of medical information in non-English-speaking people with cancer: A methodology. Health Expect 2018; 21:288-299. [PMID: 28940931 PMCID: PMC5750741 DOI: 10.1111/hex.12614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Many patients who require an interpreter have difficulty remembering information from their medical consultations. Memory aids such as consultation audio-recordings may be of benefit to these patients. However, there is no established means of measuring patients' memory of medical information. OBJECTIVES This study aimed to develop a method for eliciting and coding recall of medical information in non-English-speaking patients. DESIGN This method, called Patient-Interpreter-Clinician coding (PICcode), was developed in the context of a phase II trial conducted in two outpatient oncology clinics in Melbourne, Australia, and was refined iteratively through consultation with an expert panel and piloting. Between-coder differences in early versions of the coding system were resolved through discussion and consensus resulting in refinements to PICcode. RESULTS The final version of PICcode involved transcribing, translating and coding of audio-recorded consultations and semi-structured interviews (SSI). The SSIs were designed to elicit patients' free-recall of medical information. Every unit of medical information in the consultation was identified and categorized in a coding tree. SSIs were coded to identify the extent to which information was recalled from the consultation. DISCUSSION The iterative changes involved in developing PICcode assisted in clarifying precise details of the process and produced a widely applicable coding system. PICcode is the most comprehensively described method of determining the amount of information that patients who use an interpreter recall from their medical consultations. PICcode can be adapted for English-speaking patients and other healthcare populations.
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Affiliation(s)
- Ruby Lipson‐Smith
- Cancer Experiences ResearchPeter MacCallum Cancer CentreMelbourneVICAustralia
| | - Amelia Hyatt
- Cancer Experiences ResearchPeter MacCallum Cancer CentreMelbourneVICAustralia
| | - Alexandra Murray
- Cancer Experiences ResearchPeter MacCallum Cancer CentreMelbourneVICAustralia
| | - Phyllis Butow
- School of PsychologyUniversity of SydneySydneyNSWAustralia
- Centre of Medical Psychology and Evidence‐Based Decision‐MakingUniversity of SydneySydneyNSWAustralia
- Psycho‐Oncology Cooperative Research GroupUniversity of SydneySydneyNSWAustralia
| | - Thomas F. Hack
- College of NursingUniversity of ManitobaWinnipegMBCanada
- CancerCare Manitoba Research InstituteWinnipegMBCanada
- School of Health Sciences, University of Central Lancashire PrestonUK
| | - Michael Jefford
- Cancer Experiences ResearchPeter MacCallum Cancer CentreMelbourneVICAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia
| | - Uldis Ozolins
- School of Humanities and LanguagesUniversity of New South WalesSydneyNSWAustralia
| | - Sandra Hale
- School of Humanities and LanguagesUniversity of New South WalesSydneyNSWAustralia
| | - Penelope Schofield
- Cancer Experiences ResearchPeter MacCallum Cancer CentreMelbourneVICAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVICAustralia
- Department of Psychological SciencesSwinburne University of TechnologyMelbourneVICAustralia
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78
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Drozdova OV. [Problems of education in foreign university dental clinics]. STOMATOLOGIIA 2018; 97:82-86. [PMID: 30199075 DOI: 10.17116/stomat20189704182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- O V Drozdova
- Moscow State Medical and Dental University, Moscow, Russia
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79
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Harkin LJ, Beaver K, Dey P, Choong K. Navigating cancer using online communities: a grounded theory of survivor and family experiences. J Cancer Surviv 2017; 11:658-669. [PMID: 28470506 PMCID: PMC5671555 DOI: 10.1007/s11764-017-0616-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/13/2017] [Indexed: 12/03/2022]
Abstract
PURPOSE People affected by cancer often have unmet emotional and social support needs. Online cancer communities are a convenient channel for connecting cancer survivors, allowing them to support one another. However, it is unclear whether online community use makes a meaningful contribution to cancer survivorship, as little previous research has examined the experience of using contemporary cancer communities. We aimed to explore the experiences of visitors to online cancer communities. METHODS Twenty-three in-depth interviews were conducted with online cancer community visitors, including cancer survivors (n = 18), family members (n = 2), and individuals who were both a survivor and family member (n = 3). Interviews were analysed using a grounded theory approach. RESULTS A theory developed explaining how individuals 'navigated' the experience of cancer using online cancer communities. Online advice and information led participants on a 'journey to become informed'. Online friendships normalised survivorship and cast participants on a 'journey to recreate identity'. Participants navigated a 'journey through different worlds' as they discovered relevant and hidden communities. CONCLUSIONS This theory highlights virtual paths people affected by cancer can take to self-manage their experience of the disease. Online community experiences can be improved by promoting online evaluation skills and signposting visitors to bereavement support. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors can benefit through both lurking and posting in online communities. However, individuals risk becoming distressed when they befriend individuals who may soon die. Additionally, people affected by rarer cancers can struggle to find shared experiences online and may need to look elsewhere for support.
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Affiliation(s)
- Lydia Jo Harkin
- Division of Psychology, Nottingham Trent University, Nottingham, Nottinghamshire, NG4 1BU, UK.
| | - Kinta Beaver
- School of Health Sciences, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Paola Dey
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, L39 4QP, UK
| | - Kartina Choong
- Lancashire Law School, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
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Miller J, Barber D, Donnelly C, French S, Green M, Hill J, MacDermid J, Marsh J, Norman K, Richardson J, Taljaard M, Wideman T, Cooper L, McPhee C. Determining the impact of a new physiotherapist-led primary care model for back pain: protocol for a pilot cluster randomized controlled trial. Trials 2017; 18:526. [PMID: 29121989 PMCID: PMC5680754 DOI: 10.1186/s13063-017-2279-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/10/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Back pain is a leading contributor to disability, healthcare costs, and lost work. Family physicians are the most common first point of contact in the healthcare system for people with back pain, but physiotherapists (PTs) may be able to support the primary care team through evidence-based primary care. A cluster randomized trial is needed to determine the clinical, health system, and societal impact of a primary care model that integrates physiotherapists at the first visit for people with back pain. Prior to conducting a future fully powered cluster randomized trial, we need to demonstrate feasibility of the methods. Therefore, the purpose of this pilot study will be to: 1) Determine feasibility of patient recruitment, assessment procedures, and retention. 2) Determine the feasibility of training and implementation of a new PT-led primary care model for low back pain (LBP) 3) Explore the perspectives of patients and healthcare providers (HCPs) related to their experiences and attitudes towards the new service delivery model, barriers/facilitators to implementation, perceived satisfaction, perceived value, and impact on clinic processes and patient outcomes. METHODS This pilot cluster randomized controlled trial will enroll four sites and randomize them to implement a new PT-led primary care model for back pain or a usual physician-led primary care model. All adults booking a primary care visit for back pain will be invited to participate. Feasibility outcomes will include: recruitment and retention rates, completeness of assessment data, PT training participation and confidence after training, and PT treatment fidelity. Secondary outcomes will include the clinical, health system, cost, and process outcomes planned for the future fully powered cluster trial. Results will be analyzed and reported descriptively and qualitatively. To explore perspectives of both HCPs and patients, we will conduct semi-structured qualitative interviews with patients and focus groups with HCPs from participants in the PT-led primary care sites. DISCUSSION If this pilot demonstrates feasibility, a fully powered trial will provide evidence that has the potential to transform primary care for back pain. The full trial will inform future service design, whether these models should be more widely implemented, and training agendas. TRIAL REGISTRATION ClinicalTrials.gov, NCT03320148 . Submitted for registration on 17 September 2017.
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Affiliation(s)
- Jordan Miller
- School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada.
| | - David Barber
- Department of Family Medicine, Queen's University, Kingston, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| | - Simon French
- School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| | - Michael Green
- Department of Family Medicine, Queen's University, Kingston, Canada
| | | | - Joy MacDermid
- Physical Therapy, Western University, London, Canada
| | | | - Kathleen Norman
- School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, Ontario, K7L 3N6, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | | | - Timothy Wideman
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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Spence AD, Khasawneh M, Allen PB, Addley J. Communication of alcohol and smoking lifestyle advice to the gastroenterological patient. Best Pract Res Clin Gastroenterol 2017; 31:597-604. [PMID: 29195680 DOI: 10.1016/j.bpg.2017.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/08/2017] [Accepted: 09/16/2017] [Indexed: 02/07/2023]
Abstract
Effective communication between healthcare staff and patients is central to development of the patient-professional relationship. Many barriers influence this communication, often resulting in patients' lack of understanding and retention of information, particularly affecting advice regarding lifestyle habits, such as alcohol consumption and smoking. Alcohol and smoking misuse are potentially modifiable risk factors known to adversely affect a variety of gastroenterological conditions and improvements in communication with patients regarding this is an important management component. This review discusses the clinical impact of these factors and how healthcare professionals can improve communication. We discuss how enhancing verbal communication skills through medical training leads to greater outcomes in patient satisfaction and adherence to treatment and advice. In addition, with the rapid digitalisation of society, platforms such as social media and smartphone applications may be considered as adjuncts to traditional forms of communication.
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Affiliation(s)
- Andrew D Spence
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
| | - Mais Khasawneh
- South Eastern Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Patrick B Allen
- South Eastern Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Jennifer Addley
- South Eastern Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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Schatz T, Haberstroh J, Bindel K, Oswald F, Pantel J, Paulitsch M, Konopik N, Knopf M. Improving Comprehension in Written Medical Informed Consent Procedures. GEROPSYCH 2017. [DOI: 10.1024/1662-9647/a000169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Older adults are frequently required to undergo medical informed consent procedures. This study investigates the influence of four types of written language and visual support (Elaborated Plain Language, Easy-to-Read Language, Standard Version with additional picture, Easy-to-Read-Language with additional picture) on comprehension and affect, compared with the Standard Version alone. In an online survey, n = 87 younger participants aged 26–59 and n = 72 older participants aged 60–81 read a simulation of an informed consent form. Directly after reading it, we used the Understanding dimension of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to ask them about the information presented in the form. The results showed that, by reducing complexity and elaborating the provided information, comprehension of medical information could be improved in the older participant group. In the so-called Elaborated Plain Language groups, the results were the same for younger and older participants. This was not true for the groups that received the Standard Version, on which younger participants performed better. Variations in the language used had no influence on affect. Our conclusion is that Elaborated Plain Language can be recommended for use in medical informed consent procedures with older patients and should be taught to medical professionals.
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Affiliation(s)
- Tanja Schatz
- Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University Frankfurt am Main, Germany
- Institute of General Practice, Department of Medicine, Goethe University Frankfurt am Main, Germany
| | - Julia Haberstroh
- Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University Frankfurt am Main, Germany
- Institute of General Practice, Department of Medicine, Goethe University Frankfurt am Main, Germany
| | - Kerstin Bindel
- Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University Frankfurt am Main, Germany
| | - Frank Oswald
- Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University Frankfurt am Main, Germany
| | - Johannes Pantel
- Institute of General Practice, Department of Medicine, Goethe University Frankfurt am Main, Germany
| | - Michael Paulitsch
- Institute of General Practice, Department of Medicine, Goethe University Frankfurt am Main, Germany
| | - Nadine Konopik
- Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University Frankfurt am Main, Germany
| | - Monika Knopf
- Department of Developmental Psychology, Goethe University Frankfurt am Main, Germany
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Noordman J, Driesenaar JA, van Bruinessen IR, van Dulmen S. ListeningTime; participatory development of a web-based preparatory communication tool for elderly cancer patients and their healthcare providers. Internet Interv 2017; 9:51-56. [PMID: 30135837 PMCID: PMC6096291 DOI: 10.1016/j.invent.2017.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This paper outlines the participatory development process of a web-based preparatory communication tool for elderly cancer patients and their oncological healthcare providers (HCPs). This tool aims to support them to (better) prepare their encounters. An overarching aim of the project is to develop the tool in a participatory way to increase uptake and use. METHODS Scrum, a participatory framework originated from software development, was applied to develop the tool. Using constant feedback loops, elderly (former) cancer patients, oncological HCPs and their representatives were, as end-users, involved. RESULTS During six 'sprints', the communication tool 'ListeningTime' was developed with input from end-users. The use of scrum in developing an innovative tool was challenging in this context, because of time constraints of seriously-ill patients and busy HCPs and the co-creation involving non-profit scientific researchers and a for-profit development company. CONCLUSIONS The collaboration with end-users facilitated the development process of ListeningTime. Early involvement of end-users and flexibility in terms of planning and setup appear to be preconditions for creating a bottom-up inspired development procedure. Several challenges emerged from using scrum as participatory framework. Nevertheless, the 'pressure cooking situation', using scrum, resulted in a quick development process and a product ready for implementation.
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Affiliation(s)
- Janneke Noordman
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Jeanine A Driesenaar
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | | | - Sandra van Dulmen
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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84
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van Bruinessen IR, Leegwater B, van Dulmen S. When patients take the initiative to audio-record a clinical consultation. PATIENT EDUCATION AND COUNSELING 2017; 100:1552-1557. [PMID: 28302340 DOI: 10.1016/j.pec.2017.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE to get insight into healthcare professionals' current experience with, and views on consultation audio-recordings made on patients' initiative. METHOD 215 Dutch healthcare professionals (123 physicians and 92 nurses) working in oncology care completed a survey inquiring their experiences and views. RESULTS 71% of the respondents had experience with the consultation audio-recordings. Healthcare professionals who are in favour of the use of audio-recordings seem to embrace the evidence-based benefits for patients of listing back to a consultation again, and mention the positive influence on their patients. Opposing arguments relate to the belief that is confusing for patients or that it increases the chance that information is misinterpreted. Also the lack of control they have over the recording (fear for misuse), uncertainty about the medico-legal status, inhibiting influence on the communication process and feeling of distrust was mentioned. For almost one quarter of respondents these arguments and concerns were reason enough not to cooperate at all (9%), to cooperate only in certain cases (4%) or led to doubts about cooperation (9%). PRACTICE IMPLICATIONS the many concerns that exist among healthcare professionals need to be tackled in order to increase transparency, as audio-recordings are expected to be used increasingly.
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Affiliation(s)
| | - Brigit Leegwater
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Sandra van Dulmen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands; Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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Richard C, Glaser E, Lussier M. Communication and patient participation influencing patient recall of treatment discussions. Health Expect 2017; 20:760-770. [PMID: 27868327 PMCID: PMC5513012 DOI: 10.1111/hex.12515] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 01/10/2023] Open
Abstract
CONTEXT Patient recall of treatment information is a key variable towards chronic disease (CD) management. It is unclear what communication and patient participation characteristics predict recall. OBJECTIVES To assess what aspects of doctor-patient communication predict patient recall of medication information. To describe lifestyle treatment recall, in CD primary care patients. DESIGN Observational study within a RCT. SETTING & PARTICIPANTS Community-based primary care (PC) practices. Family physicians (n=18): practicing >5 years, with a CD patient caseload. Patients (n=159): >40 years old, English speaking, computer literate, off-target hypertension, type II diabetes and/or dyslipidaemia. MAIN VARIABLES Patient characteristics: age, education, number of CDs. Information characteristics: length of encounter, medication status, medication class. Communication variables: socio-emotional utterances, physician dominance and communication control scores and PACE (ask, check and express) utterances, measured by RIAS. Number of medication themes, dialogue and initiative measured by MEDICODE. MAIN OUTCOME MEASURES Recall of CD, lifestyle treatment and medication information. RESULTS Frequency of lifestyle discussions varied by topic. Patients recalled 43% (alcohol), 52% (diet) to 70% (exercise) of discussions. Two and a half of six possible medication themes were broached per medication discussion. Less than one was recalled. Discussing more themes, greater dialogue and patient initiative were significant predictors of improved medication information recall. DISCUSSION Critical treatment information is infrequently exchanged. Active patient engagement and explicit conversations about medications are associated with improved treatment information recall in off-target CD patients followed in PC. CONCLUSION Providers cannot take for granted that long-term off-target CD patients recall information. They need to encourage patient participation to improve recall of treatment information.
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Affiliation(s)
- Claude Richard
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
| | - Emma Glaser
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
- Faculty of MedicineUniversité de MontréalMontréalQCCanada
| | - Marie‐Thérèse Lussier
- Primary Care Research TeamCentre intégré de santé et des services sociaux de LavalLavalQCCanada
- Family Medicine and Emergency Medicine DepartmentFaculty of MedicineUniversité de MontréalMontréalQCCanada
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Barr PJ, Dannenberg MD, Ganoe CH, Haslett W, Faill R, Hassanpour S, Das A, Arend R, Masel MC, Piper S, Reicher H, Ryan J, Elwyn G. Sharing Annotated Audio Recordings of Clinic Visits With Patients-Development of the Open Recording Automated Logging System (ORALS): Study Protocol. JMIR Res Protoc 2017; 6:e121. [PMID: 28684387 PMCID: PMC5519830 DOI: 10.2196/resprot.7735] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 01/10/2023] Open
Abstract
Background Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. Objective The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement. ORALS will consist of (1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings (tagging involves identifying elements of the clinic visit most important to patients [eg, treatment plan] on the recording) and (2) a secure, easy-to-use Web interface enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. Methods We will use a mixed methods approach to develop and formatively test ORALS in 4 iterative stages: case study of pioneer clinics where recordings are currently offered to patients, ORALS design and user experience testing, ORALS software and user interface development, and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. Dartmouth’s Informatics Collaboratory for Design, Development and Dissemination team, patients, patient partners, caregivers, and clinicians will assist in developing ORALS. Results We will implement a publication plan that includes a final project report and articles for peer-reviewed journals. In addition to this work, we will regularly report on our progress using popular relevant Tweet chats and online using our website, www.openrecordings.org. We will disseminate our work at relevant conferences (eg, Academy Health, Health Datapalooza, and the Institute for Healthcare Improvement Quality Forums). Finally, Iora Health, a US-wide network of primary care practices (www.iorahealth.com), has indicated a willingness to implement ORALS on a larger scale upon completion of this development project. Conclusions Upon the completion of this project we will have developed a novel recording system that will be ready for large-scale testing. Our long-term goal is for ORALS to seamlessly fit into a clinic’s and patient’s daily routine, increasing levels of patient engagement and transparency of care.
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Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Michelle D Dannenberg
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Craig H Ganoe
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - William Haslett
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Rebecca Faill
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Saeed Hassanpour
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Department of Computer Science, Dartmouth College, Hanover, NH, United States.,Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Amar Das
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | | | - Meredith C Masel
- Oliver Center for Patient Safety and Quality Healthcare, University of Texas Medical Branch, Galveston, TX, United States
| | | | | | - James Ryan
- Ryan Family Practice, Ludington, MI, United States
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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Reagan L, Pereira K, Jefferson V, Evans Kreider K, Totten S, D’Eramo Melkus G, Johnson C, Vorderstrasse A. Diabetes Self-management Training in a Virtual Environment. DIABETES EDUCATOR 2017. [DOI: 10.1177/0145721717715632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetes self-management training (DSMT) improves diabetes health outcomes. However, low numbers of patients receive DSMT. Using virtual environments (VEs) for DSMT is an innovative approach to removing barriers for patients. The purpose of this paper is to describe the experience of health professionals and diabetes educators establishing and teaching DSMT in a VE, Diabetes LIVE© (Learning in Virtual Environments), and the implications for future use of VEs in DSMT. It was found that providing DSMT in a VE preserves real-time interaction between patients and educators. To facilitate ongoing patient learning and engagement, the DSMT curriculum was expanded beyond the core content as “Above and Beyond” topics. Using a VE for DSMT presents challenges and opportunities. Challenges include overcoming technological barriers and improving comfort levels to orient educators and patients to the functionality of the VE. Opportunities include overcoming barriers to reaching patients, particularly given the diabetes epidemic and relatively small number of diabetes educators. Using a VE also affords a simulated community for experiential learning. VEs may become powerful tools for diabetes and other health educators to reach patients. Ongoing education and support are vital to successful self-management of chronic disease.
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Affiliation(s)
- Louise Reagan
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Katherine Pereira
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Vanessa Jefferson
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Kathryn Evans Kreider
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Susan Totten
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Gail D’Eramo Melkus
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Constance Johnson
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
| | - Allison Vorderstrasse
- School of Nursing, University of Connecticut, Storrs, Connecticut (Dr Reagan)
- New York University Rory Meyers College of Nursing, New York, New York (Dr Reagan, Dr Melkus)
- Duke University School of Nursing, Durham, North Carolina (Dr Pereira, Dr Evans Kreider, Ms Totten, Dr Johnson, Dr Vorderstrasse)
- Yale School of Nursing, Orange, Connecticut (Dr Jefferson)
- University of Texas Health Science Center at Houston School of Nursing, Houston, Texas (Dr Johnson)
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Heller MK, Chapman SCE, Horne R. No blank slates: Pre-existing schemas about pharmaceuticals predict memory for side effects. Psychol Health 2017; 32:402-421. [PMID: 28219295 DOI: 10.1080/08870446.2016.1273355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Attribution of symptoms as medication side effects is informed by pre-existing beliefs about medicines and perceptions of personal sensitivity to their effects (pharmaceutical schemas). We tested whether (1) pharmaceutical schemas were associated with memory (recall/recognition) for side effect information (2) memory explained the attribution of a common unrelated symptom as a side effect. DESIGN In this analogue study participants saw the patient leaflet of a fictitious asthma drug listing eight side effects. MAIN OUTCOME MEASURES We measured recall and recognition memory for side effects and used a vignette to test whether participants attributed an unlisted common symptom (headache) as a side effect. RESULTS Participants who perceived pharmaceuticals as more harmful in general recalled fewer side effects correctly (rCorrect Recall = -.273), were less able to differentiate between listed and unlisted side effects (rRecognition Sensitivity = -.256) and were more likely to attribute the unlisted headache symptom as a side effect (rside effect attribution = .381, ps < .01). The effect of harm beliefs on side effect attribution was partially mediated by correct recall of side effects. CONCLUSION Pharmaceutical schemas are associated with memory for side effect information. Memory may explain part of the association between pharmaceutical schemas and the attribution of unrelated symptoms as side effects.
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Affiliation(s)
- Monika K Heller
- a Research Department of Practice and Policy , University College London School of Pharmacy , London , UK
| | - Sarah C E Chapman
- a Research Department of Practice and Policy , University College London School of Pharmacy , London , UK
| | - Rob Horne
- a Research Department of Practice and Policy , University College London School of Pharmacy , London , UK
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Hunt WT, O'Sullivan NA, Donnelly A. Evaluation of Australian dermatological postoperative patient information leaflets: Should we have a national checklist? Australas J Dermatol 2017; 59:118-123. [PMID: 28425573 DOI: 10.1111/ajd.12614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Patient information leaflets (PILs) are frequently provided to patients following dermatological surgery to provide advice and reassurance in the community. This evaluation reviewed the guidance specified in postoperative PILs across the 40 Australian dermatology teaching departments and clinics. METHODS All 40 departments and clinics were identified and asked to provide their postoperative information leaflets on sutured wound care (preferable) or excision biopsy (September-October 2015). For each PIL, 10 preselected parameters were evaluated. RESULTS In total, 28/40 (70%) of units responded. From these units, 11/28 (39.3%) stated they do not use a postoperative PIL. Of the 17 units that provided PILs, the mode minimum dressing duration was 24 (6/17; 35.3%) and 48 h (6/17; 35.3%). For haemostatic advice, 12 PILs specified the time to press on a bleeding wound, with the most common advice being 10 (3/12; 25%) and 20 min (3/12; 25%). Of the 14 PILs that provided analgesic advice, the mode information suggested using paracetamol only and avoiding aspirin (4/14, 28.6%). Two or more signs of infection were stated in 11/17 (64.7%) PILs; 7/17 (41.2%) advised applying petroleum jelly to the wound, almost all PILs highlighted the contact for postoperative problems 16/17 (94.1%), and 5/17 (29.4%) leaflets mentioned scarring. Altogether 8/17 (47.1%) of PILs advised on the timeframe until active exercise could resume postoperatively. CONCLUSION Guidance provided in Australian postoperative dermatological PILs is heterogeneous. A consensus checklist or template would be beneficial and ensure that advice provided to patients is more consistent; this could be adapted for local factors.
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Affiliation(s)
- William Tn Hunt
- Dermatology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | | | - Alan Donnelly
- Dermatology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Abstract
OBJECTIVE To assess the information needs and preferences of parents who were making decisions concerning treatment for their child's anxiety. METHODS Ninety-three parents were recruited from hospital-based clinics, a parent group, and a public information meeting. They completed a survey about preference for decision-making involvement, information needs, and preferences concerning source and amount of information. RESULTS Most (69%) parents indicated that they prefer a collaborative decision-making role. They rated very highly the need for general information related to treatment and information related to psychosocial interventions and medication treatment. Fewer parents rated information about logistics of treatment (e.g., scheduling, cost) as highly important although this information was considered important by many parents. Direct discussions with a provider, written information, and information accessed through the internet were the most preferred sources of information. Many parents indicated a preference for substantial amounts of information about psychosocial and medication treatments. CONCLUSION Much of the information that parents want concerning treatment is not widely available. It would be helpful to develop evidence-based brochures and web information resources that focus on answering parents' questions concerning treatment of children's anxiety.
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91
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Ernstmann N, Halbach S, Kowalski C, Pfaff H, Ansmann L. Measuring attributes of health literate health care organizations from the patients' perspective: Development and validation of a questionnaire to assess health literacy-sensitive communication (HL-COM). ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 121:58-63. [PMID: 28545615 DOI: 10.1016/j.zefq.2016.12.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies addressing the organizational contexts of care that may help increase the patients' ability to cope with a disease and to navigate through the health care system are still rare. Especially instruments allowing the assessment of such organizational efforts from the patients' perspective are missing. The aim of our study was to develop a survey instrument assessing organizational health literacy (HL) from the patients' perspective, i. e., health care organizations' responsiveness to patients' individual needs. METHODS A pool of 30 items was developed by a group of experts based on a literature review. The items were developed, tested and prioritized according to their importance in 11 semi-structured interviews and cognitive think-aloud interviews with cancer patients. The resulting 16 items were rated in a standardized postal survey involving a total of N=453 colon and breast cancer patients treated in cancer centers in Germany. An exploratory factor analysis, a confirmatory factor analysis and structural equation modelling were conducted. Item properties were analyzed. RESULTS 83.2 % of the patients were diagnosed with breast cancer, 16.8 % had a diagnosis of colon cancer. The patients' mean age was 61 (26-88), 89.4 % were female. The most common comorbidities were hypertension (34.0 %) and cardiovascular disease (11.0 %). The final prediction model included nine items measuring the degree of health literacy-sensitivity of communication. The model showed an acceptable model fit. The nine items showed corrected item-total correlations between .622 and .762 and item difficulties between 0.77 and 0.87. Cronbach's α was .912. DISCUSSION In a comprehensive development process, the original item pool comprising several aspects of organizational HL was reduced to a one-dimensional scale. The instrument measures an important aspect of organizational HL; i.e., the degree of health literacy-sensitivity of communication (HL-COM). HL-COM was found to impact patient enablement, mediated through the support by physicians. Future research will have to test these associations in the context of other diseases or institutions.
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Affiliation(s)
- Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany; Center for Integrated Oncology Köln Bonn, Germany.
| | - Sarah Halbach
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | | | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Lena Ansmann
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
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Jones GE, Singletary JH, Cashmore A, Jain V, Abhulimhen J, Chauhan J, Musson HV, Barwell JG. Developing and assessing the utility of a You-Tube based clinical genetics video channel for families affected by inherited tumours. Fam Cancer 2016; 15:351-5. [PMID: 26753801 DOI: 10.1007/s10689-016-9866-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We have designed and implemented the first worldwide You Tube channel with 22 videos covering common questions asked in familial cancer susceptibility clinics. We discuss the use of the videos including demographics of registered You Tube users, and what lessons have been learnt about how the general public uses medical information online. The most popular video on inheritance patterns has been watched on average 84 times per month. The mostly highly viewed videos include inheritance patterns, breast cancer screening and hereditary non-polyposis colorectal cancer. Registered viewers were more commonly male and the average age of the registered user was 45-54 years; similar to that seen in Genetics Clinics suggesting that age may not be a major barrier to access to this type of information for patients. The videos have been viewed in more than 140 countries confirming that there is clearly an audience for this type of information. Patient feedback questionnaires indicate that these videos provide a useful aide memoir for the clinic appointment, and most people would recommend them to others. In summary, You Tube videos are easy and cost effective to make. They have the ability to disseminate genetics education to a worldwide audience and may be a useful adjunct to clinical appointments.
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Affiliation(s)
- G E Jones
- Leicester Clinical Genetics Department, University Hospitals Leicester NHS Trust, Leicester, LE1 5WW, UK.
| | - J H Singletary
- Department of Genetics, University of Leicester, Leicester, UK
| | - A Cashmore
- Department of Genetics, University of Leicester, Leicester, UK
| | - V Jain
- Leicester Clinical Genetics Department, University Hospitals Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - J Abhulimhen
- Department of Genetics, University of Leicester, Leicester, UK
| | - J Chauhan
- Department of Genetics, University of Leicester, Leicester, UK
| | - H V Musson
- Department of Genetics, University of Leicester, Leicester, UK
| | - J G Barwell
- Leicester Clinical Genetics Department, University Hospitals Leicester NHS Trust, Leicester, LE1 5WW, UK
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Ackermann S, Ghanim L, Heierle A, Hertwig R, Langewitz W, Mata R, Bingisser R. Information structuring improves recall of emergency discharge information: a randomized clinical trial. PSYCHOL HEALTH MED 2016; 22:646-662. [PMID: 27309340 DOI: 10.1080/13548506.2016.1198816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Milne H, Huby G, Buckingham S, Hayward J, Sheikh A, Cresswell K, Pinnock H. Does sharing the electronic health record in the consultation enhance patient involvement? A mixed-methods study using multichannel video recording and in-depth interviews in primary care. Health Expect 2016; 19:602-16. [PMID: 25523361 PMCID: PMC5055250 DOI: 10.1111/hex.12320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sharing the electronic health-care record (EHR) during consultations has the potential to facilitate patient involvement in their health care, but research about this practice is limited. METHODS We used multichannel video recordings to identify examples and examine the practice of screen-sharing within 114 primary care consultations. A subset of 16 consultations was viewed by the general practitioner and/or patient in 26 reflexive interviews. Screen-sharing emerged as a significant theme and was explored further in seven additional patient interviews. Final analysis involved refining themes from interviews and observation of videos to understand how screen-sharing occurred, and its significance to patients and professionals. RESULTS Eighteen (16%) of 114 videoed consultations involved instances of screen-sharing. Screen-sharing occurred in six of the subset of 16 consultations with interviews and was a significant theme in 19 of 26 interviews. The screen was shared in three ways: 'convincing' the patient of a diagnosis or treatment; 'translating' between medical and lay understandings of disease/medication; and by patients 'verifying' the accuracy of the EHR. However, patients and most GPs perceived the screen as the doctor's domain, not to be routinely viewed by the patient. CONCLUSIONS Screen-sharing can facilitate patient involvement in the consultation, depending on the way in which sharing comes about, but the perception that the record belongs to the doctor is a barrier. To exploit the potential of sharing the screen to promote patient involvement, there is a need to reconceptualise and redesign the EHR.
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Affiliation(s)
- Heather Milne
- eHealth Research GroupCentre for Population Health SciencesThe University of EdinburghEdinburghUK
- Faculty of Health and Social StudiesUniversity College Østfold and School of Health in Social ScienceEdinburghUK
| | - Guro Huby
- Faculty of Health and Social StudiesUniversity College Østfold and School of Health in Social ScienceEdinburghUK
| | - Susan Buckingham
- eHealth Research GroupCentre for Population Health SciencesThe University of EdinburghEdinburghUK
| | - James Hayward
- Centre for Population Health SciencesThe University of EdinburghEdinburghUK
| | - Aziz Sheikh
- Centre for Population Health SciencesThe University of EdinburghEdinburghUK
| | - Kathrin Cresswell
- Centre for Population Health SciencesThe University of EdinburghEdinburghUK
| | - Hilary Pinnock
- Allergy and Respiratory GroupCentre for Population Health SciencesUniversity of EdinburghUK
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Shulman R, Kottke M. Impact of maternal knowledge of recommended weight gain in pregnancy on gestational weight gain. Am J Obstet Gynecol 2016; 214:754.e1-7. [PMID: 27012961 DOI: 10.1016/j.ajog.2016.03.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/01/2016] [Accepted: 03/11/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Obesity is prevalent among reproductive-aged women and is associated with increased obstetric complications. Weight gain recommendations exist; however, knowledge of these recommendations is low, and few women gain appropriate weight during their pregnancies. Excessive gestational weight gain is common and is associated with adverse outcomes. Little is known about the relationship between knowledge of gestational weight gain recommendations and actual weight gain. OBJECTIVES Our objectives were to assess knowledge of weight gain recommendations in pregnancy and to determine its association with actual weight gain among women who seek care at an urban, regional perinatal center. We hypothesize that low levels of knowledge will predict inappropriate weight gain in this population. STUDY DESIGN This is a cross-sectional study with linked chart review of 338 women who sought routine obstetric ultrasound scans at an urban, regional perinatal center that serves a largely low-income population of predominately black women. Descriptive statistics, chi-square test, and analysis of variance were performed. RESULTS This population has low rates of accurate knowledge of weight gain recommendations in pregnancy (27%) and low rates of appropriate gestational weight gain (30%). Inappropriate gestational weight gain was highest among women who were obese before pregnancy. Accurate knowledge of gestational weight gain recommendations was associated with appropriate weight gain in pregnancy (P = .02), as was prepregnancy weight category (P = .004) and correct identification of prepregnancy weight category (P = .005). CONCLUSION These findings support the need for improvements in educational efforts about weight gain in pregnancy for high-risk, low-income women in an urban setting, which may improve compliance with the recommendations.
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Abstract
BACKGROUND AND AIMS Patients with cirrhosis can contribute significantly to maintaining compensation through simple lifestyle measures. It is, however, unknown whether they possess sufficient knowledge to make informed decisions with regard to their health, with few resources invested in patient education. We aimed to determine the level of knowledge that patients with cirrhosis possess and whether an information leaflet can make a positive impact on this. METHODS We prospectively recruited clinically stable patients with cirrhosis to take part in a preintervention/postintervention study. Thirty-nine patients were recruited either to take part in a telephone-based questionnaire followed by repeating the questionnaire 2 months after receipt of a leaflet or to receive the leaflet directly and complete the questionnaire 2 months later. RESULTS The questionnaire demonstrated that baseline knowledge in the study group was poor, with a mean score of 3.4 out of a possible 9 points. There was a statistically significant improvement in the score to 7.5 in those who used the leaflet (Wilcoxon's signed-ranked test, P=0.0006). The mean score achieved by those who received the leaflet directly was 6.8, which is comparable to the scores of patients in the first cohort who read the leaflet and is significantly higher than the scores of the same participants before reading the leaflet (Wilcoxon's rank-sum test, P=0.001). CONCLUSION Our results suggest that patients with cirrhosis lack the knowledge to effectively manage their disease. The introduction of a leaflet resulted in a statistically significant improvement in understanding. Longitudinal studies are required to assess whether such interventions can result in improved clinical outcomes.
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Serpico V, Liepert AE, Boucher K, Fouts DL, Anderson L, Pell J, Neumayer L. The Effect of Previsit Education in Breast Cancer Patients: A Study of a Shared-decision-making Tool. Am Surg 2016. [DOI: 10.1177/000313481608200320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To enhance shared decision-making for patients with breast cancer, we developed an evidence-based educational breast cancer video (BCV) providing an overview of breast cancer biology, prognostic indicators, and surgical treatment options while introducing health care choice. By providing patients access to a BCV with information necessary to make informed surgical decisions before seeing a surgeon, we aimed to increase patient participation in the decision-making process, while decreasing distress. Patients with a new diagnosis of breast cancer were provided a link to the BCV. Group 1 participated in online pre- and postvideo questionnaires, with the BCV embedded in between. The questionnaires evaluated self-reported baseline knowledge of breast cancer and perceived distress related to the diagnosis. Changes in self-reported responses were analyzed using the Wilcoxon matched pairs test. Group 2 received a survey collecting demographics, decision-making information, and perceptions of the BCV at the time of clinic visit before meeting the surgeon. Group 1 included 69 subjects with 62 per cent reporting improved knowledge and 30 per cent reporting reduced distress in regard to their breast cancer diagnosis. Group 2 included 87 subjects; 94 to 98 per cent felt the BCV provided information and stimulated thoughts and questions to assist in breast cancer treatment decision-making. The BCV was positively received by participants and feasible to implement into clinical practice. Evidence-based media tools improve knowledge and reduce distress in patients with a new diagnosis of breast cancer as well as contributing to the shared decision-making process.
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Affiliation(s)
| | - Amy E. Liepert
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kenneth Boucher
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Diane L. Fouts
- Office of Communications, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; and
| | - Layla Anderson
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Joyce Pell
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Leigh Neumayer
- Department of Surgery, University of Utah, Salt Lake City, Utah
- Department of Surgery, University of Arizona, Tucson, Arizona
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Custodis F, Rohlehr F, Wachter A, Böhm M, Schulz M, Laufs U. Medication knowledge of patients hospitalized for heart failure at admission and after discharge. Patient Prefer Adherence 2016; 10:2333-2339. [PMID: 27877025 PMCID: PMC5108595 DOI: 10.2147/ppa.s113912] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A substantial aspect of health literacy is the knowledge of prescribed medication. In chronic heart failure, incomplete intake of prescribed drugs (medication non-adherence) is inversely associated with clinical prognosis. Therefore, we assessed medication knowledge in a cohort of patients with decompensated heart failure at hospital admission and after discharge in a prospective, cross-sectional study. METHODS One hundred and eleven patients presenting at the emergency department with acute decompensated heart failure were included (mean age 78.4±9.2, 59% men) in the study. Patients' medication knowledge was assessed during individual interviews at baseline, course of hospitalization, and 3 months after discharge. Individual responses were compared with the medical records of the referring general practitioner. RESULTS Median N-terminal prohormone of brain natriuretic peptide plasma concentration in the overall population at baseline was 4,208 pg/mL (2,023-7,101 pg/mL [interquartile range]), 20 patients died between the second and third interview. The number of prescribed drugs increased from 8±3 at baseline to 9±3 after 3 months. The majority of patients did not know the correct number of their drugs. Medication knowledge decreased continuously from baseline to the third interview. At baseline, 37% (n=41) of patients stated the correct number of drugs to be taken, whereas only 18% (n=16) knew the correct number 3 months after discharge (P=0.008). Knowledge was inversely related to N-terminal prohormone of brain natriuretic peptide levels. CONCLUSION Medication knowledge of patients with acute decompensated heart failure is poor. Despite care in a university hospital, patients' individual medication knowledge decreased after discharge. The study reveals an urgent need for better strategies to improve and promote the knowledge of prescribed medication in these very high-risk patients.
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Affiliation(s)
- Florian Custodis
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg/Saar
| | - Franziska Rohlehr
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg/Saar
| | - Angelika Wachter
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg/Saar
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg/Saar
| | - Martin Schulz
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universitaet Berlin, Berlin, Germany
| | - Ulrich Laufs
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center, Homburg/Saar
- Correspondence: Ulrich Laufs, Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Medical Center (IMED), Kirrberger Straße, 66421 Homburg/Saar, Germany, Tel +49 6841 16 15350, Fax +49 6841 16 15175, Email
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Humphrey-Murto S, Mihok M, Pugh D, Touchie C, Halman S, Wood TJ. Feedback in the OSCE: What Do Residents Remember? TEACHING AND LEARNING IN MEDICINE 2016; 28:52-60. [PMID: 26787085 DOI: 10.1080/10401334.2015.1107487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
THEORY The move to competency-based education has heightened the importance of direct observation of clinical skills and effective feedback. The Objective Structured Clinical Examination (OSCE) is widely used for assessment and affords an opportunity for both direct observation and feedback to occur simultaneously. For feedback to be effective, it should include direct observation, assessment of performance, provision of feedback, reflection, decision making, and use of feedback for learning and change. HYPOTHESES If one of the goals of feedback is to engage students to think about their performance (i.e., reflection), it would seem imperative that they can recall this feedback both immediately and into the future. This study explores recall of feedback in the context of an OSCE. Specifically, the purpose of this study was to (a) determine the amount and the accuracy of feedback that trainees remember immediately after an OSCE, as well as 1 month later, and (b) assess whether prompting immediate recall improved delayed recall. METHODS Internal medicine residents received 2 minutes of verbal feedback from physician examiners in the context of an OSCE. The feedback was audio-recorded and later transcribed. Residents were randomly allocated to the immediate recall group (immediate-RG; n = 10) or the delayed recall group (delayed-RG; n = 8). The immediate-RG completed a questionnaire prompting recall of feedback received immediately after the OSCE, and then again 1 month later. The delayed-RG completed a questionnaire only 1 month after the OSCE. The total number and accuracy of feedback points provided by examiners were compared to the points recalled by residents. Results comparing recall at 1 month between the immediate-RG and the delayed-RG were also studied. RESULTS Physician examiners provided considerably more feedback points (M = 16.3) than the residents recalled immediately after the OSCE (M = 2.61, p < .001). There was no significant difference between the number of feedback points recalled upon completion of the OSCE (2.61) compared to 1 month later (M = 1.96, p = .06, Cohen's d = .70). Prompting immediate recall did not improve later recall. The mean accuracy score for feedback recall immediately after the OSCE was 4.3/9 or "somewhat representative," and at 1 month the score dropped to 3.5/9 or "not representative" (ns). CONCLUSION Residents recall very few feedback points immediately after the OSCE and 1 month later. The feedback points that are recalled are neither very accurate nor representative of the feedback actually provided.
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Affiliation(s)
| | - Marika Mihok
- a Department of Medicine , University of Ottawa , Ottawa , Ontario , Canada
| | - Debra Pugh
- a Department of Medicine , University of Ottawa , Ottawa , Ontario , Canada
| | - Claire Touchie
- a Department of Medicine , University of Ottawa , Ottawa , Ontario , Canada
| | - Samantha Halman
- a Department of Medicine , University of Ottawa , Ottawa , Ontario , Canada
| | - Timothy J Wood
- a Department of Medicine , University of Ottawa , Ottawa , Ontario , Canada
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Ubbink DT, Santema TB, Lapid O. Shared Decision-Making in Cosmetic Medicine and Aesthetic Surgery. Aesthet Surg J 2016; 36:NP14-9. [PMID: 26104476 DOI: 10.1093/asj/sjv107] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/14/2022] Open
Abstract
Shared decision-making (SDM) invokes the bidirectional communication between physicians and patients required to involve the patient's preference in the eventual treatment choice. This paper will explain what SDM is, why it is important, and how it is performed in clinical practice. It is an essential part of evidence-based medicine, as it helps determine whether the available evidence on the possible benefits and harms of treatment options match the patient's characteristics and preferences. Cosmetic medicine and aesthetic surgery seem to be obvious fields of medicine in which SDM should be applied to achieve high-quality care.
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Affiliation(s)
- Dirk T Ubbink
- Dr Ubbink is a Principal Investigator and Dr Santema is a PhD Student, Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Lapid is a Plastic Surgeon, Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Trientje B Santema
- Dr Ubbink is a Principal Investigator and Dr Santema is a PhD Student, Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Lapid is a Plastic Surgeon, Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Oren Lapid
- Dr Ubbink is a Principal Investigator and Dr Santema is a PhD Student, Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Lapid is a Plastic Surgeon, Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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