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Tarchi L, Buonocore TM, Selvi G, Ricca V, Castellini G. Online content on eating disorders: a natural language processing study. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024; 17:275-284. [PMID: 39041376 DOI: 10.1080/17538068.2024.2379160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND Online content can inform the personal risk of developing an eating disorder, and it can influence the time and motivation to seek treatment. Patients routinely seek information online, and access to information is crucial for both prevention and treatment. The primary aim of the current study was to quantify the readability scores of online content on eating disorders using natural language processing algorithms, across two languages: English and Italian. METHODS Unique terms related to single diagnoses were searched using Google®. The content available on Wikipedia was also assessed. Readability was defined according to the Flesch Readability Ease (FRE) and the Rate Readability Index (RIX). The scientific support of retrieved content and the authoritativeness of sources were measured through standardized variables. RESULTS In Italian, online content was more likely published by private psychotherapy institutes or by websites that promote diet-advice or weight-loss. In both languages, the most readable content was on Anorexia Nervosa (RIX 4.18, FRE-en 59.6, FRE-it 41.69), Bulimia Nervosa (RIX 3.99, FRE-en 66.27, FRE-it 39.66) or Binge Eating (RIX 4.01, FRE-en 68.10, FRE-it 38.62). English sources consistently had more references than Italian pages (range 35-182, vs 1-163, respectively). and had a higher percentage of citations available in the target language. The content of these references was mainly reflective of peer-reviewed or clinical manuals. CONCLUSION Attention should be given to developing online content for Muscle Dysmorphia and Orthorexia Nervosa, as well as improving the overall readability of online content on eating disorders, especially for languages other than English.
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Affiliation(s)
- Livio Tarchi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Tommaso Mario Buonocore
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Giulia Selvi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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Mangal AL, Mücke M, Rolke R, Appelmann I. Advance directives in amyotrophic lateral sclerosis - a systematic review and meta-analysis. BMC Palliat Care 2024; 23:191. [PMID: 39075493 PMCID: PMC11285133 DOI: 10.1186/s12904-024-01524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of the upper and lower motoneuron. It is associated with a life expectancy of 2-4 years after diagnosis. Individuals experience paralysis, dysphagia, respiratory failure and loss of communicative function, rendering advance care planning (ACP) critically important. This systematic review primarily aimed to internationally compare the application of advance directives (AD) and ACP in ALS. Its secondary aim was to identify ACP preferences, identify fields for future research and to generate recommendations for improving patient care through ACP. METHODS We conducted a systematic literature review and meta-analysis. Five electronic databases (Embase, Medline, Scopus, PsycInfo and CENTRAL) were searched for qualitative and quantitative primary literature from 1999 to 2024. Cross-references were used to identify additional publications. Study selection was performed based on inclusion criteria. Number and content of AD were extracted systematically. After statistical analysis consecutive meta-analysis was performed for international differences and changes over time. Quality assessment of studies was performed using the MMAT (Mixed Methods Appraisal Tool). PROSPERO Registration (June 07, 2021) : CRD42021248040. RESULTS A total of 998 records was screened of which 26 were included in the synthesis. An increase in publication numbers of 88.9% was observed from 1999 to 2024. Results regarding use and content of AD were heterogeneous and international differences were detected. AD were signed in 60.4% of records (1,629 / 2,696 patients). The number of AD decreased over time when separating the review period in two decades (1st 1999-2011: 78% vs. 2nd 2012-2024: 42%). Study quality was superior in qualitative and mixed method designs compared to quantitative studies. CONCLUSION Further prospective studies should include detailed analyses on preferences regarding ventilation and artificial nutrition in ALS and should encompass countries of the global south. Despite the complexity of ACP with regard to individual patient needs, ACP should be part of each individual support plan for ALS patients and should specifically comprise a discussion on the preferred place of death. The available disease-specific AD documents should be preferred.
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Affiliation(s)
- Anne Lisa Mangal
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany
| | - Martin Mücke
- Department of Digitalization and General Practice, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Roman Rolke
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany
| | - Iris Appelmann
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany.
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Jo MH, Kim MJ, Oh HK, Choi MJ, Shin HR, Lee TG, Ahn HM, Kim DW, Kang SB. Communicative competence of generative artificial intelligence in responding to patient queries about colorectal cancer surgery. Int J Colorectal Dis 2024; 39:94. [PMID: 38902500 PMCID: PMC11189990 DOI: 10.1007/s00384-024-04670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To examine the ability of generative artificial intelligence (GAI) to answer patients' questions regarding colorectal cancer (CRC). METHODS Ten clinically relevant questions about CRC were selected from top-rated hospitals' websites and patient surveys and presented to three GAI tools (Chatbot Generative Pre-Trained Transformer [GPT-4], Google Bard, and CLOVA X). Their responses were compared with answers from the CRC information book. Response evaluation was performed by two groups, each consisting of five healthcare professionals (HCP) and patients. Each question was scored on a 1-5 Likert scale based on four evaluation criteria (maximum score, 20 points/question). RESULTS In an analysis including only HCPs, the information book scored 11.8 ± 1.2, GPT-4 scored 13.5 ± 1.1, Google Bard scored 11.5 ± 0.7, and CLOVA X scored 12.2 ± 1.4 (P = 0.001). The score of GPT-4 was significantly higher than those of the information book (P = 0.020) and Google Bard (P = 0.001). In an analysis including only patients, the information book scored 14.1 ± 1.4, GPT-4 scored 15.2 ± 1.8, Google Bard scored 15.5 ± 1.8, and CLOVA X scored 14.4 ± 1.8, without significant differences (P = 0.234). When both groups of evaluators were included, the information book scored 13.0 ± 0.9, GPT-4 scored 14.4 ± 1.2, Google Bard scored 13.5 ± 1.0, and CLOVA X scored 13.3 ± 1.5 (P = 0.070). CONCLUSION The three GAIs demonstrated similar or better communicative competence than the information book regarding questions related to CRC surgery in Korean. If high-quality medical information provided by GAI is supervised properly by HCPs and published as an information book, it could be helpful for patients to obtain accurate information and make informed decisions.
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Affiliation(s)
- Min Hyeong Jo
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Min-Jun Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Mi Jeong Choi
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Hye-Rim Shin
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Tae-Gyun Lee
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Hong-Min Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Howick J, de Zulueta P, Gray M. Beyond empathy training for practitioners: Cultivating empathic healthcare systems and leadership. J Eval Clin Pract 2024; 30:548-558. [PMID: 38436621 DOI: 10.1111/jep.13970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/11/2024] [Indexed: 03/05/2024]
Abstract
Empathic care benefits patients and practitioners, and empathy training for practitioners can enhance empathy. However, practitioners do not operate in a vacuum. For empathy to thrive, healthcare consultations must be situated in a nurturing milieu, guided by empathic, compassionate leaders. Empathy will be suppressed, or even reversed if practitioners are burned out and working in an unpleasant, under-resourced environment with increasingly poorly served and dissatisfied patients. Efforts to enhance empathy must therefore go beyond training practitioners to address system-level factors that foster empathy. These include patient education, cultivating empathic leadership, customer service training for reception staff, valuing cleaning and all ancillary staff, creating healing spaces, and using appropriate, efficiency saving technology to reduce the administrative burden on healthcare practitioners. We divide these elements into environmental factors, organisational factors, job factors, and individual characteristics.
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Affiliation(s)
- Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, UK
| | - Paquita de Zulueta
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Muir Gray
- Director of the Oxford Value and Stewardship Programme, Oxford, UK
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
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Søndergaard H. Patient Involvement in the Design of an Innovative Clinical Study to Compare the Palatability of Anti-Hyperkalemia Medications. Patient Prefer Adherence 2024; 18:1059-1064. [PMID: 38835400 PMCID: PMC11149637 DOI: 10.2147/ppa.s445399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/08/2024] [Indexed: 06/06/2024] Open
Abstract
The inclusion of patient representatives as study consultants brings diverse perspectives, insights, and experiences to clinical trial design and execution, and their role in the clinical trial development process is being increasingly recognized and valued. The APPETIZE study evaluated the palatability of, and preference for, three potassium binders for treating hyperkalemia in patients with chronic kidney disease. A core aspect of the development of this study was the inclusion of a patient representative during the design stage. Here, I describe the process of patient involvement in the APPETIZE study design (ClinicalTrials.gov Identifier: NCT04566653), the resultant positive impacts, and key learnings. A patient with chronic kidney disease was invited to be a member of the APPETIZE trial design team. This patient representative attended study team meetings and provided invaluable input into protocol development, questionnaire selection, design of patient information sheets and consent forms, and primary manuscript structure. These critical insights resulted in an enhanced trial design and generation of high-quality, patient-relevant data. APPETIZE provides an excellent example of a patient preference study that relied on input from multiple stakeholder groups, including, most notably, the patients themselves. This approach may serve as a model for early and deep patient engagement in the design and interpretation of clinical trials.
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Osuna E, Luna A, Pérez-Cárceles MD. [The right to patient autonomy. Updating in daily clinical care]. Med Clin (Barc) 2024; 162:e52-e55. [PMID: 38471981 DOI: 10.1016/j.medcli.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Eduardo Osuna
- Área de Medicina legal y forense, Instituto de Investigación Biomédica de la Región de Murcia (IMIB), Campus de Excelencia Internacional Campus Mare Nostrum, Universidad de Murcia, Murcia, España
| | - Aurelio Luna
- Área de Medicina legal y forense, Instituto de Investigación Biomédica de la Región de Murcia (IMIB), Campus de Excelencia Internacional Campus Mare Nostrum, Universidad de Murcia, Murcia, España
| | - María D Pérez-Cárceles
- Área de Medicina legal y forense, Instituto de Investigación Biomédica de la Región de Murcia (IMIB), Campus de Excelencia Internacional Campus Mare Nostrum, Universidad de Murcia, Murcia, España.
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Stelwagen M, Westmaas A, Van Kempen A, Scheele F. Rebalancing of professional identity roles in an integrated maternity and neonatal care setting designed to increase parent autonomy: a qualitative study among health professionals. J Interprof Care 2024:1-9. [PMID: 38655873 DOI: 10.1080/13561820.2024.2343843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
This case-based qualitative study explored the professional identity as experienced by health professionals working in an integrated maternal-neonatal ward when their practice changed from a "paternalistic" model, in which physicians and nurses were in charge, to a shared or "consumerist" model, to increase parent autonomy. We analyzed transcripts of focus group discussions and interviews with 60 health professionals on their experiences with empowering parents and described factors associated with themes of professional identity. The changes most affecting professional identity were the constant proximity of parents to their newborns and the single-family room design. These changes influenced three themes of professional identity: (1) connectedness and relationships (2) communication, and (3) competencies. A fourth theme, values, beliefs, and ethics, affected how the health professionals coped with the changes in the first three themes. When empowering parents of newborns in a hospital setting, health professionals experience beneficial as well as threatening shifts in their professional identities. Values, beliefs, and ethics associated with family integrated care helped health professionals to embrace their new roles, but other values, beliefs and ethics could create barriers. Continuous professional identity development in a patient-inclusive team is a topic for future research.
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Affiliation(s)
- Mireille Stelwagen
- Department of Teaching and Pediatrics, OLVG Hospital, Amsterdam, The Netherlands
| | - Alvin Westmaas
- Department of Social Psychology, Faculty of Health, University of Applied Sciences Leiden, Leiden, Netherlands
| | - Anne Van Kempen
- Department of Pediatrics, OLVG Hospital, Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Gynecology and Teaching, OLVG Hospital, Amsterdam, The Netherlands
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Liu PL, Zhang L, Ma X, Zhao X. Communication Matters: The Role of Patient-Centered Communication in Improving Old Adults' Health Competence and Health Outcomes. HEALTH COMMUNICATION 2024; 39:363-375. [PMID: 36628509 DOI: 10.1080/10410236.2023.2166209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Research has demonstrated links between patient-centered communication (PCC) and patients' health outcomes. However, little is known about the underlying processes that may mediate the relationship. This study is one of the first to examine the influence of PCC on older adults' health outcomes, as well as the mediation role of health competence, from a longitudinal perspective. With a general basis of Street et al.'s pathway model, we proposed and tested mediation pathways linking patient-centered communication to the older population's general and mental health, mediated by health competence. Data from 2011, 2017 and 2020 iterations of the Health Information National Trends Survey (HINTS) were used for this study. This study focused on older adults aged 60 and above. Results indicated that after controlling participants' age, gender, education, income and race, PCC is related to the older people's health outcomes either directly or indirectly, irrespective of time series. Specifically, health competence was found to significantly mediate the associations between PCC and the older adults' general health or mental health over the three iterations. Noteworthily, findings from this study also revealed that different dimensions of PCC might exert different influences on older patients' health competence and health outcomes.
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Affiliation(s)
| | - Lianshan Zhang
- School of Media and Communication, Shanghai Jiao Tong University
| | - Xiaofen Ma
- Research Center of Journalism and Social Development, School of Journalism and Communication, Renmin University of China
| | - Xinshu Zhao
- Department of Communication, University of Macau
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Kühler TC, Ateka A, Lassoued Z, Routhier FX, Mékary-Sawaya S. Real-world Data and Evidence to support a switch in status from Prescription drug to Over the Counter drug as applied by the EMA, the US FDA, the MHRA, and the BfArM. Clin Ther 2024; 46:208-216. [PMID: 38278703 DOI: 10.1016/j.clinthera.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/10/2023] [Accepted: 12/24/2023] [Indexed: 01/28/2024]
Abstract
PURPOSE We studied under which circumstances and to what extent Real-World Data (RWD) and Real-World Evidence (RWE) were used in regulatory decisions when switching products from Prescription-only (Rx) to Over-the-Counter (OTC) status with the aim of extracting learnings that could be applied in future switches. METHODS Sanofi commissioned Clarivate Analytics to identify switches from Rx to OTC in the European Union (centrally by the European Medicines Agency [EMA] and in Germany by the Bundesinstitut für Arzneimittel und Medizinprodukte [BfArM]), in the United States by the Food and Drug Administration (FDA), and in the United Kingdom by the Medicines and Healthcare products Regulatory Agency (MHRA) as far back as data were available in the public domain, mainly Health Authority webpages. They covered the period from and including 2022 and went as far back as they could find data in their proprietary database or in the public domain; for the EMA back to 2008, the US FDA back to 2001, the UK MHRA back to 1991, and the German BfArM for the period 2013-2022. We also asked Clarivate to investigate the nature of acceptance of RWD and RWE, and to what extent they are accepted by the different regulators in their decision-making and approval processes. FINDINGS We found that the number of drugs available in the OTC segment is higher in regulatory jurisdictions where OTC policies are clear and supplemented by guidelines and transparent decision-making processes at the regulator level. A wide range of different data sources, many of which can be regarded as RWD/RWE in their broadest definitions, have been used to support switches. The data required by regulators to support a switch from Rx-only to OTC availability primarily centers on drug safety-both the drug's intrinsic safety and the safety associated with consumer usage. IMPLICATIONS Clear and transparent regulatory switch frameworks are conducive to growing the number of medicines available to consumers willing to self-manage their conditions. Transparent disclosure of the RWD and RWE data sets that regulators have found acceptable in historic switch applications is desirable because it would help sponsors to facilitate and increase prospective switches, thereby benefiting patients and society.
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Nagappan A, Kalokairinou L, Wexler A. Ethical issues in direct-to-consumer healthcare: A scoping review. PLOS DIGITAL HEALTH 2024; 3:e0000452. [PMID: 38349902 PMCID: PMC10863864 DOI: 10.1371/journal.pdig.0000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024]
Abstract
An increasing number of health products and services are being offered on a direct-to-consumer (DTC) basis. To date, however, scholarship on DTC healthcare products and services has largely proceeded in a domain-specific fashion, with discussions of relevant ethical challenges occurring within specific medical specialties. The present study therefore aimed to provide a scoping review of ethical issues raised in the academic literature across types of DTC healthcare products and services. A systematic search for relevant publications between 2011-2021 was conducted on PubMed and Google Scholar using iteratively developed search terms. The final sample included 86 publications that discussed ethical issues related to DTC healthcare products and services. All publications were coded for ethical issues mentioned, primary DTC product or service discussed, type of study, year of publication, and geographical context. We found that the types of DTC healthcare products and services mentioned in our sample spanned six categories: neurotechnology (34%), testing (20%), in-person services (17%), digital health tools (14%), telemedicine (13%), and physical interventions (2%). Ethical arguments in favor of DTC healthcare included improved access (e.g., financial, geographical; 31%), increased autonomy (29%), and enhanced convenience (16%). Commonly raised ethical concerns included insufficient regulation (72%), questionable efficacy and quality (70%), safety and physical harms (66%), misleading advertising claims (56%), and privacy (34%). Other frequently occurring ethical concerns pertained to financial costs, targeting vulnerable groups, informed consent, and potential burdens on healthcare providers, the healthcare system, and society. Our findings offer insights into the cross-cutting ethical issues associated with DTC healthcare and underscore the need for increased interdisciplinary communication to address the challenges they raise.
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Affiliation(s)
- Ashwini Nagappan
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, California, United States of America
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Louiza Kalokairinou
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, United States of America
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Pruski M. AI-Enhanced Healthcare: Not a new Paradigm for Informed Consent. JOURNAL OF BIOETHICAL INQUIRY 2024:10.1007/s11673-023-10320-0. [PMID: 38300443 DOI: 10.1007/s11673-023-10320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/06/2023] [Indexed: 02/02/2024]
Abstract
With the increasing prevalence of artificial intelligence (AI) and other digital technologies in healthcare, the ethical debate surrounding their adoption is becoming more prominent. Here I consider the issue of gaining informed patient consent to AI-enhanced care from the vantage point of the United Kingdom's National Health Service setting. I build my discussion around two claims from the World Health Organization: that healthcare services should not be denied to individuals who refuse AI-enhanced care and that there is no precedence to seeking patient consent to AI-enhanced care. I discus U.K. law relating to patient consent and the General Data Protection Regulation to show that current standards relating to patient consent are adequate for AI-enhanced care. I then suggest that in the future it may not be possible to guarantee patient access to non-AI-enhanced healthcare, in a similar way to how we do not offer patients manual alternatives to automated healthcare processes. Throughout my discussion I focus on the issues of patient choice and veracity in the patient-clinician relationship. Finally, I suggest that the best way to protect patients from potential harms associated with the introduction of AI to patient care is not via an overly burdensome patient consent process but via evaluation and regulation of AI technologies.
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Affiliation(s)
- M Pruski
- School of Health Sciences, The University of Manchester, Manchester, UK.
- Department of Medical Physics and Clinical Engineering, Cardiff and Vale University Health Board, Cardiff, Wales, UK.
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Hogue A, Satcher MF, Drazdowski TK, Hagaman A, Hibbard PF, Sheidow AJ, Coetzer-Liversage A, Mitchell SG, Watson DP, Wilson KJ, Muench F, Fishman M, Wenzel K, de Martell SC, Stein LAR. Linkage facilitation services for opioid use disorder: Taxonomy of facilitation practitioners, goals, and activities. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209217. [PMID: 37981242 PMCID: PMC10922806 DOI: 10.1016/j.josat.2023.209217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/14/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION This article proposes a taxonomy of linkage facilitation services used to help persons with opioid use disorder access treatment and recovery resources. Linkage facilitation may be especially valuable for persons receiving medication for opioid use disorder (MOUD) given the considerable barriers to treatment access and initiation that have been identified. The science of linkage facilitation currently lacks both consistent communication about linkage facilitation practices and a conceptual framework for guiding research. METHODS To address this gap, this article presents a taxonomy derived from expert consensus that organizes the array of practitioners, goals, and activities associated with linkage services for OUD and related needs. Expert panelists first independently reviewed research reports and policy guidelines summarizing the science and practice of linkage facilitation for substance use disorders generally and OUD specifically, then met several times to vet the conceptual scheme and content of the taxonomy until they reached a final consensus. RESULTS The derived taxonomy contains eight domains: facilitator identity, facilitator lived experience, linkage client, facilitator-client relationship, linkage activity, linkage method, linkage connectivity, and linkage goal. For each domain, the article defines basic domain categories, highlights research and practice themes in substance use and OUD care, and introduces innovations in linkage facilitation being tested in one of two NIDA-funded research networks: Justice Community Opioid Innovation Network (JCOIN) or Consortium on Addiction Recovery Science (CoARS). CONCLUSIONS To accelerate consistent application of this taxonomy to diverse research and practice settings, the article concludes by naming several considerations for linkage facilitation workforce training and implementation.
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Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, United States of America.
| | - Milan F Satcher
- Dartmouth Health and Geisel School of Medicine at Dartmouth College, United States of America
| | | | - Angela Hagaman
- East Tennessee State University, United States of America
| | | | | | | | | | | | | | - Frederick Muench
- Partnership to End Addiction, 711 Third Avenue, 5th floor, New York, NY 10017, United States of America
| | - Marc Fishman
- Maryland Treatment Centers, United States of America
| | - Kevin Wenzel
- Maryland Treatment Centers, United States of America
| | | | - L A R Stein
- Department of Psychology, University of Rhode Island, United States of America; Department of Behavioral & Social Sciences, Brown University, United States of America; Department of Behavioral Healthcare, Developmental Disabilities & Hospitals, RI, United States of America
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Ninković M, Ilić S, Damnjanović K. Women's trust in the healthcare system in Serbia: Validation of the Women's Trust and Confidence in Healthcare System scale. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241249864. [PMID: 38770772 PMCID: PMC11127576 DOI: 10.1177/17455057241249864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Women's role as patients is associated with power relationships embedded in society. Although trust in the health care system is a general prerequisite for positive health outcomes, practices regarding women's agency in healthcare systems in Southeastern Europe reinforce women's passivity. Most of the current psychological measures of trust have been constructed and validated in "WEIRD" (samples that are drawn from populations that are White, Educated, Industrialized, Rich, and Democratic) countries, thus having a limited application in other social contexts. OBJECTIVES We aimed to construct an instrument for assessing women's trust in healthcare systems to describe the structure of trust: Women's Trust and Confidence in the Healthcare System scale. DESIGN Two independent samples (N1 = 329; N2 = 333) of adult women in Serbia voluntarily completed an online questionnaire. The questionnaire comprised 20 trust-related items which were selected from an extensive collection of women's experiences in the healthcare system and evaluated by experts on a 5-point Likert-type scale. METHODS We used exploratory factor analysis of the Women's Trust and Confidence in the Healthcare System scale to analyze the structure of trust in the first sample data set and validated it with the second sample using confirmatory factor analysis. We tested concurrent validity by exploring how women's trust in the healthcare system predicts health-related behaviors (multigroup structural equation modeling). All analyses were conducted using R statistical software. RESULTS The Women's Trust and Confidence in the Healthcare System scale (Cronbach's alpha = 0.86) indicated a three-factor structure of trust in the healthcare system: trust in healthcare professionals, distrust in the public healthcare system, and confidence in healthcare system. This was validated using an independent sample. Interpersonal trust positively predicted women's desirable health behaviors, while trust in the system had a negative impact. CONCLUSION The Women's Trust and Confidence in the Healthcare System scale captures women's trust in a paternalistic healthcare system, is reliable, and has a stable three-factor structure. The study's findings reveal the relationship between women's trust and health-related behavior: in paternalistic environments, trust reinforces women's passivity.
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Affiliation(s)
- Milica Ninković
- Laboratory for Research of Individual Differences, Department of Psychology and Institute of Philosophy, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Sandra Ilić
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Kaja Damnjanović
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
- Institute of Philosophy, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
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14
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Katsnelson G, Brenna CTA. The heart of anaesthesiology: revitalising humanism in the age of technology. Br J Anaesth 2024; 132:1-4. [PMID: 37884409 DOI: 10.1016/j.bja.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/19/2023] [Accepted: 09/30/2023] [Indexed: 10/28/2023] Open
Abstract
Technological innovation has greatly aided modern medicine, and anaesthesiology in particular, but also contributes to dehumanising influences that promote physician burnout and dissatisfaction among patients. Here we advocate for a profound reaffirmation of humanistic principles-empathy, compassion, and communication-in perioperative medicine. We propose adaptable strategies to bolster humanism in practice, such as curricular offerings, simulation training, role modelling, and recognition. As perioperative technologies continue to evolve, the threat of depersonalisation in anaesthetic care looms, making commitments to humanism a crucial precondition for healing in the communities in which we work and live.
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Affiliation(s)
- Glen Katsnelson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Connor T A Brenna
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
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15
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Rager JB, Kirch M, Singer DC, Solway E, Malani PN, Roberts JS, Kullgren JT. Use of At-Home Medical Tests Among Older US Adults: A Nationally Representative Survey. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241284168. [PMID: 39311022 PMCID: PMC11421401 DOI: 10.1177/00469580241284168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/26/2024]
Abstract
The availability of direct-to-consumer, at-home medical tests has grown over the last decade, but it is unknown how frequently older adults purchase at-home tests, how they perceive such tests, and how interested they are in using at-home tests in the future. We conducted a cross-sectional, nationally representative survey of non-institutionalized US adults aged 50 to 80 about their previous use of, perceptions of, and future intentions to use at-home medical tests. We found that nearly half of older adults (48.1%) have purchased an at-home medical test (95% CI 45.2%-51.0%), including 32.0% (95% CI 29.3%-34.8%) who purchased a COVID-19 test, 16.6% (95% CI 14.7%-18.7%) who purchased an at-home DNA or genetic test, 5.6% (95% CI 4.5%-7.0%) who purchased a screening test for cancer, and 4.4% (95% CI 3.4%-5.6%) who purchased a test for an infection other than COVID-19. Compared with White, non-Hispanic adults, Black, non-Hispanic adults were less likely to have purchased an at-home test (35.5% vs 49.6%, P < .01). Those with a college degree and those with an annual household income greater than $100K were more likely than others to have purchased at-home tests (55.5% vs 42.0%, P < .01; 60.6% vs 39.0%, P < .001, respectively). Most older adults had positive perceptions about at-home tests and expressed interest in using at-home tests in the future. At-home medical testing is now common among older adults. Clinicians should be familiar with different tests that patients can purchase and be prepared to discuss the potential advantages and disadvantages of at-home testing.
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Affiliation(s)
- Joshua B. Rager
- Indiana University School of Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
- Indiana University Center for Bioethics, Indianapolis, IN, USA
| | - Matthias Kirch
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | | | - Erica Solway
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Preeti N. Malani
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - J. Scott Roberts
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jeffrey T. Kullgren
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
- University of Michigan School of Public Health, Ann Arbor, MI, USA
- Veterans Affairs HSR&D, Center for Clinical Management Research, Ann Arbor, MI, USA
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16
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Mick I, Freger SM, van Keizerswaard J, Gholiof M, Leonardi M. Comprehensive endometriosis care: a modern multimodal approach for the treatment of pelvic pain and endometriosis. Ther Adv Reprod Health 2024; 18:26334941241277759. [PMID: 39376635 PMCID: PMC11457249 DOI: 10.1177/26334941241277759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/08/2024] [Indexed: 10/09/2024] Open
Abstract
Endometriosis is a prevalent gynecological disease, leading to chronic pain and inflammation, affecting 1 in 10 individuals presumed female at birth. The diagnostic journey is often arduous, marked by neglect of the right diagnosis and prolonged wait times, significantly compromising the quality of life among those affected. This review provides a nuanced exploration of endometriosis-associated pain management, encompassing medical, surgical, and holistic approaches, all guided by accurate and refined diagnostics. Our paramount goal is to empower physicians as key figures in confronting this intricate challenge with a patient-centric approach, ultimately aiming to improve treatment and quality of life. Acknowledging each patient's unique needs, we emphasize the importance of tailoring a spectrum of options informed by current literature and insights gleaned from our experience in a high-volume tertiary endometriosis center. It is imperative to recognize endometriosis as a complex and chronic disease, often occurring with co-morbid conditions and nuanced complexities, necessitating a long-term personalized multimodal approach for each case. In addition, incorporating principles such as patient autonomy, profound respect for diverse experiences, and practical education on treatment choices is pivotal in enhancing treatment outcomes and overall patient satisfaction.
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Affiliation(s)
- Ido Mick
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Shay M. Freger
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | | | - Mahsa Gholiof
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Mathew Leonardi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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Schefold JC, Ruzzante L, Sprung CL, Gruber A, Soreide E, Cosgrove J, Mullick S, Papathanakos G, Koulouras V, Maia PA, Ricou B, Posch M, Metnitz P, Bülow HH, Avidan A. The impact of religion on changes in end-of-life practices in European intensive care units: a comparative analysis over 16 years. Intensive Care Med 2023; 49:1339-1348. [PMID: 37812228 PMCID: PMC10622347 DOI: 10.1007/s00134-023-07228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Religious beliefs affect end-of-life practices in intensive care units (ICUs). Changes over time in end-of-life practices were not investigated regarding religions. METHODS Twenty-two European ICUs (3 regions: Northern, Central, and Southern Europe) participated in both Ethicus-1 (years 1999-2000) and Ethicus-2 studies (years 2015-2016). Data of ICU patients who died or had limitations of life-sustaining therapy were analysed regarding changes in end-of-life practices and patient/physician religious affiliations. Frequencies, timing of decision-making, and religious affiliations of physicians/patients were compared using the same definitions. RESULTS In total, 4592 adult ICU patients (n = 2807 Ethicus-1, n = 1785 Ethicus-2) were analysed. In both studies, patient and physician religious affiliations were mostly Catholic, Greek Orthodox, Jewish, Protestant, or unknown. Treating physicians (but not patients) commonly reported no religious affiliation (18%). Distribution of end-of-life practices with respect to religion and geographical regions were comparable between the two studies. Withholding [n = 1143 (40.7%) Ethicus-1 and n = 892 (50%) Ethicus-2] and withdrawing [n = 695 (24.8%) Ethicus-1 and n = 692 (38.8%) Ethicus-2] were most commonly decided. No significant changes in end-of-life practices were observed for any religion over 16 years. The number of end-of-life discussions with patients/ families/ physicians increased, while mortality and time until first decision decreased. CONCLUSIONS Changes in end-of-life practices observed over 16 years appear unrelated to religious affiliations of ICU patients or their treating physicians, but the effects of religiosity and/or culture could not be assessed. Shorter time until decision in the ICU and increased numbers of patient and family discussions may indicate increased awareness of the importance of end-of-life decision-making in the ICU.
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Affiliation(s)
- Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University of Bern, Bern, Switzerland.
| | - Livio Ruzzante
- Department of Intensive Care Medicine, Inselspital, University of Bern, Bern, Switzerland.
| | - Charles L Sprung
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Ein Karem Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anastasiia Gruber
- Center for Medical Data Science, Institute for Statistics, Medical University of Vienna, Vienna, Austria
| | - Eldar Soreide
- Section for Quality and Patient Safety, Stavanger University Hospital, Stavanger and Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Joseph Cosgrove
- Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, NE7 7RG, UK
| | - Sudakshina Mullick
- Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Georgios Papathanakos
- Department of Intensive Care Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Vasilios Koulouras
- Department of Intensive Care Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Paulo Azevedo Maia
- Intensive Care Department, Hospital Santo António (CHUdSA) and Instituto Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Bara Ricou
- Intensive Care. Department of Acute Medicine, Hospital of Geneva and University of Geneva, Geneva, Switzerland
| | - Martin Posch
- Center for Medical Data Science, Institute for Statistics, Medical University of Vienna, Vienna, Austria
| | - Philipp Metnitz
- Center for Medical Data Science, Institute for Statistics, Medical University of Vienna, Vienna, Austria
| | - Hans-Henrik Bülow
- Department of Anaesthesiology and Intensive Care, Holbæk Hospital, Holbæk, Denmark
| | - Alexander Avidan
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Ein Karem Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Donnelly P, Soares R, Eynon A, Grundy P, Durnford A. Animal products in neurosurgery - navigating informed consent. Br J Neurosurg 2023:1-4. [PMID: 37735919 DOI: 10.1080/02688697.2023.2256875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
Informed consent is an ethical and legal requirement integral to modern surgical practice. Clinicians have a duty to consider, disclose and discuss risks and concerns relevant to an individual patient. With medical advances there are now a significant number of animal-derived products and adjuncts available for use in modern neurosurgical practice, which may be relevant when consenting patients for specific procedures if such products are used. This paper highlights commonly used products in neurosurgery that contain animal-derived constituents with the aim of facilitating an informed discussion between the neurosurgeon and patient. We have reviewed the commonly used products in the centres of the authors and their commercial equivalents. The product information is taken from the manufacturer's instructions or the Federal Drug Administration documents regarding the product. Animal products commonly available to neurosurgeons can be broadly categorised into haemostatic agents, dural substitutes, dural sealants and bone cements. Many products contain a variety of animal (or human) derived products. In order to ensure informed consent and shared decision making, it is important to establish any relevant patient beliefs or views regarding the use of animal-derived products. Given the wide availability and use of neurosurgical adjuncts containing human or animal derived products, coupled with the heterogeneity within ethnic, religious, and social groups, each patient must be approached individually to ensure patient-specific concerns are identified and alternatives offered when appropriate.
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Affiliation(s)
- Patrick Donnelly
- Department of Neurosurgery, Mater Hospital Brisbane, South Brisbane, Queensland, Australia
| | - Rui Soares
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Andy Eynon
- University Hospital Southampton, Southampton, UK
| | - Paul Grundy
- University Hospital Southampton, Southampton, UK
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Ruiz Romero MV, López Tarrida ÁC, Porrúa del Saz A, Gómez Hernández MB, Martínez Monrobé MB, Sánchez Villar E, Cruz Valero C, Pereira Delgado C. [Efectividad de una intervención multimodal para la mejora de la atención al dolor crónico.]. Rev Esp Salud Publica 2023; 97:e202309071. [PMID: 37921370 PMCID: PMC10558111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/14/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE The prevalence of chronic pain in Spain is 17%, which causes suffering and significant loss of quality of life. Therapies should not focus only on pain reduction, to improve function and quality of life are necessary. Currently, it is committed to combining drugs and other therapies such as relaxation, meditation, cognitive behavioral therapy, targeted exercises, healthy lifestyles and techniques to increase self-esteem and motivation for change. These therapies can be used as part of a multimodal approach, forming part of multicomponent programs or workshops. In this paper we proposed to evaluate the effectiveness of a workshop developed from the Hospital San Juan de Dios del Ajarafe, that integrated different non-pharmacological therapies in the control of chronic non-oncologic pain and to analyze patients' perceptions of the techniques applied and how they affected pain and lifestyles. METHODS An intragroup before-after study (beginning-end of the workshop) was carried out, comparing pain, well-being, drug use, quality of life, and self-esteem. Surveys were conducted to deepen more qualitative aspects and identify improvements. The workshop consisted of psychoeducational action and training for the mental control of pain and emotions, based on the active participation of the patient in the management of his disease, promoting self-care and self-esteem, and aiming to improve well-being and quality of life. It consisted of 5 sessions of 3 hours (1 per week); of a group, interactive and practical nature. Statistical analysis was performed with SPSS vs.27.0. To compare related measures (before-after) we used Student's T tests for paired samples and Wilcoxon's test and to compare independent groups, Student's T and Mann Whitney's U; for the qualitative variables, we used Chi-Square and Fisher's test. RESULTS Four workshops were evaluated in which 63 patients participated, with a mean age of 57.6 (SD:11.37) years, 60 (95.2%) of them were women. At the end of the workshop pain decreased 1.5 median (-2.0-0) and well-being increased 2.0 (0-2.0); quality of life increased a median of 0.121 (SD: 0.209), health status 16.8 (23.78) and self-esteem 2.74 (4.73); [p<0.001]. The best valued techniques were meditations, mainly mental analgesia, affirmations in the mirror and self-esteem techniques. CONCLUSIONS Overall satisfaction with the workshop is 9.8 out of 10. There is a pain control and improvement in quality of life, self-perception of health status, well-being and self-esteem.
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Affiliation(s)
- María Victoria Ruiz Romero
- Responsable de Calidad e Investigación; Hospital San Juan de Dios del AljarafeHospital San Juan de Dios del AljarafeBormujos (Sevilla)Spain
| | - Ángeles Carmen López Tarrida
- Servicio de Cuidados Críticos y Urgencias; Hospital San Juan de Dios del AljarafeHospital San Juan de Dios del AljarafeBormujos (Sevilla)Spain
| | - Ana Porrúa del Saz
- Servicio de Rehabilitación; Hospital San Juan de Dios del AljarafeHospital San Juan de Dios del AljarafeBormujos (Sevilla)Spain
| | - María Begoña Gómez Hernández
- Fisioterapia, Servicio de Rehabilitación; Hospital San Juan de Dios del AljarafeHospital San Juan de Dios del AljarafeBormujos (Sevilla)Spain
| | - María Blanca Martínez Monrobé
- Unidad de Psicología; Hospital San Juan de Dios del AljarafeHospital San Juan de Dios del AljarafeBormujos (Sevilla)Spain
| | - Elena Sánchez Villar
- Hospitalización; Hospital San Juan de Dios del AljarafeHospital San Juan de Dios del AljarafeBormujos (Sevilla)Spain
| | - Carlos Cruz Valero
- Especialista interno Residente de Medicina Familiar y Comunitaria; Centro de Salud de CamasCentro de Salud de CamasCamas (Sevilla)Spain
| | - Consuelo Pereira Delgado
- Unidad de Medicina Interna, Servicio de Medicina; Hospital San Juan de Dios del AljarafeHospital San Juan de Dios del AljarafeBormujos (Sevilla)Spain
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20
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Brennan N, Langdon N, Keates N, Mattick K, Gale T. Graduates' preparedness for the changing doctor-patient relationship: A qualitative study. MEDICAL EDUCATION 2023; 57:712-722. [PMID: 36646510 DOI: 10.1111/medu.15020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND A positive doctor-patient relationship is a crucial part of high-quality patient care. There is a general perception that it has been changing in recent years; however, there is a lack of evidence for this. Adapting to the changing doctor-patient relationship has been identified as an important skill doctors of the future must possess. This study explores (1) multiple stakeholder perspectives on how the doctor-patient relationship is changing and (2) in what ways medical graduates are prepared for working in this changing doctor-patient relationship. METHODS We conducted a national qualitative study involving semi-structured interviews with multiple stakeholders across the United Kingdom. Interviews lasting 45-60 minutes were conducted with 67 stakeholders including doctors in the first 2 years of practice (ECD's), patient representatives, supervisors, deans, medical educators and other health care professionals. The interviews were audiorecorded, transcribed, analysed, coded in NVivo and analysed thematically using a Thematic Framework Analysis approach. RESULTS The main ways the doctor-patient relationship was perceived to be changing related to increased shared decision making and patients having increasing access to information. Communication, patient-centred care and fostering empowerment, were the skills identified as being crucial for preparedness to work in the changing doctor-patient relationship. Graduates were reported to be typically well-prepared for the preconditions (communication and delivering patient-centred care) of patient empowerment, but that more work is needed to achieve true patient empowerment. CONCLUSION This study offers a conceptual advance by identifying how the doctor-patient relationship is changing particularly around the 'patient-as-knowledge-source' dimension. On the whole ECD's are well-prepared for working in the changing doctor-patient relationship with the exception of patient empowerment skills. Further research is now needed to provide an in-depth understanding of patient empowerment that is shared among key stakeholders (particularly the patient perspective) and to underpin the design of educational interventions appropriate to career stage.
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Affiliation(s)
- Nicola Brennan
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Nicola Langdon
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | | | - Karen Mattick
- Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Thomas Gale
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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Sauerbrei A, Kerasidou A, Lucivero F, Hallowell N. The impact of artificial intelligence on the person-centred, doctor-patient relationship: some problems and solutions. BMC Med Inform Decis Mak 2023; 23:73. [PMID: 37081503 PMCID: PMC10116477 DOI: 10.1186/s12911-023-02162-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/29/2023] [Indexed: 04/22/2023] Open
Abstract
Artificial intelligence (AI) is often cited as a possible solution to current issues faced by healthcare systems. This includes the freeing up of time for doctors and facilitating person-centred doctor-patient relationships. However, given the novelty of artificial intelligence tools, there is very little concrete evidence on their impact on the doctor-patient relationship or on how to ensure that they are implemented in a way which is beneficial for person-centred care.Given the importance of empathy and compassion in the practice of person-centred care, we conducted a literature review to explore how AI impacts these two values. Besides empathy and compassion, shared decision-making, and trust relationships emerged as key values in the reviewed papers. We identified two concrete ways which can help ensure that the use of AI tools have a positive impact on person-centred doctor-patient relationships. These are (1) using AI tools in an assistive role and (2) adapting medical education. The study suggests that we need to take intentional steps in order to ensure that the deployment of AI tools in healthcare has a positive impact on person-centred doctor-patient relationships. We argue that the proposed solutions are contingent upon clarifying the values underlying future healthcare systems.
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Affiliation(s)
- Aurelia Sauerbrei
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Angeliki Kerasidou
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK
| | - Federica Lucivero
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK
| | - Nina Hallowell
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK
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Stelwagen M, Westmaas A, Van Kempen A, Scheele F. In-hospital education of parents of newborns may benefit from competency-based education: A qualitative focus group and interview study among health professionals. J Clin Nurs 2023; 32:1076-1088. [PMID: 35460132 DOI: 10.1111/jocn.16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
AIMS/OBJECTIVES The aim of this study was to appraise health professionals' self-reported practices in educating parents of hospitalised newborns from the perspective of competency-based education and to identify areas for improvement of parental learning. BACKGROUND Patient education is essential to achieve autonomy in parents of hospitalised newborns. The literature provides descriptions of the use of various components of competency-based education in patient education. This suggests that competency-based education is a valuable concept for patient education. DESIGN A case-based qualitative study. METHODS Three focus group discussions were conducted and 28 semi-structured interviews with 45 health professionals who practice in a hospital setting that is designed to empower parents. The data were analysed with a framework analysis approach, using a framework of competency-based education themes for a combined inductive and deductive content data analysis. The recommendations of the Standards for Reporting Qualitative Research checklist were followed. FINDINGS Two themes of competency-based education emerged as evidently operationalised: (1) 'Learning climate' and (2) 'Role modeling'. Five themes emerged as incompletely operationalised: (1) 'Parent curriculum based on inter-professional consensus'; (2) 'Transparency about the competencies needed'; (3) 'Access to teaching'; (4) 'Assessing and reporting results'; and (5) 'Proficiency statements based on autonomy expectations'. Two themes did not emerge: (1) 'Empowering parents to be active learners' and (2) 'Evaluation and improvement of the education program'. CONCLUSIONS Parent education is at risk of being merely on a master-apprentice model and may be more effective if it is designed on competency-based education principles. Identified areas for improvement are empowering parents to be 'active learners' and by involving them in the evaluation and improvement of the educational program. Parent education in neonatal health care may benefit from an appraisal based on competency-based education themes. RELEVANCE TO CLINICAL PRACTICE Appraising parent education based on competency-based education principles is feasible for improving the learning process towards parent autonomy.
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Affiliation(s)
- Mireille Stelwagen
- Department of Teaching and Department of Pediatrics at OLVG Hospital, Amsterdam, The Netherlands
| | - Alvin Westmaas
- Department of Social Psychology, Maastricht University, Maastricht, The Netherlands.,Faculty of Health, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Anne Van Kempen
- Department of Pediatrics at OLVG Hospital, Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Gynecology and Department Teaching at OLVG Hospital, Health systems innovation and education at the VU University Amsterdam and Amsterdam University Medical Center, Amsterdam, The Netherlands
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Blackler L, Scharf AE, Matsoukas K, Colletti M, Voigt LP. Call to action: empowering patients and families to initiate clinical ethics consultations. JOURNAL OF MEDICAL ETHICS 2023; 49:240-243. [PMID: 34732393 DOI: 10.1136/medethics-2021-107426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
Clinical ethics consultations exist to support patients, families and clinicians who are facing ethical or moral challenges related to patient care. They provide a forum for open communication, where all stakeholders are encouraged to express their concerns and articulate their viewpoints. Ethics consultations can be requested by patients, caregivers or members of a patient's clinical or supportive team. Although patients and by extension their families (especially in cases of decisional incapacity) are the common denominators in most ethics consultations, these constituents are the least likely to request them. At many healthcare organisations in the USA, ethics consultations are overwhelmingly requested by physicians and other clinicians. We believe it is vital that healthcare institutions bridge the knowledge gaps and power imbalances over access to ethics consultation services through augmented policies, procedures and infrastructure. With enhanced education and support, patients and families may use ethics consultation to elevate their voices and prioritise their unique characteristics and preferences in the delivery of their healthcare. Empowering patients and families to request ethics consultation can only strengthen the patient/family-clinician relationship, enhance the shared decision-making model of care and ultimately lead to improved patient-centred care.
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Affiliation(s)
- Liz Blackler
- Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Amy E Scharf
- Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Konstantina Matsoukas
- Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Technology Division, Library Services, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michelle Colletti
- Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Louis P Voigt
- Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Anesthesiology, Pain, and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Saboury B, Bradshaw T, Boellaard R, Buvat I, Dutta J, Hatt M, Jha AK, Li Q, Liu C, McMeekin H, Morris MA, Scott PJH, Siegel E, Sunderland JJ, Pandit-Taskar N, Wahl RL, Zuehlsdorff S, Rahmim A. Artificial Intelligence in Nuclear Medicine: Opportunities, Challenges, and Responsibilities Toward a Trustworthy Ecosystem. J Nucl Med 2023; 64:188-196. [PMID: 36522184 PMCID: PMC9902852 DOI: 10.2967/jnumed.121.263703] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Trustworthiness is a core tenet of medicine. The patient-physician relationship is evolving from a dyad to a broader ecosystem of health care. With the emergence of artificial intelligence (AI) in medicine, the elements of trust must be revisited. We envision a road map for the establishment of trustworthy AI ecosystems in nuclear medicine. In this report, AI is contextualized in the history of technologic revolutions. Opportunities for AI applications in nuclear medicine related to diagnosis, therapy, and workflow efficiency, as well as emerging challenges and critical responsibilities, are discussed. Establishing and maintaining leadership in AI require a concerted effort to promote the rational and safe deployment of this innovative technology by engaging patients, nuclear medicine physicians, scientists, technologists, and referring providers, among other stakeholders, while protecting our patients and society. This strategic plan was prepared by the AI task force of the Society of Nuclear Medicine and Molecular Imaging.
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Affiliation(s)
- Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland;
| | - Tyler Bradshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Irène Buvat
- Institut Curie, Université PSL, INSERM, Université Paris-Saclay, Orsay, France
| | - Joyita Dutta
- Department of Electrical and Computer Engineering, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Mathieu Hatt
- LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | - Abhinav K Jha
- Department of Biomedical Engineering and Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Quanzheng Li
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Helena McMeekin
- Department of Clinical Physics, Barts Health NHS Trust, London, United Kingdom
| | - Michael A Morris
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Peter J H Scott
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Eliot Siegel
- Department of Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - John J Sunderland
- Departments of Radiology and Physics, University of Iowa, Iowa City, Iowa
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri
| | - Sven Zuehlsdorff
- Siemens Medical Solutions USA, Inc., Hoffman Estates, Illinois; and
| | - Arman Rahmim
- Departments of Radiology and Physics, University of British Columbia, Vancouver, British Columbia, Canada
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Bernardi R, Wu PF. Online health communities and the patient-doctor relationship: An institutional logics perspective. Soc Sci Med 2022; 314:115494. [PMID: 36334494 DOI: 10.1016/j.socscimed.2022.115494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Taking an institutional logics perspective, this study investigates how "internet-informed" patients manage tensions between the logic of personal choice and the logic of medical professionalism as they navigate treatment decisions and the patient-doctor relationship. Based on 44 semi-structured interviews with members of an online health community for people with diabetes, this study finds that patients exercise a great deal of agency in evaluating healthcare options not only by activating the logic of personal choice but also by appropriating the logic of medical professionalism. Furthermore, patients are strategic in deciding what community advice to share with their doctor or nurse depending on the healthcare professionals' reaction to the logic of personal choice. In contrast to many previous studies that emphasise patient consumerism fuelled by information on the Internet, this study provides a more nuanced picture of patient-doctor relationship engendered by patients' participation in online health communities.
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Affiliation(s)
| | - Philip F Wu
- School of Business and Management Royal Holloway, University of London Egham
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Abouzahra M, Guenter D, Tan J. Exploring physicians’ continuous use of clinical decision support systems. EUR J INFORM SYST 2022. [DOI: 10.1080/0960085x.2022.2119172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Dale Guenter
- Department of Family Medicine, McMaster University
| | - Joseph Tan
- DeGroote School of Medicine, McMaster University
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Surendran S, Castro-Sánchez E, Nampoothiri V, Joseph S, Singh S, Tarrant C, Holmes A, Charani E. Indispensable yet invisible: A qualitative study of the roles of carers in infection prevention in a South Indian hospital. Int J Infect Dis 2022; 123:84-91. [PMID: 35988864 DOI: 10.1016/j.ijid.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/21/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVES We investigated the roles of patient carers in infection-related care on surgical wards in a South Indian hospital from the perspective of healthcare workers (HCWs), patients, and their carers. METHODS Ethnographic study included ward-round observations (138 hours) and face-to-face interviews (44 HCWs, 6 patients/carers). Data (field notes, interview transcripts) were coded in NVivo 12 and thematically analyzed. Data collection and analysis were iterative, recursive, and continued until thematic saturation. RESULTS Carers have important, unrecognized roles. At the study site, institutional expectations are formalized in policies, demanding a carer to always accompany in-patients. Such intense presence embeds families in the patient care environment, as demonstrated by their high engagement in direct personal (bathing patients) and clinical care (wound care). Carers actively participate in discussions on patient progress with HCWs, including therapeutic options. There is a misalignment between how carers are positioned by the organization (through policy mandates, institutional practices, and HCWs expectations), and the role that they play in practice, resulting in their role, though indispensable, remaining unrecognized. CONCLUSION Current models of patient and carer involvement in infection prevention and control are poorly aligned with sociocultural and contextual aspects of care. Culture-sensitive infection prevention and control policies which embrace the roles that carers play are urgently needed.
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Affiliation(s)
- Surya Surendran
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, India; Health System and Equity, The George Institute for Global Health, New Delhi, India
| | - Enrique Castro-Sánchez
- Department of Medicine, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom; School of Health Sciences, University of West London, London, United Kingdom
| | - Vrinda Nampoothiri
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Shiny Joseph
- Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | - Sanjeev Singh
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Alison Holmes
- Department of Medicine, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom
| | - Esmita Charani
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Kochi, India; Department of Medicine, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom; Centre for Excellence in Infectious Diseases Research, University of Liverpool, Liverpool, United Kingdom; Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, South Africa.
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Difficult Conversations. Plast Reconstr Surg 2022; 150:237-241. [PMID: 35895519 DOI: 10.1097/prs.0000000000009087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hertling S, Matziolis G, Graul I. [The role of the Internet as a source of medical information for orthopedic patients]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:521-530. [PMID: 35352139 PMCID: PMC8963403 DOI: 10.1007/s00132-022-04238-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The advance of the digital revolution in medicine and health is called "e-health". The Internet serves as a digital health information platform and is indispensable as a source of medical information. The aim of this work was to examine the behavior of orthopedic patients with respect to finding information on their illnesses. The role and the importance of the Internet as an informative health application for these patients are highlighted. MATERIALS AND METHODS The basis of this prospective cross-sectional study was a patient survey in Germany of orthopedic patients from July 2019 to July 2020. Descriptive statistics were calculated, and regression analyses were carried out to show coherent results. RESULTS We analyzed the responses of 1262 orthopedic patients. Most of them used the Internet as a digital health information platform. Patients rated their Internet skills as good to very good, regardless of age or educational level. Most respondents said that they currently use the Internet at least once a week to find out about their orthopedic illnesses. Patients reported a positive change in attitude towards the Internet as a digital source of medical information, and its use has increased in the past 12 months. CONCLUSION The Internet as an informative digital health application in orthopedics is used intensively and is widely accepted by patients. While mistrust of orthopedic health information from the Internet has decreased, patient confidence in meaningful digital health information platforms has increased. The Internet is seen as a useful health information platform alongside medical advice.
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Affiliation(s)
- Stefan Hertling
- Abteilung für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
- Deutsches Zentrum für Orthopädie, Campus Eisenberg, Universitätsklinikum Jena, Eisenberg, Deutschland.
| | - Georg Matziolis
- Abteilung für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - Isabel Graul
- Deutsches Zentrum für Orthopädie, Campus Eisenberg, Universitätsklinikum Jena, Eisenberg, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Halle, Halle, Deutschland
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Petrillo LA, Shimer SE, Zhou AZ, Sommer RK, Feldman JE, Hsu KE, Greer JA, Traeger LN, Temel JS. Prognostic communication about lung cancer in the precision oncology era: A multiple-perspective qualitative study. Cancer 2022; 128:3120-3128. [PMID: 35731234 DOI: 10.1002/cncr.34369] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although most patients with cancer prefer to know their prognosis, prognostic communication between oncologists and patients is often insufficient. Targeted therapies for lung cancer improve survival yet are not curative and produce variable responses. This study sought to describe how oncologists communicate about prognosis with patients receiving targeted therapies for lung cancer. METHODS This qualitative study included 39 patients with advanced lung cancer with targetable mutations, 14 caregivers, and 10 oncologists. Semistructured interviews with patients and caregivers and focus groups or interviews with oncologists were conducted to explore their experiences with prognostic communication. One oncology follow-up visit was audio-recorded per patient. A framework approach was used to analyze interview transcripts, and a content analysis of patient-oncologist dialogue was conducted. Themes were identified within each source and then integrated across sources to create a multidimensional description of prognostic communication. RESULTS Six themes in prognostic communication were identified: Patients with targetable mutations develop a distinct identity in the lung cancer community that affects their information-seeking and self-advocacy; oncologists set high expectations for targeted therapy; the uncertain availability of new therapies complicates prognostic discussions; patients and caregivers have variable information preferences; patients raise questions about progression by asking about physical symptoms or scan results; and patients' expectations of targeted therapy influence their medical decision-making. CONCLUSIONS Optimistic patient-oncologist communication shapes the expectations of patients receiving targeted therapy for lung cancer and affects their decision-making. Further research and clinical guidance are needed to help oncologists to communicate uncertain outcomes effectively.
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Affiliation(s)
- Laura A Petrillo
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sophia E Shimer
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ashley Z Zhou
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert K Sommer
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Kelly E Hsu
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lara N Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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31
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Steerling E, Houston R, Gietzen LJ, Ogilvie SJ, de Ruiter HP, Nygren JM. Examining how ethics in relation to health technology is described in the research literature: A Scoping Review (Preprint). Interact J Med Res 2022; 11:e38745. [PMID: 35969434 PMCID: PMC9425162 DOI: 10.2196/38745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emilie Steerling
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Rebecca Houston
- College of Allied Health and Nursing, Minnesota State University, Mankato, MN, United States
| | - Luke J Gietzen
- College of Allied Health and Nursing, Minnesota State University, Mankato, MN, United States
| | - Sarah J Ogilvie
- College of Allied Health and Nursing, Minnesota State University, Mankato, MN, United States
| | - Hans-Peter de Ruiter
- College of Allied Health and Nursing, Minnesota State University, Mankato, MN, United States
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Quality Assessment of Online Resources for Thoracic Outlet Syndrome Patients. Ann Vasc Surg 2022; 85:96-104. [DOI: 10.1016/j.avsg.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
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Hertling S, Hertling D, Schleußner E, Loos F, Graul I. E-health – The importance of the internet as an informative digital health application for gynecological patients in times of SARs-CoV2: A national cross-sectional survey. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.100942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fowler MD. Am I My Neighbor's Keeper? Freedom, Liberty, and Autonomy. J Christ Nurs 2022; 39:13-14. [PMID: 34860762 PMCID: PMC8647523 DOI: 10.1097/cnj.0000000000000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Marsha D Fowler
- Marsha D. Fowler, PhD, MDiv, MS, RN, FAAN, FRSA , is Professor of Ethics and Spirituality, Azusa Pacific University, Azusa, CA. She is past-chair of the ANA Ethics Committee and member of the expert panel on ethics, American Academy of Nursing. Dr. Fowler served as Historian and Code Scholar, and co-lead writer for the revision of the ANA Code of Ethics with Interpretive Statements , 2015. She authored Guide to the Code of Ethics: Development, Interpretation, and Application (ANA, 2015), and edited Religion, Religious Ethics and Nursing (Springer)
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Fang A, Abdelgadir D, Gopalan A, Ross T, Uratsu CS, Sterling SA, Grant RW, Iturralde E. Engaging patients in population-based chronic disease management: A qualitative study of barriers and intervention opportunities. PATIENT EDUCATION AND COUNSELING 2022; 105:182-189. [PMID: 33975772 PMCID: PMC8566319 DOI: 10.1016/j.pec.2021.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) continues to be a leading cause of morbidity in the U.S. Managing CVD risk factors, such as diabetes or hypertension, can be challenging for many individuals. We investigated the barriers experienced by patients who persistently struggled to reach their CVD risk factor control goals. METHODS This qualitative study examined patient, clinician, and researcher observations of individuals' experiences in a chronic disease management program. All participants (n = 332) were enrolled in a clinical trial testing a skills-based group intervention seeking to improve healthcare engagement. Data were analyzed through a general inductive approach and resulting themes were structured along the Capability-Opportunity-Motivation-Behavior framework. RESULTS Analyses identified care engagement barriers related to participants' communication skills and activation, care team relationship processes, and emotional factors. Although most participants reported benefitting from skills training, persistent barriers included distrust of their providers, shame about health challenges, and dissatisfaction with care team interactions that were described as impersonal or unresponsive. CONCLUSIONS AND PRACTICE IMPLICATIONS Efforts to support engagement in CVD risk factor management programs should address whether patients and their care team have the necessary skills, opportunities and confidence to proactively communicate health needs and engage in non-judgmental interactions for goal-setting, rapport-building, and shared decision-making.
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Affiliation(s)
- Anya Fang
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Dana Abdelgadir
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Anjali Gopalan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Thekla Ross
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Connie S Uratsu
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
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Smith C, Crowley A, Munsie M, Behfar A, DeMartino ES, Staff NP, Shapiro SA, Master Z. Academic Physician Specialists' Approaches to Counseling Patients Interested in Unproven Stem Cell and Regenerative Therapies-A Qualitative Analysis. Mayo Clin Proc 2021; 96:3086-3096. [PMID: 34454715 DOI: 10.1016/j.mayocp.2021.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the experiences, approaches, and challenges of physicians consulting patients about experimental stem cell and regenerative medicine interventions (SCRIs). PARTICIPANTS AND METHODS From August 21, 2018, through July 30, 2019, semistructured interviews of 25 specialists in cardiology, ophthalmology, orthopedics, pulmonology, and neurology were conducted and qualitatively analyzed using modified grounded theory. RESULTS All specialists used informational approaches to counsel patients, especially orthopedists. Informational approaches included explaining stem cell science, sharing risks, and providing principles. Several specialists also used relational counseling approaches including emphasizing that physicians want what is best for patients, acknowledging suffering, reassuring continued care, empathizing with patients and families, and underscoring that patients have the final decision. Many specialists reported being comfortable with the conversation, although some were less comfortable and several noted challenges in the consultation including wanting to support a patient's decision but worrying about harms from unproven SCRIs, navigating family pressure, and addressing stem cell hype and unrealistic expectations. Specialists also desired that additional resources be available for them and patients. CONCLUSION Physicians relied more heavily on providing patients with information about SCRIs than using relational counseling approaches. Efforts should be directed at helping physicians address the informational and relational needs of patients, including providing tools and resources that inform physicians about the unproven SCRI industry, building skills in empathic communication, and the creation and dissemination of evidence-based resources to offer patients.
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Affiliation(s)
- Cambray Smith
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Aidan Crowley
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Megan Munsie
- School of Biomedical Sciences and Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Center for Regenerative Medicine, Mayo Clinic, Rochester, MN
| | - Erin S DeMartino
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | | | - Shane A Shapiro
- Department of Orthopedic Surgery and Center for Regenerative Medicine, Mayo Clinic, Jacksonville, FL
| | - Zubin Master
- Center for Regenerative Medicine, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN.
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Madden EF, Christian BT, Lagisetty PA, Ray BR, Sulzer SH. Treatment provider perceptions of take-home methadone regulation before and during COVID-19. Drug Alcohol Depend 2021; 228:109100. [PMID: 34600251 PMCID: PMC8459541 DOI: 10.1016/j.drugalcdep.2021.109100] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The loosening of U.S. methadone regulations during the COVID-19 pandemic expanded calls for methadone reform. This study examines professional perceptions of methadone take-home dose regulation before and during the COVID-19 pandemic to understand responses to varied methadone distribution policies. METHODS Fifty-nine substance use disorder treatment professionals were interviewed between 2017 and 2020 in-person or over video call. An inductive iterative coding process was used to analyze the data. Constructivist grounded theory guided the collection and analysis of in-depth interviews. RESULTS Treatment professionals expressed mixed views toward methadone take-home regulations. Participants justified regulation using several arguments: 1) patient care benefitting from supervision, 2) attributing improved patient safety to take-home regulation, 3) fearing liability for methadone-related harms, and 4) relying on buprenorphine as an "escape hatch" for patients who cannot manage MMT policies. Other professionals suggested partial deregulation, while others strongly opposed pre-pandemic take-home regulation, explaining such regulations impede medication access and hinder patient-centered care. Some professionals supported the COVID-19 policy changes and saw these as a test run for broader deregulation, while others framed the changes as temporary and cautiously applied deregulation to their services, at times revoking looser rules for patients they perceived as nonadherent. CONCLUSION Treatment professionals working in a range of modalities, including opioid treatment programs, expressed hesitation toward expanded take-home methadone access. While some participants also supported forms of deregulation, post-pandemic efforts to extend looser methadone distribution policies will have to address apprehensive professionals if such policy changes are to be meaningfully adopted in community services.
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Affiliation(s)
- Erin Fanning Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 3939 Woodward Ave., Detroit, MI 48201, USA.
| | | | - Pooja A Lagisetty
- Division of General Medicine, University of Michigan Medical School, 7300 Medical Science Building I, 1301 Catherine St., Ann Arbor, MI 48109, USA
| | - Bradley R Ray
- School of Social Work, Wayne State University, 5447 Woodward Avenue, Detroit, MI 48202, USA
| | - Sandra H Sulzer
- Office of Health Equity & Community Engagement, Utah State University, 7000 Old Main Hill, Logan, UT 84322, USA
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Foot E, Leonhard A, Majeski J, Zahn L, Li HH, Caruso Brown AE. "The stakes could not be higher": A mixed methods study of parental social media use in pediatric oncology. Pediatr Blood Cancer 2021; 68:e29176. [PMID: 34133056 DOI: 10.1002/pbc.29176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/02/2021] [Accepted: 05/20/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND To describe how parents and families of children with cancer evaluate the benefits and risks of using social media (SM) and how they navigate disagreements between oncologists' advice and information found on SM. PROCEDURE Parents of children who had been previously diagnosed with cancer, and who had used SM for a purpose related to that child's health were recruited through SM sites and nonprofit organizations across the United States and were invited to complete questionnaires about their experiences using SM; a subset of participants also completed a follow-up in-depth interview. Open-ended responses and interviews were analyzed using thematic analysis. RESULTS Ninety parents completed written questionnaires; 21 completed follow-up interviews. Seventy percent reported experiencing a situation in which information shared on SM conflicted with information provided by their child's oncologist. Although 86% reported that they discussed the conflicting information with the oncologist and 70% described the oncologist's response as positive, 78% also described ongoing negative feelings about the experience. Parents described openness to discussing SM, honesty, transparency, and humility regarding the limits of medicine, and shared decision-making regarding information found on SM as increasing their trust in their oncologist. CONCLUSIONS Parents offered valuable insights regarding their experiences navigating SM, including eight recommendations for how pediatricians might approach discussing parental SM use. Future studies will evaluate the utility of these recommendations for pediatric clinicians.
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Affiliation(s)
| | | | - Jill Majeski
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Lauren Zahn
- Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Hsin H Li
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Amy E Caruso Brown
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, SUNY Upstate Medical University, Syracuse, New York, USA.,Center for Bioethics and Humanities, SUNY Upstate Medical University, Syracuse, New York, USA
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Morcillo-Muñoz Y, Castellano MHJ, Exposito FJD, Sanchez-Guarnido AJ, Alcantara MG, Baena-Parejo MI. Multimodal Interventions to Improve the Management of Chronic Non-Malignant Pain in Primary Care Using Participatory Research. Clin Pract 2021; 11:561-581. [PMID: 34449567 PMCID: PMC8395459 DOI: 10.3390/clinpract11030072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The use of diverse therapies combined with a multidisciplinary approach and prevention initiatives for patients with chronic non-malignant pain (CNMP) can improve health and have a positive impact on psychotropic drug use and the self-management of pain. PURPOSE This purpose of this study has been two-fold: to conduct a literature review with a view to selecting best evidence recommendations for CNMP and to prioritize self-care recommendations using a participatory methodology for the analysis and selection of interventions. METHODS A qualitative, descriptive, and documentary method based on participatory action research was used. FINDINGS Based on the study results, a multimodal psychosocial intervention program has been designed for CNMP that includes psychoeducational therapy, pharmacological therapy, physical exercise, and health assets. DISCUSSION The findings are consistent with previous studies underlining the need to invest in resources for the management of CNMP, including strategies for good differential diagnoses and pharmacological treatments combined with non-pharmacological treatments to confer greater well-being for people living with pain who want to participate in their own recovery.
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Affiliation(s)
- Yolanda Morcillo-Muñoz
- Primary Care RN, Andalusian Health Service District Campo de Gibraltar, 11207 Algeciras, Spain
| | | | | | | | - Miguel Gimenez Alcantara
- Primary Care, Andalusian Health District South Cordoba, 14940 Córdoba, Spain; (F.J.D.E.); (M.G.A.)
| | - Maria Isabel Baena-Parejo
- Primary Care RN, Andalusian Health Service District Cordoba, 14011 Córdoba, Spain; (M.H.J.C.); (M.I.B.-P.)
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Mwaka AD, Achan J, Adoch W, Wabinga H. From their own perspectives: a qualitative study exploring the perceptions of traditional health practitioners in northern Uganda regarding cancers, their causes and treatments. BMC FAMILY PRACTICE 2021; 22:155. [PMID: 34275446 PMCID: PMC8287672 DOI: 10.1186/s12875-021-01505-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/01/2021] [Indexed: 12/13/2022]
Abstract
Background Many cancer patients in the low- and middle-income countries seek care with traditional health practitioners (THPs) and use traditional and complementary medicines (T&CMs) for treatment of cancers. Little is known about the perceptions and influence of THPs on cancer patients’ help-seeking and treatment decisions. We aimed to explore perceptions of THPs regarding cancers, cancer causes, and preferred treatments for cancers, in order to identify aspects that can inform interventions to improve cancer outcomes in Uganda. Methods We conducted this ethnographic study in northern Uganda. In-depth interviews were conducted at the respondents’ homes in quiet, open places, and in the absence of none- respondents. Interviews were audio-recorded and transcribed verbatim within a week of the interviews. Thematic qualitative analysis approaches were used to identify themes and subthemes. Results We included 21 respondents in the study; most were male (16/21), married, with median age of 59 years (range 39 – 80). Most respondents perceived cancer as a new and challenging disease, while one respondent thought of cancer as a result of an imbalance within the body. Most confessed unawareness of the causes of cancers, but believed that cancer could result from the interplay of a number of factors including poor diets, ingestions of chemical agents, and assaults by the spirits of the dead. Some reported that cancers (especially of women’s genital tracts) were sexually transmitted, or caused by accumulation of dirt. Only few healers treated cancers. Most respondents reported that they referred cancer patients to biomedical facilities, sometimes after they have first used their medicines. Most respondents hoped that collaborative research with scientists could help them identify potent T&CMs that cure cancers. Conclusion Traditional health practitioners require training on cancer causes, symptoms and signs, and the necessity for prompt initiation of effective treatments in order to improve cancer outcomes. The predisposition of the majority of respondents to refer cancer patients to biomedical services sets a fertile ground for meaningful cooperation between biomedical and traditional health practices. The national health system in the low- and middle-income countries could formally recognize traditional health practices as a component of the national healthcare system, and encourage the two to practice side by side. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01505-w.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Jennifer Achan
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Winnie Adoch
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Kampala Cancer Registry, Department of Pathology, School of Biomedical Sciences, Makerere University, Kampala, Uganda
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Pediatric Oncologists' Experiences Returning and Incorporating Genomic Sequencing Results into Cancer Care. J Pers Med 2021; 11:jpm11060570. [PMID: 34207141 PMCID: PMC8235493 DOI: 10.3390/jpm11060570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/27/2022] Open
Abstract
Pediatric oncologists’ perspectives around returning and incorporating tumor and germline genomic sequencing (GS) results into cancer care are not well-described. To inform optimization of cancer genomics communication, we assessed oncologists’ experiences with return of genomic results (ROR), including their preparation/readiness for ROR, collaboration with genetic counselors (GCs) during ROR, and perceived challenges. The BASIC3 study paired pediatric oncologists with GCs to return results to patients’ families. We thematically analyzed 24 interviews with 12 oncologists at two post-ROR time points. Oncologists found pre-ROR meetings with GCs and geneticists essential to interpreting patients’ reports and communicating results to families. Most oncologists took a collaborative ROR approach where they discussed tumor findings and GCs discussed germline findings. Oncologists perceived many roles for GCs during ROR, including answering families’ questions and describing information in lay language. Challenges identified included conveying uncertain information in accessible language, limits of oncologists’ genetics expertise, and navigating families’ emotional responses. Oncologists emphasized how GCs’ and geneticists’ support was essential to ROR, especially for germline findings. GS can be successfully integrated into cancer care, but to account for the GC shortage, alternative ROR models and access to genetics resources will be needed to better support families and avoid burdening oncologists.
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Cheng JYJ, Wong BWZ, Chin YH, Ong ZH, Ng CH, Tham HY, Samarasekera DD, Devi KM, Chong CS. Preoperative concerns of patients undergoing general surgery. PATIENT EDUCATION AND COUNSELING 2021; 104:1467-1473. [PMID: 33303283 DOI: 10.1016/j.pec.2020.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This qualitative review aims to provide a clearer understanding of concerns general surgery (GS) patients face in the preoperative period. METHODS Medline, CINAHL, PsycINFO and Web of Science were searched for articles describing the preoperative concerns of GS patients. Qualitative and mixed method studies were included. Key quotes were extracted, coded, and thematically analyzed according to Thomas and Harden's methodology. RESULTS 27 articles were included. Three main themes were generated: (1) lead-up to surgery, (2) postoperative recovery process and (3) standard of care. While waiting for surgery, patients were often shrouded with uncertainty and concerned themselves with the potential impacts of their disease and surgery on their wellbeing and recovery. Furthermore, patients' trust and confidence in Healthcare Professionals (HCPs) was compromised when standard of care was perceived to be deficient, resulting in doubts about HCPs' credibility and capabilities. CONCLUSION Patients' preoperative concerns often stem from the uncertainty and unfamiliarity surrounding surgery. To address this, a combination of effective preoperative education, individualised communication and involvement of social support should be considered. PRACTICE IMPLICATIONS Preoperative concerns can negatively impact patients and effective interventions will result in a better perioperative experience with fewer negative consequences arising from patients' fear and anxiety.
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Affiliation(s)
| | - Bryan Wei Zhi Wong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Zhi Hao Ong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Hui Yu Tham
- Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore
| | - Dujeepa D Samarasekera
- Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kamala M Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Choon Seng Chong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore; Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore.
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Chivilgina O, Elger BS, Jotterand F. Digital Technologies for Schizophrenia Management: A Descriptive Review. SCIENCE AND ENGINEERING ETHICS 2021; 27:25. [PMID: 33835287 PMCID: PMC8035115 DOI: 10.1007/s11948-021-00302-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 03/23/2021] [Indexed: 05/05/2023]
Abstract
While the implementation of digital technology in psychiatry appears promising, there is an urgent need to address the implications of the absence of ethical design in the early development of such technologies. Some authors have noted the gap between technology development and ethical analysis and have called for an upstream examination of the ethical issues raised by digital technologies. In this paper, we address this suggestion, particularly in relation to digital healthcare technologies for patients with schizophrenia spectrum disorders. The introduction of digital technologies in psychiatry offers a broad spectrum of diagnostic and treatment options tailored to the health needs and goals of patients' care. These technologies include wearable devices, smartphone applications for high-immersive virtual realities, smart homes, telepsychiatry and messaging systems for patients in rural areas. The availability of these technologies could increase access to mental health services and improve the diagnostics of mental disorders. In this descriptive review, we systematize ethical concerns about digital technologies for mental health with a particular focus on individuals suffering from schizophrenia. There are many unsolved dilemmas and conflicts of interest in the implementation of these technologies, such as (1) the lack of evidence on efficacy and impact on self-perception; (2) the lack of clear standards for the safety of their daily implementation; (3) unclear roles of technology and a shift in the responsibilities of all parties; (4) no guarantee of data confidentiality; and (5) the lack of a user-centered design that meets the particular needs of patients with schizophrenia. mHealth can improve care in psychiatry and make mental healthcare services more efficient and personalized while destigmatizing mental health disorders. To ensure that these technologies will benefit people with mental health disorders, we need to heighten sensitivity to ethical issues among mental healthcare specialists, health policy makers, software developers, patients themselves and their proxies. Additionally, we need to develop frameworks for furthering sustainable development in the digital technologies industry and for the responsible usage of such technologies for patients with schizophrenia in the clinical setting. We suggest that digital technology in psychiatry, particularly for schizophrenia and other serious mental health disorders, should be integrated into treatment with professional supervision rather than as a self-treatment tool.
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Affiliation(s)
- Olga Chivilgina
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland.
| | - Bernice S Elger
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
- Unit of Health Law & Humanitarian Medicine At the Institute for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Fabrice Jotterand
- Institute of Biomedical Ethics, University of Basel, Basel, Switzerland
- Center for Bioethics and Medical Humanities, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, USA
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Porter AS, O'Callaghan J, Englund KA, Lorenz RR, Kodish E. Problems with the problem list: challenges of transparency in an era of patient curation. J Am Med Inform Assoc 2021; 27:981-984. [PMID: 32346726 DOI: 10.1093/jamia/ocaa040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/17/2020] [Accepted: 03/30/2020] [Indexed: 11/14/2022] Open
Abstract
In recent years, the OpenNotes movement and other changes in healthcare have driven institutions to make medical records increasingly transparent. As patients have begun to question and request changes to their Problem Lists, clinicians have come to face the ever more frequent challenge of discerning which changes to make and which to refuse. Now clinicians and patients together choose the list of problems that represent the patient's current state of health and illness. As the physician's role slides closer to consultant and the medical paternalism of the twentieth century falls further into the background of our technology-infused present, who holds the power of delineating a patient's clinical identity? This paper examines the ethical and practical dimensions of this question and proposes a research agenda that aims to answer it. Such explorations are essential to ensuring that the physician remains relevant to patient's notions of health, illness, intervention, and healing.
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Affiliation(s)
- Amy S Porter
- Center for Comprehensive Care, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | | | - Kristin A Englund
- Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Eric Kodish
- Pediatrics Institute, Cleveland Clinic Children's Hospital, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio, USA
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Kiger ME, Meyer HS, Varpio L. "It is you, me on the team together, and my child": Attending, resident, and patient family perspectives on patient ownership. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:101-109. [PMID: 33263864 PMCID: PMC7952476 DOI: 10.1007/s40037-020-00635-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/27/2020] [Accepted: 11/05/2020] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Patient ownership is an important element of physicians' professional responsibility, but important gaps remain in our understanding of this concept. We sought to develop a theory of patient ownership by studying it in continuity clinics from the perspective of residents, attending physicians, and patients. METHODS Using constructivist grounded theory, we conducted 27 semi-structured interviews of attending physicians, residents, and patient families within two pediatric continuity clinics to examine definitions, expectations, and experiences of patient ownership from March-August 2019. We constructed themes using constant comparative analysis and developed a theory describing patient ownership that takes into account a diversity of perspectives. RESULTS Patient ownership was described as a bi-directional, relational commitment between patient/family and physician that includes affective and behavioral components. The experience of patient ownership was promoted by continuity of care and constrained by logistical and other systems-based factors. The physician was seen as part of a medical care team that included clinic staff and patient families. Physicians adjusted expectations surrounding patient ownership for residents based on scheduling limitations. DISCUSSION Our theory of patient ownership portrays the patient/family as an active participant in the patient-physician relationship, rather than a passive recipient of care. While specific expectations and tasks will vary based on the practice setting, our findings reframe the way in which patient ownership can be viewed and studied in the future by attending to a diversity of perspectives.
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Affiliation(s)
- Michelle E Kiger
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
- Department of Pediatrics, Wright-Patterson Medical Center, Dayton, OH, USA.
| | - Holly S Meyer
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Laging BL, Nay R, Bauer M, Laging R, Walker K, Kenny A. Advance care planning practices in the nursing home setting: A secondary analysis. THE GERONTOLOGIST 2021; 61:1307-1316. [PMID: 33624074 DOI: 10.1093/geront/gnab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Advance care planning is intended to support resident's preferences regarding health decisions, even when they can no longer participate. Little is known about the power discourses influencing how residents, family-members, and healthcare workers engage in advance care planning and how advance care directives are used if conflict arises. A large critical ethnographic study was conducted exploring decision making when a resident's health deteriorates in the nursing home setting. Advance care planning practices were not the focus of the original study, but the richness of the data warranted further exploration. A new research question was developed to inform a secondary analysis: How does advance care planning influence the relationship between resident values and clinical expertise when determining a direction of care at the time of a resident deterioration? RESEARCH DESIGN AND METHODS A secondary analysis of data from an ethnographic study involving 184 hours of participatory observation, 40 semi-structured interviews and advance care planning policies and document review undertaken in in two nursing homes in Melbourne, Australia. RESULTS Advance care planning may result in inaccurate documentation of residents' preferences and devalue clinical decision-making and communication with residents and family-members at the time of deterioration. DISCUSSION AND IMPLICATIONS Advance care planning may contribute towards a reductionist approach to decision-making. There is an urgent need for the development of evidence-based policy and legislation to support residents, families, and healthcare workers to make appropriate decisions, including withholding invasive treatment when a resident deteriorates.
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Affiliation(s)
- Bridget L Laging
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Rhonda Nay
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Michael Bauer
- Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Victoria Australia
| | - Rohan Laging
- Alfred Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Katie Walker
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Amanda Kenny
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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Myers M, Bloss C. The Need for Education and Clinical Best Practice Guidelines in the Era of Direct-to-Consumer Genomic Testing. JMIR MEDICAL EDUCATION 2020; 6:e21787. [PMID: 33289492 PMCID: PMC7755527 DOI: 10.2196/21787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/29/2020] [Accepted: 10/26/2020] [Indexed: 06/12/2023]
Abstract
Many people share the results of their direct-to-consumer personal genomic testing (DTC-PGT) within the primary care setting, seeking interpretation of and counsel about the results. However, most primary care physicians (PCPs) are not trained to interpret and communicate about DTC-PGT results. New guidelines must be developed to help PCPs maximize the potential of emerging DTC-PGT technologies.
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Affiliation(s)
- Madeleine Myers
- University of California San Diego, La Jolla, CA, United States
| | - Cinnamon Bloss
- University of California San Diego, La Jolla, CA, United States
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Myskja BK, Steinsbekk KS. Personalized medicine, digital technology and trust: a Kantian account. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:577-587. [PMID: 32888101 PMCID: PMC7538445 DOI: 10.1007/s11019-020-09974-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 05/05/2023]
Abstract
Trust relations in the health services have changed from asymmetrical paternalism to symmetrical autonomy-based participation, according to a common account. The promises of personalized medicine emphasizing empowerment of the individual through active participation in managing her health, disease and well-being, is characteristic of symmetrical trust. In the influential Kantian account of autonomy, active participation in management of own health is not only an opportunity, but an obligation. Personalized medicine is made possible by the digitalization of medicine with an ensuing increased tailoring of diagnostics, treatment and prevention to the individual. The ideal is to increase wellness by minimizing the layer of interpretation and translation between relevant health information and the patient or user. Arguably, this opens for a new level of autonomy through increased participation in treatment and prevention, and by that, increased empowerment of the individual. However, the empirical realities reveal a more complicated landscape disturbed by information 'noise' and involving a number of complementary areas of expertise and technologies, hiding the source and logic of data interpretation. This has lead to calls for a return to a mild form of paternalism, allowing expertise coaching of patients and even withholding information, with patients escaping responsibility through blind or lazy trust. This is morally unacceptable, according to Kant's ideal of enlightenment, as we have a duty to take responsibility by trusting others reflexively, even as patients. Realizing the promises of personalized medicine requires a system of institutional controls of information and diagnostics, accessible for non-specialists, supported by medical expertise that can function as the accountable gate-keeper taking moral responsibility required for an active, reflexive trust.
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Affiliation(s)
- Bjørn K Myskja
- Department of Philosophy and Religious Studies, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.
| | - Kristin S Steinsbekk
- Department of Biomedical Laboratory Science, Norwegian University of Science and Technology - NTNU, Trondheim, Norway
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Kilbride M, Joffe S, Lynch HF. Prescription Requirements and Patient Autonomy: Considering an Over-the-Counter Default. Hastings Cent Rep 2020; 50:15-26. [PMID: 33315251 PMCID: PMC7797306 DOI: 10.1002/hast.1195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
When new drugs are approved by the Food and Drug Administration, the default assumption is that they will be available by prescription only, safe for use exclusively under clinical supervision. The paternalism underlying this default must be interrogated in order to ensure appropriate respect for patient autonomy. Upon closer inspection, prescription requirements are justified when nonprescription status would risk harm to third parties and when a large segment of the population would struggle to exercise their autonomy in using a drug safely and effectively on their own. Although these justifications can support prescription status for many drugs, we propose that reversing the FDA's current default to instead begin with a presumption in favor of over-the-counter status is the best way to avoid interference with valid claims of patient autonomy. Under this approach, a range of drug products could be considered for an OTC switch, including oral contraceptives, statins, and HIV-prevention drugs.
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Characteristics and Outcomes of Patients who Refuse Intravenous Thrombolysis for Acute Ischemic Stroke - The San Diego Experience. J Stroke Cerebrovasc Dis 2020; 29:105137. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022] Open
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