Talking the Talk: Enhancing Clinical Ethics with Health Literacy Best Practices

A Community-Based Participatory Framework to Co-Develop Patient Education Materials (PEMs) for Rare Diseases: A Model Transferable across Diseases

At least 50% of chronic disease patients don't follow their care plans, leading to lower health outcomes and higher medical costs. Providing Patient Education Materials (PEMs) to individuals living with a disease can help to overcome these problems. PEMs are especially beneficial for people suffering from multisystemic and underrecognized diseases, such as rare diseases. Congenital disorders of glycosylation (CDG) are ultra-rare diseases, where a need was identified for PEMs in plain language that can clearly explain complex information. Community involvement in the design of PEMs is extremely important for diseases whose needs are underserved, such as rare diseases; however, attempts to involve lay and professional stakeholders are lacking. This paper presents a community-based participatory framework to co-create PEMs for CDG, that is transferable to other diseases. A literature review and questionnaire were performed, and only four articles describing the development of PEMS for rare diseases have been found, which demonstrates a lack of standardized approaches. The framework and PEMs were co-developed with CDG families and will be crucial in increasing health literacy and empowering families. We will close a gap in the creation of PEMs for CDG by delivering these resources in lay language in several languages.

A Participatory Framework for Plain Language Clinical Management Guideline Development

BACKGROUND

Clinical management guidelines (CMGs) are decision support tools for patient care used by professionals, patients, and family caregivers. Since clinical experts develop numerous CMGs, their technical language hinders comprehension and access by nonmedical stakeholders. Additionally, the views of affected individuals and their families are often not incorporated into treatment guidelines. We developed an adequate methodology for addressing the needs and preferences of family and professional stakeholders regarding CMGs, a recently developed protocol for managing congenital disorders of glycosylation (CDG), a family of rare metabolic diseases. We used the CDG community and phosphomannomutase 2 (PMM2)-CDG CMGs as a pilot to test and implement our methodology.

RESULTS

We listened to 89 PMM2-CDG families and 35 professional stakeholders and quantified their CMG-related needs and preferences through an electronic questionnaire. Most families and professionals rated CMGs as relevant (86.5% and 94.3%, respectively), and valuable (84.3% and 94.3%, respectively) in CDG management. The most identified challenges were the lack of CMG awareness (50.6% of families) and the lack of plain language CMG (39.3% of professionals). Concordantly, among families, the most suggested solution was involving them in CMG development (55.1%), while professionals proposed adapting CMGs to include plain language (71.4%). Based on these results, a participatory framework built upon health literacy principles was created to improve CMG comprehension and accessibility. The outputs are six complementary CMG-related resources differentially adapted to the CDG community's needs and preferences, with a plain language PMM2-CDG CMG as the primary outcome. Additionally, the participants established a distribution plan to ensure wider access to all resources.

CONCLUSIONS

This empowering, people-centric methodology accelerates CMG development and accessibility to all stakeholders, ultimately improving the quality of life of individuals living with a specific condition and raising the possibility of application to other clinical guidelines.

Health literacy measurement: embracing diversity in a strengths-based approach to promote health and equity, and avoid epistemic injustice

Definitions of health literacy have evolved from notions of health-related literacy to a multidimensional concept that incorporates the importance of social and cultural knowledge, practices and contexts. This evolution is evident in the development of instruments that seek to measure health literacy in different ways. Health literacy measurement is important for global health because diverse stakeholders, including the WHO, use these data to inform health practice and policy, and to understand sources of inequity. In this Practice paper, we explore the potential for negative consequences, bias and epistemic injustice to occur when health literacy instruments are used across settings without due regard for the lived experiences of people in various contexts from whom data are collected. A health literacy measurement approach that is emic-sensitive, strengths based and solution oriented is needed to minimise biased data interpretation and use and to avoid epistemic injustice.

Health Literacy in the Context of Implant Care-Perspectives of (Prospective) Implant Wearers on Individual and Organisational Factors

The continuous development of medical implants offers various benefits for persons with chronic conditions but also challenges an individual’s, and the healthcare system’s, ability to deal with technical innovation. Accessing and understanding new information, navigating healthcare, and appraising the role of the implant in body perceptions and everyday life requires health literacy (HL) of those affected as well as an HL-responsive healthcare system. The interconnectedness of these aspects to ethically relevant values such as health, dependence, responsibility and self-determination reinforces the need to address HL in implant care. Following a qualitative approach, we conducted group discussions and a diary study among wearers of a cochlear, glaucoma or cardiovascular implant (or their parents). Data were analysed using the documentary method and grounded theory. The data reveal the perceptions of implant wearers regarding the implant on (1) the ability to handle technical and ambiguous information; (2) dependence and responsibility within the healthcare system; and (3) the ethical aspects of HL. Knowing more about the experiences and values of implant wearers is highly beneficial to develop HL from an ethical perspective. Respective interventions need to initially address ethically relevant values in counselling processes and implant care.

Health science knowledge translation: Critical appraisal of online physical activity promotion material

Limited research exists on how often health behavior theory concepts, principles, and techniques are embedded in the design of material to promote physical activity and exercise, such as persuasive communications disseminated via the Internet. This cross-sectional study examined 139 web articles on physical activity and exercise. We assessed how often article messages targeted recommended motivational determinants of health behavior: that is, outcome expectancy, self-efficacy, and self-regulation. Moreover, exploratory analyses were performed, which compared patterns in article messages by organization type. Results showed the largest categories were other messages and self-efficacy, each representing nearly one-third of article messages. The frequency that article messages targeted motivational determinants of physical activity and exercise differed by organization type. Our results suggest web articles that could promote physical activity and exercise motivation exist; however, they can be better constructed to meet the needs of people. For example, over half of article messages targeted a recommended motivational determinant, but the least targeted determinant was self-regulation. We present steps nurse educators and clinicians may take to improve the design or selection of physical activity and exercise promotion material.

Readability Analysis of the American Society of Ophthalmic Plastic & Reconstructive Surgery Patient Educational Brochures

INTRODUCTION

Previous studies have shown patient education material (PEM) in ophthalmology has been written at levels exceeding appropriate reading levels. However, information for readability in the field of oculoplastics remains limited. The aim of this study was to evaluate the readability of patient educational brochures from the American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS).

METHODS

Patient educational brochures from ASOPRS were analyzed for readability. The body of text from all 18 ASOPRS patient brochures was analyzed by ten validated tests for English readability assessment: Flesch Reading Ease Test (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index (CLI), Gunning Fog Index (GFI), New Dale-Chall Readability (NDC), FORCAST, Fry Graph Readability (FG), Raygor Readability Estimate (RRE), and New Fog Count (NFC).

RESULTS

The mean (± SD) readability scores from the 18 ASOPRS patient brochures were 48 (4.3), 11.0 (0.8), 13.0 (0.7), 11.7 (0.8), 13.6 (0.9), 11.3 (0.8), 11.1 (0.5), 12.1 (1.5), 12.2 (1.0), and 10.6 (1.3) for FRE, FKGL, SMOG, CLI, GFI, NDC, FORCAST, FG, RRE, and NFC, respectively. All ten of the mean readability scores were above the recommended reading levels.

CONCLUSIONS

These findings show that the average patient may have difficulty understanding educational information provided by ASOPRS patient brochures, thereby hindering their ability to make informed decisions on their healthcare. Revision with readability as a primary goal, with input from patients and caregivers, may be necessary to improve health literacy among patients who seek oculoplastic care.

Point-of-care used in the treatment of older patients with cancer. The perception and experience of nurses

BACKGROUND

Nursing tasks are changing as the proportion of people over the age of 65 years is increasing and is expected to double over the next four decades. New innovative solutions such as Point of Care Treatment (POCT) are being tested in oncological settings in order to optimise treatment, and this changes the nurse management in oncology. There is a need to explore oncology nurses' perception and experience when implementing the innovations in order to understand the implications for nursing and the treatment of older patients with cancer.

METHODS

Qualitative research with face to face interviews with nurses working in oncology. Sample size (Mean = 8). Data were recorded verbatim, transcribed, and thematic analysis used.

RESULTS

Three themes were identified: a, A great advantage in nursing, b, Change of practice in nursing care, c, Challenges in shifting roles. A majority of the participants had the perception that POCT treatment was an advantage not only for the nursing profession but for the older patients in cancer treatment as well. Monitoring the older patients with cancer at home would prevent them from accessing the hospital and get exposed to viral infections as well as saving them the journey to the hospital. Involvement from relatives, clear communication and management of the device and data transferred is essential.

CONCLUSIONS

The use of POCT in oncology will shift the nurses' tasks on the ward as well as improve treatment for older patients with cancer.

The personalised discharge letter: the experience of patients and parents from the Filadelfia Epilepsy Hospital

OBJECTIVE

To examine the experience of a discharge letter received by patients suffering from epilepsy and parents with children who suffer from epilepsy.

DESIGN

Qualitative research inspired by a phenomenological methodology approach.

SETTING

Face-to-face interviews with patients and parents of epileptic children in their own homes.

SAMPLE

Participants (total n = 11).

METHODS

In-depth interviews were recorded verbatim, transcribed and analysed.

RESULTS

Two themes were identified: (i) it was written about me and (ii) a sense of feeling secure. By being discharged with a personalised letter, the participants felt seen and heard. The discharge letter enabled them to contact their doctor and the Filadelfia hospital more efficiently if needed. Parents indicated that the discharge letter bridged the uncertainty that they often experienced when dealing with the child's school or authorities in general.

CONCLUSIONS

The discharge letter enables the participants to make the transition into everyday life with the best and most up-to-date information about themselves and their current condition as an epilepsy patient. The discharge letter empowers the patient or parents to face everyday life. The discharge becomes a kind of passport to the outside world when encountering the general practitioner, the school or other circumstances where the patient engages. The discharge letter becomes a patient-centred tool proving that enhanced communication and understanding between healthcare professionals, patients and parents succeeds. This example could be transferable to other hospitals to heighten the patient's self-efficacy and quality of life after being discharged from the hospital.