1
|
Janmyr E, Grossmann B, Nilsson A. Every Second Patient Does Not Fully Understand Written Preprocedure Information: An Explorative Study About Functional Health Literacy. J Perianesth Nurs 2024:S1089-9472(24)00050-9. [PMID: 38958625 DOI: 10.1016/j.jopan.2024.02.004] [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: 11/03/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To investigate the self-perceived functional health literacy (FHL) of patients who underwent advanced endoscopic treatment, explore whether FHL could explain aspects of patients' perioperative experiences, and determine whether patients read the provided patient information. DESIGN A prospective cross-sectional explorative study. METHODS One hundred patients who underwent endoscopic bile duct intervention were enrolled and asked to answer the Swedish version of the FHL Scale and their perioperative experiences of the intervention. Along with procedural data, all data were analyzed for group comparisons; high or low FHL. FINDINGS The study included a total of 100 patients, with half of them rating their FHL as problematic or inadequate (low FHL). Among those who perceived their FHL as inadequate, a majority had not read the provided information before the procedure. Patients with problematic or inadequate FHL experienced perioperative anxiety and pain more frequently than those with sufficient FHL (high FHL). CONCLUSIONS This study supports previous research on the association between low FHL and patients' well-being. To better meet patients' information needs, it is crucial for nurse anesthetists and other health care providers to have knowledge about FHL. Additionally, the study highlights the importance of using alternative and more effective means of delivering information to patients.
Collapse
Affiliation(s)
- Emelie Janmyr
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Anesthesia and Intensive Care, Region Östergötland, Linköping, Sweden
| | - Benjamin Grossmann
- Department of Anesthesia and Intensive Care, Region Blekinge, Karlskrona, Sweden
| | - Andreas Nilsson
- Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Anesthesia and Intensive Care, Region Östergötland, Linköping, Sweden.
| |
Collapse
|
2
|
Mirzaie AA, Hanson NC, Neal D, Berceli SA, Back MR, Scali ST, Huber TS, Upchurch GR, Shah SK. Limited health literacy is common among vascular surgery patients. Surgery 2024; 175:1600-1605. [PMID: 38461121 DOI: 10.1016/j.surg.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/08/2024] [Accepted: 02/06/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Health literacy is a crucial aspect of informed decision-making, and limited health literacy has been associated with worse health care outcomes. To date, health literacy has not been examined in vascular surgery patients. Therefore, we conducted a prospective observational study to determine the prevalence and factors associated with poor health literacy in vascular surgery patients. METHODS The Newest Vital Sign (Pfizer, New York, NY), a validated instrument, was used to appraise the health literacy of 150 patients who visited the outpatient vascular clinic at UF Health Shands Hospital between April 2022 and August 2022. Patients who scored a 4 (out of 6) or higher were classified as having adequate health literacy. Each study participant also completed a sociodemographic questionnaire. RESULTS In total, 82 out of the 150 (54%) patients we screened had limited health literacy. The prevalence of limited health literacy varied and was independently associated with increased age (odds ratio 1.06; 95% [1.02 to 1.10], P = .004), having not attended college (high school diploma versus college+ odds ratio 3.5; 95% [1.26 to 10.1], P = .018), and African American race (odds ratio 5.3; 95% [1.59 to 22.3], P = .012). A total of 83% of African American patients had limited health literacy, compared to 49% of Asian and White patients. CONCLUSION Most vascular surgery patients have limited health literacy. Increased age, fewer years of education, and African American race were associated with limited health literacy. Physicians caring for patients with lower health literacy should investigate and use communication strategies tailored to patients with limited health literacy.
Collapse
Affiliation(s)
- Amin A Mirzaie
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Nancy C Hanson
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Dan Neal
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Scott A Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Martin R Back
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Gilbert R Upchurch
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Samir K Shah
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL.
| |
Collapse
|
3
|
Mertz K, Eppler S, Shah RF, Yao J, Steffner R, Safran M, Hu S, Chou L, Amanatullah DF, Kamal RN. Health Literacy and Patient Participation in Shared Decision-Making in Orthopedic Surgery. Orthopedics 2022; 45:227-232. [PMID: 35394383 DOI: 10.3928/01477447-20220401-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The influence of health literacy on involvement in decision-making in orthopedic surgery has not been analyzed and could inform processes to engage patients. The goal of this study was to determine the relationship between health literacy and the patient's preferred involvement in decision-making. We conducted a cross-sectional observational study of patients presenting to a multispecialty orthopedic clinic. Patients completed the Literacy in Musculoskeletal Problems (LiMP) survey to evaluate their health literacy and the Control Preferences Scale (CPS) survey to evaluate their preferred level of involvement in decision-making. Statistical analysis was performed with Pearson's correlation and multivariable logistic regression. Thirty-seven percent of patients had limited health literacy (LiMP score <6). Forty-eight percent of patients preferred to share decision-making with their physician equally (CPS score=3), whereas 38% preferred to have a more active role in decision-making (CPS score≤2). There was no statistically significant correlation between health literacy and patient preference for involvement in decision-making (r=0.130; P=.150). Among patients with orthopedic conditions, there is no significant relationship between health literacy and preferred involvement in decision-making. Results from studies in other specialties that suggest that limited health literacy is associated with a preference for less involvement in decision-making are not generalizable to orthopedic surgery. Efforts to engage patients to be informed and participatory in decision-making through the use of decision aids and preference elicitation tools should be directed toward variation in preference for involvement in decision-making, but not toward patient health literacy. [Orthopedics. 2022;45(4):227-232.].
Collapse
|
4
|
van Dulmen S, Roodbeen R, Schulze L, Prantl K, Rookmaaker M, van Jaarsveld B, Noordman J, Abrahams A. Practices and perspectives of patients and healthcare professionals on shared decision-making in nephrology. BMC Nephrol 2022; 23:258. [PMID: 35864466 PMCID: PMC9306155 DOI: 10.1186/s12882-022-02887-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Given the complexity and variety in treatment options for advanced chronic kidney disease (CKD), shared decision-making (SDM) can be a challenge. SDM is needed for making decisions that best suit patients’ needs and their medical and living situations. SDM might be experienced differently by different stakeholders. This study aimed to explore clinical practice and perspectives on SDM in nephrology from three angles: observers, patients and healthcare professionals (HCPs). Methods An explanatory sequential mixed methods design was used. First, in the quantitative part of the study, outpatient consultations with patients with advanced chronic kidney disease (eGFR < 20 ml/min) were video recorded and SDM was assessed using the OPTION5 instrument. Subsequently, in the qualitative part, patients and HCPs reflected on their own SDM behaviour during individual stimulated recall interviews which were analysed using deductive thematic content analysis. Results Twenty nine consultations were recorded and observed in seven hospitals. The mean SDM score was 51 (range 25–80), indicating that SDM was applied to a moderate extent. The stimulated recall interviews with patients showed that they rely on the information provision and opinion of HCPs, expect consistency and support, and desire a proactive role. They also expect to be questioned by the HCP about their SDM preferences. HCPs said they were willing to incorporate patients’ preferences in SDM, as long as there are no medical contraindications. They also prefer patients to take a prominent role in SDM. HCPs ascribe various roles to themselves in supporting patients’ decision-making. Conclusions Although SDM was applied by HCPs to a moderate extent, improvement is needed, especially in helping patients get the information they need and in making sure that every patient is involved in SDM. This is even more important given the complex nature of the disease and the relatively high prevalence of limited health literacy among patients with chronic kidney disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02887-4.
Collapse
Affiliation(s)
- Sandra van Dulmen
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500, Utrecht, BN, Netherlands. .,Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, Netherlands. .,Faculty of Caring Science, Working Life and Social Welfare, University of Borås, Borås, Sweden.
| | - Ruud Roodbeen
- Breuer&Intraval, Research and Consultancy, Groningen, Netherlands
| | - Lotte Schulze
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500, Utrecht, BN, Netherlands
| | - Karen Prantl
- Dutch Kidney Patients Association, Bussum, Netherlands
| | - Maarten Rookmaaker
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Brigit van Jaarsveld
- Department of NephrologyAmsterdam UMC, Vrije Universiteit Amsterdam location, Amsterdam, Netherlands.,Diapriva Dialysis Center, Amsterdam, Netherlands
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500, Utrecht, BN, Netherlands
| | - Alferso Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
5
|
Jaensson M, Stenberg E, Liang Y, Nilsson U, Dahlberg K. Validity and reliability of the Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale in patients undergoing bariatric surgery in Sweden: a prospective psychometric evaluation study. BMJ Open 2021; 11:e056592. [PMID: 34848528 PMCID: PMC8634233 DOI: 10.1136/bmjopen-2021-056592] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim was to psychometrically test and evaluate the Swedish functional health literacy scale and the Swedish communicative and critical health literacy scale in patients undergoing bariatric surgery. DESIGN A prospective cross-sectional psychometric study. SETTING Patients from three bariatric centres in Sweden were consecutively included in this study. PARTICIPANTS A total of 704 patients undergoing bariatric surgery filled in the questionnaires preoperatively. Inclusion criteria were scheduled for primary bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) and greater than 17 years, proficiency in Swedish. PRIMARY AND SECONDARY MEASURES Psychometric outcomes of the Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale. RESULTS There was a higher proportion of females (74.4%, n=523) to males (25.6%, n=180). The mean age was 42 years (SD 11.5). Limited functional health literacy and limited communicative and critical health literacy (including both inadequate and problematic health literacy) was reported in 55% (n=390) and 40% (n=285), respectively. Cronbach alpha for the Swedish Functional Health Literacy scale was α=0.86 and for the Swedish Communicative and Critical Health Literacy scale, α=0.87. Construct validity showed weak to negative correlations between the Swedish Functional Health Literacy scale and income, education and SF-36/RAND36 summary scores. Confirmatory factor analysis showed a one-factor solution for the Swedish Functional Health Literacy scale and a two-factor solution for the Swedish Communicative and Critical Health Literacy scale. CONCLUSIONS The Swedish Functional Health Literacy scale and the Swedish Communicative and Critical Health Literacy scale are valid and reliable to use for patients undergoing bariatric surgery in a Swedish context. Measuring dimensions of health literacy can be used as a guide for the development of health literacy friendly patient information in patients undergoing bariatric surgery.
Collapse
Affiliation(s)
- Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro university, Örebro, Sweden
| | - Yuli Liang
- Department of Statistics, School of Business, Örebro University, Örebro, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Perioperative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
6
|
Roodbeen RTJ, Noordman J, Boland G, van Dulmen S. Shared Decision Making in Practice and the Perspectives of Health Care Professionals on Video-Recorded Consultations With Patients With Low Health Literacy in the Palliative Phase of Their Disease. MDM Policy Pract 2021; 6:23814683211023472. [PMID: 34277951 PMCID: PMC8255606 DOI: 10.1177/23814683211023472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/14/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction. An important goal of palliative care is improving the quality of life of patients and their partners/families. To attain this goal, requirements and preferences of patients need to be discussed, preferably through shared decision making (SDM). This enhances patient autonomy and patient-centeredness, requiring active participation by patients. This is demanding for palliative patients, and even more so for patients with limited health literacy (LHL). This study aimed to examine SDM in practice and assess health care professionals’ perspectives on their own SDM. Methods. An explanatory sequential mixed methods design was used. Video recordings were gathered cross-sectionally of palliative care consultations with LHL patients (n = 36) conducted by specialized palliative care clinicians and professionals integrating a palliative approach. The consultations were observed for SDM using the OPTION5 instrument. Potential determinants of SDM were examined using multilevel analysis. Sequentially, stimulated recall interviews were conducted assessing the perspectives of professionals on their SDM (n = 19). Interviews were examined using deductive thematic content analysis. Results. The average SDM score in practice was moderate, varying greatly between professionals, as shown by the multilevel analysis and by varying degrees of perceived patient involvement in SDM mentioned in the interviews. To improve this, professionals recommended 1) continuously discussing all options with patients, 2) allowing time for patients to talk, and 3) using strategic timing for involving patients in SDM. Discussion. The implementation of SDM for people with LHL in palliative care varies in quality and needs improvement. SDM needs to be enhanced in this care domain because decisions are complex and demanding for LHL patients. Future research is needed that focuses on supporting strategies for comprehensible SDM, best practices, and organizational adaptations.
Collapse
Affiliation(s)
- Ruud T J Roodbeen
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| |
Collapse
|
7
|
MacMahon A, Cody EA, Caolo K, Henry JK, Drakos MC, Demetracopoulos CA, Savenkov A, Ellis SJ. Association Between Baseline PROMIS Scores, Patient-Provider Communication Factors, and Musculoskeletal Health Literacy on Patient and Surgeon Expectations in Foot and Ankle Surgery. Foot Ankle Int 2021; 42:192-199. [PMID: 33019799 PMCID: PMC8299837 DOI: 10.1177/1071100720959017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Various factors may affect differences between patient and surgeon expectations. This study aimed to assess associations between patient-reported physical and mental status, patient-surgeon communication, and musculoskeletal health literacy with differences in patient and surgeon expectations of foot and ankle surgery. METHODS Two hundred two patients scheduled to undergo foot or ankle surgery at an academic hospital were enrolled. Preoperatively, patients and surgeons completed the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey. Patients also completed Patient-Reported Outcomes Measurement Information System (PROMIS) scores in Physical Function, Pain Interference, Pain Intensity, Depression, and Global Health. Patient-surgeon communication and musculoskeletal health literacy were assessed via the modified Patients' Perceived Involvement in Care Scale (PICS) and Literacy in Musculoskeletal Problems (LiMP) questionnaire, respectively. RESULTS Greater differences in patient and surgeon overall expectations scores were associated with worse scores in Physical Function (P = .003), Pain Interference (P = .001), Pain Intensity (P = .009), Global Physical Health (P < .001), and Depression (P = .009). A greater difference in the number of expectations between patients and surgeons was associated with all of the above (P ≤ .003) and with worse Global Mental Health (P = .003). Patient perceptions of higher surgeons' partnership building were associated with a greater number of patient than surgeon expectations (P = .017). There were no associations found between musculoskeletal health literacy and differences in expectations. CONCLUSION Worse baseline patient physical and mental status and higher patient perceptions of provider partnership building were associated with higher patient than surgeon expectations. It may be beneficial for surgeons to set more realistic expectations with patients who have greater disability and in those whom they have stronger partnerships with. Further studies are warranted to understand how modifications in patient and surgeon interactions and patient health literacy affect agreement in expectations of foot and ankle surgery. LEVEL OF EVIDENCE Level II, prospective comparative series.
Collapse
Affiliation(s)
- Aoife MacMahon
- Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065
| | - Elizabeth A. Cody
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72 Street, New York, NY 10021
| | - Kristin Caolo
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72 Street, New York, NY 10021
| | - Jensen K. Henry
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72 Street, New York, NY 10021
| | - Mark C. Drakos
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72 Street, New York, NY 10021
| | | | - Aleksander Savenkov
- Department of Healthcare Policy and Research, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065
| | - Scott J. Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 523 East 72 Street, New York, NY 10021
| |
Collapse
|
8
|
Health Literacy and Decisional Preferences in Hand Surgery. J Hand Surg Am 2021; 46:70.e1-70.e8. [PMID: 33012617 DOI: 10.1016/j.jhsa.2020.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 06/13/2020] [Accepted: 08/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients increasingly prefer to be involved in health decisions. Shared decisions are associated with less decisional conflict and improved satisfaction. This study examines the relationship between health literacy and preferred decision-making role in patients seeking care for hand problems. METHODS We performed a cross-sectional study of 226 patients who were presenting to a hand service for the first time, who were older than 18 years, not pregnant, and fluent and literate in English. Patient demographic information, work status, and education level were collected from the patient. Diagnosis and insurance status were collected from the medical record. Pain interference, depression, and upper extremity function were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires administered with computerized adaptive testing. Health literacy and preferred decision-making role were assessed using the Newest Vital Sign Test and Control Preference Scale, respectively. Discordance between preferred and actual decision-making role was assessed using the Control Preference Scale statements with the words "I prefer" omitted. Bivariate and multivariable logistic regressions were used to assess for factors associated with preferred decision-making role and discordance. RESULTS Seventy-eight percent of patients preferred an active or collaborative, rather than a passive, role in decision making. Sixty-one percent felt they had achieved their preferred role. Preferred role and achievement of that role were not associated with health literacy, age, race, insurance, work status, diagnosis, pain intensity, symptoms of depression, and magnitude of self-reported activity limitations. More years of education was associated with a more active preferred decision-making role but not with obtaining that preferred role. CONCLUSIONS Most people want to participate in decisions about their care even if they have low health literacy. CLINICAL RELEVANCE Hand specialists can seek strategies to help people understand and participate in care decisions.
Collapse
|
9
|
Shared Decision-making in Orthopaedic Surgery. J Am Acad Orthop Surg 2020; 28:e1032-e1041. [PMID: 32925380 DOI: 10.5435/jaaos-d-20-00556] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/20/2020] [Indexed: 02/01/2023] Open
Abstract
Shared decision-making (SDM) is the process by which the physician and the patient collaborate to arrive at the evidence-based treatment that best aligns with the patient's individual goals of care. The implementation of SDM practices is especially important when an invasive surgical procedure is among the treatment options. Ideally, the variation in the patient treatment choice would mirror the variability in patient goals rather than variation in a physician's ability to communicate effectively. Potentially aiding in these communication efforts, decision aids are tools gaining popularity for their ability to help physicians facilitate the SDM process with patients. This article is intended to give the practicing orthopaedic surgeon an understanding of the concept of SDM and how it can improve physician-patient communication. We will explore the key elements of SDM, attendant benefits, indications, and barriers to implementation and propose steps to begin the incorporation of SDM into practice.
Collapse
|
10
|
Chang ME, Baker SJ, Dos Santos Marques IC, Liwo AN, Chung SK, Richman JS, Knight SJ, Fouad MN, Gakumo CA, Davis TC, Chu DI. Health Literacy in Surgery. Health Lit Res Pract 2020; 4:e46-e65. [PMID: 32053207 PMCID: PMC7015264 DOI: 10.3928/24748307-20191121-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/22/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Low health literacy is associated with poor health outcomes in many chronic diseases and may have an important role in determining surgical outcomes. This study aims to comprehensively review the current state of science on adult health literacy in surgery and to identify knowledge gaps for future research. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was conducted to identify all studies from January 2002 through May 2018 that used validated instruments to assess health literacy among adult patients undergoing surgery. Studies were assessed for quality using the Newcastle-Ottawa scale and evaluated on findings by their focus on identifying health literacy levels, understanding associations with surgical outcomes, and/or developing interventions to address low health literacy. Key Results: There were 51 studies on health literacy with data from 22,139 patients included in this review. Low health literacy was present in more than one-third of surgical patients (34%, interquartile range 16%–50%). The most commonly used validated instrument for assessment of health literacy in the surgical population was the Newest Vital Sign. Most studies were focused on identifying the prevalence of low health literacy within a surgery population (84%, n = 43). Few studies focused on understanding the association of health literacy to surgical outcomes (12%, n = 6) and even fewer studies developed interventions to address health literacy (4%, n = 2). Discussion: Low health literacy is common among surgical patients. Important opportunities exist to better understand the role of health literacy in determining surgical outcomes and to develop more health literacy-sensitive models of surgical care. [HLRP: Health Literacy Research and Practice. 2020;4(1):e45–e65.] Plain Language Summary: Health literacy has not been well-studied in surgery but likely plays an important role. In this article, we reviewed all current research on health literacy in surgery to help us understand where we are at and where we need to go. We found that low health literacy is common and we need more ways to address it in surgery.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Daniel I. Chu
- Address correspondence to Daniel I. Chu, MD, Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, KB 428, 1720 2nd Avenue S., Birmingham, AL 35294-0016;
| |
Collapse
|
11
|
Expression of Concern. CORR Insights®: Patients With Limited Health Literacy Have Similar Preferences but Different Perceptions in Shared Decision-making for Carpal Tunnel Release. Clin Orthop Relat Res 2020; 478:2688. [PMID: 33044312 PMCID: PMC7572008 DOI: 10.1097/corr.0000000000001504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
12
|
[RETRACTED]Retraction Notice. Patients With Limited Health Literacy Have Similar Preferences but Different Perceptions in Surgical Decision-making for Carpal Tunnel Release. Clin Orthop Relat Res 2020; 478:2685. [PMID: 33093385 PMCID: PMC7571932 DOI: 10.1097/corr.0000000000001501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
13
|
The difference in knowledge and attitudes of using mobile health applications between actual user and non-user among adults aged 50 and older. PLoS One 2020; 15:e0241350. [PMID: 33108792 PMCID: PMC7591083 DOI: 10.1371/journal.pone.0241350] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022] Open
Abstract
Background Despite the great benefits of mobile health applications (mHAs) in managing non-communicable diseases (NCDs) internationally, studies have documented general challenges to broad adoption of mHAs among older age groups. By focusing on broad adoption, these studies have been limited in their evaluation of adults aged 50 and older who have high risk of NCDs and can benefit the most from the functionalities provided by mHAs. Objective This study aims to evaluate the knowledge, self-confidence, perceived benefits, and barriers of using mHAs depending on experience with mHAs among adults aged 50 and older. Furthermore, we aim to identify the factors associated with the actual use of mHAs. Methods We conducted a cross-sectional survey at a single tertiary hospital in Seoul, Korea, between May 1 and May 31, 2018. Of the 625 participants who were contacted, 323 participants were granted full inclusion to the study. We compared demographics, knowledge, self-confidence, and perceived benefits and barriers by experience with using mHAs, then performed logistic regression to identify the factors associated with mHA use. Results Among the participants, 64.1% (N = 207) had experience using mHAs. Those in the experienced group were more likely to have more than college education (55.1% vs. 27.5%, P < 0.001) and to report a higher monthly income (≥ $7,000, 22.7% vs. 18.1%, P = 0.05) than their less-experienced counterparts. Although the experienced group was more likely to have higher self-confidence in using mHAs, about half of the study participants, including people with experience using mHAs, did not have appropriate knowledge of mobile technology. With adjusted logistic model, higher educated (adjusted PR (aPR) = 1.53, 95% CI, 1.26–1.80), higher perceived benefits of mHAs (aPR = 1.43, 95% CI, 1.04–1.83), and higher self-confidence using mHAs (aPR = 1.41, 95% CI, 1.12–1.70) were significant factors associated with mHA use. Conclusions The use of mHAs among adults aged 50 and older is becoming more common globally; nevertheless, there are still people unable to use mHAs properly because of lack of experience and knowledge. Strategies are needed to encourage the reliable usage of mHAs among those who may need it the most by improving self-confidence and better articulating benefits.
Collapse
|
14
|
CORR Insights®: Decision-making in Orthopaedic Oncology: Does Cognitive Bias Affect a Virtual Patient's Choice Between Limb Salvage and Amputation? Clin Orthop Relat Res 2020; 478:515-516. [PMID: 31135549 PMCID: PMC7145070 DOI: 10.1097/corr.0000000000000744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
15
|
Patient Perspectives on Decision Making for Carpal Tunnel Syndrome. J Hand Surg Am 2019; 44:940-946.e4. [PMID: 31537398 DOI: 10.1016/j.jhsa.2019.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 06/02/2019] [Accepted: 08/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Interventions that improve a patient's understanding of the problem and their options might reduce surgeon-to-surgeon variation, activate healthier patient behaviors and mindset, and optimize stewardship of resources while improving quality of care. Patients with carpal tunnel syndrome (CTS) have more uncertainty about which course of action to take (so-called decision conflict) than hand surgeons. We studied patient preferences regarding shared decision making (SDM) for different parts of the treatment for CTS. We assessed the following hypotheses: (1) Younger age does not correlate with a preference for greater involvement in decisions; (2) Demographic and socioeconomic factors are not independently associated with (A) preferences for decision making (separated into preoperative, operative, postoperative, and the full SDM scale) and (B) the Control Preference Scale; (3) the SDM scale does not correlate with the Control Preference Scale. METHODS We prospectively invited 113 new and postoperative patients with CTS to participate in the study. We recorded their demographics and they completed the SDM scale and the Control Preference Scale. RESULTS The full SDM scale and all subsets showed a patient preference toward sharing the decisions for treatment with the surgeon with a moderate tendency toward patients wanting more surgeon involvement in decision making. On multivariable analysis, having commercial insurance compared with Medicare was independently associated with a preference for less surgeon involvement (ie, higher SDM scores) in decision making (regression coefficient, 0.60; 95% confidence interval, 0.03-1.2). CONCLUSIONS Patients with CTS generally prefer to share decisions with their surgeon with a tendency for more surgeon involvement especially in the operative and postoperative period. CLINICAL RELEVANCE Decision aids and preference elicitation tools used to ensure diagnostic and treatment decisions for CTS that are aligned with patient preferences are needed. Future studies might address the routine use of these tools on patient outcomes.
Collapse
|
16
|
Leopold SS. Editorial: Are We All Better-than-Average Drivers, and Better-than-Average Kissers? Outwitting the Kruger-Dunning Effect in Clinical Practice and Research. Clin Orthop Relat Res 2019; 477:2183-2185. [PMID: 31498253 PMCID: PMC6999933 DOI: 10.1097/corr.0000000000000948] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Seth S Leopold
- S. S. Leopold, Editor-In-Chief, Clinical Orthopaedics and Related Research®, Philadelphia, PA, USA
| |
Collapse
|
17
|
Jaensson M, Dahlberg K, Nilsson U. Factors influencing day surgery patients' quality of postoperative recovery and satisfaction with recovery: a narrative review. Perioper Med (Lond) 2019; 8:3. [PMID: 31139359 PMCID: PMC6530125 DOI: 10.1186/s13741-019-0115-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of healthcare services is to provide a high quality of care. One way to ensure that this aim has been fulfilled is to assess patients' satisfaction with their care. Although satisfaction is a complex concept, it is an important outcome in perioperative care. The objective of this paper is to discuss and reflect on factors that can affect patients' quality of postoperative recovery and satisfaction with recovery after day surgery. Involving patients in shared decision-making (SDM) and providing sufficient preoperative and postoperative information can improve their satisfaction. It is important to assess whether patients experience poor recovery, which can be both distressing and dissatisfying. We suggest that patients' age, sex, mental health status, and health literacy (HL) skills should be assessed preoperatively, since these factors seem to have a negative impact on patients' postoperative recovery. Identifying factors that have a negative impact on patients' quality of postoperative recovery and satisfaction with recovery after day surgery will assist healthcare professionals in supporting vulnerable patients, such as those with limited HL and poor mental health. Treating patients with respect and dignity and providing SDM can increase their quality of postoperative recovery and satisfaction with recovery.
Collapse
Affiliation(s)
- Maria Jaensson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
| | - Karuna Dahlberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
| | - Ulrica Nilsson
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute and Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
18
|
Lee KC, Berg ET, Jazayeri HE, Chuang SK, Eisig SB. Online Patient Education Materials for Orthognathic Surgery Fail to Meet Readability and Quality Standards. J Oral Maxillofac Surg 2019; 77:180.e1-180.e8. [DOI: 10.1016/j.joms.2018.08.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/03/2018] [Accepted: 08/29/2018] [Indexed: 11/29/2022]
|
19
|
Lee YH, Kim J, Cho J, Lee MH, Oh S, Bae KJ. Which Factors Affect the Rate of Surgery Performed in Patients with Carpal Tunnel Syndrome? J Hand Surg Asian Pac Vol 2018; 23:562-565. [PMID: 30428804 DOI: 10.1142/s2424835518500583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Carpal tunnel release is recommended when patients have positive electrophysiologic test and their symptoms are not resolved in spite of conservative treatment. However, only some of them eventually undergo the surgery. The purposes of this study, therefore, were to evaluate the rate of carpal tunnel release performed among the patients with positive electrophysiologic test, and to identify which factors were associated with the rate of the surgery. METHODS Subjects of this study were 865 wrists of 508 patients (90 males and 418 females) who were diagnosed as carpal tunnel syndrome between January 2013 and December 2016. The diagnosis of carpal tunnel syndrome was confirmed by electrophysiologic test, and only the patients who were followed up for more than 1 year were enrolled in this study. The average age at the time of the electrophysiologic test performed was 61.4 years, and the severity of carpal tunnel syndrome was evaluated according to the Bland scale (Gr 1-6) based on the electrophysiologic test. Whether or not the patients received carpal tunnel release was evaluated at the last follow-up visit. RESULTS Among the 865 wrists, carpal tunnel release was performed on 528 wrists (61%). Rate of the surgery performed significantly increased in patients with more severe grades on electrophyisiologic test. More patients in female (63.3%) than in male (50.3%) and more patients with age under 60 (67.5%) than age over 60 (57.1%) received the surgery. However, there was no significant difference in the rate of carpal tunnel release according to the bilaterality or dominant hand. CONCLUSIONS The rate of carpal tunnel release among the patients diagnosed and confirmed as carpal tunnel syndrome was not higher than we expected. We should also pay more attention to the patients who did not undergo carpal tunnel release and investigate the reasons why those patients did not undergo surgery.
Collapse
Affiliation(s)
- Yo-Han Lee
- * Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Jihyeung Kim
- * Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Jaewoo Cho
- * Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Min Ho Lee
- * Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Sohee Oh
- † Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kee Jeong Bae
- ‡ Department of Orthopaedic Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| |
Collapse
|