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Groos SS, Linn AJ, Kuiper JI, van Schoor NM, van der Velde N, van Weert JCM. Combining user-centered design and behavioral theory to enhance health technologies: A personas-based approach for a primary-care based multifactorial falls risk assessment tool. Int J Med Inform 2024; 186:105420. [PMID: 38518678 DOI: 10.1016/j.ijmedinf.2024.105420] [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: 12/13/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Multifactorial falls risk assessment tools (FRATs) can be an effective falls prevention method for older adults, but are often underutilized by health care professionals (HCPs). This study aims to enhance the use and implementation of multifactorial FRATs by combining behavioral theory with the user-centered design (UCD) method of personas construction. Specifically, the study aimed to (1) construct personas that are based on external (i.e., needs, preferences) and intrinsic user characteristics (i.e., behavioral determinants); and (2) use these insights to inform requirements for optimizing an existing Dutch multifactorial FRAT (i.e., the 'Valanalyse'). METHODS Survey data from HCPs (n = 31) was used to construct personas of the 'Valanalyse.' To examine differences between clusters on 68 clustering variables, a multivariate cluster analysis technique with non-parametric analyses and computational methods was used. The aggregated external and intrinsic user characteristics of personas were used to inform key design and implementation requirements for the 'Valanalyse,' respectively, whereby intrinsic user characteristics were matched with appropriate behavior change techniques to guide implementation. RESULTS Significant differences between clusters were observed in 20 clustering variables (e.g., behavioral beliefs, situations for use). These variables were used to construct six personas representing users of each cluster. Together, the six personas helped operationalize four key design requirements (e.g., guide treatment-related decision making) and 14 implementation strategies (e.g., planning coping responses) for optimizing the 'Valanalyse' in Dutch geriatric, primary care settings. CONCLUSION The findings suggest that theory- and evidence-based personas that encompass both external and intrinsic user characteristics are a useful method for understanding how the use and implementation of multifactorial FRATs can be optimized with and for HCPs, providing important implications for developers and eHealth interventions with regards to encouraging technology adoption.
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Affiliation(s)
- Sara S Groos
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands.
| | - Annemiek J Linn
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, The Netherlands
| | | | - Natasja M van Schoor
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location Vrije University, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, The Netherlands
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Linn AJ, van Weert JCM, Bylund CL. Are They Important? Patients' Communication Barriers to Discussing Online Health Information During Consultations. HEALTH COMMUNICATION 2024; 39:945-950. [PMID: 37072688 DOI: 10.1080/10410236.2023.2197311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A minority of the patients who search for online health information report discussing or having an intention to discuss this information with their healthcare provider. Not discussing online health information inhibits the provision of patient-centered care and limits the healthcare provider's possibility to tackle misinformation. Within the confines of the linguistic model of patient participation, we first provide an overview of barriers to discussing online health information during consultations. Second, we pinpoint which of these barriers indicate a need for improvement. Participants from the Netherlands (N = 300) completed a survey that measured the communication barriers (N = 15) as identified based on previous literature and interviews. Using the QUality Of Care Through the patient's Eyes (QUOTE) approach, we measured the extent to which a specific factor was a barrier ("importance") and assessed whether the barrier would withhold patients from discussing online health information ("performance"). Scores on importance and performance were multiplied to identify which barriers show the most significant room for improvement. Especially "preferring to discuss other matters" often occurred. Nine barriers showed a moderate need for improvement. We discuss the implications of these findings for healthcare providers in consultations. Future research should include observational data to analyze communication barriers to discussing online health information in consultations.
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Affiliation(s)
- Annemiek J Linn
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | | | - Carma L Bylund
- College of Journalism and Communications, College of Medicine, University of Florida
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Duimel SLL, Linn AJ, Smets EMA, Smit ES, van Weert JCM. Profiling Cancer Patients Based on Their Motives for Seeking Informational and Emotional Support Online. HEALTH COMMUNICATION 2023; 38:3223-3237. [PMID: 36415021 DOI: 10.1080/10410236.2022.2144287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Understanding why patients seek informational and/or emotional support online is fundamental to providing patients with accurate and reliable support that is tailored to their needs, preferences, and personal situation. Based on the stress and coping theory and uses and gratifications theory (UGT), this study aimed to identify theoretically-founded profiles of cancer patients differing in their motives for seeking informational and/or emotional support online, and to compare the profiles in terms of patients' psychological and background characteristics, and perception of health care services. Hierarchical cluster analysis was conducted, using questionnaire data from patients visiting a large Dutch health website (N = 181). This revealed three distinctive profiles, i.e., overall seekers (n = 83, 46.0%), occasional information seekers (n = 83, 46.0%), and contact exchangers (n = 15, 8.0%). Patients across these profiles differed in their eHealth literacy, with the contact exchangers being more eHealth literate than the overall seekers and occasional information seekers. The results can be used to create awareness among health care providers, web designers, and patient organizations on different types of cancer patients with different motives for seeking informational and/or emotional support online, and help them to tailor recommendations to and development of (online) sources that fit patients' needs. Future research could further investigate the integration of stress and coping theory with UGT by acknowledging the interplay of different coping strategies and different gratifications.
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Affiliation(s)
- Song L L Duimel
- Department of Communication, Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | - Annemiek J Linn
- Department of Communication, Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam
| | - Eline S Smit
- Department of Communication, Amsterdam School of Communication Research/ASCoR, University of Amsterdam
| | - Julia C M van Weert
- Department of Communication, Amsterdam School of Communication Research/ASCoR, University of Amsterdam
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4
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Sundler AJ, Hedén L, Holmström IK, van Dulmen S, Bergman K, Östensson S, Östman M. The patient's first point of contact (PINPOINT) - protocol of a prospective multicenter study of communication and decision-making during patient assessments by primary care registered nurses. BMC PRIMARY CARE 2023; 24:249. [PMID: 38031004 PMCID: PMC10685613 DOI: 10.1186/s12875-023-02208-0] [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: 10/18/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND A major challenge for primary care is to set priorities and balance demands with available resources. The registered nurses in this study are practice nurses working in primary care offices, playing a large role in initial assessments. The overall objective of this research is to investigate practices of communication and decision-making during nurses' initial assessment of patients' health problems in primary care, examine working mechanisms in good practices and develop feasible solutions. METHODS Project PINPOINT aims for a prospective multicenter study using various methods for data collection and analysis. A purposive sample of 150 patient‒nurse consultations, including 30 nurses and 150 patients, will be recruited at primary care centers in three different geographic areas of southwest Sweden. The study will report on outcomes of communication practices in relation to patient-reported expectations and experiences, communication processes and patient involvement, assessment and decision-making, related priorities and value conflicts with data from patient questionnaires, audio-recorded real-time communication, and reflective interviews with nurses. DISCUSSION This research will contribute to the knowledge needed for the guidance of first-line decision-making processes to best meet patient and public health needs. This knowledge is necessary for the development of assessments and decisions to be better aligned to patients and to set priorities. Insights from this research can empower patients and service providers and help understand and enhance feasible person-centered communication strategies tailored to patients' level of health literacy. More specifically, this research will contribute to knowledge that can strengthen nurses' communication, assessments, and clinical decision-making in primary care. In the long term, this will contribute to how the competencies of practice nurses and other professionals are organized and carried out to make the best use of the resources within primary care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT06067672.
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Affiliation(s)
- Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden.
| | - Lena Hedén
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Sandra van Dulmen
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Karin Bergman
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden
| | - Sofia Östensson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden
| | - Malin Östman
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Region Västra Götaland, Närhälsan Källstorp Healthcare Centre, Trollhättan, Sweden
- Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Research, Sweden
- General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kelber S. [Oncological care needs smart approaches]. UROLOGIE (HEIDELBERG, GERMANY) 2022; 61:777-780. [PMID: 35925250 DOI: 10.1007/s00120-022-01863-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
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6
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Sungur H, van den Muijsenbergh METC, van Weert JCM, Schouten BC. Caring for older culturally and linguistically diverse patients with Cancer: Healthcare Providers' perceived barriers to communication. J Geriatr Oncol 2022; 13:862-870. [PMID: 35589543 DOI: 10.1016/j.jgo.2022.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to various socio-cultural and language related factors, healthcare providers experience barriers when communicating with older culturally and linguistically diverse (CALD) patients with cancer, which can lower the quality of care received by patients and negatively impact healthcare providers. Studies focusing on communication barriers of older CALD patients with cancer and a systematic comparison of those barriers between different healthcare providers have been largely missing. OBJECTIVES In order to lay out the healthcare providers' perceived barriers to communication, the present study identified and compared communication barriers among different healthcare providers when caring for older CALD patients with cancer. METHODS An online survey was conducted among healthcare providers in the Netherlands who identified as being involved in the care of CALD patients with cancer (N = 191), specifically; GPs (NGPs = 54), specialists (Nspecialists = 29), oncology nurses (Nnurses = 77), and pharmacists (Npharmacists = 31). Providers assessed twelve pre-specified factors on (i) importance and (ii) frequency of these factors as barriers to communication. A composite score by employing the QUOTE (Quality Of care Through the patients' Eyes) methodology was used to rank, and classify factors as either potential or influential barriers. RESULTS AND CONCLUSION Overall, low Dutch language proficiency of older CALD patients with cancer, family interpreters providing inadequate translations, not knowing the extent of patients' informational needs, cultural differences in views about healthcare (i.e., illnesses and treatments) and family members blocking communication were found to be influential communication barriers. Healthcare providers showed several differences in what they perceived to be a potential or an influential barrier: Cultural differences in views about healthcare and patients getting treatment in their home countries were important barriers for GPs, while not knowing the patient's contact person was for pharmacists. Nurses perceived the highest number of influential barriers, while specialists perceived the least. We conclude that specific interventions that address differences in perceived barriers among providers are needed, and we highlight potential interventions that involve digital communication tools, such as the Conversation Starter.
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Affiliation(s)
- Hande Sungur
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
| | - Maria E T C van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; Prevention and care Programme, Pharos, National Centre of Expertise on Health Disparities, Utrecht, the Netherlands.
| | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
| | - Barbara C Schouten
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
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7
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van Poelgeest EP, Seppala LJ, Lee JM, Bahat G, Ilhan B, Lavan AH, Mair A, van Marum RJ, Onder G, Ryg J, Fernandes MA, Garfinkel D, Guðmundsson A, Hartikainen S, Kotsani M, Montero-Errasquín B, Neumann-Podczaska A, Pazan F, Petrovic M, Soulis G, Vankova H, Wehling M, Wieczorowska-Tobis K, van der Velde N. Deprescribing practices, habits and attitudes of geriatricians and geriatricians-in-training across Europe: a large web-based survey. Eur Geriatr Med 2022; 13:1455-1466. [PMID: 36319837 PMCID: PMC9722796 DOI: 10.1007/s41999-022-00702-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE To provide an overview of the current deprescribing attitudes, practices, and approaches of geriatricians and geriatricians-in-training across Europe. METHODS An online survey was disseminated among European geriatricians and geriatricians-in-training. The survey comprised Likert scale and multiple-choice questions on deprescribing approaches and practices, deprescribing education and knowledge, and facilitators/barriers of deprescribing. Responses to the survey questions and participant characteristics were quantified and differences evaluated between geriatricians and geriatricians-in-training and between European regions. RESULTS The 964 respondents (median age 42 years old; 64% female; 21% geriatricians-in-training) were generally willing to deprescribe (98%) and felt confident about deprescribing (85%). Despite differences across European regions, the most commonly reported reasons for deprescribing were functional impairment and occurrence of adverse drug reactions. The most important barriers for deprescribing were patients' unwillingness, fear of negative consequences, lack of time, and poor communication between multiple prescribers. Perceived risk of adverse drug reactions was highest for psychotropic drugs, nonsteroidal anti-inflammatory drugs, cardiovascular drugs, and opioid analgesics. Only one in four respondents (23% of geriatricians and 37% of geriatricians-in-training) think education in medical school had sufficiently prepared them for deprescribing in clinical practice. They reported that their future deprescribing activities would probably increase with improved information sharing between various prescribers, deprescribing recommendations in guidelines, and increased education and training. Approximately 90% think that a paradigm shift is required for prescribers and patients, increasing focus on the possible benefits of deprescribing (potentially) inappropriate medications. CONCLUSIONS Based on the outcomes of this survey, we recommend investing in improved inter-professional communication, better education and evidence-based recommendations to improve future patient-centered deprescribing practices.
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Affiliation(s)
- Eveline P van Poelgeest
- Department of Internal Medicine Section of Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands.
| | - Lotta J Seppala
- Department of Internal Medicine Section of Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
| | - Jihoo M Lee
- Graduate School of Communication Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Gülistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey
| | - Birkan Ilhan
- Division of Geriatrics, Department of Internal Medicine, Sisli Hamidiye Etfal Training and Research Hospital, University of Medical Sciences, Istanbul, Turkey
| | - Amanda H Lavan
- Mercers Institute of Successful Ageing, St James's Hospital, Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Alpana Mair
- Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, Scotland, UK
| | - Rob J van Marum
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
- Department of Elderly Care Medicine, Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Odense Deprescribing Initiative (ODIN), Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Marília Andreia Fernandes
- Department of Internal Medicine, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Doron Garfinkel
- Center for Appropriate Medication Use, Sheba Medical Center and Deputy Head, Homecare Hospice, Israel Cancer Association, 55 Ben Gurion Road, 5932210, Bat, Yam, Israel
| | - Aðalsteinn Guðmundsson
- Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Marina Kotsani
- Université de Lorraine, CHRU-Nancy, Pôle (Maladies du Vieillissement, Gérontologie et Soins Palliatifs), Nancy, France
| | | | | | - Farhad Pazan
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - George Soulis
- Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece
- Hellenic Open University, Patras, Greece
| | - Hana Vankova
- Cooperatio 34 - Internal Disciplines, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Wehling
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Nathalie van der Velde
- Department of Internal Medicine Section of Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
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Schouten BC, Westerneng M, Smit AM. Midwives' perceived barriers in communicating about depression with ethnic minority clients. PATIENT EDUCATION AND COUNSELING 2021; 104:2393-2399. [PMID: 34340845 DOI: 10.1016/j.pec.2021.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to assess the most influential barriers midwives perceive in communicating about depression-related symptoms with ethnic minority clients. METHODS In-depth interviews were held with midwives (N = 8) and Moroccan-Dutch women (N = 6) suffering from perinatal depression to identify the most salient communication barriers. Subsequently, an online survey among midwives (N = 60) assessing their perceived barriers and the occurrence of these barriers in practice was administered. Composite scores using the QUOTE methodology were calculated to determine influential barriers. RESULTS Three types of barriers emerged from the interviews. Educational-related barriers, client-related barriers and midwife-related barriers. Results of the survey showed that the most influential barriers were educational-related barriers (e.g. lack of culturally sensitive depression screening instruments) and client-related barriers (e.g. cultural taboo about talking about depression). CONCLUSION Culturally sensitive screening instruments for depression and patient education materials should be developed to mitigate the educational-related barriers to communicating about depression. Patient education materials should also target the clients' social environment (e.g. husbands) to help break the cultural taboo about depression. PRACTICE IMPLICATIONS Based on this study's results, communication strategies to empower both midwives and ethnic minority clients with depression can be developed in a collaborative approach.
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Affiliation(s)
- Barbara C Schouten
- Amsterdam School of Communication Research/ASCoR, Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands.
| | - Myrte Westerneng
- Amsterdam UMC, Free University Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, the Netherlands.
| | - Anne-Marike Smit
- Amsterdam UMC, Free University Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
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Martin L, Gitsels-van der Wal JT, Hitzert M, Henrichs J. Clients' perspectives on the quality of counseling for prenatal anomaly screening. A comparison between 2011 and 2019. PATIENT EDUCATION AND COUNSELING 2021; 104:1796-1805. [PMID: 33388195 DOI: 10.1016/j.pec.2020.12.012] [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: 04/25/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE There have been substantial medical developments in prenatal anomaly and aneuploidy screening. However, the quality of counseling about these tests tends to lag behind. Additional quality requirements were therefore implemented in the Netherlands in 2017 to optimize this counseling. We compared clients' counseling preferences and experiences before and after implementation of these requirements. METHODS We used the validated 57-item QUOTEprenatal questionnaire, to measure clients' counseling preferences and experiences before and after counseling in 20 obstetric organizations throughout the Netherlands. Clients' preferences and experiences were compared between pregnant women and partners, nulliparous versus multiparous clients and between results of a Dutch survey in 2011 and the current one. RESULTS Sixty-five counselors and 649 clients (353 pregnant women and 296 partners) participated in this study. Compared to 2011, slightly more clients considered the three QUOTEprenatal components of counseling (client-counselor relationship, health education, and decision-making support) to be either important or very important, especially decision-making support. More clients than in 2011 perceived their needs as being well addressed, with the lowest percentages for decision-making support. CONCLUSION Quality requirements seem to benefit the quality of counseling, as perceived by clients. PRACTICAL IMPLICATIONS Counselors should consider tailoring their decision-making support more to clients' needs.
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Affiliation(s)
- Linda Martin
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam, the Netherlands.
| | | | - Marit Hitzert
- National Institute for Public Health and the Environment (RIVM), Centre for Population Screening, Bilthoven, the Netherlands
| | - Jens Henrichs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam, the Netherlands
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10
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[Oncological certification, care concepts, and oncology nurse counselling]. Urologe A 2021; 60:513-520. [PMID: 33770203 DOI: 10.1007/s00120-021-01511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Libert Y, Peternelj L, Canivet D, Farvacques C, Liénard A, Ménard C, Merckaert I, Reynaert C, Slachmuylder JL, Razavi D. How does physicians' decisional conflict influence their ability to address treatment outcomes in a decision-making encounter with an advanced-stage cancer simulated patient? A descriptive study. PATIENT EDUCATION AND COUNSELING 2020; 103:1752-1759. [PMID: 32234266 DOI: 10.1016/j.pec.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This descriptive study assesses how physicians' decisional conflict influences their ability to address treatment outcomes (TOs) in a decision-making encounter with an advanced-stage cancer simulated patient (SP). METHODS Physicians (N = 138) performed a decision-making encounter with the SP trained to ask for TOs information. The physicians' decisional conflict regarding patients' cancer treatments in general was assessed with the General Decisional Conflict Scale (Gen-DCS). The physicians' decisional conflict regarding the SP's cancer treatments was assessed with the Specific Decisional Conflict Scale (Spe-DCS). Physicians' ability to address TOs during the encounter was assessed with an interaction analysis system: the Multi-Dimensional Analysis of Patient Outcome Predictions (MD.POP). Weekly time spent with cancer patients was assessed with a questionnaire. RESULTS Physicians' Spe-DCS (β = -.21 ; p = .014) and weekly time spent with cancer patients (β = .22 ; p = .008) predicted the number of TOs addressed during the encounter. Spe-DCS scores predicted nearly all MD.POP dimensions (r = -.18 ; p = .040 to r = -.30 to p < .001) whereas Gen-DCS scores predicted nearly none MD.POP dimensions. CONCLUSION Physicians' specific decisional conflict interferes with their ability to address TOs in a decision-making encounter with an advanced-stage cancer SP. PRACTICE IMPLICATIONS Physicians should be trained to address TOs according to patient preferences, despite their own decisional conflict.
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Affiliation(s)
- Yves Libert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Livia Peternelj
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Delphine Canivet
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Hôpital Universitaire Erasme, Service de Psychologie, Brussels, Belgium.
| | | | - Aurore Liénard
- Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Catherine Ménard
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium.
| | - Isabelle Merckaert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Christine Reynaert
- Université Catholique de Louvain, Faculté de Médecine, Brussels, Belgium.
| | | | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
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Bol N, Linn AJ, Smets EM, Verdam MG, van Weert JC. Tailored communication for older patients with cancer: Using cluster analysis to identify patient profiles based on information needs. J Geriatr Oncol 2020; 11:944-950. [DOI: 10.1016/j.jgo.2020.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/20/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
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Lehmann V, Labrie NHM, van Weert JCM, van Dulmen S, de Haes HJCJM, Kersten MJ, Pieterse AH, Smets EMA. Tailoring the amount of treatment information to cancer patients' and survivors' preferences: Effects on patient-reported outcomes. PATIENT EDUCATION AND COUNSELING 2020; 103:514-520. [PMID: 31585818 DOI: 10.1016/j.pec.2019.09.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/30/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Tailoring medical information to cancer patients' needs is recommended, but there is little guidance on how to tailor, and limited research exists about its effects. Tailoring to the amount of preferred information may be easily implementable in clinic and is tested here. METHODS A video-vignette experiment was used to systematically vary video patients' information preferences (limited/extensive) and amount of provided information (additional/no additional). N = 253 cancer patients/survivors evaluated these video-recorded consultations, serving as analogue patients (APs), and completed outcome measures. RESULTS Tailoring information to video patients' preferences had no effect on APs' evaluation of the consultation (satisfaction, trust). Yet, there was a main effect of APs' own information preferences: Those preferring extensive information recalled (MΔ = 5.8%) and recognized (MΔ = 3.5%) more information than those preferring limited information. Moreover, information provision mattered among APs who preferred limited information: They recognized even less if provided with extensive information. CONCLUSIONS Tailoring to the amount of video patient's information preferences did not affect APs' evaluation of the consultation (satisfaction, trust), while APs' personal information preferences determined their recall and recognition of medical information. PRACTICE IMPLICATIONS Information preferences should be assessed and tailored to in clinical practice. Overwhelming patients/survivors, who prefer limited information, should be prevented.
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands
| | - Nanon H M Labrie
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands; Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hanneke J C J M de Haes
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands.
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Lehmann V, Labrie NHM, van Weert JCM, van Dulmen S, de Haes HJCJM, Kersten MJ, Pieterse AH, Smets EMA. Provider caring and structuring treatment information to improve cancer patients' recall: Does it help? PATIENT EDUCATION AND COUNSELING 2020; 103:55-62. [PMID: 31349965 DOI: 10.1016/j.pec.2019.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Patient recall of medical information is usually poor. Healthcare providers can employ affect-oriented (i.e., showing care) or cognition-oriented communication styles (i.e., structuring information) to enhance recall, but research evidence is limited especially among clinical and/or older patient populations. This video-vignette study manipulated provider caring and information structuring to examine effects on recall and trust among cancer patients/survivors. METHODS In an online survey, 148 participants (Mage = 62) were randomized to one of four video conditions in a two (standard communication vs. enhanced caring) by two (standard vs. enhanced structuring) design, and completed measures of active recall, recognition, and trust. RESULTS Increased caring or structuring did not enhance active recall or recognition, instead both were higher among younger, female, or highly educated participants. The caring condition induced higher perceived trust in the provider within the whole sample, but trust was significantly correlated with decreased recall (r = -.268) among younger participants. CONCLUSIONS Provider caring can strengthen the patient-provider relationship by enhancing trust. Yet, increased trust may impair recall among younger patients. Structuring treatment information did not enhance recall and recognition, but additional research is needed. PRACTICE IMPLICATIONS Providers may use additional ways of structuring/organizing information to help enhance recall (e.g., written information).
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Nanon H M Labrie
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands; Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hanneke J C J M de Haes
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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Nguyen MH, Smets EM, Bol N, Loos EF, van Laarhoven HW, Geijsen D, van Berge Henegouwen MI, Tytgat KM, van Weert JC. Tailored Web-Based Information for Younger and Older Patients with Cancer: Randomized Controlled Trial of a Preparatory Educational Intervention on Patient Outcomes. J Med Internet Res 2019; 21:e14407. [PMID: 31573911 PMCID: PMC6774239 DOI: 10.2196/14407] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 12/22/2022] Open
Abstract
Background Many patients with cancer, including older patients (aged ≥65 years), consult the Web to prepare for their doctor’s visit. In particular, older patients have varying needs regarding the mode in which information is presented (eg, via textual, visual, or audiovisual modes) owing to age-related sensory (eg, impaired vision and hearing) and cognitive decline (eg, reduced processing speed). Therefore, Web-based information targeted at older patient populations is likely to be used and processed more effectively, and evaluated more positively, when tailored to age-related capabilities and preferences. This, in turn, may benefit patient outcomes. Objective This randomized controlled trial tested the effects of a Web-based tailored educational intervention among newly diagnosed younger (<65 years) and older (≥65 years) patients with cancer. We compared the intervention group who viewed a mode-tailored website (ie, enabling patients to tailor information using textual, visual, and audiovisual modes) with 3 control groups view a nontailored website (ie, text only, text with images, and text with videos). We examined website experience outcomes (ie, website satisfaction, website involvement, knowledge, anxiety, and communication self-efficacy) and consultation experience outcomes (ie, question asking during consultation, anxiety, and information recall). Methods Patients from a multidisciplinary outpatient clinic (N=232) viewed a mode-tailored or nontailored website as preparation before their hospital consultations to discuss diagnosis and treatment. Data were collected before (T1), during (T2), and after (T3) visitation. Website experience outcomes were assessed with questionnaires (T1). Patients’ question asking was coded from videotaped consultations, and anxiety was assessed through a questionnaire (T2). Telephone interviews were conducted to assess knowledge acquired from the website before (T1) and after consultation (T3), and information recall from the consultation (T3). Results The preparatory website was well used across all conditions (mean 34 min). Younger patients viewing the mode-tailored website were more satisfied before consultation (P=.02) and reported lower anxiety after consultation (P=.046; vs text only). This pattern was not found in older patients. Mode tailoring yielded no other significant differences in patient outcomes. Regression analyses showed that website involvement (beta=.15; P=.03) and, to a lesser extent, website satisfaction (beta=.15; P=.05) positively associated with knowledge before consultation (T1). In turn, higher knowledge before consultation (beta=.39; P<.001), together with time on the website (beta=.21; P=.002; T1), predicted information recall from consultations (T3). Patients with higher knowledge before consultation (T1) also reported higher knowledge from the website afterward (T3; beta=.22; P=.003). Conclusions Offering preparatory online information before consultations benefits information processing and patient outcomes of both younger and older newly diagnosed patients with cancer. Younger patients benefit even more when information is offered in a mode-tailored manner. We discuss the theoretical, methodological, and practical implications for patient-provider communication research in an electronic health era. Clinical Trial Netherlands Trial Register NTR5904; https://www.trialregister.nl/trial/5750
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Affiliation(s)
- Minh Hao Nguyen
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands.,Department of Communication and Media Research (IKMZ), University of Zurich, Zurich, Switzerland
| | - Ellen Ma Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Nadine Bol
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands.,Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Eugène F Loos
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | - Hanneke Wm van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Debby Geijsen
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Kristien Maj Tytgat
- Department of Gastroenterology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Julia Cm van Weert
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
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16
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Cultural and Organizational Adaptation of the QUOTE Breast Cancer Questionnaire for Italian Breast Units. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.91233] [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]
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17
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Labrie N, van Dulmen S, Kersten MJ, de Haes HJ, Pieterse AH, van Weert JC, van Spronsen DJ, Smets EM. Effective Information Provision About the Side Effects of Treatment for Malignant Lymphoma: Protocol of a Randomized Controlled Trial Using Video Vignettes. JMIR Res Protoc 2019; 8:e12453. [PMID: 31045506 PMCID: PMC6521215 DOI: 10.2196/12453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/30/2019] [Accepted: 02/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Informing patients with cancer about the possible implications of prospective treatment is a crucial yet challenging task. Unfortunately, patients' recall of medical information is generally poor and their information needs are not met. Effective information giving entails that oncologists help patients understand and recall the implications of their treatment, meanwhile fostering a trusting physician-patient relationship. Communication strategies that are often suggested to be effective are structuring and tailoring (cognition-oriented) but also are oncologists' expressions of caring or empathy (affect-oriented). OBJECTIVE The aim of this study is to provide evidence concerning the pathways linking physician communication to (improved) consultation outcomes for patients. More specifically, the aim is to determine the effects of information structuring and information tailoring, combined with physician caring, on information recall, satisfaction with information, and trust in the physician (primary objective) and on symptom distress (secondary objective). METHODS A randomized controlled trial, systematically testing the effects of information structuring and information tailoring, each combined with caring, in 2 video-vignette experiments (2×2 and 2×2×2 design). Using an online survey platform, participants will be randomly allocated (blinded) to 1 of 12 conditions in which they are asked to view a video vignette (intervention) in which an oncologist discusses a treatment plan for malignant lymphoma with a patient. The independent variables of interest are systematically varied across conditions. The outcome measures are assessed in a survey, using validated instruments. Study participants are (former) patients with cancer and their relatives recruited via online panels and patient organizations. This protocol discusses the trial design, including the video-vignette design, intervention pretesting, and a pilot study. RESULTS Data collection has now been completed, and preliminary analyses will be available in Spring 2019. A total of 470 participants completed the first part of the survey and were randomized to receive the intervention. CONCLUSIONS The results of the proposed trial will provide evidence concerning the pathways linking physician information, giving skills to (improved) consultation outcomes for patients. TRIAL REGISTRATION Netherlands Trial Register NTR6153; https://www.trialregister.nl/trial/6022 (Archived by Webcite at http://www.webcitation.org/76xVV9xC8). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12453.
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Affiliation(s)
- Nanon Labrie
- Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands.,Athena Institute, Vrije Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Sandra van Dulmen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands.,Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Marie José Kersten
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Hanneke Jcm de Haes
- Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Julia Cm van Weert
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | | | - Ellen Ma Smets
- Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
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18
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Houwen J, Moorthaemer BJE, Lucassen PLBJ, Akkermans RP, Assendelft WJJ, Olde Hartman TC, van Dulmen S. The association between patients' expectations and experiences of task-, affect- and therapy-oriented communication and their anxiety in medically unexplained symptoms consultations. Health Expect 2018; 22:338-347. [PMID: 30597697 PMCID: PMC6543164 DOI: 10.1111/hex.12854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/18/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022] Open
Abstract
Background It is unknown whether patients with medically unexplained symptoms (MUS) differ from patients with medically explained symptoms (MES) regarding their expectations and experiences on task‐oriented communication (ie, communication in which the primary focus is on exchanging medical content), affect‐oriented communication (ie, communication in which the primary focus is on the emotional aspects of the interaction) and therapy‐oriented communication (ie, communication in which the primary focus is on therapeutic aspects) of the consultation and the extent to which GPs meet their expectations. Objective This study aims to explore (a) differences in patients’ expectations and experiences in consultations with MUS patients and patients with MES and (b) the influence of patients’ experiences in these consultations on their post‐visit anxiety level. Study design Prospective cohort. Setting Eleven Dutch general practices. Measurements Patients completed the QUOTE‐COMM (Quality Of communication Through the patients’ Eyes) questionnaire before and after the consultation to assess their expectations and experiences and these were related to changes in patients’ state anxiety (abbreviated State‐Trait Anxiety Inventory; STAI). Results Expectations did not differ between patients with MUS and MES. Patients presenting with either MUS or MES rated their experiences for task‐related and affect‐oriented communication of their GP higher than their expectations. GPs met patients’ expectations less often on task‐oriented communication in MUS patients compared to MES patients (70.2% vs 80.9%; P = ˂0.001). Affect‐oriented communication seems to be most important in reducing the anxiety level of MUS patients (β −0.63, 95% Cl = −1.07 to −0.19). Discussion Although the expectations of MUS patients are less often met compared to those of MES patients, GPs often communicate according to patients’ expectations. Experiencing affect‐oriented communication is associated with a stronger reduction in anxiety in patients with MUS than in those with MES. Conclusion GPs communicate according to patients’ expectations. However, GPs met patients’ expectations on task‐oriented communication less often in patients with MUS compared to patients with MES. Experiencing affect‐oriented communication had a stronger association with the post‐consultation anxiety for patients with MUS than MES.
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Affiliation(s)
- Juul Houwen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Bas J E Moorthaemer
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Reinier P Akkermans
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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19
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Stuij SM, Labrie NHM, van Dulmen S, Kersten MJ, Christoph N, Hulsman RL, Smets E. Developing a digital communication training tool on information-provision in oncology: uncovering learning needs and training preferences. BMC MEDICAL EDUCATION 2018; 18:220. [PMID: 30249221 PMCID: PMC6154812 DOI: 10.1186/s12909-018-1308-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/02/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND Adequate information-provision forms a crucial component of optimal cancer care. However, information-provision is particularly challenging in an oncology setting. It is therefore imperative to help oncological health care practitioners (HCP) optimise their information-giving skills. New forms of online education, i.e. e-learning, enable safe and time and location independent ways of learning, enhancing access to continuous learning for HCP. As part of a user-centred approach to developing an e-learning to improve information-giving skills, this study aims to: 1) uncover the learning needs of oncological healthcare providers related to information- provision, and 2) explore their training preferences in the context of clinical practice. METHODS Focus groups and interviews were organised with oncological HCP (medical specialists and clinical nurse specialists) addressing participants' learning needs concerning information- provision and their training preferences with respect to a new digital training tool on this issue. All sessions were audiorecorded and transcribed verbatim. Using an inductive approach, transcripts were independently coded by three researchers and discussed to reach consensus. Main themes were summarised and discussed. RESULTS Four focus group sessions (total n = 13) and three interviews were conducted. The first theme concerned the patient outcomes HCP try to achieve with their information. We found HCP to mainly strive to promote patients' understanding of information. The second theme concerned HCP reported strategies and challenges when trying to inform their patients. These entailed tailoring of information to patient characteristics, structuring of information, and dealing with patients' emotions. Regarding HCP training preferences, an e-learning should be neatly connected to clinical practice. Moreover, participants desired a digital training to allow for feedback on their own (videotaped) information-giving skills from peers, communication experts, and/or patients; to monitor their progress and to tailored the training to individual learning needs. CONCLUSIONS An e-learning for improvement of information-giving skills of oncological HCP should be aimed at the transfer of skills to clinical practice, rather than at enhancing knowledge. Moreover, an e-learning is probably most effective when the facilitates individual learning needs, supports feedback on competence level and improvement, and allows input from significant others (experts, peers, or patients).
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Affiliation(s)
- Sebastiaan M. Stuij
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Nanon H. M. Labrie
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands institute for health services research), Department of Primary and Community Care, Utrecht, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway
| | - Marie José Kersten
- Department of Haematology, Academic Medical Center, Amsterdam, The Netherlands
| | - Noor Christoph
- Center for Evicence Based Education, Academic Medical Centre, Amsterdam, The Netherlands
| | - Robert L. Hulsman
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ellen Smets
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
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Insight into Patients' Experiences of Cancer Care in Taiwan: An Instrument Translation and Cross-Cultural Adaptation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081772. [PMID: 30126140 PMCID: PMC6121327 DOI: 10.3390/ijerph15081772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022]
Abstract
Background: Since Taiwan launched the Cancer Prevention Act in 2003, several prevention strategies and early detection programs have been implemented to reduce the incidence, morbidity and mortality rates of cancer. However, most of the programs have concentrated on healthcare providers. Evaluations from the patient’s perspective have been lacking. Thus, in this study a cancer patient experience questionnaire was developed in the Taiwanese context and a preliminary nationwide investigation was conducted on the status of cancer care from the patient’s perspective. Methods: An extensive literature review was first conducted to collect information on the existing instruments used to measure the cancer patient’s experience. Thereafter, a multidisciplinary expert panel was convened to select an optimal instrument based on the IOM’s six domains for evaluating patient-centered care. The European Organisation for Research and Treatment of Cancer (EORTC) translation procedure was applied to the questionnaire for cross-cultural adaptation. A nationwide field test was then implemented at certificated cancer care hospitals. Results: Fifteen questionnaires were collected for the literature review. The expert panel selected the National Cancer Patient Experience Survey based on the IOM’s recommendations. After cross-cultural translation of the questionnaire, a total of 4000 questionnaires were administered in 19 certificated cancer care hospitals and two major cancer patient associations, with 1010 being returned (25.25% response rate). Most of the respondents were middle-aged, and 70% were female. The respondents reported they had a good experience with cancer care, except for “Home care and support” and “Finding out what was wrong with you”. Stratified analysis was conducted, with the results showing that the cancer patients’ experiences varied depending on their sociodemographic and cancer-related characteristics. Conclusions: A Taiwanese version of the cancer patient experience survey questionnaire was developed. Its results showed that the cancer patient’s experiences varied, depending on the patient’s age, cancer type, and cancer history. This study can be used as a basis to establish a patient-centered care model for cancer care in Taiwan.
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21
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Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
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Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
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Bol N, Smets EMA, Burgers JA, Samii SM, De Haes HCJM, Van Weert JCM. Older Patients' Recall of Online Cancer Information: Do Ability and Motivation Matter More than Chronological Age? JOURNAL OF HEALTH COMMUNICATION 2017; 23:9-19. [PMID: 29227736 DOI: 10.1080/10810730.2017.1394400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study proposes and tests a model to provide a more comprehensive understanding of the contribution of chronological age versus age-related ability and motivation factors in explaining recall of online cancer information among older patients (n = 197). Results revealed that recall is not a matter of chronological age per se, but rather a matter of ability and motivation. Age-related ability and motivation factors explained 37.9% of the variance in recall. Health literacy, involvement with the webpage, and satisfaction with the emotional support were positively associated with recall. Furthermore, recall was negatively related to frailty, anger, future time perspective, and perceived cognitive load. The findings pose relevant opportunities for tailoring interventions to improve online information provision for older cancer patients.
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Affiliation(s)
- Nadine Bol
- a Amsterdam School of Communication Research , University of Amsterdam , Amsterdam , The Netherlands
| | - Ellen M A Smets
- b Department of Medical Psychology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Jacobus A Burgers
- c Department of Thoracic Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - Suzy M Samii
- d Department of Pulmonology , Deventer Hospital , Deventer , The Netherlands
| | - Hanneke C J M De Haes
- b Department of Medical Psychology , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Julia C M Van Weert
- a Amsterdam School of Communication Research , University of Amsterdam , Amsterdam , The Netherlands
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Bronner MB, Nguyen MH, Smets EMA, van de Ven AWH, van Weert JCM. Anxiety during cancer diagnosis: Examining the influence of monitoring coping style and treatment plan. Psychooncology 2017; 27:661-667. [PMID: 28976610 DOI: 10.1002/pon.4560] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/16/2017] [Accepted: 09/25/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Studies on anxiety within oncology show a high prevalence of anxiety both during and after the course of the disease. However, little is known about factors that influence the level of anxiety in the diagnostic phase. This study examines the presence of anxiety during diagnosis and treatment planning and explores how a monitoring (ie, information seeking) coping style and the suggested treatment plan (ie, with or without chemotherapy) interact with anxiety. METHODS Anxiety scores (6-item State-Trait Anxiety Inventory) were collected from 81 colorectal cancer patients before and after their visit to the outpatient Gastrointestinal Oncological Center Amsterdam. A cut-off score (>44) was used to indicate highly anxious patients. RESULTS More than half (59%) of the patients were classified as highly anxious before consultation. Although anxiety scores significantly decreased after consultation (t = 3.149, P = .002), 37% of the patients remained highly anxious. Reductions in anxiety were specifically observed for patients with a higher monitoring coping style and patients for whom a treatment plan without chemotherapy was proposed. Interestingly, high monitors for whom treatment without chemotherapy was proposed showed a major decrease in anxiety, whereas low monitors for whom treatment starting with chemotherapy was proposed showed a great increase in anxiety. CONCLUSIONS The diagnostic phase is associated with high levels of anxiety. Distinct patterns of anxiety were identified, depending on patients' coping style and the suggested treatment plan. Remarkably, patients with a lower monitoring coping style became particularly anxious when they were advised to start treatment with chemotherapy.
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Affiliation(s)
- Madelon B Bronner
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Minh Hao Nguyen
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anthony W H van de Ven
- Gastrointestinal Oncological Center Amsterdam (GIOCA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
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Eskildsen NB, Joergensen CR, Thomsen TG, Ross L, Dietz SM, Groenvold M, Johnsen AT. Patient empowerment: a systematic review of questionnaires measuring empowerment in cancer patients. Acta Oncol 2017; 56:156-165. [PMID: 28077053 DOI: 10.1080/0284186x.2016.1267402] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is an increased attention to and demand for patient empowerment in cancer treatment and follow-up programs. Patient empowerment has been defined as feeling in control of or having mastery in relation to cancer and cancer care. This calls for properly developed questionnaires assessing empowerment from the user perspective. The aim of this review was to identify questionnaires and subscales measuring empowerment and manifestations of empowerment among cancer patients. MATERIALS AND METHODS We conducted a systematic search of the PubMed, PsycINFO and CINAHL databases. Empowerment and multiple search terms associated with empowerment were included. We included peer-reviewed articles published in English, which described questionnaires measuring empowerment or manifestations of empowerment in a cancer setting. In addition, the questionnaire had to be a patient-reported outcome measure for adult cancer patients. RESULTS Database searches identified 831 records. Title and abstract screening resulted in 482 records being excluded. The remaining 349 full text articles were retrieved and assessed for eligibility. This led to the inclusion of 33 individual instruments measuring empowerment and manifestations of empowerment. Of these, only four were specifically developed to measure empowerment, and two were originally developed for the cancer setting, whereas the remaining two were developed elsewhere, but adapted to the cancer setting. The other 29 questionnaires were not intended to measure the concept of empowerment, but focused on patient-centered care, patient competence, self-efficacy, etc. However, they were included because part of the instrument (at least five items) was considered to measure empowerment or manifestations of empowerment. CONCLUSION Our study provides an overview of the available questionnaires, which can be used by researchers and practitioners who wish to measure the concept of empowerment among cancer patients. Very few questionnaires were explicitly developed to explore empowerment, and the review brings to light a significant lack of questionnaires that measure patient empowerment comprehensively.
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Affiliation(s)
| | | | - Thora Grothe Thomsen
- Zealand University Hospital, Roskilde, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lone Ross
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Mogens Groenvold
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anna Thit Johnsen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
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Forshaw KL, Carey ML, Hall AE, Boyes AW, Sanson-Fisher R. Preparing patients for medical interventions: A systematic review of the psychometric qualities of published instruments. PATIENT EDUCATION AND COUNSELING 2016; 99:960-973. [PMID: 26774681 DOI: 10.1016/j.pec.2015.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/02/2015] [Accepted: 12/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Preparing patients for medical interventions improves patient outcomes and is an ethical and legal imperative. This review examines the characteristics and psychometric properties of published instruments which assess patients' preparation for medical interventions. METHODS Medline, CINAHL, EMBASE and PsycINFO electronic databases were searched from the date of their inception to November 2015. Data-based publications describing the development or validation of a self-report instrument designed to assess the quality of adult patients' perceived preparation for a medical intervention were included. RESULTS Nine publications described the development or validation of seven instruments which met inclusion criteria. The psychometric qualities of the instruments varied. None met all of the accepted criteria for psychometric rigour. Although the Satisfaction with Cancer Information Profile met the highest number (n=5) of the defined psychometric properties, the study sample size was less than 100. Overall, content validity of the included instruments was the most frequently assessed criteria. CONCLUSION Few instruments have been specifically developed to assess patients' self-reported preparation for medical interventions. Of the available instruments, none demonstrated adequate rigour across essential psychometric properties. PRACTICE IMPLICATIONS The need to develop instruments examining patient preparation for medical interventions is apparent given the limitations of the instruments reviewed.
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Affiliation(s)
- Kristy L Forshaw
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia.
| | - Mariko L Carey
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia.
| | - Alix E Hall
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia.
| | - Allison W Boyes
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia.
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle & Hunter Medical Research Institute, Callaghan, Australia.
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26
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Fradgley EA, Bryant J, Paul CL, Hall AE, Sanson-Fisher RW, Oldmeadow C. Cross-Sectional Data That Explore the Relationship Between Outpatients' Quality of Life and Preferences for Quality Improvement in Oncology Settings. J Oncol Pract 2016; 12:e746-54. [PMID: 27221990 DOI: 10.1200/jop.2016.011023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This cross-sectional study assessed the association between oncology outpatients' quality improvement preferences and health-related quality of life (HRQoL). Implementation of specific initiatives preferred by patients with lower HRQoL may be a strategic approach to enhancing care for potentially vulnerable patients. METHODS English-speaking adults were recruited from five outpatient chemotherapy clinics located in New South Wales, Australia. Using touch screen devices, participants selected up to 25 initiatives that would improve their experiences and completed the Functional Assessment of Cancer Therapy-General (FACT-G) survey. The logistic odds of selecting an initiative according to FACT-G scores were calculated to determine whether preferences were associated with HRQoL after controlling for potential confounders. RESULTS Of the 411 eligible outpatients approached to participate, 263 (64%) completed surveys. Commonly selected initiatives were up-to-date information on treatment and condition progress (19.8%), access to or information on financial assistance (18.3%), and reduced clinic wait times (17.5%). For those with relatively lower FACT-G scores, the adjusted odds of selecting five initiatives illustrated an increasing trend: convenient appointment scheduling systems (+23% [P = .002]), reduced wait times (+15% [P = .01]), information on medical emergencies (+14% [P = .04]), access to or information on financial assistance (+15% [P = .009]), help to maintain daily living activities (+18% [P = .007]). CONCLUSION Two areas of improvement were commonly selected: easily accessible health services and information and support for self-management. Although the results suggest an association between a few quality improvement preferences and HRQoL, a wider spectrum of patient characteristics must be considered when targeting quality improvement to patient subgroups.
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Affiliation(s)
| | - Jamie Bryant
- University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Alix E Hall
- University of Newcastle, Callaghan, New South Wales, Australia
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Saunders C, Carter DJ, Jordan A, Duffield C, Bichel-Findlay J. Cancer patient experience measures: An evidence review. J Psychosoc Oncol 2016; 34:200-22. [PMID: 26983680 DOI: 10.1080/07347332.2016.1157717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This research investigates the instruments currently available to measure the cancer patient experience of health care. An investigation of the number of instruments, the domains covered by the instruments, and the structure and psychometric performance of instruments is undertaken. METHODS A narrative synthesis approach is used to gather evidence from multiple studies and explain the findings. Purposely broad search terms and strategies are used to capture studies with cancer patients at all stages of disease and across a range of cancer types and health care settings. RESULTS The majority of identified instruments were originally designed for the oncology field. Twelve of the studies developed new cancer patient measures; eight studies adapted existing or utilized items from existing instruments, and seven studies assessed the psychometric properties of existing instruments or assessed validated tools under different conditions (e.g., cross-cultural adaptation). The number of instruments assessing cancer patient experience that have sound psychometric properties across items was found to be low. The properties least tested are test-retest reliability, construct, convergent and discriminant validity, scale variability (floor/ceiling effects), and interpretability. CONCLUSION This review examined 10 years of research on the development of instruments to measure the cancer patient experience of health care. It found that research in this area is still in early stages of development. Further inquiry based on development and validation of cancer patient experience measures is required to support improvements in cancer care based on the perspective of cancer patients.
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Affiliation(s)
- Carla Saunders
- a Faculty of Health, Centre for Health Services Management, University of Technology Sydney , Sydney , Australia
| | - David J Carter
- a Faculty of Health, Centre for Health Services Management, University of Technology Sydney , Sydney , Australia
| | - Amy Jordan
- a Faculty of Health, Centre for Health Services Management, University of Technology Sydney , Sydney , Australia
| | - Christine Duffield
- a Faculty of Health, Centre for Health Services Management, University of Technology Sydney , Sydney , Australia
| | - Jen Bichel-Findlay
- a Faculty of Health, Centre for Health Services Management, University of Technology Sydney , Sydney , Australia
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Brandes K, Linn AJ, Smit EG, van Weert JCM. Unraveling the Determinants of Cancer Patients' Intention to Express Concerns. JOURNAL OF HEALTH COMMUNICATION 2016; 21:327-336. [PMID: 26735084 DOI: 10.1080/10810730.2015.1080325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Little is known about the behavioral determinants that underlie cancer patients' intention to express concerns during a consultation. This information can be relevant to developing effective interventions for cancer patients. In this study, the integrative model of behavioral prediction (IMBP) is used as a framework to unravel the determinants of patients' intention to express concerns. The objectives of this study are to examine which of the IMBP determinants (attitude, perceived social norm, and/or self-efficacy) are significantly related to intention and what content of these determinants can be targeted to effect a change in patients' intention. An online survey based on the IMBP determinants was distributed. A total of 236 cancer patients and cancer survivors participated. The results of the survey showed that patients' attitudes and perceived social norm were the most important determinants of their intention to express concerns. The largest change in patients' intention might be achieved by targeting the affective attitude, referring to the extent to which patients believe that expressing concerns is (un)pleasant, and the social norm, referring to the extent to which patients feel (un)supported by significant others in expressing concerns.
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Affiliation(s)
- Kim Brandes
- a Amsterdam School of Communication Research (ASCoR) , University of Amsterdam , Amsterdam , The Netherlands
| | - Annemiek J Linn
- a Amsterdam School of Communication Research (ASCoR) , University of Amsterdam , Amsterdam , The Netherlands
| | - Edith G Smit
- a Amsterdam School of Communication Research (ASCoR) , University of Amsterdam , Amsterdam , The Netherlands
| | - Julia C M van Weert
- a Amsterdam School of Communication Research (ASCoR) , University of Amsterdam , Amsterdam , The Netherlands
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29
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Alleviating gastro-intestinal symptoms and concerns by integrating patient-tailored complementary medicine in supportive cancer care. Clin Nutr 2015; 34:1215-23. [DOI: 10.1016/j.clnu.2014.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/14/2014] [Accepted: 12/16/2014] [Indexed: 01/04/2023]
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30
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Petersen GS, Knudsen JL, Vinter MM. Cancer patients' preferences of care within hospitals: a systematic literature review. Int J Qual Health Care 2015; 27:384-95. [PMID: 26265160 DOI: 10.1093/intqhc/mzv059] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Knowledge about cancer patients' preferences in health care is important because it enables care to be patient centered. However, the literature does not provide an overview. The aim of this study was to identify the dimensions of hospital-based cancer care that patients evaluate the most important using Patient-rated importance as a method. DATA SOURCE PubMed was searched in 2013/2014. STUDY SELECTION Studies were identified, if they were in accordance with specific search terms and focused on hospital-based cancer care. Totally, 11 studies were found. DATA EXTRACTION The 11 studies comprised a total of 598 items. Of these, 592 items were categorized into 19 care dimensions. The highest rated quartile of items was identified as care elements patients evaluated to be the most important. Identification of the most important dimensions was done by calculating the percentages of items within each dimension that were within the highest quartile. RESULTS OF DATA SYNTHESIS The 11 studies varied a lot in regard to aim and patient characteristics. The three most important dimensions were as follows: Rapid diagnosis and treatment; High professional standard; and Information about treatment and side(effects)/consequences. Within four dimensions, Psychosocial support, Physical facilities, Waiting time and Transparency in care, no items were within the highest quartile. CONCLUSION Patient-rated importance was a useful method in identifying the care patients preferred. Due to a limited number of studies and great diversity within studies evaluated, interpretation of results should be cautious. However, it seems that cancer patients treated in hospitals with a curative intent find treatment-related information, professional standard and short delay of diagnosis and treatment most important.
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Affiliation(s)
| | - Janne Lehmann Knudsen
- Danish Cancer Society, Documentation & Quality, Strandboulevarden 49, Copenhagen DK-2100, Denmark
| | - Mette Marianne Vinter
- Danish Cancer Society, Documentation & Quality, Strandboulevarden 49, Copenhagen DK-2100, Denmark
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31
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Schinkel S, Van Weert JCM, Kester JAM, Smit EG, Schouten BC. Does Media Use Result in More Active Communicators? Differences Between Native Dutch and Turkish-Dutch Patients in Information-Seeking Behavior and Participation During Consultations With General Practitioners. JOURNAL OF HEALTH COMMUNICATION 2015; 20:910-919. [PMID: 26073918 DOI: 10.1080/10810730.2015.1018600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study investigates differences between native Dutch and Turkish-Dutch patients with respect to media usage before and patient participation during medical consultations with general practitioners. In addition, the authors assessed the relation between patient participation and communication outcomes. The patients were recruited in the waiting rooms of general practitioners, and 191 patients (117 native Dutch, 74 Turkish-Dutch) completed pre- and postconsultation questionnaires. Of this sample, 120 patients (62.8%; 82 native Dutch, 38 Turkish-Dutch) agreed to have their consultations recorded to measure patient participation. Compared with Turkish-Dutch patients of similar educational levels, results showed that native Dutch patients used different media to search for information, participated to a greater extent during their consultations and were more responsive to their general practitioner. With respect to the Turkish-Dutch patients, media usage was related to increased patient participation, which was correlated with having fewer unfulfilled information needs; however, these relations were not found in the native Dutch patient sample. In conclusion, interventions that enhance participation among ethnic minority patients will better fulfill informational needs when such interventions stimulate information-seeking behavior in that group before a medical consultation.
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Affiliation(s)
- Sanne Schinkel
- a Amsterdam School of Communication Research , University of Amsterdam , Amsterdam , the Netherlands
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32
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Shin DW, Roter DL, Cho J, Kim SY, Yang HK, Suh B, Kim Y, Han JY, Chung IJ, Park JH. Attitudes toward disclosure of medication side effects: a nationwide survey of Korean patients, caregivers, and oncologists. Psychooncology 2015; 24:1398-406. [DOI: 10.1002/pon.3807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 02/16/2015] [Accepted: 02/24/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine/Health Promotion Center/Cancer Survivorship Clinic; Seoul National University Hospital; Seoul Korea
| | - Debra L. Roter
- Department of Health, Behavior, and Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
| | - Juhee Cho
- Department of Health, Behavior, and Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology; Sungkyunkwan University; Seoul Korea
| | - So Young Kim
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju Korea
- Division of Cancer Policy and Management, National Cancer Control Institute; National Cancer Center; Goyang Korea
| | - Hyung Kook Yang
- Division of Cancer Policy and Management, National Cancer Control Institute; National Cancer Center; Goyang Korea
- Department of Health Policy and Management; Seoul National University College of Medicine; Seoul Korea
- Institute of Health Policy and Management; Medical Research Center, Seoul National University; Seoul Korea
| | - Beomseok Suh
- Department of Family Medicine/Health Promotion Center/Cancer Survivorship Clinic; Seoul National University Hospital; Seoul Korea
| | - Yoon Kim
- Department of Health Policy and Management; Seoul National University College of Medicine; Seoul Korea
- Institute of Health Policy and Management; Medical Research Center, Seoul National University; Seoul Korea
| | - Ji-Youn Han
- Center for Lung Cancer; National Cancer Center; Goyang Korea
| | - Ik Joo Chung
- Departments of Hematology-Oncology; Chonnam National University Medical School; Gwangju Korea
| | - Jong-Hyock Park
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju Korea
- Division of Cancer Policy and Management, National Cancer Control Institute; National Cancer Center; Goyang Korea
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Brandes K, Linn AJ, Smit EG, van Weert JCM. Patients' reports of barriers to expressing concerns during cancer consultations. PATIENT EDUCATION AND COUNSELING 2015; 98:317-322. [PMID: 25499005 DOI: 10.1016/j.pec.2014.11.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/19/2014] [Accepted: 11/23/2014] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To identify cancer patients' most influential barriers to expressing concerns during cancer consultations in a new manner by examining patients' reports of perceived barriers and perceived occurrence of barriers in consultations. METHODS Two online focus groups (N=16) and an online survey (N=236) were conducted among cancer patients and cancer survivors. The online focus groups and survey were used to examine two elements of patients' barriers, i.e., patients' reports of perceived barriers and perceived occurrence of barriers in consultations. Composite scores of these two elements were calculated to determine influential barriers. RESULTS Results showed that the most influential barriers were related to providers' behavior (e.g., providers do not explicitly invite patients to express concerns) and the environment where the consultation takes place (e.g., perceived lack of time). CONCLUSION The results of this study indicate that influential barriers to expressing concerns are barriers that patients cannot overcome themselves (i.e., they are related to providers' behavior or the environment of the consultation). A collaborative approach between researchers, providers and policy makers is needed to overcome these barriers. PRACTICE IMPLICATIONS The results of this study can be used to develop strategies to overcome barriers to patients expressing concerns.
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Affiliation(s)
- Kim Brandes
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands.
| | - Annemiek J Linn
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Edith G Smit
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
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Impact of a family-centered approach on attunement of care and parents' disclosure of concerns: a quasi-experimental study. J Dev Behav Pediatr 2014; 35:292-300. [PMID: 24799267 DOI: 10.1097/dbp.0000000000000062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the importance parents place on family-centered care aspects in Preventive Child Healthcare (PCH) and to evaluate whether a family-centered approach influences the attunement of care to these preferences and the willingness of parents to disclose concerns. METHODS Parents of infants (mean age = 11.4 weeks) attending Dutch PCH participated in the quasi-experimental study. Parents of infants receiving family-centered care (intervention condition) and parents of infants receiving care-as-usual (control condition) filled in a questionnaire regarding the importance of PCH professionals' attitude, parents' empowerment, and monitoring the broad developmental context. They also assessed their experiences regarding these aspects of care. Furthermore, parents rated their willingness to disclose concerns. We compared the 2 conditions, adjusting for background characteristics, and assessed interactions by socioeconomic status (SES) and the child's social-emotional status. RESULTS Data were provided by a sample of 2542 parents of infants receiving family-centered care and 2328 parents of infants receiving care-as-usual (return rate of questionnaires 86%). Parents rated the PCH professionals' attitude as most important and monitoring the broad developmental context as least important. Scores were high in both conditions. Compared with care-as-usual, parents receiving family-centered care reported better attunement of care to their preferences (p < .001, effect sizes = 0.10-0.27). Parents' willingness to disclose concerns was similar in both conditions (p = .09). Effects were stable across SES and child's social-emotional status groups. CONCLUSIONS The family-centered approach improves attunement of care to parents' preferences, but it does not increase their already high willingness to disclose concerns.
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Tzelepis F, Rose SK, Sanson-Fisher RW, Clinton-McHarg T, Carey ML, Paul CL. Are we missing the Institute of Medicine's mark? A systematic review of patient-reported outcome measures assessing quality of patient-centred cancer care. BMC Cancer 2014; 14:41. [PMID: 24460829 PMCID: PMC3917413 DOI: 10.1186/1471-2407-14-41] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 01/20/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Institute of Medicine (IOM) has endorsed six dimensions of patient-centredness as crucial to providing quality healthcare. These dimensions outline that care must be: 1) respectful to patients' values, preferences, and expressed needs; 2) coordinated and integrated; 3) provide information, communication, and education; 4) ensure physical comfort; 5) provide emotional support-relieving fear and anxiety; and 6) involve family and friends. However, whether patient-reported outcome measures (PROMs) comprehensively cover these dimensions remains unexplored. This systematic review examined whether PROMs designed to assess the quality of patient-centred cancer care addressed all six IOM dimensions of patient-centred care and the psychometric properties of these measures. METHODS Medline, PsycINFO, Current Contents, Embase, CINAHL and Scopus were searched to retrieve published studies describing the development and psychometric properties of PROMs assessing the quality of patient-centred cancer care. Two authors determined if eligible PROMs included the six IOM dimensions of patient-centred care and evaluated the adequacy of psychometric properties based on recommended criteria for internal consistency, test-retest reliability, face/content validity, construct validity and cross-cultural adaptation. RESULTS Across all 21 PROMs, the most commonly included IOM dimension of patient-centred care was "information, communication and education" (19 measures). In contrast, only five measures assessed the "involvement of family and friends." Two measures included one IOM-endorsed patient-centred care dimension, two measures had two dimensions, seven measures had three dimensions, five measures had four dimensions, and four measures had five dimensions. One measure, the Indicators (Non-small Cell Lung Cancer), covered all six IOM dimensions of patient-centred care, but had adequate face/content validity only. Eighteen measures met the recommended adequacy criteria for construct validity, 15 for face/content validity, seven for internal consistency, three for cross-cultural adaptation and no measure for test-retest reliability. CONCLUSIONS There are no psychometrically rigorous PROMs developed with cancer patients that capture all six IOM dimensions of patient-centred care. Using more than one measure or expanding existing measures to cover all six patient-centred care dimensions could improve assessment and delivery of patient-centred care. Construction of new comprehensive measures with acceptable psychometric properties that can be used with the general cancer population may also be warranted.
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Affiliation(s)
- Flora Tzelepis
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Shiho K Rose
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Robert W Sanson-Fisher
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Tara Clinton-McHarg
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Mariko L Carey
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christine L Paul
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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van Weert JCM, Bolle S, Muusses LD. Age and Age-Related Differences in Internet Usage of Cancer Patients. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/978-3-319-07446-7_40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Linn AJ, van Dijk L, Smit EG, Jansen J, van Weert JCM. May you never forget what is worth remembering: the relation between recall of medical information and medication adherence in patients with inflammatory bowel disease. J Crohns Colitis 2013; 7:e543-50. [PMID: 23660489 DOI: 10.1016/j.crohns.2013.04.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 03/26/2013] [Accepted: 04/02/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Nurses play an important role in educating patients with inflammatory bowel disease (IBD) about immunosuppressive or biological therapy during prescribing consultations. The education for immunosuppressive or biological therapy often contains complex information. Poor medication intake behavior can be a result of poor information recall, which is often caused by complex information. OBJECTIVES The aim of this study is to measure information recall by IBD patients, and to investigate the relationship between recall and medication intake behavior. METHODS Data collection took place from September 2009 until March 2012. Eight nurses at six Dutch hospitals and 68 IBD patients participated in this study. Prescribing consultations were videotaped and patients completed surveys immediately after the consultation and after three weeks. Information recall was based on the actual communication in video recordings of the consultations. Medication intake behavior was measured by self-report. RESULTS Issues most frequently discussed were side effects and how patients had to administer their medication. IBD patients could reproduce half of the information. Recall of medical information was a significant predictor for self-reported medication intake behavior (β=0.37, p=0.007), indicating that higher recall of medical information relates to improved self-reported medication intake behavior. CONCLUSIONS This study revealed a significant relation between IBD patients' recall and self-reported medication intake behavior. When educating IBD patients about their newly prescribed medication, providers should consider recall-promoting techniques to increase medication intake behavior.
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Affiliation(s)
- Annemiek J Linn
- Amsterdam School of Communication Research / ASCoR, University of Amsterdam, Amsterdam, The Netherlands.
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Dalby CK, Nesbitt M, Frechette CA, Kennerley K, Lacoursiere LH, Buswell L. Standardization of Initial Chemotherapy Teaching to Improve Care. Clin J Oncol Nurs 2013; 17:472-5. [DOI: 10.1188/13.cjon.472-475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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van Weert JCM, Bolle S, van Dulmen S, Jansen J. Older cancer patients' information and communication needs: what they want is what they get? PATIENT EDUCATION AND COUNSELING 2013; 92:388-97. [PMID: 23602863 DOI: 10.1016/j.pec.2013.03.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/10/2013] [Accepted: 03/11/2013] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To evaluate what information and communication aspects older cancer patients (≥65) consider important in preparing for chemotherapy treatment (CT), the extent to which this corresponds with what oncology nurses consider important, and the extent to which nurses attend to these aspects during real-life educational visits in oncology. METHODS The QUOTE(chemo) was used to have patients (n=116) and nurses (n=123) rate the importance of 66 aspects of patient education. Subsequently, the implementation of these 66 aspects during videotaped nursing visits (n=155) with older cancer patients receiving CT for the first time was examined. RESULTS Older cancer patients attached most importance to 'treatment-related information', 'rehabilitation information', 'affective communication' and discussing 'realistic expectations'. Nurses placed great importance to almost all aspects except to discussing 'realistic expectations'. Discrepancies were found between expressed importance and the actual performance during the videotaped consultations, particularly in discussing realistic expectations, coping information, interpersonal communication, and tailored communication. CONCLUSION Results pointed to aspects that need improvement to ensure high quality patient education tailored to the patients' needs. PRACTICE IMPLICATIONS To make sure older cancer patients' needs are met, more attention should be paid to the development of interventions supporting both needs assessment and fulfillment.
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Affiliation(s)
- Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands.
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van Vliet LM, van der Wall E, Plum NM, Bensing JM. Explicit prognostic information and reassurance about nonabandonment when entering palliative breast cancer care: findings from a scripted video-vignette study. J Clin Oncol 2013; 31:3242-9. [PMID: 23940230 DOI: 10.1200/jco.2012.45.5865] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE When discussing the transition to palliative care for patients with breast cancer, oncologists have to find a balance between giving explicit information while not overwhelming patients and being realistic while remaining hopeful. It is unclear whether patients prefer more or less explicit prognostic information, and reassuring patients that they will not be abandoned may provide realistic hope. We assessed the effect of explicit prognostic information and reassurance about nonabandonment at the transition to palliative care. PATIENTS AND METHODS An experimental 2 × 2 study was used. Four scripted videos of a bad news conversation were created that differed only in the level of "explicitness of prognosis" and "reassurance about nonabandonment" (high v low). Patients with and survivors of breast cancer (n = 51) and healthy women (n = 53) watched the video-vignettes. The effects of the different communications on participants' anxiety, uncertainty, self-efficacy, and satisfaction were assessed by using multilevel analyses that explored the moderating influences of monitoring/blunting scores. RESULTS The highly explicit/highly reassuring video yielded the most positive outcomes, and the less explicit/less reassuring video, the most negative (P ≤ .05 for all outcome measures except anxiety). The main effects found were that explicitness and reassurance decreased participants' uncertainty (P < .001 and P = .002, respectively) and anxiety (only after reassurance; P = .001) while increasing self-efficacy (P = .004 and P < .001, respectively) and satisfaction (P < .001 and P < .001, respectively). High monitors seemed least positive, mainly following explicitness. CONCLUSION Explicit prognostic information may lead to better outcomes than general information. In addition, reassurance about nonabandonment might provide realistic hope but should be lived up to. More research is needed to translate these findings into clinical care.
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Affiliation(s)
- Liesbeth M van Vliet
- Liesbeth M. van Vliet and Jozien M. Bensing, Netherlands Institute for Health Services Research (NIVEL); Elsken van der Wall, Nicole M. Plum, and Jozien M. Bensing, Utrecht University, Utrecht, the Netherlands
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Moore PM, Rivera Mercado S, Grez Artigues M, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2013; 2013:CD003751. [PMID: 23543521 PMCID: PMC6457800 DOI: 10.1002/14651858.cd003751.pub3] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This is an updated version of a review that was originally published in the Cochrane Database of Systematic Reviews in 2004, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses have been proposed and are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether CST is effective in improving the communication skills of HCPs involved in cancer care, and in improving patient health status and satisfaction. SEARCH METHODS We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2012, MEDLINE, EMBASE, PsycInfo and CINAHL to February 2012. The original search was conducted in November 2001. In addition, we handsearched the reference lists of relevant articles and relevant conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In this updated version, we limited our criteria to RCTs evaluating 'CST' compared with 'no CST' or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real and/or simulated patients with cancer, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects model and, for continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 15 RCTs (42 records), conducted mainly in outpatient settings. Eleven studies compared CST with no CST intervention, three studies compared the effect of a follow-up CST intervention after initial CST training, and one study compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists (six studies), residents (one study) other doctors (one study), nurses (six studies) and a mixed team of HCPs (one study). Overall, 1147 HCPs participated (536 doctors, 522 nurses and 80 mixed HCPs).Ten studies contributed data to the meta-analyses. HCPs in the CST group were statistically significantly more likely to use open questions in the post-intervention interviews than the control group (five studies, 679 participant interviews; P = 0.04, I² = 65%) and more likely to show empathy towards patients (six studies, 727 participant interviews; P = 0.004, I² = 0%); we considered this evidence to be of moderate and high quality, respectively. Doctors and nurses did not perform statistically significantly differently for any HCP outcomes.There were no statistically significant differences in the other HCP communication skills except for the subgroup of participant interviews with simulated patients, where the intervention group was significantly less likely to present 'facts only' compared with the control group (four studies, 344 participant interviews; P = 0.01, I² = 70%).There were no significant differences between the groups with regard to outcomes assessing HCP 'burnout', patient satisfaction or patient perception of the HCPs communication skills. Patients in the control group experienced a greater reduction in mean anxiety scores in a meta-analyses of two studies (169 participant interviews; P = 0.02; I² = 8%); we considered this evidence to be of a very low quality. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving some types of HCP communication skills related to information gathering and supportive skills. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', patients' mental or physical health, and patient satisfaction.
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Affiliation(s)
- Philippa M Moore
- Family Medicine, P. Universidad Catolica de Chile, Lira 44, Santiago, Chile.
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van Vliet L, Francke A, Tomson S, Plum N, van der Wall E, Bensing J. When cure is no option: how explicit and hopeful can information be given? A qualitative study in breast cancer. PATIENT EDUCATION AND COUNSELING 2013; 90:315-322. [PMID: 21555199 DOI: 10.1016/j.pec.2011.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/27/2011] [Accepted: 03/29/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate how oncologists can balance explicit with general and realistic with hopeful information when discussing various topics at the transition from curative to palliative care in breast cancer. METHODS Qualitative analysis of focus groups consisting of female breast cancer survivors and healthy women. RESULTS Perceptions of survivors and healthy women largely overlapped. Participants thought that oncologists can help patients regain a future perspective during this consultation. To achieve this, four themes seemed important: honest medical information, availability of continued support, hope has many faces, and space to choose. Moreover, participants stressed they would need time to let the message sink in before any further information was provided. CONCLUSION Participants thought that when confronted with this type of consultation they would need - more or less explicit - medical information and information regarding support. In order to maintain hope, knowledge about (treatment) possibilities is important, but also the certainty not to be abandoned by the hospital at a later stage of the disease and the confidence to remain able to make one's own decisions. PRACTICE IMPLICATIONS A life-limiting diagnosis may shatter patients' future perspective; however, this study provides suggestions for oncologists to create a new perspective.
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Affiliation(s)
- Liesbeth van Vliet
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
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Prenatal counseling for congenital anomaly tests: parental preferences and perceptions of midwife performance. Prenat Diagn 2013; 33:341-53. [DOI: 10.1002/pd.4074] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Schinkel S, Schouten BC, van Weert JCM. Are GP patients' needs being met? Unfulfilled information needs among native-Dutch and Turkish-Dutch patients. PATIENT EDUCATION AND COUNSELING 2013; 90:261-7. [PMID: 23228377 DOI: 10.1016/j.pec.2012.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/07/2012] [Accepted: 11/11/2012] [Indexed: 05/10/2023]
Abstract
OBJECTIVE This study aims to assess unfulfilled information needs of native-Dutch and Turkish-Dutch general practitioner (GP) patients in the Netherlands. In addition, the relation between perceived and recorded information provision by GPs is studied. METHODS Unfulfilled information needs of native-Dutch (N=117) and Turkish-Dutch patients (N=74) were assessed through pre- and post-consultation questionnaires. Audiotapes of GP consultations were made to code GPs' information provision. RESULTS Turkish-Dutch patients experience more unfulfilled information needs than native-Dutch patients, in particular those who identify equally with Dutch and Turkish culture. Overall, perceived information provision is hardly related to recorded information provision. CONCLUSION GPs insufficiently provide Turkish-Dutch patients and, to a lesser extent, native-Dutch patients as well, the information they need. PRACTICE IMPLICATIONS GPs should be trained in giving adequate, tailored information to patients with various ethnic and cultural backgrounds.
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Affiliation(s)
- Sanne Schinkel
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, The Netherlands.
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Linn AJ, van Weert JCM, Schouten BC, Smit EG, van Bodegraven AA, van Dijk L. Words that make pills easier to swallow: a communication typology to address practical and perceptual barriers to medication intake behavior. Patient Prefer Adherence 2012; 6:871-85. [PMID: 23271896 PMCID: PMC3526884 DOI: 10.2147/ppa.s36195] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The barriers to patients' successful medication intake behavior could be reduced through tailored communication about these barriers. The aim of this study is therefore (1) to develop a new communication typology to address these barriers to successful medication intake behavior, and (2) to examine the relationship between the use of the typology and the reduction of the barriers to successful medication intake behavior. PATIENTS AND METHODS Based on a literature review, the practical and perceptual barriers to successful medication intake behavior typology (PPB-typology) was developed. The PPB-typology addresses four potential types of barriers that can be either practical (memory and daily routine barriers) or perceptual (concern and necessity barriers). The typology describes tailored communication strategies that are organized according to barriers and communication strategies that are organized according to provider and patient roles. Eighty consultations concerning first-time medication use between nurses and inflammatory bowel disease patients were videotaped. The verbal content of the consultations was analyzed using a coding system based on the PPB-typology. The Medication Understanding and Use Self-efficacy Scale and the Beliefs about Medicine Questionnaire Scale were used as indicators of patients' barriers and correlated with PPB-related scores. RESULTS The results showed that nurses generally did not communicate with patients according to the typology. However, when they did, fewer barriers to successful medication intake behavior were identified. A significant association was found between nurses who encouraged question-asking behavior and memory barriers (r = -0.228, P = 0.042) and between nurses who summarized information (r = -0.254, P = 0.023) or used cartoons or pictures (r = -0.249, P = 0.026) and concern barriers. Moreover, a significant relationship between patients' emotional cues about side effects and perceived concern barriers (r = 0.244, P = 0.029) was found as well. CONCLUSION The PPB-typology provides communication recommendations that are designed to meet patients' needs and assist providers in the promotion of successful medication intake behavior, and it can be a useful tool for developing effective communication skills training programs.
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Affiliation(s)
- Annemiek J Linn
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
- Correspondence: Annemiek J Linn, Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Kloveniersburgwal 48, 1012 CX Amsterdam, The Netherlands, Tel +31 20 525 3974, Fax +31 20 525 3681, Email
| | - Julia CM van Weert
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara C Schouten
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Edith G Smit
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | | | - Liset van Dijk
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Muusses LD, van Weert JC, van Dulmen S, Jansen J. Chemotherapy and information-seeking behaviour: characteristics of patients using mass-media information sources. Psychooncology 2011; 21:993-1002. [DOI: 10.1002/pon.1997] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 04/14/2011] [Accepted: 04/18/2011] [Indexed: 11/12/2022]
Affiliation(s)
- Linda D. Muusses
- Amsterdam School of Communication Research/ASCoR; University of Amsterdam; Amsterdam The Netherlands
- Department of Psychology; VU University Amsterdam; Amsterdam The Netherlands
| | - Julia C.M. van Weert
- Amsterdam School of Communication Research/ASCoR; University of Amsterdam; Amsterdam The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research); Utrecht The Netherlands
| | - Jesse Jansen
- Screening and Test Evaluation Program (STEP), Sydney School of Public Health; The University of Sydney; New South Wales Australia
- Centre for Medical Psychology and Evidence Based Decision Making (CeMPED); The University of Sydney; New South Wales Australia
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van Weert JCM, Jansen J, Spreeuwenberg PMM, van Dulmen S, Bensing JM. Effects of communication skills training and a Question Prompt Sheet to improve communication with older cancer patients: a randomized controlled trial. Crit Rev Oncol Hematol 2010; 80:145-59. [PMID: 21075644 DOI: 10.1016/j.critrevonc.2010.10.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 10/07/2010] [Accepted: 10/15/2010] [Indexed: 11/30/2022] Open
Abstract
A randomized pre- and post-test control group design was conducted in 12 oncology wards to investigate the effectiveness of an intervention, existing of a communication skills training with web-enabled video feedback and a Question Prompt Sheet (QPS), which aimed to improve patient education to older cancer patients (≥65 years). The effects were studied by analyzing questionnaires and video recordings of patient education sessions preceding chemotherapy with 210 different patients. Patients' recall of information was the primary outcome of the study. Recall was checked against the actual communication in the video-recordings. Moreover, communication skills were assessed by observing the extent to which nurses implemented 67 communication aspects, categorized in seven dimensions, using the QUOTE(chemo). Experimental nurses demonstrated a significant intervention effect on communicating realistic expectations. Within-group improvements were measured in the experimental group for tailored communication, affective communication and interpersonal communication. Although the use of a QPS significantly increased question asking, only limited results were found on older patients' recall scores. The overall proportion recall of recommendations showed a marginally significant pre-/post-change in proportion recall in favour of the experimental group and there was a significant pre-/post-change in two out of six sub-categories. The results indicate that nurses' communication skills can be improved by communication skills training. More research is needed to understand the difficult relationship between patient-provider communication and recall of information.
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Affiliation(s)
- Julia C M van Weert
- Amsterdam School of Communication Research ASCoR, Department of Communication Sciences, University of Amsterdam, The Netherlands.
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