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Gjosha B, van Gorkom R, Steunenberg S, Toonders F, Buimer MG, Ho GH, de Groot HGW, Veen EJ, Faes MC, Timmers T, van der Laan L. Positive experiences with the use of an eHealth smartphone application during the treatment of an abdominal aortic aneurysm. Ann Vasc Surg 2024:S0890-5096(24)00567-3. [PMID: 39366633 DOI: 10.1016/j.avsg.2024.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/17/2024] [Accepted: 07/17/2024] [Indexed: 10/06/2024]
Abstract
OBJECTIVE To evaluate the patient perceived satisfaction and feasibility of a personalized eHealth application (app) for abdominal aortic aneurysm (AAA) patients undergoing surgery. METHODS Patients were offered to download the app prior to undergoing AAA surgery, in a prospective single centre cohort study, using a mixed methods sequential explanatory design. It offers information via the timely delivery of push notifications with text, images, and videos. The information includes chapters regarding the AAA, surgical techniques (endovascular aneurysm repair and open surgical repair), and perioperative lifestyle advice such as; physical exercise programmes, healthy and protein rich diet, geriatric care, and to stop smoking or drinking alcohol. RESULTS The app was installed by 59/65 patients (91%). After installation, six patients deactivated the app (10%). The mean age was 74 years (SD = 7) and 85% of patients were male. The app was opened a median of 67 times (interquartile range [IQR] 33-127) and with a median time interval of 50 hours (IQR 28-74). Overall, 90% (53/59) completed a satisfaction questionnaire. On a numeric rating scale from 0 to 10, the median scored satisfaction for guidance was 8 (IQR 6-8), provided information was 8 (IQR 6-8), usefulness was 7 (IQR 6-8.5), and for recommending it to others 8 (IQR 6-9). Using purposeful sampling, seven patients underwent a semi-structured interview on user-experience of the app. They described experiencing positive changes to lifestyle habits, and appreciating the ability to share it with loved ones or informal caregivers. Several areas of improvement were reported. CONCLUSION The personalized eHealth app is feasible in older AAA patients and valued as a useful supplement to the standard of care. We argue that the app aids in managing a prehabilitation programme, aids in the digital transformation of healthcare, and thereby decreases the workload of hospital staff.
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Affiliation(s)
- B Gjosha
- Department of Vascular Surgery, Amphia Hospital, Breda, The Netherlands.
| | - R van Gorkom
- Department of Vascular Surgery, Amphia Hospital, Breda, The Netherlands
| | - S Steunenberg
- Department of Vascular Surgery, Amphia Hospital, Breda, The Netherlands
| | - F Toonders
- Department of Vascular Surgery, Amphia Hospital, Breda, The Netherlands
| | - M G Buimer
- Department of Vascular Surgery, Amphia Hospital, Breda, The Netherlands
| | - G H Ho
- Department of Vascular Surgery, Amphia Hospital, Breda, The Netherlands
| | - H G W de Groot
- Department of Vascular Surgery, Amphia Hospital, Breda, The Netherlands
| | - E J Veen
- Department of Vascular Surgery, Amphia Hospital, Breda, The Netherlands
| | - M C Faes
- Department of Geriatrics, Amphia Hospital, Breda, The Netherlands
| | - T Timmers
- Interactive Studios, 's-Hertogenbosch, The Netherlands; IQ Healthcare, Radboud UMC, Nijmegen, The Netherlands
| | - L van der Laan
- Department of Vascular Surgery, Amphia Hospital, Breda, The Netherlands; Department of Cardiovascular Sciences, Vascular Surgery Research group, KU Leuven, Leuven, Belgium
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Lecouturier J, Stansby G, Thomson RG. Information provision and decision-making in the treatment of abdominal aortic aneurysm: A qualitative study of patient experience. PLoS One 2023; 18:e0293354. [PMID: 37871042 PMCID: PMC10593210 DOI: 10.1371/journal.pone.0293354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION Shared decision making (SDM) refers to patients and health care professionals working together to reach a decision about treatment/care. In abdominal aortic aneurysm (AAA) treatment options are influenced by patients' clinical characteristics, their preferences, and potential trade-offs between alternative interventions. This is a prime example of where SDM is essential to ensure the right decision is made for the right patient, yet we have little understanding of what happens in practice. This study explored patient experiences to understand SDM practice in AAA surgery. METHODS We used a qualitative approach to describe, and identify improvements to, current treatment decision making in abdominal aortic aneurysm (AAA) surgery. Two groups of patients were interviewed: those at the point of discussing treatment options (with corresponding digitally recorded consultation data) and following surgical intervention from one hospital. Framework analysis was used. RESULTS Fifteen patients were interviewed, seven at the point of discussing treatment options and eight following surgical intervention. Timing, format and sources of information, verbal framing of interventions and level of patient engagement were key themes. Four areas for improvement were identified: earlier provision and more detailed written information along with signposting to quality on-line information; both intervention options, risks, benefits, and consequences, were not always discussed; some clinicians were somewhat directive in the decision-making process; and patients' treatment values/preferences were not explored-the only example was in one of the eight recorded consultations. Patients could feel overwhelmed by the information and decision and fearful of the impending surgery. CONCLUSIONS More emphasis should be placed on the provision of full information and the exploration of patient values and preferences for treatment. Clinician training and support for patients, including decision aids, could facilitate the decision-making process. Providing written information earlier and guidance on reliable on-line resources would benefits patients and their families.
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Affiliation(s)
- Jan Lecouturier
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gerry Stansby
- Northern Vascular Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- School of Surgical and Reproductive Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard G. Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Stocco F, Kwan JY, Sood M, Scott DJA, Bailey MA, Coughlin PA. Assessment of Available Online Website and YouTube Resources for Patients with Abdominal Aortic Aneurysms. Ann Vasc Surg 2023; 96:176-185. [PMID: 37169249 DOI: 10.1016/j.avsg.2023.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/26/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Over the last decade, patients have displayed a greater tendency to search for online information related to their health before seeking advice from a clinician. This study aims to determine the current quality and educational content of online patient information for abdominal aortic aneurysms (AAAs). METHODS In March 2022, the 3 most popular search engines by market shares (Google, Yahoo!, and Bing) and the video platform YouTube were interrogated for the term "abdominal aortic aneurysm". Validated scoring tools were used to assess quality and readability of the top 50 results for each search engine and to evaluate reliability and educational quality of the first 20 YouTube videos returned by the search. A custom-made scoring system was used to assess content. RESULTS Forty-five unique websites were analysed, 29% of which held Health on the Net certification. Median Flesch-Kincaid Reading Ease (interquartile range [IQR]) was 56.4 (50.4-62.75), with the average website falling under the "difficult to read" category. Median Michigan score (IQR) was 38.5 (32-43.5), reflecting "weak" quality. Websites with a higher content-specific score had a significantly higher median Michigan score. Sixty percent of websites discussed benefits and risks related to AAA treatment, and only 31% discussed advantages and disadvantages of open versus endovascular treatment. No websites mentioned the volume-outcome relationship in aneurysm surgery. Eight unique YouTube videos were assessed. Median Journal of the American Medical Association score (IQR) was 2 (2-2.25). Median Global Quality Score score (IQR) was 3 (2-4). Median content score was 1 (0-2). CONCLUSIONS The current average online information on AAA is of 'weak' quality and 'difficult' (i.e., above the standard reading ability of a 13- to 15-year-old) readability. Healthcare providers should focus on the provision of better AAA-focused patient information (e.g., appropriately referenced, regularly reviewed, and limiting advertisements where possible). The involvement of patient advisory groups during resource development is highly recommended.
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Affiliation(s)
- Fabio Stocco
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jing Yi Kwan
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mehak Sood
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Julian A Scott
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marc A Bailey
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; The Leeds Institute of Cardiovascular & Metabolic Medicine, School of Medicine, University of Leeds, Leeds, UK.
| | - Patrick A Coughlin
- The Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Nilsson O, Hultgren R, Letterstål A. Experiences of participating in an eHealth intervention for patients with abdominal aortic aneurysm: A qualitative study. JOURNAL OF VASCULAR NURSING 2023; 41:114-120. [PMID: 37684088 DOI: 10.1016/j.jvn.2023.05.007] [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: 10/20/2022] [Accepted: 05/24/2023] [Indexed: 09/10/2023]
Abstract
AIMS To explore patients' experiences of an eHealth tool and tailored psychosocial support throughout the care trajectory of AAA repair. DESIGN A qualitative interview study. METHODS Individual in-depth interviews were performed with twelve patients participating in an intervention study in conjunction with AAA surgery. Data were collected from March to December 2019. The interviews were analysed using qualitative content analysis with an inductive approach. RESULTS The patients' familiarity with and attitude to eHealth influenced their use of the eHealth tool. The interpersonal relationship with health care staff affected patients' ability to submit themselves. The preoperative information, including the eHealth tool, may result in an overwhelming amount of information, causing anxiety and leading patients to refrain from information, partly due to the timing of the information. Psychosocial support offered continuity and reassurance, and enabled the patients to elaborate on existential matters. CONCLUSION The design of eHealth services in AAA care would benefit from a consideration of patients' attitude to eHealth and familiarity with modern technology. To increase patients' accessibility to health care services, their preference for technology use and type of contact should be verified and respected. Psychosocial support should be offered with continuity to alleviate patients' emotional burden. Adjustment to patients' mental state and learning needs may forestall anxiety. IMPACT This study highlights factors that affect the acceptability of eHealth services in AAA patients. These findings can guide future design and implementation of mobile health interventions in surgical care.
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Affiliation(s)
- Olga Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Letterstål
- School of Health, Care and Social Welfare, Mälardalen University, Sweden
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Alghazawi LOK, Holtermann Entwistle O, Fehervari M, Spalding D. Unusual cause of intraoperative haemorrhage: a lesson for patient counselling. BMJ Case Rep 2022; 15:e247951. [PMID: 35680280 PMCID: PMC9185409 DOI: 10.1136/bcr-2021-247951] [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] [Accepted: 04/27/2022] [Indexed: 12/24/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a well-known malignant neoplasm of the liver associated with spontaneous haemorrhage in 3%-15% of cases. This complication is life threatening and has a mortality rate of 33%-100%. Despite the frequency and severity of spontaneous haemorrhage, the importance of patient education about this complication has not been highlighted before. There is currently no information available on the NHS UK website, and no publications have addressed the effect of patient education. We present this case report describing a patient who developed classical symptoms of haemorrhage the day before her elective HCC resection, but was unaware of its importance, and thus did not seek medical attention. She was subsequently found to have a large volume haemoperitoneum, anaemia and a ruptured HCC intraoperatively. This case illustrates the significant importance of counselled regarding the symptoms and risk of spontaneous rupture of HCC to prompt early presentation to medical services.
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Affiliation(s)
| | | | - Matyas Fehervari
- HPB Surgery, Imperial College Healthcare NHS Trust and Imperial College London, London, UK
| | - Duncan Spalding
- HPB Surgery, Imperial College Healthcare NHS Trust and Imperial College London, London, UK
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Nilsson O, Stenman M, Letterstål A, Hultgren R. A randomized clinical trial of an eHealth intervention on anxiety in patients undergoing abdominal aortic aneurysm surgery. Br J Surg 2021; 108:917-924. [PMID: 34021309 PMCID: PMC10364917 DOI: 10.1093/bjs/znab151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/10/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The potential benefit of eHealth interventions in patients with abdominal aortic aneurysm (AAA) is uncertain. The primary aim of this study was to investigate the effect of an eHealth intervention on anxiety in patients with AAA undergoing surgery. METHODS A single-centre randomized clinical trial of patients with AAA scheduled for surgical repair was undertaken. The intervention group received an eHealth tool and psychosocial support besides standard care. The control group received standard care. The analysis of treatment effects was performed as intention-to-treat and per protocol analysis. The primary outcome measure was anxiety mean score (Hospital Anxiety and Depression Scale Anxiety (HADS)-A). Secondary outcomes measures were HADS Depression and short-form 12-item health survey mean scores. RESULTS Some 120 participants were randomized. No effect on anxiety mean scores was found in the intention-to-treat analysis (-1.21 versus -0.54, P = 0.330). Among those randomized to the intervention, only 30 of 60 participants used the eHealth tool (application (app) users). The app users were younger and had a higher educational level. A decrease in anxiety mean scores was noted in those who used the app in the per protocol analysis (-2.00 versus -0.54, P = 0.028). The intervention group stated a lower physical-component health-related quality of life (HRQoL) (-4.32 versus -1.16, P = 0.042) but mental-component HRQoL and depressive symptoms were unchanged. CONCLUSIONS Delivery of an eHealth intervention in this RCT did not result in an improvement in anxiety scores in patients awaiting AAA surgery. Uptake of the eHealth tool was low, although it resulted in lower anxiety scores in those participants who actually used it. CLINICAL TRIAL REGISTRATION NUMBER NCT03157973 (http://www.clinicaltrials.gov).
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Affiliation(s)
- O Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - M Stenman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden
| | - A Letterstål
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - R Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Ericsson A, Carlson E, Ching SSY, Molassiotis A, Kumlien C. Partners' experiences of living with men who have screening-detected abdominal aortic aneurysms: A qualitative descriptive study. J Clin Nurs 2020; 29:3711-3720. [PMID: 32619284 DOI: 10.1111/jocn.15399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/28/2020] [Accepted: 06/05/2020] [Indexed: 11/27/2022]
Abstract
AIM To describe partners' experiences of living with men with a screening-detected abdominal aortic aneurysm (AAA). BACKGROUND Diagnosis of a chronic life-threatening disease affects the patients' as well as their partners' lives in different aspects. AAA, with rupture as the major consequence, is a life-threatening disease that can affect the whole family. Screening programmes for AAA have been introduced in several countries to reduce the mortality rate. Although the awareness of having an AAA influences the individuals' quality of life and well-being, it is still unclear how it affects their partners. DESIGN Qualitative descriptive design. METHODS Twenty-one partners of men with AAA were purposely selected to participate in individual semi-structured interviews between August 2017-February 2018 in Sweden. Data were transcribed and imported into NVivo-12® . The data were analysed using qualitative content analysis. The study conforms to the COREQ checklist. RESULTS Three categories were identified: (a) experiencing the unexpected; (b) being reminded of fragility; and (c) balancing a changing relationship. The partners had a positive attitude towards the screening process and were pleased that their husbands were under surveillance. Nevertheless, at the same time, the diagnosis caused worries and questions. The AAA diagnosis was constantly in the minds of the partners, which sometimes affected and limited daily activities. Furthermore, ambivalent feelings towards surgical treatment were described. The partners tried to support their men and encouraged them to achieve a healthy lifestyle. CONCLUSION The partners' well-being and daily lives were impacted by the awareness of the screening-detected AAA. Different degrees of worry were the most common reaction and were pervasive in all three categories. RELEVANCE FOR CLINICAL PRACTICE The result highlights the need to review routines or develop new strategies to include the partners in the process of screening and offer supplementary support and information.
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Affiliation(s)
- Anna Ericsson
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | | | | | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Christine Kumlien
- Department of Care Science, Malmö University, Malmö, Sweden.,Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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Khural M, Gullipalli R, Dubrowski A. Evaluating the Use of a Generic Three-Dimensionally (3D) Printed Abdominal Aortic Aneurysm Model as an Adjunct Patient Education Tool. Cureus 2020; 12:e8533. [PMID: 32665880 PMCID: PMC7352734 DOI: 10.7759/cureus.8533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
An abdominal aortic aneurysm (AAA) is a serious medical condition that requires invasive surgery or endovascular treatment with stent grafts. This procedure is primarily carried out by vascular surgeons and interventional radiologists. Current methods of educating patients about their procedure have been inadequate, causing unnecessary stress in patients who have this condition and seek treatment. In this study, we evaluate a three-dimensionally (3D) printed AAA model to use as an adjunct patient education tool, thus allowing patients to make a more knowledgeable decision when providing informed consent. The physical attributes and realism of the model are evaluated through the use of a quantitative and qualitative survey completed by physicians at St. Clare’s Mercy Hospital in St. John’s, Newfoundland. These physicians are referred to as “Experts” in our study and also rate and comment on the necessity of having patient-specific versus generic 3D AAA models for patient education purposes. The aim of this study is to determine whether our 3D printed AAA model is ready to be used as an adjunct patient education tool and to seek suggestions for improvements that can be made in the model. Furthermore, having generic 3D AAA models would significantly decrease healthcare costs as compared to patient-specific models. Thus, we also investigate if generic models would suffice from the perspective of the physicians.
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Affiliation(s)
- Manveer Khural
- Medicine, Memorial University of Newfoundland, St. John's, CAN
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Nilsson O, Hultgren R, Letterstål A. eH
ealth tool for patients with abdominal aortic aneurysm: development and initial evaluation. Scand J Caring Sci 2019; 34:348-356. [DOI: 10.1111/scs.12736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 05/24/2019] [Accepted: 06/19/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Olga Nilsson
- Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Rebecka Hultgren
- Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden
- Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Anna Letterstål
- Department of Medicine Karolinska Institutet Stockholm Sweden
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