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Islam MA, Benzir M, Siddique MKB, Awal MA, Chowdhury MAK, Joarder T. Validation of the Bangla version of the Communication Skills Attitude Scale with the medical students of Bangladesh. Health Sci Rep 2024; 7:e2274. [PMID: 39100714 PMCID: PMC11294438 DOI: 10.1002/hsr2.2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 08/06/2024] Open
Abstract
Background Effective communication skill of physicians is an important component of high-quality healthcare delivery and safe patient care. Communication is embedded in the social and cultural contexts where it takes place. An understanding of medical students' attitudes and learning communication skills would help to design and deliver culturally appropriate medical education. The Communication Skills Attitude Scale (CSAS) is a widely used and validated tool to measure the attitude of medical students toward learning communication skills in different populations, settings, and countries. However, there is no culturally adapted and validated scale in Bangla in the Bangladesh context. This study aims to culturally adapt the CSAS into Bangla, and validate it in a cohort of medical students in Bangladesh. Methods This study used a cross-sectional survey design to collect data from purposively selected 566 undergraduate medical students from the Rajshahi division. The survey was conducted from January to December 2023. Descriptive statistics like frequency distribution and measures of central tendency were used to measure perception regarding communication skills. The sample adequacy was measured through the Kaiser-Meyer-Olkin test. The internal consistency of the items was identified using Cronbach's alpha (α) coefficients. Result The results of the study show that the Bangla version of the scale is feasible, valid, and internally consistent in the context of a developing country, Bangladesh. The overall internal consistency of the Bangla version is good since the value of Cronbach's alpha (α) is 0.882. For PAS, the internal consistency is 0.933. While, for NAS, the value is 0.719. The item-wise average scores in the PAS indicate that female medical students are more willing to learn communication skills compared with male students (α = 0.933). While, the scores in the NAS indicate that the male students tend to have more negative attitude toward learning communication skills compared with female students (α = 0.719). Conclusion The CSAS-Bangla is a valid and reliable tool for assessing communication skill attitudes among Bangla speaking medical students. This scale can be used in future studies to measure the attitude of students, designing and evaluating communication skills training programs in medical colleges.
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Affiliation(s)
- Mohammad Aminul Islam
- Department of Media Studies and JournalismUniversity of Liberal Arts BangladeshDhakaBangladesh
| | - Maskura Benzir
- Department of AnatomyTMSS Medical CollegeBoguraBangladesh
| | | | - Md. Abdul Awal
- Department of Public HealthVarendra UniversityRajshahiBangladesh
| | | | - Taufique Joarder
- Global Health EvaluationSingHealth Duke‐NUS Global Health InstituteSingaporeSingapore
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Khan MMM, Munir MM, Woldesenbet S, Khalil M, Altaf A, Rashid Z, Pawlik TM. Association of surgeon's sex, and surgeon-patient dyad with financial outcomes among patients undergoing cancer surgery. J Surg Oncol 2024. [PMID: 38941176 DOI: 10.1002/jso.27752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/06/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Surgeon sex has been associated with perioperative clinical outcomes among patients undergoing oncologic surgery. There may be variations in financial outcomes relative to the surgeon-patient dyad. We sought to define the association of surgeon's sex with perioperative financial outcomes following cancer surgery. METHODS Patients who underwent resection of lung, breast, hepato-pancreato-biliary (HPB), or colorectal cancer between 2014 and 2021 were identified from the Medicare Standard Analytic Files. A generalized linear model with gamma regression was utilized to characterize the association between sex concordance and expenditures. RESULTS Among 207,935 Medicare beneficiaries (breast: n = 14,753, 7.1%, lung: n = 59,644, 28.7%, HPB: n = 23,400, 11.3%, colorectal: n = 110,118, 53.0%), 87.8% (n = 182,643) and 12.2% (n = 25,292) of patients were treated by male and female surgeons, respectively. On multivariable analysis, female surgeon sex was associated with slightly reduced index expenditures (mean difference -$353, 95%CI -$580, -$126; p = 0.003). However, there were no differences in 90-day post-discharge inpatient (mean difference -$-225, 95%CI -$570, -$121; p = 0.205) and total expenditures (mean difference $133, 95%CI -$279, $545; p = 0.525). CONCLUSIONS There was minor risk-adjusted variation in perioperative expenditures relative to surgeon sex. To improve perioperative financial outcomes, a diverse surgical workforce with respect to patient and surgeon sex is warranted.
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Affiliation(s)
- Muhammad Muntazir Mehdi Khan
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Muhammad M Munir
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mujtaba Khalil
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Abdullah Altaf
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Zayed Rashid
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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Aarons GA, Sklar M, Ehrhart MG, Roesch S, Moullin JC, Carandang K. Randomized trial of the leadership and organizational change for implementation (LOCI) strategy in substance use treatment clinics. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209437. [PMID: 38866139 DOI: 10.1016/j.josat.2024.209437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/28/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Evidence-based practice (EBP) implementation represents a strategic change that requires alignment of leadership and support throughout organizations. Leadership and Organizational Change for Implementation (LOCI) is a multifaceted implementation strategy that aims to improve implementation leadership and climate within organizations through iterative cycles of leadership and climate assessment and feedback, leadership training and coaching, and strategic planning with upper-level leaders. This study tested the effects of LOCI on transformational and implementation leadership, implementation climate, implementation citizenship behavior, and EBP reach. METHODS A multiple cohort, cluster randomized trial tests the effect of LOCI in 60 clinics across nine behavioral health organizations in California and Arizona, USA. The study randomized clinics within organizations to either LOCI or a leadership training webinar control condition in three consecutive cohorts. Repeated web-based surveys of direct service providers (nLOCI = 201, nControl = 179) assessed leadership, implementation climate, and implementation citizenship over time. Multilevel autoregressive modeling was the primary statistical analysis such that providers (level-1) were nested within clinics (level-2). The study predicted between-condition differences at 4-, 8-, and 12-month follow-up assessments. Provider engagement in a fidelity monitoring process assessed reach of motivational interviewing (i.e., number of sessions recorded/submitted for fidelity coding). An independent sample t-test explored between condition differences in motivational interviewing reach. RESULTS Results indicated between condition differences at 4 months for implementation leadership, implementation climate, and implementation citizenship behavior such that greater improvements were evidenced in the LOCI condition compared to the control condition. Reach of MI was significantly greater in the LOCI vs control condition such that LOCI providers were significantly more likely to engage in the fidelity monitoring process (chi-square (1, n = 370) = 5.59, p = .018). CONCLUSIONS LOCI was developed based on organizational theories of strategic leadership and climate to affect organizational change processes that communicate that innovation implementation is expected, supported, and recognized as a value of the organization. The LOCI implementation strategy resulted in more positive hypothesized outcomes compared to the control condition. Organizational change strategies have utility for implementing health innovations in complex, multilevel contexts and for greater sustainment of facilitative leader behaviors, strategic implementation climate, and improved implementation outcomes. TRIAL REGISTRATION This study is registered with Clinicaltrials.gov gov (NCT03042832, 2 February 2017; retrospectively registered).
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Affiliation(s)
- Gregory A Aarons
- University of California San Diego, Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812, United States of America; UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, 9500 Gilman Drive, La Jolla, CA 92093, United States of America; Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123, United States of America.
| | - Marisa Sklar
- University of California San Diego, Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812, United States of America; UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, 9500 Gilman Drive, La Jolla, CA 92093, United States of America; Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123, United States of America.
| | - Mark G Ehrhart
- University of Central Florida, Department of Psychology, United States of America.
| | - Scott Roesch
- San Diego State University, Department of Psychology, 5500 Campanile Drive, San Diego, CA 92182-4611, United States of America.
| | - Joanna C Moullin
- Curtin University, School of Population Health, Kent Street, Bentley, Western Australia 6102, Australia
| | - Kristine Carandang
- University of California San Diego, Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812, United States of America; Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123, United States of America
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Scuderi GR, Albana MF, Mont MA. Digital Technology is Influencing the Care of Total Joint Patients. J Arthroplasty 2024; 39:573-574. [PMID: 38101588 DOI: 10.1016/j.arth.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
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Balmuth EA, Luan D, Jannat-Khah D, Evans A, Wong T, Scales DA. Point-of-care ultrasound (POCUS): Assessing patient satisfaction and socioemotional benefits in the hospital setting. PLoS One 2024; 19:e0298665. [PMID: 38363766 PMCID: PMC10871481 DOI: 10.1371/journal.pone.0298665] [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: 12/07/2023] [Accepted: 01/29/2024] [Indexed: 02/18/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is an imaging modality used to make expedient patient care decisions at bedside. Though its diagnostic utility has been extensively described, POCUS is not yet considered standard of care in inpatient settings. Data from emergency department settings suggest that POCUS may yield socioemotional benefits beyond its diagnostic utility; furthermore, elements of the POCUS experience are known to promote placebo effects. These elements likely contribute to a placebo-like "POCUS positive care effect" (PPCE) with socioemotional benefits for receptive patients. Our objective is to provide the first characterization of the PPCE and its facilitating factors in an inpatient setting. In this novel mixed-methods study, we recruited 30 adult patients admitted to internal medicine floors in an urban academic medical center, recorded observations during their routine POCUS encounters, and administered post-encounter surveys. We conducted complementary quantitative and qualitative analyses to define and assess the magnitude of the PPCE. We also aimed to identify factors associated with and facilitating receptiveness to the PPCE. The results indicated that POCUS improves patients' satisfaction with their hospital providers and care overall, as well as perceived care efficiency. Mutual engagement, strong therapeutic alliances, and interpreting POCUS images to provide reassurance are most closely associated with this PPCE. Patients who have lower anxiety levels, less severe illness, and received efficient care delivery during their hospitalizations are most receptive to the PPCE. We conclude that diagnostic POCUS has the potential to exert a positive care effect for hospitalized patients. This PPCE is associated with modifiable factors at the patient, provider, and environment levels. Together, our findings lay the groundwork for an optimized "therapeutic POCUS" that yields maximal socioemotional benefits for receptive patients.
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Affiliation(s)
- Evan A. Balmuth
- Department of Medicine, Division of General Internal Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, United States of America
| | - Danny Luan
- Department of Medicine, Division of General Internal Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, United States of America
| | - Deanna Jannat-Khah
- Department of Medicine, Division of Rheumatology, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, United States of America
- Department of Medicine, Hospital for Special Surgery, New York, New York, United States of America
| | - Arthur Evans
- Department of Medicine, Division of General Internal Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, United States of America
| | - Tanping Wong
- Department of Medicine, Division of General Internal Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, United States of America
| | - David A. Scales
- Department of Medicine, Division of General Internal Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, United States of America
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Kienzle A, Niemann M, Meller S, Gwinner C. ChatGPT May Offer an Adequate Substitute for Informed Consent to Patients Prior to Total Knee Arthroplasty-Yet Caution Is Needed. J Pers Med 2024; 14:69. [PMID: 38248771 PMCID: PMC10821427 DOI: 10.3390/jpm14010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Prior to undergoing total knee arthroplasty (TKA), surgeons are often confronted with patients with numerous questions regarding the procedure and the recovery process. Due to limited staff resources and mounting individual workload, increased efficiency, e.g., using artificial intelligence (AI), is of increasing interest. We comprehensively evaluated ChatGPT's orthopedic responses using the DISCERN instrument. Three independent orthopedic surgeons rated the responses across various criteria. We found consistently high scores, predominantly exceeding a score of three out of five in almost all categories, indicative of the quality and accuracy of the information provided. Notably, the AI demonstrated proficiency in conveying precise and reliable information on orthopedic topics. However, a notable observation pertains to the generation of non-existing references for certain claims. This study underscores the significance of critically evaluating references provided by ChatGPT and emphasizes the necessity of cross-referencing information from established sources. Overall, the findings contribute valuable insights into the performance of ChatGPT in delivering accurate orthopedic information for patients in clinical use while shedding light on areas warranting further refinement. Future iterations of natural language processing systems may be able to replace, in part or in entirety, the preoperative interactions, thereby optimizing the efficiency, accessibility, and standardization of patient communication.
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Affiliation(s)
- Arne Kienzle
- Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.N.); (S.M.); (C.G.)
- Julius Wolff Institute and Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, 10117 Berlin, Germany
| | - Marcel Niemann
- Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.N.); (S.M.); (C.G.)
| | - Sebastian Meller
- Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.N.); (S.M.); (C.G.)
| | - Clemens Gwinner
- Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.N.); (S.M.); (C.G.)
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Cooper Z, Cleary S, Stelmach W, Zheng Z. Patient engagement in perioperative settings: A mixed method systematic review. J Clin Nurs 2023; 32:5865-5885. [PMID: 37073113 PMCID: PMC10946744 DOI: 10.1111/jocn.16709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/31/2023] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Patient engagement has emerged as a key focus in the research literature to facilitate patients' recovery. The term is commonly used by researchers, yet without working definitions. This lack of clarity is further complicated by the interchangeable use of a few terms. OBJECTIVES This systematic review aimed at identifying how patient engagement was conceptualised and operationalised in perioperative settings. METHODS MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched for publications in English discussing patient engagement during the perioperative phase. Three reviewers conducted study selection and methodological assessment using Joanna Briggs Institute mixed methods review framework. Reflexive thematic analysis was used to analyse qualitative data and descriptive analysis for quantitative data. FINDINGS Twenty-nine studies were included with a total sample of 6289. Study types included qualitative (n = 14) and quantitative (n = 15) with different types of surgery. Sample sizes ranged from n = 7 to n = 1315. Only 38% (n = 11) of included studies offered an explicit definition. Four themes associated with operationalisation included provision of information, which was most studied theme, communication, decision-making and action-taking behaviours. All four themes were interconnected and co-dependent on each other. CONCLUSIONS Patient engagement in perioperative settings is a complex and multifaceted concept. The conceptual void in the literature calls for more theoretically informed and comprehensive approaches to researching surgical patient engagement. Future research should aim to better understand the factors that influence patient engagement, as well as the impact of different forms of engagement on patient outcomes through the whole surgical journey of a patient.
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Affiliation(s)
- Zahra Cooper
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM)RMIT UniversityVictoriaBundooraAustralia
| | - Sonja Cleary
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM)RMIT UniversityVictoriaBundooraAustralia
| | - Wanda Stelmach
- Department of SurgeryNorthern HealthVictoriaEppingAustralia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM)RMIT UniversityVictoriaBundooraAustralia
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Karimi N, Moore AR, Lukin A, Connor SJ. Health Communication Research Informs Inflammatory Bowel Disease Practice and Research: A Narrative Review. CROHN'S & COLITIS 360 2023; 5:otad021. [PMID: 37162798 PMCID: PMC10164291 DOI: 10.1093/crocol/otad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Indexed: 05/11/2023] Open
Abstract
Background In the absence of targeted empirical evidence on effective clinical communication in inflammatory bowel disease (IBD), a broad overview of existing evidence on effective communication in healthcare and available recommendations for communication in telehealth is provided and mapped onto IBD research and practice. Methods A narrative literature review was conducted using Pubmed and Scopus databases and snowballing literature search. Results Evidence-based relationship building strategies include communicating emotions, acknowledging and addressing patients' hesitancy, and ensuring continued support. A particular recommendation regarding telehealth interaction is to avoid long stretches of talk. Effective informational strategies include facilitating and supporting information exchange and considering patients' preferences in decision-making. In teleconsultations, clinicians should ask direct questions about patients' emotional state, clarify their understanding of patients' concerns and check patients' understanding, address at least one patient-reported outcome when discussing the recommended treatment, and shorten the consultation where possible. Strategies for maximizing effective clinical communication in the spoken communicative mode include using infographics and simple language, and assessing adherence at the beginning of the consultation. For teleconsultations, clinicians are advised to allow patients to explain the reason for their call at the beginning of the teleconsultation, probe additional concerns early and before ending the teleconsultation, and be mindful of technical issues such as voice delays. Conclusions Use of question prompt lists, decision aids, micro-lessons, and communication training interventions for clinicians could be beneficial in IBD care. Further research into the implementation of such interventions as well as clinical communication concerns specific to IBD is warranted.
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Affiliation(s)
- Neda Karimi
- Address correspondence to: Neda Karimi, PhD, 1 Campbell Street, Liverpool, NSW 2170, Australia ()
| | | | - Annabelle Lukin
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Susan J Connor
- South Western Sydney Inflammatory Bowel Disease Research Group, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
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Ju I, Ohs J, Park T, Hinsley A. Harnessing an Integrated Health Communication (IHC) Framework for Campaigns: A Case of Prescription Drug Decision Making. HEALTH COMMUNICATION 2023; 38:981-992. [PMID: 34657528 DOI: 10.1080/10410236.2021.1986885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Drawing on a multiplicity of mass media and health behavior theories, we propose an integrated health communication (IHC) framework to understand and leverage the ways in which mass mediated and interpersonal sources of health information influence the public's health behavior in the context of their prescription drug decisions. Building on the agenda setting theory, two-step flow theory, and the Health Belief Model, we dig into the interrelationships between mass media and interpersonal information sources and information seeking engagement. Employing survey methodology, our framework was tested using a sample of U.S. adults (N = 628). The major results include (a) information gained through interpersonal sources and perceived benefits of the prescription drugs positively and sequentially mediate the association between mass media exposure and intent to seek prescription drug information, (b) interpersonal health information positively moderate the mediation of mass media exposure - perceived benefits - intent to seek prescription drug information, and (c) the inexpert interpersonal information's positive interaction effect with mass media exposure on intent to seek prescription drug information mediated through perceived benefits was greater with high expert interpersonal communication. These results impart valuable theoretical contributions and have the potential to guide integrated health communication (IHC) campaigns.
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Affiliation(s)
- Ilwoo Ju
- Brian Lamb School of Communication, Purdue University
| | - Jennifer Ohs
- Department of Communication, Saint Louis University
| | - Taehwan Park
- Department of Pharmacy Administration and Public Health, St. John's University
| | - Amber Hinsley
- School of Journalism and Mass Communication, Texas State University
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Mehta M, Teymouri M, Puthuparampil-Mehta B, Sawh C, Paty P, Kostun ZW, Jayakumar L, Scher L. Outcomes of the V-Healthy education and awareness program that empowers high school students to understand and diagnose vascular disease risk factors. J Vasc Surg 2023; 77:1245-1249. [PMID: 36565781 DOI: 10.1016/j.jvs.2022.12.014] [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: 09/21/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION V-Healthy (Center for Vascular Awareness Inc, Latham NY) is a grassroots vascular health education and awareness campaign that educates high school students about the importance of the vascular disease risks they face today and its impact decades later, and empowers health care professionals and schoolteachers to lead vascular health education in their communities. This study evaluates the impact of the V-Healthy initiative in empowering and educating adolescents about the implications of vascular disease risk factors and in creating a blueprint for a community outreach program that focuses on vascular health and disease education and awareness. METHODS The V-Healthy program is an initiative that connects community vascular health care professionals and educators with high school students, for a day of vascular health education. The V-Healthy program curriculum is provided in two distinct stages. Stage I consists of didactic vascular health education and takes place in the classroom for the duration of one class period (40-50 minutes). The class period is divided into four sessions including a PowerPoint presentation to teach the impact of vascular disease risk factors (hypertension, diabetes, hyperlipidemia, smoking/vaping, and genetics) on the development of peripheral arterial disease, venous disease, aortic disease, and stroke, and three hands-on sessions that introduce students to vascular innovation and technology, vascular patients, and the diagnosis of a vascular disease risk factor such as hypertension. Stage I concludes with a student questionnaire aimed to gauge students' retention of the material and attitude toward the program. Stage II offers students (with parental consent) the opportunity to participate in the "Diagnosing Hypertension" study. Students were provided automated blood pressure monitors and taught to measure blood pressure in their parents daily for 1 week. Findings are recorded in designated blood pressure logs, which are then categorized using the 2018 American Heart Association blood pressure categorization system: normal (<120/<80), elevated (120-129/<80), stage I (130-139/80-89), or stage II (≥140/≥90). No identifiable student or guardian information is collected. RESULTS Over 3 years, more than 12,000 students participated in the V-Healthy program and 5120 students completed student surveys, which indicated that 97% improved their understanding of vascular health, >93% could identify vascular disease risk factors, 84% wanted to educate their families, and 76% wanted more vascular health education. A total of 1064 students participated in the "Diagnosing Hypertension" study and diagnosed hypertension in 73% of their parents: 34% for stage I hypertension and 39% for stage II hypertension. Over a 3-year period of this study, the number of schools participating increased 20-fold (from 1 to 20), the number of volunteer vascular health professionals and schoolteachers increased 13-fold (from 16 to 210), and our ability to connect with and impact high school students grew 15-fold (from 800 to over 12,000). CONCLUSIONS V-Healthy is the first program to connect over 12,000 students to vascular health professionals in their communities to empower them to diagnose and understand vascular disease risk factors and their implications on the development of vascular disease. Furthermore, the V-Healthy program has displayed substantial growth over a 3-year period in impacting high school students and vascular health care professionals, and has the potential to be used as a blueprint for community-based vascular health education and awareness initiatives.
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Affiliation(s)
| | | | | | | | | | | | | | - Larry Scher
- Divison of Vascular & Endovascular Surgery, Department of Cardiothoracic & Vascular Surgery, Montefiore Medical Center, Bronx, NY
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Antecedents and consequences of shared decision making for patients with chronic kidney diseases: A cross-sectional survey. Int J Med Inform 2022; 168:104898. [DOI: 10.1016/j.ijmedinf.2022.104898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
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Haydon HM, Lotfaliany M, Jones C, Chelberg G, Horstmanshof L, Taylor M, Carey M, Snoswell CL, Hicks R, Banbury A. Health literacy, dementia knowledge and perceived utility of digital health modalities among future health professionals. Australas J Ageing 2022. [DOI: 10.1111/ajag.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Helen M. Haydon
- Centre for Online Health The University of Queensland Woolloongabba Queensland Australia
- Centre for Health Services Research The University of Queensland Woolloongabba Queensland Australia
| | - Mojtaba Lotfaliany
- Centre for Online Health The University of Queensland Woolloongabba Queensland Australia
- Centre for Health Services Research The University of Queensland Woolloongabba Queensland Australia
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health Deakin University Geelong Victoria Australia
| | - Cindy Jones
- Faculty of Health Sciences and Medicine Bond University Robina Queensland Australia
- Menzies Health Institute Queensland Southport Queensland Australia
| | - Georgina R. Chelberg
- Centre for Online Health The University of Queensland Woolloongabba Queensland Australia
- Centre for Health Services Research The University of Queensland Woolloongabba Queensland Australia
| | - Louise Horstmanshof
- Faculty of Health Southern Cross University Lismore New South Wales Australia
| | - Melissa Taylor
- School of Nursing and Midwifery, Centre for Health Research The University of Southern Queensland Ipswich Queensland Australia
| | - Melissa Carey
- Centre for Health Research The University of Southern Queensland Ipswich Queensland Australia
- University of Auckland Auckland New Zealand
| | - Centaine L. Snoswell
- Centre for Online Health The University of Queensland Woolloongabba Queensland Australia
- Centre for Health Services Research The University of Queensland Woolloongabba Queensland Australia
| | - Richard Hicks
- School of Psychology, Faculty of Society and Design Bond University Robina Queensland Australia
| | - Annie Banbury
- Centre for Online Health The University of Queensland Woolloongabba Queensland Australia
- Centre for Health Services Research The University of Queensland Woolloongabba Queensland Australia
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Pun J. The active participation of elderly patients in traditional Chinese medicine consultations as means to creating a community of practice: A case study in Hong Kong. Front Psychol 2022; 13:948988. [PMID: 36262457 PMCID: PMC9575849 DOI: 10.3389/fpsyg.2022.948988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Despite its historic role in Chinese society and its popularity with an elderly Chinese population, limited research has explored the discursive practices of Traditional Chinese Medicine (TCM). Our analysis of practitioner–patient interactions illustrated the reasons why TCM is widely welcomed by a specific patient group. This paper adopted the concept of Community of Practice (CoP) as a theoretical framework to document how patients interact with TCM practitioners to construct meaning through a process of participation and reification. This study aimed to explore how patients in a medical consultation context developed an understanding of their conditions and how they strategically used medical terminology to enact meaningful exchanges to realise their CoP. An inductive qualitative discourse analysis was conducted to for nine elderly patients (i.e., age > 65) in Hong Kong to demonstrate the role that a CoP played in a joint process of knowledge construction to promote a patient-centred practice and foster the active participation of the patients. TCM practitioners can develop specific communication skills to promote their patients’ CoP, which will improve patient-centred care, empower patients to actively engage in their treatments and result in higher levels of patient satisfaction.
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Traynor G, Shearn AIU, Milano EG, Ordonez MV, Velasco Forte MN, Caputo M, Schievano S, Mustard H, Wray J, Biglino G. The use of 3D-printed models in patient communication: a scoping review. JOURNAL OF 3D PRINTING IN MEDICINE 2022; 6:13-23. [PMID: 35211330 PMCID: PMC8852361 DOI: 10.2217/3dp-2021-0021] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022]
Abstract
3D models have been used as an asset in many clinical applications and a variety of disciplines, and yet the available literature studying the use of 3D models in communication is limited. This scoping review has been conducted to draw conclusions on the current evidence and learn from previous studies, using this knowledge to inform future work. Our search strategy revealed 269 papers, 19 of which were selected for final inclusion and analysis. When assessing the use of 3D models in doctor-patient communication, there is a need for larger studies and studies including a long-term follow up. Furthermore, there are forms of communication that are yet to be researched and provide a niche that may be beneficial to explore.
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Affiliation(s)
- Gemma Traynor
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | - Andrew IU Shearn
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
| | - Elena G Milano
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | | | | | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
- University Hospitals Bristol & Weston, NHS Foundation Trust, Bristol, BS1 3NU, UK
| | - Silvia Schievano
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
- Institute of Cardiovascular Science, University College London, London, WC1E 6DD, UK
| | - Hannah Mustard
- University Hospitals Bristol & Weston, NHS Foundation Trust, Bristol, BS1 3NU, UK
| | - Jo Wray
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, BS8 1UD, UK
- National Heart & Lung Institute, Imperial College London, London, SW3 6LY, UK
- Author for correspondence: Tel.: +44 117 342 3287;
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West W, Torres MB, Mitteldorf D, Capistrant BD, Konety BR, Polter E, Rosser BRS. The Challenge of Coming Out to Providers by Gay and Bisexual Men With Prostate Cancer: Qualitative Results from the Restore Study. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:426-438. [PMID: 36035335 PMCID: PMC9417115 DOI: 10.1080/19317611.2021.1924335] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 06/01/2023]
Abstract
This study investigates the experience of communicating sexual orientation by gay, bisexual and men who have sex with men (GBM) to physicians involved in their prostate cancer care. Methodology consisted of qualitative analysis conducted on 30 in-depth interviews of GBM recruited from a national online cancer support site. Results revealed four key strategies around sexual disclosure. These ranged from explicitly outing themselves to selective or non-disclosure. Disclosures had unpredictable multiple outcomes ranging from increased trust in the patient-physician relationship to seeking alternate treatment. We concluded competent care is achieved when physicians know their patient's sexual orientation, and are trained in them.
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Affiliation(s)
- William West
- Department of Writing Studies, University of Minnesota, Minneapolis, Minnesota, USA
| | | | | | | | - Badrinath R. Konety
- Department of Urology, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth Polter
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - B. R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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16
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Chandra S, Mohammadnezhad M. Doctor-Patient Communication in Primary Health Care: A Mixed-Method Study in Fiji. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147548. [PMID: 34300006 PMCID: PMC8306632 DOI: 10.3390/ijerph18147548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/18/2021] [Accepted: 07/08/2021] [Indexed: 02/05/2023]
Abstract
From a clinical perspective, effective and efficient communication is part of a strategy to ensure doctors are providing high-quality care to their patients. Despite the positive impact of effective doctor–patient communication on health outcomes, limited information is available on this in Fiji. This study was carried out to determine the current patients’ perception of doctors’ communication behaviour and identify factors affecting the doctor–patient communication in Fiji. This mixed-method study was conducted in the outpatient setting of three randomly selected health centres in the Suva Subdivision, Fiji. For the quantitative phase, systematic random sampling was used to select the 375 participants who completed the structured questionnaire; of those, 20 participants were selected for the qualitative interview. From the patients’ perception, 45.6% of them perceived doctors’ communication behaviour as good, 53.6% as fair, and 0.8% as poor communication behaviour. Qualitative findings highlight factors such as the attitude of the doctors, their approach, their interaction with the patients, and them providing an explanation as important factors during doctor–patient communication. In Fiji, the majority of patients perceived doctors’ communication behaviour as fair to good and the doctors’ skills were important for effective doctor–patient communication. This study highlighted the importance of doctor–patient communication and suggested that doctors might not be practicing patient-centred care and communication; thus, they need to upgrade their patient-centred communication skills.
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17
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Atinga RA, Akosen G, Bawontuo V. Perceived characteristics of outpatient appointment scheduling association with patient satisfaction and treatment adherence: An innovation theory application. Hosp Pract (1995) 2021; 49:298-306. [PMID: 34121573 DOI: 10.1080/21548331.2021.1942878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite the growing interest in Appointment scheduling (APS) in hospitals of developing countries, empirical assessment of their effectiveness in improving patients' experiences and adherence to treatment remains limited. We drew on the attributes of an innovation theory to hypothesize and test the extent to which perceived attributes of APS: relative advantage, compatibility, and complexity influences patient satisfaction and treatment adherence in a neurology clinic of a large Teaching Hospital in Ghana. METHODS A structured questionnaire was used to collect cross-sectional data from a sample of 295 scheduled patients visiting the clinic for follow-up care. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to analyze the hypothesized direct relationships of the APS attributes with patient satisfaction and treatment adherence, and the moderating effect of cordial doctor-patient communication in the relationships. RESULTS While the compatibility of APS with patient preference was positively associated with patient satisfaction (p < 0.01) and adherence to treatment (p < 0.01), the reverse was observed for complexity of the APS system (p < 0.01). We also found statistically significant relationship of patient satisfaction with treatment adherence (p < 0.01) which was positively moderated by cordial doctor-patient communication. CONCLUSION Findings suggest that making the APS system more compatible with patient preference can greatly improve upon patient experience satisfaction and adherence to medical treatment for effective therapeutic outcomes. PRACTICE IMPLICATION In the light of its benefits to patient care and outcomes, APS should be given priority over walk-in services in specialty clinics of developing countries.
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Affiliation(s)
- Roger A Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Box Lg 78, University of Ghana Business School, Accra, Ghana
| | - Gifty Akosen
- Department of Public Administration and Health Services Management, University of Ghana Business School, Box Lg 78, University of Ghana Business School, Accra, Ghana
| | - Vitalis Bawontuo
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Sunyani, Ghana
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Marsilio M, Fusco F, Gheduzzi E, Guglielmetti C. Co-Production Performance Evaluation in Healthcare. A Systematic Review of Methods, Tools and Metrics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3336. [PMID: 33804862 PMCID: PMC8037812 DOI: 10.3390/ijerph18073336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 12/29/2022]
Abstract
Co-produced practices and publications in the healthcare sector are gaining momentum, since they can be a useful tool in addressing the sustainability and resilience challenges of health systems. However, the investigation of positive and, mainly, negative outcomes is still confused and fragmented, and above all, a comprehensive knowledge of the metrics used to assess these outcomes is lacking. To fill this gap, this study aims to systematically review the extant literature to map the methods, tools and metrics used to empirically evaluate co-production in health services. The search took place in six databases: Scopus, Web of Science, Psych INFO, PubMed, Cochrane and CINAHL. A total of 2311 articles were screened and 203 articles were included in the analysis, according to PRISMA guidelines. Findings show that outcomes are mainly investigated through qualitative methods and from the lay actor or provider perspective. Moreover, the detailed categorisation of the quantitative measures found offers a multidimensional performance measurement system and highlights the impact areas where research is needed to develop and test new measures. Findings should also promote improvements in empirical data collection on the multiple faceted co-produced activities and spur the consciousness of the adoption of sustainable co-productive initiatives.
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Affiliation(s)
- Marta Marsilio
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122 Milan, Italy; (F.F.); (C.G.)
| | - Floriana Fusco
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122 Milan, Italy; (F.F.); (C.G.)
| | - Eleonora Gheduzzi
- School of Management, Politecnico di Milano, via Lambruschini 4, 20156 Milan, Italy;
| | - Chiara Guglielmetti
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122 Milan, Italy; (F.F.); (C.G.)
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Yeoh K, George C, Rajkhowa A, Buising K. Assessing patient understanding of their antimicrobial treatment: How are we doing and how might we improve? Infect Dis Health 2020; 25:302-308. [PMID: 32792299 DOI: 10.1016/j.idh.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Antimicrobial Stewardship Clinical Care Standard states that patients should receive certain information about their antimicrobial therapy. How well the patient communication recommendations of the standard are followed in clinical practice is not well established. The aim of this pilot quality improvement study was to assess current practices around communication with hospitalised patients about their antimicrobial therapy, to determine compliance with current recommendations, and develop and implement quality improvement actions focused on patient communication for antimicrobial stewardship in Australia. METHODS Adult inpatients receiving one or more antimicrobials for greater than 72 h were recruited. A survey was conducted to assess rates of compliance with requirements to inform patients about the indication, duration and potential side effects of current antimicrobial therapy; modes of delivery of information; and rates of patient satisfaction with the information provided. A paper-based survey was conducted on the general medical, infectious diseases, geriatric evaluation and management, and rehabilitation wards in a 500-bed tertiary Australian hospital. A sample size of 50 was determined as adequate for a baseline analysis of patient communication practices and the development of quality improvement resources and actions. Responses to categorical questions were analysed quantitatively, with additional feedback from patients was collated and analysed qualitatively. RESULTS A total of 54 patients were surveyed. A majority (83%) of patients had been informed that they were taking antimicrobials, and, of these, 96% said they knew the indication, 18% were informed of potential side effects, and 36% knew the duration. Only 22% were informed of the review plan and 27% knew if antimicrobials would be continued on discharge. Written information was given to 11% of patients. Over half (62%) of patients either wanted more information or had concerns about their antimicrobial therapy. Patients reported difficulty in obtaining information. Fifty-eight percent of patients received antimicrobial information from doctors, 13% from nurses and 12% from pharmacists. CONCLUSIONS This study identified gaps in communication with patients regarding in-hospital antimicrobial therapy, and highlighted the need for development and delivery of local quality improvement activities to address this gap.
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Affiliation(s)
- Kim Yeoh
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Level 9 North, 300 Grattan Street, Parkville, Victoria, 3050, Australia.
| | - Catherine George
- Pharmacy Department, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria, 3050, Australia; National Centre for Antimicrobial Stewardship Australia, The Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Victoria, 3000, Australia.
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship Australia, The Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Victoria, 3000, Australia; Department of Medicine and Radiology, The University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Kirsty Buising
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Level 9 North, 300 Grattan Street, Parkville, Victoria, 3050, Australia; National Centre for Antimicrobial Stewardship Australia, The Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Victoria, 3000, Australia; Department of Medicine and Radiology, The University of Melbourne, Parkville, Victoria, 3010, Australia.
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20
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von Glinski A, Ishak B, Elia CJ, Goodmanson R, Pierre C, Norvell DC, Ansari D, Brune P, Oskouian RJ, Chapman JR. Emerging Insight in the Use of an Active Post Discharge Surveillance Program in Spine Surgery: A Retrospective Pilot Study. World Neurosurg 2020; 139:e237-e244. [DOI: 10.1016/j.wneu.2020.03.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/27/2022]
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21
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Fusco F, Marsilio M, Guglielmetti C. Co-production in health policy and management: a comprehensive bibliometric review. BMC Health Serv Res 2020; 20:504. [PMID: 32503522 PMCID: PMC7275357 DOI: 10.1186/s12913-020-05241-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 04/19/2020] [Indexed: 12/25/2022] Open
Abstract
Background Due to an increasingly elderly population, a higher incidence of chronic diseases and higher expectations regarding public service provision, healthcare services are under increasing strain to cut costs while maintaining quality. The importance of promoting systems of co-produced health between stakeholders has gained considerable traction both in the literature and in public sector policy debates. This study provides a comprehensive map of the extant literature and identifies the main themes and future research needs. Methods A quantitative bibliometric analysis was carried out consisting of a performance analysis, science mapping, and a scientific collaboration analysis. Web of Science (WoS) was chosen to extract the dataset; the search was refined by language, i.e. English, and type of publication, i.e. journal academic articles and reviews. No time limitation was selected. Results The dataset is made up of 295 papers ranging from 1994 to May 2019. The analysis highlighted an annual percentage growth rate in the topic of co-production of about 25%. The articles retrieved are split between 1225 authors and 148 sources. This fragmentation was confirmed by the collaboration analysis, which revealed very few long-lasting collaborations. The scientific production is geographically polarised within the EU and Anglo-Saxon countries, with the United Kingdom playing a central role. The intellectual structure consists of three main areas: public administration and management, service management and knowledge translation literature. The co-word analysis confirms the relatively low scientific maturity of co-production applied to health services. It shows few well-developed and central terms, which refer to traditional areas of co-production (e.g. public health, social care), and some emerging themes related to social and health phenomena (e.g. the elderly and chronic diseases), the use of technologies, and the recent patient-centred approach to care (patient involvement/engagement). Conclusions The field is still far from being mature. Empirical practices, especially regarding co-delivery and co-management as well as the evaluation of their real impacts on providers and on patients are lacking and should be more widely investigated.
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Affiliation(s)
- Floriana Fusco
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122, Milan, Italy
| | - Marta Marsilio
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122, Milan, Italy.
| | - Chiara Guglielmetti
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, via Conservatorio, 7, 20122, Milan, Italy
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Bourdin A, Dubois J, Foley RA, Schluep M, Bugnon O, Berger J. Satisfaction and experiences of patients taking fingolimod and involved in a pharmacy-based patient support program in Switzerland - a qualitative study. BMC Health Serv Res 2020; 20:425. [PMID: 32410681 PMCID: PMC7227186 DOI: 10.1186/s12913-020-05278-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/30/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Fingolimod is an oral multiple sclerosis drug that is considered a specialty drug due to its high cost and safety issues. The Fingolimod Patient Support Program (F-PSP) is a specialty pharmacy service developed to ensure the responsible use of fingolimod by promoting patient safety and medication adherence. This study aims to explore the satisfaction, experiences and perceptions regarding the F-PSP among patients currently involved in this program or recently withdrawn. METHODS A qualitative study was conducted via individual, face-to-face semistructured interviews with patients involved in the F-PSP. The interviews were audio-recorded, transcribed verbatim, coded and analyzed via thematic content analysis. RESULTS The main themes identified from the interviews (n = 17) were overall perception of the F-PSP, perception of the pharmacist-led consultations, perception of the tools (electronic monitor and drug intake graph), reasons to participate or potentially withdraw, and suggestions for improvements. Participants perceived the F-PSP as a reassuring support that complemented their medical care, providing a more human, personalized and person-centered approach than usual pharmacy care. Pharmacist-led consultations were valued for the medication-related and holistic support they provided. The importance of the pharmacist's attitude was emphasized. The electronic monitor was valued for promoting daily medication adherence and allowing the involvement of relatives, which reassured participants and their relatives. The participants appreciated the drug intake graph because it provided an objective overview of medication adherence, thereby reassuring, rewarding, and motivating them. The main reason to join the program was to be supported, especially with respect to medication adherence. CONCLUSIONS Participants were satisfied with the F-PSP, each for different reasons. Their feedback enabled the identification of measures for the optimization of the F-PSP and should facilitate its dissemination and transfer to other drugs/diseases/populations. Essential elements of generic pharmacist-led patient support programs considered valuable from the patients' perspective were identified.
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Affiliation(s)
- Aline Bourdin
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
- School of Pharmaceutical Sciences, University of Geneva, Lausanne, Switzerland.
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausannee, Lausanne, Switzerland.
| | - Julie Dubois
- Qualitative Research Platform, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Rose-Anna Foley
- Qualitative Research Platform, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Myriam Schluep
- Division of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, CHUV, Lausanne, Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausannee, Lausanne, Switzerland
| | - Jérôme Berger
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausannee, Lausanne, Switzerland
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Grünewald M, Klein E, Hapfelmeier A, Wuensch A, Berberat PO, Gartmeier M. Improving physicians' surgical ward round competence through simulation-based training. PATIENT EDUCATION AND COUNSELING 2020; 103:971-977. [PMID: 31810763 DOI: 10.1016/j.pec.2019.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Ward rounds are an essential part of physicians' daily routine. Existing studies suggest that their practical implementation is inconsistent. Therefore, developing interventions to train ward round competence and assessing if they are effective educational tools are crucial goals for research. METHODS We analysed a simulation-based tutorial dedicated to fourth-year medical students, including casework and ward round simulation. We investigated the effectiveness of this intervention regarding ward round competence through a randomized controlled trial. Performance was assessed with the modified/validated surgical ward round assessment tool by two blinded and trained raters. Supplementary, motivation during the ward round tutorial was assessed for all students at different time points. RESULTS Analysis of the ratings show that, in contrast to the control group (pre: 66.1 vs. post: 64.8 points, p = 0.72), the ward round competence of the intervention group (pre: 62.6 vs. post: 69.6 points, p = 0.0169) improved significantly after participating in the ward round tutorial. CONCLUSION The results show that our simulation-based training is an effective way to improve competence of medical students in conducting surgical ward rounds. PRACTICE IMPLICATIONS Participation in ward round trainings is a valuable tool to prepare students for their future professional practise.
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Affiliation(s)
- Marc Grünewald
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany.
| | - Evelyn Klein
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany; Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaningerstrasse 22, 81675 Munich, Germany.
| | - Alexander Hapfelmeier
- Technical University of Munich, Institute of Medical Informatics, Statistics and Epidemiology, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Alexander Wuensch
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany; Clinic of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstraße 5a, 79104 Freiburg, Germany.
| | - Pascal O Berberat
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany.
| | - Martin Gartmeier
- Technical University of Munich, TUM School of Medicine, TUM Medical Education Center, Nigerstr. 3, 81675 Munich, Germany.
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Hong H, Oh HJ. The Effects of Patient-Centered Communication: Exploring the Mediating Role of Trust in Healthcare Providers. HEALTH COMMUNICATION 2020; 35:502-511. [PMID: 30706741 DOI: 10.1080/10410236.2019.1570427] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study examined the effects of patient-centered communication (PCC) on two major outcomes: patients' trust in healthcare providers and their evaluation of the quality of healthcare received. Based on conceptual model regarding the impacts of PCC, the former is considered a proximal communication outcome and the latter an intermediate outcome. Both are known to be associated with ultimate health outcomes. Analyses conducted on a dataset of 3273 respondents from the 2012 Health Information National Trends Survey in the U.S. showed that PCC was positively associated with both patients' trust in healthcare providers and evaluation of healthcare quality. Moreover, trust was a significant mediator between PCC and patients' perceptions of the quality of healthcare, and stronger mediation of trust was observed as the frequency of hospital visits increased. Some theoretical and practical implications are discussed.
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Affiliation(s)
- Hyehyun Hong
- Department of Advertising & Public Relations, Chung-Ang University
| | - Hyun Jee Oh
- Department of Communication Studies, School of Communication, Hong Kong Baptist University
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Zanobini P, Lorini C, Baldasseroni A, Dellisanti C, Bonaccorsi G. A Scoping Review on How to Make Hospitals health Literate Healthcare Organizations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031036. [PMID: 32041282 PMCID: PMC7037285 DOI: 10.3390/ijerph17031036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 12/13/2022]
Abstract
The concept of health literacy is increasingly being recognised as not just an individual trait, but also as a characteristic related to families, communities, and organisations providing health and social services. The aim of this study is to identify and describe, through a scoping review approach, the characteristics and the interventions that make a hospital a health literate health care organisation (HLHO), in order to develop an integrated conceptual model. We followed Arksey and O’Malley’s five-stage scoping review framework, refined with the Joanna Briggs Institute methodology, to identify the research questions, identify relevant studies, select studies, chart the data, and collate and summarize the data. Of the 1532 titles and abstracts screened, 106 were included. Few studies have explored the effect of environmental support on health professionals, and few outcomes related to staff satisfaction/perception of helpfulness have been reported. The most common types of interventions and outcomes were related to the patients. The logical framework developed can be an effective tool to define and understand priorities and related consequences, thereby helping researchers and policymakers to have a wider vision and a more homogeneous approach to health literacy and its use and promotion in healthcare organizations.
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Affiliation(s)
- Patrizio Zanobini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
- Correspondence: ; Tel.: +39-3663435179
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
| | - Alberto Baldasseroni
- Tuscany Regional Centre for Occupational Injuries and Diseases (CeRIMP), Central Tuscany LHU, Via di San Salvi, 12, 50135 Florence, Italy;
| | - Claudia Dellisanti
- Department of Epidemiology, Regional Health Agency of Tuscany, Via Pietro Dazzi, 1, 50141 Florence, Italy;
| | - Guglielmo Bonaccorsi
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
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Kurtz J, Steenbergh K, Kessler J, Vitous A, Barrett M, Sandhu G, Suwanabol PA. 'What I Wish My Surgeon Knew': A Novel Approach to Promote Empathic Curiosity in Surgery. JOURNAL OF SURGICAL EDUCATION 2020; 77:82-87. [PMID: 31383612 DOI: 10.1016/j.jsurg.2019.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/17/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Physician empathy is associated with a variety of superior patient and physician outcomes. Teaching physicians to practice empathic curiosity is challenging however, and relatively few efficient and effective methods have been proposed toward this end. The goal of this study was to evaluate the impact and feasibility of a novel approach to foster empathic curiosity during surgical training. DESIGN We used an exploratory qualitative approach for our study. Postoperative patients at a single hospital were invited to participate in brief semistructured interviews to better understand their unmet needs. The interview began with the question, "What do you wish your surgeon knew about you?" We audio recorded and transcribed each patient interview. We then iteratively read the transcripts, applied an inductive approach to coding, and used qualitative content analysis to identify themes. SETTING Veterans Affairs Ann Arbor Healthcare System, an academic-affiliated tertiary care facility. PARTICIPANTS Patients who underwent general surgery procedures (n = 23) between July and August 2017. RESULTS Of those who provided demographic information (n = 21), all were male and 95% were white with a mean age of 63.9 (34-77) years. Of these, 33% (n = 7) of patients experienced a postoperative complication. Patients described 3 broad categories of unmet need in the perioperative setting including: (i) being treated holistically and with dignity; (ii) using clear communication and delineating provider roles; and (iii) setting specific and realistic expectations. CONCLUSIONS Promoting the use of empathically curious questions, such as "What do you wish your surgeon knew about you?" may help surgical trainees to identify unmet needs that are crucial for optimizing surgical care.
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Affiliation(s)
- Josh Kurtz
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Jason Kessler
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Ann Vitous
- University of Michigan Center for Health Outcomes and Policy, Ann Arbor, Michigan
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Costello KL, Veinot TC. A spectrum of approaches to health information interaction: From avoidance to verification. J Assoc Inf Sci Technol 2019. [DOI: 10.1002/asi.24310] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Kaitlin L. Costello
- School of Communication and Information, RutgersThe State University of New Jersey New Brunswick New Jersey
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Carcone AI, Naar S, Clark J, MacDonell K, Zhang L. Provider behaviors that predict motivational statements in adolescents and young adults with HIV: a study of clinical communication using the Motivational Interviewing framework. AIDS Care 2019; 32:1069-1077. [PMID: 31621396 DOI: 10.1080/09540121.2019.1679709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Medical care providers' use of Motivational Interviewing (MI) is linked to improved medication adherence, viral load, and associated behaviors in adolescents and young adults living with HIV. Mastering MI is difficult for busy providers; however, tailoring MI training to the specific MI communication strategies most relevant for HIV treatment context may be a strategy to increase proficiency. The present study aimed to identify communication strategies likely to elicit motivational statements among adolescent-young adult patients living with HIV. Language used by MI-exposed providers during 80 HIV medical clinic visits was transcribed and coded to characterize patient-provider communication within the MI framework. Sequential analysis, an approach to establish empirical support for the order of behavioral events, found patients were more likely to express motivational statements after provider questions phrased to elicit motivation, reflections of motivational statements, and statements emphasizing patients' decision-making autonomy. Patients were more likely to express amotivational statements when providers asked questions phrased to elicit amotivational statements or reflected amotivational language. Training providers to strategically phrase their questions and reflections to elicit change language and to emphasize patients' autonomy may be critical skills for working with adolescents and young adults living with HIV.
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Affiliation(s)
- April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Research, Florida State University, Tallahassee, Florida, USA
| | - Jamie Clark
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Karen MacDonell
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Liying Zhang
- Biostatistics and Epidemiology Research Design Core, Wayne State University School of Medicine, Detroit, Michigan, USA
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Abstract
BACKGROUND Spine surgery patients have difficulty comprehending the patient education aimed at preparing for surgery. PURPOSE To assess the effect of a specific preoperative education approach (Knowledge Test Feedback Intervention, KTFI) on patients' verbal and visual understanding of their surgery. METHODS In this randomized controlled trial, the intervention group (n = 50) went through the KTFI and routine education, whereas the control group (n = 50) received only routine patient education. Written description of the surgical procedure and drawing of incision were used as outcome measures at baseline, at hospitalization, at discharge, and 3 and 6 months after surgery. RESULTS At baseline, half of the participants showed verbal and visual understanding of their surgery. During follow-up, understanding improved significantly with no statistically significant differences between the groups. CONCLUSION Spinal stenosis patients' understanding of their surgical procedure is imperfect. Patient educators need to ensure patient learning by evaluating comprehension outcomes.
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Goodridge D, McDonald M, New L, Scharf M, Harrison E, Rotter T, Watson E, Henry C, Penz ED. Building patient capacity to participate in care during hospitalisation: a scoping review. BMJ Open 2019; 9:e026551. [PMID: 31272973 PMCID: PMC6615828 DOI: 10.1136/bmjopen-2018-026551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To map the existing literature and describe interventions aimed at building the capacity of patients to participate in care during hospitalisation by: (1) describing and categorising the aspects of care targeted by these interventions and (2) identifying the behaviour change techniques (BCTs) used in these interventions. A patient representative participated in all aspects of this project. DESIGN Scoping review. DATA SOURCES MEDLINE, Embase and CINAHL (Inception -2017). STUDY SELECTION Studies reporting primary research studies on building the capacity of hospitalised adult patients to participate in care which described or included one or more structured or systematic interventions and described the outcomes for at least the key stakeholder group were included. DATA EXTRACTION Title and abstract screening and full text screening were conducted by pairs of trained reviewers. One reviewer extracted data, which were verified by a second reviewer. Interventions were classified according to seven aspects of care relevant to hospital settings. BCTs identified in the articles were assigned through consensus of three reviewers. RESULTS Database searches yielded a total 9899 articles, resulting in 87 articles that met the inclusion criteria. Interventions directed at building patient capacity to participate in care while hospitalised were categorised as those related to improving: patient safety (20.9%); care coordination (5.7%); effective treatment (5.7%) and/or patient-centred care using: bedside nursing handovers (5.7%); communication (29.1%); care planning (14%) or the care environment (19.8%). The majority of studies reported one or more positive outcomes from the defined intervention. Adding new elements (objects) to the environment and restructuring the social and/or physical environment were the most frequently identified BCTs. CONCLUSIONS The majority of studies to build capacity for participation in care report one or more positive outcomes, although a more comprehensive analysis is warranted.
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Affiliation(s)
- Donna Goodridge
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Meghan McDonald
- School of Nursing, Saskatchewan Polytechnic, Saskatoon, Saskatchewan, Canada
| | - Lucia New
- School of Nursing, Saskatchewan Polytechnic, Saskatoon, Saskatchewan, Canada
| | - Murray Scharf
- College of Education, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Elizabeth Harrison
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Thomas Rotter
- Healthcare Quality Programs, Queen’s University, Kingston, Ontario, Canada
| | - Erin Watson
- Leslie and Irene Dube Health Sciences Library, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Chrysanthus Henry
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Erika D Penz
- Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Shahvisi A. Medicine is Patriarchal, But Alternative Medicine is Not the Answer. JOURNAL OF BIOETHICAL INQUIRY 2019; 16:99-112. [PMID: 30570716 PMCID: PMC6474852 DOI: 10.1007/s11673-018-9890-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 12/05/2018] [Indexed: 06/09/2023]
Abstract
Women are over-represented within alternative medicine, both as consumers and as service providers. In this paper, I show that the appeal of alternative medicine to women relates to the neglect of women's health needs within scientific medicine. This is concerning because alternative medicine is severely limited in its therapeutic effects; therefore, those who choose alternative therapies are liable to experience inadequate healthcare. I argue that while many patients seek greater autonomy in alternative medicine, the absence of an evidence base and plausible mechanisms of action leaves patients unable to realize meaningful autonomy. This seems morally troubling, especially given that the neglect of women's needs within scientific medicine seems to contribute to preferences for alternative medicine. I conclude that the liberatory credentials of alternative medicine should be questioned and make recommendations to render scientific medicine better able to meet the needs of typical alternative medicine consumers.
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Affiliation(s)
- Arianne Shahvisi
- Lecturer in Ethics and Medical Humanities, Brighton & Sussex Medical School, University of Sussex, Falmer, BN1 9PX, UK.
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Concurrent and Overlapping Surgery: Perspectives From Parents of Adolescents Undergoing Spinal Posterior Instrumented Fusion for Idiopathic Scoliosis. Spine (Phila Pa 1976) 2019; 44:53-59. [PMID: 29901538 PMCID: PMC6551350 DOI: 10.1097/brs.0000000000002745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cross-sectional survey. OBJECTIVE To determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis (AIS) regarding simultaneous surgery and trainee participation. SUMMARY OF BACKGROUND DATA Simultaneous ("at the same time") surgery is under scrutiny by the public, government, payers, and the medical community. The objective of this study is to determine the perspectives of parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis. Our goal is to inform the national conversation on this subject with real patient and family voices. METHODS A survey was prospectively administered to 31 consecutive parents of patients undergoing posterior instrumented fusion for adolescent idiopathic scoliosis at a large academic medical center. "Overlapping" was defined as simultaneity during "noncritical" parts of an operation. "Concurrent" was defined as simultaneity that includes "critical" part(s) of an operation. Participants were asked to provide levels of agreement with overlapping and concurrent surgery and anesthesia, as well as with trainee involvement. RESULTS On average, respondents "strongly agree" with the need to be informed about overlapping or concurrent surgery. They "disagree" with both overlapping and concurrent scheduling, and "disagree" with trainees operating without direct supervision, even for "noncritical" parts. Informing parents about the presence of a back-up surgeon or research demonstrating safety of simultaneous surgery did not make them agreeable to simultaneous scheduling. CONCLUSION Parents have a strong desire to be informed of simultaneous spinal surgery and anesthesia as part of consent on behalf of their children. Their disagreement with simultaneous surgery, as well as with trainees operating without direct supervision, suggests discordance with current guidelines and practice and should inform the national conversation moving forward. LEVEL OF EVIDENCE N/A.
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Friesen P, Blease C. Placebo effects and racial and ethnic health disparities: an unjust and underexplored connection. JOURNAL OF MEDICAL ETHICS 2018; 44:774-781. [PMID: 29936435 DOI: 10.1136/medethics-2018-104811] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/07/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
While a significant body of bioethical literature considers how the placebo effect might introduce a conflict between autonomy and beneficence, the link between justice and the placebo effect has been neglected. Here, we bring together disparate evidence from the field of placebo studies and research on health inequalities related to race and ethnicity, and argue that, collectively, this evidence may provide the basis for an unacknowledged route by which health disparities are exacerbated. This route is constituted by an uneven distribution of placebo effects, resulting from differences in expressions of physician warmth and empathy, as well as support and patient engagement, across racial and ethnic lines. In a discussion of the ethical implications of this connection, we argue that this contribution to health disparities is a source of injustice, consider ways in which these disparities might be ameliorated and suggest that this conclusion is likely to extend to other realms of inequality as well.
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Affiliation(s)
- Phoebe Friesen
- Philosophy Department, CUNY Graduate Center, New York City, New York, USA
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Charlotte Blease
- Program in Placebo Studies, General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- School of Psychology, University College Dublin, Dublin, Ireland
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Belasen A, Belasen AT. Doctor-patient communication: a review and a rationale for using an assessment framework. J Health Organ Manag 2018; 32:891-907. [PMID: 30465487 DOI: 10.1108/jhom-10-2017-0262] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to explore the extent to which improving doctor-patient communication (DPC) can address and alleviate many healthcare delivery inefficiencies. DESIGN/METHODOLOGY/APPROACH The authors survey causes and costs of miscommunication including perceptual gaps between how physicians believe they perform their communicative duties vs how patients feel and highlight thresholds such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) used by hospitals to identify health outcomes and improve DPC. FINDINGS The authors find that DPC correlates with better and more accurate care as well as with more satisfied patients. The authors utilize an assessment framework, doctor-patient communication assessment (DPCA), empirically measuring the effectiveness of DPC. While patient care is sometimes viewed as purely technical, there is evidence that DPC strongly predicts clinical outcomes as well as patients' overall ratings of hospitals. RESEARCH LIMITATIONS/IMPLICATIONS More research is needed to extend our understanding of the impact of the DPC on the overall HCAHPS ratings of hospitals. The authors think that researchers should adopt a qualitative method (e.g. content analysis) for analyzing DPC discourse. PRACTICAL IMPLICATIONS When a sufficient amount of DPCA training is initiated, a norming procedure could be developed and a database may be employed to demonstrate training program's efficacy, a critical factor in establishing the credibility of the measurement program and nurturing support for its use. ORIGINALITY/VALUE The authors highlight clinical and operational issues as well as costs associated with miscommunication and the need to use metrics such as HCAHPS that allow consumers to see how hospitals differ on specific characteristics.
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Affiliation(s)
- Ariel Belasen
- Department of Economics and Finance, Southern Illinois University Edwardsville , Edwardsville, Illinois, USA
| | - Alan T Belasen
- MBA Program, SUNY Empire State College, Saratoga Springs, New York, USA
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Abstract
PURPOSE OF REVIEW Advances in medical imaging and three-dimensional (3D) reconstruction software have enabled a proliferation of 3D modeling and 3D printing for clinical applications. In particular, 3D printing has garnered an extraordinary media presence over the past few years. There is growing optimism that 3D printing can address patient specificity and complexity for improved interventional and surgical planning. Will this relatively untested technology bring about a paradigm shift in the clinical environment, or is it just a transient fad? RECENT FINDINGS Case studies and series centered around 3D printing are omnipresent in clinical and engineering journals. These primarily qualitative studies support the potential efficacy of the emerging technology. Few studies analyze the value of 3D printing, weighing its potential benefits against increasing costs (e.g., institutional overhead, labor, and materials). SUMMARY Clinical integration of 3D printing is growing rapidly, and its adoption into clinical practice presents unique workflow challenges. There are numerous clinical trials on the horizon that will finally help to elucidate the measured impact of 3D printing on clinical outcomes through quantitative analyses of clinical and economic metrics. The contrived integration of 3D printing into clinical practice seems all but certain as the value of this technology becomes more and more evident.
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Identification of competencies for patient education in physiotherapy using a Delphi approach. Physiotherapy 2018; 104:232-238. [DOI: 10.1016/j.physio.2017.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 06/13/2017] [Indexed: 11/18/2022]
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Brookman-Frazee L, Stahmer AC. Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials. Implement Sci 2018; 13:66. [PMID: 29743090 PMCID: PMC5944167 DOI: 10.1186/s13012-018-0757-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. This project includes two, coordinated studies testing the effectiveness of the Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes-provider training completion and intervention fidelity and subsequent child outcomes. The TEAMS Leadership Institute applies implementation leadership strategies and TEAMS Individualized Provider Strategies for training applies motivational interviewing strategies to facilitate provider and organizational behavior change. METHODS A cluster randomized implementation/effectiveness Hybrid, type 3, trial with a dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Study #1 will test the TEAMS model with AIM HI (An Individualized Mental Health Intervention for ASD) in publicly funded mental health services. Study #2 will test TEAMS with CPRT (Classroom Pivotal Response Teaching) in education settings. Thirty-seven mental health programs and 37 school districts will be randomized, stratified by county and study, to one of four groups (Standard Provider Training Only, Standard Provider Training + Leader Training, Enhanced Provider Training, Enhanced Provider Training + Leader Training) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. Implementation outcomes including provider training completion, fidelity (coded by observers blind to group assignment) and child behavior change will be examined for 295 mental health providers, 295 teachers, and 590 children. DISCUSSION This implementation intervention has the potential to increase quality of care for ASD in publicly funded settings by improving effectiveness of intervention implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services. TRIAL REGISTRATION This study is registered with Clinicaltrials.gov ( NCT03380078 ). Registered 20 December 2017, retrospectively registered.
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Affiliation(s)
- Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
| | - Aubyn C. Stahmer
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, UC Davis MIND Institute, 2825 50th Street, Sacramento, CA 95817 USA
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Jiang S, Street RL. The effects of patient-centered communication, social capital, and internet use on patient empowerment: a cross-sectional study in China. Glob Health Promot 2018. [DOI: 10.1177/1757975917749197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient empowerment is a relatively new concept in the context of the Chinese health care system. Based on Street’s ecological framework of communication in healthcare settings, this study examined the social, clinical and media factors that could empower patients. Results from a survey of 401 Chinese adults (response rate, 34%) showed that respondents felt more empowered as health care consumers when they reported having more social capital bonding and bridging, and used the Internet for health purposes more often. Importantly, having had more positive patient-centered communicative experiences with health care providers not only predicted patient empowerment, it also moderated the effects of bridging social capital and Internet use on empowerment. Specifically, the more positive the experience of interacting with health care providers, the weaker the effects of bridging social capital and Internet use on patient empowerment. The findings have important implications for patient empowerment in health care, particularly within the context of China.
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Affiliation(s)
- Shaohai Jiang
- Department of Communications and New Media, National University of Singapore, Singapore
| | - Richard L. Street
- Department of Communication, Texas A&M University, College Station, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Houston Center for Innovation in Quality, Effectiveness and Safety; Michael E. DeBakey VA Medical Center; Houston, TX, USA
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New-graduate Physical Therapists' Self-efficacy to Perform Patient Education Is Influenced by Entry-level Training Experiences. ACTA ACUST UNITED AC 2018. [DOI: 10.1097/jte.0000000000000022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Warren N, Walford K, Susilo A, New PW. Emotional Consequences of Delays in Spinal Rehabilitation Unit Admission or Discharge: A Qualitative Study on the Importance of Communication. Top Spinal Cord Inj Rehabil 2018; 24:54-62. [PMID: 29434461 DOI: 10.1310/sci17-00026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To explore the influence of health communications on the emotional consequences of delays in transfer from acute hospital into a spinal rehabilitation unit (SRU) or delays in discharge from SRU. Methods: Semi-structured interviews were conducted in this exploratory, thematic qualitative research design in an SRU, Melbourne, Australia. Results: Six patients experienced delay in admission to (n = 4) or discharge from (n = 3) the SRU, with one person experiencing both an admission and discharge delay. Median admission delay was 41.5 days, primarily related to bed availability and staffing issues. Participants experiencing a delay in transfer from the acute hospital reported feelings of uncertainty, frustration, disappointment, and concern due to a perception that their functional recovery was compromised because of delayed access to specialist rehabilitation. Psychological issues were less common than emotional responses. One participant spent some of the delay period waiting for admission to the SRU in a non-spinal rehabilitation unit and reported no concerns about his recovery. Median discharge delay was 27 days, largely due to a wait in obtaining funding for equipment. Emotional and psychological responses to delayed discharge, particularly frustration, appeared to be influenced by having a sense of control over the discharge process. Conclusion: Patients' experiences during the delay periods partially mitigated the emotional and psychological consequences of a delayed admission or discharge on their psychological well-being. Locus of control, where participants reported being able to effect some influence on their situation, appeared to moderate their emotional state. The findings suggest that clinicians can draw on the concept of control to better support patients through periods of delay.
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Affiliation(s)
- Narelle Warren
- School of Social Sciences and Psychology Department, Alfred Hospital, Monash University, Victoria, Australia
| | - Karin Walford
- School of Psychological Science, Monash University, Victoria, Australia
| | - Annisha Susilo
- School of Psychological Science, Monash University, Victoria, Australia
| | - Peter Wayne New
- Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia.,Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria, Australia
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van C, McInerney P, Cooke R. Patients' involvement in improvement initiatives: a qualitative systematic review. ACTA ACUST UNITED AC 2018; 13:232-90. [PMID: 26571293 DOI: 10.11124/jbisrir-2015-1452] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Over the last 20 years, quality improvement in health has become an important strategy in health services in many countries. With the emphasis on quality health care, there has been a shift in social paradigms towards including service users in their own health on different levels. There is growing evidence in literature on the positive impact on health outcomes where patients are active participants in their personal care. There is however less information available on the broader influence of users on improvement in systems. OBJECTIVES The objective of this review was to identify the barriers and enablers to patients being involved in quality improvement efforts directed towards their own health care. INCLUSION CRITERIA This review considered studies that included adults and children of any age experiencing any health problem.The review considered studies that explored patient or user participation in quality improvement and the factors enabling and hindering this processThe qualitative component of this review considered studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Other texts such as opinion papers and reports were also considered. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. The searches using all identified keywords and index terms included the databases PubMed, PsycINFO, Medline, Scopus, EBSCOhost and CINAHL.Qualitative, text and opinion papers were considered for inclusion in this review.Closely related concepts like community involvement, family involvement, patients' involvement in their own care (for example, in the case of shared decision making), and patient centeredness in the context of a consultation were excluded. METHODOLOGICAL QUALITY Qualitative and textual papers selected for retrieval were assessed by two independent reviewers for authenticity prior to inclusion in the review using the standardized critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION Qualitative and textual data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS The above findings were pooled and through the identification of categories, a final meta-synthesis was formulated. RESULTS Two synthesized findings were created from the included papers. Firstly, there are barriers to patients' participation in quality improvement in health and in spite of policy support for user involvement in quality improvement, it is a difficult strategy to implement. The second synthesized finding was that there are enablers to patients' involvement in quality improvement: when patients are involved in quality improvement efforts in health care, there are innovative, often unexpected, outcomes at different levels of the process, and sustaining these efforts is possible with ongoing individual or group support.Five categories which supported the synthesized findings were created through the meta-aggregative process. CONCLUSIONS There are enablers and barriers to involving patients in quality improvement in health care that need to be considered when planning such interventions.Relationships and roles will need to be very clear from the outset. A developmental approach needs to be considered where support and training is part of the project. Where patients are truly engaged in service improvement, unexpected innovation occurs.There are many more reports and opinion papers published regarding this topic than there are rigorous research studies. This leaves the field open to the development of good methodological studies related to quality improvement and in particular to the participation of patients.
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Affiliation(s)
- Claire van
- 1Department of Family Medicine, University of the Witwatersrand, Johannesburg, South Africa2The Witwatersrand Center for Evidence Based Practice: an Affiliate Center of the Joanna Briggs Institute3Center for Health Science Education, Faculty of Health Science Education, University of the Witwatersrand.4Center for Rural Health, University of the Witwatersrand, Johannesburg, South Africa
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Day MA, Anthony CA, Bedard NA, Glass NA, Clark CR, Callaghan JJ, Noiseux NO. Increasing Perioperative Communication With Automated Mobile Phone Messaging in Total Joint Arthroplasty. J Arthroplasty 2018; 33:19-24. [PMID: 29017803 DOI: 10.1016/j.arth.2017.08.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/26/2017] [Accepted: 08/31/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Automated mobile phone messaging has not been reported in total joint arthroplasty (TJA). Our purpose was to compare Press Ganey (PG) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores between TJA patients who did and did not receive perioperative automated mobile phone messages. METHODS Patients were prospectively enrolled and received messages for 1 week prior until 2 weeks after TJA. Message content included reminders, activity, and pain control. Patients answered select PG/HCAHPS and questions regarding their experience with the automated communication platform. Average PG/HCAHPS scores were compared to historical TJA patients in the 3-year window prior (control group) with significance P < .05. RESULTS Thirty-seven consecutive patients were approached and 92% (n = 34) were enrolled. The experimental group was 47% male, with 80% patients between 51 and 75 years. The experimental (n = 30) and control groups (n = 26) were similar. Patients receiving messages were more likely to have a good understanding of health responsibilities (P = .024) and feel that the care team demonstrated shared decision-making (P = .024). Of patients enrolled, 87% felt messages helped them be more prepared for surgery, 100% felt messages kept them better informed, and 97% would participate again. CONCLUSION TJA patients who received perioperative communication via automated mobile phone messaging had improved patient satisfaction scores postoperatively. Patients perceived this form of communication was useful and kept them better informed. Automated mobile phone messaging can be an easily integrated, helpful adjunct to surgeons, healthcare systems, and case managers to more effectively communicate with patients undergoing TJA in this era of value-based care.
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Affiliation(s)
- Molly A Day
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Christopher A Anthony
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Nicholas A Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Natalie A Glass
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Charles R Clark
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - John J Callaghan
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Nicolas O Noiseux
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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van de Pol MHJ, Fluit CRMG, Lagro J, Slaats Y, Olde Rikkert MGM, Lagro-Janssen ALM. Shared decision making with frail older patients: Proposed teaching framework and practice recommendations. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:482-495. [PMID: 28027017 DOI: 10.1080/02701960.2016.1276014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study has two aims: The first aim is to identify core competencies for shared decision making (SDM) with frail older persons, and the second is to determine key elements of a teaching framework, based on the authors' recently developed model for SDM with older patients who are frail. To this end the authors conducted a qualitative inquiry among health professionals (n = 53) and older patients who are frail (n = 16). Participants formulated core competencies and educational needs for SDM with older patients who are frail, which were further explored in the literature. This resulted in practice recommendations and a teaching framework with the following key elements: create a knowledge base for all health professionals, offer practical training, facilitate communication, identify discussion partners, engage patients, and collaborate. The authors' teaching framework for SDM with older patients who are frail may be useful for clinicians, educators, and researchers who aim to promote SDM with older patients who are frail.
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Affiliation(s)
- Marjolein H J van de Pol
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Cornelia R M G Fluit
- b Learning Research and Education , Radboudumc Health Academy Nijmegen , Nijmegen , The Netherlands
| | - Joep Lagro
- c Department of Internal Medicine , Haga Teaching Hospital , The Hague , The Netherlands
| | - Yvonne Slaats
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | | | - Antoine L M Lagro-Janssen
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
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Aarons GA, Ehrhart MG, Moullin JC, Torres EM, Green AE. Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol. Implement Sci 2017; 12:29. [PMID: 28253900 PMCID: PMC5335741 DOI: 10.1186/s13012-017-0562-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based practice (EBP) implementation represents a strategic change in organizations that requires effective leadership and alignment of leadership and organizational support across organizational levels. As such, there is a need for combining leadership development with organizational strategies to support organizational climate conducive to EBP implementation. The leadership and organizational change for implementation (LOCI) intervention includes leadership training for workgroup leaders, ongoing implementation leadership coaching, 360° assessment, and strategic planning with top and middle management regarding how they can support workgroup leaders in developing a positive EBP implementation climate. METHODS This test of the LOCI intervention will take place in conjunction with the implementation of motivational interviewing (MI) in 60 substance use disorder treatment programs in California, USA. Participants will include agency executives, 60 program leaders, and approximately 360 treatment staff. LOCI will be tested using a multiple cohort, cluster randomized trial that randomizes workgroups (i.e., programs) within agency to either LOCI or a webinar leadership training control condition in three consecutive cohorts. The LOCI intervention is 12 months, and the webinar control intervention takes place in months 1, 5, and 8, for each cohort. Web-based surveys of staff and supervisors will be used to collect data on leadership, implementation climate, provider attitudes, and citizenship. Audio recordings of counseling sessions will be coded for MI fidelity. The unit of analysis will be the workgroup, randomized by site within agency and with care taken that co-located workgroups are assigned to the same condition to avoid contamination. Hierarchical linear modeling (HLM) will be used to analyze the data to account for the nested data structure. DISCUSSION LOCI has been developed to be a feasible and effective approach for organizations to create a positive climate and fertile context for EBP implementation. The approach seeks to cultivate and sustain both effective general and implementation leadership as well as organizational strategies and support that will remain after the study has ended. Development of a positive implementation climate for MI should result in more positive service provider attitudes and behaviors related to the use of MI and, ultimately, higher fidelity in the use of MI. TRIAL REGISTRATION This study is registered with Clinicaltrials.gov ( NCT03042832 ), 2 February 2017, retrospectively registered.
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Affiliation(s)
- Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA. .,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.
| | - Mark G Ehrhart
- Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4611, USA
| | - Joanna C Moullin
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA.,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Elisa M Torres
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA.,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Amy E Green
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA.,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
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Kesänen J, Leino-Kilpi H, Lund T, Montin L, Puukka P, Valkeapää K. The Knowledge Test Feedback Intervention (KTFI) increases knowledge level of spinal stenosis patients before operation-A randomized controlled follow-up trial. PATIENT EDUCATION AND COUNSELING 2016; 99:1984-1991. [PMID: 27448838 DOI: 10.1016/j.pec.2016.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 04/29/2016] [Accepted: 07/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the impact of a preoperative educational intervention on the knowledge level of patients with spinal stenosis. METHODS One hundred spinal stenosis patients were randomized into a preoperative educational intervention group (IG, n=50) or a control group (CG, n=50). All the patients received routine preoperative education. In addition, the IG went through an empowering telephone discourse based on a knowledge test performed before admission to hospital. Data on patients' knowledge level were collected at baseline (after the treatment decision), admission to hospital, discharge from hospital and at 3 and 6 months follow-up. RESULTS At baseline, there was no difference in the knowledge level of the study groups. At admission, the knowledge level was significantly higher in five of six dimension of empowering knowledge in the IG compared to the CG. During follow-up, the knowledge level within the study groups remained stable. CONCLUSION A preoperative KTFI significantly increased the patients' knowledge level in most dimensions of empowering knowledge. PRACTICE IMPLICATION KTFI is an effective method of preoperative education in patients with spinal stenosis.
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Affiliation(s)
- Jukka Kesänen
- Department of Nursing Science, University of Turku, Turku, Finland; Orton Orthopaedic Hospital, Helsinki, Finland; Metropolia University of Applied Sciences, Helsinki, Finland.
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland; Turku University Hospital, Turku, Finland
| | - Teija Lund
- Helsinki University Hospital, Jorvi Hospital, Espoo, Finland
| | | | - Pauli Puukka
- National Institute for Health and Welfare, Turku, Finland
| | - Kirsi Valkeapää
- Department of Nursing Science, University of Turku, Turku, Finland; Lahti University of Applied Sciences, Lahti, Finland
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Suffering of Traumatic Amputees in Spain: Meaning, Spirituality, and Biomedicine. Holist Nurs Pract 2016; 30:312-321. [PMID: 27763925 DOI: 10.1097/hnp.0000000000000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Amputation is a traumatic incident that entails a chain of psychological, physical, and social events. The objectives of the study are to describe the beliefs and the philosophies of life related to the experience of suffering of traumatic amputees, analyze the importance of biomedical care, and describe other forms of care used.
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Reychav I, Parush A, McHaney R, Hazan M, Moshonov R. The use of mobile technology in waiting rooms to leverage women's empowerment: A conceptual context. Health Informatics J 2016; 24:277-292. [PMID: 27738260 DOI: 10.1177/1460458216671561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article focuses on a conceptual framework that can be applied to the use of mobile technology in the waiting room with the goal of empowering women recently diagnosed with abnormal Pap test results. It further describes trends which indicate a need for improved and timely information dissemination. Genecology practice outpatients report a predominant feeling of worry on receipt of abnormal medical test results, along with a clearly expressed wish for additional information. This research suggests that there is room for improvement in existing processes through use of mobile technology with carefully vetted materials which indicate a doctor is interested in the patient's well-being.
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Affiliation(s)
| | - Avi Parush
- The Israel Institute of Technology, Israel
| | | | - Maya Hazan
- The Israel Institute of Technology, Israel
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Malfait S, Eeckloo K, Lust E, Van Biesen W, Van Hecke A. Feasibility, appropriateness, meaningfulness and effectiveness of patient participation at bedside shift reporting: mixed-method research protocol. J Adv Nurs 2016; 73:482-494. [DOI: 10.1111/jan.13154] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Simon Malfait
- Ghent University Hospital; Belgium
- Faculty of Medicine and Health Sciences; Department of Public Health, UCVV; Ghent University; Belgium
| | - Kristof Eeckloo
- Ghent University Hospital; Belgium
- Faculty of Medicine and Health Sciences; Department of Public Health, UCVV; Ghent University; Belgium
| | - Elisa Lust
- Faculty of Medicine and Health Sciences; Department of Public Health, UCVV; Ghent University; Belgium
| | - Wim Van Biesen
- Ghent University Hospital; Belgium
- Faculty of Medicine and Health Sciences; Department of Internal Medicine; Ghent University; Belgium
| | - Ann Van Hecke
- Ghent University Hospital; Belgium
- Faculty of Medicine and Health Sciences; Department of Public Health, UCVV; Ghent University; Belgium
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Yeo Y. Indirect effects of contextual factors on patients' consultations with healthcare professionals about health information found online. BMC Health Serv Res 2016; 16:447. [PMID: 27576443 PMCID: PMC5006620 DOI: 10.1186/s12913-016-1713-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background E-health users are encouraged to consult healthcare professionals about the health information they found online because it facilitates e-health users to participate in an informed decision-making process with healthcare professionals on treatment options. However, few studies have examined the path of how e-health users consult healthcare professionals about the health information. Using psychological empowerment, which claims that empowering individuals requires understanding contextual factors that interact with the individuals’ intrapsychic factors, this study tested a hypothesis: the contextual factors play an indirect role between patients’ perceived poor health and their consultations with healthcare professionals about the health information found online, holding predisposing factors constant. Methods The data were collected from the Health Information National Trends Survey and used a subsample of e-health users who used healthcare services during the past year. The subsample (N = 2,297) was analyzed using structural equation modeling (SEM). Results The SEM analysis supported the hypothesized indirect model. Meanwhile, patients with low socioeconomic statuses tended to score high in the outcome measurement of the contextual factors; however, they tended not to consult professionals. Conclusions It is important to acknowledge contextual factors, which encompass communication and relational aspects as well as the process and outcomes of treatments, when empowering e-health users to use e-health tools meaningfully and become empowered in caring for their own health. Particularly, those with low income and education levels were the less powered or powerless patients: they tended not to be competent in having a voice and discussing the health information that they found online with professionals. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1713-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Younsook Yeo
- Department of Social Work, St. Cloud State University, 720 Fourth Avenue South, St. Cloud, MN, 56301-4498, USA.
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