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Roter DL, Bugayong M, Lowe C, Joyner RL, Howard AM, Wenzel J, Dobs AS. Online communication skill training of patients with cancer: A test of the behavioral intention predictive framework for communication skills. PEC INNOVATION 2024; 4:100291. [PMID: 38872981 PMCID: PMC11169459 DOI: 10.1016/j.pecinn.2024.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 05/08/2024] [Accepted: 05/19/2024] [Indexed: 06/15/2024]
Abstract
Objective To assess the Behavioral Intention Predictive Framework's utility in explaining variation in cancer patients' strong behavioral intention (SBI) to use LEAPS (Listen, Educate, Assess, Partner, Support) communication skills after viewing training videos. Methods Ninety-eight patients were enrolled through anonymized online platforms to view LEAPS training videos, complete background and communication questionnaires and report their SBI to use LEAPS skills. Results On average, patients indicated SBI to use 6 of 13 skills and 46% of patients expressed SBI across individual skills. The framework explained 27.7% of the adjusted variance in SBI with significant predictors of frequent past use of LEAPS-related shared decision-making behaviors, poor emotional health, being rarely accompanied to visits and positive ratings of narrative videos. Finally, 21.7% of the adjusted variance in problem communication was explained by infrequent use of LEAPS-related information behaviors, patient accompaniment of another adult and positive narrative scores. Conclusion Patients SBI to use multiple LEAPS skills and past problem communication were explained by framework predictors. Innovation Despite theoretical and empirical evidence that behavioral intention significantly predicts behavior, it has not been studied in patient communication research. Application of the novel framework to LEAPS training videos contributes an innovative address of this research gap.
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Affiliation(s)
- Debra L. Roter
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, USA
| | - Marielle Bugayong
- Department of Health, Behavior and Society, Johns Hopkins School of Public Health, Baltimore, USA
| | - Chenery Lowe
- Stanford Center for Biomedical Ethics, Stanford, USA
| | | | | | | | - Adrian S. Dobs
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA
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Roter DL, Lowe C, Bugayong M, Dobs AS. Cancer care partners' behavioral intention to use autonomy enhancing communication skills during accompanied visits after online skill training. PATIENT EDUCATION AND COUNSELING 2024; 123:108176. [PMID: 38422948 DOI: 10.1016/j.pec.2024.108176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The study objective is to evaluate an adaptation of the LEAPS skill framework for cancer care partners (CPs) focusing on autonomy enhancing skills and assessed by strong behavioral intention (SBI) to use these skills METHOD: Cancer CPs were recruited through public platforms to view and rate 4 LEAPS cancer-specific narratives and 52 skill demonstration videos, indicate SBI to use demonstrated skills and provide information on skill-related measures. RESULTS Half of CPs expressed SBI to use an average of 6.5 of 13 LEAPS skills which did not vary by LEAPS communication domains or examples used to demonstrate skills. Significant predictors of SBI include positive ratings of program narratives and past use of LEAPS-related behaviors in the communication domain of shared decision making (SDM). CONCLUSION CPs indicated SBIs to use multiple autonomy enhancing skills and positively rated program videos after exposure to the brief LEAPS training program. PRACTICE IMPLICATIONS The brevity of the LEAPS training videos make it possible for users to view an individual cancer-specific narrative and 13 skill demonstrations in roughly 6 min. This ultra-brief training can benefit care partners and the patients they accompany by increasing the likelihood that autonomy enhancing skills are used during accompanied visits.
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Affiliation(s)
- Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Chenery Lowe
- Center for Biomedical Ethics, Stanford University, Palo Alto, CA, USA
| | - Marielle Bugayong
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adrian S Dobs
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Suresh N, Fritz C, De Ravin E, Rajasekaran K. Modern internet search analytics and thyroidectomy: What are patients asking? World J Otorhinolaryngol Head Neck Surg 2024; 10:49-58. [PMID: 38560040 PMCID: PMC10979046 DOI: 10.1002/wjo2.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/01/2023] [Indexed: 04/04/2024] Open
Abstract
Objectives Thyroidectomy is among the most commonly performed head and neck surgeries, however, limited existing information is available on topics of interest and concern to patients. Study Design Observational. Setting Online. Methods A search engine optimization tool was utilized to extract metadata on Google-suggested questions that "People Also Ask" (PAA) pertaining to "thyroidectomy" and "thyroid surgery." These questions were categorized by Rothwell criteria and topics of interest. The Journal of the American Medical Association (JAMA) benchmark criteria enabled quality assessment. Results A total of 250 PAA questions were analyzed. Future-oriented PAA questions describing what to expect during and after the surgery on topics such as postoperative management, risks or complications of surgery, and technical details were significantly less popular among the "thyroid surgery" group (P < 0.001, P = 0.005, and P < 0.001, respectively). PAA questions about scarring and hypocalcemia were nearly threefold more popular than those related to pain (335 and 319 vs. 113 combined search engine response page count, respectively). The overall JAMA quality score remained low (2.50 ± 1.07), despite an increasing number of patients searching for "thyroidectomy" (r(77) = 0.30, P = 0.007). Conclusions Patients searching for the nonspecific term "thyroid surgery" received a curated collection of PAA questions that were significantly less likely to educate them on what to expect during and after surgery, as compared to patients with higher health literacy who search with the term "thyroidectomy." This suggests that the content of PAA questions differs based on the presumed health literacy of the internet user.
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Affiliation(s)
- Neeraj Suresh
- Department of Otorhinolaryngology–Head & Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Christian Fritz
- Department of Otorhinolaryngology–Head & Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Emma De Ravin
- Department of Otorhinolaryngology–Head & Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology–Head & Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Alhasani R, George N, Radman D, Auger C, Ahmed S. Methodologies for Evaluating the Usability of Rehabilitation Technologies Aimed at Supporting Shared Decision-Making: Scoping Review. JMIR Rehabil Assist Technol 2023; 10:e41359. [PMID: 37581911 PMCID: PMC10466154 DOI: 10.2196/41359] [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: 07/26/2022] [Revised: 02/27/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND The field of rehabilitation has seen a recent rise in technologies to support shared decision-making (SDM). Usability testing during the design process of SDM technologies is needed to optimize adoption and realize potential benefits. There is variability in how usability is defined and measured. Given the complexity of usability, a thorough examination of the methodologies used to measure usability to develop the SDM technologies used in rehabilitation care is needed. OBJECTIVE This scoping review aims to answer the following research questions: which methods and measures have been used to produce knowledge about the usability of rehabilitation technologies aimed at supporting SDM at the different phases of development and implementation? Which parameters of usability have been measured and reported? METHODS This review followed the Arksey and O'Malley framework. An electronic search was performed in the Ovid MEDLINE, Embase, CINAHL, and PsycINFO databases from January 2005 up to November 2020. In total, 2 independent reviewers screened all retrieved titles, abstracts, and full texts according to the inclusion criteria and extracted the data. The International Organization for Standardization framework was used to define the scope of usability (effectiveness, efficiency, and satisfaction). The characteristics of the studies were outlined in a descriptive summary. Findings were categorized based on usability parameters, technology interventions, and measures of usability. RESULTS A total of 38 articles were included. The most common SDM technologies were web-based aids (15/33, 46%). The usability of SDM technologies was assessed during development, preimplementation, or implementation, using 14 different methods. The most frequent methods were questionnaires (24/38, 63%) and semistructured interviews (16/38, 42%). Satisfaction (27/38, 71%) was the most common usability parameter mapped to types of SDM technologies and usability evaluation methods. User-centered design (9/15, 60%) was the most frequently used technology design framework. CONCLUSIONS The results from this scoping review highlight the importance and the complexity of usability evaluation. Although various methods and measures were shown to be used to evaluate the usability of technologies to support SDM in rehabilitation, very few evaluations used in the included studies were found to adequately span the selected usability domains. This review identified gaps in usability evaluation, as most studies (24/38, 63%) relied solely on questionnaires rather than multiple methods, and most questionnaires simply focused on the usability parameter of satisfaction. The consideration of end users (such as patients and clinicians) is of particular importance for the development of technologies to support SDM, as the process of SDM itself aims to improve patient-centered care and integrate both patient and clinician voices into their rehabilitation care.
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Affiliation(s)
- Rehab Alhasani
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Nicole George
- School of Physical and Occupation Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Dennis Radman
- School of Physical and Occupation Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
| | - Claudine Auger
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montreal, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Sara Ahmed
- School of Physical and Occupation Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada
- Constance Lethbridge Rehabilitation Center, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Ouest-de-l'Île-de-Montreal, Montreal, QC, Canada
- McGill University Health Center Research Institute, Centre for Health Outcomes Research, Montreal, QC, Canada
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5
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Addressing the Drivers of Medical Test Overuse and Cascades: User-Centered Design to Improve Patient-Doctor Communication. Jt Comm J Qual Patient Saf 2022; 48:233-240. [PMID: 35177360 PMCID: PMC9941976 DOI: 10.1016/j.jcjq.2022.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Low-value medical testing is a major component of health care overuse, both directly and through the potential for borderline and/or incidental results to trigger cascades (downstream services of uncertain value). The costs and harms from marginal test results and their cascades can add up. It is thus important to both prevent low-value tests at the outset and mitigate cascades when they arise. METHODS Informed by a framework for understanding and reducing overuse of care, this study employed user-centered design methods (focus groups and 1:1 design meetings) with patients and primary care physicians (PCPs) to understand the problem and iteratively develop an intervention. RESULTS Design meetings with 15 PCPs, 12 patients, and 3 patient focus groups revealed myriad drivers for medical test overuse and cascades. Patients commonly believed that all medical tests yield definitive results and lack downsides. PCPs cited expert recommendations, limited time during visits, fear of lawsuits, and desire to be responsive to patients as reasons for ordering potentially low-value medical tests. To address these issues, an intervention was designed using patient pre-visit educational materials, clinician reference materials on test interpretation and incidental findings, and clinician peer comparison on test overuse. CONCLUSION Overuse of medical testing is driven by a range of factors related to PCPs, patients, and their interactions. Multipronged interventions may have the potential to address these drivers after they are rigorously tested.
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Jabbour J, Dhillon HM, Shepherd HL, Sundaresan P, Milross C, Clark JR. A web-based comprehensive head and neck cancer patient education and support needs program: Usability testing. Health Informatics J 2022; 0:14604582221087128. [PMID: 35362344 DOI: 10.1177/14604582221087128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: With increasing accessibility of the World Wide Web, patients are using it to obtain patient education materials (PEM). With this in mind, our group (surgeons, radiation oncologists, medical oncologists, nursing, allied health professionals and academic researchers) developed a comprehensive information resource for patients with head and neck cancer (HNC), the Head and Neck Cancer Australia, formerly Beyond Five website. The aim of this study was to determine patient usability of the Head and Neck Cancer Australia website. Methods: Usability testing (Cognitive walkthrough & Think-Aloud) in 18 patients treated for HNC was undertaken at a Cancer centre (anonymous for reviewers). Results: The tasks rated easiest by patients were finding information on psychological well-being (mean time spent: 66 s, range: 10-565), health and well-being effecting quality of life (mean time spent: 36 s, range 9-117) and carer information (mean time spent: 10 s, range 3-35). Patients indicated the website contained a lot of information, covers most topics, was a trusted source of information and a springboard to other information. Conclusions: The Head and Neck Cancer Australia website provides a wide range of information and support in multiple formats available to HNC patients. Further refinements in design, navigation and website instructions are needed to allow effective patient interaction.
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Affiliation(s)
- Joe Jabbour
- Central Clinical School, 4334University of Sydney, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, 4334The University of Sydney, Camperdown, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-making, 4334The University of Sydney, Camperdown, NSW, Australia
| | - Heather L Shepherd
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, 4334The University of Sydney, Camperdown, NSW, Australia.,Centre for Medical Psychology & Evidence-Based Decision-making, 4334The University of Sydney, Camperdown, NSW, Australia
| | - Puma Sundaresan
- Department of Radiation Oncology and Medical Services,10138Chris O'Brien Lifehouse, Camperdown, NSW, Australia.,200123Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Chris Milross
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, The University of Sydney, Camperdown, NSW, Australia.,Department of Radiation Oncology and Medical Services, 10138Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Jonathan R Clark
- Central Clinical School, 4334University of Sydney, Sydney, NSW, Australia.,Sydney Head and Neck Cancer Institute, 10138Chris O'Brien Lifehouse, Camperdown, NSW, Australia.,South West Clinical School, University of New South Wales, NSW, Australia
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7
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Goodman W, Bagnall AM, Ashley L, Azizoddin D, Muehlensiepen F, Blum D, Bennett MI, Allsop M. The extent of engagement with telehealth approaches by patients with advanced cancer: A systematic review (Preprint). JMIR Cancer 2021; 8:e33355. [PMID: 35175205 PMCID: PMC8895292 DOI: 10.2196/33355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 01/19/2023] Open
Abstract
Background Telehealth approaches are increasingly being used to support patients with advanced diseases, including cancer. Evidence suggests that telehealth is acceptable to most patients; however, the extent of and factors influencing patient engagement remain unclear. Objective The aim of this review is to characterize the extent of engagement with telehealth interventions in patients with advanced, incurable cancer reported in the international literature. Methods This systematic review was registered with PROSPERO (International Prospective Register of Systematic Reviews) and is reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. A comprehensive search of databases was undertaken for telehealth interventions (communication between a patient with advanced cancer and their health professional via telehealth technologies), including MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Sociological Abstracts, and Web of Science, from the inception of each electronic database up until December 31, 2020. A narrative synthesis was conducted to outline the design, population, and context of the studies. A conceptual framework of digital engagement comprising quantitative behavioral measures (frequency, amount, duration, and depth of use) framed the analysis of engagement with telehealth approaches. Frequency data were transformed to a percentage (actual patient engagement as a proportion of intended engagement), and the interventions were characterized by intensity (high, medium, and low intended engagement) and mode of delivery for standardized comparisons across studies. Results Of the 19,676 identified papers, 40 (0.2%) papers covering 39 different studies were eligible for inclusion, dominated by US studies (22/39, 56%), with most being research studies (26/39, 67%). The most commonly reported measure of engagement was frequency (36/39, 92%), with substantial heterogeneity in the way in which it was measured. A standardized percentage of actual patient engagement was derived from 17 studies (17/39, 44%; n=1255), ranging from 51% to 100% with a weighted average of 75.4% (SD 15.8%). A directly proportional relationship was found between intervention intensity and actual patient engagement. Higher engagement occurred when a tablet, computer, or smartphone app was the mode of delivery. Conclusions Understanding engagement for people with advanced cancer can guide the development of telehealth approaches from their design to monitoring as part of routine care. With increasing telehealth use, the development of meaningful and context- and condition-appropriate measures of telehealth engagement is needed to address the current heterogeneity in reporting while improving the understanding of optimal implementation of telehealth for oncology and palliative care. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42018117232; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018117232
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Affiliation(s)
- William Goodman
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | | | - Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Desiree Azizoddin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | | | - David Blum
- Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Michael I Bennett
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Matthew Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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Lussier MT, Richard C, Binta Diallo F, Boivin N, Hudon C, Boustani É, Witteman H, Jbilou J. I am ready to see you now, Doctor! A mixed-method study of the Let's Discuss Health website implementation in Primary Care. Health Expect 2020; 24:243-256. [PMID: 33285012 PMCID: PMC8077096 DOI: 10.1111/hex.13158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background Let's Discuss Health (LDH) is a website that encourages patients to prepare their health‐care encounters by providing communication training, review of topics and questions that are important to them. Objective To describe LDH implementation during primary care (PC) visits for chronic illnesses. Methods Design: Descriptive mixed‐method study. Setting: 6 PC clinics. Participants: 156 patients and 51 health‐care providers (HCP). Intervention: LDH website implementation. Outcome Measures: Perceived quality and usefulness of LDH; perceived quality of HCP‐patient communication; patient activation; LDH integration in routine PC practices and barriers to its use. Results Patients reported a positive perception of the website in that it helped them to adopt an active role in the encounters; recall their visit agenda and reduce encounter‐related stress; feel more confident to ask questions, feel more motivated to prepare their future medical visits and improve their chronic illness management. However, a certain disconnect emerged between HCP and patient perceptions as to the value of LDH in promoting a sense of partnership and collaboration. The main barriers to the use of LDH are HCP lack of interest, limited access to technology, lack of time and language barriers. Conclusion Our findings indicate that it is advantageous for patients to prepare their medical encounters. However, the study needs to be replicated in other medical environments using larger and more diverse samples. Patient and Public Contribution Patient partners were involved in the conduct of this study.
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Affiliation(s)
- Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC, Canada.,Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Claude Richard
- Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Fatoumata Binta Diallo
- Laval Integrated Health and Social Services Centre (Centre de santé et des services sociaux de Laval), Groupe de recherche sur les transformations des pratiques cliniques et organisationnelles, Laval, QC, Canada
| | - Nathalie Boivin
- École réseau de Science infirmière (ÉRSI), University of Moncton, Moncton, NB, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Élie Boustani
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Holly Witteman
- Department of Family Medicine and Emergency Medicine, Laval University, Laval, QC, Canada
| | - Jalila Jbilou
- Centre de formation médicale du Nouveau Brunswick, Université de Sherbrooke, École de psychologie, University of Moncton, Moncton, NB, Canada
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Lleras de Frutos M, Casellas-Grau A, Sumalla EC, de Gracia M, Borràs JM, Ochoa Arnedo C. A systematic and comprehensive review of internet use in cancer patients: Psychological factors. Psychooncology 2019; 29:6-16. [PMID: 31385400 DOI: 10.1002/pon.5194] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/19/2019] [Accepted: 07/31/2019] [Indexed: 12/13/2022]
Affiliation(s)
- María Lleras de Frutos
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain.,Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain
| | - Anna Casellas-Grau
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain.,Observatorio de Atención Psicosocial en Cáncer, Insitut Català d'Oncologia, Barcelona, Spain
| | - Enric C Sumalla
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain
| | - Marta de Gracia
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain
| | - Josep M Borràs
- Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain.,Psycho-Oncology Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Cristian Ochoa Arnedo
- Psycho-Oncology Department, Institut Català d' Oncologia, Barcelona, Spain.,Clinical Psychology and Psychobiology Department, Universitat de Barcelona, Barcelona, Spain.,Psycho-Oncology Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
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10
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Ukoumunne OC, Vaidya B, Frost J, Anderson R, Argyle C, Daly M, Harris-Golesworthy F, Harris J, Gibson A, Ingram W, Pinkney J, Vickery J, Britten N. A preconsultation web-based tool to generate an agenda for discussion in diabetes outpatient clinics to improve patient outcomes (DIAT): a feasibility study. BMJ Open 2017; 7:e013519. [PMID: 28270389 PMCID: PMC5353257 DOI: 10.1136/bmjopen-2016-013519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To test the feasibility of running a randomised controlled trial of a preconsultation web-based intervention (Presenting Asking Checking Expressing (PACE-D)) to improve the quality of care and clinical outcomes in patients with diabetes. DESIGN AND SETTING A feasibility study (with randomisation) conducted at outpatient diabetes clinics at two secondary care hospitals in Devon, UK. PARTICIPANTS People with diabetes (type 1 and type 2) attending secondary care general diabetes outpatient clinics. INTERVENTION The PACE-D, a web-based tool adapted for patients with diabetes to use before their consultation to generate an agenda of topics to discuss with their diabetologist. OUTCOMES The percentage of eligible patients who were recruited and the percentage of participants for whom routine glycosylated haemoglobin (HbA1c) data (the putative primary outcome) could be extracted from medical notes and who completed secondary outcome assessments via questionnaire at follow-up were reported. RESULTS In contrast with the planned recruitment of 120 participants, only 71 participants were randomised during the 7-month recruitment period. This comprised 18.7% (95% CI 14.9% to 23.0%) of those who were eligible. Mean (SD) age of the participants was 56.5 (12.4) years and 66.2% had type 1 diabetes. Thirty-eight patients were randomised to the intervention arm and 33 to the control arm. HbA1c data were available for only 73% (95% CI 61% to 83%) of participants at the 6 months follow-up. The questionnaire-based data were collected for 66% (95% CI 54% to 77%) of the participants at 6 months follow-up. Participants reported that the PACE-D tool was easy to use. CONCLUSIONS A randomised controlled trial of the preconsultation web-based intervention as set out in our current protocol is not feasible without significant modification to improve recruitment and follow-up of participants. The study also provides insights into the feasibility and challenges of conducting complex intervention trials in everyday clinical practice. TRIAL REGISTRATION ISRCTN75070242.
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Affiliation(s)
- Obioha C Ukoumunne
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Bijay Vaidya
- Department of Diabetes & Endocrinology, Royal Devon and Exeter Hospital, University of Exeter Medical School, Exeter, UK
| | - Julia Frost
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Rob Anderson
- Peninsula Technology Assessment Group (PenTAG), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Catherine Argyle
- Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter Foundation Trust, Exeter, UK
| | - Mark Daly
- Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter Foundation Trust, Exeter, UK
| | - Faith Harris-Golesworthy
- Peninsula Public Involvement Group (PenPIG), NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Jim Harris
- Peninsula Public Involvement Group (PenPIG), NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Andy Gibson
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Wendy Ingram
- Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Jon Pinkney
- Plymouth University and Peninsula Schools of Medicine and Dentistry, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Jane Vickery
- Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Nicky Britten
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
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11
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Lim BT, Butow P, Mills J, Miller A, Goldstein D. Information needs of the Chinese community affected by cancer: A systematic review. Psychooncology 2017; 26:1433-1443. [DOI: 10.1002/pon.4347] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 10/14/2016] [Accepted: 12/08/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Bee Teng Lim
- Practical Support Unit; Cancer Council NSW; Woolloomooloo New South Wales Australia
| | - Phyllis Butow
- The Psycho-oncology Co-operative Research Group; the University of Sydney; Sydney New South Wales Australia
| | - Jill Mills
- Practical Support Unit; Cancer Council NSW; Woolloomooloo New South Wales Australia
| | - Annie Miller
- Practical Support Unit; Cancer Council NSW; Woolloomooloo New South Wales Australia
| | - David Goldstein
- Department of Medical Oncology; Prince of Wales Hospital; Randwick New South Wales Australia
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Fleisher L, Wen KY, Miller SM, Diefenbach M, Stanton AL, Ropka M, Morra M, Raich PC. Development and utilization of complementary communication channels for treatment decision making and survivorship issues among cancer patients: The CIS Research Consortium Experience. Internet Interv 2015; 2:392-398. [PMID: 26855885 PMCID: PMC4740910 DOI: 10.1016/j.invent.2015.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Cancer patients and survivors are assuming active roles in decision-making and digital patient support tools are widely used to facilitate patient engagement. As part of Cancer Information Service Research Consortium's randomized controlled trials focused on the efficacy of eHealth interventions to promote informed treatment decision-making for newly diagnosed prostate and breast cancer patients, and post-treatment breast cancer, we conducted a rigorous process evaluation to examine the actual use of and perceived benefits of two complementary communication channels -- print and eHealth interventions. METHODS The three Virtual Cancer Information Service (V-CIS) interventions were developed through a rigorous developmental process, guided by self-regulatory theory, informed decision-making frameworks, and health communications best practices. Control arm participants received NCI print materials; experimental arm participants received the additional V-CIS patient support tool. Actual usage data from the web-based V-CIS was also obtained and reported. RESULTS Print materials were highly used by all groups. About 60% of the experimental group reported using the V-CIS. Those who did use the V-CIS rated it highly on improvements in knowledge, patient-provider communication and decision-making. CONCLUSION The findings show that how patients actually use eHealth interventions either singularly or within the context of other communication channels is complex. PRACTICE IMPLICATIONS Integrating rigorous best practices and theoretical foundations is essential and multiple communication approaches should be considered to support patient preferences.
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Affiliation(s)
- Linda Fleisher
- Associate Research Professor - Adjunct, Cancer Prevention and Control, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA. Senior Scientist, Children's Hospital of Philadelphia, USA, 3535 Market Street - Room 1177, Philadelphia, PA 19104 USA
| | - Kuang Yi Wen
- Assistant Professor, Cancer Prevention and Control, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA
| | - Suzanne M Miller
- Director - Psychosocial and Behavioral Medicine Program, Professor - Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA
| | - Michael Diefenbach
- Associate Professor of Urology and Oncological Sciences, Director of Behavioral Research, Department of Urology, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, NY 10029 USA
| | - Annette L Stanton
- Professor, Departments of Psychology & Psychiatry/Biobehavioral Sciences, UCLA, Member, Jonsson Comprehensive Cancer Center, UCLA Cousins Center for Psychoneuroimmunology, 300 Medical Plaza Driveway, Los Angeles, CA 90095 USA
| | - Mary Ropka
- Professor of Public Health Sciences, UVA School of Medicine, Blake Center · 1224 W. Main St., Suite 400B, P.O. Box 80082, Charlottesville, VA 22908-0821 USA
| | - Marion Morra
- President, Morra Communications, 1 Platt Street, Milford, CT 06460 USA
| | - Peter C Raich
- Chief, Division of Hematology/Oncology, Denver Health and Hospitals, Professor of Medicine, Adjunct Professor of Psychology, University of Colorado Denver, 777 Bannock Street, MC1925, Denver, CO 80204 USA
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Heckman C, Darlow S, Munshi T, Caruso C, Ritterband L, Raivitch S, Fleisher L, Manne S. Development of an Internet Intervention to Address Behaviors Associated with Skin Cancer Risk among Young Adults. Internet Interv 2015; 2:340-350. [PMID: 26640776 PMCID: PMC4669098 DOI: 10.1016/j.invent.2015.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Skin cancer is the most common cancer in the US, and its incidence is increasing. The major risk factor for skin cancer is exposure to ultraviolet radiation (UV). Young adults tend to expose themselves to large amounts of UV and engage in minimal skin protection, which increases their skin cancer risk. Interventions are needed to address risk behaviors among young adults that may lead to skin cancer. The nternet offers a cost-effective way to widely disseminate efficacious interventions. The current paper describes the development of an online skin cancer risk reduction intervention (UV4.me) for young adults. PROCEDURES The iterative development process for UV4.me followed best-practice guidelines and included the following activities: individual interviews, focus groups, content development by the expert team, acceptability testing, cognitive interviewing for questionnaires, quality control testing, usability testing, and a pilot randomized controlled trial. Participant acceptability and usability feedback was assessed. PRINCIPAL RESULTS The development process produced an evidence-informed intervention that is individually-tailored, interactive, and multimedia in nature based on the Integrative Model of Behavior Prediction, a model for internet interventions, and other best-practice recommendations, expert input, as well as user acceptability and usability feedback gathered before, during, and after development. MAJOR CONCLUSIONS Development of an acceptable intervention intended to have a significant public health impact requires a relatively large investment in time, money, expertise, and ongoing user input. Lessons learned and recommendations are discussed. The comprehensive process used may help prepare others interested in creating similar behavioral health interventions.
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Affiliation(s)
- Carolyn Heckman
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
| | - Susan Darlow
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
| | - Teja Munshi
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
| | - Carolyn Caruso
- BeHealth Solutions, LLC, 375 Greenbrier Drive, Charlottesville, VA 22901
| | - Lee Ritterband
- BeHealth Solutions, LLC, 375 Greenbrier Drive, Charlottesville, VA 22901,University of Virginia Health System, 1215 Lee Street, Charlottesvile, VA 22908
| | | | - Linda Fleisher
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111
| | - Sharon Manne
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901-1914
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Win KT, Hassan NM, Bonney A, Iverson D. Benefits of Online Health Education: Perception from Consumers and Health Professionals. J Med Syst 2015; 39:27. [DOI: 10.1007/s10916-015-0224-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 02/02/2015] [Indexed: 02/07/2023]
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Wen KY, Miller SM, Kilby L, Fleisher L, Belton TD, Roy G, Hernandez E. Preventing postpartum smoking relapse among inner city women: development of a theory-based and evidence-guided text messaging intervention. JMIR Res Protoc 2014; 3:e20. [PMID: 24698804 PMCID: PMC4004157 DOI: 10.2196/resprot.3059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/27/2014] [Accepted: 02/20/2014] [Indexed: 11/15/2022] Open
Abstract
Background Underserved women are at high risk for smoking relapse after childbirth due to their unique socioeconomic and postpartum stressors and barriers. Mobile text messaging technology allows delivery of relapse prevention programs targeted to their personal needs over time. Objective To describe the development of a social-cognitive theory-based and evidence-guided text messaging intervention for preventing postpartum smoking relapse among inner city women. Methods Guided by the cognitive-social health information processing framework, user-centered design, and health communication best practices, the intervention was developed through a systematic process that included needs assessment, followed by an iterative cycling through message drafting, health literacy evaluation and rewriting, review by target community members and a scientific advisory panel, and message revision, concluding with usability testing. Results All message content was theory-grounded, derived by needs assessment analysis and evidence-based materials, reviewed and revised by the target population, health literacy experts, and scientific advisors. The final program, “Txt2Commit,” was developed as a fully automated system, designed to deliver 3 proactive messages per day for a 1-month postpartum smoking relapse intervention, with crave and lapse user-initiated message functions available when needed. Conclusions The developmental process suggests that the application of theory and best practices in the design of text messaging smoking cessation interventions is not only feasible but necessary for ensuring that the interventions are evidence based and user-centered.
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Affiliation(s)
- Kuang-Yi Wen
- Fox Chase Cancer Center/Temple University Health System, Cancer Prevention and Control, Philadelphia, PA, United States
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16
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Translating access into utilization: lessons from the design and evaluation of a health insurance Web site to promote reproductive health care for young women in Massachusetts. Contraception 2013; 88:684-90. [DOI: 10.1016/j.contraception.2013.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/03/2013] [Accepted: 09/07/2013] [Indexed: 11/21/2022]
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Rosenfeld L, Shepherd A, Agunwamba AA, McCray AT. Iterative evaluation of a web-based health information resource. JOURNAL OF HEALTH COMMUNICATION 2013; 18:974-990. [PMID: 23577665 PMCID: PMC3711962 DOI: 10.1080/10810730.2012.757395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article presents the research process and methods used to evaluate and improve a web-based health information resource, called "Community Connect to Research," intended for the public. The research process was iterative and involved collaboration with many partners. Two formal evaluations were conducted in 2009 and 2010 using key informant interviews, usability interviews, focus groups, an online survey, and readability and suitability assessment tools. These methods provided users' perspectives on the overall design, content, and literacy demands of the website as well as valuable feedback on their interaction with the website. The authors subsequently redesigned Community Connect to Research, making significant improvements on the basis of what they learned from the evaluation. The second evaluation revealed that the redesign addressed many issues found in the first evaluation and identified additional areas of possible improvement. Overall, both evaluations suggested that participants believed that the website was useful and valuable, indicating that Community Connect to Research is a health information resource that provides patients and families with accessible, relevant, and high-quality information. Regular formal evaluation is an essential tool for effective ongoing enhancement of health information resources meant for the public.
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Affiliation(s)
- Lindsay Rosenfeld
- Institute for Child, Youth, and Family Policy , Heller School of Social Policy and Management, Brandeis University, Waltham, MA 02454, USA.
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Frost J, Anderson R, Argyle C, Daly M, Harris-Golesworthy F, Harris J, Gibson A, Ingram W, Pinkney J, Ukoumunne OC, Vaidya B, Vickery J, Britten N. A pilot randomised controlled trial of a preconsultation web-based intervention to improve the care quality and clinical outcomes of diabetes outpatients (DIAT). BMJ Open 2013; 3:bmjopen-2013-003396. [PMID: 23903815 PMCID: PMC3731775 DOI: 10.1136/bmjopen-2013-003396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Diabetes is a chronic condition associated with many long-term complications. People with diabetes need to actively manage their condition, which can be complex. In consultations with healthcare professionals, patients receive advice about their diabetes but do not always discuss things which concern them, perhaps because of the perceived limited time or embarrassment. We want to test a 'preconsultation' intervention in which the patient is supported by a healthcare assistant to complete a web-based intervention aimed at producing an agenda to help them identify important areas for discussion in the consultation. Use of this agenda may enable the patient to play a more active role in that consultation and consequently become more confident, and hence more successful, in managing their condition. METHODS AND ANALYSIS In this pilot randomised controlled trial, 120 people with diabetes will be randomised with equal allocation to receive the intervention or usual clinical care. The primary outcome is reduction in glycosylated haemoglobin(HbA1c). Secondary outcomes are patient-reported communication, enablement, self-care activity, diabetes-dependent quality of life, empowerment, satisfaction, health-related quality of life and resource use. The aim of the pilot study was to estimate parameters to inform the design of the definitive trial. Follow-up on quantitative outcomes will be at 3 and 6 months. A nested qualitative study will collect data on the patients' experiences of producing an agenda. Resource use data and medication use will also be collected via a review of medical records for a sample of participants. ETHICS AND DISSEMINATION Approval was granted by the NHS Research Ethics Committee North West-Preston (13/NW/0123). Dissemination will include publication of quantitative and qualitative findings, and experience of public involvement in peer-reviewed journals. Results will also be disseminated to trial participants via workshops led by lay coapplicants. TRIAL REGISTRATION ISRCTN75070242.
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Affiliation(s)
- Julia Frost
- Institute for Health Services Research, University of Exeter Medical School, Exeter, UK
| | - Rob Anderson
- PenTAG, Institute for Health Services Research, University of Exeter Medical School, Exeter, UK
| | - Catherine Argyle
- Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter Foundation Trust, Exeter, UK
| | - Mark Daly
- Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter Foundation Trust, Exeter, UK
| | - Faith Harris-Golesworthy
- Peninsula Public Involvement Group (PenPIG), National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula
| | - Jim Harris
- Peninsula Public Involvement Group (PenPIG), National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula
| | - Andy Gibson
- Institute for Health Services Research, University of Exeter Medical School, Exeter, UK
| | - Wendy Ingram
- Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Jon Pinkney
- Plymouth University and Peninsula Schools of Medicine and Dentistry, Derriford Hospital, Plymouth Hospitals NHS Trust
| | - Obioha C Ukoumunne
- Institute for Health Services Research, University of Exeter Medical School, Exeter, UK
| | - Bijay Vaidya
- Department of Diabetes & Endocrinology, Royal Devon and Exeter Hospital, University of Exeter Medical School, Exeter, UK
| | - Jane Vickery
- Peninsula Clinical Trials Unit, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Nicky Britten
- Institute for Health Services Research, University of Exeter Medical School, Exeter, UK
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Meropol NJ, Egleston BL, Buzaglo JS, Balshem A, Benson AB, Cegala DJ, Cohen RB, Collins M, Diefenbach MA, Miller SM, Fleisher L, Millard JL, Ross EA, Schulman KA, Silver A, Slater E, Solarino N, Sulmasy DP, Trinastic J, Weinfurt KP. A Web-based communication aid for patients with cancer: the CONNECT Study. Cancer 2013; 119:1437-45. [PMID: 23335150 DOI: 10.1002/cncr.27874] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/14/2012] [Accepted: 10/01/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cancer patients and their oncologists often report differing perceptions of consultation discussions and discordant expectations regarding treatment outcomes. CONNECT, a computer-based communication aid, was developed to improve communication between patients and oncologists. METHODS CONNECT includes assessment of patient values, goals, and communication preferences; patient communication skills training; and a preconsultation physician summary report. CONNECT was tested in a 3-arm, prospective, randomized clinical trial. Prior to the initial medical oncology consultation, adult patients with advanced cancer were randomized to the following arms: 1) control; 2) CONNECT with physician summary; or 3) CONNECT without physician summary. Outcomes were assessed with postconsultation surveys. RESULTS Of 743 patients randomized, 629 completed postconsultation surveys. Patients in the intervention arms (versus control) felt that the CONNECT program made treatment decisions easier to reach (P = .003) and helped them to be more satisfied with these decisions (P < .001). In addition, patients in the intervention arms reported higher levels of satisfaction with physician communication format (P = .026) and discussion regarding support services (P = .029) and quality of life concerns (P = .042). The physician summary did not impact outcomes. Patients with higher levels of education and poorer physical functioning experienced greater benefit from CONNECT. CONCLUSIONS This prospective randomized clinical trial demonstrates that computer-based communication skills training can positively affect patient satisfaction with communication and decision-making. Measurable patient characteristics may be used to identify subgroups most likely to benefit from an intervention such as CONNECT.
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Affiliation(s)
- Neal J Meropol
- University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA.
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Henselmans I, de Haes HCJM, Smets EMA. Enhancing patient participation in oncology consultations: a best evidence synthesis of patient-targeted interventions. Psychooncology 2012; 22:961-77. [DOI: 10.1002/pon.3099] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/16/2012] [Accepted: 04/06/2012] [Indexed: 01/08/2023]
Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Hanneke C. J. M. de Haes
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
| | - Ellen M. A. Smets
- Department of Medical Psychology, Academic Medical Center; University of Amsterdam; Amsterdam Netherlands
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Rönning H, Nielsen NE, Strömberg A, Thilen U, Swahn E. Development and evaluation of a computer-based educational program for adults with congenitally malformed hearts. Eur J Cardiovasc Nurs 2012; 12:78-86. [DOI: 10.1177/1474515111432999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Helén Rönning
- Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
| | | | | | | | - Eva Swahn
- Linköping University, Linköping, Sweden
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Egleston BL, Miller SM, Meropol NJ. The impact of misclassification due to survey response fatigue on estimation and identifiability of treatment effects. Stat Med 2011; 30:3560-72. [PMID: 21953305 PMCID: PMC3552436 DOI: 10.1002/sim.4377] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 08/01/2011] [Indexed: 11/07/2022]
Abstract
Response fatigue can cause measurement error and misclassification problems in survey research. Questions asked later in a long survey are often prone to more measurement error or misclassification. The response given is a function of both the true response and participant response fatigue. We investigate the identifiability of survey order effects and their impact on estimators of treatment effects. The focus is on fatigue that affects a given answer to a question rather than fatigue that causes non-response and missing data. We consider linear, Gamma, and logistic models of response that incorporate both the true underlying response and the effect of question order. For continuous data, survey order effects have no impact on study power under a Gamma model. However, under a linear model that allows for convergence of responses to a common mean, the impact of fatigue on power will depend on how fatigue affects both the rate of mean convergence and the variance of responses. For binary data and for less than a 50% chance of a positive response, order effects cause study power to increase under a linear probability (risk difference) model but decrease under a logistic model. The results suggest that measures designed to reduce survey order effects might have unintended consequences. We present a data example that demonstrates the problem of survey order effects.
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Affiliation(s)
- Brian L Egleston
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA.
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Abstract
For the practicing physician, the behavioral implications of preventing, diagnosing, and treating cancer are many and varied. Fortunately, an enhanced capacity in informatics may help create a redesigned ecosystem in which applying evidence-based principles from behavioral medicine will become a routine part of care. Innovation to support this evolution will be spurred by the "meaningful use" criteria stipulated by the Health Information Technology for Economic and Clinical Health Act of 2009 and by focused research and development efforts within the broader health information ecosystem. The implications for how to better integrate evidence-based principles in behavioral medicine into oncology care through both spheres of development are discussed within the framework of the cancer control continuum. The promise of using the data collected through these tools to accelerate discovery in psycho-oncology is also discussed. If nurtured appropriately, these developments should help accelerate successes against cancer by altering the behavioral milieu.
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Development and pilot testing of a communication aid to assist clinicians to communicate with women diagnosed with ductal carcinoma in situ (DCIS). Support Care Cancer 2010; 19:717-23. [DOI: 10.1007/s00520-010-1040-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022]
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Yardley L, Morrison LG, Andreou P, Joseph J, Little P. Understanding reactions to an internet-delivered health-care intervention: accommodating user preferences for information provision. BMC Med Inform Decis Mak 2010; 10:52. [PMID: 20849599 PMCID: PMC2946266 DOI: 10.1186/1472-6947-10-52] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 09/17/2010] [Indexed: 12/02/2022] Open
Abstract
Background It is recognised as good practice to use qualitative methods to elicit users' views of internet-delivered health-care interventions during their development. This paper seeks to illustrate the advantages of combining usability testing with 'theoretical modelling', i.e. analyses that relate the findings of qualitative studies during intervention development to social science theory, in order to gain deeper insights into the reasons and context for how people respond to the intervention. This paper illustrates how usability testing may be enriched by theoretical modelling by means of two qualitative studies of users' views of the delivery of information in an internet-delivered intervention to help users decide whether they needed to seek medical care for their cold or flu symptoms. Methods In Study 1, 21 participants recruited from a city in southern England were asked to 'think aloud' while viewing draft web-pages presented in paper format. In Study 2, views of our prototype website were elicited, again using think aloud methods, in a sample of 26 participants purposively sampled for diversity in education levels. Both data-sets were analysed by thematic analysis. Results Study 1 revealed that although the information provided by the draft web-pages had many of the intended empowering benefits, users often felt overwhelmed by the quantity of information. Relating these findings to theory and research on factors influencing preferences for information-seeking we hypothesised that to meet the needs of different users (especially those with lower literacy levels) our website should be designed to provide only essential personalised advice, but with options to access further information. Study 2 showed that our website design did prove accessible to users with different literacy levels. However, some users seemed to want still greater control over how information was accessed. Conclusions Educational level need not be an insuperable barrier to appreciating web-based access to detailed health-related information, provided that users feel they can quickly gain access to the specific information they seek.
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Affiliation(s)
- Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK.
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