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Lukasczik M, Wolf HD, Vogel H. Development and initial evaluation of the usefulness of a question prompt list to promote patients' level of information about work-related medical rehabilitation: a pilot study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1266065. [PMID: 38425499 PMCID: PMC10901981 DOI: 10.3389/fresc.2024.1266065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
Introduction The purpose of this study was to develop a question prompt list (QPL) to support patients undergoing work-related medical rehabilitation in obtaining relevant information and to explore how patients and physicians rate the QPL regarding its usefulness, practicability, and perceived (additional) effort. Methods An initial item pool was assessed by rehabilitation patients (N = 3) in cognitive interviews, rated by physicians and other health professionals (N = 11), and then further modified. The final QPL version (16 items) was used by patients (N = 36) in medical admission interviews in an inpatient medical rehabilitation facility and then evaluated. Physicians evaluated the QPL after each interview with a study participant (N = 6; k = 39 interviews). Results The QPL was used by 50% of patients who rated its usefulness and comprehensibility positively. Neither the need for information nor satisfaction with the information received was correlated with QPL use. The physicians' assessment showed a positive evaluation regarding the provision of information and structuring of the conversation, but also a higher perceived time expenditure. Discussion While initial testing of the QPL in work-related medical rehabilitation as a tool to support patient-provider communication generally showed a favorable evaluation by patients using it and physicians, future research should address its validity and effectiveness.
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Affiliation(s)
- Matthias Lukasczik
- Rehabilitation Sciences Section, Center of Mental Health, Würzburg University Hospital, Würzburg, Germany
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Bray L, Wilkinson C, Bruce C, Davidson N, Satchwell C, Carter B. 'It's my back…'; developing the coming to spinal clinic resource to improve the health literacy of young people with adolescent idiopathic scoliosis and their parents. J Child Health Care 2023; 27:628-642. [PMID: 35435029 PMCID: PMC10676617 DOI: 10.1177/13674935221083767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study focussed on identifying the key concerns and information needs of young people with Adolescent Idiopathic Scoliosis (AIS) and their parents and examined what resources might help improve young people's 'participativeness' and health literacy during clinic consultations. A qualitative participatory design underpinned the study. Workshops involving multiple methods were used to engage with young people with AIS and their parents, who were recruited through a regional children's hospital. The study design was informed by patient and public consultation with eight young people and two parents. 10 young people (aged 14-16 years) and 11 of their parents participated in the study. Young people and their parents reported uncertainty and anxiety before coming to clinic and faced issues participating in the consultation, being involved in decision-making and understanding the information and language. These challenges resulted in unmet information needs. Young people's health literacy relating to an AIS diagnosis and treatment is facilitated by them being prepared and informed before coming to clinic and be actively supported to be involved during the consultation. We collaboratively developed the 'Coming to Spinal Clinic' resource to help young people with AIS and parents prepare for and get the most out of their visit.
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Affiliation(s)
- Lucy Bray
- Faculty of Health Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Catherine Wilkinson
- Faculty of Health Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Colin Bruce
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Neil Davidson
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Candice Satchwell
- Centre for Excellence in Learning and Teaching (CELT), University of Central Lancashire, Preston, UK
| | - Bernie Carter
- Faculty of Health Social Care and Medicine, Edge Hill University, Ormskirk, UK
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Ljungberg Persson C, Al-Nuaimi A, Esmaeili N, Svensberg K. Patients' attitudes towards using a question prompt list in community pharmacies. PATIENT EDUCATION AND COUNSELING 2023; 115:107862. [PMID: 37422951 DOI: 10.1016/j.pec.2023.107862] [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: 02/01/2023] [Revised: 05/28/2023] [Accepted: 06/17/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE To explore patients' usage rate and perceived usefulness and benefits of a question prompt list (QPL) when collecting prescribed medication in community pharmacies. METHODS Data were collected in Swedish pharmacies using questionnaires and semi-structured interviews with patients. The Technology Acceptance Model (TAM) was used, and the outcomes were usage rate, factors impacting on use, and perceived ease of use, usefulness, and benefits of self-reported question-asking and self-perceived medication knowledge. Descriptive statistics and group comparisons were performed, and qualitative data were analyzed thematically with the TAM. RESULTS Out of 145 patients filling out the questionnaire, 72 (50.0%) reported they had used the QPL. Patients with new prescriptions and non-native Swedish speakers used the QPL more often (p = 0.03; p = 0.009, respectively). The QPL was quick to read (86.3%) and easy to understand (91.4%). Forty percent stated that they asked more questions, and self-reported users scored higher on self-perceived medication knowledge. In the interviews (n = 14), the QPL was described as an eye-opener as to what one could ask the pharmacist. CONCLUSIONS Patients were willing to use a QPL in community pharmacies. PRACTICE IMPLICATIONS A QPL in pharmacies might improve patients' engagement medication knowledge, as well as showcase the expertise of pharmacists.
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Affiliation(s)
- C Ljungberg Persson
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - A Al-Nuaimi
- Department of Pharmacy, University of Uppsala, Box 580, 751 23 Uppsala, Sweden
| | - N Esmaeili
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - K Svensberg
- Department of Pharmacy, University of Uppsala, Box 580, 751 23 Uppsala, Sweden
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Dhanani S, Ramlakhan JU, Berta WB, Gagliardi AR. Optimizing the design and implementation of question prompt lists to support person-centred care: A scoping review. Health Expect 2023; 26:1404-1417. [PMID: 37227115 PMCID: PMC10349246 DOI: 10.1111/hex.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/13/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Question prompt lists (QPLs) are lists of questions that patients may want to discuss with clinicians. QPLs support person-centred care and have been associated with many beneficial outcomes including improved patient question-asking, and the amount and quality of the information provided by clinicians. The purpose of this study was to review published research on QPLs to explore how QPL design and implementation can be optimized. METHODS We performed a scoping review by searching MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Library and Joanna Briggs Database from inception to 8 May 2022, for English language studies of any design that evaluated QPLs. We used summary statistics and text to report study characteristics, and QPL design and implementation. RESULTS We included 57 studies published from 1988 to 2022 by authors in 12 countries on a range of clinical topics. Of those, 56% provided the QPL, but few described how QPLs were developed. The number of questions varied widely (range 9-191). Most QPLs were single-page handouts (44%) but others ranged from 2 to 33 pages. Most studies implemented a QPL alone with no other accompanying strategy; most often in a print format before consultations by mail (18%) or in the waiting room (66%). Both patients and clinicians identified numerous benefits to patients of QPLs (e.g., increased patient confidence to ask questions, and patient satisfaction with communication or care received; and reduced anxiety about health status or treatment). To support use, patients desired access to QPLs in advance of clinician visits, and clinicians desired information/training on how to use the QPL and answer questions. Most (88%) studies reported at least one beneficial impact of QPLs. This was true even for single-page QPLs with few questions unaccompanied by other implementation strategies. Despite favourable views of QPLs, few studies assessed outcomes amongst clinicians. CONCLUSION This review identified QPL characteristics and implementation strategies that may be associated with beneficial outcomes. Future research should confirm these findings via systematic review and explore the benefits of QPLs from the clinician's perspective. PATIENT/PUBLIC CONTRIBUTION Following this review, we used the findings to develop a QPL on hypertensive disorders of pregnancy and interviewed women and clinicians about QPL design including content, format, enablers and barriers of use, and potential outcomes including beneficial impacts and possible harms (will be published elsewhere).
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Affiliation(s)
- Shazia Dhanani
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
| | - Jessica U. Ramlakhan
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
| | - Whitney B. Berta
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
| | - Anna R. Gagliardi
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
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Waltz M, Yan H, Cadigan RJ, Canter C, Bain L, Bensen JT, Conway C, Haldeman-Englert C, Farnan L, M Foreman AK, Grant TL, Leach B, Lin FC, Mahla M, O'Daniel JM, O'Neill SC, Smith G, Powell BC, Berg JS, Rini CM. Question prompt lists and caregiver question asking in pediatric specialty appointments: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2023; 109:107620. [PMID: 36689884 PMCID: PMC9931668 DOI: 10.1016/j.pec.2022.107620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Question prompt lists (QPLs) have been effective at increasing patient involvement and question asking in medical appointments, which is critical for shared decision making. We investigated whether pre-visit preparation (PVP), including a QPL, would increase question asking among caregivers of pediatric patients with undiagnosed, suspected genetic conditions. METHODS Caregivers were randomized to receive the PVP before their appointment (n = 59) or not (control, n = 53). Appointments were audio-recorded. Transcripts were analyzed to determine questions asked. RESULTS Caregivers in the PVP group asked more questions (MeanPVP = 4.36, SDPVP = 4.66 vs. Meancontrol = 2.83, SDcontrol = 3.03, p = 0.045), including QPL questions (MeanPVP = 1.05, SDPVP = 1.39 vs. Meancontrol = 0.36, SDcontrol = 0.81, p = 0.002). Caregivers whose child had insurance other than Medicaid in the PVP group asked more total and QPL questions than their counterparts in the control group (ps = 0.005 and 0.002); there was no intervention effect among caregivers of children with Medicaid or no insurance (ps = 0.775 and 0.166). CONCLUSION The PVP increased question asking but worked less effectively among traditionally underserved groups. Additional interventions, including provider-focused efforts, may be needed to promote engagement of underserved patients. PRACTICE IMPLICATIONS Patient/family-focused interventions may not be beneficial for all populations. Providers should be aware of potential implicit and explicit biases and encourage question asking to promote patient/family engagement.
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Affiliation(s)
- Margaret Waltz
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
| | - Haoyang Yan
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R Jean Cadigan
- Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Courtney Canter
- Department of Anthropology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | - Jeannette T Bensen
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Carol Conway
- Parent/Advocate, Parent Advocates for Adult Children with Intellectual &/or Developmental Disabilities in NC, Chapel Hill, NC, USA
| | | | - Laura Farnan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Tracey L Grant
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Barbara Leach
- Parent/Advocate, Family Support Program, School of Social Work, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Madeline Mahla
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Julianne M O'Daniel
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Bradford C Powell
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Christine M Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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Sleath B, Carpenter DM, Davis SA, Budenz DL, Muir KW, Romero MS, Lee C, Tudor G, Garcia N, Adjei AA, Robin AL. Improving Black Patient Question-Asking and Provider Education During Glaucoma Visits. Ophthalmol Glaucoma 2023; 6:206-214. [PMID: 36967704 DOI: 10.1016/j.ogla.2022.09.003] [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: 04/14/2022] [Revised: 08/28/2022] [Accepted: 09/12/2022] [Indexed: 04/26/2023]
Abstract
PURPOSE The objectives of this study were to conduct a randomized, controlled trial testing the effectiveness of a previsit glaucoma video/question prompt list intervention to increase Black patient question-asking and provider education about glaucoma and glaucoma medications during visits. DESIGN A randomized, controlled trial of a glaucoma question prompt list/video intervention. PARTICIPANTS Black patients with a glaucoma diagnosis who were currently taking 1 or more glaucoma medications and reported being nonadherent. METHODS One hundred and eighty-nine Black patients with glaucoma were enrolled into a randomized, controlled trial and assigned to either a usual care or an intervention group where they watched a video emphasizing the importance of asking questions and received a glaucoma question prompt list to complete before clinic visits. Visits were audiotaped and patients were interviewed after visits. MAIN OUTCOME MEASURES Outcome measures were if the patient asked 1 or more questions about glaucoma and glaucoma medications and the number of glaucoma and glaucoma medication areas the provider educated the patient about during the visit. RESULTS Patients in the intervention group were significantly more likely to ask 1 or more questions about glaucoma than patients in the usual care group (odds ratio, 5.4; 95% confidence interval [CI], 2.8-10.4). Patients in the intervention group were significantly more likely to ask 1 or more questions about glaucoma medications than patients in the usual care group (odds ratio, 2.8; 95% CI, 1.5-5.4). Patients in the intervention group were significantly more likely to receive more areas of education about glaucoma from their providers during visits (β = 0.94; 95% CI, 0.49-1.4). Patients who asked 1 or more questions about glaucoma medications were significantly more likely to receive more areas of education about glaucoma medications from providers (β = 1.8; 95% CI, 1.2-2.5). CONCLUSIONS The intervention increased patient question-asking about glaucoma and glaucoma medications and provider education about glaucoma. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelly W Muir
- Department of Ophthalmology, School of Medicine, Duke University, Durham, North Carolina; Durham VA Medical Center, Health Services Research and Development, Durham, North Carolina
| | | | | | - Gail Tudor
- Health Professions, Southern New Hampshire University, Manchester, New Hampshire
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Abena A Adjei
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alan L Robin
- Ophthalmology, University of Michigan, Ann Arbor, Michigan; Ophthalmology and International Health, Johns Hopkins University, Baltimore, Maryland
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Rincones O, Smith A‘B, Chong P, Mancuso P, Wu VS, Sidhom M, Wong K, Ngo D, Gassner P, Girgis A. Encouraging Patients to Ask Questions: Development and Pilot Testing of a Question Prompt List for Patients Undergoing a Biopsy for Suspected Prostate Cancer. Curr Oncol 2023; 30:2088-2104. [PMID: 36826123 PMCID: PMC9954987 DOI: 10.3390/curroncol30020162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
This study assessed the acceptability and feasibility of a question prompt list (QPL) to facilitate informed treatment decision-making in men with suspected localised prostate cancer, which involves values-based choices between options with similar efficacy but different side effects. The QPL was developed through iterative consultation with consumers, clinicians and researchers. Acceptability was assessed using study-specific questions regarding QPL satisfaction and usefulness and qualitative interviews. Feasibility was determined via the proportion of men given the QPL according to medical records and the completion of standardised measures of decisional outcomes. Quantitative data were analysed using descriptive and univariate statistics. Qualitative data were thematically analysed. Fifty-two men consented; 34 provided data for analysis. The QPL recipients reported moderate-high content satisfaction (70.6%) and perceived usefulness in guiding appointments when receiving biopsy results (64.7%). Two main qualitative themes also indicated the QPL acceptability: (1) the freedom to ask-acceptable timing, flexible usage and usefulness of the QPL, and (2) satisfaction with the QPL content. However, only 18.4% of eligible men received the QPL, indicating limited feasibility. The QPL is safe and acceptable, but further research is needed regarding how to facilitate the uptake of the question prompt list in clinical practice.
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Affiliation(s)
- Orlando Rincones
- Ingham Institute for Applied Medical Research, Liverpool 2170, Australia
| | - Allan ‘Ben’ Smith
- Ingham Institute for Applied Medical Research, Liverpool 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales Sydney, Liverpool 2170, Australia
- Correspondence:
| | - Peter Chong
- Lake Macquarie Urology, Newcastle 2290, Australia
| | - Pascal Mancuso
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool 2170, Australia
- Department of Urological Surgery, South Western Sydney Local Health District, Liverpool 2170, Australia
| | - Verena Shuwen Wu
- Ingham Institute for Applied Medical Research, Liverpool 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales Sydney, Liverpool 2170, Australia
| | - Mark Sidhom
- South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales Sydney, Liverpool 2170, Australia
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool 2170, Australia
| | - Karen Wong
- South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales Sydney, Liverpool 2170, Australia
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool 2170, Australia
| | - Diana Ngo
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool 2170, Australia
| | - Paul Gassner
- Department of Urological Surgery, South Western Sydney Local Health District, Liverpool 2170, Australia
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, Liverpool 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine & Health, University of New South Wales Sydney, Liverpool 2170, Australia
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Ting YY, Ey JD, Treloar EC, Reid JL, Bradshaw EL, Maddern GJ. Patient prompts in surgical consultations: A systematic review. Surgery 2022; 172:1759-1767. [PMID: 36184314 DOI: 10.1016/j.surg.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/03/2022] [Accepted: 08/24/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Quality communication has been found to improve patient outcomes. Despite good communication, information may still be forgotten or misunderstood by patients. A question prompt list is a document to help patients ask questions. Question prompt lists are well perceived by various stakeholders and have been found of benefit to patients. This systematic review evaluated the effectiveness of patient question prompting documents in surgical outpatient consultations. METHODS MEDLINE, EMBASE, and PsychINFO were searched on September 13, 2021. Study selection, data extraction, and risk of bias assessment were performed in duplicate. We included English studies that investigated the use of question prompt lists and their influence on patient outcomes. We excluded studies that did not have a comparator group. Because of heterogeneity of outcome measures, meta-analysis was precluded. This study was registered with PROSPERO (identification number: CRD42021279058). RESULTS Searches identified 107 suitable studies; however, only 7 studies met eligibility criteria. All included studies were randomized controlled trials, but the designs of studies were heterogenous. Three out of 7 included studies were at a high risk of bias. The included studies investigated different outcomes that could be broadly categorized into 5 themes: consultation characteristics, patient engagement, patient well-being, information exchange, and patient satisfaction. None of the studies looked at patient recall of information. Aside from length of consultation, the overall results for each category were mixed. CONCLUSION Current literature has suggested that question prompt lists are a low-risk intervention that could improve patient engagement and patient-doctor communication; however, there is limited evidence at present to conclusively promote their usage in perioperative surgical consultations.
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Affiliation(s)
- Ying Yang Ting
- Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, Australia
| | - Jesse D Ey
- Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, Australia
| | - Ellie C Treloar
- Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, Australia
| | - Jessica L Reid
- Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, Australia
| | - Emma L Bradshaw
- Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, Australia
| | - Guy J Maddern
- Discipline of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, Australia.
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Sleath B, Carpenter DM, Davis SA, Budenz DL, Muir KW, Romero MS, Lee C, Tudor G, Garcia N, Adjei AA, Robin AL. Acceptance of a Pre-visit Intervention to Engage African American Glaucoma Patients during Visits. Optom Vis Sci 2022; 99:838-843. [PMID: 36594752 DOI: 10.1097/opx.0000000000001959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
SIGNIFICANCE The glaucoma question prompt list/video intervention was well received by patients. Eighty-seven percent of patients recommended that other patients should watch the educational video before their visits, and 89% said that other patients should complete the question prompt list before visits. PURPOSE The objectives of this study were to (a) describe patient feedback on a glaucoma question prompt list/video intervention designed to motivate African American patients to be more engaged during visits and (b) examine patient demographics associated with acceptance of the intervention. METHODS We are conducting a randomized controlled trial of a glaucoma question prompt list/video intervention. African American patients with glaucoma were enrolled and assigned to a control group or an intervention group where they watched a video emphasizing the importance of asking questions and received a prompt list to complete before visits. All patients were interviewed after visits and are being followed up for 12 months. RESULTS One hundred eighty-nine African American patients with glaucoma were enrolled into the larger trial. Of the 93 patients randomized to the intervention group, 89% said that patients should complete the prompt lists before visits, and 87% recommended that patients should watch the video before visits. Older patients were significantly less likely to believe that other patients should watch the video before their visits (t = -3.7, P = .04). Patients with fewer years of education were significantly more likely to rate the video as being more useful than patients with more years of education (Pearson correlation, -0.27; P = .01). Patients who reported being less adherent on the visual analog scale were more likely to rate the video as being more useful (Pearson correlation, -0.23; P = .03). CONCLUSIONS This study demonstrates that the question prompt list/video was accepted by the majority of African American patients who received the intervention.
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Affiliation(s)
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Gail Tudor
- Health Professions, Southern New Hampshire University, Manchester, New Hampshire
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Abena A Adjei
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
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Tracy MC, Muscat DM, Shepherd HL, Trevena LJ. Doctors' Attitudes to Patient Question Asking, Patient-Generated Question Lists, and Question Prompt Lists: A Qualitative Study. Med Decis Making 2021; 42:283-292. [PMID: 34455860 DOI: 10.1177/0272989x211029579] [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: 11/17/2022]
Abstract
BACKGROUND Participation by patients in their own health care improves quality and safety. Question prompt lists (QPLs) can improve participation, particularly with doctors' endorsement. Few data have explored doctors' attitudes on these tools. We sought the experiences and attitudes of general practitioners and other specialists toward patient question asking and QPLs in their practice. METHODS In-depth, semistructured interviews and focus groups with purposively selected Australian doctors were conducted. Interview guides were used to explore doctors' experiences of patient question asking, patients' lists, and a sample QPL created using an Australian government-funded online tool, "Question Builder." Recordings were transcribed verbatim and data analyzed thematically using the method by Braun and Clarke. RESULTS Focus groups with 3 to 9 participants and a further 17 individual interviews were conducted. There was a total of 40 participants, 23 general practitioners and 17 other specialists (e.g., physicians, surgeons, pediatricians). Our analysis was summarized into several themes. 1) The doctors expected, encouraged, and had significant experience of patient question asking and patients' lists. They described many barriers for patients and their efforts to ensure patients had the information they needed. 2) The doctors felt responsible for creating an environment conducive to patient question asking, the delivery of answers, having strategies for unanswered questions, and balancing the agendas of both parties in the consultation. 3) Structured QPLs that prepared patients and facilitated the consultation agenda were viewed positively. The degree of time pressures participating doctors experienced in their context had a strong influence on how they responded to the sample QPL. CONCLUSION Doctors in this study expected patients to ask questions and endorsed the benefits of QPLs. However, there were more diverse views about the feasibility of implementing them in practice. Designing QPLs to fit within current workflows, via more succinct and tailored designs, may result in wider doctor acceptance and endorsement, hence maximizing the benefits of QPLs with improved patient participation and patient safety.
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Affiliation(s)
- Marguerite Clare Tracy
- ASK-GP Centre for Research Excellence, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Danielle Maree Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Heather L Shepherd
- Susan Wakil Sydney Nursing School, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW, Australia)
| | - Lyndal Jane Trevena
- ASK-GP Centre for Research Excellence, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Hawks C, Viswambaram P, Cloney C, Botha E, Brown M, Chambers S, Paterson C, Hayne D. Nurse-led telephone notification of a prostate cancer diagnosis: Prospective analysis of men's preferences for and experiences of a same-day assessment and diagnostic clinic. Eur J Cancer Care (Engl) 2021; 30:e13493. [PMID: 34309943 DOI: 10.1111/ecc.13493] [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: 01/15/2021] [Revised: 05/22/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The 'One Stop Prostate Clinic' (OSPC) was a same-day prostate cancer assessment and/or diagnostic clinic. Preferences and experiences of men who received initial telephone notification of their prostate biopsy results (cancer or benign) by the OSPC Clinical Nurse (CN) are reported. METHODS Prospective mixed methods study using survey instrument and thematic analysis of OSPC preferences and experiences. RESULTS One thousand men attended the OSPC between August 2011 and November 2017, 876 underwent prostate biopsies; 790/876 (90%) men consented to telephone notification of biopsy results, 5/876 (1%) declined and 79/876 (9%) were ineligible/not contacted. 220/403 men (55%) returned the OSPC questionnaire; 135/220 (61%) men received a cancer diagnosis, 119/132 (90%) would choose this method again and 7/132 (5.5%) would not and 6/132 (4.5%) were unsure; 94/135 (70%) reported no disadvantages with this notification method. Overall satisfaction rate with the OSPC was 96% (209/218) men. CONCLUSION Initial telephone notification of prostate biopsy results by the OSPC CN was preferred by the vast majority of eligible men. Many men with a cancer diagnosis did not experience any disadvantages. This method of results delivery can be incorporated by other tumour groups.
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Affiliation(s)
- Cynthia Hawks
- Medical School, Surgery, University of Western Australia, Perth, Western Australia, Australia.,Urology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Pravin Viswambaram
- Medical School, Surgery, University of Western Australia, Perth, Western Australia, Australia.,Urology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Claire Cloney
- Urology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Erica Botha
- Urology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Matthew Brown
- Urology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Suzanne Chambers
- Faculty of Health, University of Technology, Sydney, New South Wales, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Catherine Paterson
- Faculty of Health, Canberra University, Canberra, Australian Capital Territory, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
| | - Dickon Hayne
- Medical School, Surgery, University of Western Australia, Perth, Western Australia, Australia.,Urology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, New South Wales, Australia
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Richards R, Kinnersley P, Brain K, Wood F. Cancer Clinicians' Views Regarding an App That Helps Patients With Cancer Meet Their Information Needs: Qualitative Interview Study. JMIR Cancer 2021; 7:e23671. [PMID: 33955836 PMCID: PMC8138703 DOI: 10.2196/23671] [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: 09/17/2020] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many patients with cancer have unmet information needs during the course of the illness. Smart devices, such as smartphones and tablet computers, provide an opportunity to deliver information to patients remotely. We aim to develop an app intervention to help patients with cancer meet their illness-related information needs in noninpatient settings. In addition to the in-depth exploration of the issues faced by the target users of a potential intervention, it is important to gain an understanding of the context in which the intervention will be used and the potential influences on its adoption. As such, understanding the views of clinicians is key to the successful implementation of this type of app in practice. Additionally, clinicians have an awareness of their patients' needs and can provide further insight into the type of app and features that might be most beneficial. OBJECTIVE This study aims to explore cancer clinicians' views on this type of intervention and whether they would support the use of an app in cancer care. Specifically, the perceived acceptability of an app used in consultations, useful app features, the potential benefits and disadvantages of an app, and barriers to app use were explored. METHODS A total of 20 qualitative, semistructured interviews were conducted with 22 clinicians from urological, colorectal, breast, or gynecological cancer clinics across 2 hospitals in South Wales. The interviews were audio recorded, transcribed, and analyzed using thematic analysis. RESULTS Clinicians felt that it would be acceptable for patients to use such an app in noninpatient settings, including during consultations. The benefits of this type of app were anticipated to be a more informed patient, an increased sense of control for patients, better doctor-patient communication, and a more efficient and effective consultation. In contrast, an increase in clinicians' workload and poorer communication in consultations, which depended on the included app features, were identified as potential disadvantages. The anticipated barriers to app use included patients' age and prior experience with smart technology, their access to smart devices, the confidentiality of information, and an avoidant coping approach to their condition. CONCLUSIONS This study suggests that clinicians should support their patients in using an app to help them meet their information needs both at home and during consultations. This study highlights some of the potential barriers for this type of intervention in practice, which could be minimized during the intervention design process.
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Affiliation(s)
- Rebecca Richards
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Paul Kinnersley
- Centre for Medical Education, Cardiff University, Cardiff, United Kingdom
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Fiona Wood
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
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Kim GS, Shim MS, Choi JY, Lee JI, Kim JM. Testing a Question Prompt Intervention to Improve Communication between Patients with HIV and Healthcare Providers: A Pilot Study. J Community Health Nurs 2021; 37:153-163. [PMID: 32820975 DOI: 10.1080/07370016.2020.1780045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We tested the feasibility and acceptability of a question prompt intervention for patients recently diagnosed with HIV using a single group pretest-posttest design. Three healthcare providers (HCPs) and 18 patients, enrolled by convenience sampling, participated. Patients chose questions from a list of 14 items about patients' adherence and health problems; then, they were provided with information. Communication time with nurses and number of questions significantly decreased, while health-related quality of life increased. The most frequently asked questions concerned medication adherence, sexual relationships, and the meaning of test results. The intervention facilitated communication with HCPs among patients.
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Affiliation(s)
- Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University , Seoul, Republic of Korea
| | - Mi-So Shim
- Department of Nursing, Graduate School of Yonsei University , Seoul, Republic of Korea
| | - Jun Yong Choi
- Department of Internal Medicine, College of Medicine, Yonsei University , Seoul, Republic of Korea
| | - Jeong In Lee
- Division of Nursing/Infectious Disease, Yonsei University Health System , Seoul, Republic of Korea
| | - Ji Min Kim
- Division of Nursing/Infectious Disease, Yonsei University Health System , Seoul, Republic of Korea
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Chawak S, Chittem M, Maya S, Dhillon HM, Butow PN. The Question-prompt list (QPL): Why it is needed in the Indian oncology setting? Cancer Rep (Hoboken) 2021; 4:e1316. [PMID: 33295152 PMCID: PMC8451377 DOI: 10.1002/cnr2.1316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In India, caregivers are an integral part of the illness experience, especially in cancer, to the extent that they can become proxy decision-makers for the patient. Further, owing to acute resource constraints in the Indian healthcare system, it may be difficult for oncologists to assess and elicit questions from each patient/caregiver. Consequently, there is a need to address these unique aspects of oncology care in India to improve patient outcomes and understanding of their illness and treatment. This can be achieved through a Question Prompt List (QPL), a checklist used by care recipients during medical consultations. RECENT FINDINGS This narrative review will first introduce research on the development and effectiveness of the QPL, and then it will highlight current gaps in oncology care in India and explore how the QPL may aid in closing these gaps. A literature search of the empirical research focused on the development, feasibility and acceptability of the QPL in oncology settings was conducted. The final review included 40 articles pertaining to QPL research. Additionally, psycho-oncology research in India centered on information needs and experiences was reviewed. Current Indian psycho-oncology research reports patients' want to be actively involved in their cancer care and a need for more illness information. However, a high demand on physicians' resources and the family caregivers' interference can be barriers to meeting patients' information/communication needs. International research demonstrates that a QPL helps structure and decrease consultation time, improves patient satisfaction with care, and improves the quality of communication during medical encounters. CONCLUSION QPLs for Indian patients and caregivers may focus on the scope of medical consultations to address patient needs while influencing the course and content of the patient-caregiver-physician interactions. Further, it can address the resource constraints in Indian oncology care settings, thus reducing the physician's burden.
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Affiliation(s)
- Shweta Chawak
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Mahati Chittem
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Sravannthi Maya
- Department of Liberal ArtsIndian Institute of Technology HyderabadHyderabadIndia
| | - Haryana M. Dhillon
- Centre for Medical Psychology & Evidence‐based Decision‐making, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Phyllis N. Butow
- Centre for Medical Psychology & Evidence‐based Decision‐making, School of PsychologyThe University of SydneySydneyNew South WalesAustralia
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Evaluation of the "3 Good Questions" program for shared decision-making in pediatric medicine: a feasibility study. Eur J Pediatr 2021; 180:1235-1242. [PMID: 33169239 PMCID: PMC7940148 DOI: 10.1007/s00431-020-03868-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 01/25/2023]
Abstract
The "3 Good Questions" program was developed to increase shared decision making. The current pilot-study determined the feasibility of these questions to increase shared decision-making in Dutch pediatric medicine. Pre-/postintervention surveys were used to include children (10-18 years) at pediatric outpatient clinics of four hospitals in the Netherlands. After their appointment, two different groups of children completed the questionnaires. Group 1 filled in the survey before the intervention; group 2 completed the survey after active implementation of the "3 Good Questions" program. The primary outcome was to determine the feasibility (reach, applicability). Secondary outcomes were related to patient involvement in healthcare and treatment decisions and decision-making process between child and healthcare professional. In total, 168 and 114 children in groups 1 and 2 (61 vs 63% female, P = 0.68; age 13.3 ± 2.4 vs 13.8 ± 2.4 years, P = 0.72), respectively, completed the questionnaire. In group 2, 44% of children were aware of the "3 Good Questions", of whom 18% posed ≥ 1 of the "3 Good Questions" during their appointment (feasibility). The "3 Good Questions" program led to more shared decision-making (SDM-Q-9: P = < 0.001;95%CI: - 2.43 to - 1.17). The majority of children who have read or heard of the "3 Good Questions" would recommend this program to other children.Conclusion: Implementation of the "3 Good Questions" program seemed feasible, although it is necessary to further explore the implementation of this program at national level as a simple way for children and healthcare professionals to share decisions in practice. What is known • Children have the right to be included in decision-making, and inclusion can improve patient satisfaction and quality of care, and reduce costs. • The "3 Good Questions" program was successfully implemented in adult healthcare to increase shared decision making, and therefore these "3 Good Questions" have been adapted to a child version. What is new • In this pilot study, we found that the implementation of the "3 Good Questions" program to increase shared decision-making in pediatric medicine seemed feasible. Although it is necessary to further explore the implementation of the "3 Good Questions" program at national level as a simple way for children and healthcare professionals to share decisions in practice.
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16
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Idalski Carcone A, Ellis DA, Eggly S, MacDonell KE, Ghosh S, Buggs-Saxton C, Ondersma SJ. Improving Diabetes Management in Emerging Adulthood: An Intervention Development Study Using the Multiphase Optimization Strategy. JMIR Res Protoc 2020; 9:e20191. [PMID: 33079068 PMCID: PMC7609201 DOI: 10.2196/20191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022] Open
Abstract
Background Poor diabetes self-management in emerging adulthood (age 18-25 years) is associated with poorer diabetes health and diabetes complications. Emerging adults’ focus on individuation and independence underlies their poor diabetes outcomes, offering a lever for behavior change. Self-determination theory (SDT) suggests that interventions leveraging emerging adults’ innate developmental need for autonomy may offer a route to improving diabetes outcomes by increasing feelings of responsibility for and control over diabetes self-management activities. Objective This research project will use the multiphase optimization strategy to test the efficacy of three autonomy-supportive intervention components to elicit a clinically significant improvement in metabolic control, assessed by a 0.5% improvement in hemoglobin A1c (HbA1c), among older adolescents and emerging adults (16-25 years) with poorly controlled type 1 diabetes (T1D; HbA1c≥9.0%). Methods A question prompt list (QPL) is a tool to empower patients to assume a more active role during medical visits by asking questions and stating concerns. The motivation enhancement system (MES) is a brief counseling intervention that uses motivational interviewing communication strategies to build intrinsic motivation and self-efficacy for self-management. Text message reminders to complete diabetes care tasks may increase self-efficacy for diabetes self-management. After refining these intervention components for emerging adults, we will conduct a component selection experiment using an eight-arm full factorial design: 2 (QPL yes or no)×2 (MES yes or no)×2 (Text yes or no). Participants will complete 3 study visits: baseline, treatment end at 2 months, and a follow-up at 6 months. The primary outcome is metabolic control, which will be measured via HbA1c. Secondary outcomes include diabetes management and diabetes clinic attendance. SDT constructs of intrinsic motivation, self-efficacy, and the quality of the patient-provider relationship (ie, relatedness) are hypothesized mediators. Depression symptoms and emerging adults’ gender are hypothesized moderators. We will use the mixed-effects linear model for the analysis of variance of a factorial design to analyze continuous longitudinal experimental data; the generalized linear model will be used with categorical outcomes (eg, treatment attendance). The experiment was powered to detect the main effects of the intervention on the primary outcome. Results A total of 20 participants have enrolled and completed a qualitative interview after reviewing one or more intervention components. Analysis of interview data are underway, with a report of these results anticipated in the fall of 2020. The clinical trial will be launched in the fall 2020, with participants enrolled through May 2023 and data collection continuing through November 2023. Conclusions At the end of this experiment, we will have empirical evidence to support a large-scale, multisite effectiveness trial of an intervention package that has been optimized for older adolescents and emerging adults with poorly controlled T1D. Trial Registration ClinicalTrials.gov NCT04066959; https://clinicaltrials.gov/ct2/show/NCT04066959 International Registered Report Identifier (IRRID) DERR1-10.2196/20191
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Affiliation(s)
- April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Susan Eggly
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Wayne State University, Detroit, MI, United States
| | - Karen E MacDonell
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Samiran Ghosh
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Colleen Buggs-Saxton
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Steven J Ondersma
- Division of Public Health, Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, MI, United States
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17
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Jayasekera J, Vadaparampil ST, Eggly S, Street RL, Foster Moore T, Isaacs C, Han HS, Augusto B, Garcia J, Lopez K, O'Neill SC. Question Prompt List to Support Patient-Provider Communication in the Use of the 21-Gene Recurrence Test: Feasibility, Acceptability, and Outcomes. JCO Oncol Pract 2020; 16:e1085-e1097. [PMID: 32463763 PMCID: PMC7564130 DOI: 10.1200/jop.19.00661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The 21-gene recurrence score (RS) assay is used to guide breast cancer treatment decisions but can be poorly understood by patients. We examined the effects of a question prompt list (QPL) on knowledge, distress, and decisional conflict related to genomic testing and treatment in early-stage breast cancer. METHODS We describe the feasibility and acceptability of the QPL and the impact of the QPL on knowledge, distress, and decisional conflict before and after the receipt of the QPL (MEND 2, N = 65). We also compared distress and decisional conflict between women who received the QPL (MEND 2, N = 65) and a comparable group of women who did not receive the QPL who participated in an earlier observational study within the same clinics (MEND 1, N = 136). RESULTS MEND 2 participants indicated high acceptability and feasibility using the QPL. Knowledge increased post-QPL (P < .01) but did not decrease distress. Decisional conflict was lower among women in MEND 2 compared with those in MEND 1 (P < .01), with no statistically significant differences in distress. CONCLUSION The findings suggest that the QPL is feasible, acceptable, can improve knowledge and decrease decisional conflict in the large group of women deciding treatment while integrating RS test results.
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Affiliation(s)
| | | | | | | | | | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | | | | | | | - Katherine Lopez
- Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
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18
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Lindig A, Hahlweg P, Frerichs W, Topf C, Reemts M, Scholl I. Adaptation and qualitative evaluation of Ask 3 Questions - a simple and generic intervention to foster patient empowerment. Health Expect 2020; 23:1310-1325. [PMID: 32738027 PMCID: PMC7696208 DOI: 10.1111/hex.13114] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/19/2020] [Accepted: 07/12/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Patients are often not actively engaged in medical encounters. Short interventions like Ask 3 Questions (Ask3Q) can increase patient participation in decision-making. Up to now, Ask3Q was not available in German. OBJECTIVE To translate Ask3Q and evaluate its acceptability and feasibility. METHODS We translated and adapted several English versions of Ask3Q using a team translation protocol and cognitive interviews. Acceptability and feasibility of the final German Ask3Q version were assessed via focus groups and interviews with patients and healthcare professionals (HCPs). Data were analysed via qualitative content analysis. RESULTS Translation and adaptation were successful. Participants of focus groups and interviews perceived Ask3Q as a tool to empower patients to ask more questions. Moreover, it was seen as a guideline for physicians not to forget conveying important information. Several characteristics of patients, HCPs, the clinical setting and the intervention were identified as facilitators and barriers for an effective implementation of Ask3Q. CONCLUSION We provide the German version of Ask3Q. According to participants, implementation of Ask3Q in the German healthcare system is feasible. Future studies should evaluate if positive effects of Ask3Q can be replicated for patient participation and communication behaviour of HCPs in Germany.
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Affiliation(s)
- Anja Lindig
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Center of Health Care ResearchUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Pola Hahlweg
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Center of Health Care ResearchUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Wiebke Frerichs
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Center of Health Care ResearchUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Cheyenne Topf
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Martin Reemts
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Isabelle Scholl
- Department of Medical PsychologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Center of Health Care ResearchUniversity Medical Center Hamburg‐EppendorfHamburgGermany
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Filler T, Foster AM, Grace SL, Stewart DE, Straus SE, Gagliardi AR. Patient-Centered Care for Women: Delphi Consensus on Evidence-Derived Recommendations. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1012-1019. [PMID: 32828212 DOI: 10.1016/j.jval.2020.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/06/2020] [Accepted: 03/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patient-centered care (PCC) could reduce gender inequities in quality of care. Little is known about how to implement patient-centered care for women (PCCW). We aimed to generate consensus recommendations for achieving PCCW. METHODS We used a 2-round Delphi technique. Panelists included 21 women of varied age, ethnicity, education, and urban/rural residence; and 21 health professionals with PCC or women's health expertise. Panelists rated recommendations, derived from prior research and organized by a 6-domain PCC framework, on a 7-point Likert scale in an online survey. We used summary statistics to report response frequencies and defined consensus as when ≥85% panelists chose 5 to 7. RESULTS The response rate was 100%. In round 1, women and professionals retained 46 (97.9%) and 42 (89.4%) of 47 initial recommendations, respectively. The round 2 survey included 6 recommendations for women and 5 recommendations for professionals (did not achieve consensus in round 1 or were newly suggested). In round 2, women retained 2 of 6 recommendations and professionals retained 3 of 5 recommendations. Overall, 49 recommendations were generated. Both groups agreed on 44 (94.0%) recommendations (13 retained by 100% of both women and clinicians): fostering patient-physician relationship (n = 11), exchanging information (n = 10), responding to emotions (n = 4), managing uncertainty (n = 5), making decisions (n = 8), and enabling patient self-management (n = 6). CONCLUSION The recommendations represent the range of PCC domains, are based on evidence from primary research, and reflect high concordance between women and professional panelists. They can inform the development of policies, guidelines, programs, and performance measures that foster PCCW.
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Affiliation(s)
- Tali Filler
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | | | - Donna E Stewart
- Centre for Mental Health, University Health Network, Toronto, Canada
| | - Sharon E Straus
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
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Nyhof BB, Jameel B, Dunn S, Grace SL, Khanlou N, Stewart DE, Gagliardi AR. Identifying strategies to implement patient-centred care for women: Qualitative interviews with women. PATIENT EDUCATION AND COUNSELING 2020; 103:1422-1427. [PMID: 32063437 DOI: 10.1016/j.pec.2020.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/02/2020] [Accepted: 02/07/2020] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Patient-centred care (PCC) is one approach for mitigating gendered inequities in health care quality. Little is known about how to implement PCC for women (PCCW). This study explored women's views about PCCW implementation. METHODS Descriptive analysis of semi-structured qualitative telephone interviews with diverse women about PCC using an established 6-domain PCC framework. RESULTS Participants were 33 women who varied in health care experience, age, education and setting. Themes were consistent across these characteristics. Women said that clinicians often dismissed their healthcare concerns. We transformed desired PCC elements into strategies to implement PCCW, 27 at the point-of-care (i.e. assume a non-judgmental disposition, demonstrate active listening, elicit questions, acknowledge emotions, explore preferences for treatment, and offer self-care information) and 3 at the system level (education for women/girls and clinicians about PCCW, widespread access to women's-only services or women clinicians). CONCLUSION Many women experienced suboptimal PCC. By sharing their PCC experiences, women identified PCC elements of importance to them, and insight on actionable point-of-care and system-level strategies to implement PCCW. PRACTICE IMPLICATIONS This study revealed numerous ways that clinicians can foster PCCW, and insight on how healthcare managers and policy-makers can support PCCW implementation.
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Affiliation(s)
- Bryanna B Nyhof
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Bismah Jameel
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Sheila Dunn
- Women's College Hospital Research Institute, Women's College Hospital, Toronto, Canada
| | - Sherry L Grace
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada; Faculty of Health, York University, Toronto, Canada
| | | | - Donna E Stewart
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
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21
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Barton E, Moore TF, Hamel L, Penner L, Albrecht T, Eggly S. The influence of a question prompt list on patient-oncologist information exchange in an African-American population. PATIENT EDUCATION AND COUNSELING 2020; 103:505-513. [PMID: 31585820 PMCID: PMC7720840 DOI: 10.1016/j.pec.2019.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/15/2019] [Accepted: 09/18/2019] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Question Prompt Lists (QPL) increase patient active participation in oncology interactions, but questions remain regarding how QPLs influence patient-oncologist information exchange. We examined how a QPL influenced information exchange during oncology interactions with African-American patients. METHODS Data were self-reports and video recordings from a parent study testing the effects of a QPL in the outpatient clinics of two urban cancer hospitals. In this secondary analysis, we investigated which QPL questions patients identified as ones they wanted to ask their oncologists, how frequently patients/companions used patient active participation statements to seek information related to each QPL question, whether oncologists provided QPL-related information unprompted or prompted by patients/companions, and how frequently patients' QPL-related information needs were addressed or unaddressed. RESULTS The QPL influenced information exchange by increasing patients' and companions' (if present) prompting for QPL-related information from their oncologists. Patients/companions most often prompted for QPL-related information about side effects and patient experience. CONCLUSION This study builds on prior research on QPL interventions by expanding the object of study to information exchange and by analyzing patients' information needs. PRACTICE IMPLICATIONS This research demonstrates that a QPL supports patient/companion participation in oncology consultations by making information exchange more interactive.
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Affiliation(s)
- Ellen Barton
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA; Linguistics Program, Wayne State University, Detroit, MI, USA.
| | - Tanina Foster Moore
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
| | - Lauren Hamel
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
| | - Louis Penner
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
| | - Terrance Albrecht
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
| | - Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
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Ekberg S, Herbert A, Johns K, Tarrant G, Sansone H, Yates P, Danby S, Bradford NK. Finding a way with words: Delphi study to develop a discussion prompt list for paediatric palliative care. Palliat Med 2020; 34:291-299. [PMID: 31752593 DOI: 10.1177/0269216319888988] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Effective communication is a cornerstone of quality paediatric palliative care. Families report struggling, however, to know what to discuss, with whom, and when. Although question prompt lists exist for adult palliative care, they do not suit the unique circumstances of paediatric palliative care. AIM To develop a prompt list suitable for paediatric palliative care. DESIGN Underpinned by Delphi methodology, a six-phase procedure was adopted: (1) drafting items based on the findings of a literature review, (2) condensing the list of items based on group discussion, (3) refining items based on a survey of expert healthcare professionals, (4) additional refining of items based on another survey of professionals, (5) further refining of items based on cognitive interviews with family members, and (6) final review by healthcare professional and family member groups. PARTICIPANTS Three participant groups were involved during various phases: (1) members of an Australasian paediatric palliative care national reference group, (2) healthcare professionals associated with a local paediatric palliative care service, and (3) family members who were users of the same local service. RESULTS Through multi-phase consultation across participant groups, the draft question prompt list was refined progressively to 28 items, split across two booklets to allow end-of-life items to be provided separately, and reconceptualised as a discussion prompt list rather than a question prompt list. CONCLUSION By involving representatives of major stakeholder groups, this study has facilitated the design of a prompt list suited to the circumstances of paediatric palliative care. Future research should trial the effectiveness of this resource.
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Affiliation(s)
- Stuart Ekberg
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Centre for Children's Health Research, South Brisbane, QLD, Australia
| | - Anthony Herbert
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Centre for Children's Health Research, South Brisbane, QLD, Australia.,Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia.,School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kristi Johns
- Centre for Children's Health Research, South Brisbane, QLD, Australia.,Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
| | - Gabrielle Tarrant
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Holly Sansone
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Centre for Children's Health Research, South Brisbane, QLD, Australia
| | - Patsy Yates
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Centre for Children's Health Research, South Brisbane, QLD, Australia.,School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Susan Danby
- Centre for Children's Health Research, South Brisbane, QLD, Australia.,School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, QLD, Australia
| | - Natalie K Bradford
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Centre for Children's Health Research, South Brisbane, QLD, Australia.,School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
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Beyond Oncology: Question Prompt Lists in Healthcare-A Scoping Review Protocol. Methods Protoc 2020; 3:mps3010009. [PMID: 31963298 PMCID: PMC7189668 DOI: 10.3390/mps3010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 11/16/2022] Open
Abstract
Question prompt lists (QPL) are an instrument to promote patient participation in medical encounters by providing a set of questions patients can use during consultations. QPL have predominantly been examined in oncology. Less is known about their use in other contexts. Therefore, we plan to conduct a scoping review to provide an overview of the fields of healthcare in which QPL have been developed and evaluated. MEDLINE/PUBMED, PSYCINFO, PSYNDEX, WEB OF SCIENCE, and CINAHL will be systematically searched. Primary studies from different healthcare contexts that address the following participants/target groups will be included: persons with an acute, chronic, or recurring health condition other than cancer; healthy persons in non-oncological primary preventive measures. There will be no restrictions in terms of study design, sample size, or outcomes. However, only published studies will be included. Studies that were published in English and German between 1990 and 2019 will be examined. Two independent reviewers will apply defined inclusion/exclusion criteria and determine study eligibility in the review process guided by the PRISMA statement.
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Improving Communication in Outpatient Consultations in People With Cirrhosis: The Development of a Question Prompt List (QPL). J Clin Gastroenterol 2020; 54:898-904. [PMID: 32301836 PMCID: PMC7664949 DOI: 10.1097/mcg.0000000000001347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Liver health professionals have difficulty discussing liver cirrhosis and its prognosis with patients and families. Question Prompt Lists (QPLs), which are evidence-based lists of "recommended questions," may improve communication but need to be designed specifically for the target population. This study aimed to develop and pilot a QPL for patients with cirrhosis. METHODS A mixed-methods design in 3 phases. In phase 1 (item generation), potential questions for inclusion in the QPL were identified from 3 sources-a scoping literature review; an online survey; and interviews with patients, family members, and health professionals. In phase 2 (QPL construction), a multidisciplinary expert panel finalized the selection of questions and the format of the QPL. In phase 3 (pilot study), the QPL was assessed for acceptability and feasibility in a hepatology outpatient clinic population. RESULTS From 258 topics initially identified, 30 questions were included in the first draft of the QPL. After review by a multidisciplinary expert panel including patients, the QPL was reduced to 22 questions. In the pilot study, 133/215 eligible patients consented to participate, although only 67/133 used the QPL in their clinic appointment. Among those who used the QPL, all questions were asked at least once. The most commonly asked question related to life expectancy. Most participants expressed support for the content of the QPL. CONCLUSIONS A QPL, suitable for use in patients with liver cirrhosis attending hepatology outpatient clinics, has been developed and piloted. The QPL seems to be feasible to use and acceptable to patients and clinicians. Further work is needed to evaluate its effectiveness and to determine optimum delivery in clinical practice.
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25
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Yeganeh L, Khan NN, Boyle JA, Gibson-Helm M, Teede H, Vincent AJ. Development and evaluation of an early menopause question prompt list. ACTA ACUST UNITED AC 2020; 27:102-109. [DOI: 10.1097/gme.0000000000001429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Licqurish SM, Cook OY, Pattuwage LP, Saunders C, Jefford M, Koczwara B, Johnson CE, Emery JD. Tools to facilitate communication during physician-patient consultations in cancer care: An overview of systematic reviews. CA Cancer J Clin 2019; 69:497-520. [PMID: 31339560 DOI: 10.3322/caac.21573] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Tools have been developed to facilitate communication and support information exchange between people diagnosed with cancer and their physicians. Patient-reported outcome measures, question prompt lists, patient-held records, tape recordings of consultations, decision aids, and survivorship care plans have all been promoted as potential tools, and there is extensive literature exploring their impact on patient outcomes. Eleven systematic reviews of studies evaluating tools to facilitate patient-physician communication were reviewed and summarized in this overview of systematic reviews. Across the systematic reviews, 87 publications reported on 84 primary studies involving 15,381 participants. Routine use of patient-reported outcome measures and feedback of results to clinicians can improve pain management, physician-patient communication, and symptom detection and control; increase utilization of supportive care; and increase patient involvement in care. Question prompt lists can increase the number of questions asked by patients without increasing consultation length and may encourage them to reflect and plan questions before the consultation. There is limited benefit in audio recording consultations or using patient-held records during consultations. Physicians should be supported by adequately resourced health services to respond effectively to the range of clinical and broader patient needs identified through the routine use of tools to facilitate communication.
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Affiliation(s)
- Sharon M Licqurish
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Olivia Y Cook
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Loyal P Pattuwage
- National Stroke Foundation, Melbourne, Australia and Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia
| | - Christobel Saunders
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Bogda Koczwara
- Flinders Center for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - Claire E Johnson
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Supportive and Palliative Care, Eastern Health, Melbourne, Victoria, Australia
| | - Jon D Emery
- Center for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
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Lemmon ME, Huffstetler HE, Donohue P, Katz M, Barks MC, Schindler E, Brandon D, Boss RD, Ubel PA. Neurodevelopmental Risk: A Tool to Enhance Conversations With Families of Infants. J Child Neurol 2019; 34:653-659. [PMID: 31137987 PMCID: PMC7282194 DOI: 10.1177/0883073819844927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Parents of infants at risk of neurodevelopmental impairment require clear and individualized information about what to expect for their child, yet data suggest they have difficulty knowing how to ask for this information. Here, we pilot a Question Prompt List (QPL) with parents of infants at risk of neurodevelopmental impairment. To assess real-time use of the QPL, we recorded family meetings and collected data from parents and clinicians about the QPL experience. Qualitative data were analyzed using directed content analysis. Ten parents were enrolled. In family meetings, clinicians universally acknowledged the QPL and most used the QPL to guide meeting content. All parents who used the QPL found it useful and would recommend the tool to others. In interviews, parents described that the QPL offered novel questions and facilitated more prepared answers from the team. Future studies should test the impact of this QPL on parent understanding and communication quality.
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Affiliation(s)
- Monica E. Lemmon
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA,Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA,Margolis Center for Health Policy, Duke University, Durham, DC, USA
| | | | - Pamela Donohue
- Division of Neonatology, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Madelaine Katz
- Margolis Center for Health Policy, Duke University, Durham, DC, USA
| | - Mary C. Barks
- Margolis Center for Health Policy, Duke University, Durham, DC, USA
| | - Emma Schindler
- Margolis Center for Health Policy, Duke University, Durham, DC, USA
| | - Debra Brandon
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA,School of Nursing, Duke University, Durham, NC, USA
| | - Renee D. Boss
- Division of Neonatology, Department of Pediatrics, Johns Hopkins Hospital, Baltimore, MD, USA,Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Peter A. Ubel
- Fuqua School of Business, Sanford School of Public Policy, School of Medicine, Duke University, Durham, NC, USA
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Question prompts to empower cancer patients: results of a randomized controlled trial. Support Care Cancer 2019; 28:2571-2579. [DOI: 10.1007/s00520-019-05036-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/08/2019] [Indexed: 12/31/2022]
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Development and preliminary results on the feasibility of a renal diet specific question prompt sheet for use in nephrology clinics. BMC Nephrol 2019; 20:48. [PMID: 30755163 PMCID: PMC6373020 DOI: 10.1186/s12882-019-1231-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/25/2019] [Indexed: 01/05/2023] Open
Abstract
Background Adherence to the diet prescription for chronic kidney disease is suboptimal. Interventions to improve dietary adherence suggest that improving communication between the patient and the health professional is fundamental to improving outcomes. Providing patients with a question prompt sheet prior to the consultation has been demonstrated to be an effective method for improving communication between patient and health professional. In the absence of a renal diet specific version, the aims of this study were to develop and test the feasibility of a renal diet specific question prompt sheet for use in nephrology clinics. Methods Phase one utilized social listening methodology, online content analysis and clinic observations to obtain an extensive list of frequently asked questions about the renal diet. Following refinement with health professionals, the draft question prompt sheet was then sent in Phase two to patients one week prior to their scheduled consultation with the renal dietitian. Feedback was obtained from patients, carers and dietitians using semi structured interviews post clinic consultation. Quantitative data was analyzed using counts and proportions, while free text responses were analyzed thematically. Results A total of 769 unique renal diet related questions were reduced to an 18-item question prompt sheet. Feedback from thirteen patients (six males), six carers and six dietitians involved in the preliminary feasibility study was overwhelmingly positive. The majority of patients found the question prompt sheet to be easy to understand and agreed it facilitated communication with the dietitian. All participants agreed that they would recommend use of question prompt sheet to other patients. Suggestions for future use included health professional training in use of the sheet, particularly about how to help patients prioritize their most important questions. Conclusions The 18-item renal diet question prompt sheet developed in this preliminary study appears to be a feasible tool for use in nephrology consultations especially by dietitians. Further research quantifying the impact on question asking and patient centeredness should be undertaken. In addition, user testing with patients from culturally diverse and low literacy backgrounds would be useful. Electronic supplementary material The online version of this article (10.1186/s12882-019-1231-3) contains supplementary material, which is available to authorized users.
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Low JTS, Rohde G, Pittordou K, Candy B, Davis S, Marshall A, Stone P. Supportive and palliative care in people with cirrhosis: International systematic review of the perspective of patients, family members and health professionals. J Hepatol 2018; 69:1260-1273. [PMID: 30243996 DOI: 10.1016/j.jhep.2018.08.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/15/2018] [Accepted: 08/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS People with cirrhosis have unmet needs, which could benefit from a palliative care approach. Developing effective services needs to be based on evidence from those with personal experience. This review aims to explore; patient and family perspectives of perceived needs including communication; health professionals' perspectives on delivery of care and improving palliative care between specialities. METHODS A literature search was conducted in Medline, Embase and CINAHL using key words reporting on the perspectives of patients with liver cirrhosis (18 years and over), family members or health professionals on the provision of care in liver cirrhosis. Study quality was assessed using the Mixed Methods Appraisal Tool. Qualitative and quantitative findings were grouped together according to the main relevant themes identified. RESULTS Nineteen research studies predominantly from high-income Western countries were identified, with a total sample consisting of 1,413 patients, 31 family carers and 733 health professionals. Patients and family members had limited understanding of cirrhosis or its impact. They wanted better information about their disease, its treatment and help with psychological and practical needs. Health professionals had difficulty communicating about these issues to patients and their families. General practitioners left care predominantly to the liver clinicians, who lacked confidence to have discussions about prognosis or future care preferences. The role of palliative care was recognised as important in caring for this group through earlier integration with liver and community services. CONCLUSIONS Health professionals need support to improve their communication with patients, to address patients' broader needs beyond medical treatment and to develop new models to improve palliative care coordination between different medical specialities. Future research should focus on developing communication aides, testing existing tools to identify suitable patients for supportive care and exploring robust ways of evaluating supportive care interventions, with more studies needed from middle- and low-income countries. Registration number: PROSPERO CRD42017064770. LAY SUMMARY Patients and their families had a poor understanding of advanced liver disease and its impact on them. They need more information about the treatments they receive and how to get practical and psychological support. Liver specialists and GPs found it difficult to talk to patients and their families about the seriousness of advanced liver disease and the lack of healthcare options available to them if their condition gets worse. All doctors and nurses involved in the care of patients with advanced liver disease recognise that palliative and supportive care have an important role in improving patient care.
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Affiliation(s)
- Joseph T S Low
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, United Kingdom.
| | - Gudrun Rohde
- Faculty of Health and Sport Sciences, University of Agder and Department of Clinical Research, Sorlandet Hospital, Postboks 422, 4604 Kristiansand, Norway
| | - Katherine Pittordou
- Whittington Health NHS Trust, Magdala Avenue, London N19 5NF, United Kingdom
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, United Kingdom
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, United Kingdom
| | - Aileen Marshall
- Sheila Sherlock Liver Unit, Royal Free Hospital & University College London Institute of Liver and Digestive Health, UCL Royal Free Campus, Pond Street, London NW3 2QG, United Kingdom
| | - Paddy Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, United Kingdom
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Amundsen A, Bergvik S, Butow P, Tattersall MHN, Sørlie T, Nordøy T. Supporting doctor-patient communication: Providing a question prompt list and audio recording of the consultation as communication aids to outpatients in a cancer clinic. PATIENT EDUCATION AND COUNSELING 2018; 101:1594-1600. [PMID: 29703493 DOI: 10.1016/j.pec.2018.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/20/2018] [Accepted: 04/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To document the effect of a cancer specific question prompt list (QPL) on patients question asking and shared decision-making (SDM), and to evaluate the combined effect of the QPL and consultation audio recording (CAR) on patient outcomes. METHOD This exploratory study compared two groups of patients receiving either a QPL or combined QPL/CAR, to a control group. Measurements included number/types of questions asked, and physician SDM behavior (OPTION score). Questionnaire data included anxiety/depression and quality of life (QoL). RESULTS A total of 93 patients participated (31 Control, 30 QPL and 32 Combined). Patients in the intervention groups asked more questions concerning prognosis (p < .0001), the disease (p = .006) and quality of treatment (p < .001) than patients in the control group, but no impact was found on the OPTION score. An increase in mean consultation length was observed in the intervention groups compared to the control group (44 vs. 36 min; p = .028). Patients rated both interventions positively. CONCLUSION Provision of the QPL facilitates patients to ask a broader range of questions, but does not increase physician SDM behavior. PRACTICAL IMPLEMENTATION The combination of QPL and CAR seems feasible and should be tested in an implementation study following the disease trajectory.
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Affiliation(s)
- Anita Amundsen
- University Hospital of North Norway, Oncology Department, Tromsø, Norway.
| | - Svein Bergvik
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Martin H N Tattersall
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Tore Sørlie
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway; Department of Mental Health and Addictions, University Hospital of North Norway, Tromsø, Norway
| | - Tone Nordøy
- University Hospital of North Norway, Oncology Department, Tromsø, Norway; Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
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Development of a question prompt list for women with polycystic ovary syndrome. Fertil Steril 2018; 110:514-522. [DOI: 10.1016/j.fertnstert.2018.04.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/02/2018] [Accepted: 04/17/2018] [Indexed: 01/11/2023]
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Hyatt A, Lipson-Smith R, Gough K, Butow P, Jefford M, Hack TF, Hale S, Zucchi E, White S, Ozolins U, Schofield P. Culturally and linguistically diverse oncology patients' perspectives of consultation audio-recordings and question prompt lists. Psychooncology 2018; 27:2180-2188. [DOI: 10.1002/pon.4789] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Amelia Hyatt
- Cancer Experiences Research; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Ruby Lipson-Smith
- Cancer Experiences Research; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Karla Gough
- Cancer Experiences Research; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences; University of Melbourne; Parkville Australia
| | - Phyllis Butow
- Centre of Medical Psychology and Evidence-Based Decision-Making; University of Sydney; Sydney Australia
- Psycho-Oncology Cooperative Research Group; University of Sydney; Sydney Australia
| | - Michael Jefford
- Cancer Experiences Research; Peter MacCallum Cancer Centre; Melbourne Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Australia
| | - Thomas F. Hack
- College of Nursing, Rady Faculty of Health Sciences; University of Manitoba; Winnipeg Canada
- Research Institute in Haematology and Oncology at CancerCare Manitoba; Winnipeg Manitoba Canada
| | - Sandra Hale
- School of Humanities and Languages; University of New South Wales; Sydney Australia
| | - Emiliano Zucchi
- Transcultural & Language Services; Northern Health; Melbourne Australia
| | - Shane White
- Department of Medicine; Northern Health; Melbourne Australia
| | - Uldis Ozolins
- School of Humanities and Languages; University of New South Wales; Sydney Australia
| | - Penelope Schofield
- Cancer Experiences Research; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Psychological Sciences; Swinburne University of Technology; Melbourne Australia
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Rogers SN, Lowe D, Lowies C, Yeo ST, Allmark C, Mcavery D, Humphris GM, Flavel R, Semple C, Thomas SJ, Kanatas A. Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: a cluster preference randomized controlled trial. BMC Cancer 2018; 18:444. [PMID: 29669529 PMCID: PMC5907378 DOI: 10.1186/s12885-018-4355-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 04/09/2018] [Indexed: 01/27/2023] Open
Abstract
Background The consequences of treatment for Head and Neck cancer (HNC) patients has profound detrimental impacts such as impaired QOL, emotional distress, delayed recovery and frequent use of healthcare. The aim of this trial is to determine if the routine use of the Patients Concerns Inventory (PCI) package in review clinics during the first year following treatment can improve overall quality of life, reduce the social-emotional impact of cancer and reduce levels of distress. Furthermore, we aim to describe the economic costs and benefits of using the PCI. Methods This will be a cluster preference randomised control trial with consultants either ‘using’ or ‘not using’ the PCI package at clinic. It will involve two centres Leeds and Liverpool. 416 eligible patients from at least 10 consultant clusters are required to show a clinically meaningful difference in the primary outcome. The primary outcome is the percentage of participants with less than good overall quality of life at the final one-year clinic as measured by the University of Washington QOL questionnaire version 4 (UWQOLv4). Secondary outcomes at one-year are the mean social-emotional subscale (UWQOLv4) score, Distress Thermometer (DT) score ≥ 4, and key health economic measures (QALY-EQ-5D-5 L; CSRI). Discussion This trial will provide knowledge on the effectiveness of a consultation intervention package based around the PCI used at routine follow-up clinics following treatment of head and neck cancer with curative intent. If this intervention is (cost) effective for patients, the next step will be to promote wider use of this approach as standard care in clinical practice. Trial registration 32,382. Clinical Trials Identifier, NCT03086629. Protocol: Version 3.0, 1st July 2017.
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Affiliation(s)
- Simon N Rogers
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK. .,Edge Hill University, Liverpool and Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Road, L39 4QP, Ormskirk, St Helens, UK. .,Consultant Regional Maxillofacial Unit, University Hospital Aintree, L9 1AE, Liverpool, UK.
| | - Derek Lowe
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK.,Edge Hill University, Liverpool and Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Road, L39 4QP, Ormskirk, St Helens, UK
| | - Cher Lowies
- Head and Neck Clinical Trials, University Hospital Aintree, Clinical Sciences Building, Liverpool, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Healthcare Sciences, College of Health and Behavioural Sciences (CoHaBS), Bangor University, Ardudwy Building, Normal Site, Bangor, UK
| | - Christine Allmark
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Dominic Mcavery
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
| | - Gerald M Humphris
- School of Medicine, Medical & Biological Sciences, North Haugh, St Andrews, UK
| | | | - Cherith Semple
- Macmillan Health and Wellbeing Service, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, UK
| | - Steven J Thomas
- Oral and Maxillofacial Surgery Department, University, Bristol, Lower Maudlin Street, Bristol, UK
| | - Anastasios Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
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No question too small: development of a question prompt list for parents of critically ill infants. J Perinatol 2018; 38:386-391. [PMID: 29472708 DOI: 10.1038/s41372-017-0029-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/27/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To develop a question prompt list tailored to the needs of parents of critically ill infants at risk of neurodevelopmental impairment. STUDY DESIGN Question content was derived from audio-recorded neonatal intensive care unit family meetings and interviews with parents of infants treated with therapeutic hypothermia. Question content was refined using clinician focus groups. Acceptability testing was performed with parents and clinicians caring for infants in the neonatal intensive care unit. RESULTS All clinicians and parents found the QPL content acceptable. Parents universally endorsed that the question prompt list was useful to them and would help them prepare for a meeting with their infant's healthcare team. CONCLUSION This question prompt list, designed for parents of critically ill infants, is acceptable to parents and clinicians, and can be used in the acute neonatal course to facilitate parent engagement in family meetings.
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Stafford L, Sinclair M, Turner J, Newman L, Wakefield C, Krishnasamy M, Mann GB, Gilham L, Mason K, Rauch P, Cannell J, Schofield P. Study protocol for Enhancing Parenting In Cancer (EPIC): development and evaluation of a brief psycho-educational intervention to support parents with cancer who have young children. Pilot Feasibility Stud 2017; 3:72. [PMID: 29238608 PMCID: PMC5725968 DOI: 10.1186/s40814-017-0215-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/01/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Parents with cancer have high rates of psychological morbidity, and their children are at risk of poor psychosocial outcomes, particularly in the context of parental distress and poor family communication. Parents express concerns about the impact of cancer on their children and report a lack of professional guidance in meeting their children's needs. Few parenting interventions exist and current interventions have extensive infrastructure demands making them unsuitable for routine use in most health settings. The aims of this study are to develop and establish the feasibility and acceptability of a novel and accessible psycho-educational intervention to improve parenting efficacy and decrease parental stress among adults with cancer who have children aged 3-12 years. The intervention will be suitable for parents with cancer who are receiving treatment with a view to longer term survival, irrespective of cancer diagnosis, and their respective co-parents. METHODS/DESIGN This study comprises two phases using the UK Medical Research Council framework for developing complex interventions. In the development phase, intervention content will be iteratively developed and evaluated in consultation with consumers, and in the piloting phase, feasibility will be tested in a clinical sample of 20 parents with cancer and their co-parents using a single arm, pre-test post-test design. The intervention will comprise an audiovisual resource (DVD), a question prompt list, and a telephone call with a clinical psychologist. Questionnaires administered pre- and 1 month post-intervention will assess parental stress, psychological morbidity, quality of life, self-efficacy and perceptions of child adjustment, and family functioning. Intervention feasibility will be determined by mixed-method participant evaluation of perceived usefulness, benefits, and acceptability. DISCUSSION This new initiative will translate existing descriptive evidence into an accessible intervention that supports parenting during cancer treatment and meets the information needs of parents with cancer and their families. This is an important advance: despite increasing recognition of the impact of parental cancer on the family, intervention research lags behind the descriptive literature. This low-intensity, accessible, and targeted intervention places minimal burden on infrastructure and promotes patient autonomy and self-management. If feasible, this style of intervention may be a template for future interventions with similar populations.
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Affiliation(s)
- Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria Australia
| | - Michelle Sinclair
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria Australia
| | - Jane Turner
- Discipline of Psychiatry, University of Queensland, Herston, Queensland Australia
- Royal Brisbane and Women's Hospital, Brisbane, Queensland Australia
| | - Louise Newman
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria Australia
| | - Claire Wakefield
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales Australia
| | - Mei Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Victoria Australia
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Victoria Australia
| | - G Bruce Mann
- Breast Service, Victorian Comprehensive Cancer Centre, Parkville, Victoria Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria Australia
| | - Leslie Gilham
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria Australia
| | - Kylie Mason
- Parkville Integrated Haematology Service, Victorian Comprehensive Cancer Centre, Parkville, Victoria Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria Australia
| | - Paula Rauch
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Julia Cannell
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria Australia
| | - Penelope Schofield
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Parkville, Victoria Australia
- Department of Psychology, Swinburne University, Hawthorn, Victoria Australia
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Sleath B, Carpenter DM, Davis SA, Watson CH, Lee C, Loughlin CE, Garcia N, Etheridge D, Rivera-Duchesne L, Reuland DS, Batey K, Duchesne C, Tudor G. Acceptance of a pre-visit intervention to engage teens in pediatric asthma visits. PATIENT EDUCATION AND COUNSELING 2017; 100:2005-2011. [PMID: 28550963 PMCID: PMC5600669 DOI: 10.1016/j.pec.2017.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/21/2017] [Accepted: 05/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objectives of this study were to: (a) describe teen feedback on an asthma question prompt list/video intervention designed to motivate teens to be more engaged during visits and (b) examine teen demographics associated with teen acceptance of the intervention. METHODS Two hundred and fifty-nine teens ages 11 to 17 with persistent asthma were enrolled into a randomized, controlled trial and assigned to either a standard care or an intervention group where they watched an educational video with their parents and received a prompt list to complete before visits. Teens were interviewed after visits. RESULTS Of the 185 teens randomized to the intervention group: 93% said teens should complete the prompt lists before visits; 95% recommended teens should watch the video before visits; teens with moderate/severe persistent asthma were significantly more likely to find the prompt list useful; non-White teens were significantly more likely to find the prompt list and video more useful. CONCLUSIONS Teens exposed to the question prompt list/video had very positive feedback about the intervention. PRACTICE IMPLICATIONS Providers/practices should consider having teens complete question prompt lists during pre-visit wait time for use during visits and watch the video with their parents before visits.
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Affiliation(s)
- Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, CB # 7590, Chapel Hill, NC 27599-7590, USA.
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Claire Hayes Watson
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Charles Lee
- Polyglot Systems, Inc., 2000 Aerial Center Pkwy, Morrisville, NC 27560, USA.
| | - Ceila E Loughlin
- Department of Pediatric Pulmonology, School of Medicine University of North Carolina at Chapel Hill, CB 7217, Chapel Hill, NC 27599-7217, USA.
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, CB # 7590, Chapel Hill, NC 27599-7590, USA.
| | - Dana Etheridge
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Laura Rivera-Duchesne
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA.
| | - Daniel S Reuland
- University of North Carolina at Chapel Hill, School of Medicine, Division of General Internal Medicine and Clinical Epidemiology, USA
| | - Karolyne Batey
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA
| | - Cristina Duchesne
- Independent Contractor to Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7573, Chapel Hill, NC 27599-7573, USA
| | - Gail Tudor
- Department of Science and Mathematics, Director of Institutional Research, Husson University, Bangor, ME 04401-2929, USA.
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Belkora JK, Naguit M, Stupar L, Wiley J, Volz S, O'Donnell S. The Effects of Coaching Patients to List Questions Before Visiting Cancer Specialists: Retrospective Evaluation of Visit Preparation in a Rural, Underserved Setting. J Particip Med 2017; 9:e15. [PMID: 36262006 PMCID: PMC8108566 DOI: 10.2196/jopm.8949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 03/27/2017] [Accepted: 04/24/2017] [Indexed: 11/14/2022] Open
Abstract
Background A community-based organization implemented an evidence-based intervention to help rural cancer patients list questions before oncology visits. Objective Was the question-listing intervention effective in reducing anxiety and increasing decision self-efficacy? Methods The organization surveyed patients on decision self-efficacy (273 respondents, 99% response rate) and anxiety (190, 68%) before and after question-listing interventions delivered from 2006 – 2011. We analyzed responses using two-sided paired t-tests at 5% significance and conducted linear regression to identify significant predictors of change. We examined predictors related to the patient (location, demographics, disease status and baseline decision self-efficacy and anxiety); the intervention (including interventionist case volume); and the visit (including type of doctor seen). Results Question-listing was associated with higher mean decision self-efficacy (2.70/3.43 pre/post, 1-4 min-max, P<.001) and lower mean anxiety (7.26/5.87, 1-10 min-max, P<.001). Significant predictors of change in decision self-efficacy included: patient location; interventionist case volume; baseline decision self-efficacy and anxiety. Higher baseline anxiety was also associated with reductions in anxiety. Conclusions In a sustained community-based implementation, the intervention helped patients prepare for oncology visits. Patients reported higher self-efficacy and lower anxiety.
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Moloczij N, Krishnasamy M, Butow P, Hack TF, Stafford L, Jefford M, Schofield P. Barriers and facilitators to the implementation of audio-recordings and question prompt lists in cancer care consultations: A qualitative study. PATIENT EDUCATION AND COUNSELING 2017; 100:1083-1091. [PMID: 28117193 DOI: 10.1016/j.pec.2017.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/22/2016] [Accepted: 01/07/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Question prompt lists (QPLs) and consultation audio-recordings (CARs) are two communication strategies that can assist cancer patients in understanding and recalling information. We aimed to explore clinician and organisational barriers and facilitators to implementing QPLs and CARs into usual care. METHODS Semi-structured interviews with twenty clinicians and senior hospital administrators, recruited from four hospitals. Interviews were recorded, transcribed verbatim and thematic descriptive analysis was utilised. RESULTS CARs and QPLs are to some degree already being initiated by patients but not embedded in usual care. Systematic use should be driven by patient preference. Successful implementation will depend on minimal burden to clinical environments and feedback about patient use. CARs concerns included: medico-legal issues, ability of the CAR to be shared beyond the consultation, and recording and storage logistics within existing medical record systems. QPLs issues included: applicability of the QPLs, ensuring patients who might benefit from QPL's are able to access them, and limited use when there are other existing communication strategies. CONCLUSIONS While CARs and QPLs are beneficial for patients, there are important individual, system and medico-legal considerations regarding usual care. PRACTICE IMPLICATIONS Identifying and addressing practical implications of CARs and QPLs prior to clinical implementation is essential.
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Affiliation(s)
- Natasha Moloczij
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia; School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Mei Krishnasamy
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia; School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Phyllis Butow
- School of Psychology, University of Sydney, Sydney, Australia
| | - Thomas F Hack
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lesley Stafford
- Centre for Women's Mental Health, The Royal Women's Hospital, Melbourne, Australia
| | - Michael Jefford
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Penelope Schofield
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Psychology, Swinburne University of Technology, Melbourne, Australia
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Brandes K, van Weert JCM. Implementing consultation audio-recordings and question prompt lists into routine cancer care: How can we address healthcare providers' barriers? PATIENT EDUCATION AND COUNSELING 2017; 100:1029-1030. [PMID: 28455108 DOI: 10.1016/j.pec.2017.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Kim Brandes
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, 2052, Australia.
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, The Netherlands
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Ahmed R, McCaffery KJ, Silove N, Butow P, Clarke S, Kohn M, Aslani P. The evaluation of a question prompt list for attention-deficit/hyperactivity disorder in pediatric care: A pilot study. Res Social Adm Pharm 2017; 13:172-186. [DOI: 10.1016/j.sapharm.2016.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
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Naehrig DN, Koh ES, Vogiatzis M, Yanagisawa W, Kwong C, Shepherd HL, Milross C, Dhillon HM. Impact of cognitive function on communication in patients with primary or secondary brain tumours. J Neurooncol 2016; 126:299-307. [PMID: 26498590 DOI: 10.1007/s11060-015-1964-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 10/19/2015] [Indexed: 11/12/2022]
Abstract
Communication support tools (CST) improve patient outcomes in oncology including: knowledge, satisfaction, self-management, and adherence to planned treatment. Little is known about communication support tools use in patients with primary or secondary brain tumours. We aimed to explore cognitive function and communication support tool use in this population. This prospective survey involved patients, caregivers and health professionals. Questionnaires were completed after initial brain radiotherapy consultation and 1-2 weeks later. Patients completed the Montreal Cognitive Assessment (MoCA). Descriptive statistics are reported. Fifty-three patients participated, median age 62 years, ECOG status 0-2 (90 %), with 75 % having secondary brain metastasis. 21/53 (40 %) patients reported needing help reading medical information. Only 28 % patients had normal cognition (MoCA score ≥ 26/30). Initially, 82 % of patients and 87 % of caregivers reported the consultation was 'extremely/quite clear, and 69 % of their health professionals thought consultation 'extremely/quite clear' to patient. At follow-up, fewer patients (75 %) reported health professionals' explanation as 'extremely/quite clear'. Although patients recalled discussed illness and treatment details, 82 % recalled treatment-related side effects and management thereof by 46 %. CST use was reported by 22 % patients, 19 % caregivers, and 27 %health professionals. When used, tools improved understanding according to 92 % patients, 100 % caregivers, and 91 % health professionals. The majority of patients have some level of cognitive impairment. Information discussed appears clear to most patients, but this is not sustained, and recall of treatment toxicity management is poor. Few CSTs are used in consultations, but when used, are reported as helpful by all.
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Jacobs M, Henselmans I, Arts DL, Ten Koppel M, Gisbertz SS, Lagarde SM, van Berge Henegouwen MI, Sprangers MAG, de Haes HCJM, Smets EMA. Development and feasibility of a web-based question prompt sheet to support information provision of health-related quality of life topics after oesophageal cancer surgery. Eur J Cancer Care (Engl) 2016; 27. [PMID: 27734559 DOI: 10.1111/ecc.12593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
We developed a web-based question prompt sheet (QPS) to support information provision of health-related quality of life (HRQL) topics after oesophageal cancer surgery. The QPS was evaluated and updated in three consecutive studies. In Study 1, eight patients were guided in using the QPS. Feasibility was assessed by cognitive walkthrough, questionnaire and interview. We obtained 430 notes (217 negative, 213 positive) of patients' actions and or remarks, and 91 suggestions. With minor support, most patients were able to use the QPS. In Study 2, forty patients independently used and appraised a modified version of the QPS by questionnaire. All patients deemed the QPS to be usable and useful. In Study 3, 21 patients and three surgeons used the QPS in clinical practice. Clinical feasibility was assessed by the number of QPS sent to the researcher/surgeon. Patients and surgeons were surveyed and the follow-up consultation was audio-recorded. Surgeons were additionally interviewed. Twenty/fourteen patients sent their QPS to the researcher/surgeon. Five QPSs were read by the consultation surgeon. Patients considered the QPS usable and useful. Surgeons considered the QPS of added value and helpful in informing patients, but currently not clinically feasible due to increased consultation time.
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Affiliation(s)
- M Jacobs
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - I Henselmans
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - D L Arts
- Department of Clinical Informatics, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - M Ten Koppel
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - S M Lagarde
- Department of Surgery, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - M I van Berge Henegouwen
- Department of Surgery, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - M A G Sprangers
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - H C J M de Haes
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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Lin JJ, Chao J, Bickell NA, Wisnivesky JP. Patient-provider communication and hormonal therapy side effects in breast cancer survivors. Women Health 2016; 57:976-989. [PMID: 27618729 DOI: 10.1080/03630242.2016.1235071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Side effects from hormonal therapy (HT) for breast cancer treatment occur frequently and are associated with worse quality of life and HT non-adherence. Whether improved patient-physician communication is associated with patients' reporting of side effects is unknown. We undertook this study to assess factors associated with women's reports of HT side effects. Between December 2012 and April 2013, we conducted a cross-sectional survey of breast cancer patients undergoing HT in an urban medical center. Descriptive statistics, univariate analyses, and multivariate analyses were used to evaluate associations. Of the 100 participants, 67% reported having HT side effects. However, when prompted, an additional 9% reported experiencing specific HT-related symptoms. Despite very high communication scores, one-third of participants reported they had not discussed side effects with providers. Multivariate analysis showed that after controlling for age, education, race, and medication beliefs, women who had difficulty asking providers for more information were more likely to report side effects (odds ratio 8.27, 95% confidence interval 1.01-69.88). Although HT side effects often occur and are bothersome, patient-provider discussions about side effects remain suboptimal. Providers should actively ask patients about medication side effects so that they can be addressed to improve quality of life and potentially, medication adherence.
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Affiliation(s)
- Jenny J Lin
- a Division of General Internal Medicine, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Jennifer Chao
- a Division of General Internal Medicine, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Nina A Bickell
- a Division of General Internal Medicine, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA.,b Department of Population Health and Policy , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Juan P Wisnivesky
- a Division of General Internal Medicine, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
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Lipson-Smith R, Hyatt A, Butow P, Hack TF, Jefford M, Hale S, Hocking A, Sirianni M, Ozolins U, Yiu D, Schofield P. Are audio recordings the answer? - a pilot study of a communication intervention for non-English speaking patients with cancer. Psychooncology 2016; 25:1237-1240. [PMID: 27291636 DOI: 10.1002/pon.4193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Ruby Lipson-Smith
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Amelia Hyatt
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Phyllis Butow
- School of Psychology, University of Sydney, Sydney, Australia.,Centre of Medical Psychology and Evidence-Based Decision-Making, University of Sydney, Sydney, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, Australia
| | - Thomas F Hack
- College of Nursing, University of Manitoba, Winnipeg, Canada.,Canadian Breast Cancer Foundation, Prairies/NWT, Canada
| | - Michael Jefford
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Sandra Hale
- Humanities and Languages, University of New South Wales, Sydney, Australia
| | - Alison Hocking
- Social Work, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michela Sirianni
- Social Work, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Uldis Ozolins
- Humanities and Languages, University of New South Wales, Sydney, Australia
| | - Dorothy Yiu
- Chinese Cancer Society of Victoria, Melbourne, Australia
| | - Penelope Schofield
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia. .,Psychology, Swinburne University of Technology, Melbourne, Australia.
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46
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Miller N, Rogers SN. A review of question prompt lists used in the oncology setting with comparison to the Patient Concerns Inventory. Eur J Cancer Care (Engl) 2016; 27. [PMID: 26989045 DOI: 10.1111/ecc.12489] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 12/01/2022]
Abstract
A question prompt list (QPL) is a simple and inexpensive communication tool used to facilitate patient participation in medical consultations. The QPL is composed of a structured list of questions and has been shown to be an effective way of helping ensure patients' individual information needs are appropriately met. This intervention has been investigated in a variety of settings but not specifically head and neck cancer (HNC). The aim of this paper was to perform a narrative review of literature reporting the use of a QPL for oncology patients and to draw comparison to the Patient Concerns Inventory (PCI-HN). The databases Scopus, PubMed and MEDLINE were searched using the key terms 'question prompt list', 'question prompt sheet', 'cancer' and 'oncology'. Of 98 articles hand searched, 30 of which were found to meet all inclusion criteria, and described in a tabulated summary. The studies concluded that the QPL was an effective intervention, enabling active patient participation in medical consultations. The PCI-HN is specific for HNC and differs from many QPLs, which are more general cancer tools. The QPL approach should prove to be a useful intervention for HNC sufferers, however further research into the clinical utility is required.
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Affiliation(s)
- N Miller
- Liverpool University, Liverpool, UK
| | - S N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK.,University Hospital Aintree, Liverpool, UK
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Shepherd HL, Barratt A, Jones A, Bateson D, Carey K, Trevena LJ, McGeechan K, Del Mar CB, Butow PN, Epstein RM, Entwistle V, Weisberg E. Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) Patient-Clinician Communication Model(®) intervention in a primary health-care setting. Health Expect 2015; 19:1160-8. [PMID: 26364752 PMCID: PMC5152736 DOI: 10.1111/hex.12409] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2015] [Indexed: 12/03/2022] Open
Abstract
Objective To test the feasibility and assess the uptake and acceptability of implementing a consumer questions programme, AskShareKnow, to encourage consumers to use the questions ‘1. What are my options; 2. What are the possible benefits and harms of those options; 3. How likely are each of those benefits and harms to happen to me?’ These three questions have previously shown important effects in improving the quality of information provided during consultations and in facilitating patient involvement. Methods This single‐arm intervention study invited participants attending a reproductive and sexual health‐care clinic to view a 4‐min video‐clip in the waiting room. Participants completed three questionnaires: (T1) prior to viewing the intervention; (T2) immediately after their consultation; and (T3) two weeks later. Results A total of 121 (78%) participants viewed the video‐clip before their consultation. Eighty‐four (69%) participants asked one or more questions, and 35 (29%) participants asked all three questions. For those making a decision, 55 (87%) participants asked one or more questions, while 27 (43%) participants asked all three questions. Eighty‐seven (72%) participants recommended the questions. After two weeks, 47 (49%) of the participants recalled the questions. Conclusions Enabling patients to view a short video‐clip before an appointment to improve information and involvement in health‐care consultations is feasible and led to a high uptake of question asking in consultations. Practice Implications This AskShareKnow programme is a simple and feasible method of training patients to use a brief consumer‐targeted intervention that has previously shown important effects in improving the quality of information provided during consultations and in facilitating patient involvement and use of evidence‐based questions.
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Affiliation(s)
- Heather L Shepherd
- Centre for Medical Psychology and Evidence-based Decision-making, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Alexandra Barratt
- Centre for Medical Psychology and Evidence-based Decision-making, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Anna Jones
- Centre for Medical Psychology and Evidence-based Decision-making, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Deborah Bateson
- Family Planning NSW, Sydney, NSW, Australia.,Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, NSW, Australia
| | - Karen Carey
- Health Consumers Council, Perth, WA, Australia
| | - Lyndal J Trevena
- Centre for Medical Psychology and Evidence-based Decision-making, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kevin McGeechan
- Centre for Medical Psychology and Evidence-based Decision-making, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Chris B Del Mar
- Centre for Research in Evidence Based Practice, Bond University, Robina, QLD, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision-making, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Ronald M Epstein
- Center for Communication and Disparities Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Vikki Entwistle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Edith Weisberg
- Family Planning NSW, Sydney, NSW, Australia.,Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, NSW, Australia
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Sansoni JE, Grootemaat P, Duncan C. Question Prompt Lists in health consultations: A review. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)00258-X. [PMID: 26104993 DOI: 10.1016/j.pec.2015.05.015] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/14/2015] [Accepted: 05/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This review examines the use and effectiveness of Question Prompt Lists (QPL) as communication aids to enhance patient question asking, information provision to patients and patient participation in health and medical consultations. METHODS A systematic search was undertaken to identify relevant literature concerning QPLs including academic databases, Google-based and snowball searching. Forty-two relevant studies reporting 50 interventions were identified. RESULTS Although findings varied there was some evidence that a QPL endorsed by the physician increased total question asking. Using a QPL increased question asking concerning specific content areas (e.g. prognosis). There was some evidence that physicians provided more information during consultations. There were no consistent findings concerning effects on patient knowledge recall, anxiety and satisfaction or consultation time. Some interventions that increased question asking had longer consultation times. CONCLUSION There is evidence that an appropriate QPL, endorsed by the physician and provided immediately before the consultation, may increase patient question asking and lead to more information being provided by the physician. PRACTICE IMPLICATIONS There is increasing evidence to support QPL use in routine practice. Further trials might address the issues identified including an assessment of QPL optimal length and QPL adaptation for cultural and special needs groups.
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Affiliation(s)
- Janet E Sansoni
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia.
| | - Pam Grootemaat
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Cathy Duncan
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
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Mancini J, Butow PN, Julian-Reynier C, Dring R, Festy P, Fenaux P, Vey N. Question prompt list responds to information needs of myelodysplastic syndromes patients and caregivers. Leuk Res 2015; 39:599-605. [DOI: 10.1016/j.leukres.2015.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 11/16/2022]
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Belkora J, Volz S, Loth M, Teng A, Zarin-Pass M, Moore D, Esserman L. Coaching patients in the use of decision and communication aids: RE-AIM evaluation of a patient support program. BMC Health Serv Res 2015; 15:209. [PMID: 26017564 PMCID: PMC4446845 DOI: 10.1186/s12913-015-0872-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Decision aids educate patients about treatment options and outcomes. Communication aids include question lists, consultation summaries, and audio-recordings. In efficacy studies, decision aids increased patient knowledge, while communication aids increased patient question-asking and information recall. Starting in 2004, we trained successive cohorts of post-baccalaureate, pre-medical interns to coach patients in the use of decision and communication aids at our university-based breast cancer clinic. Methods From July 2005 through June 2012, we used the RE-AIM framework to measure Reach, Effectiveness, Adoption, Implementation and Maintenance of our interventions. Results Reach: Over the study period, our program sent a total of 5,153 decision aids and directly administered 2,004 communication aids. In the most recent program year (2012), out of 1,524 eligible patient appointments, we successfully contacted 1,212 (80 %); coached 1,110 (73 %) in the self-administered use of decision and communication aids; sent 958 (63 %) decision aids; and directly administered communication aids for 419 (27 %) patients. In a 2010 survey, coached patients reported self-administering one or more communication aids in 81 % of visits Effectiveness: In our pre-post comparisons, decision aids were associated with increased patient knowledge and decreased decisional conflict. Communication aids were associated with increased self-efficacy and number of questions; and with high ratings of patient preparedness and satisfaction Adoption: Among visitors sent decision aids, 82 % of survey respondents reviewed some or all; among those administered communication aids, 86 % reviewed one or more after the visit Implementation: Through continuous quality adaptations, we increased the proportion of available staff time used for patient support (i.e. exploitation of workforce capacity) from 29 % in 2005 to 84 % in 2012 Maintenance: The main barrier to sustainability was the cost of paid intern labor. We addressed this by testing a service learning model in which student interns work as program coaches in exchange for academic credit rather than salary. The feasibility test succeeded, and we are now expanding the use of unpaid interns.
Conclusion We have sustained a clinic-wide implementation of decision and communication aids through a novel staffing model that uses paid and unpaid student interns as coaches.
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Affiliation(s)
- Jeff Belkora
- Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333, California St, Suite 265, San Francisco, CA, 94118, USA.
| | - Shelley Volz
- Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333, California St, Suite 265, San Francisco, CA, 94118, USA.
| | - Meredith Loth
- Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333, California St, Suite 265, San Francisco, CA, 94118, USA.
| | - Alexandra Teng
- Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333, California St, Suite 265, San Francisco, CA, 94118, USA.
| | - Margot Zarin-Pass
- Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333, California St, Suite 265, San Francisco, CA, 94118, USA.
| | - Dan Moore
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA, 94115, USA.
| | - Laura Esserman
- Carol Franc Buck Breast Care Center, University of California, San Francisco, 1600 Divisadero Street, 2nd Floor, San Francisco, CA, 94115, USA.
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