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Oosterhaven J, Pell CD, Schröder CD, Popma H, Spierenburg L, Devillé WL, Wittink H. Health literacy and pain neuroscience education in an interdisciplinary pain management programme: a qualitative study of patient perspectives. Pain Rep 2023; 8:e1093. [PMID: 37868618 PMCID: PMC10586826 DOI: 10.1097/pr9.0000000000001093] [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: 01/18/2023] [Revised: 05/17/2023] [Accepted: 06/10/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Pain neuroscience education is part of interdisciplinary pain management programs (IPMPs). To date, the role of health literacy on patients' understanding of pain neuroscience education has not sufficiently been examined. Objectives Drawing on interviews with patients with diverse levels of health literacy, this article explores patient perspectives on pain neuroscience education. Methods Purposively sampled patients from an IPMP were interviewed twice (waiting list and after 4 weeks). A directed qualitative content analysis was performed with the Integrated Conceptual Model of Health Literacy as an analytic framework. Results Thirteen patients with chronic musculoskeletal pain were interviewed: 4 men and 9 women aged from 21 to 77 years with diverse educational and mostly low health literacy. One participant dropped out after baseline. Some participants gained access to health information actively; others relied on the expertise of their healthcare providers. Most participants did not seem to receive the information in the pain neuroscience education as intended, experienced difficulties with understanding the message, negatively appraised the information, and were not able to apply this in their daily lives. Health literacy levels likely played a role in this. Conclusions Pain neuroscience education tailored to patients' health literacy levels, information needs, and learning strategies is needed.
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Affiliation(s)
- Janke Oosterhaven
- Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Utrecht, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
| | - Christopher D. Pell
- Department of Global Health, Academic Medical Centre, Amsterdam Institute for Global Health and Development (AIGHD), University of Amsterdam, Amsterdam, the Netherlands
| | - Carin D. Schröder
- Ecare4you, Amersfoort, the Netherlands
- Center of Excellence for Rehabilitation Medicine Utrecht, UMC Utrecht Brain Center, University Medical Center Utrecht, and de Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Hans Popma
- Rehabilitation Centre Heliomare, Wijk aan Zee, the Netherlands
| | - Loes Spierenburg
- Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Walter L.J.M. Devillé
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands
| | - Harriet Wittink
- Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Utrecht, The Netherlands
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Duan E, Garry K, Horwitz LI, Weerahandi H. "I Am Not the Same as I Was Before": A Qualitative Analysis of COVID-19 Survivors. Int J Behav Med 2023; 30:663-672. [PMID: 36227557 PMCID: PMC9559269 DOI: 10.1007/s12529-022-10129-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the illness experience of patients' long-term emotional and physical recovery from severe COVID-19 infection. This study aimed to expand upon the recovery process of COVID-19 survivors up to 6 months after hospital discharge. METHODS Qualitative analysis of free-response answers from a cohort study of 152 patients ≥ 18 years hospitalized with laboratory-confirmed SARS-CoV-2 surveyed at 1-month post hospital discharge and 6-months post hospital discharge. Responses were analyzed with a grounded theory approach to identify overarching themes. RESULTS Participants described persistent complications, both physical and mental, that have affected their recovery from COVID-19. Five overarching themes of post-acute patient experiences were generated: (1) an increased awareness of a mind and body connection, (2) feelings of premature aging, (3) an overall decline in quality of life, (4) a continued fear of infection, and (5) methods of coping. CONCLUSIONS Patients described lasting changes to their mental health and overall quality of life in connection to physical complications after severe COVID-19 infection. Patients' reports of their experience call for a greater awareness of the psychological aspects of COVID-19 recovery to provide both physical and psychological rehabilitation services. Additional resources such as education around re-infection and financial resources are needed.
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Affiliation(s)
- Emily Duan
- NYU Grossman School of Medicine, New York, NY, USA
| | - Kira Garry
- University Park Program, Pennsylvania State College of Medicine, State College, Hershey, PA, USA
| | - Leora I Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, 227 East 30th St., NY, 10016, New York, USA
| | - Himali Weerahandi
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA.
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, 227 East 30th St., NY, 10016, New York, USA.
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Gould DJ, Dowsey MM, Glanville-Hearst M, Spelman T, Bailey JA, Choong PFM, Bunzli S. Patients' Views on AI for Risk Prediction in Shared Decision-Making for Knee Replacement Surgery: Qualitative Interview Study. J Med Internet Res 2023; 25:e43632. [PMID: 37721797 PMCID: PMC10546266 DOI: 10.2196/43632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/04/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND The use of artificial intelligence (AI) in decision-making around knee replacement surgery is increasing, and this technology holds promise to improve the prediction of patient outcomes. Ambiguity surrounds the definition of AI, and there are mixed views on its application in clinical settings. OBJECTIVE In this study, we aimed to explore the understanding and attitudes of patients who underwent knee replacement surgery regarding AI in the context of risk prediction for shared clinical decision-making. METHODS This qualitative study involved patients who underwent knee replacement surgery at a tertiary referral center for joint replacement surgery. The participants were selected based on their age and sex. Semistructured interviews explored the participants' understanding of AI and their opinions on its use in shared clinical decision-making. Data collection and reflexive thematic analyses were conducted concurrently. Recruitment continued until thematic saturation was achieved. RESULTS Thematic saturation was achieved with 19 interviews and confirmed with 1 additional interview, resulting in 20 participants being interviewed (female participants: n=11, 55%; male participants: n=9, 45%; median age: 66 years). A total of 11 (55%) participants had a substantial postoperative complication. Three themes captured the participants' understanding of AI and their perceptions of its use in shared clinical decision-making. The theme Expectations captured the participants' views of themselves as individuals with the right to self-determination as they sought therapeutic solutions tailored to their circumstances, needs, and desires, including whether to use AI at all. The theme Empowerment highlighted the potential of AI to enable patients to develop realistic expectations and equip them with personalized risk information to discuss in shared decision-making conversations with the surgeon. The theme Partnership captured the importance of symbiosis between AI and clinicians because AI has varied levels of interpretability and understanding of human emotions and empathy. CONCLUSIONS Patients who underwent knee replacement surgery in this study had varied levels of familiarity with AI and diverse conceptualizations of its definitions and capabilities. Educating patients about AI through nontechnical explanations and illustrative scenarios could help inform their decision to use it for risk prediction in the shared decision-making process with their surgeon. These findings could be used in the process of developing a questionnaire to ascertain the views of patients undergoing knee replacement surgery on the acceptability of AI in shared clinical decision-making. Future work could investigate the accuracy of this patient group's understanding of AI, beyond their familiarity with it, and how this influences their acceptance of its use. Surgeons may play a key role in finding a place for AI in the clinical setting as the uptake of this technology in health care continues to grow.
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Affiliation(s)
- Daniel J Gould
- St Vincent's Hospital, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Michelle M Dowsey
- St Vincent's Hospital, Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Australia
| | | | - Tim Spelman
- St Vincent's Hospital, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - James A Bailey
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Peter F M Choong
- St Vincent's Hospital, Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
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Montpetit-Tourangeau K, Diaz-Arenales AS, Dyer JO, Rochette A. The Black Box of Patient Education: An Expert Consultation on Patient Education Interventions and Strategies for the Management of Subacromial Pain Syndrome. Physiother Can 2023; 75:215-232. [PMID: 37736407 PMCID: PMC10510546 DOI: 10.3138/ptc-2022-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/25/2023] [Indexed: 09/23/2023]
Abstract
Purpose To identify patient education, interventions, and strategies to optimize the management of subacromial pain syndrome (SAPS) in physical therapy, based on the experiential knowledge of patient-partners and caregivers involved in the rehabilitation of this condition. Method Using a semi-deductive approach building on the evidence extracted from the literature, an expert consultation using focus groups was conducted. The experts were physical therapists (n = 5) and an occupational therapist with extensive clinical experience, as well as a patient-partner. Analysis followed the Framework method. Results Two main themes emerged: (1) interventions directly related to patient education, consisting of nine sub-themes, including symptom self-management and pain phenomenon, and (2) patient education strategies to broadly frame the interventions, consisting of 10 sub-themes, including educational materials and clinical teaching approaches. Conclusion The consultation confirmed and expanded the knowledge from the literature by adding knowledge that emerged from the experts' practical experience. It resulted in the development of preliminary statements on structured patient education interventions and management strategies for SAPS. These emerging statements are, to our knowledge, the first to inform patient education specifically as it relates to the management of SAPS taking into account psychosocial and contextual factors.
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Affiliation(s)
- Katherine Montpetit-Tourangeau
- From the:
School of Rehabilitation, University of Montreal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada
| | | | - Joseph-Omer Dyer
- From the:
School of Rehabilitation, University of Montreal, Montreal, Canada
- Interdisciplinary Research Group in Cognition and Professional Reasoning, Center for Applied Pedagogy in Health Sciences, University of Montreal, Montreal, Canada
| | - Annie Rochette
- From the:
School of Rehabilitation, University of Montreal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada
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Rizzo RRN, Wand BM, Leake HB, O'Hagan ET, Bagg MK, Bunzli S, Traeger AC, Gustin SM, Moseley GL, Sharma S, Cashin AG, McAuley JH. "My Back is Fit for Movement": A Qualitative Study Alongside a Randomized Controlled Trial for Chronic Low Back Pain. THE JOURNAL OF PAIN 2023; 24:824-839. [PMID: 36577460 DOI: 10.1016/j.jpain.2022.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
A new wave of treatments has emerged to target nervous system alterations and maladaptive conceptualizations about pain for chronic low back pain. The acceptability of these treatments is still uncertain. We conducted a qualitative study alongside a randomized controlled trial to identify perceptions of facilitators or barriers to participation in a non-pharmacological intervention that resulted in clinically meaningful reductions across 12 months for disability compared to a sham intervention. We conducted semi-structured interviews with participants from the trial's active arm after they completed the 12-week program. We included a purposeful sample (baseline and clinical characteristics) (n = 20). We used reflexive thematic analysis informed by the Theoretical Framework of Acceptability for health care interventions. We identified positive and negative emotional/cognitive responses associated with treatment acceptability and potential efficacy, including emotional support, cognitive empowerment, readiness for self-management, and acceptance of face-to-face and online components designed to target the brain. These findings suggest the importance of psychoeducation and behavior change techniques to create a positive attitude towards movement and increase the perception of pain control; systematic approaches to monitor and target misconceptions about the interventions during treatment; and psychoeducation and behavior change techniques to maintain the improvements after the cessation of formal care. PERSPECTIVE: This article presents the experiences of people with chronic low back pain participating in a new non-pharmacological brain-targeted treatment that includes face-to-face and self-directed approaches. The facilitators and barriers of the interventions could potentially inform adaptations and optimization of treatments designed to target the brain to treat chronic low back pain.
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Affiliation(s)
- Rodrigo R N Rizzo
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia.
| | - Benedict M Wand
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Hayley B Leake
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Edel T O'Hagan
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia. Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Adrian C Traeger
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia; NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
| | - James H McAuley
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia; Centre for Pain IMPACT (Investigating Mechanisms of Pain to Advance Clinical Translation), Neuroscience Research Australia, Sydney, Australia
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Hinton L, Dumelow C, Hodgkinson J, Montgomery C, Martin A, Allen C, Tucker K, Green ME, Wilson H, McManus RJ, Chappell LC, Band R. 'Nesting networks': Women's experiences of social network support in high-risk pregnancy. Midwifery 2023; 120:103622. [PMID: 36893551 DOI: 10.1016/j.midw.2023.103622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Social support, an individual's social relationships (both online and offline), may provide protection against adverse mental health outcomes, such as anxiety and depression, which are high in women who have been hospitalised with high-risk pregnancy. This study explored the social support available to women at higher risk of preeclampsia during pregnancy by examining personal social networks. DESIGN Semi-structured interviews were accompanied by social network mapping using the web-based social networking tool GENIE. SETTING England. PARTICIPANTS Twenty-one women were recruited, of whom 18 were interviewed both during pregnancy and postnatally between April 2019 and April 2020. Nineteen women completed maps pre-natally, 17 women completed maps pre-natally and post-natally. Women were taking part in the BUMP study, a randomised clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. RESULTS Women's social networks tightened during pregnancy. The inner network changed most dramatically postnatally with women reporting fewer network members. Interviews revealed networks were primarily 'real-life' rather than online social networks, with members providing emotional, informational, and practical support. Women with a high-risk pregnancy valued the relationships they developed with health professionals during pregnancy, and would like their midwife to have a more central role in their networks by providing informational and, where needed, emotional support. The social network mapping data supported the qualitative accounts of changing networks across high-risk pregnancy. CONCLUSION Women with a high-risk pregnancy seek to build "nesting networks" to support them through pregnancy into motherhood. Different types of support are sought from trusted sources. Midwives can play a key role. PRACTICE IMPLICATIONS As well as highlighting other potential needs during pregnancy and the ways in which they can be met, support from midwives has a key role. Through talking to women early in their pregnancy, signposting information and explaining ways to contact health professionals regarding informational or emotional support would fill a gap that currently is met by other aspects of their network.
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Affiliation(s)
- L Hinton
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge.
| | - C Dumelow
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - J Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - C Montgomery
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - A Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - C Allen
- School of Health Sciences, University of Southampton, Southampton, UK. SO17 1BJ
| | - K Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - H Wilson
- Department of Women and Children's Health, King's College London, London
| | - R J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - L C Chappell
- Department of Women and Children's Health, King's College London, London
| | - R Band
- School of Health Sciences, University of Southampton, Southampton, UK. SO17 1BJ
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Burkinshaw K, Tsourtos G, Cations M. System and policy-level barriers and facilitators for timely and accurate diagnosis of young onset dementia. Int J Geriatr Psychiatry 2023; 38:e5859. [PMID: 36484460 DOI: 10.1002/gps.5859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The multiyear diagnostic journey for young onset dementia (YOD) is fraught with clinical and personal difficulties and poses significant uncertainty for people living with YOD and their families. Most existing research has examined the personal and/or clinical barriers to a timely diagnosis of YOD, but less evidence exists regarding system level factors. The aim of this study is to investigate health professionals' insights for a timely and accurate YOD diagnosis at the system level. DESIGN Grounded theory qualitative study. SETTING AND PARTICIPANTS Semi-structured in-depth interviews with 11 health professionals working across varied healthcare settings were conducted online via videoconference. MEASUREMENTS Data were contrasted and compared within and between transcripts using the constant comparative method. RESULTS Seven themes emerged about barriers and facilitators for timely and accurate diagnosis of YOD: (1) stigma and awareness of YOD; (2) mismatched policy; (3) fractured health system; (4) inadequate pathways for YOD diagnostic care; (5) effective use of General Practitioners; (6) inequitable access and fragmented service navigation; (7) diverse and marginalised groups. CONCLUSION A complex web of systemic and system level barriers contributes to the delay of accurate and timely diagnosis for YOD. Diverse and marginalised groups experience greater inequitable disadvantage regarding YOD diagnostic care. There is an urgent need to focus on YOD diagnosis facilitators at the broader health system level.
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Affiliation(s)
- Kirsty Burkinshaw
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - George Tsourtos
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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Allen J. Exploring Adult Patients’ Perceptions and Experiences of Telemedicine Consultations in Primary Care: A Qualitative Systematic Review. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2022. [DOI: 10.5195/ijms.2022.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic transformed a gradual uptake of telemedicine, into a sudden worldwide implementation of telemedicine consultations. Primary care is a particular area affected and one where telemedicine consultations are expected to be the future. However, for effective long-term implementation it is vital that patient perceptions and experiences are understood. The aim of this qualitative systematic review was to explore the perceptions and experiences of adults who have used telemedicine consultations in primary care. Studies were identified through a search of four electronic databases (MEDLINE, EMBASE, CINAHL, and CENTRAL) alongside reference list and citation searches. Quality assessment was conducted using the CASP checklist and data was synthesized using a simplified approach to thematic analysis. From 2492 identified records, ten studies met the eligibility criteria all of which were judged as either good or moderate quality. Three themes were identified which were potential benefits, potential barriers, and beneficial prerequisites for telemedicine consultations in primary care. Within these themes, sixteen sub-themes were identified with examples including accessibility and convenience for potential benefits, lack of face-to-face interaction and impersonal consultations for potential barriers, and continuity of care for beneficial prerequisites. Analysing these subthemes, four main recommendations for practice can be made which are to utilise continuity of care, offer both video and telephone consultations, provide adequate support, and that healthcare professionals should demonstrate an explicit understanding of the patient’s health issues. Further research is needed to explore and expand on this topic area and future research should be viewed as a continuous process.
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Andersen ER, Hofmann BM, Kjelle E. Reducing low-value radiological services in Norway -a qualitative multi-professional study on measures and facilitators for change. BMC Health Serv Res 2022; 22:678. [PMID: 35596215 PMCID: PMC9122550 DOI: 10.1186/s12913-022-08077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/11/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Overuse, underuse, and significant variation in the utilisation of radiological services are well documented in the literature. Several radiological examinations are identified as low-value examinations as they do not lead to a change in diagnosis or course of treatment. Even so, such examinations are frequently performed. Many measures for reducing low-value imaging have been carried out with variable outcomes. While there is little evidence as to why some measures work and others do not, adjusting to the context seems important for success. The objective of this study was to investigate which measures stakeholders consider appropriate for reducing the use of low-value imaging and what it takes to make them work. METHODS Semi-structured interviews were conducted among radiographers, radiologists, radiological department managers, hospital clinicians, general practitioners, and health government/authorities' representatives. The interview guide covered two broad areas: Experience with low-value services, and possible future measures deemed appropriate for reducing low-value services. Data were analysed in line with a qualitative framework analysis. RESULTS The analysis included information from 27 participants. All participants acknowledged that low-value imaging was a problem, but few had very specific suggestions on reducing this in practice. Suggested measures were to stop referrals from being sent, provide support in assessing referrals, or change the healthcare system. Identified facilitators were categorised as management and resources, evidence, and experienced value. In general, appropriate measures should be practical, well-founded, and valuable. CONCLUSIONS This study provides insight into various stakeholders' perceptions of suitable interventions to reduce low-value imaging. While many measures for reducing low-value imaging are available, contextual sensitivity is crucial to make them work.
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Affiliation(s)
- Eivind Richter Andersen
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 1, N-2802, Gjøvik, Norway.
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 1, N-2802, Gjøvik, Norway.,Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Elin Kjelle
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 1, N-2802, Gjøvik, Norway
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Marchand C, Communier A, Maurice A, Njantou P, Vilder C, Figiel S, Malcher MF, de Andrade V, Thévenin L. [Not Available]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; 34:9-19. [PMID: 36102096 DOI: 10.3917/spub.221.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this study was to identify the health education needs of people suffering from several pathologies including HIV and/or hepatitis, living in vulnerable conditions in Therapeutic Coordination Apartments (known in French as Appartements de Coordination Thérapeutique under the acronym ACT). METHOD This article is based on a qualitative and collaborative study involving in research team people living in ACT, professionals of ACT and academics. Interview guides based on the literature were developed. Nine ACTs participated: there were interviews with 36 people with chronic conditions, 9 focus groups with staff members and 9 additional interviews with ACT managers. RESULTS Health education needs were identified. These involved: managing one's multiple conditions, managing certain diseases in particular, daily life with multiple chronic conditions, the connections and origins of the diseases. Factors influencing how they deal with one disease rather than another were expressed. The educational needs of people with HIV and/or hepatitis have been highlighted. CONCLUSION Health education needs still exist despite the care that people living in ACTs receive. The study makes it possible to put forward proposals for improving support and, more specifically, health education interventions implemented in ACTs: asking additional questions to identify health education needs more precisely, providing polypathology therapeutic patient education (TPE) training to the teams, involving the affected populations, taking into account health literacy levels.
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van Buren MC, Beck DK, Lely AT, van de Wetering J, Massey EK. EXPloring attitudes and factors influencing reproductive Choices in kidney Transplant patients (The EXPECT-study). Clin Transplant 2021; 35:e14473. [PMID: 34453355 PMCID: PMC9285546 DOI: 10.1111/ctr.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022]
Abstract
Pregnancy can have risks after kidney transplantation (KT). This mixed‐methods study aimed to identify the percentage of women getting pregnant after KT and explore motives for and against pregnancy together with psychosocial and medical factors involved in decision making. Furthermore, experiences of pregnancy and child‐raising were explored. Women who got pregnant after KT were matched with women who had not been pregnant after KT. Semi‐structured interviews were conducted, transcribed verbatim and analyzed using directed content analysis. After KT, only 12% of women got pregnant. Eight women with pregnancies after KT were included (P‐group) and matched with 12 women who had not been pregnant after KT (NP‐group). Women after KT experienced a high threshold to discuss their pregnancy wish with their nephrologist. The nephrologists’ advice played an important role in decision‐making, but differed between the groups. In the P‐group, a desire for autonomy and positive role models were decisive factors in proceeding with their pregnancy wish. In the NP‐group, disease burden and risk perception were decisive factors in not proceeding with their pregnancy. Nephrologists need to be proactive in broaching this subject and aware of factors influencing the decision and outcomes. Standardized preconception guidelines on pregnancy counseling are recommended.
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Affiliation(s)
- Marleen C van Buren
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, The Netherlands
| | - Denise K Beck
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, The Netherlands
| | - A Titia Lely
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jacqueline van de Wetering
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, The Netherlands
| | - Emma K Massey
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, The Netherlands
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Taylor F, Ogidi J, Chauhan R, Ladva Z, Brearley S, Drennan VM. Introducing physician associates to hospital patients: Development and feasibility testing of a patient experience-based intervention. Health Expect 2020; 24:77-86. [PMID: 33238078 PMCID: PMC7879547 DOI: 10.1111/hex.13149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/10/2020] [Accepted: 10/15/2020] [Indexed: 01/14/2023] Open
Abstract
Background Physician associates (PAs) are one of many new mid‐level health practitioner roles being introduced worldwide. They are a recent innovation in English hospitals. Patient confusion with novel mid‐level practitioner titles and roles is well documented, alongside evidence of a positive association between patients’ ability to identify practitioners and patient satisfaction. No prior research developed an intervention to introduce PAs or any other new practitioner role to hospital patients. Objective To develop, with patient and public involvement and engagement (PPIE), an intervention for introducing the PA role to hospital patients, and to test feasibility. Methods Intervention development was underpinned by an experience‐based co‐design approach. Workshop participants generated ideas for introducing PAs, subsequently explored in semi‐structured interviews with hospital patients (n = 13). Interview findings were used by participants in a second workshop to design the intervention. Feasibility of the intervention was assessed in relation to its acceptability and efficacy using semi‐structured interviews with hospital patients (n = 20) and PAs (n = 3). Results The intervention developed was a patient information leaflet. It was considered feasible to use in the hospital setting, helpful to patients in understanding the PA role and acceptable to both patients and PAs. The intervention was also appreciated by patients for providing reassurance of care and support. Conclusions An experience‐based co‐design approach enabled development of an intervention tailored to patients’ experiential preferences. Positive evidence of feasibility and utility is encouraging, supporting future larger‐scale testing. Patient and public contribution PPIE representatives were involved in the study design, intervention development and data interpretation.
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Affiliation(s)
- Francesca Taylor
- Joint Faculty of Kingston University and St George's University of London, St George's University of London, London, UK
| | - Jonathan Ogidi
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rakhee Chauhan
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Zeena Ladva
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sally Brearley
- Joint Faculty of Kingston University and St George's University of London, St George's University of London, London, UK
| | - Vari M Drennan
- Joint Faculty of Kingston University and St George's University of London, St George's University of London, London, UK
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Stephens JH, O’Keefe M, Schembri M, Baghurst PA. Parents Need More Support: A Qualitative Study of the Experiences of Australian Parents Who Are Waiting for Surgical Intervention for Their Children With Otitis Media. J Patient Exp 2020; 7:717-725. [PMID: 33294607 PMCID: PMC7705822 DOI: 10.1177/2374373519883495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the experiences, expectations, and motivations of parents/caregivers of children with otitis media who were booked to undergo tympanostomy tube insertion. METHOD A cross-sectional cohort study was conducted using semistructured interviews with 39 parents. Interviews were conducted via telephone and analyzed for key themes. RESULTS Three themes emerged that incorporated a range of subthemes: (1) the impact of the child's underlying condition on the family, (2) the cues and prompts that influenced parents to seek intervention, and (3) the parents' expectations of the health-care system. The child's otitis media disrupted the day-to-day functioning of the family and the child's well-being, but despite this, the families found ways to adapt and cope. Parents were influenced by their friends, family, and medical practitioners when making treatment decisions and had differing expectations of the health-care system. CONCLUSION Parents need support during their child's illness to help with pressures placed on the family and also in making health-care decisions for their child. Clinicians should consider these issues when discussing treatment options with parents.
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Affiliation(s)
- Jacqueline H Stephens
- Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maree O’Keefe
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Schembri
- Ear, Nose and Throat Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Peter A Baghurst
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Monteiro EP, Gomide HP, Remor E. Massive open online course for Brazilian healthcare providers working with substance use disorders: curriculum design. BMC MEDICAL EDUCATION 2020; 20:240. [PMID: 32727430 PMCID: PMC7391619 DOI: 10.1186/s12909-020-02162-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/21/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Interpersonal and technical skills are required for the care of people living with substance use disorders. Considering the applicability and usability of online courses as continuing professional education initiatives, this study aimed to describe the content design process of an introductory-level healthcare-centered Massive Open Online Course (MOOC). METHODS The content of the course was informed through needs assessment, by using three sources: (a) narrative literature review, (b) Delphi health experts panel consensus, and (c) focus groups conducted with people living with substance use disorders. The data from the empirical research phases were analyzed through qualitative Thematic Analysis. RESULTS The product of this research project is the introductory-level Massive Open Online Course "Healthcare: Developing Relational Skills for the Assistance of People Living with Substance Use Disorders" which approaches health communication and empathetic relational professional skills as a means of reducing stigmatization of people living with substance use disorders. CONCLUSIONS Diverse strategies for designing distance education initiatives have to consider different views on the subject being approached in such courses. The product presented in this paper has the potential to be an educational tool for topics traditionally not addressed in Brazilian continuing education and can be used as a model to the design of online courses directed to the development of work-related skills for the healthcare professions.
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Affiliation(s)
- Erika Pizziolo Monteiro
- Institute of Psychology, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2600, Porto Alegre, Rio Grande do Sul, 90035-003, Brazil
| | - Henrique Pinto Gomide
- Department of Education, Universidade Federal de Viçosa (UFV), Av. Purdue s/n, Viçosa, 36570-000, Minas Gerais, Brazil
| | - Eduardo Remor
- Institute of Psychology, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2600, Porto Alegre, Rio Grande do Sul, 90035-003, Brazil.
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Nonterah CW, Gardiner HM. Pre-transplant evaluation completion for Black/African American renal patients: Two theoretical frameworks. PATIENT EDUCATION AND COUNSELING 2020; 103:988-998. [PMID: 31733984 DOI: 10.1016/j.pec.2019.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Black/African Americans (B/AA) are less likely to complete the pre-transplant evaluation for kidney transplantation despite higher prevalence rates of end-stage renal disease (ESRD). To better understand the barriers and motivators to completing the evaluation process, two qualitative studies were conducted to categorize and elucidate the relationships between these factors. METHODS In Phase I, semi-structured interviews were conducted with a stratified purposeful sample of transplant professionals (N = 23). Focus groups were conducted during Phase II with a purposeful sample of B/AA patients (N = 30). RESULTS Thematic analyses assessed using grounded theory revealed a multitude of factors at individual and systemic levels, including health and informational/educational-related factors. Two comprehensive theoretical frameworks, a socio-ecological model of barriers and a model of motivators are presented. Medical mistrust is an example of a community factor identified as impeding completion rates. Systemic motivators included compressed time for testing and fewer intervals between doctor's appointments. CONCLUSIONS This study offers a structure for understanding impediments to and facilitators of pre-transplant evaluation completion as seen through the eyes of both B/AA ESRD patients seeking transplant and the providers who work with them. PRACTICE IMPLICATIONS Recommendations for intervention and systemic changes to narrow health disparities are discussed.
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Affiliation(s)
- Camilla W Nonterah
- University of Richmond, 114 UR Drive, Richmond, 23173-0001, United States.
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Abstract
Background Although many women benefit from breast reconstruction after mastectomy, several studies report women's dissatisfaction with the level of information they were provided with before reconstruction. Objective The present meta-synthesis examines the qualitative literature that explores women's experiences of breast reconstruction after mastectomy and highlights women's healthcare information needs. Methods After a comprehensive search of 6 electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Scopus), we followed the methodology for synthesizing qualitative research. The search produced 423 studies, which were assessed against 5 inclusion criteria. A meta-synthesis methodology was used to analyze the data through taxonomic classification and constant targeted comparison. Results Some 17 studies met the inclusion criteria, and findings from 16 studies were synthesized. The role of the healthcare practitioner is noted as a major influence on women's expectations, and in some instances, women did not feel adequately informed about the outcomes of surgery and the recovery process. In general, women's desire for normality and effective emotional coping shapes their information needs. Conclusion The information needs of women are better understood after considering women's actual experiences with breast reconstruction. It is important to inform women of the immediate outcomes of reconstruction surgery and the recovery process. Implications for Practice In an attempt to better address women's information needs, healthcare practitioners should discover women's initial expectations of reconstruction as a starting point in the consultation. In addition, the research revealed the importance of the nurse navigator in terms of assisting women through the recovery process.
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Jarvis MA, Padmanabhanunni A, Balakrishna Y, Chipps J. The effectiveness of interventions addressing loneliness in older persons: An umbrella review. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2019.100177] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Thestrup Hansen S, Kjerholt M, Friis Christensen S, Hølge-Hazelton B, Brodersen J. Haematologists' experiences implementing patient reported outcome measures (PROMs) in an outpatient clinic: a qualitative study for applied practice. J Patient Rep Outcomes 2019; 3:74. [PMID: 31884569 PMCID: PMC6935381 DOI: 10.1186/s41687-019-0166-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/11/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The patient-doctor relationship is crucial to provide person-centred care, allowing the alleviation of symptom burden caused by disease or treatment. Implementing Patient Reported Outcome Measures (PROMs) is suggested to inform the decision-making process and lead to initiation of care. Yet there are knowledge gaps regarding how meaningful it is to incorporate PROMs in clinical settings. The aim of this study was to investigate haematologists' experiences when PROMs were implemented in an outpatient setting. METHODS Fourteen participant observations, 13 individual interviews and three in-depth interviews were conducted with haematologists, guided by the qualitative methodology Interpretive Description. Analysis was inspired by Habermas' critical theoretical framework. RESULTS The haematologists included were characterised by dichotomous experiences with PROMs, either resistant to or supporting their implementation. None were observed to elaborate on PROMs during consultations: instead, primary attention was spent discussing the hematological agenda dictated by the system. CONCLUSION The use of PROMs for individualized care was linked with extensive uncertainties and PROMs were not requested by the haematologists. To improve individualized care, other approaches may be more suitable. If PROMs are to be incorporated into future clinical practice, they should be tested tothe specific patient group and involve relevant users.
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Affiliation(s)
- Stine Thestrup Hansen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark.
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Mette Kjerholt
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Sarah Friis Christensen
- Department of Haematology, Zealand University Hospital, Vestermarksvej 9, 1.sal, 4000, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bibi Hølge-Hazelton
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- The Research Support Unit, Zealand University Hospital, Roskilde, Denmark
| | - John Brodersen
- Department of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre of Research & Education in General Practice, Primary Health Care Research Unit, Copenhagen, Region Zealand, Denmark
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Taylor F, Halter M, Drennan VM. Understanding patients' satisfaction with physician assistant/associate encounters through communication experiences: a qualitative study in acute hospitals in England. BMC Health Serv Res 2019; 19:603. [PMID: 31455342 PMCID: PMC6712610 DOI: 10.1186/s12913-019-4410-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/06/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Physician assistants/associates (PAs) are a recent innovation in acute hospital teams in England and many other countries worldwide. Although existing evidence indicates generally high levels of patient satisfaction with their PA hospital encounters, little is known about the factors associated with this outcome. There is a lack of evidence on the process of PA-patient communication in hospital encounters and how this might influence satisfaction. This study therefore aimed to understand patients' satisfaction with PA acute hospital encounters through PA-patient communication experiences. METHODS A qualitative study was conducted among patients and representatives of patients seen by or receiving care from one of the PAs working in acute hospital services in England. Semi-structured interviews were undertaken face-to-face with study participants in the hospital setting and shortly after their PA encounter. Data were coded and analysed using thematic analysis. The study was framed within a theoretical model of core functions of medical encounter communication. RESULTS Fifteen patients and patient representatives who had experienced a PA encounter participated in interviews, across five hospitals in England. Four interrelated communication experiences were important to participants who were satisfied with the encounter in general: feeling trust and confidence in the relationship, sharing relevant and meaningful information, experiencing emotional care and support, and sharing discussion on illness management and treatment. However, many participants misconceived PAs to be doctors, raising a potential risk of reduced trust in the PA relationship and negative implications for satisfaction with their PA encounter. Participants considered it beneficial that patients be informed about the PA role to prevent confusion. CONCLUSIONS PA encounters offer a constructive example of successful clinician-patient communication experiences in acute hospital encounters from the patient's perspective. Study participants were generally naïve to the PA role. Hospital services and organisations introducing these mid-level or advanced care practitioner roles should consider giving attention to informing patients about the roles.
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Affiliation(s)
- Francesca Taylor
- Centre for Health & Social Care Research, Joint Faculty of Kingston University & St George's University of London, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Mary Halter
- Centre for Health & Social Care Research, Joint Faculty of Kingston University & St George's University of London, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Vari M Drennan
- Centre for Health & Social Care Research, Joint Faculty of Kingston University & St George's University of London, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK
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Vetrovsky T, Vetrovska K, Bunc V. A qualitative exploration of the experiences of primary care patients engaged in email counseling meant to increase physical activity. ACTA GYMNICA 2019. [DOI: 10.5507/ag.2019.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Munthe-Kaas HM, Glenton C, Booth A, Noyes J, Lewin S. Systematic mapping of existing tools to appraise methodological strengths and limitations of qualitative research: first stage in the development of the CAMELOT tool. BMC Med Res Methodol 2019; 19:113. [PMID: 31164084 PMCID: PMC6549363 DOI: 10.1186/s12874-019-0728-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/09/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Qualitative evidence synthesis is increasingly used alongside reviews of effectiveness to inform guidelines and other decisions. To support this use, the GRADE-CERQual approach was developed to assess and communicate the confidence we have in findings from reviews of qualitative research. One component of this approach requires an appraisal of the methodological limitations of studies contributing data to a review finding. Diverse critical appraisal tools for qualitative research are currently being used. However, it is unclear which tool is most appropriate for informing a GRADE-CERQual assessment of confidence. METHODOLOGY We searched for tools that were explicitly intended for critically appraising the methodological quality of qualitative research. We searched the reference lists of existing methodological reviews for critical appraisal tools, and also conducted a systematic search in June 2016 for tools published in health science and social science databases. Two reviewers screened identified titles and abstracts, and then screened the full text of potentially relevant articles. One reviewer extracted data from each article and a second reviewer checked the extraction. We used a best-fit framework synthesis approach to code checklist criteria from each identified tool and to organise these into themes. RESULTS We identified 102 critical appraisal tools: 71 tools had previously been included in methodological reviews, and 31 tools were identified from our systematic search. Almost half of the tools were published after 2010. Few authors described how their tool was developed, or why a new tool was needed. After coding all criteria, we developed a framework that included 22 themes. None of the tools included all 22 themes. Some themes were included in up to 95 of the tools. CONCLUSION It is problematic that researchers continue to develop new tools without adequately examining the many tools that already exist. Furthermore, the plethora of tools, old and new, indicates a lack of consensus regarding the best tool to use, and an absence of empirical evidence about the most important criteria for assessing the methodological limitations of qualitative research, including in the context of use with GRADE-CERQual.
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Affiliation(s)
| | | | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Salmon P, Young B. Qualitative methods can test and challenge what we think we know about clinical communication - if they are not too constrained by methodological 'brands'. PATIENT EDUCATION AND COUNSELING 2018; 101:1515-1517. [PMID: 30037663 DOI: 10.1016/j.pec.2018.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
| | - Bridget Young
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Komaromy M, Madden EF, Zurawski A, Kalishman S, Barker K, O'Sullivan P, Jurado M, Arora S. Contingent engagement: What we learn from patients with complex health problems and low socioeconomic status. PATIENT EDUCATION AND COUNSELING 2018; 101:524-531. [PMID: 28890084 DOI: 10.1016/j.pec.2017.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/06/2017] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Elicit patients' perceptions of factors that facilitate their engagement in care METHODS: In-depth interviews with 20 adult Medicaid patients who had complex health problems, frequent hospitalizations/emergency department use, and who were enrolled in an intensive, team-based care program designed to address medical, behavioral, and social needs. RESULTS Prior to engaging in the program, participants described weak relationships with primary care providers, frequent hospitalizations and emergency visits, poor adherence to medications and severe social barriers to care. After participating in the program, participants identified key factors that enabled them to develop trust and engage with care including: availability for extended intensive interactions, a non-judgmental approach, addressing patients' material needs, and providing social contact for isolated patients. After developing relationships with their care team, participants described changes such as sustained interactions with their primary care team and incremental improvements in health behaviors. CONCLUSION These findings illuminate factors promoting "contingent engagement" for low socio-economic status patients with complex health problems, which allow them to become proactive in ways commensurate with their circumstances, and offers insights for designing interventions to improve patient outcomes. PRACTICE IMPLICATIONS For these patients, engagement is contingent on healthcare providers' efforts to develop trust and address patients' material needs.
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Affiliation(s)
- Miriam Komaromy
- The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | | | - Andrea Zurawski
- The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Summers Kalishman
- The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Family and Community Medicine, Office of Education at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Kristin Barker
- Department of Sociology, University of New Mexico, Albuquerque, NM, USA
| | | | - Martin Jurado
- The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Sanjeev Arora
- The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Poscia A, Stojanovic J, La Milia DI, Duplaga M, Grysztar M, Moscato U, Onder G, Collamati A, Ricciardi W, Magnavita N. Interventions targeting loneliness and social isolation among the older people: An update systematic review. Exp Gerontol 2017; 102:133-144. [PMID: 29199121 DOI: 10.1016/j.exger.2017.11.017] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/17/2017] [Accepted: 11/24/2017] [Indexed: 11/24/2022]
Abstract
This systematic review aims to summarize and update the current knowledge on the effectiveness of the existing interventions for alleviating loneliness and social isolation among older persons. A search of PubMed, ISI Web of science, SCOPUS, The Cochrane Library, and CINAHL databases was performed. The terminology combined all possible alternatives of the following keywords: social isolation, loneliness, old people, intervention and effectiveness. Eligible studies were published between January 2011 and February 2016 in English or Italian language and regarded the implementation of loneliness/social isolation interventions among the older generations. Outcome measures in terms of the intervention effects needed to be reported. In total, 15 quantitative and five qualitative studies were ultimately included in this review. Eighteen interventions were reported across the quantitative studies. Six out of 11 group interventions (55%), one out of four mixed interventions (25%) and all three individual interventions reported at least one significant finding related to loneliness or social isolation. Our review suggested that new technologies and community engaged arts might be seen as a promising tool for tackling social isolation and loneliness among the older individuals. Future studies need to work on methodological quality and take into consideration the suggestions of the present literature in order to provide firm evidence.
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Affiliation(s)
- Andrea Poscia
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jovana Stojanovic
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniele Ignazio La Milia
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariusz Duplaga
- Department of Health Promotion, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Grysztar
- Department of Health Promotion, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Umberto Moscato
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Institute of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Agnese Collamati
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Walter Ricciardi
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy; National Institute of Health, Rome, Italy
| | - Nicola Magnavita
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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Noordman J, Driesenaar JA, Henselmans I, Verboom J, Heijmans M, van Dulmen S. Patient participation during oncological encounters: Barriers and need for supportive interventions experienced by elderly cancer patients. PATIENT EDUCATION AND COUNSELING 2017; 100:2262-2268. [PMID: 28619272 DOI: 10.1016/j.pec.2017.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To enhance patient participation during (oncological) encounters, this study aims to gain insight into communication barriers and supportive interventions experienced by elderly patients with cancer. METHOD A mixed method design, including both quantitative (secondary survey data analysis) and qualitative (interviews) methods Survey data were used to identify communication barriers and need for supportive interventions of elderly cancer patients, compared to younger patients. Next, interviews provided in-depth insight into elderly patients' experiences and underlying mechanisms. RESULTS A majority of the 70 participating elderly cancer patients (53%) felt confident in communicating and participating during medical encounters. However, 47% of patients experienced barriers to effectively communicate with their healthcare provider and felt the need for supportive interventions. The 14 interviewed patients mentioned barriers and facilitators related to attributes of themselves (e.g. feeling sick, self-efficacy), the provider (e.g. taking patient seriously) and the healthcare system (e.g. time constraints). CONCLUSIONS Although many elderly cancer patients feel confident, offering support to patients who feel less confident in communicating with their provider is recommended. PRACTICE IMPLICATIONS The outcomes of this study can be used as a first step for developing interventions for elderly cancer patients to overcome communication barriers, and help providers to facilitate this process.
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Affiliation(s)
- Janneke Noordman
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
| | - Jeanine A Driesenaar
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jedidja Verboom
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Monique Heijmans
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Sandra van Dulmen
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands; Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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Improving knowledge about the effectiveness of psychotherapy. PSYCHOTHERAPY AND POLITICS INTERNATIONAL 2017. [DOI: 10.1002/ppi.1424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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King R, Robinson V, Ryan CG, Martin DJ. An exploration of the extent and nature of reconceptualisation of pain following pain neurophysiology education: A qualitative study of experiences of people with chronic musculoskeletal pain. PATIENT EDUCATION AND COUNSELING 2016; 99:1389-1393. [PMID: 27021238 DOI: 10.1016/j.pec.2016.03.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/03/2016] [Accepted: 03/13/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Pain neurophysiology education (PNE), a method of pain education, purports to work by helping patients reconceptualise their pain, shifting from a tissue injury model towards a biopsychosocial understanding related to neural sensitivity. Better understanding of pain reconceptualisation following PNE is needed to improve the delivery of this educational approach to enhance its effectiveness. This study aimed to investigate the extent and nature of reconceptualisation following PNE. METHODS In a qualitative design, based on Interpretive Phenomenological Analysis, thematic analysis was carried out on individual interviews with 7 adults before and three weeks after receiving PNE at a pain clinic. RESULTS Three themes emerged describing variable degrees of reconceptualisation; prior beliefs as facilitators and barriers to reconceptualisation; and the influence of reconceptualisation on clinical benefits of PNE. CONCLUSION The results lend support to claims that reconceptualisation is an important mechanism in PNE and justify further investigation of this phenomenon. PRACTICAL IMPLICATIONS When delivering PNE to patients with chronic pain helping patients to reconceptualise their pain may be key to enhancing the clinical benefits of the intervention. Understanding prior beliefs may be an important step in facilitating reconceptualisation.
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Affiliation(s)
- Rick King
- Health and Social Care Institute, Teesside University, Middlesbrough, UK; Pain Clinic, James Cook University Hospital, South Tees NHS Hospitals Trust, Middlesbrough, UK.
| | - Victoria Robinson
- Pain Clinic, James Cook University Hospital, South Tees NHS Hospitals Trust, Middlesbrough, UK.
| | - Cormac G Ryan
- Health and Social Care Institute, Teesside University, Middlesbrough, UK.
| | - Denis J Martin
- Health and Social Care Institute, Teesside University, Middlesbrough, UK.
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Diviani N, van den Putte B, Meppelink CS, van Weert JCM. Exploring the role of health literacy in the evaluation of online health information: Insights from a mixed-methods study. PATIENT EDUCATION AND COUNSELING 2016; 99:1017-25. [PMID: 26817407 DOI: 10.1016/j.pec.2016.01.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/15/2015] [Accepted: 01/15/2016] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To gain new insights into the relationship between health literacy and evaluation of online health information. METHODS Using a mixed-methods approach, forty-four semi-structured interviews were conducted followed by a short questionnaire on health literacy and eHealth literacy. Qualitative and quantitative data were merged to explore differences and similarities among respondents with different health literacy levels. RESULTS Thematic analysis showed that most respondents did not question the quality of online health information and relied on evaluation criteria not recognized by existing web quality guidelines. Individuals with low health literacy, despite presenting higher eHealth literacy scores, appeared to use less established criteria and to rely more heavily on non-established ones compared to those with high health literacy. CONCLUSION Disparities in evaluation ability among people with different health literacy might be related to differences in awareness of the issue and to the use of different evaluation criteria. Future research should quantitatively investigate the interplay between health literacy, use of established and non-established criteria, and ability to evaluate online health information. PRACTICE IMPLICATIONS Communication and patient education efforts should aim to raise awareness on online health information quality and to promote use of established evaluation criteria, especially among low health literate citizens.
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Affiliation(s)
- Nicola Diviani
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands.
| | - Bas van den Putte
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands; Trimbos Institute, Netherlands Institute for Mental Health and Addiction, Utrecht, The Netherlands
| | - Corine S Meppelink
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands
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Chen YRR, Schulz PJ. The Effect of Information Communication Technology Interventions on Reducing Social Isolation in the Elderly: A Systematic Review. J Med Internet Res 2016; 18:e18. [PMID: 26822073 PMCID: PMC4751336 DOI: 10.2196/jmir.4596] [Citation(s) in RCA: 344] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/03/2015] [Accepted: 10/07/2015] [Indexed: 12/02/2022] Open
Abstract
Background The aging of the population is an inexorable change that challenges governments and societies in every developed country. Based on clinical and empirical data, social isolation is found to be prevalent among elderly people, and it has negative consequences on the elderly’s psychological and physical health. Targeting social isolation has become a focus area for policy and practice. Evidence indicates that contemporary information and communication technologies (ICT) have the potential to prevent or reduce the social isolation of elderly people via various mechanisms. Objective This systematic review explored the effects of ICT interventions on reducing social isolation of the elderly. Methods Relevant electronic databases (PsycINFO, PubMed, MEDLINE, EBSCO, SSCI, Communication Studies: a SAGE Full-Text Collection, Communication & Mass Media Complete, Association for Computing Machinery (ACM) Digital Library, and IEEE Xplore) were systematically searched using a unified strategy to identify quantitative and qualitative studies on the effectiveness of ICT-mediated social isolation interventions for elderly people published in English between 2002 and 2015. Narrative synthesis was performed to interpret the results of the identified studies, and their quality was also appraised. Results Twenty-five publications were included in the review. Four of them were evaluated as rigorous research. Most studies measured the effectiveness of ICT by measuring specific dimensions rather than social isolation in general. ICT use was consistently found to affect social support, social connectedness, and social isolation in general positively. The results for loneliness were inconclusive. Even though most were positive, some studies found a nonsignificant or negative impact. More importantly, the positive effect of ICT use on social connectedness and social support seemed to be short-term and did not last for more than six months after the intervention. The results for self-esteem and control over one’s life were consistent but generally nonsignificant. ICT was found to alleviate the elderly’s social isolation through four mechanisms: connecting to the outside world, gaining social support, engaging in activities of interests, and boosting self-confidence. Conclusions More well-designed studies that contain a minimum risk of research bias are needed to draw conclusions on the effectiveness of ICT interventions for elderly people in reducing their perceived social isolation as a multidimensional concept. The results of this review suggest that ICT could be an effective tool to tackle social isolation among the elderly. However, it is not suitable for every senior alike. Future research should identify who among elderly people can most benefit from ICT use in reducing social isolation. Research on other types of ICT (eg, mobile phone–based instant messaging apps) should be conducted to promote understanding and practice of ICT-based social-isolation interventions for elderly people.
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Weaver MS, Baker JN, Gattuso JS, Gibson DV, Sykes AD, Hinds PS. Adolescents' preferences for treatment decisional involvement during their cancer. Cancer 2015; 121:4416-24. [PMID: 26348790 DOI: 10.1002/cncr.29663] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 07/28/2015] [Accepted: 08/10/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND This qualitative study investigated the medical decision-making preferences of adolescent oncology patients and the parental and clinician behaviors that adolescents report to be supportive of their preferred level of decision-making involvement. METHODS Interviews were conducted with 40 adolescents between the ages of 12 and 18 years who were undergoing cancer treatment in Memphis, Tenn or Washington, DC. Role preferences were converted into a predetermined Likert scale decisional preference score. A semantic content analysis was used to analyze patient reports of parental behaviors, attitudes, knowledge levels, and relational interactions that facilitated their preferred level of involvement in decision making. Clinician behaviors described as supportive of decisional processes were also categorized thematically. A teen advisory council validated study findings. Data reporting followed strict adherence to Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS Adolescents indicated a spectrum of preferred decisional roles, with the most common being an actively involved role (26 of 40 or 65%), although a shared decision-making approach was still valued. There was no statistically significant difference in the preferred decisional role with respect to demographic or medical characteristics, including the relapse status, although adolescents who preferred autonomous interview settings were more likely to prefer active decisional roles (P < .001). Adolescents recognized that situational and social contexts might shift their preferred level of involvement in medical decisions. Although adolescents wanted to be involved in decisions, they also expressed an appreciation of family insight, parental presence, and clinician guidance. CONCLUSIONS Adolescents with cancer are able to retrospectively identify their preferences for inclusion in medical decision making, and even when preferring involvement, they value the input of trusted others.
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Affiliation(s)
- Meaghann S Weaver
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, Children's National Health System, Washington, DC
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jami S Gattuso
- Department of Nursing Research, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Deborah V Gibson
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - April D Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Pamela S Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Washington, DC.,Department of Pediatrics, George Washington University, Washington, DC
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Hongxia M, Huiling L, Jingshu G, Hongli M, Jianping L, Ernest NH, Annika B, Elisabet SV, Xin M, Xiaoke W. Value of qualitative research in polycystic ovary syndrome. Chin Med J (Engl) 2014. [DOI: 10.1097/00029330-201409200-00021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Affiliation(s)
- Michelle Cleary
- School of Nursing and Midwifery; University of Western Sydney; NSW Australia
| | | | - Mark Hayter
- Faculty of Health and Social Care; University of Hull; UK
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