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Luengo TD, Rivas AB, Loureido E, Vargas E. Reducing preoperative anxiety in parents of surgical patients. Heliyon 2023; 9:e15920. [PMID: 37215828 PMCID: PMC10195889 DOI: 10.1016/j.heliyon.2023.e15920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023] Open
Abstract
Aims and objectives To investigate preoperative anxiety in parents of paediatric surgical patients, testing whether the provision of information (using video and story books) regarding the surgical process can impact on reducing anxiety. Analyse if any personal factors influence the reduction of anxiety. Background Attending a surgical theatre generates anxiety, especially in the case of children. The effect of different preoperative intervention procedures in children that attempt to reduce their anxiety level have been studied a great deal. However, although their parents also suffer high levels of anxiety, potential intervention to reduce their levels has not received the same attention. Study design Randomised Clinical trial. Methods One hundred and twenty-five parents of children (8-12 y.o.) undergoing surgery in a public hospital were randomly assigned to the control group CG (34 individuals) or one of the 3 experimental groups EG (91). In this Randomised Controlled Study, children and parents of the experimental groups were provided with a story book, a video with additional information of nursing, or both. Prior to the surgical intervention, the State Anxiety, S-A, and Trait Anxiety, T-A, of the parents and children were measured using the STAI and STAIC questionnaires respectively. Data collection was carried out for 12 months starting in October 2016. Results Parents' S-A in the control group was higher than in the experimental groups. A linear model explains the parents' S-A using as regressors: children S-A, age and T-A of the parents, and children age. Conclusions Providing information about the surgical process (through stories or videos) to which a child is going to be subjected can reduce the anxiety of the parents. Relevance to clinical practice Given their close connection to the patient and the potential effects on the children of their psychological situation, healthcare professionals should consider paying greater attention to communicating with the parents.
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Affiliation(s)
- Trinidad Díaz Luengo
- Medicine and Nursing School, Dpt. of Medicine, University of Oviedo, Spain
- Área del Bloque Quirúrgico y Esterilización, Hospital Universitario Cabueñes, Gijón, Spain
| | - Ana Belén Rivas
- Unidad de Investigación Clínica y Ensayos Clínicos, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento Enfermería. Facultad Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Elena Loureido
- Hospital Universitario Central de Asturias, Operating Room Service, Oviedo, Spain
| | - Emilio Vargas
- Servicio de Farmacología Clínica, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid(UCM), Madrid, Spain
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Selvarajan A, Arulanandam B, Guadagno E, Poenaru D. Family risk communication preferences in pediatric surgery: A scoping review. J Pediatr Surg 2023; 58:891-901. [PMID: 36822973 DOI: 10.1016/j.jpedsurg.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Effective patient-surgeon communication is vital in pediatric surgical practice. However, family (including child) preferences for the format and content of risk communication information are largely unknown. In order to optimize the shared-decision making process, this scoping review explored the family-preferred methods for risk communication in pediatric surgery. METHODS A search was conducted in 7 databases from inception until June 2020 to identify family risk communication preferences in pediatric surgical patients, with language restricted to English and French. Two independent reviewers completed the screening in Rayyan software following PRISMA protocol. Included publications were reviewed for data extraction, analyzed, and assessed for risk of bias using standardized instruments. RESULTS A total of 6370 publications were retrieved, out of which 70 were included. Studies were predominantly from ENT (30.0%), general surgery (15.7%), and urology (11.4%). Family-preferred risk communication methods were classified as visual, verbal, technology-based, written, decision aids or other. Technological (32.4%) and written tools (29.7%) were most commonly chosen by families as their preferred risk communication methods. Written tools were frequently used in general surgery and urology, while technology-based tools were widely used in ENT. Most studies were cross-sectional and had a significant risk of bias. CONCLUSION Eliciting families' preferences for risk communication methods is critical for the implementation of shared decision-making. Different risk communication media appear to be preferred within specific surgical domains. To further improve shared-decision making in pediatric surgery, the development and usage of robust, validated risk communication tools are necessary. LEVEL OF EVIDENCE Level IV (Scoping Review).
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Affiliation(s)
- Arthega Selvarajan
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Brandon Arulanandam
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan Poenaru
- McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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Karatas C, Caldwell PH, Scott KM. How paediatricians communicate with parents who access online health information. J Paediatr Child Health 2022; 58:2169-2176. [PMID: 36054381 PMCID: PMC10087747 DOI: 10.1111/jpc.16176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/12/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
AIMS Recent years have seen an exponential increase in the proportion of parents searching for online health information on their child's medical condition. We investigated the experiences, attitudes and approaches of paediatricians interacting with parents who search for online health information and the impact on the doctor-parent relationship. METHODS This qualitative study was conducted utilising semi-structured interviews with 17 paediatric physicians, surgeons, anaesthetists and trainees working in an Australian children's hospital. Data were analysed through deductive and inductive thematic analysis using line-by-line coding. RESULTS Three key themes were identified: paediatricians' experiences with, and attitudes towards, parents using online health information; paediatricians' communication approaches; and the perceived impact on the doctor-parent relationship. These themes demonstrated that most paediatricians acknowledged the information parents found and directed parents to reliable websites. Following discussions with Internet-informed parents, a few changed their management plans and a few reported discouraging parents from further searching online. CONCLUSIONS Our results indicate that paediatricians predominantly used patient-centred communication strategies to care for patients in partnership with parents. Paediatricians contextualising online health information can contribute to a quality partnership with parents and facilitate shared decision-making, potentially fostering better health outcomes for children. Our conclusions may inform clinicians' communication approaches when interacting with Internet-informed parents and stimulate research about more effective doctor-parent communication approaches. In a digital age, paediatricians may benefit from employing more time-efficient approaches to manage increasing workloads with their new role of digital stewardship of parents.
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Affiliation(s)
- Ceylan Karatas
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Graduate School of Medicine, The University of Wollongong, Wollongong, New South Wales, Australia
| | - Patrina Hy Caldwell
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, Kids Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Karen M Scott
- Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
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Understanding the effectiveness of consent processes and conversations in pediatric surgery: A systematic-scoping review. J Pediatr Surg 2022; 57:834-844. [PMID: 36031429 DOI: 10.1016/j.jpedsurg.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The consent conversation in pediatric surgery is an essential part of pre-operative care which, when inadequate, can lead to significant adverse consequences for the child, parents, surgeon, other healthcare workers and the healthcare system. We reviewed the published literature on what key stakeholders perceive are the components of effective and ineffective consenting processes in pediatric surgery. METHODS A medical librarian searched seven databases to retrieve articles looking at the informed consenting process in surgical care for the pediatric population. Two independent reviewers screened all publications and categorized them by stakeholder perspectives (patient/family, surgical team, other healthcare team, and hospital administration or policy maker). General study characteristics, interventions to improve consent and features of effective and ineffective consent conversations were extracted. RESULTS 5079 titles and abstracts were screened, resulting in 88 full-text studies and 43 articles included in the final review. Most publications (51%) discussed informed consent only from the patient/family perspective, while 21% added surgeon's perspective. No study approached the consenting process from the perspective of all stakeholder groups. Effective consent components identified included use of multimedia, presence of multiple conversations prior to surgery, and individualized communication catered to unique family knowledge and needs. In contrast, ineffective conversations did not include a clear assessment of parental understanding, delivered too much information, and did not address parental anxiety. CONCLUSIONS The literature on the consenting process in pediatric surgery is narrow in stakeholder perspectives. Our findings highlight gaps in the literature and opportunities to improve the informed consent processes prior to pediatric surgery.
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Terrasson J, Rault A, Dolbeault S, Brédart A. Question prompt lists to improve communication between cancer patients and healthcare professionals. Curr Opin Oncol 2022; 34:265-269. [PMID: 35730518 DOI: 10.1097/cco.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This literature review sets out to summarize knowledge on the impact of question prompt lists (QPLs) on patient-physician communication in oncology and to provide an account of current research on the development, adaptation, and implementation of this type of communication tool. RECENT FINDINGS Provided with a QPL, patients seem to ask more questions, in particular on sensitive issues like those around the end-of-life period and they recall the information provided better. There is a need to adapt QPLs, taking account of divergences in attitudes towards illness, participation in decision-making, and discussions about the illness prognosis across cultures. QPLs may also need to be tailored to specific concerns of patients at the different stages in the care trajectory and to the particularities of each cancer type. These adaptations contribute to the effectiveness of the tool because they make it possible to tailor it to the challenges and constraints experienced in clinical practice. SUMMARY QPLs are designed to enhance patients' communication with their physicians. Further research is required to develop QPLs suited to each cultural and clinical setting, involving health professionals so as to facilitate the implementation of these tools in routine practice.
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Affiliation(s)
- Johanna Terrasson
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris
| | - Aude Rault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris
| | - Sylvie Dolbeault
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris.,CESP, University Paris-Sud, UVSQ, INSERM, University Paris-Saclay, Villejuif cedex, France
| | - Anne Brédart
- Institut Curie, Supportive Care Department, Psycho-oncology Unit, PSL University, Paris.,Paris University, Psychology Institute, Psychopathology and health process laboratory Boulogne-Billancourt
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Bader M, Zheng L, Rao D, Shiyanbola O, Myers L, Davis T, O'Leary C, McKee M, Wolf M, Assaf AR. Towards a more patient-centered clinical trial process: A systematic review of interventions incorporating health literacy best practices. Contemp Clin Trials 2022; 116:106733. [PMID: 35301134 DOI: 10.1016/j.cct.2022.106733] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/15/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A 2019 public workshop convened by the National Academies of Sciences, Engineering and Medicine (NASEM) Roundtable on Health Literacy identified a need to develop evidence-based guidance for best practices for health literacy and patient activation in clinical trials. PURPOSE To identify studies of health literacy interventions within medical care or clinical trial settings that were associated with improved measures of health literacy or patient activation, to help inform best practices in the clinical trial process. DATA SOURCES Literature searches were conducted in PubMed, the Cumulative Index to Nursing and Allied Health Literature, SCOPUS, Cochrane, and Web of Science from January 2009 to June 2021. STUDY SELECTION Of 3592 records screened, 22 records investigating 27 unique health literacy interventions in randomized controlled studies were included for qualitative synthesis. DATA EXTRACTION Data screening and abstraction were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. DATA SYNTHESIS Types of health literacy interventions were multimedia or technology-based (11 studies), simplification of written material (six studies) and in-person sessions (five studies). These interventions were applied at various stages in the healthcare and clinical trial process. All studies used unique outcome measures, including patient comprehension, quality of informed consent, and patient activation and engagement. CONCLUSIONS The findings of our study suggest that best practice guidelines recommend health literacy interventions during the clinical trial process, presentation of information in multiple forms, involvement of patients in information optimization, and improved standardization in health literacy outcome measures.
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Affiliation(s)
- Mehnaz Bader
- Worldwide Medical and Safety, Pfizer Inc, New York, NY, USA.
| | - Linda Zheng
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Deepika Rao
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Laurie Myers
- Global Health Literacy and Oncology Health Equity, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Terry Davis
- Department of Medicine, Louisiana State University Health - Shreveport, Shreveport, LA, USA
| | | | - Michael McKee
- Department of Family Medicine, University of Michigan/Michigan Medicine, Ann Arbor, MI, USA
| | - Michael Wolf
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Annlouise R Assaf
- Worldwide Medical and Safety, Pfizer Inc, New York, NY, USA; School of Public Health, Brown University, Providence, RI, USA
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Novel Way to Improve Satisfaction, Comprehension, and Anxiety in Caregivers: A Randomized Trial Exploring the Use of Comprehensive, Illustrated Children's Books for Pediatric Surgical Populations. J Am Coll Surg 2022; 234:263-273. [PMID: 35213488 DOI: 10.1097/xcs.0000000000000057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgery generates anxiety and stress, which can negatively impact informed consent and postoperative outcomes. This study assessed whether educational, illustrated children's books improve comprehension, satisfaction, and anxiety of caregivers in pediatric surgical populations. METHODS A prospective randomized trial was initiated at a tertiary care children's hospital. All patients ≤ 18 years old with caregiver and diagnosis of 1) uncomplicated appendicitis (English or Spanish speaking); 2) ruptured appendicitis; 3) pyloric stenosis; 4) need for gastrostomy tube; or 5) umbilical hernia were eligible. Conventional consent was obtained followed by completion of 17 validated survey questions addressing apprehension, satisfaction, and comprehension. Randomization (2:1) occurred after consent and before operative intervention with the experimental group (EG) receiving an illustrated comprehensive children's book outlining anatomy, pathophysiology, hospital course, and postoperative care. A second identical survey was completed before discharge. Primary outcomes were caregiver apprehension, satisfaction, and comprehension. RESULTS Eighty caregivers were included (55: EG, 25: control group [CG]). There were no significant differences in patient or caregiver demographics between groups. The baseline survey demonstrated no difference in comprehension, satisfaction, or apprehension between groups (all p values NS). After intervention, EG had significant improvement in 14 of 17 questions compared with CG (all p < 0.05). When tabulated by content, there was significant improvement in comprehension (p = 0.0009), satisfaction (p < 0.0001), and apprehension (p < 0.0001). CONCLUSION The use of illustrated educational children's books to explain pathophysiology and surgical care is a novel method to improve comprehension, satisfaction, and anxiety of caregivers. This could benefit informed consent, understanding, and postoperative outcomes.
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Brédart A, Rault A, Terrasson J, Seigneur E, De Koning L, Hess E, Savignoni A, Cottu P, Pierga JY, Piperno-Neumann S, Rodrigues M, Bouleuc C, Dolbeault S. Helping Patients Communicate With Oncologists When Cancer Treatment Resistance Occurs to Develop, Test, and Implement a Patient Communication Aid: Sequential Collaborative Mixed Methods Study. JMIR Res Protoc 2022; 11:e26414. [PMID: 35019850 PMCID: PMC8792782 DOI: 10.2196/26414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most cancer-related deaths result from disseminated diseases that develop resistance to anticancer treatments. Inappropriate communication in this challenging situation may result in unmet patient information and support needs. Patient communication aids such as question prompt lists (QPLs) may help. OBJECTIVE This study aims to develop and pilot-test a specific QPL in the following two contrasting clinical contexts in France after cancer resistance has developed: triple-negative and luminal B metastatic breast cancer (MBC) and metastatic uveal melanoma (MUM). METHODS A sequential study design with a mixed methods collaborative approach will be applied. The first step aims to build a specific QPL. Step 1a will explore oncologist-patient communication issues from oncology professionals' interviews (n=20 approximately). Step 1b will appraise information and support needs experienced by patients with MBC or MUM both quantitatively (n=80) and qualitatively (n=40 approximately). These data will be used to develop and pilot-test a QPL specific to patients with cancer experiencing initial or acquired resistance to treatment. We expect to obtain a core QPL that comprises questions and concerns commonly expressed by patients with resistant cancer and is complemented by specific issues for either MBC or MUM cancer sites. In step 1c, 2 focus groups of patients with any type of metastatic cancer (n=4) and health care professionals (n=4) will be conducted to revise the content of a preliminary QPL and elaborate an acceptable and feasible clinical implementation. In step 1d, the content of the QPL version 1 and implementation guidance will be validated using a Delphi process. Step 2 will pilot-test the QPL version 1 in real practice with patients with MBC or MUM (n=80). Clinical utility will be assessed by comparing responses to questionnaires administered in step 1b (QPL-naive historical control group) and step 2 (QPL intervention group). RESULTS This study received grants in March and December 2019 and was approved by the French national ethics committee in July 2019. As of October 2021, interviews with oncology professionals have been conducted and analyzed (N=26 to reach saturation), and 39 and 27 patients with MBC and MUM, respectively, have been recruited. CONCLUSIONS A clinically and culturally tailored QPL is expected to facilitate patients' participation in consultations, improve oncologists' responses to patients' information and support needs, and thus foster patients' psychological adjustment to the diagnosis and follow-up of cancer resistance to treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT04118062; http://clinicaltrials.gov/ct2/show/NCT04118062. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26414.
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Affiliation(s)
- Anne Brédart
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
- Psychopathology and Health Process, Paris University, Boulogne Billancourt, France
| | - Aude Rault
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Johanna Terrasson
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Etienne Seigneur
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
| | - Leanne De Koning
- Research Centre, Paris Sciences et Lettres Research University, Institut Curie, Paris, France
| | - Elisabeth Hess
- Research Centre, Paris Sciences et Lettres Research University, Institut Curie, Paris, France
| | - Alexia Savignoni
- Direction Recherche Ensemble Hospitalier, Data Management Unit, Biometry Department, Institut Curie, Saint-Cloud, France
| | - Paul Cottu
- Medical Oncology Department, Institut Curie, Paris, France
| | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie, Paris, France
- Faculty of medicine, Paris University, Paris, France
| | | | | | - Carole Bouleuc
- Département Interdisciplinaire de Soins de Support pour le Patient en Oncologie, Department of Supportive Care, Institut Curie, Paris, France
| | - Sylvie Dolbeault
- Psycho-Oncology Unit, Institut Curie, Paris Sciences et Lettres Research University, Paris, France
- Research Centre in Epidemiology and Population Health (CESP), INSERM, U1018, University Paris-Sud, Villejuif, France
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Guo A, Wang P. The Current State of Doctors' Communication Skills in Mainland China from the Perspective of Doctors' Self-evaluation and Patients' Evaluation: A Cross-Sectional Study. PATIENT EDUCATION AND COUNSELING 2021; 104:1674-1680. [PMID: 33384190 DOI: 10.1016/j.pec.2020.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess doctors' communication skills in mainland China using the SEGUE Framework. METHODS A survey on doctors' communication skills with doctors (n = 1361) and patients (n = 1757) from 14 provinces in eastern, central and western China was conducted. RESULTS The doctors' self-evaluation scores were higher than patients' evaluations (p < .001). The scores of female doctors were higher than males (p = .022). Both doctors' self-evaluations and patients' evaluations indicated that the scores of doctors in tertiary hospitals were higher than those in primary hospitals. CONCLUSION Doctors' communication skills don't match patients' needs. Female doctors are more empathetic and patient than male doctors and consequently have better communication skills. Doctors in tertiary hospitals have better communication skills because tertiary hospitals provide more training opportunities in communication skills and have better medical services and management. PRACTICE IMPLICATIONS This study confirms the applicability of the SEGUE Framework to doctors and patients in mainland China. The effectiveness of cultivating doctors' communication skills should be evaluated through feedback from the perspective of both doctors and patients. Medical institutes need to prioritize patients' needs and provide training in doctors' communication skills to address the discrepancy in the perceptions of doctors and patients.
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Affiliation(s)
- Ai Guo
- Shanghai Normal University, Department of Psychology, Shanghai, China; School of Psychiatry, Wenzhou Medical University, Wenzhou, China
| | - Pei Wang
- School of Psychiatry, Wenzhou Medical University, Wenzhou, China; East China Normal University, Faculty of Education, Shanghai, China.
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Kampouroglou G, Velonaki VS, Pavlopoulou I, Drakou E, Kosmopoulos M, Kouvas N, Tsagkaris S, Fildissis G, Nikas K, Tsoumakas K. Parental anxiety in pediatric surgery consultations: the role of health literacy and need for information. J Pediatr Surg 2020; 55:590-596. [PMID: 31431293 DOI: 10.1016/j.jpedsurg.2019.07.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/15/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Although important, parental anxiety, health literacy and need-for-information in pediatric surgery outpatient clinics have not been extensively studied. Lower educational attainments, minorities and lower socioeconomic status have been associated with limited health literacy. Parental anxiety has been related to health literacy, sex, education and information needs. The aim of this study is to investigate health literacy and need-for-information and their association to parental anxiety in consultations of pediatric surgery. MATERIALS & METHODS We conducted an observational, cross-sectional study in the outpatient pediatric surgery clinic from December 2016 to October 2017. Health literacy, anxiety and need-for-information of parents/guardians of children waiting for pediatric surgical consultation were evaluated. Multivariate regression analysis was used to examine the impact of health literacy and need-for-information on parental/guardian anxiety considering sociodemographic and clinical characteristics of the participants. RESULTS Almost half (46.1%) of the 664 parents/guardians recruited had limited or problematic health literacy and 79.8% of the sample was classified as being anxious. Parental/guardian anxiety was associated at the multiple regression analysis with parental health literacy level (β = -0.282, p < 0.001), need-for-information preoperatively (β = 0.907, p < 0.001), educational level (β = -0.716, p = 0.001), sex (β = 1.563, p < 0.001), and severity of the condition of the child (β = 0.379, p < 0.001). CONCLUSION Parents/guardians experience high levels of anxiety, which is associated to health literacy and need-for-information. These factors should be considered in pediatric surgical consultations, aiming to reduce parental anxiety. TYPE OF STUDY Retrospective Study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | - Venetia-Sofia Velonaki
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Ioanna Pavlopoulou
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Eleni Drakou
- Medical School of Athens, National and Kapodistrian University of Athens, Greece
| | - Marinos Kosmopoulos
- Medical School of Athens, National and Kapodistrian University of Athens, Greece
| | - Nikos Kouvas
- Medical School of Athens, National and Kapodistrian University of Athens, Greece
| | - Stavros Tsagkaris
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Georgios Fildissis
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Nikas
- Department of Pediatric Surgery, Agia Sophia Children's Hospital, Athens, Greece
| | - Konstantinos Tsoumakas
- Department of Nursing, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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11
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Gurung G, Richardson A, Wyeth E, Edmonds L, Derrett S. Child/youth, family and public engagement in paediatric services in high-income countries: A systematic scoping review. Health Expect 2020; 23:261-273. [PMID: 31981295 PMCID: PMC7104655 DOI: 10.1111/hex.13017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 01/02/2023] Open
Abstract
Background Patient and public engagement in paediatric health‐care decision making is under‐researched, and there is a lack of systematically reviewed literature in this area. Objective To examine the extent, range and nature of published research investigating the engagement of children/youth, families and the public in paediatric service improvement, to summarize key aspects of the research identified and to identify gaps to help inform future research needs. Methods Literature was sought in MEDLINE, EMBASE, PsycINFO and CINAHL. Eligible articles presented research focused on patient, family and public engagement strategies in the paediatric health‐care setting. Two reviewers extracted and charted data and analysed findings using a descriptive numerical summary analysis and a thematic analysis. Results From 4331 articles, 21 were eligible. Most were from the United States. The majority of studies were undertaken in hospital settings and used quantitative methods. Various patient and public engagement strategies/interventions were examined, including shared decision‐making tools, questionnaires, youth councils/family advisory groups, patient portals and online networks. Most of the studies examined child/youth/parent satisfaction, with fewer investigating treatment outcomes or service improvement. The majority of studies investigated an engagement strategy at the ‘individual treatment’ level of engagement. Regarding the continuum of engagement, most of the studies were at either the ‘consultation’ or ‘involvement’ stage. Conclusion Future research needs to focus on the investigation of engagement strategies delivered in primary care, and the use of more qualitative and mixed methods approaches is recommended. There is a gap in the area of engagement strategies directed towards ‘service design and resources’ and ‘macro/policy’ levels.
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Affiliation(s)
- Gagan Gurung
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.,Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Amy Richardson
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Liza Edmonds
- Children's Health and NICU, Southern District Health Board, Dunedin, New Zealand.,Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Roy M, Corkum JP, Urbach DR, Novak CB, von Schroeder HP, McCabe SJ, Okrainec K. Health Literacy Among Surgical Patients: A Systematic Review and Meta-analysis. World J Surg 2018; 43:96-106. [DOI: 10.1007/s00268-018-4754-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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13
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Choe JK, Ibarra C, Feinn RS, Rodriguez-Davalos MI, Carter CW. Concurrent Surgery and the Role of the Pediatric Attending Surgeon: Comparing Parents' and Surgeons' Expectations. J Am Coll Surg 2018; 226:1022-1029. [DOI: 10.1016/j.jamcollsurg.2018.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
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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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D'Agostino TA, Atkinson TM, Latella LE, Rogers M, Morrissey D, DeRosa AP, Parker PA. Promoting patient participation in healthcare interactions through communication skills training: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1247-1257. [PMID: 28238421 PMCID: PMC5466484 DOI: 10.1016/j.pec.2017.02.016] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/24/2017] [Accepted: 02/13/2017] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To present literature on training patients in the use of effective communication skills. METHODS Systematic searches were conducted in six databases. References were screened for inclusion through several phases. Extracted data included intervention study design, sample characteristics, content and structure of training programs, outcomes assessed, and findings reported. RESULTS A total of 32 unique intervention studies were included. Most targeted primary care or cancer patients and used a randomized controlled study design. Interventions used a variety of training formats and modes of delivering educational material. Reported findings suggest that communication training is an effective approach to increase patients' total level of active participation in healthcare interactions and that some communication behaviors may be more amenable to training (e.g., expressing concerns). Trained patients do not have longer visits and tend to receive more information from their providers. Most studies have found no relationship between communication training and improved health, psychosocial wellbeing, or treatment-related outcomes. CONCLUSIONS Findings reinforce the importance and potential benefits of patient communication training. PRACTICE IMPLICATIONS Additional research is warranted to determine the most efficacious training programs with the strongest potential for dissemination.
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Affiliation(s)
- Thomas A D'Agostino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren E Latella
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Madeline Rogers
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dana Morrissey
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Antonio P DeRosa
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Lopez C, Hanson CC, Yorke D, Johnson JK, Mill MR, Brown KJ, Barach P. Improving communication with families of patients undergoing pediatric cardiac surgery. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2016.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Parent Perceptions of How Nurse Encounters Can Provide Caring Support for the Family in Early Acute Care After Children's Severe Traumatic Brain Injury. J Neurosci Nurs 2016; 48:E2-E15. [PMID: 26871242 DOI: 10.1097/jnn.0000000000000192] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A child's severe traumatic brain injury (TBI) creates a family crisis requiring extensive cultural, informational, psychological, and environmental support. Nurses need to understand parents' expectations of caring in early acute care so they can tailor their attitudes, beliefs, and behaviors appropriately to accommodate the family's needs. METHODS In a previous qualitative study of 42 parents or caregivers from 37 families of children with moderate-to-severe TBI, parents of children with severe TBI (n = 25) described their appraisals of nurse caring and uncaring behaviors in early acute care. Swanson's theory of caring was used to categorize parents' descriptions to inform nursing early acute care practices and family-centered care. RESULTS Caring nurse encounters included (a) involving parents in the care of their child and reflecting on all sociocultural factors shaping family resources and responses (knowing); (b) respecting that family grief can be co-mingled with resilience and that parents are typically competent to be involved in decision making (maintaining belief); (d) actively listening and engaging parents to fully understand family values and needs (being with); (e) decreasing parents' workload to get information and emotional support and provide a safe cultural, psychological, and physical environment for the family (doing for); and (f) providing anticipatory guidance to navigate the early acute care system and giving assistance to learn and adjust to their situation (enabling). CONCLUSION Application of Swanson's caring theory is prescriptive in helping individual nurses and early acute care systems to meet important family needs after children's severe TBI.
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Hamel LM, Penner LA, Albrecht TL, Heath E, Gwede CK, Eggly S. Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients With Cancer. Cancer Control 2016; 23:327-337. [PMID: 27842322 PMCID: PMC5131730 DOI: 10.1177/107327481602300404] [Citation(s) in RCA: 288] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial - a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care. METHODS Using a multilevel model as a framework, potential barriers to trial enrollment of racial and ethnic minorities were identified at system, individual, and interpersonal levels. Exactly how each level directly or indirectly contributes to doctor-patient communication was also reviewed. Selected examples of implemented interventions are included to help address these barriers. We then propose our own evidence-based intervention addressing barriers at the individual and interpersonal levels. RESULTS Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Interventions focused at each level have been relatively successful, but multilevel interventions have the greatest potential for success. CONCLUSION To increase the enrollment of racial and ethnic minorities in clinical trials, future interventions should address barriers at multiple levels.
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Affiliation(s)
- Lauren M Hamel
- Wayne State University, Karmanos Cancer Institute, Department of Oncology, Population Studies Disparities Research Program, Detroit, MI, USA.
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Interventions to improve child-parent-medical provider communication: A systematic review. Soc Sci Med 2016; 166:120-127. [DOI: 10.1016/j.socscimed.2016.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 07/25/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
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Thompson A. Hippocrates and the smart phone: The evolving parent and doctor relationship. J Paediatr Child Health 2016; 52:366-9. [PMID: 27145497 DOI: 10.1111/jpc.13170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew Thompson
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand
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De Oliveira GS, McCarthy RJ, Wolf MS, Holl J. The impact of health literacy in the care of surgical patients: a qualitative systematic review. BMC Surg 2015; 15:86. [PMID: 26182987 PMCID: PMC4504415 DOI: 10.1186/s12893-015-0073-6] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 07/09/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Inadequate health literacy affects more than 90 million Americans and it has been associated with adverse outcomes in the medicine field including increased hospitalization rates and greater mortality. Since surgical patients are often required to make complex decisions and adhere to complex instructions, health literacy may have a profound impact in the surgical practice. The main objective of the current study was to systematically evaluate the role of health literacy in surgical patients. METHODS A systematic search was performed to identify studies that evaluated the role of health literacy in the perioperative setting following the PRISMA guidelines. Only studies that examined health literacy using a validated instrument in the perioperative setting were included. RESULTS Ten studies including data on 1147 patients were included. The median (IQR) number of patients in the included studies was 101 (30 to 152). The majority of studies used the Short Test of Functional Literacy in adults (STOFHLA) to evaluate patients' health literacy. Five studies evaluated the patients preoperatively, four studies evaluated patients in the postoperative period and in one study the time of evaluation in relation to the surgical procedure was not defined. The lowest prevalence of inadequate health literacy was detected in kidney transplant patients, 6 out of 124 (5 %), while the highest prevalence of inadequate health literacy was detected in orthopedic patients having total joint replacement, 86 out of 126 (60 %). Inadequate health literacy in the preoperative period was associated with poor medical information comprehension and it may adversely affect adherence to preoperative medications and even modulate surgical disparities. Inadequate health literacy in the postoperative period was associated with poor comprehension of discharge instructions and worse kidney function in transplant recipients. CONCLUSIONS Health literacy seems to have a very significant impact in the care of surgical patients. More studies to establish the impact of poor health literacy on perioperative outcomes are needed.
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Affiliation(s)
- Gildasio S De Oliveira
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 241 East Huron St, F5-704, Chicago, IL, USA.
| | - Robert J McCarthy
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 241 East Huron St, F5-704, Chicago, IL, USA
| | - Michael S Wolf
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jane Holl
- Center for Health Care studies, Northwestern University, Chicago, USA
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Silver MP. Patient perspectives on online health information and communication with doctors: a qualitative study of patients 50 years old and over. J Med Internet Res 2015; 17:e19. [PMID: 25586865 PMCID: PMC4319073 DOI: 10.2196/jmir.3588] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 11/02/2014] [Accepted: 12/02/2014] [Indexed: 12/28/2022] Open
Abstract
Background As health care systems around the world shift toward models that emphasize self-care management, there is increasing pressure for patients to obtain health information online. It is critical that patients are able to identify potential problems with using the Internet to diagnose and treat a health issue and that they feel comfortable communicating with their doctor about the health information they acquire from the Internet. Objective Our aim was to examine patient-identified (1) problems with using the Internet to identify and treat a health issue, (2) barriers to communication with a doctor about online health information seeking, and (3) facilitators of communication with a doctor about patient searches for health information on the Internet. Methods For this qualitative exploratory study, semistructured interviews were conducted with a sample of 56 adults age 50 years old and over. General concerns regarding use of the Internet to diagnose and treat a health issue were examined separately for participants based on whether they had ever discussed health information obtained through the Internet with a doctor. Discussions about barriers to and facilitators of communication about patient searches for health information on the Internet with a doctor were analyzed using thematic analysis. Results Six higher-level general concerns emerged: (1) limitations in own ability, (2) credibility/limitations of online information, (3) anxiety, (4) time consumption, (5) conflict, and (6) non-physical harm. The most prevalent concern raised by participants who communicated with a doctor about their online health information seeking related to the credibility or limitations in online information. Participants who had never communicated with a doctor about their online health information seeking most commonly reported concerns about non-physical harm. Four barriers to communication emerged: (1) concerns about embarrassment, (2) concerns that the doctor doesn’t want to hear about it, (3) belief that there is no need to bring it up, and (4) forgetting to bring it up. Facilitators of communication included: (1) having a family member present at doctor visits, (2) doctor-initiated inquiries, and (3) encountering an advertisement that suggested talking with a doctor. Conclusions Overall, participants displayed awareness of potential problems related to online health information seeking. Findings from this study point to a set of barriers as well as facilitators of communication about online health information seeking between patients and doctors. This study highlights the need for enhanced patient communication skills, eHealth literacy assessments that are accompanied by targeted resources pointing individuals to high-quality credible online health information, and the need to remind patients of the importance of consulting a medical professional when they use online health resources to diagnose and treat a health issue.
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Affiliation(s)
- Michelle Pannor Silver
- Department of Anthropology/Health Studies, University of Toronto Scarborough Campus, Toronto, ON, Canada.
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