What are the contents of patient engagement interventions for older adults? A systematic review of randomized controlled trials

Research status and hotspots of patient engagement: A bibliometric analysis

OBJECTIVE

This analysis aimed to examine current global trends in patient engagement research and identify critical focus areas.

METHODS

We searched the Web of Science Core Collection database for pertinent literature from January 1, 2000 to December 31, 2022. CiteSpace and VOSviewer were used for information analysis.

RESULTS

The bibliometric analysis covered 11,386 documents from 140 countries/regions, featuring contributions from 12,731 organizations and 45,489 authors. The United States and The University of Toronto were the most prolific country and institution. Leading researchers in publications and citations included Hibbard JH, Elwyn G, Legare F, and Street RL. Patient Education and Counseling led among journals.

CONCLUSION

Patient engagement research has experienced significant growth over the past two decades. The core of patient engagement research includes concepts, content, practical frameworks, impact assessment, and barriers. The current research focal points revolve around interventions for chronic disease patients, integrating digital health technologies to improve engagement, and incorporating patient-reported outcomes (PROs) into healthcare delivery.

PRACTICE IMPLICATIONS

This study unveils key trends and emphasizes global collaboration, strategic focus on chronic disease interventions, integration of digital health technologies, and the pivotal role of PROs. Embracing these insights promises to optimize healthcare practices and empower patients on a global scale.

Uncovering Nursing Communication Strategies and Relational Styles to Foster Patient Engagement in Oncology: A Scoping Review

Nurses play an active role in fostering engagement of oncological patients, and, therefore, adopting effective communication and interpersonal skills is crucial. However, the nurse-patient relationship and communication strategies are frequently undervalued. This scoping review aims to address this gap with a twofold objective: (1) to explore the existing literature to identify communication strategies and relational styles employed by nurses to promote patient engagement in non-pediatric oncology patients; (2) to assess current knowledge on this topic to determine the need for future research. The search was conducted on different scientific databases and grey literature. The review was conducted following the methodology outlined in the Joanna Briggs Institute guidance for scoping reviews and the updated version of the PRISMA-ScR Checklist. Thirteen articles were included in the study. The studies in total enrolled 863 participants. Four clusters of nursing interventions were identified, encompassing communication strategies and relational styles of varying complexity, along with ten categories of general outcomes emerging from their implementation. This study summarizes the current knowledge regarding nursing communication strategies and relational styles used to promote patient engagement in oncological patients. Further research is needed, to evaluate and integrate the researched techniques, tools, and interventions for future clinical nursing practice.

Effectiveness of a nurse-led personalized patient engagement program to promote type 2 diabetes self-management: A randomized controlled trial

PHEinAction® is a theory-based nurse-led patient engagement intervention developed among an Italian older adult population with various chronic diseases to facilitate cognitive, emotional, and behavioral processes in promoting individuals' active roles. This study aims to adapt and evaluate the effectiveness of PHEinAction® on diabetes self-management (DSM) among Turkish type 2 diabetes mellitus patients. First, the generic content of the intervention was customized for diabetes management and adapted for the Turkish population, including back-forward translation and expert panel evaluation; then, a randomized controlled trial was conducted with 51 adult diabetes patients randomly assigned to intervention or the control group receiving the usual care. The intervention consisted of two in-person sessions of 4-week intervals, a telephone consultation, and home-based written exercises, which involved personalized care activities addressing individuals' engagement levels and covering the cognitive, emotional, and behavioral aspects. The scores for treatment adherence, self-efficacy, and patient engagement had significantly improved with a large size effect in the intervention group at the fourth-week follow-up compared with the control group. Findings suggest that the nurse-led personalized patient engagement program could effectively promote DSM.

Patients' perspectives of factors influencing active participation in healthcare interactions: A qualitative study

OBJECTIVE

To understand patients' perspectives of factors influencing their active participation in healthcare interactions.

METHODS

A descriptive qualitative approach informed by naturalistic inquiry was used to secondarily analyse interview and focus group data from a study that co-designed a communication-skills learning resource for patients. The COM-B Behaviour Model was used to explore factors that influenced patient participation in healthcare communication. Thirty-nine participants took part in either individual interviews (n = 25) or a focus group (n = 14).

RESULTS

From the COM-B domains nine factors emerged: capability (personal characteristics, patient language and culture, emotion or stress arising from the interaction), opportunity (time constraints, empowering actions, patient-clinician relationship, having a support person present) and motivation (preparation prior to the interaction, perception of patient-provider power imbalance).

CONCLUSION

Many of the factors influencing active patient participation are modifiable, suggesting barriers to effective communication are not insurmountable. Clinicians and patients both play a role in improving communication; effective strategies include agenda setting, cultural and communication skills training for staff, and teach-back.

PRACTICE IMPLICATIONS

Clinicians must be aware of the factors influencing patient active participation in healthcare interactions. Healthcare organisations should consider providing communication-skills training for clinicians so they can implement strategies to overcome communication barriers with patients.

Theory-driven development of an educative nutritional intervention (ENI) supporting older hospital patients to eat sufficiently, assisted by an eHealth solution: an intervention mapping approach

Background:

Insufficient protein and energy intake is a prevalent and serious problem in older hospital patients. Here, we describe the development of a program consisting of 1) an educative nutritional intervention (ENI) to support older hospital patients to participate in their own nutritional care using the eHealth solution Food’n’Go, and 2) a plan for education and support of healthcare professionals, enabling them to conduct the ENI. Further, we describe the evaluation of the acceptability of the program as perceived by nursing staff and dieticians.

Methods:

The Intervention Mapping (IM) framework was used to design and develop the ENI through six steps: 1) a logic model of the problem was developed; 2) performance objectives and related change objectives were defined for patients, relatives, and healthcare professionals; 3) the intervention was designed using relevant theory-based change methods; 4) program materials were produced; and finally, 5) implementation and maintenance were planned and 6) evaluation of the program was planned. End users (patients, relatives, and healthcare professionals) were involved in the design and development of the ENI.

Results:

Based on the logic model, the personal determinants (knowledge, skills, self-efficacy, outcome expectation, social support, attitude, and awareness) related to the patients and their relatives were addressed in the ENI, and those related to the healthcare professionals were addressed in the plan for their education and support. Theories of behavioral change, technology acceptance, and nutritional management for older persons were applied. A plan for evaluation of the effectiveness (intake of energy and protein) and feasibility of the ENI was conducted. The feasibility measurements were the behaviors and determinants related to the intervention outcome that were identified in the logic model of change. The ENI was perceived as acceptable by the nursing staff and dieticians.

Conclusion:

We developed a theory- and evidence-based intervention guided by the IM framework and a sociotechnical approach, which was perceived as acceptable and ready for use to support older hospital patients to eat sufficiently assisted by eHealth.

Giving voice to informal caregivers of community-dwelling older adults: A systematic review of empowerment interventions

Taking care for older adults can place informal caregivers at risk for developing health problems. Therefore, interventions aiming to empower informal caregivers have been developed. Empowerment refers to a health promotion process including strategies to improve informal caregivers' self-care behaviours, stress-management and caregiving skills. In literature, empowerment-oriented interventions often target subsamples of informal caregivers defined through the care receiver's condition. These interventions, however, do not adequately capture the complexity of care needs and might even exclude informal caregivers taking care for older people without a specific diagnosis or with a subthreshold condition. Therefore, the aim of this systematic review is to provide an overview of the content and effectiveness of empowerment-oriented interventions directed at informal caregivers of community-dwelling older adults. Following the PRISMA guidelines, a systematic review was performed by searching the following databases: PubMed, PsycINFO, EMBASE and Web of Science. From a total of 6798 unique publications, 13 intervention studies, of which seven randomised controlled trials, were eligible for inclusion. According to the Mixed Methods Appraisal Tool, eight studies scored poor. The intervention studies under review represented different domains of empowerment, with cultivation of positive feelings being the most prevalent one. Social participation and physical health received little attention in interventions. Although no adverse intervention effects were observed, the studies reported mixed results with 57 positive and 47 neutral effects. The limited number and poor quality of studies emphasise the need for future research investigating the effectiveness of empowerment-oriented interventions targeting informal caregivers of older adults.

Experiences of patients with multimorbidity with primary care and the association with patient activation: a cross-sectional study in Germany

OBJECTIVES

This study aimed to explore the association between patient activation and patients' experience of care among an elderly multimorbid population in Germany.

DESIGN

Cross-sectional study.

SETTING

Primary care practices in two German settings.

PARTICIPANTS

346 patients with 3 or more chronic conditions aged 65 years and over from 36 primary care practices.

OUTCOME MEASURES

Patient activation was measured with the patient activation measure (PAM). To assess patient experiences with primary care, a set of questions concerning domains of primary care were included. Multilevel regression analyses were performed to examine which domains of care were associated with patient activation.

RESULTS

Out of 1243 invited patients, a total of 346 took part in the study (participation rate 27.8 %). Mean PAM score was 76.1. Across all patients, 3.8% achieved PAM level 1, 7.5% level 2, 27.2% level 3% and 60.7% level 4. PAM scores suggest a highly activated patient group. In the regression analysis, three out ten domains of patients' experiences showed an association with patient activation. The domains 'being involved in decision as much as desired' (B=-8.56, p=0.012) and 'receiving a self-management plan' (B=6.51, p=0.051) were associated with higher patient activation scores. Patients with an up-to-date medication plan had lower patient activation scores (B=-12.01, p=0.041).

CONCLUSION

Specific domains of primary care were found to be associated with patient activation. To enhance patient activation, primary care physicians may increase involvement of patients in decisions. Future research should examine the causality of these associations.

TRIAL REGISTRATION NUMBER

DRKS00015718.

Nursing interventions to promote patient engagement in cancer care: A systematic review

BACKGROUND

Patient engagement is becoming increasingly relevant in cancer care. Nurses have been recognized as crucial in promoting active engagement of people with carcer. Despite the growing interest on this topic and the relevance of patient engagement interventions to improve patient' conditions, to the best of our knowledge there is no synthesis of the literature on the characteristics and impact of nurse-led patient engagement intervention for adults with cancer.

OBJECTIVE

This review aims to systematically summarize nurse-led patient engagement interventions for adult patients diagnosed with cancer and to describe the state of the art on the impact of these interventions on patients' outcomes.

DESIGN

Systematic review.

SETTING(S)

Hospital and outpatient care.

PARTICIPANTS

Adults with cancer.

METHODS

We searched PubMed, CINAHL, Embase, Scopus, Web of Science and Cochrane library from 2005 to 2021. We included randomized clinical trials, quasi-experimental studies and single-arm, pre-test/post-test studies written in English, Spanish, French and Italian. All the included articles reported nurse-led patient engagement interventions designed to improve patient engagement in the management of their own disease and to assess outcomes related to patient engagement. We appraised the methodological quality of the included articles with the Joanna Briggs Institute appraisal tools.

RESULTS

Twenty-four articles met the inclusion criteria. Four distinct types of nurse-led engagement interventions, showing different degrees of complexity, were classified: (i) generic health information delivery, (ii) patient-specific information delivery, (iii) personalized decision support and (iv) motivational support. These interventions were effective in supporting behavioral changes and reducing symptoms burden of adults with cancer. In addition, many of the retrieved studies showed significant increase in patients' knowledge, informed decisions making, perceived quality of nurse-patient interaction and quality of life after the engagement intervention.

CONCLUSIONS

This systematic review summarized a wide variety of nurse-led patient engagement interventions with different degrees of complexity. In addition, a significant positive effect of these interventions was found on outcomes such as patient activation, self-efficacy, health literacy and quality of life. Among those identified, nurse-led motivational interventions appear to be the most effective ones for improving engagement outcomes in adults with cancer.

REGISTRATION NUMBER

PROSPERO Nr: CRD42020146189.

Discharge Planning of Older Persons from Hospital: Comparison of Observed Practice to Recommended Best Practice

Older people are particularly vulnerable to hospital re-presentation following discharge. Ideal discharge planning processes facilitate the transition from hospital to home and prevent subsequent re-presentations to hospital. The objective of this study was to examine discharge planning processes in two Australian hospitals, compare them between sites and to best-practice recommendations. An ethnographic observational study of discharge planning processes was conducted at two general medical inpatient wards at a large tertiary hospital and a smaller regional hospital in Brisbane, Australia. Participants were patients and ward staff involved in discharge planning during a hospital admission. A literature review was conducted to elicit best-practice recommendations for discharge planning. Data for this study (duration: 112 h) were collected directly using field notes by a research assistant embedded in the ward. A directed qualitative content analysis approach was used for data analysis. Results were compared to best-practice recommendations. Findings indicate that both hospitals implemented various best-practice interventions to enhance communication, collaboration, coordination and patient/family engagement for optimal discharge planning. Strategies used were context specific and effective to varying degrees. Clear responsibilities and goals within the multidisciplinary team helped to create cohesive, well-functioning teams. More work is needed to engage patients and families in discharge planning, and to encourage health professionals to consider patients and family as active team members in the discharge planning process.

Effectiveness of patient activation interventions on chronic obstructive pulmonary disease self-management outcomes: A systematic review

BACKGROUND

Chronic obstructive pulmonary disease is the third leading cause of death worldwide. Although there is currently no cure for chronic obstructive pulmonary disease, the available self-management strategies can result in improving the symptoms, slowing the disease progression, reducing the frequency of acute exacerbations, improving the patients' quality of life and minimising health care utilisation-associated costs. Patient activation is often considered an essential driver of self-management; however, there are contradictory evidence about its impact on chronic obstructive pulmonary disease self-management.

OBJECTIVE

This review aims to fill this gap by collating the available evidence on the effectiveness of patient activation-driven chronic obstructive pulmonary disease self-management interventions.

METHODS

Databases including MEDLINE, Academic Search Complete, CINAHL Plus, Science Citation Index, Social Sciences Citation Index, Scopus, APA PsychInfo, EMBASE and ScienceDirect were searched for randomised controlled trials of patient activation-driven chronic obstructive pulmonary disease self-management interventions between 2004 and July 2020. The search terms included chronic obstructive pulmonary disease, self-management/self-care and patient activation/patient engagement.

FINDINGS

The initial search resulted in 645 articles, and after reviewing, 10 randomised controlled trials met the inclusion and exclusion criteria. Our review found that patient activation level had a positive association with chronic obstructive pulmonary disease self-management and clinical outcomes, and higher patient activation levels led to better outcomes. The interventions also led to moderate improvements in patient activation level. However, improved patient activation levels did not improve hospitalisation rates, quality of life and mental health.

CONCLUSION

Our findings suggest that patient activation can be used as a reliable tool for improving chronic obstructive pulmonary disease self-management and clinical outcomes; however, it should encompass all aspects of patient activation, especially the emotional aspect.

A Scoping Review of Person and Family Engagement in the context of Multiple Chronic Conditions

OBJECTIVE

To review definitions, concepts, and evidence regarding person and family engagement for persons with multiple chronic conditions (MCC) in order to identify opportunities to advance the field.

DATA SOURCE

Ovid MEDLINE STUDY DESIGN: We performed a two-step process: (1) a critical review of conceptual models of engagement to identify key concepts most pertinent to engagement among persons with MCC as a "launch pad" to our scoping review, and (2) a scoping review of reviews of engagement for persons living with MCC.

DATA COLLECTION/EXTRACTION METHODS

First, we critically reviewed six models of engagement. Second, our scoping review identified 1297 citations, with 67 articles meeting criteria for inclusion. Of these, we focused on reviews, of which there were nine titles/abstracts retained for full text consideration. Six full-text reviews were included in the final analysis. The purpose, review type, population, number/type of included studies, theoretical framework, and findings of each study were extracted and analyzed thematically.

PRINCIPAL FINDINGS

Conceptual models of engagement differ with respect to areas of emphasis (e.g., systems or clinical encounters) as well as attention to vulnerable populations; involvement of family; consideration of cost-benefit tradeoffs; and attention to outcomes that matter most. Our scoping review of reviews identified just one article explicitly focused on engagement interventions for those with MCC. Other reviews examined elements of self-management and involvement in decision-making, conceptually related to engagement without explicit use of the word. We find that existing evidence has predominantly described individual-level strategies rather than targeting organizations, systems, or policies. Barriers to engagement are not well described, nor are potential downsides to engagement. Family engagement is rarely considered.

CONCLUSIONS

Promising areas of future work include attention to barriers to engagement including trust, goal-based care, the design of structural changes to care delivery, tradeoffs between benefits and costs, and family engagement. This article is protected by copyright. All rights reserved.

Implementing enhanced patient care to promote patient engagement in HIV care in a rural setting in Kenya

BACKGROUND

Patient engagement is effective in promoting adherence to HIV care. In an effort to promote patient-centered care, we implemented an enhanced patient care (EPC) intervention that addresses a combination of system-level barriers including provider training, continuity of clinician-patient relationship, enhanced treatment dialogue and better clinic scheduling. We describe the initial implementation of the EPC intervention in a rural HIV clinic in Kenya, and the factors that facilitated its implementation.

METHODS

The intervention occurred in one of the rural Academic Model Providing Healthcare (AMPATHplus) health facilities in Busia County in the western region of Kenya. Both qualitative and quantitative data were collected through training and meeting proceedings/minutes, a patient tracking tool, treatment dialogue and a peer confirmation tool. Qualitative data were coded and emerging themes on the implementation and adaptation of the intervention were developed. Descriptive analysis including percentages and means were performed on the quantitative data.

RESULTS

Our analysis identified four key factors that facilitated the implementation of this intervention. (1) The smooth integration of the intervention as part of care that was facilitated by provider training, biweekly meetings between the research and clinical team and having an intervention that promotes the health facility agenda. (2) Commitment of stakeholders including providers and patients to the intervention. (3) The adaptability of the intervention to the existing context while still maintaining fidelity to the intervention. (4) Embedding the intervention in a facility with adequate infrastructure to support its implementation.

CONCLUSIONS

This analysis demonstrates the value of using mixed methods approaches to study the implementation of an intervention. Our findings emphasize how critical local support, local infrastructure, and effective communication are to adapting a new intervention in a clinical care program.

Effectiveness of a nurse-led, face-to-face health coaching intervention in enhancing activation and secondary outcomes of primary care users with chronic conditions

Prevalence of chronic diseases and multimorbidity is rising, and it remains unclear what the best strategy is for activating people with chronic conditions in their self-care. We designed a two-group quasi-experimental time series trial to examine the effectiveness of a nurse-led, face-to-face, individually-tailored health coaching (HC) intervention in improving patient activation and secondary outcomes (self-efficacy, quality of life, anxiety and depression symptoms, medication adherence, hospitalization and emergency visits) among primary care users with chronic conditions. A total of 118 people with chronic conditions were recruited through a primary care center and allocated to either the intervention group (IG) (n = 58) or control group (CG) (n = 60). The IG received a nurse-led individually-tailored HC intervention involving 4-6 face-to-face multicomponent sessions covering six core activation topics. The CG received usual primary care. Data were collected at baseline, after the intervention (6 weeks after baseline for controls) and at 6 and 12 months from baseline. Compared with controls, the IG had significantly higher patient activation scores after the intervention (73.29 vs. 66.51, p = .006). However, this improvement was not maintained at follow-up and there were no significant differences in secondary outcomes across the study period. HC may be an effective strategy for achieving short-term improvements in the activation of primary care users with chronic conditions. Further studies with different methodological approaches are needed to elucidate how HC may improve and sustain changes in patient activation.

"#I-Am-Engaged": Conceptualization and First Implementation of a Multi-Actor Participatory, Co-designed Social Media Campaign to Raise Italians Citizens' Engagement in Preventing the Spread of COVID-19 Virus

The COVID-19 pandemic forced health authorities around the world to introduce public health measures to contain the risks of contagion. This greatly impacted on citizens' quality of life, often raising concerns and reactance. There is an ongoing urgent need to promote and sustain behavioral changes and adherence to preventive measures. Based on the theoretical framework of the Patient Health Engagement Model and a participatory co-design process, a social media campaign aimed at improving citizens' health engagement toward behavioral change for preventing the spread of COVID-19 was promoted in Italy in the early months of the pandemic. In this paper, we describe the methodological process adopted to develop the campaign, its characteristics, and the first results-in terms of audience reach and engagement in its early implementation. The discussion of this grounded-up and citizen-centered approach to social campaign development highlights key ways of promoting learning, engaging citizens, and supporting their participation in the co-production of educational interventions for behavioral change toward preventive actions.

Effects of a Death Education Intervention for Older People with Chronic Disease and Family Caregivers: A Quasi-Experimental Study

PURPOSE

To investigate the effectiveness of a structured death education program for older adults with chronic illness and their family caregivers.

METHODS

This study adopted two-group, nonrandomized quasi-experimental design. Patient-caregiver dyads in the intervention group (N = 40 dyads) engaged in the death education program at the bedside once a week for 5 weeks, and were compared with participants (N = 40 dyads) in the control group who received usual health education. The program consisted of five sessions based on the Interaction Model of Client Health Behavior. Death attitude, death competence, well-being, family function, and satisfaction were measured at baseline (T0), immediately after the intervention (T1), and 1 month later (T2). Data collection was conducted from July 30, 2019, to December 30, 2019.

RESULTS

The intention-to-treat analysis The intention-to-treat analysis of between groups at 1-month follow-up revealed that the intervention group had greater decreases in the fear of death (p=.002, 95% CI -2.53, -0.47; p<.001, 95% CI -3.61, -1.65) and death avoidance (p<.001, 95% CI -3.46, -1.84; p<.001, 95% CI -3.89, -2.43), had greater increases in the neutral acceptance (p=.032, 95% CI 0.05, 1.38; p<.001, 95% CI 0.99, 2.56) and death competence (p<.001, 95% CI 4.10, 8.01; p<.001, 95% CI 7.80, 12.11) in patients and caregivers, respectively. There were significant intergroup differences over time for patient well-being of (p<.001, 95% CI 3.06, 9.74) and satisfaction of (p<.001, 95% CI 2.01, 4.59). Results were consistent with the results from the sensitivity analysis.

CONCLUSION

This study demonstrated the feasibility and benefits of death education in hospitals and provided an implementation plan for nursing professionals. Nurses should consider providing death education for older adults with chronic diseases and their families to promote the development of palliative care and the quality of end-of-life.

Italian Consensus Statement on Patient Engagement in Chronic Care: Process and Outcomes

Patient engagement has been recognized as a key priority in chronic care. However, scholars agree that guidelines are needed to ensure effective patient engagement strategies. To this end, a Consensus Conference process was promoted with the following methodological steps: (1) extensive literature review about patient engagement initiatives in chronic care; (2) a stakeholders survey to collect best practices and (3) workshops with experts. On the basis of the information collected, a consensus statement was drafted, revised, and finalized by a panel of select renowned experts. These experts agreed in defining engagement as an eco-systemic concept involving multiple actors all of which contribute to influence patients’ willingness and ability to engage in chronic care. Moreover, experts recommended, whenever possible, to adopt standardized instruments to assess engagement levels and related unmet needs. Then, experts strongly advised appropriate trainings for healthcare professionals about patient engagement strategies. Furthermore, the importance of promoting healthcare professionals’ wellbeing has been advocated. Family caregivers, as well as patients’ organizations - should be trained and engaged to increase the effectiveness of interventions dedicated to patients. Finally, experts agreed that digital technologies should be considered as a crucial enhancer for patient engagement in chronic care.

Interventions to Enhance Patient and Family Engagement Among Adults With Multiple Chronic Conditions: A Systematic Scoping Review

PURPOSE

In the United States, 42% of adults, and 81% of adults over 65 years of age live with multiple chronic condition (MCC). Current interventions to facilitate engagement in care focus primarily on the patient; however, many individuals with MCC manage and live with their conditions within the context of their family. This review sought to identify interventions used to facilitate patient and/or family engagement among adults with MCC.

METHODS

We adhered as closely as possible to PRISMA guidelines and conducted a systematic scoping review using a modified approach by Arksey and O'Malley. We searched PubMed, Web of Science, and Scopus using terms related to MCC, patient and family engagement, and intervention. We included articles that: (1) were published in English; (2) were peer-reviewed; (3) described an engagement intervention (with or without a comparator); and (4) targeted individuals with MCC. We abstracted data from included articles and classified them using the Multidimensional Framework for Patient and Family Engagement in Health and Health Care, and the Classification Model of Patient Engagement.

RESULTS

We identified 21 discrete interventions. Six (29%) were classified as having the highest degree of engagement. Eighteen (85%) focused on engagement at the direct care level. Only one was specifically designed to engage families.

CONCLUSIONS

Many engagement interventions currently exist for adults with MCC. Few of these interventions foster the highest degree of engagement; most focus on engagement at the level of direct care and do not specifically target family member involvement.

Clinician-patient communication during the diagnostic workup: The ABIDE project

Introduction

We aimed to describe clinician-patient communication in the diagnostic process of memory clinics, specifically clinician behavior known to facilitate knowledgeable participation of patients during consultations.

Methods

In this multicenter, observational study, we audio-recorded routine diagnostic consultations of 41 clinicians and 136 patients/caregivers at eight memory clinics. Patients/caregivers completed surveys after each audiotaped consultation. We used a study-specific coding scheme to categorize communication behavior.

Results

Clinicians often provided information on (results of) diagnostic testing. They infrequently invited questions and/or checked understanding. Clinician behavior to involve patients in decision-making about diagnostic testing was limited. Of note, patients/caregivers rarely expressed their information or involvement preferences. Yet, approximately, one quarter of them would have liked to receive more information.

Discussion

Involving patients more explicitly by means of shared decision-making could benefit the quality of care provided in memory clinics because it enables clinicians to attune the diagnostic workup to the individual patient's needs.

•

Considering patient preferences in the diagnostic process enables personalized care.

•

Knowledgeable participation in diagnostic consultations is therefore warranted.

•

Clinicians often provided information on diagnostic procedures and test results.

•

Yet, they showed limited behavior to promote patients' understanding.

•

And patients were seldom involved in decision-making about diagnostic testing.

Exploring the early-stage implementation of a patient engagement support intervention in an integrated-care context-A qualitative study of a participatory process

AIMS AND OBJECTIVES

To explore: (a) the usual patient education in different care services of an integrated-care organisation, (b) the healthcare professionals' experiences with adding a patient engagement support intervention called PHEinAction in the patient education practice and (c) the co-designed activities to assist the implementation.

BACKGROUND

Including individual support for engaging patients in care into patient education practice is a key effort of integrated-care organisations. However, there is a paucity of studies exploring the implementation of similar efforts.

DESIGN AND METHODS

We conducted a qualitative study of a participatory process with 26 healthcare professionals-mostly nurses (n = 22) with leading roles (n = 12)-of different care services in one Italian integrated-care organisation. Data were collected through multiple sources (observations and shadowing; interviews; documents/artefacts; workshops) during the first 6 months of the implementation of PHEinAction. A thematic analysis using a hybrid approach was performed. COREQ guidelines were followed.

RESULTS

The existing patient education practice of hospital, ambulatory and community healthcare services of the organisation differed in contents, perceived responsibility and focus area. These key aspects of patient education influenced the healthcare professionals' experiences with the implementation. The experiences informed the activities enacted during the participatory process to assist the implementation, from the co-creation of artefacts to the deployment of peer group supervision.

CONCLUSION

The implementation of a brief intervention for patient engagement support required a process of adjustment to the single settings and a continuous support to healthcare professionals. It also required performing complementary activities to assist the implementation and its adoption in new care services.

RELEVANCE TO CLINICAL PRACTICE

This qualitative study contributes to the understanding of the pitfalls and strategies that may surround embedding patient engagement support in the educational practice of complex organisations, potentially facilitating the deployment to other care settings.