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Sweileh WM. Analysis and mapping the research landscape on patient-centred care in the context of chronic disease management. J Eval Clin Pract 2024; 30:638-650. [PMID: 38567707 DOI: 10.1111/jep.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 02/07/2024] [Accepted: 03/18/2024] [Indexed: 05/25/2024]
Abstract
RATIONALE Patient-centred care has emerged as a transformative approach in managing chronic diseases, aiming to actively involve patients in their healthcare decisions. AIMS AND OBJECTIVES This study was conducted to analyse and map the research landscape on patient-centred care in the context of chronic disease management. METHODS This study used Scopus to retrieve the relevant articles. The analysis focused on the growth pattern, highly cited articles, randomised clinical trials, patients and providers perspectives, facilitators and barriers, frequent author keywords, emerging topics, and prolific countries and journals in the field. RESULTS In total, 926 research articles met the inclusion criteria. There was a notable increase in the number of publications over time. Cancer had the highest number of articles (n = 379, 40.9%), followed by diabetes mellitus, and mental health and psychiatric conditions. Studies on patient-centred care in diabetic patients received the highest number of citations. The results identified 52 randomised controlled trials that covered four major themes: patient-centred care for diabetes management, shared decision-making in mental health and primary care, shared decision-making in cancer care, and economic evaluation and cost-effectiveness. The study identified 51 studies that examined the impact of tools such as computer-based systems, decision aids, smartphone apps, and online tools to improve patient-centred outcomes. A map of author keywords showed that renal dialysis, HIV, and atrial fibrillation were the most recent topics in the field. Researchers from the United States contributed to more than half of the retrieved publications. The top active journals included "Patient Education and Counselling" and "Health Expectations". CONCLUSION This study provides valuable insights into the research landscape of patient-centred care within the context of chronic diseases. The current study provided a comprehensive overview of the research landscape on patient-centred care, which can empower patients by raising their awareness about clinical experiences and outcomes.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology and Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Chuang YH, Wang CC, Hsiao CY, Lu CY, Wu JC, Hou WH. Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study. BMJ Open 2024; 14:e075693. [PMID: 38309751 PMCID: PMC10840022 DOI: 10.1136/bmjopen-2023-075693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan. DESIGN In-depth interviews and thematic analysis. SETTING Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022. PARTICIPANTS 21 outpatients with at least three visits for DJD and who were aware of SDM. RESULTS Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations. CONCLUSIONS In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.
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Affiliation(s)
- Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei, Taiwan
| | - Chih-Chien Wang
- College of Management, Da-Yeh University, Changhua, Taiwan
- Graduate Institute of Information Management, National Taipei University, Taipei, Taiwan
| | - Chih-Yin Hsiao
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yeh Lu
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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Alders I, Smits C, Brand P, van Dulmen S. Patient coaching: What do patients want? A mixed methods study in waiting rooms of outpatient clinics. PLoS One 2022; 17:e0269677. [PMID: 35679303 PMCID: PMC9182226 DOI: 10.1371/journal.pone.0269677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Effective communication in specialist consultations is difficult for some patients. These patients could benefit from support from a coach who accompanies them to and during medical specialist consultations to improve communication in the consultation room. This study aims to investigate patients’ perspective on interest in support from a patient coach, what kind of support they would like to receive and what characterizes an ideal patient coach. Methods We applied a mixed method design to obtain a realistic understanding of patients’ perspectives on a patient coach. Patients in the waiting rooms of outpatient clinics were asked to fill out a short questionnaire which included questions about demographic characteristics, perceived efficacy in patient-provider interaction and patients’ interest in support from a patient coach. Subsequently, patients interested in a patient coach were asked to participate in a semi-structured interview. The quantitative data were examined using univariate analysis and the qualitative interview data were analysed using content analysis. Results The survey was completed by 154 patients and eight of them were interviewed. Perceived efficacy in patient-physician interactions was the only variable that showed a significant difference between patients with and without an interest in support from a patient coach. The interviews revealed that a bad communication experience was the main reason for having an interest in support from a patient coach. Before the consultation, a patient coach should take the time to get to know the patient, build trust, and help the patient create an agenda, so take the patient seriously and recognize the patient as a whole person. During the consultation, a patient coach should support the patient by intervening and mediating when necessary to elicit the patient’s agenda. After the consultation, a patient coach should be able to explain and discuss medical information and treatment consequences. An ideal patient coach should have medical knowledge, a strong personality and good communication skills. Conclusion Especially patients who had a bad communication experience in a specialist consultation would like support from a patient coach. The kind of support they valued most was intervening and mediating during the consultation. To build the necessary trust, patient coaches should take time to get to know the patient and take the patient seriously. Medical knowledge, good communication skills and a strong personality were considered prerequisites for patient coaches to be capable to intervene in specialist consultations.
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Affiliation(s)
- Irène Alders
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- * E-mail:
| | - Carolien Smits
- Program Older Adults and Health, Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Paul Brand
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands
- Postgraduate School of Medicine, University Medical Centre Groningen, Groningen, Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
- Faculty of Caring Science, University of Borås, Borås, Sweden
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Tang C, Wang A, Yan J. Exploring motivations and resistances for implementing shared decision-making in clinical practice: A systematic review based on a structure-process-outcome model. Health Expect 2022; 25:1254-1268. [PMID: 35662361 PMCID: PMC9327808 DOI: 10.1111/hex.13541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/22/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Shared decision-making (SDM) as a multicollaborative approach is vital for facilitating patient-centred care. Considering the limited clinical practice, we attempted to synthesize the motivations and resistances, and investigate their mutual relationships for advancing the implementation of SDM. METHODS A comprehensive systematic review using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was performed. 'Shared decision making' was searched as the mesh term through PubMed, Web of Science and EBSCO from 2000 to 2021, and the quality of literature was appraised using the QualSyst Tool. Motivations and resistances were categorized based on content analysis and the 'structure-process-outcome' model. RESULTS From 8319 potential citations, 105 were included, comprising 53 qualitative studies (the average quality score is 0.92) and 52 quantitative studies (the average quality score is 0.95). A total of 42 categories of factors were identified into 11 themes and further grouped into three dimensions: structure, process and outcome. The structure dimension comprised six themes (71.43%), the process dimension contained four themes (11.01%) and the outcome dimension covered only one theme. Across all categories, decision-making time and patients' decision preparedness in the process dimension were the most reported, followed by physicians' communication skills and health care environment in the structure dimension. Analysis of implementation of SDM among various types of diseases showed that more influencing factors were extracted from chronic diseases and unspecified disease decisions. CONCLUSIONS The major determinants for the implementation of SDM are focused on the structural dimension, which challenges the health systems of both developed and low- and middle-income countries. Furthermore, we consider it important to understand more about the interactions among the factors to take integrated measures to address the problems and to ensure the effectiveness of implementing SDM. PATIENT OR PUBLIC CONTRIBUTION Patients, healthcare professionals and other stakeholders articulated their perspectives on the implementation of SDM actively, and these were adopted and analysed in this study. However, the above-mentioned individuals were not directly involved in the process of this study. Protocol was registered on PROSPERO (CRD42021259309).
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Affiliation(s)
- Changhai Tang
- School of Public Health, Weifang Medical University, Weifang, Shandong, China
| | - Anqi Wang
- School of Public Health, Weifang Medical University, Weifang, Shandong, China
| | - Jingjing Yan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
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Kasper J, Stensdal LA, Kienlin S, Eiring Ø, Neset T, Andersen-Hollekim T, Fog Heen A. New status report from Norway: Implementation of patient involvement in Norwegian health care. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:105-112. [PMID: 35618624 DOI: 10.1016/j.zefq.2022.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
In Norway, shared decision-making (SDM) is on the top of the priorities announced by the health authorities. Accountability for implementing this priority has been delegated to the four health regions, and from there into particular departments, hospital trusts, working groups or SDM coordinators. Using abundant public funding, different approaches to producing and implementing patient decision aids have been developed. However, none of these is implemented by any Norwegian services on a regular basis, while the accessible decision aids on the national health platform are not quality approved and in very little use. An ongoing new project is aimed to resolve this dilemma. Health professional training has been developed as a meta-curriculum with multiple modules, adaptive to setting and user group, and designed as an open-source learning platform, based upon the experience of "SDM Ambassadors" delivering the training. Most of the modules are already implemented on a regular basis in the South-Eastern Health Region, and 5000 health care professionals have already graduated from the training modules. However, in the standard patient pathways, and in most of the national medical guidelines, the patient is still considered to be a passive receiver of directives or recommendations, rather than an active participant in their own health decisions. Considerable structural implementation has been done in the education guidelines of all health professions on all levels to embed SDM principles. Teaching in SDM skills, quality of information and evidence-based nursing has become standard in most of the programs at Norwegian universities. Nevertheless, we currently still have no reliable estimate on the degree to which patients are actually involved in their own health decision-making. Further efforts in the process of implementing the patient's choice in the health system should involve the municipal services, follow a research-based strategy, include monitoring and consider the quality level of the informational environment of health-related decisions.
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Affiliation(s)
- Jürgen Kasper
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMET Metropolitan University, Oslo, Norway.
| | - Lilli-Ann Stensdal
- The South-Eastern Norway Regional Health Authority, User representatives board, Hamar, Norway
| | - Simone Kienlin
- Faculty of Health Sciences, Department of Health and Caring Sciences, UiT -The Arctic University of Norway, Alta, Norway; The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway
| | - Øystein Eiring
- Norwegian Institute of Public Health, Innlandet Hospital Trust, Norway
| | - Tore Neset
- Norwegian Regional Advisory unit on Patient Education, Kristiansand, Norway
| | - Tone Andersen-Hollekim
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Anja Fog Heen
- Dept. of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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A qualitative evidence synthesis using meta-ethnography to understand the experience of living with osteoarthritis pain. Pain 2022; 163:e1169-e1183. [PMID: 35504032 DOI: 10.1097/j.pain.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Osteoarthritis pain affects the lives of a large number of people around the world. Understanding other people's experience is integral to effective care and qualitative research can have an important part to pay in education and good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis in order to incorporate this knowledge into an educational resource. We comprehensively searched four bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10123 titles, 548 abstracts and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world. We developed 7 themes from more than 600 findings: it is part of my life's tapestry; (yet) it is consuming me; it constrains my body and my occupations; I am becoming separated yet dependent; I accept, but I will not let it define me; (yet) this makes me feel less than the person I was. Our findings highlight the profound impact that osteoarthritis can have on people's lives and the struggle to hold onto a sense of self. They indicate that recognising these losses, and taking osteoarthritis seriously, is an integral part of effective healthcare. This finding may be transferable beyond this condition.
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Chung FF, Wang PY, Lin SC, Lee YH, Wu HY, Lin MH. Shared clinical decision-making experiences in nursing: a qualitative study. BMC Nurs 2021; 20:85. [PMID: 34074284 PMCID: PMC8167946 DOI: 10.1186/s12912-021-00597-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/06/2021] [Indexed: 01/09/2023] Open
Abstract
Background Shared decision making (SDM) is a patient-centered nursing concept that emphasizes the autonomy of patients. SDM is a co-operative process that involves information exchange and communication between medical staff and patients for making treatment decisions. In this study, we explored the experiences of clinical nursing staff participating in SDM. Methods This study adopted a qualitative research design. Semistructured interviews were conducted with 21 nurses at a medical center in northern Taiwan. All interview recordings were transcribed verbatim. Content analysis was performed to analyze the data. Results The findings yielded the following three themes covering seven categories: knowledge regarding SDM, trigger discussion and coordination, and respect of sociocultural factors. Conclusions The results of this study describe the experiences of clinical nursing staff participating in SDM and can be used as a reference for nursing education and nursing administrative supervisors wishing to plan and enhance professional nursing SDM in nursing education. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00597-0.
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Affiliation(s)
- Fen-Fang Chung
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, R.O.C
| | - Pao-Yu Wang
- Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan, R.O.C
| | - Shu-Chuan Lin
- Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Yu-Hsia Lee
- Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Hon-Yen Wu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C.,Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, R.O.C.,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Mei-Hsiang Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Mingde 1st Rd. Beitou Dist, Taipei, Taiwan, R.O.C..
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Cost-sensitive probability for weighted voting in an ensemble model for multi-class classification problems. APPL INTELL 2021. [DOI: 10.1007/s10489-020-02106-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AbstractEnsemble learning is an algorithm that utilizes various types of classification models. This algorithm can enhance the prediction efficiency of component models. However, the efficiency of combining models typically depends on the diversity and accuracy of the predicted results of ensemble models. However, the problem of multi-class data is still encountered. In the proposed approach, cost-sensitive learning was implemented to evaluate the prediction accuracy for each class, which was used to construct a cost-sensitivity matrix of the true positive (TP) rate. This TP rate can be used as a weight value and combined with a probability value to drive ensemble learning for a specified class. We proposed an ensemble model, which was a type of heterogenous model, namely, a combination of various individual classification models (support vector machine, Bayes, K-nearest neighbour, naïve Bayes, decision tree, and multi-layer perceptron) in experiments on 3-, 4-, 5- and 6-classifier models. The efficiencies of the propose models were compared to those of the individual classifier model and homogenous models (Adaboost, bagging, stacking, voting, random forest, and random subspaces) with various multi-class data sets. The experimental results demonstrate that the cost-sensitive probability for the weighted voting ensemble model that was derived from 3 models provided the most accurate results for the dataset in multi-class prediction. The objective of this study was to increase the efficiency of predicting classification results in multi-class classification tasks and to improve the classification results.
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