Development of an observational tool to assess health coaching fidelity

Systematic review of observational coding systems to assess patient-healthcare professional interactions

OBJECTIVES

Systematic coding is used to study interactions between patients and healthcare professionals from an independent observer perspective. Many coding systems are available, but an up-to-date overview is lacking. We aimed to: (1) provide a comprehensive overview of systems for systematic coding of patient-healthcare professional interactions; and describe their 2) general characteristics and development, and 3) validation and adaptation.

METHODS

We systematically searched peer-reviewed empirical articles in five databases (Cochrane, Embase, PubMed/Medline, CINAHL, PsychINFO) using variations of the following keywords: (i) patient and/or other stakeholder, (ii) healthcare professional (iii), interactions in healthcare, (iv) coding tool, and (v) development and/or validation. All titles/abstracts and full-texts were screened independently and in duplicate. Additionally, coding systems were identified through an earlier review, an open-access research database, and a forward-reference search of all included coding systems up to that point. For all eligible systems, we extracted characteristics and psychometric properties.

RESULTS

From a total of 6950 identified articles from literature databases, 188 full-text articles were screened. Thirty-five articles were included from additional sources. In total, we included 124 articles describing 98 coding systems. Systems were highly variable in terms of topic (e.g., patient-centered communication, shared decision making, behavior change counseling), clinical context (e.g., oncology, pediatrics, generic), rigor of development and reporting, coding complexity, and extent of psychometric testing. Inter-rater reliability was reported for most coding systems; only few were tested for other types of reliability or for validity.

CONCLUSIONS

A plethora of coding systems are available, but more systematic reporting and psychometric testing are urgently needed to enhance evidence of validity. Testing may initially focus on the most relevant and broadly applicable coding systems.

PRACTICE IMPLICATIONS

These results can aid researchers in selecting the most suitable coding system for their purposes. Researchers may consider using or adapting existing systems, before developing new coding systems.

Towards multi-faceted outcomes of participation-based interventions: mapping the PREP's effects for children and youth with disabilities

PURPOSE

Systematically organizing participation effects may guide participation-based research designs in rehabilitation. This perspective paper uses existing evidence on Pathways and Resources for Engagement and Participation (PREP) to showcase the multitude of effects from a single intervention and synthesize the magnitude of these effects.

METHODS

An outcome matrix of participation effects comprising three dimensions (intermediate, instrumental, ultimate) and two levels (transient, enduring) was used to systematically map PREP's effects. Forest plot demonstrated clinically important changes in the Canadian Occupational Performance Measure (COPM) across studies. Effect sizes were calculated.

RESULTS

The majority of outcomes from 11 studies were mapped to ultimate-transient effects (e.g., changes in participation of self-chosen activities), followed by instrumental-transient effects (e.g., changes in motor body functions). Fewer outcomes were mapped to ultimate-enduring effects (e.g., changes of participation for a longer period or across settings) or intermediate-enduring effects (e.g., therapist-applied knowledge), demonstrating the gaps for investigating enduring effects. COPM changes in most studies (89%) showed clinical significance with small to large effects.

CONCLUSIONS

Systematic mapping from PREP example guides categorizing multidimensional outcomes. Future participation-based studies can employ individual-based mixed-methods designs to delve into the long-lasting enduring outcomes of youth capacity-building and the transformative process of pursuing meaningful participation goals.

A Rubric to Assess the Design and Intervention Quality of Randomized Controlled Trials in Health and Wellness Coaching

Objective

To collect health and wellness coaching (HWC) literature related to treatment of obesity and Type 2 Diabetes (T2D) for systematic assessment using a novel rubric.

Data Source

Pubmed, CINAHL, and PsychInfo.

Study Inclusion and Exclusion

Given 282 articles retrieved, only randomized and controlled trials meeting a HWC criteria-based definition were included; studies with intervention <4 months or <4 sessions were excluded.

Data Extraction

Rubric assessment required details of two theoretical frameworks (i.e., study design and HWC intervention design) be extracted from each included paper.

Data Synthesis

Data were derived from a 28-item rubric querying items such as sampling characteristics, statistical methods, coach characteristics, HWC strategy, and intervention fidelity.

Results

29 articles were reviewed. Inter-rater rubric scoring yielded high intraclass correlation (r = .85). Rubric assessment of HWC literature resulted in moderate scores (56.7%), with study design scoring higher than intervention design; within intervention design, T2D studies scored higher than obesity.

Conclusions

A novel research design rubric is presented and successfully applied to assess HWC research related to treatment of obesity and T2D. Most studies reported beneficial clinical findings; however, rubric results revealed moderate scores for study and intervention design. Implications for future HWC research are discussed.

Pilot study of implementing the Shared Healthcare Actions & Reflections Electronic systems in Survivorship (SHARE-S) program in coordination with clinical care

INTRODUCTION

Initial cancer survivorship care planning efforts focused on information sharing demonstrated limited impact on patient health outcomes. We designed the Shared Healthcare Actions & Reflections Electronic Systems in survivorship (SHARE-S) program to enhance survivorship guideline implementation by transitioning some effort from clinicians to technology and patients through supporting health self-management (e.g., healthy lifestyles).

METHODS

We conducted a single-group hybrid implementation-effectiveness pilot study. SHARE-S incorporated three strategies: (1) e-referral from the clinical team for patient engagement, (2) three health self-management coach calls, and (3) text messages to enhance coaching. Our primary implementation measure was the proportion of patients e-referred who enrolled (target >30%). Secondary implementation measures assessed patient engagement. We also measured effectiveness by describing changes in patient health outcomes.

RESULTS

Of the 118 cancer survivor patients e-referred, 40 engaged in SHARE-S (proportion enrolled = 34%). Participants had a mean age of 57.4 years (SD = 15.7), 73% were female, 23% were Black/African American, and 5 (12.5%) were from a rural location. Patient-level adherence to coach calls was >90%. Changes from baseline to follow-up showed at least a small effect (Cohen's d = 0.2) for improvements in: mindful attention, alcohol use, physical activity, fruit and vegetable intake, days of mindfulness practice, depressive symptoms, ability to participate in social roles and activities, cancer-specific quality of life, benefits of having cancer, and positive feelings.

CONCLUSION

The SHARE-S program successfully engaged cancer survivor patients. Once enrolled, patients showed promising improvements in health outcomes. Supporting patient self-management is an important component of optimizing delivery of cancer survivorship care.

Holistic Wellness Coaching for Older Adults: Preliminary Evidence for a Novel Wellness Intervention in Senior Living Communities

Although resident wellness is increasingly a priority in senior living communities, there are few programs that promote holistic wellness in later life. A total of 79 residents (ages 71 to 97; M = 84.27, SD = 6.46) from eight senior living communities completed a pilot study of a novel, staff-led wellness coaching program consisting of resident-driven goals and individual and group coaching sessions. Participants completed surveys at three time points (pre-program, post-program, and 1-month follow-up). Repeated measures ANOVAs revealed positive changes in resident health satisfaction, physical quality of life (QOL), psychological QOL, loneliness, relatedness, competence, and sense of purpose. Some of these results (i.e., psychological QOL, loneliness) persisted at follow-up. Residents reported high satisfaction with the program. These findings have implications for the application of holistic wellness frameworks in later life, as well as the development and implementation of wellness coaching programs with older adults.

Optimising telephone triage of patients calling for acute shortness of breath during out-of-hours primary care: protocol of a multiple methods study (Opticall)

INTRODUCTION

Callers with acute shortness of breath (SOB) are a challenge for telephone triage at out-of-hours primary care (OHS-PC) as SOB could be the sign of a potentially life-threatening disease, yet mostly is a symptom of a broad range of self-limiting disorders. Current telephone triage practice is mainly expert based and clear evidence on accuracy, safety and efficiency of the use of the Netherlands Triage Standard (NTS) by triage nurses based on the eventual clinical outcome is lacking for this domain.

METHODS AND DATA ANALYSIS

Multiple methods study in five OHS-PC services in the Utrecht region, the Netherlands. Data will be collected from OHS-PC electronic health records (EHR) and backed up tapes of telephone triage conversations, which will be linked to routine primary care EHR data. In cross-sectional studies, we will (1) validate the NTS urgency classification for adults with SOB against final diagnoses and (2) develop diagnostic prediction models for urgent diagnoses (eg, composite endpoint of urgent diagnoses, pulmonary embolism, acute coronary syndrome, acute heart failure and pneumonia). We will develop improvement measures for the use of the NTS by triage nurses through practice observations and semistructured interviews with patients, triage nurses and general practitioners (GPs). In an action research approach, we will, in collaboration with these stakeholders, implement and evaluate our findings in both GP and triage nurse educational programmes as well as in OHS-PC services.

ETHICS AND DISSEMINATION

The Medical Ethics Review Committee Utrecht, the Netherlands, approved the study protocol (protocol 21/361). We will take into account the 'code of conduct for responsible research' of the WHO, the EU General Data Protection Regulation and the 'Dutch Medical Treatment Contracts Act'. Results will be disseminated in peer-reviewed publications and at (inter)national meetings.

TRIAL REGISTRATION NUMBER

NL9682.