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Lochmann M, Girodet M, Despax J, Baudry V, Duranti J, Mastroianni B, Vanacker H, Vinceneux A, Brahmi M, Renard O, Verlingue L, Amini-Adle M, Swalduz A, Gautier J, Ducimetière F, Anota A, Cassier PA, Chvetzoff G, Christophe V. Qualitative evaluation of motives for acceptance or refusal of early palliative care in patients included in early-phase clinical trials in a French comprehensive cancer center: the PALPHA study. Support Care Cancer 2024; 32:353. [PMID: 38748187 DOI: 10.1007/s00520-024-08535-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/29/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The integration of palliative care (PC) into oncological management is recommended well before the end of life. It improves quality of life and symptom control and reduces the aggressiveness of end-of-life care. However, its appropriate timing is still debated. Entry into an early-phase clinical trial (ECT) represents hopes for the patient when standard treatments have failed. It is an opportune moment to integrate PC to preserve the patient's general health status. The objective of this study was to evaluate the motives for acceptance or refusal of early PC management in patients included in an ECT. METHODS Patients eligible to enter an ECT were identified and concomitant PC was proposed. All patients received exploratory interviews conducted by a researcher. Their contents were analyzed in a double-blind thematic analysis with a self-determination model. RESULTS Motives for acceptance (PC acceptors: n = 27) were both intrinsic (e.g., pain relief, psychological support, anticipation of the future) and extrinsic (e.g., trust in the medical profession, for a relative, to support the advance of research). Motives for refusal (PC refusers: n = 3) were solely intrinsic (e.g., PC associated with death, negative representation of psychological support, no need for additional care, claim of independence). CONCLUSIONS The motives of acceptors and refusers are not internalized in the same way and call for different autonomy needs. Acceptors and refusers are influenced by opposite representations of PC and a different perception of mixed management.
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Affiliation(s)
- Mathilde Lochmann
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France.
| | - Magali Girodet
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Evaluation Médicale et Sarcomes (EMS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Johanna Despax
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Valentine Baudry
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Julie Duranti
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Bénédicte Mastroianni
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Hélène Vanacker
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Armelle Vinceneux
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Mehdi Brahmi
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Olivier Renard
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Loïc Verlingue
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Mona Amini-Adle
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Aurélie Swalduz
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Julien Gautier
- Direction de la Recherche Clinique et de l'Innovation (DRCI), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Françoise Ducimetière
- Evaluation Médicale et Sarcomes (EMS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Amélie Anota
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Direction de la Recherche Clinique et de l'Innovation (DRCI), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Philippe A Cassier
- Département de Cancérologie Médicale, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
| | - Gisèle Chvetzoff
- Département Interdisciplinaire des Soins de Support en Oncologie, Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France
| | - Véronique Christophe
- Département des Sciences Humaines et Sociales (SHS), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Centre de Recherche sur le Cancer de Lyon (CRCL), Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex, France
- Université Claude Bernard Lyon 1 (UCBL), 43 Bd du 11 Novembre 1918, 69100, Villeurbanne, France
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Tseng TY, Mitchell MM, Chander G, Latkin C, Kennedy C, Knowlton AR. Patient-centered Engagement as a Mediator in the Associations of Healthcare Discrimination, Pain Care Denial, and Later Substance Use Among a Sample of Predominately African Americans Living with HIV. AIDS Behav 2024; 28:429-438. [PMID: 38060111 DOI: 10.1007/s10461-023-04235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Chronic pain is prevalent and often under-addressed among people with HIV and people who use drugs, likely compounding the stress of discrimination in healthcare, and self-medicating along with its associated overdose risk or other problematic coping. Due to challenges in treating pain and HIV in the context of substance use, collaborative, patient-centered patient-provider engagement (PCE) may be particularly important for mitigating the impact of pain on illicit drug use and promoting sustained recovery. We examined whether PCE with primary care provider (PCE-PCP) mediated the effects of pain, discrimination, and denial of prescription pain medication on later substance use for pain among a sample of 331 predominately African Americans with HIV and a drug use history in Baltimore, Maryland, USA. Baseline pain level was directly associated with a higher chance of substance use for pain at 12 months (Standardized Coefficient = 0.26, p < .01). Indirect paths were observed from baseline healthcare discrimination (Standardized Coefficient = 0.05, 95% CI=[0.01, 0.13]) and pain medication denial (Standardized Coefficient = 0.06, 95% CI=[0.01, 0.14]) to a higher chance of substance use for pain at 12 months. Effects of prior discrimination and pain medication denial on later self-medication were mediated through worse PCE-PCP at 6 months. Results underscore the importance of PCE interpersonal skills and integrative care models in addressing mistreatment in healthcare and substance use in this population. An integrated approach for treating pain and substance use disorders concurrently with HIV and other comorbidities is much needed. Interventions should target individuals at multiple risks of discriminations and healthcare professionals to promote PCE.
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Affiliation(s)
- Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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3
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Shah RH, Blake D, Celso B, Bell C, Turner A. Does Samaritan, a Digital Support Platform, Help Improve Social Determinants of Health for Mental Health Offenders in Jacksonville, Florida? Cureus 2024; 16:e52915. [PMID: 38406034 PMCID: PMC10893824 DOI: 10.7759/cureus.52915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Background The objective of this study is to evaluate if access to Samaritan, a digital support platform, improves the social determinants of health (SDOH) needs for patients enrolled in a jail diversion program in Jacksonville, FL. Methodology A total of 59 patients who were enrolled in a jail diversion program for homeless mentally ill misdemeanor offenders in Jacksonville, FL, participated in the study. Of the 59 patients, 47 individuals consented to participate in Samaritan while 12 declined participation. Demographics and the Health Leads Social Needs Screening Tool scores from the electronic health record were compared between groups along with average financial support from Samaritan. These non-normally distributed variables were compared using Wilcoxon rank-sum tests. Results The majority of study participants were male (92%, n = 43). The average age of study participants was 42 years. The average income from donors on the platform over three months for those who opted in was $48.80 (SD = 53.75). Among the individual Health Leads Social Needs Screening Tool questions, intact Housing was statistically significant (Z = -2.002, p = 0.045), suggesting access to a digital technology such as Samaritan might help improve SDOH needs. Conclusions Access to digital technologies, such as Samaritan, might help offenders with mental illness adjust to the many challenges they face upon reentry into the community. As such, these devices may represent one means for improving SDOH needs for disadvantaged mental health patients.
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Affiliation(s)
- Rishubh H Shah
- Psychiatry, University of Florida College of Medicine, Gainesville, USA
| | - Dionne Blake
- Psychiatry, University of Florida College of Medicine, Gainesville, USA
| | - Brian Celso
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Colleen Bell
- Psychiatry, HCA Florida Orange Park Hospital, Jacksonville, USA
| | - Ana Turner
- Psychiatry, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
- Psychiatry, University of Florida, Gainesville, USA
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Liu PL, Yeo TED, Ye JF. Examining the Intervening Roles of Patient-Centered Care and Patient Activation in the Health Impacts of Offline Healthcare Obstacles and Online Health Consultations Among Deaf and Hard-of-Hearing Patients. HEALTH COMMUNICATION 2023:1-10. [PMID: 37853546 DOI: 10.1080/10410236.2023.2268909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Deaf and hard-of-hearing (DHH) patients often encounter difficulties in effective communication with healthcare professionals and are less likely to receive quality medical care. However, DHH populations are understudied in health communication research. This study examined how offline healthcare obstacles and online health consultation impact DHH patients' health, and the mediating roles of patient-centered care (PCC) and patient activation. Data from 323 DHH patients were analyzed using structural equation modeling to test the hypothesized mediation pathway model. Results indicate that offline healthcare obstacles negatively affect DHH patients' perception of patient-centeredness, which reduces their ability and confidence in self-care (conceptualized as patient activation in this study). This reduced patient activation may jeopardize DHH patients' physical and psychological health. Meanwhile, online health consultation is positively associated with PCC, and higher levels of PCC can increase patient activation, contributing to better physical and psychological health. Testing the same model with hearing-abled participants (n = 3542) revealed significant differences in these intervening relationships. Overall, this study provides valuable insights into the relationship between DHH patients' healthcare experience and their health outcomes. The findings support interventions that focus on enhancing PCC and patient activation to improve the physical and psychological health outcomes of DHH patients.
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Olchowska-Kotala A, Strządała A, Barański J. Patients' Values and Desire for Autonomy: An Empirical Study from Poland. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:409-419. [PMID: 36961586 PMCID: PMC10624733 DOI: 10.1007/s11673-023-10241-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/20/2022] [Indexed: 06/18/2023]
Abstract
There is a growing body of literature concerning factors that can influence patients' perception, preferences, or expectations with regard to autonomy in making healthcare decisions. Although many factors responsible for the desire for autonomy in medical decision-making are already recognized, little is known about how the desire for autonomy is related to values, which refer to important goals of human actions. The present study was designed to determine the relationship between the desire for autonomy and basic personal values drawn on Schwartz's value theory. We conducted survey in two age groups: younger and older adults. In the group of younger adults, the desire for autonomy was associated with the need to be appreciated as a person, motivation to act independently, and the abandonment of traditional order and values, whereas in the group of older adults, with independent thinking and a lack of humility. Our study highlighted that the desire for autonomy may result from slightly different reasons in people of particular age groups. These findings might be helpful for medical professionals in developing accurate communication patterns with different age groups of patients.
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Affiliation(s)
- Agnieszka Olchowska-Kotala
- Department of Medical Humanities and Social Sciences, Wroclaw Medical University, ul Mikulicza-Radeckiego 7, 50-368, Wroclaw, Poland
| | - Agata Strządała
- Department of Medical Humanities and Social Sciences, Wroclaw Medical University, ul Mikulicza-Radeckiego 7, 50-368, Wroclaw, Poland.
| | - Jarosław Barański
- Department of Medical Humanities and Social Sciences, Wroclaw Medical University, ul Mikulicza-Radeckiego 7, 50-368, Wroclaw, Poland
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Panahi S, Spearman B, Sundrud J, Lunceford M, Kamimura A. The Impact of Patient Autonomy Among Uninsured Free Clinic Patients. J Patient Exp 2023; 10:23743735231179041. [PMID: 37323759 PMCID: PMC10265317 DOI: 10.1177/23743735231179041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Uninsured primary care patients tend to experience barriers to autonomy in clinical decision-making due to limited choices of healthcare facilities and low health literacy. This study examined whether certain factors, including the component of patient-centeredness, are associated with patient autonomy among these populations and contribute to reducing disparities in healthcare. This was a cross-sectional study using a convenience sample of free clinic patients aged 18 years and older who spoke English and/or Spanish. Multiple regression analyses were performed to understand factors associated with Ideal Patient's Autonomy. Data were collected from September to December 2019. Findings conclude that Spanish-speaking patients at the free clinic have a stronger belief in a paternalist model of the provider-patient relationship (P < .01). Better communication between patients and providers results in higher levels of autonomy (P < .01). Higher levels of educational attainment and better communication partnership were associated with higher levels of a free clinic patient's understanding of treatment risks (P < .01). This research study found that components of patient-centeredness are important considerations for improving patient autonomy among free clinic patients.
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Affiliation(s)
- Samin Panahi
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Akiko Kamimura
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
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7
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Chen TT, Chueh KH, Chen KC, Chou CL, Yang JJ. The Satisfaction With Care of Patients With Schizophrenia in Taiwan: A Cross-Sectional Survey of Patient-Centered Care Domains. J Nurs Res 2023; 31:e268. [PMID: 36976539 DOI: 10.1097/jnr.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Pharmacological interventions combined with nonpharmacological treatments such as patient-centered care (PCC)-related activities are widely used to enhance outcomes in patients with schizophrenia. However, few studies have examined and identified the PCC factors essential to achieving better outcomes in patients with schizophrenia. PURPOSE This study was designed to identify the Picker-Institute-identified PCC domains associated with satisfaction and to determine which of these domains are most important in the context of schizophrenia care. METHODS Data were collected using patient surveys in outpatient settings and record reviews at two hospitals in northern Taiwan between November and December 2016. PCC data were collected in five domains: (a) support of patient autonomy; (b) goal setting; (c) collaboration and integration of healthcare services; (d) information, education, and communication; and (e) emotional support. The outcome measure was patient satisfaction. The study controlled for demographic factors, including age, gender, education, occupation, marriage, and urbanization level in the respondent's area of residence. Clinical characteristics included the Clinical Global Impressions severity and improvement index scores, previous admission, previous emergency department visit, and readmission within 1 year. Methods were adopted to prevent common method variance bias. Multivariable linear regression with stepwise selection and the generalized estimating equation were used to analyze the data. RESULTS After controlling for confounding factors, the generalized estimating equation model found only three PCC factors significantly associated with patient satisfaction, which differed slightly from the results of the multivariable linear regression. These three factors are as follows, in order of importance: information, education, and communication (parameter = 0.65 [0.37, 0.92], p < .001); emotional support (parameter = 0.52 [0.22, 0.81], p < .001); and goal setting (parameter = 0.31 [0.10, 0.51], p = .004). CONCLUSIONS The three critical PCC-related factors were evaluated in terms of enhancing patient satisfaction in patients with schizophrenia. Practicable strategies related to these three factors should also be developed for implementation in clinical settings.
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Affiliation(s)
- Tsung-Tai Chen
- PhD, Associate Professor, Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Ke-Hsin Chueh
- PhD, RN, Associate Professor, Department of Nursing, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Kao-Chen Chen
- MS, Case Manager Supervisor, Department of Health, New Taipei City Government, New Taipei, Taiwan
| | - Chi-Ling Chou
- BSN, RN, Head Nurse, Department of Community Psychiatry & Addition Psychiatry, Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei, Taiwan
| | - Jing-Jung Yang
- MS, MD, Attending Physician, Department of Psychiatry, Cardinal Tien Hospital, and Adjunct Instructor, School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
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Liu PL, Yeo TED. How Online Patient-Provider Communication Impacts Quality of Life: Examining the Role of Patient-Centered Care and Health Competence. HEALTH COMMUNICATION 2023; 38:562-567. [PMID: 34340609 DOI: 10.1080/10410236.2021.1961971] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The question of how patient-provider communication affects health outcomes has been a longstanding concern for health communication scholarship and practice. As patient-provider communication becomes increasingly mediated by digital technologies, much research has sought to compare online patient-provider communication (OPPC) with that conducted in-person, weighing its relative merits against its costs and barriers. This line of inquiry has mostly focused on the comparative benefits of OPPC for service delivery with little attempt to link these benefits to the wider health implications of OPPC. Consequently, the mechanisms that explain the impacts of OPPC on patients' overall wellbeing have been underexamined. Through a survey of 681 participants in China, this study examined the direct and indirect pathways between OPPC and quality of life (i.e., sleep, exercise, social activities, and psychological wellbeing). Our results demonstrate statistically significant direct relationships between OPPC and the four quality-of-life constructs examined as well as the mediation effects of patient-centered care and health competence in these relationships. The findings call for greater attention to the longer-term contributions of OPPC in empowering patients, especially those who are underserved by the healthcare system.
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Bedingfield N, Lashewicz B, Fisher D, King-Shier K. Canadian tuberculosis health care workers' perspectives on education and counselling for patients and family members who are born outside of Canada. Glob Public Health 2023; 18:2174265. [PMID: 36789497 DOI: 10.1080/17441692.2023.2174265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Tuberculosis health care workers (TB HCWs) in low incidence settings have important perspectives on providing TB education and counselling to patients and family members born in other countries. The purpose of this qualitative study was to explore HCWs' perspectives on barriers and facilitators for capacity-building education and counselling with patients and family members born outside of Canada experiencing advanced infectious TB in Calgary, a city in western Canada. Data were collected through semi-structured interviews and field notes and thematically analysed. Twenty-four HCWs representing clerical staff, nurses, physicians, and allied health professionals employed in TB care were interviewed. HCWs described how multi-level barriers such as patients' fear of death, complex intra-family communication, information-laden appointments, and patients' precarious employment collided resulting in overwhelmed patients and reduced connection to family. Some HCWs were unsure how to discuss TB stigma with patients and family members. HCWs perceived that increased continuity of care and providing patients and family members with digestible amounts of information earlier were important steps towards better practice. HCWs identified that patients and families could benefit from preparation for initial appointments, increased continuity, and improved patient education materials. HCWs should also receive skills-training to facilitate individual and family counselling.
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Affiliation(s)
- Nancy Bedingfield
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Dina Fisher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kathryn King-Shier
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Faculty of Nursing, University of Calgary, Calgary, Canada
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Wathen CN, Schmitt B, MacGregor JCD. Measuring Trauma- (and Violence-) Informed Care: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:261-277. [PMID: 34235986 PMCID: PMC9660280 DOI: 10.1177/15248380211029399] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Trauma- (and violence-) informed care (T(V)IC) has emerged as an important practice approach across a spectrum of care settings; however how to measure its implementation and impact has not been well-examined. The purpose of this scoping review is to describe the nature and extent of available measures of T(V)IC, including the cross-cutting concepts of vicarious trauma and implicit bias. Using multiple search strategies, including searches conducted by a professional librarian from database inception to Summer 2020, 1074 articles were retrieved and independently screened for eligibility by two team members. A total of 228 were reviewed in full text, yielding 13 measures that met pre-defined inclusion criteria: 1) full-text available in English; 2) describes the initial development and validation of a measure, that 3) is intended to be used to evaluate T(V)IC. A related review of vicarious trauma measures yielded two that are predominant in this literature. Among the 13 measures identified, there was significant diversity in what aspects of T(V)IC are assessed, with a clear emphasis on "knowledge" and "safety", and less on "collaboration/choice" and "strengths-based" concepts. The items and measures are roughly split in terms of assessing individual-level knowledge, attitudes and practices, and organizational policies and protocols. Few measures examine structural factors, including racism, misogyny, poverty and other inequities, and their impact on people's lives. We conclude that existing measures do not generally cover the full potential range of the T(V)IC, and that those seeking such a measure would need to adapt and/or combine two or more existing tools.
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Affiliation(s)
- C. Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, London,
Ontario, Canada
| | - Brenna Schmitt
- Arthur Labatt Family School of Nursing, Western University, London,
Ontario, Canada
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11
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Nadia S, Rivai F, Sidin I, Pasinringi SA. What is known about patient-centered care application in post-surgical breast cancer patients? Breast Dis 2023; 42:233-243. [PMID: 37522192 DOI: 10.3233/bd-239004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Over the past two decades, patient-centered care has become internationally recognized as a dimension of high-quality health care. Recent research has shown that patient-centered care has many benefits, which are broadly categorized as patient experience and clinical and operational benefits. OBJECTIVE The study aimed at analyzing the correlation between the application of patient-centered care (PCC) and length of stay, patient satisfaction, and clinical outcome of post-surgical breast cancer patients. METHODS The study design was cross-sectional. A sample of 100 patients was determined and selected with the inclusion criteria. Data were collected using measuring tools comprising patient-centered care and patient satisfaction questionnaires as well as medical records to evaluate the length of stay and clinical outcomes. Bivariate analysis was conducted to analyze the correlation between patient-centered-care and length of stay (LOS), patient satisfaction, and the clinical outcomes of inpatients. RESULTS A correlation was found between patient-centered care (PCC) application and patient satisfaction (p = 0.005), but no correlation was observed between PCC application and length of stay (LOS) (p = 0.176) as well as clinical outcome (p = 0.128). CONCLUSIONS The application of patient-centered care can be attributed to patient satisfaction but is not correlated to length of stay and clinical outcome of post-surgical breast cancer patients. The hospital should create an accepted definition and commonly agreed set of dimensions used for the concept of operationalization and its measurement to implement PCC and improve overall patient satisfaction and clinical outcome and reduce the length of stay as expected.
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Affiliation(s)
- Shafa Nadia
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
| | - Fridawaty Rivai
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
- Hasanuddin University Hospital, Makassar, South Sulawesi, Indonesia
| | - Indahwaty Sidin
- Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
- Hasanuddin University Hospital, Makassar, South Sulawesi, Indonesia
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Linking Heart Health and Mental Wellbeing: Centering Indigenous Perspectives from across Canada. J Clin Med 2022; 11:jcm11216485. [PMID: 36362713 PMCID: PMC9657304 DOI: 10.3390/jcm11216485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Indigenous peoples have thrived since time immemorial across North America; however, over the past three to four generations there has been a marked increase in health disparities amongst Indigenous peoples versus the general population. Heart disease and mental health issues have been well documented and appear to be interrelated within Indigenous peoples across Canada. However, Western medicine has yet to clearly identify the reasons for the increased prevalence of heart disease and mental health issues and their relationship. In this narrative review, we discuss how Indigenous perspectives of health and wholistic wellness may provide greater insight into the connection between heart disease and mental wellbeing within Indigenous peoples and communities across Canada. We argue that colonization (and its institutions, such as the Indian Residential School system) and a failure to include or acknowledge traditional Indigenous health and wellness practices and beliefs within Western medicine have accelerated these health disparities within Indigenous peoples. We summarize some of the many Indigenous cultural perspectives and wholistic approaches to heart health and mental wellbeing. Lastly, we provide recommendations that support and wholistic perspective and Indigenous peoples on their journey of heart health and mental wellbeing.
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Liu PL, Zhao X, Ye JF. The Effects of the Use of Patient-Accessible Electronic Health Record Portals on Cancer Survivors’ Health Outcomes: Cross-sectional Survey Study. J Med Internet Res 2022; 24:e39614. [DOI: 10.2196/39614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/04/2022] [Accepted: 09/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background
In the past decade, patient-accessible electronic health record (PAEHR) systems have emerged as an important tool for health management both at the hospital level and individual level. However, little is known about the effects of PAEHR portals on the survivorship of patients with chronic health conditions (eg, cancer).
Objective
This study aims to investigate the effects of the use of PAEHR portals on cancer survivors’ health outcomes and to examine the mediation pathways through patient-centered communication (PCC) and health self-efficacy.
Methods
Data for this study were derived from the Health Information National Trends Survey (HINTS 5, Cycle 4) collected from February 2020 to June 2020. This study only involved respondents who reported having been diagnosed with cancer (N=626). Descriptive analyses were performed, and the mediation models were tested using Model 6 from the SPSS macro PROCESS. Statistically significant relationships among PAEHR portal use, PCC, health self-efficacy, and physical and psychological health were examined using bootstrapping procedures. In this study, we referred to the regression coefficients generated by min-max normalization as percentage coefficients (bp). The 95% bootstrapped CIs were used with 10,000 resamplings.
Results
No positive direct associations between PAEHR portal use and cancer survivors’ health outcomes were found. The results supported the indirect relationship between PAEHR portal use and cancer survivors’ psychological health via (1) PCC (bp=0.029; β=.023, 95% CI .009-.054), and (2) PCC and health self-efficacy in sequence (bp=0.006; β=.005, 95% CI .002-.014). Besides, the indirect association between PAEHR portal use and cancer survivors’ physical health (bp=0.006; β=.004, 95% CI .002-.018) via sequential mediators of PCC and health self-efficacy was also statistically acknowledged.
Conclusions
This study offers empirical evidence about the significant role of PAEHR portals in delivering PCC, improving health self-efficacy, and ultimately contributing to cancer survivors’ physical and psychological health.
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14
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The Ethics of Explanted Orthopaedic Hardware Return to Requesting Patients. J Orthop Trauma 2022; 36:371-374. [PMID: 34999624 DOI: 10.1097/bot.0000000000002336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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15
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Kim EY, Chang SO. A Meta-Synthesis Study of Person-Centered Care Experience from the Perspective of Nursing Home Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148576. [PMID: 35886426 PMCID: PMC9317621 DOI: 10.3390/ijerph19148576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022]
Abstract
Purpose: To systematically review and synthesize the evidence for the experience of person-centered care from the perspective of nursing home residents to understand their views in depth. Methods: The seven steps of Nobit and Hare’s meta-ethnography, a well-known meta-synthesis method, were applied. We used four databases for the literature search (PubMed, Web of Science, EMBASE, and CINAHL). Results: A total of seven studies were included for review. As a result of synthesizing the results, three themes (“promotion of mutual understanding through communication”, “care that acknowledges the independence of residents” and “finding the optimized state”) and six sub-themes were derived. Conclusions: This study has provided an in-depth understanding of person-centered care and will contribute to increasing its practical application.
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Affiliation(s)
- Eun-Young Kim
- College of Nursing, Korea University, Seoul 02841, Korea;
| | - Sung-Ok Chang
- College of Nursing, and BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul 02841, Korea
- Correspondence: ; Tel.: +82-2-3290-4918
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16
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Tian X, Zhang S. Expert or experiential knowledge? How knowledge informs situated action in childcare practices. Soc Sci Med 2022; 307:115195. [PMID: 35810691 DOI: 10.1016/j.socscimed.2022.115195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022]
Abstract
The study examines how alternative health information affects the professional authority of doctors. Drawing on in-depth interviews with mothers in Hong Kong and focusing on child-rearing practices, we find that mothers glean expert knowledge from doctors and experiential knowledge from online resources, social networks, and direct observations. Despite the prevalence of information online and traditional Chinese remedies, mothers do not use experiential knowledge to challenge doctors. Instead, they self-interpret medical advice and set self-determined courses of action based on their own practical situations. Generally, they dichotomize child-rearing and caring issues into medical versus non-medical domains to which they apply expert and experiential knowledge, respectively. How a condition is categorized depends on whether their individualized experiential knowledge is adequate to allow them to manage the health of their child. This study concludes that mothers with alternative health information still respect professional authorities in clinical interactions, which accords with previous sociological studies, but mothers often consider expert knowledge overly generic, so they take initiative to translate generic health-related knowledge into individualized knowledge for their child and determine their own course of action. Our theoretical contribution is to bring situational concerns into the debate of professional authority by revealing how the accumulation of experiential knowledge informs situated action.
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Affiliation(s)
- Xiaoli Tian
- Department of Sociology, The University of Hong Kong, China.
| | - Sai Zhang
- Department of Sociology, The University of Hong Kong, China
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17
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Liang Z, Xu M, Liu G, Zhou Y, Howard P. Patient-centred care and patient autonomy: doctors' views in Chinese hospitals. BMC Med Ethics 2022; 23:38. [PMID: 35395761 PMCID: PMC8994393 DOI: 10.1186/s12910-022-00777-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 03/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Patient-centred care and patient autonomy is one of the key factors to better quality of service provision, hence patient outcomes. It enables the development of patients’ trusts which is an important element to a better doctor-patient relationship. Given the increasing number of patient disputes and conflicts between patients and doctors in Chinese public hospital, it is timely to ensure patient-centred care is fully and successfully implemented. However, limited studies have examined the views and practice in different aspects of patient-centred care among doctors in the Chinese public hospitals. Methods A quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China. Results In total, 614 doctors from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the inconsistent views among doctors in terms of their perception and practice in various aspects patient-centred care and patient autonomy regardless of the hospital where they work (category II or category III), their unit speciality (surgical or non-surgical), their gender or seniority. The high proportion of doctors (more than 20%) who did not perceive the importance of patient consultation prior to determining diagnostic and treatment procedure is alarming. This in in part due to the belief held by more than half of the doctors that patients were unable to make rational decisions and their involvement in treatment planning process did not necessarily lead to better treatment outcomes. Conclusion The study calls for the development of system level policy and organisation wide strategies in encouraging and enabling the practice of patient-centred care and patient autonomy with the purposes of improving the quality of the service provided to patients by Chinese hospitals. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00777-w.
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Affiliation(s)
- Zhanming Liang
- The Second Affiliated Hospital of Shandong First Medical University, Taian, China.,James Cook University, Townsville, Australia
| | - Min Xu
- The Second Affiliated Hospital of Shandong First Medical University, Taian, China.
| | - Guowei Liu
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongli Zhou
- Shandong University of Traditional Chinese Medicine, Jinan, China
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18
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Ngui K, Lam P, Materne M, Hilmer S. Patient-reported Experience Measures in Deprescribing for Hospitalised Older Patients: A Prospective, Multicentre, Observational Study. Intern Med J 2022. [PMID: 35112777 DOI: 10.1111/imj.15707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/18/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalisation provides an opportunity for medication review and deprescribing. Patient-reported experience measures (PREM) for deprescribing in older patients in-hospital are not well-described. AIM To pilot test and describe PREM for deprescribing in older patients, compare PREM by patient characteristics, and investigate patients' awareness of medication changes on hospital discharge. METHODS This prospective, multicentre, observational cohort study at two tertiary hospitals in Sydney, Australia, evaluated the PREM questionnaire developed by the NSW Therapeutic Advisory Group. It was completed by patients (or their next of kin) recruited from acute geriatric medicine and orthogeriatric services. Association with nine patient characteristics was analysed using the chi-square test and multivariable regression. Awareness of medication changes and test-retest reliability were analysed using descriptive statistics. RESULTS Overall, 201 participants completed the questionnaire, with 170 eligible for analysis; 34/170 (20%) were aware of reduction or cessation of their usual medications on discharge and reported involvement in decision making and receiving enough information to reduce or stop one or more of their usual medications (positive PREM). Independent predictors of positive PREM included respondent (next of kin), hospital (Hospital 1), language (English), and specialty (acute geriatric medicine). Overall, 92 of 155 (59.4%) patients with medication changes were aware of those changes on hospital discharge. CONCLUSIONS These PREMs are a feasible tool to examine older patients' experiences of deprescribing in-hospital and may be applied to evaluate interventions to improve awareness, shared decision making, and provision of information when deprescribing for older patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Keat Ngui
- Department of General & Acute Medicine, Liverpool Hospital, Liverpool NSW 2170, Australia. Faculty of Health and Medicine, University of Newcastle
| | - Patrick Lam
- Orthopaedic Research Institute, Department of Orthopaedic Surgery, St George Hospital Campus, University of New South Wales, Sydney, Australia, Level 2, 4-10 South Street, Kogarah, Sydney, New South Wales, 2217, Australia
| | | | - Sarah Hilmer
- Departments of Clinical Pharmacology and Aged Care, Kolling Institute, Royal North Shore Hospital and Faculty of Medicine and Health, University of Sydney, St Leonards, New South Wales, 2065, Australia
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19
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Seitz HH, Grady JG. Measuring veterinary client preferences for autonomy and information when making medical decisions for their pets. J Am Vet Med Assoc 2021; 259:1471-1480. [PMID: 34757930 DOI: 10.2460/javma.19.12.0630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To adapt the 3 scales of the Autonomy Preference Index to veterinary medicine and validate the 3 new scales to measure pet owner preferences for autonomy and information when making medical decisions for their pets. SAMPLE 10 small-animal veterinarians and 10 small-animal clients at a veterinary school-based community practice (pilot study) and 311 small-animal clients of the practice (validation study), of which 47 participated in a follow-up survey. PROCEDURES Wording of items in the Autonomy Preference Index was adapted, and instrument wording was finalized on the basis of feedback obtained in the pilot study to create 3 scales: the Veterinary General Decision-Making Preferences Scale (VGDMPS), Veterinary Clinical Decision-Making Preferences Scale (VCDMPS), and Veterinary Information-Seeking Preferences Scale (VISPS). The 3 scales were then validated by means of administering them to small-animal clients in a clinical setting. RESULTS The 3 scales had acceptable reliability and validity, but clients expressed concern over item wording in the VGDMPS during the pilot study. Overall, results showed that clients had a very high preference for information (mean ± SD VISPS score, 4.78 ± 0.36 on a scale from 1 to 5). Preferences for autonomy varied, but mean values reflected a low-to-moderate desire for autonomy in clinical decision-making (mean ± SD VCDMPS score, 2.04 ± 0.62 on a scale from 1 to 5). CONCLUSIONS AND CLINICAL RELEVANCE The VCDMPS was a reliable and valid instrument for measuring client preferences for autonomy in clinical decision-making. Veterinarians could potentially use this instrument to better understand pet owner preferences and tailor their communication approach accordingly.
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Affiliation(s)
- Holli H Seitz
- From the Department of Communication and Social Science Research Center, Mississippi State University, Mississippi State, MS 39762
| | - Jesse G Grady
- From the Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762
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Wang X, Ho MJ. When patient-centred and family-centred approaches clash: Taiwanese health professions students' patient autonomy dilemmas. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1625-1640. [PMID: 34436701 DOI: 10.1007/s10459-021-10064-9] [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: 09/26/2020] [Accepted: 08/08/2021] [Indexed: 06/13/2023]
Abstract
The main purpose of the study was to examine whether health professions students in Taiwan who study in different programmes experience similar patient autonomy-related professionalism dilemmas caused by disconnections between school and clinical culture. To investigate this issue, we draw specifically on situated learning theory and its cultural concept to examine their professionalism dilemma narratives that were collected through interviews. Of the 79 interviewed students, nearly half of them experienced patient autonomy dilemmas caused by conflicts between school and clinical culture, which have significant negative impacts on their learning and emotional wellbeing. Four major types of patient autonomy-related dilemmas emerge from the data. It was also found that when school culture and clinical culture clash, the latter has a greater influence on students. Thus, the study argues that Taiwanese students' frequent encounters with patient-autonomy dilemmas highlight the challenges faced by health professions students in transferring knowledge between school and clinical cultures, and clinical culture has a more powerful influence on their behaviour and clinical decision making. This phenomenon should be taken into account when organizing health professions education.
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Affiliation(s)
- Xin Wang
- Department of Humanities, Jiang Nan University, No. 1800, Lihu Avenue, Wuxi, 214122, People's Republic of China
| | - Ming-Jung Ho
- Department of Family Medicine, Centre for Innovation and Leadership in Education (CENTILE), Georgetown University Medical Center, Washington, DC, 20057, USA.
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Tuzzio L, Berry AL, Gleason K, Barrow J, Bayliss EA, Gray MF, Delate T, Bermet Z, Uratsu CS, Grant RW, Ralston JD. Aligning care with the personal values of patients with complex care needs. Health Serv Res 2021; 56 Suppl 1:1037-1044. [PMID: 34363205 PMCID: PMC8515216 DOI: 10.1111/1475-6773.13862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To identify opportunities to align care with the personal values of patients from three distinct groups with complex medical, behavioral, and social needs. DATA SOURCES/STUDY SETTING Between June and August 2019, we conducted semi-structured interviews with individuals with complex care needs in two integrated health care delivery systems. STUDY DESIGN Qualitative study using semi-structured interviews. DATA COLLECTION METHODS We interviewed three groups of patients at Kaiser Permanente Washington and Kaiser Permanente Colorado representing three distinct profiles of complex care needs: Group A ("obesity, opioid prescription, and low-resourced neighborhood"), Group B ("older, high medical morbidity, emergency department, and hospital use"), and Group C ("older, mental and physical health concerns, and low-resourced neighborhood"). These profiles were identified based on prior work and prioritized by internal primary care stakeholders. Interview transcripts were analyzed using thematic analysis. PRINCIPAL FINDINGS Twenty-four patients participated; eight from each complex needs profile. Mean age across groups was 71 (range 48-86) years. We identified five themes common across the three groups that captured patients' views regarding values-aligned care. These themes focused on the importance of care teams exploring and acknowledging a patient's values, providing access to nonphysician providers who have different perspectives on care delivery, offering values-aligned mental health care, ensuring connection to community-based resources that support values and address needs, and providing care that supports the patient plus their family and caregivers. CONCLUSIONS Our results suggest several opportunities to improve how care is delivered to patients with different complex medical, behavioral, and social needs. Future research is needed to better understand how to incorporate these opportunities into health care.
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Affiliation(s)
- Leah Tuzzio
- Kaiser Permanente Washington Health Research InstituteSeattleWAUSA
| | - Andrew L. Berry
- Department of Biomedical Informatics & Medical EducationUniversity of WashingtonSeattleWashingtonUSA
| | - Kathy Gleason
- Kaiser Permanente Colorado Institute for Health ResearchAuroraColoradoUSA
| | - Jennifer Barrow
- Kaiser Permanente Colorado Institute for Health ResearchAuroraColoradoUSA
| | | | | | - Thomas Delate
- Pharmacy Outcomes Research Group, Kaiser Permanente National PharmacyAuroraColoradoUSA
| | - Zoe Bermet
- Kaiser Permanente Washington Health Research InstituteSeattleWAUSA
| | - Connie S. Uratsu
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - Richard W. Grant
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | - James D. Ralston
- Kaiser Permanente Washington Health Research InstituteSeattleWAUSA
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22
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Deng G, Cai W, Yang M, Lio J, Feng C, Ma X, Liang L. Linking doctor-patient relationship to medical residents' work engagement: The influences of role overload and conflict avoidance. BMC FAMILY PRACTICE 2021; 22:191. [PMID: 34560844 PMCID: PMC8464118 DOI: 10.1186/s12875-021-01541-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
Background Chinese residents’ practical work experiences are different from those described in Western studies. To explore potential mechanisms underlying the effects of doctor-patient relationships on medical residents’ work engagement, verifying a posited mediating effect of role overload, and moderating effect of conflict avoidance, in the Chinese context. Methods Based on the conservation of resources theory, a composite model was constructed. This study’s data were collected from four different Chinese tertiary hospitals; 195 residents undergoing regularization training took this survey. Hierarchical moderated and mediated regression analyses were utilized. Results Doctor-patient relationship were found to be positively related to residents’ work engagement (β=0.31, p≤0.001). Role overload partially mediated the effect of these relationships on work engagement, and the moderating role of conflict avoidance in the relationship between doctor-patient relationship and conflict avoidance was negative. Conclusion Maintaining good doctor-patient relationship can prompt residents to increase their engagement in work in order to meet their patients’ needs. Furthermore, role overload has a particular influence in early career stages. Not only is it necessary for residents to gain a sense of recognition and support while they carry out their job responsibilities, especially while dealing with complex doctor-patient relationship, but it is also important to create work environments that can help residents shape their professional competency.
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Affiliation(s)
- Guangwei Deng
- School of Management, Hefei University of Technology, Hefei, Anhui Province, 230009, P.R. China
| | - Wenjun Cai
- School of Management, University of Science and Technology of China, Hefei, P.R. China
| | - Monica Yang
- Robert B. Willumstad School of Business, Adelphi University, Garden City, USA
| | - Jonathan Lio
- Department of Medicine, University of Chicago, Chicago, USA
| | - Chenpeng Feng
- School of Management, Hefei University of Technology, Hefei, Anhui Province, 230009, P.R. China.
| | - Xiaopeng Ma
- Department of General Surgery, the First Affiliated Hospital of University of Science and Technology of China, Hefei, P.R. China
| | - Liang Liang
- School of Management, Hefei University of Technology, Hefei, Anhui Province, 230009, P.R. China
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Freda MF, Raffaele DLP, Esposito G, Ragozini G, Testa I. A new measure for the assessment of the university engagement: The SInAPSi academic engagement scale (SAES). CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02189-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractDespite the growing interest on the notion of academic engagement (AE) and its relevance for students’ success, a few valid and reliable instruments on AE have been developed. Moreover, most of the available measures consider AE as a student’s trait rather than a relational and situated dynamic process. This study presents the development and validation of a new instrument, the SInAPSi Academic Engagement Scale (SAES), which was developed within a project coordinated by the SInAPSi center of the Authors’ University and it aims to measure AE. The main sample was constituted by 680 students and a convenience sample of 312 biology and biotechnologies students was also involved to perform the confirmatory factor analysis of the initial factor structure of the SAES. Construct validity was assessed using the University Student Engagement Inventory (USEI), while criterion-related validity was established with the Academic Motivation Scale (AMS), the students’ confidence in one’s own preparation for academic studies and their academic performance. Results show that the SAES presents a robust factor structure, a good convergent and discriminant validity, and satisfactory psychometric properties. Furthermore, the SAES shows a positive correlation with the USEI and the AMS, the students’ confidence in their preparation for academic studies and their academic performance. The results indicate that the SAES can produce valid and reliable data on AE and it may have strong implications for assessing AE and implementing intervention programs for university students.
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24
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Ongolly FK, Dolla A, Ngure K, Irungu EM, Odoyo J, Wamoni E, Peebles K, Mugwanya K, Mugo NR, Bukusi EA, Morton J, Baeten JM, O’Malley G. "I Just Decided to Stop:" Understanding PrEP Discontinuation Among Individuals Initiating PrEP in HIV Care Centers in Kenya. J Acquir Immune Defic Syndr 2021; 87:e150-e158. [PMID: 33492024 PMCID: PMC8026512 DOI: 10.1097/qai.0000000000002625] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) discontinuation rates in clinical trials and demonstration projects have been well characterized; however, little is known about discontinuation in routine public health settings in sub-Saharan Africa. Understanding discontinuation in nonstudy settings is important for establishing expectations for PrEP continuation in national programs and for facilitating effective PrEP scale-up. METHODS We conducted in-depth interviews with 46 individuals who had initiated PrEP at 25 HIV comprehensive care clinics (CCCs) in central and western Kenya and whose clinic records indicated they had discontinued. RESULTS Many of our study participants discontinued PrEP when their perceived risk decreased (eg, hiatus or end of a sexual relationship or partner known to be living with HIV became virally suppressed). Others reported discontinuation due to side effects, daily pill burden, preference for condoms, or their partner's insistence. Participant narratives frequently described facility level factors such as stigma-related discomforts with accessing PrEP at CCCs, inconvenient clinic location or operating hours, long wait times, and short refill dates as discouraging factors, suggesting actionable areas for improving PrEP access and continuation. CONCLUSION Clients frequently make intentional decisions to discontinue PrEP as they weigh different prevention options within the context of complex lives. Many clients will decide to discontinue PrEP when perceiving themselves to be at reduced risk and PrEP counseling must include provisions for addressing seasons of risk. PrEP will not be the right prevention method for everyone, or forever. Expanding PrEP access points and increasing sex-positive messaging may facilitate PrEP being a better option for many.
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Affiliation(s)
| | - Annabel Dolla
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Kenneth Ngure
- Department of Global Health, Seattle, Washington, USA
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Elizabeth M. Irungu
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Josephine Odoyo
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Elizabeth Wamoni
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Kathryn Peebles
- Department of Epidemiology, Medicine, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Kenneth Mugwanya
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Nelly R. Mugo
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
- Department of Global Health, Seattle, Washington, USA
| | - Elizabeth A. Bukusi
- Department of Global Health, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, Seattle, Washington, USA
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Jennifer Morton
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Jared M. Baeten
- Department of Global Health, Seattle, Washington, USA
- Department of Epidemiology, Medicine, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Gabrielle O’Malley
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
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Wathen CN, MacGregor JCD, Beyrem S. Impacts of trauma- and violence-informed care education: A mixed method follow-up evaluation with health & social service professionals. Public Health Nurs 2021; 38:645-654. [PMID: 33629448 DOI: 10.1111/phn.12883] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Trauma- and violence-informed care (TVIC) creates safety by understanding the impacts of trauma on health and behavior, and the intersecting impacts of structural and interpersonal violence. This study examined the impact, 1-2 years later, of TVIC professional education. DESIGN, SAMPLE AND MEASUREMENTS We conducted a mixed method descriptive follow-up evaluation (online survey, n = 67, and semi-structured interviews, n = 7) with health and social service providers, leaders and researchers who attended TVIC workshops. Participants were asked how the workshop impacted their thinking, actions and perceptions of organizational changes. RESULTS Participants reported greater impact on attitudes than on behaviors. The most common change in awareness and thinking related to better understanding of the links among trauma, pain and substance use. Practice changes included more active listening and empathy, less use of jargon and less judgement in care encounters. Participants linked these practices to better care interactions, and more trust, openness and satisfaction among service users. CONCLUSION Educating health professionals and others (e.g. educators) about trauma, violence, and discrimination is not easy. TVIC education can help shift potentially stigmatizing attitudes which can then precipitate practice change. These approaches are emerging as an important way to improve health and quality of life.
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Affiliation(s)
- C Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
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26
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Kepper M, Walsh-Bailey C, Staiano A, Fowler LA, Gacad A, Blackwood A, Fowler SA, Kelley M. Health Information Technology Use Among Healthcare Providers Treating Children and Adolescents With Obesity: a Systematic Review. CURR EPIDEMIOL REP 2021. [DOI: 10.1007/s40471-021-00262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Luo H, Liu G, Lu J, Xue D. Association of shared decision making with inpatient satisfaction: a cross-sectional study. BMC Med Inform Decis Mak 2021; 21:25. [PMID: 33494744 PMCID: PMC7831242 DOI: 10.1186/s12911-021-01385-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/06/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China. METHODS A cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models. RESULTS The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to "My physician informed me of different treatment alternatives" was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals). CONCLUSIONS Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.
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Affiliation(s)
- Huiwen Luo
- Department of Hospital Management, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, No. 138, Yi Xue Yuan Road, Shanghai, 200032, People's Republic of China
| | - Guohua Liu
- Shanghai Medical Ethos Association, Jiangan District, No. 328, Huashan Road, Shanghai, 200040, People's Republic of China
| | - Jing Lu
- Shanghai Medical Ethos Association, Jiangan District, No. 328, Huashan Road, Shanghai, 200040, People's Republic of China
| | - Di Xue
- Department of Hospital Management, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, No. 138, Yi Xue Yuan Road, Shanghai, 200032, People's Republic of China.
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Abstract
Background: Extensive research suggests that positive patient experience leads to improvement in patient health outcomes. Patient experience is particularly important in ambulatory care, where a patient builds a long-term relationship with a provider to manage his/her chronic illness over the span of years. Despite these known benefits, patient experience and its impact on health outcomes is poorly understood in low- and middle-income countries, where resources may be limited and primary care infrastructure spotty. Objectives: This paper aims to better characterize patient experience in a tertiary teaching hospital in Accra, Ghana. Methods: Forty qualitative interviews were conducted in the Outpatient Medical Clinic at Korle-Bu Teaching Hospital in Accra, Ghana. All interviews were transcribed and a qualitative analysis of central themes was evaluated by the study team. Findings: We found patients eager to share their views on clinical care in an ambulatory clinic in Ghana’s largest tertiary care center. Patients voiced desires for decreasing patient wait times, increasing wayfinding resources to navigate the clinic, creating appointment times, and implementing continuity of care with a single physician. The majority of patients also reported feeling actively engaged in their clinical care and emphasized their positive interpersonal interactions with providers. Conclusions: These findings suggest that patients described positive interpersonal experiences with providers at this ambulatory clinic, but identified numerous operational changes that could be made to vastly improve patient experience.
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Farnese ML, Girardi G, Fida R, Bivona U, Bartolo M, De Tanti A, Intiso D, Scarponi F, Antonucci G. Caregivers' engagement during in-hospital care of sABI's patients: Evaluation of informal co-production from the health providers' perspective. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2086-2094. [PMID: 32483930 DOI: 10.1111/hsc.13019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/13/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
One of the challenges of providing healthcare services is to enhance its value (for patients, staff and the service) by integrating the informal caregivers into the care process, both concretely managing their patient's health conditions and treatment (co-executing) and participating in the whole healthcare process (co-planning). This study aims at exploring the co-production contribution to the healthcare process, analysing whether and how it is related to higher caregivers' satisfaction with service care and reduced staff burnout, in the eyes of the staff. It also investigated two possible factors supporting caregivers in their role of co-producers, namely relationship among staff and informal caregivers related to knowledge sharing (i.e. an ability determinant supporting co-production) and related to role social conflict (i.e. a willingness determinant reducing co-production). Results of a structural equation model on a sample of 119 healthcare providers employed by neurorehabilitation centers in Italy with severe acquired brain injury confirmed that knowledge sharing positively related with caregivers' co-executing and co-planning. Also, social role conflict was negatively related with co-executing but positively with co-planning. Furthermore, co-planning resulted in being unrelated to both outcomes, whereas co-executing was associated with caregivers' satisfaction, as measured by staff perceptions. Overall, our data provided initial empirical evidence supporting the ability of the determinant's contribution in allowing informal caregivers to assume an active role in both co-production domains. Furthermore, as expected, the role of conflict willingness determinant was found to be a hindering factor for co-executing but, conversely, a trigger for co-planning. This result should be considered more carefully in future studies.
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Affiliation(s)
| | - Giovanna Girardi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Roberta Fida
- Norwich Business School, University of East Anglia, Norwich, UK
| | | | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
| | - Antonio De Tanti
- Istituto S.Stefano Riabilitazione, Centro Cardinal Ferrari, Fontanellato (PR), Italy
| | - Domenico Intiso
- UOC di Medicina Fisica e Riabilitativa, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
| | | | - Gabriella Antonucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- IRCCS Fondazione S. Lucia, Roma, Italy
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Winther S, Fredens M, Hansen MB, Benthien KS, Nielsen CP, Grønkjær M. Proactive Health Support: Exploring Face-to-Face Start-Up Sessions Between Participants and Registered Nurses at the Onset of Telephone-Based Self-Management Support. Glob Qual Nurs Res 2020; 7:2333393620930026. [PMID: 32656297 PMCID: PMC7328475 DOI: 10.1177/2333393620930026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 12/04/2022] Open
Abstract
Proactive Health Support (PaHS) is a large-scale intervention in Denmark
carried out by registered nurses (RNs) who provide self-management
support to people at risk of hospital admission to enhance their
health, coping, and quality of life. PaHS is initiated with a
face-to-face session followed by telephone conversations. We aimed to
explore the start-up sessions, including if and how the relationship
between participants and RNs developed at the onset of PaHS. We used
an ethnographic design including observations and informal interviews.
Data were analyzed using a phenomenological–hermeneutical approach.
The study showed that contexts such as hospitals and RNs legitimized
the intervention. Face-to-face communication contributed to
credibility, just as the same RN throughout the intervention ensured
continuity. We conclude that start-up sessions before telephone-based
self-management support enable a trust-based relationship between
participants and RNs. Continuous contact with the same RNs throughout
the session promoted participation in the intervention.
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Affiliation(s)
| | - Mia Fredens
- DEFACTUM, Social & Health Services and Labor Market, Aarhus, Denmark
| | | | | | | | - Mette Grønkjær
- Aalborg University Hospital, Aalborg, Denmark.,Aalborg University, Aalborg, Denmark
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Implementation and Effectiveness of an Interprofessional Support Program for Patients with Type 2 Diabetes in Swiss Primary Care: A Study Protocol. PHARMACY 2020; 8:pharmacy8020106. [PMID: 32575887 PMCID: PMC7357028 DOI: 10.3390/pharmacy8020106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/24/2022] Open
Abstract
This research protocol illustrates the use of implementation science to support the development, dissemination and integration in primary care of effective and sustainable collaborative pharmacy services for chronic care management. The objective is to evaluate the implementation and the effectiveness of a pharmacist-led patient support program including regular motivational interviews; medication adherence, patient-reported outcomes, and clinical outcomes monitoring; and interactions with physicians, for patients with type 2 diabetes taking at least one oral antidiabetic medication in the French-speaking part of Switzerland. This is a prospective, multi-centered, observational, cohort study using a hybrid design to assess the patient support program. The evaluation includes three levels of analysis: (1) the implementation strategies, (2) the overall implementation process, and (3) the effectiveness of the program. Qualitative and quantitative methods are used, and outcomes are assessed at each stage of the implementation process: exploration, preparation, operation, and sustainability. This research project will provide key insights into the processes of implementing patient support programs on a large scale and adapting the traditional community pharmacy practices towards the delivery of person-centered and collaborative services.
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Tarı Kasnakoğlu B, Pak H. Role expectations from doctors and effects on nonmedical outcomes. J Eval Clin Pract 2020; 26:903-910. [PMID: 31270903 DOI: 10.1111/jep.13224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The predominant assumption of doctor professionalism may be prone to unpredicted alterations in the face of "a new age of doctoring." The aim in this study is to explore one dimension in the doctor-patient dyadic relationship: the face-to-face interaction between doctors and patients and whether satisfaction of role expectations affects service outcomes as perceived by the patient-consumer. METHODS In the first qualitative phase, 10 physicians and 11 patients were interviewed in-depth for the purposes of understanding the variations in role expectations from doctors. These details were then used to construct the scenarios to be used in the second quantitative phase. Scenario-based experimental data were collected using a cross-sectional sample consisting of 432 individuals. RESULTS Although positive emotions lead to positive outcomes when the doctor is role-congruent, positive emotions lead to even better outcomes when the doctor is behaving too friendly. In addition, negative emotions lead to negative outcomes in both scenarios; however, outcomes become worse when the doctor is role-incongruent. CONCLUSIONS Role expectations play a moderating role between emotions and service outcomes. The medical performance can be perceived good or bad depending on whether the doctor smiles "too much" or not. Results are discussed within the context of role expectation theory and the changing nature of service relationships in the health care sector.
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Affiliation(s)
- Berna Tarı Kasnakoğlu
- Department of Business Administration, TOBB University of Economics and Technology, Ankara, Turkey
| | - Halil Pak
- Marketing Vocational School, Izmir University of Economics, Izmir, Turkey
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Plahouras JE, Mehta S, Buchman DZ, Foussias G, Daskalakis ZJ, Blumberger DM. Experiences with legally mandated treatment in patients with schizophrenia: A systematic review of qualitative studies. Eur Psychiatry 2020; 63:e39. [PMID: 32406364 PMCID: PMC7355163 DOI: 10.1192/j.eurpsy.2020.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Patients with severe mental illness, including schizophrenia, may be legally mandated to undergo psychiatric treatment. Patients’ experiences in these situations are not well characterized. This systematic review of qualitative studies aims to describe the experiences of patients with schizophrenia and related disorders who have undergone legally mandated treatment. Methods: Four bibliographic databases were searched: CINAHL Plus (1981–2019), EMBASE (1947–2019), MEDLINE (1946–2019), and PsycINFO (1806–2019). These databases were searched for keywords, text words, and medical subject headings related to schizophrenia, legally mandated treatment and patient experience. The reference lists of included studies and systematic reviews were also investigated. The identified titles and abstracts were reviewed for study inclusion. A thematic analysis was completed for the synthesis of positive and negative aspects of legally mandated treatment. Results: A total of 4,008 citations were identified. Eighteen studies were included in the final synthesis. For the thematic analysis, results were collated under two broad themes; positive patient experiences and negative patient experiences. Patients were satisfied when their autonomy was respected, and dissatisfied when it was not. Patients often retrospectively recognized that their treatment was beneficial. Furthermore, negative aspects of the treatment included deficits in communication and a lack of information. Conclusions: Intervention research has historically focused on clinical outcomes and the quantitative aspects of treatment. Thus, this study provides insight into the qualitative aspects of patients’ experiences with legally mandated treatment. Recognizing these opinions and experiences can lead to better attitudes toward treatment for patients with schizophrenia and related psychiatric illnesses.
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Affiliation(s)
- Joanne E Plahouras
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, OntarioCanada
| | - Shobha Mehta
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, OntarioCanada
| | - Daniel Z Buchman
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada.,Bioethics Department, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - George Foussias
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, OntarioCanada.,Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, OntarioCanada.,Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Van Humbeeck L, Malfait S, Holvoet E, Vogelaers D, De Pauw M, Van Den Noortgate N, Van Biesen W. Value discrepancies between nurses and patients: A survey study. Nurs Ethics 2020; 27:1044-1055. [DOI: 10.1177/0969733020906595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Patient-centeredness, respect for patient autonomy, and shared decision-making have now made it to center stage in discussions on quality of care. Knowing what actually counts in care and how it should be accomplished from the patients’ and nurses’ perspective seems crucial. Aim To explore how patients and their nurses perceive the importance and enactment of values in their healthcare. Research design An observational, cross-sectional study using a self-developed questionnaire, consisting of 15 items related to seven values (e.g. uniqueness, autonomy, professionalism, compassion, responsiveness, partnership, and empowerment) as described in the taxonomy of Bastemeijer et al. Participants and research context The survey was completed by 384 patients and 81 nurses. Participants were recruited on eight internal medicine wards of a 1000-bed university hospital in Belgium. Ethical considerations This study was approved by the ethical committee of the Ghent University Hospital (B670201836799). Findings (1) Patients and nurses prioritize values of care differently; (2) nurses report not being able to enact the values they prioritize in actual practice as much as one would like to; and (3) there is a gap in experienced delivery of a comprehensible explanation of all treatment options, a conversation based on equality, making shared decisions, and being non-judgmental between nurses and patients. Discussion Our findings challenge nurses’ overemphasis on professional compassion and uniqueness while arguing for increased attention on authentic shared decision-making and empowerment. The first step to a patient-centered culture truly involving patients in their healthcare is communication and information provision, rather than focusing on tangible and normative constructs. Conclusion Our findings revealed differences in prioritization and actual enactment of values in care between patients and nurses. This was especially so for values related to communication, provision of complete unbiased information, and shared decision-making. Nurses should prioritize providing comprehensible information and using conversations based on equality to make decision together with patients.
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Brickley B, Sladdin I, Williams LT, Morgan M, Ross A, Trigger K, Ball L. A new model of patient-centred care for general practitioners: results of an integrative review. Fam Pract 2020; 37:154-172. [PMID: 31670759 DOI: 10.1093/fampra/cmz063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND GPs providing patient-centred care (PCC) is embedded in international health care policies due to its positive impact on patients and potential to lower health care costs. However, what is currently known about GP-delivered PCC is unknown. OBJECTIVE To synthesize literature investigating GP-delivered PCC and address 'what is currently known about GP-delivered PCC?' METHOD A systematic literature search was conducted between June and July 2018. Eligible articles were empirical, full-text studies published in English between January 2003 and July 2018, related to at least three of the four dimensions of PCC described by Hudon et al. (2011), and related to preventative, acute, and/or chronic care by GPs. Following screening, full-text articles were independently assessed for inclusion by two investigators. Data were extracted and quality assessed by two researchers. Findings on PCC were analysed thematically (meta-synthesis). RESULTS Thirty medium- to high-quality studies met the inclusions criteria. Included studies utilized varied designs, with the most frequent being quantitative, cross-sectional. A theoretical model of PCC was synthesized from included studies and contained four major components: (i) understanding the whole person, (ii) finding common ground, (iii) experiencing time and (iv) aiming for positive outcomes. Harms of PCC were rarely reported. CONCLUSIONS Four overarching theoretical components of PCC relate to elements of the consultation and experience of time. These components can be used to inform the development of toolkits to support GPs and general practice organizations in pursuit of PCC as well as tools to measure patient-centredness.
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Affiliation(s)
- Bryce Brickley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ishtar Sladdin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Mark Morgan
- Bond University, Gold Coast, Queensland, Australia
| | - Alyson Ross
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Kellie Trigger
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Hauschildt K, De Vries R. Reinforcing medical authority: clinical ethics consultation and the resolution of conflicts in treatment decisions. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:307-326. [PMID: 31565808 PMCID: PMC7012693 DOI: 10.1111/1467-9566.13003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Despite substantial efforts in the past 15 years to professionalise the field of clinical ethics consultation, sociologists have not re-examined past hypotheses about the role of such services in medical decision-making and their effect on physician authority. In relation to those hypotheses, we explore two questions: (i) What kinds of issues does ethics consultation resolve? and (ii) what is the nature of the resolution afforded by these consults? We examined ethics consultation records created between 2011 and mid-2015 at a large tertiary care US hospital and found that in most cases, the problems addressed are not novel ethical dilemmas as classically conceived, but are instead disagreements between clinicians and patients or their surrogates about treatment. The resolution offered by a typical ethics consultation involves strategies to improve communication rather than the parsing of ethical obligations. In cases where disagreements persist, the proposed solution is most often based on technical clinical judgements, reinforcing the role of physician authority in patient care and the ethical decisions made about that care.
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Affiliation(s)
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Michigan, USA
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37
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Lacasta Tintorer D, Manresa Domínguez JM, Jiménez-Zarco A, Rodríguez-Blanco T, Flayeh Beneyto S, Torán-Monserrat P, Mundet Tuduri X, Saigí-Rubió F. Efficiency as a determinant of loyalty among users of a Community of Clinical Practice: a comparative study between the implementation and consolidation phases. BMC FAMILY PRACTICE 2020; 21:15. [PMID: 31980016 PMCID: PMC6979059 DOI: 10.1186/s12875-020-1081-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/06/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND A community of clinical practice called the Online Communication Tool between Primary and Hospital Care (ECOPIH) was created to enable primary care and specialist care professionals to communicate with each other in order to resolve real clinical cases, thereby improving communication and coordination between care levels. The present work seeks to analyse whether ECOPIH makes it possible to reduce the number of referrals. To that end, the objectives are: (1) To find out the degree of loyalty among ECOPIH users, by comparing the medical professionals' profiles in the tool's implementation phase to those in its consolidation phase. (2) To evaluate the degree of fulfilment of users' expectations, by establishing the determining factors that had an influence on the physicians' intention to use ECOPIH in the implementation phase and observing whether its use had an effective, direct impact on the number of patient referrals that primary care physicians made to specialist care professionals. METHODS Two studies were conducted. Based on a survey of all the physicians in a Primary Care area, Study 1 was a descriptive study in ECOPIH's implementation phase. Study 2 was a randomised intervention study of ECOPIH users in the tool's consolidation phase. The results from both studies were compared. Various bivariate and multivariate statistical techniques (exploratory factor analysis, cluster analysis, logistic regression analysis and ANOVA) were used in both studies, which were conducted on a sample of 111 and 178 physicians, respectively. RESULTS We confirmed the existence of an ECOPIH user profile stable across both phases: under-50-year-old women. Regarding the second objective, there were two particular findings. First, the discriminant factors that had an influence on greater ECOPIH use were habitual Social media website and app use and Perceived usefulness for reducing costs. Second, PC professionals who were ECOPIH members made fewer referrals to SC professionals in Cardiology, Endocrinology and Gastroenterology than older PC professionals who were not ECOPIH members. CONCLUSIONS The use of a community of clinical practice by primary care and specialist care professionals helps to reduce the number of referrals among medical professionals.
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Affiliation(s)
- David Lacasta Tintorer
- Centre d’Atenció Primària Gran Sol, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut. Avinguda del Doctor Bassols, 112 - 130, 08914 Badalona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, CAP El Maresme. Camí del Mig, 36 planta 4ª, 08303 Mataró, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès. Campus de la UAB, Plaça Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
| | - Josep Maria Manresa Domínguez
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, CAP El Maresme. Camí del Mig, 36 planta 4ª, 08303 Mataró, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès. Campus de la UAB, Plaça Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
| | - Ana Jiménez-Zarco
- Faculty of Economics and Business, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Teresa Rodríguez-Blanco
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès. Campus de la UAB, Plaça Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain
| | - Souhel Flayeh Beneyto
- Centre d’Atenció Primària Gran Sol, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut. Avinguda del Doctor Bassols, 112 - 130, 08914 Badalona, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, CAP El Maresme. Camí del Mig, 36 planta 4ª, 08303 Mataró, Spain
- Departament de Ciències Mèdiques, Universitat de Girona, C/ Emili Grahit, 77, 2n, 17003 Girona, Spain
| | - Xavier Mundet Tuduri
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès. Campus de la UAB, Plaça Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
- Unitat de Suport a la Recerca Barcelona Ciutat, IDIAP Jordi Gol, Carrer Sardenya 375, 08025 Barcelona, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona. Av. Tibidabo, 39-43, 08035 Barcelona, Spain
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Lee AS, Yung PSH, Mok KM, Hagger MS, Chan DK. Psychological processes of ACL-patients' post-surgery rehabilitation: A prospective test of an integrated theoretical model. Soc Sci Med 2020; 244:112646. [DOI: 10.1016/j.socscimed.2019.112646] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/09/2019] [Accepted: 10/26/2019] [Indexed: 11/15/2022]
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Krvavac A, Patel PH, Kamel G, Hu Z, Patel N. Improving Consent Documentation in the Medical Intensive Care Unit. Cureus 2019; 11:e6174. [PMID: 31890381 PMCID: PMC6913954 DOI: 10.7759/cureus.6174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The contemporary patient-centered medical practice relies upon the acquisition of informed consent, which serves as written proof that the patient has recognized and agreed to the risks and benefits of their treatment. Well-documented informed consent forms are not only reflective of important ethical practices in medicine but can also serve as legal documents to protect healthcare providers from undue liabilities. We conducted a quality improvement project with the intention to improve the accuracy and completeness of consent form documentation in the medical intensive care unit. The evaluation of consent forms before our intervention revealed that only 6.8% were correctly completed, with an average of 10.2 out of 14 (73%) essential items correct. Our intervention involved a multifaceted approach that included targeted education in combination with process improvement. The post-intervention results at one month revealed improvement in consent form accuracy from 6.8% to 60% (p = 0.0001), with an increase in the average number of essential items documented correctly from 10.2 to 13.5 (p = 0.0001). Data were collected three months post-intervention to evaluate for sustained improvement. Results revealed a significant decrease in consent form accuracy to 39% when compared to the one-month post-intervention data but still maintained a statistically significant improvement when compared to initial baseline data; 6.8% to 39% (p = <0.01). Following the intervention, overall consent form accuracy improved significantly at our institution. Furthermore, these positive adjustments persisted when assessed at three months post-intervention despite the decrease as compared to one-month post-intervention. This trend suggests that our multifaceted intervention was able to increase the quality and accuracy of consent form documentation successfully.
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Affiliation(s)
- Armin Krvavac
- Pulmonary & Critical Care, University of Missouri Healthcare, Columbia, USA
| | - Pujan H Patel
- Respiratory Medicine, Royal Brompton Hospital, London, GBR
| | - Ghassan Kamel
- Internal Medicine - Critical Care, Saint Louis University School of Medicine, St. Louis, USA
| | - Zeyu Hu
- Internal Medicine - Critical Care, Saint Louis University School of Medicine, St. Louis, USA
| | - Nirav Patel
- Medicine, Louisiana Children's Medical Center (LCMC) Healthcare, New Orleans, USA
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Hirsch-Moverman Y, Mantell JE, Lebelo L, Wynn C, Hesseling AC, Howard AA, Nachman S, Frederix K, Maama LB, El-Sadr WM. Tuberculosis preventive treatment preferences among care givers of children in Lesotho: a pilot study. Int J Tuberc Lung Dis 2019; 22:858-862. [PMID: 29991393 DOI: 10.5588/ijtld.17.0809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Shorter-duration regimens for preventing drug-susceptible tuberculosis (TB) have been shown to be safe and efficacious in children, and may improve acceptability, adherence, and treatment completion. While these regimens have been used in children in low TB burden countries, they are not yet widely used in high TB burden countries. SETTING Five health facilities in one district in Lesotho, a high TB burden country. OBJECTIVE Assess the preventive treatment preferences of care givers of child TB contacts. DESIGN Qualitative data were collected using in-depth interviews with 12 care givers whose children completed preventive treatment, and analyzed using grounded theory. FINDINGS Care givers were interested in being involved in the children's treatment decisions. Pill burden, treatment duration and related frequency of dosing were identified as important factors that influenced preventive treatment preferences among care givers. CONCLUSION Understanding care giver preferences and involving them in treatment decisions may facilitate efforts to implement successful preventive treatment for TB among children in high TB burden countries.
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Affiliation(s)
- Y Hirsch-Moverman
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
| | - J E Mantell
- HIV Center for Clinical & Behavioral Studies, Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University, Department of Psychiatry, New York
| | - L Lebelo
- ICAP at Columbia University, Mailman School of Public Health, New York
| | - C Wynn
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A A Howard
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
| | - S Nachman
- Pediatric Infectious Diseases, State University of New York Stony Brook, Stony Brook, New York, USA
| | - K Frederix
- ICAP at Columbia University, Mailman School of Public Health, New York
| | - L B Maama
- Lesotho Ministry of Health National Tuberculosis Program, Maseru, Lesotho
| | - W M El-Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, Department of Epidemiology, Columbia University, New York
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Koskinen JSS. The concept of Datenherrschaft of patient information from a Heideggerian perspective. JOURNAL OF INFORMATION COMMUNICATION & ETHICS IN SOCIETY 2019. [DOI: 10.1108/jices-04-2018-0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PurposeIn this paper, patient information is approached from a Heideggerian perspective with the intention to gather an understanding about the personal nature of the information. The purpose of this paper is to analyse the ownership of patient information and then present Datenherrschaft (German for “mastery over information”) as a suitable model for patient ownership of patient information.Design/methodology/approachThis paper is theoretical in approach. It is based on arguments derived from Heidegger’s work in the Being and Time.FindingsBased on this Heideggerian approcah, a proposal for using the special definition of ownership of patient information – Datenherrschaft – given to a patient is suggested. From a Heideggerian perspective, it can be stated that the patient has the strongest rights towards patient information because this information is crucial for a patient to have an understanding about their Dasein (being-in-the-world).Research limitations/implicationsDatenherrschaft is used as an example of an ethically justified way of regulating the patient information ownership and should be analysed further. Especially the practical implications of implementing Datenherrschaft need more research.Originality/valuePatient information ownership is an issue that is neither unambiguously solved in many countries, nor has it, in our view, been ethically justified. The potential solution – Datenherrschaft – presented in this paper is clear and has strong philosophical justifications.
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Kamimura A, Weaver S, Armenta B, Gull B, Ashby J. Patient centeredness: The perspectives of uninsured primary care patients in the United States. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519836424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction Patient-centered care has become increasingly important within the United States (US) healthcare system. Given that patient-centered care predicts patient satisfaction, health outcomes, and cost-effectiveness, it is of the utmost importance to study patient-centered care from the perspectives of marginalized populations including minorities, immigrants, and other underserved populations. The purpose of this study is to examine factors that affect underserved primary care patients’ perceptions of patient centeredness. Methods The data were cross-sectional and collected in Fall 2016. Free clinic patients (N = 723) completed a self-administered survey, which measures patient centeredness, patient involvement in care, and clinical empathy. Validated measures were part of the survey, and the internal consistency of scales was tested. The general linear model was performed to predict factors associated with patients’ perceptions of patient centeredness. Results Higher levels of perceived patient involvement in care and higher levels of perceived empathy in consultation are related to higher levels of patient centeredness. While better physical health is associated with higher levels of perceived empathy in consultation, high levels of emotional health and depression are not. Conclusions Patients’ perceptions of involvement and empathy are important factors for patient-centered care, although this study did not show causal directions among variables. Based on the findings of this study, it is recommended that future studies should focus on the following three points: (1) to develop and evaluate trainings for providers, (2) develop education classes for patients who utilize free clinics, (3) analyze how these programs affect patient-centered care and health outcomes.
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Zhang L, Qiu Y, Zhang N, Li S. How Difficult Doctor‒Patient Relationships Impair Physicians' Work Engagement: The Roles of Prosocial Motivation and Problem-Solving Pondering. Psychol Rep 2019; 123:885-902. [PMID: 30732545 DOI: 10.1177/0033294119826887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Difficult doctor‒patient relationships are a common reality in many health-care organizations. Its harmful impacts have been mainly discussed from the perspectives of patients. However, understanding of its negative effects on physicians is limited. Drawing on the job demands-resources model and the conservation of resources theory, we hypothesize that difficult relationships with patients negatively predict physicians' work engagement, mediated by physicians' personal resources (e.g. prosocial motivation and problem-solving pondering). A sample of 588 physicians from 24 Chinese hospitals completed questionnaires in a two-wave survey. Structural equation modeling and bootstrap estimation results provide support for the hypothesized relationships. Difficult doctor‒patient relationships have a direct and negative effect on physicians' work engagement. Specifically, there is a sequence in which the difficult doctor‒patient relationship first impedes physicians' prosocial motivation, leading to decreased problem-solving pondering, which subsequently impairs physicians' work engagement. Theoretical and practical implications of these findings are discussed.
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Affiliation(s)
- Linlin Zhang
- Department of Applied Psychology, College of Humanities and Social Sciences, Harbin Engineering University, China
| | - Yang Qiu
- Department of Management, Harbin Institute of Technology, China
| | - Nan Zhang
- School of Psychology, Central China Normal University, China
| | - Shuang Li
- Department of Applied Psychology, College of Humanities and Social Sciences, Harbin Engineering University, China
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An Interval Type-2 Fuzzy Similarity-Based MABAC Approach for Patient-Centered Care. MATHEMATICS 2019. [DOI: 10.3390/math7020140] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient-centered care is an essential part of the implementation of integrated medicine, integrating humanistic care into nursing services, enhancing communication between caregivers and patients, and providing personalized service to patients. Based on the similarity of interval type-2 fuzzy numbers (IT2FNs), a novel similarity-based methodology is presented for the selection of the most suitable medical treatment under a patient-centered environment. First, we propose a new similarity based on the geometric properties of interval type-2 fuzzy numbers and present a new property based on the center of gravity. Meanwhile, in order to better highlight the advantages of the proposed similarity, we selected 30 samples for comparative experiments. Second, considering the straightforward logic of the multi-attributive border approximation area comparison (MABAC) method, we extended it based on similarity to make the decision more accurate. Finally, a realistic patient-centered type-2 diabetes treatment selection problem is presented to verify the practicality and effectiveness of the proposed algorithm. A comparative analysis with existing methods is also described.
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Souesme G, Ferrand C. What is an autonomy supportive environment in geriatric care units? Focus group interviews with healthcare professionals. Int J Older People Nurs 2019; 14:e12221. [DOI: 10.1111/opn.12221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 11/27/2018] [Accepted: 12/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Guillaume Souesme
- Research Team of Psychology of Ages of Life and Adaptation (EA 2114); University of Tours; Tours France
| | - Claude Ferrand
- Research Team of Psychology of Ages of Life and Adaptation (EA 2114); University of Tours; Tours France
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Luther L, Fukui S, Garabrant JM, Rollins AL, Morse G, Henry N, Shimp D, Gearhart T, Salyers MP. Measuring Quality of Care in Community Mental Health: Validation of Concordant Clinician and Client Quality-of-Care Scales. J Behav Health Serv Res 2019; 46:64-79. [PMID: 29651600 PMCID: PMC6185830 DOI: 10.1007/s11414-018-9601-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Measuring quality of care can transform care, but few tools exist to measure quality from the client's perspective. The aim of this study was to create concordant clinician and client self-report quality-of-care scales in a sample of community mental health clinicians (n = 189) and clients (n = 469). The client scale had three distinct factors (Person-Centered Care, Negative Staff Interactions, and Inattentive Care), while the clinician scale had two: Person-Centered Care and Discordant Care. Both versions demonstrated adequate internal consistency and validity with measures related to satisfaction and the therapeutic relationship. These measures are promising, brief quality assessment tools.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 124, Indianapolis, Indiana, 46220, USA.
- ACT Center of Indiana, 402 North Blackford Street, LD 124, Indianapolis, IN, 46220, USA.
| | - Sadaaki Fukui
- Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, 1545 Lilac Lane, Twente Hall, Lawrence, KS, 66045, USA
| | - Jennifer M Garabrant
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 124, Indianapolis, Indiana, 46220, USA
- ACT Center of Indiana, 402 North Blackford Street, LD 124, Indianapolis, IN, 46220, USA
| | - Angela L Rollins
- ACT Center of Indiana, 402 North Blackford Street, LD 124, Indianapolis, IN, 46220, USA
- Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, 1481 W. 10th Street, 11-H Indianapolis, Indianapolis, Indiana, 46202, USA
| | - Gary Morse
- Places for People, Inc., 4130 Lindell Boulevard, St. Louis, MO, 63108, USA
- Department of Psychological Sciences, University of Missouri-St. Louis, One University Boulevard, 325 Stadler Hall, St. Louis, MO, 63121, USA
| | - Nancy Henry
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 124, Indianapolis, Indiana, 46220, USA
- ACT Center of Indiana, 402 North Blackford Street, LD 124, Indianapolis, IN, 46220, USA
| | - Dawn Shimp
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 124, Indianapolis, Indiana, 46220, USA
- ACT Center of Indiana, 402 North Blackford Street, LD 124, Indianapolis, IN, 46220, USA
| | - Timothy Gearhart
- Four County Counseling Center, 1015 Michigan Avenue, Logansport, IN, 46947, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 124, Indianapolis, Indiana, 46220, USA
- ACT Center of Indiana, 402 North Blackford Street, LD 124, Indianapolis, IN, 46220, USA
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Mattukat K, Boehm P, Raberger K, Schaefer C, Keyszer G, Mau W. How Much Information and Participation Do Patients with Inflammatory Rheumatic Diseases Prefer in Interaction with Physicians? Results of a Participatory Research Project. Patient Prefer Adherence 2019; 13:2145-2158. [PMID: 31908422 PMCID: PMC6927260 DOI: 10.2147/ppa.s209346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/25/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Patient preferences for information and participation in medical decision-making are important prerequisites to realize a shared decision between patients and physicians. This paper aims at exploring these preferences in German patients with inflammatory rheumatic diseases and at identifying relevant determinants of these preferences. METHODS In a cross-sectional survey, adult patients with rheumatoid arthritis (RA), spondyloarthritis (SA) or different connective tissue diseases (CTS) filled out a questionnaire. Data were collected via a written questionnaire (1) sent to members of a regional self-help group or (2) handed out to patients at their rheumatologist's appointment, and (3) via an online questionnaire available nationwide. Measurements included information and participation preferences (Autonomy Preference Index; API: 0-100), as well as health-related and sociodemographic variables. Analyses included ANOVAs (group differences) and multiple regression analyses (determinants of preferences). To ensure the analysis was patient-centered we involved a trained representative of the German League Against Rheumatism as a research partner. RESULTS 1616 patients returned questionnaires [44% response, 79% female, mean age 54 years, diagnoses 63% RA, 28% SA, 19% CTS]. Participants reported a concurring major preference for information but vastly different preferences for participation. A greater preference for participation was associated with female sex, younger age, higher household income, and self-help group membership. Conversely, a lower preference for participation was linked to blue-collar workers, retirement, higher confidence in the rheumatologist, and poorer health literacy. CONCLUSION Whereas patients consistently welcome comprehensive information about their disease and its different treatment options, not all patients wish to be involved in therapeutic decisions. Especially older patients with lower education status and lower health literacy, but higher confidence in their rheumatologist tend to leave the decisions rather to the physician. Different preferences should be considered in the doctor-patient communication.
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Affiliation(s)
- Kerstin Mattukat
- Institute of Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Correspondence: Kerstin Mattukat Institute of Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Street 8, Halle (Saale)06112, GermanyTel +49 345 557-7646Fax +49 345 557-4206 Email
| | - Peter Boehm
- Federal Association of the German League Against Rheumatism, Bonn, Germany
| | - Katja Raberger
- Institute of Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christoph Schaefer
- Clinic for Internal Medicine II, Department of Internal Medicine, University Hospital Halle, Halle (Saale), Germany
| | - Gernot Keyszer
- Clinic for Internal Medicine II, Department of Internal Medicine, University Hospital Halle, Halle (Saale), Germany
| | - Wilfried Mau
- Institute of Rehabilitation Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Náfrádi L, Kostova Z, Nakamoto K, Schulz PJ. The doctor-patient relationship and patient resilience in chronic pain: A qualitative approach to patients' perspectives. Chronic Illn 2018; 14:256-270. [PMID: 29096534 DOI: 10.1177/1742395317739961] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To study patients' perspectives about the role of the doctor-patient relationship in promoting the resilience process. METHODS We conducted in-depth interviews with 20 chronic pain patients. Using open-ended questions, the interviews explored aspects of the doctor-patient relationship that impacted the patients' perceptions of their resilience. Thematic analysis built on an inductive, adaptive approach to data coding was employed to organize a representation of key factors affecting resilience. RESULTS The themes emerging from the interviews inform us about how the different aspects of the doctor-patient relationship can promote patient resilience in chronic pain. Three main themes emerged: the doctor providing psychological support, promoting patients' health literacy related to chronic pain and its treatment, and empowering the patients to cooperate in finding the right treatment. This fosters patients' direct outcomes (feeling validated, health literate, and empowered), which, in turn, lead to adaptive coping responses and day-to-day disease management. These direct outcomes are crucial for patients to maintain socially and personally meaningful activities and their functional (physical) capacity. DISCUSSION A doctor-patient relationship following the precepts of the patient-centered care is a significant resource that can lead to increased patient resilience. Thus, future interventions promoting patient resilience might consider addressing the doctor-patient relationship.
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Affiliation(s)
- Lilla Náfrádi
- 1 Institute of Communication and Health, Universita della Svizzera Italiana, Università della Svizzera Italiana, Lugano, Switzerland
| | - Zlatina Kostova
- 2 Department of Psychiatry, University of Massachusetts Medical School, Worcester, USA
| | - Kent Nakamoto
- 1 Institute of Communication and Health, Universita della Svizzera Italiana, Università della Svizzera Italiana, Lugano, Switzerland
| | - Peter J Schulz
- 1 Institute of Communication and Health, Universita della Svizzera Italiana, Università della Svizzera Italiana, Lugano, Switzerland
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Wong S, Jacova C. Older Adults' Attitudes towards Cognitive Testing: Moving towards Person-Centeredness. Dement Geriatr Cogn Dis Extra 2018; 8:348-359. [PMID: 30483302 PMCID: PMC6243915 DOI: 10.1159/000493464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/02/2018] [Indexed: 12/17/2022] Open
Abstract
Background Research on person-centered cognitive testing is beginning to emerge. The current study is the first to focus on eliciting concrete preferences around the test experience. Methods Adults ≥50 years old completed the Attitudes Around Cognitive Testing (AACT) questionnaire on mturk.com. AACT elicits preferences for cognitive tests, the importance attributed to having choices, and willingness to engage in testing. Results Data are reported for 289 respondents. The proportion of participants expressing preferences varied by domain (modality [49.5%], location [47.2%], company [80.1%], result delivery [78.3-89.7%]). Importance ratings for all domains had a median of 4 and a range of 1-5 using a Likert scale of agreement. Most participants (85.5%) were willing to engage in testing. Conclusion Older adults have preferences for cognitive tests, especially with delivery of results.
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Affiliation(s)
- Sara Wong
- Pacific University, Hillsboro, Oregon, USA
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