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Lyons MS, Dhakal S, Baker C, Chaput G, Finelli A, Kupets R, Look Hong NJ, Gagliardi AR. Preferred labels and language to discuss low-risk lesions that may be cancer precursors: A review. PATIENT EDUCATION AND COUNSELING 2024; 126:108321. [PMID: 38805874 DOI: 10.1016/j.pec.2024.108321] [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: 10/27/2023] [Revised: 04/02/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVES Patients diagnosed with low-risk lesions are confused about whether they have cancer, and experience similar anxiety to those with invasive cancer, which affects quality of life. Current labels for low-risk lesions were chosen by clinicians and lack meaning to patients. METHODS We reviewed published research on preferred labels and language for low-risk lesions, and the rationale for those preferences. RESULTS Of 6569 titles screened, we included 13 studies. Among healthy adults with cervix or prostate lesions, use of the term "cancer" rather than "nodule" or "lesion" resulted in greater anxiety, higher perceived disease severity, and selection of more invasive treatment. Physicians asked about removing "carcinoma" from thyroid lesion labels to reduce patient anxiety and discourage over-treatment did not support this change, instead preferring a term that included "neoplasm". CONCLUSIONS This review revealed a startling paucity of research on preferences for low-risk lesion labels and language, and associated rationale. Future research is needed to understand how to improve communication about low-risk lesions. PRACTICE IMPLICATIONS To reduce anxiety and improve the overall well-being of patients, it is crucial to gain a deeper understanding of how to improve patient-provider conversations regarding screen-detected lesions with a low risk of developing into invasive cancer.
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Affiliation(s)
- Mavis S Lyons
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Smita Dhakal
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Clara Baker
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | | | - Antonio Finelli
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Rachel Kupets
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nicole J Look Hong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
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2
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Dickerson LK, Lipson TA, Chauhan SSB, Allen GI, Young B, Park JO, Pillarisetty VG, O'Connell KM, Sham JG. Evaluating surgeon communication of pancreatic cancer prognosis using the VitalTalk ADAPT framework. J Surg Oncol 2024. [PMID: 38990255 DOI: 10.1002/jso.27777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND AND OBJECTIVES Few data exist to guide optimal communication practices for surgical oncologists. VitalTalk, an evidence-based communication skills training model for clinicians, offers the five-step ADAPT tool for discussing prognosis. This study aimed to characterize surgeon communication of pancreatic cancer prognosis using VitalTalk's ADAPT framework. METHODS Contemporaneous audio recordings from 12 initial surgeon-patient encounters for borderline resectable pancreatic cancer were transcribed. Directed qualitative content analysis based on ADAPT (Ask, Discover, Anticipate, Provide, and Track) was used to deductively code transcripts. RESULTS All encounters contained at least one ADAPT step while only one (8%) incorporated four or five steps. Surgeons provided prognostic information (Provide) in all but one encounter (92%); most was qualitative and clustered into themes: serious illness, surgical candidacy, prognostic ambiguity, and cancer recurrence. Surgeons elicited understanding (Ask), requested information preferences (Discover), anticipated ambivalence (Anticipate), and responded to emotion (Track) in a minority of encounters (25%-42%); of 15 patient emotional cues, six were not addressed by surgeons. CONCLUSIONS During an initial encounter for pancreatic cancer, surgeons focus heavily on providing information but omit critical prognostic communication steps. Future studies are needed to investigate if surgeon training in palliative care-based communication is feasible and impacts patient-perceived quality of communication.
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Affiliation(s)
- Lindsay K Dickerson
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Trisha A Lipson
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Griffen I Allen
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Bill Young
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - James O Park
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Venu G Pillarisetty
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Kathleen M O'Connell
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jonathan G Sham
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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Primeau C, Chau M, Turner MR, Paterson C. Patient Experiences of Patient-Clinician Communication Among Cancer Multidisciplinary Healthcare Professionals During "Breaking Bad News": A Qualitative Systematic Review. Semin Oncol Nurs 2024:151680. [PMID: 38918149 DOI: 10.1016/j.soncn.2024.151680] [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: 03/06/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To explore patient experiences of patient-clinician communication during the critical moments of "breaking bad news" in cancer care. METHODS A qualitative systematic review followed the Joanna Briggs Institute methodology and has been reported according to PRISMA guidelines. Databases, including APA PsycINFO, CINAHL, MEDLINE, and Scopus, were searched from the beginning of their date range coverage to April 2023. Data extraction and quality assessment were performed, and a meta-aggregation approach was used for data synthesis. RESULTS Twenty-eight studies were included and represented 976 patients. Key themes included (1) sensing something is wrong (prior to diagnosis), (2) reaction to the diagnosis, (3) information (during breaking bad news), (4) communication with health care professionals, (5) specialist versus nonspecialist centers, (6) decision-making, and (7) feeling supported. The review underscores the need for health care professionals to adeptly navigate and respond to individual patient needs during confronting and distressing times. CONCLUSIONS The complexity and individuality of patient-clinician communication suggest that further education is needed among the cancer multidisciplinary team to develop personalized, empathetic communication strategies in clinical practice, catering to diverse patient preferences. The findings call for more inclusive research across different cultures and languages, and a need to understand evolving communication needs, especially in the context of increasing digital communication modalities in health care. IMPLICATIONS FOR CANCER SURVIVORSHIP This review provides valuable new insights into developing effective communication strategies that are responsive to the diverse needs of patients undergoing cancer treatment. Its findings emphasize the importance of empathy, flexibility, and a personalized approach in delivering bad news and supporting patients throughout survivorship.
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Affiliation(s)
- Charlotte Primeau
- Warwick Manufacturing Group, University of Warwick Coventry, Coventry, UK
| | - Minh Chau
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia; School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Murray R Turner
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia; Flinders University, Caring Futures Institute, Adelaide, Australia; Central Adelaide Local Health Network, Adelaide, Australia.
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Burnett C, Boehmer U, Jesdale BM. Perceptions of patient-provider communications with healthcare providers among sexual and gender minority individuals in the United States. PATIENT EDUCATION AND COUNSELING 2024; 127:108347. [PMID: 38968873 DOI: 10.1016/j.pec.2024.108347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/17/2024] [Accepted: 06/06/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVES To identify perceived differences in the key domains of patient-provider communications between sexual and gender minority (SGM) and non-SGM patients. METHODS We reviewed data from the Health Information National Trends Survey (HINTS) to assess patient perspectives on different domains of patient-provider communications in the ideological framework by Epstein and Street (2007) [1]. Between SGM-identified (N = 491) and cisgender, heterosexual respondents (N = 7426), we assessed the proportions of responses to survey questions about the six domains of patient-provider communications and calculated odds ratios (OR) with 95 % confidence intervals (CI) (N = 7917). RESULTS Overall, compared to cisgender, heterosexual individuals, fewer SGM individuals reported always experiencing optimal patient-provider communications across all domains, most notably in areas of emotional support (OR=0.70, 95 % CI: (0.51, 0.97)), patient self-management (OR=0.73, 95 % CI: (0.54, 0.99)), and managing uncertainty (OR=0.68, 95 % CI: (0.49, 0.94)). CONCLUSION Further research on detailed SGM patient perceptions of their relationships with healthcare providers is needed to understand why such differences in communication exist and provide practical recommendations to improve care delivery. PRACTICE IMPLICATIONS SGM patients perceive their current provider communications to be suboptimal, so we must improve emotional management training in future provider-based SGM competency trainings and encourage patient self-management during individual provider encounters.
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Affiliation(s)
- Colin Burnett
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA.
| | - Ulrike Boehmer
- Boston University School of Public Health, Boston, MA, USA
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
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Totzkay D. The potential influence of patient-centered communication, online provider communication, and social determinants of health on cancer screening. PATIENT EDUCATION AND COUNSELING 2024; 123:108238. [PMID: 38452686 DOI: 10.1016/j.pec.2024.108238] [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: 07/03/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE To understand how breast and cervical cancer screening are influenced by communicating with a healthcare provider, patient activation, and social determinants of health. METHOD Data were from the National Cancer Institute's Health Information National Trends Survey, focusing on women with no history of cancer at least 21 years old (N = 1466) to study cervical cancer screening and those at least 40 years old (N = 1114) to study breast cancer screening. Variables included patient-centered communication, electronic healthcare communication, patient activation, race/ethnicity, education, health insurance status, Appalachian residence, and financial insecurity. RESULTS Electronic communication predicted both cancer screens, but especially for White women. Patient-centered communication influenced cervical cancer screening only for women with insurance. It only influenced mammography for those without insurance. Patient activation did not influence either cancer screen behavior. CONCLUSION These data demonstrate more nuance is needed to parse potential effects of advocated-for healthcare behaviors. Use of publicly available datasets from can be informative but are limited methodologically. PRACTICE IMPLICATIONS Healthcare providers and systems should promote use of patient portals and other electronic means of interaction outside regular clinical visits for all patients. However, attention needs to be paid to the unequal benefits they afford to patients.
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Affiliation(s)
- Dan Totzkay
- Department of Communication Studies, West Virginia University, Morgantown, WV, USA.
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Jiang S, Wu Z, Zhang X, Ji Y, Xu J, Liu P, Liu Y, Zheng J, Zhao L, Chen J. How does patient-centered communication influence patient trust?: The roles of patient participation and patient preference. PATIENT EDUCATION AND COUNSELING 2024; 122:108161. [PMID: 38308973 DOI: 10.1016/j.pec.2024.108161] [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: 09/08/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE The aim of this study was to examine the effects of patient-centered communication, patient participation, and patient preference on patient trust in the context of China. METHODS A cross-sectional survey was conducted involving 217 cancer patients in China. Mediation and moderation analyses were performed to examine the relationships among the study variables. RESULTS First, patient-centered communication increased patient participation in decision-making, which, in turn, enhanced patient trust. Second, patient-centered communication did not have a direct effect on patient trust. Third, patient preference for a passive role in decision-making weakened the relationship between patient participation and patient trust. CONCLUSION The results underscore the significant effect of facilitating patient participation in linking patient-centered communication to patient trust. However, medical communication should also respond to patients' preferred roles in the decision-making process. PRACTICE IMPLICATIONS Doctors should provide patients with opportunities to ask questions and express their concerns. In addition, they should evaluate patients' preferred degree of involvement before inviting them to contribute so as to respect their preferences and values.
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Affiliation(s)
- Shaohai Jiang
- Department of Communications and New Media, National University of Singapore, Singapore 999002, Singapore
| | - Zhengyu Wu
- School of Public Affairs, Xiamen University, Xiamen 361000, China
| | - Xiaoyu Zhang
- China Agricultural Film and Television Center, Beijing 100020, China
| | - Ying Ji
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | | | - Peng Liu
- Beijing Hospital, Beijing 100020, China
| | - Yan Liu
- Cancer Hospital Chinese Academy of Medical Science, Beijing 100020, China
| | - Jie Zheng
- Department of neurosurgery, Huashan Hospital, Fudan University, Shanghai 200000, China
| | - Liang Zhao
- Cancer Hospital Chinese Academy of Medical Science, Beijing 100020, China
| | - Jingxi Chen
- College of Arts and Media, Tongji University, Weixin Building, No.4800 Cao'an Road, Jiading District, Shanghai 201801, China.
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7
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Gengeswaran N, Brandwood A, Anderson NN, Ramlakhan JU, Gagliardi AR. Do clinical guidelines support person-centred care for women affected by dementia: A content analysis. DEMENTIA 2024; 23:525-549. [PMID: 38567809 PMCID: PMC11059842 DOI: 10.1177/14713012241244982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Dementia disproportionately affects women including persons living with dementia and caregivers. Person-centered care, rather than disease-focused, is recommended to improve care for affected persons including caregivers. General practitioners play a central role in dementia care but find it challenging due to inadequate training. The study aimed to assess if and how dementia guidelines provide clinicians with guidance on person-centred care for women affected by dementia. METHODS We searched for publicly available English-language guidelines on the overall management of dementia in MEDLINE, EMBASE and the Guidelines International Network repository. We employed deductive and summative content analysis, and categorized person-centered care guideline content based on established frameworks, and conveyed our results using summary statistics, text, and tables. RESULTS We reviewed 15 guidelines published from 2006 to 2020 in eight countries. Few (4, 23%) involved persons living with dementia or caregivers in guideline development. Regarding general person-centred care, guidelines mostly addressed the domains of exchange information (93%), share decisions (93%), enable self-management (93%) and address emotions (87%), while few offered content on manage uncertainty (33%) or foster a healing relationship (13%). Regarding dementia-specific person-centred care, most guidelines addressed intersectionality (tailoring care for diverse characteristics) (80%), but few included content on the domains of quality of life (67%), dignity (53%) or sex/gender issues (20%). Even when mentioned, the guidance was typically brief. We identified 32 general and 18 dementia-specific strategies to achieve person-centered care by compiling information from these guidelines. CONCLUSIONS This study identified inconsistent and insufficient guideline content on person-centred care for women with dementia. Compiled strategies for achieving person-centred care could be used by developers to enhance existing and future dementia guidelines; and inform the development of policies or programs, education, tools for clinicians, and quality improvement measures for evaluating dementia care. Future research is crucial for promoting person-centred dementia care for women living with dementia.
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Affiliation(s)
- Nevetda Gengeswaran
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Alec Brandwood
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Jessica U Ramlakhan
- Toronto General Hospital Research Institute, University Health Network, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Canada
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8
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Haverfield MC, Carrillo Y, Itliong JN, Ahmed A, Nash A, Singer A, Lorenz KA. Cultivating Relationship-Centered Care: Patient, Caregiver, and Provider Communication Preferences for and Experiences with Prognostic Conversations. HEALTH COMMUNICATION 2024; 39:1256-1267. [PMID: 37165555 DOI: 10.1080/10410236.2023.2210383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Prognostic conversations present many challenges for patients, caregivers, and providers alike. Most research examining the context of prognostic conversations have used a more siloed approach to gather the range of perspectives of those involved, typically through the lens of patient-centered care. However, the mutual influence evident in prognostic conversations suggests a relationship-centered care model may be useful in cancer communication research. Similarities and differences in preferences for and experiences with prognostic conversations among oncology patients, caregivers, and providers (N = 32) were explored. Identified themes were then mapped to the principles of the relationship-centered care framework to extend our understanding of prognostic conversations and contribute to a new direction in the application of relationship-centered care. Findings suggest fewer similarities than differences, point to important discrepancies among participant perspectives, and reinforce the utility of relationship-centered care in identifying communication practices that enhance the prognostic conversation experience.
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Affiliation(s)
| | | | | | - Anum Ahmed
- Communication Studies, San José State University
| | - Amia Nash
- School of Public Health, University of California
| | - Adam Singer
- School of Medicine, University of California Los Angeles
| | - Karl A Lorenz
- VA Palo Alto Health Care System, Center for Innovation to Implementation
- Department of Primary Care and Population Health, Stanford University School of Medicine
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9
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Abbaticchio A, Theodorlis M, Marshall D, MacKay C, Borkhoff CM, Hazlewood GS, Battistella M, Lofters A, Ahluwalia V, Gagliardi AR. Policies in Canada fail to address disparities in access to person-centred osteoarthritis care: a content analysis. BMC Health Serv Res 2024; 24:522. [PMID: 38664819 PMCID: PMC11044343 DOI: 10.1186/s12913-024-10966-5] [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] [Received: 04/30/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access OA care, particularly racialized women. One way to reduce inequities is through policies that can influence healthcare services. We examined how OA-relevant policies in Canada address equitable, person-centred OA care for women. METHODS We used content analysis to extract data from English-language OA-relevant documents referred to as policies or other synonymous terms published in 2000 or later identified by searching governmental and other web sites. We used summary statistics to describe policy characteristics, person-centred care using McCormack's six-domain framework, and mention of OA prevalence, barriers and strategies to improve equitable access to OA care among women. RESULTS We included 14 policies developed from 2004 to 2021. None comprehensively addressed all person-centred care domains, and few addressed individual domains: enable self-management (50%), share decisions (43%), exchange information (29%), respond to emotions (14%), foster a healing relationship (0%) and manage uncertainty (0%). Even when mentioned, content offered little guidance for how to achieve person-centred OA care. Few policies acknowledged greater prevalence of OA among women (36%), older (29%) or Indigenous persons (29%) and those of lower socioeconomic status (14%); or barriers to OA care among those of lower socioeconomic status (50%), in rural areas (43%), of older age (37%) or ethno-cultural groups (21%), or women (21%). Four (29%) policies recommended strategies for improving access to OA care at the patient (self-management education material in different languages and tailored to cultural norms), clinician (healthcare professional education) and system level (evaluate OA service equity, engage lay health leaders in delivering self-management programs, and offer self-management programs in a variety of formats). Five (36%) policies recommended research on how to improve OA care for equity-seeking groups. CONCLUSIONS Canadian OA-relevant policies lack guidance to overcome disparities in access to person-centred OA care for equity-seeking groups including women. This study identified several ways to strengthen policies. Ongoing research must identify the needs and preferences of equity-seeking persons with OA, and evaluate the impact of various models of service delivery, knowledge needed to influence OA-relevant policy.
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Affiliation(s)
- Angelina Abbaticchio
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | | | | | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Marisa Battistella
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada.
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Skiba MB, Wells SJ, Brick R, Tanner L, Rock K, Marchese V, Khalil N, Raches D, Thomas K, Krause KJ, Swartz MC. A Systematic Review of Telehealth-Based Pediatric Cancer Rehabilitation Interventions on Disability. Telemed J E Health 2024; 30:901-918. [PMID: 38010811 PMCID: PMC11040188 DOI: 10.1089/tmj.2023.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/23/2023] [Accepted: 09/08/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Telehealth is an emerging method which may overcome barriers to rehabilitation access for pediatric cancer survivors (aged ≤19 years). This systematic review aimed to examine telehealth-based rehabilitation interventions aimed at preventing, maintaining, or improving disability in pediatric cancer survivors. Methods: We performed systematic searches in Ovid MEDLINE, Ovid EMBASE, Cochrane Library, SCOPUS, Web of Science, and CINAHL Plus between 1994 and 2022. Eligible studies included telehealth-based interventions assessing disability outcomes in pediatric cancers. Results: Database searches identified 4,040 records. Nine unique interventions met the eligibility criteria. Telehealth delivery methods included telephone (n = 6), email (n = 3), mobile health applications (n = 3), social media (n = 3), videoconferencing (n = 2), text messaging (n = 2), active video gaming (n = 2), and websites (n = 2). Interventions focused on physical activity (n = 8) or self-management (n = 1). Outcomes assessing disability varied (n = 6). Three studies reported statistically and clinically significant results. Narrative synthesis of findings was constructed based on the Picker's principles for patient-centered care: (1) values, preferences, and needs; (2) involve family and friends; (3) coordination of care; (4) provide social support; (5) holistic well-being; and (6) information and communication. Conclusions: Telehealth-based rehabilitation interventions for pediatric cancer survivors is an emerging research area with potential to improve disability outcomes. Adequately powered trials with consistency in disability outcome measures are warranted. Additional research is needed to determine the effectiveness and best practices for telehealth-based pediatric cancer rehabilitation.
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Affiliation(s)
- Meghan B. Skiba
- Biobehavioral Health Science Division, College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Stephanie J. Wells
- Division of Pediatric, Pediatrics-Research Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rachelle Brick
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland, USA
| | - Lynn Tanner
- Physical Medicine and Rehabilitation, Children's Minnesota Hospital, Minneapolis, Minnesota, USA
| | - Kelly Rock
- Physical Therapy Department, University of Florida, Gainesville, Florida, USA
- Physical Therapy and Rehabilitation Science Department, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Victoria Marchese
- Physical Therapy and Rehabilitation Science Department, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nashwa Khalil
- Rusk Rehabilitation, NYU Langone Health, New York, New York, USA
| | - Darcy Raches
- Psychology Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Kristin Thomas
- Laboratory Howard Heads Sports Medicine, Vail Health, Edwards, Colorado, USA
| | - Kate J. Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria C. Swartz
- Division of Pediatric, Pediatrics-Research Department, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Liu PL, Zhang L, Ma X, Zhao X. Communication Matters: The Role of Patient-Centered Communication in Improving Old Adults' Health Competence and Health Outcomes. HEALTH COMMUNICATION 2024; 39:363-375. [PMID: 36628509 DOI: 10.1080/10410236.2023.2166209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Research has demonstrated links between patient-centered communication (PCC) and patients' health outcomes. However, little is known about the underlying processes that may mediate the relationship. This study is one of the first to examine the influence of PCC on older adults' health outcomes, as well as the mediation role of health competence, from a longitudinal perspective. With a general basis of Street et al.'s pathway model, we proposed and tested mediation pathways linking patient-centered communication to the older population's general and mental health, mediated by health competence. Data from 2011, 2017 and 2020 iterations of the Health Information National Trends Survey (HINTS) were used for this study. This study focused on older adults aged 60 and above. Results indicated that after controlling participants' age, gender, education, income and race, PCC is related to the older people's health outcomes either directly or indirectly, irrespective of time series. Specifically, health competence was found to significantly mediate the associations between PCC and the older adults' general health or mental health over the three iterations. Noteworthily, findings from this study also revealed that different dimensions of PCC might exert different influences on older patients' health competence and health outcomes.
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Affiliation(s)
| | - Lianshan Zhang
- School of Media and Communication, Shanghai Jiao Tong University
| | - Xiaofen Ma
- Research Center of Journalism and Social Development, School of Journalism and Communication, Renmin University of China
| | - Xinshu Zhao
- Department of Communication, University of Macau
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12
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Næss SCK. 'Don't freak out if you get a letter saying cancer patient pathways!': Communication work between different demands in cancer care. Health (London) 2024; 28:313-330. [PMID: 36238971 PMCID: PMC10900861 DOI: 10.1177/13634593221127819] [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] [Indexed: 11/17/2022]
Abstract
This article explores healthcare professionals' experiences of their work with patient communication in standardised cancer patient pathways (CPPs). The theoretical and methodological framework for this study is institutional ethnography. Data were collected through semi-structured interviews with 72 healthcare professionals, including general practitioners, specialist physicians and other hospital staff, in five Norwegian hospitals. The study reveals four aspects of communication work that illuminate how the CPP policy mediates the way healthcare professionals interact with patients through communicating continuity, communicating (by dodging) the dreaded C-word, communicating patient participation, and communicating the relevance of time. Healthcare professionals' balancing of their different experiential realities run as a common thread through the four aspects of communication work identified in this study. The CPP policy, with its explicit focus on transparency, speed, and time frames creates challenges in an already delicate situation.
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13
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Starr LT, Washington K, Pitzer K, Oliver DP, Demiris G. Close but Not Close Enough: How Distance Caregiving is Associated with Hospice Family Caregiver Hospice Communication Experiences. HEALTH COMMUNICATION 2024; 39:482-492. [PMID: 36683376 PMCID: PMC10362092 DOI: 10.1080/10410236.2023.2170199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Half of hospice family caregivers report having unmet information needs, which can contribute to poor pain and symptom management, emergency department use, and hospice disenrollment for care-recipients and to caregiver strain and stress. Effective communication between hospice teams and family caregivers is critical yet communication inadequacies persist. Despite the growing prevalence of distance caregiving, including in hospice care, and the relationship between caregiver proximity and communication effectiveness, little is known about how caregiver proximity is associated with caregiver perceptions of hospice communication. In this secondary analysis of quantitative data from two multisite randomized clinical trials (NCT03712410 and NCT02929108) for hospice family caregivers (N = 525), multivariate linear models with demographic and contextual controls were used to analyze caregivers' perceptions of caregiver-centered communication with hospice providers based on caregiver proximity to the hospice care-recipient. In multivariate models, "local" hospice family caregivers who lived within 1 hour of the hospice care-recipient reported less effective communication with the hospice team than co-residing caregivers; and older caregivers rated communication more favorably than younger caregivers. To improve communication and collaboration between hospice teams and caregivers, regardless of proximity, distance communication training for hospice teams and interventions such as telehealth communication and virtual tools that enable triadic collaboration are recommended. Research is needed to understand why local caregivers, specifically, perceive communication quality less favorably and how hospice teams can better meet local and distance caregiver communication needs.
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Affiliation(s)
- Lauren T. Starr
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
| | - Karla Washington
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
| | - Kyle Pitzer
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
| | - Debra Parker Oliver
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
- Barnes Jewish College, Goldfarb School of Nursing, St. Louis, Missouri
| | - George Demiris
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania
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14
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Ye JF, Zheng S, Ao SH, Yan CD, Lai Y, Lai Z, Zhao X. How does patient-centered communication work? Trend analysis of mediation through cancer worry and health self-efficacy, 2011-2020. J Health Psychol 2024:13591053241228437. [PMID: 38305168 DOI: 10.1177/13591053241228437] [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: 02/03/2024] Open
Abstract
This study proposed and tested the cross-sectional effects of patient-centered communication (PCC) on cancer screening behaviors via an affective-cognitive sequential chain of mediation through cancer worry and health self-efficacy. Cross-sectional data were analyzed from four iterations of the Health Information National Trends Survey (2011, 2014, 2017, and 2020). The results found that lowered cancer worry following PCC does not show a cross-sectional positive effect in promoting cancer screening behaviors, while enhanced health self-efficacy as a subsequent state is a facilitator of screening behaviors. The findings further demonstrated increased PCC, a rise in cancer worry, and a sustained level of health self-efficacy. Also, our research has identified an upward trend in cancer screening behaviors from 2011 to 2017, followed by a notable decrease in 2020. These insights underscore the nuanced ways PCC can foster cancer screening behaviors, emphasizing the importance of emotional and cognitive aspects in clinical settings.
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Affiliation(s)
| | | | | | | | | | - Ze Lai
- University of Macau, China
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15
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Meekers D, Elkins A, Obozekhai V. Tools for patient-centred family planning counselling: A scoping review. J Glob Health 2024; 14:04038. [PMID: 38303671 PMCID: PMC10846870 DOI: 10.7189/jogh.14.04038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Background The focus of family planning counselling is gradually shifting from the tiered-effectiveness model to patient-centred counselling. Although tools exist that aim to make family planning counselling more patient-oriented without increasing the provider's workload, they are not widely used. This scoping review aims to address this by identifying key tools to make family planning care more patient-centred, reviewing the domains of patient-centred care they address, and identifying gaps in the evidence base. Methods We systematically searched PubMed and SCOPUS for documents on 'patient-centred family planning counselling or support' published between 2013 and 2022. Eligibility criteria included discussion of: 1) strategies for providing patient-centred care; 2) interventions using a patient-centred approach; or 3) the impact of patient-centred approaches. We identified tools for patient-centred care, and mapped them against an existing framework of the main domains of patient-centred care. We reported the available evidence of the impact on those tools. Results Our scoping review is based on 33 documents. We identified six tools for increasing the patient-centeredness of family planning counselling. None of the tools addressed all domains of patient-centred care. Evidence about the impact of these tools remains scarce. Although there is some evidence about the acceptability of the tools, key evidence gaps include the effect of the tools on quality of care and family planning outcomes. Conclusions Family planning implementers should be aware that existing tools differ in the extent to which they address key domains of patient-centred family planning counselling. There is a need for further research on factors that may deter providers from adopting these tools. A larger evidence base is needed to permit a future systematic review to determine the effect of these tools on family planning outcomes, such as method adoption and continuation.
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Affiliation(s)
- Dominique Meekers
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Aaron Elkins
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Vivian Obozekhai
- DKT International, A. G. Leventis Building, Iddo House, Lagos Mainland, Lagos, Nigeria
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16
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Chou WYS, Gaysynsky A. A relationship-centered approach to addressing mistrust. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:320-323. [PMID: 37732639 DOI: 10.1080/17538068.2023.2258683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Wen-Ying Sylvia Chou
- Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
| | - Anna Gaysynsky
- Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
- ICF Next, Rockville, MD, USA
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17
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Ventura F, Costa P, Chaplin J, Domingues I, Ferreira RJDO, McCormack B, Parreira P, Sousa LB. Portuguese translation, cultural adaptation, and validation of the Person-Centred Practice Inventory - Staff (PCPI-S). CIENCIA & SAUDE COLETIVA 2023; 28:3347-3366. [PMID: 37971016 DOI: 10.1590/1413-812320232811.17072022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/10/2023] [Indexed: 11/19/2023] Open
Abstract
Aiming to translate, culturally adapt, and psychometrically evaluate the Person-centred Practice Inventory - Staff (PCPI-S) for Portuguese healthcare professionals, this methodological study was conducted sequentially in two phases. Phase I followed the 10-steps recommendations from the ISPOR taskforce for translation and cultural adaptation of patient reported outcome measures. Phase II comprised a quantitative cross-sectional virtual survey of the translated PCPI-S with healthcare professionals, who were reached through snowball sampling from both primary and specialized care settings. The psychometric properties of the PCPI-S were determined by assessing reliability and construct validity. A sample of 304 healthcare professionals participated in Phase II. Ceiling effects were found. The overall internal consistency was excellent (> 0.9). The confirmatory factor analysis showed a good model fit after minor modifications, revealing construct validity, and supporting the theoretical framework. In conclusion, the three-factorial model of PCPI-S adjusted to the studied sample is a valid and reliable instrument to assess the perceptions of healthcare professionals on person-centred practice in various Portuguese clinical contexts. Considering the ceiling effects, the effect of social desirability should be explored.
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Affiliation(s)
- Filipa Ventura
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra. Av. Bissaya Barreto s/n. 3046-851 Coimbra Portugal.
| | - Paulo Costa
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra. Av. Bissaya Barreto s/n. 3046-851 Coimbra Portugal.
- Universidade Católica Portuguesa
| | - John Chaplin
- The Sahlgrenska Academy, University of Gothenburg. Gothenburg Sweden
| | - Inês Domingues
- Escola Superior de Enfermagem de Coimbra. Coimbra Portugal
| | | | - Brendan McCormack
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney. Sydney Australia
| | - Pedro Parreira
- Escola Superior de Enfermagem de Coimbra. Coimbra Portugal
| | - Liliana B Sousa
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra. Av. Bissaya Barreto s/n. 3046-851 Coimbra Portugal.
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18
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Gagliardi AR, Abbaticchio A, Theodorlis M, Marshall D, MacKay C, Borkhoff CM, Hazlewood GS, Battistella M, Lofters A, Ahluwalia V. Multi-level strategies to improve equitable timely person-centred osteoarthritis care for diverse women: qualitative interviews with women and healthcare professionals. Int J Equity Health 2023; 22:207. [PMID: 37803475 PMCID: PMC10559457 DOI: 10.1186/s12939-023-02026-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: 06/21/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Women are more likely to develop osteoarthritis (OA), and have greater OA pain and disability compared with men, but are less likely to receive guideline-recommended management, particularly racialized women. OA care of diverse women, and strategies to improve the quality of their OA care is understudied. The purpose of this study was to explore strategies to overcome barriers of access to OA care for diverse women. METHODS We conducted qualitative interviews with key informants and used content analysis to identify themes regarding what constitutes person-centred OA care, barriers of OA care, and strategies to support equitable timely access to person-centred OA care. RESULTS We interviewed 27 women who varied by ethno-cultural group (e.g. African or Caribbean Black, Chinese, Filipino, Indian, Pakistani, Caucasian), age, region of Canada, level of education, location of OA and years with OA; and 31 healthcare professionals who varied by profession (e.g. family physician, nurse practitioner, community pharmacist, physio- and occupational therapists, chiropractors, healthcare executives, policy-makers), career stage, region of Canada and type of organization. Participants within and across groups largely agreed on approaches for person-centred OA care across six domains: foster a healing relationship, exchange information, address emotions, manage uncertainty, share decisions and enable self-management. Participants identified 22 barriers of access and 18 strategies to overcome barriers at the patient- (e.g. educational sessions and materials that accommodate cultural norms offered in different languages and formats for persons affected by OA), healthcare professional- (e.g. medical and continuing education on OA and on providing OA care tailored to intersectional factors) and system- (e.g. public health campaigns to raise awareness of OA, and how to prevent and manage it; self-referral to and public funding for therapy, greater number and ethno-cultural diversity of healthcare professionals, healthcare policies that address the needs of diverse women, dedicated inter-professional OA clinics, and a national strategy to coordinate OA care) levels. CONCLUSIONS This research contributes to a gap in knowledge of how to optimize OA care for disadvantaged groups including diverse women. Ongoing efforts are needed to examine how best to implement these strategies, which will require multi-sector collaboration and must engage diverse women.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada.
| | - Angelina Abbaticchio
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Deborah Marshall
- University of Calgary, 2500 University Drive NW, Calgary Alberta T2N1N4, Canada
| | - Crystal MacKay
- West Park Healthcare Centre, 82 Buttonwood Ave, York, M6M2J5, Canada
| | - Cornelia M Borkhoff
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Marisa Battistella
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Aisha Lofters
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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19
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Sardessai-Nadkarni AA, Street RL. Understanding the pathways linking patient-centered communication to cancer survivors' emotional health: examining the mediating roles of self-efficacy and cognitive reappraisal. J Cancer Surviv 2023; 17:1266-1275. [PMID: 35167049 DOI: 10.1007/s11764-022-01170-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Many cancer survivors commonly face psychological health issues upon cancer diagnosis, both during and after treatment. Patient-centered communication can play an important role in improving health outcomes among cancer survivors across the cancer continuum. The current study examined the influence of patient-centered communication on self-efficacy in managing health, cognitive reappraisal, and emotional distress among cancer survivors. METHODS The analysis was conducted on a subsample of 809 cancer survivors acquired from a nationally representative 2019 Health Information National Trends Survey 5 (Cycle 3). Multivariate regression analysis was conducted to explore the pathways through which patient-centered communication can be associated with cancer survivors' emotional distress, mediated by self-efficacy and cognitive reappraisal. RESULTS The results indicated that effective patient-centered provider communication led to higher self-efficacy in managing health, greater involvement in cognitive reappraisal, and decreased emotional distress among cancer survivors. Additionally, the results revealed that the effect of patient-centered communication that led to decreased emotional distress was fully mediated through self-efficacy and cognitive reappraisal. CONCLUSIONS Although patient-centered communication positively relates to various emotional health outcomes among cancer survivors, it does not affect their emotional health directly. Self-efficacy and cognitive reappraisal play a crucial role in explaining the underlying mechanisms of such effects. IMPLICATIONS FOR CANCER SURVIVORS Future interventions to promote patient-centered communication in cancer care should give more emphasis to managing patients' emotions. Providers should not only recognize, elicit, and respond to patient's emotions, but also develop emotional regulation skills among patients, and improve their ability to cope with emotional distress.
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Affiliation(s)
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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20
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Wan CS, Nankervis A, Teede H, Aroni R. Priorities to improve woman-centred gestational diabetes mellitus care: A qualitative study to compare views between clinical and consumer end-users. J Hum Nutr Diet 2023; 36:1636-1648. [PMID: 37282816 DOI: 10.1111/jhn.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Immigrants worldwide have a two-fold higher risk of gestational diabetes mellitus (GDM) than women of the host country. Providing culturally appropriate woman-centred GDM care to attenuate adverse maternal and neonatal health outcomes is a persistent challenge for health services. Underpinned by the Knowledge to Action Framework, understanding and comparing the views of patients from different ethnic backgrounds and healthcare professionals (HCPs) about current and optimal GDM care can highlight priority areas to improve woman-centred care. This qualitative study aimed to compare the views of ethnic Chinese and Australian-born Caucasian women and their HCPs, including endocrinologists, obstetricians, midwives, diabetes nurse educators and dietitians, about what constitutes optimal GDM care and how to improve woman-centred GDM care. METHODS Purposive sampling was used to recruit 42 Chinese and 30 Caucasian women with GDM and 17 HCPs from two large Australian hospital maternity services to complete in-depth, semi-structured interviews. Patients' and HCPs' views were thematically analysed and compared. RESULTS Four out of nine themes showed misalignments between patients' and HCPs' views on GDM care, reflecting priority areas to improve woman-centred care by (i) reaching agreement on the attitudes towards different treatment targets between HCPs; (ii) enhancing inter-professional communication; (iii) improving GDM care transition to postpartum care; and (iv) providing detailed dietary advice tailored to Chinese patients' cultural diet. CONCLUSIONS Further research on reaching consensus on treatment targets, enhancing inter-professional communication, developing a perinatal care transition model from pregnancy to postpartum, and developing Chinese patient-oriented educational resources is required to improve woman-centred care.
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Affiliation(s)
- Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, VIC, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, VIC, Australia
| | - Alison Nankervis
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
- Departments of Diabetes and Endocrinology, The Royal Melbourne and Royal Women's Hospitals, Parkville, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, VIC, Australia
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Rosalie Aroni
- Medical School, College of Health and Medicine, Canberra, ACT, Australia
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21
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Abuwa C, Abbaticchio A, Theodorlis M, Marshall D, MacKay C, Borkhoff CM, Hazlewood GS, Battistella M, Lofters A, Ahluwalia V, Gagliardi AR. Identifying strategies that support equitable person-centred osteoarthritis care for diverse women: content analysis of guidelines. BMC Musculoskelet Disord 2023; 24:734. [PMID: 37710195 PMCID: PMC10500823 DOI: 10.1186/s12891-023-06877-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/12/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access early diagnosis and management, or experience OA care tailored through person-centred approaches to their needs and preferences, particularly racialized women. One way to support clinicians in optimizing OA care is through clinical guidelines. We aimed to examine the content of OA guidelines for guidance on providing equitable, person-centred care to disadvantaged groups including women. METHODS We searched indexed databases and websites for English-language OA-relevant guidelines published in 2000 or later by non-profit organizations. We used manifest content analysis to extract data, and summary statistics and text to describe guideline characteristics, person-centred care (PCC) using a six-domain PCC framework, OA prevalence or barriers by intersectional factors, and strategies to improve equitable access to OA care. RESULTS We included 36 OA guidelines published from 2003 to 2021 in 8 regions or countries. Few (39%) development panels included patients. While most (81%) guidelines included at least one PCC domain, guidance was often brief or vague, few addressed exchange information, respond to emotions and manage uncertainty, and none referred to fostering a healing relationship. Few (39%) guidelines acknowledged or described greater prevalence of OA among particular groups; only 3 (8%) noted that socioeconomic status was a barrier to OA care, and only 2 (6%) offered guidance to clinicians on how to improve equitable access to OA care: assess acceptability, availability, accessibility, and affordability of self-management interventions; and employ risk assessment tools to identify patients without means to cope well at home after surgery. CONCLUSIONS This study revealed that OA guidelines do not support clinicians in caring for diverse persons with OA who face disadvantages due to intersectional factors that influence access to and quality of care. Developers could strengthen OA guidelines by incorporating guidance for PCC and for equity that could be drawn from existing frameworks and tools, and by including diverse persons with OA on guideline development panels. Future research is needed to identify multi-level (patient, clinician, system) strategies that could be implemented via guidelines or in other ways to improve equitable, person-centred OA care. PATIENT OR PUBLIC CONTRIBUTION This study was informed by a team of researchers, collaborators, and thirteen diverse women with lived experience, who contributed to planning, and data collection, analysis and interpretation by reviewing study materials and providing verbal (during meetings) and written (via email) feedback.
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Affiliation(s)
- Chidinma Abuwa
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Angelina Abbaticchio
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Madeline Theodorlis
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | | | | | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Marisa Battistella
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada.
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22
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Mahdiabadi FR, Mirzaei S, Entezari A, Nasiriani K. The effect of implementing the COMFORT communication model on communication skills of nursing students. Int J Palliat Nurs 2023; 29:412-420. [PMID: 37757811 DOI: 10.12968/ijpn.2023.29.9.412] [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: 09/29/2023]
Abstract
BACKGROUND Effective communication as a key component of palliative care requires sufficient knowledge and experience to make nursing interventions successful. AIM This quasi-experimental study was conducted to determine the effectiveness of the COMFORT communication model as an intervention to improve student nurses' communication skills while they are under clinical training in specialist palliative care inpatient units. METHODS The population sample included 86 student nurses who were randomly assigned into two groups of 40. The intervention group received training on communication skills using the COMFORT communication model. Nine lectures were delivered online or offline; the lectures lasted between 25 to 60 minutes. The control group received the conventional educational programme about communication with patients and families, according to the curriculum of the bachelor's degree in nursing. Data were collected using the Communication Skills Questionnaire and Communication Skills Attitude Scale and analysed using IBM® SPSS® Statistics 22.0. RESULTS The findings showed that, after the implementation of COMFORT communication model, there was a statistically significant difference in communication skills between the intervention group (122.95±9.36) and the control group (110.1±8.92). There was also a significant difference in attitudes toward communication skills between the intervention group (90.25±8.86) and the control group (90.85±9.15) (P=0.0001). The findings of the study revealed that the COMFORT Communication model created significant statistical differences in the student's attitude, knowledge and communication skills. CONCLUSION Novice nurses sometimes struggle with the level of communication skills needed when caring for patients with an end-stage illness. The implementation of the COMFORT communication model significantly improved communication skills and attitudes toward communication. Due to the need to establish effective communication as the core of nursing practice, the implementation of this training programme is recommended for students and qualified nurses, particularly when providing palliative care.
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Affiliation(s)
- Farzad Reisi Mahdiabadi
- Master Student, Critical Care Nursing, Research Centre for Nursing and Midwifery Care, Noncommunicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Iran
| | - Samaneh Mirzaei
- Assistant Professor, Department of Health in Emergencies and Disasters, School of Public Health, Shahid Sadoughi University of Medical Sciences, Iran
| | - Ahmad Entezari
- Instructor, Department of Anesthesia and Operation Room, School of Paramedical Sciences, Shahid Sadoughi University of Medical Sciences, Iran
| | - Khadijeh Nasiriani
- Professor, Spiritual Heath Research Center, Research Centre for Nursing and Midwifery Care, Noncommunicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Iran
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23
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Bashkin O, Asna N, Amoyal M, Dopelt K. The Role of Nurses in the Quality of Cancer Care Management: Perceptions of Cancer Survivors and Oncology Teams. Semin Oncol Nurs 2023; 39:151423. [PMID: 37055296 DOI: 10.1016/j.soncn.2023.151423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/28/2023] [Accepted: 03/15/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVES This study aimed to explore the perceptions of cancer survivors and oncology professionals of quality in cancer care and the role of oncology nurses in prompting and maintaining quality across the cancer care continuum. DATA SOURCES Semistructured in-depth interviews were conducted with 16 cancer survivors and 22 healthcare professionals between August and October 2021. The interviews were transcribed and analyzed using ATLAS.ti v8 software according to a thematic analysis method based on grounded theory. The COnsolidated criteria for REporting Qualitative research (COREQ) was used to guide the report of the study. CONCLUSION Four main themes emerged from the interviews, which are outlined as follows. (1) Patient participation in the cancer care plan: shared information and decision-making; (2) emotional and support aspects in cancer care; (3) continuity in cancer care: from being a patient at the hospital to a survivor in the community; and (4) cancer care management. Cancer survivors pointed to elements that can increase the quality of cancer care, including the ongoing provision of information, support in decision-making, and continuity of care. Oncology staff interviewees mentioned the need for a single staff member to manage the cancer care plan and serve as a case manager for patients and survivors. IMPLICATIONS FOR NURSING PRACTICE Nurses have a central role in achieving the highest possible quality of cancer care for the growing number of survivors and their families. It is recommended to expand the role of oncology nurses, providing them the training and competencies needed to formally declare them as care managers throughout the continuum of cancer care.
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Affiliation(s)
- Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel.
| | - Noam Asna
- Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Mazal Amoyal
- Palliative Care Unit, Barzilai Medical Center, Ashkelon, Israel
| | - Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel; Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Dhanani S, Ramlakhan JU, Berta WB, Gagliardi AR. Optimizing the design and implementation of question prompt lists to support person-centred care: A scoping review. Health Expect 2023; 26:1404-1417. [PMID: 37227115 PMCID: PMC10349246 DOI: 10.1111/hex.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/13/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Question prompt lists (QPLs) are lists of questions that patients may want to discuss with clinicians. QPLs support person-centred care and have been associated with many beneficial outcomes including improved patient question-asking, and the amount and quality of the information provided by clinicians. The purpose of this study was to review published research on QPLs to explore how QPL design and implementation can be optimized. METHODS We performed a scoping review by searching MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Library and Joanna Briggs Database from inception to 8 May 2022, for English language studies of any design that evaluated QPLs. We used summary statistics and text to report study characteristics, and QPL design and implementation. RESULTS We included 57 studies published from 1988 to 2022 by authors in 12 countries on a range of clinical topics. Of those, 56% provided the QPL, but few described how QPLs were developed. The number of questions varied widely (range 9-191). Most QPLs were single-page handouts (44%) but others ranged from 2 to 33 pages. Most studies implemented a QPL alone with no other accompanying strategy; most often in a print format before consultations by mail (18%) or in the waiting room (66%). Both patients and clinicians identified numerous benefits to patients of QPLs (e.g., increased patient confidence to ask questions, and patient satisfaction with communication or care received; and reduced anxiety about health status or treatment). To support use, patients desired access to QPLs in advance of clinician visits, and clinicians desired information/training on how to use the QPL and answer questions. Most (88%) studies reported at least one beneficial impact of QPLs. This was true even for single-page QPLs with few questions unaccompanied by other implementation strategies. Despite favourable views of QPLs, few studies assessed outcomes amongst clinicians. CONCLUSION This review identified QPL characteristics and implementation strategies that may be associated with beneficial outcomes. Future research should confirm these findings via systematic review and explore the benefits of QPLs from the clinician's perspective. PATIENT/PUBLIC CONTRIBUTION Following this review, we used the findings to develop a QPL on hypertensive disorders of pregnancy and interviewed women and clinicians about QPL design including content, format, enablers and barriers of use, and potential outcomes including beneficial impacts and possible harms (will be published elsewhere).
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Affiliation(s)
- Shazia Dhanani
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
| | - Jessica U. Ramlakhan
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
| | - Whitney B. Berta
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
| | - Anna R. Gagliardi
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
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Tomozawa C, Kaneko M, Sasaki M, Miyake H. Clients' and genetic counselors' perceptions of empathy in Japan: A pilot study of simulated consultations of genetic counseling. PLoS One 2023; 18:e0288881. [PMID: 37467241 DOI: 10.1371/journal.pone.0288881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
The rapidly increasing availability of genetic testing is driving the acceleration of genetic counseling implementation. Empathy is important in medical encounters in general and forms a core component of a successful genetic counseling session; however, empirical evidence on empathy in genetic counseling is minimal. This study aimed to explore the perceptions of empathy in simulated genetic counseling consultations from the perspectives of clients and genetic counselors. Semi-structured interviews and interpersonal process recall were used with participants of simulated genetic counseling consultations to elicit their experiences of empathy. A constructivist grounded theory was used for data analysis. A total of 15 participants, including 10 clients and 5 genetic counselors, participated in 10 simulated counseling sessions. The genetic counselors attempted to demonstrate empathy and were sensitive toward detecting changes in clients. Meanwhile, the clients' perceptions represented their feelings and thoughts elicited through the counselors' empathic approaches. This was the first process study to examine empathy in simulated genetic counseling sessions. Our model of communication of empathy is a process in which counselors try to address implicit aspects of clients, and clients are provided with time and a safe place for introspection, which contributes to discussions on building good relationships with patients. There is also a suggestion of the utility of simulated consultations for healthcare providers to learn empathic communication.
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Affiliation(s)
- Chikako Tomozawa
- Division of Life Sciences, Department of Genetic Counseling, Graduate School of Humanities and Sciences, Ochanomizu University, Bunkyo-ku, Tokyo, Japan
| | - Mikiko Kaneko
- Department of Clinical Genetics, The Jikei University Hospital, Minato-ku, Tokyo, Japan
| | - Motoko Sasaki
- Division of Life Sciences, Department of Genetic Counseling, Graduate School of Humanities and Sciences, Ochanomizu University, Bunkyo-ku, Tokyo, Japan
- Genetics Division, Institute for Human Life Science, Ochanomizu University, Bunkyo-ku, Tokyo, Japan
| | - Hidehiko Miyake
- Division of Life Sciences, Department of Genetic Counseling, Graduate School of Humanities and Sciences, Ochanomizu University, Bunkyo-ku, Tokyo, Japan
- Genetics Division, Institute for Human Life Science, Ochanomizu University, Bunkyo-ku, Tokyo, Japan
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Gualandi R, Ivziku D, Caruso R, Di Giacinto C, Lommi M, Tartaglini D, De Benedictis A. Nurse-Patient Communication and Relationship When Wearing Personal Protective Equipment: Nurses' Experience in a COVID-19 Ward. Healthcare (Basel) 2023; 11:1960. [PMID: 37444794 DOI: 10.3390/healthcare11131960] [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: 04/30/2023] [Revised: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
Little is known about which communication strategies nurses carried out and whether the nurse-patient relationship has been altered due to the mandated use of personal protective equipment during the COVID-19 pandemic. This study describes how nurse-patient communication and relationships took place from the point of view of nurses engaged in caring for patients with COVID-19. A qualitative descriptive study design following COREQ guidelines was conducted. Semi-structured telephone interviews with nurses working in the COVID ward of an Italian university hospital were performed between September 2020 and June 2021. Ten nurses were recruited using convenience sampling. One overarching theme, three main themes, and nine sub-themes were identified. The overarching theme 'The in-out relationship: 'in here and out there' and 'inside me and out of me' included the main themes 'A closed system different from normal', 'Uncovering meaningful human gestures', and 'A deep experience to live''. The relational nature of nursing-where 'me and you' and the context are the main elements-leads nurses to find new ways of interacting and communicating with patients, even in a new situation that has never been experienced. Enhancing human gestures, thinking about new contexts of care, and educating new generations to maintain human-to-human interaction, regardless of the context of care, are the directives to be explored for creating the future of nursing care.
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Affiliation(s)
- Raffaella Gualandi
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Dhurata Ivziku
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Rosario Caruso
- Clinical Research Service, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milano, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milano, Italy
| | - Chiara Di Giacinto
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Marzia Lommi
- Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy
| | - Daniela Tartaglini
- Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Anna De Benedictis
- Clinical Directory, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
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Sheeran N, Jones L, Pines R, Jin B, Pamoso A, Eigeland J, Benedetti M. How culture influences patient preferences for patient-centered care with their doctors. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:186-196. [PMID: 37401877 DOI: 10.1080/17538068.2022.2095098] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Patient-centered care (PCC) is the prevailing model of care globally. However, most research on PCC has been conducted in Westernized countries or has focused on only two facets of PCC: decision-making and information exchange. Our study examined how culture influences patients' preferences for five facets of PCC, including communication, decision-making, empathy, individualized focus, and relationship. METHODS Participants (N = 2071) from Hong Kong, the Philippines, Australia, and the U.S.A. completed an online survey assessing their preferences for exchange of information, autonomy in decision-making, expression and validation of their emotions, focus on them as an individual, and the doctor-patient relationship. RESULTS Participants from all four countries had similar preferences for empathy and shared decision-making. For other facets of PCC, participants in the Philippines and Australia expressed somewhat similar preferences, as did those in the U.S.A. and Hong Kong, challenging East-West stereotypes. Participants in the Philippines placed greater value on relationships, whereas Australians valued more autonomy. Participants in Hong Kong more commonly preferred doctor-directed care, with less importance placed on the relationship. Responses from U.S.A. participants were surprising, as they ranked the need for individualized care and two-way flow of information as least important. CONCLUSIONS Empathy, information exchange, and shared decision-making are values shared across countries, while preferences for how the information is shared, and the importance of the doctor-patient relationship differ.
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Affiliation(s)
- Nicola Sheeran
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Liz Jones
- Department of Psychology, Monash University Malaysia, Kuala Lumpur, Malaysia
| | - Rachyl Pines
- Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Blair Jin
- Department of English and Communication, Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Aron Pamoso
- Department of Psychology, University of Southern Philippines Foundation, Cebu City, Philippines
| | - Jessica Eigeland
- School of Applied Psychology, Griffith University, Brisbane, Australia
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Pook M, Najafi T, Lapointe-Gagner M, Nguyen-Powanda P, Elhaj H, Rajabiyazdi F, Kaneva P, Lee L, Feldman LS, Fiore JF. Patients' experiences undergoing cancer surgery during the COVID-19 pandemic: a qualitative study. Support Care Cancer 2023; 31:400. [PMID: 37335423 DOI: 10.1007/s00520-023-07861-w] [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: 02/10/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE This study aimed to understand patients' experiences undergoing cancer surgery during the COVID-19 pandemic. In response to COVID-19, many elective cancer surgeries were delayed creating a massive backlog of cases. Patients' experiences with surgical delays may inform healthcare systems' responses to the backlog of cases and guide preparations for future healthcare emergencies. METHODS This was a qualitative description study. Patients undergoing general surgery for cancer at two university-affiliated hospitals between March 2020 and January 2021 were invited to one-to-one interviews. Patients were purposefully selected using quota sampling until interviews produced no new information (i.e., thematic saturation). Interviews were conducted using a semi-structured guide and analyzed according to inductive thematic analysis. RESULTS Twenty patients were included [mean age 64 ± 12.9; male (n = 10); surgical delay (n = 14); cancer sites: breast (n = 8), skin (n = 4), hepato-pancreato-biliary (n = 4), colorectal (n = 2), and gastro-esophageal (n = 2)]. When determining their willingness to undergo surgery, patients weighed the risk of COVID-19 infection against the urgency of their disease. Changes to the hospital environment (e.g., COVID-19 preventative measures) and deviations from expected treatment (e.g., alternative treatments, remote consultations, rescheduled care) caused diverse psychological responses, ranging from increased satisfaction to severe distress. Patients employed several coping strategies to mitigate distress, including eliciting reassurance from care providers, seeking information from unconventional sources, and reframing care interruptions. CONCLUSIONS Changes in care during the pandemic elicited diverse psychological responses from patients undergoing cancer surgery. Coping was facilitated by consistent communication with providers, emphasizing the importance of patient-centered expectation setting as we prepare for the future within and beyond the pandemic.
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Affiliation(s)
- Makena Pook
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Tahereh Najafi
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1650 Cedar Ave, H3G 1A4, Montreal, QC, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Hiba Elhaj
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Fateme Rajabiyazdi
- Department of Systems and Computer Engineering, Carleton University, Ottawa, ON, Canada
| | - Pepa Kaneva
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Lawrence Lee
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1650 Cedar Ave, H3G 1A4, Montreal, QC, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Liane S Feldman
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1650 Cedar Ave, H3G 1A4, Montreal, QC, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Julio F Fiore
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 1650 Cedar Ave, H3G 1A4, Montreal, QC, Canada.
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
- Department of Surgery, McGill University, Montreal, QC, Canada.
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Godfrey EM, Fiastro AE, Ruben MR, Young EV, Bennett IM, Jacob-Files E. Patient Perspectives Regarding Clinician Communication During Telemedicine Compared With In-Clinic Abortion. Obstet Gynecol 2023; 141:1139-1153. [PMID: 37141602 PMCID: PMC10440237 DOI: 10.1097/aog.0000000000005192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/02/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To explore patient perspectives regarding patient-clinician communication during telemedicine medication abortion compared with traditional, facility based, in-clinic visits. METHODS We conducted semi-structured interviews with participants who received either live, face-to-face telemedicine or in-clinic medication abortion from a large, reproductive health care facility in Washington State. Using Miller's conceptual framework for patient-doctor communication in telemedicine settings, we developed questions exploring participants' experiences of the medication abortion consultation, including the clinician's verbal and nonverbal interpersonal approach and communication of relevant medical information, and the setting where care was received. We used inductive-deductive constant comparative analysis to identify major themes. We summarize patient perspectives using patient-clinician communication terms outlined in Dennis' quality abortion care indicator list. RESULTS Thirty participants completed interviews (aged 20-38 years), 20 of whom had medication abortion by telemedicine and 10 who received in-clinic services. Participants who received telemedicine abortion services reported high-quality patient-clinician communication, which came from their freedom to choose their consultation location, and reported feeling more relaxed during clinical encounters. In contrast, most in-clinic participants portrayed their consultations as lengthy, chaotic, and lacking comfort. In all other domains, both telemedicine and in-clinic participants reported similar levels of interpersonal connection to their clinicians. Both groups appreciated medical information about how to take the abortion pills and relied heavily on clinic-based printed materials and independent online resources to answer questions during the at-home termination process. Both telemedicine and in-clinic participant groups were highly satisfied with their care. CONCLUSION Patient-centered communication skills used by clinicians during facility based, in-clinic care translated well to the telemedicine setting. However, we found that patients who received medication abortion through telemedicine favorably ranked their patient-clinician communication overall as compared with those in traditional, in-clinic settings. In this way, telemedicine abortion appears to be a beneficial patient-centered approach to this critical reproductive health service.
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Affiliation(s)
- Emily M Godfrey
- Departments of Family Medicine and Obstetrics and Gynecology, University of Washington School of Medicine, and the University of Washington School of Medicine, Seattle, Washington
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Zhou Y, Acevedo Callejas ML, Li Y, MacGeorge EL. What Does Patient-Centered Communication Look Like?: Linguistic Markers of Provider Compassionate Care and Shared Decision-Making and Their Impacts on Patient Outcomes. HEALTH COMMUNICATION 2023; 38:1003-1013. [PMID: 34657522 DOI: 10.1080/10410236.2021.1989139] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Patient-centered communication promotes positive patient outcomes. This study examines the linguistic markers of two key dimensions of patient-centered communication (i.e., provider compassionate care and shared decision-making) and their mediating effects on patient perceived quality of and affective responses to the provider's treatment recommendations. Transcripts (N = 343) of provider talk from provider-patient interactions in medical visits for upper respiratory infection symptoms where patients were not prescribed with antibiotics were analyzed with the Linguistic Inquiry and Word Count (LIWC) dictionary. Results showed that providers' use of affiliation words positively predicted patients' perceptions of their providers' compassionate care. Providers' use of insight words negatively predicted patients' perceptions of provider shared decision-making. Meanwhile, providers' use of first-person singular pronouns, causation and differentiation words, and clout words were positively related to perceived provider shared decision-making. Patient perceived compassionate care and shared decision-making further increased patients' positive affect toward and perceived quality of non-antibiotic treatment recommendations. These perceptions also reduced their negative affect toward the recommendations. Implications of the findings are discussed with regard to patient-centered communication in relation to the promotion of antibiotic stewardship.
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Affiliation(s)
- Yanmengqian Zhou
- Department of Communication Arts & Sciences, State College, Pennsylvania State University
| | | | - Yuwei Li
- Department of Communication Arts & Sciences, State College, Pennsylvania State University
| | - Erina L MacGeorge
- Department of Communication Arts & Sciences, State College, Pennsylvania State University
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Elkefi S, Asan O. The Impact of Patient-Centered Care on Cancer Patients' QOC, Self-Efficacy, and Trust Towards Doctors: Analysis of a National Survey. J Patient Exp 2023; 10:23743735231151533. [PMID: 36698621 PMCID: PMC9869234 DOI: 10.1177/23743735231151533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Patient-centered approaches impact cancer patients' perceptions and outcomes in different ways. This study explores the impact of patient-centered care practices on cancer patients' quality-of-care (QOC), self-efficacy, and trust in their doctors. We utilized cross-sectional national survey data from the National Cancer Institute collected between 2017 and 2020. All estimates were weighted using the jackknife method. We used multivariable logistic regression to test our hypotheses adjusted for the demographics of the 1932 cancer patients that responded to the survey. Findings indicate that patient-centered communication resulted in better QOC, self-efficacy, and trust in doctors. In addition, engagement in their care improved patients' trust in cancer-related information received from doctors. QOC and patients' trust in doctors were significantly improved with the patients' understanding of the next steps, addressing feelings, clear explanation of the problems, spending enough time with the clinicians, addressing uncertainty, and involvement in decisions. Patients who were given a chance to ask questions were significantly more likely to trust their doctors. Technology use did not impact any of these interactions. Patient-centered strategies should consider the needs of the patients in the cancer settings to improve overall outcomes. Organizations should also build strategies that are goal-oriented and centered around the patients' needs, as standard strategies cannot induce the wanted results.
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Affiliation(s)
- Safa Elkefi
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, USA
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Dong K, Gagliardi AR. Person-centered care for diverse women: Narrative review of foundational research. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231192317. [PMID: 37596928 PMCID: PMC10440084 DOI: 10.1177/17455057231192317] [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: 12/14/2022] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
Despite advocacy and recommendations to improve health care and health for persons who identify as women, women continue to face inequities in access to and quality of care. Person-centered care for women is one approach that could reduce gendered inequities. We conducted a series of studies to understand what constitutes person-centered care for women and how to achieve it. The overall aim of this article is to highlight the key findings of those studies that can inform policy, practice, and ongoing research. We conducted a narrative review of all studies related to person-centered care for women conducted in our group starting in 2018 over a 5-year period, which was general at the outset, and increasingly focused on racialized immigrant women who constitute a large proportion of the Canadian population. We organized study summaries by research phase: synthesis of person-centered care for women research, exploration of existing person-centered care for women guidance, consultation with key informants, consensus survey of key informants to prioritize strategies to achieve person-centered care for women, and consensus meeting with key informants to prioritize future research. We conducted the reported research in collaboration with an advisory group of diverse women and managers of community agencies. Our research revealed that little prior research had fully established what constitutes person-centered care for women, and in particular, how to achieve it. We also found little acknowledgment of person-centered care for women or strategies to support it in medical curriculum, clinical guidelines, or healthcare policies. We subsequently consulted women who differed by age, ethno-cultural group, health issue, education and geography, and clinicians of different specialties, who offered considerable insight on strategies to support person-centered care for women. Other diverse women, clinicians, healthcare managers, and researchers prioritized issues that warrant future research. We hope that by compiling a summary of our completed research, we draw attention to the need for person-centered care for women and motivate others to pursue it through policy, practice, and research.
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Affiliation(s)
- Kelly Dong
- Division of General Surgery and Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
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Patient-Centered Communication (PCC) scale: Psychometric analysis and validation of a health survey measure. PLoS One 2022; 17:e0279725. [PMID: 36584146 PMCID: PMC9803193 DOI: 10.1371/journal.pone.0279725] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Patient-centered communication (PCC) is one important component of patient-centered care and seen as a goal for most clinical encounters. Previous research has shown that higher PCC is related to an increase in healthy behaviors and less morbidity, among other outcomes. Given its importance, the National Cancer Institute (NCI) commissioned a monograph in 2007 to synthesize the existing literature on PCC and determine measurement objectives and strategies for measuring this construct, with a particular focus on cancer survivors. Based on this effort, a seven-item PCC scale was included on the Health Information National Trends Survey (HINTS), a probability-based survey of the US adult population. This study used HINTS data collected in 2018 to evaluate the psychometric properties of the PCC scale for the general US adult population including measures of reliability and validity. RESULTS Through an exploratory factor analysis, the seven-item PCC scale was shown to be unidimensional with good internal consistency (Cronbach's alpha = .92). A confirmatory factor analysis verified the factor structure. Other construct validity metrics included known groups and discriminant validity. Known group comparisons were conducted for several sociodemographic factors and health self-efficacy confirming a priori assumptions. Discriminant validity tests with measures of social support and anxiety/depression showed relatively weak associations. CONCLUSIONS The psychometric properties of this scale demonstrate its scientific utility for both surveillance research and other smaller-scale studies. Given its association with many health outcomes, it can also be used to better understand the dynamics in a clinical encounter.
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Willingness to engage in post-discharge follow-up service conducted via video telemedicine: Cross-sectional study. Int J Med Inform 2022; 168:104885. [DOI: 10.1016/j.ijmedinf.2022.104885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022]
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Pozzar RA, Xiong N, Hong F, Wright AA, Goff BA, Underhill-Blazey ML, Tulsky JA, Hammer MJ, Berry DL. How does patient-centered communication in ovarian cancer care enhance patient well-being? A mixed methods study. Gynecol Oncol 2022; 167:261-268. [PMID: 36057465 DOI: 10.1016/j.ygyno.2022.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/15/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Greater perceived patient-centered communication (PCC) is associated with better health-related quality of life (HRQoL) in patients with ovarian cancer. Quantitative measures of PCC and HRQoL do little to explain this association. We interviewed patients with high and low ratings of PCC to understand how it is associated with HRQoL. METHODS Explanatory sequential mixed methods study. Participants were English-speaking U.S. adults with ovarian cancer. We assessed PCC with the Patient-Centered Communication - Cancer (PCC-Ca)-36 (possible score range 1-5; higher scores represent greater patient-centeredness), and purposively sampled 14 participants with total scores in the top and bottom quartiles. Participants completed individual, semi-structured interviews about their communication experiences. Guided by the National Cancer Institute Framework for PCC in Cancer Care, we analyzed interview transcripts using directed content analysis. We integrated survey and interview findings in a joint display. RESULTS Among 176 survey respondents, PCC-Ca-36 total scores ranged from 1.7 to 5.0. Participants with scores in the top quartile (4.8-5.0) perceived clinicians as proactive and attentive to psychosocial concerns. Those with scores in the bottom quartile (1.7-3.5) described not feeling known as an individual and receiving limited support for self-management. CONCLUSIONS The association between PCC and QoL may be partially explained by differences in perceived support for psychosocial concerns and self-management. PCC may facilitate receipt of proactive, personalized care.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Niya Xiong
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alexi A Wright
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - James A Tulsky
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Pettini G, Sanchini V, Pat-Horenczyk R, Sousa B, Masiero M, Marzorati C, Galimberti VE, Munzone E, Mattson J, Vehmanen L, Utriainen M, Roziner I, Lemos R, Frasquilho D, Cardoso F, Oliveira-Maia AJ, Kolokotroni E, Stamatakos G, Leskelä RL, Haavisto I, Salonen J, Richter R, Karademas E, Poikonen-Saksela P, Mazzocco K. Predicting Effective Adaptation to Breast Cancer to Help Women BOUNCE Back: Protocol for a Multicenter Clinical Pilot Study. JMIR Res Protoc 2022; 11:e34564. [PMID: 36222801 PMCID: PMC9607923 DOI: 10.2196/34564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/11/2022] [Accepted: 04/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Despite the continued progress of medicine, dealing with breast cancer is becoming a major socioeconomic challenge, particularly due to its increasing incidence. The ability to better manage and adapt to the entire care process depends not only on the type of cancer but also on the patient’s sociodemographic and psychological characteristics as well as on the social environment in which a person lives and interacts. Therefore, it is important to understand which factors may contribute to successful adaptation to breast cancer. To our knowledge, no studies have been performed on the combination effect of multiple psychological, biological, and functional variables in predicting the patient’s ability to bounce back from a stressful life event, such as a breast cancer diagnosis. Here we describe the study protocol of a multicenter clinical study entitled “Predicting Effective Adaptation to Breast Cancer to Help Women to BOUNCE Back” or, in short, BOUNCE. Objective The aim of the study is to build a quantitative mathematical model of factors associated with the capacity for optimal adjustment to cancer and to study resilience through the cancer continuum in a population of patients with breast cancer. Methods A total of 660 women with breast cancer will be recruited from five European cancer centers in Italy, Finland, Israel, and Portugal. Biomedical and psychosocial variables will be collected using the Noona Healthcare platform. Psychosocial, sociodemographic, lifestyle, and clinical variables will be measured every 3 months, starting from presurgery assessment (ie, baseline) to 18 months after surgery. Temporal data mining, time-series prediction, sequence classification methods, clustering time-series data, and temporal association rules will be used to develop the predictive model. Results The recruitment process stared in January 2019 and ended in November 2021. Preliminary results have been published in a scientific journal and are available for consultation on the BOUNCE project website. Data analysis and dissemination of the study results will be performed in 2022. Conclusions This study will develop a predictive model that is able to describe individual resilience and identify different resilience trajectories along the care process. The results will allow the implementation of tailored interventions according to patients’ needs, supported by eHealth technologies. Trial Registration ClinicalTrials.gov NCT05095675; https://clinicaltrials.gov/ct2/show/NCT05095675 International Registered Report Identifier (IRRID) DERR1-10.2196/34564
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Affiliation(s)
- Greta Pettini
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - Virginia Sanchini
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Ruth Pat-Horenczyk
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Berta Sousa
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisboa, Portugal
| | - Marianna Masiero
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Johanna Mattson
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leena Vehmanen
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Meri Utriainen
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ilan Roziner
- Department of Communication Disorders, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raquel Lemos
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal.,ISPA, Instituto Universitário, Lisboa, Portugal
| | - Diana Frasquilho
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisboa, Portugal
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisboa, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisboa, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Eleni Kolokotroni
- In Silico Oncology and In Silico Medicine Group, Institute of Communication and Computer Systems, Athens, Greece.,School of Electrical and Computer Engineering, Athens, Greece.,National Technical University of Athens, Athens, Greece
| | - Georgios Stamatakos
- In Silico Oncology and In Silico Medicine Group, Institute of Communication and Computer Systems, Athens, Greece.,School of Electrical and Computer Engineering, Athens, Greece.,National Technical University of Athens, Athens, Greece
| | | | | | | | | | - Evangelos Karademas
- Department of Psychology, University of Crete, Crete, Greece.,Foundation for Research and Technology - Hellas, Heraklion, Greece
| | - Paula Poikonen-Saksela
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Mertz S, Benjamin C, Girvalaki C, Cardone A, Gono P, May SG, Comerford E, Than KS, Birch K, Roach M, Myers S, Sasane M, Lavi L, Cameron A, Cardoso F. Progression-free survival and quality of life in metastatic breast cancer: The patient perspective. Breast 2022; 65:84-90. [PMID: 35870420 PMCID: PMC9307669 DOI: 10.1016/j.breast.2022.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/10/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Objective Materials and methods Results Conclusion Overall survival benefit combined with good QoL are the most important endpoints for mBC patients. Time without disease progression is meaningful to patients when coupled with no worsening in or improvements in QoL. Quality of life is highly individual and evolves throughout the treatment journey. Surrogate endpoints are confusing; more patient-centered language is needed. Healthcare professionals should account for disease and psychological well-being.
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Affiliation(s)
- Shirley Mertz
- Metastatic Breast Cancer Network, 165 West 46th St, Suite 712, New York, NY, 10036, USA
| | - Christine Benjamin
- SHARE Cancer Support, 165 West 46th St, Suite 712, New York, NY, 10036, USA
| | - Charis Girvalaki
- European Cancer Patient Coalition, 40, Rue de Montoyer/Montoyerstraat, B-1000, Brussels, Belgium
| | - Antonella Cardone
- European Cancer Patient Coalition, 40, Rue de Montoyer/Montoyerstraat, B-1000, Brussels, Belgium
| | - Paulina Gono
- European Cancer Patient Coalition, 40, Rue de Montoyer/Montoyerstraat, B-1000, Brussels, Belgium
| | - Suepattra G May
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA.
| | - Erin Comerford
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Kyi-Sin Than
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Kelly Birch
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Meaghan Roach
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Sky Myers
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Medha Sasane
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Liat Lavi
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Anna Cameron
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation and ABC Global Alliance, Lisbon, Portugal
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38
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Djambazov S, Giammanco MD, Gitto L. Econometric analysis of oncology patients' Health-Related Quality of Life determinants in Bulgaria. Cent Eur J Public Health 2022; 30:160-165. [DOI: 10.21101/cejph.a7095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 07/27/2022] [Indexed: 11/15/2022]
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Ghanbari-Afra L, Adib-Hajbaghery M, Dianati M. Human Caring: A Concept Analysis. J Caring Sci 2022; 11:246-254. [DOI: 10.34172/jcs.2022.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/17/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: Human caring combines science, art, and humanity. Humanity is the heart of care and interpersonal interactions. Despite the critical emphasis on human caring and concern for nursing care without humanity, there is no clear definition for human caring in nursing. This study aimed to analyze the concept of human caring. Methods: Walker and Avant’s strategy for concept analysis was used. Electronic databases such as PubMed, Scopus, Ovid, Google Scholar, Magiran, Iran Doc, SID, and a number of dictionaries were searched without any limitation in date. Search keywords were "care", "caring", "human caring", "humanization", "patient care", "comprehensive care" and "nursing care". We searched all documents published before September 2020. In the initial search, 1637 articles were found but finally, 39 relevant articles remained in the study. Results: The nine defining attributes of human caring were establishing therapeutic communication, presence at the patient bedside, empathy, providing scientific care, subjectivity, dynamicity, respecting the patient’s rights and ethics of care, helping the patient achieve a feeling of well-being, and art and creativity. Antecedents of human caring were categorized into three categories namely, human, personal, and organizational factors. The consequences were also categorized into consequences related to nurse, profession, patient, and organization. Conclusion: A theoretical definition and a conceptual model of human caring were developed. This concept should be included in the nursing curricula at all undergraduate and graduate levels and even in nurses’ in-service training programs.
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Affiliation(s)
- Leila Ghanbari-Afra
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Mansour Dianati
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
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40
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Walsh A, Bodaghkhani E, Etchegary H, Alcock L, Patey C, Senior D, Asghari S. Patient-centered care in the emergency department: a systematic review and meta-ethnographic synthesis. Int J Emerg Med 2022; 15:36. [PMID: 35953783 PMCID: PMC9367087 DOI: 10.1186/s12245-022-00438-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-centered care (PCC) is an emerging priority in many healthcare settings but lacks clarity in the emergency department (ED). It is of interest to know what PCC practices are most important to patients to better their experience. The objective of this study was to conduct a mixed-methods systematic review of PCC in the ED. METHODS We used stakeholder and patient engagement to consult with clinicians, subject-matter experts, patient partners, and community organizations to determine patient needs. We examined all articles in the ED context with PCC as the intervention. Two independent reviewers screened 3136 articles and 13 were included. A meta-ethnographic analysis was conducted to determine common themes of PCC. RESULTS Themes included emotional support, communication, education, involvement of patient/family in information sharing and decision making, comfort of environment, respect and trust, continuity, and transition of care. Challenges in the ED reflected a lack of PCC. Moreover, implementation of PCC had many benefits including higher patient satisfaction with their care. Though there were commonalities of PCC components, there was no consistently used definition for PCC in the ED. CONCLUSION The findings of this review support the evidence that PCC is of high value to the ED setting and should be standardized in practice.
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Affiliation(s)
- Anna Walsh
- Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Elnaz Bodaghkhani
- Emergency Medicine Department, The University of British Columbia, Vancouver, Canada
| | - Holly Etchegary
- Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Lindsay Alcock
- Health Sciences Library, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Christopher Patey
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Dorothy Senior
- Community Scholar with Center for Rural Health Studies, Discipline of Family Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Centre for Rural Health Studies, Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada. .,Department of Family Medicine, Centre for Rural Health Studies Faculty of Medicine, Memorial University of Newfoundland and Labrador Health Sciences Centre, 300 Prince Philip Drive, NL, A1B 3V6, St. John's, Canada.
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Zaidi M, Amante DJ, Anderson E, Ito Fukunaga M, Faro JM, Frisard C, Sadasivam RS, Lemon SC. Association Between Patient Portal Use and Perceived Patient-Centered Communication Among Adults With Cancer: Cross-sectional Survey Study. JMIR Cancer 2022; 8:e34745. [PMID: 35943789 PMCID: PMC9399875 DOI: 10.2196/34745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/12/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether more frequent use of patient portals is associated with increased perceived PCC and which mechanisms might mediate this relationship have not been fully studied. OBJECTIVE The goal of this study was to investigate the association between the frequency of access of patient portals and perceived PCC in patients diagnosed with cancer. We further sought to examine whether this association was mediated by patients' self-efficacy in health information-seeking. METHODS We used data from the Health Information National Trend Survey 5 (HINTS 5) cycle 3 (2019) and cycle 4 (2020). This analysis includes 1222 individuals who self-reported having a current or past diagnosis of cancer. Perceived PCC was measured with a 7-item HINTS 5-derived scale and classified as low, medium, or high. Patient portal use was measured by a single item assessing the frequency of use. Self-efficacy about health information-seeking was assessed with a 1-item measure assessing confidence in obtaining health information. We used adjusted multinomial logistic regression models to estimate relative risk ratios (RRRs)/effect sizes of the association between patient portal use and perceived PCC. Mediation by health information self-efficacy was investigated using the Baron and Kenny and Karlson-Holm-Breen methods. RESULTS A total of 54.5% of the sample reported that they had not accessed their patient portals in the past 12 months, 12.6% accessed it 1 to 2 times, 24.8% accessed it 3 to 9 times, and 8.2% accessed it 10 or more times. Overall, the frequency of accessing the patient portal was marginally associated (P=.06) with perceived PCC in an adjusted multinominal logistic regression model. Patients who accessed their patient portal 10 or more times in the previous 12 months were almost 4 times more likely (RRR 3.8, 95% CI 1.6-9.0) to report high perceived PCC. In mediation analysis, the association between patient portal use and perceived PCC was attenuated adjusting for health information-seeking self-efficacy, but those with the most frequent patient portal use (10 or more times in the previous 12 months) were still almost 2.5 times more likely to report high perceived PCC (RRR 2.4, 95% CI 1.1-5.6) compared to those with no portal use. CONCLUSIONS Increased frequency of patient portal use was associated with higher PCC, and an individual's health information-seeking self-efficacy partially mediated this association. These findings emphasize the importance of encouraging patients and providers to use patient portals to assist in patient-centeredness of cancer care. Interventions to promote the adoption and use of patient portals could incorporate strategies to improve health information self-efficacy.
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Affiliation(s)
- Maryum Zaidi
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Daniel J Amante
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Ekaterina Anderson
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Mayuko Ito Fukunaga
- Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Jamie M Faro
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Christine Frisard
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
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Tarbi EC, Blanch-Hartigan D, van Vliet LM, Gramling R, Tulsky JA, Sanders JJ. Toward a basic science of communication in serious illness. PATIENT EDUCATION AND COUNSELING 2022; 105:1963-1969. [PMID: 35410737 DOI: 10.1016/j.pec.2022.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
High-quality communication can mitigate suffering during serious illness. Innovations in theory and technology present the opportunity to advance serious illness communication research, moving beyond inquiry that links broad communication constructs to health outcomes toward operationalizing and understanding the impact of discrete communication functions on human experience. Given the high stakes of communication during serious illness, we see a critical need to develop a basic science approach to serious illness communication research. Such an approach seeks to link "what actually happens during a conversation" - the lexical and non-lexical communication content elements, as well as contextual factors - with the emotional and cognitive experiences of patients, caregivers, and clinicians. This paper defines and justifies a basic science approach to serious illness communication research and outlines investigative and methodological opportunities in this area. A systematic understanding of the building blocks of serious illness communication can help identify evidence-informed communication strategies that promote positive patient outcomes, shape more targeted communication skills training for clinicians, and lead to more tailored and meaningful serious illness care.
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Affiliation(s)
- Elise C Tarbi
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, USA.
| | | | | | - Robert Gramling
- University of Vermont. Department of Family Medicine, Burlington, USA.
| | - James A Tulsky
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, USA; Brigham and Women's Hospital, Division of Palliative Medicine, Department of Medicine, Boston, USA.
| | - Justin J Sanders
- McGill University, Division of Palliative Care, Department of Family Medicine, Montreal, Canada.
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Xu X, Bridges SM. Enhancing patient-centred communication across barriers: The case of intersubjectivity management in medical interpreting. PATIENT EDUCATION AND COUNSELING 2022; 105:2012-2018. [PMID: 34823925 DOI: 10.1016/j.pec.2021.11.006] [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: 04/14/2021] [Revised: 10/04/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study introduces the concept of intersubjectivity management in medical interpreting and identifies relevant interactional strategies employed by the interpreter, also explores their effectiveness in facilitating positive clinician-patient communication. METHODS We used conversation analysis (CA) to analyse 27 video recordings of interpreter-mediated dental visits, participants involve English-speaking dentists, Cantonese as the first language (L1) patients and bilingual dental surgery assistants (DSA) who also play the role of ad hoc interpreters. RESULTS The DSA-as-interpreter manages intersubjectivity for the dentist and patient through interactional strategies, such as reformulating action types, redesigning contents and information capacity, summarising and concentrating turns, constantly monitoring the situation and eliciting spoken or unspoken expressions that are medically relevant from both sides to validate them. The strategies effectively enabled and enhanced the mutual understanding and interpersonal alignment between the dentist and patient. More importantly, the DSA constantly orients to patient-centred communication. CONCLUSION Although not professionally trained for interpreting, the DSA-as-interpreters demonstrated discursive strategies. The strategies evidently facilitated positive dentist-patient communication and relationships. PRACTICE IMPLICATIONS The conceptualisation and significant strategies demonstrated by the DSA-as-interpreters could potentially inform the solution of enhancing multilingual health communication in clinical staff training.
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Affiliation(s)
- Xinyue Xu
- Faculty of Education, The University of Hong Kong, Hong Kong, China.
| | - Susan M Bridges
- Faculty of Education, The University of Hong Kong, Hong Kong, China.
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Henrikson NB, Anderson ML, Dickerson J, Ewing JJ, Garcia R, Keast E, King DA, Lewis C, Locher B, McMullen C, Norris CM, Petrik AF, Ramaprasan A, Rivelli JS, Schneider JL, Shulman L, Tuzzio L, Banegas MP. The Cancer Financial Experience (CAFÉ) study: randomized controlled trial of a financial navigation intervention to address cancer-related financial hardship. Trials 2022; 23:402. [PMID: 35562781 PMCID: PMC9099299 DOI: 10.1186/s13063-022-06344-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an urgent need for evidence on how interventions can prevent or mitigate cancer-related financial hardship. Our objectives are to compare self-reported financial hardship, quality of life, and health services use between patients receiving a financial navigation intervention versus a comparison group at 12 months follow-up, and to assess patient-level factors associated with dose received of a financial navigation intervention. METHODS The Cancer Financial Experience (CAFÉ) study is a multi-site randomized controlled trial (RCT) with individual-level randomization. Participants will be offered either brief (one financial navigation cycle, Arm 2) or extended (three financial navigation cycles, Arm 3) financial navigation. The intervention period for both Arms 2 and 3 is 6 months. The comparison group (Arm 1) will receive enhanced usual care. The setting for the CAFÉ study is the medical oncology and radiation oncology clinics at two integrated health systems in the Pacific Northwest. Inclusion criteria includes age 18 or older with a recent cancer diagnosis and visit to a study clinic as identified through administrative data. Outcomes will be assessed at 12-month follow-up. Primary outcomes are self-reported financial distress and health-related quality of life. Secondary outcomes are delayed or foregone care; receipt of medical financial assistance; and account delinquency. A mixed methods exploratory analysis will investigate factors associated with total intervention dose received. DISCUSSION The CAFÉ study will provide much-needed early trial evidence on the impact of financial navigation in reducing cancer-related financial hardship. It is theory-informed, clinic-based, aligned with patient preferences, and has been developed following preliminary qualitative studies and stakeholder input. By design, it will provide prospective evidence on the potential benefits of financial navigation on patient-relevant cancer outcomes. The CAFÉ trial's strengths include its broad inclusion criteria, its equity-focused sampling plan, its novel intervention developed in partnership with clinical and operations stakeholders, and mixed methods secondary analyses related to intervention dose offered and dose received. The resulting analytic dataset will allow for rich mixed methods analysis and provide critical information related to implementation of the intervention should it prove effective. TRIAL REGISTRATION ClinicalTrials.gov NCT05018000 . August 23, 2021.
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Affiliation(s)
- Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - John Dickerson
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - John J Ewing
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Robin Garcia
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Erin Keast
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Deborah A King
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Cara Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Blake Locher
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Consuelo M Norris
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amanda F Petrik
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Arvind Ramaprasan
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | - Lisa Shulman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Matthew P Banegas
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- University of California San Diego, San Diego, CA, USA
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45
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Marulappa N, Anderson NN, Bethell J, Bourbonnais A, Kelly F, McMurray J, Rogers HL, Vedel I, Gagliardi AR. How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review. BMC Health Serv Res 2022; 22:541. [PMID: 35459214 PMCID: PMC9034625 DOI: 10.1186/s12913-022-07875-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers). Methods We conducted a scoping review by searching multiple databases from 2000 inclusive to June 7, 2020. We extracted data on study characteristics and PCCS approaches, evaluation, determinants or the impact of strategies to implement PCCS. We used summary statistics to report data and interpreted findings with an existing person-centred care framework. Results We included 22 studies with qualitative (55%) or quantitative/multiple methods design (45%) involving affected persons (50%), or healthcare workers (50%). Studies varied in how PCCS was conceptualized; 59% cited a PCC definition or framework. Affected persons and healthcare workers largely agreed on what constitutes PCCS (e.g. foster partnership, promote autonomy, support carers). In 4 studies that evaluated care, barriers of PCCS were reported at the affected person (e.g. family conflict), healthcare worker (e.g. lack of knowledge) and organizational (e.g. resource constraints) levels. Studies that evaluated strategies to implement PCCS approaches were largely targeted to healthcare workers, and showed that in-person inter-professional educational meetings yielded both perceived (e.g. improved engagement of affected persons) and observed (e.g. use of PCCS approaches) beneficial outcomes. Few studies reported results by gender or other intersectional factors, and none revealed if or how to tailor PCCS for women. This synthesis confirmed and elaborated the PCC framework, resulting in a Framework of PCCS for Dementia. Conclusion Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07875-w.
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Affiliation(s)
- Nidhi Marulappa
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Natalie N Anderson
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada
| | - Jennifer Bethell
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, PO Box 6128, Montreal, QC, H3C 3J7, Canada
| | - Fiona Kelly
- Division of Nursing, Queen Margaret University, Queen Margaret University Drive, Musselburgh, East Lothian, EH21 6UU, UK
| | - Josephine McMurray
- Lazaridis School of Business and Economics/Health Studies, Wilfrid Laurier University, 73 George Street, Brantford, ON, N3T 3Y3, Canada
| | - Heather L Rogers
- Biocruces Bizkaia Health Research Institute and Ikerbasque Basque Foundation for Science, Bilbao, Spain, Plaza Cruces s/n, E-48903, Barakaldo, Spain
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G2C4, Canada.
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Leonardsen ACL, Helgesen AK, Stensvold A, Magnussen J, Grøndahl VA. Cancer patients' perspectives on remote monitoring at home during the COVID-19 pandemic- a qualitative study in Norway. BMC Health Serv Res 2022; 22:453. [PMID: 35387645 PMCID: PMC8985561 DOI: 10.1186/s12913-022-07897-4] [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: 02/11/2022] [Accepted: 04/01/2022] [Indexed: 01/04/2023] Open
Abstract
Background The COVID-19 pandemic triggered an unprecedented demand for digital health technology solutions, such as remote monitoring. Previous research has focused on patients with chronic diseases, and their experiences with remote monitoring during the pandemic. Several recommendations have been presented to reduce the frequency of cancer patients’ visits to oncology centers and minimizing the risk of exposure to COVID-19, such as remote monitoring. However, few studies have explored how this has influenced the healthcare services to cancer patients. Aim To explore cancer patients’ perspectives on remote monitoring at home during the COVID-19 pandemic. Design The study had a qualitative design, using in-depth, individual interviews. Methods A total of eleven interviews were conducted with patients who received remote monitoring during the COVID-19 outbreak. Three of the interviews were conducted by telephone, and eight on a digital platform, audio recorded, and transcribed verbatime. Data were analyzed using reflexive thematic analysis as recommended by Braun & Clarke. Results All participants were conscious about being vulnerable to infections due to having cancer and receiving cancer treatment, and the pandemic to them represented an extra burden. Most of the participants experienced that their healthcare services had changed due to the pandemic, but there was no consensus on how the services had changed. All of the participants presented remote monitoring as something «new». Whether they received remote monitoring by telephone, video consultations or more advanced solutions with the possibility to complete a questionnaire or fill in measurements, did not seem to impact their views. However, all agreed that remote monitoring could never totally replace physical consultations in hospital. Participants’ views seemed to grow more positive over time, but still they emphasized both positive and negative aspects of remote monitoring solutions in cancer care. Conclusion Remote monitoring was introduced as a necessity in cancer care during the COVID-19 outbreak. This may seem as an efficient solution, allowing for patients to stay at home and avoid infection. Our results indicate that, in the case of cancer patients, it is important that healthcare personnel balance the remote monitoring solution with person-to-person contact.
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Affiliation(s)
- Ann-Chatrin Linqvist Leonardsen
- Department of Health, Welfare and Organization, Østfold University College/Østfold Hospital Trust, Postal box code (PB) 700, 1757, Halden, Norway.
| | - Ann Karin Helgesen
- Department of Health, Welfare and Organization, Østfold University College, PB 700, NO-1757, Halden, Norway
| | - Andreas Stensvold
- Cancer Department, Østfold Hospital Trust, Postal box code 300, NO-1714, Grålum, Norway
| | | | - Vigdis A Grøndahl
- Department of Health, Welfare and Organization, Østfold University College, PB 700, NO-1757, Halden, Norway
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LeBaron V, Boukhechba M, Edwards J, Flickinger T, Ling D, Barnes LE. Exploring the use of wearable sensors and natural language processing technology to improve patient-clinician communication: Protocol for a feasibility study (Preprint). JMIR Res Protoc 2022; 11:e37975. [PMID: 35594139 PMCID: PMC9166632 DOI: 10.2196/37975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Virginia LeBaron
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Mehdi Boukhechba
- School of Engineering & Applied Science, University of Virginia, Charlottesville, VA, United States
| | - James Edwards
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Tabor Flickinger
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - David Ling
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Laura E Barnes
- School of Engineering & Applied Science, University of Virginia, Charlottesville, VA, United States
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Dawson A, Assifi A, Turkmani S. Woman and girl-centred care for those affected by female genital mutilation: a scoping review of provider tools and guidelines. Reprod Health 2022; 19:50. [PMID: 35193606 PMCID: PMC8862274 DOI: 10.1186/s12978-022-01356-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A woman and girl centred, rights-based approach to health care is critical to achieving sexual and reproductive health. However, women with female genital mutilation in high-income countries have been found to receive sub-optimal care. This study examined documents guiding clinicians in health and community service settings in English-speaking high-income countries to identify approaches to ensure quality women and girl-centred care for those with or at risk of female genital mutilation. METHOD We undertook a scoping review using the integrative model of patient-centredness to identify principles, enablers, and activities to facilitate woman and girl-centred care interactions. We developed an inclusion criterion to identify documents such as guidance statements and tools and technical guidelines, procedural documents and clinical practice guidelines. We searched the databases and websites of health professional associations, ministries of health, hospitals, national, state and local government and non-government organisations working in female genital mutilation in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation tool was used to appraise screened documents. FINDINGS One-hundred and twenty-four documents were included in this scoping review; 88 were developed in the United Kingdom, 20 in Australia, nine in the United States, three in Canada, two in New Zealand and two in Ireland. The focus of documents from the United Kingdom on multi-professional safeguarding (62), while those retrieved from Australia, Canada, Ireland, New Zealand and the US focused on clinical practice. Twelve percent of the included documents contained references to all principles of patient-centred care, and only one document spoke to all principles, enablers and activities. CONCLUSION This study demonstrates the need to improve the female genital mutilation-related guidance provided to professionals to care for and protect women and girls. Professionals need to involve women and girls with or at risk of female genital mutilation in the co-design of guidelines and tools and evaluation of them and the co-production of health care.
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Affiliation(s)
- Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health University of Technology, Sydney, Australia.
| | - Anisa Assifi
- Department of General Practice, Monash University, Melbourne, Australia
| | - Sabera Turkmani
- Australian Centre for Public and Population Health Research, Faculty of Health University of Technology, Sydney, Australia
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Dwan C, Willig C. Existential uncertainty in the patient cancer experience: Delimiting the concept. Palliat Support Care 2022; 21:1-7. [PMID: 35166199 DOI: 10.1017/s1478951522000104] [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: 11/06/2022]
Abstract
OBJECTIVE To delimit the concept of existential uncertainty in the patient cancer experience from other, related aspects of uncertainty in the context of an existing framework of health-related uncertainty. METHODS In-depth interviews were carried out with six people living with cancer and analyzed using theory-driven, concept-focused thematic analysis. RESULTS Our analysis suggests that existential uncertainty is concerned with meaning rather than information; with the person rather than the disease; and with the fundamental nature of our human being-in-the-world rather than the more practical aspects of our relationships with others. Patient expressions of existential uncertainty may involve a nonscientific discourse of metaphor, analogy, and imagination. SIGNIFICANCE OF RESULTS It is important for professionals working in supportive oncology to have a conceptual understanding of uncertainty in order to choose how best to respond to patients' needs, as different interventions may be more or less appropriate to different aspects of patient uncertainty.
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Su M, Zhou Z, Si Y, Fan X. The Association Between Patient-Centered Communication and Primary Care Quality in Urban China: Evidence From a Standardized Patient Study. Front Public Health 2022; 9:779293. [PMID: 35186869 PMCID: PMC8854212 DOI: 10.3389/fpubh.2021.779293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Effective patient-physician communication has been considered a central clinical function and core value of health system. Currently, there are no studies directly evaluating the association between patient-centered communication (PCC) and primary care quality in urban China. This study aims to investigate the association between PCC and primary care quality. Methods The standardized patients were used to measure PCC and the quality of health care. We recruited 12 standardized patients from local communities presenting fixed cases (unstable angina and asthma), including 492 interactions between physicians and standardized patients across 63 CHCs in Xi'an, China. PCC was scored on three dismissions: (1) exploring disease and illness experience, (2) understanding the whole person, and (3) finding common ground. We measured the quality of the primary care by (1) accuracy of diagnosis, (2) consultation time, (3) appropriateness of treatment, (4) unnecessary exams; (5) unnecessary drugs, and (6) medical expenditure. Ordinary least-squares regression models with fixed effects were used for the continuous variables and logistic regression models with fixed effects were used for the categorical variables. Results The average score of PCC1, PCC2, and PCC3 was 12.24 ± 4.04 (out of 64), 0.79 ± 0.64 (out of 3), and 10.19 ± 3.60 (out of 17), respectively. The total score of PCC was 23.22 ± 6.24 (out of 84). We found 44.11% of the visits having a correct diagnosis, and 24.19% of the visits having correct treatment. The average number of unnecessary exams and drugs was 0.91 ± 1.05, and 0.45 ± 0.82, respectively. The average total cost was 35.00 ± 41.26 CNY. After controlling for the potential confounding factors and fixed effects, the PCC increased the correct diagnosis by 10 percentage points (P < 0.01), the correct treatment by 7 percentage points (P < 0.01), the consultation time by 0.17 min (P < 0.01), the number of unnecessary drugs by 0.03 items (P < 0.01), and the medical expenditure by 1.46 CNY (P < 0.01). Conclusions This study revealed pretty poor communication between primary care providers and patients. The PCC model has not been achieved, which could be one source of the intensified physician-patient relationship. Our findings showed the PCC model in the primary care settings has positive associations with the quality of the primary care. Interactions with a higher score of PCC were more likely to have a correct diagnosis and correct treatment, more consultation time, more unnecessary drugs, and higher medical expenditure. To improve PCC, the clinical capacity and communication skills of primary care providers need to be strengthened. Also, strategies on reforming the pay structure to better reflect the value of physicians and providing a stronger motivation for performance improvement are urgently needed.
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Affiliation(s)
- Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Zhongliang Zhou
| | - Yafei Si
- School of Risk & Actuarial Studies and CEPAR, University of New South Wales, Sydney, NSW, Australia
| | - Xiaojing Fan
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
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