Patients' rights, quality of life, and health care system performance

"It's like asking for a necktie when you don't have underwear": Discourses on patient rights in southern Karnataka, India

BACKGROUND

Ensuring patient rights is an extension of applying human rights principles to health care. A critical examination of how the notion of patient rights is perceived and enacted by various actors through critical discourse analysis (CDA) can help understand the impediments to its realization in practice.

METHODS

We studied the discourses and discursive practices on patient rights in subnational policies and in ten health facilities in southern Karnataka, India. We conducted interviews (78), focus group discussions (3) with care-seeking individuals, care-providers, health care administrators and public health officials. We also conducted participant observation in selected health facilities and examined subnational policy documents of Karnataka pertaining to patient rights. We analyzed the qualitative data for major and minor themes.

RESULTS

Patient rights discourses were not based upon human rights notions. In the context of neoliberalism, they were predominantly embedded within the logic of quality of care, economic, and consumerist perspectives. Relatively powerful actors such as care-providers and health facility administrators used a panoply of discursive strategies such as emphasizing alternate discourses and controlling discursive resources to suppress the promotion of patient rights among care-seeking individuals in health facilities. As a result, the capacity of care-seeking individuals to know and claim patient rights was restricted. With neoliberal health policies promoting austerity measures on public health care system and weak implementation of health care regulations, patient rights discourses remained subdued in health facilities in Karnataka, India.

CONCLUSIONS

The empirical findings on the local expression of patient rights in the discourses allowed for theoretical insights on the translation of conceptual understandings of patient rights to practice in the everyday lives of health system actors and care-seeking individuals. The CDA approach was helpful to identify the problematic aspects of discourses and discursive practices on patient rights where health facility administrators and care-providers wielded power to oppress care-seeking individuals. From the practical point of view, the study demonstrated the limitations of care-seeking individuals in the discursive realms to assert their agency as practitioners of (patient) rights in health facilities.

Patients' healthcare, education, engagement, and empowerment rights' framework: Patients', caretakers' and health care workers' perspectives from Oromia, Ethiopia

BACKGROUND

Successful health care and clinical services essentially depend on patients' realization of ones' rights, and health workers' and facilities' fulfillments and protections of these rights. However, little is documented about how patients and health workers perceive patients' rights during care-seeking practices.

METHODS

A qualitative study was conducted in four hospitals in Ethiopia through 8 focus group discussions with patients and 14 individual interviews with diverse groups of patients, caretakers, and 14 interviews with health workers. Participants were recruited through a purposive sampling method to meet the saturation of ideas about patients' rights. The sampled patients, caretakers, and professionals were enlisted from various departments in the hospitals. The data analysis was assisted by ATLAS.ti 7.1.4.

RESULTS

The study identified three major categories of healthcare rights (clinical, socio-cultural, and organizational), incorporating supporting elements of education, engagement, and empowerment. Study participants reported detailed rights the patients would have during hospital visits which included the right to timely access to care and treatment, adequate medications) with full respect, dignity, and without any discrimination. Patients widely perceived that they had the right to tell their illness history and know their illness in the language they can understand. It was also widely agreed that patients have the right to be educated and guided to make informed choices of services, procedures, and medications. Additionally, patients reported that they had the right to be accompanied by caretakers together with the right to use facilities and resources and get instructions on how to utilize these resources, the right to be protected from exposure to infections and unsafe conditions in hospitals, right to get a diet of their preference, and right to referral for further care. Nevertheless, there was a common concern among patients and caretakers that these rights were mostly non-existent in practice which were due to barriers related to patients (fear of consequence; a sense of dependency, feeling of powerlessness, perceptions of low medical literacy), health workers (negligence, lack of awareness and recognition of patient rights, undermining patients), and facilities' readiness and support, including lack of guiding framework.

CONCLUSIONS

Perceived patients' rights in the context of hospital visits were profoundly numerous, ranging from the right to access clinical and non-clinical services that are humanely respectful, fulfilling socio-cultural contexts, and in a manner that is organizationally coordinated. Nonetheless, the rights were not largely realized and fulfilled. Engaging, educating, and empowering patients, caretakers, and health care providers supported with policy framework could help to move towards patient-centered and right-based healthcare whereby patients' rights are protected and fulfilled in such resource-limited settings.

Diabetes patients’ perspectives on the patients’ rights: evidence from east of Iran

Purpose

The Iranian patients’ rights charter defines patient rights as a reflection of fundamental human rights in the field of medicine and incorporates all elements of patient rights accepted in international texts. The purpose of this paper is to study the way in which diabetes patients’ rights are being exercised in everyday hospital practice in Birjand, Iran.

Design/methodology/approach

A cross-sectional study design was used in 2014. The sample size was estimated 150 patients, out of which 108 diabetes patients completed questionnaire. The questionnaire of diabetes patients’ perspectives on the patients’ rights was used to collect data. The questionnaire consists of 22 questions. Data entry and analysis were carried out using SPSS software (version 22). Descriptive and inferential statistics were calculated with all survey items and total scores, as well as demographic data.

Findings

The response rate was 72 percent. Overall, the mean score percentage of diabetes patients’ perspectives on the patients’ rights was 74.04± 8.4. Furthermore, statistical significant differences were found among diabetes patients in relation to patients’ perspectives on the patients’ rights according to highest level of education (F=16.52, p=0.002), their habitat(t=3.49, p=0.001), age groups (F=18.70, p=0.0001) and the duration of the disease (F=5.16, p=0.007). The results showed that no statistically significant differences were observed among diabetes patients in relation to diabetes patients’ perspectives on the patients’ rights according to their gender (F=1.57, p=0.12) and marital status (F=1.56, p=0.09).

Originality/value

Clinicians can provide care based on patients’ rights, and their knowledge of patients’ rights needs to be evaluated. Educational courses, leaflets, booklets and posters can be helpful in this regard. In addition, professional organizations and the Ministry of Health need to be more sensitive to this issue.

Quality of care as a determinant of health-related quality of life in ill-hospitalized adolescents at a tertiary care hospital in North India

OBJECTIVE

To evaluate if quality of care (QoC) provided by hospital is a determinant of ill-hospitalized adolescent's health-related quality of life (HRQoL) from parent's perspective.

DESIGN

Prospective cross-sectional study conducted at a tertiary care hospital of Northern India after institutional ethical approval.

SETTING

Hospital in pediatric department of a tertiary care, teaching medical University in Lucknow, northern India.

PARTICIPANTS

Sick adolescents aged between 10 and 19 years and hospitalized for four categories of illnesses, namely, acute infective; chronic infective, non-hemopoetic; hemopoetic disorders and miscellaneous.

INTERVENTION

QOC assessment was done using 'Pyramid instrument' and HRQoL by culturally modified WHOQOL-BREF (World Health Organization Quality of Life-BREF). The Pyramid instrument comprises 43 questions to collect information about awareness of eight indices: namely illness, routines, accessibility, medical treatment, care processes, staff attitude, participation and staff work environment and scored on 1-4 Likert scale. WHOQOL-BREF has four domains: physical, psychological, social relations and environment and scored on 1-5 Likert scale.

RESULTS

From January 2008 to December 2008, 300 adolescents with a mean age of 12.5 ± 2.6 years and 61.3% males were included. The pyramid instrument showed a substantial internal consistency (α = 0.88, P-value < 0.0001). The mean QoC was highest for medical treatment (0.76 ± 0.13) and lowest for participation (0.54 ± 0.16). The mean parent's report of child's HRQoL was highest for physical (42.8 ± 7.4) and lowest for environment domain (37.2 ± 7.1). Four QoC indices namely, medical treatment, care processes, staff attitude and participation had significant associations with the mean HRQoL. In a hierarchical linear regression, staff attitude was the only significant determinant of HRQoL (β coefficient: 23.16, 95% confidence interval: 15.8-30.5, P-value < 0.0001).

CONCLUSION

The Pyramid instrument is a reliable instrument for assessing parent's perception of QoC provided to hospitalized adolescents in Indian context. QoC was positively associated with HRQoL, thus, an increased focus on QoC especially staff attitude is likely to enhance adolescent's overall HRQoL.

Parental reporting of quality of care as a determinant of health related quality of life of ill adolescents at a tertiary care hospital in northern India

OBJECTIVE

To assess if Quality of Care (QoC) is a determinant of Health Related Quality of Life (HRQoL) in ill adolescents.

METHODS

This Cross-sectional study, at a tertiary care hospital of Northern India was conducted after institutional ethical approval on ill adolescents availing ambulatory or in-patient care from Pediatrics department. From August 2009 through November 2010, 300 patients availing ambulatory or in-patient care were recruited, with mean age 11.5 years ±1.5SD, of which 65.7% were males. After obtaining parental written consent and oral assent from subjects, parents reported their perception of QoC as well as adolescent's HRQoL through Pyramid and culturally modified WHOQOL-BREF, respectively. Pyramid (score range 0-1) has 43 questions about awareness of 8 indices; namely illness, routines, accessibility, medical treatment, care processes, staff attitude, participation and staff work environment. WHOQOL-BREF (score range 0-100) has 4 domains: physical, psychological, social relations and environment.

RESULTS

Mean HRQoL was 42.5 ± 5.6, mean QoC was 0.67 ± 0.07 and mean scores were not significantly different for patients on ambulatory and in-patient care. Correlation between overall HRQoL and QoC was 0.32 (p < 0.0001). Information about illness index was the only significant determinant of good HRQoL in binary logistic regression (Odd's Ratio 4.19, 95% CI 2.39-7.33; p < 0.0001).

CONCLUSIONS

QoC is a significant determinant of ill adolescent's HRQoL at a tertiary care hospital.

Knowledge about patients' rights among professionals in public health care in Finland

BACKGROUND

The legal rights of patients include civil rights for patients and the duties of healthcare professionals. Knowledge of legislation and the ability to put juridical norms into practice are among the main aspects of professionals.

AIM

The aim of the study was to describe the level of healthcare professionals' knowledge about patients' legal rights and to describe background variables associated with the knowledge. The legal rights are based on the Finnish Act on the Status and Rights of Patients.

METHOD

The data were collected from healthcare professionals (nurses and physicians) in public health care in Finland (recruited N = 290, responded n = 191) with a questionnaire designed for the study. The response rate was 66%. The data were analysed statistically.

RESULTS

Healthcare professionals were partially familiar with patients' legal rights. The right to good health care, treatment and access to care and right to self-determination were the best-known areas. The respondents lacked knowledge on the right to information and the right to use the services of patient ombudsman. Based on self-evaluation, half of the respondents thought that they had weak knowledge of the legislation on patients' rights. However, they perceived knowledge about patients' rights as being important. There was no correlation between respondents' self-evaluated knowledge and actual scoring on the knowledge test.

CONCLUSION

These results implicate a need for further education aimed at healthcare professionals and development of professional training about patients' legal rights.

A practical instrument to explore patients' needs in palliative care: the Problems and Needs in Palliative Care questionnaire short version

OBJECTIVE

Short and convenient checklists are necessary tools to support and structure needs assessments in daily palliative practice. This study aims to develop a short version of the Problems and Needs in Palliative Care questionnaire (PNPC-sv); a self-report questionnaire for patients covering all dimensions of palliative care, to investigate their problems and (unmet) needs.

METHODS

The original Problems and Needs in Palliative Care questionnaire (PNPC) instrument is a comprehensive checklist of problems and needs for palliative care, and has shown validity and reliability. With its 90 items, however, it is not always practical. Thus it was abridged to a short version with 33 items. The validity and reliability are established with its item response, its internal consistency, and with its correlations with the original PNPC and with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and COOP/WONCA quality-of-life measures. A secondary analysis was done with data from 94 patients with metastatic cancer who had completed the long version.

RESULTS

Each item in the PNPC represents a problem relevant to 25% of the patients or more. High correlations of PNPC-sv and PNPC domains demonstrate construct validity. The dimension reliability was satisfactory (Cronbach's alpha > 0.70), while two problem-aspect domains were less coherent. The PNPC-sv domains show convergent validity with corresponding health-related quality-of-life domains.

CONCLUSION

The PNPC-sv is a concise, patient-centred tool that helps to identify the problems affecting the patient's quality of life and needs for care. It identifies prevalent needs for care and appears reliable. Further research should study the clinical effects of integrating the questionnaire into daily palliative-care practice.

A Primer on Health-Related Quality of Life in Chronic Pain Medicine

BACKGROUND

Pain is a complex and individual experience that is often difficult for patients to fully describe using a conventional pain intensity scale. Health-related quality of life is an additional metric by which to assess patients' subjective perspective on their chronic pain experience and its adverse effect on their lives. Health-related quality of life encompasses those aspects of health and well-being valued by patients, specifically, their physical, emotional, and cognitive function, and their ability to participate in meaningful activities within their family, workplace, and community.

METHODS

A methodical search of the medical literature was undertaken to identify the most commonly applied health-related quality of life measurement instruments. These measurement instruments were then assessed within the context of chronic pain medicine clinical practice and research.

RESULTS

This primer provides an overview of the concept of health-related quality of life as a clinical measurement and the specific means by which to measure health-related quality of life across various cultures in adults, as well as in children and adolescents, suffering from chronic pain conditions.

CONCLUSIONS

We have the ability and impetus to routinely assess adult and pediatric health-related quality of life in chronic pain medicine. However, further attention needs to be focused on overcoming barriers to the more widespread measurement of health-related quality of life. A valid preference-based, utility measure of health-related quality of life is a requirement for performing a cost-utility (cost-effectiveness) analysis and undertaking formal decision analysis modeling.

The problems experienced by patients with cancer and their needs for palliative care

OBJECTIVES

To investigate the problems that patients experience and their met- and unmet needs for professional help. This information is necessary to tailor palliative care to patient needs.

PATIENTS AND METHODS

Patients (n=94) with disseminated cancer completed a validated checklist with 90 potential problems and needs for palliative care (PNPC questionnaire).

MAIN RESULTS

On average, patients experienced 37 problems (range 0-68) and required more professional attention for eight problems (range 0-71). The five most prevalent problems were: fatigue, heavy housework, coping with the unpredictability of the future, fear of metastases, and frustrations because I can do less than before. The five issues most in need of extra attention were: informational needs, coping with the unpredictability of the future, fear of metastases, fear of physical suffering, and difficulties remembering what was told (during consultations). Younger patients experienced more social, psychological, and financial problems. Some 10% of patients expressed a multitude of problems and needs.

CONCLUSIONS

While patients with metastasized cancer experienced a wide variety of problems, they asked for more support for only a few specific problems. Evidently, "problems" are not synonymous with unmet needs. Therefore, not only problems but also needs for care should be assessed. A structural need for support to cope with fears of suffering and loss of autonomy was found. Ten percent of patients expressed a multitude of problems and needs and might benefit either from psychological counseling or better palliative care.