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Maleki M, Dehghan Nayeri N, Hamidieh AA, Pouraboli B. Parents' experiences of living with a child with cancer undergoing hematopoietic stem cell transplantation: a qualitative content analysis study. Front Psychol 2024; 15:1359978. [PMID: 38533218 PMCID: PMC10963479 DOI: 10.3389/fpsyg.2024.1359978] [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: 01/04/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
Objectives Pediatric Hematopoietic Stem Cell Transplant (HSCT) profoundly impacts the physical, psychological, and social aspects of parents' lives. Thus, this study aimed to explore the experiences of parents living with a child with cancer who undergoes HSCT. Methods This qualitative study involved 20 parents of children with cancer who were undergoing HSCT at a referral hospital in Iran. Purposive sampling was used to select the participants from February 2023 to November 2023. In-depth semi-structured interviews, featuring open-ended questions, were utilized for data collection. Data analysis was performed using conventional content analysis. Results Data analysis revealed two main themes. "Surrounded by hardships" and "Self-actualization." The first theme encompassed participants' experiences of facing difficulties in life after being aware of their child's need for HSCT. This theme consisted of four categories: "uncertainty about the child's future," "exhaustion from the child's treatment process," "worrying about the healthy child(ren)," and "helplessness." The second theme "self-actualization" included with two categories: "transformation in life's philosophy" and "acquisition of new capabilities." These categories highlighted the positive outcomes experienced by the participants following their child's HSCT. Conclusion Our findings underscore the importance of healthcare providers being attuned to parents' experiences throughout their child's HSCT trajectory. It is crucial for healthcare providers to encourage parents to articulate their concerns and feelings and seek support from healthcare providers, family, and friends. The development of psychological support services in healthcare settings can facilitate tailored interventions to alleviate parents' difficulties.
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Affiliation(s)
- Maryam Maleki
- Department of Pediatric and Neonatal Intensive Care Nursing Education, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ali Hamidieh
- Pediatric Cell and Gene Therapy Research Centre, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Batool Pouraboli
- Department of Pediatric and Neonatal Intensive Care Nursing Education, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Lanyo TN, Zielinski R, Kukula VA, Apetorgbor VEA, Ghosh B, Lockhart NA, Lori JR. Improving respectful maternity care through group antenatal care: findings from a cluster randomized controlled trial. RESEARCH SQUARE 2023:rs.3.rs-3682833. [PMID: 38196651 PMCID: PMC10775374 DOI: 10.21203/rs.3.rs-3682833/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background Disrespect and patient mistreatment are identified as barriers to care-seeking and low uptake of facility-based deliveries. These mitigating factors have led to slow progress in the achievement of maternal and child health targets, especially in Ghana. Group antenatal care, as an alternative to individual antenatal was implemented to explore the impact on outcomes, including mothers' perception of respectful care. Methods A cluster randomized controlled trial was conducted in 14 health facilities across four districts in the Easter Region of Ghana. These facilities were randomized to intervention or control using a matched pair. Data was collected at several timepoints: enrollment (Time 0), 34 weeks gestation to 3 weeks post-delivery (Time 1), 6 to 12 weeks post-delivery (Time 2), 5 to 8 months post-delivery (Time 3), and 11 to 14 months post-delivery (Time 4). Questions related to respectful care were asked at Time 2, while a focus group discussion (FGDs) was conducted as part of a process evaluation to examine participants' experiences about respectful maternity care. Results The findings from the intervention group indicate that participants perceived higher levels of respect in comparison to the control group. Privacy and con dentiality were maintained. They believed they had been provided with adequate information, education, and counseling, empowering them to make informed decisions. Participants perceived a shortened waiting time and reduced discrimination in care provision. Generally, there were higher levels of satisfaction with antenatal care. Conclusion The provision of respectful maternity care, which is essential to increasing healthcare utilization, has been demonstrated to correlate positively with group antenatal care.
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Raj M, Stephenson AL, DePuccio MJ, Sullivan EE, Tarver W, Fleuren B, Thomas SC, Scheck McAlearney A. Conceptual Framework for Integrating Family Caregivers Into the Health Care Team: A Scoping Review. Med Care Res Rev 2023; 80:131-144. [PMID: 36000495 DOI: 10.1177/10775587221118435] [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: 11/16/2022]
Abstract
More than 80% of family care partners of older adults are responsible for coordinating care between and among providers; yet, their inclusion in the health care delivery process lacks recognition, coordination, and standardization. Despite efforts to include care partners (e.g., through informal or formal proxy access to their care recipient's patient portal), policies and procedures around care partner inclusion are complex and inconsistently implemented. We conducted a scoping review of peer-reviewed articles published from 2015 to 2021 and reviewed a final sample of 45 U.S.-based studies. Few articles specifically examine the inclusion of care partners in health care teams; those that do, do not define or measure care partner inclusion in a standardized way. Efforts to consider care partners as "partners" rather than "visitors" require further consideration of how to build health care teams inclusive of care partners. Incentives for health care organizations and providers to practice inclusive team-building may be required.
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Affiliation(s)
| | | | | | | | | | | | - Samuel C Thomas
- Stanford School of Medicine and Intermountain Healthcare, USA
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Koblick SB, Yu M, DeMoss M, Liu Q, Nessle CN, Rozwadowski M, Troost JP, Miner JA, Hassett A, Carlozzi NE, Barton DL, Tewari M, Hanauer DA, Choi SW. A pilot intervention of using a mobile health app (ONC Roadmap) to enhance health-related quality of life in family caregivers of pediatric patients with cancer. Mhealth 2023; 9:5. [PMID: 36760786 PMCID: PMC9902233 DOI: 10.21037/mhealth-22-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/25/2022] [Indexed: 01/28/2023] Open
Abstract
Background The Roadmap mobile health (mHealth) app was developed to provide health-related quality of life (HRQOL) support for family caregivers of patients with cancer. Methods Eligibility included: family caregivers (age ≥18 years) who self-reported as the primary caregiver of their pediatric patient with cancer; patients (age ≥5 years) who were receiving cancer care at the University of Michigan. Feasibility was calculated as the percentage of caregivers who logged into ONC Roadmap and engaged with it at least twice weekly for at least 50% of the 120-day study duration. Feasibility and acceptability was also assessed through a Feasibility and Acceptability questionnaire and the Mobile App Rating Scale to specifically assess app-quality. Exploratory analyses were also conducted to assess HRQOL self- or parent proxy assessments and physiological data capture. Results Between September 2020-September 2021, 100 participants (or 50 caregiver-patient dyads) consented and enrolled in the ONC Roadmap study for 120-days. Feasibility of the study was met, wherein the majority of caregivers (N=32; 65%) logged into ONC Roadmap and engaged with it at least twice weekly for at least 50% of the study duration (defined a priori in the Protocol). The Feasibility and Acceptability questionnaire responses indicated that the study was feasible and acceptable with the majority (>50%) reporting Agree or Strongly Agree with positive Net Favorability [(Agree + Strongly Agree) - (Disagree + Totally Disagree)] in each of the domains (e.g., Fitbit use, ONC Roadmap use, completing longitudinal assessments, engaging in similar future study, study expectations). Improvements were seen across the majority of the mental HRQOL domains across all groups; even though underpowered, there were significant improvements in caregiver-specific aspects of HRQOL and anxiety and in depression and fatigue for children (ages 8-17 years), and a trend toward improvement in depression for children ages 8-17 years and in fatigue for adult patients. Conclusions This study supports that mHealth technology may be a promising platform to provide HRQOL support for caregivers of pediatric patients with cancer. Importantly, the findings suggest that the study protocol was feasible, and participants were favorable to participate in future studies of this intervention alongside routine cancer care delivery.
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Affiliation(s)
- Sarah B. Koblick
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Miao Yu
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Matthew DeMoss
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Qiaoxue Liu
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Charles N. Nessle
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | | | - Jonathan P. Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer A. Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Afton Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Debra L. Barton
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Muneesh Tewari
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - David A. Hanauer
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
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Chardon ML, Klages KL, Joffe NE, Pai ALH. Recommendations for Providing Medication Adherence Support After Pediatric Hematopoietic Stem Cell Transplant: Caregivers' Lived Experience. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:5-16. [PMID: 36221958 PMCID: PMC9982233 DOI: 10.1177/27527530221121723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background. Medication adherence is challenging after pediatric hematopoietic stem cell transplant (HCT), particularly after hospital discharge. Post-HCT medication adherence is important to manage morbidity and mortality risk. Designing interventions that are effective and acceptable to caregivers is key to improving post-HCT medication adherence. This study aimed to characterize caregiver preferences about medication adherence support from their child's medical team. Methods. Twenty-nine caregivers of children who received an HCT completed semi-structured qualitative interviews about their experience with, and recommendations for improving, medication adherence support provided by the medical team. Twenty-two caregivers also completed a card sort task to clarify the content of received support and caregiver recommendations for future HCT families. Results. Thematic analysis revealed eight themes grouped into two categories: Communication Is Key and Practical Medication Adherence Support. Caregivers emphasized the importance of communication in helping them manage their child's outpatient medications and provided suggestions to further strengthen communication. The types of practical medication adherence support used varied across caregivers highlighting the importance of tailoring adherence support to each family's needs. Caregivers also identified all the domains as potentially helpful for other families. Discussion. Findings suggest that caregivers prefer that efforts to improve outpatient medication adherence post-HCT prioritize the medical team initiating frequent, clear, and open communication about medications, and provide educational materials on adherence (e.g., handouts). Results also indicate that practical medication adherence supports should be offered based on family preferences but that families may particularly appreciate tips about addressing medication challenges based on other caregivers' lived experience.
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Affiliation(s)
- Marie L. Chardon
- Division of Behavioral Medicine & Clinical Psychology,
Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Kimberly L. Klages
- Division of Behavioral Medicine & Clinical Psychology,
Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Naomi E. Joffe
- Division of Behavioral Medicine & Clinical Psychology,
Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Patient and Family Wellness Center, Cancer and Blood Diseases
Institute, CCHMC, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of
Medicine, Cincinnati, OH, USA
| | - Ahna L. H. Pai
- Division of Behavioral Medicine & Clinical Psychology,
Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
- Patient and Family Wellness Center, Cancer and Blood Diseases
Institute, CCHMC, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of
Medicine, Cincinnati, OH, USA
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6
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Smith CA, Kelly MM. Open Notes, a digital transformation of pediatric inpatient care: Focus groups of parents and other stakeholders (Preprint). J Particip Med 2022; 14:e37759. [PMID: 35635743 PMCID: PMC9153906 DOI: 10.2196/37759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background Patient portals are a health information technology that allows patients and their proxies, such as caregivers and family members, to access designated portions of their electronic health record using mobile devices and web browsers. The Open Notes initiative in the United States, which became federal law in April 2021, has redrawn and expanded the boundaries of medical records. Only a few studies have focused on sharing notes with parents or caregivers of pediatric patients. Objective This study aimed to investigate the anticipated impact of increasing the flow of electronic health record information, specifically physicians’ daily inpatient progress notes, via a patient portal to parents during their child’s acute hospital stay—an understudied population and an understudied setting. Methods A total of 5 in-person focus groups were conducted with 34 stakeholders most likely impacted by sharing of physicians’ inpatient notes with parents of hospitalized children: hospital administrators, hospitalist physicians, interns and resident physicians, nurses, and the parents themselves. Results Distinct themes identified as benefits of pediatric inpatient Open Notes for parents emerged from all the 5 focus groups. These themes were communication, recapitulation and reinforcement, education, stress reduction, quality control, and improving family-provider relationships. Challenges identified included burden on provider, medical jargon, communication, sensitive content, and decreasing trust. Conclusions Providing patients and, in the case of pediatrics, caregivers with access to medical records via patient portals increases the flow of information and, in turn, their ability to participate in the discourse of their care. Parents in this study demonstrated not only that they act as monitors and guardians of their children’s health but also that they are observers of the clinical processes taking place in the hospital and at their child’s bedside. This includes the clinical documentation process, from the creation of notes to the reading and sharing of the notes. Parents acknowledge not only the importance of notes in the clinicians’ workflow but also their collaboration with providers as part of the health care team.
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Affiliation(s)
| | - Michelle M Kelly
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
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Handley SC, Passarella M, Martin AE, Lorch SA, Srinivas SK, Nembhard IM. Development and Testing of a Survey Measure of Organizational Perinatal
Patient‐Centered
Care Culture. Health Serv Res 2022; 57:806-819. [PMID: 35128641 PMCID: PMC9264452 DOI: 10.1111/1475-6773.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop and test a measure of patient-centered care (PCC) culture in hospital-based perinatal care. DATA SOURCES Data were obtained from US perinatal hospitals: one provided survey development data and 14 contributed data for survey testing. STUDY DESIGN We used qualitative and quantitative methods to develop the mother-infant centered care (MICC) culture survey. Qualitative methods included observation, focus group, interviews, and expert consultations to adapt items from other settings and create new items capturing dimensions of PCC articulated by The Commonwealth Fund. We quantitatively assessed survey psychometric properties using reliability (Cronbach's α and Pearson correlation coefficients) and validity (exploratory and confirmatory factor analysis [CFA]) statistics, and refined the survey. After confirming aggregation suitability (ICCs), we calculated "MICC culture scores" at the individual, unit, and hospital level and assessed associations between scores and survey-collected, staff-reported outcomes to evaluate concurrent validity. DATA COLLECTION Survey development included 12 site-visit observations, one semi-structured focus group (five participants), two semi-structured interviews, five cognitive interviews, and three expert consultations. Survey testing used online surveys administered to obstetric and neonatal unit staff (N = 316). PRINCIPAL FINDINGS Using responses from 10 hospitals with ≥4 responses from both units (n = 240), the 20-item MICC culture survey demonstrated reliability (Cronbach's α = 0.95) while capturing all PCC dimensions (subscale Cronbach's α = 0.72-0.87). CFA showed validity through goodness-of-fit (overall chi-square = 214 [p-value = 0.012], SRMR = 0.056, RMSEA = 0.041, CFI = 0.97, and TLI = 0.96). Aggregation statistics (ICCs < 0.05) justify unit- and hospital-level aggregation. Demonstrating preliminary validity, individual-, unit-, and hospital-level MICC culture scores were associated with all outcomes (satisfaction with care provided, within-unit team effectiveness, and relational coordination [RC] between units) (p-values < 0.05), except for neonatal unit scores and RC (p-value = 0.11). CONCLUSIONS The MICC culture survey is a psychometrically sound measure of PCC culture for hospital-based perinatal care. Survey scores are associated with staff-reported outcomes. Future studies with patient outcomes will aid identification of improvement opportunities in perinatal care.
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Affiliation(s)
- Sara C. Handley
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia and the Perelman School of Medicine‐University of Pennsylvania Philadelphia Pennsylvania
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Molly Passarella
- Department of Pediatrics Children’s Hospital of Philadelphia Philadelphia PA
| | - Ashley E. Martin
- Department of Pediatrics Children’s Hospital of Philadelphia Philadelphia PA
| | - Scott A. Lorch
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia and the Perelman School of Medicine‐University of Pennsylvania Philadelphia Pennsylvania
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Sindhu K. Srinivas
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
- Department of Obstetrics and Gynecology Perelman School of Medicine‐University of Pennsylvania Philadelphia Pennsylvania
| | - Ingrid M. Nembhard
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
- The Wharton School University of Pennsylvania Philadelphia PA
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Raj M, Gupta V, Hoodin F, Clingan C, Roslin C, Yahng L, Braun T, Choi SW. Evaluating mobile Health technology use among cancer caregivers in the digital era. Digit Health 2022; 8:20552076221109071. [PMID: 35769358 PMCID: PMC9234853 DOI: 10.1177/20552076221109071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/10/2022] [Accepted: 06/06/2022] [Indexed: 01/29/2023] Open
Abstract
Introduction Digital health technology-based interventions have the potential to support cancer caregivers in caregiving responsibilities and in managing their own health and well-being. The objective of this study was to examine the association between caregiving characteristics and different types of digital health technologies used in a national sample of caregivers of patients undergoing hematopoietic cell transplantation (HCT). Methods We conducted an online, cross-sectional survey of 948 HCT caregivers. Results Spousal caregivers comprised nearly one-third of respondents (27.1%) with a median age of 59 years (range: 18-80 years), compared with parents (32.9%: 38 years), adult children (28.9%: 38 years), and other (11.1%; e.g. friend, other family member: 36 years). Almost two-thirds (65.4%) of all respondents reported using an app for fitness or step counting and 41.3% reported using a smartwatch. However, spousal caregivers were the least likely group to use mobile apps (0.72; P < 0.005) or smartwatches (OR = 0.46; P < 0.005) compared with parent caregivers in models adjusted for demographics and coping style. Caregiving for six months or greater was associated with the use of fewer apps compared with caregiving for less than six months in adjusted models (OR = 0.80, P < 0.005). Caregivers of patients receiving an allogeneic transplant (i.e. non-self-donor) used more apps on average than caregivers of patients receiving an autologous transplant (i.e. self-donor) in adjusted models (OR = 1.36, P < 0.005). Conclusion Digital health technologies reflect promising avenues for supporting cancer caregivers. While digital technologies are becoming increasingly pervasive, older caregivers remain an underserved population. Future research should integrate older adult caregivers in the co-design and development activities of technology-driven caregiver support products.
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Affiliation(s)
- Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, IL, 61820, USA
| | - Vibhuti Gupta
- Department of Computer Science & Data Science, School of Applied Computational Sciences, Meharry Medical College, Nashville, TN, USA
| | - Flora Hoodin
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Caroline Clingan
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Chloe Roslin
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Lilian Yahng
- Center for Survey Research, Indiana University, Bloomington, IN, USA
| | - Thomas Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sung Won Choi
- Department of Computer Science & Data Science, School of Applied Computational Sciences, Meharry Medical College, Nashville, TN, USA
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Understanding the financial and psychological impact of employment disruption among caregivers of pediatric HSCT recipients: a mixed methods analysis. Support Care Cancer 2022; 30:4747-4757. [PMID: 35132462 PMCID: PMC8821838 DOI: 10.1007/s00520-022-06883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Pediatric hematopoietic stem cell transplantation (HSCT) confers a substantial financial burden onto patients' families. In addition to high direct medical costs, HSCTs typically require at least one caregiver to take time away from work or other responsibilities, often leading to reduced household income. Using mixed methods, we sought to understand the impact of pediatric HSCT on caregiver employment and financial need. METHODS We surveyed caregivers of living pediatric patients who underwent HSCT at one of two southeastern transplant centers between 2012 and 2018 (N = 95). We then interviewed a subset of caregivers (N = 18) to understand whether and how employment disruption contributed to financial distress. RESULTS Among caregivers surveyed, the majority of household wage earners changed their work schedules to attend medical appointments and missed workdays. This resulted in income loss for 87% of families, with 31% experiencing an income reduction of over 50%. Qualitative interviews pointed to four emergent themes: (1) employment disruption exacerbated existing financial challenges; (2) parental division of labor between caregiving and providing financially led to heightened psychological distress; (3) existing employment leave and protection resources were essential but not sufficient; and (4) the ability to work remotely and having a supportive employer facilitated employment maintenance throughout the HSCT process. CONCLUSION Expanded employment protections and access to accommodations are needed to limit the impact of HSCT on household income, health insurance, and financial hardship. Additionally, interventions are needed to ensure caregivers are equipped with the information necessary to navigate conversations with employers and prepare for the financial and psychological reality of employment disruption.
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Tan CE, Lau SCD, Latiff ZA, Lee CC, Teh KH, Sidik SM. Information needs of Malaysian parents of children with cancer: a qualitative study. Asia Pac J Oncol Nurs 2021; 9:143-152. [PMID: 35494095 PMCID: PMC9052854 DOI: 10.1016/j.apjon.2021.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Informational support is an important pillar of psychosocial care for parents of children with cancer. Understanding the information needs of these parents may improve the provision of family-centered informational support. This paper aims to explore the information needs of Malaysian parents whose children have cancer. Methods This qualitative study was conducted among 14 parents of children with cancer and 8 healthcare providers. The parents were recruited from two urban pediatric oncology centers in Malaysia. Healthcare providers were recruited from these centers, as well as from community-based palliative care providers. In-depth interviews were conducted based on semi-structured topic guides, audio-recorded, and transcribed for thematic analysis using elements of the grounded theory approach. Results Analysis revealed three themes of information needs, which were: “interaction with the healthcare system,” “care for the child at home” and “psychosocial support for parents”. Information needs on parents’ interaction with the healthcare system consisted of disease and treatment-related information, as well as health system navigation. Information needs on care for the child at home were represented by their caregiving for basic activities of daily living, medical caregiving, and psychosocial caregiving. Psychosocial support for parents included information on practical support and self-care. There were differences in priorities for information needs between parents and healthcare providers. Conclusions Meeting the information needs of parents is an important part of psychosocial care in pediatric cancer care. Informational support may empower parents in caregiving for their child. The development of suitable information resources will be invaluable for healthcare providers in supporting parents’ needs.
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Raj M, Iott B. Evaluation of Family Caregivers' Use of Their Adult Care Recipient's Patient Portal From the 2019 Health Information National Trends Survey: Secondary Analysis. JMIR Aging 2021; 4:e29074. [PMID: 34605766 PMCID: PMC8524330 DOI: 10.2196/29074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/14/2021] [Accepted: 06/19/2021] [Indexed: 01/26/2023] Open
Abstract
Background Patient engagement is critical for realizing the value of telehealth modalities such as the patient portal. Family caregiver engagement may also be critical for facilitating the use of the patient portal among adult patients, including older adults. Objective This study aims to analyze the 2019 Health Information National Trends Survey to characterize family caregivers’ use of their care recipient’s patient portal in terms of sociodemographic, health, and caregiving characteristics and caregivers’ use of their own portal. Methods We conducted a secondary analysis of cross-sectional data from the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 3. This survey was administered to 5438 US adults between January and May 2019. We analyzed data from 320 respondents who were identified as family caregivers. We created measures to reflect family caregivers’ use of their care recipient’s and their own portal, caregiver demographic and caregiving characteristics, and care recipient health characteristics. Results Over half of the caregivers (179/320, 55.9%) reported using their own portal at least once, whereas only one-third (105/320, 32.8%) reported using their care recipient’s record in the previous 12 months. Caregivers using their own portal were significantly more likely to use their care recipient’s portal (odds ratio 11.18; P<.001). Conclusions Policies should enable patients to designate family caregivers who can access their patient portal. Providers could screen caregivers for challenges in their caregiving responsibilities that may be addressed through the portal so they can better support their adult relatives. Interventions to support family caregivers, especially older caregivers, in using their own portal may facilitate their use of their care recipient’s portal.
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Affiliation(s)
- Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, IL, United States
| | - Bradley Iott
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States
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12
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Chen Y, Aljafari R, Xiao B, Venkatesh V. Empowering physicians with health information technology: An empirical investigation in Chinese hospitals. J Am Med Inform Assoc 2021; 28:915-922. [PMID: 33712828 DOI: 10.1093/jamia/ocab034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 02/24/2021] [Accepted: 02/19/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Few studies examine physicians' use of different features of health information technology (HIT) in relation to their psychological empowerment and stress, especially in China, where many hospitals are being pushed to share digitized medical information. Further, there are mixed findings about the impact of HIT on stress, with some studies suggesting that HIT increases stress and others suggesting no effect. Hence, there is a need for a nuanced view of HITs to incorporate different features, regions, and outcomes. This work seeks to extend the existing body of knowledge on HIT by assessing the effects of basic (data-related) and advanced (clinical) HIT features on physician empowerment, stress, and ultimately, job satisfaction in Chinese hospitals. MATERIALS AND METHODS We surveyed 367 physicians at 5 class 3 hospitals (ie, regional hospitals that provide specialist medical and healthcare services and carry out high levels of teaching and scientific research tasks) in 5 provinces in China. We specified and estimated a structural equation model using partial least squares. RESULTS Physicians who used advanced features experienced improvement in all dimensions of physician empowerment and significant reduction in stress. Physicians who used basic technology, however, experienced improvement in fewer dimensions of physician empowerment and no significant change in stress. Except for efficacy, all dimensions of physician empowerment and stress predicted job satisfaction. CONCLUSIONS Healthcare professionals should assess the purpose of HIT features and expect different effects on intermediate and ultimate outcomes. The nuanced view of HIT features and processes leading to outcomes sheds light on their differential effects and resolves inconsistencies in prior findings on HIT effects.
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Affiliation(s)
- Yang Chen
- Department of Business Management, School of Business Administration, Southwestern University of Finance and Economics, Chengdu, P.R. China
| | - Ruba Aljafari
- Center for Healthcare Management, Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bo Xiao
- Department of Information Technology Management, Shidler College of Business, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Viswanath Venkatesh
- Department of Business Information Technology, Pamplin College of Business, Virginia Tech, Blacksburg, Virginia, USA
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13
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Beckmann NB, Dietrich MS, Hooke MC, Gilmer MJ, Akard TF. Parental Posttraumatic Growth After Pediatric Hematopoietic Stem Cell Transplant. J Hosp Palliat Nurs 2021; 23:331-338. [PMID: 34185727 DOI: 10.1097/njh.0000000000000759] [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] [Indexed: 11/25/2022]
Abstract
Little is known about the development of posttraumatic growth among parents of children with serious advanced disease. The purpose of this study is to describe parental posttraumatic growth 100 days after pediatric stem cell transplant. This is a cross-sectional, descriptive study of 24 parents, approximately 100 days after their children received stem cell transplant. Participants reported environmental, personal, and disease characteristics and completed measures of distress, coping, rumination, and posttraumatic growth. Evidence of parental posttraumatic growth was described in each of 5 dimensions (relating to others, new possibilities, personal strength, spiritual change, and appreciation of life). Posttraumatic growth was positively associated with parental distress, disengagement coping, and rumination measures (r = 0.44-0.47, P < .05). Appreciation of life demonstrated the strongest associations with distress and rumination (r = 0.53-0.61, P < .01). Curvilinear relationships were observed for the association of distress, disengagement coping, and involuntary engagement with posttraumatic growth (P < .05). Study results highlight opportunities for palliative care nurses and clinicians to facilitate opportunities to support parent posttraumatic growth during treatment for children's advanced disease.
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14
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Liu YM, Jaing TH, Wen YC, Chen SH, Weng PY, Lin L, Wu CL. Health-related quality of life predicts length of hospital stay and survival rates for pediatric patients receiving allogeneic hematopoietic cell transplantation. Qual Life Res 2021; 30:3421-3430. [PMID: 34018123 DOI: 10.1007/s11136-021-02887-1] [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] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE We examined the association between health-related quality of life (HRQoL) of pediatric patients during hospitalization for allogeneic hematopoietic cell transplantation (HCT) and length of hospital stay, and 1-year survival. METHODS Primary family caregivers were proxy-assessors for the Pediatric Quality of Life (PedsQL) Stem Cell Transplant Module at three time points: 5-days pre-HCT (T0); 14-days post-HCT (engraftment, T1); and 1-week before hospital discharge (T2). Cox regression analyses determined predictors of the overall 1-year survival after allogeneic HCT. RESULTS Thirty-nine eligible caregivers completed all assessments. The mean age of the pediatric patients was 9.07 years (SD = 5.2). PedsQL Stem Cell Transplant Module scores decreased from 71.33 (SD = 13.26) at T0 to 55.41(SD = 13.05) at T1 (p < 0.001) and increased to 68.46 (SD = 13.97) at T2 (p < 0.001). There was no significant difference between scores at T0 and T2. Longer length of hospital stay was associated with children who were younger and had greater relative changes in scores on the caregiver-proxy PedsQL Stem Cell Transplant Module from T0 to T1. PedsQL Stem Cell Transplant Module scores ≥ 58.07 at T2 were associated with higher 1-year survival rates (Hazard Ratio = 0.12, 95% Confidence Interval = 0.02-0.78; p = 0.03). CONCLUSION Our findings suggest that assessment of HRQoL during early HCT can add prognostic value beyond demographic and HCT factors. Understanding the HRQoL status during hospitalization for HCT could help identify pediatric patients with low prospects of 1-year survival in order to provide support interventions to improve HRQoL and survival rates.
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Affiliation(s)
- Ying-Mei Liu
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- , No. 261, Wen-Hwa 1st Road, Guishan District, Taoyuan, Taiwan.
| | - Tang-Her Jaing
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Yin Weng
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lin Lin
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Chia-Ling Wu
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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15
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Raj M, Gupta V, Hoodin F, Yahng L, Braun T, Choi SW. Evaluating health technology engagement among family caregivers of patients undergoing hematopoietic cell transplantation. RESEARCH SQUARE 2021. [PMID: 34013246 PMCID: PMC8132239 DOI: 10.21203/rs.3.rs-427058/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose: Digital health technology-based interventions have the potential to support caregivers in their caregiving responsibilities and in managing their own health and well-being. Designing digital health technologies to support caregivers of patients undergoing hematopoietic cell transplantation requires evaluating their engagement with these technologies. The objective of this study was to examine the association between caregiving characteristics and different types of digital health technologies used. Methods: We conducted an online cross-sectional, national survey of 948 unpaid family caregivers of patients undergoing hematopoietic cell transplantation. Results: Almost two-thirds (65.4%) of respondents reported using an app for fitness or step counting, while 41.3% reported using a smartwatch. The average number of apps used was 3.3 (range 0-9). In adjusted models, adult children who were caregivers (OR=5.82, p<0.005) and caregivers of another relative (OR=2.51, p<0.005) were significantly more likely to use a fitness tracker than caregivers of a child. Caregiving for six months or greater was associated with use of fewer apps compared with caregiving for less than six months in adjusted models (OR=0.80, p<0.005). Caregivers of patients receiving an allogeneic transplant used more apps on average than caregivers of patients receiving an autologous transplant, in adjusted (OR=1.36, p<0.005) models. Conclusion: Digital health technologies may reflect promising avenues for supporting caregivers of patients undergoing HCT. The rapid insurgence of telehealth, propelled by the current COVID-19 pandemic, emphasizes the need for a better understanding of digital health technology for future study design.
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Affiliation(s)
| | | | | | | | | | - Sung Won Choi
- University of Michigan Medicine: University of Michigan Michigan Medicine
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16
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Beckmann NB, Dietrich MS, Hooke MC, Gilmer MJ, Akard TF. Parent Caregiving Experiences and Posttraumatic Growth Following Pediatric Hematopoietic Stem Cell Transplant. J Pediatr Oncol Nurs 2021; 38:242-253. [PMID: 33750237 DOI: 10.1177/1043454221992306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Parents of children recovering from hematopoietic stem cell transplant (HSCT) experience significant distress due to unpredictable and potentially life-threatening complications. Distress is heightened by intensive caregiving parents provide the child during the first 100 days after HSCT. Management of distress and adaptation to caregiving responsibilities may be enhanced if parents find benefit in their experiences through posttraumatic growth (PTG), yet little is known about how parents' experiences after HSCT foster PTG. This study aimed to explore how parents experience caregiving and PTG 100 days after children's HSCT. Methods: Thirty-one parents completed semi-structured interviews ∼100 days after children received HSCT. Results: Four major themes emerged from the data to describe parent experiences after HSCT: (1) psychosocial and healthcare contextual factors; (2) cognitive, affective, and social support reactions to HSCT; (3) problem-based, emotion-based, and cognitive coping strategies; and (4) PTG. Discussion: Results increase the understanding of how parents' experiences and caregiving responsibilities contribute to PTG. These findings may guide future research to understand how these experiences influence PTG. Nurses are integral to the parents' experiences. Future work should focus on nursing interventions that enhance positive reinterpretation of parents' experiences after their children's HSCT.
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Affiliation(s)
- Nicole B Beckmann
- School of Nursing, 16194Vanderbilt University, Nashville, USA.,Pediatric Blood & Marrow Transplant, 65830University of Minnesota Masonic Children's Hospital, Minneapolis, USA
| | - Mary S Dietrich
- School of Nursing, 16194Vanderbilt University, Nashville, USA
| | - Mary C Hooke
- School of Nursing, University of Minnesota, Minneapolis, USA
| | - Mary J Gilmer
- School of Nursing, 16194Vanderbilt University, Nashville, USA
| | - Terrah F Akard
- School of Nursing, 16194Vanderbilt University, Nashville, USA
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17
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Gupta V, Raj M, Hoodin F, Yahng L, Braun T, Choi SW. Electronic Health Record Portal Use by Family Caregivers of Patients Undergoing Hematopoietic Cell Transplantation: United States National Survey Study. JMIR Cancer 2021; 7:e26509. [PMID: 33687332 PMCID: PMC8086639 DOI: 10.2196/26509] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 12/27/2022] Open
Abstract
Background As family caregivers of patients undergoing hematopoietic cell transplantation have multifaceted caregiving responsibilities (such as medical, household, financial) of long duration, they also have multiple physical, social, psychological, and informational needs. Objective This study explored the prevalence of electronic health record patient portal use by family caregivers for managing both their own and their hematopoietic cell transplantation care recipient’s health, as well as potential factors associated with portal use. Methods An electronic caregiver health survey, first developed via cognitive interviewing methods of hematopoietic cell transplantation caregivers, was distributed nationally (in the United States) by patient advocacy organizations to family caregivers of hematopoietic cell transplantation patients. It was used to assess self-reported caregiver demographics, caregiving characteristics, depression and anxiety with the Patient Health Questionnaire–4, coping with the Brief COPE, and caregiver portal use to manage care recipient’s and their own health. Results We found that 77% of respondents (720/937) accessed electronic health record patient portals for their care recipients, themselves, or both. Multivariate models indicated use of care recipient electronic health record portals by caregivers was more likely with young, White, married, low-income caregivers caring for a parent, residing with the care recipient, and experiencing more caregiver depression. Caregiver use of their own electronic health record portal was more likely with young, White, high-income caregivers caring for a parent and experiencing chronic medical conditions of their own. Partially due to multicollinearity, anxiety and coping did not contribute independently to this model. Conclusions Findings from the survey could open avenues for future research into caregiver use of technology for informational support or intervention, including wearables and mobile health. International Registered Report Identifier (IRRID) RR2-10.2196/4918
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Affiliation(s)
- Vibhuti Gupta
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, IL, United States
| | - Flora Hoodin
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Lilian Yahng
- Center for Survey Research, Indiana University, Bloomington, IN, United States
| | - Thomas Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
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18
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Handley SC, Bell S, Nembhard IM. A Systematic Review of Surveys for Measuring Patient-centered Care in the Hospital Setting. Med Care 2021; 59:228-237. [PMID: 33229897 PMCID: PMC7878319 DOI: 10.1097/mlr.0000000000001474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient-centered care (PCC) is a core component of quality care and its measurement is fundamental for research and improvement efforts. However, an inventory of surveys for measuring PCC in hospitals, a core care setting, is not available. OBJECTIVE To identify surveys for assessing PCC in hospitals, assess PCC dimensions that they capture, report their psychometric properties, and evaluate applicability to individual and/or dyadic (eg, mother-infant pairs in pregnancy) patients. RESEARCH DESIGN We conducted a systematic review of articles published before January 2019 available on PubMed, Web of Science, and EBSCO Host and references of extracted papers to identify surveys used to measure "patient-centered care" or "family-centered care." Surveys used in hospitals and capturing at least 3 dimensions of PCC, as articulated by the Picker Institute, were included and reviewed in full. Surveys' descriptions, subscales, PCC dimensions, psychometric properties, and applicability to individual and dyadic patients were assessed. RESULTS Thirteen of 614 articles met inclusion criteria. Nine surveys were identified, which were designed to obtain assessments from patients/families (n=5), hospital staff (n=2), and both patients/families and hospital staff (n=2). No survey captured all 8 Picker dimensions of PCC [median=6 (range, 5-7)]. Psychometric properties were reported infrequently. All surveys applied to individual patients, none to dyadic patients. CONCLUSIONS Multiple surveys for measuring PCC in hospitals are available. Opportunities exist to improve survey comprehensiveness regarding dimensions of PCC, reporting of psychometric properties, and development of measures to capture PCC for dyadic patients.
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Affiliation(s)
- Sara C. Handley
- Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Sydney Bell
- The Wharton School, University of Pennsylvania, Philadelphia, PA
| | - Ingrid M. Nembhard
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- The Wharton School, University of Pennsylvania, Philadelphia, PA
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19
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Lazor T, De Souza C, Urquhart R, Serhal E, Gagliardi AR. Few guidelines offer recommendations on how to assess and manage anxiety and distress in children with cancer: a content analysis. Support Care Cancer 2020; 29:2279-2288. [PMID: 33150522 DOI: 10.1007/s00520-020-05845-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To (1) describe and compare, across all eligible guidelines, recommendations that address any aspect of clinical assessment or management of anxiety and distress experienced by children and adolescents undergoing cancer treatment or hematopoietic stem cell transplantation (HSCT), and (2) assess guideline characteristics that influence identified recommendations. METHODS We searched five databases for relevant guidelines and conducted a grey literature search. Guidelines had to refer to children 0-18 years old who were undergoing cancer treatment or HSCT, describe any aspect of clinical assessment or management of symptoms of anxiety and distress, and be publicly accessible and published in English on or after 2000. RESULTS We identified 118 guidelines on pediatric cancer of which 13 mentioned clinical assessment or management of anxiety and distress. Six contained ≥ 1 recommendation addressing assessments of symptoms of which only two recommended specific screening instruments. Ten contained ≥ 1 recommendation addressing interventions for symptoms, of which six described specific interventions such as distraction and medication. Psychologists and nurses were the most common panel members and three guideline panels included a patient advocate. Only two guidelines received overall quality ratings > 80.0%. CONCLUSION We identified no guidelines that were specific to clinical assessment or management of anxiety and distress among children and adolescents undergoing cancer treatment or HSCT, and thus, clinicians lack evidence-informed guidance on how to manage these specific symptoms. Future research should establish high-quality guidelines that offer recommendations specific to clinical assessment and management of anxiety and distress in pediatric oncology and HSCT.
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Affiliation(s)
- Tanya Lazor
- Department of Social Work, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
| | - Claire De Souza
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, M5S 1A8, Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Eva Serhal
- Centre for Addiction and Mental Health, Toronto, Ontario, M5J 2C9, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, Toronto, Ontario, M5G 2C4, Canada
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20
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Rozwadowski M, Dittakavi M, Mazzoli A, Hassett AL, Braun T, Barton DL, Carlozzi N, Sen S, Tewari M, Hanauer DA, Choi SW. Promoting Health and Well-Being Through Mobile Health Technology (Roadmap 2.0) in Family Caregivers and Patients Undergoing Hematopoietic Stem Cell Transplantation: Protocol for the Development of a Mobile Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e19288. [PMID: 32945777 PMCID: PMC7532463 DOI: 10.2196/19288] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 12/18/2022] Open
Abstract
Background Cancer patients who undergo allogeneic hematopoietic stem cell transplantation are among the most medically fragile patient populations with extreme demands for caregivers. Indeed, with earlier hospital discharges, the demands placed on caregivers continue to intensify. Moreover, an increased number of allogeneic hematopoietic stem cell transplantations are being performed worldwide, and this expensive procedure has significant economic consequences. Thus, the health and well-being of family caregivers have attracted widespread attention. Mobile health technology has been shown to deliver flexible, and time- and cost-sparing interventions to support family caregivers across the care trajectory. Objective This protocol aims to leverage technology to deliver a novel caregiver-facing mobile health intervention named Roadmap 2.0. We will evaluate the effectiveness of Roadmap 2.0 in family caregivers of patients undergoing hematopoietic stem cell transplantation. Methods The Roadmap 2.0 intervention will consist of a mobile randomized trial comparing a positive psychology intervention arm with a control arm in family caregiver-patient dyads. The primary outcome will be caregiver health-related quality of life, as assessed by the PROMIS Global Health scale at day 120 post-transplant. Secondary outcomes will include other PROMIS caregiver- and patient-reported outcomes, including companionship, self-efficacy for managing symptoms, self-efficacy for managing daily activities, positive affect and well-being, sleep disturbance, depression, and anxiety. Semistructured qualitative interviews will be conducted among participants at the completion of the study. We will also measure objective physiological markers (eg, sleep, activity, heart rate) through wearable wrist sensors and health care utilization data through electronic health records. Results We plan to enroll 166 family caregiver-patient dyads for the full data analysis. The study has received Institutional Review Board approval as well as Code Review and Information Assurance approval from our health information technology services. Owing to the COVID-19 pandemic, the study has been briefly put on hold. However, recruitment began in August 2020. We have converted all recruitment, enrollment, and onboarding processes to be conducted remotely through video telehealth. Consent will be obtained electronically through the Roadmap 2.0 app. Conclusions This mobile randomized trial will determine if positive psychology-based activities delivered through mobile health technology can improve caregiver health-related quality of life over a 16-week study period. This study will provide additional data on the effects of wearable wrist sensors on caregiver and patient self-report outcomes. Trial Registration ClinicalTrials.gov NCT04094844; https://www.clinicaltrials.gov/ct2/show/NCT04094844 International Registered Report Identifier (IRRID) PRR1-10.2196/19288
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Affiliation(s)
- Michelle Rozwadowski
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Manasa Dittakavi
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Mazzoli
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Afton L Hassett
- Department of Anesthesia, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Thomas Braun
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Debra L Barton
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Noelle Carlozzi
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Srijan Sen
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Muneesh Tewari
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - David A Hanauer
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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21
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Gilljam BM, Nygren JM, Svedberg P, Arvidsson S. Impact of an Electronic Health Service on Child Participation in Pediatric Oncology Care: Quasiexperimental Study. J Med Internet Res 2020; 22:e17673. [PMID: 32720907 PMCID: PMC7420525 DOI: 10.2196/17673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/16/2023] Open
Abstract
Background For children 6-12 years old, there is a shortage of electronic Health (eHealth) services that promote their participation in health care. Therefore, a digital communication tool, called Sisom, was developed to give children a voice in their health care. Children with long-term diseases want to be more involved in their health care and have the right to receive information, be listened to, express their opinions, and participate in decision making in health care. However, the outcomes of using Sisom in practice at pediatric oncology clinics have not been investigated. Objective The aim of this study was to investigate children’s participation during appointments with pediatricians at pediatric oncology clinics, with or without the use of the eHealth service Sisom. Methods A quasiexperimental design with mixed methods was used. We analyzed 27 filmed appointments with pediatricians for 14 children (8 girls and 6 boys) aged 6-12 years (mean 8.3 years) with a cancer diagnosis. The intervention group consisted of children who used Sisom prior to their appointments with pediatricians at a pediatric oncology clinic, and the control group consisted of children who had appointments with pediatricians at 4 pediatric oncology clinics. Data from observations from the videos were quantitatively and qualitatively analyzed. The quantitative analysis included manual calculations of how many times the pediatricians spoke directly to the children, the proportion of the appointment time that the children were talking, and levels of participation by the children. For the qualitative analysis, we used directed content analysis to analyze the children’s levels of participation guided by a framework based on Shier’s model of participation. Results Pediatricians directed a greater proportion of their discussion toward the child in the intervention group (731 occasions) than in the control group (624 occasions), but the proportion of the appointment time the children talked was almost the same for both the intervention and control groups (mean 17.0 minutes vs 17.6 minutes). The levels of participation corresponded to the first three levels of Shier’s participation model: children were listened to, children were supported to express their views, and children’s views were taken into account. The results showed an increased level of participation by the children in the intervention group. Several codes that were found did not fit into any of the existing categories, and a new category was thus formed: children received information. Conclusions This study shows that the eHealth service Sisom can increase children’s participation during appointments with health care professionals. Further studies employing a randomized control design focusing on the effects of eHealth services on children’s health outcomes, perceived participation, and cost-effectiveness could make a significant contribution to guiding the implementation of eHealth services in pediatric care.
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Affiliation(s)
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Susann Arvidsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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22
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Brookshire-Gay K, LaLonde L, Byrd M, Neenan A, Seyedsalehi S, Hanauer DA, Choi SW, Hoodin F. Health Information Technology Utilization by Adolescent and Young Adult Aged Inpatients Undergoing Hematopoietic Cell Transplantation. J Adolesc Young Adult Oncol 2020; 10:100-104. [PMID: 32716668 DOI: 10.1089/jayao.2020.0079] [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: 11/12/2022] Open
Abstract
This longitudinal study examined feasibility of "Roadmap 1.0," a modular health information application integrated with the electronic medical record, provided to 30 adolescent and young adult (AYA) inpatients 11-24 years of age undergoing hematopoietic stem cell transplantation (HSCT). Feasibility was demonstrated: 70% accessed the application. Utilization was highest the first 2 weeks of hospitalization, with the laboratory results module used most. Users' tension and fatigue were higher than nonusers' at baseline, but not hospital discharge or day 100. Results suggest AYAs utilize health information technology in ways consistent with the HSCT trajectory and Roadmap 1.0 addressed informational and psychological needs.
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Affiliation(s)
| | - Leah LaLonde
- Department of Psychology, Eastern Michigan University Ypsilanti, Ypsilanti, Michigan, USA
| | - Michelle Byrd
- Department of Psychology, Eastern Michigan University Ypsilanti, Ypsilanti, Michigan, USA
| | - Alexandra Neenan
- Department of Psychology, Eastern Michigan University Ypsilanti, Ypsilanti, Michigan, USA
| | - Sajjad Seyedsalehi
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - David A Hanauer
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Sung Won Choi
- Department of Pediatrics, and University of Michigan, Ann Arbor, Michigan, USA
| | - Flora Hoodin
- Department of Psychology, Eastern Michigan University Ypsilanti, Ypsilanti, Michigan, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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23
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Crotty BH, Asan O, Holt J, Tyszka J, Erickson J, Stolley M, Pezzin LE, Nattinger AB. Qualitative Assessment of Unmet Information Management Needs of Informal Cancer Caregivers: Four Themes to Inform Oncology Practice. JCO Clin Cancer Inform 2020; 4:521-528. [PMID: 32530708 DOI: 10.1200/cci.19.00159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Family and friends often provide informal care for patients with cancer, coordinating care and supporting patients at home. Stress, depression, and burnout are increasingly recognized among these informal caregivers. Although past research has described a range of needs, including the need for information, details about unmet informational needs for caregivers have not been fully described. We sought to assess unmet information management needs for informal caregivers in the digital era. METHODS This was a qualitative research study with semistructured interviews and focus groups of nonprofessional caregivers for patients with cancer, facilitated using a discussion guide. Eligible caregivers supported patients in the community who were in treatment (chemotherapy or radiotherapy) or completed treatment within 3 years. Participants were recruited using informational flyers at an academic cancer center and in the local community of metropolitan Milwaukee, Wisconsin. Sessions were transcribed verbatim and analyzed inductively to identify themes. RESULTS Thirteen caregivers participated, the majority between 41 and 60 years of age: seven of 13, 53.8%, were predominantly women; 10 of 13 (76.9%) were educated, 10 of 13 (76.9%) had graduated from college; and of modest means, six of 13 (46.2%) had household incomes < $35,000. Four themes emerged: (1) the information overload paradox, where caregivers felt overloaded by information yet had unmet informational needs; (2) navigating volatility as a caregiver, with changing or unknown expectations; (3) caregivers as information brokers, which placed new burdens on caregivers to seek, share, and protect information; and (4) care for the caregiver, including unmet information needs related to self-care. CONCLUSION This study identified several informational challenges affecting caregivers. Caregivers have dynamic and evolving informational needs, and strategies that support caregivers through just-in-time information availability or dedicated caregiver check-ins may provide relief within the stress of caregiving.
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Affiliation(s)
| | - Onur Asan
- Stevens Institute of Technology, Hoboken, NJ
| | - Jeana Holt
- Medical College of Wisconsin, Milwaukee, WI
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Liu YM, Wen YC, Weng PY, Jaing TH, Chen SH. Exploring the concerns and experiences of parents of children scheduled to receive haematopoietic stem cell transplant. J Adv Nurs 2020; 76:1737-1745. [PMID: 32281120 DOI: 10.1111/jan.14386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022]
Abstract
AIMS To explore the concerns and experiences of parents of children scheduled to receive allogeneic haematopoietic stem cell transplantation. DESIGN A qualitative secondary analysis of interview data from an intervention study. METHODS A total of 28 parents (4 fathers and 24 mothers) were recruited from a children's hospital, which performs approximately one-third of all paediatric haematopoietic stem cell transplantation cases in Taiwan. Data were collected between September 2015-August 2018 by one researcher with face-to-face interviews, which were tape-recorded and transcribed verbatim. The data were analysed using inductive content analysis to extract the main themes. RESULTS Five themes describing parental concerns prior to paediatric haematopoietic stem cell transplantation were identified: the child became their first priority, seeking solutions, an interweaving of hope and uncertainty, grateful for the chance of a cure and the long road to recovery. CONCLUSION Understanding the concerns and experiences of our participants as they navigated the pre-transplantation period could reduce parents' uncertainty and improve the care of their child. IMPACT These experiences provide information that could be used by healthcare professionals to develop support interventions and strategies tailored to the individual needs of each parent, which could prepare parents for their child's haematopoietic stem cell transplantation.
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Affiliation(s)
- Ying-Mei Liu
- Department of Nursing, Chang Gung University of Science and Technology, Linkou, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Yin Weng
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tang-Her Jaing
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shih-Hsiang Chen
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan
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25
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Kelly MM, Thurber AS, Coller RJ, Khan A, Dean SM, Smith W, Hoonakker PLT. Parent Perceptions of Real-time Access to Their Hospitalized Child's Medical Records Using an Inpatient Portal: A Qualitative Study. Hosp Pediatr 2020; 9:273-280. [PMID: 30894398 DOI: 10.1542/hpeds.2018-0166] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Engaging with parents in care improves pediatric care quality and patient safety; however, parents of hospitalized children often lack the information necessary to effectively participate. To enhance engagement, some hospitals now provide parents with real-time online access to information from their child's inpatient medical record during hospitalization. Whether these "inpatient portals" provide benefits for parents of hospitalized children is unknown. Our objectives were to identify why parents used an inpatient portal application on a tablet computer during their child's hospitalization and identify their perspectives of ways to optimize the technology. METHODS Semistructured in-person interviews were conducted with 14 parents who were given a tablet computer with a commercially available inpatient portal application for use throughout their child's hospitalization. The portal included vital signs, diagnoses, medications, laboratory test results, patients' schedule, messaging, education, and provider pictures and/or roles. Interviews were audio recorded and transcribed and continued until reaching thematic saturation. Three researchers used an inductive approach to identify emergent themes regarding why parents used the portal. RESULTS Five themes emerged regarding parent motivations for accessing information within the portal: (1) monitoring progress, (2) feeling empowered and/or relying less on staff, (3) facilitating rounding communication and/or decision-making, (4) ensuring information accuracy and/or providing reassurance, and (5) aiding memory. Parents recommended that the hospital continue to offer the portal and expand it to allow parents to answer admission questions, provide feedback, and access doctors' daily notes. CONCLUSIONS Providing parents with real-time clinical information during their child's hospitalization using an inpatient portal may enhance their ability to engage in caregiving tasks critical to ensuring inpatient care quality and safety.
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Affiliation(s)
- Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; .,Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin
| | - Anne S Thurber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Alisa Khan
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Shannon M Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,University of Wisconsin Health, Madison, Wisconsin
| | - Windy Smith
- University of Wisconsin Health, Madison, Wisconsin
| | - Peter L T Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin
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Shin JY, Choi SW. Online interventions geared toward increasing resilience and reducing distress in family caregivers. Curr Opin Support Palliat Care 2020; 14:60-66. [PMID: 31842019 PMCID: PMC6996606 DOI: 10.1097/spc.0000000000000481] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Family caregivers of patients with cancer often spend a great deal of effort on physically and emotionally demanding work while taking care of patients. However, the majority of caregivers are not properly equipped for their role as caregivers, which may lead to increased distress in both caregivers and patients. Herein, we reviewed the recent literature (last 3 years) examining online interventions that seek to support caregiver resilience and decrease distress. RECENT FINDINGS Our search identified interventions involving three main themes: informational support, positive activities, and social support. These are mostly in the form of web-based tools and mobile apps targeting both usability and quality of life. Social network services are also considered in this review as a new environment for caregivers to connect with other individuals with lived experience in similar circumstances. SUMMARY Existing studies on online interventions to support caregivers is still at a formative development stage and pilot tests of feasibility, rather than a substantive body of randomized controlled trials to assess the impact in different user populations, or to determine specific factors that impact caregiver distress level or resilience. More research is needed to further assess the long-term effects of online interventions on caregiver stress and resilience. Also, the role of different types of social network services and new forms of interaction, such as conversational agents, has not yet been fully investigated in caregiver populations. Future research should strive to seek new modes of providing services that may present novel opportunities to enhance caregiver resilience and reduce distress.
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Affiliation(s)
- Ji Youn Shin
- College of Communication Arts and Sciences, Michigan State University, East Lansing, MI
| | - Sung Won Choi
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI
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27
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Kedroske J, Koblick S, Chaar D, Mazzoli A, O'Brien M, Yahng L, Vue R, Chappell G, Shin JY, Hanauer DA, Choi SW. Development of a National Caregiver Health Survey for Hematopoietic Stem Cell Transplant: Qualitative Study of Cognitive Interviews and Verbal Probing. JMIR Form Res 2020; 4:e17077. [PMID: 32012037 PMCID: PMC7005696 DOI: 10.2196/17077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
Background Roadmap 1.0 is a mobile health app that was previously developed for caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT). Formative research targeted toward its end users (caregivers) can help inform app design and development, allowing additional components to be incorporated into the app, which can then be tested in a future randomized controlled trial. Objective This study aimed to create a methodologically rigorous national survey that would help inform the development of Roadmap 2.0. Methods We conducted a prospective, qualitative research study that took place between November 18, 2018, and February 7, 2019, in a blood and marrow transplant unit within a large academic medical institution in the midwestern part of the United States. Cognitive interviews, including think-aloud and verbal probing techniques, were conducted in 10 adult caregivers (≥18 years) of patients who had undergone HSCT. Results Most participants were female (9/10, 90%), white (9/10, 90%), married (9/10, 90%), employed at least part time (6/10, 60%), caregivers of adult patients (7/10, 70%), and had some college education (9/10, 90%) and an annual household income of $60,000 or higher (6/10, 60%). All but one interview was audio-recorded, with permission. Overall, participants were engaged in the cognitive interview process of the draft survey, which included 7 topics. The interviews highlighted areas wherein survey items could be further refined, such as offering more response choices (eg, “NA”) or clarifying the type of transplant (eg, autologous or allogeneic) or context of transplant care (eg, pre-HSCT, during HSCT, post-HSCT, inpatient, and outpatient). Apart from these findings, the items in demographics, caregiving experiences, technology, positive activities, and mood were generally interpreted as intended. On the basis of the transcript data and field notes by the interviewer, items within self-efficacy (Caregiver Self-Efficacy Scale) and coping (Brief Coping Orientation to Problems Experienced inventory) questionnaires generated more confusion among interviewer and participants, reflecting difficulties in interpreting the meaning of some survey items. Conclusions This study incorporated the four cognitive aspects of survey methodology that describe the question-answering process—(1) comprehension, (2) information retrieval, (3) judgment and decision making, and (4) responding—by using the think-aloud and probing techniques in cognitive interviews. We conclude that this methodologically rigorous process informed revisions and improved our final questionnaire design. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.49188
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Affiliation(s)
- Jacob Kedroske
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Koblick
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
| | - Dima Chaar
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Mazzoli
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
| | - Maureen O'Brien
- Institute for Social Research, Survey Research Operations, University of Michigan, Ann Arbor, MI, United States
| | - Lilian Yahng
- Center for Survey Research, Indiana University, Bloomington, IN, United States
| | - Rebecca Vue
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
| | - Grant Chappell
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
| | - Ji Youn Shin
- College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, United States
| | - David A Hanauer
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, United States
| | - Sung Won Choi
- Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, United States
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Greysen SR, Harrison JD, Rareshide C, Magan Y, Seghal N, Rosenthal J, Jacolbia R, Auerbach AD. A randomized controlled trial to improve engagement of hospitalized patients with their patient portals. J Am Med Inform Assoc 2019; 25:1626-1633. [PMID: 30346543 DOI: 10.1093/jamia/ocy125] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/02/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives To test a patient-centered, tablet-based bedside educational intervention in the hospital and to evaluate the efficacy of this intervention to increase patient engagement with their patient portals during hospitalization and after discharge. Materials and Methods We conducted a randomized controlled trial of adult patients admitted to the hospitalist service in one large, academic medical center. All participants were supplied with a tablet computer for 1 day during their inpatient stay and assistance with portal registration and initial login as needed. Additionally, intervention group patients received a focused bedside education to demonstrate key functions of the portal and explain the importance of these functions to their upcoming transition to post-discharge care. Our primary outcomes were proportion of patients who logged into the portal and completed specific tasks after discharge. Secondary outcomes were observed ability to navigate the portal before discharge and self-reported patient satisfaction with bedside tablet use to access the portal. Results We enrolled 97 participants (50 intervention; 47 control); overall 57% logged into their portals ≥1 time within 7 days of discharge (58% intervention vs. 55% control). Mean number of logins was higher for the intervention group (3.48 vs. 2.94 control), and mean number of specific portal tasks performed was higher in the intervention group; however, no individual comparison reached statistical significance. Observed ability to login and navigate the portal in the hospital was higher for the intervention group (64% vs. 60% control), but only 1 specific portal task was significant (view provider messaging tab: 92% vs. 77% control, P = .04). Time needed to deliver the intervention was brief (<15 min for 80%), and satisfaction with the bedside tablet to access the portal was high in the intervention group (88% satisfied/very satisfied). Conclusion Our intervention was highly feasible and acceptable to patients, and we found a highly consistent, but statistically non-significant, trend towards higher inpatient engagement and post-discharge use of key portal functions among patients in the intervention group.
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Affiliation(s)
- S Ryan Greysen
- Section of Hospital Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James D Harrison
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Charles Rareshide
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Yimdriuska Magan
- School of Medicine, University of California Davis, Davis, CA, USA
| | - Neil Seghal
- School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | | | - Ronald Jacolbia
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
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29
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Chaar D, Shin JY, Mazzoli A, Vue R, Kedroske J, Chappell G, Hanauer DA, Barton D, Hassett AL, Choi SW. A Mobile Health App (Roadmap 2.0) for Patients Undergoing Hematopoietic Stem Cell Transplant: Qualitative Study on Family Caregivers' Perspectives and Design Considerations. JMIR Mhealth Uhealth 2019; 7:e15775. [PMID: 31651402 PMCID: PMC6913725 DOI: 10.2196/15775] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/30/2019] [Accepted: 09/23/2019] [Indexed: 01/26/2023] Open
Abstract
Background Hematopoietic stem cell transplantation (HCT), also referred to as blood and marrow transplantation (BMT), is a high-risk, but potentially curative therapy for a number of cancer and noncancer conditions. BMT Roadmap (Roadmap 1.0) is a mobile health app that was developed as a family caregiver–facing tool to provide informational needs about the health status of patients undergoing inpatient HCT. Objective This study explored the views and perceptions of family caregivers of patients undergoing HCT and their input regarding further technology development and expansion of BMT Roadmap into the outpatient setting (referred to as Roadmap 2.0). Methods Semistructured qualitative interviews were conducted among 24 family caregivers. Questions were developed from existing literature coupled with prior in-depth observations and interviews in hospital-based settings to explore the study objectives. Participants were recruited during routine outpatient clinic appointments of HCT patients, and all interviews were conducted in the participants’ homes, the setting in which Roadmap 2.0 is intended for use. A thematic analysis was performed using a consistent set of codes derived from our prior research. New emerging codes were also included, and the coding structure was refined with iterative cycles of coding and data collection. Results Four major themes emerged through our qualitative analysis: (1) stress related to balancing caregiving duties; (2) learning and adapting to new routines (resilience); (3) balancing one’s own needs with the patient’s needs (insight); and (4) benefits of caregiving. When caregivers were further probed about their views on engagement with positive activity interventions (ie, pleasant activities that promote positive emotions and well-being such as expressing gratitude or engaging in activities that promote positive thoughts, emotions, and behaviors), they preferred a “menu” of positive activities to help support caregiver health and well-being. Conclusions This study involved family caregivers as participants in the development of new components for Roadmap 2.0. Our research provided a further understanding of the many priorities that hematopoietic stem cell transplant family caregivers face while maintaining balance in their lives. Their schedules can often be unpredictable, even more so once the patient is discharged from the hospital. Our findings suggest that expanding Roadmap 2.0 into the outpatient setting may provide critical caregiver support and that HCT caregivers are interested in and willing to engage in positive activities that may enhance well-being and attenuate the stress associated with caregiving. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.4918
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Affiliation(s)
- Dima Chaar
- University of Michigan, School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States
| | - Ji Youn Shin
- Michigan State University, College of Communication Arts and Sciences, Department of Media and Information, East Lansing, MI, United States
| | - Amanda Mazzoli
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Rebecca Vue
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Jacob Kedroske
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Grant Chappell
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - David A Hanauer
- University of Michigan, Medical School, Michigan Institute for Clinical and Health Research, Ann Arbor, MI, United States
| | - Debra Barton
- University of Michigan, School of Nursing, Ann Arbor, MI, United States
| | - Afton L Hassett
- University of Michigan, Medical School, Department of Anesthesiology, Ann Arbor, MI, United States
| | - Sung Won Choi
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
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30
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Runaas L, Hoodin F, Munaco A, Fauer A, Sankaran R, Churay T, Mohammed S, Seyedsalehi S, Chappell G, Carlozzi N, Fetters MD, Kentor R, McDiarmid L, Brookshire K, Warfield C, Byrd M, Kaziunas S, Maher M, Magenau J, An L, Cohn A, Hanauer DA, Choi SW. Novel Health Information Technology Tool Use by Adult Patients Undergoing Allogeneic Hematopoietic Cell Transplantation: Longitudinal Quantitative and Qualitative Patient-Reported Outcomes. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652535 PMCID: PMC6873938 DOI: 10.1200/cci.17.00110] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Health information technology (IT) is an ideal medium to improve the delivery of patient-centered care and increase patient engagement. Health IT interventions should be designed with the end user in mind and be specific to the needs of a given population. Hematopoietic cell transplantation (HCT), commonly referred to as blood and marrow transplantation (BMT), is a prime example of a complex medical procedure where patient-caregiver-provider engagement is central to a safe and successful outcome. We have previously reported on the design and development of an HCT-specific health IT tool, BMT Roadmap. Methods This study highlights longitudinal quantitative and qualitative patient-reported outcomes (PROs) in 20 adult patients undergoing allogeneic HCT. Patients completed PROs at three time points (baseline, day 30 post-HTC, and day 100 post-HCT) and provided weekly qualitative data through semistructured interviews while using BMT Roadmap. Results The mean hospital stay was 23.3 days (range, 17 to 37 days), and patients had access to BMT Roadmap for a mean of 21.3 days (range, 15 to 37 days). The total time spent on BMT Roadmap ranged from 0 to 139 minutes per patient, with a mean of 55 minutes (standard deviation, 47.6 minutes). We found that patients readily engaged with the tool and completed qualitative interviews and quantitative PROs. The Patient Activation Measure, a validated measure of patient engagement, increased for patients from baseline to discharge and day 100. Activation was significantly and negatively correlated with depression and anxiety PROs at discharge, suggesting that this may be an important time point for intervention. Conclusion Given the feasibility and promising results reported in this study, next steps include expanding our current health IT platform and implementing a randomized trial to assess the impact of BMT Roadmap on critical PROs.
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Affiliation(s)
- Lyndsey Runaas
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Flora Hoodin
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Anna Munaco
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Alex Fauer
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Roshun Sankaran
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Tracey Churay
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Saara Mohammed
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Sajjad Seyedsalehi
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Grant Chappell
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Noelle Carlozzi
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Michael D Fetters
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Rachel Kentor
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Leah McDiarmid
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Kristina Brookshire
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Casiana Warfield
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Michelle Byrd
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Sharon Kaziunas
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Molly Maher
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - John Magenau
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Larry An
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Amy Cohn
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - David A Hanauer
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
| | - Sung Won Choi
- Lyndsey Runaas, Flora Hoodin, Tracey Churay, Saara Mohammed, Sajjad Seyedsalehi, Grant Chappell, Noelle Carlozzi, Michael D. Fetters, Sharon Kaziunas, Molly Maher, John Magenau, Larry An, David A. Hanauer, and Sung Won Choi, Michigan Medicine; Anna Munaco, Alex Fauer, Roshun Sankaran, and Amy Cohn, University of Michigan College of Engineering, Ann Arbor; and Flora Hoodin, Rachel Kentor, Leah McDiarmid, Kristina Brookshire, Casiana Warfield, and Michelle Byrd, Eastern Michigan University, Ypsilanti, MI
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Zhang R, Lu X, Wu W, Shang X. Why do patients follow physicians' advice? The influence of patients' regulatory focus on adherence: an empirical study in China. BMC Health Serv Res 2019; 19:301. [PMID: 31077196 PMCID: PMC6511214 DOI: 10.1186/s12913-019-4127-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 04/25/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In general, medical regimens and treatments are more likely to be effective if patients follow their physicians' advice. However, limited studies have focused on the relationship between regulatory focus and patient adherence. This study explores the antecedents of patient adherence employing regulatory focus theory. METHODS This study established a research model consisting of two independent variables, two mediators, one dependent variable, two moderators, three control variables, and six hypotheses. An online survey involving 336 valid responses was conducted to collect data in China. We used structural equation modelling and confirmatory factor analysis to test the hypotheses and to develop the research model. RESULTS The reliability and validity of the measures were accepted. In terms of control variables, age had a positive effect on conservative treatment-related health information seeking behaviour, and patients with different resident statuses held different attitudes towards seeking conservative treatment-related health information. However, educational level did not have any effect on the variables of the research model. The hypothesis testing results corroborate that promotion focus had a positive impact on patients' emerging treatment-related health information seeking behaviour; prevention focus had a positive impact on patients' conservative treatment-related health information seeking behaviour, which had a positive impact on patient adherence. In addition, media campaigns had a positive impact on the relationship between promotion focus and emerging treatment-related health information seeking behaviour, and website reputation had a positive impact on the relationship between prevention focus and conservative treatment-related health information seeking behaviour. CONCLUSIONS Individuals can be encouraged to seek health information and share health-related knowledge through mass media, such as the Internet, when the quality of information, especially information from online sources, is guaranteed. In addition, physicians need to improve their professionalism and expand their knowledge of conservative healthcare. As a further application of our work, an Internet information recommendation system can be designed to recommend different types of health information for users according to their regulatory focus.
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Affiliation(s)
- Runtong Zhang
- School of Economics and Management, Beijing Jiaotong University, Shangyuancun 3, Haidian District, Beijing, 100044 China
| | - Xinyi Lu
- School of Economics and Management, Beijing Jiaotong University, Shangyuancun 3, Haidian District, Beijing, 100044 China
| | - Wen Wu
- School of Economics and Management, Beijing Jiaotong University, Shangyuancun 3, Haidian District, Beijing, 100044 China
| | - Xiaopu Shang
- School of Economics and Management, Beijing Jiaotong University, Shangyuancun 3, Haidian District, Beijing, 100044 China
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Asan O, Scanlon MC, Crotty B, Holden RJ, Flynn KE. Parental Perceptions of Displayed Patient Data in a PICU: An Example of Unintentional Empowerment. Pediatr Crit Care Med 2019; 20:435-441. [PMID: 31058783 PMCID: PMC6716150 DOI: 10.1097/pcc.0000000000001895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To explore the perceptions of parents of pediatric patients in a PICU regarding real-time open electronic health record data displayed in patient rooms. DESIGN Cross-sectional qualitative interview study. SETTING PICU in a large Midwestern tertiary-care children's hospital. SUBJECTS Parents of patients in a PICU (n = 33). MEASUREMENTS AND MAIN RESULTS Qualitative data were collected through in-person semi-structured, individual, and small-group interviews. Data were collected from March 2016 to July 2016, with approval from the study hospital's institutional review board. Data were analyzed using inductive thematic analysis. Results included positive effects of accessing real-time open electronic health record data on family empowerment, situation awareness, potential error detection, understanding of medical data, and facilitating discussions during rounds. Concerns were reported regarding privacy of information as well as potential misinterpretation of displayed data. We identified several ways to improve this collaborative technology to make it more family-centered. CONCLUSIONS This study suggests that a new health information technology system providing continuous access to open electronic health record data may be an effective way to empower and engage parents in the PICU, but potential drawbacks were also noted. The results also provide insights into the collaborative use of health information technology in the PICU setting.
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Affiliation(s)
- Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ,USA
| | - Matthew C. Scanlon
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bradley Crotty
- Center for Advancing Population Science, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI,USA
| | - Richard J. Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathryn E. Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Caregiver availability and patient access to hematopoietic cell transplantation: social worker perspectives inform practice. Support Care Cancer 2019; 27:4253-4264. [DOI: 10.1007/s00520-019-04696-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/08/2019] [Indexed: 01/09/2023]
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Tai-Seale M, Downing NL, Jones VG, Milani RV, Zhao B, Clay B, Sharp CD, Chan AS, Longhurst CA. Technology-Enabled Consumer Engagement: Promising Practices At Four Health Care Delivery Organizations. Health Aff (Millwood) 2019; 38:383-390. [DOI: 10.1377/hlthaff.2018.05027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ming Tai-Seale
- Ming Tai-Seale is a professor in the Department of Family Medicine and Public Health at the University of California San Diego (UCSD) School of Medicine, director of outcomes analysis and scholarship at UC San Diego Health, and director of research at UCSD Health Sciences International, in La Jolla
| | - N. Lance Downing
- N. Lance Downing is a clinical assistant professor of medicine at the Stanford School of Medicine and program director for the Stanford Program in AI-Assisted Care, both in Palo Alto, California
| | - Veena Goel Jones
- Veena Goel Jones is medical director of digital patient experience and a pediatric hospitalist at Sutter Health and an adjunct clinical assistant professor of pediatrics at the Stanford School of Medicine
| | - Richard V. Milani
- Richard V. Milani is chief clinical transformation officer at Ochsner Health System in New Orleans, Louisiana
| | - Beiqun Zhao
- Beiqun Zhao is a National Library of Medicine/National Institutes of Health biomedical informatics fellow and a general surgery resident at UC San Diego Health
| | - Brian Clay
- Brian Clay is a chief medical information officer at UC San Diego Health and a clinical professor of medicine at the UCSD School of Medicine
| | - Christopher Demuth Sharp
- Christopher Demuth Sharp is chief medical information officer at Stanford Health Care and a clinical associate professor at the Stanford School of Medicine
| | - Albert Solomon Chan
- Albert Solomon Chan is chief of digital patient experience and an investigator at Sutter Health and an adjunct professor at the Stanford Center for Biomedical Informatics Research, Stanford School of Medicine
| | - Christopher A. Longhurst
- Christopher A. Longhurst is chief information officer and associate chief medical officer at UC San Diego Health, and a clinical professor of medicine and pediatrics at the UCSD School of Medicine
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Tang S, Landery D, Covington G, Ward J. The Use of a Video for Discharge Education for Parents After Pediatric Stem Cell Transplantation. J Pediatr Oncol Nurs 2019. [DOI: 10.1177/1043454218818059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Caring for a child at home after hematopoietic stem cell transplant (HSCT) is challenging for parents, and discharge education is critical to ensure parents are prepared. The purpose of this study is to evaluate the feasibility and effectiveness of a discharge video intervention (DVI) as an adjunct to standard discharge teaching (SDT). Method: A two-phase study was conducted at an urban children’s hospital in the western United States. Phase 1 involved SDT alone followed by nurse-administered proficiency testing of parent knowledge in caring for their children at home using a 4-point Likert-type scale of parents of children post-allogeneic HSCT. These results informed the DVI, created in English and Spanish in Phase 2. The DVI content included topics on home cleaning, notifying the medical team, graft-versus-host disease (GVHD), diet and visitor restrictions, and outpatient visits. In Phase 2, the DVI was viewable by parents who also received SDT. Parents’ proficiency was evaluated using the same procedure as in Phase 1. Results: Thirty-four parents participated: 17 in Phase 1 (SDT), 17 in Phase 2 (SDT + DVI). The DVI was viewed by parents in Phase 2 approximately twice prior to discharge. Parents in Phase 2 had higher proficiency scores on home cleaning, signs/symptoms of GVHD, and diet restriction. Parents in Phase 1 had higher proficiency regarding notifying the team. Conclusions: The DVI was feasible and demonstrated incremental increases in parent’s proficiency related to some discharge topics.
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Affiliation(s)
- Shinyi Tang
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Dawn Landery
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Jessica Ward
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
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Supporting caregivers during hematopoietic cell transplantation for children with primary immunodeficiency disorders. J Allergy Clin Immunol 2018; 143:2271-2278. [PMID: 31178019 DOI: 10.1016/j.jaci.2018.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/23/2018] [Accepted: 10/09/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Caregivers of children with primary immunodeficiency disorders (PIDs) experience significant psychological distress during their child's hematopoietic cell transplantation (HCT) process. OBJECTIVES This study aims to understand caregiver challenges and identify areas for health care system-level improvements to enhance caregiver well-being. METHODS In this mixed-methods study caregivers of children with PIDs were contacted in August to November 2017 through online and electronic mailing lists of rare disease consortiums and foundations. Caregivers were invited to participate in an online survey assessing sociodemographic variables, the child's medical characteristics, psychosocial support use, and the World Health Organization-5 Well-Being Index. Open-ended questions about health care system improvements were included. Descriptive statistics and linear multivariate regression analyses were conducted. A modified content analysis method was used to code responses and identify emergent themes. RESULTS Among the 80 caregiver respondents, caregivers had a median age of 34 years (range, 23-62 years) and were predominantly female, white, and married with male children given a diagnosis of severe combined immune deficiency. In the adjusted regression model lower caregiver well-being was significantly associated with lower household income and medical complications. Challenges during HCT include maintaining relationships with partners and the child's healthy sibling or siblings, managing self-care, and coping with feelings of uncertainty. Caregivers suggested several organizational-level solutions to enhance psychosocial support, including respite services, online connections to other PID caregivers, and bedside mental health services. CONCLUSIONS Certain high-risk subpopulations of caregivers might need more targeted psychosocial support to reduce the long-term effect of the HCT experience on their well-being. Caregivers suggested several organizational-level solutions for provision of this support.
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Aljabri D, Dumitrascu A, Burton MC, White L, Khan M, Xirasagar S, Horner R, Naessens J. Patient portal adoption and use by hospitalized cancer patients: a retrospective study of its impact on adverse events, utilization, and patient satisfaction. BMC Med Inform Decis Mak 2018; 18:70. [PMID: 30053809 PMCID: PMC6062873 DOI: 10.1186/s12911-018-0644-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 06/26/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Portal use has been studied among outpatients, but its utility and impact on inpatients is unclear. This study describes portal adoption and use among hospitalized cancer patients and investigates associations with selected safety, utilization, and satisfaction measures. METHODS A retrospective review of 4594 adult hospitalized cancer patients was conducted between 2012 and 2014 at Mayo Clinic in Jacksonville, Florida, comparing portal adopters, who registered for a portal account prior to hospitalization, with nonadopters. Adopters were classified by their portal activity during hospitalization as active or inactive inpatient users. Univariate and several logistic and linear regression models were used for analysis. RESULTS Of total patients, 2352 (51.2%) were portal adopters, and of them, 632 (26.8%) were active inpatient users. Portal adoption was associated with patients who were young, female, married, with higher income, and had more frequent hospitalizations (P < .05). Active inpatient use was associated with patients who were young, married, nonlocals, with higher disease severity, and were hospitalized for medical treatment (P < .05). In univariate analyses, self-management knowledge scores were higher among adopters vs nonadopters (84.3 and 80.0, respectively; P = .01) and among active vs inactive inpatient users (87.0 and 83.3, respectively; P = .04). In regression models adjusted for age and disease severity, the association between portal behaviors and majority of measures were not significant (P > .05). CONCLUSIONS Over half of our cancer inpatients adopted a portal prior to hospitalization, with increased adoption associated with predisposing and enabling determinants (eg: age, sex, marital status, income), and increased inpatient use associated with need (eg: nonlocal residence and disease severity). Additional research and greater effort to expand the portal functionality is needed to impact inpatient outcomes.
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Affiliation(s)
- Duaa Aljabri
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL USA
| | - Adrian Dumitrascu
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL USA
| | - M. Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL USA
| | - Launia White
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL USA
| | - Mahmud Khan
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - Ronnie Horner
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC USA
| | - James Naessens
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
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Lee DJ, Cronin R, Robinson J, Anders S, Unertl K, Kelly K, Hankins H, Skeens R, Jackson GP. Common Consumer Health-Related Needs in the Pediatric Hospital Setting: Lessons from an Engagement Consultation Service. Appl Clin Inform 2018; 9:595-603. [PMID: 30089333 PMCID: PMC6082659 DOI: 10.1055/s-0038-1667205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Informed and engaged parents may influence outcomes for childhood illness. Understanding the needs of the caregivers of pediatric patients is a critical first step in promoting engagement in their child's care. In 2014, we developed an Engagement Consultation Service at the Monroe Carell Jr. Children's Hospital at Vanderbilt. This service determines the health-related needs of the caregivers of hospitalized children and makes educational or technology recommendations to meet those needs and support engagement. OBJECTIVES This report describes the most common health-related needs identified in the caregivers of hospitalized pediatric patients and details the recommended interventions to meet those needs. METHODS The most commonly reported consumer health-related needs from our 3-year experience with the Engagement Consultation Service were extracted from consultations notes. Each need was classified by semantic type using a taxonomy of consumer health needs. Typical recommendations for each need and their administration were detailed. RESULTS The most frequently recognized needs involved communicating with health care providers after discharge, using medical devices, distinguishing between benign and concerning symptoms, knowing what questions to ask providers and remembering them, finding trustworthy sources of information online, understanding disease prognosis, and getting emotional support. A variety of apps, Web sites, printed materials, and online groups were recommended. CONCLUSION The parents of hospitalized patients share several common health-related needs that can be addressed with educational and technology interventions. An inpatient Engagement Consultation Service provides a generalizable framework for identifying health-related needs and delivers tools to meet those needs and promote engagement during and after hospitalizations.
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Affiliation(s)
- Daniel J. Lee
- Department of Urology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
| | - Robert Cronin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
- Department of Internal Medicine, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
| | - Jamie Robinson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
- Department of Surgery, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
| | - Shilo Anders
- Department of Anesthesiology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
| | - Kim Unertl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
| | - Katherine Kelly
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
| | - Heather Hankins
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
| | - Ryan Skeens
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
| | - Gretchen P. Jackson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
- Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
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Robinson JR, Anders SH, Novak LL, Simpson CL, Holroyd LE, Bennett KA, Jackson GP. Consumer health-related needs of pregnant women and their caregivers. JAMIA Open 2018; 1:57-66. [PMID: 30474071 PMCID: PMC6241505 DOI: 10.1093/jamiaopen/ooy018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/02/2018] [Accepted: 06/04/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To build effective applications, technology designers must understand consumer health needs. Pregnancy is a common health condition, and expectant families have unanswered questions. This study examined consumer health-related needs in pregnant women and caregivers and determined the types of needs that were not met. Materials and Methods We enrolled pregnant women <36 weeks’ gestational age and caregivers from advanced maternal–fetal and group prenatal care settings. Participant characteristics were collected through surveys, and health-related needs were elicited in semi-structured interviews. Researchers categorized needs by semantic type and whether they were met (ie, met, partially met, or unmet). Inter-rater reliability was measured by Cohen’s kappa. Results Seventy-one pregnant women and 29 caregivers participated and reported 1054 needs, 28% unmet, and 49% partially met. Need types were 66.2% informational, 15.9% logistical, 8.9% social, 8.6% medical, and 0.3% other. Inter-rater reliability was near perfect (κ=0.95, P < 0.001). Discussion Common topics of unmet needs were prognosis, life management, and need for emotional support. For pregnant women, these unmet needs focused around being healthy, childbirth, infant care, and being a good mother; caregivers’ needs involved caring for the mother, the natural course of pregnancy, and life after pregnancy. Conclusion Pregnant women and caregivers have a rich set of health-related needs with many not fully met. Caregivers’ needs differed from those of pregnant women and may not be adequately addressed by resources designed for mothers. Many unmet needs involved stress and life management. Knowledge about consumer health needs can inform the design of better technologies for pregnancy.
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Affiliation(s)
- Jamie R Robinson
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, CCC-4312 MCN, Nashville, Tennessee 37232-2730, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End, Suite 14107, Nashville, Tennessee 37203, USA
- Corresponding Author: Jamie R. Robinson, MD, MS, Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, CCC-4312 MCN, Nashville, TN 37232-2730, USA ()
| | - Shilo H Anders
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End, Suite 14107, Nashville, Tennessee 37203, USA
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, Tennessee 37232, USA
| | - Laurie L Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End, Suite 14107, Nashville, Tennessee 37203, USA
| | - Christopher L Simpson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End, Suite 14107, Nashville, Tennessee 37203, USA
| | - Lauren E Holroyd
- School of Medicine, Vanderbilt University, 2215 Garland Avenue, Light Hall, Nashville, Tennessee 37203, USA
| | - Kelly A Bennett
- Department of Obstetrics and Gynecology, 1211 Medical Center Drive, Nashville, Tennessee 37232, USA
| | - Gretchen P Jackson
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, CCC-4312 MCN, Nashville, Tennessee 37232-2730, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End, Suite 14107, Nashville, Tennessee 37203, USA
- Department of Pediatrics, 1211 Medical Center Drive, Nashville, Tennessee 37232, USA
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Asan O, Holden RJ, Flynn KE, Murkowski K, Scanlon MC. Providers' assessment of a novel interactive health information technology in a pediatric intensive care unit. JAMIA Open 2018; 1:32-41. [PMID: 31528847 PMCID: PMC6746319 DOI: 10.1093/jamiaopen/ooy020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective To explore perceptions of critical care providers about a novel collaborative inpatient health information technology (HIT) in a pediatric intensive care unit (PICU) setting. Methods This cross-sectional, concurrent mixed methods study was conducted in the PICU of a large midwestern children's hospital. The technology, the Large Customizable Interactive Monitor (LCIM), is a flat panel touch screen monitor that displays validated patient information from the electronic health record. It does not require a password to login and is available in each patient's room for viewing and interactive use by physicians, nurses, and families. Quantitative data were collected via self-administered, standardized surveys, and qualitative data via in-person, semistructured interviews between January and April 2015. Data were analyzed using descriptive statistics and inductive thematic analysis. Results The qualitative analysis showed positive impacts of the LCIM on providers' workflow, team interactions, and interactions with families. Providers reported concerns regarding perceived patient information overload and associated anxiety and burden for families. Sixty percent of providers thought that LCIM was useful for their jobs at different levels, and almost 70% of providers reported that LCIM improved information sharing and communication with families. The average overall satisfaction score was 3.4 on a 0 to 6 scale, between "a moderate amount" and "pretty much." Discussion and Conclusion This study provides new insight into collaborative HIT in the inpatient pediatric setting and demonstrates that using such technology has the potential to improve providers' experiences with families and just-in-time access to EHR information in a format more easily shared with families.
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Affiliation(s)
- Onur Asan
- Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Kathryn E Flynn
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kathy Murkowski
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew C Scanlon
- Department of Pediatrics, Division of Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Kelly MM, Coller RJ, Hoonakker PL. Inpatient Portals for Hospitalized Patients and Caregivers: A Systematic Review. J Hosp Med 2018; 13:405-412. [PMID: 29261819 PMCID: PMC6136247 DOI: 10.12788/jhm.2894] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patient portals, web-based personal health records linked to electronic health records (EHRs), provide patients access to their healthcare information and facilitate communication with providers. Growing evidence supports portal use in ambulatory settings; however, only recently have portals been used with hospitalized patients. Our objective was to review the literature evaluating the design, use, and impact of inpatient portals, which are patient portals designed to give hospitalized patients and caregivers inpatient EHR clinical information for the purpose of engaging them in hospital care. Literature was reviewed from 2006 to 2017 in PubMed, Web of Science, CINALPlus, Cochrane, and Scopus to identify English language studies evaluating patient portals, engagement, and inpatient care. Data were analyzed considering the following 3 themes: inpatient portal design, use and usability, and impact. Of 731 studies, 17 were included, 9 of which were published after 2015. Most studies were qualitative with small samples focusing on inpatient portal design; 1 nonrandomized trial was identified. Studies described hospitalized patients' and caregivers' information needs and design recommendations. Most patient and caregiver participants in included studies were interested in using an inpatient portal, used it when offered, and found it easy to use and/or useful. Evidence supporting the role of inpatient portals in improving patient and caregiver engagement, knowledge, communication, and care quality and safety is limited. Included studies indicated providers had concerns about using inpatient portals; however, the extent to which these concerns have been realized remains unclear. Inpatient portal research is emerging. Further investigation is needed to optimally design inpatient portals to maximize potential benefits for hospitalized patients and caregivers while minimizing unintended consequences for healthcare teams.
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Affiliation(s)
- Michelle M Kelly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
- Center for Quality and Productivity Improvement, University of Wisconsin, Madison, Wisconsin, USA
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Peter Lt Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin, Madison, Wisconsin, USA
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Shin JY, Kang TI, Noll RB, Choi SW. Supporting Caregivers of Patients With Cancer: A Summary of Technology-Mediated Interventions and Future Directions. Am Soc Clin Oncol Educ Book 2018; 38:838-849. [PMID: 30231412 DOI: 10.1200/edbk_201397] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper aims to review literature published on the support of cancer caregivers with health technology. Eighteen articles were reviewed to better understand cancer caregiving and categorized into four different themes: (1) design guidelines, (2) information facilitation, (3) social support, and (4) multicomponent interventions. Analysis of the current articles revealed that there are substantial gaps in knowledge regarding a range of health technologies that facilitate family caregiver support and its distribution to health institutions. Further research is needed in this area, as family caregivers are primary providers of essential elements of care to patients. Future studies should unpack existing barriers that interfere with the development of health technology interventions in cancer care.
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Affiliation(s)
- Ji Youn Shin
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Tammy I Kang
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Robert B Noll
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Sung Won Choi
- From the University of Michigan, Ann Arbor, MI; Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Children's Hospital of Pittsburgh, Pittsburgh, PA
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43
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Grossman LV, Creber RM, Restaino S, Vawdrey DK. Sharing Clinical Notes with Hospitalized Patients via an Acute Care Portal. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2017:800-809. [PMID: 29854146 PMCID: PMC5977594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Though several institutions offer hospitalized patients access to their medical records through acute care patient portals, no studies have assessed the potential impact of patients' access to physicians' notes through these systems. We employed a mixed-methods approach, including patient surveys, system usage log analysis, and qualitative interviews, to describe patients' perspectives on receiving their clinical notes and usage of the clinical notes feature in an acute care patient portal. Patients visited the clinical notes feature more frequently and for longer durations than any other feature. In qualitative interviews, patients reported improved access to information, better insight into their conditions, decreased anxiety, increased appreciation for clinicians, improvements in health behaviors, and more engagement in care. Our results suggest that sharing notes with hospitalized patients is feasible and beneficial, although further studies should investigate the magnitude of benefit and explore the unintended negative consequences associated with increased transparency of clinical information.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, NY
| | | | - Susan Restaino
- Department of Medicine, Columbia University, New York, NY
| | - David K Vawdrey
- Value Institute, NewYork-Presbyterian Hospital, New York, NY
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Grossman LV, Choi SW, Collins S, Dykes PC, O’Leary KJ, Rizer M, Strong P, Yen PY, Vawdrey DK. Implementation of acute care patient portals: recommendations on utility and use from six early adopters. J Am Med Inform Assoc 2018; 25:370-379. [PMID: 29040634 PMCID: PMC7646852 DOI: 10.1093/jamia/ocx074] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/09/2017] [Accepted: 06/16/2017] [Indexed: 02/02/2023] Open
Abstract
Objective To provide recommendations on how to most effectively implement advanced features of acute care patient portals, including: (1) patient-provider communication, (2) care plan information, (3) clinical data viewing, (4) patient education, (5) patient safety, (6) caregiver access, and (7) hospital amenities. Recommendations We summarize the experiences of 6 organizations that have implemented acute care portals, representing a variety of settings and technologies. We discuss the considerations for and challenges of incorporating various features into an acute care patient portal, and extract the lessons learned from each institution's experience. We recommend that stakeholders in acute care patient portals should: (1) consider the benefits and challenges of generic and structured electronic care team messaging; (2) examine strategies to provide rich care plan information, such as daily schedule, problem list, care goals, discharge criteria, and post-hospitalization care plan; (3) offer increasingly comprehensive access to clinical data and medical record information; (4) develop alternative strategies for patient education that go beyond infobuttons; (5) focus on improving patient safety through explicit safety-oriented features; (6) consider strategies to engage patient caregivers through portals while remaining cognizant of potential Health Insurance Portability and Accountability Act (HIPAA) violations; (7) consider offering amenities to patients through acute care portals, such as information about navigating the hospital or electronic food ordering.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Sung W Choi
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Sarah Collins
- Partners Healthcare System, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Patricia C Dykes
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kevin J O’Leary
- Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Milisa Rizer
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | | | - Po-Yin Yen
- The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- Value Institute, NewYork–Presbyterian Hospital, New York, NY, USA
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45
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Jackson GP, Robinson JR, Ingram E, Masterman M, Ivory C, Holloway D, Anders S, Cronin RM. A technology-based patient and family engagement consult service for the pediatric hospital setting. J Am Med Inform Assoc 2018; 25:167-174. [PMID: 29016789 PMCID: PMC6080811 DOI: 10.1093/jamia/ocx067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/24/2017] [Accepted: 06/06/2017] [Indexed: 01/09/2023] Open
Abstract
Objective The Vanderbilt Children's Hospital launched an innovative Technology-Based Patient and Family Engagement Consult Service in 2014. This paper describes our initial experience with this service, characterizes health-related needs of families of hospitalized children, and details the technologies recommended to promote engagement and meet needs. Materials and Methods We retrospectively reviewed consult service documentation for patient characteristics, health-related needs, and consultation team recommendations. Needs were categorized using a consumer health needs taxonomy. Recommendations were classified by technology type. Results Twenty-two consultations were conducted with families of patients ranging in age from newborn to 15 years, most with new diagnoses or chronic illnesses. The consultation team identified 99 health-related needs (4.5 per consultation) and made 166 recommendations (7.5 per consultation, 1.7 per need). Need categories included 38 informational needs, 26 medical needs, 23 logistical needs, and 12 social needs. The most common recommendations were websites (50, 30%) and mobile applications (30, 18%). The most frequent recommendations by need category were websites for informational needs (39, 50%), mobile applications for medical needs (15, 40%), patient portals for logistical needs (12, 44%), and disease-specific support groups for social needs (19, 56%). Discussion Families of hospitalized pediatric patients have a variety of health-related needs, many of which could be addressed by technology recommendations from an engagement consult service. Conclusion This service is the first of its kind, offering a potentially generalizable and scalable approach to assessing health-related needs, meeting them with technologies, and promoting patient and family engagement in the inpatient setting.
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Affiliation(s)
- Gretchen P Jackson
- Department of Pediatric Surgery, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
- Department of Biomedical Informatics, VUMC, Nashville, TN, USA
- Department of Pediatrics, VUMC, Nashville, TN, USA
| | - Jamie R Robinson
- Department of Pediatric Surgery, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
- Department of Biomedical Informatics, VUMC, Nashville, TN, USA
| | - Ebone Ingram
- Department of Psychiatry, VUMC, Nashville, TN, USA
| | - Mary Masterman
- Department of Family Medicine, University of Kansas, Kansas City, KS, USA
| | - Catherine Ivory
- Department of Biomedical Informatics, VUMC, Nashville, TN, USA
- Vanderbilt School of Nursing, Vanderbilt University, Nashville, TN, USA
| | | | - Shilo Anders
- Department of Pediatric Surgery, Vanderbilt University Medical Center (VUMC), Nashville, TN, USA
- Department of Anesthesiology, VUMC, Nashville, TN, USA
| | - Robert M Cronin
- Department of Biomedical Informatics, VUMC, Nashville, TN, USA
- Department of Pediatrics, VUMC, Nashville, TN, USA
- Department of Medicine, VUMC, Nashville, TN, USA
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Clinician Perspectives on an Electronic Portal to Improve Communication with Patients and Families in the Intensive Care Unit. Ann Am Thorac Soc 2018; 13:2197-2206. [PMID: 27700144 DOI: 10.1513/annalsats.201605-351oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Communication in the intensive care unit (ICU) often falls short of patient and family needs, putting them at risk for significant physical and emotional harm. As electronic patient portals rapidly evolve, one designed specifically for the ICU might potentially enhance communication among patients, family members, and clinicians; however, the views of frontline ICU staff on such technology are unknown. OBJECTIVES To identify clinician perspectives on the current state of communication among patients, families, and clinicians in the ICU, and assess their views on whether and how an electronic portal may address existing communication deficits and improve care. METHODS Three focus groups comprised altogether of 26 clinicians from 6 ICUs, representing several disciplines in an academic medical center in Boston, Massachusetts. Transcripts were analyzed inductively for major themes using grounded theory. MEASUREMENTS AND MAIN RESULTS We identified seven themes reflecting clinician perspectives on communication challenges and desired portal functionality: (1) comprehension and literacy; (2) results and updates; (3) patient and family preferences; (4) interclinician communication; (5) family informational needs; (6) the ICU as an unfamiliar environment; and (7) enhancing humanism through technology. Each theme included current gaps in practice, potential benefits and concerns related to an ICU communication portal, and participant recommendations. Benefits included enhanced education, patient/family engagement, and clinician workflow. Challenges included the stress and uncertainty of ICU care, fear of technology replacing human connection, existing interclinician communication failures, and the tension between informing families without overwhelming them. CONCLUSIONS Overall, clinicians were cautiously supportive of an electronic portal to enhance communication in the ICU and made several specific recommendations for design and implementation. As new technologies expand opportunities for greater transparency and participation in care, clinician buy-in and positive impact will depend, in large part, on the extent to which the concerns of stakeholders are addressed. At the same time, clinicians anticipate several potential benefits that could help support provider workflow and engage patients and families through enhanced communication and humanism.
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47
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Dalal AK, Bates DW, Collins S. Opportunities and Challenges for Improving the Patient Experience in the Acute and Postacute Care Setting Using Patient Portals: The Patient's Perspective. J Hosp Med 2017; 12:1012-1016. [PMID: 29073310 DOI: 10.12788/jhm.2860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Efforts to improve the patient experience are increasingly focusing on engaging patients and their "care partners" by using patient portals. The Acute Care Patient Portal Task Force was supported by the Gordon and Betty Moore Foundation to convene a national meeting of an interdisciplinary group of stakeholders, including patient advocates, to consider how the acute and postacute care patient experience can be improved by using patient-facing technologies. We identified key opportunities and challenges for enhancing cognitive support, promoting respect while maintaining boundaries, and facilitating patient and family empowerment through the lens of the patient. Institutions, clinicians, and vendors would benefit tremendously by considering these 3 patient-centered themes when partnering with patients and family advisors to implement and realize the full potential of patient portals to enhance the acute and postacute care experience.
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Affiliation(s)
- Anuj K Dalal
- Brigham and Women's Hospital, Boston, Massachusetts, USA.
- Harvard Medical School, Boston, Massachusetts, USA
| | - David W Bates
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Collins
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Partners Healthcare System, Wellesley, Massachusetts, USA
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48
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Instruments to measure anxiety in children, adolescents, and young adults with cancer: a systematic review. Support Care Cancer 2017; 25:2921-2931. [PMID: 28578534 DOI: 10.1007/s00520-017-3743-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 05/04/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE The primary objective was to describe anxiety measurement instruments used in children and adolescents with cancer or undergoing hematopoietic stem cell transplantation (HSCT) and summarize their content and psychometric properties. METHODS We conducted searches of MEDLINE, Embase, PsycINFO, HAPI, and CINAHL. We included studies that used at least one instrument to measure anxiety quantitatively in children or adolescents with cancer or undergoing HSCT. Two authors independently identified studies and abstracted study demographics and instrument characteristics. RESULTS Twenty-seven instruments, 14 multi-item and 13 single-item, were used between 78 studies. The most commonly used instrument was the State-Trait Anxiety Inventory in 46 studies. Three multi-item instruments (Children's Manifest Anxiety Scale-Mandarin version, PROMIS Pediatric Anxiety Short Form, and the State-Trait Anxiety Inventory) and two single-item instruments (Faces Pain Scale-Revised and 10-cm Visual Analogue Scale, both adapted for anxiety) were found to be reliable and valid in children with cancer. CONCLUSIONS We identified 14 different multi-item and 13 different single-item anxiety measurement instruments that have been used in pediatric cancer or HSCT. Only three multi-item and two single-item instruments were identified as being reliable and valid among pediatric cancer or HSCT patients and would therefore be appropriate to measure anxiety in this population.
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49
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Runaas L, Hanauer D, Maher M, Bischoff E, Fauer A, Hoang T, Munaco A, Sankaran R, Gupta R, Seyedsalehi S, Cohn A, An L, Tewari M, Choi SW. BMT Roadmap: A User-Centered Design Health Information Technology Tool to Promote Patient-Centered Care in Pediatric Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2017; 23:813-819. [PMID: 28132870 DOI: 10.1016/j.bbmt.2017.01.080] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/22/2017] [Indexed: 12/12/2022]
Abstract
Health information technology (HIT) has great potential for increasing patient engagement. Pediatric hematopoietic cell transplantation (HCT) is a setting ripe for using HIT but in which little research exists. "BMT Roadmap" is a web-based application that integrates patient-specific information and includes several domains: laboratory results, medications, clinical trial details, photos of the healthcare team, trajectory of transplant process, and discharge checklist. BMT Roadmap was provided to 10 caregivers of patients undergoing first-time HCT. Research assistants performed weekly qualitative interviews throughout the patient's hospitalization and at discharge and day 100 to assess the impact of BMT Roadmap. Rigorous thematic analysis revealed 5 recurrent themes: emotional impact of the HCT process itself; critical importance of communication among patients, caregivers, and healthcare providers; ways in which BMT Roadmap was helpful during inpatient setting; suggestions for improving BMT Roadmap; and other strategies for organization and management of complex healthcare needs that could be incorporated into BMT Roadmap. Caregivers found the tool useful and easy to use, leading them to want even greater access to information. BMT Roadmap was feasible, with no disruption to inpatient care. Although this initial study is limited by the small sample size and single-institution experience, these initial findings are encouraging and support further investigation.
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Affiliation(s)
- Lyndsey Runaas
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David Hanauer
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; Comprehensive Cancer Center, Bioinformatics Core, University of Michigan, Ann Arbor, Michigan
| | - Molly Maher
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Evan Bischoff
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Alex Fauer
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; Center for Healthcare Engineering and Safety, University of Michigan College of Engineering, Ann Arbor, Michigan
| | - Tiffany Hoang
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anna Munaco
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; Center for Healthcare Engineering and Safety, University of Michigan College of Engineering, Ann Arbor, Michigan
| | - Roshun Sankaran
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; Center for Healthcare Engineering and Safety, University of Michigan College of Engineering, Ann Arbor, Michigan
| | - Rahael Gupta
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sajjad Seyedsalehi
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Amy Cohn
- Center for Healthcare Engineering and Safety, University of Michigan College of Engineering, Ann Arbor, Michigan; Department of Industrial and Operations Engineering, University of Michigan College of Engineering, Ann Arbor, Michigan
| | - Larry An
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Center for Health Communications Research, Ann Arbor, Michigan
| | - Muneesh Tewari
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Biomedical Engineering, University of Michigan College of Engineering, Ann Arbor, Michigan; Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan; Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
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Tang C, Lorenzi N, Harle CA, Zhou X, Chen Y. Interactive systems for patient-centered care to enhance patient engagement. J Am Med Inform Assoc 2016; 23:2-4. [PMID: 26912537 DOI: 10.1093/jamia/ocv198] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlotte Tang
- Department of Computer Science, Engineering and Physics, University of Michigan-Flint, Flint, MI, USA
| | - Nancy Lorenzi
- Department of Biomedical Informatics, School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Christopher A Harle
- Department of Health Policy and Management, Indiana University, Indianapolis, IN, USA
| | - Xiaomu Zhou
- School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - Yunan Chen
- Department of informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA, USA
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