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van der Voorden M, Sipma WS, de Jong MFC, Franx A, Ahaus KCTB. The immaturity of patient engagement in value-based healthcare-A systematic review. Front Public Health 2023; 11:1144027. [PMID: 37250089 PMCID: PMC10213745 DOI: 10.3389/fpubh.2023.1144027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/10/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction In recent years, Value-Based Healthcare (VBHC) has been gaining traction, particularly in hospitals. A core VBHC element is patient value, i.e., what matters most to the patient and at what cost can this be delivered. This interpretation of value implies patient engagement in patient-doctor communication. Although patient engagement in direct care in the VBHC setting is well described, patient engagement at the organizational level of improving care has hardly been studied. This systematic review maps current knowledge regarding the intensity and impact of patient engagement in VBHC initiatives. We focus on the organizational level of a continuous patient engagement model. Methods We performed a systematic review following PRISMA guidelines using five electronic databases. The search strategy yielded 1,546 records, of which 21 studies were eligible for inclusion. Search terms were VBHC and patient engagement, or similar keywords, and we included only empirical studies in hospitals or transmural settings at the organizational level. Results We found that consultation, using either questionnaires or interviews by researchers, is the most common method to involve patients in VBHC. Higher levels of patient engagement, such as advisory roles, co-design, or collaborative teams are rare. We found no examples of the highest level of patient engagement such as patients co-leading care improvement committees. Conclusion This study included 21 articles, the majority of which were observational, resulting in a limited quality of evidence. Our review shows that patient engagement at the organizational level in VBHC initiatives still relies on low engagement tools such as questionnaires and interviews. Higher-level engagement tools such as advisory roles and collaborative teams are rarely used. Higher-level engagement offers opportunities to improve healthcare and care pathways through co-design with the people being served. We urge VBHC initiatives to embrace all levels of patient engagement to ensure that patient values find their way to the heart of these initiatives.
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Affiliation(s)
- Michael van der Voorden
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Wim S. Sipma
- Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | | | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Kees C. T. B. Ahaus
- Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Zamanipoor Najafabadi AH, van der Meer PB, Boele FW, Taphoorn MJB, Klein M, Peerdeman SM, van Furth WR, Dirven L. The long-term caregiver burden in World Health Organization grade I and II meningioma: It is not just the patient. Neurooncol Adv 2021; 3:vdaa169. [PMID: 33543144 PMCID: PMC7850085 DOI: 10.1093/noajnl/vdaa169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Little is known about long-term caregiver burden in meningioma patients. We assessed meningioma caregiver burden, its association with informal caregiver's well-being and possible determinants. Methods In this multicenter cross-sectional study, informal caregivers completed the Caregiver Burden Scale (five domains and total score). Patients completed a disease-specific health-related quality of life (HRQoL) questionnaire focusing on symptoms (EORTC QLQ-BN20) and underwent neurocognitive assessment. Both groups completed a generic HRQoL questionnaire (SF-36) and the Hospital Anxiety, and Depression Scale. We assessed the association between caregiver burden and their HRQoL, anxiety and depression. Furthermore, we assessed determinants for the caregiver burden. Multivariable regression analysis was used to correct for confounders. Results One hundred and twenty-nine informal caregivers were included (median 10 years after patients' treatment). Caregivers reported burden in ≥1 domain (34%) or total burden score (15%). A one-point increase in total caregiver burden score was associated with a clinically relevant decrease in caregiver's HRQoL (SF-36) in 5/8 domains (score range: -10.4 to -14.7) and 2/2 component scores (-3.5 to -5.9), and with more anxiety (3.8) and depression (3.0). Patients' lower HRQoL, increased symptom burden, and increased anxiety and depression were determinants for higher caregiver burden, but not patients' or caregivers' sociodemographic characteristics, patients' neurocognitive functioning, or tumor- and treatment-related characteristics. Conclusions Ten years after initial treatment, up to 35% of informal caregivers reported a clinically relevant burden, which was linked with worse HRQoL, and more anxiety and depression in both patients and caregivers, emphasizing the strong interdependent relationship. Support for meningioma caregivers is therefore warranted.
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Affiliation(s)
- Amir H Zamanipoor Najafabadi
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center and Haaglanden Medical Center & Haga Teaching Hospitals, Leiden and The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Florien W Boele
- Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, UK.,Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin Klein
- Brain Tumor Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Saskia M Peerdeman
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center and Haaglanden Medical Center & Haga Teaching Hospitals, Leiden and The Hague, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Brain Tumor Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Shared decision-making in neurosurgery: a scoping review. Acta Neurochir (Wien) 2021; 163:2371-2382. [PMID: 33942189 PMCID: PMC8357744 DOI: 10.1007/s00701-021-04867-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/26/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In modern neurosurgery, there are often several treatment alternatives, with different risks and benefits. Shared decision-making (SDM) has gained interest during the last decade, although SDM in the neurosurgical field is not widely studied. Therefore, the aim of this scoping review was to present the current landscape of SDM in neurosurgery. METHODS A literature review was carried out in PubMed and Scopus. We used a search strategy based on keywords used in existing literature on SDM in neurosurgery. Full-text, peer-reviewed articles published from 2000 up to the search date February 16, 2021, with patients 18 years and older were included if articles evaluated SDM in neurosurgery from the patient's perspective. RESULTS We identified 22 articles whereof 7 covered vestibular schwannomas, 7 covered spinal surgery, and 4 covered gliomas. The other topics were brain metastases, benign brain lesions, Parkinson's disease and evaluation of neurosurgical care. Different methods were used, with majority using forms, questionnaires, or interviews. Effects of SDM interventions were studied in 6 articles; the remaining articles explored factors influencing patients' decisions or discussed SDM aids. CONCLUSION SDM is a tool to involve patients in the decision-making process and considers patients' preferences and what the patients find important. This scoping review illustrates the relative lack of SDM in the neurosurgical literature. Even though results indicate potential benefit of SDM, the extent of influence on treatment, outcome, and patient's satisfaction is still unknown. Finally, the use of decision aids may be a meaningful contribution to the SDM process.
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Zamanipoor Najafabadi AH, van der Meer PB, Boele FW, Taphoorn MJB, Klein M, Peerdeman SM, van Furth WR, Dirven L. Determinants and predictors for the long-term disease burden of intracranial meningioma patients. J Neurooncol 2020; 151:201-210. [PMID: 33073326 PMCID: PMC7875939 DOI: 10.1007/s11060-020-03650-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/12/2020] [Indexed: 01/04/2023]
Abstract
Introduction Meningioma is a heterogeneous disease and patients may suffer from long-term tumor- and treatment-related sequelae. To help identify patients at risk for these late effects, we first assessed variables associated with impaired long-term health-related quality of life (HRQoL) and impaired neurocognitive function on group level (i.e. determinants). Next, prediction models were developed to predict the risk for long-term neurocognitive or HRQoL impairment on individual patient-level. Methods Secondary data analysis of a cross-sectional multicenter study with intracranial WHO grade I/II meningioma patients, in which HRQoL (Short-Form 36) and neurocognitive functioning (standardized test battery) were assessed. Multivariable regression models were used to assess determinants for these outcomes corrected for confounders, and to build prediction models, evaluated with C-statistics. Results Data from 190 patients were analyzed (median 9 years after intervention). Main determinants for poor HRQoL or impaired neurocognitive function were patients’ sociodemographic characteristics, surgical complications, reoperation, radiotherapy, presence of edema, and a larger tumor diameter on last MRI. Prediction models with a moderate/good ability to discriminate between individual patients with and without impaired HRQoL (C-statistic 0.73, 95% CI 0.65 to 0.81) and neurocognitive function (C-statistic 0.78, 95%CI 0.70 to 0.85) were built. Not all predictors (e.g. tumor location) within these models were also determinants. Conclusions The identified determinants help clinicians to better understand long-term meningioma disease burden. Prediction models can help early identification of individual patients at risk for long-term neurocognitive or HRQoL impairment, facilitating tailored provision of information and allocation of scarce supportive care services to those most likely to benefit. Electronic supplementary material The online version of this article (10.1007/s11060-020-03650-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amir H Zamanipoor Najafabadi
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands. .,Haaglanden Medical Center & Haga Teaching Hospitals, The Hague, The Netherlands. .,Department of Neurology, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands.
| | - Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands
| | - Florien W Boele
- Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, LS9 7TF, UK.,Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin Klein
- Department of Medical Psychology, Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Saskia M Peerdeman
- Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands.,Haaglanden Medical Center & Haga Teaching Hospitals, The Hague, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, Postal Zone J11-R, 2333ZA, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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