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Crafoord MT, Sundberg K, Nilsson MI, Fjell M, Langius-Eklöf A. Patients' Individualized Care Perceptions and Health Literacy Using an Interactive App During Breast and Prostate Cancer Treatment: Two Parallel Randomized Controlled Trials. Comput Inform Nurs 2023; 41:706-716. [PMID: 36749849 DOI: 10.1097/cin.0000000000001007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The use of symptom management mobile apps can reduce patients' symptom burden during cancer treatment, but the evidence is lacking about their effect on care. Moreover, if patients' health literacy can be improved, it needs to be more rigorously tested. This study aimed to evaluate patients' perceptions of individualized care and health literacy using an interactive app in two randomized trials. Patients undergoing neoadjuvant chemotherapy for breast cancer (N = 149) and radiotherapy for prostate cancer (N = 150) were consecutively included and randomized into one intervention or control group. Outcome measures were Individualized Care Scale, Swedish Functional Health Literacy Scale, and Swedish Communicative and Critical Health Literacy Scale. In the breast cancer trial, no group differences were observed regarding individualized care or health literacy. Most patients had sufficient health literacy levels. In the prostate cancer trial, intervention group patients rated higher perceived individualized care regarding decision control at follow-up than the control group. Less than half had sufficient health literacy levels and intervention group patients significantly improved their ability to seek, understand, and communicate health information. Education level explained significant variance in health literacy in both trials. Using an interactive app can positively affect individualization in care and health literacy skills among patients treated for prostate cancer, although further research is warranted.
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Affiliation(s)
- Marie-Therése Crafoord
- Author Affiliations : Department of Neurobiology, Care Sciences and Society, Karolinska Institutet (Ms Crafoord, and Drs Sundberg, Fjell, and Langius-Eklöf); Function Area Social Work in Health Care, Karolinska University Hospital, and Karolinska Institutet, Department of Neurobiology, Care Sciences and Society (Dr Nilsson); and Academic Primary Care Center, Stockholm County Council (Dr Nilsson), Stockholm, Sweden
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Ventura F, Brovall M, Smith F. Beyond effectiveness evaluation: Contributing to the discussion on complexity of digital health interventions with examples from cancer care. Front Public Health 2022; 10:883315. [PMID: 35968430 PMCID: PMC9374100 DOI: 10.3389/fpubh.2022.883315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Digital health interventions (DHIs) have become essential complementary solutions in health care to enhance support and communication at a distance, with evidence of improving patient outcomes. Improving clinical outcomes is a major determinant of success in any health intervention, influencing its funding, development, adoption and implementation in real-world practice. In this article we explore our experiences of developing and testing DHIs to identify and discuss complexity challenges along their intervention research lifecycle. Informed by the case study research approach, we selected three individual DHIs aimed at satisfying the supportive and educational needs of people living with cancer. The Care Expert, the Digi-Do and the Gatapp were underpinned on different complexity frameworks i.e., the Medical Research Council framework and the Non-adoption, Abandonment, Scale-up, Spread and Sustainability framework. This variance on the methodological underpinning was expected to prompt a multifaceted discussion on the complexity dimensions endorsed by each of the frameworks. Our discussion endorses the adoption of mixed-methods research designs, to gather the perspectives of stakeholders and end-users, as well as pragmatic evaluation approaches that value effectiveness outcomes as much as process outcomes. Furthermore, the dissemination and sustainability agenda of DHIs needs to be considered from early-stage development with the inclusion of a business model. This business plan should be worked in partnership with healthcare services, regulatory bodies and industry, aiming to assure the management of the DHI throughout time.
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Affiliation(s)
- Filipa Ventura
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
- *Correspondence: Filipa Ventura
| | - Maria Brovall
- Department of Nursing, School of Health and Welfare, Jönköping Academy, Jönköping University, Jönköping, Sweden
- Department of Oncology, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frida Smith
- Regional Cancer Centre West, Western Sweden Healthcare Region, Gothenburg, Sweden
- Department of Technology Management and Economics, Center for Healthcare Improvement, Chalmers University of Technology, Gothenburg, Sweden
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Meaningful use of a digital platform and structured telephone support to facilitate remote person-centred care - a mixed-method study on patient perspectives. BMC Health Serv Res 2022; 22:442. [PMID: 35379247 PMCID: PMC8981820 DOI: 10.1186/s12913-022-07831-8] [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: 11/19/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Process evaluations are useful in clarifying results obtained from randomised controlled trials (RCTs). Traditionally, the degree of intervention usage in process evaluations is monitored by measuring dose or evaluating implementation fidelity. From a person-centred perspective, such evaluations should be supplemented with patients’ experiences of meaningful use, given that intervention use should be agreed upon between interested parties and tailored to each patient. This study aimed to elucidate patients’ experiences of a remote person-centred care (PCC) intervention by deepening the understanding of, if, how and for whom the intervention contributed to meaningful use. Methods Patients (n = 86) were recruited from the RCT PROTECT intervention group. A convergent mixed-method approach was implemented. Data were collected in parallel with the ongoing RCT via a survey, including ratings and written comments on meaningful or non-meaningful use. Also, interviews were performed with twelve purposefully selected participants. Descriptive statistics, logistic regression and content analysis were employed. Data sources were integrated in the results. Results Most participants rated the overall intervention as meaningful to use, with the telephone support rated as most meaningful. Interviews and written comments showed that patient ratings on meaningful use were explained by four categories: Not in need, Communication deficiency, Benefits in everyday life and A personal boost. Meaningful use of rating symptoms on the digital platform was predicted by living alone (adjusted odds ratio [aOR] = 2.8 P = .044). A diagnosis of chronic obstructive pulmonary disease (COPD) predicted meaningful use of digital platform direct messaging (aOR = 3.5, P = .045). Moreover, having access to direct-dial telephone contact explained meaningful use among participants with low ratings of technical competence (aOR = 3.6, P = .014). Conclusions The combined digital platform and structured telephone support could be helpful in identifying preventive actions to maintain health for people diagnosed with COPD and chronic heart failure but tends to be more meaningful for those diagnosed with COPD. Overall, lower adoption of the digital platform was seen compared to telephone support. Shortcomings were noted in the digital platform’s implementation that negatively influences experiences of meaningful use. When used, the intervention proved to be an easily applicable and valued tool to support preventive actions in a person-centred manner.
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Ventura F, Moreira IMPB, Raposo V, Queirós PJP, Mendes A. A prática centrada na pessoa: da idiossincrasia do cuidar à inovação em saúde. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311xpt278121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A prática centrada na pessoa assume um papel preponderante na organização e gestão de sistemas de saúde, bem como na definição de políticas de saúde. Este ensaio teve como objetivo identificar os princípios éticos e estruturas teóricas da prática centrada na pessoa, assim como as diretrizes portuguesas e europeias que sirvam a sua regulamentação. Foi conduzida uma reflexão teórica ancorada na revisão narrativa crítica do estado da arte sobre a prática centrada na pessoa, que visou responder à questão: quais os elementos estruturantes da prática de cuidados centrados na pessoa que a tornam diferenciadora na obtenção de ganhos em saúde? A reflexão crítica contextualiza a mudança de paradigma para a prática centrada na pessoa e identifica os domínios do estado da arte que lhe estão associados: conhecimento filosófico, referenciais teóricos para a prática clínica, ensino e investigação, abordagens para a implementação, e regulamentação. Esses domínios terão de ser necessariamente contemplados para um desenvolvimento e implementação sistemáticos e sustentáveis com efetiva tradução em ganhos em saúde.
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Affiliation(s)
| | | | | | | | - Aida Mendes
- Escola Superior de Enfermagem de Coimbra, Portugal
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Ventura F, Moreira IMPB, Raposo V, Queirós PJP, Mendes A. Person-centered practice: from idiosyncrasy of care to health innovation. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311xen278121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Person-centered practice plays a significant role in the organization and management of health systems, as well as in the definition of health policies. This essay aimed to identify the ethical principles and theoretical structures of a person-centered practice, as well as the Portuguese and European national guidelines establish its regulation. A theoretical reflection was conducted based on the critical narrative review of the state of the art on person-centered practice, which aimed to answer the question: what are the structuring elements of the person-centered care practice that make it distinguished in obtaining health gains? Critical reflection contextualizes the paradigm shift to a person-centered practice and identifies the state-of-the-art domains associated with it: philosophical knowledge, theoretical frameworks for clinical practice, teaching and research, approaches to implementation, and regulation. These areas will necessarily have to be considered for a systematic and sustainable development and implementation with effective transformation into health gains.
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Affiliation(s)
| | | | | | | | - Aida Mendes
- Escola Superior de Enfermagem de Coimbra, Portugal
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Ali L, Wallström S, Ekman I, Swedberg K, Fors A. Effects of person-centred care via telephone on self-efficacy in patients with chronic obstructive pulmonary disease: Subgroup analysis of a randomized controlled trial. Nurs Open 2021; 8:927-935. [PMID: 33570304 PMCID: PMC7877134 DOI: 10.1002/nop2.701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/04/2020] [Indexed: 01/20/2023] Open
Abstract
AIM To evaluate the effects of PCC in the form of structured telephone support on self-reported cardiac self-efficacy in patients with COPD. METHODS We enrolled 105 patients, aged ≥50 years, admitted to hospital and diagnosed with COPD from January 2015 to November 2016. The patients received usual care or PCC via telephone added to usual care. The Swedish Cardiac Self-Efficacy Scale comprising three dimensions (control symptoms, control illness and maintain functioning) was used as outcome measure. Data was collected at baseline, and at 3- and 6-month follow-ups. RESULTS At both the 3- and 6-month follow-ups, the intervention group improved significantly more than the control group in the control illness dimension (p = .012 and p = .032, respectively). No differences were found in the other two dimensions. CONCLUSIONS PCC in the form of structured telephone support increases patients' confidence in managing their illness and may be a feasible strategy to support patients in their homes.
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Affiliation(s)
- Lilas Ali
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
- Psychiatric DepartmentSahlgrenska University HospitalGothenburgSweden
| | - Sara Wallström
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
| | - Inger Ekman
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
| | - Karl Swedberg
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
- Department of Molecular and Clinical MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Andreas Fors
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
- Research and Development Primary Health CareRegion Västra GötalandGothenburgSweden
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Aapro M, Bossi P, Dasari A, Fallowfield L, Gascón P, Geller M, Jordan K, Kim J, Martin K, Porzig S. Digital health for optimal supportive care in oncology: benefits, limits, and future perspectives. Support Care Cancer 2020; 28:4589-4612. [PMID: 32533435 PMCID: PMC7447627 DOI: 10.1007/s00520-020-05539-1] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Digital health provides solutions that capture patient-reported outcomes (PROs) and allows symptom monitoring and patient management. Digital therapeutics is the provision to patients of evidence-based therapeutic interventions through software applications aimed at prevention, monitoring, management, and treatment of symptoms and diseases or for treatment optimization. The digital health solutions collecting PROs address many unmet needs, including access to care and reassurance, increase in adherence and treatment efficacy, and decrease in hospitalizations. With current developments in oncology including increased availability of oral drugs and reduced availability of healthcare professionals, these solutions offer an innovative approach to optimize healthcare resource utilization. DESIGN This scoping review clarifies the role and impact of the digital health solutions in oncology supportive care, with a view of the current segmentation according to their technical features (connection to sensors, PRO collection, remote monitoring, self-management in real time…), and identifies evidence from clinical studies published about their benefits and limitations and drivers and barriers to adoption. A qualitative summary is presented. RESULTS Sixty-six studies were identified and included in the qualitative synthesis. Studies supported the use of 38 digital health solutions collecting ePROs and allowing remote monitoring, with benefits to patients regarding symptom reporting and management, reduction in symptom distress, decrease in unplanned hospitalizations and related costs and improved quality of life and survival. Among those 38 solutions 21 provided patient self-management with impactful symptom support, improvement of QoL, usefulness and reassurance. Principal challenges are in developing and implementing digital solutions to suit most patients, while ensuring patient compliance and adaptability for use in different healthcare systems and living environments. CONCLUSIONS There is growing evidence that digital health collecting ePROs provide benefits to patients related to clinical and health economic endpoints. These digital solutions can be integrated into routine supportive care in oncology practice to provide improved patient-centered care.
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Affiliation(s)
- M Aapro
- Medical Oncology, Genolier Cancer Center, Clinique de Genolier, Genolier, Switzerland.
- Institut Multidisciplinaire d'Oncologie (IMO), Clinique de Genolier, Case Postale (PO Box) 100, 1 Route de Muids, CH-1272, Genolier, Switzerland.
| | - P Bossi
- Department of Medical Oncology, University of Brescia, Brescia, Italy
| | - A Dasari
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - P Gascón
- Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - M Geller
- Gynecologic Oncology, Department of Obstetrics, Gynecology and Women's Health (OBGYN), University of Minnesota, Minneapolis, MN, USA
| | - K Jordan
- Department of Medicine, Haematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Kim
- Medical Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - K Martin
- Gyneco-oncology, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - S Porzig
- Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Ali L, Fors A, Ekman I. Need of support in people with chronic obstructive pulmonary disease. J Clin Nurs 2018; 27:e1089-e1096. [PMID: 29149463 PMCID: PMC5900916 DOI: 10.1111/jocn.14170] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2017] [Indexed: 12/29/2022]
Abstract
AIM AND OBJECTIVE The aim of this study was to describe peoples' experiences and expectations of support when living with chronic obstructive pulmonary disease. METHOD We conducted and analysed face-to-face or telephone interviews with 17 individuals (aged 44-77 years) diagnosed with chronic obstructive pulmonary disease. The interviewer asked open-ended questions aimed at encouraging further narration, and we analysed the participants' narratives using a phenomenological hermeneutical approach. This report adheres to the COREQ guidelines. RESULTS The overall theme suggests that people with chronic obstructive pulmonary disease describe support as shared knowledge and experiences, based on the following subthemes; similar experiences, the need of genuine professional knowledge, self-reliance versus self-blame, and the Internet - feeling safe but uncertain. CONCLUSIONS People with chronic obstructive pulmonary disease find their strength through shared knowledge and dialogical support with others who have similar experiences and with professionals. A person-centred eHealth approach may be suitable for this group as it offers both collaboration and support. RELEVANCE TO CLINICAL PRACTICE There is a demand for access to genuine professional knowledge as additional support to patients' own capabilities and needs. Patient associations were assessed as reliable sources of information and to some extent also support, but the importance of access to professional sources was also stressed.
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Affiliation(s)
- Lilas Ali
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
| | - Andreas Fors
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
- Närhälsan Research and DevelopmentPrimary Health CareRegion Västra GötalandGothenburgSweden
| | - Inger Ekman
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
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Jeffery AD, Novak LL, Kennedy B, Dietrich MS, Mion LC. Participatory design of probability-based decision support tools for in-hospital nurses. J Am Med Inform Assoc 2018. [PMID: 28637180 DOI: 10.1093/jamia/ocx060] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective To describe nurses' preferences for the design of a probability-based clinical decision support (PB-CDS) tool for in-hospital clinical deterioration. Methods A convenience sample of bedside nurses, charge nurses, and rapid response nurses (n = 20) from adult and pediatric hospitals completed participatory design sessions with researchers in a simulation laboratory to elicit preferred design considerations for a PB-CDS tool. Following theme-based content analysis, we shared findings with user interface designers and created a low-fidelity prototype. Results Three major themes and several considerations for design elements of a PB-CDS tool surfaced from end users. Themes focused on "painting a picture" of the patient condition over time, promoting empowerment, and aligning probability information with what a nurse already believes about the patient. The most notable design element consideration included visualizing a temporal trend of the predicted probability of the outcome along with user-selected overlapping depictions of vital signs, laboratory values, and outcome-related treatments and interventions. Participants expressed that the prototype adequately operationalized requests from the design sessions. Conclusions Participatory design served as a valuable method in taking the first step toward developing PB-CDS tools for nurses. This information about preferred design elements of tools that support, rather than interrupt, nurses' cognitive workflows can benefit future studies in this field as well as nurses' practice.
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Affiliation(s)
- Alvin D Jeffery
- US Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA.,School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Laurie L Novak
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Betsy Kennedy
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Lorraine C Mion
- College of Nursing, The Ohio State University, Columbus, OH, USA
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