1
|
Wolff JL, Wec A, Peereboom D, Gleason KT, Amjad H, Burgdorf JG, Cassidy J, DesRoches CM, Fabius CD, Green AR, Lin CT, Nothelle SK, Powell DS, Riffin CA, Smith J, Lum HD. Care partners and consumer health information technology: A framework to guide systems-level initiatives in support of digital health equity. Learn Health Syst 2024; 8:e10408. [PMID: 38883870 PMCID: PMC11176584 DOI: 10.1002/lrh2.10408] [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: 08/22/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Consumer-oriented health information technologies (CHIT) such as the patient portal have a growing role in care delivery redesign initiatives such as the Learning Health System. Care partners commonly navigate CHIT demands alongside persons with complex health and social needs, but their role is not well specified. Methods We assemble evidence and concepts from the literature describing interpersonal communication, relational coordination theory, and systems-thinking to develop an integrative framework describing the care partner's role in applied CHIT innovations. Our framework describes pathways through which systematic engagement of the care partner affects longitudinal work processes and multi-level outcomes relevant to Learning Health Systems. Results Our framework is grounded in relational coordination, an emerging theory for understanding the dynamics of coordinating work that emphasizes role-based relationships and communication, and the Systems Engineering Initiative for Patient Safety (SEIPS) model. Cross-cutting work systems geared toward explicit and purposeful support of the care partner role through CHIT may advance work processes by promoting frequent, timely, accurate, problem-solving communication, reinforced by shared goals, shared knowledge, and mutual respect between patients, care partners, and care team. We further contend that systematic engagement of the care partner in longitudinal work processes exerts beneficial effects on care delivery experiences and efficiencies at both individual and organizational levels. We discuss the utility of our framework through the lens of an illustrative case study involving patient portal-mediated pre-visit agenda setting. Conclusions Our framework can be used to guide applied embedded CHIT interventions that support the care partner role and bring value to Learning Health Systems through advancing digital health equity, improving user experiences, and driving efficiencies through improved coordination within complex work systems.
Collapse
Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Aleksandra Wec
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Danielle Peereboom
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Kelly T Gleason
- Johns Hopkins University School of Nursing Baltimore Maryland USA
| | - Halima Amjad
- Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Julia G Burgdorf
- Center for Home Care Policy & Research Visiting Nurse Service of New York New York New York USA
| | - Jessica Cassidy
- School of Social Work University of Texas at Arlington Arlington Texas USA
| | | | - Chanee D Fabius
- Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Ariel R Green
- Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - C T Lin
- University of Colorado Aurora Colorado USA
| | - Stephanie K Nothelle
- Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Danielle S Powell
- Department of Hearing & Speech Sciences University of Maryland College Park Maryland USA
| | - Catherine A Riffin
- Division of Geriatrics and Palliative Medicine Weill Cornell Medical Center New York New York USA
| | - Jamie Smith
- Johns Hopkins School of Nursing Baltimore Maryland USA
| | - Hillary D Lum
- Division of Geriatric Medicine University of Colorado School of Medicine Aurora Colorado USA
| |
Collapse
|
2
|
Roter DL, Lowe C, Bugayong M, Dobs AS. Cancer care partners' behavioral intention to use autonomy enhancing communication skills during accompanied visits after online skill training. PATIENT EDUCATION AND COUNSELING 2024; 123:108176. [PMID: 38422948 DOI: 10.1016/j.pec.2024.108176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The study objective is to evaluate an adaptation of the LEAPS skill framework for cancer care partners (CPs) focusing on autonomy enhancing skills and assessed by strong behavioral intention (SBI) to use these skills METHOD: Cancer CPs were recruited through public platforms to view and rate 4 LEAPS cancer-specific narratives and 52 skill demonstration videos, indicate SBI to use demonstrated skills and provide information on skill-related measures. RESULTS Half of CPs expressed SBI to use an average of 6.5 of 13 LEAPS skills which did not vary by LEAPS communication domains or examples used to demonstrate skills. Significant predictors of SBI include positive ratings of program narratives and past use of LEAPS-related behaviors in the communication domain of shared decision making (SDM). CONCLUSION CPs indicated SBIs to use multiple autonomy enhancing skills and positively rated program videos after exposure to the brief LEAPS training program. PRACTICE IMPLICATIONS The brevity of the LEAPS training videos make it possible for users to view an individual cancer-specific narrative and 13 skill demonstrations in roughly 6 min. This ultra-brief training can benefit care partners and the patients they accompany by increasing the likelihood that autonomy enhancing skills are used during accompanied visits.
Collapse
Affiliation(s)
- Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Chenery Lowe
- Center for Biomedical Ethics, Stanford University, Palo Alto, CA, USA
| | - Marielle Bugayong
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adrian S Dobs
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
3
|
Pozzar RA, Tulsky JA, Berry DL, Batista J, Yackel HD, Phan H, Wright AA. Developing a Collaborative Agenda-Setting Intervention (CASI) to promote patient-centered communication in ovarian cancer care: A design thinking approach. PATIENT EDUCATION AND COUNSELING 2024; 120:108099. [PMID: 38086227 DOI: 10.1016/j.pec.2023.108099] [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] [Received: 07/20/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVES Patient-centered communication (PCC) occurs when clinicians respond to patients' needs, preferences, and concerns. While PCC is associated with better health-related quality of life in patients with cancer, patients with ovarian cancer have reported unmet communication needs. We used design thinking to develop an intervention to promote PCC in ovarian cancer care. METHODS Following the steps of design thinking, we empathized with stakeholders by reviewing the literature, then created stakeholder and journey maps to define the design challenge. To ideate solutions, we developed a challenge map. Finally, we developed wireframe prototypes and tested them with stakeholders. RESULTS Empathizing revealed that misaligned visit priorities precipitated suboptimal communication. Defining the design challenge and ideating solutions highlighted the need to normalize preference assessments, promote communication self-efficacy, and enhance visit efficiency. The Collaborative Agenda-Setting Intervention (CASI) elicits patients' needs and preferences and delivers communication guidance at the point of care. Stakeholders approved of the prototype. CONCLUSION Design thinking provided a systematic approach to empathizing with stakeholders, identifying challenges, and innovating solutions. PRACTICE IMPLICATIONS To our knowledge, the CASI is the first intervention to set the visit agenda and support communication from within the electronic health record. Future research will assess its usability and acceptability.
Collapse
Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - James A Tulsky
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Donna L Berry
- University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Jeidy Batista
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | | | - Hang Phan
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | - Alexi A Wright
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| |
Collapse
|
4
|
Wolff JL, Cagle J, Echavarria D, Dy SM, Giovannetti ER, Boyd CM, Hanna V, Hussain N, Reiff JS, Scerpella D, Zhang T, Roth DL. Sharing Health Care Wishes in Primary Care (SHARE) among older adults with possible cognitive impairment in primary care: Study protocol for a randomized controlled trial. Contemp Clin Trials 2023; 129:107208. [PMID: 37116645 PMCID: PMC10258688 DOI: 10.1016/j.cct.2023.107208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Little is known about effective strategies to improve advance care planning (ACP) for persons with cognitive impairment in primary care, the most common setting of care. We describe a randomized controlled trial to test the efficacy of a multicomponent communication intervention, "Sharing Healthcare Wishes in Primary Care" (SHARE). PARTICIPANTS Planned enrollment of 248 dyads of adults 80 years and older with possible cognitive impairment and their care partner, from primary care clinics at 2 Mid-Atlantic health systems. METHODS The treatment protocol encompasses an introductory letter from the clinic; access to a designated facilitator trained in ACP; person-family agenda-setting to align perspectives about the family's role; and print education. The control protocol encompasses minimally enhanced usual care, which includes print education and a blank advance directive. Randomization occurs at the individual dyad-level. Patient and care partner surveys are fielded at baseline, 6-, 12-, and 24- months. Fidelity of interventionist delivery of the protocol is measured through audio-recordings of ACP conversations and post-meeting reports, and by ongoing monitoring and support of interventionists. OUTCOMES The primary outcome is quality of end-of-life care communication at 6 months; secondary outcomes include ACP process measures. An exploratory aim examines end-of-life care quality and bereaved care partner experiences for patients who die by 24 months. CONCLUSIONS Caregiver burden, clinician barriers, and impaired decisional capacity amplify the difficulty and importance of ACP discussions in the context of cognitive impairment: this intervention will comprehensively examine communication processes for this special subpopulation in a key setting of primary care. REGISTRATION ClinicalTrials.gov: NCT04593472.
Collapse
Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - John Cagle
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD, United States of America.
| | - Diane Echavarria
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States of America.
| | - Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States of America.
| | - Erin R Giovannetti
- Health Economics and Aging Research Institute, MedStar Health, 10980 Grantchester Way Columbia, MD 21044, United States of America.
| | - Cynthia M Boyd
- Division of Geriatric Medicine & Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building, Center Tower, Room 317, Baltimore, MD 21224, United States of America.
| | - Valecia Hanna
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States of America.
| | - Naaz Hussain
- Johns Hopkins Community Physicians, 45 TJ Drive, Suite 109, Frederick, MD 21702, United States of America.
| | - Jenni S Reiff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Danny Scerpella
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, United States of America.
| | - Talan Zhang
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, United States of America.
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, United States of America.
| |
Collapse
|
5
|
Gasteiger C, Perera A, Yielder R, Scholz U, Dalbeth N, Petrie KJ. Using family-centered communication to optimize patient-provider-companion encounters about changing to biosimilars: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2023; 106:142-150. [PMID: 36400636 DOI: 10.1016/j.pec.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To explore whether family-centered communication impacts decisions and optimizes patient-companion-provider consultations. METHODS A parallel, two-arm randomized controlled trial was conducted with 108 participants acting as patients with inflammatory arthritis or companions. Pairs attended a mock consultation where a physician explained the change from a bio-originator to a biosimilar using family-centered or patient-only communication. Participants reported their willingness to transition, risk perceptions, understanding and social support, and completed various scales including the Patient Perception Scale. Interviews helped understand perceptions towards the consultation. RESULTS Family-centered communication did not impact willingness to change or cognitive risk perceptions compared to patient-only communication. However, it improved emotional risk perceptions (p = 0.047, Cohen's d=.55) and satisfaction with communication (p = 0.015, Cohen's d=.71). Feeling the explanation was reassuring was associated with less worry (p = 0.004). Receiving emotional support (p = 0.014) and companions asking fewer questions (p = 0.046) were associated with higher recall. The intervention improved companion involvement (p < 0.001, Cohen's d= 1.23) and support (p = 0.002, Cohen's d=.86). Interviews showed that encouraging questions, inclusive body language, and acknowledging companions facilitated involvement. CONCLUSION Family-centered communication augments patient-companion-provider encounters but does not influence willingness to change treatment. PRACTICE IMPLICATIONS Practitioners can use family-centered communication when discussing biosimilars but should provide reassurance, encourage emotional support, and summarize key points to improve understanding.
Collapse
Affiliation(s)
- Chiara Gasteiger
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Anna Perera
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rachael Yielder
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Urte Scholz
- University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland; Department of Psychology - Applied Social and Health Psychology, University of Zurich, Zurich, Switzerland
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
6
|
SHARING Choices: Design and rationale for a pragmatic trial of an advance care planning intervention for older adults with and without dementia in primary care. Contemp Clin Trials 2022; 119:106818. [PMID: 35690262 DOI: 10.1016/j.cct.2022.106818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Advance care planning (ACP) and involving family are particularly important in dementia, and primary care is a key setting. The purpose of this trial is to examine the impact and implementation of SHARING Choices, an intervention to improve communication for older adults with and without dementia through proactively supporting ACP and family engagement in primary care. METHODS We cluster-randomized 55 diverse primary care practices across two health systems to the intervention or usual care. SHARING Choices is a multicomponent intervention that aims to improve communication through patient and family engagement in ACP, agenda setting, and shared access to the patient portal for all patients over 65 years of age. The primary outcomes include documentation of an advance directive or medical orders for life-sustaining treatment in the electronic health record (EHR) at 12 months for all patients and receipt of potentially burdensome care within 6 months of death for the subgroup of patients with serious illness. We plan a priori sub-analysis for patients with dementia. Data sources include the health system EHRs and the Maryland health information exchange. We use a mixed-methods approach to evaluate uptake, fidelity and adaptation of the intervention and implementation facilitators and barriers. CONCLUSIONS This cluster-randomized pragmatic trial examines ACP with a focus on the key population of those with dementia, implementation in diverse settings and innovative approaches to trial design and outcome abstraction. Mixed-methods approaches enable understanding of intervention delivery and facilitators and barriers to implementation in rapidly changing health care systems. CLINICALTRIALS gov Identifier: NCT04819191.
Collapse
|
7
|
Smith KM, Scerpella D, Guo A, Hussain N, Colburn JL, Cotter VT, Aufill J, Dy SM, Wolff JL. Perceived Barriers and Facilitators of Implementing a Multicomponent Intervention to Improve Communication With Older Adults With and Without Dementia (SHARING Choices) in Primary Care: A Qualitative Study. J Prim Care Community Health 2022; 13:21501319221137251. [PMID: 36398937 PMCID: PMC9677296 DOI: 10.1177/21501319221137251] [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: 11/19/2022] Open
Abstract
INTRODUCTION Implementing patient- and family-centered communication strategies has proven challenging in primary care, particularly for persons with dementia. To address this, we designed SHARING Choices, a multicomponent intervention combining patient and family partnered agenda setting, electronic portal access, and supports for advance care planning (ACP). This qualitative descriptive study describes factors affecting SHARING Choices implementation within primary care. METHODS Semi-structured interviews or focus groups with patient/family dyads (family, friends, unpaid caregivers) and primary care stakeholders (clinicians, staff, administrators) elicited perceived barriers and facilitators of SHARING Choices implementation. Field notes and interview transcripts were coded using template analysis along the Consolidated Framework for Implementation Research (CFIR) constructs. Content analysis identified themes not readily categorized within CFIR. RESULTS About 22 dyads, including 14 with cognitive impairment, and 30 stakeholders participated in the study. Participants were receptive to the SHARING Choices components. Enablers of SHARING Choices included adaptability of the intervention, purposive engagement of family (particularly for patients with dementia), consistency with organizational priorities, and the relative advantage of SHARING Choices compared to current practices. Perceived barriers to implementation included intervention complexity, space constraints, workflow, and ACP hesitancy. The ACP facilitator was perceived as supportive in addressing individual and organizational implementation barriers including patient health and technology literacy and clinician time for ACP discussions. CONCLUSIONS Patients, family, and primary care clinicians endorsed the objectives and individual components of SHARING Choices. Strategies to enhance adoption were to simplify materials, streamline processes, leverage existing workflows, and embed ACP facilitators within the primary care team.
Collapse
Affiliation(s)
- Kelly M Smith
- Michael Garron Hospital - Toronto East Health Network, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Danny Scerpella
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Guo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Jennifer Aufill
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sydney M Dy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
8
|
Jenkins HR, Rupert DJ, Etta V, Peinado S, Wolff JL, Lewis MA, Chang P, Cené CW. Examining Information Needs of Heart Failure Patients and Family Companions Using a Previsit Question Prompt List and Audiotaped Data: Findings From a Pilot Study. J Card Fail 2021; 28:896-905. [PMID: 34818567 DOI: 10.1016/j.cardfail.2021.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Question prompt lists (QPLs) are an effective tool for improving communication during medical visits. However, no studies have attempted to correlate intentions related to question asking and actual questions asked during visits. Moreover, few studies have used QPLs with patients with heart failure (HF) or family companions who accompany them to visits. We examined the use of a previsit QPL for patients with HF and their family companions intended to enhance engagement in HF care. The aim of this research was to assess which questions from the QPL patients and companions selected most frequently to ask and compare this item with which questions were actually asked during the medical visit. METHODS AND RESULTS This secondary analysis of QOLs and audiotaped visit data from a pilot study enrolled and consented patients with HF, family companions, and HF clinicians. A single group of 30 patients with HF and 23 family companions received the QPL to complete in the waiting room immediately before their cardiology visit. To meet our aims, we calculated the frequencies for each question selected and asked from the QPL, using data derived from completed prompt lists and audiotaped medical visits. A follow-up survey was administered 2 days after the appointment to assess differences in how participants filled out and used the prompt list. Patients and companions primarily selected and asked questions from the QPL regarding the management and treatment of the disease, general questions about HF, and questions about prognosis. Participants rarely asked questions about support for family and friends or health care team roles and responsibilities. Patients and companions did not ask many of the questions they reported wanting to ask. CONCLUSIONS Prompt lists may empower patients and companions to communicate with their clinician by identifying important questions to help overcome patients' and companions' knowledge gaps. More research is needed to understand the true impact of prompt lists on patient-family-clinician communication and subsequent HF outcomes, and how best to implement them in clinical workflows to increase their potential usefulness.
Collapse
Affiliation(s)
| | - Douglas J Rupert
- RTI International, Center for Communication Science, Research Triangle Park, North Carolina
| | - Valerie Etta
- RTI International, Center for Communication Science, Research Triangle Park, North Carolina
| | - Susana Peinado
- RTI International, Center for Communication Science, Research Triangle Park, North Carolina
| | - Jennifer L Wolff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Megan A Lewis
- RTI International, Center for Communication Science, Research Triangle Park, North Carolina
| | - Patricia Chang
- University of North Carolina, Chapel Hill, North Carolina; Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Crystal W Cené
- University of North Carolina, Chapel Hill, North Carolina; Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| |
Collapse
|
9
|
Riffin C, Wolff JL, Butterworth J, Adelman RD, Pillemer KA. Challenges and approaches to involving family caregivers in primary care. PATIENT EDUCATION AND COUNSELING 2021; 104:1644-1651. [PMID: 33280966 PMCID: PMC8160020 DOI: 10.1016/j.pec.2020.11.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Older adults are commonly accompanied to routine medical visits. This study identifies challenges and explores approaches to managing patient-family interactions in primary care. METHODS Semi-structured interviews were conducted with primary care clinicians and staff (N = 30) as well as older adult patients and family caregivers (N = 40). Interviews were analyzed using content analysis. RESULTS Three major challenges to patient-family interactions were identified: navigating patient autonomy and family motivation to participate; adjudicating patient-family disagreements; and minimizing obtrusive behaviors by caregivers. Three approaches to managing patient-family interactions were identified. Collaborating involved non-judgmental listening, consensus-building, and validation of different perspectives. Dividing involved separating the patient and family member to elicit confidential information from one member of the dyad. Focusing involved re-directing the conversation to either the patient or family member while minimizing input from the other. Approaches varied by patients' cognitive status and overall health condition. In general, patients and caregivers expressed the most positive attitudes toward collaborating and patient-directed focusing approaches. CONCLUSION Primary care clinicians use varied approaches to managing their interactions with patient-family dyads. Patients and caregivers generally prefer those approaches that involve collaborative rather than individual discussions. PRACTICE IMPLICATIONS Findings suggest the potential for the development of communication-focused interventions to promote positive clinician-patient-family interactions.
Collapse
Affiliation(s)
| | - Jennifer L Wolff
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Ronald D Adelman
- Department of Medicine, Weill Cornell Medicine, New York, USA; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Department of Human Development, Cornell University, Ithaca, USA
| | - Karl A Pillemer
- Department of Human Development, Cornell University, Ithaca, USA
| |
Collapse
|
10
|
Gholamzadeh M, Abtahi H, Ghazisaeeidi M. Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion. BMC Health Serv Res 2021; 21:458. [PMID: 33985502 PMCID: PMC8116646 DOI: 10.1186/s12913-021-06456-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
Background One of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process. Objective The main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice. Methods Web of Science, Scopus, IEEE, and PubMed databases were searched using keywords from January 2001 to November 2020. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, qualitative analysis was done to suggest an appropriate framework by mapping the main concepts. Results Out of 385 citations were retrieved in initial database searches, 49 studies from ten countries were included. Applied pre-visit techniques can be classified into eight categories. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to before visits. Accordingly, the main approach of included articles was patient preparedness. While 38 studies reported this approach is effective, three studies reported the effectiveness of such tools as moderate, only two articles believed it had a low effect on improving patient-centered care. Conclusion This survey summarized the characteristics of published studies on pre-visit planning in the proposed framework. This approach could enhance the quality of patient care alongside enhancement patient-provider communication. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06456-7.
Collapse
Affiliation(s)
- Marsa Gholamzadeh
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeeidi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran.
| |
Collapse
|
11
|
Wolff JL, Scerpella D, Cockey K, Hussain N, Funkhouser T, Echavarria D, Aufill J, Guo A, Sloan DH, Dy SM, Smith KM. SHARING Choices: A Pilot Study to Engage Family in Advance Care Planning of Older Adults With and Without Cognitive Impairment in the Primary Care Context. Am J Hosp Palliat Care 2020; 38:1314-1321. [PMID: 33325729 DOI: 10.1177/1049909120978771] [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] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Few advance care planning (ACP) interventions proactively engage family or address the needs of older adults with and without cognitive impairment in the primary care context. OBJECTIVES To pilot a multicomponent intervention involving: an introductory letter describing a new clinic initiative and inviting patients to complete a patient-family pre-visit agenda-setting checklist, share their electronic health information with family, and talk about their wishes for future care with a trained ACP facilitator (SHARING Choices). METHODS SHARING Choices was delivered to 40 patient-family dyads from 3 primary care clinics. Facilitators completed post-ACP reports. Patient and family participants completed baseline and 6-week surveys. RESULTS Patients were on average 75 years (range 65-90). Family were spouses (85.0%) or adult children (15.0%). At 6 weeks, nearly half of dyads participated in ACP conversations (n = 19) or used the agenda-setting checklist (n = 17), one-third (n = 13) registered family to access the patient's portal account, and most (n = 28) provided the primary care team with a new or previously completed advance directive. Of 12 patients who screened positive for cognitive impairment, 9 completed ACP conversations and 10 provided the clinic with an advance directive. ACP engagement, measured on a 4-point scale, was comparatively lower at baseline and 6 weeks among family (3.05 and 3.19) than patients (3.56 and 3.54). Patients remarked that SHARING Choices clarified communication and preferences while family reported a better understanding of their role in ACP and communication. CONCLUSION SHARING Choices was acceptable among older adults with and without cognitive impairment and may increase advance directive completion.
Collapse
Affiliation(s)
- Jennifer L Wolff
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danny Scerpella
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kimberly Cockey
- 121577MedStar Health Institute for Quality and Safety, MedStar Health System, Columbia, MD, USA
| | - Naaz Hussain
- 527470Johns Hopkins Community Physicians, Baltimore, MD, USA
| | - Tara Funkhouser
- 527470Johns Hopkins Community Physicians, Baltimore, MD, USA
| | - Diane Echavarria
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Aufill
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Guo
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danetta H Sloan
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior, and Society, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sydney M Dy
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kelly M Smith
- 121577MedStar Health Institute for Quality and Safety, MedStar Health System, Columbia, MD, USA
| | | |
Collapse
|
12
|
Impact of hearing loss on clinical interactions between older adults and health professionals: a systematic review. Eur Geriatr Med 2020; 11:919-928. [DOI: 10.1007/s41999-020-00358-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
|
13
|
Keast R, Butow PN, Juraskova I, Laidsaar-Powell R. Online resources for family caregivers of cognitively competent patients: A review of user-driven reputable health website content on caregiver communication with health professionals. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30235-4. [PMID: 32739067 DOI: 10.1016/j.pec.2020.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Most patients want their family involved in consultations and decisions, however some family caregivers report feeling overwhelmed and unsure of their role. As caregivers are increasingly looking to medical websites for guidance, this study aimed to review reputable web-resources available to inform family caregivers on how to be involved in medical consultations and decisions. METHODS Google searches were performed using lay search strings, to imitate how a cancer caregiver may locate information. Relevant webpages were included if they were directed at caregivers and from a reputable health organisation. Qualitative content analyses were performed on the included webpages. RESULTS 22 webpages were included and 8 were directed at caregivers of cancer patients. Six key categories of information were identified: preparing for consultations, helping during consultations, advocating for the patient, decision-making, communicating in hospital settings, and communicating with family and friends. CONCLUSION A range of online resources were found to guide family caregivers, particularly cancer caregivers, on involvement in consultations. However, few provided information to caregivers on complex situations such as treatment decision-making, advocating for patient's needs, and communicating in a hospital setting. PRACTICE IMPLICATIONS Clinicians can actively refer family caregivers to online resources that support caregiver communication in medical settings.
Collapse
Affiliation(s)
- Rachael Keast
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia.
| | - Phyllis N Butow
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia; Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, NSW, Australia
| | - Ilona Juraskova
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
14
|
Varghese S, Geller JC, Ohlow MA. Decision regret in implantable cardioverter-defibrillator recipients : A cross-sectional analysis on patients that regret their decision after ICD implantation. Herzschrittmacherther Elektrophysiol 2020; 31:77-83. [PMID: 32078717 DOI: 10.1007/s00399-020-00675-x] [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: 11/19/2019] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are designed to deliver therapy in the event of malignant ventricular arrhythmias. Despite their benefits, some ICD recipients regret their decision on device implantation. OBJECTIVES The aim of this study was to evaluate the incidence, predictors, and consequences of recipients that regretted their decision after implantation. METHODS A questionnaire-based cross-sectional survey of consecutive ICD recipients examined during a routine outpatient follow-up visit was conducted. Their level of depression and anxiety was assessed with the hospital anxiety and depression scale (HADS). Quality of life (QOL) was assessed using the Minnesota living with heart failure questionnaire. RESULTS Of 434 ICD recipients invited to the study, 423 (97.5%) agreed and completed the survey, 349 (83%) had a primary prevention indication, and 339 (80%) ischemic cardiomyopathy. A total of 41 recipients (9.7%) regretted their decision to undergo ICD implantation. These patients were: (1) younger (63 versus 69 years), (2) more frequently in New York Heart Association (NYHA) ≥2 functional class (63% versus 22%), (3) had higher education levels (more than high-school: 76% versus 60%), (4) felt that preoperative information was lacking (22% versus 4%), (5) had more complications in the perioperative period (15% versus 3%), (6) felt less safe after ICD implantation (54% versus 5%), and (7) considered more frequently ICD deactivation during near end-of-life situations (54% versus 29%). Mean QOL and HADS scores were significantly worse in these patients (36 versus 30 and 12 versus 8.8 points, respectively; p < 0.01 for all). CONCLUSION Almost 10% of ICD recipients regretted their decision after implantation. Predictors included younger age, higher education levels, complicated perioperative period, and lack of preoperative information.
Collapse
Affiliation(s)
- Swaroop Varghese
- Division of Cardiology, Ameosklinikum Halberstadt, Halberstadt, Germany
| | - J Christoph Geller
- Division of Invasive and Interventional Electrophysiology, Zentralklinik, Bad Berka, Germany
| | - Marc-Alexander Ohlow
- Division of Cardiology, Zentralklinik, Robert-Koch-Allee 9, 99438, Bad Berka, Germany.
| |
Collapse
|
15
|
Wolff JL, Aufill J, Echavarria D, Heughan JA, Lee KT, Connolly RM, Fetting JH, Jelovac D, Papathakis K, Riley C, Stearns V, Thorner E, Zafman N, Levy HP, Dy SM, Wolff AC. Sharing in care: engaging care partners in the care and communication of breast cancer patients. Breast Cancer Res Treat 2019; 177:127-136. [PMID: 31165374 PMCID: PMC6640103 DOI: 10.1007/s10549-019-05306-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Family is often overlooked in cancer care. We developed a patient-family agenda setting intervention to engage family in cancer care communication. METHODS We conducted a pilot randomized controlled trial (NCT03283553) of patients on active treatment for breast cancer and their family "care partner." Intervention dyads (n = 69) completed a self-administered checklist to clarify care partner roles, establish a shared visit agenda, and facilitate MyChart patient portal access. Control dyads (n = 63) received usual care. We assessed intervention acceptability and initial effects from post-visit surveys and MyChart utilization at 6 weeks. RESULTS At baseline, most patients (89.4%) but few care partners (1.5%) were registered for MyChart. Most patients (79.4%) wanted their care partner to have access to their records and 39.4% of care partners reported accessing MyChart. In completing the checklist, patients and care partners endorsed active communication roles for the care partner and identified a similar visit agenda: most (> 90%) reported the checklist was easy, useful, and recommended it to others. At 6 weeks, intervention (vs control) care partners were more likely to be registered for MyChart (75.4% vs 1.6%; p < 0.001), to have logged in (43.5% vs 0%; p < 0.001) and viewed clinical notes (30.4% vs 0%; p < 0.001), but were no more likely to exchange direct messages with clinicians (1.5% vs 0%; p = 0.175). No differences in patients' MyChart use were observed, but intervention patients more often viewed clinical notes (50.7% vs 9.5%; p < 0.001). CONCLUSIONS A patient-family agenda setting intervention was acceptable and affected online practices of cancer patients and care partners.
Collapse
Affiliation(s)
- Jennifer L Wolff
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692, Baltimore, MD, 21205, USA.
| | - Jennifer Aufill
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692, Baltimore, MD, 21205, USA
| | - Diane Echavarria
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692, Baltimore, MD, 21205, USA
| | - JaAlah-Ai Heughan
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692, Baltimore, MD, 21205, USA
| | - Kimberley T Lee
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Roisin M Connolly
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - John H Fetting
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Danijela Jelovac
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Katie Papathakis
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Carol Riley
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Vered Stearns
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Elissa Thorner
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Nelli Zafman
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA
| | - Howard P Levy
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sydney M Dy
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 692, Baltimore, MD, 21205, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, 201 N. Broadway, Viragh 10-289, Baltimore, MD, 21287, USA.
| |
Collapse
|
16
|
Parikh M, Rajendran I, D'Amico S, Luo M, Gardiner P. Characteristics and Components of Medical Group Visits for Chronic Health Conditions: A Systematic Scoping Review. J Altern Complement Med 2019; 25:683-698. [PMID: 30945935 DOI: 10.1089/acm.2018.0524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objectives: Chronic health conditions are a major challenge to the health care system. Medical Group Visits (MGVs) are a valuable health care delivery model used in a variety of medical settings and patient populations. We conducted a systematic scoping review of MGV research literature for chronic health conditions to summarize the characteristics and individual components of MGVs in the United States of America and Canada. Design: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review methodology and searched five databases using nine widely used MGV-related terms. Subjects: We included studies conducted in the United States and Canada, whose participants were >18 years old and attended an MGV conducted in a medical setting by a billable health care provider. We excluded groups related to diabetes, pregnancy, and cancer. Results: Of 3777 studies identified, we found 55 eligible studies of which 9 are randomized controlled trials and 46 are observational studies. The majority of studies were conducted in academic medical centers, were observational in design, and recruited patients using physician referrals. The three most frequently studied groups include a combination of several chronic conditions (n = 12), chronic pain conditions (n = 10), and cardiovascular disease (n = 9). Curriculum components included didactics (n = 55), experiential activities (n = 27), and socializing components (n = 12). Didactic areas include (1) medical topics such as symptoms management (n = 27) of which 14 included pain management, and (2) lifestyle/educational component (n = 33) that comprised of talks on nutrition (n = 29), exercise (n = 20), stress (n = 16), and sleep (n = 10). The top integrative medicine (IM) modalities (n = 13) included: mindfulness techniques (n = 8), meditation (n = 6), and yoga (n = 5). Substantial heterogeneity was observed in the recruitment, implementation, curriculum components, and outcomes reported. Conclusion: The MGV is a model of patient-centered care that has captured the attention of researchers. IM modalities are well represented in the curriculum components of MGVs. Further investigation into the components identified by this study, may help in better targeting of group interventions to patients and contexts, where it is most likely to be effective.
Collapse
Affiliation(s)
- Manasi Parikh
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Iniya Rajendran
- 2Department of Internal Medicine, Boston Medical Center, Boston, MA
| | - Salvatore D'Amico
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Man Luo
- 1Department of Family Medicine and Boston Medical Center, Boston, MA
| | - Paula Gardiner
- 3Department of Family Medicine and Community Health, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, MA
| |
Collapse
|
17
|
Boyd C, Smith CD, Masoudi FA, Blaum CS, Dodson JA, Green AR, Kelley A, Matlock D, Ouellet J, Rich MW, Schoenborn NL, Tinetti ME. Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity. J Am Geriatr Soc 2019; 67:665-673. [DOI: 10.1111/jgs.15809] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 01/21/2023]
Affiliation(s)
- Cynthia Boyd
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | | | - Frederick A. Masoudi
- Department of Medicine (Cardiology); University of Colorado Anschutz Medical Campus; Aurora Colorado
| | - Caroline S. Blaum
- Department of Medicine; New York University School of Medicine; New York New York
| | - John A. Dodson
- Department of Medicine; New York University School of Medicine; New York New York
| | - Ariel R. Green
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Amy Kelley
- Department of Geriatrics and Palliative Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Daniel Matlock
- Department of Medicine (General Internal Medicine); University of Colorado School of Medicine; Denver Colorado
| | - Jennifer Ouellet
- Department of Internal Medicine; Yale School of Medicine, Yale School of Public Health; New Haven Connecticut
| | - Michael W. Rich
- Department of Internal Medicine; Washington University School of Medicine; St Louis Missouri
| | - Nancy L. Schoenborn
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Mary E. Tinetti
- Department of Internal Medicine; Yale School of Medicine, Yale School of Public Health; New Haven Connecticut
| |
Collapse
|
18
|
Patient-Family Agenda Setting for Primary Care Patients with Cognitive Impairment: the SAME Page Trial. J Gen Intern Med 2018; 33:1478-1486. [PMID: 30022409 PMCID: PMC6108993 DOI: 10.1007/s11606-018-4563-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/16/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Establishing priorities for discussion during time-limited primary care visits is challenging in the care of patients with cognitive impairment. These patients commonly attend primary care visits with a family companion. OBJECTIVE To examine whether a patient-family agenda setting intervention improves primary care visit communication for patients with cognitive impairment DESIGN: Two-group pilot randomized controlled study PARTICIPANTS: Patients aged 65 + with cognitive impairment and family companions (n = 93 dyads) and clinicians (n = 14) from two general and one geriatrics primary care clinic INTERVENTION: A self-administered paper-pencil checklist to clarify the role of the companion and establish a shared visit agenda MEASUREMENTS: Patient-centered communication (primary); verbal activity, information disclosure including discussion of memory, and visit duration (secondary), from audio recordings of visit discussion RESULTS: Dyads were randomized to usual care (n = 44) or intervention (n = 49). Intervention participants endorsed an active communication role for companions to help patients understand what the clinician says or means (90% of dyads), remind patients to ask questions or ask clinicians questions directly (84% of dyads), or listen and take notes (82% of dyads). Intervention dyads identified 4.4 health issues for the agenda on average: patients more often identified memory (59.2 versus 38.8%; p = 0.012) and mood (42.9 versus 24.5%; p = 0.013) whereas companions more often identified safety (36.7 versus 18.4%; p = 0.039) and personality/behavior change (32.7 versus 16.3%; p = 0.011). Communication was significantly more patient-centered in intervention than in control visits at general clinics (p < 0.001) and in pooled analyses (ratio of 0.86 versus 0.68; p = 0.046). At general clinics, intervention (versus control) dyads contributed more lifestyle and psychosocial talk (p < 0.001) and less biomedical talk (p < 0.001) and companions were more verbally active (p < 0.005). No intervention effects were found at the geriatrics clinic. No effect on memory discussions or visit duration was observed. CONCLUSION Patient-family agenda setting may improve primary care visit communication for patients with cognitive impairment. TRIAL REGISTRATION ClinicalTrials.gov : NCT02986958.
Collapse
|
19
|
Helping Older Adults Improve Their Medication Experience (HOME) by Addressing Medication Regimen Complexity in Home Healthcare. Home Healthc Now 2018; 36:10-19. [PMID: 29298192 DOI: 10.1097/nhh.0000000000000632] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In skilled home healthcare (SHHC), communication between nurses and physicians is often inadequate for medication reconciliation and needed changes to the medication regimens are rarely made. Fragmentation of electronic health record (EHR) systems, transitions of care, lack of physician-nurse in-person contact, and poor understanding of medications by patients and their families put patients at risk for serious adverse outcomes. The aim of this study was to develop and test the HOME tool, an informatics tool to improve communication about medication regimens, share the insights of home care nurses with physicians, and highlight to physicians and nurses the complexity of medication schedules. We used human computer interaction design and evaluation principles, automated extraction from standardized forms, and modification of existing EHR fields to highlight key medication-related insights that had arisen during the SHHC visit. Separate versions of the tool were developed for physicians/nurses and patients/caregivers. A pilot of the tool was conducted using 20 SHHC encounters. Home care nurses and physicians found the tool useful for communication. Home care nurses were able to implement the HOME tool into their clinical workflow and reported improved communication with physicians about medications. This simple and largely automated tool improves understanding and communication around medications in SHHC.
Collapse
|
20
|
Sentell TL, Shen C, Landsittel D, Mays MH, Southerland J, King MH, Taira DA. Racial/Ethnic Differences in Those Accompanying Medicare Patients to the Doctor: Insights from the 2013 Medicare Current Beneficiary's Survey. J Immigr Minor Health 2018; 20:776-783. [PMID: 28405871 PMCID: PMC5656534 DOI: 10.1007/s10903-017-0582-8] [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] [Indexed: 10/19/2022]
Abstract
Surprisingly little current, population-level detail exists regarding companion accompaniment for health care among Medicare beneficiaries, particularly by race/ethnicity. For respondents in the 2013 Medicare Current Beneficiary's Survey Access to Care public use data (N = 12,253), multivariable models predicted accompaniment to the doctor by race/ethnicity, adjusting for confounders. Chi square analyses compared, by race/ethnicity, who was accompanying and why. Overall, 37.5% of beneficiaries had accompaniment. In multivariable analyses, non-Hispanic blacks (OR 1.18; 95% CI 1.03-1.36) and Hispanics (OR 1.47; 95% CI 1.25-1.74) were significantly more likely than non-Hispanic whites to have accompaniment. Over 35% of all three groups had someone to "take notes," "ask questions," and/or "explain things," which did not vary by race/ethnicity; significant differences were seen for "explain instructions," "translate," and "moral support." Hispanics had the highest percentages for all three. Many Medicare beneficiaries have accompaniment to doctors' appointments, particularly in minority racial/ethnic groups, which should be considered in policy and practice.
Collapse
Affiliation(s)
- Tetine Lynn Sentell
- Office of Public Health Studies, University of Hawai'i at Manoa, 1960 East-West Road, Biomed D104-G, Honolulu, HI, 96821, USA.
| | - Chengli Shen
- Section on Biomarkers and Prediction Modeling, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Doug Landsittel
- Section on Biomarkers and Prediction Modeling, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Helen Mays
- Puerto Rico Clinical and Translational Research Consortium, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | | | | | - Deborah A Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI, USA
| |
Collapse
|
21
|
Roter DL, Narayanan S, Smith K, Bullman R, Rausch P, Wolff JL, Alexander GC. Family caregivers' facilitation of daily adult prescription medication use. PATIENT EDUCATION AND COUNSELING 2018; 101:908-916. [PMID: 29352620 DOI: 10.1016/j.pec.2017.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To describe ways family members assist adult patients with prescription medications at home, during medical visits and at the pharmacy. METHODS Online survey of 400 adults (caregivers) who help another adult (care recipient) with prescription medication use. Regression modeled the contribution of caregiver communication during recipients' medical visits, evaluation of physicians' medication communication and discussions with the dispensing pharmacist on caregivers' assistance with home medication management. RESULTS Female (68%) family members (94%) assisted care recipients with multimorbidity (mean 2.9 conditions) and polypharmacy (mean 3.2 prescriptions). On average, caregivers performed 3 visit communication behaviors (e.g., notetaking) and implemented 2.6 home medication management strategies (e.g., filling/monitoring pill boxes). Communication-related variables explained 17% of home medication management assistance; including caregivers' visit communication (std. beta 0.31), physicians' medication communication (std. beta 0.15) and pharmacist discussions (std. beta 0.10). The final model included recipients' multimorbidity and caregiver education (std. betas 0.21 and 0.13) explaining 22% of caregiver assistance with home medication management. CONCLUSION Caregivers' assistance with safe and effective home medication use crosses care contexts and is facilitated by clinician and pharmacist communication. PRACTICE IMPLICATIONS Support for caregiver engagement in healthcare conversations can contribute to patient adherence and family-centered, high quality care.
Collapse
Affiliation(s)
- Debra L Roter
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Katherine Smith
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ray Bullman
- National Council on Patient Information and Education, Washington, DC, USA
| | - Paula Rausch
- US Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, USA
| | - Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | |
Collapse
|
22
|
Vick JB, Amjad H, Smith KC, Boyd CM, Gitlin LN, Roth DL, Roter DL, Wolff JL. "Let him speak:" a descriptive qualitative study of the roles and behaviors of family companions in primary care visits among older adults with cognitive impairment. Int J Geriatr Psychiatry 2018; 33:e103-e112. [PMID: 28585721 PMCID: PMC5862540 DOI: 10.1002/gps.4732] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/04/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Cognitive impairment poses communication challenges in primary care. Although family "companions" commonly attend primary care visits of older adults with cognitive impairment, little is known about how their involvement affects communication. Therefore, we sought to understand how companion involvement affects the quality of primary care visit communication for older adults with cognitive impairment. METHODS Cross-sectional, descriptive qualitative study participants were as follows: (1) English-speaking adults age 65 or older with mild, moderate, or severe cognitive impairment; (2) family members or other unpaid companions who accompany older adults to primary care visits; and (3) primary care clinicians. Twenty semi-structured and in-depth qualitative interviews of older adults and their companions (N = 20 dyads) and two focus groups (N = 10 primary care clinicians) were conducted. Interviews and focus groups were transcribed and analyzed thematically. RESULTS Family companions commonly facilitate communication by advocating for patients, ensuring the accuracy of information exchange and understanding, and preserving rapport. Significant communication challenges were also identified, including patient and companion role ambiguity, competing visit agendas, and primary care clinician confusion regarding the most accurate source of information. Patients, companions, and clinicians each identified strategies to improve communication, chief among them being to identify, differentiate, and respect both patient and companion priorities and perspectives. CONCLUSIONS Family companions actively participate in primary care visits of older adults with cognitive impairment in ways that promote and inhibit effective communication. Findings suggest the need for strategies that more effectively and purposefully involve family in the care of primary care patients with cognitive impairment. Copyright © 2017 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
| | | | | | - Cynthia M. Boyd
- Johns Hopkins University School of Medicine
- Johns Hopkins Bloomberg School of Public Health
| | - Laura N. Gitlin
- Johns Hopkins University School of Medicine
- Johns Hopkins University School of Nursing, Center for Innovative Care in Aging
| | - David L. Roth
- Johns Hopkins University School of Medicine
- Johns Hopkins Bloomberg School of Public Health
| | | | - Jennifer L. Wolff
- Johns Hopkins University School of Medicine
- Johns Hopkins Bloomberg School of Public Health
| |
Collapse
|
23
|
Guan Y, Roter DL, Erby LH, Wolff JL, Gitlin LN, Roberts JS, Green RC, Christensen KD. Communication Predictors of Patient and Companion Satisfaction with Alzheimer's Genetic Risk Disclosure. JOURNAL OF HEALTH COMMUNICATION 2018; 23:807-814. [PMID: 30325721 PMCID: PMC6452435 DOI: 10.1080/10810730.2018.1528319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The objective of this study was to identify how features of Alzheimer's disease (AD) genetic risk disclosure communication relate to patient and visit companion satisfaction. We conducted secondary analyses of 79 session recordings from the fourth REVEAL Study, a randomized-controlled trial of AD genetic risk disclosure among patients with mild cognitive impairment. Patient and companion satisfaction were ascertained from postdisclosure surveys. The Roter Interaction Analysis System (RIAS) was used to code triadic communication between the counselor, patient, and companion. High satisfaction was evident for 24% of patients (N = 19) and 48% of companions (N = 38). Multivariate logistic regressions showed that high patient satisfaction was associated with patients' expression of emotions (OR = 1.1, 95% CI: 1.0-1.1) and companions' questions about psychosocial and lifestyle topics (OR = 1.8, 95% CI: 1.1-2.8). High companion satisfaction was positively related to the RIAS overall patient-centeredness score for the session (OR = 4.0, 95% CI: 1.0-15.6) (all p-values <0.05). Communication predictors of patient and companion satisfaction reflect specific or summary indicators of patient-centeredness. Findings also suggest that visit companions positively influence patient satisfaction. The study results support the growing literature and policy attention directed toward delivering family-centered care.
Collapse
Affiliation(s)
- Yue Guan
- a Behavioral Sciences and Health Education, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Debra L Roter
- b Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Lori H Erby
- c Social and Behavioral Research Branch , National Human Genome Research Institute, National Institutes of Health , Bethesda , Maryland , USA
| | - Jennifer L Wolff
- d Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Laura N Gitlin
- e Department of Community Public Health, Center for Innovative Care in Aging, School of Nursing , Johns Hopkins University , Baltimore , MD , USA
| | - J Scott Roberts
- f Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
| | - Robert C Green
- g Division of Genetics, Department of Medicine , Brigham and Women's Hospital , Boston , MA , USA
- h Department of Medicine , Harvard Medical School , Boston , MA , USA
- i Broad Institute of MIT and Harvard , Cambridge , MA , USA
- j Partners Personalized Medicine , Boston , MA , USA
| | - Kurt D Christensen
- g Division of Genetics, Department of Medicine , Brigham and Women's Hospital , Boston , MA , USA
- h Department of Medicine , Harvard Medical School , Boston , MA , USA
| |
Collapse
|
24
|
Lee A, Piette JD, Heisler M, Janevic M, Langa KM, Rosland AM. Family members' experiences supporting adults with chronic illness: A national survey. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2017; 35:463-473. [PMID: 29283613 PMCID: PMC5751928 DOI: 10.1037/fsh0000293] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Family and friends often help chronically ill adults manage their conditions. Information about specific ways supporters help with disease management, and their experiences with and concerns about helping are lacking. This study describes key roles and concerns of family members who support the health management of adults with chronic illness, and compares experiences of health supporters living in and outside of support recipients' homes. METHODS Data were obtained from a national internet survey of 1,722 adults selected to represent the U.S. POPULATION Detailed survey questions were completed by 703 respondents who reported providing regular disease-management help to at least one functionally-independent family member or friend with at least one of five chronic conditions (diabetes, heart failure, chronic lung disease, arthritis, depression). RESULTS Current supporters assisted 834 chronically ill adults: 257 receiving in-home support and 577 receiving out-of-home support. Current supporters spent 2.1 hours/week on average helping their support recipient with health care, and 21.2% attended their recipient's health care appointments. Many recipients discussed crucial concerns about medication side effects (47.0%) and trouble paying for medications (32.0%) with supporters. However, 41.0% of supporters reported insufficient information about recipients' health conditions and regimen to be helpful. In-home supporters reported arguing more often with support recipients, but also received more information from recipients' health care providers than out-of-home supporters. DISCUSSION Family and friends have significant potential to influence patients' chronic illness self-management. Programs to engage chronically ill patients' families to support self-management could provide information and skills targeting needs identified by supporters. (PsycINFO Database Record
Collapse
Affiliation(s)
- Aaron Lee
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - John D. Piette
- VA Center for Clinical Management Research, Ann Arbor, MI
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Michele Heisler
- VA Center for Clinical Management Research, Ann Arbor, MI
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Mary Janevic
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Kenneth M. Langa
- VA Center for Clinical Management Research, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Ann-Marie Rosland
- VA Center for Clinical Management Research, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| |
Collapse
|
25
|
Bazargan M, Smith J, Yazdanshenas H, Movassaghi M, Martins D, Orum G. Non-adherence to medication regimens among older African-American adults. BMC Geriatr 2017; 17:163. [PMID: 28743244 PMCID: PMC5526276 DOI: 10.1186/s12877-017-0558-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 07/17/2017] [Indexed: 01/13/2023] Open
Abstract
Background Despite concerns about racial differences on adherence to prescribed medication rigimens among older adults, current information about nonadherence among underserved elderly African Americans with co-morbidities is limited. This study examines the association between adherence to drug regimens and an array of medication-related factors, including polypharmacy, medication regimen complexity, use of Potentially Inappropriate Medications (PIM), and knowledge about the therapeutic purpose and instructions of medication use. Methods Four-hundred African Americans, aged 65 years and older, were recruited from South Los Angeles. Structured, face-to-face interviews and visual inspection of participants’ medications were conducted. From the medication container labels, information including strength of the drug, expiration date, instructions, and special warnings were recorded. The Medication Regimen Complexity Index (MRCI) was measured to quantify multiple features of drug regimen complexity. The Beers Criteria was used to measure the PIM use. Results Participants reported taking an average of 5.7 prescription drugs. Over 56% could not identify the purpose of at least one of their medications. Only two-thirds knew dosage regimen of their medications. Thirty-five percent of participants indicated that they purposely had skipped taking at least one of their medications within last three days. Only 8% of participants admitted that they forgot to take their medications. The results of multivariate analysis showed that co-payment for drugs, memory deficits, MRCI, and medication-related knowledge were all associated with adherence to dosage regimen of medications. Participants with a higher level of knowledge about therapeutic purpose and knowledge about dosage regimen of their medications were seven times (CI: 4.2–10.8) more likely to adhere to frequency and dose of medications. Participants with a low complexity index were two times (CI: 1.1–3.9) more likely to adhere to the dosage regimen of their medications, compared with participants with high drug regimen complexity index. Conclusions While other studies have documented that non-adherence remains an important issue among older adults, our study shows that for underserved elderly African Americans, these issues are particularly striking. A periodic comprehensive assessment of all medications that they use remains a critical initial step to identify medication related issues. Assessment of their disease and medication related knowledge (e.g., therapeutic purposes, side-effects, special instructions, etc.) and their ability to follow complicated medication regimens and modification of their drug regimens requires inter-professional collaboration.
Collapse
Affiliation(s)
- Mohsen Bazargan
- Charles R. Drew University of Medicine & Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA. .,University of California, Los Angeles, CA, USA. .,Department of Family Medicine, Los Angeles, CA, USA. .,Public Health Program, Los Angeles, CA, USA.
| | - James Smith
- Charles R. Drew University of Medicine & Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA
| | - Hamed Yazdanshenas
- Charles R. Drew University of Medicine & Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA.,University of California, Los Angeles, CA, USA
| | | | - David Martins
- Charles R. Drew University of Medicine & Science, 1731 East 120th Street, Los Angeles, CA, 90005, USA.,University of California, Los Angeles, CA, USA
| | - Gail Orum
- Keck Graduate Institutes, School of Pharmacy, Claremont, CA, USA
| |
Collapse
|
26
|
Cohen JM, Blustein J, Weinstein BE, Dischinger H, Sherman S, Grudzen C, Chodosh J. Studies of Physician-Patient Communication with Older Patients: How Often is Hearing Loss Considered? A Systematic Literature Review. J Am Geriatr Soc 2017; 65:1642-1649. [DOI: 10.1111/jgs.14860] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jamie M. Cohen
- State University of New York Upstate Medical University; Syracuse New York
| | - Jan Blustein
- Wagner Graduate School of Public Service, New York University; New York New York
- Department of Population Health; New York University School of Medicine; New York New York
| | - Barbara E. Weinstein
- Doctor of Audiology Program; The Graduate Center, City University of New York; New York New York
| | - Hannah Dischinger
- Oregon Health & Science University School of Medicine; Portland Oregon
| | - Scott Sherman
- Department of Population Health; New York University School of Medicine; New York New York
- Division of Geriatric Medicine and Palliative Care, Department of Medicine; New York University School of Medicine; New York New York
| | - Corita Grudzen
- Department of Emergency Medicine; New York University School of Medicine; New York New York
| | - Joshua Chodosh
- Department of Population Health; New York University School of Medicine; New York New York
- Division of Geriatric Medicine and Palliative Care, Department of Medicine; New York University School of Medicine; New York New York
- VA New York Harbor Heathcare System; New York New York
| |
Collapse
|
27
|
An In-home Advanced Robotic System to Manage Elderly Home-care Patients' Medications: A Pilot Safety and Usability Study. Clin Ther 2017; 39:1054-1061. [PMID: 28433400 DOI: 10.1016/j.clinthera.2017.03.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/17/2017] [Accepted: 03/22/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE We examined the safety profile and usability of an integrated advanced robotic device and telecare system to promote medication adherence for elderly home-care patients. METHODS There were two phases. Phase I aimed to verify under controlled conditions in a single nursing home (n = 17 patients) that no robotic malfunctions would hinder the device's safe use. Phase II involved home-care patients from 3 sites (n = 27) who were on long-term medication. On-time dispensing and missed doses were recorded by the robotic system. Patients' and nurses' experiences were assessed with structured interviews. FINDINGS The 17 nursing home patients had 457 total days using the device (Phase I; mean, 26.9 per patient). On-time sachet retrieval occurred with 97.7% of the alerts, and no medication doses were missed. At baseline, Phase II home-dwelling patients reported difficulty remembering to take their medicines (23%), and 18% missed at least 2 doses per week. Most Phase II patients (78%) lived alone. The device delivered and patients retrieved medicine sachets for 99% of the alerts. All patients and 96% of nurses reported the device was easy to use. IMPLICATIONS This trial demonstrated the safety profile and usability of an in-home advanced robotic device and telecare system and its acceptability to patients and nurses. It supports individualized patient dosing schedules, patient-provider communications, and on-time, in-home medication delivery to promote adherence. Real time dose-by-dose monitoring and communication with providers if a dose is missed provide oversight generally not seen in home care.
Collapse
|
28
|
Wolff JL, Guan Y, Boyd CM, Vick J, Amjad H, Roth DL, Gitlin LN, Roter DL. Examining the context and helpfulness of family companion contributions to older adults' primary care visits. PATIENT EDUCATION AND COUNSELING 2017; 100:487-494. [PMID: 27817986 PMCID: PMC5350029 DOI: 10.1016/j.pec.2016.10.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 10/14/2016] [Accepted: 10/22/2016] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Older adults commonly involve family (broadly defined) in their care. We examined communication behaviors of family companions during older adults' primary care visits, including whether these behaviors vary with respect to how older adults manage their health, preferences for involving family in medical decision-making, and ratings of companion helpfulness. METHODS Analysis of audio-taped primary care visits of older patients who were accompanied by a family companion (n=30 dyads) and linked patient surveys. RESULTS Family companions predominantly facilitated doctor and patient information exchange. More than half of companion communication behaviors were directed at improving doctor understanding of the patient. Companions were more verbally active during visits of patients who delegated the management of their health to others than visits of patients who co-managed or self-managed their health. Companions were rated as more helpful by patients who preferred active involvement of family in medical decision-making. CONCLUSION Family companion participation and helpfulness in primary care communication varies by patients' preferences for involving family in medical decision-making and approach to manage their health. PRACTICE IMPLICATIONS Research to examine the effects of clarifying patient and family companion expectations for primary care visits could inform strategies to improve the patient-centeredness of medical communication.
Collapse
Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management and Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 692, Baltimore, MD 21205, United States; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Baltimore, MD 21224-2734, United States; Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite 2-700, Baltimore, MD 21205-2223, United States; Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD 21205-2110, United States.
| | - Yue Guan
- Program in Personalized & Genomic Medicine, Division of Endocrinology, Diabetes & Nutrition, Department of Medicine, University of Maryland School of Medicine, 685 W. Baltimore St., MSTF 3-14D, Baltimore, MD 21201, United States.
| | - Cynthia M Boyd
- Department of Health Policy and Management and Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 692, Baltimore, MD 21205, United States; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Baltimore, MD 21224-2734, United States; Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite 2-700, Baltimore, MD 21205-2223, United States; Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD 21205-2110, United States.
| | - Judith Vick
- Johns Hopkins University School of Medicine, Edward D. Miller Research Building, 733 North Broadway, Suite 137, Baltimore, MD 21205-2196, United States
| | - Halima Amjad
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Baltimore, MD 21224-2734, United States; Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite 2-700, Baltimore, MD 21205-2223, United States; Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD 21205-2110, United States.
| | - David L Roth
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Baltimore, MD 21224-2734, United States; Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite 2-700, Baltimore, MD 21205-2223, United States; Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD 21205-2110, United States.
| | - Laura N Gitlin
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Center Tower, Baltimore, MD 21224-2734, United States; Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Suite 2-700, Baltimore, MD 21205-2223, United States; Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD 21205-2110, United States.
| | - Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 750, Baltimore, MD 21205205, United States.
| |
Collapse
|
29
|
Cené CW, Haymore B, Laux JP, Lin FC, Carthron D, Roter D, Cooper LA, Chang PP, Jensen BC, Miller PF, Corbie-Smith G. Family presence and participation during medical visits of heart failure patients: An analysis of survey and audiotaped communication data. PATIENT EDUCATION AND COUNSELING 2017; 100:250-258. [PMID: 27609321 PMCID: PMC5322738 DOI: 10.1016/j.pec.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To describe the frequency, roles, and utility of family companion involvement in the care of patients with Heart Failure (HF) care and to examine the association between audiotaped patient, companion, and provider communication behaviors. METHODS We collected survey data and audiotaped a single medical visit for 93 HF patients (36 brought a companion into the examination room) and their cardiology provider. Communication data was analyzed using the Roter Interaction Analysis System. RESULTS There were 32% more positive rapport-building statements (p<0.01) and almost three times as many social rapport-building statements (p<0.01) from patients and companions in accompanied visits versus unaccompanied patient visits. There were less psychosocial information giving statements in accompanied visits compared to unaccompanied patient visits (p<0.01.) Providers made 25% more biomedical information giving statements (p=0.04) and almost three times more social rapport-building statements (p<0.01) in accompanied visits. Providers asked fewer biomedical and psychosocial questions in accompanied versus unaccompanied visits. Providers made 16% fewer partnership-building statements in accompanied versus unaccompanied visits (p=0.01). CONCLUSIONS Our findings are mixed regarding the benefits of accompaniment for facilitating patient-provider communication based on survey and audiotaped data. PRACTICE IMPLICATIONS Strategies to enhance engagement during visits, such as pre-visit question prompt lists, may be beneficial.
Collapse
Affiliation(s)
- Crystal W Cené
- Department of Medicine, Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill School of Medicine, NC, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Beth Haymore
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jeffrey P Laux
- North Carolina Translational & Clinical Sciences Institute, University of North Carolina at Chapel Hill School, Chapel Hill, NC, USA; Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- North Carolina Translational & Clinical Sciences Institute, University of North Carolina at Chapel Hill School, Chapel Hill, NC, USA; Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dana Carthron
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Debra Roter
- Department of Health Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patricia P Chang
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Brian C Jensen
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Paula F Miller
- Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Giselle Corbie-Smith
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA; Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA; Center for Health Equity Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
30
|
Green AR, Jenkins A, Masoudi FA, Magid DJ, Kutner JS, Leff B, Matlock DD. Decision-Making Experiences of Patients with Implantable Cardioverter Defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1061-1069. [PMID: 27566614 DOI: 10.1111/pace.12943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/03/2016] [Accepted: 08/18/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND When patients are not adequately engaged in decision making, they may be at risk of decision regret. Our objective was to explore patients' perceptions of their decision-making experiences related to implantable cardioverter defibrillators (ICDs). METHODS Cross-sectional, mailed survey of 412 patients who received an ICD without cardiac resynchronization therapy for any indication between 2006 and 2009. Patients were asked about decision participation and decision regret. RESULTS A total of 295 patients with ICDs responded (72% response rate). Overall, 79% reported that they were as involved in the decision as they wanted. However, 28% reported that they were not told of the option of not getting an ICD and 37% did not remember being asked if they wanted an ICD. In total, 19% reported not wanting their ICD at the time of implantation. Those who did not want the ICD were younger (<65 years; 74% vs 43%, P < 0.001), had higher decision regret (31/100 vs 11/100, P < 0.001), and reported less participation in decision making (the doctor "totally" made the decision, 9% vs 3%; P < 0.001). CONCLUSIONS A considerable number of ICD recipients recalled not wanting their ICD at the time of implantation. While these findings may be prone to recall bias, they likely identify opportunities to improve ICD decision making.
Collapse
Affiliation(s)
- Ariel R Green
- Division of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Amy Jenkins
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado
| | - David J Magid
- Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado.,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jean S Kutner
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Bruce Leff
- Division of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Daniel D Matlock
- Division of Geriatrics, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado
| |
Collapse
|
31
|
Shin DW, Cho J, Roter DL, Kim SY, Yang HK, Park K, Kim HJ, Shin HY, Kwon TG, Park JH. Attitudes Toward Family Involvement in Cancer Treatment Decision Making: The Perspectives of Patients, Family Caregivers, and Their Oncologists. Psychooncology 2016; 26:770-778. [PMID: 27437905 DOI: 10.1002/pon.4226] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND To investigate how cancer patients, family caregiver, and their treating oncologist view the risks and benefits of family involvement in cancer treatment decision making (TDM) or the degree to which these perceptions may differ. PATIENTS AND METHODS A nationwide, multicenter survey was conducted with 134 oncologists and 725 of their patients and accompanying caregivers. Participant answered to modified Control Preferences Scale and investigator-developed questionnaire regarding family involvement in cancer TDM. RESULTS Most participants (>90%) thought that family should be involved in cancer TDM. When asked if the oncologist should allow family involvement if the patient did not want them involved, most patients and caregivers (>85%) thought they should. However, under this circumstance, only 56.0% of oncologists supported family involvement. Patients were significantly more likely to skew their responses toward patient rather than family decisional control than were their caregivers (P < .003); oncologists were more likely to skew their responses toward patient rather than family decisional control than caregivers (P < .001). Most respondents thought that family involvement is helpful and neither hamper patient autonomy nor complicate cancer TDM process. Oncologists were largely positive, but less so in these ratings than either patients or caregivers (P < .002). CONCLUSIONS Patients, family caregivers, and, to a lesser degree, oncologists expect and valued family involvement in cancer TDM. These findings support a reconsideration of traditional models focused on protection of patient autonomy to a more contextualized form of relational autonomy, whereby the patient and family caregivers can be seen as a unit for autonomous decision.
Collapse
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Korea.,Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea
| | - Juhee Cho
- Cancer Education Center, Samsung Comprehensive Cancer Center, School of Medicine and SAHIST, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - So Young Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
| | - Hyung Kook Yang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Keeho Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyung Jin Kim
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea
| | - Hee-Young Shin
- Department of Biomedical Science, Chonnam National University Medical School, Gwangju, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea.,Joint Institute for Regenerative Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jong Hyock Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
| |
Collapse
|
32
|
Roter DL, Yost KJ, O'Byrne T, Branda M, Leppin A, Kimball B, Fernandez C, Jatoi A, Kumbamu A, Montori V, Koenig B, Geller G, Larson S, Tilburt J. Communication predictors and consequences of Complementary and Alternative Medicine (CAM) discussions in oncology visits. PATIENT EDUCATION AND COUNSELING 2016; 99:1519-25. [PMID: 27296081 PMCID: PMC5007180 DOI: 10.1016/j.pec.2016.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/07/2016] [Accepted: 06/02/2016] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Cancer patients use complementary and alternative medicine (CAM), but do not routinely talk about it with their clinicians. This study describes CAM discussions in oncology visits, the communication patterns that facilitate these discussions and their association with visit satisfaction. METHODS 327 patients (58% female; average age 61) and 37 clinicians were recorded during an oncology visit and completed post-visit questionnaires. All CAM discussions were tagged and the Roter Interaction Analysis System (RIAS) was used to code visit dialogue. RESULTS CAM was discussed in 36 of 327 visits; discussions were brief ( CONCLUSIONS CAM discussions do not occur at random; they take place in visits characterized by patient-centered communication and are associated with higher visit satisfaction. PRACTICE IMPLICATIONS CAM discussions are perceived positively by both patients and clinicians and are facilitated by patient-centered visit communication.
Collapse
Affiliation(s)
- Debra L Roter
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | - Barbara Koenig
- University of California San Francisco, San Francisco, CA, USA
| | - Gail Geller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan Larson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | |
Collapse
|
33
|
Sussman T, Mccusker J, Yaffe M, Belzile E, Sewitch M, Cole M, Strumpf E. Family members' or friends' involvement in self-care for patients with depressive symptoms and co-morbid chronic conditions. Chronic Illn 2016; 12:182-98. [PMID: 26935233 DOI: 10.1177/1742395316633510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/30/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe the support that patients reported receiving from family or friends (F/F) while participating in a self-care intervention for depressive symptoms; examine associations between patient-reported F/F support and use of self-care materials; and describe F/F perceptions of involvement in a subsample of F/F. METHODS One hundred eighty-nine of 223 (85%) patients aged 40+ with chronic physical conditions and co-morbid depressive symptoms participating in a randomized self-care intervention trial, completed structured telephone surveys at three months about the F/F support received. Ten F/F participated in post study qualitative interviews on the support provided. RESULTS 30%, 44%, and 91% of patients reported overall F/F support with self-care, F/F involvement with the self-care intervention and emotional support, respectively. 61% felt positively and 10% felt negatively or conflicted with F/F support. F/F involvement in the self-care intervention was the only variable associated with patient use of self-care materials when examined alongside all F/F support variables (Proportional Odds Ratio = 1.21; 95% C.I. = 1.01, 1.45). F/F perceived less involvement in the self-care intervention than patients. DISCUSSION Patients engaged in a self-care intervention for depressive symptoms use more self-care materials when they perceive F/F involvement in the intervention. Patients and F/F may perceive involvement differently and benefit from discussions about potential F/F roles.
Collapse
Affiliation(s)
- Tamara Sussman
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Jane Mccusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University St Mary's Research Centre, Montreal, QC, Canada
| | - Mark Yaffe
- Department of Family Medicine, McGill University, Montreal, QC, Canada Department of Family Medicine, St. Mary's Hospital Centre, St. Mary's Hospital Centre, Montreal, QC, Canada
| | | | - Maida Sewitch
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Department of Medicine, McGill University, Montreal, QC, Canada Divisions of Gastroenterology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada
| | - Martin Cole
- St Mary's Research Centre, Montreal, QC, Canada Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University Department of Economics, McGill University, Montreal, QC, Canada
| |
Collapse
|
34
|
Patient and family empowerment as agents of ambulatory care safety and quality. BMJ Qual Saf 2016; 26:508-512. [DOI: 10.1136/bmjqs-2016-005489] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 07/24/2016] [Accepted: 08/06/2016] [Indexed: 11/03/2022]
|
35
|
Janevic MR, Piette JD, Ratz DP, Kim HM, Rosland AM. Correlates of family involvement before and during medical visits among older adults with high-risk diabetes. Diabet Med 2016; 33:1140-8. [PMID: 26642179 PMCID: PMC4896854 DOI: 10.1111/dme.13045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 11/27/2022]
Abstract
AIMS To examine the characteristics of patients with diabetes who regularly receive help from a supporter in preparing for and attending medical visits, and the association between this help and clinical risk factors for diabetes complications. METHODS We linked survey data about family involvement for patients in the Veterans Health Administration system with poorly controlled Type 2 diabetes (n = 588; mean 67 years; 97% male) with health record data on blood pressure, glycaemic control and prescription-fill gaps. We used multivariable regression to assess whether supporter presence and, among patients with supporters, supporter role (visit preparation, accompaniment to medical visit or no involvement) were associated with concurrent trends in clinical risk factors over 2 years, adjusting for sociodemographic and health characteristics. RESULTS Most patients (78%) had a main health supporter; of these, more had regular support for preparing for appointments (69%) than were regularly accompanied to them (45%). Patients with preparation help only were younger and more educated than accompanied patients. Support presence and type was not significantly associated with clinical risk factors. CONCLUSIONS Family help preparing for appointments was common among these patients with high-risk diabetes. In its current form, family support for medical visits may not affect clinical factors in the short term. Supporters helping patients engage in medical visits may need training and assistance to have an impact on the clinical trajectory of patients with diabetes.
Collapse
Affiliation(s)
- M R Janevic
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - J D Piette
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - D P Ratz
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - H M Kim
- Center for Statistical Consultation and Research, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - A-M Rosland
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
- Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
36
|
Cené CW, Johnson BH, Wells N, Baker B, Davis R, Turchi R. A Narrative Review of Patient and Family Engagement: The "Foundation" of the Medical "Home". Med Care 2016; 54:697-705. [PMID: 27111748 PMCID: PMC4907812 DOI: 10.1097/mlr.0000000000000548] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patient and family engagement (PFE) is vital to the spirit of the medical home. This article reflects the efforts of an expert consensus panel, the Patient and Family Engagement Workgroup, as part of the Society of General Internal Medicine's 2013 Research Conference. OBJECTIVE To review extant literature on PFE in pediatric and adult medicine and quality improvement, highlight emerging best practices and models, suggest questions for future research, and provide references to tools and resources to facilitate implementation of PFE strategies. METHODS We conducted a narrative review of relevant articles published from 2000 to 2015. Additional information was retrieved from personal contact with experts and recommended sources from workgroup members. RESULTS Despite the theoretical importance of PFE and policy recommendations that PFE occurs at all levels across the health care system, evidence of effectiveness is limited, particularly for quality improvement. There is some evidence that PFE is effective, mostly related to engagement in the care of individual patients, but the evidence is mixed and few studies have assessed the effect of PFE on health outcomes. Measurement issues and the lack of a single comprehensive conceptual model pose challenges to progress in this field. Recommendations for future research and a list of practical tools and resources to facilitate PFE are provided. CONCLUSIONS Although PFE appeals to patients, families, providers, and policy-makers, research is needed to assess outcomes beyond satisfaction, address implementation barriers, and support engagement in practice redesign and quality improvement. Partnering with patients and families has great potential to support high-quality health care and optimize outcomes.
Collapse
Affiliation(s)
- Crystal W. Cené
- Division of General Internal Medicine, University of North Carolina at Chapel Hill School of Medicine
| | | | | | - Beverly Baker
- National Center for Family Professional Partnerships, Family Voices, Inc
| | - Renee Davis
- Drexel University School of Public Health/College of Medicine, Philadelphia PA
| | - Renee Turchi
- Division of General Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, PA
- Drexel University School of Public Health/College of Medicine, Philadelphia PA
| |
Collapse
|
37
|
Laidsaar-Powell R, Butow P, Bu S, Fisher A, Juraskova I. Oncologists’ and oncology nurses’ attitudes and practices towards family involvement in cancer consultations. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12470] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- R. Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED); School of Psychology; The University of Sydney; Sydney NSW Australia
| | - P. Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED); School of Psychology; The University of Sydney; Sydney NSW Australia
| | - S. Bu
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED); School of Psychology; The University of Sydney; Sydney NSW Australia
| | - A. Fisher
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED); School of Psychology; The University of Sydney; Sydney NSW Australia
| | - I. Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED); School of Psychology; The University of Sydney; Sydney NSW Australia
| |
Collapse
|
38
|
Laidsaar-Powell R, Butow P, Bu S, Dear R, Fisher A, Coll J, Juraskova I. Exploring the communication of oncologists, patients and family members in cancer consultations: development and application of a coding system capturing family-relevant behaviours (KINcode). Psychooncology 2015; 25:787-94. [DOI: 10.1002/pon.4003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/14/2015] [Accepted: 09/17/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
- Psycho-Oncology Co-operative Research Group (PoCoG); The University of Sydney; Sydney New South Wales Australia
| | - Stella Bu
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Rachel Dear
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Alana Fisher
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
| | - Joseph Coll
- Psycho-Oncology Co-operative Research Group (PoCoG); The University of Sydney; Sydney New South Wales Australia
| | - Ilona Juraskova
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology; The University of Sydney; Sydney New South Wales Australia
| |
Collapse
|
39
|
Roth DL, Fredman L, Haley WE. Informal caregiving and its impact on health: a reappraisal from population-based studies. THE GERONTOLOGIST 2015; 55:309-19. [PMID: 26035608 DOI: 10.1093/geront/gnu177] [Citation(s) in RCA: 468] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/05/2014] [Indexed: 12/11/2022] Open
Abstract
Considerable research and public discourse on family caregiving portrays it as a stressful and burdensome experience with serious negative health consequences. A landmark study by Schulz and Beach that reported higher mortality rates for strained spouse caregivers has been widely cited as evidence for the physical health risks of caregiving and is often a centerpiece of advocacy for improved caregiver services. However, 5 subsequent population-based studies have found reduced mortality and extended longevity for caregivers as a whole compared with noncaregiving controls. Most caregivers also report benefits from caregiving, and many report little or no caregiving-related strain. Policy reports, media portrayals, and many research reports commonly present an overly dire picture of the health risks associated with caregiving and largely ignore alternative positive findings. As the pool of traditional family caregivers declines in the coming years, a more balanced and updated portrayal of the health effects of caregiving is needed to encourage more persons to take on caregiving roles, and to better target evidence-based services to the subgroup of caregivers who are highly strained or otherwise at risk. Recommendations are discussed for research that will better integrate and clarify both the negative and potential positive health effects of informal caregiving.
Collapse
Affiliation(s)
- David L Roth
- Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.
| | - Lisa Fredman
- Department of Epidemiology, Boston University, Massachusetts
| | | |
Collapse
|
40
|
Wolff JL, Spillman B. Older adults receiving assistance with physician visits and prescribed medications and their family caregivers: prevalence, characteristics, and hours of care. J Gerontol B Psychol Sci Soc Sci 2015; 69 Suppl 1:S65-72. [PMID: 25342825 DOI: 10.1093/geronb/gbu119] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To profile older adults receiving assistance with physician visits and prescribed medications and the time demands associated with their care. METHODS Observational study of 7,197 community-dwelling adults ages 65+ responding to the 2011 National Health and Aging Trends Study. RESULTS More than one third of older adults receive assistance with either physician visits or prescribed medications (26.3%), or both (9.9%). The 3.3 million older adults who receive assistance with both physician visits and prescribed medications are a high-need subgroup: 3 in 5 have possible (16.5%) or probable (46.1%) dementia and three quarters (76.6%) receive help with mobility, self-care, or household activities. These 3.3 million older adults receive more than twice as many weekly hours of help with all activities (60.5 hr) as those receiving help with either physician visits or prescribed medications (26.5 hr), or neither (18.6 hr). Older adults receiving help with both physician visits and prescribed medications are assisted by 7.2 million helpers, most often adult children (46.6%), or spouses (23.6%). The 3.1 million helpers who assist with both physician visits and prescribed medications provide an average of 45.4 hr of help per week; nearly two thirds (64.3%) also assist with mobility or self-care. DISCUSSION Older adults receiving help with both physician visits and prescribed medications typically have high health and functioning needs that involve significant time demands for caregivers.
Collapse
Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy & Management and Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | |
Collapse
|