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McKinn S, Chapman N, Sharman JE, Nash R, Nelson MR, Sutton L, Yung C, Doust J, Hawkes AL, Bonner C. How do general practitioners manage patient health literacy differences in cardiovascular disease prevention consultations? An interview study. PATIENT EDUCATION AND COUNSELING 2024; 125:108299. [PMID: 38657560 DOI: 10.1016/j.pec.2024.108299] [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: 08/16/2023] [Revised: 02/12/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Low health literacy is associated with worse health outcomes, including for cardiovascular disease (CVD). However, general practitioners (GPs) have limited support to identify and address patient health literacy needs in CVD prevention consultations. This study explored GPs' experiences of patient health literacy needs during CVD risk assessment and management consultations. METHODS Semi-structured interviews with 18 GPs in Tasmania, Australia in 2021. A Framework Analysis approach was used to code transcripts to a thematic framework. RESULTS GPs perceptions on patient health literacy informed three themes: 1. Methods of estimating health literacy; 2. GPs' perceptions about the impact of health literacy on CVD prevention including risk factor knowledge and behaviours; and 3. Strategies for communicating with patients experiencing health literacy challenges. The findings show that while no formal tools were used to assess health literacy in this sample, perceived health literacy can change GPs' communication and prevention strategies. CONCLUSION The findings raise concerns about the equity of choices made available to patients, based on subjective perceptions of their health literacy level. PRACTICE IMPLICATION GPs could be better supported to assess and address patient health literacy needs in CVD prevention consultations.
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Affiliation(s)
- Shannon McKinn
- Sydney Health Literacy Lab, University of Sydney, Sydney, Australia
| | - Niamh Chapman
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Rosie Nash
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Laura Sutton
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Cassia Yung
- Sydney Health Literacy Lab, University of Sydney, Sydney, Australia
| | - Jenny Doust
- Australian Women and Girls' Health Research (AWaGHR) Centre, University of Queensland, Queensland, Australia
| | - Anna L Hawkes
- School of Public Health, University of Queensland, Queensland, Australia
| | - Carissa Bonner
- Sydney Health Literacy Lab, University of Sydney, Sydney, Australia; Menzies Centre for Health Policy & Economics, University of Sydney, Sydney, Australia.
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Popa M, Young B, Rousseau N, Cherry MG, Jenkins I, Cloke J, Pettitt A, Jenkinson MD, Ahmed S, Pemberton AR, Sherratt FC. Consultations about randomised controlled trials are shorter and less in-depth for socioeconomically disadvantaged patients compared to socioeconomically advantaged patients: qualitative analysis across three trials. Trials 2024; 25:382. [PMID: 38872208 DOI: 10.1186/s13063-024-08216-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Patients from socioeconomically disadvantaged backgrounds are underserved in randomised controlled trials, yet they experience a much greater burden of disease compared with patients from socioeconomically advantaged areas. It is crucial to make trials more inclusive to ensure that treatments and interventions are safe and effective in real-world contexts. Improving how information about trials is verbally communicated is an unexplored strategy to make trials more inclusive. This study examined how trials are communicated verbally, comparing consultations involving patients from the most and least socioeconomically disadvantaged areas. METHODS Secondary qualitative analysis of 55 trial consultation transcripts from 41 patients, sampled from 3 qualitative studies embedded in their respective UK multi-site, cancer-related randomised controlled trials. Patients living in the most and least socioeconomically disadvantaged areas, defined using English Indices of Multiple Deprivation decile scores, were purposively sampled. Analysis was largely thematic and drew on the constant comparison method. RESULTS Recruiters communicated clinical uncertainty in a similar way for patients living in different socioeconomic areas. Consultations with disadvantaged patients were, on average, half the duration of those with advantaged patients, and tended to involve recruiters providing less in-depth explanations of trial concepts, used phrasing that softened trial arm risks, and described trial processes (e.g. randomisation) using informal or metaphorical phrasing. Disadvantaged and advantaged patients differed in the concerns they expressed; disadvantaged patients voiced fewer concerns and asked fewer questions but were also less likely to be invited to do so by recruiters. CONCLUSION Interactions about trials unfolded in different ways between patients living in different socioeconomic areas, likely due to both patient- and recruiter-related factors. We present considerations for recruiters when discussing trials with patients from socioeconomically disadvantaged backgrounds, aimed at enhancing trial communication. Future research should examine disadvantaged patients' and recruiters' experiences of verbal trial communication to inform guidance that addresses the needs and preferences of underserved groups.
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Affiliation(s)
- Mariana Popa
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Bridget Young
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Nikki Rousseau
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Mary G Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Isobel Jenkins
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Jane Cloke
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Andrew Pettitt
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Saiqa Ahmed
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Allan R Pemberton
- NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Frances C Sherratt
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
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Beyer K, Lawlor A, Remmers S, Bezuidenhout C, Gómez Rivas J, Venderbos LD, Smith EJ, Gandaglia G, MacLennan S, MacLennan SJ, Bjartell A, Briganti A, Cornford P, Evans-Axelsson S, Ribal MJ, N'Dow J, Briers E, Roobol MJ, Van Hemelrijck M. How Can We Improve Patient-Clinician Communication for Men Diagnosed with Prostate Cancer? EUR UROL SUPPL 2024; 62:1-7. [PMID: 38585208 PMCID: PMC10998269 DOI: 10.1016/j.euros.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 04/09/2024] Open
Abstract
Background and objective The ability of health care professionals to communicate with patients compassionately and effectively is crucial for shared decision-making, but little research has investigated patient-clinician communication. As part of PIONEER-an international Big Data Consortium led by the European Association of Urology to answer key questions for men with prostate cancer (PCa), funded through the IMI2 Joint Undertaking under grant agreement 777492- we investigated communication between men diagnosed with PCa and the health care professional(s) treating them across Europe. Methods We used the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Communication 26, which was shared via the PIONEER and patient organisations on March 11, 2022. We sought men who spoke French, Italian, Spanish, German, Dutch, or English who were diagnosed with PCa and were undergoing or had already received treatment for their PCa. Results and limitations A total of 372 men reported that they communicated with their clinician during either the diagnostic or the treatment period. Overall, the majority of participants reported positive experiences. However, important opportunities to enhance communication were identified, particularly with regard to correcting misunderstandings, understanding the patient's preferred approach to information presentation, addressing challenging questions, supporting the patient's comprehension of information, attending to the patient's emotional needs, and assessing what information had already been given to patients about their disease and treatment, and how much of it was understood. Conclusions and clinical implications These results help us to identify gaps and barriers to shared treatment decision making. This knowledge will help devise measures to improve patient-health care professional communication in the PCa setting. Patient summary As part of the PIONEER initiative, we investigated the communication between men diagnosed with prostate cancer and their health care professionals across Europe. A total of 372 men from six different countries participated in the study. Most participants reported positive experiences, but areas where communication could be improved were identified. These included addressing misunderstandings, tailoring the presentation of information to the patient's preferences, handling difficult questions, supporting emotional needs, and assessing the patient's understanding of their diagnosis and treatment.
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Affiliation(s)
- Katharina Beyer
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Ailbhe Lawlor
- Translational Oncology and Urology Research, King’s College London, London, UK
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Carla Bezuidenhout
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Juan Gómez Rivas
- Department of Urology, Clínico San Carlos University Hospital, Madrid, Spain
| | - Lionne D.F. Venderbos
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Emma J. Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giorgio Gandaglia
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Steven MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland
| | | | - Anders Bjartell
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Alberto Briganti
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Philip Cornford
- Department of Translational Medicine, Lund University, Lund, Sweden
| | | | - Maria J. Ribal
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - James N'Dow
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Monique J. Roobol
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | | | - for the PIONEER Consortium
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
- Translational Oncology and Urology Research, King’s College London, London, UK
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
- Department of Urology, Clínico San Carlos University Hospital, Madrid, Spain
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
- Department of Translational Medicine, Lund University, Lund, Sweden
- Medical Affairs Oncology, Bayer AB, Stockholm, Sweden
- Patient advocate, Hasselt, Belgium
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4
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Kruser JM, Ashana DC, Courtright KR, Kross EK, Neville TH, Rubin E, Schenker Y, Sullivan DR, Thornton JD, Viglianti EM, Costa DK, Creutzfeldt CJ, Detsky ME, Engel HJ, Grover N, Hope AA, Katz JN, Kohn R, Miller AG, Nabozny MJ, Nelson JE, Shanawani H, Stevens JP, Turnbull AE, Weiss CH, Wirpsa MJ, Cox CE. Defining the Time-limited Trial for Patients with Critical Illness: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2024; 21:187-199. [PMID: 38063572 PMCID: PMC10848901 DOI: 10.1513/annalsats.202310-925st] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
In critical care, the specific, structured approach to patient care known as a "time-limited trial" has been promoted in the literature to help patients, surrogate decision makers, and clinicians navigate consequential decisions about life-sustaining therapy in the face of uncertainty. Despite promotion of the time-limited trial approach, a lack of consensus about its definition and essential elements prevents optimal clinical use and rigorous evaluation of its impact. The objectives of this American Thoracic Society Workshop Committee were to establish a consensus definition of a time-limited trial in critical care, identify the essential elements for conducting a time-limited trial, and prioritize directions for future work. We achieved these objectives through a structured search of the literature, a modified Delphi process with 100 interdisciplinary and interprofessional stakeholders, and iterative committee discussions. We conclude that a time-limited trial for patients with critical illness is a collaborative plan among clinicians and a patient and/or their surrogate decision makers to use life-sustaining therapy for a defined duration, after which the patient's response to therapy informs the decision to continue care directed toward recovery, transition to care focused exclusively on comfort, or extend the trial's duration. The plan's 16 essential elements follow four sequential phases: consider, plan, support, and reassess. We acknowledge considerable gaps in evidence about the impact of time-limited trials and highlight a concern that if inadequately implemented, time-limited trials may perpetuate unintended harm. Future work is needed to better implement this defined, specific approach to care in practice through a person-centered equity lens and to evaluate its impact on patients, surrogates, and clinicians.
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Dutruel SP, Hentel KD, Hecht EM, Kadom N. Patient-Centered Radiology Communications: Engaging Patients as Partners. J Am Coll Radiol 2024; 21:7-18. [PMID: 37863150 DOI: 10.1016/j.jacr.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023]
Abstract
Patient-centered care is a model in which, by bringing the patient's perspective to the design and delivery of health care, we can better meet patients' needs, enhancing the quality of care. Patient-centered care requires finding ways to communicate effectively with a diverse patient population that has various levels of health literacy, cultural backgrounds, and unique needs and preferences. Moreover, multimedia resources have the potential to inform and educate patients promoting greater independence. In this review, we discuss the fundamentals of communication with the different modes used in radiology and the key elements of effective communication. Then, we highlight five opportunities along the continuum of care in the radiology practice in which we can improve communications to empower our patients and families and strengthen this partnership. Lastly, we discuss the importance on communication training of the workforce, optimizing and seamlessly integrating technology solutions into our workflows, and the need for patient feedback in the design and delivery of care.
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Affiliation(s)
- Silvina P Dutruel
- Department of Radiology, Weill Cornell Medical Center, New York, New York.
| | - Keith D Hentel
- Professor, Clinical Radiology, Executive Vice Chairman, Department of Radiology; Vice President, Weill Cornell Imaging at New York-Presbyterian, New York, New York
| | - Elizabeth M Hecht
- Vice Chair for Academic Affairs, Department of Radiology, Weill Cornell Medical Center, New York, New York. https://twitter.com/ehecht_md
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Director of Quality, Department of Radiology, Children's Healthcare of Atlanta, Georgia; Interim Director of Quality, Department of Radiology, Emory Healthcare, Atlanta, Georgia; Chair, Practice and Performance Improvement Committee, ARRS; and Chair, Metrics Committee, ACR
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6
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Ayre J, Muscat DM, Mac O, Bonner C, Dunn AG, Dalmazzo J, Mouwad D, McCaffery K. Helping patient educators meet health literacy needs: End-user testing and iterative development of an innovative health literacy editing tool. PEC INNOVATION 2023; 2:100162. [PMID: 37384149 PMCID: PMC10294045 DOI: 10.1016/j.pecinn.2023.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/15/2023] [Accepted: 05/06/2023] [Indexed: 06/30/2023]
Abstract
Objective The Sydney Health Literacy Lab (SHeLL) Editor is an online text-editing tool that provides real-time assessment and feedback on written health information (assesses grade reading score, complex language, passive voice). This study aimed to explore how the design could be further enhanced to help health information providers interpret and act on automated feedback. Methods The prototype was iteratively refined across four rounds of user-testing with health services staff (N = 20). Participants took part in online interviews and a brief follow-up survey using validated usability scales (System Usability Scale, Technology Acceptance Model). After each round, Yardley's (2021) optimisation criteria guided which changes would be implemented. Results Participants rated the Editor as having adequate usability (M = 82.8 out of 100, SD = 13.5). Most modifications sought to reduce information overload (e.g. simplifying instructions for new users) or make feedback motivating and actionable (e.g. using frequent incremental feedback to highlight changes to the text altered assessment scores). Conclusion terative user-testing was critical to balancing academic values and the practical needs of the Editor's target users. The final version emphasises actionable real-time feedback and not just assessment. Innovation The Editor is a new tool that will help health information providers apply health literacy principles to written text.
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Affiliation(s)
- Julie Ayre
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Danielle M. Muscat
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Olivia Mac
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Carissa Bonner
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adam G. Dunn
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Jason Dalmazzo
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Dana Mouwad
- Western Sydney Local Health District, Health Literacy Hub, Westmead, NSW, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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7
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Romeo BG, Bevan JL. Using the Disclosure Decision-Making Model to Examine Patient Confusion Disclosure. HEALTH COMMUNICATION 2023:1-8. [PMID: 37798842 DOI: 10.1080/10410236.2023.2265121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The disclosure decision-making model (DD-MM) has been heavily explored within its initially proposed scope. Fewer known studies have tested the DD-MM's boundaries by assessing the model's application beyond close personal relationships, and none have explored it in a context outside of long-term health conditions. The current study investigates the disclosure decision-making process of patients to their healthcare providers when they experience situational confusion. A primarily quantitative online survey analyzed data from 251 U.S. adults who felt confusion during a recent appointment with their healthcare provider. Findings indicate that, although stigma and perceived disclosure efficacy impacted patient confusion disclosure as anticipated, anticipated response and relational quality (i.e., receiver assessments) did not play a significant role in disclosure. Stigma, anticipated response, and perceived disclosure efficacy were all related to remaining patient confusion as expected. This study contributes to our understanding of the scope of disclosure decision-making model as well as the to-date overlooked nuances of situational patient confusion: what impacts confusion disclosure and its likelihood to remain beyond the appointment's end. Limitations, implications, and future directions are discussed.
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8
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Keim-Malpass J, Vavolizza RD, Cohn WF, Kennedy EM, Showalter SL. Cancer Screening and Treatment Delays During the COVID-19 Pandemic and the Role of Health Literacy in Care Re-engagement: Findings from an NCI-Designated Comprehensive Cancer Center sample. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1405-1412. [PMID: 37202597 PMCID: PMC10195653 DOI: 10.1007/s13187-023-02312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
The COVID-19 pandemic has led to numerous delays in cancer-related care and cancer-specific screening, but the extent is not fully understood. For those that experience a delay or disruption in care, health related self-management is required to re-engage in care pathways and the role of health literacy in this pathway has not been explored. The purpose of this analysis is to (1) report the frequency of self-reported delays in cancer treatment and preventative screening services at an academic, NCI-designated center during the COVID-19 pandemic and (2) investigate cancer-related care and screening delays among those with adequate and limited health literacy. A cross-sectional survey was administered from an NCI-designated Cancer Center with a rural catchment area during November 2020 through March 2021. A total of 1,533 participants completed the survey, and nearly 19 percent of participants were categorized as having limited health literacy. Twenty percent of those with a cancer diagnosis reported a delay in cancer-related care; and 23-30% of the sample reported a delay in cancer screening. In general, the proportions of delays among those with adequate and limited health literacy were similar with the exception of colorectal cancer screening. There was also a notable difference in the ability to re-engage in cervical cancer screening among those with adequate and limited health literacy. Thus, there is a role for those engaged in cancer-related education and outreach to offer additional navigation resources for those at risk to cancer-related care and screening disruptions. Future study is warranted to investigate the role of health literacy on cancer care engagement.
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Affiliation(s)
- Jessica Keim-Malpass
- Department of Pediatrics, Division of Hematology-Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Rick D Vavolizza
- Department of Surgery, Division of Surgical Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Erin M Kennedy
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Shayna L Showalter
- Department of Surgery, Division of Surgical Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA
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Roscoe RD, Balyan R, McNamara DS, Banawan M, Schillinger D. Automated Strategy Feedback Can Improve the Readability of Physicians' Electronic Communications to Simulated Patients. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER STUDIES 2023; 176:103059. [PMID: 37193118 PMCID: PMC10174593 DOI: 10.1016/j.ijhcs.2023.103059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Modern communication between health care professionals and patients increasingly relies upon secure messages (SMs) exchanged through an electronic patient portal. Despite the convenience of secure messaging, challenges include gaps between physician and patient expertise along with the asynchronous nature of such communication. Importantly, less readable SMs from physicians (e.g., too complicated) may result in patient confusion, non-adherence, and ultimately poorer health outcomes. The current simulation trial synthesizes work on patient-physician electronic communication, message readability assessments, and feedback to explore the potential for automated strategy feedback to improve the readability of physicians' SMs to patients. Within a simulated secure messaging portal featuring multiple simulated patient scenarios, computational algorithms assessed the complexity of SMs written by 67 participating physicians to patients. The messaging portal provided strategy feedback for how physician responses might be improved (e.g., adding details and information to reduce complexity). Analyses of changes in SM complexity revealed that automated strategy feedback indeed helped physicians compose and refine more readable messages. Although the effects for any individual SM were slight, the cumulative effects within and across patient scenarios showed trends of decreasing complexity. Physicians appeared to learn how to craft more readable SMs via interactions with the feedback system. Implications for secure messaging systems and physician training are discussed, along with considerations for further investigation of broader physician populations and effects on patient experience.
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Affiliation(s)
- Rod D Roscoe
- Arizona State University 7271 E. Sonoran Arroyo Mall Santa Catalina Hall 150 Mesa, AZ 85212 USA
| | - Renu Balyan
- State University of New York at Old Westbury PO Box 210, Old Westbury, NY 11568 USA
| | | | - Michelle Banawan
- Asian Institute of Management 123 Paseo de Roxas Avenue Makati, Metro Manila 1229, Philippines
| | - Dean Schillinger
- School of Medicine, Division of General Internal Medicine University of California, San Francisco 500 Parnassus Avenue San Francisco, CA 94143 USA
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10
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Ownby RL, Waldrop D, Davenport R, Simonson M, Caballero J, Thomas-Purcell K, Purcell D, Ayala V, Gonzalez J, Patel N, Kondwani K. A mobile app for chronic disease self-management for individuals with low health literacy: A multisite randomized controlled clinical trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.01.23288020. [PMID: 37066256 PMCID: PMC10104214 DOI: 10.1101/2023.04.01.23288020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Objective The purpose of this study was to evaluate the effects of a mobile app designed to improve chronic disease self-management in older adult patients with low health literacy and who had at least one chronic health condition, and to assess the impact of delivering information at different levels of reading difficulty. Methods A randomized controlled trial was completed at two sites. Individuals 40 years of age and older screened for low health literacy who had at least one chronic health condition were randomly assigned to a tailored information multimedia app with text at one of three grade levels. Four primary outcomes were assessed: patient activation, chronic disease self-efficacy, health-related quality of life, and medication adherence. Results All groups showed overall increases in activation, self-efficacy, and health-related quality of life, but no change in medication adherence. No between-group differences were observed. Conclusions The mobile app was effective in increasing participants' levels of several psychosocial variables, but reading difficulty level was not significantly related to outcomes.Registered at clinicaltrials.gov NCT02922439.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta GA
| | - Rosemary Davenport
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Michael Simonson
- Instructional Technology and Distance Education Program, Fischler College of Education, Nova Southeastern University, Fort Lauderdale FL
| | | | | | - Donrie Purcell
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Victoria Ayala
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Juan Gonzalez
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Neil Patel
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Kofi Kondwani
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Fort Lauderdale FL
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van der Scheer-Horst E, Rutten G, Stortenbeker I, Borkent J, Swormink WK, Das E, Staal JB, van Lankveld W. Limited health literacy in primary care physiotherapy: Does a physiotherapist use techniques to improve communication? PATIENT EDUCATION AND COUNSELING 2023; 109:107624. [PMID: 36657334 DOI: 10.1016/j.pec.2023.107624] [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: 05/24/2022] [Revised: 12/08/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Research shows that health professionals should adapt their communication when addressing patients with limited health literacy (HL). However, the extent to which physiotherapists apply recommended communication techniques is unclear. METHODS We conducted a two phase mixed-method study, first holding focus group interviews among patients and experts on communication to explore the need for adjusted communication in physiotherapist-patient interaction. Second, we manually coded audio recordings of primary care physiotherapy consultations to investigate the extent to which physiotherapists applied these recommended communication techniques, and adjusted their communication towards patients with lower education. RESULTS Focus group interviews identified four categories of communication elements: the teach-back method, medical jargon explanation, summarizing patient's narratives, and checking patient's understanding. In 50 audio recordings we identified 2670 clauses. We report limited use of the recommended communication techniques; the teach-back method was used in 2% of consultations (95%CI: 0.4%-10.5%) while medical jargon explanation was used in 84% (95%CI: 71.5%-91.7%). Mixed effects logistic regression models showed no association between lower education and communication techniques. CONCLUSION Although physiotherapists need to adjust their communication to patients with lower education, they rarely apply the recommended communication techniques. PRACTICE IMPLICATIONS Knowledge about limited HL among physiotherapists needs to be increased.
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Affiliation(s)
| | - Geert Rutten
- HAN University of Applied Sciences, School for Allied Health, Nijmegen, the Netherlands.
| | - Inge Stortenbeker
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
| | - Jos Borkent
- HAN University of Applied Sciences, School for Allied Health, Nijmegen, the Netherlands.
| | | | - Enny Das
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands.
| | - J Bart Staal
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ healthcare, Nijmegen, the Netherlands; HAN University of Applied Sciences, School for Allied Health, Nijmegen, The Netherlands, Radboud University Medical Centre, IQ healthcare, Nijmegen, the Netherlands.
| | - Wim van Lankveld
- HAN University of Applied Sciences, School for Allied Health, Nijmegen, the Netherlands.
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12
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Boeder S, Matamoros D, Mansy C. Practical Guidance for Healthcare Providers on Collaborating with People with Type 2 Diabetes: Advancing Treatment and Initiating Injectable Therapy. Diabetes Ther 2023; 14:425-446. [PMID: 36520406 PMCID: PMC9943835 DOI: 10.1007/s13300-022-01330-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022] Open
Abstract
Type 2 diabetes (T2D) progresses over time, and to achieve and maintain adequate glucose control, many people eventually require injectable therapies such as insulin. However, there can be significant barriers to the initiation of these medications, both from people living with T2D and from healthcare practitioners (HCPs). Misconceptions and misinformation relating to the potential risks and benefits of injectable therapies are common and can contribute to negative perceptions regarding their use. Additionally, HCPs are often unaware of the emotional burden associated with T2D. In particular, diabetes distress is a key contributory factor that needs to be addressed to alleviate fears before diabetes education can be successful. The onus is often on the HCP to initiate effective, individualized communication with each patient and make that person feel an active and equal participant in the management of their T2D. Shared decision-making has been demonstrated to improve understanding of the pathophysiology and treatment options, to increase risk awareness, adherence, and persistence, and to improve self-management behaviors (e.g., exercise, self-care) and patient satisfaction. While therapeutic inertia can result from both patient and HCP, HCPs need to bear the responsibility for escalating therapy when necessary. A proactive approach by the HCP, combined with shared decision-making and a patient-centric approach, are important for optimal T2D management; therefore, an open and effective relationship between the HCP and the person living with T2D is essential. This article is written by a person with T2D, a nurse practitioner/Certified Diabetes Care and Education Specialist, and a clinical endocrinologist, with the goal of providing a holistic view of the management experience, exploring patient needs and expectations, recognizing and avoiding HCP and patient barriers, and providing practical advice to HCPs to empower patients who would benefit from injectable therapy.Infographic and video abstract available for this article.
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Affiliation(s)
- Schafer Boeder
- Division of Endocrinology and Metabolism, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, CA, USA.
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13
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Vecchiato S. Clear, easy, plain, and simple as keywords for text simplification. Front Artif Intell 2022; 5:1042258. [DOI: 10.3389/frai.2022.1042258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
In this paper, we distinguish between four interconnected notions that recur in the literature on text simplification: clarity, easiness, plainness, and simplicity. While plain language and easy language have both been the subject of standardization efforts, there are few attempts to define text clarity and text simplicity. Indeed, in the definition of plain language, clarity has been favored at the expense of simplicity but is employed as a self-evident notion. Meanwhile, text simplicity suffers from a negative connotation and is more likely to be defined by its antonym, text complexity. In our analysis, we examine the current definitions of plain language and easy language and discuss common definitions of text clarity and text complexity. We propose a model of text simplification that can clarify the transition from specialized texts to plain language texts, and easy language texts. It is our contention that text simplification should be placed in a more general framework of discursive ergonomics.
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Andreucci A, Skovdal Rathleff M, Ørskov Reuther F, Hussein M, Rahimzai S, Linnemann TD, Johansen SK. “I had already tried that before going to the doctor” – exploring adolescents’ with knee pain perspectives on ‘wait and see’ as a management strategy in primary care; a study with brief semi-structured qualitative interviews. Scand J Pain 2022; 23:341-352. [PMID: 36279174 DOI: 10.1515/sjpain-2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/26/2022] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
The aim of this study was to examine how the “wait-and-see” recommendation affects adolescents’ understanding of their illness and symptoms and their care-seeking behavior.
Methods
This study included brief qualitative, semi-structured online interviews. Adolescents (age 10–19 years) with long-term knee pain, who had been recommended “wait-and-see” by their general practitioner (GP), were recruited via previous studies and social media. Two researchers conducted brief semi-structured interviews through Microsoft Teams. An interview guide with open questions was created prior to the interviews and updated as new questions emerged. The extracted data was transcribed and analyzed via a reflexive thematic approach in NVivo.
Results
Eight adolescents (mean age 17.8) with longstanding or recurrent knee pain (mean duration 3.5 years) were included. The analysis identified four main themes: (1) The perception of wait and see over time, (2) The GP’s acknowledgement and consideration, (3) experienced limitation from knee pain and (4) the importance of getting a diagnosis. The perception of “wait-and-see” approach changed from positive to negative when adolescents received the recommendation multiple times. Adolescents experienced frustration with their situation and a lack of consideration from their GP made them cautious about seeking additional care. Knee pain significantly limited the adolescents’ physical-and social activities. Receiving a diagnosis was important and helped adolescents dealing with their pain.
Conclusions
The connotation of wait-and-see changed from positive to negative for adolescents when receiving the recommendation multiple times. The participants felt getting a clinical diagnosis was a relief. Furthermore, the lack of consideration and acknowledgement from the GP plays an essential role in the adolescent’s understanding of their knee pain.
Implications
Recommending adolescents to “wait-and-see” multiple times in relation to their knee problems can lead adolescents experience frustration and a lack of consideration from their GP. It would be advisable for GPs to provide adolescents with a diagnosis as it can facilitate them in dealing with their pain and to use simple language when explaining adolescents their condition to improve communication.
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Affiliation(s)
- Alessandro Andreucci
- Department of Clinical Medicine , Center for General Practice at Aalborg University, Aalborg University , Aalborg East , Denmark
| | - Michael Skovdal Rathleff
- Department of Clinical Medicine , Center for General Practice at Aalborg University, Aalborg University , Aalborg East , Denmark
- Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Aalborg , Denmark
| | - Frederikke Ørskov Reuther
- Department of Clinical Medicine , Center for General Practice at Aalborg University, Aalborg University , Aalborg East , Denmark
| | - Mariann Hussein
- Department of Clinical Medicine , Center for General Practice at Aalborg University, Aalborg University , Aalborg East , Denmark
| | - Sultana Rahimzai
- Department of Clinical Medicine , Center for General Practice at Aalborg University, Aalborg University , Aalborg East , Denmark
| | - Trine Dorthea Linnemann
- Department of Clinical Medicine , Center for General Practice at Aalborg University, Aalborg University , Aalborg East , Denmark
| | - Simon Kristoffer Johansen
- Department of Clinical Medicine , Center for General Practice at Aalborg University, Aalborg University , Aalborg East , Denmark
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Antel R, Abbasgholizadeh-Rahimi S, Guadagno E, Harley JM, Poenaru D. The use of artificial intelligence and virtual reality in doctor-patient risk communication: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:3038-3050. [PMID: 35725526 DOI: 10.1016/j.pec.2022.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 05/14/2023]
Abstract
OBJECTIVES While the development of artificial intelligence (AI) and virtual reality (VR) technologies in medicine has been significant, their application to doctor-patient communication is limited. As communicating risk is a challenging, yet essential, component of shared decision-making (SDM) in surgery, this review aims to explore the current use of AI and VR in doctor-patient surgical risk communication. METHODS The search strategy was prepared by a medical librarian and run in 7 electronic databases. Articles were screened by a single reviewer. Included articles described the use of AI or VR applicable to surgical risk communication between patients, their families, and the surgical team. RESULTS From 4576 collected articles, 64 were included in this review. Identified applications included decision support tools (15, 23.4%), tailored patient information resources (13, 20.3%), treatment visualization tools (17, 26.6%) and communication training platforms (19, 29.7%). Overall, these technologies enhance risk communication and SDM, despite heterogeneity in evaluation methods. However, improvements in the usability and versatility of these interventions are needed. CONCLUSIONS There is emerging literature regarding applications of AI and VR to facilitate doctor-patient surgical risk communication. PRACTICE IMPLICATIONS AI and VR hold the potential to personalize doctor-patient surgical risk communication to individual patients and healthcare contexts.
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Affiliation(s)
- Ryan Antel
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
| | - Samira Abbasgholizadeh-Rahimi
- Department of Family Medicine, McGill University, Montreal, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Electrical and Computer Engineering Department, McGill University, Montreal, Canada.
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center and McGill University, Montreal, Canada.
| | - Jason M Harley
- Department of Experimental Surgery, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Canada; Institute for Health Sciences Education, McGill University, Montreal, Canada.
| | - Dan Poenaru
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center and McGill University, Montreal, Canada.
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