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Munch L, Stensgaard S, Feinberg MB, Elwyn G, Lomborg K. Evaluating the effect of Conversation Cards on agenda-setting in annual diabetes status visits: A multi-method study. PATIENT EDUCATION AND COUNSELING 2024; 119:108084. [PMID: 38029577 DOI: 10.1016/j.pec.2023.108084] [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: 07/13/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To evaluate Conversation Cards for shared agenda-setting between patients and nurses in status visits for type 2 diabetes. METHODS Non-randomized comparison of survey responses between intervention and control groups. Content analysis of interview data of patient experiences from a purposive sample of the intervention group. RESULTS The survey included 52 patients in the intervention and 55 in the control group. Survey data showed no significant differences between the groups. Regardless of the intervention, patients experienced that topics relevant to them were addressed. One in four patients rated the Conversation Cards as very supportive. Interview data indicated that the Conversation Cards added structure, commitment to the conversation, and support to raise topics not previously considered diabetes related. CONCLUSION Topics of concern were addressed in both intervention and control groups. The Conversation Cards for agenda-setting clarified a mutually agreed structure of the conversation, eased raising hitherto ignored topics, and increased engagement. PRACTICE IMPLICATIONS The Conversation Cards have potential to improve shared agenda-setting, but implementation requires efforts from both parties. Patients are expected to consider their concerns and take an active part in agenda-setting. Nurses are expected to collaborate with the patient in the agenda-setting, which might challenge the nurses' habitual practice.
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Affiliation(s)
- Lene Munch
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark.
| | - Sebrina Stensgaard
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Mie Buron Feinberg
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kirsten Lomborg
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Wyld K, Hendrieckx C, Griffin A, Barrett H, D'Silva N. Agenda-setting by young adults with type 1 diabetes and associations with emotional well-being/social support: results from an observational study. Intern Med J 2023; 53:1347-1355. [PMID: 36008367 DOI: 10.1111/imj.15919] [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: 01/20/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Diabetes Psychosocial Assessment Tool (DPAT) was developed to assess the psychosocial well-being of young adults with type 1 diabetes in clinical practice. The DPAT includes three validated questionnaires (assessing diabetes distress, anxiety/depressive symptoms and emotional well-being) and an agenda-setting tool. It is currently used by the Queensland Statewide Diabetes Clinical Network (available at Clinical Excellence Queensland). AIMS To describe agenda items set by young adults with type 1 diabetes and investigate their association with emotional well-being/social support. METHODS The DPAT was completed by young adults attending routine diabetes outpatient appointments at the Mater Hospital (Brisbane) between November 2016 and January 2020. For the current analysis, data included responses on agenda-setting and outcomes from three validated questionnaires. RESULTS Responses of 277 young adults (15-26 years) were analysed. Ninety-four (34%) reported one to three agenda item(s). Common agenda items were diabetes technology and medications, but other topics raised included pregnancy, body image and eating concerns. Participants with moderate diabetes distress or anxiety symptoms were more likely to list at least one agenda item (P = 0.006; P = 0.002), as were females and older participants. CONCLUSION Several agenda items for young adults with type 1 diabetes were identified and were more likely to be raised by those with elevated diabetes distress and anxiety symptoms. The DPAT is a valuable and convenient tool that can be easily applied in routine clinical practice to enable clinicians to understand the concerns of the young adult population and deliver personalised medicine to optimise long-term outcomes.
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Affiliation(s)
- Katherine Wyld
- Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Brisbane, Queensland, Australia
| | - Christel Hendrieckx
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Alison Griffin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Helen Barrett
- Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Neisha D'Silva
- Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Brisbane, Queensland, Australia
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Lomborg K, Munch L, Krøner FH, Elwyn G. "Less is more": A design thinking approach to the development of the agenda-setting conversation cards for people with type 2 diabetes. PEC INNOVATION 2022; 1:100097. [PMID: 37213776 PMCID: PMC10194191 DOI: 10.1016/j.pecinn.2022.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 05/23/2023]
Abstract
Objectives To report a design-thinking approach to a user-centred agenda-setting tool for use in type 2 diabetes clinics. Methods The study followed design-thinking phases: emphasizing, defining, and ideating an intervention, followed by iterative user-testing of prototypes. It was conducted at a Danish diabetes center using observations, interviews, workshops, focus groups, and questionnaires. Results Nurses wanted to put more emphasis on agenda-setting in status visits. During brainstorms the idea of using illustrated cards that listed key agenda topics was proposed and became the goal of this research. Adopting a design-thinking approach provided the basis for developing prototypes for iterative user-testing that led to a version that was acceptable to stakeholders. The resulting tool, Conversation Cards, was a set of cards that listed and illustrated seven key topics that were considered important to consider during diabetes status visits. Conclusion The goal of the Conversation Card intervention is to support collaborative agenda-setting in diabetes status visits. Further evaluation is needed to determine the utility and acceptability of the tool to nurses and to people with diabetes in routine settings. Innovation This novel tool is designed to trigger agenda-setting conversations and thereby prioritize individuals' choice of topics to talk about during diabetes status visits.
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Affiliation(s)
- Kirsten Lomborg
- Department of Clinical Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Lene Munch
- Department of Clinical Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Freja Holmberg Krøner
- Department of Clinical Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
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Zafra‐Tanaka JH, Beran D, Bernabe‐Ortiz A. Health system responses for type 1 diabetes: A scoping review. Diabet Med 2022; 39:e14805. [PMID: 35124856 PMCID: PMC9306957 DOI: 10.1111/dme.14805] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
AIMS The focus of health system interventions for noncommunicable diseases and diabetes focus mainly on primary health care responses. However, existing interventions are not necessarily adapted for the complex management of type 1 diabetes (T1DM). We aimed to identify and describe health system interventions which have been developed to improve the management of T1DM globally. METHODS We conducted a scoping review by searching MEDLINE, Embase, and Global Health using OVID for peer-review articles published in either English, Spanish, Portuguese or French in the last 10 years. We classified the intervention strategies according to the Effective Practice and Organization of Care (EPOC) taxonomy for health system interventions and the World Health Organization (WHO) health system building blocks. RESULTS This review identified 159 health system interventions to improve T1DM management. Over half of the studies focused only on children or adolescents with type 1 diabetes. Only a small fraction of the studies were conducted in low-and-middle income countries (LMICs). According to the EPOC taxonomy, the most frequently studied category was delivery arrangement interventions, while implementation strategies and financial arrangements were less frequently studied. Also, governance arrangements domains were not studied. The most common combination of intervention strategies included self-management with either telemedicine, use of information and smart home technologies. CONCLUSIONS There is a need to expand potential interventions to other EPOC strategies to assess their potential effect on health outcomes in people with T1DM, as well as to involve more LMIC settings as the impact may be greater in these settings.
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Affiliation(s)
- Jessica H. Zafra‐Tanaka
- CRONICAS Center of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Division of Tropical and Humanitarian MedicineUniversity of Geneva and Geneva University HospitalsGenevaSwitzerland
| | - David Beran
- Division of Tropical and Humanitarian MedicineUniversity of Geneva and Geneva University HospitalsGenevaSwitzerland
| | - Antonio Bernabe‐Ortiz
- CRONICAS Center of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Universidad Científica del SurLimaPeru
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Robinson TD, Pollard T, Sarver WL. Examining the Use of Web-Based Health Education and Information Among Ambulatory Care Clinic Diabetic Patients. J Ambul Care Manage 2022; 45:55-62. [PMID: 34524176 DOI: 10.1097/jac.0000000000000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Web-based health education provides access to information and better coordination of care. Demographic and geographical factors may impact use and effectiveness of these services. The purpose of this study was to identify factors associated with use of web-based health education programs among diabetic patients at ambulatory clinics of a safety-net hospital. This was a retrospective chart review. Total sample size was 300. Patients who completed a web-based video were younger, Caucasian, living outside inner city core, users of patient portal, and more likely to complete annual diabetic eye examination. Web-based education may empower patients to manage health conditions and improve health outcomes. Health care organizations must consider barriers to use of these tools.
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Jimenez G, Tyagi S, Osman T, Spinazze P, van der Kleij R, Chavannes NH, Car J. Improving the Primary Care Consultation for Diabetes and Depression Through Digital Medical Interview Assistant Systems: Narrative Review. J Med Internet Res 2020; 22:e18109. [PMID: 32663144 PMCID: PMC7486669 DOI: 10.2196/18109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/10/2020] [Accepted: 04/27/2020] [Indexed: 12/27/2022] Open
Abstract
Background Digital medical interview assistant (DMIA) systems, also known as computer-assisted history taking (CAHT) systems, have the potential to improve the quality of care and the medical consultation by exploring more patient-related aspects without time constraints and, therefore, acquiring more and better-quality information prior to the face-to-face consultation. The consultation in primary care is the broadest in terms of the amount of topics to be covered and, at the same time, the shortest in terms of time spent with the patient. Objective Our aim is to explore how DMIA systems may be used specifically in the context of primary care, to improve the consultations for diabetes and depression, as exemplars of chronic conditions. Methods A narrative review was conducted focusing on (1) the characteristics of the primary care consultation in general, and for diabetes and depression specifically, and (2) the impact of DMIA and CAHT systems on the medical consultation. Through thematic analysis, we identified the characteristics of the primary care consultation that a DMIA system would be able to improve. Based on the identified primary care consultation tasks and the potential benefits of DMIA systems, we developed a sample questionnaire for diabetes and depression to illustrate how such a system may work. Results A DMIA system, prior to the first consultation, could aid in the essential primary care tasks of case finding and screening, diagnosing, and, if needed, timely referral to specialists or urgent care. Similarly, for follow-up consultations, this system could aid with the control and monitoring of these conditions, help check for additional health issues, and update the primary care provider about visits to other providers or further testing. Successfully implementing a DMIA system for these tasks would improve the quality of the data obtained, which means earlier diagnosis and treatment. Such a system would improve the use of face-to-face consultation time, thereby streamlining the interaction and allowing the focus to be the patient's needs, which ultimately would lead to better health outcomes and patient satisfaction. However, for such a system to be successfully incorporated, there are important considerations to be taken into account, such as the language to be used and the challenges for implementing eHealth innovations in primary care and health care in general. Conclusions Given the benefits explored here, we foresee that DMIA systems could have an important impact in the primary care consultation for diabetes and depression and, potentially, for other chronic conditions. Earlier case finding and a more accurate diagnosis, due to more and better-quality data, paired with improved monitoring of disease progress should improve the quality of care and keep the management of chronic conditions at the primary care level. A somewhat simple, easily scalable technology could go a long way to improve the health of the millions of people affected with chronic conditions, especially if working in conjunction with already-established health technologies such as electronic medical records and clinical decision support systems.
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Affiliation(s)
- Geronimo Jimenez
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Tarig Osman
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Pier Spinazze
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Frost J, Gibson A, Ukoumunne O, Vaidya B, Britten N. Does a simple web-based intervention facilitate the articulation of patients' unvoiced agenda for a consultation with their diabetologists? A qualitative study. BMJ Open 2019; 9:e026588. [PMID: 31203240 PMCID: PMC6588975 DOI: 10.1136/bmjopen-2018-026588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To explore whether a preconsultation web-based intervention enables patients with diabetes to articulate their agenda in a consultation in the hospital outpatient clinic with their diabetologist. METHODS AND DESIGN A qualitative study embedded in a pragmatic pilot randomised controlled trial. SETTING Two city outpatient departments in England. PARTICIPANTS 25 patients attending a follow-up consultation and 6 diabetologists. INTERVENTION The PACE-D, a web-based tool adapted for patients with diabetes to use before their consultation to generate an agenda of topics to discuss with their diabetologist. DATA COLLECTION 25 participants had their consultation with their diabetologist audio-recorded: 12 in the control arm and 13 in the intervention arm; 12 of the latter also had their PACE-D intervention session and a consultation recorded. Semi-structured interviews with 6 diabetologists, and 12 patients (6 in the intervention group and 6 in the control group). ANALYSIS Thematic discourse analysis undertaken with patient representatives trained in qualitative data analysis techniques. RESULTS We identified four consultation types: diabetologist facilitated; patient identified; consultant facilitated and patient initiated and patient ignored. We also identified three critical aspects that explained the production and utilisation of the agenda form: existing consultative style; orientation to the use of the intervention and impact on the consultation. Where patients and diabetologists have a shared preference for a consultant-led or patient-led consultation, the intervention augments effective communication and shared decision making. However, where preferences diverge (eg, there is a mismatch in patients' and diabetologists' preferences and orientations), the intervention does not improve the potential for shared decision making. CONCLUSION A simple web-based intervention facilitates the articulation of patients' unvoiced agenda for a consultation with their diabetologist, but only when pre-existing consultation styles and orientations already favour shared decision making. More needs to be done to translate patient empowerment in the consultation setting into genuine self-efficacy. TRIAL REGISTRATION NUMBER ISRCTN75070242.
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Affiliation(s)
- Julia Frost
- Medical School, University of Exeter, Exeter, UK
| | - Andy Gibson
- Health and Social Sciences, University of the West of England, Bristol, Bristol, UK
| | - Obioha Ukoumunne
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Bijay Vaidya
- Macleod Diabetes Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Institute for Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Nicky Britten
- Institute for Health Service Research, University of Exeter Medical School, Exeter, UK
- PenCLAHRC: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula, University of Exeter Medical School, Exeter, UK
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Frost J, Gibson A, Harris-Golesworthy F, Harris J, Britten N. Patient involvement in qualitative data analysis in a trial of a patient-centred intervention: Reconciling lay knowledge and scientific method. Health Expect 2018; 21:1111-1121. [PMID: 30073734 PMCID: PMC6250869 DOI: 10.1111/hex.12814] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We conducted a pilot study of an intervention to facilitate patients' agenda setting in clinical consultations. The primary aim of the study was to test the feasibility of running the randomized controlled trial. A secondary objective was to assess the extent to which patient and public involvement (PPI) could contribute to the process of qualitative data analysis (QDA). AIMS To describe a novel approach to including patient partners in QDA; to illustrate the kinds of contribution that patient partners made to QDA in this context; and to propose a characterization of a process by which patient involvement can contribute to knowledge production. METHODS Six patient and public representatives were supported to contribute to data analysis via a range of modalities. During a series of QDA workshops, experienced research staff role-played consultations and interviews, and provided vignettes. Workshop data and PPI diaries were analysed using thematic discourse analysis. RESULTS We characterized a process of thesis, antithesis and synthesis. This PPI group contributed to the rigour and validity of the study findings by challenging their own and the researchers' assumptions, and by testing the emerging hypotheses. By training PPI representatives to undertake qualitative data analysis, we transformed our understanding of doctor-patient consultations. CONCLUSIONS This research required changes to our usual research practices but was in keeping with the objective of establishing meaningful patient involvement for a future definitive trial. This work was informed by concepts of critical humility, and a process of knowledge production enabled via the construction of a knowledge space.
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Affiliation(s)
- Julia Frost
- University of Exeter Medical School, Exeter, UK
| | - Andy Gibson
- Department of Health and Social Sciences, University of West England, Bristol, UK
| | | | - Jim Harris
- PenCLAHRC Patient and Public Involvement Team, University of Exeter Medical School, Exeter, UK
| | - Nicky Britten
- University of Exeter Medical School, University of Exeter, Exeter, UK
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