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Bechthold AC, McIlvennan CK, Matlock DD, Ejem DB, Wells RD, LeJeune J, Bakitas MA, Odom JN. "When I do have some time, rather than spend it polishing silver, I want to spend it with my grandkids": a qualitative exploration of patient values following left ventricular assist device implantation. BMC Palliat Care 2024; 23:128. [PMID: 38778297 PMCID: PMC11110360 DOI: 10.1186/s12904-024-01454-y] [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: 02/13/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Values are broadly understood to have implications for how individuals make decisions and cope with serious illness stressors, yet it remains uncertain how patients and their family and friend caregivers discuss, reflect upon, and act on their values in the post-left ventricular assist device (LVAD) implantation context. This study aimed to explore the values elicitation experiences of patients with an LVAD in the post-implantation period. METHODS Qualitative descriptive study of LVAD recipients. Socio-demographics and patient resource use were analyzed using descriptive statistics and semi-structured interview data using thematic analysis. Adult (> 18 years) patients with an LVAD receiving care at an outpatient clinic in the Southeastern United States. RESULTS Interviewed patients (n = 27) were 30-76 years, 59% male, 67% non-Hispanic Black, 70% married/living with a partner, and 70% urban-dwelling. Three broad themes of patient values elicitation experiences emerged: 1) LVAD implantation prompts deep reflection about life and what is important, 2) patient values are communicated in various circumstances to convey personal goals and priorities to caregivers and clinicians, and 3) patients leverage their values for strength and guidance in navigating life post-LVAD implantation. LVAD implantation was an impactful experience often leading to reevaluation of patients' values; these values became instrumental to making health decisions and coping with stressors during the post-LVAD implantation period. Patient values arose within broad, informal exchanges and focused, decision-making conversations with their caregiver and the healthcare team. CONCLUSIONS Clinicians should consider assessing the values of patients post-implantation to facilitate shared understanding of their goals/priorities and identify potential changes in their coping.
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Affiliation(s)
- Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South NB 350, Birmingham, AL, 35294, USA.
| | - Colleen K McIlvennan
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel D Matlock
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Deborah B Ejem
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South NB 350, Birmingham, AL, 35294, USA
| | - Rachel D Wells
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South NB 350, Birmingham, AL, 35294, USA
| | - Jesse LeJeune
- Cardiology Clinic, UAB Hospital, Birmingham, AL, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South NB 350, Birmingham, AL, 35294, USA
| | - J Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South NB 350, Birmingham, AL, 35294, USA
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Schuttner L, Lee JR, Hockett Sherlock S, Ralston JD, Rosland AM, Nelson K, Simons C, Sayre GG. Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative Study. Risk Manag Healthc Policy 2022; 15:2135-2146. [PMID: 36415219 PMCID: PMC9675988 DOI: 10.2147/rmhp.s380021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The prevalence of patients with multimorbidity (ie, multiple chronic conditions) is increasing. Clinical decision-making guided by patients' values, health priorities and goals, and treatment preferences is particularly important in the context of interacting diseases and psychosocial needs. Physicians face challenges incorporating patient perspectives into care plans. We examined primary care physician (PCP) views on the influence of patients' values, health priorities and goals, and preferences on clinical decisions for patients with multimorbidity and increased psychosocial complexity. Methods We conducted semi-structured telephone interviews with 23 PCPs within patient-centered medical home teams in a nationally integrated health system in the United States between May and July 2020. Data were analyzed via thematic analysis with deductive and inductive coding. Results Three major themes emerged: 1. Patient personal values were rarely explicitly discussed in routine clinical encounters but informed more commonly discussed concepts of patient priorities, goals, and preferences; 2. Patient values, health priorities and goals, and preferences were sources of divergent views about care plans between healthcare teams, patients, and families; 3. Physicians used explicit strategies to communicate and negotiate about patient values, health priorities and goals, and preferences when developing care plans, including trust-building; devoting extra effort to individualizing care; connecting patient values to healthcare recommendations; deliberate elicitation and acknowledgement of patient concerns; providing "space" for patient perspectives; incorporating family into care planning; pairing physician to patient priorities; and collaborative teamwork. Conclusion Primary care physicians perceive patient values, health priorities and goals, and preferences as influential during clinical decision-making for complex patients with multimorbidity. Participants used concrete strategies to negotiate alignment of these aspects when physician-patient divergence occurred. While rarely discussed directly in clinical encounters, personal values affected patient health priorities, goals, and preferences during care planning, suggesting a clinical role for more deliberate elicitation and discussion of patient values for this population.
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Affiliation(s)
- Linnaea Schuttner
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jenney R Lee
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Stacey Hockett Sherlock
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, VA Iowa City Health Care System, Iowa City, IA, USA
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karin Nelson
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Carol Simons
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - George G Sayre
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
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Bechthold AC, Montgomery AP, Fazeli PL, Dionne-Odom JN. Values elicitation among adults making health-related decisions: A concept analysis. Nurs Forum 2022; 57:885-892. [PMID: 35430733 DOI: 10.1111/nuf.12730] [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: 10/29/2021] [Revised: 02/21/2022] [Accepted: 04/03/2022] [Indexed: 06/14/2023]
Abstract
AIM To conduct a concept analysis of values elicitation in the context of health care and treatment decision-making and formulate a conceptual definition. BACKGROUND Values elicitation is a commonly cited term for an activity to help patients identify values and evaluate their application in health care decision-making, yet it remains ambiguous and difficult to differentiate from similar concepts. DESIGN Concept analysis. DATA SOURCE Three databases, including PubMed, CINAHL Plus, and Scopus, were searched from inception to February 2021. REVIEW METHODS Walker and Avant's eight-stage method was used to identify attributes, cases, antecedents, consequences, and empirical referents and formulate a conceptual definition. RESULTS The concept analysis identified 3 attributes, 10 consequences, 7 antecedents, and 3 empirical referents. Our analysis defines values elicitation as an intentional process whereby individuals explore their core beliefs, alone or with others, to (1) determine their preference, or a lack thereof, between health or treatment options, and (2) frame decisions. CONCLUSIONS The findings have the potential to influence the identification, discussion, and measurement of values elicitation by nurses and researchers across disciplines. Further exploration of this concept is warranted as the literature continues to emerge.
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Affiliation(s)
- Avery C Bechthold
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aoyjai P Montgomery
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rutjes H, Willemsen MC, Feijt MA, IJsselsteijn WA. The Influence of Personal Health Data on the Health Coaching Process. Front Big Data 2022; 5:678061. [PMID: 35774853 PMCID: PMC9237329 DOI: 10.3389/fdata.2022.678061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/29/2022] [Indexed: 12/01/2022] Open
Abstract
Tracking health data, for example, through wearable devices or health apps, is increasingly commonplace. Consequently, health coaches (e.g., personal trainers, dieticians) are facing growing numbers of clients who bring their data to the clinic. These data potentially add value to the coaching process, for example, by showing more objective and specific information on clients' behaviors. However, in practice, it turns out to be hard to effectively utilize health data in a coaching setting, and it is not yet fully understood how data affect the coaching process and the coach-client communication. We organized a workshop (12 coaches, 3 clients) and a field study (5 coaches, 6 clients), where we observed coach-client interactions enriched with data. By including both familiar and unfamiliar coach-client pairs, as well as alternating the timing of the data presented (i.e., at the beginning, or halfway through the session), we acquired a variety of data-driven coaching interactions and analyzed this using a mixture of qualitative and quantitative methods. Our results show that data are not “plug-and-play.” There is an extensive process of interpreting and contextualizing data, in which the client has a key role, which is essential to gain relevant and actionable insights from the data useful to the coaching process. We also observed that data affect the coach-client communication on both content and relationship levels. We will reflect on these insights in terms of design recommendations for wearable tracking devices and e-health technology to effectively support health coaches and their interactions with their clients.
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Cruz-Martínez RR, Wentzel J, Bente BE, Sanderman R, van Gemert-Pijnen JE. Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis. JMIR Cardio 2021; 5:e31985. [PMID: 34855608 PMCID: PMC8686487 DOI: 10.2196/31985] [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: 07/12/2021] [Revised: 08/16/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients' fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. OBJECTIVE This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. METHODS Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. RESULTS In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients' values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. CONCLUSIONS Positively, existing eHealth technologies could be connected with CVD patients' values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions.
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Affiliation(s)
- Roberto Rafael Cruz-Martínez
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,Department of Health and Social Studies, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Britt Elise Bente
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,General Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
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Houben M, Brankaert R, Kenning G, Eggen B, Bongers I. The Perspectives of Professional Caregivers on Implementing Audio-Based Technology in Residential Dementia Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176333. [PMID: 32878116 PMCID: PMC7504695 DOI: 10.3390/ijerph17176333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 02/04/2023]
Abstract
Music and familiar everyday sounds can be meaningful for people with dementia by providing benefits such as evoking memories and emotions or prompting social interactions with caregivers or relatives. Motivated by this potential, researchers and designers are investigating how to leverage these beneficial effects of sound in care environments through audio-based technology. However, there is a gap in the knowledge of how audio-based technology can be successfully implemented within everyday care practice. In this paper, we present the outcome of three participatory workshops with 18 professional caregivers to explore how audio-based technology can add value to existing care processes and activities in residential dementia care. During the participatory workshops, professional caregivers (1) mapped existing care activities; (2) linked findings in research with practice, and (3) designed scenarios for the Vita sound cushion. Care professionals indicate how audio-based technology can support existing care practice by influencing the mood of residents and by supporting social interaction during moments of care, daytime activities, or situational sessions. This study bridges research findings with insights from practice, contributing to a shared understanding of opportunities for embedding audio-based technology in dementia care. These opportunities motivate future research to implement and evaluate audio-based technology in residential dementia care.
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Affiliation(s)
- Maarten Houben
- Department of Industrial Design, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (R.B.); (B.E.)
- Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands;
- Correspondence:
| | - Rens Brankaert
- Department of Industrial Design, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (R.B.); (B.E.)
- School for Allied Health Professions, Fontys University of Applied Sciences, 5600 AH Eindhoven, The Netherlands
| | - Gail Kenning
- Ageing Futures Institute, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Berry Eggen
- Department of Industrial Design, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (R.B.); (B.E.)
| | - Inge Bongers
- Tranzo, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands;
- Mental Healthcare Institute Eindhoven, 5626 ND Eindhoven, The Netherlands
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Berry ABL, Lim CY, Hartzler AL, Hirsch T, Ludman E, Wagner EH, Ralston JD. "It's good to know you're not a stranger every time". ACTA ACUST UNITED AC 2017. [DOI: 10.1145/3134658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Catherine Y. Lim
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Andrea L. Hartzler
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Tad Hirsch
- University of Washington, Seattle, WA, USA
| | - Evette Ludman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Edward H. Wagner
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - James D. Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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