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Marfo E, Salami B, Adjei C, MacDonald S. Human papillomavirus (HPV) vaccination in a privately funded program in Ghana: A qualitative case study. Hum Vaccin Immunother 2024; 20:2397219. [PMID: 39255822 PMCID: PMC11404574 DOI: 10.1080/21645515.2024.2397219] [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: 05/25/2024] [Revised: 08/09/2024] [Accepted: 08/23/2024] [Indexed: 09/12/2024] Open
Abstract
HPV vaccination is one of the safest and most effective interventions against HPV-related cancers. From 2013 to 2018, HPV vaccination was piloted in Ghana in preparation for a national program. Yet, at the time of this study, there was no publicly funded HPV vaccination program in Ghana. We explored an existing privately funded HPV vaccination program in Ghana to identify challenges and gaps and to gather insights to inform vaccination practice and national policy. This study used a qualitative case study research design. We conducted semi-structured interviews on experiences, barriers, and challenges in HPV vaccination at the Greater-Accra Regional Hospital between October 1 and November 26, 2023. Participants (N = 16) included HPV vaccinators (n = 8) and program/policy leaders (n = 8). Our thematic analysis focused on HPV vaccination processes, practice challenges, and policy interests. Four main themes emerged from our analyses. Our findings revealed many challenges faced by the HPV vaccination program. These include a lack of guiding policy/framework for the HPV vaccination program, an emphasis on sexual history, cervical screening, and HPV DNA test in determining vaccination eligibility by vaccinators, and a lack of formal provider and recipient HPV education programs. Although many vaccinators advocated for a universal HPV program, some policy/program leaders were reluctant to prioritize HPV vaccination advocacy due to their focus on acute health concerns. A vaccination program without a policy can be limited in quality and efficiency, as there will be no accountability and sustainability measures. We recommend the need to develop standardized guidelines to support evidence-based HPV vaccination practice.
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Affiliation(s)
- Emmanuel Marfo
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Bukola Salami
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Charles Adjei
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
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Chae S, Bae J, Youn N, Lopez KD, Sutamtewagul G, Rakel B. Agreement between patient-reported and clinically documented symptoms of acute myeloid leukemia: Study protocol. J Adv Nurs 2024. [PMID: 38969361 DOI: 10.1111/jan.16320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/19/2024] [Indexed: 07/07/2024]
Abstract
AIM To describe our methods to compare patient-reported symptoms of acute myeloid leukemia and the corresponding documentation by healthcare providers in the electronic health record. BACKGROUND Patients with acute myeloid leukemia experience many distressing symptoms, particularly related to chemotherapy. The timely recognition and provision of evidence-based interventions to manage these symptoms can improve outcomes. However, lack of standardized formatting for symptom documentation within electronic health records leads to challenges for clinicians when accessing and comprehending patients' symptom information, as it primarily exists in narrative forms in various parts of the electronic health record. This variability raises concerns about over- or under-reporting of symptoms. Consistency between patient-reported symptoms and clinician's symptom documentation is important for patient-centered symptom management, but little is known about the degree of agreement between patient reports and their documentation. This is a detailed description of the study's methodology, procedures and design to determine how patient-reported symptoms are similar or different from symptoms documented in electronic health records by clinicians. DESIGN Exploratory, descriptive study. METHODS Forty symptoms will be assessed as patient-reported outcomes using the modified version of the Memorial Symptom Assessment Scale. The research team will annotate symptoms from the electronic health record (clinical notes and flowsheets) corresponding to the 40 symptoms. The degree of agreement between patient reports and electronic health record documentation will be analyzed using positive and negative agreement, kappa statistics and McNemar's test. CONCLUSION We present innovative methods to comprehensively compare the symptoms reported by acute myeloid leukemia patients with all available electronic health record documentation, including clinical notes and flowsheets, providing insights into symptom reporting in clinical practice. IMPACT Findings from this study will provide foundational understanding and compelling evidence, suggesting the need for more thorough efforts to assess patients' symptoms. Methods presented in this paper are applicable to other symptom-intensive diseases.
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Affiliation(s)
- Sena Chae
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Jaewon Bae
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Nayung Youn
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Karen Dunn Lopez
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Grerk Sutamtewagul
- Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Barbara Rakel
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
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Cooper AL, Albrecht MA, Kelly S, Eccles SP, Brown JA. A pre-post interventional study to reduce time spent on clinical documentation by nurses and midwives. J Adv Nurs 2024; 80:1452-1463. [PMID: 37983743 DOI: 10.1111/jan.15931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
AIM To evaluate the impact of a co-designed intervention to reduce time spent on clinical documentation and increase time for direct patient care. DESIGN A pre- and post-test interventional study with multi-method evaluation, reported according to the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs guidelines. METHODS An intervention to decrease the burden of documentation was co-designed and implemented. Pre- and post-intervention data were collected via time and motion studies and the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey. Documentation audits were conducted to assess intervention fidelity. RESULTS Twenty-six shifts were observed (13 pre-intervention, 13 post-intervention). Although the coronavirus pandemic contributed to decreases in staffing levels by 38% (from 118 to 73 staff), the number of task episodes completed increased post-intervention, across all shift patterns. Documentation took less time to complete post-intervention when assessing time per episode. A mean increase of 201 episodes was observed on morning shifts, 78 on evening shifts and 309 on night shifts. There were small increases for time spent on direct patient care compared to pre-intervention but there was less time per episode. Results from the BurDoNsaM survey indicated that participants felt documentation took less time post-intervention. Documentation audits found completion improved as staff gained familiarity, but deteriorated when staffing levels were reduced. CONCLUSION The intervention was able to reduce time spent completing documentation, increasing the time available for direct patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Completing clinical documentation is part of the daily work of nurses and midwives. Clinical documentation needs to accurately capture key information in a concise and streamlined manner to avoid unnecessary burdens and release time for direct patient care. IMPACT This study tested a co-designed intervention to address the burden of clinical documentation for nurses and midwives, The intervention reduced time spent on clinical documentation and increased time for direct patient care, This study could be replicated to reduce the burden of clinical documentation in other settings and benefit clinicians and patients by releasing more time for direct patient care. REPORTING METHOD The study is reported using the Transparent Reporting of Evaluations with Nonrandomised Evaluations Designs (TREND) guidelines. PATIENT OR PUBLIC CONTRIBUTION The research project and intervention evaluated in this study were co-designed through a clinician-researcher collaboration. A research team that consisted of clinically based nurses and midwives and nurse scientists was formed to address the burden of clinical documentation. As the end-users of clinical documentation, the clinically based nurse and midwife co-investigators were involved in the design, conduct, interpretation of the data, and preparation of the manuscript.
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Affiliation(s)
- Alannah L Cooper
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Matthew A Albrecht
- School of Nursing, Curtin University, Bentley, Western Australia, Australia
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
- Western Australian Centre for Road Safety Research, School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Suzanne Kelly
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Siobhan P Eccles
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Janie A Brown
- School of Nursing, Curtin University, Bentley, Western Australia, Australia
- St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia
- The Western Australian Group for Evidence Informed Healthcare Practice, Curtin University, Perth, Western Australia, Australia
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Moy AJ, Withall J, Hobensack M, Yeji Lee R, Levy DR, Rossetti SC, Rosenbloom ST, Johnson K, Cato K. Eliciting Insights From Chat Logs of the 25X5 Symposium to Reduce Documentation Burden: Novel Application of Topic Modeling. J Med Internet Res 2023; 25:e45645. [PMID: 37195741 PMCID: PMC10233429 DOI: 10.2196/45645] [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: 01/11/2023] [Revised: 03/03/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Addressing clinician documentation burden through "targeted solutions" is a growing priority for many organizations ranging from government and academia to industry. Between January and February 2021, the 25 by 5: Symposium to Reduce Documentation Burden on US Clinicians by 75% (25X5 Symposium) convened across 2 weekly 2-hour sessions among experts and stakeholders to generate actionable goals for reducing clinician documentation over the next 5 years. Throughout this web-based symposium, we passively collected attendees' contributions to a chat functionality-with their knowledge that the content would be deidentified and made publicly available. This presented a novel opportunity to synthesize and understand participants' perceptions and interests from chat messages. We performed a content analysis of 25X5 Symposium chat logs to identify themes about reducing clinician documentation burden. OBJECTIVE The objective of this study was to explore unstructured chat log content from the web-based 25X5 Symposium to elicit latent insights on clinician documentation burden among clinicians, health care leaders, and other stakeholders using topic modeling. METHODS Across the 6 sessions, we captured 1787 messages among 167 unique chat participants cumulatively; 14 were private messages not included in the analysis. We implemented a latent Dirichlet allocation (LDA) topic model on the aggregated dataset to identify clinician documentation burden topics mentioned in the chat logs. Coherence scores and manual examination informed optimal model selection. Next, 5 domain experts independently and qualitatively assigned descriptive labels to model-identified topics and classified them into higher-level categories, which were finalized through a panel consensus. RESULTS We uncovered ten topics using the LDA model: (1) determining data and documentation needs (422/1773, 23.8%); (2) collectively reassessing documentation requirements in electronic health records (EHRs) (252/1773, 14.2%); (3) focusing documentation on patient narrative (162/1773, 9.1%); (4) documentation that adds value (147/1773, 8.3%); (5) regulatory impact on clinician burden (142/1773, 8%); (6) improved EHR user interface and design (128/1773, 7.2%); (7) addressing poor usability (122/1773, 6.9%); (8) sharing 25X5 Symposium resources (122/1773, 6.9%); (9) capturing data related to clinician practice (113/1773, 6.4%); and (10) the role of quality measures and technology in burnout (110/1773, 6.2%). Among these 10 topics, 5 high-level categories emerged: consensus building (821/1773, 46.3%), burden sources (365/1773, 20.6%), EHR design (250/1773, 14.1%), patient-centered care (162/1773, 9.1%), and symposium comments (122/1773, 6.9%). CONCLUSIONS We conducted a topic modeling analysis on 25X5 Symposium multiparticipant chat logs to explore the feasibility of this novel application and elicit additional insights on clinician documentation burden among attendees. Based on the results of our LDA analysis, consensus building, burden sources, EHR design, and patient-centered care may be important themes to consider when addressing clinician documentation burden. Our findings demonstrate the value of topic modeling in discovering topics associated with clinician documentation burden using unstructured textual content. Topic modeling may be a suitable approach to examine latent themes presented in web-based symposium chat logs.
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Affiliation(s)
- Amanda J Moy
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Jennifer Withall
- School of Nursing, Columbia University, New York, NY, United States
| | - Mollie Hobensack
- School of Nursing, Columbia University, New York, NY, United States
| | - Rachel Yeji Lee
- School of Nursing, Columbia University, New York, NY, United States
| | - Deborah R Levy
- School of Medicine, Yale University, New Haven, CT, United States
- Veteran's Affairs Connecticut Health Care System, Pain, Research, Informatics, Multi-morbidities Education Center, West Haven, CT, United States
| | - Sarah C Rossetti
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
- School of Nursing, Columbia University, New York, NY, United States
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, United States
| | - Kevin Johnson
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Kenrick Cato
- School of Nursing, Columbia University, New York, NY, United States
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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