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Semchishen SN, Colman I. Mental health services use among learning disabilities: data from a population-based study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02728-9. [PMID: 38985327 DOI: 10.1007/s00127-024-02728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 07/05/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE People with learning disabilities have complex challenges and needs that differ from people without these conditions. Accessing needed health and mental health care may be affected by level of independence and severity of learning challenges. Our study examined factors and associations which impact help seeking and satisfaction with mental health care in a Canadian nationally representative sample. METHODS Logistic regression and multinomial logistic regression was used to analyze the 2012 Canadian Community Health Survey- Mental Health (CCHS 2012) cross-sectional survey. We investigated the odds of distressed individuals (1) perceiving a need for mental health care, (2) seeking out professional mental health care, and (3) if their needs were met by mental health services. The presence of a learning disability was assessed as a moderator variable in all models. RESULTS Distressed adults with learning disabilities did not perceive a need for mental health care as often as distressed adults without a learning disability (OR = 3.82;95%CI:1.64,8.93 vs. OR = 12.00;95%CI:9.19,15.67). Distressed adults with a learning disability weren't as likely to seek out mental health services, but were more satisfied with the mental health care they received as compared to adults without a learning disability. CONCLUSION The findings suggest that adults with learning disabilities have unmet needs. They are less likely to perceive a need for treatment, or to seek treatment, when they are distressed. Future investigation is necessary to understand the factors that influence perceived need and treatment seeking in this under-served population.
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Affiliation(s)
- Seana N Semchishen
- School of Epidemiology and Public Health, University of Ottawa, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
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Dow LA, Kapo J, Boyle F, Shin JA. Framework for Considering Primary and Subspecialty Palliative Care and Guiding Serious Illness Communication for Patients With Breast Cancer. Am Soc Clin Oncol Educ Book 2024; 44:e432554. [PMID: 39018514 DOI: 10.1200/edbk_432554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
Palliative care is a comprehensive approach aimed at enhancing the quality of life of patients and their families living with serious illnesses such as breast cancer. This approach includes assessing and managing pain and other physical symptoms, attending to psychosocial and spiritual aspects of care, fostering effective communication and decision making, and providing support in coordinating care that upholds a person's values and preferences from the time of diagnosis throughout the illness trajectory. This type of care can be provided by palliative care specialists (ideally an interprofessional team) working alongside the oncology team, referred to as subspecialty palliative care. Conversely, the fundamental aspects of this approach, which we sometimes call primary palliative care, are provided by all clinicians caring for patients with breast cancer. Given that access to subspecialty palliative care can vary globally, especially in rural and resource-constrained settings, it is imperative for all oncology clinicians to receive training in the core components of palliative care. This study aims to provide a basic framework to recognize what the core primary palliative care skills are in routine oncology practice, to delineate basic serious illness communication strategies, and to introduce when to consider the integration of subspecialty palliative care into the care of patients with breast cancer.
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Skedsmo K, Bingen HM, Hofsø K, Steindal SA, Hagelin CL, Hilderson D, Nes AAG, Smis D, Stenseth HV, Olaussen C. Postgraduate nursing students' experiences with simulation-based learning in palliative care education: A qualitative study. Nurse Educ Pract 2023; 73:103832. [PMID: 37948917 DOI: 10.1016/j.nepr.2023.103832] [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: 03/21/2023] [Revised: 09/06/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
AIM The aim of this study was to explore postgraduate palliative care nursing students' experiences with simulation-based learning focusing on communication skills, as a learning method in palliative care education. BACKGROUND Communication is one of several important competencies in palliative care and found to be challenging. Developing appropriate communication skills in palliative care requires education and practice. To provide postgraduate palliative care nursing students with the required knowledge and experience, practical and active learning approaches, such as simulation-based learning, can be applied. Several studies have explored undergraduate nursing students' experiences with simulation-based learning in palliative care. However, to our knowledge no studies have explored postgraduate palliative care nursing students` experiences with simulation-based learning focusing on communication skills in palliative care education. DESIGN An exploratory descriptive design. METHODS A qualitative method was employed. Three focus group interviews were conducted in May 2022 using videoconferencing (Zoom) with 11 postgraduate palliative care nursing students, eight of whom wrote reflective notes. Data were analysed using systematic text condensation. RESULTS Three categories were identified in the data analysis: 1) from uncertain expectations to the real experience of simulation-based learning; 2) being a skilled professional in everyday life versus being observed in the scenarios; and 3) the balance between self-confidence and challenges in experiencing professional development and mastery. CONCLUSIONS Postgraduate palliative care nursing students seemed to experience anxiety towards simulation-based learning in palliative care education, as well as variable expectations for the approach. This could be due to their unfamiliarity with the learning method. The need for repetition was underlined and the students indicated that they would like to be able to participate in several simulation sessions to familiarise themselves with the approach. The contrast between being a skilled professional in everyday life and the pressure of being observed and judged in the scenarios was an important finding. Students outlined the desire to feel safe, but also highlighted the importance of being challenged to experience professional development and enhanced mastery. Generally, the findings indicate that academic and psychological safety should be a focus during simulation-based learning and instructors should understand that students may have varied learning strategies, divergent learning experiences and shifting beliefs in their own competencies.
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Affiliation(s)
| | | | - Kristin Hofsø
- Lovisenberg Diaconal University College, Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo, University Hospital, Oslo, Norway
| | - Simen A Steindal
- Institute of nursing, Faculty of Health Studies, VID Specialized University, Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway
| | - Carina Lundh Hagelin
- Department of Health Care Sciences, Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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Hatzikiriakidis K, Ayton D, Skouteris H, Patitsas L, Smith K, Dhulia A, Poon P. A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care. Palliat Med 2023; 37:1079-1099. [PMID: 37448148 DOI: 10.1177/02692163231183007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. AIM The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. DESIGN A rapid umbrella review was conducted and informed by the Joanna Briggs Institute's methodological guidance for conducting umbrella reviews. DATA SOURCES Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. RESULTS A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. CONCLUSIONS This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | | | | | - Peter Poon
- Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Murugesu L, Damman OC, Timmermans DRM, de Wit S, Nieuwenhuijze M, Smets EMA, Fransen MP. Health literate-sensitive shared decision-making in maternity care: needs for support among maternity care professionals in the Netherlands. BMC Pregnancy Childbirth 2023; 23:594. [PMID: 37605153 PMCID: PMC10440871 DOI: 10.1186/s12884-023-05915-9] [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: 02/27/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) in maternity care is challenging when clients have insufficient health literacy (HL) skills. This study gained insight in how professionals apply HL-sensitive SDM in Dutch maternity care and their needs for support therein. METHODS Maternity care professionals (n = 30) completed a survey on SDM and the role of HL. Midwives (n = 13) were observed during simulated conversations discussing pain relief options and interviewed afterwards. The client-actors were instructed to portrait specific inadequate HL skills. Observation items focused on adapting communication to HL, and SDM (OPTION-5). RESULTS In the survey, professionals indicated experiencing most challenges when estimating clients' information comprehension. Observations showed that most midwives created choice awareness and informed clients about options, whereas exploring preferences and actual decision-making together with clients were observed less frequently. Their perceived HL-related obstacles and needs for support related to clients' information comprehension. In the interviews, midwives reported putting much effort into explaining available options in maternity care, but also that decisions about pain relief are often postponed until the moment of labour. CONCLUSION Professionals' self-reported needs focus on clients' information comprehension. However, observations indicate that it is not the stage of informing, but rather value clarification and actual decision-making that need improvement in HL-sensitive SDM.
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Affiliation(s)
- Laxsini Murugesu
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Olga C Damman
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Danielle R M Timmermans
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Sanne de Wit
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Universiteitssingel 60, Maastricht, 6229 ER, the Netherlands
- CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Ellen M A Smets
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands
| | - Mirjam P Fransen
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Singh H, Haghayegh AT, Shah R, Cheung L, Wijekoon S, Reel K, Sangrar R. A qualitative exploration of allied health providers' perspectives on cultural humility in palliative and end-of-life care. BMC Palliat Care 2023; 22:92. [PMID: 37434238 DOI: 10.1186/s12904-023-01214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Cultural factors, including religious or cultural beliefs, shape patients' death and dying experiences, including palliative and end-of-life (EOL) care preferences. Allied health providers must understand their patients' cultural preferences to support them in palliative and EOL care effectively. Cultural humility is a practice which requires allied health providers to evaluate their own values, biases, and assumptions and be open to learning from others, which may enhance cross-cultural interactions by allowing providers to understand patients' perceptions of and preferences for their health, illness, and dying. However, there is limited knowledge of how allied health providers apply cultural humility in palliative and EOL care within a Canadian context. Thus, this study describes Canadian allied health providers' perspectives of cultural humility practice in palliative and EOL care settings, including how they understand the concept and practice of cultural humility, and navigate relationships with patients who are palliative or at EOL and from diverse cultural backgrounds. METHODS In this qualitative interpretive description study, remote interviews were conducted with allied health providers who currently or recently practiced in a Canadian palliative or EOL care setting. Interviews were audio-recorded, transcribed, and analyzed using interpretive descriptive analysis techniques. RESULTS Eleven allied health providers from the following disciplines participated: speech-language pathology, occupational therapy, physiotherapy, and dietetics. Three themes were identified: (1) Interpreting and understanding of cultural humility in palliative and EOL care (i.e., recognizing positionality, biases and preconceived notions and learning from patients); (2) Values, conflicts, and ethical uncertainties when practicing cultural humility at EOL between provider and patient and family, and within the team and constraints/biases within the system preventing culturally humble practices; (3) The 'how to' of cultural humility in palliative and EOL care (i.e., ethical decision-making in palliative and EOL care, complexities within the care team, and conflicts and challenges due to contextual/system-level factors). CONCLUSIONS Allied health providers used various strategies to manage relationships with patients and practice cultural humility, including intra- and inter-personal strategies, and contextual/health systems enablers. Conflicts and challenges they encountered related to cultural humility practices may be addressed through relational or health system strategies, including professional development and decision-making support.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Arta Taghavi Haghayegh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Riya Shah
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sachindri Wijekoon
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kevin Reel
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ruheena Sangrar
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
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Álvarez-Gálvez J, Ortega-Martín E, Carretero-Bravo J, Pérez-Muñoz C, Suárez-Lledó V, Ramos-Fiol B. Social determinants of multimorbidity patterns: A systematic review. Front Public Health 2023; 11:1081518. [PMID: 37050950 PMCID: PMC10084932 DOI: 10.3389/fpubh.2023.1081518] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/02/2023] [Indexed: 03/28/2023] Open
Abstract
Social determinants of multimorbidity are poorly understood in clinical practice. This review aims to characterize the different multimorbidity patterns described in the literature while identifying the social and behavioral determinants that may affect their emergence and subsequent evolution. We searched PubMed, Embase, Scopus, Web of Science, Ovid MEDLINE, CINAHL Complete, PsycINFO and Google Scholar. In total, 97 studies were chosen from the 48,044 identified. Cardiometabolic, musculoskeletal, mental, and respiratory patterns were the most prevalent. Cardiometabolic multimorbidity profiles were common among men with low socioeconomic status, while musculoskeletal, mental and complex patterns were found to be more prevalent among women. Alcohol consumption and smoking increased the risk of multimorbidity, especially in men. While the association of multimorbidity with lower socioeconomic status is evident, patterns of mild multimorbidity, mental and respiratory related to middle and high socioeconomic status are also observed. The findings of the present review point to the need for further studies addressing the impact of multimorbidity and its social determinants in population groups where this problem remains invisible (e.g., women, children, adolescents and young adults, ethnic groups, disabled population, older people living alone and/or with few social relations), as well as further work with more heterogeneous samples (i.e., not only focusing on older people) and using more robust methodologies for better classification and subsequent understanding of multimorbidity patterns. Besides, more studies focusing on the social determinants of multimorbidity and its inequalities are urgently needed in low- and middle-income countries, where this problem is currently understudied.
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Affiliation(s)
- Javier Álvarez-Gálvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
- The University Research Institute for Sustainable Social Development (Instituto Universitario de Investigación para el Desarrollo Social Sostenible), University of Cadiz, Jerez de la Frontera, Spain
| | - Esther Ortega-Martín
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
- *Correspondence: Esther Ortega-Martín
| | - Jesús Carretero-Bravo
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
| | - Celia Pérez-Muñoz
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain
| | - Víctor Suárez-Lledó
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
| | - Begoña Ramos-Fiol
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
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Noordman J, Roodbeen R, Gach L, Schulze L, Rademakers J, van den Muijsenbergh M, Boland G, van Dulmen S. 'A basic understanding'; evaluation of a blended training programme for healthcare providers in hospital-based palliative care to improve communication with patients with limited health literacy. BMC MEDICAL EDUCATION 2022; 22:613. [PMID: 35953800 PMCID: PMC9371628 DOI: 10.1186/s12909-022-03685-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The non-curative setting makes communication and shared decision-making in palliative care extremely demanding. This is even more so for patients with limited health literacy. So far, research in palliative care focusing on shared decision-making with patients with limited health literacy is lacking. Recent research from our team indicates that the assessment of these patients' understanding of their situation and the implementation of shared decision-making in palliative care, needs improvement. METHODS To improve communication and decision-making, especially with patients with limited health literacy, we developed and evaluated a blended training programme for healthcare providers. The training programme comprised of an e-learning and a team training. The evaluation was performed by 1. conducting interviews (n = 15) focused on evaluating the whole programme and, 2. coding video-recorded outpatient consultations on the extent to which providers involved patients in decision-making before (n = 19) and after (n = 20) the intervention, using the 5-item OPTION coding instrument. RESULTS The interviews showed that healthcare providers valued the skills they had learned during the e-learning and team training. Providers specifically valued the teach-back technique, learned to use simpler wording and felt better able to recognize patients with limited health literacy. Many providers reported a change in communication behaviour as a consequence of the training programme. Suggestions for improvement for both e-learning and training were, amongst others, a follow-up team training course and a new scenarios for the e-learning about discussing palliative care. For both the pre- and the post-measurement, involving patients in decision-making lies between a minimal and a moderate effort; differences were not significant. CONCLUSIONS The e-learning and team training were valued positively by the healthcare providers. Adaptations to the e-learning have been made after evaluation. The e-learning has been implemented in several hospitals and medical education. To improve shared decision-making in practice a more sustained effort is needed.
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Affiliation(s)
- Janneke Noordman
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands.
| | - Ruud Roodbeen
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
- Research Department, Breuer & Intraval, Research and Consultancy, Groningen, The Netherlands
| | - Leonie Gach
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
| | - Lotte Schulze
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
| | - Jany Rademakers
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Maria van den Muijsenbergh
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Gudule Boland
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN, Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Koopmanschap I, Martin L, Gitsels - van der Wal JT, Suurmond J. Counselling for prenatal anomaly screening to migrant women in the Netherlands: An interview study of primary care midwives’ perceived barriers with client–midwife communication. Eur J Midwifery 2022; 6:29. [PMID: 35633755 PMCID: PMC9118623 DOI: 10.18332/ejm/147911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/27/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Large ethnic inequalities exist in the prenatal screening offer, counselling, informed decision-making, and uptake of prenatal anomaly tests. More insight into midwives’ experiences with offering prenatal counselling to migrant women may provide better insight into the origins and consequences of these ethnic inequalities. METHODS We conducted interviews with 12 midwives certified as counsellors for prenatal anomaly screening for women they identified as migrants. Interviews were analyzed using thematic analysis. RESULTS Midwives reported most difficulties in communicating with women of ‘non-western migrant background’, which include first- and second-generation migrants from Africa, Latin-America, Asia, and Turkey. They experienced barriers in communication related to linguistics, health literacy, sociocultural and religious differences, with midwife stereotyping affecting all three aspects of counselling: health education, decision-making support, and the client–midwife relation. Health education was difficult because of language barriers and low health-literacy of clients, decision-making support was hampered by sociocultural and religious midwife–client differences, and client–midwife relations were under pressure due to sociocultural and religious midwife–client differences and midwife stereotyping. CONCLUSIONS Barriers to optimal communication seem to contribute to suboptimal counselling, especially for women of ‘non-western migrant background’. Client–midwife communication thus potentially adds to the ethnic disparities observed in the offer of and informed decision-making about prenatal anomaly screening in the Netherlands. The quality of prenatal counselling for women from all ethnic backgrounds might be improved by addressing linguistic, health literacy, sociocultural and religious barriers in future training and continuing education of prenatal counsellors.
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Affiliation(s)
- Isabel Koopmanschap
- Amsterdam University Medical Center, Department of Public and Occupational Health, University of Amsterdam, Amsterdam, Netherlands
| | - Linda Martin
- Department of Midwifery Science, Academy Midwifery Amsterdam and Groningen (AVAG), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Janneke T. Gitsels - van der Wal
- Department of Midwifery Science, Academy Midwifery Amsterdam and Groningen (AVAG), Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jeanine Suurmond
- Amsterdam University Medical Center, Department of Public and Occupational Health, University of Amsterdam, Amsterdam, Netherlands
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Chavez-Tapia NC, Barrientos-Gutierrez T, Torres-Ibarra L, Sanchez-Jiménez B, Juarez-Hernandez E, Ramos-Ostos M, Alva-Lopez LF, Uribe M. Incremental levels of diagnostic information incentivize health-seeking in non-alcoholic fatty liver: a randomized clinical trial. Sci Rep 2022; 12:8272. [PMID: 35585153 PMCID: PMC9117664 DOI: 10.1038/s41598-022-12295-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/03/2022] [Indexed: 02/06/2023] Open
Abstract
Patients with chronic disorders like non-alcoholic fatty liver disease (NAFLD) face important challenges adhering to diagnostic and treatment tracks. As NAFLD increases, the need to incentivize health-seeking behaviors grows. No evidence-based interventions to address this gap exist. The aim of the study was to estimate the effect of providing increasing levels of diagnostic information on medical care-seeking in adults newly diagnosed with NAFLD. We randomly assigned adults with a sonographic diagnosis of NAFLD at a check-up unit in Mexico to one of five groups. All groups received medical consultation. A: no further interventions; B: received multimedia educational material (MEM); C: MEM + NAFLD-fibrosis-score (NFS); D: MEM + transient elastography (TE); E: MEM + NFS + TE. 1209 participants were randomized, follow-up rate 91%; 82% male, BMI 30.5 ± 4 kg/m2. There were no differences in the proportion of patients undergoing further diagnostic evaluation of liver fibrosis (A 0.4%, E 0.4%, P-for-trend = 0.269). Groups who received more information sought specialized medical care more frequently: A 22%, E 30% (P-for-trend = 0.047). A trend to receive treatment was also observed at higher levels of information: A 26.7%, E 36.3% (P-for-trend = 0.134). Increasing the amount of diagnostic information seemed to increase patient's health-seeking. Tailoring the communication of information obtained for diagnosis could help to increase health-seeking in chronic disease patients.Trial registration: NCT01874249 (full date of first registration 11-06-2013).
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Affiliation(s)
- Norberto C Chavez-Tapia
- Obesity and Digestive Diseases Unit and Translational Research Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150 Col. Toriello Guerra Tlalpan, 14050, Mexico City, Mexico.
| | | | - Leticia Torres-Ibarra
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Beatriz Sanchez-Jiménez
- Gastroenterology Department, Centro Medico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Eva Juarez-Hernandez
- Translational Research Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Martha Ramos-Ostos
- Integral Diagnosis and Treatment Center, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Luis F Alva-Lopez
- Radiology and Medical Imaging Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Misael Uribe
- Obesity and Digestive Diseases Unit and Translational Research Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150 Col. Toriello Guerra Tlalpan, 14050, Mexico City, Mexico
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Geurts EMA, Pittens CACM, Boland G, van Dulmen S, Noordman J. Persuasive communication in medical decision-making during consultations with patients with limited health literacy in hospital-based palliative care. PATIENT EDUCATION AND COUNSELING 2022; 105:1130-1137. [PMID: 34456095 DOI: 10.1016/j.pec.2021.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Both patients in the palliative phase of their disease and patients with limited health literacy (LHL) have an increased risk of being influenced by healthcare providers (HCPs) when making decisions. This study aims to explore to what extent persuasive communication occurs during shared decision-making (SDM) by (1) providing an overview of persuasive communication behaviours relevant for medical decision-making and (2) exemplifying these using real-life outpatient consultations. METHODS An exploratory qualitative design was applied: (1) brief literature review; (2) analysis of verbatim extracts from outpatient consultations and stimulated recall sessions with HCPs; and (3) stakeholder meetings. RESULTS 24 different persuasive communication behaviours were identified, which can be divided in seven categories: biased presentation of information, authoritative framing, probability framing, illusion of decisional control, normative framing, making assumptions and using emotions or feelings. CONCLUSIONS Persuasive communication is multi-faceted in outpatient consultations. Although undesirable, it may prove useful in specific situations making it necessary to study the phenomenon more in depth and deepen our understanding of its mechanisms and impact. PRACTICE IMPLICATIONS Awareness among HCPs about the use of persuasive communication needs to be created through training and education. Also, HCPs need help in providing balanced information.
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Affiliation(s)
- Esther M A Geurts
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands; Department of Social Medicine, Maastricht University, Maastricht, The Netherlands.
| | | | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
| | - Janneke Noordman
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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Otte R, Roodbeen R, Boland G, Noordman J, van Dulmen S. Affective communication with patients with limited health literacy in the palliative phase of COPD or lung cancer: Analysis of video-recorded consultations in outpatient care. PLoS One 2022; 17:e0263433. [PMID: 35143534 PMCID: PMC8830703 DOI: 10.1371/journal.pone.0263433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/19/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Affective communication in outpatient care is important, especially in the palliative phase. Appropriate responses by healthcare providers to emotional cues or concerns let patients express their feelings and enhance information recall and patient satisfaction. Patients with limited health literacy experience more barriers in health-related communication and information, which makes recognizing their cues and concerns even more relevant. This study explores emotional cues/concerns expressed by patients with limited health literacy and evaluates healthcare providers' responses to these utterances. METHODS Verona Coding Definitions of Emotional Sequences (VR-CoDES), a consensus-based system for coding patients' expression of emotional distress in medical consultations, was used in this exploratory observational study to analyse affective communication in video-recorded outpatient consultations. Consultations of 18 (10 female, 8 male) COPD or lung cancer patients (aged 70.3±6.8) with limited health literacy were recorded and analysed. Eight healthcare providers in four hospitals participated in the study. RESULTS 101 cues and 11 concerns were observed, making 6.2 (SD = 4.2) cues or concerns per consultation. Healthcare provider responses were explicit in 56% and left scope for further disclosures in 58% of the cases. Patients with limited health literacy seem to express more cues or concerns than other patient populations. Healthcare providers responded roughly equally often in five different ways, but they shied away from further exploring the emotion disclosed in the cue/concern. Future research should elaborate on these exploratory observations, especially regarding why HCPs often only leave limited space for further disclosure of emotions in palliative care.
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Affiliation(s)
- Rebecca Otte
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Strategic Communication Group, Wageningen University and Research, Wageningen, the Netherlands
| | - Ruud Roodbeen
- Breuer&Intraval, Research and Consultancy, Research Department, Groningen, the Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, the Netherlands
| | - Janneke Noordman
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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OUP accepted manuscript. Health Promot Int 2022:6573373. [DOI: 10.1093/heapro/daac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Rosa WE, Buck HG, Squires AP, Kozachik SL, Huijer HAS, Bakitas M, Boit JM, Bradley PK, Cacchione PZ, Chan GK, Crisp N, Dahlin C, Daoust P, Davidson PM, Davis S, Doumit MAA, Fink RM, Herr KA, Hinds PS, Hughes TL, Karanja V, Kenny DJ, King CR, Klopper HC, Knebel AR, Kurth AE, Madigan EA, Malloy P, Matzo M, Mazanec P, Meghani SH, Monroe TB, Moreland PJ, Paice JA, Phillips JC, Rushton CH, Shamian J, Shattell M, Snethen JA, Ulrich CM, Wholihan D, Wocial LD, Ferrell BR. American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access. Nurs Outlook 2021; 69:961-968. [PMID: 34711419 PMCID: PMC8717680 DOI: 10.1016/j.outlook.2021.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/26/2021] [Accepted: 06/12/2021] [Indexed: 01/19/2023]
Abstract
The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.
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Affiliation(s)
- William E Rosa
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel; Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Health Expert Panel.
| | - Harleah G Buck
- Palliative Care & End-of-Life Expert Panel; Expert Panel on Aging
| | | | | | - Huda Abu-Saad Huijer
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel
| | | | | | | | | | | | | | | | | | - Patricia M Davidson
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel
| | | | | | | | - Keela A Herr
- Palliative Care & End-of-Life Expert Panel; Expert Panel on Aging
| | | | - Tonda L Hughes
- Global Nursing & Health Expert Panel; Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Health Expert Panel
| | | | | | | | | | | | | | | | | | | | | | | | - Todd B Monroe
- Palliative Care & End-of-Life Expert Panel; Expert Panel on Aging
| | - Patricia J Moreland
- Palliative Care & End-of-Life Expert Panel; Global Nursing & Health Expert Panel
| | | | - J Craig Phillips
- Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) Health Expert Panel
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Cordeiro FR, Dos Santos Marques R, De Oliveira Silva K, Cruz Martins M, Vestena Zillmer JG, Sant'Ana Tristão F. Educação em saúde e final de vida no hospital. AVANCES EN ENFERMERÍA 2021. [DOI: 10.15446/av.enferm.v40n1.86942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: identificar ações de educação em saúde direcionadas às pessoas em final da vida e seus cuidadores, informais e formais, no hospital, além de avaliar o nível de evidência de tais ações.
Síntese do conteúdo: o estudo foi realizado entre dezembro de 2019 e janeiro de 2020, nas bases de dados Web of Science, Scopus e MEDLINE. Identificaram-se 6.762 artigos, dos quais 42 integram a análise por serem artigos originais ou de revisão escritos em português, espanhol, inglês ou francês; a amostra dos estudos foi composta por pacientes maiores de 19 anos, com doença avançada e/ou em final de vida ou cuidadores ou profissionais de saúde. Os dados foram agrupados por similaridade do tema das ações, conforme Polit e Beck, e o nível de evidência avaliado segundo Melnyk e Fineout-Overholt. O vídeo foi a ação com maior força de recomendação, seguida por cartilhas. As unidades temáticas foram “Ações para o controle da dor”, “Narrativas sobre o final da vida”, “Planejamento de cuidados”, “Dialogando sobre os cuidados paliativos” e “Comunicação e final de vida”.
Conclusões: ações de educação em saúde no final da vida devem considerar as tecnologias da informação e da comunicação, além das condições socioculturais, clínicas e cognitivas dessa etapa do adoecimento.
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van Vliet LM, Meijers MC, van Dulmen S, van der Wall E, Plum N, Stouthard J, Francke AL. Addressing challenges in information-provision: a qualitative study among oncologists and women with advanced breast cancer. BMC Palliat Care 2021; 20:142. [PMID: 34521393 PMCID: PMC8442372 DOI: 10.1186/s12904-021-00836-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a need for more insight into how to address challenges of information-provision for women with advanced breast cancer. We aimed to explore oncologists' and patients' views on (i) the challenges of information-provision, and (ii) possible strategies to address these challenges, meanwhile (iii) exploring the possible facilitating role of positive expectations and empathy. METHODS Semi-structured interviews were held with oncologists (n = 10) and women with advanced breast cancer (n = 14). Principles of Thematic Analysis were followed, with two researchers analyzing transcribed data, supported by Atlas.ti software. RESULTS Taken together the data from oncologists and patients, we found that when communicating with patients with advanced cancer, oncologists face challenges, including handling patients' unrealistic disease (status) beliefs, and choosing approaches for discussing available treatment options and their side effects. Possible strategies to address these challenges include balancing information with acceptance of denial, and using medical expertise to guide treatment discussions. A sensitive issue is whether to discuss the option of no anti-cancer treatment. Meanwhile, approaches and preferences for discussions of side effects vary. Positive expectations and empathy can facilitate information-provision by creating space and helping patients to open up more. CONCLUSIONS Integrating oncologists' and patients' views, oncologists can provide realistic information while also, temporarily, accepting denial, and can use their medical expertise to address challenges around unrealistic beliefs and discussion of treatment options. Finding ways to tailor discussions of no anti-cancer treatment and side-effect information are needed. Positive expectations and empathy might facilitate - tailored - information-provision, leading ultimately to patient-centered care lying at the heart of medicine.
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Affiliation(s)
- Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands.
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands.
| | - Maartje C Meijers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicole Plum
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Anneke L Francke
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, the Netherlands
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Laureij LT, van der Hulst M, Lagendijk J, Been JV, Ernst-Smelt HE, Franx A, Lugtenberg M. Insight into the process of postpartum care utilisation and in-home support among vulnerable women in the Netherlands: an in-depth qualitative exploration. BMJ Open 2021; 11:e046696. [PMID: 34489272 PMCID: PMC8422309 DOI: 10.1136/bmjopen-2020-046696] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/30/2022] Open
Abstract
OBJECTIVE To gain insight into the process of postpartum care utilisation and in-home support among vulnerable women. DESIGN, METHOD, PARTICIPANTS AND SETTING A qualitative interview study was conducted among 23 pregnant and postpartum vulnerable women in the Netherlands, following a grounded theory approach. Women were determined as vulnerable by their healthcare providers. Theoretical sampling of participants was applied and was alternated by data analysis to include information-rich cases until saturation was achieved. RESULTS A conceptual framework of postpartum care utilisation was generated consisting of three phases: pregnancy, early postpartum period and late postpartum period. Within these phases, information provision, parenting self-efficacy and social network were identified as overarching themes. Perceived inadequate information on content of postpartum care posed a major barrier to forming realistic expectations during pregnancy and hindered its utilisation. Low self-efficacy facilitated postpartum care utilisation. All women experienced increased self-efficacy during and after postpartum care. Support from a social network influenced expectations regarding the added value of postpartum care during pregnancy, and lowered actual utilisation during the postpartum period. The costs of postpartum care and the role of the maternity care assistant acted as general barriers or facilitators influencing the three overarching themes and therefore postpartum care utilisation indirectly. CONCLUSIONS Our findings suggest that postpartum care utilisation among vulnerable women may be improved by considering the particular phase and relevant themes applying to individual women, and adapt care accordingly. We recommend to provide comprehensive, understandable information and to emphasise the gains of postpartum care in improving self-efficacy for vulnerable women. Moreover, involving a woman's social network in postpartum care may add value to this care for this population.
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Affiliation(s)
- Lyzette T Laureij
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Marije van der Hulst
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Jacqueline Lagendijk
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Jasper V Been
- Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Hiske E Ernst-Smelt
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
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Roodbeen RTJ, Noordman J, Boland G, van Dulmen S. Shared Decision Making in Practice and the Perspectives of Health Care Professionals on Video-Recorded Consultations With Patients With Low Health Literacy in the Palliative Phase of Their Disease. MDM Policy Pract 2021; 6:23814683211023472. [PMID: 34277951 PMCID: PMC8255606 DOI: 10.1177/23814683211023472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/14/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction. An important goal of palliative care is improving the quality of life of patients and their partners/families. To attain this goal, requirements and preferences of patients need to be discussed, preferably through shared decision making (SDM). This enhances patient autonomy and patient-centeredness, requiring active participation by patients. This is demanding for palliative patients, and even more so for patients with limited health literacy (LHL). This study aimed to examine SDM in practice and assess health care professionals’ perspectives on their own SDM. Methods. An explanatory sequential mixed methods design was used. Video recordings were gathered cross-sectionally of palliative care consultations with LHL patients (n = 36) conducted by specialized palliative care clinicians and professionals integrating a palliative approach. The consultations were observed for SDM using the OPTION5 instrument. Potential determinants of SDM were examined using multilevel analysis. Sequentially, stimulated recall interviews were conducted assessing the perspectives of professionals on their SDM (n = 19). Interviews were examined using deductive thematic content analysis. Results. The average SDM score in practice was moderate, varying greatly between professionals, as shown by the multilevel analysis and by varying degrees of perceived patient involvement in SDM mentioned in the interviews. To improve this, professionals recommended 1) continuously discussing all options with patients, 2) allowing time for patients to talk, and 3) using strategic timing for involving patients in SDM. Discussion. The implementation of SDM for people with LHL in palliative care varies in quality and needs improvement. SDM needs to be enhanced in this care domain because decisions are complex and demanding for LHL patients. Future research is needed that focuses on supporting strategies for comprehensible SDM, best practices, and organizational adaptations.
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Affiliation(s)
- Ruud T J Roodbeen
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
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Socio-Economic Deprivation and Symptom Burden in UK Hospice Patients with Advanced Cancer-Findings from a Longitudinal Study. Cancers (Basel) 2021; 13:cancers13112537. [PMID: 34064172 PMCID: PMC8196745 DOI: 10.3390/cancers13112537] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary We know that socio-economic factors influence delay in presentation and diagnosis of cancer and that patients living in areas of greater socio-economic deprivation are less likely to be referred to palliative care services including hospice. However, very little is known regarding the impact of socio-economic deprivation on symptom burden in advanced cancer patients. Our study found that patients experiencing greater socio-economic deprivation were more likely to report depression and pain and greater global symptom burden than patients from less socio-economically deprived areas. We also found that reporting a lack of information at time of diagnosis was significantly associated with socio-economic deprivation. Although more than one-third of patients recruited into this study were diagnosed with cancer within the preceding 12 months, this was not associated with socio-economic factors and socio-economic factors did not appear to influence survival in our study. The impact of socio-economic factors on symptom burden and information needs should be acknowledged within palliative care settings. Abstract Socio-economic deprivation is known to impact on cancer diagnosis, treatment and access to services, but little is known of the impact of socio-economic deprivation on symptom burden in patients with advanced cancer. Patients with advanced cancer attending hospice day services were recruited into a 24 week longitudinal study. An area-based index of social deprivation was collected along with depression and symptom burden at baseline, 8, 16 and 24 weeks. Of the 595 patients included, with an age range of 33–89 years and a mean age of 68 years, 67% were female, and 37% were diagnosed with cancer in the last 12 months. Twenty nine percent lived in one of the most deprived 20% of neighbourhoods. Patients living in the most socio-economically deprived areas were significantly likely to report receiving insufficient information regarding their cancer at diagnosis (p = 0.007), greater pain (p = 0.02), moderate to severe depression (p = 0.04) and higher global symptom burden (p = 0.04). This study is the first to report that patients with advanced cancer attending hospice services, living in the most deprived neighbourhoods experience significantly greater symptom burden, notably depression and pain. We recommend using patient outcome measures in order to provide targeted support and thereby reduce the increased symptom burden that socio-economically disadvantaged patients experience at the end of life.
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van Vliet LM, Noordman J, Mijnlieff M, Roodbeen R, Boland G, van Dulmen S. Health literacy, information provision and satisfaction in advanced cancer consultations: two observational studies using level of education as a proxy. BMJ Support Palliat Care 2021:bmjspcare-2020-002859. [PMID: 34006513 DOI: 10.1136/bmjspcare-2020-002859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/09/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Patients with low health literacy (LHL) might feel less informed and satisfied with provided information than patients with high health literacy (HHL). In the setting of advanced cancer, we explored whether LHL patients, compared with HHL patients are: (1) often less informed, and (2) less satisfied with clinicians' communication (a) in general and (b) following information provision specifically. METHODS Data from two observational studies using recorded consultations were combined. Clinicians' provided information and patients' health literacy level-defined by educational levels-and satisfaction were measured. Χ2 tests and regression (moderation) analyses assessed the relation between health literacy and information provision, and between information provision and satisfaction, meanwhile exploring moderating influences of health literacy. RESULTS Of 61 included patients, 25 (41%) had LHL. LHL and HHL patients were equally seldom informed about the disease's incurability (36% vs 42%, p=0.66). LHL patients were more often informed about the option of not pursuing anticancer therapy than HHL patients (28% vs 8%, p=0.04). LHL patients were more satisfied with clinicians' communication than HHL patients (M=9.3 vs M=8.5, p=0.03), especially when the option of no anticancer treatment was discussed (p=0.04). Discussing the disease's incurability did not influence satisfaction levels (p=0.58) for LHL and HHL patients. CONCLUSIONS LHL patients were not less informed, yet more satisfied than HHL patients. Both groups were equally seldom informed about the disease's incurability. No anticancer therapy was mostly discussed with LHL patients who were more satisfied following this information. Clinicians should be encouraged to inform all patients about the disease status and (non)treatment options, while not overlooking empathic support.
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Affiliation(s)
- Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
| | | | - Marit Mijnlieff
- Department of Communication, NIVEL, Utrecht, The Netherlands
| | - Ruud Roodbeen
- Department of Communication, NIVEL, Utrecht, The Netherlands
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, The Netherlands
| | - Gudule Boland
- Pharos, Dutch Center of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Sandra van Dulmen
- Department of Communication, NIVEL, Utrecht, The Netherlands
- Institute for Healh Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Health Literacy Among Patients With Chronic Lung Disease Entering Pulmonary Rehabilitation and Their Resident Loved Ones. J Cardiopulm Rehabil Prev 2021; 41:336-340. [PMID: 33797458 DOI: 10.1097/hcr.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was determine the prevalence of low health literacy (HL) and low reading ability among patients with chronic lung disease referred for pulmonary rehabilitation (PR) in the Netherlands and their loved ones; and to understand whether low HL or low reading ability influence PR outcomes. METHODS Health literacy was measured using the Health Literacy Survey-Europe Q16 (HLS-EU-Q16). Reading ability and cognitive functioning were measured using the Rapid Estimate of Adult Literacy in Medicine-Dutch (REALM-D) and the Montreal Cognitive Assessment. Exercise capacity, health status, and symptoms of anxiety and depression were assessed. RESULTS Patients (n = 120) entering PR and loved ones (n = 41) participated. Of all patients, 51% had low HL and 29% had low reading ability. Also, 39% of all loved ones had low HL. PR outcomes were comparable between patients with low or adequate HL. Patients with adequate reading ability showed greater improvement in symptoms of depression than patients with low reading ability (P = .047). CONCLUSION Low HL and low reading ability are common among patients entering PR and their loved ones. For patients with low or adequate HL, PR is an effective treatment. Whether considering low HL and low reading ability by offering tailored education during treatment could augment the benefits of PR warrants further study.
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Selgert L, Bender B, Hinding B, Federmann A, Mihaljevic AL, Post R, Jonietz A, Norcini J, Tekian A, Jünger J. Development, testing and generalizability of a standardized evaluation form for the assessment of patient-directed reports in the new final medical licensing examination in Germany. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc71. [PMID: 33824907 PMCID: PMC7994883 DOI: 10.3205/zma001467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/10/2020] [Accepted: 09/21/2020] [Indexed: 06/12/2023]
Abstract
Background: As doctors often fail to explain diagnoses and therapies to patients in an understandable and appropriate way, the improvement of doctor-patient communication is essential. The current medical training and examinations are focused on verbal rather than on written communication. Following the premise of "assessment drives learning", the final medical licensing examination in Germany has been further developed by the German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP). As part of the discharge management the candidates have to prepare a report for the patient that is understandable and provides them with all important information about their stay in hospital. Aim: A standardized evaluation form for formative and summative feedback has been developed and tested with regard to applicability and the assurance of test quality criteria, especially the reliability to assess the written communication skills of the students. Methodology: In an expert consensus procedure, a draft for a standardized evaluation form was developed. This form was revised after an initial trial run on patient-directed reports written by students in their last year of medical studies. Afterwards twenty-one patient-directed reports were evaluated by fourteen different examiners. The reliability was tested by calculating the generalizability-coefficient and by analysing the inter-rater reliability. Results: The first test on the evaluation of the patient-directed reports indicated the practicability of the application and the usefulness of the evaluation form as an instrument for assessing the written communication skills of students. The analyses of the inter-rater reliability showed that the degree of agreement in the evaluations was partly different between two groups of examiners. The calculated G-coefficient indicates a high reliability. The content validity of the evaluation form was given through the comprehensive medical expertise in the development process. Conclusion: Assessing written patient-directed communication is a benefit of the newly developed last part of the medical licensing examination in Germany. Continuous formative assessment and feedback based on the evaluation form is intended to improve the written communication skills of future doctors. Furthermore, a better understanding of their diagnosis and treatment as well as a trusting relationship with their doctor may empower patients in the medical decision process and lead to fewer dismissal errors in the future. For consistent use of the evaluation form a standardized training of examiners should be implemented.
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Affiliation(s)
- Lena Selgert
- Institut für medizinische und pharmazeutische Prüfungsfragen (IMPP), Mainz, Germany
| | - Bernd Bender
- Institut für medizinische und pharmazeutische Prüfungsfragen (IMPP), Mainz, Germany
| | - Barbara Hinding
- Institut für medizinische und pharmazeutische Prüfungsfragen (IMPP), Mainz, Germany
| | - Aline Federmann
- Institut für medizinische und pharmazeutische Prüfungsfragen (IMPP), Mainz, Germany
| | - André L. Mihaljevic
- Universitätsklinikum Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg, Germany
| | | | | | - John Norcini
- SUNY Upstate Medical University, Department of Psychiatry, New York, USA
| | - Ara Tekian
- University of Illinois at Chicago, College of Medicine, Illinois, USA
| | - Jana Jünger
- Institut für medizinische und pharmazeutische Prüfungsfragen (IMPP), Mainz, Germany
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Michalsen A, Neitzke G, Dutzmann J, Rogge A, Seidlein AH, Jöbges S, Burchardi H, Hartog C, Nauck F, Salomon F, Duttge G, Michels G, Knochel K, Meier S, Gretenkort P, Janssens U. [Overtreatment in intensive care medicine-recognition, designation, and avoidance : Position paper of the Ethics Section of the DIVI and the Ethics section of the DGIIN]. Med Klin Intensivmed Notfmed 2021; 116:281-294. [PMID: 33646332 PMCID: PMC7919250 DOI: 10.1007/s00063-021-00794-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
Ungeachtet der sozialgesetzlichen Vorgaben existieren im deutschen Gesundheitssystem in der Patientenversorgung nebeneinander Unter‑, Fehl- und Überversorgung. Überversorgung bezeichnet diagnostische und therapeutische Maßnahmen, die nicht angemessen sind, da sie die Lebensdauer oder Lebensqualität der Patienten nicht verbessern, mehr Schaden als Nutzen verursachen und/oder von den Patienten nicht gewollt werden. Daraus können hohe Belastungen für die Patienten, deren Familien, die Behandlungsteams und die Gesellschaft resultieren. Dieses Positionspapier erläutert Ursachen von Überversorgung in der Intensivmedizin und gibt differenzierte Empfehlungen zu ihrer Erkennung und Vermeidung. Zur Erkennung und Vermeidung von Überversorgung in der Intensivmedizin erfordert es Maßnahmen auf der Mikro‑, Meso- und Makroebene, insbesondere die folgenden: 1) regelmäßige Evaluierung des Therapieziels im Behandlungsteam unter Berücksichtigung des Patientenwillens und unter Begleitung von Patienten und Angehörigen; 2) Förderung einer patientenzentrierten Unternehmenskultur im Krankenhaus mit Vorrang einer qualitativ hochwertigen Patientenversorgung; 3) Minimierung von Fehlanreizen im Krankenhausfinanzierungssystem gestützt auf die notwendige Reformierung des fallpauschalbasierten Vergütungssystems; 4) Stärkung der interdisziplinären/interprofessionellen Zusammenarbeit in Aus‑, Fort- und Weiterbildung; 5) Initiierung und Begleitung eines gesellschaftlichen Diskurses zur Überversorgung.
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Affiliation(s)
- Andrej Michalsen
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Konstanz, Konstanz, Deutschland
| | - Gerald Neitzke
- Institut für Geschichte, Ethik und Philosophie der Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Jochen Dutzmann
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Annette Rogge
- Geschäftsbereichs der Medizinethik, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Anna-Henrikje Seidlein
- Institut für Ethik und Geschichte der Medizin, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Susanne Jöbges
- Institut für Biomedizinische Ethik und Geschichte der Medizin, Universität Zürich, Zürich, Schweiz
| | | | - Christiane Hartog
- Klinik für Anästhesiologie und Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Deutschland.,Patienten- und Angehörigenzentrierte Versorgung (PAV), Klinik Bavaria, Kreischa, Deutschland
| | - Friedemann Nauck
- Klinik für Palliativmedizin, Georg-August-Universität Göttingen, Göttingen, Deutschland
| | | | - Gunnar Duttge
- Abteilung für strafrechtliches Medizin- und Biorecht, Georg-August-Universität Göttingen, Göttingen, Deutschland
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital Eschweiler, Eschweiler, Deutschland
| | - Kathrin Knochel
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital Kinderpalliativzentrum, Klinikum der Universität München, München, Deutschland.,Ethik der Medizin und Gesundheitstechnologie, Technische Universität München, München, Deutschland
| | - Stefan Meier
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Peter Gretenkort
- Simulations- und Notfallakademie, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital Eschweiler, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland.
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ZEIDI ISAMOHAMMADI, MORSHEDI HADI, ALIZADEH OTAGHVAR HAMIDREZA. A theory of planned behavior-enhanced intervention to promote health literacy and self-care behaviors of type 2 diabetic patients. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 61:E601-E613. [PMID: 33628967 PMCID: PMC7888399 DOI: 10.15167/2421-4248/jpmh2020.61.4.1504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/12/2020] [Indexed: 12/30/2022]
Abstract
Background Improved health literacy and awareness could help type 2 diabetic patients to control the disease complications. Objective The current study aimed to evaluate the impact of theory-based educational intervention on health literacy and self-care behaviors of type 2 diabetic patients in Tonekabon city. Methods This randomized controlled trial study was conducted at health care centers in Tonekabon city, Iran, from April 5, 2017, to October 22, 2018. Using multistage random sampling, 166 patients with type 2 diabetes divided into two groups: theory-based intervention (n = 83) and custom education (n = 83). The data collection tools consisted of demographic information, Theory of Planned Behavior (TPB) measures, health literacy for Iranian adults (HELIA) and summary of diabetes self-care activities (SDSCA). The five 45-minute group training sessions based on the baseline assessment and model constructs along with the targeted pamphlet and m-health strategy were designed for the experimental group. Data were analyzed using chi-square, independent and paired t-test and Analysis of covariance (ANCOVA). Results After controlling for pre-test effect, there was a significant difference between the two groups in terms of mean scores of attitudes, subjective norms, perceived behavior control and intention in post-test (P < 0.001). Also, after controlling for the pre-test effect, the results showed a significant difference in the self-care domain in the post-test (P < 0.001). Finally, after controlling for the pre-test variable effect, covariance analysis reflects significant difference in total health literacy score and its dimension at posttest (P < 0.001). Conclusions Applying TPB based education is suggested to maintain and improve self-care behaviors and health literacy in type 2 diabetic patients and other chronic diseases.
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Affiliation(s)
- ISA MOHAMMADI ZEIDI
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Correspondence: Isa Mohammadi Zeidi, Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran - Tel. +98 9124146500 - E-mail: ,
| | - HADI MORSHEDI
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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25
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Noordman J, Schulze L, Roodbeen R, Boland G, van Vliet LM, van den Muijsenbergh M, van Dulmen S. Instrumental and affective communication with patients with limited health literacy in the palliative phase of cancer or COPD. BMC Palliat Care 2020; 19:152. [PMID: 33028308 PMCID: PMC7542099 DOI: 10.1186/s12904-020-00658-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background Patients have a ‘need to know’ (instrumental need) and a ‘need to feel known’ (affective need). During consultations with patients with limited health literacy (LHL) in the palliative phase of their disease, both the instrumental and the affective communication skills of healthcare providers are important. The study aims to explore instrumental and affective communication between care providers and LHL patients in the palliative phase of COPD or cancer. Methods In 2018, consultations between LHL patients in the palliative phase of cancer or COPD and their healthcare providers were video-recorded in four hospitals in the Netherlands. As there was no observation algorithm available for this setting, several items were created to parameterize healthcare providers’ instrumental communication (seven items: understanding, patient priorities, medical status, treatment options, treatment consequences, prognosis, and information about emotional distress) and affective communication (six items: hope, support, reassurance, empathy, appreciation, and emotional coping). The degree of each item was recorded for each consultation, with relevant segments of the observation selected and transcribed to support the items. Results Consultations between 17 care providers and 39 patients were video-recorded and analyzed. Care providers primarily used instrumental communication, most often by giving information about treatment options and assessing patients’ care priorities. Care providers assessed patients’ understanding of their disease less often. The patients’ prognosis was not mentioned in half the consultations. Within the affective domain, the care providers did provide support for their patients; providing hope, reassurance, empathy, and appreciation and discussing emotional coping were observed less often. Conclusions Care providers used mostly instrumental communication, especially treatment information, in consultations with LHL patients in the palliative phase of cancer or COPD. Most care providers did not check if the patient understood the information, which is rather crucial, especially given patients’ limited level of health literacy. Healthcare providers did provide support for patients, but other expressions of affective communication by care providers were less common. To adapt the communication to LHL patients in palliative care, care providers could be less wordy and reduce the amount of information, use ‘teach-back’ techniques and pay more attention to affective communication.
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Affiliation(s)
- Janneke Noordman
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands.
| | - Lotte Schulze
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands
| | - Ruud Roodbeen
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands.,Department of Tranzo Scientific Centre for Care and Well-being, Tilburg University, Tilburg, Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Liesbeth M van Vliet
- Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Maria van den Muijsenbergh
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands.,Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500 BN, Utrecht, Netherlands.,Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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26
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Kamran R, Dal Cin A. Designing a Mission statement Mobile app for palliative care: an innovation project utilizing design-thinking methodology. BMC Palliat Care 2020; 19:151. [PMID: 33023545 PMCID: PMC7542118 DOI: 10.1186/s12904-020-00659-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/27/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Eliciting individual values and preferences of patients is essential to delivering high quality palliative care and ensuring patient-centered advance care planning. Despite advance care planning conserving healthcare costs by up to 36%, reducing psychological distress of patients and caregivers, and ensuring palliative care delivery in line with patient wishes, less than 33% of adults engage in it. We aimed to develop a mobile application intervention to address the challenges related to advance care planning and improve the delivery of palliative care. METHODS Design-thinking methodology was used to develop a mobile application, in response to issues prominently identified in current palliative care literature. RESULTS Issues surrounding communication of patient values from both the patient and provider side is identified as a main issue in palliative care. We designed a mobile application intervention prototype to address this. CONCLUSIONS Our "Mission Statement" mobile application will allow patients to create a mission statement identifying what they want their care team to know about them, as well as space to identify important values and preferences. Patients will be able to evolve their mission statement and values and preferences over the course of their palliative care journey through the application. Design-thinking methodology is an effective tool to drive healthcare innovation and bridge the gap between research findings and implementation.
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Affiliation(s)
- Rakhshan Kamran
- Michael G. DeGroote School of Medicine, McMaster University, MDCL 3114, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Arianna Dal Cin
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada
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27
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Thodé M, Pasman HRW, van Vliet LM, Damman OC, Ket JCF, Francke AL, Jongerden IP. Feasibility and effectiveness of tools that support communication and decision making in life-prolonging treatments for patients in hospital: a systematic review. BMJ Support Palliat Care 2020; 12:262-269. [PMID: 33020150 PMCID: PMC9411882 DOI: 10.1136/bmjspcare-2020-002284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/12/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022]
Abstract
Objective Patients with advanced diseases and frail older adults often face decisions regarding life-prolonging treatment. Our aim was to provide an overview of the feasibility and effectiveness of tools that support communication between healthcare professionals and patients regarding decisions on life-prolonging treatments in hospital settings. Design Systematic review: We searched PubMed, CINAHL, PsycINFO, Embase, Cochrane Library and Google Scholar (2009–2019) to identify studies that reported feasibility or effectiveness of tools that support communication about life-prolonging treatments in adult patients with advanced diseases or frail older adults in hospital settings. The Mixed Methods Appraisal Tool was used for quality appraisal of the included studies. Results Seven studies were included, all involving patients with advanced cancer. The overall methodological quality of the included studies was moderate to high. Five studies described question prompt lists (QPLs), either as a stand-alone tool or as part of a multifaceted programme; two studies described decision aids (DAs). All QPLs and one DA were considered feasible by both patients with advanced cancer and healthcare professionals. Two studies reported on the effectiveness of QPL use, revealing a decrease in patient anxiety and an increase in cues for discussing end-of-life care with physicians. The effectiveness of one DA was reported; it led to more understanding of the treatment in patients. Conclusions Use of QPLs or DAs, as a single intervention or part of a programme, may help in communicating about treatment options with patients, which is an important precondition for making informed decisions.
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Affiliation(s)
- Maureen Thodé
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Center of Expertise in Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Irene P Jongerden
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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28
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Wang C, Zhou L. Prevalence and risk factors of low health literacy in residents of Anhui province: A cross-sectional survey. Medicine (Baltimore) 2020; 99:e20547. [PMID: 32846749 PMCID: PMC7447391 DOI: 10.1097/md.0000000000020547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/03/2020] [Accepted: 05/03/2020] [Indexed: 11/25/2022] Open
Abstract
This survey aimed to evaluate the prevalence of low health literacy and correlations of demographic characteristics with low health literacy risk in residents of Anhui province.A total of 5120 residents of Anhui province were interviewed in this cross-sectional survey, and 4816 (94.1%) gave valid responses. Sociodemographic characteristics were collected. Health literacy and its 3 subscales, including basic knowledge and concepts, lifestyle, and health-related skill, were assessed. Low health literacy was defined as <80.0% of the total score or score of each subscale.Mean total health literacy score was 62.7±17.2 (maximum 100 points), and was 31.5 ± 9.0 (maximum 47 points), 17.0 ± 4.8 (maximum 28 points), and 14.2 ± 4.1 (maximum 25 points) in terms of basic knowledge and concepts score, lifestyle score, and health-related skill score, respectively. The prevalence of low health literacy was 81.4%, and was 71.3% in terms of basic knowledge and concepts subscale, 87.9% with regard to lifestyle subscale, and 86.3% in view of health-related skill subscale. In addition, older age (P = .001), male (P < .001), decreased education level (P < .001), lower annual household income (P < .001), and location at rural area (P < .001) associated with increased risk of low health literacy. Moreover, multivariate logistic regression revealed that male, lower education level, and location at rural area were independent risk factors of low health literacy (all P < .05).The prevalence of low health literacy is high in residents of Anhui province, and male, lower education level, as well as location at rural area are independent risk factors of low health literacy.
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29
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Roodbeen R, Vreke A, Boland G, Rademakers J, van den Muijsenbergh M, Noordman J, van Dulmen S. Communication and shared decision-making with patients with limited health literacy; helpful strategies, barriers and suggestions for improvement reported by hospital-based palliative care providers. PLoS One 2020; 15:e0234926. [PMID: 32559237 PMCID: PMC7304585 DOI: 10.1371/journal.pone.0234926] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Communication and shared decision-making (SDM) are essential to patient-centered care. Hospital-based palliative care with patients with limited health literacy (LHL) poses particular demands on communication. In this context, patients' emotions and vulnerable condition impact their skills to obtain, understand, process and apply information about health and healthcare even more. If healthcare providers (HCPs) meet these demands, it could enhance communication. In this study, HCPs were interviewed and asked for their strategies, barriers and suggestions for improvement regarding communication and SDM with LHL patients in hospital-based palliative care. METHODS A qualitative interview study was conducted in 2018 in four Dutch hospitals with 17 HCPs-11 physicians and 6 nurses. Transcripts were analyzed using thematic analysis. RESULTS In general HCPs recognized limited literacy as a concept, however, they did not recognize limited health literacy. Regarding SDM some HCPs were strong advocates, others did not believe in SDM as a concept and perceived it as unfeasible. Furthermore, five themes, acting as either strategies, barriers or suggestions for improvement emerged from the interviews: 1) time management; 2) HCPs' communication skills; 3) information tailoring; 4) characteristics of patients and significant others; 5) the content of the medical information. CONCLUSIONS According to HCPs, more time to communicate with their patients could resolve the most prominent barriers emerged from this study. Further research should investigate the organizational possibilities for this and the actual effectiveness of additional time on effective communication and SDM. Additionally, more awareness for the concept of LHL is needed as a precondition for recognizing LHL. Furthermore, future research should be directed towards opportunities for tailoring communication, and the extent to which limited knowledge and complex information affect communication and SDM. This study provides first insights into perspectives of HCPs, indicating directions for research on communication, SDM and LHL in hospital-based palliative care.
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Affiliation(s)
- Ruud Roodbeen
- Nivel (Netherlands institute for health services research), Utrecht, the Netherlands
- Department of Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands
| | - Astrid Vreke
- Nivel (Netherlands institute for health services research), Utrecht, the Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Jany Rademakers
- Nivel (Netherlands institute for health services research), Utrecht, the Netherlands
- Department of Family Medicine, CAPHRI (Care and Public Health Research Institute), Maastricht University, Maastricht, the Netherlands
| | - Maria van den Muijsenbergh
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), Utrecht, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), Utrecht, the Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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30
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Kobayashi R, Ishizaki M. Examining the Interaction Between Medical Information Seeking Online and Understanding: Exploratory Study. JMIR Cancer 2019; 5:e13240. [PMID: 31586366 PMCID: PMC6783696 DOI: 10.2196/13240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/23/2019] [Accepted: 08/19/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Online information seeking on medical topics by patients can have beneficial effects by helping them decide on treatment options and fostering better relationships with doctors. The quality of websites and processes of seeking information online have mostly been studied, with a focus on the accuracy and reliability of websites; however, few studies have examined the relationship between other aspects of quality and the processes of seeking medical information online. OBJECTIVE This exploratory study aimed to shed light on the quality of websites used for information seeking from the perspective of understanding medical information in combination with seeking it online. METHODS The study participants were 15 Japanese university students with no problem using the internet. A questionnaire survey about health literacy (47 items on a 4-point Likert scale) and information navigation skills on the internet (8 items on a 5-point Likert scale) was conducted before participants engaged in online information seeking and qualitative interviews. The students searched for information on a disease and its treatment. The websites viewed were gathered from search behavior recorded by software and browser logs. Follow-up interviews were conducted to elicit explanations from the participants about the assignments and their views of online information seeking. The explanations were evaluated by 55 health care professionals on a 3-point Likert scale and then assessed based on their comments and the participant interviews. RESULTS The mean age of the participants was 20.6 years (median 21; SD 1.06). All participants were able to access reliable websites with information relevant to the assignments. The mean ratings of the students' explanations were 108.6 (median 109; range=83-134) for the disease and 105.6 (median 104; range=87-117) for its treatment. The inter-rater reliability were 0.84 (95% CI 0.77-0.90) and 0.95 (95% CI 0.93-0.97), indicating good and excellent, respectively. The mean of the sum of the health literacy skills was 115.1 (median 115; range=80-166) and the mean for information navigation skills was 25.9 (median 26; range=17-36), respectively. Health literacy and information navigation skills were moderately correlated (r=0.54; 95% CI 0.033-0.822; P=.04). Among the four stages of health literacy, understanding and appraising (r=0.53; 95% CI 0.025-0.820; P=.04) were moderately correlated with information navigation skills (r=0.52; 95% CI 0.013-0.816; P=.046). The participants had no difficulties operating and browsing the internet and considered medical and public institution websites to be reliable; however, due to unfamiliarity with medical terms, they had difficulties choosing a site from the results obtained and comparing and synthesizing information provided by different sites. They also looked for sites providing orderly information in plain language but provided explanations from sites that gave inadequate interpretations of information. CONCLUSIONS This study revealed interactions between searching the internet for, and understanding, medical information by analyzing the processes of information seeking online, physicians' evaluations and comments about the participants' explanations, and the participants' perceptions.
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Affiliation(s)
- Rei Kobayashi
- Interfaculty Initiative in Information Studies, The University of Tokyo, Tokyo, Japan
| | - Masato Ishizaki
- Interfaculty Initiative in Information Studies, The University of Tokyo, Tokyo, Japan
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31
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Janssen DJA, Rechberger S, Wouters EFM, Schols JMGA, Johnson MJ, Currow DC, Curtis JR, Spruit MA. Clustering of 27,525,663 Death Records from the United States Based on Health Conditions Associated with Death: An Example of big Health Data Exploration. J Clin Med 2019; 8:jcm8070922. [PMID: 31252579 PMCID: PMC6678953 DOI: 10.3390/jcm8070922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Insight into health conditions associated with death can inform healthcare policy. We aimed to cluster 27,525,663 deceased people based on the health conditions associated with death to study the associations between the health condition clusters, demographics, the recorded underlying cause and place of death. Methods: Data from all deaths in the United States registered between 2006 and 2016 from the National Vital Statistics System of the National Center for Health Statistics were analyzed. A self-organizing map (SOM) was used to create an ordered representation of the mortality data. Results: 16 clusters based on the health conditions associated with death were found showing significant differences in socio-demographics, place, and cause of death. Most people died at old age (73.1 (18.0) years) and had multiple health conditions. Chronic ischemic heart disease was the main cause of death. Most people died in the hospital or at home. Conclusions: The prevalence of multiple health conditions at death requires a shift from disease-oriented towards person-centred palliative care at the end of life, including timely advance care planning. Understanding differences in population-based patterns and clusters of end-of-life experiences is an important step toward developing a strategy for implementing population-based palliative care.
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Affiliation(s)
- Daisy J A Janssen
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, 6085NM Horn, The Netherlands.
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), 6229HX Maastricht, The Netherlands.
- Department of Health Services Research, Maastricht University, 6229GT Maastricht, The Netherlands.
| | | | - Emiel F M Wouters
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, 6085NM Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229HX Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University, 6229GT Maastricht, The Netherlands
- Department of Family Medicine, Maastricht University, 6229HA Maastricht, The Netherlands
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull and York Medical School, University of Hull, Hull HU6 7RX, UK
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW2007 New South Wales, Australia
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
| | - Martijn A Spruit
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, 6085NM Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229HX Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, 6229ER Maastricht, The Netherlands
- REVAL-Rehabilitation Research Center, BIOMED-Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, BE3590 Diepenbeek, Belgium
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