Promoting patient empowerment in the healthcare system: highlighting the need for patient-centered drug policy

Assessing the Influence of Patient Empowerment Gained Through Mental Health Apps on Patient Trust in the Health Care Provider and Patient Compliance With the Recommended Treatment: Cross-sectional Study

BACKGROUND

In chronic mental illness, noncompliance with treatment significantly worsens the illness course and outcomes for patients. Considering that nearly 1 billion people worldwide experience mental health issues, including 1 of 5 Canadians in any given year, finding tools to lower noncompliance in these populations is critical for health care systems. A promising avenue is apps that make mental health services more accessible to patients. However, little is known regarding the impact of the empowerment gained from mental health apps on patient compliance with recommended treatment.

OBJECTIVE

This study aimed to investigate the impact of patient empowerment gained through mental health apps on patient trust in the health care provider and patient compliance with the recommended treatment.

METHODS

A cross-sectional web-based survey was conducted in Canada. Eligible participants were Canadian adults diagnosed with chronic mental health disorders who were using at least one of the following apps: Dialogue, MindBeacon, Deprexis, Ginger, Talkspace, BetterHelp, MindStrong, Mindshift, Bloom, Headspace, and Calm. A total of 347 valid questionnaires were collected and analyzed using partial least-squares structural equation modeling. Trust in the health care provider and patient compliance were measured with multiple-item scales adapted from existing scales. Patient empowerment was conceived and measured as a higher-order construct encompassing the following 2 dimensions: patient process and patient outcome. All the items contributing to the constructs in the model were measured with 7-point Likert scales. The reliability and validity of the measurement model were assessed, and the path coefficients of the structural model were estimated.

RESULTS

The results clearly show that patient empowerment gained through mental health apps positively influenced patient trust in the health care provider (β=.306; P<.001). Patient trust in the health care provider had a positive effect on patient compliance (β=.725; P<.001). The direct relationship between patient empowerment and patient compliance was not significant (β=.061, P=.23). Interestingly, the data highlight that the effect of patient empowerment on patient compliance was fully mediated by trust in the health care provider (β=.222; P<.001). The results show that patient empowerment gained through the mental health app involves 2 dimensions: a process and an outcome.

CONCLUSIONS

This study shows that for individuals living with mental health disorders, empowerment gained through mental health apps enhances trust in the health care provider. It reveals that patient empowerment impacts patient compliance but only through the full mediating effect of patient trust in the health care provider, indicating that patient trust is a critical variable to enhance patient compliance. Hence, our results confirm that health care systems could encourage the use of mental health apps to favor a climate that facilitates patients' trust in health care provider recommendations, possibly leading to better compliance with the recommended treatment.

Availability and evaluation of medication management resources for carers of people with dementia: a scoping review with an environmental scan

INTRODUCTION

There is a need for resources to guide informal carers in medication management for people with dementia. Availability of resources on medication management guidance has yet to be explored.

AREAS COVERED

A systematic search of MEDLINE, Embase, CINAHL and PsycINFO was performed in May 2022 to identify and evaluate resources for carers of people with dementia that provide guidance in medication management. Google and known repositories were also searched. Readability of text-based resources was examined using the Flesch-Kincaid reading level, the Flesch reading ease and the Gunning-Fog index. Resources were further evaluated using the Patient Education Material Assessment Tool (PEMAT or PEMAT-A/V).

EXPERT OPINION

Fifteen resources were identified, which largely focused on medication administration with limited discussion of shared decision-making. Current resources do not appear to have included people living with dementia or their carers in their development and did not address high-risk care settings. Codesign of resources with carers and people with dementia would ensure that resources are comprehensive and target their needs. Future research should therefore focus on development of readily available and understandable resources that provide medication management guidance for carers across different health settings, to comprehensively address the multi-faceted nature of dementia.

Defining Patient Engagement in Research: Results of a Systematic Review and Analysis: Report of the ISPOR Patient-Centered Special Interest Group

OBJECTIVES

Lack of clarity on the definition of "patient engagement" has been highlighted as a barrier to fully implementing patient engagement in research. This study identified themes within existing definitions related to patient engagement and proposes a consensus definition of "patient engagement in research."

METHODS

A systematic review was conducted to identify definitions of patient engagement and related terms in published literature (2006-2018). Definitions were extracted and qualitatively analyzed to identify themes and characteristics. A multistakeholder approach, including academia, industry, and patient representation, was taken at all stages. A proposed definition is offered based on a synthesis of the findings.

RESULTS

Of 1821 abstracts identified and screened for eligibility, 317 were selected for full-text review. Of these, 169 articles met inclusion criteria, from which 244 distinct definitions were extracted for analysis. The most frequently defined terms were: "patient-centered" (30.5%), "patient engagement" (15.5%), and "patient participation" (13.4%). The majority of definitions were specific to the healthcare delivery setting (70.5%); 11.9% were specific to research. Among the definitions of "patient engagement," the most common themes were "active process," "patient involvement," and "patient as participant." In the research setting, the top themes were "patient as partner," "patient involvement," and "active process"; these did not appear in the top 3 themes of nonresearch definitions.

CONCLUSION

Distinct themes are associated with the term "patient engagement" and with engagement in the "research" setting. Based on an analysis of existing literature and review by patient, industry, and academic stakeholders, we propose a scalable consensus definition of "patient engagement in research."

Autonomous and informed decision-making: The case of colorectal cancer screening

INTRODUCTION

It is increasingly considered important that people make an autonomous and informed decision concerning colorectal cancer (CRC) screening. However, the realisation of autonomy within the concept of informed decision-making might be interpreted too narrowly. Additionally, relatively little is known about what the eligible population believes to be a 'good' screening decision. Therefore, we aimed to explore how the concepts of autonomous and informed decision-making relate to how the eligible CRC screening population makes their decision and when they believe to have made a 'good' screening decision.

METHODS

We conducted 27 semi-structured interviews with the eligible CRC screening population (eighteen CRC screening participants and nine non-participants). The general topics discussed concerned how people made their CRC screening decision, how they experienced making this decision and when they considered they had made a 'good' decision.

RESULTS

Most interviewees viewed a 'good' CRC screening decision as one based on both reasoning and feeling/intuition, and that is made freely. However, many CRC screening non-participants experienced a certain social pressure to participate. All CRC screening non-participants viewed making an informed decision as essential. This appeared to be the case to a lesser extent for CRC screening participants. For most, experiences and values were involved in their decision-making.

CONCLUSION

Our sample of the eligible CRC screening population viewed aspects related to the concepts of autonomous and informed decision-making as important for making a 'good' CRC screening decision. However, in particular the existence of a social norm may be affecting a true autonomous decision-making process. Additionally, the present concept of informed decision-making with its strong emphasis on making a fully informed and well-considered decision does not appear to be entirely reflective of the process in practice. More efforts could be made to attune to the diverse values and factors that are involved in deciding about CRC screening participation.

Patient involvement in reflective multicriteria decision analysis to assist decision making in oncology

OBJECTIVES

Patient involvement in drug evaluation decision making is increasing. The aim of the current study was to develop a multi-criteria decision analysis (MCDA) framework that would enable the inclusion of the patient perspective in the selection of appropriate criteria for MCDAs being used in the value assessments of oncologic drugs.

METHODS

A literature review was conducted to identify and define criteria used in drug assessments from patient perspectives. The Evidence and Value: Impact on Decision Making methodology was used to develop a MCDA framework. Identified criteria were discussed by a sample of oncology patient association representatives who decided which criteria were important from patient perspectives. Selected criteria were rated by importance. The preliminary MCDA framework was tested through the assessment of a hypothetical oncology treatment. A discussion was carried out to agree on a final pilot MCDA framework.

RESULTS

Twenty-two criteria were extracted from the literature review. After criteria discussion, sixteen criteria remained. The most important criteria were comparative patient reported outcomes (PRO), comparative efficacy and disease severity. After the discussion generated by the scoring of the hypothetical oncology treatment, the final pilot MCDA framework included seven quantitative criteria ("disease severity", "unmet needs", "comparative efficacy / effectiveness", "comparative safety / tolerability", "comparative PROs", "contribution of oncological innovation") and one contextual criterion ("population priorities and access").

CONCLUSIONS

The present study developed a pilot reflective MCDA framework that could increase patient's capability to participate in the decision-making process by providing systematic drug assessments from the patient perspective.

Men's and women's response to treatment and perceptions of outcomes in a randomized controlled trial of injectable opioid assisted treatment for severe opioid use disorder

Background

To test whether there are gender differences in treatment outcomes among patients receiving injectable opioids for the treatment of long-term opioid-dependence. The study additionally explores whether men and women have different perceptions of treatment effectiveness.

Methods

This study is a secondary analysis from SALOME, a double-blind, phase III, randomized controlled trial testing the non-inferiorirty of injectable hydromorphone to injectable diacetylmorphine among 202 long-term street opioid injectors in Vancouver (Canada). Given this was a secondary analysis, no a priori power calaculation was conducted. Differences in baseline characteristics and six-month treatment outcomes (illicit heroin use, opioid use, crack cocaine use, non-legal activities, physical and psychological health scores, urine positive for street heroin markers, and retention) were analysed by gender using fitted models. Responses to an open ended question on reasons for treatment effectiveness were explored with a thematic analysis.

Results

Men and women differed significantly on a number of characteristics at baseline. For example, women were significantly younger, presented to treatment with significantly higher rates of prior month sex work (31.5% vs. 0%), and used significantly more crack cocaine (14.71 vs. 8.38 days). After six-months of treatment there were no significant differences in treatment outcomes by gender, after adjusting for baseline values. For both men and women, improved health and quality of life were the most common reasons provided for treatment effectiveness, however women were more specific in the types of health improvements.

Conclusions

Despite presenting to treatment with vulnerabilities not faced to the same extent by men, at six-months women did not differ significantly from men in tested trial efficacy outcomes. While the primary outcome in the trial was the reduction of illicit opioid use, in the open-ended responses both men and women focused their comments on improvement in health and quality of life as reasons for treatment effectiveness. The supervised model of care with injectable medications provides a particularly suitable framework for providing care to opioid-dependent men and women not attracted or retained by other treatments. The absence of statistical differences reported in this secondary analysis may be due to lack of adequate statistical power to detect meaningful effects.

Trial registration

This trial is registered with ClinicalTrials.gov (NCT01447212) Registered: October 4, 2011 at the following link: https://clinicaltrials.gov/ct2/show/NCT01447212.

Internet use frequency and patient-centered care: measuring patient preferences for participation using the health information wants questionnaire

Background

The Internet is bringing fundamental changes to medical practice through improved access to health information and participation in decision making. However, patient preferences for participation in health care vary greatly. Promoting patient-centered health care requires an understanding of the relationship between Internet use and a broader range of preferences for participation than previously measured.

Objective

To explore (1) whether there is a significant relationship between Internet use frequency and patients’ overall preferences for obtaining health information and decision-making autonomy, and (2) whether the relationships between Internet use frequency and information and decision-making preferences differ with respect to different aspects of health conditions.

Methods

The Health Information Wants Questionnaire (HIWQ) was administered to gather data about patients’ preferences for the (1) amount of information desired about different aspects of a health condition, and (2) level of decision-making autonomy desired across those same aspects.

Results

The study sample included 438 individuals: 226 undergraduates (mean age 20; SD 2.15) and 212 community-dwelling older adults (mean age 72; SD 9.00). A significant difference was found between the younger and older age groups’ Internet use frequencies, with the younger age group having significantly more frequent Internet use than the older age group (younger age group mean 5.98, SD 0.33; older age group mean 3.50, SD 2.00; t₄₃₆=17.42, P<.01). Internet use frequency was positively related to the overall preference rating (γ=.15, P<.05), suggesting that frequent Internet users preferred significantly more information and decision making than infrequent Internet users. The relationships between Internet use frequency and different types of preferences varied: compared with infrequent Internet users, frequent Internet users preferred more information but less decision making for diagnosis (γ=.57, P<.01); more information and more decision-making autonomy for laboratory test (γ=.15, P<.05), complementary and alternative medicine (γ=.32, P<.01), and self-care (γ=.15, P<.05); and less information but more decision-making autonomy for the psychosocial (γ=-.51, P<.01) and health care provider (γ=-.27, P<.05) aspects. No significant difference was found between frequent and infrequent Internet users in their preferences for treatment information and decision making.

Conclusions

Internet use frequency has a positive relationship with the overall preferences for obtaining health information and decision-making autonomy, but its relationship with different types of preferences varies. These findings have important implications for medical practice.

Effectiveness of a quality improvement intervention targeting cardiovascular risk factors: are patients responsive to information and encouragement by mail or post?

Introduction

There is important evidence on the beneficial effects of treatment of cardiovascular risk factors in terms of morbidity and mortality, but important challenges remain in motivating patients to adhere to their treatment regimen. This study aimed to describe the effectiveness of a quality improvement intervention that included information and regular encouragement by email or letter on cardiovascular risk factors for patients at high risk for cardiovascular disease.

Methods

This randomized single-blind study included patients of both sexes aged between 45 and 80 years old who had increased cardiovascular risk. Patients were randomly allocated to either a usual care group (UCG) or advanced care group (ACG). Patients in the UCG received regular care while patients in the ACG received usual care plus regular information and encouragement on cardiovascular risk factors by email or letter. Visits for both groups were planned at 0, 3, and 6 months. The outcome measures were blood pressure, weight, body mass index (BMI), waist circumference (WC), and smoking status.

Results

Out of 178 eligible patients from one single primary care practice, 55 participated in the study, three of whom dropped out. After 6 months, there was a significant decrease in mean systolic and diastolic blood pressure in the UCG and ACG (P < 0.05). The decreases were already significant after 3 months, except for systolic blood pressure in the UCG. There was also a significant increase in the proportion of patients who met the target values for blood pressure in the UCG and ACG. There was a nonsignificant decrease of the average weight in the ACG, but significantly more patients lost weight in the UCG (P = 0.02). BMI, WC, and smoking status did not change in either group.

Conclusion

This study found that there was a significant decrease of systolic and diastolic blood pressure in both study groups. Weight, BMI, WC, and smoking did not improve in either group. Information on cardiovascular risk factors and encouragement by means of letters or email did not provide additional benefits. Thus, effective patient empowerment probably requires more behaviorally sophisticated support to increase self-management, self-efficacy, and self-esteem in patients.

Patient health information materials in waiting rooms of family physicians: do patients care?

BACKGROUND

Patient health information materials (PHIMs), such as leaflets and posters are widely used by family physicians to reinforce or illustrate information, and to remind people of information received previously. This facilitates improved health-related knowledge and self-management by patients.

OBJECTIVE

This study assesses the use of PHIMs by patient. It also addresses their perception of the quality and the impact of PHIMs on the interaction with their physician, along with changes in health-related knowledge and self-management.

METHODS

QUESTIONNAIRE SURVEY AMONG PATIENTS OF FAMILY PRACTICES OF ONE TOWN IN BELGIUM, ASSESSING: (1) the extent to which patients read PHIMs in waiting rooms (leaflets and posters) and take them home, (2) the patients' perception of the impact of PHIMs on interaction with their physician, their change in health-related knowledge and self-management, and (3) the patients judgment of the quality of PHIMs.

RESULTS

We included 903 questionnaires taken from ten practices. Ninety-four percent of respondents stated they read PHIMs (leaflets), 45% took the leaflets home, and 78% indicated they understood the content of the leaflets. Nineteen percent of respondents reportedly discussed the content of the leaflets with their physician and 26% indicated that leaflets allowed them to ask fewer questions of their physician. Thirty-four percent indicated that leaflets had previously helped them to improve their health-related knowledge and self-management. Forty-two percent reportedly discussed the content of the leaflets with others. Patient characteristics are of significant influence on the perceived impact of PHIMS in physician interaction, health-related knowledge, and self-management.

CONCLUSION

This study suggests that patients value health information materials in the waiting rooms of family physicians and that they perceive such materials as being helpful in improving patient-physician interaction, health-related knowledge, and self-management.

Can pharmacoeconomics and outcomes research contribute to the empowerment of women affected by breast cancer?

Breakthroughs in genetic testing have informed patients and physicians in the treatment of breast cancer; however, they have also added to the complexity of decision-making. Genetic testing for breast cancer susceptibility not only changes treatment and screening options, but also challenges the way in which interventions are evaluated. While comparative effectiveness and cost-effective analysis methods are now standard for evaluation at the societal level, technologies such as genetic testing require us to consider the role of patient preference, especially as we move towards more personalized approaches to medicine. In this review, we discuss the changing role of pharmacoeconomics and outcomes research by highlighting how the discipline could use patient preference methods, such as conjoint analysis, to promote shared decision-making and to empower breast cancer patients. By adopting these methods we could move our focus from what is best for payers or society to one that applies scientific methods to identify what is best for patients.

Toward healthy aging through empowering self-care during the climacteric stage

BACKGROUND

While they progress through the climacteric stage, women often develop physical and psychological health needs, calling for innovative health-care services that can be translated into preventive programs and empowerment towards self-care.

OBJECTIVE

To identify the changes in women's discourse regarding their concerns and needs about the climacteric stage and self-care after they had participated in an integrative women-centered health-care model with empowerment for self-care.

METHODS

Women's narratives during counseling group sessions were analyzed using qualitative inductive thematic analysis.

RESULTS

A total of 121 women between 45 and 59 years of age participated. At the beginning of the counseling group sessions, we identified the following themes: (1) Lack of information about changes during the climacteric stage and self-care; (2) Tradition: the climacteric stage as a taboo subject; (3) Life's changes and transitions: the complexity of the climacteric experience; (4) Stigma of menopause; (5) Relationship between the traditional gender role and the lack of self-care. At the end of the counseling group sessions, the themes were: (1) The climacteric as a natural stage; (2) Expectations for old age; (3) Empowerment and the change of awareness for self-care; (3) De-medicalization of the climacteric; (4) The richness of group work; (5) Empowerment as motivation to convey acquired knowledge.

CONCLUSION

Women in the climacteric stage require more information about their physical, psychological and social needs, as well as the potential impact on their health during old age. Empowerment during the climacteric can contribute to improving the perception about this stage as well as the importance of self-care.

Regulatory agencies, pharmaceutical information and the Internet: a European perspective

The Internet facilitates access to health information and can therefore support the effectiveness of healthcare provision and empower patients in healthcare decisions. In the field of pharmaceutical therapy the electronic provision of information can improve compliance and strengthen the general understanding of pharmaceutical risks and benefits. Current political developments in Europe encourage a stronger role of the pharmaceutical industry in this regard. In light of potential conflicts inherent to the private provision of information and given their public health mandate, regulatory bodies in the pharmaceutical sector may represent an important alternative source of information. The explorative analysis in this paper reviews the websites of European pharmaceutical regulatory agencies regarding the usability and provision of information from a Layman's perspective. It is found that while the majority of agencies do provide product-related information, the usability of websites from the lay perspective is subject to variation. The reluctant position of agencies can be attributed to sectoral path dependencies, the regulatory approach and a lack of regulatory resources.

Informed citizen and empowered citizen in health: results from an European survey

Background

The knowledge about the relationship between health-related activities on the Internet (i.e. informed citizens) and individuals' control over their own experiences of health or illness (i.e. empowered citizens) is valuable but scarce. In this paper, we investigate the correlation between four ways of using the Internet for information on health or illness and citizens attitudes and behaviours toward health professionals and health systems and establish the profile of empowered eHealth citizens in Europe.

Methods

Data was collected during April and May 2007 (N = 7022), through computer-assisted telephone interviews (CATI). Respondents from Denmark, Germany, Greece, Latvia, Norway, Poland and Portugal participated in the survey. The profiles were generated using logistic regressions and are based on: a) socio-demographic and health information, b) the level of use of health-related online services, c) the level of use of the Internet to get health information to decide whether to consult a health professional, prepare for a medical appointment and assess its outcome, and d) the impact of online health information on citizens' attitudes and behavior towards health professionals and health systems.

Results

Citizens using the Internet to decide whether to consult a health professional or to get a second opinion are likely to be frequent visitors of health sites, active participants of online health forums and recurrent buyers of medicines and other health related products online, while only infrequent epatients, visiting doctors they have never met face-to-face. Participation in online health communities seems to be related with more inquisitive and autonomous patients.

Conclusions

The profiles of empowered eHealth citizens in Europe are situational and country dependent. The number of Europeans using the Internet to get health information to help them deal with a consultation is raising and having access to online health information seems to be associated with growing number of inquisitive and self-reliant patients. Doctors are increasingly likely to experience consultations with knowledgeable and empowered patients, who will challenge them in various ways.

Qualitative triadic study of the relational factors influencing the formation of quality in a community-based aged health care service network

A service is produced through the interactions of the various service participants. This study aims to identify the factors that influence the interactions of the service providers, recipients, and enablers of a community-based aged health care service, within a single service network. Interviews were conducted with the manager, three care workers, and five clients using the convergent interview technique. Data were analyzed inductively using thematic content analysis. Client focus, client contribution, client empowerment, and provider empowerment were identified as key themes. Whilst these themes are independently supported by the literature, they have previously been studied largely in isolation to each other.

Enablement in health care context: a concept analysis

RATIONALE, AIMS AND OBJECTIVES

The enablement process is defined as a professional intervention aiming to recognize, support and emphasize the patient's capacity to have control over her or his health and life. The purpose of this article was to study the enablement concept through a concept analysis in the health care context to identify: (1) its attributes and (2) its antecedents and consequents.

METHOD

A concept analysis was performed according to the method of Rodgers. The literature was reviewed from 1980 to June 2008, using search strategies adapted to the databases Cinahl, Medline, Embase, PsycInfo and Social Works Abstract, and hand searching. All articles contributing to a deeper understanding of the concept were included. The analysis was carried out according to a thematic analysis procedure, as described by Miles & Huberman.

RESULTS

The search identified 1305 citations. After in-depth assessment of 148 potentially eligible citations, 61 articles were included in the review. Five articles were added with hand searching. Sixty-seven per cent of these articles were related to nursing. The attributes of the enablement concept included: contribution to the therapeutic relationship; consideration of the person as a whole; facilitation of learning; valorization of the person's strengths; implication and support to decision making; and broadening of the possibilities.

CONCLUSION

These attributes could be used as a basis for other studies on enablement. Conceptual and empirical work is still needed to better position this concept among others such as patient-centred care, shared decision making and patient's participation.

Assessing enablement in clinical practice: a systematic review of available instruments

RATIONALE, AIMS AND OBJECTIVES

Enablement is an intervention by which the health care provider recognizes, promotes and enhances patients' ability to control their health and life. An abundant health literature suggests that enablement is associated with good outcomes. In this review, we aimed at identifying and comparing instruments that assess enablement in the health care context.

METHOD

We conducted a systematic literature review using Medline, Embase, Cochrane, Cinahl and PsycINFO databases, 1980 through March 2009, with specific search strategy for each database. Citations were included if they reported: (1) development and/or validation of an instrument; (2) evaluation of enablement in a health care context; and (3) quantitative results following administration of the instrument. The quality of each main retained citation was assessed using a modified version of the Standards for Reporting of Diagnostic Accuracy.

RESULTS

Of 3135 citations identified, 53 were retrieved for detailed evaluation. Four articles were included. Two instruments were found: the Patient Empowerment Scale (PES) and the Empowering Speech Practices Scale (ESPS). Both instruments assessed enablement in hospital setting, one from the inpatient's perspective (PES) and the other from both perspectives (ESPS).

CONCLUSION

Two instruments assess enablement in hospital setting. No instrument is currently available to assess enablement in an ambulatory care context.

The empowerment process in people with diabetes: an Iranian perspective

BACKGROUND

Empowerment and power are well-researched concepts concerning people with chronic diseases. However, few researchers have focused specifically on the process of empowerment in Iranian people with diabetes. Understanding the empowerment process could help health professionals facilitate empowerment.

AIM

To explore the empowerment process in Iranian people with diabetes.

METHOD

A grounded theory research design was used incorporating in-depth interviews to collect the data from men and women aged 21-73 years (n = 16). Data were collected between February and July 2007. Constant comparative analysis was undertaken to identify key categories.

FINDINGS

Participants indicated being embarrassed by the diagnosis, thirsting to learn, living in the shadow of fear, accepting diabetes as reality, managing diabetes and feeling empowered were distinct but interconnected phases in the empowerment process. The empowerment process was influenced by cultural and religious beliefs including the concept of the doctor as holy man, accepting diabetes as God's will, caring for the body because it was God's gift, paying attention to symptomatic disease, and support from peers and family, especially daughters.

CONCLUSION

The empowerment process consists of several distinct but interconnected phases. The findings will help health professionals develop a deeper understanding of how Iranian people with diabetes become empowered.