Cognitive interviewing in risk minimization survey development: patient and healthcare professional surveys

Physician Awareness of the Safe Use of Cyproterone Acetate in Europe: A Survey on the Effectiveness of Additional Risk Minimization Measures

BACKGROUND

Cyproterone acetate (CPA) is a synthetic progesterone derivative introduced in the 1970s and prescribed as antiandrogenic therapy for inoperable prostate cancer, sexual deviations in men, and signs of androgenization in women. In 2020, the CPA summary of product characteristics (SmPC) was revised to include an updated special warning and precaution about (1) the risk of meningioma with increasing cumulative dose and (2) contraindication in patients with meningioma or history of meningioma. A Direct Healthcare Professional Communication (DHPC) was distributed. The European Medicine Agency's Pharmacovigilance Risk Assessment Committee requested that marketing authorization holders in Europe conduct a survey to assess physicians' knowledge of the updated key safety information. The primary objective of this study was to measure physicians' awareness (i.e., did they receive and review the revised SmPC and DHPC) and level of knowledge and understanding of the key safety information pertaining to the restricted use of CPA monotherapy because of the risk of meningioma.

METHODS

This cross-sectional web-based survey was administered to dermatologists, endocrinologists, gynecologists, urologists, oncologists, psychiatrists, and general practitioners in France, Germany, Poland, Spain, and the Netherlands who had prescribed CPA monotherapy in the previous 12 months to assess awareness of the risk of meningioma associated with CPA monotherapy.

RESULTS

Of the 613 physicians who participated, 85% correctly indicated that CPA monotherapy should be prescribed with the lowest effective dose, 75% correctly indicated that the risk of meningioma increases with increasing cumulative CPA monotherapy doses, and 73% correctly indicated that treatment with CPA-containing products must be stopped permanently if a patient is diagnosed with meningioma. Overall, 40% of physicians reported having received the DHPC, and 42% reported having received the revised SmPC.

CONCLUSIONS

Despite low recall of receipt of the updated SmPC and DHPC, most physicians surveyed are aware of the meningioma risk and actions to mitigate the risk.

Understanding Patients' Experiences with Borderline Personality Disorder: Qualitative Interviews

Background

Patient perspectives of living with borderline personality disorder (BPD) are not traditionally captured in the literature. To overcome this gap, we explored participants' experiences with BPD to gain a better understanding of symptoms and impacts related to the condition.

Methods

Two experienced researchers conducted semistructured interviews with a subset of participants from a randomized controlled trial evaluating a BPD treatment. The interview study was independent from the trial. Interviews focused on participants' experiences with BPD prior to the trial, including the symptoms and impacts of BPD. Interview transcripts were analyzed to identify dominant trends and generate patterns in the way participants described their experiences with BPD.

Results

A total of 50 adults with BPD participated in the interview study. The mean age of the participants was 28.5 years (range, 18-53 years) and 72.0% were female. All participants described having difficulties with extreme emotional responses and interpersonal relationships, and most participants reported experiencing issues with self-image, impulsivity, suspiciousness/distrust, feelings of emptiness, and anger. The symptoms that were most bothersome to participants were extreme moods or emotional responses and a pattern of unstable personal relationships. All participants remarked that their BPD-related symptoms negatively impacted their interpersonal relationships, and nearly two-thirds of the sample reported that the impact of BPD on their relationships was the most bothersome. Additionally, more than half of the participants discussed impacts on work or school, memory or thinking, self-care, and financial and legal issues.

Conclusion

Participants reported that the most bothersome symptoms of BPD were those related to extreme moods or emotional responses and interpersonal relationships. Participants similarly described the impact of BPD on their interpersonal relationships as the most bothersome. Overall, participant perspectives from this study indicate that the burden of BPD is significant and new treatments tailored to patients' real-world needs are warranted.

Community pharmacist engagement in opioid use disorder prevention and treatment behaviors: A descriptive analysis

OBJECTIVES

This study describes community pharmacists' opioid analgesic and medication for opioid use disorder (MOUD) practice behaviors and behavioral intentions in the context of primary, secondary, and tertiary prevention of opioid use disorder (OUD).

METHODS

The study sampling frame consisted of 2302 Tennessee community-practice pharmacists who were asked to complete a mailed, paper questionnaire. Behavioral intentions were elicited by asking pharmacists to indicate the number of times (0 to 10) they engage in a behavior, given 10 patients in 3 distinct vignettes. Perceptions of evidence-based MOUD and pain management patient care practices were also elicited.

RESULTS

A response rate of 19.7% was achieved. Pharmacists reported using a brief questionnaire to evaluate risk of opioid misuse with 2.1 ± 3.7 (mean ± SD) out of 10 patients, screening 2.1 ± 3.7 patients for current opioid misuse, discussing co-dispensing of naloxone with 2.9 ± 3.4 to 3.3 ± 4 out of 10 patients at a risk of overdose, and dispensing buprenorphine/naloxone to a mean of 4.6 ± 4.2 patients when they presented a prescription. Respondents perceived 38% of pain management and 30% of MOUD prescribers in their area to practice evidenced-based care.

CONCLUSION

Pharmacists have an opportunity to improve the outcomes for patients prescribed opioids by increasing engagement across OUD prevention levels.

Measuring shared mental models in healthcare

Objective

To review common qualitative and quantitative methods of measuring shared mental models appropriate for use in the healthcare setting.

Background

Shared mental models are the overlap of individuals’ set of knowledge and/or assumptions that act as the basis for understanding and decision making between individuals. Within healthcare, shared mental models facilitate effective teamwork and theorized to influence clinical decision making and performance. With the current rapid growth and expansion of healthcare teams, it is critical that we understand and correctly use shared mental model measurement methods assess optimal team performance. Unfortunately, agreement on the proper measurement of shared mental models within healthcare remains diffuse.

Method

This paper presents methods appropriate to measure shared mental models within healthcare.

Results

Multiple shared mental model measurement methods are discussed with regard to their utility within this setting, ease of use, and difficulties in deploying within the healthcare operational environment. For rigorous analysis of shared mental models, it is recommended that a combination of qualitative and quantitative analyses be employed.

Conclusion

There are multitude of shared mental model measurement methods that can be used in the healthcare domain; although there is no perfect solution for every situation. Researchers can utilize this article to determine the best approach for their needs.

The association between insurance type and cost-related delay in care: a survey

OBJECTIVES

Massachusetts has insurance rates similar to those projected under the Affordable Care Act, but many of the state's patients are insured through private insurance plans with high out-of-pocket costs. We aimed to explore the relationship between insurance type (private vs public) and delays in care due to cost, stratified by income.

STUDY DESIGN

Cross-sectional study.

METHODS

We conducted a study of English-speaking adults recruited from the waiting rooms of the emergency department or outpatient clinics of a large healthcare system in western Massachusetts. Our primary outcome was the association between insurance type and cost-related delay in care, stratified by income.

RESULTS

Of 800 individuals approached, 619 (77%) completed the survey. Participants were 60.6% male and 40.2% white, 37.2% Hispanic, and 12.6% black. The majority (61.4%) of those surveyed had public insurance, 34.1% had private insurance, and 4.5% were uninsured. Overall, 13.3% reported delays in seeking care that were related to cost. The impact of insurance on delay of care differed significantly by income tertile (P = .02): in the middle-income group ($12,500 to <$25,000 per person annually), privately insured respondents were more likely to delay care due to cost compared with publicly insured subjects (15.6% vs 8.1%; odds ratio [OR], 4.4; 95% confidence interval [CI], 1.9-10.2, unadjusted; OR, 2.2; 95% CI, 0.9-5.8, adjusted).

CONCLUSIONS

Cost-related delays in care are prevalent despite the presence of an insurance mandate. Middle-income, privately insured patients report more cost-related delays in care compared with publicly insured patients with similar incomes.

Nursing judgement and decision-making using the Sedation Withdrawal Score (SWS) in children

AIMS

The aim of the study was to evaluate registered children's nurses' approaches to the assessment and management of withdrawal syndrome in children.

BACKGROUND

Assessment of withdrawal syndrome is undertaken following critical illness when the child's condition may be unstable with competing differential diagnoses. Assessment tools aim to standardize and improve recognition of withdrawal syndrome. Making the right decisions in complex clinical situations requires a degree of mental effort and it is not known how nurses make decisions when undertaking withdrawal assessments.

DESIGN

Cognitive interviews with clinical vignettes.

METHODS

Interviews were undertaken with 12 nurses to explore the cognitive processes they used when assessing children using the Sedation Withdrawal Score (SWS) tool. Interviews took place in Autumn 2013.

FINDINGS

Each stage of decision-making-noticing, interpreting and responding-presented cognitive challenges for nurses. When defining withdrawal behaviours nurses tended to blur the boundaries between Sedation Withdrawal Score signs. Challenges in interpreting behaviours arose from not knowing if the patient's behaviour was a result of withdrawal or other co-morbidities. Nurses gave a range of diagnoses when interpreting the vignettes, despite being provided with identical information. Treatment responses corresponded to definite withdrawal diagnoses, but varied when nurses were unsure of the diagnosis.

CONCLUSION

Cognitive interviews with vignettes provided insight into nurses' judgement and decision-making. The SWS does not standardize the assessment of withdrawal due to the complexity of the context where assessments take place and the difficulties of determining the cause of equivocal behaviours in children recovering from critical illness.

Refinement of the symptom screening in pediatrics tool (SSPedi)

Background:

Objective was to evaluate and refine a new instrument for paediatric cancer symptom screening named the Symptom Screening in Pediatrics Tool (SSPedi).

Methods:

Respondents were children 8–18 years of age undergoing active cancer treatment and parents of eligible children. Respondents completed SSPedi once and then responded to semi-structured questions. They rated how easy or difficult SSPedi was to complete. For items containing two concepts, we asked respondents whether concepts should remain together or be separated into two questions. We also asked about each item's importance and whether items were missing. Cognitive probing was conducted in children to evaluate their understanding of items and the response scale. After each group of 10 children and 10 parents, responses were reviewed to determine whether modifications were required. Recruitment ceased with the first group of 10 children in which modifications were not required.

Results:

Thirty children and 20 parents were required to achieve a final version of SSPedi. Fifteen items remain in the final version; the score ranges from 0 to 60.

Conclusions:

Using opinions of children with cancer and parents of paediatric cancer patients, we successfully developed a symptom screening tool that is easy to complete, is understandable and demonstrates content validity.