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Zhang Y, Xia W, Liu T. Influence of humanistic care on negative emotions, nursing quality, and patient satisfaction in outpatient gynecological surgery. Am J Transl Res 2024; 16:3220-3230. [PMID: 39114727 PMCID: PMC11301512 DOI: 10.62347/qcag2084] [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: 03/20/2024] [Accepted: 06/19/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To explore the impact of humanistic care on negative emotions, nursing quality and patient satisfaction among women undergoing outpatient gynecological surgery. METHODS This retrospective study involved 108 patients who underwent outpatient gynecological surgery at the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine between August 2022 and August 2023. The patients were divided into two groups: 51 patients received routine care (control group) and 57 received humanistic care (experimental group). Data collected included vital signs (heart rate [HR] and systolic/diastolic blood pressure [SBP/DBP]), pain levels (Visual Analogue Scale [VAS] scores at 12 and 24 hours postoperative), negative emotions (Self-rating Anxiety/Depression Scale [SAS/SDS]), comfort (Kolcaba's General Comfort Questionnaire [GCQ]), sexual functioning (Brief Index of Sexual Functioning for Women), nursing quality (errors, defects, and complaints) and patient satisfaction. RESULTS Intraoperative SBP, DBP, along with HR, were significantly lower in the experimental group compared to the control group (all P<0.05). Postoperative pain levels at both 12 and 24 hours were also significantly reduced in the experimental group (both P<0.01). Furthermore, the experimental group demonstrated significant reductions in SAS and SDS scores and higher GCQ scores across physical, psychospiritual, environmental, and sociocultural dimensions (all P<0.05). There were no significant differences between the groups in terms of sexual desire, activity, and satisfaction (all P>0.05). Nursing quality was significantly better (P=0.029) and patient satisfaction with nursing care was higher (P=0.015) in the experimental group. CONCLUSIONS Humanistic care significantly reduces negative emotions and enhances comfort, nursing quality, and patient satisfaction in women undergoing outpatient gynecological surgery. This approach does not affect sexual functioning indicators but offers substantial improvements in overall patient care and outcomes. Its high value for clinical promotion underscores its potential as a transformative approach in outpatient gynecological settings.
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Affiliation(s)
- Yunni Zhang
- Department of Outpatient Nursing, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine Hangzhou 310000, Zhejiang, China
| | - Wei Xia
- Department of Outpatient Nursing, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine Hangzhou 310000, Zhejiang, China
| | - Tingting Liu
- Department of Outpatient Nursing, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine Hangzhou 310000, Zhejiang, China
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Richmond J, Anderson A, Cunningham-Erves J, Ozawa S, Wilkins CH. Conceptualizing and Measuring Trust, Mistrust, and Distrust: Implications for Advancing Health Equity and Building Trustworthiness. Annu Rev Public Health 2024; 45:465-484. [PMID: 38100649 PMCID: PMC11156570 DOI: 10.1146/annurev-publhealth-061022-044737] [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] [Indexed: 12/17/2023]
Abstract
Trust is vital to public confidence in health and science, yet there is no consensus on the most useful way to conceptualize, define, measure, or intervene on trust and its related constructs (e.g., mistrust, distrust, and trustworthiness). In this review, we synthesize literature from this wide-ranging field that has conceptual roots in racism, marginalization, and other forms of oppression. We summarize key definitions and conceptual frameworks and offer guidance to scholars aiming to measure these constructs. We also review how trust-related constructs are associated with health outcomes, describe interventions in this field, and provide recommendations for building trust and institutional trustworthiness and advancing health equity. We ultimately call for future efforts to focus on improving the trustworthiness of public health professionals, scientists, health care providers, and systems instead of aiming to increase trust in these entities as they currently exist and behave.
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Affiliation(s)
- Jennifer Richmond
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew Anderson
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Consuelo H Wilkins
- Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
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Hantzmon SV, Davenport CA, Das Gupta MN, Adekunle TA, Gaither SE, Olsen MK, Pinheiro SO, Johnson KS, Mahoney H, Falls A, Lloyd L, Pollak KI. Race differences in patient trust and distrust from audio-recorded cardiology encounters. PATIENT EDUCATION AND COUNSELING 2024; 119:108083. [PMID: 37989068 PMCID: PMC10842896 DOI: 10.1016/j.pec.2023.108083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Many have reported racial disparities in self-reported trust in clinicians but have not directly assessed expressions of trust and distrust in physician-patient encounters. We created a codebook to examine racial differences in patient trust and distrust through audio-recorded cardiologist-patient interactions. METHODS We analyzed data from a randomized controlled trial of audio-recorded outpatient cardiology encounters (50 White and 51 Black patients). We created a codebook for trust and distrust that was applied to recordings between White cardiologists and White and Black patients. We assessed differences in trust, distrust, and guardedness while adjusting for patient age, sex, and first appointment with the cardiologist. RESULTS Compared to White patients, Black patients had significantly lower expressions of trust ([IRR] [95 % CI]: 0.59 [0.41, 0.84]) and a significantly lower mean guarded/open score ([β] [95 % CI] -0.38 [-0.71, -0.04]). There was no statistically significant association between race and odds of at least one distrustful expression (OR [95 % CI] 1.36 [0.37, 4.94]). CONCLUSION AND PRACTICE IMPLICATIONS We found that coders can reliably identify patient expressions of trust and distrust rather than relying on problematic self-reported measures. Results suggest that White clinicians can improve their communication with Black patients to increase expressions of trust.
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Affiliation(s)
- Sarah V Hantzmon
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA
| | | | - Maya N Das Gupta
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA
| | - Temi A Adekunle
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Sarah E Gaither
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA; Samuel DuBois Cook Center on Social Equity, Duke University, Durham, NC, USA
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sandro O Pinheiro
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly S Johnson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Medical Center, Durham, NC, USA
| | - Hannah Mahoney
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Allison Falls
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Lauren Lloyd
- Department of Psychology and Neuroscience, Duke University Trinity College of Arts and Sciences, Durham, NC, USA
| | - Kathryn I Pollak
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA.
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Holmen H, Flølo T, Tørris C, Løyland B, Almendingen K, Bjørnnes AK, Albertini Früh E, Grov EK, Helseth S, Kvarme LG, Malambo R, Misvær N, Rasalingam A, Riiser K, Sandbekken IH, Schippert AC, Sparboe-Nilsen B, Sundar TKB, Sæterstrand T, Utne I, Valla L, Winger A, Torbjørnsen A. Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:36. [PMID: 38248501 PMCID: PMC10815593 DOI: 10.3390/ijerph21010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.
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Affiliation(s)
- Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Intervention Centre, Oslo University Hospital, 4950 Oslo, Norway
| | - Tone Flølo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Department of Surgery, Voss Hospital, Haukeland University Hospital, 5704 Voss, Norway
| | - Christine Tørris
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Kari Almendingen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Elena Albertini Früh
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Sølvi Helseth
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Rosah Malambo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Nina Misvær
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Anurajee Rasalingam
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Kirsti Riiser
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Ida Hellum Sandbekken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ana Carla Schippert
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Bente Sparboe-Nilsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
| | - Turid Kristin Bigum Sundar
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Torill Sæterstrand
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Lisbeth Valla
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), 0484 Oslo, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
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Seetharam SP, Shankar V, Udupa K, Anjanappa R, Reddy N. Quality of life assessment in the first episode of acute coronary syndrome. J Clin Transl Res 2023; 9:265-271. [PMID: 37593241 PMCID: PMC10431193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/19/2023] [Accepted: 06/26/2023] [Indexed: 08/19/2023] Open
Abstract
Background Assessment of health-related quality of life (HRQoL) is an important measure of a patient's recovery after an illness. However, HRQoL among acute coronary syndrome (ACS) survivors has not been extensively studied following cardiac management. Aim The purpose of this study was to assess the quality of life (QoL) among ACS patients who have undergone percutaneous coronary intervention (PCI). Methods This cohort study included 145 consecutive male ACS patients between March 2021 and May 2022. Of these patients, 138 (mean age 54.3 ± 10.7 years) completed the QoL assessment using the short form-12 (SF-12) health survey questionnaire. Seventy (51%) of them presented with ST-segment elevation myocardial infarction (STEMI), 18 (13%) had non-STEMI, 39 (28%) had evolved MI, and 11 (8%) had unstable angina. Recruited patients' QoL data were assessed at various time points post-PCI. Results At the end of the 12 months of follow-up, major clinical events (MCE) defined as death, sudden death, or re-acute myocardial infarction occurred in 54.9% of patients. Out of 7 MCE, four deaths and three re-AMIs had occurred. SF-12 physical component score was found to be significantly improved when compared to the mental component score, which seems to improve without reaching statistical significance over time. Among event-free ACS patients, we found a significant positive correlation between left ventricular ejection fraction and HRQoL. Conclusion Improvement in HRQoL (physical component) was seen among ACS patients post-PCI. Relevance for Patients QoL assessment outcomes should be considered in clinical settings, practice guidelines, and treatment modality post-PCI to improve QoL in post-ACS survivors.
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Affiliation(s)
- Smitha Pernaje Seetharam
- Department of Physiology, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
| | - Vinutha Shankar
- Department of Physiology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India
| | - Kaviraja Udupa
- Department of Neurophysiology, NIMHANS, Bengaluru, Karnataka, India
| | - Raveesha Anjanappa
- Department of General Medicine, R. L. Jalappa Hospital, Sri Devaraj Urs Academy of Higher Education and Research Kolar, Karnataka, India
| | - Niranjan Reddy
- Department of Cardiology, R. L. Jalappa Hospital, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
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Alnajjar LI, Alzaben MA, Alghamdi AA, Alomani M, Abbas MS, Altammami RF, Alabdullatif SA, Rokan AKB, Youssef AM, Alhubaishi AA. The remission rate, metabolic changes, and quality of life assessment among patients with type 2 diabetes post-bariatric surgery in Riyadh, Saudi Arabia: A cross-sectional study. Saudi Med J 2023; 44:694-702. [PMID: 37463701 PMCID: PMC10370379 DOI: 10.15537/smj.2023.44.7.20230080] [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: 02/06/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES To assess the remission rate, metabolic changes, and quality of life after bariatric surgery among Saudi patients with type 2 diabetes (T2DM). METHODS This cross-sectional study was conducted in 2 main centers in the Riyadh, Saudi Arabia. The study included patients with T2DM who underwent either laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) surgery from 2014 to 2018. The remission rate was defined based on the American Diabetes Association (ADA) and the International Diabetes Federation (IDF) criteria. Quality of life was assessed using the World Health Organization Quality of Life (WHOQOL)-BREF. RESULTS A total of 232 patients were included with a mean age of 44.3 ± 10.3 years. 93.4% of the patients had LSG, while only 6.6% had RYGB surgery. Among patients who underwent either LSG or RYGB surgery, there was a significant improvement in metabolic and glycemic markers compared to the baseline. According to the ADA criteria, 48.5% of the patients had complete remission, while 18.9% had partial remission. Overall, 7% of the patients met the IDF optimization criteria, while 5.7% met the IDF improvement criteria. The mean score for all the QOL domains exceeded 63 ± 13, with the environmental and physical health domains having the highest scores. CONCLUSION Among Saudi patients, bariatric surgery was associated with high remission rates and a better quality of life.
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Affiliation(s)
- Lina I. Alnajjar
- From the Department of Pharmacy Practice (Alnajjar, Alhubaishi), and from the College of Pharmacy (Alnajjar, Alhubaishi, Alghamdi, Alomani, Abbas, Altammami, Alabdullatif, Bin Rokan), Princess Nourah bint Abdulrahman University; from the Medical Affairs, Department (Alzaben);, Sultan Bin Abdulaziz Humanitarian City; and from the Research and Scientific Center (Youssef), Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Alzaben
- From the Department of Pharmacy Practice (Alnajjar, Alhubaishi), and from the College of Pharmacy (Alnajjar, Alhubaishi, Alghamdi, Alomani, Abbas, Altammami, Alabdullatif, Bin Rokan), Princess Nourah bint Abdulrahman University; from the Medical Affairs, Department (Alzaben);, Sultan Bin Abdulaziz Humanitarian City; and from the Research and Scientific Center (Youssef), Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia.
| | - Atheer A. Alghamdi
- From the Department of Pharmacy Practice (Alnajjar, Alhubaishi), and from the College of Pharmacy (Alnajjar, Alhubaishi, Alghamdi, Alomani, Abbas, Altammami, Alabdullatif, Bin Rokan), Princess Nourah bint Abdulrahman University; from the Medical Affairs, Department (Alzaben);, Sultan Bin Abdulaziz Humanitarian City; and from the Research and Scientific Center (Youssef), Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia.
| | - Munirah.O. Alomani
- From the Department of Pharmacy Practice (Alnajjar, Alhubaishi), and from the College of Pharmacy (Alnajjar, Alhubaishi, Alghamdi, Alomani, Abbas, Altammami, Alabdullatif, Bin Rokan), Princess Nourah bint Abdulrahman University; from the Medical Affairs, Department (Alzaben);, Sultan Bin Abdulaziz Humanitarian City; and from the Research and Scientific Center (Youssef), Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia.
| | - Maha S. Abbas
- From the Department of Pharmacy Practice (Alnajjar, Alhubaishi), and from the College of Pharmacy (Alnajjar, Alhubaishi, Alghamdi, Alomani, Abbas, Altammami, Alabdullatif, Bin Rokan), Princess Nourah bint Abdulrahman University; from the Medical Affairs, Department (Alzaben);, Sultan Bin Abdulaziz Humanitarian City; and from the Research and Scientific Center (Youssef), Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia.
| | - Rahaf F. Altammami
- From the Department of Pharmacy Practice (Alnajjar, Alhubaishi), and from the College of Pharmacy (Alnajjar, Alhubaishi, Alghamdi, Alomani, Abbas, Altammami, Alabdullatif, Bin Rokan), Princess Nourah bint Abdulrahman University; from the Medical Affairs, Department (Alzaben);, Sultan Bin Abdulaziz Humanitarian City; and from the Research and Scientific Center (Youssef), Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia.
| | - Sara A. Alabdullatif
- From the Department of Pharmacy Practice (Alnajjar, Alhubaishi), and from the College of Pharmacy (Alnajjar, Alhubaishi, Alghamdi, Alomani, Abbas, Altammami, Alabdullatif, Bin Rokan), Princess Nourah bint Abdulrahman University; from the Medical Affairs, Department (Alzaben);, Sultan Bin Abdulaziz Humanitarian City; and from the Research and Scientific Center (Youssef), Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia.
| | - Aljawharah K. Bin Rokan
- From the Department of Pharmacy Practice (Alnajjar, Alhubaishi), and from the College of Pharmacy (Alnajjar, Alhubaishi, Alghamdi, Alomani, Abbas, Altammami, Alabdullatif, Bin Rokan), Princess Nourah bint Abdulrahman University; from the Medical Affairs, Department (Alzaben);, Sultan Bin Abdulaziz Humanitarian City; and from the Research and Scientific Center (Youssef), Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia.
| | - Amira M. Youssef
- From the Department of Pharmacy Practice (Alnajjar, Alhubaishi), and from the College of Pharmacy (Alnajjar, Alhubaishi, Alghamdi, Alomani, Abbas, Altammami, Alabdullatif, Bin Rokan), Princess Nourah bint Abdulrahman University; from the Medical Affairs, Department (Alzaben);, Sultan Bin Abdulaziz Humanitarian City; and from the Research and Scientific Center (Youssef), Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia.
| | - Alaa A. Alhubaishi
- From the Department of Pharmacy Practice (Alnajjar, Alhubaishi), and from the College of Pharmacy (Alnajjar, Alhubaishi, Alghamdi, Alomani, Abbas, Altammami, Alabdullatif, Bin Rokan), Princess Nourah bint Abdulrahman University; from the Medical Affairs, Department (Alzaben);, Sultan Bin Abdulaziz Humanitarian City; and from the Research and Scientific Center (Youssef), Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia.
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Pekmezaris R, Cigaran E, Patel V, Clement D, Sardo Molmenti CL, Molmenti E. Randomized intervention to assess the effectiveness of an educational video on organ donation intent among Hispanics in the New York metropolitan area. World J Transplant 2023; 13:190-200. [PMID: 37388392 PMCID: PMC10303414 DOI: 10.5500/wjt.v13.i4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The Hispanic community has a high demand for organ donation but a shortage of donors. Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions. Factors acting as barriers to organ donation registration have been classified as: (1) Bodily integrity; (2) medical mistrust; (3) “ick”-feelings of disgust towards organ donation; and (4) “jinx”-fear that registration may result in one dying due to premeditated plans. We predict that by providing necessary information and education about the donation process via a short video, individuals will be more willing to register as organ donors.
AIM To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metropolitan area.
METHODS This study was approved by the Institutional Review Board at Northwell Health. The approval reference number is No. 19-0009 (as presented in Supplementary material). Eligible participants included Hispanic New York City (NYC) residents, 18 years of age and above, who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents. The survey an 85-item Redcap survey measured participant demographics, attitudes, and knowledge of organ donation as well as the intention to register as an organ donor. Attention checks were implemented throughout the survey, and responses were excluded for those who did fail. Participants were randomly assigned two-between subject conditions: To view a short video on organ donation and then proceed to complete the survey (i.e., video first) and view the same video at the end of the survey (video last). No intra-group activities were conducted. This study utilized an evidenced-based emotive educational intervention (video) which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles. Results were analyzed using Jamovi statistical software. Three hundred sixty-five Hispanic individuals were included in the analysis. Once consent was obtained and participants entered the survey (the survey sample is presented in Supplementary material), participants were asked to report on demographic variables and their general impression of organ donation after death. The video depicted stories regarding organ donation after death from various viewpoints, including from the loved ones of a deceased person who died waiting for a transplant; from the loved ones of a deceased person whose organs were donated upon death; and, from those who were currently waiting for a transplant.
RESULTS Using a binomial logistic regression, the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors. The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions (odds ratio: 2.05, 95% confidence interval: 1.06-3.97). Motivations for participation in organ donation were also captured with many stating the importance of messages coming from “people like me” and a message that highlights “the welfare of those in need”. Overall, the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous. Future studies should explore using targeted messaging that resonates with specific cultural groups, highlighting the welfare of others.
CONCLUSION This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.
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Affiliation(s)
- Renee Pekmezaris
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Edgardo Cigaran
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Vidhi Patel
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Damian Clement
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | | | - Ernesto Molmenti
- Department of Nephrology, Northwell Health/Zucker School of Medicine at Hosftra, Manhasset, NY 11030, United States
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Daggett A, Abdollahi S, Hashemzadeh M. The Effect of Language Concordance on Health Care Relationship Trust Score. Cureus 2023; 15:e39530. [PMID: 37366455 PMCID: PMC10290885 DOI: 10.7759/cureus.39530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Various barriers exist for Limited English Proficient (LEP) patients in the United States healthcare system, including language barriers. To address language access, interpreters have been used as well as physicians who speak the same language (language concordance), with unknown effect. By studying the strength of patient-physician relationships under different communication parameters, such as the use of a variety of language services, we can better understand healthcare interactions and move toward optimizing patient care and health outcomes. This study investigates the importance of language-concordant care in LEP populations to build trusting patient-physician relationships. OBJECTIVE To determine whether Spanish-speaking patients who receive health care from language-concordant (in this study, Spanish-speaking) physicians have higher total trust scores on the Health Care Relationship (HCR) Trust scale than patients who use professional or ad hoc interpreters. METHODS This is a prospective survey conducted on Spanish-speaking adult patients coming to family and internal medicine outpatient clinics in the Phoenix, AZ, metro area. Of 214 recruited subjects, 176 completed the survey. Primary outcomes of the study: measured total mean Health Care Relationship (HCR) trust score among three groups (language concordant, professional interpreter, ad hoc interpreter). Secondary outcomes of the study: variance of trust scores among three groups for individual survey items. Results: The group with language concordant providers had a mean trust score of 48.73, significantly higher than the mean for the group with ad hoc interpreters with a mean of 45.53 (p = 0.0090). Patients with a professional interpreter also had a higher mean trust score of 48.27 than the ad hoc interpreters (p = 0.0119). There were several individual questions where the professional language groups had statistically significantly higher HCR trust scores than the ad hoc interpreter group in terms of their trust in specific instances, i.e., involving the patient in discussing treatment options, making the patient feel worthy of the doctor's time, and their doctor telling them the whole truth. There were no differences in overall mean scores or individual scores for the two professional language groups (language concordant providers and professional interpreters). CONCLUSIONS The results reinforce the current understanding that professionally acknowledged and trained speakers of a second language in the medical setting allow for the formation of stronger patient-physician relationships, specifically in terms of a patient's trust in their physician. In addition to continuing to increase the availability of high-quality interpreters, the same effort should be placed on increasing the diversity of languages spoken by physicians to foster trusting patient-physician relationship formation.
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Affiliation(s)
- Alexandria Daggett
- Pediatrics, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | | | - Mehrtash Hashemzadeh
- Biostatistics, University of Arizona College of Medicine - Phoenix, Phoenix, USA
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Wunsch E, Krause L, Gevers TJ, Schramm C, Janik MK, Krawczyk M, Willemse J, Uhlenbusch N, Löwe B, Lohse AW, Milkiewicz P. Confidence in treatment is contributing to quality of life in autoimmune liver diseases. The results of ERN RARE-LIVER online survey. Liver Int 2023; 43:381-392. [PMID: 36177700 PMCID: PMC10091761 DOI: 10.1111/liv.15440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Autoimmune liver diseases (AILDs) are associated with impaired health-related quality of life (HrQoL). The aim of this project was to identify potentially modifiable factors related to HrQoL in a large transnational cohort of patients with AILDs. METHODS A cross-sectional online survey was conducted on patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) or primary sclerosing cholangitis from 15 European countries. HrQoL was measured with EQ-5D-5L and EQ visual analogue scale (EQ-VAS) and analysed in relation to demographic, psychosocial, disease- and treatment-related factors. A Patient Health Questionnaire-2 score >3 indicated relevant depression. Multivariable linear regression analyses were used to identify potentially modifiable factors associated with HrQoL and confidence in treatment whilst adjusting for known confounders. RESULTS A group of 1178 European patients (79% female, mean age 48 ± 14 years) participated in the study. HrQoL was impaired in all three diseases (mean EQ-5D-5L = 0.75, mean EQ VAS = 68.9), most markedly in PBC (mean EQ-5D-5L = 0.73, mean EQ-VAS = 66.2). Relevant depression, which was detected in 17% of patients, was prominently associated with impaired HrQoL. In the regression analysis, treatment confidence was identified as an important modifiable factor positively contributing to HrQoL. This influence was observable even after adjusting for other covariates including depression. Management in a transplant centre, treatment with azathioprine in AIH, and with ursodeoxycholic acid in PBC, was associated with increased treatment confidence. Finally, improved patient-physician relationships contributed to treatment confidence. CONCLUSION Treatment confidence is a relevant modifiable determinant of HrQoL and should be further investigated to improve the standards of care for patients with AILDs.
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Affiliation(s)
- Ewa Wunsch
- Translational Medicine Group, Pomeranian Medical University in Szczecin, Szczecin, Poland.,RARE-LIVER European Reference Network
| | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tom Jg Gevers
- RARE-LIVER European Reference Network.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Christoph Schramm
- RARE-LIVER European Reference Network.,Department of Medicine and Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Hamburg Center for Translational Immunology (HCTI), Hamburg, Germany
| | - Maciej K Janik
- RARE-LIVER European Reference Network.,Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Krawczyk
- RARE-LIVER European Reference Network.,Department of Medicine II, Saarland University Medical Center, Homburg, Germany.,Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - José Willemse
- RARE-LIVER European Reference Network.,Dutch Liver Patients Association, Hoogland, The Netherlands
| | - Natalie Uhlenbusch
- RARE-LIVER European Reference Network.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- RARE-LIVER European Reference Network.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar Wilhelm Lohse
- RARE-LIVER European Reference Network.,Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Piotr Milkiewicz
- Translational Medicine Group, Pomeranian Medical University in Szczecin, Szczecin, Poland.,RARE-LIVER European Reference Network.,Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland
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Ye W, Wang L, Wang Y, Wang C, Zeng J. Depression and anxiety symptoms among patients receiving maintenance hemodialysis: a single center cross-sectional study. BMC Nephrol 2022; 23:417. [PMID: 36585621 PMCID: PMC9804950 DOI: 10.1186/s12882-022-03051-8] [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: 08/30/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To investigate depression and anxiety and related factors among patients receiving maintenance hemodialysis (MHD). METHODS This cross-sectional study included patients underwent MHD in 3/2022 at Jinshan Hospital affiliated to Fudan University. Depression and anxiety levels of patients were assessed using Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. SF-36 was used to assess patients' quality of life. Multiple linear regression analysis was used to determine the variables associated with the scores of BDI/BAI. RESULTS A total of 103 patients were included, 71 cases (68.93%) and 38 cases (36.89%) with depression and anxiety, respectively. The scores of almost all domains of the SF-36 showed a declining trend with increasing depression or anxiety among patients on MHD. Higher Charlson Comorbidity Index (CCI) (β =0.066, 95%CI: 0.016-0.116, P = 0.010), lower educational status (β = - 0.139, 95%CI: - 0.243- -0.036, P = 0.009), and number of oral medications (β =0.177, 95%CI: 0.031-0.324, P = 0.018) were significantly associated with higher BDI scores. Longer dialysis duration (β =0.098, 95%CI: 0.003-0.193, P = 0.044) and number of oral medications (β =4.714, 95%CI: 1.837-7.590, P = 0.002) were significantly associated with higher BAI scores. CONCLUSIONS Depression and anxiety may be likely to occur among patients undergoing MHD and impact their quality of life. Higher CCI, lower educational status and usage of multiple oral medications may be associated with depression, whereas longer dialysis duration and multiple oral medications may be associated with anxiety in MHD patients.
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Affiliation(s)
- Wei Ye
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Lizhen Wang
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Yu Wang
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Chengjun Wang
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Jingyi Zeng
- grid.415108.90000 0004 1757 9178Department of Nephrology, Fujian Provincial Hospital, Fuzhou, 350001 China
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Schnelle C, Clark J, Mascord R, Jones MA. Is There a Doctors' Effect on Patients' Physical Health, Beyond the Intervention and All Known Factors? A Systematic Review. Ther Clin Risk Manag 2022; 18:721-737. [PMID: 35903086 PMCID: PMC9314759 DOI: 10.2147/tcrm.s372464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/11/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose Despite billions of doctor visits worldwide each year, little is known on whether doctors themselves affect patients' physical health after accounting for intervention and confounders such as patients' and doctors' data, hospital effects, nor how strong that doctors' effect is. Knowledge of surgeons' and psychotherapists' effects exists, but not for 102 other medical specialties notwithstanding the importance of such knowledge. Methods Eligibility Criteria: Randomized controlled trials (RCTs), case-control, and cohort studies including medical doctors except surgeons for any intervention, reporting the proportion of variance in patients' outcomes owing to the doctors (random effects), or the fixed effects of grading doctors by outcomes, after multivariate adjustment. Exclusions: studies of <15 doctors or solely reporting doctors' effects for known variables. Sources Medline, Embase, PsycINFO, inception to June 2020. Manual search for papers referring/referred to by resulting studies. Risk of Bias Using Newcastle-Ottawa scale. Results Despite all medical interventions bar surgery being eligible, only thirty cohort papers were found, covering 36,239 doctors, with 10 specialties, 21 interventions, 60 outcomes (17 unique). Studies reported doctors' effects by grading doctors from best to worst, or by diversely calculating the doctor-attributed percentage of patients' outcome variation, ie the intra-class correlation coefficient (ICC). Sixteen studies presented fixed effects, 18 random effects, and 3 another approach. No RCTs found. Thirteen studies reported exceptionally good and/or poor performers with confidence intervals wholly outside the average performance. ICC range 0 to 33%, mean 3.9%. Highly diverse reporting, meta-analysis therefore not applicable. Conclusion Doctors, on their own, can affect patients' physical health for many interventions and outcomes. Effects range from negligible to substantial, even after accounting for all known variables. Many published cohorts may reveal valuable information by reanalyzing their data for doctors' effects. Positive and negative doctor outliers appear regularly. Therefore, it can matter which doctor is chosen.
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Affiliation(s)
- Christoph Schnelle
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Justin Clark
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Rachel Mascord
- General Dentist, BMA House, Sydney, New South Wales, Australia
| | - Mark A Jones
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
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Schnelle C, Jones MA. The Doctors' Effect on Patients' Physical Health Outcomes Beyond the Intervention: A Methodological Review. Clin Epidemiol 2022; 14:851-870. [PMID: 35879943 PMCID: PMC9307914 DOI: 10.2147/clep.s357927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/22/2022] [Indexed: 01/02/2023] Open
Abstract
Background Previous research suggests that when a treatment is delivered, patients' outcomes may vary systematically by medical practitioner. Objective To conduct a methodological review of studies reporting on the effect of doctors on patients' physical health outcomes and to provide recommendations on how this effect could be measured and reported in a consistent and appropriate way. Methods The data source was 79 included studies and randomized controlled trials from a systematic review of doctors' effects on patients' physical health. We qualitatively assessed the studies and summarized how the doctors' effect was measured and reported. Results The doctors' effects on patients' physical health outcomes were reported as fixed effects, identifying high and low outliers, or random effects, which estimate the variation in patient health outcomes due to the doctor after accounting for all available variables via the intra-class correlation coefficient. Multivariable multilevel regression is commonly used to adjust for patient risk, doctor experience and other demographics, and also to account for the clustering effect of hospitals in estimating both fixed and random effects. Conclusion This methodological review identified inconsistencies in how the doctor's effect on patients' physical health outcomes is measured and reported. For grading doctors from worst to best performances and estimating random effects, specific recommendations are given along with the specific data points to report.
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Affiliation(s)
- Christoph Schnelle
- Institute of Evidence-Based Healthcare, Bond University, Robina, QLD, 4226, Australia
| | - Mark A Jones
- Institute of Evidence-Based Healthcare, Bond University, Robina, QLD, 4226, Australia
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Lindström M, Pirnouzifard M. Trust in the healthcare system and mortality: A population-based prospective cohort study in southern Sweden. SSM Popul Health 2022; 18:101109. [PMID: 35535209 PMCID: PMC9077527 DOI: 10.1016/j.ssmph.2022.101109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022] Open
Abstract
Aims To investigate associations between trust in the healthcare system and all-cause, cardiovascular, cancer and other causes mortality. Study design Prospective cohort study. Methods A public health questionnaire was conducted in 2008 in Scania, the southernmost part of Sweden, with a 54.1% participation rate with a postal questionnaire and three reminders. In this study 24,833 respondents were included. The baseline questionnaire study was linked to prospective 8.3-year follow-up cause-specific mortality register data. Survival (Cox) regression analyses were conducted. Results A 15.2% proportion of respondents reported very high, 59.1% rather high, and 21.7% not particularly high trust in the healthcare system, while 3.2% reported no trust at all and 0.9% did not know. The groups with rather high and not particularly high trust in the healthcare system had significantly lower all-cause mortality than the reference group with very high trust in the healthcare system. These statistically significant results remained throughout the multiple analyses, and were explained by lower cancer mortality in both the rather high and not particularly high trust respondent groups, and lower cardiovascular mortality in the not particularly high trust respondent group. No significant results were observed in the adjusted models for other causes mortality. No significant results were observed for the no trust and don't know categories in the multiple adjusted models, but these groups are small. Conclusions The results suggest a comparative advantage of moderate trust compared to very high trust in this setting of long waiting times for cancer and CVD treatment. Trust in the healthcare system and mortality was investigated. Rather high and not particularly high trust groups had lower all-cause mortality than the very high trust group. The lower mortality was mainly explained by lower cancer mortality. The lower mortality was partly explained by lower CVD mortality. The findings are associated with long-term queueing for particularly cancer treatment.
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Bazargan M, Cobb S, Assari S. Completion of advance directives among African Americans and Whites adults. PATIENT EDUCATION AND COUNSELING 2021; 104:2763-2771. [PMID: 33840551 PMCID: PMC8481344 DOI: 10.1016/j.pec.2021.03.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The primary purpose of this study was to analyze the completion of advance directives among African American and White adults and examine related factors, including demographics, socio-economic status, health conditions, and experiences with health care providers. METHODS This study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We compared correlates of completion of advance directives among a sample of 1635 African American and White adults. Multivariate analysis was conducted. RESULTS Whites were 50% more likely to complete an advance directive than African Americans. The major differences between African Americans and Whites were mainly explained by the level of mistrust and discrimination experienced by African Americans and partially explained by demographic characteristics. Our study showed that at both bivariate and multivariate levels, participation in religious activities was associated with higher odds of completion of an advance directive for both African Americans and Whites. CONCLUSION Interventional studies needed to address the impact of mistrust and perceived discrimination on advance directive completion. PRACTICAL IMPLICATIONS Culturally appropriate multifaceted, theoretical- and religious-based interventions are needed that include minority health care providers, church leaders, and legal counselors to educate, modify attitudes, provide skills and resources for communicating with health care providers and family members.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA; Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Department of Public Health, CDU, Los Angeles, CA, USA; Physician Assistant Program, CDU, Los Angeles, CA, USA.
| | - Sharon Cobb
- School of Nursing, CDU, Los Angeles, CA, USA
| | - Shervin Assari
- Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA; Department of Public Health, CDU, Los Angeles, CA, USA
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Bazargan M, Cobb S, Assari S, Bazargan-Hejazi S. Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication. Am J Hosp Palliat Care 2021; 39:461-471. [PMID: 34476995 PMCID: PMC10173884 DOI: 10.1177/10499091211036885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Increasing severity of serious illness requires individuals to prepare and make decisions to mitigate adverse consequences of their illness. In a racial and ethnically diverse sample, the current study examined preparedness for serious illness among adults in California. METHODS This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. Participants included 542 non-Hispanic White (52%), non-Hispanic Black (28%), and Hispanic (20%) adults who reported at least one chronic medical condition that they perceived to be a serious illness. Race/ethnicity, socio-demographic factors, health status, discrimination, mistrust, and communication with provider were measured. To perform data analysis, we used logistic regression models. RESULTS Our findings revealed that 19%, 24%, and 34% of non-Hispanic White, non-Hispanic Blacks, and Hispanic believed they were not prepared if their medical condition gets worse, respectively. Over 60% indicated that their healthcare providers never engaged them in discussions of their feelings of fear, stress, or sadness related to their illnesses. Results of bivariate analyses showed that race/ethnicity was associated with serious illness preparedness. However, multivariate analysis uncovered that serious illness preparedness was only lower in the presence of medical mistrust in healthcare providers, perceived discrimination, less communication with providers, and poorer quality of self-rated health. CONCLUSION This study draws attention to the need for healthcare systems and primary care providers to engage in effective discussions and education regarding serious illness preparedness with their patients, which can be beneficial for both individuals and family members and increase quality of care.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science & University of California at Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.,Physician Assistant Program, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.,Department of Family Medicine, UCLA, Los Angeles, CA, USA
| | - Sharon Cobb
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science & University of California at Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science & University of California at Los Angeles (UCLA), Los Angeles, CA, USA
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Russell D, Burgdorf JG, Kramer C, Chase JAD. Family Caregivers' Conceptions of Trust in Home Health Care Providers. Res Gerontol Nurs 2021; 14:200-210. [PMID: 34288782 DOI: 10.3928/19404921-20210526-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Trust is important to family caregivers of older adults receiving home health care (HHC). Caregivers rely extensively on nurses, home health aides, and other providers to manage complex care tasks. The current study examined how family caregivers conceive of trust in HHC providers. Directed content analysis methods were applied to 40 qualitative interviews conducted with caregivers of HHC patients aged ≥65 years. Results indicated that caregivers invested trust in providers who displayed competencies in caring for patients with chronic conditions and functional difficulties, willingness to foster frequent and open communication with room for questions and feedback, confidence in their ability to be present and alert for patients, and fidelity to a variety of tasks contributing to holistic care. Caregivers' conceptions of trust in providers are affected by interpersonal aspects of their interactions with providers as well as the broader systems of care within which they participate. [Research in Gerontological Nursing, 14(4), 200-210.].
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Tur-Sinai A, Barnea R, Tal O. Analyzing patient trust through the lens of hospitals managers-The other side of the coin. PLoS One 2021; 16:e0250626. [PMID: 33901238 PMCID: PMC8075209 DOI: 10.1371/journal.pone.0250626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/10/2021] [Indexed: 11/28/2022] Open
Abstract
Trust is an essential element in patient-physician relationships, yet trust is perceived differently among providers and customers exist. During January-February 2020 we examined the standpoints of medical managers and administrative directors from the private and public health hospitals on patient-physician trust, using a structured questionnaire. Thirty-six managers in public and private hospitals (24 from the public sector and 12 from the private sector) responded to the survey. Managers in the private sector rated trust higher in comparison to managers in the public sector, including trust related to patient satisfaction, professionalism and accountability. Managers from public hospitals gave higher scores to the need for patient education and shared responsibility prior to medical procedures. Administrative directors gave higher scores to various dimensions of trust and autonomy while medical managers gave higher scores to economic considerations. Trust is a fundamental component of the healthcare system and may be used to improve the provision and quality of care by analyzing standpoints and comparable continuous monitoring. Differences in position, education and training influence the perception of trust among managers in the health system. This survey may allow policy makers and opinion leaders to continue building and maintaining trust between patients and care providers.
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Affiliation(s)
- Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
- School of Nursing, University of Rochester Medical Center, Rochester, NY, United States of America
- * E-mail:
| | - Royi Barnea
- Assuta Health Services Research Institute, Tel Aviv, Israel
| | - Orna Tal
- Shamir Medical Center (Assaf Harofeh), Be’er Ya’akov, Israel
- Israeli Center for Emerging Technologies (ICET), Tel Aviv, Israel
- Department of Management, Bar Ilan University, Ramat Gan, Israel
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Tang M, Wang SH, Li HL, Chen H, Sun XY, Bian WW, Sheng J, Ma SJ. Mental health status and quality of life in elderly patients with coronary heart disease. PeerJ 2021; 9:e10903. [PMID: 33643714 PMCID: PMC7896500 DOI: 10.7717/peerj.10903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/14/2021] [Indexed: 12/21/2022] Open
Abstract
Background Coronary heart disease (CHD) is the leading cause of morbidity and mortality among elderly individuals. Patients with CHD are at high risk for mental health disorders, and psychological issues may affect the quality of life (QoL) of these patients. Nevertheless, there is little evidence regarding the psychological issues and QoL of patients with CHD among the elderly population. This study aimed to investigate the relationship between comorbidities and mental status as well as QoL among elderly patients with CHD. Methods Overall, 216 patients were included in this cross-sectional, observational, single-center study. The demographics and clinical manifestations of the patients were collected from electronic medical records. All patients were interviewed using the Chinese version of Symptom Checklist 90 (SCL-90) to assess the mental health status and the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF) to assess the QoL. Results In total, 96 men and 120 women, with a mean age of 71.69 ± 8.30 years, were included. When controlling for the patients’ sex, marital status and stroke, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid type 2 diabetes mellitus had the significant influence on average positive factors (Coef., 5.809; 95% CI [2.467–9.152] p = 0.001); when controlling for the patients’ sex, marital status and type 2 diabetes mellitus, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid stroke had the significant influence on average positive factors (Coef., 8.680; 95% CI [4.826–12.534]; p < 0.001); when controlling for the patients’ sex, marital status, type 2 diabetes mellitus and stroke, multiple stepwise linear regression analyses suggested that for CHD patients, comorbid primary hypertension had the significant influence on phobic anxiety (Coef., 0.178; 95% CI [0.010–0.347]; p = 0.038). Conclusions For elderly CHD patients, comorbid type 2 diabetes mellitus and stroke were at risk for psychological problems and lower QoL. Our findings may guide patients and clinicians to make better decisions and achieve better outcomes.
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Affiliation(s)
- Min Tang
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song-Hao Wang
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui-Lin Li
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han Chen
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin-Yi Sun
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei-Wei Bian
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Sheng
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shao-Jun Ma
- Department of Geriatrics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Bazargan M, Cobb S, Assari S. Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults. Ann Fam Med 2021; 19:4-15. [PMID: 33431385 PMCID: PMC7800756 DOI: 10.1370/afm.2632] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Although we know that racial and ethnic minorities are more likely to have mistrust in the health care system, very limited knowledge exists on correlates of such medical mistrust among this population. In this study, we explored correlates of medical mistrust in a representative sample of adults. METHODS We analyzed cross-sectional study data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We ascertained race/ethnicity, health status, perceived discrimination, demographics, socioeconomic factors, and medical mistrust. For data analysis, we used multinomial logistic regression models. RESULTS Analyses were based on 704 non-Hispanic Black adults, 711 Hispanic adults, and 913 non-Hispanic White adults. Racial/ethnic background was significantly associated with the level of medical mistrust. Adjusting for all covariates, odds of reporting medical mistrust were 73% higher (adjusted odds ratio [aOR] = 1.73; 95% CI, 1.15-2.61, P <.01) and 49% higher (aOR = 1.49; 95% CI, 1.02-2.17, P <.05) for non-Hispanic Black and Hispanic adults when compared with non-Hispanic White adults, respectively. Perceived discrimination was also associated with higher odds of medical mistrust. Indicating perceived discrimination due to income and insurance was associated with 98% higher odds of medical mistrust (aOR = 1.98; 95% CI, 1.71-2.29, P <.001). Similarly, the experience of discrimination due to racial/ethnic background and language was associated with a 25% increase in the odds of medical mistrust (aOR = 1.25; 95% CI, 1.10-1.43; P <.001). CONCLUSIONS Perceived discrimination is correlated with medical mistrust. If this association is causal, that is, if perceived discrimination causes medical mistrust, then decreasing such discrimination may improve trust in medical clinicians and reduce disparities in health outcomes. Addressing discrimination in health care settings is appropriate for many reasons related to social justice. More longitudinal research is needed to understand how complex societal, economic, psychological, and historical factors contribute to medical mistrust. This type of research may in turn inform the design of multilevel community- and theory-based training models to increase the structural competency of health care clinicians so as to reduce medical mistrust.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Physician Assistant Program, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sharon Cobb
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, California
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