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Sun HL, Klaassen RJ, Anger DL, Mendell AL, Olatunde S. Shared decision-making related to treatment of haemophilia: A scoping review of influential factors and available support tools. Haemophilia 2024; 30:880-893. [PMID: 38684450 DOI: 10.1111/hae.15026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Treatment selection in haemophilia is increasingly challenging given evolving therapeutic options and the need for individualization. Shared decision-making (SDM) approaches have recently gained interest, though a synthesis of available studies is lacking. AIM A scoping review was conducted to summarize literature reporting on factors impacting treatment SDM in haemophilia and tools or models available to support such decisions. METHODS PubMed, Embase, the Cochrane Library, Web of Science and grey literature were searched for studies published through August 2023. Original studies reporting on facilitators and barriers to haemophilia SDM and SDM tools were included and analyzed for themes, characteristics and gaps. RESULTS A total of 625 records were identified and 14 unique studies were selected (factors influencing treatment SDM, n = 7; SDM tools, n = 7). The studies typically included input from persons with haemophilia, caregivers and healthcare practitioners (HCPs). Thematic organization of factors influencing SDM revealed three main categories: knowledge, patient characteristics and HCP-patient interactions. Availability of information was a commonly reported facilitator of SDM, while poor HCP-patient engagement was a commonly reported barrier. Tools varied in focus, with some facilitating general treatment SDM while others supported selection of certain therapy types. The studies underscored additional factors critical for SDM, such as alignment of HCP-patient perceptions, shared language and tailoring of tools to specific subpopulations. CONCLUSION Few studies report on treatment SDM factors and tools in haemophilia; available tools vary considerably. It remains unclear whether published tools have been successfully implemented into clinical practice. Additional research is warranted.
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Affiliation(s)
- Haowei Linda Sun
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert J Klaassen
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ottawa Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Dana L Anger
- WRITRIX Medical Communications Inc., Burlington, Ontario, Canada
| | - Ari L Mendell
- Compass Leaf Medical Communications Inc., Guelph, Ontario, Canada
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Hermans C, Noone D, Benson G, Dolan G, Eichler H, Jiménez-Yuste V, Königs C, Lobet S, Pollard D, Zupančić-Šalek S, Mancuso ME. Hemophilia treatment in 2021: Choosing the"optimal" treatment using an integrative, patient-oriented approach to shared decision-making between patients and clinicians. Blood Rev 2021; 52:100890. [PMID: 34736780 DOI: 10.1016/j.blre.2021.100890] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 01/19/2023]
Abstract
The mainstay of hemophilia treatment is to prevent bleeding through regular long-term prophylaxis and to control acute breakthrough bleeds. Various treatment options are currently available for prophylaxis, and treatment decision-making is a challenging and multifaceted process of identifying the most appropriate option for each patient. A multidisciplinary expert panel convened to develop a practical, patient-oriented algorithm to facilitate shared treatment decision-making between clinicians and patients. Key variables were identified, and an algorithm proposed based on five variables: bleeding phenotype, musculoskeletal status, treatment adherence, venous access, and lifestyle. A complementary, patient-focused preference tool was also hypothesized, with the aim of exploring individual patients' priorities, preferences, and goals. It is hoped that the proposed algorithm and the hypothesized patient preference tool will assist in selecting a treatment for each patient that is as efficient as possible in preventing bleeds while also accounting for the patient's expectations and priorities.
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Affiliation(s)
- Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium.
| | | | - Gary Benson
- Haemophilia and Thrombosis Centre, Belfast City Hospital, Belfast, Ireland
| | - Gerry Dolan
- Centre for Haemostasis and Thrombosis, St Thomas' Hospital, London, UK
| | - Hermann Eichler
- University and University Hospital of Saarland, Institute of Clinical Haemostaseology and Transfusion Medicine, Homburg, Saar, Germany
| | - Víctor Jiménez-Yuste
- Hospital Universitario La Paz, Unidad de Coagulopatías, Servicio de Hematología, Autonoma University, Madrid, Spain
| | - Christoph Königs
- Clinical and Molecular Haemostasis, Department of Paediatrics and Adolescent Medicine, Goethe University, Frankfurt, Germany
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium; Neuromusculoskeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Debra Pollard
- Katharine Dormandy Haemophilia & Thrombosis Centre, Royal Free London NHS Foundation Trust, London, UK
| | | | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Hart DP, Branchford BR, Hendry S, Ledniczky R, Sidonio RF, Négrier C, Kim M, Rice M, Minshall M, Arcé C, Prince S, Kelleher M, Lee S. Optimizing language for effective communication of gene therapy concepts with hemophilia patients: a qualitative study. Orphanet J Rare Dis 2021; 16:189. [PMID: 33910590 PMCID: PMC8082836 DOI: 10.1186/s13023-020-01555-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/23/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND For communities of people living with hemophilia and other genetic conditions, gene therapy could represent a paradigm shift in treatment strategies. As investigational therapeutic modalities such as gene therapy become more widely used and discussed, there is a critical need for all stakeholders to communicate using a lexicon that is intelligible, accurate, consistent, and representative of novel treatments. In doing so, expectations can be more carefully managed and potential risks, benefits, and limitations better understood. In recognition of this need, a first-ever study of gene therapy lexicon was conducted using established methods of market research and linguistic analysis. METHODS Ninety-four participants representing hematologists, nurses, caregivers, and people with hemophilia A, in six countries (US, UK, Spain, Germany, France, Italy) took part in a series of in-depth interviews, face-to-face focus groups, an advisory board meeting, and online group interviews to develop, refine, and test verbal, written, and pictorial language concepts through a three-phase iterative process. Sessions were conducted in local languages using detailed discussion guides. Feedback from participants was captured using real-time instant-response dial testing to measure moment-by-moment emotional responses to language stimuli. Semiquantitative analysis of the responses informed selection of preferred language concepts for final testing, and qualitative discussion explored preference rationale. Participants also completed polling and forced rank and choice written exercises. RESULTS Study feedback showed that the hemophilia community has preferences around consistent lexicon to describe hemophilia and its management. Expert linguistic analysis of feedback from the three phases enabled agreement of a consensus lexicon of vocabulary and an optimized summary narrative for talking about gene therapy amongst people affected by hemophilia A. Preferences were largely consistent across audiences and countries, although some country-specific recommendations were made. A representative summary phrase was agreed: "Gene therapy is being studied in clinical trials with the aim to allow the body to produce factor VIII protein on its own". CONCLUSIONS The use of preferred language across different stakeholders increases understanding and comfort during discussions of novel and complex therapeutic modalities such as gene therapy. Consistent use of community-informed lexicon minimizes miscommunication and facilitates informed decision-making regarding potential future treatment opportunities.
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Affiliation(s)
- Daniel P Hart
- Royal London Haemophilia Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, E1 1BB, UK.
| | - Brian R Branchford
- Hemophilia and Thrombosis Center, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Sarah Hendry
- Maslansky + Partners, 200 Varick Street, Suite 601, New York, NY, 10014, USA
| | - Robert Ledniczky
- Maslansky + Partners, 200 Varick Street, Suite 601, New York, NY, 10014, USA
| | | | - Claude Négrier
- Hemophilia and Thrombosis Center, Hôpital Cardiologique, Université Lyon 1, Lyon, France
| | - Michelle Kim
- Hemophilia Foundation of Southern California, Pasadena, CA, USA
| | | | | | - Claire Arcé
- Association française des hémophiles, Paris, France
| | | | | | - Sharon Lee
- BioMarin Pharmaceutical Inc., Novato, CA, USA
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Balen EC, Krawczyk M, Gue D, Jackson S, Gouw SC, Bom JG, Sawatzky R. Patient‐centred care in haemophilia: Patient perspectives on visualization and participation in decision‐making. Haemophilia 2019; 25:938-945. [DOI: 10.1111/hae.13830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/25/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Erna C. Balen
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
| | - Marian Krawczyk
- Lord Kelvin Adam Smith Fellow, School of Interdisciplinary Studies University of Glasgow Glasgow UK
- School of Nursing Trinity Western University Langley Canada
- Centre for Health Evaluation & Outcome Sciences Providence Health Care Research Institute Vancouver Canada
| | - Deborah Gue
- British Columbia Provincial Bleeding Disorders Program ‐ Adult Division St. Paul’s Hospital Vancouver Canada
| | - Shannon Jackson
- British Columbia Provincial Bleeding Disorders Program ‐ Adult Division St. Paul’s Hospital Vancouver Canada
| | - Samantha C. Gouw
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
- Department of Pediatric Hematology, Emma Children’s Hospital Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Johanna G. Bom
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
- Sanquin Research Center for Clinical Transfusion Research Leiden The Netherlands
| | - Richard Sawatzky
- School of Nursing Trinity Western University Langley Canada
- Centre for Health Evaluation & Outcome Sciences Providence Health Care Research Institute Vancouver Canada
- Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
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De la Corte-Rodriguez H, Rodriguez-Merchan EC, Alvarez-Roman T, Martin-Salces M, Garcia-Barcenilla S, Jimenez-Yuste V. Health education and empowerment in adult patients with haemophilia. Expert Rev Hematol 2019; 12:989-995. [PMID: 31393181 DOI: 10.1080/17474086.2019.1650640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: The purpose of this study is to evaluate the degree of education and empowerment of the patients of the Haemophilia Unit at 'La Paz' University Hospital (Madrid, Spain).Materials and methods: Haemophilic patients attending routine haemophilia consultations were asked to complete a questionnaire with a view to determining the patient´s perceived knowledge about the disease; their ability to make individual and group decisions; and whether the frequency of their hospital visits could be reduced.Results: Patients were shown to have ample knowledge about the disease. Knowledge had been acquired chiefly through personal experience and from the interaction with healthcare providers. Nearly 70% of patients felt capable of making decisions on matters affecting their health. Over half of the patients considered that their hospital visits could be reduced if they had more information. Patients experiencing the largest number of bleeding episodes were those showing the highest levels of empowerment. Over half the patients were satisfied with the institutional support they received.Conclusion: These patients with haemophilia are in general reasonably empowered on account of their personal experiences and their interaction with the healthcare providers. Current widespread access to information makes it easier to step up educational interventions in patients at lower haemorrhagic risk.
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Jackson S, Santoro C, Gue D, Ferretti A, Gaglioti D, Squire S, Mazzucconi MG, Hermans C. Clinical practice of personalized prophylaxis in hemophilia: Illustrations of experiences and benefits from two continents. Clin Case Rep 2019; 7:689-694. [PMID: 30997065 PMCID: PMC6452482 DOI: 10.1002/ccr3.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/07/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022] Open
Abstract
These cases of people with hemophilia (PWH) illustrate the importance of understanding the patient's expectations and desires and adapting treatment to meet these needs, in addition to traditional clinical targets. Population PK modeling and FVIII products with improved PK profiles provide the opportunity to individualize care and improve long-term outcomes.
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Affiliation(s)
- Shannon Jackson
- Inherited Bleeding Disorders Program of BC – Adult DivisionSt. Paul's HospitalVancouverBritish ColumbiaCanada
- Division of Hematology, Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cristina Santoro
- Division of Hematology, Department of Cellular Biotechnologies and HematologySapienza University of Rome, Policlinico Umberto IRomeItaly
| | - Deborah Gue
- Inherited Bleeding Disorders Program of BC – Adult DivisionSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Antonietta Ferretti
- Division of Hematology, Department of Cellular Biotechnologies and HematologySapienza University of Rome, Policlinico Umberto IRomeItaly
| | - Domenico Gaglioti
- Clinical Unit of Oral Lesion SurgerySapienza University of Rome, George Eastman Institute, Policlinico Umberto IRomeItaly
| | - Sandra Squire
- Inherited Bleeding Disorders Program of BC – Adult DivisionSt. Paul's HospitalVancouverBritish ColumbiaCanada
| | - Maria Gabriella Mazzucconi
- Division of Hematology, Department of Cellular Biotechnologies and HematologySapienza University of Rome, Policlinico Umberto IRomeItaly
| | - Cedric Hermans
- Hemostasis and Thrombosis Unit, Division of HematologyCliniques Universitaires Saint Luc, Université Catholique de LouvainBrusselsBelgium
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7
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McCabe E, Miciak M, Dennett L, Manns P, Guptill C, Hall J, Gross DP. Measuring therapeutic relationship in the care of patients with haemophilia: A scoping review. Health Expect 2018; 21:1208-1230. [PMID: 30160003 PMCID: PMC6250875 DOI: 10.1111/hex.12827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/16/2018] [Accepted: 07/20/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We conducted a scoping review of the tools used to measure therapeutic relationship in patients with haemophilia. BACKGROUND Haemophilia is an inherited bleeding disorder caused by a deficiency of a clotting factor in the blood. Therapeutic relationship is foundational to the management of patients with chronic diseases like haemophilia. A reliable and valid measurement tool for assessing therapeutic relationship is needed to evaluate the quality of care received by these patients, and to rigorously study the association between therapeutic relationship and the outcomes of treatment. METHODS We adopted the Arksey and O'Malley framework for scoping studies. The following electronic databases were searched for studies that measured a construct related to therapeutic relationships in haemophilia care: MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus. We inventoried these studies, identified the measurement tools used, and described each tool by purpose, content, measurement properties and target population. We identified gaps in the current evidence and directions for future research. RESULTS There were 253 unique records retrieved in the search, and twenty studies were deemed relevant. Ten measurement tools were identified. None of the tools measured therapeutic relationship as a single entity; however, six tools measured constructs considered part of patient-provider relationship (eg trust, communication, working alliance). There has been little validation testing of these tools in haemophilia patient populations. CONCLUSIONS There is a need for a validated tool for measuring therapeutic relationship in the care of patients with haemophilia. This review provides a foundation for future research in this area.
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Affiliation(s)
- Erin McCabe
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Performance Management and Evaluation, Alberta Innovates, Edmonton, AB, Canada
| | - Liz Dennett
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Patricia Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Christine Guptill
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jeremy Hall
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Douglas P Gross
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Nossair F, Thornburg CD. The role of patient and healthcare professionals in the era of new hemophilia treatments in developed and developing countries. Ther Adv Hematol 2018; 9:239-249. [PMID: 30181844 DOI: 10.1177/2040620718784830] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/27/2018] [Indexed: 01/19/2023] Open
Abstract
Medical decisions in hemophilia care are primarily related to the type of factor replacement and treatment regimen. With the growing number of treatment options for patients with hemophilia, decision making is more complex and requires careful consideration of benefits, risks, and patient goals. Shared decision making and decision-aid tools facilitate patient and healthcare provider communication. In this review, the overall role of shared decision making in medicine is outlined, with special emphasis on models for practical implementation. Examples of shared decision making in hemophilia are outlined, and application to new therapeutics is discussed through a case-based approach.
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Affiliation(s)
- Fadi Nossair
- Hemophilia and Thrombosis Treatment Center, Rady Children's Hospital San Diego, San Diego, USA
| | - Courtney D Thornburg
- Professor of Pediatrics, UC San Diego, 3020 Children's Way, MC 5035, San Diego, CA 92123, USA
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9
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Diagnosis and care of patients with mild haemophilia: practical recommendations for clinical management. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:535-544. [PMID: 29328905 DOI: 10.2450/2017.0150-17] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/26/2017] [Indexed: 12/17/2022]
Abstract
Mild haemophilia is defined by factor levels between 0.05 and 0.40 IU/mL and is characterised by traumatic bleeds. Major issues associated with mild haemophilia are that it may not present for many years after birth, and that awareness, even within families, may be low. Methodological problems exist in diagnosis, such as inconsistencies in results obtained from different assays used to measure factor levels in mild haemophilia. Advances in genetic testing provide insight into diagnosis as well as the likelihood of inhibitor development, which is not uncommon in patients with mild or moderate haemophilia and can increase morbidity. The management of patients with mild haemophilia is a challenge. This review includes suggestions around formulating treatment plans for these patients, encompassing the full spectrum from clinical care of the newly diagnosed neonate to that of the ageing patient with multiple comorbidities. Management strategies consider not only the vast differences in these patients' needs, but also risks of inhibitor development and approaches to optimally engage patients.
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10
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Sun HL, McIntosh KA, Squire SJ, Yang M, Bartholomew C, Gue DS, Camp PG, Jackson SC. Patient powered prophylaxis: A 12-month study of individualized prophylaxis in adults with severe haemophilia A. Haemophilia 2017; 23:877-883. [PMID: 28851133 DOI: 10.1111/hae.13319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adults with severe haemophilia A (SHA) may experience breakthrough bleeds despite standard weight-based FVIII prophylaxis three times weekly. Individualized prophylaxis has evolved to optimize patient outcomes. AIMS This study aimed to evaluate the impact of a standardized approach to individualized prophylaxis on annualized bleeding rates (ABR), factor utilization, physical activity and quality of life in adults with SHA. METHODS In this prospective cohort study, patients with baseline FVIII:C <2% and ABR >3 on weight-based prophylaxis received a standardized approach to individualized prophylaxis. Changes in ABR, annualized FVIII consumption and adherence from the 12-month prestudy and 12-month intervention period were compared. Changes in Haemo-QoL-A total score, Physical Functioning (PF) subscale and physical activity level measured by accelerometry were also examined. RESULTS Eighteen patients participated (median age 26 years). Individualized prophylaxis decreased total bleeds in the population by 69% and traumatic bleeds by 73%. The median ABR decreased from 7.5 to 2 (P<.001). Annualized factor consumption increased by 7.3%, as a result of 66% reduction in factor utilization for treatment of bleeds and 25% increase in factor utilization for prophylaxis. Adherence scores for frequency and dosing did not change. There was a significant increase in the Haemo-QoL-A total score (P=.02) and PF score (P=.01) from baseline to 4 months but no change in physical activity. CONCLUSION Patients with SHA who switched from standard to individualized prophylaxis show reduced ABR and increased FVIII consumption, and also improved their health-related quality of life. The mechanism is independent of adherence to prescribed prophylactic regimen.
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Affiliation(s)
- Haowei Linda Sun
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada.,Division of Hematology, Department of Medicine, University of British Columbia (UBC) and St. Paul's Hospital, Vancouver, BC, Canada
| | - Kam A McIntosh
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - Sandra J Squire
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - Ming Yang
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - Claude Bartholomew
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - Deb S Gue
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - Pat G Camp
- Centre for Heart Lung Innovation, Vancouver, BC, Canada.,UBC Department of Physical Therapy, Vancouver, BC, Canada
| | - Shannon C Jackson
- British Columbia Provincial Bleeding Disorders Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada.,Division of Hematology, Department of Medicine, University of British Columbia (UBC) and St. Paul's Hospital, Vancouver, BC, Canada
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11
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Christie D, Glew S. A clinical review of communication training for haematologists and haemato-oncologists: a case of art versus science. Br J Haematol 2017; 178:11-19. [PMID: 28543173 DOI: 10.1111/bjh.14606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The art of communication at times seems at odds with the science of medicine. Poor communication is associated with risks for patient and physician. Communication skills are highly relevant for haematologists and are associated with increased physician and patient satisfaction, positive psychosocial outcomes and possible health outcomes. Medical communication training has recently become widespread but is largely restricted to junior medical professionals. In haematology, the proliferation of high quality communication skills is low and there are few interventions catering for the required skillset. A review identified five applicable interventions for haematologists. There is variation in intervention length and structure, and most studies measure targeted skill fidelity rather than patient outcomes. Work on motivation and empowerment holds potential for haematological conditions, but is largely absent from care. This review highlights the need for new interventions for haematologists which focus on producing and maintaining positive patient outcomes.
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Affiliation(s)
- Deborah Christie
- Department of Child and Adolescent Psychological Services, UCLH NHS Foundation Trust, London, UK.,UCL Institute of Epidemiology and Public Health, London, UK
| | - Sarah Glew
- Department of Child and Adolescent Psychological Services, UCLH NHS Foundation Trust, London, UK
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12
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Abstract
Prophylactic clotting-factor regimens reduce the occurrence of bleeding episodes and maintain joint health in individuals with moderate and severe hemophilia. However, these outcomes are only achieved with adherence to prescribed prophylaxis regimens. There are several types of barriers to adherence related to key patient, condition, treatment, health-care system, and/or socioeconomic variables. Notably, health-care professionals may not prescribe prophylaxis if they perceive that a patient will be nonadherent. Prophylactic treatment strategies should be developed with the patient and family, focused on individualized treatment goals. Personalized strategies are needed to reinforce the importance of and encourage confidence in administering the regular infusions required for prophylactic therapy. These strategies may include verbal and written information delivered by health-care professionals, peers, and inter-active media. The advent of extended half-life clotting factors requiring less frequent infusion may improve adherence.
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Affiliation(s)
- Courtney D Thornburg
- Hemophilia and Thrombosis Treatment Center, Rady Children’s Hospital, San Diego, CA
- Correspondence: Courtney D Thornburg, Rady Children’s Hospital, 3020 Children’s Way – MC 5035, San Diego, CA 92123, USA, Tel +1 858 966 5811, Email
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