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Sprong MCA, Zwagerman IR, Soeters L, Slieker MG, Takken T, van den Hoogen A, van Brussel M. Prioritizing family-centered developmental care: insights from parents of children with critical congenital heart disease: a qualitative study. Eur J Pediatr 2024; 183:3863-3876. [PMID: 38888645 PMCID: PMC11322194 DOI: 10.1007/s00431-024-05600-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/28/2024] [Accepted: 05/04/2024] [Indexed: 06/20/2024]
Abstract
As survivors of early cardiac surgery are at high risk of neurodevelopmental impairments, systematic health observations of children with critical congenital heart disease (CCHD) throughout childhood are recommended to enable early diagnosis and offer interventions to optimize neurodevelopment. A qualitative study using thematic analysis was performed to explore parents' concerns, experiences, and needs regarding the development and received developmental care of their child (0-10 years) during hospital admission and beyond. Data were collected using semi-structured online interviews with 20 parents of children with CCHD. Four major themes were identified: (1) "impact of diagnosis and disease on the family-system," (2) "parental concerns from diagnoses and beyond," (3) "the need for information," and (4) "the need for individualized and family-centered care." The main themes can be divided into 13 sub-themes as impact, concerns, and needs are influenced by various impactful moments from diagnosis and afterwards. Conclusion: This study confirms the importance of early identification of neurodevelopmental problems by experienced healthcare professionals, especially in the early years when parental expectations and concerns about their child's neurodevelopment are lower. A tailor-made family-centered follow-up program should be offered, which pays attention to both the neurodevelopment of patients with CCHD as well as the mental wellbeing of the entire family system. Furthermore, an online portal is recommended with a variety of reliable, controlled, understandable information from which parents can obtain the desired information to understand better the consequences of specific heart condition and to provide their child with the best possible guidance. What is Known: • Survivors of early cardiac surgery are at high risk of neurodevelopmental impairments; systematic health observations of children with CCHD throughout childhood are strongly recommended. What is New: • Parents need a tailor-made family-centered follow-up program, which pays attention to both the neurodevelopment of patients with CCHD as well as the mental wellbeing of the entire family system. • An online portal offering diverse, trustworthy information and sources would effectively meet parents' needs by providing accessible insights into the potential consequences of specific heart conditions and guiding them in supporting their child optimally.
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Affiliation(s)
- Maaike C A Sprong
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, KB 02.056.0, PO Box 85090, Utrecht, 3508 AB Utrecht, The Netherlands.
| | - Iza R Zwagerman
- Department of Pediatric Psychology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, 3508 AB Utrecht, The Netherlands
| | - Lotte Soeters
- Department of Pediatric Psychology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, 3508 AB Utrecht, The Netherlands
| | - Martijn G Slieker
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, 3508 AB Utrecht, The Netherlands
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, KB 02.056.0, PO Box 85090, Utrecht, 3508 AB Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, 3508 AB Utrecht, The Netherlands
| | - Marco van Brussel
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, KB 02.056.0, PO Box 85090, Utrecht, 3508 AB Utrecht, The Netherlands
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2
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Chou FL, Donovan DJ, Weller RJ, Fremed MA, Glickstein JS, Krishnan US. Disparities in resource utilisation by families of children with cardiac conditions. Cardiol Young 2024; 34:325-333. [PMID: 37415565 DOI: 10.1017/s1047951123001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
OBJECTIVES There are limited data documenting sources of medical information that families use to learn about paediatric cardiac conditions. Our study aims to characterise these resources and to identify any disparities in resource utilisation. We hypothesise there are significant variations in the resources utilised by families from different educational and socio-economic backgrounds. METHODS A survey evaluating what resources families use (websites, healthcare professionals, social media, etc.) to better understand paediatric cardiac conditions was administered to caretakers and paediatric patients at Morgan Stanley Children's Hospital. Patients with a prior diagnosis of CHD, cardiac arrhythmia, and/or heart failure were included. Caretakers' levels of education (fewer than 16 years vs. 16 years or more) and patients' medical insurance types (public vs. private) were compared with regard to the utilisation of resources. RESULTS Surveys completed by 137 (91%) caretakers and 27 (90%) patients were analysed. Websites were utilised by 72% of caretakers and 56% of patients. Both private insurance and higher education were associated with greater reported utilisation of websites, healthcare professionals, and personal networks (by insurance p = 0.009, p = 0.001, p = 0.006; by education p = 0.022, p < 0.001, p = 0.018). They were also more likely to report use of electronic devices (such as a computer) compared to those with public medical insurance and fewer than 16 years of education (p < 0.001, p < 0.001, respectively). CONCLUSION Both levels of education and insurance status are associated with the utilisation of informative resources and digital devices by families seeking to learn more about cardiac conditions in children.
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Affiliation(s)
- Francisca L Chou
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Denis J Donovan
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel J Weller
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael A Fremed
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Julie S Glickstein
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Usha S Krishnan
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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3
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Patient portals for the adolescent and young adult population: Benefits, risks and guidance for use. Curr Probl Pediatr Adolesc Health Care 2021; 51:101101. [PMID: 34776370 PMCID: PMC9760217 DOI: 10.1016/j.cppeds.2021.101101] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient portals are the primary means by which electronic health information (EHI) is shared with patients and families. The use of patient portals increased during the COVID-19 pandemic and may continue to rise with the implementation and enforcement of the 21st Century Cures Act that encourages facilitation of access to EHI and prohibits information blocking. Research on the use of patient portals by adolescents and their families is limited. Potential benefits of portal use to adolescents include increased engagement in their own health care, direct communication with their health care clinicians, and facilitation of transition of care to new clinicians in adulthood. Clinicians need to educate adolescents on the functions available through the portal, appropriate use and expectations for messaging through the portal, and the pros and cons of viewing EHI such as test results independently. Parental proxy access to the adolescent's portal should be carefully and thoughtfully implemented, because it poses a potential breach to confidential care via disclosure of sensitive or protected information. Adolescents who choose to deny their parents proxy access to the portal should be supported in that decision. It is important that all clinicians understand portal functionality and have strategies to optimize use within their practice. This paper provides the reader considerations and tips for portal use within this population.
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Wollmann K, der Keylen PV, Tomandl J, Meerpohl JJ, Sofroniou M, Maun A, Voigt-Radloff S. The information needs of internet users and their requirements for online health information-A scoping review of qualitative and quantitative studies. PATIENT EDUCATION AND COUNSELING 2021; 104:1904-1932. [PMID: 33563502 DOI: 10.1016/j.pec.2021.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/05/2021] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This scoping review has been conducted to summarise the information needs of internet users and their requirements for online health information. METHODS We searched MEDLINE, Web of Science and Scopus up to July 2019. Qualitative, quantitative and mixed-method studies were included and a thematic synthesis with category formation and exact description of the items was carried out. RESULTS 118 studies were included. To address all users' needs mentioned in the included studies, we grouped them into nine main categories: authority, comprehension, currency, evidence-based information, exchange with others, independence, purpose, services, user experience. The evaluation showed that website users wanted qualifications of authors to be cited. Users preferred health information that offered interactive elements and resources for relatives, whilst also providing an opportunity for online contact with others. The ease with which information was accessed and the intelligibility of texts were regarded as being very important to users. CONCLUSION Given the rapid evolvement and changes of online health information, it is crucial to provide up to date insights and a comprehensive overview of the range of criteria. PRACTICE IMPLICATIONS With the results obtained through this scoping review, the creators of online health information could be assisted in providing user-specific resources.
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Affiliation(s)
- Katharina Wollmann
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
| | - Piet van der Keylen
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany.
| | - Johanna Tomandl
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany.
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
| | - Mario Sofroniou
- Institute for General Practice/Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Andy Maun
- Institute for General Practice/Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center - University of Freiburg, Germany.
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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5
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Manivannan S, Baskaran R, Fisher J, Tasker I, Zaben M. Current Status of Websites Offering Information to Patients with Traumatic Brain Injury and Caregivers: Time for Reform? World Neurosurg 2021; 153:e419-e427. [PMID: 34229103 DOI: 10.1016/j.wneu.2021.06.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is a global public health problem, causing long-term burden to patients and caregivers. Patients and their families often resort to seeking online information regarding TBI management while awaiting formal health care consultations. Although this information is accessible and immediately available, little is known about the quality of online resources. We evaluated the accessibility, relevance, and readability of information regarding TBI from major online search engines. METHODS TBI-related search terms were entered into 2 online search engines (Google and Yahoo), and the first 30 websites per search were assessed for eligibility. Quality (DISCERN score, JAMA Benchmark score) and readability (Flesch-Kincaid Grade Level, Flesch Reading Ease Score) were assessed. Associations between search ranking, quality, and readability were evaluated. RESULTS In total, 202 websites were evaluated with mean DISCERN score 36.5 ± 9.9/80, signifying poor global quality, and mean JAMA Benchmark score 2.8 ± 1.1/4. The majority required 9-12 years of education (113/202; 55.9%) according to Flesch-Kincaid Grade Level and categorized as "Difficult" on Flesch Reading Ease Score (94/202; 46.5%). Website quality was not associated with search ranking or readability. CONCLUSIONS There is a paucity of high-quality online resources for patients with TBI. Herein, we highlight: 1) the importance of guidance from healthcare professionals regarding online-information seeking; and 2) recommendations for the most useful online resources available.
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Affiliation(s)
- Susruta Manivannan
- Department of Neurosurgery, Southampton General Hospital, Southampton, United Kingdom
| | | | - Jack Fisher
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Imogen Tasker
- School of Biomedical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Malik Zaben
- Neuroscience and Mental Health Research Institute (NMHRI), Cardiff University, Cardiff, United Kingdom; Department of Neurosurgery, University Hospital of Wales, Cardiff, United Kingdom.
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Cecchetto FH, Bonato GD, Barreto TSM, Riegel F, Pellanda LC. Translation, cross-cultural adaptation, and validation of the Leuven Knowledge Questionnaire for congenital heart disease instrument into Brazilian Portuguese. J Pediatr (Rio J) 2021; 97:402-408. [PMID: 32781036 PMCID: PMC9432303 DOI: 10.1016/j.jped.2020.07.004] [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: 05/08/2020] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To translate the Leuven Knowledge Questionnaire for Congenital Heart Disease into Brazilian Portuguese and to validate its psychometric properties with parents and family caregivers of children with congenital heart disease. METHOD This was a six-step methodological study, including the translation, synthesis, back-translation, evaluation of the version translated by the committee of experts, pre-testing, and validation, for which two pilot tests were used including the think-aloud protocol. The content validity index and the frequency of socioeconomic data were calculated in a statistical programming environment. RESULTS In content validation, the instrument showed good applicability among experts, with average content validity index of 0.8-1, while kappa agreement analysis was between 0.76 to 1; both results were considered adequate for validation. CONCLUSIONS The results suggest reliability among the evaluators, indicating the instrument's accuracy and the possibility of using it to assess the knowledge of parents and family caregivers about congenital heart disease.
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Affiliation(s)
| | - Giuseppe Dick Bonato
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Fernando Riegel
- Universidade Federal de Mato Grosso (UFMT), Campus Universitário do Araguaia, Cuiabá, MT, Brazil
| | - Lúcia Campos Pellanda
- Fundação Universitária de Cardiologia (FUC), Instituto de Cardiologia (IC), Porto Alegre, RS, Brazil.
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7
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Etnel JRG, Bons LR, De Heer F, Robbers-Visser D, Van Beynum IM, Straver B, Jongbloed MR, Kiès P, Slieker MG, Van Dijk APJ, Kluin J, Bertels RA, Utens EMWJ, The R, Van Galen E, Mulder BJM, Blom NA, Hazekamp MG, Roos-Hesselink JW, Helbing WA, Bogers AJJC, Takkenberg JJM. Patient information portal for congenital aortic and pulmonary valve disease: a stepped-wedge cluster randomised trial. Open Heart 2021; 8:openhrt-2020-001252. [PMID: 33757975 PMCID: PMC7993296 DOI: 10.1136/openhrt-2020-001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In response to an increased need for patient information in congenital heart disease, we previously developed an online, evidence-based information portal for patients with congenital aortic and pulmonary valve disease. To assess its effectiveness, a stepped-wedge cluster randomised trial was conducted. METHODS Adult patients and caregivers of paediatric patients with congenital aortic and/or pulmonary valve disease and/or tetralogy of Fallot who visited the outpatient clinic at any of the four participating centres in the Netherlands between 1 March 2016-1 July 2017 were prospectively included. The intervention (information portal) was introduced in the outpatient clinic according to a stepped-wedge randomised design. One month after outpatient clinic visit, each participant completed a questionnaire on disease-specific knowledge, anxiety, depression, mental quality of life, involvement and opinion/attitude concerning patient information and involvement. RESULTS 343 participants were included (221 control, 122 intervention). Cardiac diagnosis (p=0.873), educational level (p=0.153) and sex (p=0.603) were comparable between the two groups. All outcomes were comparable between groups in the intention-to-treat analyses. However, only 51.6% of subjects in the intervention group (n=63) reported actually visiting the portal. Among these subjects (as-treated), disease-specific knowledge (p=0.041) and mental health (p=0.039) were significantly better than in control subjects, while other baseline and outcome variables were comparable. CONCLUSION Even after being invited by their cardiologists, only half of the participants actually visited the information portal. Only in those participants that actually visited the portal, knowledge of disease and mental health were significantly better. This underlines the importance of effective implementation of online evidence-based patient information portals in clinical practice.
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Affiliation(s)
- Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lidia R Bons
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Frederiek De Heer
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands
| | | | - Ingrid M Van Beynum
- Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Bart Straver
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, Netherlands
| | | | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Martijn G Slieker
- Department of Pediatric Cardiology, Radboudumc, Nijmegen, Netherlands
| | | | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands.,Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robin A Bertels
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands.,De Bascule, Academic Center for Child Psychiatry, Amsterdam, Netherlands
| | | | - Eugene Van Galen
- Patient Association 'Patiëntenvereniging Aangeboren Hartafwijkingen', Maarssen, Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Willem A Helbing
- Department of Pediatric Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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8
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Shi W, Ghisi GLM, Hyun K, Zhang L, Gallagher R. Patient education interventions for health behaviour change in adults diagnosed with coronary heart disease: A protocol for a systematic review and meta-analysis. J Adv Nurs 2020; 77:1043-1050. [PMID: 33210356 DOI: 10.1111/jan.14656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/26/2022]
Abstract
AIM To assess the efficacy of structured patient education on disease-related knowledge and health behaviour change outcomes in adults with coronary heart disease. DESIGN Systematic review and meta-analyses including meta-regression on education duration. METHODS Seven databases (including Medline, Pubmed (non-Medline), CINAHL, PsycINFO, Embase, Emcare and Cochrane central register of controlled trials) will be searched from inception through 2020 to identify relevant randomized controlled trials testing interventions to improve health behaviours and disease-related knowledge in adults with coronary heart disease. Risk for bias will be assessed using the Cochrane Risk for Bias tool. Data will be synthesized using random-effects meta-analyses in Comprehensive Meta-Analysis Version 3. Heterogeneity will be assessed using Cochrane's Q statistic and the I-squared statistic will be reported. Meta-regression will be used to determine the effect of intervention duration. Publication bias will be assessed using funnel plots and Egger's test and which will be adjusted by conducting the trim-and-fill test when necessary. Funding for this project began in March 2020. DISCUSSION We will examine knowledge and behaviour outcomes including physical activity, dietary habits, smoking and medication adherence for patients with coronary heart diseases. This review will be the most comprehensive meta-analysis of structured patient education interventions to date and the first to analyse the effect of education duration. IMPACT The efficacy of patient education on knowledge and behaviour outcomes for patients with coronary heart diseases has not yet been established. This systematic review will determine the efficacy of structured patient education on knowledge and behaviour outcomes and determine whether the duration of patient education influences patient outcomes and thus guide intervention design. PROSPERO registration Number: CRD42020173467.
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Affiliation(s)
- Wendan Shi
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gabriela L M Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Karice Hyun
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,ANZAC Research Institute, The University of Sydney, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Ling Zhang
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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9
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den Ouden JE, The R, Myren BJ, Boll D, Driel WJV, Lalisang RI, Kruitwagen RF, van Altena AM. Development of a decision aid for primary treatment of patients with advanced-stage ovarian cancer. Int J Gynecol Cancer 2020; 30:837-844. [PMID: 32276940 DOI: 10.1136/ijgc-2019-001095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/03/2020] [Accepted: 02/18/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Despite renewed treatment options for advanced epithelial ovarian cancer, survival remains poor. The Patient Association and the Gynecological Oncology Working Party in the Netherlands have identified a need for a tool to improve shared decision-making. The aim of this study was to develop an evidence-based online decision aid for patients with advanced epithelial ovarian cancer and their medical team. METHODS First, we identified the patients' and clinicians' needs using surveys and in-depth interviews. Second, we conducted multidisciplinary face-to-face meetings with representatives from all stakeholders (clinicians and patient representatives) to determine the content of the decision aid. Third, we developed the decision aid using standardized criteria and national guidelines. Finally, we tested the usability of the tool with patients and clinicians who participated in the needs assessment. RESULTS Patients and clinicians indicated the need for more sources of reliable information that include all treatment options available in the Netherlands. Although most interviewees were satisfied with the level of information available at the time of their own treatment, the majority (90%) of the patients stated that no choice of treatment was offered. We developed a consultation sheet and an online decision aid based on patient interviews and team discussions. The sheet contains a summary of all treatment options and login codes for the decision aid; it will be offered to patients at their first consultation. The decision aid can be used at home and includes information about epithelial ovarian cancer and all available treatment options and questions about quality of life and treatment preferences, delivering a personalized summary for discussion during the following consultation about the primary treatment choices. DISCUSSION In cooperation with patients and clinicians, we developed a decision aid for advanced-stage epithelial ovarian cancer patients and their medical team to support shared decision-making, based on a confirmed need for more extensive information sources. The decision aid is currently under assessment in a multicenter implementation trial.
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Affiliation(s)
- Judith E den Ouden
- Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
| | - Regina The
- Development and Implementation of Decision Aids, ZorgKeuzeLab, Delft, Netherlands
| | - Britt J Myren
- Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
| | - Dorry Boll
- Obstetrics and Gynecology, Catharina Hospital, Eindhoven, Netherlands
| | - Willemien J van Driel
- Center for Gynecological Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Roy I Lalisang
- Internal Medicine, Division Medical Oncology, Maastricht University Medical Center, Maastricht, Netherlands.,GROW, School for Oncology and Developmental Biology, Maastricht, Netherlands
| | - Roy Fpm Kruitwagen
- GROW, School for Oncology and Developmental Biology, Maastricht, Netherlands.,Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Anne M van Altena
- Obstetrics and Gynecology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands
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Gökalp AL, de Heer F, Etnel JRG, Kluin J, Takkenberg JJM. Clinical and quality of life outcomes after aortic valve replacement and aortic root surgery in adult patients <65 years old. Ann Cardiothorac Surg 2019; 8:372-382. [PMID: 31240181 DOI: 10.21037/acs.2019.04.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Selecting the optimal surgical treatment strategy in patients below the age of 65 years (i.e., non-elderly patients) with aortic valve or aortic root disease remains challenging. The objective of the current study is to summarize contemporary research on clinical and quality of life outcomes after aortic valve replacement (AVR) and aortic root surgery in non-elderly patients. Recent systematic reviews on clinical outcome after biological and mechanical AVR, the Ross procedure and aortic root surgery show that event occurrence is considerable after any type of AVR or aortic root surgery and-with the exception of the Ross procedure-survival is suboptimal. Although thromboembolism and bleeding events are more common after mechanical AVR and root surgery, these events are also considerably present after biological AVR, the Ross procedure and valve-sparing aortic root surgery (VSRR). Similarly, reoperation is more common after biological AVR, the Ross procedure and VSRR, but also occurs frequently after mechanical AVR and root replacement. Published evidence in AVR patients points to the direction of better health-related quality of life (HRQoL) outcomes with a biological solutions, while the HRQoL after aortic root surgery is limited and contradictory. This review illustrates that treatment for non-elderly aortic valve and aortic root disease patients needs to be tailored to the individual patient, considering both clinical and HRQoL outcomes as crucial factors to reach a treatment decision that best reflects the patient's values and goals in life.
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Affiliation(s)
- Arjen L Gökalp
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jolanda Kluin
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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11
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Etnel JR, Huygens SA, Grashuis P, Pekbay B, Papageorgiou G, Roos Hesselink JW, Bogers AJ, Takkenberg JJ. Bioprosthetic Aortic Valve Replacement in Nonelderly Adults. Circ Cardiovasc Qual Outcomes 2019; 12:e005481. [DOI: 10.1161/circoutcomes.118.005481] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jonathan R.G. Etnel
- Department of Cardiothoracic Surgery (J.R.G.E., S.A.H., P.G., B.P., G.P., A.J.J.C.B., J.J.M.T.), Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simone A. Huygens
- Department of Cardiothoracic Surgery (J.R.G.E., S.A.H., P.G., B.P., G.P., A.J.J.C.B., J.J.M.T.), Erasmus University Medical Center, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands (S.A.H.)
| | - Pepijn Grashuis
- Department of Cardiothoracic Surgery (J.R.G.E., S.A.H., P.G., B.P., G.P., A.J.J.C.B., J.J.M.T.), Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Begüm. Pekbay
- Department of Cardiothoracic Surgery (J.R.G.E., S.A.H., P.G., B.P., G.P., A.J.J.C.B., J.J.M.T.), Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Grigorios Papageorgiou
- Department of Cardiothoracic Surgery (J.R.G.E., S.A.H., P.G., B.P., G.P., A.J.J.C.B., J.J.M.T.), Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Biostatistics (G.P.), Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jolien W. Roos Hesselink
- Department of Cardiology (J.W.R.H.), Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ad J.J.C. Bogers
- Department of Cardiothoracic Surgery (J.R.G.E., S.A.H., P.G., B.P., G.P., A.J.J.C.B., J.J.M.T.), Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johanna J.M. Takkenberg
- Department of Cardiothoracic Surgery (J.R.G.E., S.A.H., P.G., B.P., G.P., A.J.J.C.B., J.J.M.T.), Erasmus University Medical Center, Rotterdam, The Netherlands
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Etnel JR, Grashuis P, Huygens SA, Pekbay B, Papageorgiou G, Helbing WA, Roos-Hesselink JW, Bogers AJ, Mokhles MM, Takkenberg JJ. The Ross Procedure: A Systematic Review, Meta-Analysis, and Microsimulation. Circ Cardiovasc Qual Outcomes 2018; 11:e004748. [DOI: 10.1161/circoutcomes.118.004748] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jonathan R.G. Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands (J.R.G.E., P.G., S.A.H., B.P., G.P., A.J.J.C.B., M.M.M., J.J.M.T.)
| | - Pepijn Grashuis
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands (J.R.G.E., P.G., S.A.H., B.P., G.P., A.J.J.C.B., M.M.M., J.J.M.T.)
| | - Simone A. Huygens
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands (J.R.G.E., P.G., S.A.H., B.P., G.P., A.J.J.C.B., M.M.M., J.J.M.T.)
- Erasmus School of Health Policy & Management, ErasmusUniversity Rotterdam, The Netherlands (S.A.H.)
| | - Begüm Pekbay
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands (J.R.G.E., P.G., S.A.H., B.P., G.P., A.J.J.C.B., M.M.M., J.J.M.T.)
| | - Grigorios Papageorgiou
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands (J.R.G.E., P.G., S.A.H., B.P., G.P., A.J.J.C.B., M.M.M., J.J.M.T.)
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands (G.P.)
| | - Willem A. Helbing
- Division of Cardiology, Department of Pediatrics, Erasmus University Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands (W.A.H.)
| | - Jolien W. Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands (J.W.R.-H.)
| | - Ad J.J.C. Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands (J.R.G.E., P.G., S.A.H., B.P., G.P., A.J.J.C.B., M.M.M., J.J.M.T.)
| | - M. Mostafa Mokhles
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands (J.R.G.E., P.G., S.A.H., B.P., G.P., A.J.J.C.B., M.M.M., J.J.M.T.)
| | - Johanna J.M. Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands (J.R.G.E., P.G., S.A.H., B.P., G.P., A.J.J.C.B., M.M.M., J.J.M.T.)
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13
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Kauw D, Koole MAC, van Dorth JR, Tulevski II, Somsen GA, Schijven MP, Dohmen DAJ, Bouma BJ, Mulder BJM, Schuuring MJ, Winter MM. eHealth in patients with congenital heart disease: a review. Expert Rev Cardiovasc Ther 2018; 16:627-634. [PMID: 30079780 DOI: 10.1080/14779072.2018.1508343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Mobile health (mHealth), an advanced form of eHealth is expected to drastically change the field of traditional healthcare in the near future as wearables and mobile applications are rapidly increasing in number. The majority of patients with congenital heart disease (CHD) now reach adulthood and this relative young patient population seems particularly suited for mHealth, as they require lifelong follow-up, experience high morbidity burden, and were raised in this digital era. In patients with acquired heart disease the potential of eHealth has been demonstrated, yet data are still inconclusive. Areas covered: In this review of the current literature we evaluated the effect of various eHealth interventions in patients with CHD. Our search resulted in a mere 10 studies, which comprised mostly of children or adolescents with severe CHD. Home-monitoring of saturation and weight through mHealth was found to be beneficial in patients after palliation procedures, and video conferencing was found to have a positive effect on anxiety and healthcare utilization. Expert commentary: Due to high morbidity and mortality in patients with CHD and the promising results of eHealth interventions, further research is desperately needed.
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Affiliation(s)
- Dirkjan Kauw
- a Department of Cardiology , Amsterdam UMC, University of Amsterdam , Amsterdam , the Netherlands.,b Netherlands Heart Institute , Utrecht , the Netherlands
| | - M A C Koole
- a Department of Cardiology , Amsterdam UMC, University of Amsterdam , Amsterdam , the Netherlands.,c Department of Cardiology , Red Cross Hospital , Beverwijk , the Netherlands.,d Cardiology Centers of the Netherlands , Amsterdam , the Netherlands
| | - Jolien R van Dorth
- a Department of Cardiology , Amsterdam UMC, University of Amsterdam , Amsterdam , the Netherlands
| | - Igor I Tulevski
- d Cardiology Centers of the Netherlands , Amsterdam , the Netherlands
| | - G Aernout Somsen
- d Cardiology Centers of the Netherlands , Amsterdam , the Netherlands
| | - Marlies P Schijven
- e Department of Surgery , Amsterdam UMC, University of Amsterdam , Amsterdam , the Netherlands
| | | | - Berto J Bouma
- a Department of Cardiology , Amsterdam UMC, University of Amsterdam , Amsterdam , the Netherlands
| | - Barbara J M Mulder
- a Department of Cardiology , Amsterdam UMC, University of Amsterdam , Amsterdam , the Netherlands
| | - Mark J Schuuring
- a Department of Cardiology , Amsterdam UMC, University of Amsterdam , Amsterdam , the Netherlands.,g Department of Cardiology , Haga Teaching Hospital , The Hague , the Netherlands
| | - Michiel M Winter
- a Department of Cardiology , Amsterdam UMC, University of Amsterdam , Amsterdam , the Netherlands.,d Cardiology Centers of the Netherlands , Amsterdam , the Netherlands
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14
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Brown KL, Utens E, Marino BS. The ten things you need to know about long-term outcomes following paediatric cardiac surgery. Intensive Care Med 2018; 44:918-921. [PMID: 29696293 DOI: 10.1007/s00134-018-5176-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/11/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Katherine L Brown
- Charles West Division, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK. .,Institute Cardiovascular Science, University College London, London, UK.
| | - Elisabeth Utens
- Child and Adolescent Psychiatry, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry the Bascule Department Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Bradley S Marino
- Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA.,Research and Academic Affairs, Divisions of Cardiology and Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
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