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Grossman ES, Berger I. Inclusion of a computerized test in ADHD diagnosis process can improve trust in the specialists' decision and elevate adherence levels. Sci Rep 2024; 14:4392. [PMID: 38388799 PMCID: PMC10884014 DOI: 10.1038/s41598-024-54834-y] [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: 05/04/2023] [Accepted: 02/16/2024] [Indexed: 02/24/2024] Open
Abstract
Attention deficit and hyperactivity disorder (ADHD) affects many life aspects of children and adults. Accurate identification, diagnosis and treatment of ADHD can facilitate better care. However, ADHD diagnosis and treatment methods are subject of controversy. Objective measures can elevate trust in specialist's decision and treatment adherence. In this observational study we asked whether knowing that a computerized test was included in ADHD diagnosis process results in more trust and intention to adhere with treatment recommendations. Questionnaires were administered to 459 people, 196 men, average age = 40.57 (8.90). Questions regarding expected trust and adherence, trust trait, trust in physician and health-care-institutions, and ADHD scales followed a scenario about parents referred to a neurologist for sons' ADHD diagnosis. The scenario presented to the test group (n = 185) mentioned that a computerized test was part of the diagnostic process. The control group scenario didn't mention any computerized test in the diagnostic process. Test group participants expressed more trust in the diagnosis and greater levels of intention for treatment adherence. Group differences in intention for treatment adherence were mediated by trust in decision. Inclusion of a computerized test in ADHD diagnosis process can improve trust in the specialists' decision and elevate adherence levels.
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Affiliation(s)
| | - Itai Berger
- Pediatric Neurology, Pediatric Division, Faculty of Health Sciences, Assuta Ashdod University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
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2
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Taveira A, Macedo AP, Martins S, Costa EP. Psychometric properties analysis of helping relationships skills inventory for Portuguese nurses and doctors. Heliyon 2024; 10:e23713. [PMID: 38187244 PMCID: PMC10767506 DOI: 10.1016/j.heliyon.2023.e23713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/08/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024] Open
Abstract
This paper answered some authors' requests to analyze the Helping Relationships Skills Inventory psychometric properties, a four dimensions measure. At this level, the study contributed to accessing the first reliable and valid instrument headed to Portuguese nurses and doctors. Methods: An online survey with Portuguese nurses and doctors (n = 262) was managed to assess the psychometrics properties analysis of the Helping Relationships Skills Inventory. Data were analyzed using descriptive statistics, confirmatory factor analysis, the average variance extracted (AVE), the heterotrait-monotrait ratio of correlations (HTMT), Cronbach's Alpha, and McDonald's Omega were computed. Results: The four-factor of the original Helping Relationships Skills Inventory was only supported by Exploratory Factor Analysis, with good internal consistency. Our study accepted this correlational structure hypothesis, which demonstrated acceptable to good sensitivity, convergent validity (AVE: 0.84-0.67), and reliability (Cronbach's Alpha: 0.92-0.88; McDonald'Omega: 0.93-0.79). Also stays verified discriminant validity for the majority of the factors with some reserves between Generics and Emphatics dimensions (HTMT: 0.90), revealing high commonality among them (r = 0.84; p < .001) Conclusions: The findings support the sensitivity, construct validity, and reliability of the Helping Relationships Skills Inventory among Portuguese nurses and doctors. However, will be useful to associate qualitative methodologies to explore the phenomenon better.
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Affiliation(s)
- Adriana Taveira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Ana Paula Macedo
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal/School of Nursing (ESE), University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Silvana Martins
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, Polo C, 3046-851 Coimbra, Portugal
| | - e Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Faculty of Psychology and Education Sciences of the University of Porto, Portugal
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Ninković M, Ilić S, Damnjanović K. Women's trust in the healthcare system in Serbia: Validation of the Women's Trust and Confidence in Healthcare System scale. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241249864. [PMID: 38770772 PMCID: PMC11127576 DOI: 10.1177/17455057241249864] [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: 02/12/2023] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Women's role as patients is associated with power relationships embedded in society. Although trust in the health care system is a general prerequisite for positive health outcomes, practices regarding women's agency in healthcare systems in Southeastern Europe reinforce women's passivity. Most of the current psychological measures of trust have been constructed and validated in "WEIRD" (samples that are drawn from populations that are White, Educated, Industrialized, Rich, and Democratic) countries, thus having a limited application in other social contexts. OBJECTIVES We aimed to construct an instrument for assessing women's trust in healthcare systems to describe the structure of trust: Women's Trust and Confidence in the Healthcare System scale. DESIGN Two independent samples (N1 = 329; N2 = 333) of adult women in Serbia voluntarily completed an online questionnaire. The questionnaire comprised 20 trust-related items which were selected from an extensive collection of women's experiences in the healthcare system and evaluated by experts on a 5-point Likert-type scale. METHODS We used exploratory factor analysis of the Women's Trust and Confidence in the Healthcare System scale to analyze the structure of trust in the first sample data set and validated it with the second sample using confirmatory factor analysis. We tested concurrent validity by exploring how women's trust in the healthcare system predicts health-related behaviors (multigroup structural equation modeling). All analyses were conducted using R statistical software. RESULTS The Women's Trust and Confidence in the Healthcare System scale (Cronbach's alpha = 0.86) indicated a three-factor structure of trust in the healthcare system: trust in healthcare professionals, distrust in the public healthcare system, and confidence in healthcare system. This was validated using an independent sample. Interpersonal trust positively predicted women's desirable health behaviors, while trust in the system had a negative impact. CONCLUSION The Women's Trust and Confidence in the Healthcare System scale captures women's trust in a paternalistic healthcare system, is reliable, and has a stable three-factor structure. The study's findings reveal the relationship between women's trust and health-related behavior: in paternalistic environments, trust reinforces women's passivity.
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Affiliation(s)
- Milica Ninković
- Laboratory for Research of Individual Differences, Department of Psychology and Institute of Philosophy, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Sandra Ilić
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - Kaja Damnjanović
- Laboratory for Experimental Psychology, Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
- Institute of Philosophy, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
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4
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Leese J, Zhu S, Townsend AF, Backman CL, Nimmon L, Li LC. Ethical issues experienced by persons with rheumatoid arthritis in a wearable-enabled physical activity intervention study. Health Expect 2022; 25:1418-1431. [PMID: 35303379 PMCID: PMC9327860 DOI: 10.1111/hex.13481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/29/2021] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Using wearables to self‐monitor physical activity is a promising approach to support arthritis self‐management. Little is known, however, about the context in which ethical issues may be experienced when using a wearable in self‐management. We used a relational ethics lens to better understand how persons with rheumatoid arthritis (RA) experience their use of a wearable as part of a physical activity counselling intervention study involving a physiotherapist (PT). Methods Constructivist grounded theory and a relational ethics lens guided the study design. This conceptual framework drew attention to benefits, downsides and tensions experienced in a context of relational settings (micro and macro) in which participants live. Fourteen initial and eleven follow‐up interviews took place with persons with RA in British Columbia, Canada, following participation in a wearable‐enabled intervention study. Results We created three main categories, exploring how experiences of benefits, downsides and tensions when using the intervention intertwined with shared moral values placed on self‐control, trustworthiness, independence and productivity: (1) For some, using a wearable helped to ‘do something right’ by taking more control over reaching physical activity goals. Some, however, felt ambivalent, believing both there was nothing more they could do and that they had not done enough to reach their goal; (2) Some participants described how sharing wearable data supported and challenged mutual trustworthiness in their relationship with the PT; (3) For some, using a wearable affirmed or challenged their sense of self‐respect as an independent and productive person. Conclusion Participants in this study reported that using a wearable could support and challenge their arthritis self‐management. Constructing moral identity, with qualities of self‐control, trustworthiness, independence and productivity, within the relational settings in which participants live, was integral to ethical issues encountered. This study is a key step to advance understanding of ethical issues of using a wearable as an adjunct for engaging in physical activity from a patient's perspective. Patient or Public Contribution Perspectives of persons with arthritis (mostly members of Arthritis Research Canada's Arthritis Patient Advisory Board) were sought to shape the research question and interpretations throughout data analysis.
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Affiliation(s)
- Jenny Leese
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Siyi Zhu
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Rehabilitation Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Anne F Townsend
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Division of Health Research, Health Innovation One, Lancaster University, Lancaster, UK
| | - Catherine L Backman
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, Centre for Health Education Scholarship, P.A. Woodward Instructional Resources Centre (IRC), University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Arthritis Research Canada, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Palmer Kelly E, Hyer M, Paredes AZ, McGee J, Tsilimigras DI, Cloyd J, Ejaz A, Park KU, Pawlik TM. Comparing Surgeon Approaches to Patient-Centered Cancer Care Using Vignette Methodology. J Gastrointest Surg 2021; 25:1307-1315. [PMID: 32519248 DOI: 10.1007/s11605-020-04661-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/15/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND We sought to characterize surgeon perceptions of patient attachment-related behaviors relative to patient-centered approaches during treatment decision-making within the clinical encounter. METHODS An online survey including clinical vignettes was sent to board-certified surgeons to assess their approach to patient-centered treatment decision-making. Within these vignettes, patient behaviors associated with attachment styles (secure vs 3 insecure subtypes: avoidant, anxious, and fearful) were fixed and patient factors (age, race, occupation, and gender) were randomized. Analysis included repeated measures mixed-effects linear regression. RESULTS Among the 208 respondents, the majority were male (65.4%) and White/Caucasian (84.5%) with an average age of 51.6 years (SD = 9.9). Most surgeons had been in practice for more than 10 years (66.8%) and treated adult patients (77.4%). Surgical specializations included breast (27.2%), HPB (35.0%), and broad-based/general (21.8%). Patient race, age, and gender did not impact surgeons' patient-centered approach to treatment decision-making (all ps > 0.05). However, when the "patient" had a white collar occupation and were securely attached, surgeons reported a greater likeliness to spend equal time presenting all treatment options (p = 0.02 and p < 0.001, respectively) and believe the patient wanted an active role in decision-making (p = 0.01 and p < 0.001, respectively). Surgeons reported being least likely to agree with a patient's treatment decision (p < 0.001) and an increased likelihood of being directive (p = 0.002) when patients exhibited behaviors associated with avoidant attachment. CONCLUSION Attachment-related behaviors were associated with differences in surgeon approaches to patient-centered decision-making. Attachment styles may offer a framework for providers to understand patient behaviors and needs, thereby providing insight on how to tailor their approach and provide optimal patient-centered care.
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Affiliation(s)
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Anghela Z Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Julia McGee
- Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Ko Un Park
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA.
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Gulick V, Graves D, Ames S, Krishnamani PP. Effect of a Virtual Reality-Enhanced Exercise and Education Intervention on Patient Engagement and Learning in Cardiac Rehabilitation: Randomized Controlled Trial. J Med Internet Res 2021; 23:e23882. [PMID: 33856355 PMCID: PMC8085751 DOI: 10.2196/23882] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/10/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is clinically proven to reduce morbidity and mortality; however, many eligible patients do not enroll in treatment. Furthermore, many enrolled patients do not complete their full course of treatment. This is greatly influenced by socioeconomic factors but is also because of patients' lack of understanding of the importance of their care and a lack of motivation to maintain attendance. OBJECTIVE This study aims to explore the potential benefits of virtual reality (VR) walking trails within CR treatment, specifically with regard to patient knowledge retention, satisfaction with treatment, and the overall attendance of treatment sessions. METHODS New CR patients were enrolled and randomized on a rolling basis to either the control group or intervention group. Intervention patients completed their time on the treadmill with VR walking trails, which included audio-recorded education, whereas control patients completed the standard of care therapy. Both groups were assisted by nursing staff for all treatment sessions. Primary outcomes were determined by assessing 6-minute walk test improvement. In addition, secondary outcomes of patients' cardiac knowledge and satisfaction were assessed via a computer-based questionnaire; patient adherence to the recommended number of sessions was also monitored. Cardiac knowledge assessment included a prerehabilitation education quiz, and the same quiz was repeated at patients' final visit and again at the 2-month follow-up. The satisfaction questionnaire was completed at the final visit. RESULTS Between January 2018 and May 2019, 72 patients were enrolled-41 in the intervention group and 31 in the control group. On the basis of the results of the prerehabilitation and postrehabilitation 6-minute walk test, no significant differences were observed between the intervention and control groups (P=.64). No statistical differences were observed between groups in terms of education (P=.86) or satisfaction (P=.32) at any time point. The control group had statistically more favorable rates of attendance, as determined by the risk group comparison (P=.02) and the comparison of the rates for completing the minimum number of sessions (P=.046), but no correlation was observed between the study group and reasons for ending treatment. CONCLUSIONS Although no improvements were seen in the VR intervention group over the control group, it is worth noting that limitations in the study design may have influenced these outcomes, not the medium itself. Furthermore, the qualitative information suggests that patients may have indeed enjoyed their experience with VR, even though quantitative satisfaction data did not capture this. Further considerations for how and when VR should be applied to CR are suggested in this paper. TRIAL REGISTRATION ClinicalTrials.gov NCT03945201; https://clinicaltrials.gov/ct2/show/NCT03945201.
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Affiliation(s)
- Victoria Gulick
- Information Services & Technologies, Jefferson Health, Philadelphia, PA, United States
| | - Daniel Graves
- Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, United States
| | - Shannon Ames
- Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, United States
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Takamura A, Imafuku R. What is the impact of the Rashomon approach in primary care education?: An educational case report of implementing dialogue and improvisation into medical education. BMC MEDICAL EDUCATION 2021; 21:143. [PMID: 33663483 PMCID: PMC7934433 DOI: 10.1186/s12909-021-02570-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The excessive sub-divided or concrete pre-determined objectives found in the technological approach in contemporary medical education curricula may hinder the students' spontaneous learning about diverse needs and values in care. However, medical professionals must learn the diversity for care or a variety of social factors of the patients influencing decision making in daily practice. METHODS We introduced a new method of curriculum development called the Rashomon approach. For testing the Rashomon approach, educational activities to teach the diversity in primary care were developed in four modules: 1) explication of the competency without specifying sub-objectives; 2) dialogue among multiple professional students; 3) visits and interviews of the patients; 4) dialogue with teachers' improvisation. The students' outcomes and responses were quantitatively and qualitatively analyzed. RESULTS A total of 135 medical students joined this study in 2017. The descriptive data suggested that the key concepts of diversity in primary care were fully recognized and that the pre-determined general goals were achieved. Scores on the understanding of social factors in medicine, respect for other professionals, professional identity, and satisfaction with the course were very high. CONCLUSION Instead of the technological approach, the Rashomon approach, in which only a general goal guides educational activities was used in this research. Improvisation and dialogue fit the approach and were potentially effective activities to learn the multifaceted practice of medicine. In an era of competency-based education, the Rashomon approach could be a very useful framework in primary care education.
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Affiliation(s)
- Akiteru Takamura
- Department of Medical Education, Kanazawa Medical University, 1-1 Uchinada-machi Daigaku, Kahoku-gun, Kanazawa, Ishikawa, 920-0293, Japan.
| | - Rintaro Imafuku
- Medical Education Development Center, Gifu University, Gifu, Japan
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Chérrez-Ojeda I, Vera C, Vanegas E, Gallardo JC, Felix M, Espinoza-Fuentes F, Chedraui P, Gavilanes AWD, Mata VL. The use of information and communication technologies in Latin American dentists: a cross-sectional study from Ecuador. BMC Oral Health 2020; 20:146. [PMID: 32429887 PMCID: PMC7236194 DOI: 10.1186/s12903-020-01137-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of information and communication technologies (ICTs) provide the tools for enabling fast and reliable real-time communications, as well as the transfer of information between dental professionals and their patients. However, little is known about the frequency and preference of ICTs among Latin-American dentists. Our study aims to fill this gap by assessing different aspects related to ICTs, mainly the frequency of use, perceptions, and barriers among Ecuadorian dentists. METHODS An anonymous, cross-sectional survey-based study was conducted among 342 Ecuadorian dentists. The final questionnaire included 13 items related to the frequency of use, perceptions, and barriers of ICTs. Bivariate analysis was performed by using chi-squared testing to explore the association between the independent variables and the intended use of ICTs, as well as to characterize the perceptions and barriers related to ICTs. RESULTS In general, most participants reported the use of ICTs to communicate with colleagues (99.7%), and patients (96.2%), while only 63.5% reported using ICTs to obtain academic information in their daily practice. WhatsApp was rated as the most used ICT for communicating with colleagues and patients. A majority of participants considered that ICTs can be useful for facilitating continuing dental education (92.1%), searching new work opportunities (91.5%), promoting health (90.1%), working with colleagues and other health professionals (91.2%), promoting their professional services (90.6%), and for resolving clinical cases (87.7%). On the subject of barriers, privacy and security concerns about personal and/or patient information was the biggest concern among dentists (65%), followed by lack of time to learn how to use and/or use ICTs (48%), lack of mobile internet access (28.1%), and lack of internet access at work (24.9%). CONCLUSION In our study, we found that Ecuadorian dentists had a high usage rate of ICTs, mainly for communicating with other colleagues and patients, while the academic use of technology remains a comparatively underused application. Most of the participants surveyed had a positive perception towards ICTs, while privacy and security concerns were identified as the main barrier. Older age was associated with a less favourable perception toward ICTs, as well as an increased likelihood of reporting barriers related to the use of technology.
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Affiliation(s)
- Ivan Chérrez-Ojeda
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador. .,Respiralab Research Group, Guayaquil, Ecuador.
| | - Carlos Vera
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Emanuel Vanegas
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Juan Carlos Gallardo
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador
| | - Miguel Felix
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | | | - Peter Chedraui
- Facultad De Ciencias Médicas, Instituto De Investigación e Innovación En Salud Integral, Universidad Católica De Santiago De Guayaquil, Guayaquil, Ecuador.,Facultad De Ciencias De La Salud, Universidad Católica "Nuestra Señora De La Asunción", Asunción, Paraguay
| | - Antonio W D Gavilanes
- School of Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.,Department of Pediatrics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Valeria L Mata
- Universidad Espíritu Santo, Km. 2.5 vía La Puntilla, Zip code: 0901-952, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
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9
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Palmer Kelly E, Hyer M, Paredes AZ, McGee J, Cloyd J, Ejaz A, Park KU, Pawlik TM. Assessing Differences in Cancer Surgeon Approaches to Patient-Centered Decision-Making Using Vignette-Based Methodology. Ann Surg Oncol 2020; 27:2149-2156. [PMID: 32318948 DOI: 10.1245/s10434-020-08488-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective of this study is to assess surgeon-patient-centered decision-making (PCDM) strategies relative to surgeon and patient factors. METHODS Approaches to PCDM were evaluated using a cross-sectional survey based on clinical vignettes assessing surgeon likeliness (0 = not at all likely, 100 = very likely) to utilize PCDM strategies. Data were analyzed using repeated-measures mixed-effects linear regression. Adjusted estimates are provided as least-squares mean (LSM) values. RESULTS The final analytic sample consisted of 208 respondents (58.5% response rate); the majority of respondents were male (67.7%) and Caucasian (82.0%) with an average age of 51.6 years (standard deviation, SD = 9.9 years, range 34.0-78.0 years). Specialties included breast (18.9%), hepatopancreatobiliary (21.4%), and other (59.7%). Surgeons practicing at academic (versus nonacademic) hospitals were less likely to be directive (LSM: 66.2 vs. 70.3, p = 0.004), spend equal time discussing all treatment options (LSM: 77.9 vs. 82.3, p = 0.001), and make explicit treatment recommendations (LSM: 67.7 vs. 71.7, p = 0.005). Surgeons who specialized in breast cancer (versus other specialties), in practice 10+ years (versus < 10 years), and female (versus male) were more likely to spend time discussing all treatment options (LSM: 82.8 vs. 77.3; 81.6 vs. 78.6; and 82.1 vs. 78.0, all p < 0.05). Surgeons perceived patients who had blue-collar (versus white-collar) jobs as less likely to want active participation in decision-making (LSM: 62.9 vs. 65.6, p = 0.02). CONCLUSION Surgeon approaches to PCDM varied based on a number of surgeon and patient characteristics. Further studies are needed to understand how surgeon PCDM strategies can be tailored to specific care contexts and patient needs.
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Affiliation(s)
| | - Madison Hyer
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Anghela Z Paredes
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Julia McGee
- The Ohio State University, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Ko Un Park
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
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10
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Baessler F, Zafar A, Schweizer S, Ciprianidis A, Sander A, Preussler S, Honecker H, Wolf M, Bartolovic M, Wagner FL, Klein SB, Weidlich J, Ditzen B, Roesch-Ely D, Nikendei C, Schultz JH. Are we preparing future doctors to deal with emotionally challenging situations? Analysis of a medical curriculum. PATIENT EDUCATION AND COUNSELING 2019; 102:1304-1312. [PMID: 30852116 DOI: 10.1016/j.pec.2019.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Skilful communication by doctors is necessary for healthcare delivery during emotionally challenging situations. This study analyses a medical curriculum for the frequency and intensity of teaching content on communication in emotionally challenging situations. METHODS A questionnaire with 31 questions ("EmotCog31") was used to evaluate teaching sessions at 17 departments of a medical school for one semester. RESULTS Teaching content on communication in emotionally challenging situations was observed in 62 of 724 (∼nine percent) teaching sessions. Fifty-six percent of these sessions were within psychosocial specialisations. Lecturers used mental diseases as teaching topics four times more than somatic diseases. Forty-two percent of the 62 sessions were large-group while fifty-eight percent were small-group, interactive sessions. Clinical examples were used in sixty-nine percent of these sessions. Eighty-one percent of the handouts provided and sixty-six percent of simulated patient scenarios used were rated as helpful. Two-thirds of teaching sessions were rated positively when they included practical context. CONCLUSION There was a considerable lack of teaching on communication skills in an emotional context. Teaching was limited to psychosocial specialties, reducing the impact of available knowledge for other medical specialties. PRACTICE IMPLICATIONS More interactive, practically oriented teaching methods are useful for teaching emotional communication skills.
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Affiliation(s)
- Franziska Baessler
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Ali Zafar
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Sophie Schweizer
- Department of Gynecology and Obstetrics, Heidelberg University Hospital, Germany.
| | - Anja Ciprianidis
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Anja Sander
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
| | - Stella Preussler
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
| | - Hannah Honecker
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany.
| | - Michael Wolf
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Marina Bartolovic
- Department of General Adult Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany.
| | - Fabienne Louise Wagner
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Sonja Bettina Klein
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Joshua Weidlich
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Beate Ditzen
- Institute of Medical Psychology, Heidelberg University Hospital, Bergfheimer Str. 20, 69115 Heidelberg, Germany.
| | - Daniela Roesch-Ely
- Department of General Adult Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany.
| | - Christoph Nikendei
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Jobst-Hendrik Schultz
- Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
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Ozeke O, Ozeke V, Coskun O, Budakoglu II. Second victims in health care: current perspectives. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:593-603. [PMID: 31496861 PMCID: PMC6697646 DOI: 10.2147/amep.s185912] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/24/2019] [Indexed: 05/13/2023]
Abstract
Medical errors are a serious public health problem and the third-leading cause of death after heart disease and cancer. Every day, the health care professionals (HCPs) practice their skill and knowledge within excessively complex situations and meet unexpected patient outcomes. These unexpected complications and unintentional errors will always be a part of the medical system due to the universal nature of human fallibility and technology. While not all errors are life-threatening, they can significantly compromise a patient's quality of life. However, the victims of medical error reach far beyond the patient. The second victim (SV), which defined for the first time by Albert Wu in his description of the impact of errors on HCPs by both personally and professionally, is a medical emergency equivalent to post-traumatic stress disorder. When the errors occur, it causes a domino effect including the four groups: the patient and family (first victim), the HCP [SV], the hospital reputation (third victim), and patients who are harmed subsequently (fourth victims). The rights of our patients to safe, reliable, and patient-centered care are critical and most important as a primary and utmost aim of medicine. However, we also have to take care of our own (SVs), especially when we have good people who mean to do well and then find themselves in an emotionally complex situation. There is a need to articulate to the public, politicians, and media how system failure leads to medical error even in hand of well-educated and competent HCPs are given an increasing clinical workload. Furthermore, despite several leading institutions in western countries have developed formal support programs that allow HCPs to cope with their emotional distress by obtaining timely support in an emphatic, confidential, non-judgmental environment, we need to raise awareness of this phenomenon and appropriate institutional responses both to harmed patients and their families and HCPs.
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Affiliation(s)
- Ozcan Ozeke
- Health Sciences University, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
- Correspondence: Ozcan OzekeSağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Kardiyoloji Klinigi, Ankara06800, TurkiyeTel +90 505 383 6773Email
| | - Vildan Ozeke
- Gaziosmanpasa University, Department of Computer Education and Instructional Technology, Tokat, Turkey
- Gazi University, Department of Medical Education and Informatics, Ankara, Turkey
| | - Ozlem Coskun
- Gazi University, Department of Medical Education and Informatics, Ankara, Turkey
| | - Isil Irem Budakoglu
- Gazi University, Department of Medical Education and Informatics, Ankara, Turkey
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Hogans BB, Gallagher RM. A Global Year for Pain Education: Progress, Trends, and the Way Forward. PAIN MEDICINE 2018; 19:1507-1511. [PMID: 29873787 DOI: 10.1093/pm/pny102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Beth B Hogans
- Department of Neurology, Johns Hopkins School of Medicine, NIH Pain Consortium Johns Hopkins University Center of Excellence in Pain Education (CoEPE), 600 North Wolfe Street, 5-117 Meyer, Baltimore, MD 21287
| | - Rollin M Gallagher
- Pain Medicine (Oxford University Press), Psychiatry and Anesthesiology, Director for Pain Policy Research and Primary Care, Penn Pain Medicine University of Pennsylvania Affiliate Faculty Center for Health Equities Research and Promotion Corporal Michael C Crezcant VA Medical Center Philadelphia, PA
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Pogach LM, Aron DC. Defining and measuring population health quality of outpatient diabetes care in Israel: lessons from the quality indicators in community health program. Isr J Health Policy Res 2018; 7:22. [PMID: 29724239 PMCID: PMC5932887 DOI: 10.1186/s13584-018-0216-1] [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: 03/24/2018] [Accepted: 04/19/2018] [Indexed: 12/12/2022] Open
Abstract
In Israel, as in other Organization for Economic Co-operation and Development countries, performance measurement is a key public health strategy in monitoring and improving population health outcomes. The Israeli Quality Indicators in Community Healthcare (QICH) program has utilized electronic health records to monitor ambulatory care for the entire Israeli population since 2002. In 2006 the measures were updated to include laboratory values. They have been subsequently revised by stratifying by age, duration, adding medications, and changing frequency of testing for certain process measures. However, the QICH glycemic control measures do not address co-morbid conditions either thru exclusion criteria or higher target ranges. They also do not address potential over treatment in patients with complex medication conditions. In the United States there have also been changes in nationally endorsed diabetes specific performance measures since 2007. However, there have also been public disagreements among United States professional societies, government agencies, and performance measurement organizations as to whether the current glycemic dichotomous (“all or none”) threshold measures, without exclusion criteria, are consistent with the most recent evidence. Specifically, most guidelines now recommend individualized target goals based upon co-morbid conditions, risk of harms from medications, and patient preferences. Concerns have been raised that the current glycemic performance measures have resulted in inappropriate care, such as medication over-treatment, and serious harms, such as hypoglycemia, especially in older adults. There currently are no national surveillance systems or measures that monitor these untoward outcomes. We recommend several actions that QICH could consider to advance diabetes specific performance measurement science and population health: Convene an international conference; implement technical modifications of current measures and surveillance systems; and, most importantly, acknowledge patient autonomy by developing measures that document individualization of target values using shared decision making.
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Merzagora I, Amadasi A, Blandino A, Travaini G. The expert and the foreigner: Reflections of forensic transcultural psychopathology on a total of 86 reports by experts on criminal liability. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 57:24-30. [PMID: 29548501 DOI: 10.1016/j.ijlp.2017.12.005] [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: 03/27/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 06/08/2023]
Abstract
In recent times Italy has been experiencing massive migration flows, therefore the attention on the issue of crimes committed by foreigners is increasing. But within trials, in the evaluation of criminal liability of foreigners, how do experts deal with them? Do the performed evaluations take cultural diversity into account? The present study took origin from these questions and examined a total of 86 reports by experts on criminal liability of foreign persons (16 females and 70 males). Examinees have been declared indictable in 31 cases (36%), totally mentally ill in 40 cases (45%) and with diminished liability in 15 cases (17%); when liability was excluded, examinees were diagnosed in 11 cases with mood disorders, in 23 cases with personality disorders, in 4 cases with adaptation disorders and post-traumatic stress disorder and in 10 cases with different diagnoses (in some cases more than one diagnosis was present). None of the reports used the section of the DSM concerning "cultural framing". Tests were used in 48 surveys (56% of cases), with more tests for each examinee, for a total of 39 Rorschach, 14 Raven test, 8 Minnesota Multiphasic Personality Inventory - MMPI - 4 Wechsler Adult Intelligence Scale - WAIS - level test, 8 Thematic Apperception test. When subjects were diagnosed with mental disorder and with diminished liability, 42 (79%) were also socially dangerous. Results highlight the importance of the relationship between the expert and the foreigner. Many factors ought to be critically considered by experts dealing with foreigners, like cultural awareness, knowledge of verbal communication, critical consideration of meanings and diagnosis, knowledge of the foreigners' personal story, presence of tests with inexact information and cultural fallacy.
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Affiliation(s)
- Isabella Merzagora
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy.
| | - Alberto Amadasi
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy
| | - Alberto Blandino
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy
| | - Guido Travaini
- Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy
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Pluut B. Differences that matter: developing critical insights into discourses of patient-centeredness. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2016; 19:501-515. [PMID: 27251048 PMCID: PMC5088218 DOI: 10.1007/s11019-016-9712-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Patient-centeredness can be considered a popular, and at the same time "fuzzy", concept. Scientists have proposed different definitions and models. The present article studies scientific publications that discuss the meaning of patient-centeredness to identify different "discourses" of patient-centeredness. Three discourses are presented; the first is labelled as "caring for patients", the second as "empowering patients" and the third as "being responsive". Each of these discourses has different things to say about (a) the why of patient-centeredness; (b) the patient's identity; (c) the role of the healthcare professional; (d) responsibilities for medical decision-making, and (e) the role of health information. This article compares and contrasts the discourses in ways that allow us to see differences that matter for practitioners in healthcare. On the basis of a relational constructionist philosophy, it is argued that discursive diversity is both an inevitable and a potentially valuable aspect of conversations in healthcare. We are therefore invited to center the challenge of dealing with diversity in productive ways. This article ends with a discussion of the practical implications of the discourse analysis for projects that aim to make healthcare more patient-centered. Debates on patient-centered "Health Information Exchange" are used to explain the need for a recognition of different discourses of patient-centeredness and a reflexive stance towards them.
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Affiliation(s)
- Bettine Pluut
- Utrecht University School of Governance, Bijlhouwerstraat 6, 3511 ZC, Utrecht, Netherlands.
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Jahn Kassim PN, Alias F. Religious, Ethical and Legal Considerations in End-of-Life Issues: Fundamental Requisites for Medical Decision Making. JOURNAL OF RELIGION AND HEALTH 2016; 55:119-134. [PMID: 25576401 DOI: 10.1007/s10943-014-9995-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Religion and spirituality have always played a major and intervening role in a person's life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient's religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient's values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients' varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions.
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Affiliation(s)
- Puteri Nemie Jahn Kassim
- Civil Law Department, Ahmad Ibrahim Kulliyyah of Laws, International Islamic University Malaysia, 53100, Kuala Lumpur, Malaysia.
| | - Fadhlina Alias
- Ahmad Ibrahim Kulliyyah of Laws, International Islamic University Malaysia, 53100, Kuala Lumpur, Malaysia
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Townsend A, Leese J, Adam P, McDonald M, Li LC, Kerr S, Backman CL. eHealth, Participatory Medicine, and Ethical Care: A Focus Group Study of Patients' and Health Care Providers' Use of Health-Related Internet Information. J Med Internet Res 2015; 17:e155. [PMID: 26099267 PMCID: PMC4526955 DOI: 10.2196/jmir.3792] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 03/16/2015] [Accepted: 05/24/2015] [Indexed: 11/17/2022] Open
Abstract
Background The rapid explosion in online digital health resources is seen as transformational, accelerating the shift from traditionally passive patients to patients as partners and altering the patient–health care professional (HCP) relationship. Patients with chronic conditions are increasingly engaged, enabled, and empowered to be partners in their care and encouraged to take responsibility for managing their conditions with HCP support. Objective In this paper, we focus on patients’ and HCPs’ use of health-related Internet information and how it influences the patient-HCP relationship. In particular, we examine the challenges emerging in medical encounters as roles and relationships shift and apply a conceptual framework of relational ethics to examine explicit and nuanced ethical dimensions emerging in patient-HCP interactions as both parties make increased use of health-related Internet information. Methods We purposively sampled patients and HCPs in British Columbia, Canada, to participate in focus groups. To be eligible, patients self-reported a diagnosis of arthritis and at least one other chronic health condition; HCPs reported a caseload with >25% of patients with arthritis and multimorbidity. We used a semistructured, but flexible, discussion guide. All discussions were audiotaped and transcribed verbatim. Elements of grounded theory guided our constant comparison thematic analytic approach. Analysis was iterative. A relational ethics conceptual lens was applied to the data. Results We recruited 32 participants (18 patients, 14 HCPs). They attended seven focus groups: four with patients and three with rehabilitation professionals and physicians. Predominant themes to emerge were how use of health-related Internet information fostered (1) changing roles, (2) patient-HCP partnerships, and (3) tensions and burdens for patients and HCPs. Conclusions Relational aspects such as mutual trust, uncertainty, and vulnerability are illuminated in patient-HCP interactions around health-related Internet information and the negotiated space of clinical encounters. New roles and associated responsibilities have key ethical dimensions that make clear the changes are fundamental and important to understand in ethical care. When faced with tensions and burdens around incorporating health-related Internet information as a resource in clinical encounters, participants described a particular ambivalence illustrating the fundamental changes being negotiated by both patients and HCPs.
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