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Murry LT, Desselle SP. Barriers to person-centered service design in pharmacy practice: examples, lessons, and potential solutions. Int J Clin Pharm 2024; 46:542-547. [PMID: 38194008 DOI: 10.1007/s11096-023-01689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/09/2023] [Indexed: 01/10/2024]
Abstract
Despite increased attention to, and frameworks conceptualizing person-centered care, systematic, organizational, and provider-level barriers continue to discourage the development and delivery of person-centered care (PCC) in pharmacy practice and beyond. This commentary describes existing pharmacy-specific literature related to PCC, barriers to PCC within the context of pharmacy practice, and potential solutions to increase person-centeredness in pharmacy services. Literature to substantiate and describe barriers and potential solutions was identified from 2008 to 2023, a period where the emphasis on PCC in pharmacy practice dramatically increased. Overall, pharmacy-specific literature was identified describing four key barriers to PCC. Several potential solutions were identified, including: using innovative and theory-informed approaches to collecting individual need and preference information, employing processes and equipping providers to facilitate trust, changing organizational culture, and aligning quality metrics and financial incentives with PCC. Identified solutions may be used to address individual, organizational, and systematic barriers to promote PCC.
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Affiliation(s)
- Logan T Murry
- The University of Iowa College of Pharmacy, 180 S Grand Ave, Iowa City, IA, 52242, USA.
- The Accreditation Council for Pharmacy Education, Chicago, IL, 60603, USA.
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Meadows RJ, Gehr AW, Lu Y, Maynard G, Akpan IN, Taskin T, Fulda KG, Patel D, Matches S, Ojha RP, Thompson EL. Effectiveness of provider communication training for increasing human papillomavirus vaccine initiation at a safety-net health system. Prev Med Rep 2024; 39:102660. [PMID: 38426039 PMCID: PMC10901897 DOI: 10.1016/j.pmedr.2024.102660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
Background Strong provider recommendation can increase uptake of human papillomavirus (HPV) vaccination. Therefore, we developed and implemented a provider education intervention on communication strategies for recommending HPV vaccination with clinic-level audit and feedback (HPV: Communicating about HPV to Adults and Teens [HPV CHAT]). We aimed to evaluate the effect of HPV CHAT on HPV vaccine uptake in seven family medicine and pediatric clinics in a large urban health system (USA). Methods We used a quasi-experimental design, where the eligible population included people aged 9-26 years with at least one encounter in June 2020-February 2023 at one of the participating community health clinics. We used interrupted time-series analysis to assess changes in the prevalence of HPV vaccine uptake. We used segmented Poisson regression with a log link function to estimate prevalence ratios (PR) and 95% confidence limits (CL) for level (immediate) and slope (over time) changes with adjustment for seasonality using Fourier transformation. Results Our study population comprised 60,328 observations in which the median age was 17 years (interquartile range: 13-21). A majority (58%) were female and 87% were racial/ethnic minorities. Overall, we observed no sizeable effect of the intervention on HPV vaccination uptake. Nonetheless, heterogeneity was observed by age group with modest increases in individuals aged 9-12 and 13-17 years. Conclusion Our provider feedback intervention had minimal effect on increasing prevalence of HPV vaccination in seven family medicine and pediatric clinics. Novel strategies are needed to address provider barriers related to HPV vaccination.
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Affiliation(s)
- Rachel J. Meadows
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Aaron W. Gehr
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Yan Lu
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Grace Maynard
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Idara N. Akpan
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Tanjila Taskin
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kimberly G. Fulda
- North Texas Primary Care Practice-Based Research Network (NorTex), Department of Family Medicine and Osteopathic Manipulative Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Divya Patel
- Department of Epidemiology, Human Genetics and Environmental Science, UTHealth Houston School of Public Health in Austin, Austin, TX, USA
| | - Sarah Matches
- Department of Pediatrics & Women’s Health, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Rohit P. Ojha
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX, USA
| | - Erika L. Thompson
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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Alabsi SM, Duval S, Sundberg M, Williams D, Luepker RV, Eder M, Van't Hof JR. Regular aspirin use among a sample of American Indians/Alaskan Natives in the Upper Midwest region of the United States. Prev Med Rep 2024; 37:102571. [PMID: 38222307 PMCID: PMC10784686 DOI: 10.1016/j.pmedr.2023.102571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024] Open
Abstract
Despite high prevalence of cardiovascular disease (CVD) and CVD risk factors among American Indian or Alaska Native adults (AI/AN), there is little information on aspirin use in this population. This survey-based study seeks to understand prevalence of aspirin use in a sample of AI/AN adults in the Upper Midwestern United States. In-person and telephone based surveys were conducted querying self-reported CVD and CVD risk factors, aspirin use, and aspirin related discussion with clinicians. A total of 237 AI/AN participants were included: mean age (SD) was 60.8 (8.4) years; 143 (60 %) were women; 59 (25 %) reported CVD history. CVD risk factors were common particularly smoking (37 %) and diabetes (37 %). Aspirin use was much higher among those with CVD (secondary prevention, 76 %) than those without (primary prevention, 33 %). Primary prevention aspirin use was significantly associated with age and all CVD risk factors in unadjusted analyses. After adjustment for demographics and CVD risk factors, only age (aRR 1.13 per 5 years, 95 % CI 1.02, 1.25) and diabetes (aRR 2.44, 95 % CI 1.52, 3.92) remained significantly associated with aspirin. Regardless of CVD status, a higher proportion of those taking aspirin reported a conversation about aspirin with their doctor compared to those not taking aspirin. Among participants with no CVD, those who had such a conversation were 2.6 times more likely to use aspirin than those who did not have a conversation (aRR 2.64, 95 % CI 1.58, 4.44). The findings of this study emphasize the importance of the patient-provider relationship for preventive therapy.
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Affiliation(s)
| | - Sue Duval
- Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis MN, USA
| | - Michael Sundberg
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Donovan Williams
- Division of Geriatrics, Palliative and Primary Care, University of Minnesota Medical School, Minneapolis MN, USA
| | - Russell V. Luepker
- Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis MN, USA
- University of Minnesota School of Public Health, Division of Epidemiology and Public Health, Minneapolis, MN, USA
| | - Milton Eder
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jeremy R. Van't Hof
- Cardiovascular Division and Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical School, Minneapolis MN, USA
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Zhu X, Squiers L, Helmueller L, Madson G, Southwell BG, Alam S, Finney Rutten LJ. Provider communication contributes to colorectal cancer screening intention through improving screening outcome expectancies and perceived behavioral control. Soc Sci Med 2024; 340:116397. [PMID: 38043438 DOI: 10.1016/j.socscimed.2023.116397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023]
Abstract
Colorectal cancer (CRC) screening continues to be underutilized in the US despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Yet, available literature provides little information as to how specific information providers communicate influence patient decision-making about CRC screening. We tested the pathways through which information communicated by providers about the "Why" and "How" of CRC screening using the mt-sDNA test contributes to intention to complete the test. Data came from a behavioral theory-informed survey that we developed to identify psychosocial factors associated with mt-sDNA screening. RTI International administered the survey between 03/2022-06/2022 to a sample of US adults ages 45-75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021-9/2021. Participants completed an electronic or paper survey. We tested the proposed relationships using structural equation modeling and tested indirect effects using Monte Carlo method. A total of 2,973 participants completed the survey (response rate: 21.7%) and 81.6% (n = 2,427) reported have had a conversation with their health care provider about mt-sDNA screening before the test was ordered. We found that "Why" information from providers was positively associated with perceived effectiveness of mt-sDNA screening, while "How" information was positively associated with perceived ease of use. "Why" information contributed to screening intention through perceived effectiveness while "How" information contributed to screening intention through perceived ease of use. These findings emphasize the critical role of provider communication in shaping patient decision-making regarding CRC screening. CRC screening interventions could consider implementing provider-patient communication strategies focusing on improving patient understanding of the rationale for CRC screening and the effectiveness of available screening options as well as addressing barriers and enhancing patients' self-efficacy in completing their preferred screening option.
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Affiliation(s)
- Xuan Zhu
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | | - Shama Alam
- Exact Sciences Corporation, Madison, WI, USA
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Malhotra A, Whitley-Williams P. Training Residents and Medical Students to Overcome Parents' Vaccine Hesitancy. Pediatr Clin North Am 2023; 70:321-327. [PMID: 36841599 DOI: 10.1016/j.pcl.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Strong provider recommendations increase vaccine confidence. Medical students and pediatric residents, as future physicians, will play an important role in the messaging about vaccines to their parents and patients. The importance of inclusion of vaccine education and communication skills in the medical school curriculum and residency training programs must be recognized to ensure provider confidence in discussions with vaccine-hesitant parents and patients.
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Affiliation(s)
- Amisha Malhotra
- Division of Pediatric Allergy, Immunology and Infectious Diseases, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ 08901, USA
| | - Patricia Whitley-Williams
- Division of Pediatric Allergy, Immunology and Infectious Diseases, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ 08901, USA.
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Faro JM, Yue KL, Singh A, Soni A, Ding EY, Shi Q, McManus DD. Wearable device use and technology preferences in cancer survivors with or at risk for atrial fibrillation. Cardiovasc Digit Health J 2022; 3:S23-S27. [PMID: 36589761 PMCID: PMC9795259 DOI: 10.1016/j.cvdhj.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Cancer survivors face increased risk of heart disease, including atrial fibrillation (AF). Certain types of technology, such as consumer wearable devices, can be useful to monitor for AF, but little is known about wearables and AF monitoring in cancer survivor populations. Objective The purpose of this study was to understand technology usage and preferences in cancer survivors with or at risk for AF, and to describe demographic factors associated with wearable device ownership in this population. Methods Eligible patients completed a remote survey assessment regarding use of commercial wearable devices. The survey contained questions designed to assess commercial wearable device use, electronic health communications, and perceptions regarding the participant's cardiac health. Results A total of 424 cancer survivors (mean age 74.2 years; 53.1% female; 98.8% white) were studied. Although most participants owned a smartphone (85.9%), only 31.8% owned a wearable device. Over half (53.5%) of cancer survivors were worried about their heart health. Overall, patients believed arrhythmias (79.7%) were the most important heart condition for a wearable to detect. Survivors reported being most willing to share blood pressure (95.6%) and heart rate (95.3%) data with their providers and were least willing to share information about their diet, weight, and physical activity using these devices. Conclusion Understanding factors such as device ownership, usage, and heart health concerns in cancer survivors can play an important role in improving cardiovascular monitoring and its accessibility. Long-term patient outcomes may be improved by incorporating wearable devices into routine care of cancer survivors.
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Affiliation(s)
- Jamie M. Faro
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts,Address reprint requests and correspondence: Dr Jamie Faro, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA 01605.
| | - Kai-Lou Yue
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Aditi Singh
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Apurv Soni
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Eric Y. Ding
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Qiming Shi
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David D. McManus
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Doty AM, Rising KL, Hsiao T, Amadio G, Gentsch AT, Salcedo VJ, McElwee I, Cameron KA, Salzman DH, Papanagnou D, McCarthy DM. "Unfortunately, I don't have an answer for you": How resident physicians communicate diagnostic uncertainty to patients during emergency department discharge. Patient Educ Couns 2022; 105:2053-2057. [PMID: 35168855 PMCID: PMC9177889 DOI: 10.1016/j.pec.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/24/2021] [Accepted: 12/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe how emergency medicine resident physicians discuss diagnostic uncertainty during a simulated ED discharge discussion. METHODS A secondary content analysis of simulated clinical encounter audiotapes completed by emergency medicine residents across two sites. RESULTS When discussing lack of diagnosis, residents explained the evaluation revealed no cause for symptoms, noted concerning diagnoses that were excluded, and acknowledged both symptoms and patients' feelings. Residents used explicit and implicit language to discuss diagnostic uncertainty with similar frequency. Almost half of the residents discussed the ED role as focused on emergent illness to give patients context for their uncertain diagnoses. However, 28% of residents in this study did not discuss diagnostic uncertainty in any form. All residents provided reassurance. CONCLUSION Residents use a range of approaches to discuss diagnostic uncertainty with patients at the time of a simulated ED discharge, with some residents omitting discussion of uncertainty entirely. PRACTICE IMPLICATIONS These findings represent the current state of communication, which needs improvement. These findings do not immediately transfer to clinical practice recommendations, but rather support a need for both further study and development of formal communication training on this topic.
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Affiliation(s)
- Amanda Mb Doty
- Center for Connected Care, Thomas Jefferson University, Philadelphia, USA.
| | - Kristin L Rising
- Center for Connected Care, Thomas Jefferson University, Philadelphia, USA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - TingAnn Hsiao
- Center for Connected Care, Thomas Jefferson University, Philadelphia, USA
| | - Grace Amadio
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | | | - Venise J Salcedo
- Center for Connected Care, Thomas Jefferson University, Philadelphia, USA
| | - Ian McElwee
- Center for Connected Care, Thomas Jefferson University, Philadelphia, USA
| | - Kenzie A Cameron
- Department of Medicine, Northwestern University, Chicago, USA; Research Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA
| | - David H Salzman
- Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, USA; Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Dimitrios Papanagnou
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Danielle M McCarthy
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Reid HW, Lin OM, Fabbro RL, Johnson KS, Svetkey LP, Olsen MK, Matsouaka RA, Chung ST, Batch BC. Racial differences in patient perception of interactions with providers are associated with health outcomes in type II diabetes. Patient Educ Couns 2021; 104:1993-2003. [PMID: 33579569 PMCID: PMC8217118 DOI: 10.1016/j.pec.2021.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Examine the association of patient perceptions of care with hemoglobin A1c (HbA1c), medication adherence, and missed appointments in non-Hispanic Black (NHB) and White (NHW) patients with type 2 diabetes (T2DM). METHODS We used linear and logistic regression models to analyze the association of the Interpersonal Processes of Care survey (IPC) with HbA1c, medication adherence, and missed appointments. We then examined how these associations differed by race. RESULTS There was no overall association between IPC subdomains and HbA1c in our sample (N = 221). NHB patients perceiving their provider always explained results and medications had a HbA1c on average 0.59 (-1.13, -0.04; p = 0.04) points lower than those perceiving their provider sometimes explained results and medications. No effect was observed in NHWs. Never perceiving disrespect from office staff was associated with an average 0.67 (-1.1, -0.24; p = 0.002) point improvement in medication adherence for all patients. Never perceiving discrimination from providers was associated with a 0.44 (-0.63, -0.25; p < 0.0001) decrease in the probability of missing an appointment for NHB patients. CONCLUSIONS These results demonstrate that particular aspects of communication in the patient-provider interaction may contribute to racial disparities in T2DM. PRACTICE IMPLICATIONS Communication training for both providers and staff may reduce disparities in T2DM.
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Affiliation(s)
| | | | | | - Kimberly S Johnson
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Center for Aging and Human Development, Duke University School of Medicine, Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, USA
| | - Laura P Svetkey
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, USA
| | - Maren K Olsen
- Duke University Department of Biostatistics and Bioinformatics, Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, USA
| | - Roland A Matsouaka
- Duke University Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University, Durham, USA
| | | | - Bryan C Batch
- Department of Medicine, Division of Endocrinology, Duke University School of Medicine, Durham, USA
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Oh NL, Biddell CB, Rhodes BE, Brewer NT. Provider communication and HPV vaccine uptake: A meta-analysis and systematic review. Prev Med 2021; 148:106554. [PMID: 33857561 DOI: 10.1016/j.ypmed.2021.106554] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/06/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022]
Abstract
Provider communication can be critically important to families as they consider HPV vaccination. We sought to characterize the association of provider communication and HPV vaccine uptake, and when communication better motivates vaccination. We searched four databases for studies published between 2006 and 2019. Eligible studies examined health care provider communication (defined as recommendation or discussion) and HPV vaccine uptake (defined as initiation, completion, or follow-through) in the US. Two coders independently identified eligible studies and coded effect sizes and study characteristics. We pooled effect sizes using random-effects meta-analysis. We identified 59 eligible studies of 265,083 patients. Receiving a provider recommendation was associated with higher HPV vaccine initiation (pooled OR = 10.1, 95% CI: 7.6-13.4). HPV vaccine initiation was 24% for patients without and 60% for patients with a provider recommendation. The pooled effect size for provider recommendation and initiation was smaller for probability samples, clinical records, and NIS-Teen (all p < 0.002). Recommendations were equally effective for males and females, for different patient ages, and over time. Provider recommendation was also associated with higher HPV vaccine series completion and follow-through. Provider discussion was similarly associated with higher HPV vaccine initiation (OR = 12.4, 95% CI: 6.3-24.3). In summary, provider communication was robustly associated with HPV vaccination initiation, completion, and follow-through. These findings suggest that US public health efforts to increase HPV vaccine coverage should continue to emphasize provider communication.
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Affiliation(s)
- N Loren Oh
- University of North Carolina School of Medicine, United States of America; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Blythe E Rhodes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America.
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Spees LP, Roberts MC, Freedman AN, Butler EN, Klein WMP, Prabhu Das I, de Moor JS. Involving patients and their families in deciding to use next generation sequencing: Results from a nationally representative survey of U.S. oncologists. Patient Educ Couns 2021; 104:33-39. [PMID: 32197930 PMCID: PMC7484216 DOI: 10.1016/j.pec.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Next generation sequencing (NGS) may aid in tumor classification and treatment. Barriers to shared decision-making may influence use of NGS. We examined, from oncologists' perspectives, whether barriers to involving patients/families in decision-making were associated with NGS use. METHODS Using data from the first national survey of medical oncologists' perspectives on precision medicine (N = 1281), we approached our analyses in two phases. Bivariate analyses initially evaluated associations between barriers to involving patients/families in deciding to use NGS and provider- and organizational-level characteristics. Modified Poisson regressions then examined associations between patient/family barriers and NGS use. RESULTS Approximately 59 % of oncologists reported at least one barrier to involving patients/families in decision-making regarding NGS use. Those reporting patient/family barriers tended to have fewer genomic resources at their practices, to be in rural or suburban areas, and to have a higher proportion of Medicaid patients. However, these barriers were not associated with NGS use. CONCLUSIONS Oncologists encounter barriers to involving patients/families in NGS testing decisions. Organizational barriers may also potentially play a role in testing decisions. PRACTICE IMPLICATIONS To foster patient-centered care, strategies to support patient involvement in genomic testing decisions are needed, particularly among practices in low-resource settings.
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Affiliation(s)
- Lisa P Spees
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Megan C Roberts
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA; Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Andrew N Freedman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - Eboneé N Butler
- Division of Cancer Prevention, National Cancer Institute, Rockville, USA
| | - William M P Klein
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - Irene Prabhu Das
- Office of the Director, National Institutes of Health, Bethesda, USA
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
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Coburn SS, Callon WA, Eakin MN, Pruette CS, Brady TM, Mendley SR, Tuchman S, Fivush BA, Riekert KA. Evaluating provider communication in pediatric chronic kidney disease care using a global coding system. Patient Educ Couns 2020; 103:1358-1365. [PMID: 32147305 PMCID: PMC8760619 DOI: 10.1016/j.pec.2020.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Among adolescents and young adults (AYAs) with chronic illness, effective provider communication is essential for patient-centered care during a sensitive developmental period. However, communication in chronic illness care for AYAs is not well studied. Our objectives were to describe the provider communication skills in pediatric chronic kidney disease (CKD) care visits; and determine if communication skills differ by AYA characteristics. METHODS We adapted a global consultation rating system for pediatric subspecialty care using audiotaped clinic encounters of 18 pediatric nephrologists with 99 AYAs (age M(SD) = 14.9(2.6)) with CKD stages 1-5 and 96 caregivers. We hypothesized that provider communication skills would differ by AYA characteristics (age, gender, and race). RESULTS The strongest provider skills included initiating the session and developing rapport; lowest rated skills were asking patient's perspective and checking understanding. Communication scores did not consistently differ by AYA age or race, but were rated higher with female AYAs in several domains (ps<0.05). CONCLUSIONS Pediatric providers generally had adequate or good communication scores with AYAs, but improvement in certain skills, particularly with male AYAs, may further support patient-centered care. PRACTICE IMPLICATIONS To achieve consistent, patient-centered communication with AYAs, an observation-based global assessment may identify areas for provider improvement.
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Affiliation(s)
- Shayna S Coburn
- Johns Hopkins University, School of Medicine, Division of Pulmonary and Critical Care Medicine, 5501 Hopkins Bayview Blvd, Baltimore, MD, 21224, United States.
| | - Wynne A Callon
- Johns Hopkins University, School of Medicine, Division of Pulmonary and Critical Care Medicine, 5501 Hopkins Bayview Blvd, Baltimore, MD, 21224, United States.
| | - Michelle N Eakin
- Johns Hopkins University, School of Medicine, Division of Pulmonary and Critical Care Medicine, 5501 Hopkins Bayview Blvd, Baltimore, MD, 21224, United States.
| | - Cozumel S Pruette
- Johns Hopkins University, School of Medicine, Division of Pediatric Nephrology, 200 N. Wolfe Street, Baltimore, MD, 21287, United States.
| | - Tammy M Brady
- Johns Hopkins University, School of Medicine, Division of Pediatric Nephrology, 200 N. Wolfe Street, Baltimore, MD, 21287, United States.
| | - Susan R Mendley
- NIH/National Institute for Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States.
| | - Shamir Tuchman
- Children's National Health System, Washington, DC Division of Nephrology, 111 Michigan Ave NW, Washington, D.C., 20010, United States.
| | - Barbara A Fivush
- Johns Hopkins University, School of Medicine, Division of Pediatric Nephrology, 200 N. Wolfe Street, Baltimore, MD, 21287, United States.
| | - Kristin A Riekert
- Johns Hopkins University, School of Medicine, Division of Pulmonary and Critical Care Medicine, 5501 Hopkins Bayview Blvd, Baltimore, MD, 21224, United States.
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Cronin RM, Yang M, Hankins JS, Byrd J, Pernell BM, Kassim A, Adams-Graves P, Thompson AA, Kalinyak K, DeBaun M, Treadwell M. Association between hospital admissions and healthcare provider communication for individuals with sickle cell disease. ACTA ACUST UNITED AC 2020; 25:229-240. [PMID: 32552526 DOI: 10.1080/16078454.2020.1780737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To test the hypothesis that caregivers' or adult participants' low ratings of provider communication are associated with more hospital admissions among adults and children with sickle cell disease (SCD), respectively. Secondarily, we determined whether there was an association between the caregivers' or participants' health literacy and rating of providers' communication. Methods: Primary data were collected from participants through surveys between 2014 and 2016, across six sickle cell centers throughout the U.S. In this cross-sectional cohort study, 211 adults with SCD and 331 caregivers of children with SCD completed surveys evaluating provider communication using the Consumer Assessment of Healthcare Providers and Systems (CAHPS), healthcare utilization, health literacy, and other sociodemographic and behavioral variables. Analyses included descriptive statistics, bivariate analyses, and logistic regression. Results: Participants with better ratings of provider communication were less likely to be hospitalized (odds ratio (OR) = 0.54, 95% confidence interval (CI) = [0.35, 0.83]). Positive ratings of provider communication were associated with fewer readmissions for children (OR = 0.23, 95% CI = [0.09, 0.57]). Participants with better ratings of provider communication were less likely to rate their health literacy as lower (regression coefficient (B) = -0.28, 95% CI = [-0.46, -0.10]). Conclusions: Low ratings of provider communication were associated with more hospitalizations and readmissions in SCD, suggesting the need for interventions targeted at improving patient-provider communication which could decrease hospitalizations for this population.
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Affiliation(s)
- Robert M Cronin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, RI, USA.,American Institutes for Research, Chapel Hill, NC, USA
| | - Jane S Hankins
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeannie Byrd
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brandi M Pernell
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Division of Hematology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adetola Kassim
- Department of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Patricia Adams-Graves
- Department of General Internal Medicine and Hematology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alexis A Thompson
- Department of Pediatrics, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Karen Kalinyak
- Division of Hematology in Cancer and Blood Diseases Institute, University of Cincinnati, Cincinnati, OH, USA
| | - Michael DeBaun
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marsha Treadwell
- Department of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
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Lape EC, Katz JN, Blucher JA, Chen AT, Silva GS, Schwab JH, Balboni TA, Losina E, Schoenfeld AJ. Patient experiences of decision-making in the treatment of spinal metastases: a qualitative study. Spine J 2020; 20:905-14. [PMID: 31899375 DOI: 10.1016/j.spinee.2019.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/21/2019] [Accepted: 12/27/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND In the treatment of spinal metastases the risks of surgery must be balanced against potential benefits, particularly in light of limited life-expectancy. Patient experiences and preferences regarding decision-making in this context are not well explored. PURPOSE We performed a qualitative study involving patients receiving treatment for spinal metastatic disease. We sought to understand factors that influenced decision-making around care for spinal metastases. STUDY SETTING Three tertiary academic medical centers. PATIENT SAMPLE We recruited patients presenting for treatment of spinal metastatic disease at one of three tertiary centers in Boston, MA. OUTCOME MEASURES We conducted semistructured interviews using a guide that probed participants' experiences with making treatment decisions. METHODS We performed a thematic analysis that produced a list of themes, subthemes, and statement explaining how the themes related to the study's guiding questions. Patients were recruited until thematic saturation was reached. RESULTS We interviewed 23 participants before reaching thematic saturation. The enormity of treatment decisions, and of the diagnosis of spinal metastases itself, shaped participant preferences for who should take responsibility for the decision and whether to accept treatments bearing greater risk of complications. Pre-existing participant beliefs about decision-making and about surgery interacted with the clinical context in a way that tended to promote accepting physician recommendations and delaying or avoiding surgery. CONCLUSIONS The diagnosis of spinal metastatic disease played an outsized role in shaping participant preferences for agency in treatment decision-making. Further research should address strategies to support patient understanding of treatment options in clinical contexts-such as spinal metastases-characterized by ominous underlying disease and high-risk, often urgent interventions.
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Lehmann V, Labrie NHM, van Weert JCM, van Dulmen S, de Haes HJCJM, Kersten MJ, Pieterse AH, Smets EMA. Provider caring and structuring treatment information to improve cancer patients' recall: Does it help? Patient Educ Couns 2020; 103:55-62. [PMID: 31349965 DOI: 10.1016/j.pec.2019.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Patient recall of medical information is usually poor. Healthcare providers can employ affect-oriented (i.e., showing care) or cognition-oriented communication styles (i.e., structuring information) to enhance recall, but research evidence is limited especially among clinical and/or older patient populations. This video-vignette study manipulated provider caring and information structuring to examine effects on recall and trust among cancer patients/survivors. METHODS In an online survey, 148 participants (Mage = 62) were randomized to one of four video conditions in a two (standard communication vs. enhanced caring) by two (standard vs. enhanced structuring) design, and completed measures of active recall, recognition, and trust. RESULTS Increased caring or structuring did not enhance active recall or recognition, instead both were higher among younger, female, or highly educated participants. The caring condition induced higher perceived trust in the provider within the whole sample, but trust was significantly correlated with decreased recall (r = -.268) among younger participants. CONCLUSIONS Provider caring can strengthen the patient-provider relationship by enhancing trust. Yet, increased trust may impair recall among younger patients. Structuring treatment information did not enhance recall and recognition, but additional research is needed. PRACTICE IMPLICATIONS Providers may use additional ways of structuring/organizing information to help enhance recall (e.g., written information).
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Nanon H M Labrie
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands; Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hanneke J C J M de Haes
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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15
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Wong EC, Collins RL, Breslau J, Burnam MA, Cefalu MS, Roth E. Associations between provider communication and personal recovery outcomes. BMC Psychiatry 2019; 19:102. [PMID: 30922292 PMCID: PMC6439978 DOI: 10.1186/s12888-019-2084-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/18/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This study examined whether two types of provider communication considered important to quality of care (i.e., shows respect and explains understandably) are associated with mental health outcomes related to personal recovery (i.e., connectedness, hope, internalized stigma, life satisfaction, and empowerment). This study also tested whether these associations varied by the type of provider seen (i.e., mental health professional versus general medical doctor). METHODS This sample included participants from the 2014 California Well-Being Survey, a representative survey of California residents with probable mental illness, who had recently obtained mental health services (N = 429). Multiple regression was used to test associations between provider communication and personal recovery outcomes and whether these associations were modified by provider type. RESULTS Providers showing respect was associated with better outcomes across all five of the personal recovery domains, connectedness (β = 1.12; p < .001), hope (β = 0.72; p < .0001), empowerment (β = 0.38; p < .05), life satisfaction (β = 1.10; p < .001) and internalized stigma (β = - 0.49; p < .05). Associations between provider showing respect and recovery outcomes were stronger among those who had seen a mental health professional only versus a general medical doctor only. CONCLUSIONS Respectful communication may result in greater personal recovery from mental health problems. Respecting consumer perspectives is a hallmark feature of both recovery-oriented services and quality care, yet these fields have operated independently of one another. Greater integration between these two areas could significantly improve recovery-oriented mental health outcomes and quality of care.
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Affiliation(s)
- Eunice C. Wong
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - Rebecca L. Collins
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - Joshua Breslau
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - M. Audrey Burnam
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - Matthew S. Cefalu
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
| | - Elizabeth Roth
- 0000 0004 0370 7685grid.34474.30RAND Corporation, 1776 Main Street, Santa Monica, CA USA
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16
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Shelton RC, Brotzman LE, Crookes DM, Robles P, Neugut AII. Decision-making under clinical uncertainty: An in-depth examination of provider perspectives on adjuvant chemotherapy for stage II colon cancer. Patient Educ Couns 2019; 102:284-290. [PMID: 30262401 PMCID: PMC6377327 DOI: 10.1016/j.pec.2018.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/22/2018] [Accepted: 09/14/2018] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Decision-making about adjuvant chemotherapy (ACT) for stage II colon cancer is complex, particularly in light of clinical uncertainty regarding treatment benefits. Little is known about provider communication and factors influencing decision-making and recommendations in this setting. METHODS We recruited providers from six US cancer centers and hospitals who care for stage II colon cancer patients. Providers participated in a 30-45 minute interview. Transcripts of interviews were coded for qualitative analysis. RESULTS We interviewed 42 providers (Oncologists: 52%; surgeons: 24%; nurses: 14%). Though most providers were aware of stage II colon cancer treatment guidelines, their use and communication of recommended guidelines was limited. Most reported tailoring delivery and content of their communication, often based on perceived patient education level, but patient involvement in decision-making varied. Findings highlight the complexity of, ACT decision-making, including the central role of providers and family members. CONCLUSIONS Providers are not consistently following recommended guidelines for communicating about ACT among stage II colon cancer patients or eliciting patient preferences for involvement in treatment decisions. PRACTICE IMPLICATIONS Given clinical uncertainty surrounding use of ACT for stage II colon cancer, efforts are needed to enhance guideline implementation, provider education, and communication to facilitate decision-making.
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Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA.
| | - Laura E Brotzman
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Danielle M Crookes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| | - Patrick Robles
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - AIfred I Neugut
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
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17
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Kalra N, Ayankola J, Babalola S. Healthcare provider interaction and other predictors of long-acting reversible contraception adoption among women in Nigeria. Int J Gynaecol Obstet 2018; 144:153-160. [PMID: 30407627 DOI: 10.1002/ijgo.12705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/14/2018] [Accepted: 11/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To test the association between healthcare provider communication and adoption of long-acting reversible contraception (LARC) among women in Nigeria. METHODS The present cross-sectional observational secondary analysis included women aged 18-49 who were interviewed between June 1 and July 31, 2014, at selected family planning sites in Ibadan and Kaduna, Nigeria. A multivariate generalized estimating equation was utilized to assess the predictors of LARC adoption. RESULTS 597 women were interviewed, and the study showed that each unit increase on the GATHER index-a self-reported measure of interaction with the provider-was significantly associated with a 16% increased likelihood (adjusted odds ratio [AOR] 1.16, 95% confidence interval [CI] 1.03-1.32) of adopting LARCs. Joint decision making with a partner (AOR 1.51, 95% CI 1.0-2.20), desire to have children in the next 2 years (AOR 0.36, 95% CI 0.18-0.74), whether or not a pregnancy in the next 6 months would be a problem (AOR 1.69, 95% CI 1.16-2.46), and LARC use in the past (AOR 4.15, 95% CI 1.19-14.50) were associated with LARC uptake. CONCLUSION Improved patient-provider communication involving patient preferences, information about all methods of contraception, and planned follow-up could play a central role in increasing the demand for, and uptake of, LARCs.
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Affiliation(s)
- Naira Kalra
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Ayankola
- Nigerian Urban Reproductive Health Initiative (NURHI2), Ibadan, Nigeria
| | - Stella Babalola
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Fung R, Hyde JH, Davis M. Oiling the gate: a mobile application to improve the admissions process from the emergency department to an academic community hospital inpatient medicine service. J Community Hosp Intern Med Perspect 2018; 8:1-5. [PMID: 29441157 PMCID: PMC5804721 DOI: 10.1080/20009666.2018.1425578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/28/2017] [Indexed: 12/24/2022] Open
Abstract
The process of admitting patients from the emergency department (ED) to an academic internal medicine (AIM) service in a community teaching hospital is one fraught with variability and disorder. This results in an inconsistent volume of patients admitted to academic versus private hospitalist services and results in frustration of both ED and AIM clinicians. We postulated that implementation of a mobile application (app) would improve provider satisfaction and increase admissions to the academic service. The app was designed and implemented to be easily accessible to ED physicians, regularly updated by academic residents on call, and a real-time source of the number of open AIM admission spots. We found a significant improvement in ED and AIM provider satisfaction with the admission process. There was also a significant increase in admissions to the AIM service after implementation of the app. We submit that the implementation of a mobile app is a viable, cost-efficient, and effective method to streamline the admission process from the ED to AIM services at community-based hospitals.
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Affiliation(s)
- Russell Fung
- College of Medicine, University of Tennessee, Chattanooga, TN, USA
| | - Jensen Hart Hyde
- College of Medicine, University of Tennessee, Chattanooga, TN, USA
| | - Mike Davis
- College of Medicine, University of Tennessee, Chattanooga, TN, USA
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19
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Brown KN, Leigh JP, Kamran H, Bagshaw SM, Fowler RA, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, Soo A, Stelfox HT. Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes. Crit Care 2018; 22:19. [PMID: 29374498 PMCID: PMC5787341 DOI: 10.1186/s13054-018-1941-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/02/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. METHODS This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients. RESULTS A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9-2.3) were analyzed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p < 0.001). There was a discrepancy between documentation of patient issues in the last ICU and first ward notes; mean agreement of patient issues was 42% [95% CI 31-53%]. Qualitative analyses identified eight themes related to focus (central point - e.g., problem list), structure (organization, - e.g., note-taking style), and purpose (intention - e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority. CONCLUSIONS Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.
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20
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McVay MA, Yancy WS Jr, Scott CN, Wilson-Barlow L, Woolson S, McSherry WC, Allen S, Voils CI. Patient factors associated with initiation of behavioral weight loss treatment: a prospective observational study in an integrated care setting. Transl Behav Med 2017; 7:75-83. [PMID: 27501799 DOI: 10.1007/s13142-016-0430-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Low enrollment in behavioral weight loss treatments limits their impact. We aimed to identify factors associated with treatment initiation. The participants were outpatients (n = 198) at Veterans Affairs (VA) healthcare facilities who were referred to a free VA-based behavioral weight loss treatment. Participants were assessed on psychosocial factors potentially relevant to treatment initiation. Subsequent treatment initiation was determined via medical record review. Study participants were 77 % male, 60 % African American, and 54 % initiated treatment. In multivariable analyses, treatment initiation was associated with being single, higher anxiety, and patients' perceptions that referring provider supported their weight autonomy. Endorsement of treatment barriers was not associated with treatment initiation. Treatments offering in-person sessions and mood management components were rated as more preferred. Initiation of behavioral weight loss treatments may increase if patients believe that providers respect their weight control autonomy and if healthcare organizations offer treatments that match patients' preferences.
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21
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Martinez KA, Resnicow K, Williams GC, Silva M, Abrahamse P, Shumway DA, Wallner LP, Katz SJ, Hawley ST. Does physician communication style impact patient report of decision quality for breast cancer treatment? Patient Educ Couns 2016; 99:1947-1954. [PMID: 27395750 PMCID: PMC5121061 DOI: 10.1016/j.pec.2016.06.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 04/21/2016] [Accepted: 06/22/2016] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Provider communication that supports patient autonomy has been associated with numerous positive patient outcomes. However, to date, no research has examined the relationship between perceived provider communication style and patient-assessed decision quality in breast cancer. METHODS Using a population-based sample of women with localized breast cancer, we assessed patient perceptions of autonomy-supportive communication from their surgeons and medical oncologists, as well as patient-reported decision quality. We used multivariable linear regression to examine the association between autonomy-supportive communication and subjective decision quality for surgery and chemotherapy decisions, controlling for sociodemographic and clinical factors, as well as patient-reported communication preference (non-directive or directive). RESULTS Among the 1690 women included in the overall sample, patient-reported decision quality scores were positively associated with higher levels of perceived autonomy-supportive communication from surgeons (β=0.30; p<0.001) and medical oncologists (β=0.26; p<0.001). Patient communication style preference moderated the association between physician communication style received and perceived decision quality. CONCLUSION Autonomy-supportive communication by physicians was associated with higher subjective decision quality among women with localized breast cancer. These results support future efforts to design interventions that enhance autonomy-supportive communication. PRACTICE IMPLICATIONS Autonomy-supportive communication by cancer doctors can improve patients' perceived decision quality.
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Affiliation(s)
- Kathryn A Martinez
- Cleveland Clinic, Center for Value-Based Care Research, 9500 Euclid Ave, G10 Cleveland, OH 44195, USA.
| | - Ken Resnicow
- University of Michigan School of Public Health, 109 Observatory Street Ann Arbor, MI 48109-2029, USA.
| | - Geoffrey C Williams
- University of Rochester, School of Medicine, 500 Joseph C. Wilson Blvd Rochester, NY 14611, USA.
| | - Marlene Silva
- University of Lisbon, Faculty of Human Kinetics, Estrada da Costa, 1495-710, Cruz Quebrada, Lisbon, Portugal.
| | - Paul Abrahamse
- University of Michigan School of Medicine, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Dean A Shumway
- University of Michigan School of Medicine, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Lauren P Wallner
- University of Michigan School of Medicine, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Steven J Katz
- University of Michigan School of Medicine, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Sarah T Hawley
- University of Michigan School of Medicine, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
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22
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Milucky JL, Deal AM, Anders C, Wu R, McNally RS, Lee CN. Coordination of Care for Breast Reconstruction Patients: A Provider Survey. Clin Breast Cancer 2016; 17:e59-e64. [PMID: 27592542 DOI: 10.1016/j.clbc.2016.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/19/2016] [Accepted: 07/20/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Communication between medical oncologists (MOs) and plastic surgeons (PSs) is important to optimize outcomes for patients with breast cancer seeking breast reconstruction. We sought to evaluate the knowledge MOs and PSs have of each others' fields, roles expected of each other, and frequency of communication. METHODS A cross-sectional survey was conducted in a convenience sample of MOs and PSs. The survey included knowledge questions about reconstruction and chemotherapy, questions about provider and patient responsibilities for timely chemotherapy initiation, and questions about communication with other specialties. RESULTS MOs and PSs had similar knowledge scores (MOs, 59%; PSs, 56%; P = .5), but both lacked knowledge about aspects of the other specialty's field related to breast reconstruction. The MOs and PSs agreed on the MOs' degree of responsibility for timely chemotherapy initiation (MOs mean, 4.6; PSs mean, 4.4 (out of 5); P = .2). However, they disagreed about the PS's responsibility for timely chemotherapy initiation (MOs mean, 3.8; PSs mean, 3.0; P = .01). Communication occurred about 2.5 times more often for patients with complications than patients without complications (P < .0001). CONCLUSION MOs and PSs have deficits in knowledge about each other fields and differ in their opinion regarding the burden of responsibility in ensuring timely chemotherapy initiation, suggesting room for improvement in communication and understanding.
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Affiliation(s)
- Jennifer L Milucky
- Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
| | - Allison M Deal
- Biostatistics and Clinical Data Management Core, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Carey Anders
- Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Rebecca Wu
- Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Richard Sean McNally
- Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Clara N Lee
- Department of Surgery, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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Wang C, Sen A, Plegue M, Ruffin MT, O'Neill SM, Rubinstein WS, Acheson LS. Impact of family history assessment on communication with family members and health care providers: A report from the Family Healthware™ Impact Trial (FHITr). Prev Med 2015; 77:28-34. [PMID: 25901453 PMCID: PMC4508012 DOI: 10.1016/j.ypmed.2015.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/06/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study examines the impact of Family Healthware™ on communication behaviors; specifically, communication with family members and health care providers about family health history. METHODS A total of 3786 participants were enrolled in the Family Healthware™ Impact Trial (FHITr) in the United States from 2005-7. The trial employed a two-arm cluster-randomized design, with primary care practices serving as the unit of randomization. Using generalized estimating equations (GEE), analyses focused on communication behaviors at 6month follow-up, adjusting for age, site and practice clustering. RESULTS A significant interaction was observed between study arm and baseline communication status for the family communication outcomes (p's<.01), indicating that intervention had effects of different magnitude between those already communicating at baseline and those who were not. Among participants who were not communicating at baseline, intervention participants had higher odds of communicating with family members about family history risk (OR=1.24, p=0.042) and actively collecting family history information at follow-up (OR=2.67, p=0.026). Family Healthware™ did not have a significant effect on family communication among those already communicating at baseline, or on provider communication, regardless of baseline communication status. Greater communication was observed among those at increased familial risk for a greater number of diseases. CONCLUSION Family Healthware™ prompted more communication about family history with family members, among those who were not previously communicating. Efforts are needed to identify approaches to encourage greater sharing of family history information, particularly with health care providers.
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Affiliation(s)
- Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, USA.
| | - Ananda Sen
- Department of Biostatistics, University of Michigan, Ann Arbor, USA; Department of Family Medicine, University of Michigan, Ann Arbor, USA
| | - Melissa Plegue
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, USA; Department of Family Medicine, University of Michigan, Ann Arbor, USA
| | - Mack T Ruffin
- Department of Family Medicine, University of Michigan, Ann Arbor, USA
| | - Suzanne M O'Neill
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, USA
| | - Wendy S Rubinstein
- National Center for Biotechnology Information, National Institutes of Health, Bethesda, USA
| | - Louise S Acheson
- Departments of Family Medicine & Community Health and Reproductive Biology, Case Western Reserve University and Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Cleveland, USA
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24
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Wong MS, Gudzune KA, Bleich SN. Provider communication quality: influence of patients' weight and race. Patient Educ Couns 2015; 98:492-8. [PMID: 25617907 PMCID: PMC4379992 DOI: 10.1016/j.pec.2014.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/25/2014] [Accepted: 12/21/2014] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To examine the relationship between patient weight and provider communication quality and determine whether patient race/ethnicity modifies this association. METHODS We conducted a cross-sectional analysis with 2009-2010 medical expenditures panel survey-household component (N=25,971). Our dependent variables were patient report of providers explaining well, listening, showing respect, and spending time. Our independent variables were patient weight status and patient weight-race/ethnicity groups. Using survey weights, we performed multivariate logistic regression to examine the adjusted association between patient weight and patient-provider communication measures, and whether patient race/ethnicity modifies this relationship. RESULTS Compared to healthy weight whites, obese blacks were less likely to report that their providers explained things well (OR 0.78; p=0.02) or spent enough time with them (OR 0.81; p=0.04), and overweight blacks were also less likely to report that providers spent enough time with them (OR 0.78; p=0.02). Healthy weight Hispanics were also less likely to report adequate provider explanations (OR 0.74; p=0.04). CONCLUSION Our study provides preliminary evidence that overweight/obese black and healthy weight Hispanic patients experience disparities in provider communication quality. PRACTICE IMPLICATION Curricula on weight bias and cultural competency might improve communication between providers and their overweight/obese black and healthy weight Hispanic patients.
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Affiliation(s)
- Michelle S Wong
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA.
| | - Kimberly A Gudzune
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sara N Bleich
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, USA
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25
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Bhatia HL, Patel NR, Choma NN, Grande J, Giuse DA, Lehmann CU. Code status and resuscitation options in the electronic health record. Resuscitation 2014; 87:14-20. [PMID: 25447035 DOI: 10.1016/j.resuscitation.2014.10.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/30/2014] [Accepted: 10/20/2014] [Indexed: 11/25/2022]
Abstract
AIM The advance discussion and documentation of code-status is important in preventing undesired cardiopulmonary resuscitation and related end of life interventions. Code-status documentation remains infrequent and paper-based, which limits its usefulness. This study evaluates a tool to document code-status in the electronic health records at a large teaching hospital, and analyzes the corresponding data. METHODS Encounter data for patients admitted to the Medical Center were collected over a period of 12 months (01-APR-2012-31-MAR-2013) and the code-status attribute was tracked for individual patients. The code-status data were analyzed separately for adult and pediatric patient populations. We considered 131,399 encounters for 83,248 adult patients and 80,778 encounters for 55,656 pediatric patients in this study. RESULTS 71% of the adult patients and 30% of the pediatric patients studied had a documented code-status. Age and severity of illness influenced the decision to document code-status. Demographics such as gender, race, ethnicity, and proximity of primary residence were also associated with the documentation of code-status. CONCLUSION Absence of a recorded code-status may result in unnecessary interventions. Code-status in paper charts may be difficult to access in cardiopulmonary arrest situations and may result in unnecessary and unwanted interventions and procedures. Documentation of code-status in electronic records creates a readily available reference for care providers.
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Affiliation(s)
- Haresh L Bhatia
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States.
| | - Neal R Patel
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Neesha N Choma
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Jonathan Grande
- Informatics Center, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Dario A Giuse
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States; Informatics Center, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Christoph U Lehmann
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
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