bims-paceca 2022-05-01 papers

bims-paceca

Biomed News

on Patient-centred care

Issue of 2022–05–01
25 papers selected by
Rob Penfold, Queensland Health

Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review.
Healthcare students' attitudes towards patient centred care: a systematic review with meta-analysis.
Introducing a digital portal that enables patients to access their health records.
Shared decision-making in general practice from a patient perspective. A cross-sectional survey.
Definition and conceptualization of the patient-centered care pathway, a proposed integrative framework for consensus: a Concept analysis and systematic review.
Availability and use of number needed to treat (NNT) based decision aids for pharmaceutical interventions.
Feasibility of video recording interpersonal interactions between patients and hospital staff during usual care.
Patients' Experiences with Cancer Care: Impact of the COVID-19 Pandemic.
Getting to know our patients and what matters: exploring the elicitation of patient values, preferences, and circumstances in neurological rehabilitation.
"What it really takes" - A qualitative study of how professionals coproduce healthcare service with immigrant patients.
Digital Technologies to Support Better Outcome and Experience of Care in Patients with Heart Failure.
An Online Training Program to Improve Clinicians' Skills in Communicating About Serious Illness.
Question prompt lists and endorsement of question-asking support patients to get the information they seek-A longitudinal qualitative study.
Healthcare professional perspectives on barriers and enablers to falls prevention education: A qualitative study.
Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory.
Improving outcomes through patient-generated evidence-the next step in patient advocacy.
Advance care planning imperative: High-quality patient-centred goals of care.
The importance of shared meaning-making for sustainable knowledge translation and health literacy.
Preferred Role in Healthcare Decision-Making Over Time among Patients with Heart Failure: My Decision, Or My Doctor's Decision?
Strategies to overcome vaccine hesitancy: a systematic review.
The Growing Imperative for Patient and Caregiver Partnership.
What older people and their relatives say is important during acute hospitalisation: a qualitative study.
Assessing the Effects of eHealth Tutorials on Older Adults' eHealth Literacy.
A systematic literature review of patient perspectives of barriers and facilitators to access, adherence, stigma, and persistence to treatment for substance use disorder.
Implementation of an organisational wide approach to improving policy documents using plain language: a case study.

BMJ Open. 2022 Apr 25. 12(4): e057335

Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review.

Mary Simons, Frances Rapport, Yvonne Zurynski, Marcus Stoodley, Jeremy Cullis, Andrew S Davidson.

   OBJECTIVES: This scoping review aims to synthesise the current evidence on the inclusion and effectiveness of integrating evidence-based medicine (EBM) and shared decision-making (SDM) into training courses for doctors in training to enhance patient care. Both EBM and SDM appear to be taught separately and their combined role in providing high-quality patient care has not yet been explored.
DESIGN: Scoping review of literature from January 2017 to June 2021.
SETTING: Any setting where doctors in training could undertake EBM and/or SDM courses (hospitals, universities, clinics and online).
PARTICIPANTS: Doctors in training (also known as junior doctors, residents, registrars, trainees, fellows) defined as medical graduates undertaking further training to establish a career pathway.
METHODS: Searches were conducted in the databases Medline, Embase, Scopus and Cochrane Library. Bibliographies of included articles and their cited references were hand searched and assessed for inclusion. Included studies described training and outcomes of either EBM, SDM or both. Reported outcomes included EBM knowledge and skill tests, attitude surveys, SDM checklists and surveys and patient and doctor experience data obtained from surveys, focus groups and interviews.
RESULTS: Of the 26 included studies, 15 described EBM training courses, 10 described SDM training courses and 1 course combined both EBM and SDM. Courses were heterogeneous in their content and outcomes, making comparisons difficult. EBM courses prioritised quantitative outcome assessments and linked knowledge and skills, such as critical appraisal, but overlooked other key elements of patient-centred care including SDM.
CONCLUSIONS: SDM and EBM are taught separately in most training courses. The inclusion of SDM, evaluated by qualitative assessments, is currently omitted, yet could provide a more person-centred care focus in EBM courses and should be investigated to increase our knowledge of the effectiveness of such courses and their role in improving doctors' skills and patient care.
PROTOCOL: A protocol for this review has been published and contains further details of the methodology.

Keywords:  education & training (see medical education & training); internal medicine; qualitative research

DOI:  https://doi.org/10.1136/bmjopen-2021-057335
BMC Med Educ. 2022 Apr 27. 22(1): 324

Healthcare students' attitudes towards patient centred care: a systematic review with meta-analysis.

Geronimo Bejarano, Ben Csiernik, James J Young, Kent Stuber, Joshua R Zadro.

   BACKGROUND: Patient centred care is commonly recommended in clinical practice guidelines to improve patient outcomes and reduce healthcare costs. Identifying measurement tools used to assess healthcare students' attitudes towards patient centered care and determining their attitudes is the first step to ensuring patient centred care is provided in the future. The primary aim of this review was to describe the measurement tools used to assess healthcare students' attitudes towards patient centred care. The secondary aim was to quantify healthcare students' attitudes towards patient centred care.
METHODS: An electronic database search was conducted in MEDLINE, EMBASE, CINAHL from inception until March 1, 2021, with combined terms relating to 'patient centred care', 'attitudes', and 'healthcare students'. Studies that quantitatively assessed healthcare students' attitudes towards patient centred care were included. Measurement tools used in the included studies were qualitatively described. Meta-analysis was conducted to quantify healthcare students' attitudes towards patient centred care and assess the respective influence of gender, profession, and study geographical location on healthcare students' attitudes towards patient centred care.
RESULTS: The electronic search identified 3948 total studies. One hundred twenty-nine full texts were screened, and 49 studies were included. There were 16 measurement tools used to assess healthcare students' attitudes towards patient centered care. Most studies (53%, n = 26) used the Patient-Practitioner Orientation Scale (PPOS) to assess patient centered care. Meta-analyses of 20 studies with 26 total groups resulted in a pooled mean PPOS score of 4.16 on a 0-6 scale (95% Confidence Interval [CI]: 3.95, 4.37), indicating low attitudes towards patient centered care. Additional analyses found that women have significantly higher attitudes towards patients centred care than men (pooled effect 0.14 [95% CI: 0.05, 0.23], n = 8 studies) and mean PPOS scores appear similar among sub-groups of only medical students (pooled mean 4.13, 95% CI: 3.85, 4.42, n = 13 studies) and only American healthcare students (pooled mean 4.49, 95% CI: 4.35, 4.64, n = 5 studies).
CONCLUSIONS: Several different measurement tools have been used to assess healthcare students' attitudes towards patient centred care, but the most commonly used is the PPOS. Our results indicate that healthcare students have low attitudes towards patient centred care. Future studies should evaluate if attitudes towards patient centred care can be improved during healthcare education.

Keywords:  Patient centred; Patient-practitioner orientation scale; Students

DOI:  https://doi.org/10.1186/s12909-022-03371-1
Nurs Manag (Harrow). 2021 Dec 02. 28(6): 36-42

Introducing a digital portal that enables patients to access their health records.

Helen Balsdon.

  People manage many aspects of their lives online through digital devices such as smartphones. However, the ability for people to manage their healthcare digitally has not yet been fully realised. Patient portals are secure online links that offer patients convenient and constant access to their personal health records. Evidence has suggested that patient portals can enhance patients' engagement in their own care and support them to manage any long-term conditions. This article describes the introduction of a patient portal at Cambridge University Hospitals NHS Foundation Trust. The article outlines the process of implementation and discusses the lessons learned, which may be of value to other organisations.

Keywords:  patient empowerment; patient engagement; professional; professional issues; record-keeping; technology

DOI:  https://doi.org/10.7748/nm.2021.1994
Scand J Prim Health Care. 2022 Apr 28. 1-6

Shared decision-making in general practice from a patient perspective. A cross-sectional survey.

Birgitte Nørgaard, Signe Beck Titlestad, Michael Marcussen.

   OBJECTIVES: We aimed to assess patient involvement in terms of shared decision-making in general practice from the perspectives of patients with chronic obstructive pulmonary disease (COPD) or type 2 diabetes (T2DM) (or both).
DESIGN: A cross-sectional survey using the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) ranging from 0 to 5 (best).
SETTING AND SUBJECTS: Patients diagnosed with either T2DM and/or COPD were asked to focus on their most recent consultation in general practice concerning their T2DM or lung disease. Responders were approached through the Danish Diabetes Association and Danish Lung Association.
RESULTS: The sample included 468 responders. Mean scores for the total sample were between 3.3 and 4.2. The overall mean score for all items was 3.7. The highest overall mean score was for patients with T2DM, whereas the lowest overall mean score was for patients having both T2DM and COPD. Furthermore, we observed a slightly lower overall mean score for women compared to men and for those younger than 65 years compared to those aged 65 years or older.
CONCLUSION: Overall, patients are involved in shared decision-making in general practice Minor nuances were found because patients with COPD were less involved in shared decision-making compared to patients with T2DM. Similarly, younger patients and women were less involved than older patients and men.

Keywords:  General practice; patient involvement; patient perspectives; shared decision-making

DOI:  https://doi.org/10.1080/02813432.2022.2069700
BMC Health Serv Res. 2022 Apr 26. 22(1): 558

Definition and conceptualization of the patient-centered care pathway, a proposed integrative framework for consensus: a Concept analysis and systematic review.

Jean-Baptiste Gartner, Kassim Said Abasse, Frédéric Bergeron, Paolo Landa, Célia Lemaire, André Côté.

   BACKGROUND: Confusion exists over the definition of the care pathway concept and existing conceptual frameworks contain various inadequacies which have led to implementation difficulties. In the current global context of rapidly changing health care systems, there is great need for a standardized definition and integrative framework that can guide implementation. This study aims to propose an accurate and up-to-date definition of care pathway and an integrative conceptual framework.
METHODS: An innovative hybrid method combining systematic review, concept analysis and bibliometric analysis was undertaken to summarize qualitative, quantitative, and mixed-method studies. Databases searched were PubMed, Embase and ABI/Inform. Methodological quality of included studies was then assessed.
RESULTS: Forty-four studies met the inclusion criteria. Using concept analysis, we developed a fine-grained understanding, an integrative conceptual framework, and an up-to-date definition of patient-centered care pathway by proposing 28 subcategories grouped into seven attributes. This conceptual framework considers both operational and social realities and supports the improvement and sustainable transformation of clinical, administrative, and organizational practices for the benefit of patients and caregivers, while considering professional experience, organizational constraints, and social dynamics. The proposed attributes of a fluid and effective pathway are (i) the centricity of patients and caregivers, (ii) the positioning of professional actors involved in the care pathway, (iii) the operation management through the care delivery process, (iv) the particularities of coordination structures, (v) the structural context of the system and organizations, (vi) the role of the information system and data management and (vii) the advent of the learning system. Antecedents are presented as key success factors of pathway implementation. By using the consequences and empirical referents, such as outcomes and evidence of care pathway interventions, we went beyond the single theoretical aim, proposing the application of the conceptual framework to healthcare management.
CONCLUSIONS: This study has developed an up-to-date definition of patient-centered care pathway and an integrative conceptual framework. Our framework encompasses 28 subcategories grouped into seven attributes that should be considered in complex care pathway intervention. The formulation of these attributes, antecedents as success factors and consequences as potential outcomes, allows the operationalization of this model for any pathway in any context.

Keywords:  Care pathway; Care process; Concept analysis; Healthcare management; Learning health system; Patient journey; Patient-centered; Sustainable transformation; Systematic review

DOI:  https://doi.org/10.1186/s12913-022-07960-0
Explor Res Clin Soc Pharm. 2021 Jun;2 100039

Availability and use of number needed to treat (NNT) based decision aids for pharmaceutical interventions.

Cassandra Nguyen, Mark Naunton, Jackson Thomas, Lyn Todd, John McEwen, Mary Bushell.

   Background: The number needed to treat (NNT) is a medical statistic used to gauge the efficacy of therapeutic interventions. The versatility of this absolute effect measure has allowed its use in the formulation of many decision aids to support patients and practitioners in making informed healthcare choices. With the rising number of tools available to health professionals, this review synthesizes what is known of the current NNT-based tools which depict the efficacy of pharmaceutical interventions.
Objectives: To explore the current spectrum of NNT-based decision aids accessible to health professionals with a focus on the potential utility of these devices by pharmacist practitioners.
Methods: A literature review was performed in MEDLINE, CINAHL, Web of Science, PsychINFO and Cochrane Library (CENTRAL, Cochrane Database of Systematic Reviews and the Cochrane Methodology Register) for studies published between January 1st 2000 and August 29th 2019. The language was restricted to English unless an appropriate translation existed. Studies that reported NNT-based decision aids of pharmaceutical or therapeutic interventions were included. One author performed study selection and data extraction.
Results: A total of 365 records were identified, of which 19 NNT-based tools met the eligibility criteria, comprising of 8 tool databases and 11 individual decision aids. Decision aids appeared in multiple forms: databases, pictograms, graphs, interactive applications, calculators and charts. All aids were accessible online with a printer-friendly option, and very few came at a cost (e.g. requiring a subscription or access fee). The main tool innovators were the United Kingdom (UK) and United States (US), with English being the language of choice.
Conclusions: Evidence that NNT-based decision aids can contribute to greater satisfaction and involvement of patients in medical decision making is limited and inconclusive. A case for the utilization of these tools by pharmacists has yet to be fully examined in the medical research. NNT tools may provide a valuable resource to upskill pharmacists in communication of research evidence.

Keywords:  Evidence-based medicine; Literature review; NNT tools; Number needed to treat; Patient decision aids; Pictographs; Risk communication

DOI:  https://doi.org/10.1016/j.rcsop.2021.100039
Pilot Feasibility Stud. 2022 Apr 29. 8(1): 96

Feasibility of video recording interpersonal interactions between patients and hospital staff during usual care.

Angela L Todd, Lynette Roberts, Kirsty Foster.

   BACKGROUND: Video-reflexive ethnography (VRE) has been used to record aspects of patient care which are then shared with staff to drive self-identified improvements. Interpersonal interactions between patients and hospital staff are key to high-quality, patient-centred care and mostly occur randomly throughout a patient's hospital stay. One of the most common types of hospital admission is for women giving birth.
AIMS: To assess the feasibility of adapting the VRE methodology to capture naturally occurring interactions between patients and health staff over an extended period during hospital admission, and to assess whether the approach would yield useful interaction data.
PARTICIPANTS: Twelve women, who had a planned caesarean section at 37+ weeks, were considered low risk (no known medical or obstetric complication) and were admitted to a postnatal unit after giving birth, and the staff who attended them.
METHODS: This study took place in a large hospital in Sydney, Australia, where approximately 2200 women give birth each year. Continuous unattended video recordings were made during each woman's hospital stay to capture interactions with hospital staff. The recordings were reviewed to determine what kinds of interaction data could be obtained.
RESULTS: In order to recruit 12 eligible women, we needed to invite 45 to participate. The estimated recruitment period of 3-4 months had to be extended to 8 months. A fixed video camera was successfully installed in the hospital room of each woman and a remote control provided. A total of 246.5 h of video recordings was obtained, of which 38 h (15.5%) involved interpersonal interactions with staff. Two women reported negative responses from staff about being video recorded. Both quantitative and qualitative data could be obtained from the recordings.
CONCLUSION: Video recordings of interpersonal interactions between patients and staff in an in patient hospital care setting can be obtained and can provide unique insights into the complexity of healthcare delivery. However, significant contextual barriers can exist to engaging staff in quality improvement initiatives that are not part of their usual healthcare activities.

Keywords:  Feasibility; Interpersonal communication; Patient experience; Quality improvement; VRE; Video recording

DOI:  https://doi.org/10.1186/s40814-022-01052-w
J Patient Exp. 2022 ;9 23743735221092567

Patients' Experiences with Cancer Care: Impact of the COVID-19 Pandemic.

Katherine Treiman, Elissa C Kranzler, Rebecca Moultrie, Laura Arena, Nicole Mack, Erica Fortune, Reese Garcia, Richard L Street.

  The COVID-19 pandemic heightened the psychosocial impact of a cancer diagnosis as patients face concerns about the risk of infection and serious disease and uncertainties about the impact on their treatment. We conducted an online survey (n = 317) and focus groups (n = 19) with patients to examine their experiences with cancer care during the pandemic. Most survey respondents (68%) reported one or more disruptions or delays in care, including appointments switched to telehealth (49%). Patients perceived both benefits (e.g., convenience) and drawbacks (e.g., more impersonal) to telehealth. For many patients, COVID-19-related restrictions on bringing family members to support them during appointments was a major concern and left them feeling alone and vulnerable during treatment. Patients' self-reported coping during the pandemic was positively associated with age, education, and income (P < .05 for each) and better communication with their doctors during telehealth sessions (P < .001). Study findings highlight the importance of patient-centered care and communication to help patients cope with the challenges of the pandemic. Further research is needed to develop guidelines for use of telehealth as part of patient-centered cancer care.

Keywords:  COVID-19 pandemic; cancer; coping; distress and anxiety; patient experience; patient-centered care; psycho-oncology; psychosocial distress; telehealth

DOI:  https://doi.org/10.1177/23743735221092567
Disabil Rehabil. 2022 Apr 27. 1-9

Getting to know our patients and what matters: exploring the elicitation of patient values, preferences, and circumstances in neurological rehabilitation.

Catherine Vingerhoets, Jean Hay-Smith, Fiona Graham.

   PURPOSE: Patient values, preferences, and circumstances are critical to decision-making in both patient-centred and evidence-based practice models of healthcare. Despite the established importance of integrating these patient attributes, the ways they are elicited in rehabilitation remain unclear. This study aimed to explore how health professionals elicit and share patients' 'values', 'preferences', and 'circumstances', and what they understand by the terms.
METHODS: This exploratory qualitative descriptive study used interviews with 13 clinicians from interprofessional teams in inpatient neurological rehabilitation. Data were analysed using a general inductive approach.
RESULTS: Participants understood 'values' to mean what is important and meaningful; 'preferences' as likes/dislikes and choices; and 'circumstances' as the social, physical, and environmental context surrounding the person. Formal and informal strategies were used to gather information directly from patients or indirectly from other sources. The processes of eliciting and communicating this information were influenced by relationships and relied on contributions from many people. Elicitation involved a flexible approach tailored to the individual and considering each unique context.
CONCLUSION: The strategies used and the approach used to implement these strategies were both essential to eliciting patient values, preferences, and circumstances in neurological rehabilitation. These findings offer insights into the practices of interprofessional rehabilitation clinicians. Implications for rehabilitationEliciting patient values, preferences, and circumstances involves a combination of strategies and approaches that are applied gradually throughout the continuum of rehabilitation.These processes are flexible, and strategies should be tailored to individual patients/families and phases of rehabilitation.Clinicians should be attentive to informal opportunities to gather valuable information throughout rehabilitation.Establishing positive relationships and using effective communication is foundational to these processes.

Keywords:  Elicitation; circumstances; interprofessional; preferences; rehabilitation; values

DOI:  https://doi.org/10.1080/09638288.2022.2063416
J Migr Health. 2022 ;5 100101

"What it really takes" - A qualitative study of how professionals coproduce healthcare service with immigrant patients.

Christina Radl-Karimi, Dorthe S Nielsen, Morten Sodemann, Paul Batalden, Christian von Plessen.

   Background: The concept of coproduction shows great promise for meaningful partnerships between patients and health professionals. This is particularly relevant for immigrant patients who are less inclined to take an active role in consultations. The present study described health professionals' practices and experiences of coproducing healthcare service with immigrant and refugee patients in clinical encounters.
Methods: We conducted a three-phase qualitative study with immigrant and refugee patients and health professionals at an interdisciplinary outpatient clinic for immigrants and refugees with complex long-standing health problems at a Danish university hospital. First, we conducted 25 observations of consultations between seven professionals (three doctors, three nurses, one social worker) and 24 patients with varied backgrounds and health problems. Findings were discussed in a focus group and individual interviews with the migrant clinic's staff. Finally, the themes were discussed with co-researchers and revised in a member check with experienced clinicians. Data were analyzed through meaning condensation, supported by the NVivo software.
Results: We identified four themes characterizing the work of health professionals in creating coproduced healthcare service: a team effort of sense-making, disentangling the chaos first, when everything fails - listen to the patient, and continuity - becoming part of the patient's story.
Conclusion: Interdisciplinary work fostering values of doing what makes sense to form a positive partnership with the patient allows health professionals to act autonomously, flexibly, and creatively. Using communication tools designed around patient needs, create optimal conditions for coproduction as health professionals empathically validate and integrate patient experiences. Professionals need advanced listening and relational skills and tolerance of ambiguity and insecurity. Relational continuity facilitates long-term coproduction but also bears risks of emotional dependency.

Keywords:  Coproduction; Cultural competency; Delivery of health care; Immigrants; Patient-centered care; Refugees

DOI:  https://doi.org/10.1016/j.jmh.2022.100101
Curr Heart Fail Rep. 2022 Apr 29.

Digital Technologies to Support Better Outcome and Experience of Care in Patients with Heart Failure.

K C C McBeath, C E Angermann, M R Cowie.

   PURPOSE OF REVIEW: In this article, we review a range of digital technologies for possible application in heart failure patients, with a focus on lessons learned. We also discuss a future model of heart failure management, as digital technologies continue to become part of standard care.
RECENT FINDINGS: Digital technologies are increasingly used by healthcare professionals and those living with heart failure to support more personalised and timely shared decision-making, earlier identification of problems, and an improved experience of care. The COVID-19 pandemic has accelerated the acceptability and implementation of a range of digital technologies, including remote monitoring and health tracking, mobile health (wearable technology and smartphone-based applications), and the use of machine learning to augment data interpretation and decision-making. Much has been learned over recent decades on the challenges and opportunities of technology development, including how best to evaluate the impact of digital health interventions on health and healthcare, the human factors involved in implementation and how best to integrate dataflows into the clinical pathway. Supporting patients with heart failure as well as healthcare professionals (both with a broad range of health and digital literacy skills) is crucial to success. Access to digital technologies and the internet remains a challenge for some patients. The aim should be to identify the right technology for the right patient at the right time, in a process of co-design and co-implementation with patients.

Keywords:  Digital health; Digital technology; Heart failure; Person-centred care; Shared decision-making

DOI:  https://doi.org/10.1007/s11897-022-00548-z
Am J Crit Care. 2022 May 01. 31(3): 189-201

An Online Training Program to Improve Clinicians' Skills in Communicating About Serious Illness.

William C Gautier, Menna Abaye, Shelly Dev, Jennifer B Seaman, Rachel A Butler, Marie K Norman, Robert M Arnold, Holly O Witteman, Tara E Cook, Deepika Mohan, Douglas B White.

BACKGROUND: Large-scale efforts to train clinicians in serious-illness communication skills are needed, but 2 important gaps in knowledge remain. (1) No proven training method exists that can be readily scaled to train thousands of clinicians. (2) Though the value of interprofessional collaboration to support incapacitated patients' surrogates is increasingly recognized, few interventions for training intensive care unit (ICU) nurses in important communication skills can be leveraged to provide interprofessional family support.
OBJECTIVE: To develop and test a web/videoconference-based platform to train nurses to communicate about serious illness.
METHODS: A user-centered process was used to develop the intervention, including (1) iteratively engaging a stakeholder panel, (2) developing prototype and beta versions of the platform, and (3) 3 rounds of user testing with 13 ICU nurses. Participants' ratings of usability, acceptability, and perceived effectiveness were assessed quantitatively and qualitatively.
RESULTS: Stakeholders stressed that the intervention should leverage interactive learning and a streamlined digital interface. A training platform was developed consisting of 6 interactive online training lessons and 3 group-based video-conference practice sessions. Participants rated the program as usable (mean summary score 84 [96th percentile]), acceptable (mean, 4.5/5; SD, 0.7), and effective (mean, 4.8/5; SD, 0.6). Ten of 13 nurses would recommend the intervention over 2-day in-person training.
CONCLUSIONS: Nurses testing this web-based training program judged it usable, acceptable, and effective. These data support proceeding with an appropriately powered efficacy trial.

DOI: https://doi.org/10.4037/ajcc2022105
Health Expect. 2022 Apr 26.

Question prompt lists and endorsement of question-asking support patients to get the information they seek-A longitudinal qualitative study.

Marguerite Tracy, Julie Ayre, Olivia Mac, Tessa Copp, Emerita Lyndal Trevena, Heather Shepherd.

   INTRODUCTION: Question prompt lists (QPLs) have been found to support patients to ask questions and improve the information they receive from doctors. However, some QPL tools, which have been available online for almost 15 years, have little published data on their impact in real-world settings. This study's aim was to understand patients' attitudes and experiences accessing health information and to assess the impact of introducing two generic QPLs over 3 months.
METHODS: A longitudinal qualitative study consisting of three semi-structured interviews over a three-month period was conducted with 31 purposively selected participants, adults ≥18 years, recruited online and through social media. Participants were introduced to two different QPLs currently available online ('Question Builder'; 'AskShareKnow'). Inductive thematic analysis of a total of 92 semi-structured telephone interviews was conducted during May-November 2020.
RESULTS: Three main themes are described. (1) Participants described barriers and facilitators to accessing health information: navigating a complex health system; difficulty asking questions of their healthcare professionals and that they value doctors with good communication skills. (2) QPLs helped some participants recognize the role of question-asking in consultations, made them feel more empowered and helped them prepare and prioritize. (3) Participants wanted QPLs to be easier to use, be accessible when needed and that question-asking and QPLs should be normalized in medical consultations.
CONCLUSIONS: Well-designed and easily accessible QPLs can empower people to ask questions and be more involved in decisions about their health care. Endorsement of question-asking in consultations by healthcare professionals and providing QPL tools at the point of contact with health services will be key to realizing the potential of QPLs.
PATIENT OR PUBLIC CONTRIBUTION: This study was completed in conjunction with a reference group consisting of a consumer representative, representatives from the Australian Commission on Safety and Quality in Health Care, Healthdirect Australia Ltd., and the research team.

Keywords:  doctor endorsement; health literacy; health services accessibility; patient participation; question prompt lists; shared decision-making

DOI:  https://doi.org/10.1111/hex.13509
PLoS One. 2022 ;17(4): e0266797

Healthcare professional perspectives on barriers and enablers to falls prevention education: A qualitative study.

Hazel Heng, Debra Kiegaldie, Susan C Slade, Dana Jazayeri, Louise Shaw, Matthew Knight, Cathy Jones, Anne-Marie Hill, Meg E Morris.

In hospitals, patient falls prevention education is frequently delivered by nurses and allied health professionals. Hospital falls rates remain high globally, despite the many systems and approaches that attempt to mitigate falling. The aim of this study was to investigate health professional views on the enablers and barriers to providing patient falls education in hospitals. Four focus groups with 23 nursing and allied health professionals were conducted at 3 hospitals. Three researchers independently coded the data and findings were analysed thematically with a descriptive qualitative approach to identify and develop themes according to barriers and enablers. Barriers included (i) limited interprofessional communication about patient falls; (ii) sub-optimal systems for falls education for patients and health professionals, and (iii) perceived patient-related barriers to falls education. Enablers to providing patient falls education included: (i) implementing strategies to increase patient empowerment; (ii) ensuring that health professionals had access to effective modes of patient education; and (iii) facilitating interprofessional collaboration. Health professionals identified the need to overcome organisational, patient and clinician-related barriers to falls education. Fostering collective responsibility amongst health professionals for evidence-based falls prevention was also highlighted.

DOI: https://doi.org/10.1371/journal.pone.0266797
JMIR Med Educ. 2022 Apr 29. 8(2): e30988

Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory.

Andrew A White, Ann M King, Angelo E D'Addario, Karen Berg Brigham, Suzanne Dintzis, Emily E Fay, Thomas H Gallagher, Kathleen M Mazor.

   BACKGROUND: Residents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios.
OBJECTIVE: We aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app.
METHODS: Internal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents' error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople.
RESULTS: Internal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates' and crowdsourced laypeople's ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75.
CONCLUSIONS: Crowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills.

Keywords:  communication; communication assessment; crowdsourcing; generalizability theory; graduate medical education; medical education; medical error; medical error disclosure; patient-centered care; simulation studies

DOI:  https://doi.org/10.2196/30988
Lancet Haematol. 2022 Apr 25. pii: S2352-3026(22)00131-4. [Epub ahead of print]

Improving outcomes through patient-generated evidence-the next step in patient advocacy.

Jan Geissler, Stefan Huber.

DOI: https://doi.org/10.1016/S2352-3026(22)00131-4
BMJ Support Palliat Care. 2022 Apr 27. pii: bmjspcare-2022-003677. [Epub ahead of print]

Advance care planning imperative: High-quality patient-centred goals of care.

Amy Allen Case, Andrew S Epstein, Jillian L Gustin.

  Advance care planning (ACP) discussions aim to ensure goal-concordant care for patients with serious illness, throughout treatment and especially at the end of life. But recent literature has forced the field of palliative care to wrestle with the definition and impact of ACP. Are ACP discussions worthwhile? Is there a difference between ACP discussions early in a patient's illness versus discussions occurring later when a concrete medical care decision must be made? Here, we identify elements needed to answer these questions and describe how a multisite initiative will elucidate the value of discussing and documenting what matters most to patients.

Keywords:  Cancer; Communication; End of life care; Quality of life; Supportive care

DOI:  https://doi.org/10.1136/bmjspcare-2022-003677
J Eval Clin Pract. 2022 Apr 24.

The importance of shared meaning-making for sustainable knowledge translation and health literacy.

Astrid K Wahl, Marit H Andersen, John Ødemark, Anna Reisaether, Kristin H Urstad, Eivind Engebretsen.

  The aim of the present paper is to describe and discuss how recent theories about translation, bridging medical and humanistic understandings of knowledge translation, in the medical humanities can bring about a new understanding of health literacy in the context of patient education. We argue that knowledge translation must be understood as active engagement with contextual meaning, considering the understandings, interpretation, and expertise of both patient and health care provider (deconstruction of the distinction between biomedical and cultural knowledge). To illustrate our points, we will describe the case of Jim, a kidney transplant recipient who received standard patient education but lost the graft (the new kidney). If we apply Kristeva's view to this context, graft function is not merely biology but a complex biocultural fact. In this perspective, graft function is seen as a phenomenon that embraces translation between health as a biomedical phenomenon and healing as lived experience, and that opens for shared meaning-making processes between the patient and the health care provider. In Jim's case, this means that we need to rethink the approach to patient education in a way that encourages the patient's idiosyncratic way of thinking and experiencing, and to transform health information into a means for sustaining Jim's singular life - not biological life "in general." The patient education programme did not take into consideration the singularities of Jim's biographical temporality, with its changes in everyday life, priorities, attitudes, and values. Hence, we claim that health literacy should involve a simultaneous interrogation of the patients and the health professional's constructions of knowledge.

Keywords:  health literacy; kidney transplantation; knowledge translation; medical humanities; patient education

DOI:  https://doi.org/10.1111/jep.13690
J Card Fail. 2022 Apr 22. pii: S1071-9164(22)00493-6. [Epub ahead of print]

Preferred Role in Healthcare Decision-Making Over Time among Patients with Heart Failure: My Decision, Or My Doctor's Decision?

Lubin R Deng, Daniel D Matlock, David B Bekelman.

   BACKGROUND: Understanding patients' preferred role in decision-making can improve patient-centered care. This study aimed to determine change and the predictors of change in preferred decision-making roles over time in patients with heart failure.
METHODS AND RESULTS: During the CASA (Collaborative Care to Alleviate Symptoms and Adjust to Illness) trial, patients' preferred roles in decision-making were measured using the Control Preferences Scale (range 1-5, higher=less active; N=312) at four timepoints over one year. The effect of the CASA intervention on preferred decision-making roles was tested using generalized linear mixed models. Whether preferences changed over time in the whole population was determined using linear regression. Demographic and health-related factors were examined as predictors of change using multiple linear regression. At baseline, most participants preferred active (score 1-2, 37.2%) or collaborative (score 3, 44.9%) roles. The CASA intervention did not influence preferred decision-making roles (p>0.1). Preferences significantly changed over one year (p<0.01), becoming more active (82.1%, 84.2%, 89.0%, 90.1% active/collaborative at each timepoint). Among all models and covariates, there were no significant predictors of change (p>0.1).
CONCLUSIONS: Patients' preferred roles in decision-making change over time, but changes are not well predicted. Clinicians should frequently and directly communicate with patients about their preferred decision-making role.

Keywords:  Control Preferences Scale; Decision-making; heart failure; preferences

DOI:  https://doi.org/10.1016/j.cardfail.2022.03.357
Syst Rev. 2022 Apr 26. 11(1): 78

Strategies to overcome vaccine hesitancy: a systematic review.

Prem Singh, Pritu Dhalaria, Satabdi Kashyap, Gopal Krishna Soni, Partha Nandi, Shreeparna Ghosh, Mrinal Kar Mohapatra, Apurva Rastogi, Divya Prakash.

   BACKGROUND: Vaccination, albeit a necessity in the prevention of infectious diseases, requires appropriate strategies for addressing vaccine hesitancy at an individual and community level. However, there remains a glaring scarcity of available literature in that regard. Therefore, this review aims to scrutinize globally tested interventions to increase the vaccination uptake by addressing vaccine hesitancy at various stages of these interventions across the globe and help policy makers in implementing appropriate strategies to address the issue.
METHODS: A systematic review of descriptive and analytic studies was conducted using specific key word searches to identify literature containing information about interventions directed at vaccine hesitancy. The search was done using PubMed, Global Health, and Science Direct databases. Data extraction was based on study characteristics such as author details; study design; and type, duration, and outcome of an intervention.
RESULTS: A total of 105 studies were identified of which 33 studies were included in the final review. Community-based interventions, monetary incentives, and technology-based health literacy demonstrated significant improvement in the utilization of immunization services. On the other hand, media-based intervention studies did not bring about a desired change in overcoming vaccine hesitancy.
CONCLUSION: This study indicates that the strategies should be based on the need and reasons for vaccine hesitancy for the targeted population. A multidimensional approach involving community members, families, and individuals is required to address this challenging issue.

Keywords:  Global health; Immunization; Vaccination; Vaccine hesitancy; Vaccine refusal; Vaccines

DOI:  https://doi.org/10.1186/s13643-022-01941-4
Healthc Q. 2022 Apr;pii: hcq.2022.26782. [Epub ahead of print]24(SP): 4

The Growing Imperative for Patient and Caregiver Partnership.

Anne Wojtak.

This special edition of Healthcare Quarterly (HQ) has been developed through a novel partnership between the Ontario Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit (OSSU) and Longwoods Publishing. The concept for this edition emerged from an alignment of interests between the partners. OSSU's mandate is to support patient-oriented health and health services research in Ontario and to facilitate the uptake of research evidence to improve health policy and decision making. HQ's mission is to recognize, nurture and champion excellence in the Canadian healthcare system by sharing leading practices in health services delivery and policy development. As we look toward the future of healthcare and health system transformation, leading practices will be increasingly defined by the degree to which they are designed and implemented in full partnership with patients and caregivers. This perspective, shared by both OSSU and Longwoods, is at the heart of this publication.

DOI: https://doi.org/10.12927/hcq.2022.26782
BMC Health Serv Res. 2022 Apr 29. 22(1): 578

What older people and their relatives say is important during acute hospitalisation: a qualitative study.

Nina Mickelson Weldingh, Marit Kirkevold.

   BACKGROUND: Due to the growing population of older people across the world, providing safe and effective care is an increasing concern. Older persons in need for hospitalisation often have, or are susceptible to develop, cognitive impairment. Hospitals need to adapt to ensure high-quality care for this vulnerable patient group. Several age-friendly frameworks and models aiming at reducing risks and complications have been promoted. However, care for older people must be based on the persons' reported needs, and relatives are often an important part of older persons' social support. The primary aim of this study was to explore older peoples' and their relatives' experiences of acute hospitalisation and determine what is important for them to experience a good hospital stay. The study was not limited to patients with cognitive impairment; but included a wider group of older individuals vulnerable to developing delirium, with or without an underlying chronic cognitive impairment.
METHODS: This study had a qualitative research design in which people aged 75 years or older and their relatives were interviewed during an acute hospitalisation. The study was conducted at two medical wards at a large university hospital in Norway, and included a total of 60 participants. All interviews were informed by a semi-structured interview guide and were thematically analysed.
RESULTS: Four major themes were identified in the older people's and the relatives' descriptions of how they experienced the hospital stay and what was important for them during the hospital stay: being seen and valued as a person, individualised care, patient-adapted communication and information, and collaboration with relatives. The themes span both positive and negative experiences, reflecting great variability in the experiences described. The presence of these four characteristics promoted positive experiences among patients and relatives, whereas the absence or negative valuation of them promoted negative experiences.
CONCLUSIONS: The findings underscore the interrelatedness of older people and their relatives and that patients and relatives are quite consistent in their experiences and opinions. This suggests that listening to the concerns of relatives is important, as they can voice the older patient's needs and concerns in situations where older people might find it difficult to do so. Furthermore, the results underscore how 'small things' matter in relation to how health professionals capture the patient's individual values, need for care, information and involvement of relatives and that these are essential to ensure predictability and security and a good stay for older people and their relatives.

Keywords:  Acute care; Acute hospitalisation; Age-friendly hospital; Cognitive impairment; Family involvement; Older people; Patient experiences

DOI:  https://doi.org/10.1186/s12913-022-07981-9
J Appl Gerontol. 2022 Apr 24. 7334648221088281

Assessing the Effects of eHealth Tutorials on Older Adults' eHealth Literacy.

Atami S De Main, Bo Xie, Kristina Shiroma, Tom Yeh, Nathan Davis, Xu Han.

  eHealth literacy is the ability to access, assess, and use digital health information. This study compared the effects of a multimedia tutorial versus a paper-based control in improving older adults' eHealth literacy from pre- to posttest. A total of 99 community-dwelling older adults (63-90 years old; mean = 73.09) participated from July 2019 to February 2020. Overall, knowledge about computer/Internet terms, eHealth literacy efficacy, knowledge about the quality of health information websites, and procedural skills in computer/Internet use improved significantly from pre- to posttest. No interaction effect was found between time and group. Participants in both groups had an overwhelmingly positive attitude toward training. Their attitudes toward training approached a statistically significant difference between the two conditions: F (1, 89) = 3.75, p = .056, partial η2 = .040, with the multimedia condition showing more positive attitudes. These findings have implications for designing effective eHealth literacy interventions for older adults.

Keywords:  attitudes; eHealth literacy; multimedia tutorial; older adults

DOI:  https://doi.org/10.1177/07334648221088281
Explor Res Clin Soc Pharm. 2021 Jun;2 100029

A systematic literature review of patient perspectives of barriers and facilitators to access, adherence, stigma, and persistence to treatment for substance use disorder.

Alina Cernasev, Kenneth C Hohmeier, Kelsey Frederick, Hilary Jasmin, Justin Gatwood.

   Introduction: The opioid crisis has left a devastating impact on the United States (U.S.) for over 20 years. The over-prescribing of opioid medications and availability of illicit opioids have contributed to the U.S. opioid epidemic. Given the complexity of the epidemic, substance use disorder, and its treatment, there is an urgent need for a thorough review of the qualitative literature which has captured the patient's experiences Such patient-derived qualitative data on lived experiences and perspectives may allow researchers, clinicians, and policy makers to glean new insights into addressing this epidemic.
Objectives: The objective of this paper is to present a systematic literature review of the existing U.S. qualitative research and provide a patient perspective on medications for opioid use disorder (MOUD), including barriers and facilitators to MOUD use.
Methods: In November 2019, four electronic databases (PubMed, CINAHL, Scopus, and Web of Science) were searched by a medical librarian using a combination of keywords, Medical Subject Headings (MeSH), and/or CINAHL subject headings. 8766 results were imported into EndNote, then duplicate records were removed, leaving a total of 4722 articles. The unique records were imported into Rayyan QCRI an online platform designed to expedite screening. Blinded screening was undertaken in duplicate by four reviewers. Two researchers abstracted all the articles and used thematic analysis.
Results: The screening in the abstract phase excluded 4681 results, leaving 41 studies for full-text screening to determine their eligibility for inclusion in the review. After screening, 21 articles were included in the study and the analysis is based on these articles Common themes across studies included stigmatization, perceived barriers to MOUD, and MOUD treatment deserts and provider shortages.
Conclusions: Qualitative research studies conducted to date have uncovered substantial MOUD treatment barriers which are both social and structural in nature. Such barriers to treatment may serve to exacerbate the current epidemic and must be taken into consideration in designing policy and treatment solutions for patients with OUD.

Keywords:  Buprenorphine; Methadone; Opioid use disorder; Patient; Qualitative; Systematic literature review

DOI:  https://doi.org/10.1016/j.rcsop.2021.100029
Aust Health Rev. 2022 Apr 28.

Implementation of an organisational wide approach to improving policy documents using plain language: a case study.

Kelly Lambert, Ceinwen Johnstone, Lucia Vellar, Natalie Berg.

The impact of poorly written policies in healthcare is enormous, with the potential for significant economic and personal costs. Our local health district embarked on a major revision of policy document development that sought to reframe the process of policy development using health literacy principles. This included mandatory policy development changes that require policy to be written in plain language, at a readability level of grade 10-12. Staff training in plain language writing was undertaken. Consumer and staff feedback was incorporated in policy development. Four elements were critical to this process: effective leadership, effective instruction, practical support, and evidence-driven decisions. Staff responses to the revised processes were overwhelmingly positive and resulted in improved policy readability. The involvement of consumers in policy development has evolved. From this study, we have learned how to improve the governance of policy documents. It is possible for health literacy principles to be embedded in the development and revision of these documents.

DOI: https://doi.org/10.1071/AH21297