bims-paceca 2022-06-12 papers

bims-paceca

Biomed News

on Patient-centred care

Issue of 2022–06–12
thirty papers selected by
Rob Penfold, Queensland Health

Financial Health Literacy and the Shared Decision-Making Process in Healthcare.
Shared decision making for efficacious wound care.
Exploring motivations and resistances for implementing shared decision-making in clinical practice: A systematic review based on a structure-process-outcome model.
Bringing personal perspective elicitation to the heart of shared decision-making: A scoping review.
Improved Patient Experience and Outcomes: Is Patient-Provider Concordance the Key?
The Diabetes Simulation Challenge: Enhancing Patient Perspective-Taking for Medical Students.
Patient coaching: What do patients want? A mixed methods study in waiting rooms of outpatient clinics.
Outdated healthcare structures, sick care paradigm, and medical terms: Barriers to evidence-based, Patient-Centered and interprofessional care.
Editorial: 20 years after the start of international Shared Decision-Making activities: Is it time to celebrate? Probably… .
Barriers and Facilitators to Healthcare Access in Adults with Intellectual and Developmental Disorders and Communication Difficulties: an Integrative Review.
Development of Training Curriculum to Improve Patient Communication Skills and Social Support Among Community Health Workers.
Activating people to partner in health and self-care: use of the Patient Activation Measure.
Plain language summaries: A systematic review of theory, guidelines and empirical research.
A national co-design workshop of a mobile-based application for vascular access as a patient decision aid.
Moving Beyond the LGBTQIA+ Acronym: Toward Patient-Centered Care.
Development of the Consumer Involvement & Engagement Toolkit: a digital resource to build capacity for undertaking patient-centred clinical trials in Australia.
Improving care for patients in the outlying wards: Lessons from patients' care experience.
Patient accounts for nonadherence: A critical window into the patient experience.
ShareHeart: A patient journey map of patients with ischemia and non-obstructive coronary artery disease based on qualitative research.
Pull Up a Seat: Engaging Patients as Empowered Partners in Health Equity Transformation.
The Depiction of Autonomy and Shared Decision-Making by Children and Adolescents in Medical Television.
Physician Communication Skills in Telemedicine: The Role of Eye Contact.
Just Talk to Me - A Qualitative Study of Patient Satisfaction in Emergency Departments.
Co-Design Approaches Involving Older Adults in the Development of Electronic Healthcare Tools: A Systematic Review.
Patients with Limited Health Literacy Have Worse Preoperative Function, Pain Control and Experience Prolonged Hospitalizations Following Shoulder Arthroplasty.
Patient-centred clinical trial design.
Partnership working between nurses and patients' families in the critical care environment.
Identifying Strategies for Facilitating Physical Activity Among Older Adults: A Behaviour Change Wheel 'Retrofit' Driven Analysis of Victorian Local Government Policy.
Design-Relevant Factors Affecting the Patient Experience in Digital Health: Preliminary Results of an Umbrella Systematic Review.
"What Matters Most" to Older Adults With Cancer: Advance Care Planning.

Int J Environ Res Public Health. 2022 May 27. pii: 6510. [Epub ahead of print]19(11):

Financial Health Literacy and the Shared Decision-Making Process in Healthcare.

Caitlin S O'Mara, Justin P Young, Zachary K Winkelmann.

Patient-centered care is the delivery of care that is unique to each patient, individualized to their needs, and established through a shared patient-clinician decision-making process [...].

DOI: https://doi.org/10.3390/ijerph19116510
Br J Community Nurs. 2022 Jun 01. 27(Sup6): S8-S10

Shared decision making for efficacious wound care.

Sarah Jane Palmer.

DOI: https://doi.org/10.12968/bjcn.2022.27.Sup6.S8
Health Expect. 2022 Jun 05.

Exploring motivations and resistances for implementing shared decision-making in clinical practice: A systematic review based on a structure-process-outcome model.

Changhai Tang, Anqi Wang, Jingjing Yan.

   OBJECTIVE: Shared decision-making (SDM) as a multicollaborative approach is vital for facilitating patient-centred care. Considering the limited clinical practice, we attempted to synthesize the motivations and resistances, and investigate their mutual relationships for advancing the implementation of SDM.
METHODS: A comprehensive systematic review using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was performed. 'Shared decision making' was searched as the mesh term through PubMed, Web of Science and EBSCO from 2000 to 2021, and the quality of literature was appraised using the QualSyst Tool. Motivations and resistances were categorized based on content analysis and the 'structure-process-outcome' model.
RESULTS: From 8319 potential citations, 105 were included, comprising 53 qualitative studies (the average quality score is 0.92) and 52 quantitative studies (the average quality score is 0.95). A total of 42 categories of factors were identified into 11 themes and further grouped into three dimensions: structure, process and outcome. The structure dimension comprised six themes (71.43%), the process dimension contained four themes (11.01%) and the outcome dimension covered only one theme. Across all categories, decision-making time and patients' decision preparedness in the process dimension were the most reported, followed by physicians' communication skills and health care environment in the structure dimension. Analysis of implementation of SDM among various types of diseases showed that more influencing factors were extracted from chronic diseases and unspecified disease decisions.
CONCLUSIONS: The major determinants for the implementation of SDM are focused on the structural dimension, which challenges the health systems of both developed and low- and middle-income countries. Furthermore, we consider it important to understand more about the interactions among the factors to take integrated measures to address the problems and to ensure the effectiveness of implementing SDM.
PATIENT OR PUBLIC CONTRIBUTION: Patients, healthcare professionals and other stakeholders articulated their perspectives on the implementation of SDM actively, and these were adopted and analysed in this study. However, the above-mentioned individuals were not directly involved in the process of this study. Protocol was registered on PROSPERO (CRD42021259309).

Keywords:  motivation; patient-centred care; resistance; shared decision-making; structure-process-outcome model

DOI:  https://doi.org/10.1111/hex.13541
Patient Educ Couns. 2022 May 16. pii: S0738-3991(22)00249-X. [Epub ahead of print]

Bringing personal perspective elicitation to the heart of shared decision-making: A scoping review.

Ester A Rake, Ivana C H Box, Dunja Dreesens, Marjan J Meinders, Jan A M Kremer, Johanna W M Aarts, Glyn Elwyn.

   OBJECTIVES: Proponents of shared decision-making (SDM) advocate the elicitation of the patient's perspective. This scoping review explores if, and to what extent, the personal perspectives of patients are elicited during a clinical encounter, as part of a SDM process. We define personal perspective elicitation (PPE) as: the disclosure (either elicited by the clinician or spontaneously expressed by the patient) of information related to the patient's personal preferences, values and/or context.
METHODS: A search was conducted in five literature databases from inception dates up to July 2020, to identify empirical studies about SDM (with/without SDM instrument).
RESULTS: The search identified 4562 abstracts; 263 articles were read in full text, resulting in 99 included studies. Studies reported low levels of PPE. Integration of personal perspectives into the conversation or a future care plan was largely absent. The majority of the discussed content related to physical health, while social and psychological topics were mostly unaddressed.
CONCLUSIONS: PPE occurs on a very low level in efforts to achieve SDM according to evaluation studies.
PRACTICE IMPLICATIONS: PPE is advocated but rarely achieved in SDM evaluation studies. Causes should be identified, followed by designing interventions to improve this aspect of SDM.

Keywords:  Personal perspective elicitation; Preferences, values and context; Scoping review; Shared decision-making

DOI:  https://doi.org/10.1016/j.pec.2022.05.009
J Patient Exp. 2022 ;9 23743735221103033

Improved Patient Experience and Outcomes: Is Patient-Provider Concordance the Key?

Sonia V Otte.

  Health disparities remain ubiquitous in the United States despite initiatives by the federal government and other organizations. A long-term solution for health inequity is needed in order to help improve patient outcomes for all. The purpose of this review is to examine if racial, gender, or multifactorial concordance (eg, race, age, gender, education, language) between patient and provider leads to a better patient experience and improved health outcomes. A PubMed search for articles published between 2016 and 2021 resulted in 23 separate studies that met inclusion criteria. The results from these studies were inconclusive in determining an association between patient-provider concordance and patient outcomes. Further research is needed to evaluate the positive, neutral, and sometimes negative impact of patient-provider concordance. By diversifying healthcare professions and improving cultural competency and communication training programs, providers may be better prepared to care for diverse populations in both concordant and discordant patient relationships.

Keywords:  clinician–patient relationship; communication; culture/diversity; patient engagement; patient outcomes; patient satisfaction; patient/relationship-centered skills; patient–provider concordance

DOI:  https://doi.org/10.1177/23743735221103033
Diabetes Spectr. 2022 ;35(2): 150-158

The Diabetes Simulation Challenge: Enhancing Patient Perspective-Taking for Medical Students.

Emily Shaffer-Hudkins, Sara Hinojosa Orbeck, Kathy Bradley-Klug, Nicole Johnson.

The Diabetes Simulation Challenge is a unique training tool to foster empathy, a key facet of patient-centered care, for medical students. Thirty-two medical students participated in a 24-hour perspective-taking activity as part of their curriculum, during which they simulated some common experiences of living with a chronic health condition, specifically type 1 diabetes. Students' written reflections were analyzed using a phenomenological qualitative approach to provide a composite description of the experience. An exhaustive, iterative method of thematic analysis that included manual coding was used to determine whether this activity led to expressions of empathy or thoughts and beliefs consistent with patient-centered health care. Nine unique themes emerged, six of which indicated that students adopted the perspective of an individual with a chronic illness. Most of the students' reflections illustrated an understanding of the behavioral, social, and emotional challenges related to living with type 1 diabetes, as well as increased empathy toward individuals with the disease. Medical students who aim to provide patient-centered care benefited from this perspective-taking exercise, and training programs should consider using such methods to extend learning beyond traditional didactic education.

DOI: https://doi.org/10.2337/ds21-0039
PLoS One. 2022 ;17(6): e0269677

Patient coaching: What do patients want? A mixed methods study in waiting rooms of outpatient clinics.

Irène Alders, Carolien Smits, Paul Brand, Sandra van Dulmen.

INTRODUCTION: Effective communication in specialist consultations is difficult for some patients. These patients could benefit from support from a coach who accompanies them to and during medical specialist consultations to improve communication in the consultation room. This study aims to investigate patients' perspective on interest in support from a patient coach, what kind of support they would like to receive and what characterizes an ideal patient coach.
METHODS: We applied a mixed method design to obtain a realistic understanding of patients' perspectives on a patient coach. Patients in the waiting rooms of outpatient clinics were asked to fill out a short questionnaire which included questions about demographic characteristics, perceived efficacy in patient-provider interaction and patients' interest in support from a patient coach. Subsequently, patients interested in a patient coach were asked to participate in a semi-structured interview. The quantitative data were examined using univariate analysis and the qualitative interview data were analysed using content analysis.
RESULTS: The survey was completed by 154 patients and eight of them were interviewed. Perceived efficacy in patient-physician interactions was the only variable that showed a significant difference between patients with and without an interest in support from a patient coach. The interviews revealed that a bad communication experience was the main reason for having an interest in support from a patient coach. Before the consultation, a patient coach should take the time to get to know the patient, build trust, and help the patient create an agenda, so take the patient seriously and recognize the patient as a whole person. During the consultation, a patient coach should support the patient by intervening and mediating when necessary to elicit the patient's agenda. After the consultation, a patient coach should be able to explain and discuss medical information and treatment consequences. An ideal patient coach should have medical knowledge, a strong personality and good communication skills.
CONCLUSION: Especially patients who had a bad communication experience in a specialist consultation would like support from a patient coach. The kind of support they valued most was intervening and mediating during the consultation. To build the necessary trust, patient coaches should take time to get to know the patient and take the patient seriously. Medical knowledge, good communication skills and a strong personality were considered prerequisites for patient coaches to be capable to intervene in specialist consultations.

DOI: https://doi.org/10.1371/journal.pone.0269677
Worldviews Evid Based Nurs. 2022 Jun 05.

Outdated healthcare structures, sick care paradigm, and medical terms: Barriers to evidence-based, Patient-Centered and interprofessional care.

Sharon Tucker, Bernadette Mazurek Melnyk, Molly McNett.

DOI: https://doi.org/10.1111/wvn.12592
Z Evid Fortbild Qual Gesundhwes. 2022 May 31. pii: S1865-9217(22)00102-7. [Epub ahead of print]

Editorial: 20 years after the start of international Shared Decision-Making activities: Is it time to celebrate? Probably… .

Paulina Bravo, Martin Härter, Kirsten McCaffery, Anik Giguère, Pola Hahlweg, Glyn Elwyn.

DOI: https://doi.org/10.1016/j.zefq.2022.05.009
Rev J Autism Dev Disord. 2022 May 30. 1-13

Barriers and Facilitators to Healthcare Access in Adults with Intellectual and Developmental Disorders and Communication Difficulties: an Integrative Review.

Kathryn Shady, Shannon Phillips, Susan Newman.

  This integrative review explores the barriers to and facilitators of healthcare access in adults with intellectual and developmental disorders (IDD) and communication difficulties (CD) using Levesque et al.'s conceptual framework of access to health. IDDs are a group of disorders that occur early in childhood and often involve language dysfunction. CDs are prevalent in adults with IDD. Several themes emerged as barriers to access for adults with IDDs and CDs including health literacy, understanding health information, and screening; fear and negative patient expectations; impaired autonomy; time; accommodation needs; insurance coverage and financial hardship; communication; coordination and continuity of care; and supporter presence and inclusion. Communication between providers, patients, and supporters is a significant barrier for adults with IDD and CD.
Supplementary Information: The online version contains supplementary material available at 10.1007/s40489-022-00324-8.

Keywords:  Communication disorder or difficulties; Developmentally disabled adult; Health system access

DOI:  https://doi.org/10.1007/s40489-022-00324-8
Health Lit Res Pract. 2022 Apr;6(2): e142-e150

Development of Training Curriculum to Improve Patient Communication Skills and Social Support Among Community Health Workers.

Jennifer Holcomb, Gayla M Ferguson, Logan Thornton, Linda Highfield.

BACKGROUND: Effective provider communication skills are important for patient decision-making and understanding, particularly for those with low health literacy. A gap exists in training methods and curriculum for community health workers (CHWs). Brief description of activity: Through a clinical and academic partnership, pilot training curriculum focused on patient communication skills was developed to align with CHW scope of work.
IMPLEMENTATION: The curriculum was implemented in three 2-hour training sessions over WebEx with seven state-certified CHWs. The goal was for CHWs to understand the key elements and application of active listening, Teach Back, and action planning in a clinical setting. The sessions included didactic and skills practice modules for each skill.
RESULTS: A survey was distributed to CHWs to evaluate knowledge, skills, and attitudes and reactions to training methods, instructors, and relevance using the Kirkpatrick's evaluation model (Reaction and Learning). Although CHWs agreed that they had actively participated in the training and that the instructors were well-prepared, there was less agreement that the course was relevant. CHWs reported an increase in understanding of active listening and action planning, capability of using Teach Back and providing social support, and ability to teach, whereas a decrease was reported in the capability to use action planning. When probed about training relevance, CHWs felt action listening and Teach Back were relevant, but that action planning was not relevant to their responsibilities. This gap in responsibilities was also acknowledged by the clinical leadership.
LESSONS LEARNED: The training allowed the CHWs to build on subsequent skills from previous sessions and to discuss struggles. A need for tools for integrating the skills in the clinical workflow were requested by CHWs and clinical leadership. These tools offer the opportunity to tailor future trainings on communication skills or patient scenarios. Future trainings should include CHWs to provide insight into scope of work. [HLRP: Health Literacy Research and Practice. 2022;6(2):e142-e150.] Plain Language Summary: It is important for community health workers to communicate with patients so that patients can understand information and make their own decisions. There is not enough known about the best way to train CHWs in patient communication. This training was created to help CHWs use three patient communication skills in their clinic.

DOI: https://doi.org/10.3928/24748307-20220518-02
Med J Aust. 2022 Jun 06. 216 Suppl 10 S5-S8

Activating people to partner in health and self-care: use of the Patient Activation Measure.

Tina Janamian, Michael Greco, David Cosgriff, Laurence Baker, Paresh Dawda.

  Patient activation is a behavioural concept and is at the heart of personalised care. It is defined as an individual's knowledge, skill and confidence for managing their health and health care. Evidence indicates that patient activation scores can predict health behaviour and are closely linked to various clinical outcomes: reduced unnecessary emergency department visits, hospital admissions and re-admissions. Patients with lower activation levels (25-40% of the population) are less likely to adopt healthy behaviour, and more likely to have poorer clinical outcomes and higher rates of hospitalisation. Effective interventions can improve a patient's activation level, and positive change in activation equates to positive change in self-care behaviour. But to improve patient activation, we must first measure it using a robust evidence-based tool such as the Patient Activation Measure (PAM) survey. Armed with the patient's PAM score, providers can tailor their care and help patients achieve better self-care, which can improve outcomes of care and reduce unnecessary health care utilisation. The PAM is also useful for population segmentation and risk stratification - to target interventions and health strategies to meet the needs of patients who are at different points along the activation continuum, to measure the performance of health care systems, and to evaluate the effectiveness of health care interventions. The role of patient activation requires further serious consideration if we are to improve the long-term health and wellbeing of all Australians. The PAM tool is a feasible and cost-effective solution for achieving the Quadruple Aim - improving population health, the cost-efficiency of the health system, and patient and provider experience.

Keywords:  Chronic disease; Community health planning; Cost of illness; Delivery of healthcare; Education, public health; Health communication; Health promotion; Health services research; Health systems; Physician-patient relations; Preventive medicine; Primary health care

DOI:  https://doi.org/10.5694/mja2.51535
PLoS One. 2022 ;17(6): e0268789

Plain language summaries: A systematic review of theory, guidelines and empirical research.

Marlene Stoll, Martin Kerwer, Klaus Lieb, Anita Chasiotis.

Plain language summaries (PLSs) have been introduced to communicate research in an understandable way to a nonexpert audience. Guidelines for writing PLSs have been developed and empirical research on PLSs has been conducted, but terminology and research approaches in this comparatively young field vary considerably. This prompted us to review the current state of the art of the theoretical and empirical literature on PLSs. The two main objectives of this review were to develop a conceptual framework for PLS theory, and to synthesize empirical evidence on PLS criteria. We began by searching Web of Science, PubMed, PsycInfo and PSYNDEX (last search 07/2021). In our review, we included empirical investigations of PLSs, reports on PLS development, PLS guidelines, and theoretical articles referring to PLSs. A conceptual framework was developed through content analysis. Empirical studies investigating effects of PLS criteria on defined outcomes were narratively synthesized. We identified 7,714 records, of which 90 articles met the inclusion criteria. All articles were used to develop a conceptual framework for PLSs which comprises 12 categories: six of PLS aims and six of PLS characteristics. Thirty-three articles empirically investigated effects of PLSs on several outcomes, but study designs were too heterogeneous to identify definite criteria for high-quality PLSs. Few studies identified effects of various criteria on accessibility, understanding, knowledge, communication of research, and empowerment. We did not find empirical evidence to support most of the criteria we identified in the PLS writing guidelines. We conclude that although considerable work on establishing and investigating PLSs is available, empirical evidence on criteria for high-quality PLSs remains scarce. The conceptual framework developed in this review may provide a valuable starting point for future guideline developers and PLS researchers.

DOI: https://doi.org/10.1371/journal.pone.0268789
J Vasc Access. 2022 Jun 10. 11297298221091140

A national co-design workshop of a mobile-based application for vascular access as a patient decision aid.

David Kingsmore, Ramsay Meiklem, Karen Stevenson, Peter Thomson, Matt Bouamrane, Mark Dunlop.

   BACKGROUND: Increasing options for vascular access have increased the need for more effective communication to optimize patient engagement and ensure effective consent. An advanced prototype of the mobile application (VA App) was developed over 3 years as a patient decision aid. For the first time, entry to the 2021 UK Kidney Week was opened to all professions and patients and was held online. The VA App was presented in an inter-active session. This report summarizes the findings.
METHODS: A 30-min interactive session was allocated with the session delivered in four sections: (1) demographic data was collected; (2) an overall opinion was obtained about current patient information sources and satisfaction with these; (3) the participants were asked a series of eight questions regarding the main problem areas previously identified; (4) following a 6-min demonstration video, the participants were then re-asked the same questions to determine if the VA App would improve/worsen these areas.
RESULTS: Completed data from 30 participants showed great variation in all demographics. The most cited source was verbal and rated the best, whilst all other sources were felt to be poor by 90%. All eight aspects of current information sources rated poorly. There was a unanimous agreement that the VA App could make this better. Interestingly, when the eight aspects were ranked by order of the worst to best, this matched the order of the benefits of the VA App.
DISCUSSION: This is the first report of an on-line, multi-professional co-design workshop. With a unanimous view that current systems are very limited and that better patient information systems are required, the VA App was found to be a potential solution as a patient decision aid. Interestingly, paper leaflets were widely viewed as the least used and the least effective mechanism for communicating information to patients. Funding for a commercially produced mobile application has been secured and will be further tested in the near future.

Keywords:  Patient decision aid; arteriovenous access; haemodialysis; patient information; vascular access

DOI:  https://doi.org/10.1177/11297298221091140
Rehabil Nurs. 2022 Jun 10.

Moving Beyond the LGBTQIA+ Acronym: Toward Patient-Centered Care.

Evan McEwing, Terrie Black, Joseph Zolobczuk, Umut Dursun.

PURPOSE: The LGBTQIA+ communities experience distinct health disparities and inequities in health outcomes. Healthcare providers must be conscious of these factors to facilitate optimal, person-centered care. This narrative briefly covers health disparities in the LGBTQIA+ community and posits strategies to promote inclusive care.
METHODS: Current literature and clinical best practices from several authoritative sources on LGBTQIA+-specific issues and gender-affirming care were reviewed. Sources included several LGBTQIA+-specific healthcare organizations, national healthcare provider organizations, and federal agency policy statements. Inclusive terminology and healthcare practices are included.
RESULTS: Healthcare providers must educate themselves on caring for gender- and sexual orientation-diverse populations to optimize the health status of these communities. It is essential that providers examine their own potential biases and maintain an openness to learning about LGBTQIA+ communities.
CONCLUSIONS: Healthcare providers have a responsibility to not only understand issues specific to LGBTQIA+ individuals but also advocate for these groups. As nurses, we must continue to support public health policies that seek to end disparities and ensure health equity for all.
CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Rehabilitation nurses are caring for more diverse populations than ever before and must understand how to provide compassionate, individualized care. Although this article focuses on the LGBTQIA+ community, the principles discussed are applicable across all populations.

DOI: https://doi.org/10.1097/RNJ.0000000000000378
Public Health Res Pract. 2022 Jun 01. pii: 32122209. [Epub ahead of print]

Development of the Consumer Involvement & Engagement Toolkit: a digital resource to build capacity for undertaking patient-centred clinical trials in Australia.

Tanya Symons, Janelle Bowden, Anne McKenzie, Julia M Fallon-Ferguson, Leanne Y Weekes, James Ansell, Rinki Murphy, Shilpa Jesudason, Manoj Saxena, Alistair Nichol, Nicola Straiton.

OBJECTIVE: This manuscript describes the novel approach to developing a toolkit to support meaningful consumer involvement in clinical trials in Australia to help guide others in considering the development of similar resources.The toolkit aims to support greater consumer involvement in shaping how clinical research is prioritised, designed and conducted. Type of program or service: A working group of researchers, research organisations and consumers was established to co-develop the Consumer Involvement and Engagement Toolkit (the 'Toolkit'), a digital resource to guide researchers and organisations regarding consumer involvement in clinical trials.
FINDINGS: A literature review and international scan of best practice revealed numerous resources outlining best practice for consumer involvement in clinical research and clear evidence of its impact and value. Through a novel content-sharing process, we were able to utilise these resources to develop a comprehensive Toolkit for researchers and research organisations that provides world-class guidance.
LESSONS LEARNT: There is a growing movement to ensure consumer involvement in healthcare, including in clinical research. We discovered its proponents were willing to share their tools and resources to promote international consumer involvement. Although these international tools and resources needed adaptation to suit the Australian research environment, this was achievable with far less effort than developing them from scratch.

DOI: https://doi.org/10.17061/phrp32122209
Acute Med. 2022 ;21(2): 80-85

Improving care for patients in the outlying wards: Lessons from patients' care experience.

V Sobolewska, H Duff, F Craighead, I Macpherson, A Veiraiah, S Dummer, K A Lockman.

IMPORTANCE: Overcrowding in hospitals and lack of capacity in general medical wards can result in a medical patient being transferred to other specialty wards often referred as 'outlying' or 'boarding' wards.
OBJECTIVES: We explored the experiences of our outlying patients to identify local factors that affect their care experience and inform interventions that could improve their care deliveries and outcomes.
DESIGN, SETTING, AND PARTICIPANTS: Qualitative interviews using semi-structured questions were conducted in 21 medical patients from a mixture of specialty wards in a large tertiary NHS hospital.
MAIN OUTCOMES AND MEASURES: Perceptions of the factors contributing to the experience of being a patient on a boarding ward, and potential solutions.
RESULTS: Almost all participants reported experiences of good care in an outlying ward. Positive comments highlighted good nursing care, restful environment and a strong focus on patient-centred care. However, none of the participants could identify the team or consultant responsible for their care and this was linked to multiple doctors being involved in the patient's care. Participants also perceived that the frequency of review was reduced and occurred much later in the day than that experienced in the medical ward. Most felt indifferent about the care ownership, timing and frequency of review but in some cases, this led to confusion and the perception of poor progress. Further, participants felt that they had to actively seek information relating to clinical progress. Negative experience of discharge planning was also reported. The associated themes included conflicting information and delays in social care provision. This led to anxiety, frustration and the perception of being a barrier to patient flow.
CONCLUSIONS AND RELEVANCE: Patient experience of the outlying ward is positive, and this can provide a foundation for improvement. Our findings suggest that better care processes and improved communication are needed to promote equity and quality of care. However, this should be complemented with efforts to overcome wider challenges that affect the entire continuum of flow within the healthcare system.

DOI: https://doi.org/10.52964/AMJA.0902
Patient Educ Couns. 2022 May 20. pii: S0738-3991(22)00250-6. [Epub ahead of print]

Patient accounts for nonadherence: A critical window into the patient experience.

Jeanine Warisse Turner, James D Robinson, Rachelle E Barrett Toman, Fan Wang, Michelle Roett.

   OBJECTIVES: This paper explores patient use of excuses to better understand the patient experience during clinical interactions.
METHODS: A content analysis of 32 residents treating 99 different patients was used to reveal accounts of nonadherence. Using grounded theory, these accounts were coded into types and then reduced using a Q-sort.
RESULTS: Analysis revealed 163 accounts of nonadherence. When questioned about their adherence to treatment, 68% of patients offered at least one account for nonadherence during the visit. These accounts were coded into fourteen types and then the Q-sort identified four types of accounts: healthcare system failures, treatment failure, situational exigencies, and self-directed. Of the accounts offered, 7% of the patients provided 6 or more accounts and 25% provided between 3 and 5 accounts.
CONCLUSIONS: The examination of excuses provides a unique way to gain insight into how patients communicate with their physicians. Patient accounts ranged from those where patients indicated adherence was within their control (self-directed) and accounts outside their control (healthcare system failure, treatment failure, and situational exigency).
PRACTICE IMPLICATIONS: The types of accounts of nonadherence patients could provide doctors insight into the patient experience. Recognizing these types could allow opportunities for doctors to develop communication strategies for encouraging patient adherence.

Keywords:  Doctor and patient interaction; Excuses; Patient adherence; patient accounts

DOI:  https://doi.org/10.1016/j.pec.2022.05.010
J Clin Nurs. 2022 Jun 10.

ShareHeart: A patient journey map of patients with ischemia and non-obstructive coronary artery disease based on qualitative research.

Dinah L Van Schalkwijk, Jos W M G Widdershoven, Suzette Elias-Smale, Marielle Hartzema-Meijer, Brenda L Den Oudsten, Jenny Slatman, Paula M C Mommersteeg.

   AIMS AND OBJECTIVES: To visualise the health care experiences and needs of patients with ischemia with non-obstructive coronary arteries in a patient journey map. As such, future design challenges can be provided, and it can be used for future healthcare optimization.
BACKGROUND: Ischemia with non-obstructive coronary arteries is a chronic cardiac condition caused by vascular dysfunctions. Ischemia with non-obstructive coronary arteries is often unrecognised, significantly impairs daily functioning, and is more prevalent among women. Patients' experiences remain unexplored, and a clear patient-centered care pathway is lacking.
DESIGN: A qualitative interpretative research design was performed and the standards for reporting qualitative research (SRQR) has been used.
METHODS: In total, 36 women were included and participated in eight semi-structured focus group interviews. Thematic analysis was used, and identified themes were further classified using 'patient journey mapping.' Additionally, Picker's 'eight principles of patient-centered care' were linked to the results and integrated in the patient journey map.
RESULTS: Participants experienced a lack of familiarity with the specific cardiac condition by healthcare providers, repeated hospitalisation, testing and referrals, shortage of specialised cardiologists, and feelings of not being heard. In addition, needs for a multidisciplinary treatment program (including physical and psychological support), better information provision, and an easily accessible contact person were expressed.
CONCLUSIONS: The resulting patient journey map shows how patients experienced and interacted with the current healthcare system. Overall, the results show a complex and long healthcare pathway and important themes for healthcare experiences and needs were identified. Future research could focus on the development and implementation of a patient-centered evidence-based clinical pathway optimising experiences and quality of life.
RELEVANCE TO CLINICAL PRACTICE: The visual tool can help health care professionals, policy makers, and researchers improve healthcare provision which is patient-centered and tailored to the preferences of patients with ischemia with non-obstructive coronary arteries.

Keywords:  health care quality improvement; ischemia with non-obstructive coronary arteries (INOCA); patient centered care; patient journey map; patients experiences; qualitative study

DOI:  https://doi.org/10.1111/jocn.16409
J Adv Pract Oncol. 2022 Apr;13(3): 202-204

Pull Up a Seat: Engaging Patients as Empowered Partners in Health Equity Transformation.

Maimah Karmo, Amy Pierre.

At the JADPRO Live Virtual 2021 keynote interview, Maimah Karmo, CEO and Founder of the Tigerlily Foundation, spoke with Amy Pierre, MSN, ANP-BC, on her breast cancer experience and drive to establish an organization that educates, advocates for, and empowers young women of color at every stage of their breast cancer journey. Ms. Karmo and Ms. Pierre also discussed the role of the advanced practitioner in furthering patient-centered, equitable care.

DOI: https://doi.org/10.6004/jadpro.2022.13.3.3
Cureus. 2022 May;14(5): e24662

The Depiction of Autonomy and Shared Decision-Making by Children and Adolescents in Medical Television.

Marina E Golden, Ndifreke Ekpa, Bridget Rafferty, Robert P Olympia.

  Background Many studies have shown the importance of patient autonomy and shared decision-making in medical treatment. However, television (TV) depiction of medicine continues to present a skewed depiction of healthcare and its effects. This has been observed in adult patients but little has been studied in the pediatric population. Methodology This study analyzed the depiction of pediatric patients (7-18 years old) autonomy and their participation in the shared decision-making process in the first season of medical TV dramas that premiered from 1994 to 2017, including ER (1994), Grey's Anatomy (2005), Red Band Society (2014), and The Good Doctor (2017). These shows were scored to record each instance of a medical decision made. Results Of the 238 medical decisions recorded, pediatric patients made a medical decision 61 times (57.5%). A total of 110 instances were omitted due to the patient's inability to give consent, usually due to altered mental status, and 22 instances were omitted due to age being less than seven years. Interestingly, there was an increasing proportion of pediatric patients involved in the decision-making process over time, moving from 17 of 39 medical decisions (43.6%) of patients in ER (1994) to 22 of 33 medical decisions (66.7%) in The Good Doctor (2017) (p = 0.050213). Conclusions The results revealed that TV medical dramas have been including children in their medical decision-making more over time. This has major implications for the way writers structure their shows and how medical providers interact with their patients.

Keywords:  adolescents; assent; autonomy; children; medical television; shared decision-making

DOI:  https://doi.org/10.7759/cureus.24662
Stud Health Technol Inform. 2022 Jun 06. 290 849-853

Physician Communication Skills in Telemedicine: The Role of Eye Contact.

Samar Helou, Elie El Helou, Jeanine El Helou.

  Gaze is an important non-verbal behavior in patient-physician communication. We examine the effect of the physician's gaze direction in video consultations on their communication and interpersonal skills ratings. 51 subjects watched videos of a physician providing the same teleconsultations while (a) looking directly at the camera and (b) looking at the computer screen. After each video, the participants rated the physician's skills. The results showed that looking at the camera is perceived as making eye contact and is associated with higher ratings on two communication skill items: (1) using empathy to communicate appreciation of the patient's feelings, and (2) providing support by expressing concern, understanding, and willingness to help. The effect of eye contact depended on the content of the consultation and on the general attitude of the physician. These results highlight the role of eye contact in video consultations and its dependency on other verbal and non-verbal behaviors.

Keywords:  Nonverbal Communication; Patient-physician communication; Telemedicine

DOI:  https://doi.org/10.3233/SHTI220199
Stud Health Technol Inform. 2022 Jun 06. 290 385-389

Just Talk to Me - A Qualitative Study of Patient Satisfaction in Emergency Departments.

Maximilian Haug, Maria Dahm, Heiko Gewald, Andrew Georgiou.

  Communication between patients and hospital staff is a vital part of patient satisfaction and can contribute to better healthcare outcomes. Especially in emergency departments, where the workload is high, it is difficult to always address the communication needs of patients. In a qualitative study, we interviewed 32 patients in emergency departments in Australia. We found that, in the context of the emergency department, the characteristics of the source assumes an essential role in the appraisal of information. Especially if patients show low health literacy hospital staff needs to engage with them. It is important that patients feel informed as this increases patient satisfaction, even though they may not fully understand the delivered information.

Keywords:  Communication; Emergency Department; Patients

DOI:  https://doi.org/10.3233/SHTI220102
Stud Health Technol Inform. 2022 Jun 06. 290 1112-1113

Co-Design Approaches Involving Older Adults in the Development of Electronic Healthcare Tools: A Systematic Review.

Amy Cole, Karthik Adapa, Daniel R Richardson, Lukasz M Mazur.

  We present evidence on the current state of utilizing co-design approaches involving older adults in developing electronic healthcare tools (EHTs). Research gaps were identified in defining the stages, involvement processes, and levels of participation using existing theoretical frameworks. Future studies should explore both involvement processes and levels of participation to optimally empower and collaborate with older adults in developing EHTs.

Keywords:  Aged; Digital Technology; Universal Design

DOI:  https://doi.org/10.3233/SHTI220293
J Shoulder Elbow Surg. 2022 Jun 04. pii: S1058-2746(22)00492-X. [Epub ahead of print]

Patients with Limited Health Literacy Have Worse Preoperative Function, Pain Control and Experience Prolonged Hospitalizations Following Shoulder Arthroplasty.

Richard N Puzzitiello, Eileen M Colliton, Daniel Swanson, Mariano E Menendez, Michael A Moverman, Paul A Hart, Edward Allen, Jacob M Kirsch, Andrew Jawa.

   BACKGROUND: Patients with limited health literacy (LHL) may have difficulty understanding and acting upon medical information, placing them at risk for potential misuse of health services and adverse outcomes. The purposes of our study were to determine (1) the prevalence of LHL in patients undergoing inpatient shoulder arthroplasty, (2) its association with the degree of preoperative symptom intensity and magnitude of limitations, (3) and its effects on perioperative outcomes including postoperative length of stay (LOS), total inpatient costs, and inpatient opioid consumption.
METHODS: We retrospectively identified 230 patients who underwent elective inpatient reverse or anatomic shoulder arthroplasty between January 2018 and May 2021 from a prospectively maintained single surgeon registry. The health literacy of each patient was assessed preoperatively using the validated 4-item Brief Health Literacy Screening Tool (BHLST). Patients with a BHLST score of 17 or less were categorized as having LHL. The outcomes of interest were preoperative patient reported outcome scores and range of motion, LOS, total postoperative inpatient opioid consumption, and total inpatient costs as calculated using time-driven activity-based cost (TDABC) methodology. Univariate analysis was performed to determine associations with LHL and patient characteristics as well as the outcomes of interest. Multivariable linear regression modeling was used to determine the association between LHL and LOS while controlling for potentially confounding variables.
RESULTS: Overall, 58 (25.2%) patients were classified as having LHL. Prior to surgery, these patients had significantly higher rates of opioid use (P = .002), more self-reported allergies (P = .007), worse American Shoulder and Elbow Surgeons (ASES) scores (P = .001), visual analog scale (VAS) pain scores (P = .020), forward elevation (P < .001) and external rotation (P = .022) but did not significantly differ in terms of any additional demographic or clinical characteristics (P > .05). Patients with LHL had significantly longer lengths-of-stay (1.84 ± 0.92 days vs. 1.57 ± 0.58 days, P = .012) but did not differ in terms of total hospitalization costs (P = .65) or total inpatient opioid consumption (P = .721). In multivariable analysis, LHL was independently predictive of significantly longer LOS (β, 0.14; 95% CI, 0.02 - 0.42; P = .035).
CONCLUSION: Limited health literacy is commonplace among patients undergoing elective shoulder arthroplasty and is associated with greater preoperative symptom severity and activity intolerance. Its association with longer hospitalizations suggests that HL is an important factor to consider for postoperative disposition planning.

Keywords:  Shoulder arthroplasty; cost; health literacy; inpatient; length of stay

DOI:  https://doi.org/10.1016/j.jse.2022.05.001
Nat Rev Nephrol. 2022 Jun 06.

Patient-centred clinical trial design.

Allison Tong, Nicole Scholes-Robertson, Carmel Hawley, Andrea K Viecelli, Simon A Carter, Adeera Levin, Brenda R Hemmelgarn, Tess Harris, Jonathan C Craig.

Patient involvement in clinical trial design can facilitate the recruitment and retention of participants as well as potentially increase the uptake of the tested intervention and the impact of the findings on patient outcomes. Despite these benefits, patients still have very limited involvement in designing and conducting trials in nephrology. Many trials do not address research questions and outcomes that are important to patients, including patient-reported outcomes that reflect how patients feel and function. This limitation can undermine the relevance, reliability and value of trial-based evidence for decision-making in clinical practice and health policy. However, efforts to involve patients with kidney disease are increasing across all stages of the trial process from priority setting, to study design (including selection of outcomes and approaches to improve participant recruitment and retention) and dissemination and implementation of the findings. Harnessing the patient voice in designing trials can ensure that efforts and resources are directed towards patient-centred trials that address the needs, concerns and priorities of patients living with kidney disease with the aim of achieving transformative improvements in care and outcomes.

DOI: https://doi.org/10.1038/s41581-022-00585-w
Nurs Stand. 2022 Jun 06.

Partnership working between nurses and patients' families in the critical care environment.

Lucy Kirkham.

  When an individual becomes critically ill, they may be admitted to a critical care environment, which can have significant effects on themselves and their family. There is a wealth of literature exploring the experiences and priorities of patients and their families in relation to critical care, but also a lack of research on practical interventions that can improve care delivery in this setting. This article explores partnership working between nurses and patients' families in the critical care environment and examines the barriers to, and facilitators of, family-centred care. The author draws on the literature to consider interventions that could enhance family-centred care in this setting, and makes some recommendations for practice.

Keywords:  clinical; critical care; families; intensive care; management; patient experience; patients; person-centred care; professional; service improvement

DOI:  https://doi.org/10.7748/ns.2022.e11669
Health Promot J Austr. 2022 Jun 03.

Identifying Strategies for Facilitating Physical Activity Among Older Adults: A Behaviour Change Wheel 'Retrofit' Driven Analysis of Victorian Local Government Policy.

Michael Butson, Ruth Jeanes.

   ISSUE ADDRESSED: The significance of physical activity (PA) for the health and wellbeing of older adults is well documented. Local government (LG) publish PA policy and interventions to encourage and improve older adult PA participation. However, LG documents have rarely been studied to examine the extent to which LG incorporates evidence-based strategies into the development of older adult PA policy.
METHODS: The Behaviour Change Wheel (BCW) 'retrofitting' approach was used to identify and explain available evidence-based PA policies and interventions across 10 Victorian LGs. A document analysis was completed using LG policy and involved elements of content analysis and thematic analysis.
RESULTS: The analysis found 41 documents that included policy and interventions to encourage and improve PA among older adults. Some of the more popular BCW combinations included service provision and enablement and environmental/ social planning, and environmental restructuring. In addition, LGs embrace modifying the built environment and creating partnerships. However, our results suggest that some are not considering modelling or incentives to increase PA.
CONCLUSIONS: According to the BCWs, Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Equity (APEASE) criteria, it is not feasible for Victorian LGs to be including all intervention functions and supporting policy functions. However, contemporary older adult PA intervention literature suggests LGs could benefit from including incentives and modelling into current PA policy. SO WHAT?: This research is one of the first to identify and explain how Victorian LGs facilitate PA participation among older adults. This research will guide Victorian LGs when drafting and implementing PA policy in the future.

Keywords:  Behaviour Change; Older Adults; Physical Activity Policy; Victorian Local Governments

DOI:  https://doi.org/10.1002/hpja.627
Stud Health Technol Inform. 2022 Jun 06. 290 862-866

Design-Relevant Factors Affecting the Patient Experience in Digital Health: Preliminary Results of an Umbrella Systematic Review.

Tingting Wang, Guido Giunti, Marijke Melles, Richard Goossens.

  Since Covid-19, digital health interventions (DHIs) have been embraced as never before. The pandemic led to many new challenges, including the patient experience in digital health care delivery. In this literature study, we identified and synthesized factors that impact patient experience in digital health (dPEx), and reviewed the methods and strategies relevant to its design and implementation. We conducted an umbrella review including 15 reviews representing 543 studies. Four themes were identified that describe design-relevant factors that impact dPEx: individual context, content, technical issues, and design features. We propose a preliminary framework to explain the relationship between each factor and support user-centered design efforts. Further research is needed to identify which factors have the most impact.

Keywords:  Quality Improvement; Telemedicine; User-centered Design

DOI:  https://doi.org/10.3233/SHTI220202
J Hosp Palliat Nurs. 2022 Jun 07.

"What Matters Most" to Older Adults With Cancer: Advance Care Planning.

Cassandra Vonnes, Lauren Parrish, Rosalie El-Rady, Dorothy Patterson, Tina M Mason.

Approximately 1 in 3 adults have some type of advance directive. Advance care planning (ACP) is associated with greater use of supportive care services and decreased patient and family stress. Despite this, organizations continue to have difficulty in implementing effective programs for increasing ACP. Increasing knowledge and comfort of the health care team with end-of-life discussions and ACP is essential. Educational efforts should focus on decreasing known barriers to ACP discussions such as discomfort, unclear role, lack of experience, and limited education. Role playing and case discussions taught by geriatric resources nurses can help increase staff knowledge and comfort regarding ACP. Role playing allows staff to think about their own mortality and what will happen in various situations if ACP is not complete. Team members find that once they have completed their own ACP, they are more comfortable discussing ACP with patients and caregivers. Nurses should collaborate with social workers and chaplains for ACP education and discussing what matters most to them. Patients are encouraged to make sure that they provide advance directives to their health care providers. This article shares an interprofessional team approach to improving processes for ACP as a component of "what matters most" to older adults with cancer.

DOI: https://doi.org/10.1097/NJH.0000000000000877