bims-paceca Biomed News
on Patient-centred care
Issue of 2022–07–03
thirteen papers selected by
Rob Penfold, Queensland Health
  1. Factors that influence older patients' participation in clinical communication within developed country hospitals and GP clinics: A systematic review of current literature.
  2. Do You Employ Shared Decision-Making in Your Practice?
  3. Experiences of Patient-Centered Care Among Older Community-Dwelling Australians.
  4. Nursing interventions to promote patient engagement in cancer care: A systematic review.
  5. Nothing for Me or About Me, Without Me: Codesign of Clinical Decision Support.
  6. Overconfidence in Managing Health Concerns: The Dunning-Kruger Effect and Health Literacy.
  7. A qualitative assessment of the pulmonary rehabilitation decision-making needs of patients living with COPD.
  8. Information Overload in Patient Education: A Wilsonian Concept Analysis.
  9. Improving the odds together: a framework for breast cancer research scientists to include patient advocates in their research.
  10. Patient-reported outcome measures (PROMs) to guide clinical care: recommendations and challenges.
  11. Automated telephone follow-up programs after hospital discharge: Do older adults engage with these programs?
  12. The Influence of Wearables on Health Care Outcomes in Chronic Disease: Systematic Review.
  13. Understanding the processes behind the decisions - GPs and complex multimorbidity decision making.
  1. PLoS One. 2022 ;17(6): e0269840
    Factors that influence older patients' participation in clinical communication within developed country hospitals and GP clinics: A systematic review of current literature.
    Harry James Gaffney, Mohammad Hamiduzzaman.
       BACKGROUND: Engaging older adults in clinical communication is an essential aspect of high-quality elder care, patient safety and satisfaction in hospitals and GP clinics. However, the factors that influence older adults' participation during their appointments with health professionals from the older patient's perspective remain under-investigated.
    OBJECTIVES: We aimed to fill this knowledge gap by reviewing research articles that have examined older patients' involvement in clinical communication. In doing so, we hope to assist healthcare professionals and institutions in developing new strategies to improve older patients' participation and engagement in clinical communication.
    METHODS: A systematic review of nine databases was conducted for studies reporting identified influences on older patients' participation in clinical communication published from 2010. These studies were then subjected to thematic analysis for stratification.
    RESULTS: Twenty-one articles with a total of 36,797 participants were included and highlighted three major themes that influenced older patients' participation in the clinical communication. The first theme identified includes accessibility to appointments, support, health information and person-centred care, highlighting that access to appointments, person centred care and health information significantly influences clinical communication participation. Relevant and understandable healthcare information identified that communication factors [i.e. tailored health information, health literacy and patient language barriers, and communication impairments] influences older patients' participation. Older Patient perceptions of HCP credibility and trustworthiness highlighted how patient's perceptions of health professionals influence their willingness to participate in clinical communications.
    CONCLUSIONS AND IMPLICATIONS: This review demonstrates that there are several factors that contribute to insufficient or no participation of older patients in clinical communication in hospitals and GP clinics. These include accessibility to relevant and understandable health information, and the perceived health professional credibility and trustworthiness. Identifying ways to address these factors may improve patient participation, doctor-patient collaboration and overall health outcomes for older patients.
    DOI:  https://doi.org/10.1371/journal.pone.0269840
  2. J Adv Pract Oncol. 2022 May;13(4): 359-360
    Do You Employ Shared Decision-Making in Your Practice?
    Beth Faiman.
      
    DOI:  https://doi.org/10.6004/jadpro.2022.13.4.1
  3. Front Public Health. 2022 ;10 912137
    Experiences of Patient-Centered Care Among Older Community-Dwelling Australians.
    Breanne Hobden, Elise Mansfield, Megan Freund, Matthew Clapham, Rob Sanson-Fisher.
       Background: Older adults represent the largest consumers of health care. It is, therefore, important that they receive adequate patient-centered care to empower them to be proactive in managing their health.
    Aims: This study examined the proportion of older community-dwelling individuals who report receiving patient-centered care during healthcare consultations.
    Methods: A cross-sectional study was conducted with 117 clients of an Australian aged care provider. Clients completed a survey examining their perceptions of whether they received patient-centered care (11-items) from healthcare professionals.
    Results: The mean number of patient-centered care items reported was 8.7 (±3.1). Speaking to the patient with respect was the item most often reported to be patient-centered (94%). Asking patients about treatment goals or expectations (62%) and how involved they would like to be in treatment (67%) were the items least reported to be patient-centered.
    Conclusion: Older adults perceived some important aspects of care were not provided with a patient-centered approach. There is a need to improve healthcare providers' elicitation of older patients' care preferences, enabling patients to determine their level of involvement in their health management.
    Keywords:  aged care; community-dwelling; consultation; healthcare; older adults; patient care; patient-centered care; perceptions
    DOI:  https://doi.org/10.3389/fpubh.2022.912137
  4. Int J Nurs Stud. 2022 May 27. pii: S0020-7489(22)00118-3. [Epub ahead of print]133 104289
    Nursing interventions to promote patient engagement in cancer care: A systematic review.
    Loris Bonetti, Angela Tolotti, Gloria Anderson, Tiziana Nania, Camilla Vignaduzzo, Davide Sari, Serena Barello.
       BACKGROUND: Patient engagement is becoming increasingly relevant in cancer care. Nurses have been recognized as crucial in promoting active engagement of people with carcer. Despite the growing interest on this topic and the relevance of patient engagement interventions to improve patient' conditions, to the best of our knowledge there is no synthesis of the literature on the characteristics and impact of nurse-led patient engagement intervention for adults with cancer.
    OBJECTIVE: This review aims to systematically summarize nurse-led patient engagement interventions for adult patients diagnosed with cancer and to describe the state of the art on the impact of these interventions on patients' outcomes.
    DESIGN: Systematic review.
    SETTING(S): Hospital and outpatient care.
    PARTICIPANTS: Adults with cancer.
    METHODS: We searched PubMed, CINAHL, Embase, Scopus, Web of Science and Cochrane library from 2005 to 2021. We included randomized clinical trials, quasi-experimental studies and single-arm, pre-test/post-test studies written in English, Spanish, French and Italian. All the included articles reported nurse-led patient engagement interventions designed to improve patient engagement in the management of their own disease and to assess outcomes related to patient engagement. We appraised the methodological quality of the included articles with the Joanna Briggs Institute appraisal tools.
    RESULTS: Twenty-four articles met the inclusion criteria. Four distinct types of nurse-led engagement interventions, showing different degrees of complexity, were classified: (i) generic health information delivery, (ii) patient-specific information delivery, (iii) personalized decision support and (iv) motivational support. These interventions were effective in supporting behavioral changes and reducing symptoms burden of adults with cancer. In addition, many of the retrieved studies showed significant increase in patients' knowledge, informed decisions making, perceived quality of nurse-patient interaction and quality of life after the engagement intervention.
    CONCLUSIONS: This systematic review summarized a wide variety of nurse-led patient engagement interventions with different degrees of complexity. In addition, a significant positive effect of these interventions was found on outcomes such as patient activation, self-efficacy, health literacy and quality of life. Among those identified, nurse-led motivational interventions appear to be the most effective ones for improving engagement outcomes in adults with cancer.
    REGISTRATION NUMBER: PROSPERO Nr: CRD42020146189.
    Keywords:  Empowerment; Neoplasm; Non-randomized controlled trials; Nurse; Patient engagement; Patient involvement; Patient participation; Randomize control trial; Systematic review
    DOI:  https://doi.org/10.1016/j.ijnurstu.2022.104289
  5. Appl Clin Inform. 2022 May;13(3): 641-646
    Nothing for Me or About Me, Without Me: Codesign of Clinical Decision Support.
    Danny van Leeuwen, Michael Mittelman, Lacy Fabian, Edwin A Lomotan.
       BACKGROUND:  Partnerships among patients, families, caregivers, and clinicians are critical to helping patients lead their best lives given their specific genetics, conditions, circumstances, and the environments in which they live, work, and play. These partnerships extend to the development of health information technology, including clinical decision support (CDS). Design of these technologies, however, often occurs without a profound understanding of the true needs, wants, and concerns of patients and family members. Patient perspective is important not only for patient-facing applications but for provider-facing applications, especially those intended to support shared decision-making.
    OBJECTIVES:  Our objective is to describe models for effectively engaging patients and caregivers during CDS development and implementation and to inspire CDS developers to partner with patients and caregivers to improve the potential impact of CDS.
    METHODS:  This article serves as a case study of how two patient activists successfully implemented models for engaging patients and caregivers in a federal program designed to increase the uptake of research evidence into clinical practice through CDS. Models included virtual focus groups, social media, agile software development, and attention to privacy and cybersecurity.
    RESULTS:  Impact on the federal program has been substantial and has resulted in improved CDS training materials, new prototype CDS applications, prioritization of new functionality and features, and increased engagement of patient and caregiver communities in ongoing projects. Among these opportunities is a group of developers and patient activists dedicated and committed to exploring strategic and operational opportunities to codesign CDS applications.
    CONCLUSION:  Codesign and implementation of CDS can occur as a partnership among developers, implementers, patients, cybersecurity and privacy activists, and caregivers. Several approaches are viable, and an iterative process is most promising. Additional work is needed to investigate scalability of the approaches explored by this case study and to identify measures of meaningful inclusion of patients/caregivers in CDS projects.
    DOI:  https://doi.org/10.1055/s-0042-1750355
  6. J Clin Psychol Med Settings. 2022 Jun 29.
    Overconfidence in Managing Health Concerns: The Dunning-Kruger Effect and Health Literacy.
    Brittany E Canady, Mikayla Larzo.
      Health literacy is often low within the general population. The Dunning-Kruger effect (DKE) suggests that individuals may experience a cognitive bias in which they overestimate their own knowledge base. This study examines the DKE regarding health literacy and health behaviors. A community sample (n = 504) completed questionnaires measuring objective health literacy, confidence in health knowledge, and health behaviors and medical conditions. Results support the presence of a DKE for health literacy; individuals with low health literacy reported equal or greater confidence in health knowledge than individuals with higher health literacy. Individuals with lower health literacy reported more problematic engagement in health behaviors. Low health literacy can impact engagement in health behavior and effect health outcomes, but individuals may not realize this deficit. Implications for clinical intervention include the need to address cognitive bias and enhance motivation to participate in health literacy interventions.
    Keywords:  Cognitive bias; Dunning–Kruger effect; Health behavior; Health literacy
    DOI:  https://doi.org/10.1007/s10880-022-09895-4
  7. NPJ Prim Care Respir Med. 2022 Jun 29. 32(1): 23
    A qualitative assessment of the pulmonary rehabilitation decision-making needs of patients living with COPD.
    A C Barradell, C Bourne, B Alkhathlan, M Larkin, S J Singh.
      Pulmonary rehabilitation (PR) is highly evidenced but underutilised in patients living with chronic obstructive pulmonary disease (COPD). A menu of centre and home-based programmes is available to facilitate uptake but is not routinely offered. An appraisal of the current PR referral approach compared to a menu-based approach was warranted to explore the decision-making needs of patients living with COPD when considering a referral to PR. Face-to-face or telephone, semi-structured interviews were conducted with patients diagnosed with COPD and referred to PR and referring HCPs. Interviews were audio-recorded, transcribed verbatim and analysed using the enhanced critical incident technique. 14 HCPs and 11 patients were interviewed (n = 25). Interview data generated 276 critical incidents which informed 28 categories (30 sub-categories). Five high-level themes captured patients' decision-making needs for PR: Understanding COPD, understanding PR, perceived ability to access PR, a desire to accept PR, and supporting the offer. A menu-based approach would further support patients' PR decision-making, however, insufficient knowledge of the programmes would limit its perceived feasibility and acceptability. The development of shared decision making interventions (e.g., a patient decision aid) to elicit patient-centred, meaningful discussions about the menu is suggested.
    DOI:  https://doi.org/10.1038/s41533-022-00285-9
  8. Nurs Sci Q. 2022 07;35(3): 341-349
    Information Overload in Patient Education: A Wilsonian Concept Analysis.
    Tongyao Wang, Joachim G Voss.
      The authors of this concept analysis seek to clarify the concept of information overload within the context of patient education in healthcare. A modified six-step Wilsonian concept analysis method with a review of qualified manuscripts from PubMed, PsycInfo, CINAHL, and MEDLINE from 2000 to 2018 was conducted. Information overload occurs when an individual acknowledges that information received is beyond his or her information-absorbing threshold. The causes include quantity and quality of the information and information delivery structures. Information overload is associated with higher levels of stress and poor self-care performance. It is significant for healthcare providers to recognize patients' feelings of information overload.
    Keywords:  concept analysis; health literacy; patient education; self-care; stress
    DOI:  https://doi.org/10.1177/08943184221092451
  9. NPJ Breast Cancer. 2022 Jun 30. 8(1): 75
    Improving the odds together: a framework for breast cancer research scientists to include patient advocates in their research.
    Hillary Stires, Igor Bado, Thelma Brown, Martha Carlson, Isaac S Chan, Gloria V Echeverria, Andrew J Ewald, Bora Lim, Carla Lloyd, Julia Maues, Steffi Oesterreich, Robert N Riter, Kelly Shanahan, Alana L Welm, Josh Newby.
      Including patient advocates in basic cancer research ensures that breast cancer research is intentional, supports effective communication with broader audiences, and directly connects researchers with those who they are striving to help. Despite this utility, many cancer research scientists do not work with patient advocates. To understand barriers to engagement and build a framework for enhanced interactions in the future, we hosted a workshop with patient advocates and researchers who do engage, then discussed findings at an international metastatic breast cancer conference to solicit additional feedback and suggestions. Findings demonstrate that researchers are uncertain about how to initiate and maintain relationships with advocates. We offer actionable steps to support researchers working with patient advocates to improve cancer research and accomplish our collective goal of improving lives of those who have been diagnosed with breast cancer. We hope that this initiative will facilitate such collaborative efforts.
    DOI:  https://doi.org/10.1038/s41523-022-00440-y
  10. Med J Aust. 2022 Jun 26.
    Patient-reported outcome measures (PROMs) to guide clinical care: recommendations and challenges.
    Anupriya Agarwal, Rachael L Morton.
      
    Keywords:  Clinical decision-making; Continuity of patient care; Information services; Patient safety; Quality of health care; Quality of life
    DOI:  https://doi.org/10.5694/mja2.51625
  11. J Am Geriatr Soc. 2022 Jun 29.
    Automated telephone follow-up programs after hospital discharge: Do older adults engage with these programs?
    James D Harrison, Rebecca L Sudore, Andrew D Auerbach, Sachin Shah, Sandra Oreper, Margaret Meg Wheeler, Margaret C Fang.
       BACKGROUND: Health systems have developed automated telephone call programs to screen and triage patients' post-hospital discharge issues and concerns. The aims of our study were to determine whether and how older adults engage with automated post-hospital discharge telephone programs and to describe the prevalence of patient-reported post-discharge issues.
    METHODS: We identified all telephone calls made by an urban academic medical center as part of a post-hospital discharge program between May 1, 2018 and April 30, 2019. The program used automated telephone outreach to patients or their caregivers that included 11 distinct steps 3 days post-discharge. All adults discharged home from the hospital, were included, and we categorized patients into ≤64 years, 65-84 years, and ≥85 years age groups. We then compared call reach rate, completeness of 11-step calls and patient-reported issues between age groups.
    RESULTS: Eighteen thousand and seventy six patients were included. More patients 65-84 years old were reached compared to patients ≤64 years old (84.3% vs. 78.9%, AME 5.52%; 95%CI: 3.58%-7.45%). Completion rates of automated calls for those ≥85 years old were also high. Patients ≥85 years old were more likely to have questions about their follow-up plans and need assistance scheduling appointments compared to those ≤64 years old (19.0% vs. 11.9%, AME 7.0% (95%CI: 2.7%-11.3%).
    CONCLUSION: Post-hospital automated telephone calls are feasible and effective at reaching older adults. Future work should focus on improving discharge communication to ensure older adults are aware of their follow-up plan and appointments.
    Keywords:  health services delivery; telemedicine; transitional care
    DOI:  https://doi.org/10.1111/jgs.17939
  12. J Med Internet Res. 2022 Jul 01. 24(7): e36690
    The Influence of Wearables on Health Care Outcomes in Chronic Disease: Systematic Review.
    Graeme Mattison, Oliver Canfell, Doug Forrester, Chelsea Dobbins, Daniel Smith, Juha Töyräs, Clair Sullivan.
       BACKGROUND: Chronic diseases contribute to high rates of disability and mortality. Patient engagement in chronic disease self-management is an essential component of chronic disease models of health care. Wearables provide patient-centered health data in real time, which can help inform self-management decision-making. Despite the perceived benefits of wearables in improving chronic disease self-management, their influence on health care outcomes remains poorly understood.
    OBJECTIVE: This review aimed to examine the influence of wearables on health care outcomes in individuals with chronic diseases through a systematic review of the literature.
    METHODS: A narrative systematic review was conducted by searching 6 databases for randomized and observational studies published between January 1, 2016, and July 1, 2021, that included the use of a wearable intervention in a chronic disease group to assess its impact on a predefined outcome measure. These outcomes were defined as any influence on the patient or clinician experience, cost-effectiveness, or health care outcomes as a result of the wearable intervention. Data from the included studies were extracted based on 6 key themes, which formed the basis for a narrative qualitative synthesis. All outcomes were mapped against each component of the Quadruple Aim of health care. The guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement were followed in this study.
    RESULTS: A total of 30 articles were included; studies reported 2446 participants (mean age: range 10.1-74.4 years), and the influence of 14 types of wearables on 18 chronic diseases was presented. The most studied chronic diseases were type 2 diabetes (4/30, 13%), Parkinson disease (3/30, 10%), and chronic lower back pain (3/30, 10%). The results were mixed when assessing the impact on a predefined primary outcome, with 50% (15/30) of studies finding a positive influence on the studied outcome and 50% (15/30) demonstrating a nil effect. There was a positive effect of 3D virtual reality systems on chronic pain in 7% (2/30) of studies that evaluated 2 distinct chronic pain syndromes. Mixed results were observed in influencing exercise capacity; weight; and biomarkers of disease, such as hemoglobin A1c, in diabetes. In total, 155 outcomes were studied. Most (139/155, 89.7%) addressed the health care outcomes component. This included pain (11/155, 7.5%), quality of life (7/155, 4.8%), and physical function (5/155, 3.4%). Approximately 7.7% (12/155) of outcome measures represented the patient experience component, with 1.3% (2/155) addressing the clinician experience and cost.
    CONCLUSIONS: Given their popularity and capability, wearables may play an integral role in chronic disease management. However, further research is required to generate a strong evidence base for safe and effective implementation.
    TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42021244562; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=244562.
    Keywords:  chronic disease; health care outcome; wearable
    DOI:  https://doi.org/10.2196/36690
  13. BMC Prim Care. 2022 Jun 28. 23(1): 162
    Understanding the processes behind the decisions - GPs and complex multimorbidity decision making.
    Lloyd D Hughes.
      Complex multimorbidity, defined either as three or more chronic conditions affecting three or more different body systems or by the patients General Practitioner (GPs), is associated with various adverse outcomes. Understanding how GPs reach decisions for this complex group of patients is currently under-researched, with potential implications for health systems and service delivery. Schuttner and colleagues, through a qualitative approach, reported that internal factors of individuals (decisions tailored to patients; Primary Care Physician (PCP) consultation style; care planning towards an agreed goal of care), external factors within the environment or context of encounter (patient access to healthcare; organizational structures acting as barriers), and relationship-based factors (collaborative care planning; decisions within a dynamic patient clinician relationship) all influence care planning decisions. There are other important findings which have broader relevance to the literature such as the ongoing separation of physical and mental health which persist even within integrated care systems, GPs continue to prioritize continuity of care and that organizational barriers are reported as factors in clinician decision-making for patients. More broadly, the work has proved valuable in extending previously reported findings surrounding care coordination, and limitation of current guidelines for patients with complex multimorbidity. Work-load in general practice is increasing due to an ageing population, increasing prevalence of multimorbidity and polypharmacy, and transfer of clinical activities from secondary to primary care. The future for GPs is more complexity in the clinic room, understanding how GPs make decisions and how this can be supported is crucial for the sustainability for general practice.
    Keywords:  Complexity; Decision-Making; Multimorbidity
    DOI:  https://doi.org/10.1186/s12875-022-01781-0
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