bims-paceca Biomed News
on Patient-centred care
Issue of 2022–07–17
fiveteen papers selected by
Rob Penfold, Queensland Health
  1. A Multinational Study of Patient Preferences for How Decisions Are Made in Their Care.
  2. Shared decision making. Patient-centered evidence.
  3. The role of patients in the governance of a sustainable healthcare system: A scoping review.
  4. Adoption of Patient Engagement Strategies by Physician Practices in the United States.
  5. A theoretical systematic review of patient involvement in health and social care education.
  6. The Framing Dilemma: Quantitative Information, Shared Decision Making, and Nudging.
  7. A systematic review of patient-reported dignity and dignified care during acute hospital admission.
  8. Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021.
  9. Experiences of empathy training in healthcare: A systematic review of qualitative studies.
  10. Determinants of Poor Treatment Adherence among Patients with Type 2 Diabetes and Limited Health Literacy: A Scoping Review.
  11. There's an app for that, but nobody's using it: Insights on improving patient access and adherence to digital therapeutics in Germany.
  12. What Matters to Patients with Alzheimer's Disease and Their Care Partners? Implications for Understanding the Value of Future Interventions.
  13. Women's experiences and expectations of intimate partner abuse identification in healthcare settings: a qualitative evidence synthesis.
  14. Patient satisfaction with nursing care: A bibliometric and visualization analysis (1950-2021).
  15. Content features and its implementation in novel app-based psycho-oncological interventions for cancer survivors: a narrative review.
  1. Med Care Res Rev. 2022 Jul 11. 10775587221108749
    A Multinational Study of Patient Preferences for How Decisions Are Made in Their Care.
    Rachyl Pines, Nicola Sheeran, Liz Jones, Annika Pearson, Aron H Pamoso, Yin Blair Jin, Maria Benedetti.
      Inadequate consideration has been given to patient preferences for patient-centered care (PCC) across countries or cultures in our increasingly global society. We examined what 1,698 participants from the United States, Hong Kong, Philippines, and Australia described as important when making health care decisions. Analysis of frequencies following directed content coding of open-ended questions revealed differences in patients' preferences for doctor behaviors and decision-making considerations across countries. Being well informed by their doctor emerged as most important in decision-making, especially in Hong Kong. Participants in Australia and the United States wanted their doctor to meet their emotional needs. The safety and efficacy of treatments were the most common consideration, especially for Hong Kong. Findings suggest that doctors should focus on information exchange and identifying patient concerns about efficacy, lifestyle impact, cost, and recovery speed. Rather than assuming patients prefer shared decision-making, doctors must assess patient's decision control preferences.
    Keywords:  culture; health care decision-making; informed decision-making; patient-centered care; shared decision-making
    DOI:  https://doi.org/10.1177/10775587221108749
  2. Cir Esp (Engl Ed). 2022 Jul 06. pii: S2173-5077(22)00238-1. [Epub ahead of print]
    Shared decision making. Patient-centered evidence.
    Manuel López Cano, Josep M García-Alamino.
      
    DOI:  https://doi.org/10.1016/j.cireng.2021.10.022
  3. PLoS One. 2022 ;17(7): e0271122
    The role of patients in the governance of a sustainable healthcare system: A scoping review.
    Monica Aggarwal, Sukhraj Gill, Adeel Siddiquei, Kristina Kokorelias, Giulio DiDiodato.
      Patients, healthcare providers and insurers need a governance framework to establish the 'rules of use' to deliver more responsible use of services. The objective of this review was to provide an overview of frameworks and analyze the definitions of patient accountability to identify themes and potential gaps in the literature. Fifteen bibliographic databases were searched until July 2021. This included: MEDLINE, EMBASE, CINAHL, PsycINFO, SPORTDiscus, Allied and Complementary Medicine Database, Web of Science, HealthSTAR, Scopus, ABI/INFORM Global, Cochrane Library, ERIC, International Bibliography of the Social Sciences, Sociological Abstracts, Worldwide Political Science Abstracts and International Political Science Abstracts. Searches were also completed in Google Scholar. Inclusion criteria included articles focused on accountability of patients, and exclusions included articles that were not available, not written in English, with missing information, and commentaries or editorials. In total, 85530 unique abstracts were identified, and 27 articles were included based on the inclusion criteria. The results showed that patient accountability is rarely used and poorly defined. Most studies focused on what patients should be held to account for and agreed that patients should be responsible for behaviours that may contribute to adverse health outcomes. Some studies promoted a punitive approach as a mechanism of enforcement. Most studies argued for positive incentives or written agreements and contracts. While many studies recognized the value of patient accountability frameworks, there was a concern that these frameworks could further exacerbate existing socioeconomic disparities and contribute to poor health-related behaviours and outcomes (e.g., stigmatizing marginalized groups). Shared models of accountability between patients and healthcare providers or patients and communities were preferred. Before committing to a patient accountability framework for improving patient health and sustaining a healthcare system, the concept must be acceptable and reasonable to patients, providers, and society as a whole.
    DOI:  https://doi.org/10.1371/journal.pone.0271122
  4. Med Care. 2022 Jul 14.
    Adoption of Patient Engagement Strategies by Physician Practices in the United States.
    Chris Miller-Rosales, Valerie A Lewis, Stephen M Shortell, Hector P Rodriguez.
       BACKGROUND: Patient engagement strategies can equip patients with tools to navigate treatment decisions and improve patient-centered outcomes. Despite increased recognition about the importance of patient engagement, little is known about the extent of physician practice adoption of patient engagement strategies nationally.
    METHODS: We analyzed data collected from the National Survey of Healthcare Organizations and Systems (NSHOS) on physician practice adoption of patient engagement strategies. Stratified-cluster sampling was used to select physician practices operating under different organizational structures. Multivariable linear regression models estimated the association of practice ownership, health information technology functionality, use of screening activities, patient responsiveness, chronic care management processes, and the adoption of patient engagement strategies, including shared decision-making, motivational interviewing, and shared medical appointments. All regression models controlled for participation in payment reforms, practice size, Medicaid revenue percentage, and geographic region.
    RESULTS: We found modest and varied adoption of patient engagement strategies by practices of different ownership types, with health system-owned practices having the lowest adoption of ownership types. Practice capabilities, including chronic care management processes, routine screening of medical and social risks, and patient care dissemination strategies were associated with greater practice-level adoption of patient engagement strategies.
    CONCLUSIONS: This national study is the first to characterize the adoption of patient engagement strategies by US physician practices. We found modest adoption of shared decision-making and motivational interviewing, and low adoption of shared medical appointments. Risk-based payment reform has the potential to motivate greater practice-level patient engagement, but the extent to which it occurs may depend on internal practice capabilities.
    DOI:  https://doi.org/10.1097/MLR.0000000000001748
  5. Adv Health Sci Educ Theory Pract. 2022 Jul 16.
    A theoretical systematic review of patient involvement in health and social care education.
    Amber Bennett-Weston, Simon Gay, Elizabeth S Anderson.
      Patient involvement in health and social care education lacks theoretical underpinning, despite increasing calls for rigour. Theories help explain how learning is advanced and offer guidance for how faculty work with patients who become involved in curriculum delivery. We conducted a systematic review to synthesise how theory shapes our understanding of patient involvement in health and social care education. Three databases were systematically searched. Studies demonstrating explicit and high-quality application of theory to patient involvement in teaching and learning or involvement within a community of health and social care educators, were included. A narrative synthesis was undertaken using Activity Theory as an analytical lens to highlight the multifaceted components of patient involvement in professional education. Seven high-quality, theoretically underpinned studies were included. Four studies applied theory to pedagogy, showing how deep learning from patient involvement occurred. Despite a growing body of studies which attempt to use theory to explain learning, many were descriptive, lacked theoretical quality and were therefore excluded. Three studies applied theory to illuminate the complexity of involving patients in the educational system, showing how patients can be supported and valued in teaching roles. This review highlights that more work is required to identify the mechanisms through which patient involvement enhances learning and, to explore what involvement within the education community means for faculty and patients. Our understandings of patient-educator partnerships for learning could be progressed by further high-quality theory driven studies, which include the patient voice.
    Keywords:  Patient involvement; Professional education; Systematic review; Theoretical quality
    DOI:  https://doi.org/10.1007/s10459-022-10137-3
  6. Med Decis Making. 2022 Aug;42(6): 726-728
    The Framing Dilemma: Quantitative Information, Shared Decision Making, and Nudging.
    Peter H Schwartz.
      
    DOI:  https://doi.org/10.1177/0272989X221109830
  7. J Adv Nurs. 2022 Jul 16.
    A systematic review of patient-reported dignity and dignified care during acute hospital admission.
    Abdul-Ganiyu Fuseini, Lenore Ley, Helen Rawson, Bernice Redley, Debra Kerr.
       AIMS: To synthesize quantitative evidence on levels of dignity during acute hospital admission and identify barriers and facilitators to patients' dignity or dignified care from the perspective of hospitalized patients. The secondary aim was to examine the relationship between dignity and demographic, clinical and psychological characteristics of patients.
    DESIGN: A systematic review based on the protocol of the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline for reporting systematic reviews.
    DATA SOURCES: Five electronic databases (PubMed, CINAHL, Embase, PsycINFO, AgeLine) were searched in February 2021, followed by backward-forward searching using Web of Science and Scopus databases.
    REVIEW METHODS: Potentially eligible articles were scrutinized by two reviewers. Articles that met the eligibility criteria were appraised for quality using the Critical Appraisal Tool for Cross-Sectional Studies. Two reviewers extracted data for the review and resolved differences by consensus.
    RESULTS: Out of 3052 potentially eligible studies, 25 met the inclusion criteria. Levels of dignity for hospitalized patients vary widely across geographic locations. Patients' dignity is upheld when healthcare professionals communicate effectively, maintain their privacy, and provide dignity therapy. Patients' perceptions of dignity were, in some studies, reported to be associated with demographic (e.g. age, marital status, gender, employment, educational status), clinical (e.g. hospitalization, functional impairment, physical symptoms) and psychological (e.g. depression, anxiety, demoralization, coping mechanisms) variables whilst other studies did not observe such associations.
    CONCLUSION: Patients in acute care settings experience mild to a severe loss of dignity across different geographic locations. Patients' dignity is influenced by several demographic, clinical and psychological characteristics of patients.
    IMPACT: The findings of the review support impetus for improvement in dignified care for hospitalized patients, addressing factors that facilitate or impede patients' dignity. Measures aimed at alleviating suffering, fostering functional independence and addressing patients' psychosocial needs can be used to promote dignity.
    Keywords:  acute care; acute hospital admission; autonomy; communication; dignified care; dignity; healthcare professionals; nursing; patients; privacy; systematic review
    DOI:  https://doi.org/10.1111/jan.15370
  8. PLoS One. 2022 ;17(7): e0271524
    Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021.
    Mahmoud Tavousi, Samira Mohammadi, Jila Sadighi, Fatemeh Zarei, Ramin Mozafari Kermani, Rahele Rostami, Ali Montazeri.
       BACKGROUND: It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages.
    METHODS: The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021.
    RESULTS: The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties.
    CONCLUSION: This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.
    DOI:  https://doi.org/10.1371/journal.pone.0271524
  9. Patient Educ Couns. 2022 Jun 30. pii: S0738-3991(22)00295-6. [Epub ahead of print]
    Experiences of empathy training in healthcare: A systematic review of qualitative studies.
    Rachel Winter, Navin Leanage, Nia Roberts, Robert I Norman, Jeremy Howick.
       OBJECTIVE: To synthesise qualitative studies reporting student, practitioner, or patient experiences of empathy-training in healthcare.
    METHODS: We included qualitative studies exploring (i) student or practitioner experiences of empathy training, or (ii) patient experiences of being treated by someone who has undergone empathy training. We used the Critical Appraisal Skills Programme (CASP) tool to assess study quality. Thematic synthesis was used to integrate findings from studies and to generate new insights.
    RESULTS: Our search yielded 2768 citations, of which 23 (1487 participants) met inclusion criteria. Two clusters of themes were identified from included studies. Firstly, themes related to practitioner/trainee professionalism and wellbeing, where the main finding was that participants experienced benefit from therapeutic empathy training. Secondly, themes related to the understanding and treatment of patients, where the main finding was practitioners' deeper recognition of the positive impact of empathic care.
    CONCLUSIONS: This review found that taking part in empathy-focused training can benefit practitioner/student personal growth and professional development, and benefits patient care. This review is limited by the difficulty in defining empathy and heterogeneity amongst included studies.
    PRACTICE IMPLICATIONS: These results support a rationale for empathy training and the development of a framework to ensure training is having the desired effect.
    Keywords:  Empathy; Interdisciplinary education; Medical education; Qualitative research; Systematic review
    DOI:  https://doi.org/10.1016/j.pec.2022.06.015
  10. J Diabetes Res. 2022 ;2022 2980250
    Determinants of Poor Treatment Adherence among Patients with Type 2 Diabetes and Limited Health Literacy: A Scoping Review.
    Nasrin Pourhabibi, Bahram Mohebbi, Roya Sadeghi, Elham Shakibazadeh, Mojgan Sanjari, Azar Tol, Mehdi Yaseri.
      Prevention of complications and successful control of diabetes require preventive and therapeutic measures. Patients' nonadherence to medication and diet regimens and healthcare protocols is associated with significant therapeutic and economic consequences. The present scoping review aims to identify determinants of poor treatment adherence among patients with type 2 diabetes and limited health literacy in 2021. This scoping review was conducted in five stages: designing a research question, searching and extracting related studies, selecting related studies, tabulating information, and reporting results. Data were collected from six foreign electronic databases (Embase, Science Direct, PubMed, Google Scholar, Scopus, and Web of Science) and four Iranian electronic databases (MagIran, SID, IranDoc, and IranMedex) using keywords "Type 2 diabetes", "barriers", "treatment", "medication", "adherence", "non-adherence", "limited adherence", and "limited health literacy" from January 2010 to November 2021. From an initial 146 articles, 18 articles were eligible for review. Eighteen studies involving 3925 patients with T2DM from eight countries were included. The prevalence of nonadherence ranged from 42% to 74.3%. Barriers to treatment adherence, which were common among the articles, included economic problems, poor communication with healthcare team, lack of family support, lack of knowledge, misconceptions, and limited health literacy. The results of the present study provided modifiable and nonmodifiable factors affecting treatment adherence among patients with type 2 diabetes. Modifiable factors are essential by performing appropriate interventions with the target group and health professionals.
    DOI:  https://doi.org/10.1155/2022/2980250
  11. Digit Health. 2022 Jan-Dec;8:8 20552076221104672
    There's an app for that, but nobody's using it: Insights on improving patient access and adherence to digital therapeutics in Germany.
    Florian Dahlhausen, Maximillian Zinner, Linn Bieske, Jan P Ehlers, Philip Boehme, Leonard Fehring.
       Background: Mobile health applications and their subset digital therapeutics-defined as evidence-based software interventions to prevent, manage, or treat a medical condition-offer great potential to improve patient care. However, such solutions often struggle to reach widespread adoption.
    Objective: This study seeks to explore healthcare stakeholders' roles and potential for fostering patient access and adherence to evidence-based digital therapeutics and thereby improve health outcomes from the perspective of digital therapeutics developers and distributors.
    Methods: Semi-structured qualitative and semiquantitative interviews were conducted with 19 experts from developers and distributors of digital therapeutics in Germany to discuss their perceived relevance of different healthcare stakeholders and strategies in promoting patient access and adherence to digital therapeutics.
    Results: Healthcare professionals were found to have the greatest potential to promote both access and patient adherence to digital therapeutics, followed by health insurers, pharmaceutical companies, and patients themselves. In terms of patient access, healthcare professionals have potential due to their ability to prescribe digital therapeutics. Other stakeholders' potential stems from their capacity to influence healthcare professionals prescription decision. In terms of patient adherence, only healthcare professionals are of high relevance by onboarding patients and monitoring digital therapeutics use. Most healthcare stakeholders currently do not fully leverage their potential. Further educating healthcare professionals and simplifying processes for them, empowering patients to seek treatment with digital therapeutics, and designing digital therapeutics' product features for better adherence can help improve patient access and adherence.
    Conclusions: Established healthcare stakeholders and digital therapeutics developers both need to take action to improve patient access and adherence to digital therapeutics. Several macro-level changes can support these efforts, including broader information dissemination, improved financial incentives, simplified prescription and activation processes, and a wider adoption of blended care and pay-for-performance payment models.
    Keywords:  DTx; Mobile health; adherence; adoption; apps; digital health; digital therapeutics; healthcare professionals; mHealth; reimbursement
    DOI:  https://doi.org/10.1177/20552076221104672
  12. J Prev Alzheimers Dis. 2022 ;9(3): 550-555
    What Matters to Patients with Alzheimer's Disease and Their Care Partners? Implications for Understanding the Value of Future Interventions.
    F Jessen, J Georges, M Wortmann, S Benham-Hermetz.
      Alzheimer's Disease (AD) is the most common cause of dementia. Recent thinking portrays AD as a continuum consisting of three stages: an asymptomatic preclinical period, a mild cognitive impairment phase, and dementia, which can be further classified as mild, moderate or severe. While many studies explore the cognitive and functional aspects of AD, fully understanding AD pathophysiology, as well as the potential value of pharmacological and psycho-social interventions, requires a deeper understanding of patient and care partner priorities, particularly in the early stages where such interventions may have the greatest impact in slowing or delaying progression. Available studies highlight a diverse range of patient and care partner priorities, including impacts on their emotions, moods, and social lives. These priorities have not been systematically incorporated in the clinical and value assessments of potential interventions. We propose approaches to better understand the humanistic impact of AD including conducting additional research into the impacts of interventions from the point of view of patients and care partners, expanding notions of 'value' and improving health system capacity for diagnosis.
    Keywords:  Alzheimer’s Disease; dementia; patient preferences; value frameworks
    DOI:  https://doi.org/10.14283/jpad.2022.22
  13. BMJ Open. 2022 Jul 14. 12(7): e058582
    Women's experiences and expectations of intimate partner abuse identification in healthcare settings: a qualitative evidence synthesis.
    Evangelica Korab-Chandler, Minerva Kyei-Onanjiri, Jacqueline Cameron, Kelsey Hegarty, Laura Tarzia.
       OBJECTIVES: To explore women's experiences and expectations of intimate partner abuse (IPA) disclosure and identification in healthcare settings, focusing on the process of disclosure/identification rather than the healthcare responses that come afterwards.
    DESIGN: Systematic review and meta-synthesis of qualitative studies DATA SOURCES: Relevant studies were sourced by using keywords to search the databases MEDLINE, EMBASE, CINAHL, PsychINFO, SocINDEX and ASSIA in September 2021.
    ELIGIBILITY CRITERIA: Studies needed to focus on women's views about IPA disclosure and identification in healthcare settings, use qualitative methods and have been published in the last 5 years.
    DATA EXTRACTION AND SYNTHESIS: Relevant data were extracted into a customised template. The Critical Appraisal Skills Programme checklist for qualitative research was used to assess the methodological quality of included studies. A thematic synthesis approach was applied to the data, and confidence in the findings was appraised using The Confidence in the Evidence from Reviews of Qualitative research methods.
    RESULTS: Thirty-four studies were included from a range of healthcare settings and countries. Three key themes were generated through analysing their data: (1) Provide universal education, (2) Create a safe and supportive environment for disclosure and (3) It is about how you ask. Included papers were rated overall as being of moderate quality, and moderate-high confidence was placed in the review findings.
    CONCLUSIONS: Women in the included studies articulated a desire to routinely receive information about IPA, lending support to a universal education approach that equips all women with an understanding of IPA and options for assistance, regardless of disclosure. Women's suggestions for how to promote an environment conducive to disclosure and how to enquire about IPA have clear implications for clinical practice.PROSPERO registration numberCRD42018091523.
    Keywords:  PUBLIC HEALTH; QUALITATIVE RESEARCH; Quality in health care
    DOI:  https://doi.org/10.1136/bmjopen-2021-058582
  14. Int J Nurs Pract. 2022 Jul 12. e13076
    Patient satisfaction with nursing care: A bibliometric and visualization analysis (1950-2021).
    Waleed M Sweileh.
       AIM: The current study aimed to provide an overview of research publications on patient satisfaction with nursing care.
    BACKGROUND: Research activity on patient satisfaction with nursing care is an indicator of the commitment of policymakers to improve the quality of health services.
    DESIGN: This was a descriptive cross-sectional bibliometric study.
    METHODS: The Scopus database was used to retrieve relevant documents for the period from 1950 to 31 December 2021. The keywords 'patient satisfaction' and 'nursing care' were used in the search strategy. Two volunteers validated the search strategy.
    RESULTS: The search strategy found 387 documents authored by 1470 researchers and disseminated through 241 journals. Research on patient satisfaction with nursing care (a) has experienced a steep growth over the last decade; (b) was mainly published by scholars from a limited number of countries; (c) has limited cross-country collaboration and limited author collaboration; (d) has addressed research topics concerning the quality of care, instrument validation, emergency department and hospital care and (e) has shown the highest readability for topics related to nurses' burnout and patient satisfaction.
    CONCLUSION: Researchers and educators, especially in low- and middle-income countries, need to focus on this field to support activities to upgrade health services and patient outcomes.
    Keywords:  bibliometrics; nursing care; patient satisfaction; research activity
    DOI:  https://doi.org/10.1111/ijn.13076
  15. Curr Opin Oncol. 2022 Jul 01. 34(4): 313-319
    Content features and its implementation in novel app-based psycho-oncological interventions for cancer survivors: a narrative review.
    Franziska Springer, Anja Mehnert-Theuerkauf.
       PURPOSE OF REVIEW: The interest in and availability of app-based psycho-oncological interventions for cancer survivors has grown rapidly. In this narrative review, we therefore aim to provide an overview of the psychological content features included in psycho-oncological apps and how the content is implemented in the apps.
    RECENT FINDINGS: A total of 19 studies (six randomized controlled trials, six studies with prepost design, five study protocols and two app developments), all published in the last 18 months (July 2020 to December 2021), were analyzed in terms of the described app-based interventions and their psycho-oncological content. Apps for cancer survivors are conducted for a variety of different diagnoses and often target a specific patient population, for example patients with a specific therapy. The most frequent content features are psychoeducation, self-monitoring of symptoms, and some sort of exercise or relaxation program. Depending on the app's purpose, some offer specific content, such as decision aids, medication schedules or modules to improve coping strategies. Most apps combine informative and interactive elements.
    SUMMARY: Psycho-oncological apps for cancer survivors target many relevant psychological problem areas and aim to improve patient empowerment. Available mHealth interventions can therefore be seen as a good complement for cancer care and also offer the possibility to improve patient involvement.
    DOI:  https://doi.org/10.1097/CCO.0000000000000836
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