bims-paceca Biomed News
on Patient-centred care
Issue of 2022–09–18
eleven papers selected by
Rob Penfold, Queensland Health
  1. Shared decision-making in cardiac care: can we close the gap between good intentions and improved outcomes?
  2. Decision-Making Ability: A Missing Link Between Health Literacy, Contextual Factors, and Health.
  3. Impact of low health literacy on patients' health outcomes: a multicenter cohort study.
  4. Community health literacy outcome measurement practices: A scoping review of recent interventions.
  5. Experiences of interaction between people with cancer and their healthcare professionals: A systematic review and meta-synthesis of qualitative studies.
  6. Can Humanism Be Infused Into Clinical Encounters in a Time-Constrained, Technology-Driven Era?
  7. Available tools to evaluate digital health literacy and engagement with eHealth resources: A scoping review.
  8. Prehabilitation and Rehabilitation for Patients with Lung Cancer: A Review of Where we are Today.
  9. What would it take to die well? A systematic review of systematic reviews on the conditions for a good death.
  10. Strategies for Enhancing the Implementation of Universal Mental Health Prevention Programs in Schools: A Systematic Review.
  11. Using incorpoRATE to examine clinician willingness to engage in shared decision making: A study of Family Medicine residents.
  1. Heart. 2022 Sep 14. pii: heartjnl-2022-321482. [Epub ahead of print]
    Shared decision-making in cardiac care: can we close the gap between good intentions and improved outcomes?
    Sandra Lauck, Krystina Lewis.
      
    Keywords:  education, medical; quality of health care
    DOI:  https://doi.org/10.1136/heartjnl-2022-321482
  2. Health Lit Res Pract. 2022 Jul;6(3): e213-e223
    Decision-Making Ability: A Missing Link Between Health Literacy, Contextual Factors, and Health.
    René Rüegg.
       BACKGROUND: Health literacy has often been described as an important precondition for good health decisions, healthy behaviors, and health. However, reviews reveal low evidence for intervention effectiveness through health literacy. This result calls for more investigations to be done in the pathway from health literacy to health, considering intermediate outcomes of health literacy.
    OBJECTIVE: This study explores an important immediate objective of health literacy, namely the decision-making ability (DMA) regarding health issues. The study's hypothesis claims the DMA to be an important mediator between health literacy and health outcomes. Furthermore, the study assumes that the effect of the DMA on different health outcomes is not only contingent on health literacy but also on contextual factors. To test the above hypotheses, six different health literacy dimensions and four health outcomes have been analyzed.
    METHODS: Cross-sectional data from the Young Adult Survey Switzerland was used for mediation analyses (N = 4, 569, age, 18 to 25 years, all male). Multiple regression and KHB (Karlson, Holm, and Breen) decomposition analyses were applied to estimate mediation effects between health literacy and health outcomes.
    KEY RESULTS: Five of six health literacy dimensions explained the DMA in a linear regression model. The coefficients of the DMA explaining health outcomes were substantially reduced when health literacy items were included into the models (6.1%-20.3%). Furthermore, the associations between health literacy and the health outcomes were fully explained by contextual factors, except in the mental health model.
    CONCLUSIONS: The results support the hypothesis that higher health literacy levels do not necessarily lead to better health directly. Rather, health literacy is just one of multiple factors contributing to a higher DMA and, further, to favorable health outcomes. The results of this study call for more investigations in the health decision-making process and the role of contextual factors. [HLRP: Health Literacy Research and Practice. 2022;6(3):e213-e223.] Plain Language Summary: The study investigated the ability to make good health decisions while considering health literacy. The results support the intermediate function of the decision-making ability on the path to favorable health outcomes. Furthermore, it is found that the DMA as well as health literacy are highly contingent on contextual factors. The results shed light into the complex decision-making process regarding health issues.
    DOI:  https://doi.org/10.3928/24748307-20220718-01
  3. BMC Health Serv Res. 2022 Sep 12. 22(1): 1148
    Impact of low health literacy on patients' health outcomes: a multicenter cohort study.
    Rabia Shahid, Muhammad Shoker, Luan Manh Chu, Ryan Frehlick, Heather Ward, Punam Pahwa.
       BACKGROUND: This study aims to assess the health literacy of medical patients admitted to hospitals and examine its correlation with patients' emergency department visits, hospital readmissions, and durations of hospital stay.
    METHODS: This prospective cohort study recruited patients admitted to the general internal medicine units at the two urban tertiary care hospitals. Health literacy was measured using the full-length Test of Functional Health Literacy in Adults. Logistic regression analyses were performed to examine the correlation between health literacy and the desired outcomes. The primary outcome of interest of this study was to determine the correlation between health literacy and emergency department revisit within 90 days of discharge. The secondary outcomes of interest were to assess the correlation between health literacy and length of stay and hospital readmission within 90 days of discharge.
    RESULTS: We found that 50% had adequate health literacy, 32% had inadequate, and 18% of patients had marginal health literacy. Patients with inadequate health literacy were more likely to revisit the emergency department as compared to patients with adequate health literacy (odds ratio: 3.0; 95% Confidence Interval: 1.3-6.9, p = 0.01). In patients with inadequate health literacy, the mean predicted probability of emergency department revisits was 0.22 ± 0.11 if their education level was some high school or less and 0.57 ± 0.18 if they had completed college. No significant correlation was noted between health literacy and duration of hospital stay or readmission.
    CONCLUSIONS: Only half of the patients admitted to the general internal medicine unit had adequate health literacy. Patients with low health literacy, but high education, had a higher probability of emergency department revisits.
    Keywords:  Emergency department revisit; Health literacy; Hospital readmission; Length of stay; Patient outcomes
    DOI:  https://doi.org/10.1186/s12913-022-08527-9
  4. Health Sci Rep. 2022 Sep;5(5): e810
    Community health literacy outcome measurement practices: A scoping review of recent interventions.
    Luke Sawyers, Claire Anderson, Parisa Aslani, Gregory Duncan, Sobia S Janjua, Li Shean Toh.
       Introduction: Evidence suggests that, while a preference for functional Health Literacy (HL) outcome measurement exists, researchers are converging towards more all-encompassing instruments. While this claim is present in the HL field, minimal research has comprehensively explored the state of community HL measurement practices at the direct and proxy level. The almost exclusive focus on direct, as opposed to proxy, community HL measurement indicates a review of progress is needed.
    Objective: To identify HL outcome measurement practices for community HL interventions at the direct and proxy level of measurement.
    Search Strategy: Medline, PsycINFO, Web of Science, ERIC, Embase, Scopus, CINAHL, ProQuest Dissertations and Theses, Google Scholar and targeted websites were searched.
    Inclusion Criteria: Studies were sampled from the general population, included HL as an outcome of interest, involved an intervention aiming to improve HL, were English-text publications and were published ≥2010.
    Data Extraction and Synthesis: Study author(s) and publication years, sample characteristics, intervention profiles and direct and proxy instrument and outcome measurement information were extracted. Full-text review retrieved 25 eligible studies.
    Main Results: In total, 21 unique direct and 38 unique proxy instruments were extracted. The majority of interventions assessed functional compared to communicative, critical, and other HL domains, with objective instruments more frequently used than subjective or combined objective-subjective types, though more unique subjective HL instruments were extracted overall. The Test of Functional HL in Adults was the most popular instrument, and perceived health, knowledge, behaviors and health intentions were the most frequent proxy outcome measures, with only the Healthy Lifestyle Behavior Scale-II and Patient Activation Measure used across multiple interventions.
    Discussion and Conclusions: Direct HL outcome practices endured a unidimensional profile, despite previous suggestions of a convergence towards holistic instruments. This review provides the first overview of proxy HL measurement across community HL interventions, identifying substantial variation in proxy outcome practices.
    Patient or Public Contribution: A University-based senior librarian contributed to the development of the search strategy, and reviewed iterations of the strategy until refinement was complete. No further public or patient contribution was made given the review-based nature of the research.
    Keywords:  community; health literacy; intervention; measurement; outcome; review
    DOI:  https://doi.org/10.1002/hsr2.810
  5. Eur J Oncol Nurs. 2022 Aug 31. pii: S1462-3889(22)00106-5. [Epub ahead of print]60 102198
    Experiences of interaction between people with cancer and their healthcare professionals: A systematic review and meta-synthesis of qualitative studies.
    Romain Collet, Mel Major, Maarten van Egmond, Marike van der Leeden, Rhea Maccow, Anne Eskes, Martijn Stuiver.
       PURPOSE: This study investigates patients' experiences of interaction with their healthcare professionals (HCPs) during cancer treatment and identifies elements that HCPs can utilize to improve cancer care provision.
    METHODS: PubMed, CINAHL, PsycINFO, SCOPUS, and Embase were systematically searched for relevant studies published from January 2010 until February 2022. Qualitative studies investigating adult patients' perspectives on their interaction with HCPs during cancer treatment were included. Studies conducted during the diagnosis or end-of-life treatment phase were excluded. Duplicate removal, screening, and quality appraisal were independently performed by four reviewers using Covidence.org. We performed a thematic meta-synthesis of qualitative data extracted from studies meeting the quality criteria in three stages: excerpts coding, codes categorization, and theme identification by merging similar categories.
    RESULTS: Eighty-eight studies were included for quality appraisal, of which 50 papers met the quality inclusion criteria. Three themes were identified as essential to positively perceived patient-HCP interaction: "Support, respect and agency", "Quantity, timing, and clarity of information", and "Confidence, honesty, and expertise". Overall, patients experienced positive interaction with HCPs when the approach was person-centered and when HCPs possessed strong interpersonal skills. However, patients expressed negative experiences when their preferences regarding communication and the type of personal support needed were ignored.
    CONCLUSIONS: This meta-synthesis emphasizes the importance for HCPs to recognize all patients' needs, including communication and personal support preferences, to provide high-quality care. Consequently, healthcare professionals should continuously train their verbal and non-verbal communication, empathy, active listening, and collaboration skills during their undergraduate and continuing education.
    Keywords:  Allied health personnel; Nurse-patient relations; Oncology nursing; Patient-centered care; Physician-patient relations; Professional-patient relations; Qualitative research; Systematic review
    DOI:  https://doi.org/10.1016/j.ejon.2022.102198
  6. Cureus. 2022 Aug;14(8): e27836
    Can Humanism Be Infused Into Clinical Encounters in a Time-Constrained, Technology-Driven Era?
    Ami Schattner.
      A humanistic, personal, empathic, and patient-centered attitude towards the patient and family during the clinical encounter is often neglected in many settings. However, patients give it an utmost priority; moreover, the Institute of Medicine stressed it as a fundamental approach to improve the quality of care in the US, and the potential benefits accrued by its implementation are substantial. These benefits encompass patients (including increased satisfaction, trust, adherence, and 'hard' health outcomes), physicians (including rediscovering meaning and escaping burnout), and health care systems. Highlighting the quintessential value of humanism and patient-centeredness in the encounter, we discuss the cornerstones of adopting a 'personal' attitude that requires sincere friendly 'connecting' to the patient which can be accomplished with little loss of time, and their myriad advantages, to motivate clinicians to be more mindful of the patient and his or her circumstances.
    Keywords:  clinical encounter; communication; empathy; humanism; patient-centered care; patient-physician relationship; quality of care
    DOI:  https://doi.org/10.7759/cureus.27836
  7. Heliyon. 2022 Aug;8(8): e10380
    Available tools to evaluate digital health literacy and engagement with eHealth resources: A scoping review.
    Alice Faux-Nightingale, Fraser Philp, Darren Chadwick, Baldev Singh, Anand Pandyan.
       Background: As eHealth and use of information and communication technologies (ICT) within healthcare becomes widespread, it is important to ensure that these forms of healthcare are accessible to the users. One factor that is key to accessing eHealth is digital health literacy.
    Objectives: This scoping review assesses available tools that can be used to evaluate digital health literacy.
    Methods: A systematic literature search was made in MEDLINE, CINAHL, APA PsychInfo, Ageline, AMED, and APA PsychArticles to present the tools currently in use to assess digital health literacy. A qualitative synthesis of the evidence was carried out using a data charting form created for this review. Extracted data included details of the population of investigation and digital health literacy tool used. A report was produced following PRISMA-ScR guidelines.
    Results: In total, 53 papers with adult participants and 3 with adolescent participants (aged between 12 and 19 years) were included in the scoping review. 5 questionnaires were identified that measured digital health literacy or attitudes towards the internet, of which the eHealth Literacy Scale (eHEALS) was the most commonly used questionnaire for both adults and children. Two children's questionnaires were often accompanied by a second task to verify the accuracy of the responses to the eHEALS questions.
    Conclusions: eHEALS is the most commonly used method to assess digital health literacy and assess whether an individual is able to engage actively with eHealthcare or virtual resources. However, care needs to be taken to ensure that its administration does not exclude digitally disadvantaged groups from completing it. Future research would benefit from assessing whether digital health literacy tools are appropriate for use in clinical settings, working to ensure that any scales developed in this area are practical and can be used to support the allocation of resources to ensure that people are able to access healthcare equitably.
    Keywords:  Access to care; Health literacy; Health technology/technology assessment; Information technology; Social deprivation
    DOI:  https://doi.org/10.1016/j.heliyon.2022.e10380
  8. Clin Oncol (R Coll Radiol). 2022 Sep 07. pii: S0936-6555(22)00373-9. [Epub ahead of print]
    Prehabilitation and Rehabilitation for Patients with Lung Cancer: A Review of Where we are Today.
    C Burnett, J C Bestall, S Burke, E Morgan, R L Murray, S Greenwood-Wilson, G F Williams, K N Franks.
      Lung cancer is the third most common type of cancer in the UK, with nearly 50 000 new cases diagnosed a year. Treatments for lung cancer have improved in recent years with the advent of new surgical and radiotherapy techniques and the increased use of immunotherapies. These advances have resulted in increasing numbers of patients surviving beyond the completion of their treatment. Lung cancer patients are now not dying from their cancer diagnosis, but from other co-existing pathologies. Lung cancer patients commonly present with multiple comorbidities. Mitigating the effects of poor lifestyles and changing behaviours may improve the efficacy of treatments, reduce side-effects and improve the quality of life for lung cancer patients. Published evidence supports the use of interventions to manage behavioural habits, to optimise the health of patients. There is no consensus as to what, when or how to embed these into the patient pathway. Supporting patients before, during and after their cancer treatments to increase activity, eat well and stop smoking have been seen to decrease side-effects and improve patient outcomes and wellbeing. The challenge is to provide a package of interventions that is acceptable to patients and fits within the patient pathway so as not to conflict with diagnostic and therapeutic activities. This article reviews where we are today with providing behavioural support to optimise the health of lung cancer patients undergoing treatment.
    Keywords:  Behavioural support; lung cancer; prehabilitation; rehabilitation
    DOI:  https://doi.org/10.1016/j.clon.2022.08.028
  9. Lancet Healthy Longev. 2021 Sep;pii: S2666-7568(21)00097-0. [Epub ahead of print]2(9): e593-e600
    What would it take to die well? A systematic review of systematic reviews on the conditions for a good death.
    Mehreen Zaman, Sara Espinal-Arango, Ashita Mohapatra, Alejandro R Jadad.
      The medicalisation of life under the influence of health-care systems, focused on curing diseases, has made dying well challenging. This systematic review identifies common themes from published systematic reviews about the conditions for a good death as a means to guide decisions around this universal event. MEDLINE, Embase, APA PsycInfo, and AMED were searched for citations with "good death" or "dying well" in their titles on Sept 23, 2020, and complemented with backward reference and forward citation screening with Google Scholar. Articles published in peer-reviewed journals in any language were included. Articles that focused on the identification of conditions for a good death and described how primary studies were sought and selected were also included. Data on general characteristics, quality, and themes were extracted independently. 13 of 275 potentially eligible reviews were included. Common themes were dying at the preferred place, relief from pain and psychological distress, emotional support from loved ones, autonomous treatment decision making, avoidance of futile life-prolonging interventions and of being a burden to others, right to assisted suicide or euthanasia, effective communication with professionals, and performance of rituals. No reviews specified the meaning or timing of death, connected themes, or prioritised them. Vague jargon was often used to describe complex concepts. Most conditions for a good death could be offered to most dying people, without costly medical infrastructure or specialised knowledge. Efforts to describe these conditions clearly, to identify whether there are exceptions or missing items, and whether they apply in non-dominant settings (ie, outstide institutional, affluent, anglophone, and Christian settings) are needed.
    DOI:  https://doi.org/10.1016/S2666-7568(21)00097-0
  10. Prev Sci. 2022 Sep 13.
    Strategies for Enhancing the Implementation of Universal Mental Health Prevention Programs in Schools: A Systematic Review.
    Rachel Baffsky, Rebecca Ivers, Patricia Cullen, Jessica Wang, Lauren McGillivray, Michelle Torok.
      A number of school-based mental health prevention programs have been found to be effective in research trials, but little is known about how to support implementation in real-life settings. To address this translational problem, this systematic review aims to identify effective strategies for enhancing the implementation of mental health prevention programs for children in schools. Four electronic databases were searched for empirical, peer-reviewed articles in English from January 2000 to October 2021 reporting the effects of implementation strategies for school-based universal mental health programs. Twenty-one articles were included in the narrative synthesis and assessed for quality using the Mixed Methods Appraisal Tool. Twenty-two strategies were found to be effective at improving program fidelity or adoption. The strategies with the strongest positive evidence base were those that involved monitoring and provision of feedback, engaging principals as program leaders, improving teachers' buy-in and organising school personnel implementation meetings. We recommend school-based practitioners trial strategies with positive findings from this review as part of their continuous quality improvement. This review highlights the pressing need for large-scale, randomised controlled trials to develop and trial more robust strategies to enhance adoption, as the five implementation studies found to measure adoption used qualitative methods limited by small samples sizes and case study designs.
    Keywords:  Implementation science; Mental health; Prevention; School-based interventions; Systematic review
    DOI:  https://doi.org/10.1007/s11121-022-01434-9
  11. Patient Educ Couns. 2022 Aug 23. pii: S0738-3991(22)00390-1. [Epub ahead of print]
    Using incorpoRATE to examine clinician willingness to engage in shared decision making: A study of Family Medicine residents.
    Roland Grad, Amrita Sandhu, Michael Ferrante, Vinita D'Souza, Lily Puterman-Salzman, Samira Abbasgholizadeh Rahimi, Gabrielle Stevens, Glyn Elwyn.
       OBJECTIVES: We evaluated the willingness of Family Medicine residents to engage in SDM, before and after an educational intervention.
    METHODS: We delivered a lecture and a workshop for residents on implementing SDM in preventive health care. Before the lecture (T1), participants completed a measure of their willingness to engage in SDM. Six months later, participants completed the measure a second time (T2).
    RESULTS: At T1, 64 of 73 residents who attended the educational session completed incorpoRATE. Six months later, 44 of 64 participants completed the measure a second time (T2). The range of incorpoRATE sum scores at T1 was from 4.9 to 9.1 out of 10. Among the 44 participants who completed incorpoRATE at both time points, the mean scores were 7.0 ± 1.0 at T1 and 7.4 ± 1.0 at T2 (t = -2.833, p = 0.007, Cohen's D = 0.43).
    CONCLUSION: Among Family Medicine residents, the willingness to engage in SDM is highly variable. This suggests a lack of consensus in the mind of these residents about SDM. Although mean scores at T2 were significantly higher, we question the educational importance of this change.
    PRACTICE IMPLICATIONS: incorpoRATE is a promising measure for educators. Understanding how willing a particular physician audience is to undertake SDM, and which elements require attention, could be helpful in designing more targeted curricula. Further research is needed to understand how the perceived stakes of a clinical situation influence physician willingness to engage in SDM.
    Keywords:  Attitude of health personnel; Communication; Education; Internship and residency; Learning; Measurement; Physicians; Shared decision making; Training
    DOI:  https://doi.org/10.1016/j.pec.2022.08.012
This page is being maintained by Thomas Krichel. It was last updated on 2024‒11‒22 at 4:26.