Women’s preferences for and experiences with prenatal genetic testing decision making: Sociodemographic disparities in preference-concordant decision making

Objective

To investigate women’s preferred approach to prenatal genetic testing decision making and assess concordance between preference and experience.

Preferences for patient-centered care among cancer survivors 5 years post-diagnosis

ObjectiveOur primary objective was to identify predictors associated with preferences for patient-centered care among cancer survivors and the association between cancer health literacy and patient-centered care preferences.MethodsCross sectional analyses of N = 345 adult cancer survivors (5 years post cancer diagnosis) attending follow-ups at University Malaya Medical Centre, Malaysia. Face-to face-interviews were conducted using the 30-item Cancer Health Literacy Test and the Patient-Practitioner Orientation Scale to determine preference for patient-centered care.ResultsCancer survivors’ preference for patient-centered care was associated with a higher cancer health literacy score, higher educational level, being employed, breast cancer diagnosis, and not desiring psychological support [F (14, 327) = 11.25, p < 0.001, R² = 0.325].ConclusionFindings from this study provide insights into preferences for patient-centered care among cancer survivors during receipt of follow-up care, which remains an understudied phase of cancer care delivery.Practice implicationsEfforts are needed to ensure different preferences for care are taken into account particularly in the setting of variable cancer health literacy.     

Cultural competence and metaphor in mental healthcare interactions: A linguistic perspective

ObjectivesThe aim of this study is to understand how Spanish-speaking patients conceptualize mental health issues. This study uses a linguistic perspective to focus on how 23 Mexican-origin patients and their doctor talk about mental health during psychiatric interviews conducted in Spanish and how they negotiate cultural barriers.MethodsThis work analyzes when the doctor and his patients reference metaphors (e.g. feeling “empty,” feeling “low”). Metaphors are pervasive in all cultures and languages and reveal important information about people’s attitudes and feelings about a range of conditions and circumstances.ResultsThis work demonstrates the role of metaphor and linguistic analysis in uncovering culturally based constructions of mental health. The results reveal that the doctor and patients reference different sets of metaphors, which, at times, causes miscommunication.ConclusionsPractitioner awareness of how patients use metaphorical expressions in health is crucial for promoting advanced cultural and linguistic competence and ultimately, patient-centered care.Practice implicationsThe main findings have implications for health communication with minority groups such as Spanish-speaking Latinos/as in the United States. Practitioners working with Spanish-speaking patients should be familiar with how Latinos/as conceptualize health and how to avoid or repair confusion caused by cultural barriers.     

Treatment satisfaction mediates the association between perceived physician empathy and psychological distress in a community sample of individuals with chronic pain

ObjectiveWhile the benefits of patient-centered care have been consistently demonstrated in the health literature, there exists a dearth of pathway research within health outcome research, especially within the chronic pain context. This study examined the relationship between perceived physician empathy and patient psychological distress and its underlying mechanism.MethodsA community sample of 259 adults with chronic pain completed online questionnaires measuring patient-perceived physician empathy, treatment satisfaction, depressive and anxiety symptoms. Analyses were conducted using correlational and mediation analyses.ResultsResults revealed perceived empathy to be positively and strongly correlated with treatment satisfaction (r = .72, p < .001). A significant negative correlation was also demonstrated between perceived empathy and depressive symptoms (r = -.13, p < .05), but not between perceived empathy and anxious symptoms (r = .03, p = .65). Results revealed significant mediation models between perceived empathy and patient depressive symptoms (indirect effect: B = -.19, SE =.06, 95 % CI [-.31, -.09]) and anxious symptoms (indirect effect: B = -.24, SE = .06, 95 % CI [-.35, -.14]), via treatment satisfaction as mediator and including covariates.ConclusionChronic pain patients who perceive greater levels of physician empathy experience fewer depressive and anxious symptoms, as mediated by treatment satisfaction.Practice implicationsClinical training and practice should promote empathetic components of health communication within chronic pain treatment.     

VIG-Express: Consenso de un sistema de valoración multidimensional/geriátrica rápida en Cataluña

ObjetivoConsensuar una herramienta de valoración multidimensional/geriátrica rápida (VMGR), como sistema compartido y universal de valoración multidimensional de personas con multimorbilidad, fragilidad, complejidad o situación avanzada, para todos los profesionales del sistema de salud y social de Cataluña.DiseñoConsenso de profesionales en tres fases, combinando sesiones presenciales con trabajo telemático.EmplazamientoCataluña.ParticipantesSe constituyó un grupo de 27 profesionales de carácter interdisciplinario representativo de los distintos ámbitos de atención.MétodoSe han combinado las metodologías de Design thinking para el consenso inicial de características de la herramienta de VMGR (fase 1), con la metodología Lean Start-Up para el diseño de la nueva herramienta de VMGR (fase 2), que finalmente se testeó en un grupo de pacientes (fase 3).ResultadosEn la fase 1 se consensuó que la herramienta de VMGR ideal debía permitir una valoración ad hoc de las personas, ser rápida y ágil (tiempo < 10 minutos), identificar las dimensiones alteradas mediante preguntas trigger y facilitar el diagnóstico de situación (idealmente cuantificado). En la fase 2 se elaboró el prototipo de una nueva herramienta de VMGR de 15 + dos preguntas (VIG-Express), finalmente testeada en 35 personas en la fase 3.ConclusionesEn los resultados preliminares, la herramienta VIG-Express parece facilitar una valoración multidimensional sencilla y rápida y la personalización de las intervenciones, así como una mirada única y un relato compartido entre los profesionales de los distintos ámbitos de atención. Serán necesarios más estudios para corroborar estos hallazgos.Palabras clave: Evaluación geriátrica, Consenso, Diagnóstico de la situación, Atención dirigida al paciente, Sistemas de atención de salud integrada     

Assessing the Concurrent Validity and Interrater Reliability of Patient-Led Screening Using the Malnutrition Screening Tool in the Ambulatory Cancer Care Outpatient Setting

BackgroundThe prevalence of malnutrition in cancer patients is reported as high as 65%; however, malnutrition screening is often substandard. The Malnutrition Screening Tool (MST) has been validated for use by health care professionals to detect at-risk patients; however, there is a gap in the literature regarding validation of patient-led MST screening.ObjectiveThe aim of the study was to assess the concurrent validity of patient-led MST against the Subjective Global Assessment (SGA) and the interrater reliability of patient-led MST against dietitian-led MST in patients attending ambulatory cancer care services for chemotherapy or supportive treatments.Design/participantsA single-site diagnostic accuracy study of 201 patients between May and June 2017 attending the ambulatory cancer care setting at an Australian metropolitan tertiary hospital in Queensland.Main outcome measurementsThe primary outcome measures were concurrent validity and interrater reliability of MST scores as determined by patients (patient-MST), dietitians (dietitian-MST), and SGA as completed by the dietitian.Statistical analysisConcurrent validity of patient-led MST scores against the SGA was determined using specificity, sensitivity, positive predictive values, and negative predictive values. Interrater reliability of patient-MST and dietitian-MST was assessed using κ coefficient.ResultsThe ability of the patient-led MST scores (0 to 1 vs 2 to 5) to indicate nutrition status was found to have a sensitivity of 94% (95% CI 81% to 99%), a specificity of 86% (95% CI 79% to 91%), and an area under the receiver operating characteristic curve of 0.93 (95% CI 0.89 to 0.96). The positive predictive value was 59% (95% CI 45% to 71%), and the negative predictive value was 99% (95% CI 95% to 100%). A weighted κ of 0.83 (95% CI 0.82 to 0.87) between patient-MST and dietitian-MST was found.ConclusionPatient-led MST screening is a reliable and valid measure that can accurately identify ambulatory cancer care patients as at risk or not at risk of malnutrition.     

美国卫生体系整合模式探索及其对我国的启示

我国正在大力探索建设优质高效的以人为本的整合型医疗卫生服务体系。面对卫生体系严重的碎片化问题,美国近年来在卫生服务的整合方面做了不少尝试。其中,在建设责任型保健组织（Accountable Care Organization,ACO）和以患者为中心的医疗之家（Patient-Centered Medical Home,PCMH）方面取得了一些有益的经验。本文在文献综述基础上探讨了这两类实践的主要做法、成果、问题,及其对我国支付方式改革、医疗卫生机构整合、基层医疗卫生服务团队建设、卫生信息体系整合及如何因地制宜推进整合改革的相关启示。     

Empowerment in people with Parkinson’s disease: A scoping review and qualitative interview study

ObjectiveTo synthesize empowerment definitions in Parkinson’s disease (PD) literature and understand people with PD’s perspective on empowerment in the context of an existing empowerment conceptual model.MethodsThis mixed-methods study included a scoping review of PD empowerment literature and interviews with adults with PD. Five databases were searched for articles that defined empowerment concepts. We analyzed 1:1 semi-structured interviews on empowerment with people with PD. All data were analyzed using hybrid thematic analysis.ResultsEight of 242 records were included in this review. Empowerment is defined as an intrapersonal (e.g., personal control over oneself or healthcare) or interpersonal construct (e.g., person-centered care). Thirty-seven participants completed the interview. Participants perceived empowerment as a multifaceted concept that interacts with determinants and moderators from different ecological levels.ConclusionEmpowerment is a noteworthy multilevel and relational construct that can interplay with important health-related factors. The developed working conceptual model of empowerment can inform future studies to explore empowerment concepts in more depth and develop PD empowerment-based interventions.Practice implicationsThe empowerment definitions, indicators, determinants, and moderators identified in this study can help researchers, clinicians, and policymakers critically conceptualize empowerment and develop interventions to support people with PD.     

以患者为中心的护理模式在腹腔镜胆囊切除术中的应用及对患者应激反应的影响

目的 探讨以患者为中心的护理模式在腹腔镜胆囊切除术中的应用效果及对患者应激反应的影响.方法 选取2019年3月至2021年3月于我院行腹腔镜胆囊切除术的64例患者,按照入组单双顺序平均分为观察组(以患者为中心的护理模式)与对照组(常规急诊护理)各32例.比较两组的生理应激反应、心理应激反应和术后恢复情况.结果 干预后,...