Patient's education by nurse: what we really do achieve?

AIM: To evaluate what is really achieved with nurse education in an outpatient heart failure population. METHOD: The answers obtained in a nurse questionnaire performed at the first visit to the Unit and at 1 year of follow-up were compared. The questionnaire was addressed to know how compliant patients were and how much they knew about their disease and their treatment. RESULTS: Two hundred and ninety eight patients (219 men and 79 women) were evaluated. Baseline mean age was 65 years (35-86). At first visit only 30% knew and understood the performance of the heart; 56% at 1 year (p<0.001). Only 28% initially understood the disease; 55% at follow-up (p<0.001). Awareness of more than 3 worsening signs increased from 66.5% to 86.5% (p<0.001). Knowledge of the names of all the pills they were receiving increased from 33% to 44% (p<0.001), of the action of these pills from 24% to 44% (p<0.001), and of how to use nitroglycerine among patients with ischemic heart disease from 87% to 96% (p<0.001). Initially 63% monitored their weight only at the medical visit and 21% monitored it at least once a week; at 1 year these percentages were 16% and 39% respectively (p<0.001). At baseline 45% checked blood pressure only at the medical visit and 28.5% checked it at least once a week; at 1 year these percentages were 12% and 43% (p<0.001). Whereas no significant differences were found in sodium restricted diet compliance, exercise performance increased slightly although statistically significantly (p=0.01). The great majority of patients never or only very rarely smoked or drunk alcoholic beverages, both at first visit and at 1 year, although both habits increased slightly during follow-up. No significant differences in treatment compliance (92% vs. 88% were taking all the medications prescribed) were found. CONCLUSION: Nurse-guided education has changed self-care behaviour of patients with heart failure in several important aspects, as weight and blood monitoring, and has increased their knowledge and understanding of the disease and treatment. However, these improvements have not been reflected in a better compliance of treatment and sodium restricted diet. Such aspects need more and more work to obtain better results.     

Quantity and quality of information desired by Portuguese cancer patients

 Disclosure of the diagnosis of cancer to the patients affected has always been a controversial issue in the doctor–patient relationship. Undoubtedly this is so not only because of differences between countries and cultures, but also because there have been changes of opinion over the years. The aim of this study was to evaluate the quality and quantity of information desired by Portuguese cancer patients, and how and from whom they want to hear this information. Our sample comprised a total of 193 cancer patients, 87 men and 106 women. We found that 68.9% knew what their diagnosis was. In our sample, 74% wanted "as much information as possible, good or bad"; 85% said they wanted to know if their disease was cancer; 95% wanted to know the best or worst likely outcome of their disease; and 96.4% wanted to know the chances of getting cured. Most patients said they would prefer to be informed by physicians (92.7%) and have access to a telephone helpline, books and television. In conclusion, most patients wanted to know as much as possible about their illness and treatment, and the majority preferred to be involved in treatment decisions. Published online: 9 September 1999     

Childhood and adolescent cancer survivors' knowledge of their disease and effects of treatment.

Most children diagnosed with cancer will become survivors of their disease. However, a large number of these children may be at risk for the development of late complications. It is not clear whether these survivors and their families are aware of their treatment history including diagnosis, treatment, and the late complications of their treatment. The purpose of this needs assessment was to ascertain survivors' knowledge of their disease, the various treatment modalities, and whether they were aware of their individual risks for developing late complications of their treatment. A brief six-item questionnaire was developed to determine survivors' knowledge of their cancer treatment and to be completed just before at their survivor visit. A total of 141 survivors completed this questionnaire. The mean age at diagnosis was 6.8 years, and the median age at the time of this assessment was 16 years. Although all of the subjects stated they knew their disease, only 84% (n = 118) listed their diagnosis. The majority of the survivors knew they received chemotherapy, but only 50% were able to list one or more specific drugs they received. Further lack of knowledge was also evident for survivors who received radiotherapy. The results of this assessment represent a lack of knowledge especially of the survivors' individual risk for developing late complications of their therapy. Education about late complications of therapy should be introduced early and often such as at diagnosis, within months of the completion of therapy, and during every survivor clinic visit. A complete treatment summary should be provided to all survivors. This summary should include the survivors' individual risks for developing late complications and how their own health behaviors may influence the development of these late complications.     

Using medical records for older patient education in ambulatory practice

The effectiveness of sharing medical records in improving physician-older patient communication was evaluated in 203 ambulatory chronically ill older patients (mean age, 70.1 years) by a randomized controlled trial. Ninety-five experimental group patients received copies of their physicians' progress notes 1 week after their last office visit, and 108 control patients did not. After 1-2 weeks, knowledge of health problems, medication, and nonmedication treatments was assessed by interview. Experimental group patients knew 74.1% of their health problems, compared with 64.1% in the control groups (P less than 0.05). There was no difference in knowledge of medications or adherence to medication regimens. Experimental group patients displayed higher treatment knowledge scores than control group patients (P less than 0.01). Less-educated patients showed greater adherence to nonmedication treatments. Shared medical records can enhance physician-older patient communication about health problems and nonmedication treatments, but they do little to enhance medication knowledge or adherence to medication regimens.     

Use of the Internet by patients and their families to obtain genetics-related information

OBJECTIVE: To characterize use of the Internet by patients and their families referred to general genetics clinics. PATIENTS AND METHODS: We developed a survey to assess Internet use among patients visiting urban and rural clinics in Colorado and Wyoming. One hundred eighty-nine surveys were distributed to patients and their family members visiting outpatient general genetics clinics in spring 2000. The 8-page anonymous survey instrument asked about use of the Internet to obtain genetics-related information (GRI). All participants were asked whether a physician or health professional had referred them to the Internet for GRI. Subjects who had previously used the Internet to search for GRI were asked to rate whether they considered the GRI they encountered to be accurate, inaccurate, easy to understand, confusing, or trustworthy. RESULTS: One hundred fifty-seven surveys (83%) were returned (52% urban; 48% rural). Ninety (60%) of 149 respondents were at the clinic for a new-patient visit, and 59 (40%) were follow-up visits. All respondents were older than 17 years; 141 (91%) of 155 respondents were the patient's parent or guardian. Seventy-three (47%) of 155 respondents had searched the Internet for GRI prior to their clinic visit. The patients and families themselves initiated the majority of such efforts; only 8 (5%) of 148 respondents had been referred to a site on the World Wide Web by a physician. Interestingly, 136 (92%) of 147 respondents indicated that they would be likely to visit a Web site that was recommended by a geneticist. The most compelling reasons for searching the Internet for GRI were to get information in layperson's terms (60/131 [46%]); to get information about treatment (16/131 [12%]); and to get information about genetic research (16/131 [12%]). Among respondents who reported visiting GRI Web sites, 24 (41%) of 58 agreed that information was confusing or difficult to understand, 35 (53%) of 66 agreed that information was accurate and trustworthy, and 44 (77%) of 57 agreed that using the Internet was a positive experience. CONCLUSION: Internet use among patients referred to general genetics clinics and their family members appears to be widespread. Respondents reported that they found some of the information confusing and questioned its accuracy. Referral to Web sites by physicians was reported rarely, although the majority of respondents said they would visit a Web site recommended by a genetics physician. Further studies are needed to establish the accuracy of Internet information and how best to integrate and/or accommodate the data into the genetics clinic.     

Exploring knowledge and skills on HIV in student nurses and midwives

A cross-sectional survey design using a self-administered questionnaire was sent to a sample of 62 final-year student nurses and midwives to describe their knowledge of, skills related to, and attitudes towards, human immunodeficiency virus/acquired immune deficiency syndrome. Out of the 47 respondents who return the questionnaire, only 53% stated that they had received class instruction on the topic and 63.8% claimed to have increased their knowledge mainly from reading professional journals. Although only 32% said that they had cared for a patient or knew of a family member or another person with the disease, 91% indicated that they were willing to care for such patients. Overall, the respondents demonstrated positive attitudes towards this group of patients and a good level of knowledge about the subject, although some gaps were evident. However, a large majority stated that their skills to cater for the physical and psychological needs of this group of patients were deficient and would like further training.     

Cancer patient education in Iran: a descriptive study

Abstract. This study was carried out to examine the status of cancer patient education in Iran. Using the Multinational Association of Supportive Care in Cancer's (MASCC) patient education questionnaire, 310 individuals - a sample of heterogeneous cancer patients ( n=167) and their relatives ( n=143) - were enrolled in the study. The pooled results indicated that only 15% of respondents believed more than 80% of cancer patients were told of their diagnosis. In contrast, 30% of respondents thought less than 20% of patients knew their cancer diagnosis. When asked, "Were you given written materials about (i) cancer, (ii) treatment, and (iii) symptom management", the vast majority of respondents said "No" (91%, 87%, and 87%, respectively). When respondents were asked, "Would you like to learn more about cancer and treatments", 97% said "Yes". Most respondents indicated the need for information on the treatments available (27%) and general information about cancer (20%); most had sought information from health professionals (31%), other cancer patients and friends (29%), and television (22%). Finally, it was found that concern about patients' depression (17%), lack of printed materials (13%), the idea that it was better for patients not to know (12%), and families' requests not to tell the patient (11%) were the most frequently stated barriers to or reasons for restricted cancer patient education. The findings of the study suggest that cancer patient education in Iran is very poor and there is an urgent need to develop policy guidelines on disclosure of cancer diagnoses and patient education.     

Health care service utilization among the elderly: findings from the Study to Understand the Chronic Condition Experience of the Elderly and the Disabled (SUCCEED project)

Rationale and objectives Age‐related effects on health service utilization are not well understood. Most previous studies have examined only a single specific health care service or disease condition or have focused exclusively on economic variables. We aim to measure age‐related change in health care utilization among the elderly. Methods A population‐based retrospective cohort study was conducted using linked data from four administrative databases (OHIP, ODB, CIHI and RPDB). All Ontario residents over the age of 65 years and eligible for public health coverage were included in the analysis (approximately 1.6 million residents). Main outcome measures include utilization indicators for family physician visits, specialist physician visits, Emergency Department visits, drugs, lab claims, X‐rays, inpatient admissions, CT scans and MRI scans. Results The mean number of utilization events for Ontarians aged 65+ years for the 1‐year study period was 70 events (women = 76, men = 63). The overall absolute difference between the 65–69 age group and the 85+ age group was 155% (women = 162%, men = 130%), or 76 more events per person in the older group (women = 82, men = 61). Women averaged more events per person than men, as well as greater percentage differences by age. Drugs and diagnostics account for the majority of events. Only MRI and specialist visits were not higher among the older age groups. Conclusions At the population level, overall health care utilization would appear to increase significantly with age. It is unclear whether increasing health care utilization prevents morbidity, decreases mortality, or improves quality of life.     

Emergency department patient knowledge of medications

Therapeutic decisions made by Emergency Physicians are often influenced by which prescribed medications are being taken by patients. We sought to assess Emergency Department (ED) patients’ knowledge of their medications by using a survey. A convenience sample of adult ED patients was surveyed verbally by a research assistant. Two-hundred patients were enrolled. Only 48% of patients could recall or produce a list or the actual bottles of all of their medications, 39% knew the times they take their medications, and only 24% knew all the dosages. Seventeen percent brought a list or the actual medication bottles with them to the ED. Patients who had a primary care physician knew all their medications 51% of the time, compared to 43% who did not have a physician. Fifty-one percent of insured patients compared to 38% of non-insured patients could identify all of their medications. Although knowledge of medications is often critical for decision making in the ED, a significant number of patients are unable to provide this information.     

End of life care: a discursive analysis of specialist palliative care nursing

AIM: The aim of this paper is to consider alternative approaches to service delivery for patients with chronic life-limiting illnesses other than cancer. It will also discuss the issues that arise when considering specialist palliative care services within a broader public health context in the United Kingdom. BACKGROUND: Contemporary specialist palliative care in the United Kingdom can be said to have two main client groups: the majority are people with a diagnosis of cancer, and a minority are those with a number of other chronic illnesses. From the evidence to date, patients dying from chronic, non-malignant disease experience a considerable number of unmet needs in terms of symptom control and psychosocial support. Although debates in the literature over the last decade have challenged the focus of specialist palliative care services on patients with a cancer diagnosis, only a minority of those with other chronic illnesses receive specialist palliative care services. DISCUSSION: Current models of specialist palliative care may not be the most appropriate for addressing the complex problems experienced by the many patients with a non-cancer diagnosis. We suggest that care should be structured around patient problems, viewing specialist palliative care as a service for those with complex end of life symptoms or problems. A role for innovative nurse-led care is proposed. CONCLUSION: Reframing the approach to specialist palliative care in the United Kingdom will require great effort on the part of all health and social care professionals, not least nurses. Critical and creative thinking are prerequisites to the development of new models of working. We suggest that a more coherent approach to research and education is required, in particular strategies that explore how patients and nurses can work together in exploring experiences of illness in order to develop more proactive approaches to care.     

妇科内分泌专家门诊医患交流质量的现状调查

目的了解妇科内分泌专家门诊医患交流中的情况及问题,以便改进工作,提高诊疗质量。方法采用自编《妇科内分泌专家门诊的医患交流质量评估表》对2010年4～8月期间在四川大学华西第二医院妇科内分泌专家韩字研教授门诊就诊的403例女性患者进行调查。结果患者提供病史和接受诊疗信息的情况:通过医生询问病史,只有29%(118/403)和38%(152/403)的患者能准确提供既往治疗史和检查情况。当医生向患者交代本次检查情况及治疗意见后,仅21%(86/403)的患者能准确理解检查结果,27%(108/403)的患者能准确理解处理和治疗意见。相关性分析显示,患者提供病史和接受诊疗信息的准确性在21～40岁年龄组高于≤20岁年龄组,初中及以上文化程度组高于小学组,非医护患者组低于医护患者组,差异均有统计学意义(P值均<0.05)。患者就诊态度:医患交流中,有55%(222/403)的患者希望得到医生更多关注,37.5%(151/403)的患者对医疗的期望值过高。结论在妇科内分泌专家门诊,大多数患者因受年龄、文化程度和职业影响,不能准确提供既往检查和治疗史,也不能准确理解本次检查情况和治疗意见,另外,患者的心理需求值得关注。     

Gender Differences in Emergency Department Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Objectives: Although more men are diagnosed as having chronic obstructive pulmonary disease (COPD), its prevalence is increasing among women. Little is known about gender differences in exacerbations of COPD. The objective of this study was to determine if acute presentation, management, and outcomes differ among men and women seeking care in the emergency department (ED) for exacerbation of COPD. Methods: This was a secondary analysis of a prospective cohort study of ED patients aged 55 years or older who presented with an exacerbation of COPD. Subjects underwent structured interviews in the ED and two weeks later. Results: The cohort consisted of 397 subjects with COPD, of whom 52% were women. Self-report of COPD only tended to be more common among men (61% of men vs. 52% of women), while mixed COPD/asthma tended to be more common among women (39% vs. 48%; p = 0.10). Despite reporting similar chronic symptom severity, women were less likely than men to use anticholinergic agents before their ED visit (59% vs. 69%; p = 0.04). During the exacerbation, women initiated less home therapy and were less likely to seek emergency care within the first 24 hours of symptom onset (25% vs. 36%; p = 0.01). Although ED care and disposition were similar, post-ED outcomes differed. At two-week follow-up, men were more likely to report an ongoing exacerbation (42% vs. 31%; p = 0.03). Conclusions: Men and women who present to the ED for treatment of an exacerbation of COPD have substantial differences in long-term medication use, self-treatment during exacerbation, delay in emergency care, and post-ED outcomes. Further studies are warranted to confirm and explain these gender-related differences.     

Diabetic patients with prior specialist care have better glycaemic control than those with prior primary care

OBJECTIVE: To compare glycaemic control, as reflected in the A1c level, of diabetic patients with primary care vs. with specialist care. METHODS: The study used administrative data from eastern Ontario, Canada, and a database containing the results of all A1c tests from this region between 1 September 1999 and 1 September 2000. To avoid referral bias, diabetic patients with an index specialist visit were selected and separated into those with exclusively primary care previously (n = 974) and those with prior specialist care (n = 3533). We compared A1c levels measured within 30 days of the index visit and hence attributable to the prior care. To control for confounding between the groups, both multiple linear regression and propensity score-based matching were used. RESULTS: After controlling for confounders, patients with prior specialist care had significantly lower A1c levels (P < 0.0001). Other predictors of lower A1c included older age, shorter diabetes duration, rural residence and higher neighbourhood income. In propensity score-matched cohorts, the A1c level was 8.3 +/- 2.0% with prior primary care vs. 7.9 +/- 1.6% with prior specialist care (P < 0.0001). CONCLUSIONS: Specialist care prior to the index visit was associated with a lower A1c level than prior primary care. This difference would result in reductions in diabetes complications for patients with ongoing specialist care.     

FOLLOW-UP OF BREAST CANCER: TIME FOR A NEW APPROACH?

After treatment for breast cancer women are monitored for recurrent disease by means of routine hospital-based follow-up appointments. The aim of this study is to determine the efficiency of this system, by establishing how recurrence presents to our hospital. The study comes at a time of increasing pressure on breast clinics from new patient referrals and the need, since April 1999, to see all cases classified as urgent within two weeks of referral. A consecutive series of 643 patients who presented with operable breast cancer between 1992 and 1998 were reviewed. Details about the 108 patients who had locoregional or metastatic relapse were obtained from our breast cancer database and their clinical records. Full data were available on 104 patients: 77 (74%) were seen at expedited (interval) appointments and a further 18 (17.3%) drew attention to symptoms at a routine visit. Two cases of locoregional recurrence were revealed by surveillance imaging. Unsuspected disease, locoregional in all cases, was detected on examination in 7 (6.7%) patients. The median time to presentation of recurrence was 19 months for metastatic and 18 months for locoregional disease. Breast cancer recurrence usually presents to an interval clinic. Most cases that are confirmed following a routine review are already symptomatic. Long-term routine hospital follow-up after treatment for breast cancer appears inefficient and unnecessary. Following liaison with local general practitioners we propose to discharge patients from routine review after two years. Thereafter they will have scheduled appointments with their GPs with immediate access to specialist review in the breast care unit if required.     

糖尿病联络护士工作情况调查与分析

目的：了解医院糖尿病联络护士自2006年以来在临床开展糖尿病专科护理工作的情况,为下一步更好地发挥联络护士的作用提供参考。方法：自设糖尿病联络护士工作情况调查表,从一般情况、专科知识掌握和临床指导三方面对全院65名糖尿病联络护士进行问卷调查,并对调查结果进行统计、分析。结果：糖尿病联络护士对常用操作及相关知识比较熟悉,掌握率达89％以上,而对专科性较强的知识掌握率较低,仅为49．23％;有73．85％的联络护士能对科内护士进行专科知识培训,86．15％～92．31％的联络护士能主动纠正科内护士的不规范操作;65名联络护士共指导病人约7030人次。结论：糖尿病联络护士能发挥网络作用,为病人提供专业指导,使病人受益;能纠正科内护士不规范的操作,使全院糖尿病专科护理工作更加规范。     

Attitudes to contraception in women seeking termination of pregnancy

This study of attitudes toward contraception among women seeking abortion involved consecutive patients seen at intervals over a 10-month period. 253 women with an age range of 14-47 years were interviewed. Medical contraindications to use of the combined oral contraceptive (OC) pill were reported by 32 women (12.6%). In 17 cases the woman, not her doctor, had decided to stop OC use. The IUD was contraindicated in 8 women (3.2%). The women who used no contraception included a few who relied on the safe period or withdrawal. In those aged 19 or younger, 56 (57%) used no method at the time of conception and 39 of these had never used any contraceptive method. Sheath failure was said to have occurred in 80 conceptions (31.6%), and 15 women (5.9%) fitted with an IUD conceived. 32 women (12.6%) conceived while taking the combined OC. 27 of these women were aware that they had forgotten to take 1 or more of their pills. 2 women were prescribed antibiotics and were not advised to use other precautions. 2 women were taking a 20 mg estrogen pill, and it was only in these 2 that any method failure could be identified. All but 5 of the 133 women who selected the combined pill were under age 30. Tubal ligation was chosen by 14 of the 31 women aged 35 or older. Sources of information on contraception and associated fears were recorded, and women in whom either the pill or the IUD was contraindicated are excluded. In younger women the doctor was used less as a source of information than friends or books but more than school, boyfriend, or husband. The doctor was used more by women aged 30 or older. The number of women with "fears" was sizeable. 55.7% of those aged 19 or under lacked useful maternal advice. 28 said they had problems in obtaining contraceptive supplies and advice. There were 12 young women aged 14 or 15, 8 of whom had not sought contraceptive advice since they did not have boyfriends and their sexual encounters were isolated and unpremeditated. The advice reported to have been given by some doctors seems to have been inappropriate. All the women aged 30 years or older not needing contraception had undergone tubal ligation. The interviews were found to be helpful to many patients. Some found it useful to have an impartial listener at a time of emotional stress. Others found more positive help in clarifying their ideas and correcting misbeliefs. Planning for the future was considered particularly helpful.     

Characteristics of patients with upper respiratory tract infection presenting to a walk-in clinic

OBJECTIVE: To profile patients with upper respiratory tract infection (URI) presenting to a walk-in clinic, to quantify their perspectives on the need for antibiotic therapy, and to find out their predictions of future behavior for similar illnesses. PATIENTS AND METHODS: In the spring of 1998, previsit and postvisit questionnaires were distributed at the clinic to patients 18 years of age or older with URI symptoms. RESULTS: Based on 210 completed previsit questionnaires, 161 respondents (77%) had been ill 5 or more days, 200 (95%) had cough, 177 (84%) had phlegm, 132 (63%) had sinus pain, and 79 (38%) had fever. Additionally, 54 patients (26%) reported a history of chronic obstructive pulmonary disease, asthma, or chronic sinusitis, and 37 (18%) were smokers. Most patients were between 18 and 40 years of age. The 210 patients were categorized into 2 groups: those who believed that antibiotics were necessary (157 [75%]) and those who believed antibiotics were unnecessary (53 [25%]). The only statistically significant difference between the 2 groups was in patients with sinus pain: 109 (69%) wanted antibiotics compared with 23 (43%) who did not (P<.001). Of the 210 patients, 130 completed postvisit questionnaires, 129 (99%) of whom reported satisfaction with the clinic visit. All patients who either desired or received antibiotics indicated they would likely seek medical care for future URIs. CONCLUSIONS: The majority of patients with presumed URI presenting to this walk-in clinic expect to receive treatment with antibiotics. Of our 130 study patients, 83 (64%) received antibiotics regardless of their desire for antibiotic treatment. Satisfaction with the office visit was independent of patients' initial beliefs about antibiotics and whether antibiotics were prescribed.     

Implications of the Facing Dementia Survey for health care professionals across Europe

Approximately 600 general practitioners, primary care physicians and specialists in six European nations (France, Germany, Italy, Poland, Spain and UK) who treat patients with Alzheimer's disease (AD) were interviewed during the Facing Dementia Survey. Compared with generalists, specialists displayed the most optimism regarding the effects of age, believing that health and memory do not inevitably deteriorate as one grows older. Most physician respondents agreed that the diagnosis of AD is too often delayed. A primary reason cited for this delay was the difficulty experienced by both physicians and the general public in identifying early signs of AD. Many physicians believed treatments are available that can slow the disease course. The vast majority surveyed in each nation believed that early treatment of AD can delay disease progression [mean, 87%; range, 68% (United Kingdom) to 96% (Poland)]. More than half of physicians who initiate treatment in France (66%), Germany (59%), Italy (82%), Poland (82%) and Spain (69%) said they institute treatment for AD immediately after diagnosis. The exception was the United Kingdom, where 48% initiated treatment immediately, whereas more than half waited at least a month to start therapy. To a large extent, physicians saw the governments of their countries as a hindrance rather than a help in caring for persons with AD.