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1.
Objective
To test the effect of Choice, an interactive tailored patient assessment tool (ITPA), on cancer patients’ expressed cues and concerns (C&Cs), and clinicians’ responses to these C&Cs.Methods
97 experimental group consultations, where patients used the Choice ITPA to report their symptoms and problems in preparation to their consultation, were compared to 99 control group consultations. All consultations were audio-taped and coded using the Verona Coding Definitions of Emotional Sequences (VR-CoDES).Results
We identified 473 cues and 109 concerns with a mean number of 3.0 (SD = 3.2). The most frequent utterance was cue B (45.2%), indicating expression of uncertainty or hope. We found more C&Cs in consultations with the Choice ITPA compared to the control group (p < 0.01), and in consultations with nurses compared to physicians (p < 0.001). No differences in clinicians’ response types in the two groups were found. However, significant differences in response type between nurses and physicians were found.Conclusion
The Choice ITPA was an effective tool to disclose cancer patients’ cues and concerns.Practice implications
The Choice ITPA proved to be an effective intervention for cancer patients to express more C&Cs, but should be accompanied with communication skills training to potentially produce more patient-centered responses from the clinicians. (ClinicalTrials.gov number NCT00857103.) 相似文献2.
Pieterse AH Henselmans I de Haes HC Koning CC Geijsen ED Smets EM 《Patient education and counseling》2011,85(3):e251-e259
Objective
To assess clinicians’ use of shared decision making (SDM) skills, enabling patient treatment evaluations (appraisals); and varieties of patient appraisals and clinicians’ preceding and following utterances.Methods
Two coders rated videotaped initial visits of 25 early-stage prostate cancer patients to their radiation oncologist. SDM skills were assessed using the Decision Analysis System for Oncology (DAS-O); appraisals and clinicians’ utterances were labeled using qualitative methodology.Results
Clinicians offered a treatment choice to 10 patients. They informed 15/25 about pros and 20/25 about cons of options. Patients expressed 67 appraisals (median/visit = 2; range, 0-12). Half of appraisals were favorable and one-fourth was unfavorable toward treatment options. One-fifth referred to explicit tradeoffs. One-third of appraisals followed clinician requests; 58% followed clinician information. Clinicians approved almost half of appraisals. They contested, ignored or highlighted a minority.Conclusion
Clinicians infrequently offered patients a choice or explored appraisals. Most appraisals supported rather than challenged treatment options. Clinicians most often legitimized appraisals, thereby helping patients to feel good about the decision. Exploring appraisals may help patients in forming more stable preferences, thus benefiting patients in the long run.Practice implication
Clinicians should request patient appraisals and ascertain whether these seem well-informed before making treatment recommendations. 相似文献3.
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Matsuyama RK Wilson-Genderson M Kuhn L Moghanaki D Vachhani H Paasche-Orlow M 《Patient education and counseling》2011,85(3):e229-e236
Objective
Cancer patients receiving adjuvant therapy encounter increasingly complex situations and decisions with each new procedure and therapy. To make informed decisions about care, they need to be able to access, process, and understand information. Individuals with limited health literacy may not be able to obtain or understand important information about their cancer and treatment. The rate of low health literacy has been shown to be higher among African Americans than among non-Hispanic Whites. This study examined the associations between race, health literacy, and self-reported needs for information about disease, diagnostic tests, treatments, physical care, and psychosocial resources.Methods
Measures assessing information needs were administered to 138 newly diagnosed cancer patients. Demographics were assessed by survey and health literacy was assessed with two commonly used measures: the Rapid Estimate Adult Literacy in Medicine (REALM) and the Short Test of Health Literacy in Adults (STOFHLA).Results
Study findings indicate that educational attainment, rather than health literacy, is a significant predictor of information needs.Conclusion
Overcoming barriers to information needs may be less dependent on literacy considerations and more dependent on issues that divide across levels of educational attainment.Practice implications
Oncologists and hospital staff should be attentive to the fact that many patients require additional assistance to meet their information needs. 相似文献6.
Objective
This study tested the efficacy of a patient engagement intervention for older adults with multiple chronic illnesses.Methods
Seventy-nine participants were randomly assigned to receive the intervention (Intervention Group), contacts on a different topic (Safety Group), or Usual Care. The Intervention and Safety Groups attended a 2-h workshop and participated in phone calls; one before and one after a naturally-occurring medical encounter. The Intervention Group discussed patient engagement concepts from publicly distributed content. The Safety Group discussed general safety (e.g., fire safety, identity theft). Self-report measures were gathered by telephone interview at Baseline and 6-months following Baseline.Results
We did not find expected improvements in patient activation and health-related quality of life. However, the Intervention Group was the only group to show a statistically significant improvement in self-efficacy for self-management.Conclusion
The intervention shows promise for improving quality of life and/or health, but requires refinement to reach persons not already engaged in their healthcare and to strengthen its effects.Practice implications
Patient-directed skills training interventions may be a successful way to support clinicians’ and others’ efforts to encourage older patients to be actively involved in their care. 相似文献7.
Donal Flynn Peggy Gregory Mark Gabbay 《International journal of medical informatics》2009,78(9):588-604
Objectives
(1) To assess expectations and experiences of a new eHealth service by patients and staff in three primary care settings; (2) to ascertain attitudes to a range of future, primary care-oriented eHealth services.Design
Qualitative case study.Setting
Three UK general practices introducing an eHealth service for booking patient appointments.Participants
Ninety patients purposively selected from users and non-users of the new service and 28 staff (clinicians, management and administrative staff).Results
Actual patient use of the service was lower than stated intention. Patients and staff felt that more active promotion of the service would have resulted in more use. Low usage did not result in a negative assessment of the service by most staff. Different patient groupings were identified with characteristics that may be used as predictors of eHealth service use and indicators of training needs. GPs and patients expressed opposing viewpoints on a range of future eHealth services.Conclusions
Take-up of eHealth services may be lower than expected. To overcome patient barriers, factors that may narrow the intention-behaviour gap such as level of service promotion, GP endorsement, and usage by different patient groups, should be investigated. For clinician barriers, the eHealth evidence base needs strengthening, while for primary care practices, a learning process including staff training needs to be instituted. The differing views of patients and GPs about components of eHealth means that policymakers need to plan for a lengthy political process to obtain agreement on contentious issues if they are to achieve successful eHealth services. 相似文献8.
van Geffen EC Philbert D van Boheemen C van Dijk L Bos MB Bouvy ML 《Patient education and counseling》2011,83(3):303-309
Objective
To assess the extent to which patients feel they have received enough information on cardiovascular drugs and experienced counseling at the pharmacy. In addition, to identify factors that are predictors for patient satisfaction with the information received.Methods
Fifteen community pharmacies participated. New and chronic users of cardiovascular medication received a questionnaire containing sociodemographic and health questions, a measure of satisfaction with information received (SIMS), beliefs about medication (BMQ), and frequency of pharmacy counseling.Results
Of the 578 respondents, 335 (58%) indicated to be unsatisfied with the information received on 3 or more SIMS items. Patients’ age, beliefs about medication, duration of cardiovascular treatment and use of antithrombotics predicted patients’ satisfaction with information received. Two-thirds of patients reported ‘never’ to have experienced 5 of 8 counseling activities at the pharmacy.Conclusions
A considerable proportion of patients are unsatisfied with the information received on cardiovascular medication. The majority of patients have only received a limited scope of medication counseling at the pharmacy.Practice implications
Information and counseling should be tailored to patients’ needs and concerns about cardiovascular medication and the experience patients already have with treatment. Pharmacists could enhance their role in supporting patients using cardiovascular medication. 相似文献9.
Rebecca L. Mador 《International journal of medical informatics》2009,78(7):435-445
Purpose
The introduction of a Critical Care Information System (CCIS) into an intensive care unit (ICU) is purported to reduce the time health care providers (HCP) spend on documentation and increase the time available for direct patient care. However, there is a paucity of rigorous empirical research that has investigated these assertions. Moreover, those studies that have sought to elucidate the relationship between the introduction of a CCIS and the time spent by staff on in/direct patient care activities have published contradictory findings. The objective of this literature review is to establish the impact of a CCIS on time spent documenting and in direct patient care by staff in the ICU.Methods
Five electronic databases were searched including PubMed Central, EMBASE, CINAHL, IEEE Xplore, and the Cochrane Database of Systematic Reviews. Reference lists of all published papers were hand searched, and citations reviewed to identify extra papers. We included studies that were empirical articles, published in English, and provided original data on the impact of a CCIS on time spent documenting and in direct patient care by staff in the ICU.Results
In total, 12 articles met the inclusion criteria. Workflow analysis (66%) and time-and-motion analysis (25%) were the most common forms of data collection. Three (25%) studies found an increase in time spent charting, five (42%) found no difference, and four (33%) studies reported a decrease. Results on the impact of a CCIS on direct patient care were similarly inconclusive.Conclusions
Due to the discrepant findings and several key methodological issues, the impact of a CCIS on time spent charting and in direct patient care remains unclear. This review highlights the need for an increase in rigorous empirical research in this area and provides recommendations for the design and implementation of future studies. 相似文献10.
Jha AK Doolan D Grandt D Scott T Bates DW 《International journal of medical informatics》2008,77(12):848-854
Objective
To assess the state of health information technology (HIT) adoption and use in seven industrialized nations.Design
We used a combination of literature review, as well as interviews with experts in individual nations, to determine use of key information technologies.Main outcome measures
We examined rates of electronic health record (EHR) use in ambulatory care and hospital settings, along with current activities in health information exchange (HIE) in seven countries: the United States (U.S.), Canada, United Kingdom (UK), Germany, Netherlands, Australia, and New Zealand (NZ).Results
Four nations (the UK, Netherlands, Australia, and NZ) had nearly universal use of EHRs among general practitioners (each >90%) and Germany was far along (40-80%). The U.S. and Canada had a minority of ambulatory care physicians who used EHRs consistently (10-30%). While there are no high quality data for the hospital setting from any of the nations we examined, evidence suggests that only a small fraction of hospitals (<10%) in any single country had the key components of an EHR. HIE efforts were a high priority in all seven nations but the early efforts have had varying degrees of active clinical data exchange.Conclusion
We examined HIT adoption in seven industrialized nations and found that many have achieved high levels of ambulatory EHR adoption but lagged with respect to inpatient EHR and HIE. These data suggest that increased efforts will be needed if interoperable EHRs are soon to become ubiquitous in these seven nations. 相似文献11.
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Wendy G. Anderson Kathryn WintersRobert M. Arnold Kathleen A. PuntilloDouglas B. White Andrew D. Auerbach 《Patient education and counseling》2011,82(2):275-279
Objective
To assess the feasibility of studying physician-patient communication in the acute care setting.Methods
We recruited hospitalist physicians and patients from two hospitals within a university system and audio-recorded their first encounter. Recruitment, data collection, and challenges encountered were tracked.Results
Thirty-two physicians consented (rate 91%). Between August 2008 and March 2009, 441 patients were referred, 210 (48%) were screened, and 119 (66% of 179 eligible) consented. We audio-recorded encounters of 80 patients with 27 physicians. Physicians’ primary concern about participation was interference with their workflow. Addressing their concerns and building the protocol around their schedules facilitated participation. Challenges unique to the acute care setting were: (1) extremely limited time for patient identification, screening, and enrollment during which patients were ill and busy with clinical care activities and (2) little advance knowledge of when physician-patient encounters would occur. Employing a full-time study coordinator mitigated these challenges.Conclusion
Physician concerns for participating in communication studies are similar in ambulatory and acute care settings. The acute care setting presents novel challenges for patient recruitment and data collection.Practice implications
These methods should be used to study provider-patient communication in acute care settings. Future work should test strategies to increase patient enrollment. 相似文献13.
Objective
Most U.S. women obtain abortions at specialty clinics. This qualitative study explores abortion clinic patients’ opinions about receiving abortions from general women's health care providers.Methods
We conducted 20 h-long, semi-structured interviews with diverse women who had abortions in the U.S. Heartland. Each described her usual health care provider and how she accessed abortion care. We used qualitative analytic methods to organize and interpret the data.Results
Despite having a general provider, most women sought clinic abortions. Some women offered reasons for preferring specialty care and others for preferring abortion from their general provider. Most women assumed their general provider did not “do abortion” and many believed those providers were opposed to abortion. Women who had delivered a baby were concerned with their image in their general provider's eyes. Two women were denied care by their general providers.Conclusion
Women's preferences for abortion care centered on privacy, cost, empathy, ability to control their image, and desire for safe quality care. Two women who sought abortions through their general providers experienced negative repercussions.Practice implications
General providers should proactively make patients aware of their positions on abortion and if supportive indicate that they can provide that care and/or a referral. 相似文献14.
Maria L. Jibaja-Weiss Robert J. VolkThomas S. Granchi Nancy E. NeffEmily K. Robinson Stephen J. SpannNoriaki Aoki Lois C. FriedmanJ. Robert Beck 《Patient education and counseling》2011,84(1):41-48
Objective
To evaluate an entertainment-based patient decision aid for early stage breast cancer surgery in low health literacy patients.Methods
Newly diagnosed female patients with early stage breast cancer from two public hospitals were randomized to receive an entertainment-based decision aid for breast cancer treatment along with usual care (intervention arm) or to receive usual care only (control arm). Pre-decision (baseline), pre-surgery, and 1-year follow-up assessments were conducted.Results
Patients assigned to the intervention arm of the study were more likely than the controls to choose mastectomy rather than breast-conserving surgery; however, they appeared better informed and clearer about their surgical options than women assigned to the control group. No differences in satisfaction with the surgical decision or the decision-making process were observed between the patients who viewed the intervention and those assigned to the control group.Conclusions
Entertainment education may be a desirable strategy for informing lower health literate women about breast cancer surgery options.Practice Implications
Incorporating patient decision aids, particularly computer-based decision aids, into standard clinical practice remains a challenge; however, patients may be directed to view programs at home or at public locations (e.g., libraries, community centers). 相似文献15.
Mitchell B Armour C Lee M Song YJ Stewart K Peterson G Hughes J Smith L Krass I 《Patient education and counseling》2011,83(3):288-294
Objective
To evaluate the capacity and effectiveness of trained community pharmacists in delivering the Diabetes Medication Assistance Service (DMAS) via (1) number and types of self-management support interventions (SMSIs); (2) number of goals set and attained by patients and (3) patient outcomes (glycaemic control, medication adherence and satisfaction).Methods
Pharmacists (n = 109) from 90 community pharmacies in Australia were trained and credentialed to deliver the DMAS. The training focused on developing pharmacists’ knowledge and skills in supporting patients’ diabetes self-management.Results
A total of 387 patients completed the trial. The mean number of SMSIs per patient was 35 (SD ±31) and the majority (87%) had at least one documented goal that was fully or partially attained. There were significant health benefits for patients including improved glycaemic control and a reduced risk of non-adherence to medications. Over 90% of DMAS patients reported improvements in their knowledge about diabetes self-management.Conclusion
The DMAS provides self management support in the community pharmacy for people with T2DM which may result in improved clinical outcomes.Practice implication
Given appropriate training in diabetes care and behavior change strategies, community pharmacists can offer programs which provide self-management support to their patients with T2DM and improve their health outcomes. 相似文献16.
Lynne Robins Saskia WittebornLanae Miner Larry MaukschKelly Edwards Douglas Brock 《Patient education and counseling》2011,83(1):73-79
Objective
To categorize physician communication demonstrating understanding of what patients want to know and skill in conveying that information. Physicians underestimate how much information patients want and patients rarely seek information during clinic visits. Transparent communication is advocated to facilitate patient understanding and support autonomy, informed decision-making and relationship development.Methods
Analysis and coding of 263 audiotaped interactions between 33 primary care physicians and their patients in eight community-based, primary care clinics in Washington State, USA.Results
Physicians proactively used five types of process transparency to preview speech and actions. Four types of content transparency were used to explicate diagnosis and treatment, demystify medical language and concepts, and interpret biomedical information. Physicians spent the greatest proportion of clinic time explicating medical content.Conclusion
The primacy of information exchange over process-oriented, relational communication was demonstrated. Proactive transparency appears promising to increase understanding and collaboration.Practice implications
In patient-centered care where collaboration is the ideal, transparency in its various forms is a critical ingredient. Without much communicative effort, physicians who proactively communicated that an examination was over, that they were leaving the exam room briefly so patients could dress provided information that appeared to address patient uncertainty and demonstrated empathy and respect. 相似文献17.
Objective
To apply a dual visual/textual modal approach in developing and evaluating a medicine information leaflet with pictograms suitable for low-literate HIV/AIDS patients. To identify and recommend best practices in this type of information design.Methods
A simple leaflet incorporating pictograms was designed for an antiretroviral regimen. Cognitive testing for understanding was conducted in 39 low-literate, South African, antiretroviral-naïve adults. Participants were required to locate and explain the information, and were questioned on their opinion of leaflet layout and contents.Results
Average understanding of the leaflet was 60%. Basic medication information was the best understood. An overall lack of knowledge of HIV/AIDS and its core concepts was found. Only half the participants considered this simple leaflet “easy” to read. All endorsed the inclusion of pictograms.Conclusion
This testing method used in ARV-naïve individuals was invaluable in identifying areas needing modification before its use in patients. Text associated with pictograms was more noticeable and better understood, but only if they were closely juxtaposed.Practice implications
Leaflet design should consider culture and literacy skills, be informed by learning theory and design principles, include visuals to enhance appeal and improve understanding, and involve end-users. Verbal counseling should accompany written information. 相似文献18.
Hyla H. Polen Kevin A. Clauson Wendy Thomson Antonia Zapantis Jennie Q. Lou 《International journal of medical informatics》2009,78(10):679-687
Background
Nursing is arguably the most organizationally diverse healthcare profession. Educational backgrounds may vary, even among similarly credentialed nurses. Drug information databases used as clinical decision support tools can improve access to pharmacologic information at point-of-care when housed on personal digital assistants. They may also help address the disparity in drug information and pharmacology education between nurses.Objectives
To evaluate nursing-specific drug information database content on personal digital assistants (PDAs).Methods
Seven nursing-specific PDA databases were evaluated for scope (absence or presence of an answer) and completeness (three-point scale) via the use of 80 general category and 80 subspecialty drug information questions. Erroneous information was also tracked. Individual scope and completeness scores were delineated by rank order and chi square was performed to determine differences in scope and completeness scores between the databases.Results
Davis's Drug Guide for Nurses (DDGN) and Nursing Lexi-Drugs (NLD) tied for the highest scores for scope, including each answering 72.5% of the 160 evaluation questions. No significant differences existed between their scores and those earned by Nursing2008 Drug Handbook (p < 0.05). The highest scores for completeness were earned by NLD with 58.1% and DDGN at 57.1%. Saunders Nursing Drug Handbook was the only database that showed a significantly lower score in completeness as compared to the other six databases (p < 0.05). A 4.2% overall error rate was found among database answers.Discussion
Significant differences were found among the performances in the databases evaluated in this study for their ability to answer commonly encountered drug information issues in nursing practice. All databases contained some erroneous information and even the top performers failed to provide answers to more than one-fourth of the questions posed. The availability of accurate and timely drug information at point-of-care can play a vital role in patient management and outcomes, but current resources that are available need to be improved. 相似文献19.
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