Insights about interventions to address food insecurity in adults with type 2 diabetes: Valuable lessons from the stories of African Americans living in the inner city

ObjectivesThis qualitative study aimed to gain insight from the perspectives of food insecure African Americans living in an inner city regarding important diabetes intervention strategies and components.MethodsUsing a grounded theory approach, two focus groups (totaling 16 individuals) were conducted in Milwaukee, Wisconsin. Purposive, convenience sampling was used to identify food insecure adults with diabetes. Questions were asked using a moderator guide to explore challenges and barriers to managing diabetes within the context of food insecurity, and facilitators or resources that helped participants improve diabetes management. Questions were open ended and followed by probes asking for additional perspectives and personal experiences related to the overarching topic, and questions asking to clarify statements.ResultsOverarching concepts and themes specific to possible interventions discussed during the focus groups included group education, peer support, access to community resources and programs, stress management, and faith-based programs as desired intervention outcomes.ConclusionsKey findings from the current study show that inner-city African Americans with diabetes desire interventions that foster social and community support systems.Practice ImplicationsGiven this insight, more robust and comprehensive interventions are needed to account for the multifaceted experience of food insecurity and diabetes within the inner-city environment.     

A systematic review of interventions for family caregivers who care for patients with advanced cancer at home

ObjectiveTo examine the characteristics of interventions to support family caregivers of patients with advanced cancer.MethodsFive databases (CINAHL, Medline, PsycINFO, Web of Science, and the Cochrane Library) were searched for English language articles of intervention studies utilizing randomized controlled trials or quasi-experimental designs, reporting caregiver-related outcomes of interventions for family caregivers caring for patients with advanced cancer at home.ResultsA total of 11 studies met the inclusion criteria. Based on these studies, the types of interventions were categorized into psychosocial, educational, or both. The characteristics of interventions varied. Most interventions demonstrated statistically significant results of reducing psychological distress and caregiving burden and improving quality of life, self-efficacy, and competence for caregiving. However, there was inconsistency in the use of measures.ConclusionsMost studies showed positive effects of the interventions on caregiver-specific outcomes, yet direct comparisons of the effectiveness were limited. There is a lack of research aimed to support family caregivers’ physical health.Practice implicationsGiven caregivers’ needs to maintain their wellbeing and the positive effects of support for them, research examining long-term efficacy of interventions and measuring objective health outcomes with rigorous quality of studies is still needed for better outcomes for family caregivers of patients with advanced cancer.     

Training interventions for healthcare providers offering group-based patient education. A scoping review

ObjectivesTo provide overview of research on training interventions for healthcare providers aimed at promoting competencies in delivering group-based patient education.MethodsA systematic literature search identified relevant studies. Data was extracted on training details, study design, outcomes and experiences. Results were summarized and qualitative data analyzed using content analysis.ResultsTwenty-seven studies exploring various training interventions were included. Ten studies used qualitative methods, eight quantitative and nine mixed methods. Use of a comparison group, validated instruments and follow-up measures was rare. Healthcare providers’ reactions to training were mostly positive. Several studies indicated positive short-term effects on self-efficacy and knowledge. Results on observed skills and patient outcomes were inconclusive. Results on healthcare providers’ experience of delivery of group-based patient education following training were categorized into 1) Benefits of training interventions, 2) Barriers to implementation and 3) Delivery support.ConclusionsFurther evaluation of training for healthcare providers delivering group-based patient education is needed before conclusions on training efficacy can be drawn. The results indicate an expanding research field still in maturation.Practice implicationsEfficacy studies evaluating theoretically grounded training with clear attention on group facilitation and follow-up support are needed. Inclusion of validated instruments and long-term outcomes is encouraged.     

Efficacy of DiaLife,an Education Program for Relatives of Adults with Diabetes – A Cluster Randomized Controlled Trial

ObjectiveDiabetes affects the lives of patients and their close relatives. Considering the proven benefit of patient education programs, DiaLife was elaborated as the first German education program addressing the needs of relatives. The objective of this study was to investigate its efficacy.MethodsThe evaluation was implemented in the form of a cRCT with longitudinal design and waiting list condition. In total, 179 relatives were recruited. Participants’ diabetes-related knowledge was defined as the primary outcome. Diabetes-related strains, family interaction and other psychosocial factors were determined as secondary outcomes.ResultsA generalized estimating equation model showed a persistent increase of diabetes-related knowledge in the intervention group compared to the control group regardless of the type of diabetes. Concerning secondary outcomes, mixed linear models showed an improvement for relatives of people with type 2 diabetes who participated in the DiaLife program.ConclusionThis study provides evidence of DiaLife’s efficacy regarding a persistent increase of diabetes-related knowledge and a positive effect on psychosocial outcomes in relatives of people with type 2 but not in type 1 diabetes. Adding (an)other psychosocial module(s) might improve their well-being and psychosocial outcomes.Practice ImplicationsDiabetes centers should consider implementing an education program for relatives, such as DiaLife, in their curriculum.Trial registrationThe study was registered at the German Clinical Trials Register (DRKS00015157; date of registration: 24.08.2018).     

The use of virtual reality in patient education related to medical somatic treatment: A scoping review

ObjectiveTo map the available evidence on the context, content and outcome of VR in patient education in situations related to preparation for medical somatic treatment.MethodsA Scoping review. In October 2020, the Embase, CINAHL, MEDLINE and PsycINFO databases were searched with the terms ‘Virtual Reality’ and ‘Patient Education’. The literature was synthesised and mapped with a narrative approach.Results17 studies published between 2015 and 2020 were included in the qualitative synthesis.VR was applied in (paediatric) surgery and radiation therapy treatment. VR interventions were heterogeneous regarding technical applications, context of implementation, guidance by healthcare professionals and integration in education sessions. Anxiety reduction was demonstrated significantly in some studies. Patients experienced VR education useful; it enhanced understanding, improved communication with healthcare professionals and encouraged treatment compliance.ConclusionsThe application of VR in patient education is a promising technology. Patients are highly satisfied and experience enhanced understanding. VR education was not effective in reducing all anxiety, pain and stress and improving preparedness for treatment.Practice implicationsIt is important to develop VR interventions profoundly. The application of a methodological framework for VR development is recommended. Involve patients, educationalists and technology professionals in the development of technology interventions.     

Current practices in the instruction of lifestyle medicine in medical curricula

ObjectiveA review of current practices of educational interventions for lifestyle medicine was performed to inform the design of interventions with long-term goals of improving patient outcomes.MethodsSystematic review of PubMed, MedEdPORTAL, and Cochrane using keywords “lifestyle medicine,” “education,” “medical students,” and “medical school” was done by 3 independent reviewers. Location, learner, curricular hours, focus, outcomes, and impact are reported.ResultsOf 452 identified citations, 32 met criteria. Most studies (81%) were conducted in the U.S. and designed for medical students (72%). Studies focused primarily on nutrition (78%) and exercise (59%). Curricula were delivered on average across 13.7 h. Lectures were used in 53% of papers. The outcomes most commonly studied were satisfaction (66%,), knowledge perception (66%), and reported clinical practices (34%). Intervention impact at level 2b (31%) and level 3 (34%) were most common.ConclusionMedical educators looking to integrate lifestyle education curriculum should consider current resources as a starting point, especially ones with higher outcome measurements.Practice ImplicationsNovel interventions should target lifestyle medicine competencies with equitable distribution among learners using active learning approaches. The authors propose initial efforts focusing on instruction of clinical educators and practicing physicians, with advocacy for increased reimbursement.     

Inter-ICU transfer of patients with ventilator dependent respiratory failure: Qualitative analysis of family and physician perspectives

ObjectivesVentilator dependent respiratory failure (VDRF) patients are seriously ill and often transferred between ICUs. Our objective was to obtain multi-stakeholder insights into the experiences of families during inter-ICU transfer.MethodsWe conducted a qualitative study using semi-structured interviews with family members of VDRF patients as well as clinicians that have received or transferred VDRF patients to our hospital. Interviews were transcribed and template analysis was used to identify themes within/across stakeholder groups.ResultsPatient, family, clinician and systems-level factors were identified as key themes during inter-ICU transfer. The main findings highlight that family members were rarely engaged in the decision to transfer as well as a lack of standardized communication between clinicians during care transitions. Family members were reassured with the care after transfer in spite of practical and financial challenges. Clinicians acknowledged the lack of a systematic approach for meeting the needs of families and suggested various resources.ConclusionsThis is one of the first qualitative studies to gather a multi-stakeholder perspective and identify problems faced by families during inter-ICU transfer of VDRF patients.Practice implicationsOur results provide a starting point for the development of family-centered support interventions which will need to be tested in future studies.     

Telehealth delivery of motivational interviewing for diabetes management: A systematic review of randomized controlled trials

ObjectivesThe objective of this systematic review was to explore and report the evidence and gaps in the literature for randomized controlled trials (RCTs) studying the effects of motivational interviewing (MI)-based telehealth interventions on outcomes among persons with diabetes (PWD) or prediabetes.MethodsFollowing a modified Cochrane approach, we searched Pubmed, CENTRAL, CINAHL, PsycINFO, and Clinicaltrials.gov. Included studies were RCTs published in English before March 25, 2021 evaluating MI-based telehealth on outcomes for adults with diabetes or prediabetes. Results: A total of 21 retained articles captured results for 6436 PWD. Among the most commonly investigated outcomes, 60% of articles documented A1C reductions (ranging from<1% to>3%), 56% documented systolic blood pressure reductions, 57% documented diabetes self-efficacy/empowerment improvements, and 40% documented physical activity improvements. Conversely, diastolic blood pressure, lipid panels, body mass index, depressive symptoms, and quality of life were frequently measured outcomes, where MI-based telehealth yielded minor effects (<30% of articles demonstrating improvements).ConclusionsMI-based telehealth seems most effective for improving A1C, systolic blood pressure, diabetes self-efficacy, and physical activity behaviors. Variability in outcome assessment and intervention heterogeneity were key challenges impeding comparisons across retained articles.Practice implicationsMI-based telehealth interventions demonstrate promising results for improving outcomes in PWD.     

The Effect of Technology-Based Interventions on Pain,Depression, and Quality of Life in Patients With Cancer: A Systematic Review of Randomized Controlled Trials

BackgroundThe burden of cancer is increasing; projections over the next 2 decades suggest that the annual cases of cancer will rise from 14 million in 2012 to 22 million. However, cancer patients in the 21st century are living longer due to the availability of novel therapeutic regimens, which has prompted a growing focus on maintaining patients’ health-related quality of life. Telehealth is increasingly being used to connect with patients outside of traditional clinical settings, and early work has shown its importance in improving quality of life and other clinical outcomes in cancer care.ObjectiveThe aim of this study was to systematically assess the literature for the effect of supportive telehealth interventions on pain, depression, and quality of life in cancer patients via a systematic review of clinical trials.MethodsWe searched PubMed, EMBASE, Google Scholar, CINAHL, and PsycINFO in July 2013 and updated the literature search again in January 2015 for prospective randomized trials evaluating the effect of telehealth interventions in cancer care with pain, depression, and quality of life as main outcomes. Two of the authors independently reviewed and extracted data from eligible randomized controlled trials, based on pre-determined selection criteria. Methodological quality of studies was assessed by the Cochrane Collaboration risk of bias tool.ResultsOf the 4929 articles retrieved from databases and relevant bibliographies, a total of 20 RCTs were included in the final review. The studies were largely heterogeneous in the type and duration of the intervention as well as in outcome assessments. A majority of the studies were telephone-based interventions that remotely connected patients with their health care provider or health coach. The intervention times ranged from 1 week to 12 months. In general, most of the studies had low risk of bias across the domains of the Cochrane Collaboration risk of bias tool, but most of the studies had insufficient information about the allocation concealment domain. Two of the three studies focused on pain control reported significant effects of the intervention; four of the nine studies focus on depression reported significant effects, while only the studies that were focused on quality of life reported significant effects.ConclusionsThis systematic review demonstrates the potential of telehealth interventions in improving outcomes in cancer care. However, more high-quality large-sized trials are needed to demonstrate cogent evidence of its effectiveness.     

Educational preferences in individuals with cardiometabolic disease differs with age,ethnicity and educational status

ObjectivesTo evaluate how sociodemographic factors influence educational modality preferences in people with cardiometabolic disease.MethodsThis was a cross-sectional study performed in people with diabetes and cardiovascular disease, who completed a questionnaire to denote their previous experience and ranked preferences for different educational modalities.ResultsThe questionnaire was completed by 3751 people, of whom 59% were men, median (interquartile range) age was 68 (59?76) years, and 78% were White European. In total, 73% had diabetes, 35% had heart disease, and 10% had history of stroke; the majority (83.4%) had one of these conditions. Overall preference was for one-to-one education (77% ranked first choice), and telephone education ranked the lowest. People tended to prefer modalities they had previously experienced.ConclusionsWe highlight the importance of considering factors that could influence selection of educational modalities including age, ethnicity, gender and educational level. We anticipate this approach will aid in the design, delivery and tailoring of educational programmes that are accessible to the diverse cohort of people living with chronic diseases, including diabetes and cardiovascular disease.Practice ImplicationsGiven the influence of multiple demographic factors and previous experiences on expressed preferences, providers should support individuals to make informed decisions about educational interventions to maximise engagement.     

The evidence supporting educational videos for patients and caregivers receiving hospice and palliative care: A systematic review

ObjectiveThe purpose of this study is to explore the evidence surrounding educational videos for patients and family caregivers in hospice and palliative care. We ask three research questions: 1. What is the evidence for video interventions? 2. What is the quality of the evidence behind video interventions? 3. What are the outcomes of video interventions?MethodsThe study is a systematic review, following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Researchers systematically searched five databases for experimental and observational studies on the evidence supporting video education for hospice and palliative care patients and caregivers, published in 1969–2019.ResultsThe review identified 31 relevant articles with moderate-high quality of evidence. Most studies were experimental (74 %), came from the United States (84 %) and had a mean sample size of 139 participants. Studies showed that video interventions positively affect preferences of care and advance care planning, provide emotional support, and serve as decision and information aids.ConclusionA strong body of evidence has emerged for video education interventions in hospice and palliative care. Additional research assessing video interventions’ impact on clinical outcomes is needed.Practice implicationsVideos are a promising tool for patient and family education in hospice and palliative care.     

Encounters between medical and lay knowledge in therapeutic patient education. A qualitative study based on an oral chemotherapy program

ObjectivesThe growing number of cancer patients treated with Oral Chemotherapy (OC) at home, is prompting many healthcare centers to develop Therapeutic Patient Education (TPE) programs. This study aimed to 1) describe the different forms of knowledge shared and learned in these programs, and 2) better understand how self-care and psychosocial skills are promoted in the TPE context.MethodThis study used qualitative data from the French “ONCORAL” program. Data collection was conducted with non-participant observations. The corpus comprised 42 TPE sessions.ResultsAnalysis highlighted that TPE specifically helps patients’ functional health, revealed the medical expectations and social norms that shape the patient’s role, and exposed the difficulties faced by the patient when acquiring self-care skills. Self-care skills and psychosocial skills also appeared to be mutually dependent in the context of TPE.ConclusionTPE programs which focus more on developing medical knowledge inevitably give less importance to psychosocial skills. Yet the recognition and promotion of the latter in TPE may lead to positive coping strategies related to medical outcomes, such as adherence.Practice implicationDedicated TPE program objectives for patients undergoing oral chemotherapy should recognize not only the value of medical knowledge but also of lay knowledge.     

Communicating unexpected pharmacogenomic results to biobank contributors: A focus group study

ObjectivesThe goals of this study were to explore 1) the impact of returning unexpected pharmacogenomic (PGx) results to biobank contributors, and 2) participant views about improving communication.MethodsWe conducted a qualitative focus group study with biobank participants (N = 54) who were notified by mail of an individual research result indicating increased risk for adverse events associated with the common cancer drug 5-fluorouracil (5-FU). We employed a framework approach for analysis.ResultsOur results revealed three themes illustrating participants’ questions and uncertainty, especially regarding how to share results with health providers and family members, and remember them over time. Participants valued results for themselves and others, and for the future of medicine. Risk perception was framed by health identity. “Toxicity narratives,” or familiarity with another’s adverse reaction to chemotherapy, increased the sense of importance participants reported.ConclusionThese focus group results highlight research participant remaining questions and high valuation of PGx results, even when unexpected.Practice implicationsWe identify PGx research participants’ needs for clear clinical translation messaging that attends to health identity, pragmatics of sharing information with family members, and patient perceptions of barriers to transferring research results to a clinical context.     

Patient and family member perspectives on searching for cancer clinical trials: A qualitative interview study

ObjectiveClinical trials are vital in the context of ovarian cancer and may offer further treatment options during disease recurrence, yet enrollment remains low. Understanding patient and family member experiences with identifying trials can inform engagement and education efforts.MethodsInterviews were conducted with 33 patients who had experience with clinical trial conversations and 39 nominated family members. Thematic analysis examined experiences and generated findings for clinical practice.ResultsTrial conversations with providers at diagnosis were uncommon and often overwhelming. Most participants delayed engagement until later in the disease course. With hindsight, though, some wished they considered trials earlier. Difficulty identifying appropriate trials led some to defer searching to providers, but then they worried about missed opportunities. Most family members felt unqualified to search.ConclusionTrial conversations during clinical encounters should start early and include specifying search responsibilities of providers, patients, and family. Patients and family members can be engaged in searches but need guidance.Practice implicationsTrials should be discussed throughout the disease course, even if patients are not ready to participate or are not making a treatment decision. Education should focus on identifying trials that meet search criteria. Transparency regarding each individual’s role in identifying trials is critical.     

Australian patients’ perception of the efficacy of the physical activity referral scheme (PARS)

BackgroundOptimum physical activity (PA) interventions could be delivered via physical activity referral schemes (PARS) if utilised adequately. However, the evidence supporting PARS effectiveness is weak due to low uptake and non-adherence to interventions.ObjectivePatients’ experiences of PARS were explored to obtain in-depth insight into their perceived quality of care and practical ways to optimise the programme’s effectiveness.MethodsA sequential explanatory mixed methods design was employed to probe cross-sectional quantitative survey data (n = 111) on patients’ knowledge and beliefs about PA and PARS and qualitative interview data (n = 15) on their experiences of PARS. Informed by Donabedian framework of healthcare quality assessment, quantitative and qualitative findings were integrated to identify practical ways to enhance PARS effectiveness.ResultsParticipants displayed good PA knowledge, had positive beliefs and perceived PARS to be useful. Nonetheless, bottlenecks in the structure and process of PARS impact on patient health outcomes and hinder the programme’s uptake.ConclusionExploring other referral mechanisms into PARS such as self or nurse-initiated referrals could improve the programme’s visibility and effectiveness.Practice implicationsImproved support, enhanced visibility of EPs, ongoing interactions between GPs and EPs and education about referral pathways would foster improved uptake, adherence and health outcomes for patients.     

Promoting physical activity in persons with type 2 diabetes mellitus: A systematic review of systematic reviews

ObjectiveThere is a large amount of studies about interventions for promoting physical activity (PA) in persons with type 2 diabetes (T2D) as well as several systematic reviews referring to these studies. The objective of this contribution is to provide a systematic review of these systematic reviews.MethodPubMed, PsychInfo and the Cochrane Library were searched for systematic reviews and/or meta-analyses regarding interventions for promoting PA in persons with T2D. The individual reviews and the relationships between the reviews were analysed.ResultsEighteen reviews were included. Seventeen of these reviews contained references to included trials, amounting to 113 trials in total. Five of the reviews addressed PA interventions in general; six addressed specific devices for delivering the intervention; five addressed specific approaches for giving the participants feedback about their outcomes; and two addressed specific therapeutic approaches. Only 14 cross-references were found.ConclusionGiving feedback about outcomes and helping people to integrate PA in their daily lives seem to be the most effective intervention components. Basing intervention development on theories seems helpful.Practical implicationsInterventions should give feedback about outcomes and help to integrate PA in daily life. Intervention development should be theory-based.