Patients' satisfaction with information and experiences with counseling on cardiovascular medication received at the pharmacy

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.     

Testing the utility of a cancer clinical trial specific Question Prompt List (QPL-CT) during oncology consultations

Objective

A Question Prompt List (QPL) is a proven, simple intervention to aid patients to be active participants in consultations with their physicians by asking questions. We aimed to further develop and test the efficacy of a targeted QPL for clinical trials (QPL-CT).

Methods

Breast, Lung and Genitourinary cancer patients who were facing a discussion about a therapeutic clinical trial completed short pre- and post-consultation questionnaires and used the QPL-CT in their discussions with their oncologists.

Results

30 participants were recruited from 6 oncologists. All QPL-CT questions were selected by at least one-third of participants. Participants mostly wanted and asked questions about personal trial benefit. Oncologists provided information about personal benefit to varying degrees, thus patients did not ask some questions. Patients were still left with some unasked and unanswered questions.

Conclusion

The QPL-CT has potential as a simple, inexpensive intervention to aid such communication. Further investigation is needed to demonstrate the efficacy of the QPL-CT in improving cancer patient outcomes.

Practice implications

These preliminary finding suggest that important areas of clinical trials are overlooked in clinical consultations. The QPL-CT may be an effective method to encourage oncologists to endorse patient question asking about clinical trials and prompt patient questions.     

Can wireless text messaging improve adherence to preventive activities? Results of a randomised controlled trial

Objective

To determine the effectiveness of cell phone wireless text messaging for improving adherence to a healthy behaviour.

Design

A randomised, unblinded, controlled trial was conducted with 102 subjects, 18 years or older, each having a cell phone and willing to take 1 vitamin C pill per day for 1 month for preventive reasons. Intervention group participants received text messaging reminders and were asked to acknowledge receiving their messages after taking the vitamins, whereas control group subjects had no text messaging activity.

Measurements

Self-reported adherence and the number of participant text messages acknowledging vitamins taken.

Results

Both groups reported an increased adherence after the trial: by 246% for the intervention group and by 131% for the control group. There was a non-significant difference between the two groups at endpoint: an average difference of 0.8 between the number of pills missed in the last week of the trial (2.5 out of 7 in the intervention and 3.3 out of 7 in the control group) with a power of 0.54. The study revealed a significant correlation (coefficient = −0.352, sig. = 0.01) between the average number of text messaging acknowledgements sent by the intervention group participants and the number of pills they reported missed during the last week of the trial.

Conclusion

This was a small randomised controlled trial with inconclusive but encouraging results. It suggests a new approach in addressing insufficient adherence in outpatient conditions and shows that the use of information technology tools for compliance warrants further research.     

“I need to lead my own life in any case”—A study of patients in dialysis with or without a partner

Objective

To elicit psychological and psychosocial problems existing in patients in dialysis and their partners, its being felt that the diversity involved has important implications for how service in dialysis units is delivered to patients and their partners.

Methods

The results of a series of interviews of 39 patients in dialysis and 21 partners of theirs, each interview individual, concerning their ways of thinking and their feelings and the behaviour, were analyzed in qualitative and content-oriented terms.

Results

Five basic themes could be identified: importance of treatment being individualized, dependency on an apparatus, consequences of the disease and its treatment, hopes for the future, and thoughts concerning life and death. Diversities relating to age, civil status, cultural and gender matters were disclosed.

Conclusion

The interview approach illustrated the importance of extended professional and individualized support in handling psychological and psychosocial disparities and needs in order to make treatment regimes more acceptable to the persons involved.

Practice implications

Suggestions are made concerning efforts to improve the care of patients receiving dialysis, and the importance of working with the patients and those closest to them in multidisciplinary teams.     

Information needs about medication according to patients discharged from a general hospital

Objective

Medication regimens change during hospital admission, and these discrepancies can lead to an increased risk of patient harm after hospital discharge. Information about medication according to the patient's needs may contribute to patient safety by improvement of knowledge and adherence. The goal of this study is to explore the patient's needs on information about medication at hospital discharge.

Research design and methods

Qualitative, semi-structured interviews were performed with 31 patients from the pulmonology, internal medicine and cardiology departments who were discharged with at least one prescribed drug from the hospital to primary care in the Netherlands. Interviews were analysed with content analysis.

Results

Patients had variable needs concerning information about discharge medication. Most patients wanted to receive basic information about their medication, alternatives for the prescribed medication and side effects. Some patients did not need basic information or explicitly mentioned that information about side effects would negatively influence their attitude towards medication. Patients preferred a combination of oral instructions and written information.

Conclusions

Information at discharge should be tailored to the individual needs of the patient.

Practice implications

In the process of providing patient information at hospital discharge, the preference of some patients for non-disclosure of information should be recognised.     

The effect of school-based cervical cancer education on perceptions towards human papillomavirus vaccination among Hong Kong Chinese adolescent girls

Objective

To evaluate the effects of school-based cervical cancer education on Hong Kong Chinese adolescent girls.

Methods

Adolescent girls (n = 953) in local secondary schools attended a tailored educational program on cervical cancer prevention. Self-administered questionnaires were used before and after the program to measure its effects on participants’ knowledge, attitude and perceived social norms towards human papillomavirus (HPV) vaccination and their intention to be HPV vaccinated.

Results

Before the program, HPV vaccine acceptance was favorable but relevant knowledge was low. After the program, participants had greater knowledge and a more positive attitude (both p < 0.001), with more girls anticipating family (41.6% before vs. 58.9% after) and peer support (32.8% before vs. 56.9% after). There were 11.3% more girls who indicated an intention to accept the vaccine afterward. More knowledge, a more positive attitude and perceived support from significant others predicted a stronger intention to be HPV vaccinated.

Conclusion

The educational program had a positive impact on participants’ perceptions towards HPV vaccination and their intention to be vaccinated.

Practice implications

School-based cervical cancer education is a viable means to meet the substantial educational needs of adolescents. Promotion of HPV vaccination should also include educating and influencing perceptions of families and peers.     

Author Index

Objective

To operationally define cancer literacy, understanding which aspects of cancer are important to be known by a layperson to be considered cancer literate.

Methods

A Delphi study in three consecutive rounds was conducted among a panel of Swiss cancer experts (oncologists, GPs, nurses from oncology wards, social workers, public health experts).

Results

The result of the Delphi process is a first operational definition of the concept of cancer literacy, a list of the aspects of cancer that, in the expert's view, laypeople should know to be considered cancer literate.

Conclusions

We have now an idea of what should be known about cancer. The study also provides us with some useful hints about what should be communicated about cancer, e.g. via public communication campaigns, school education, or media.

Practice implications

The operational definition of the concept can be used for the development and the validation of a measure of cancer literacy, not anymore limited to basic literacy and numeracy skills.     

Diabetes Medication Assistance Service: the pharmacist's role in supporting patient self-management of type 2 diabetes (T2DM) in Australia

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.     

Can private pharmacy providers offer comprehensive reproductive health services to users of emergency contraceptives? Evidence from Nairobi, Kenya

Objective

To evaluate the provision of reproductive health information and services to users of emergency contraceptives (ECs) by private pharmacists.

Methods

The study involved intervention (9) and control (8) pharmacies, with baseline and endline assessments of EC provision through the use of mystery clients. Intervention pharmacies received weekly updates on EC, fliers with three key messages on EC, and information, education, and communication materials. Logistic regression models are estimated to predict the provision of reproductive health services to EC clients.

Results

The differences between the control and intervention pharmacies with respect to the provision of additional information on EC and regular family planning services are in the expected direction but statistically insignificant. In contrast, the likelihood of providing information or referral for counseling or testing for sexually transmitted infections or HIV was lower in the intervention than in the control pharmacies but the difference was also not statistically significant.

Conclusion

Pharmacy providers in the country face institutional challenges in providing reproductive health services to EC clients.

Practice implications

The challenges could be addressed through pre-service training, targeted in-service training, sensitization of clients, and point-of-sale materials such as brochures, posters and package inserts.     

Exploring the community pharmacist's role in palliative care: focusing on the person not just the prescription

Objective

Changes in health care provision have led to an emphasis on providing end of life care within the home. community pharmacists are well positioned to provide services to community-based palliative care patients and carers.

Methods

A multiple qualitative case study design was adopted. A total of 16 focus groups and 19 interviews with pharmacists, nurses, general practitioners and carers were undertaken across metropolitan and regional settings in Western Australia, New South Wales, Queensland and Victoria. Data were analysed thematically using a framework that allowed similarities and differences across stakeholder groups and locations to be examined and compared.

Results

Three main themes emerged: effective communication; challenges to effective communication; and: towards best practice, which comprised two themes: community pharmacists’ skills and community pharmacists’ needs.

Discussion

A key component of the provision of palliative care was having effective communication skills. Although community pharmacists saw an opportunity to provide interpersonal support, they suggested that they would need to develop more effective communication skills to fulfil this role.

Conclusion

There is clear need for continuing professional development in this area - particularly in communicating effectively and managing strong emotions.

Practice implications

Community pharmacists are willing to support palliative care patients and carers but need education, support and resources.     

Education level, not health literacy, associated with information needs for patients with cancer

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.     

Assessment of patient communication skills during OSCE: examining effectiveness of a training program in minimizing inter-grader variability

Objective

To assess effectiveness of a training program in reducing inter-grader variability in grading communication skills during an objective structured clinical exam (OSCE).

Methods

Global communication (GC) skills are assessed by standardized participants (SP) and faculty during each OSCE using a 6 item rubric. Despite criteria delineated in the GC rubric, inter-grader variability was observed. During 2008-2009 academic year, a training program was implemented before each OSCE to achieve more consistent interpretation and grading in GC skills. GC grades between SP and faculty for 2nd and 3rd level student OSCEs during 2008-2009 (post-training) were compared to 2007-2008 (pre-training). Data was analyzed using repeated measures ANOVA.

Results

274 and 281 students participated in OSCEs during 2007-2008 and 2008-2009 academic years, respectively. Training significantly (P < .001) decreased grader variability between SPs and faculty. There was a greater mean difference between faculty vs. SP before training (faculty 14.68, SP 15.87) compared to after training (faculty 13.51, SP 13.78). Mean GC scores for both faculty and SPs also decreased significantly after training.

Conclusion and practice implications

A training program may be necessary to reduce inter-rater variability in assessment of OSCE communication skills if it is to be truly helpful to student pharmacists learning to counsel patients.     

Maximizing your Patient Education Skills (MPES): A multi-site evaluation of an innovative patient education skills training course for oncology health care professionals

Objective

To evaluate the acceptability and relevance of the Maximizing your Patient Education Skills (MPES) course and to determine whether it significantly improved knowledge regarding patient education (PE) theory, self-assessed PE competencies, and PE skills using case based vignettes.

Methods

1-Group, multi-site, pre-post-intervention. Participants completed a pre-assessment (T1), participated in the 4-h MPES course, and then a 3-month post-assessment (T2). A focus group was conducted with sub-set of participants.

Results

98 (75%) of participants completed both time points. Participants were highly satisfied with MPES and found it to be relevant. Results showed that MPES had a significant impact on all of our outcome measures.

Conclusion

Findings from this study show that oncology HCPs knowledge of patient education theory, self-assessed competencies and skills can improve after participating in a brief problem-focused and interactive workshop.

Practice implications

Given the evidence that well-planned education and support can contribute to a number of positive health outcomes and the evidence that HCPs may lack the skills to teach and support patients and their families effectively, these results suggest that MPES course may be of value to oncology professionals. Efforts to further develop this course include exploring alternative funding models and using different learning platforms.     

An illustrated leaflet containing antiretroviral information targeted for low-literate readers: development and evaluation

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.     

Trust and distrust among Appalachian women regarding cervical cancer screening: a qualitative study

Objective

To explore Appalachian women's perceptions of trust and distrust of healthcare providers and the medical care system as they relate to views about cervical cancer and screening.

Methods

Thirty-six Ohio Appalachia female residents participated in community focus groups conducted by trained facilitators. Discussion topics included factors related to cervical cancer, and the issues of trust and distrust in medical care. The tape-recorded focus groups were transcribed and analyzed to identify salient themes.

Results

Five themes emerged related to trust in healthcare. Patient-centered communication and encouragement from a healthcare provider led women to trust their physicians and the medical care system. In contrast, lack of patient-centered communication by providers and perceptions of poor quality of care led to distrust. Physician gender concordance also contributed to trust as women reported trust of female physicians and distrust of male physicians; trust in male physicians was reported to be increased by the presence of a female nurse.

Conclusions

Important factors associated with trust and distrust of providers and the medical care system may impact health-seeking behaviors among underserved women.

Practice implications

Opportunities to improve patient-centered communication around the issues of prevention and cervical cancer screening (such as providing patient-focused information about access to appropriate screening tests) could be used to improve patient care and build patients’ trust.     

Information needs of informal caregivers of older adults with chronic health conditions

Objective

To systematically examine current evidence pertaining to information needs of informal caregivers of older adults with chronic health conditions.

Methods

Structured search of MEDLINE, MEDLINE IN-PROCESS, CINAHL, and PsycINFO databases to identify studies of caregiver information needs, followed by data extraction and syntheses.

Results

The 62 articles that met the stated inclusion criteria highlighted extensive needs among informal caregivers for practical, accessible, timely information.

Conclusion

The identified information needs of informal caregivers can inform organizations and agencies that seek to provide disease and illness-related information.

Practice implications

Existing evidence supports the implementation of a health information delivery system designed to meet the needs of informal caregivers of older adults with chronic health conditions.     

Measuring the impact of nurse cue-response behaviour on cancer patients’ emotional cues

Objective

This study aimed to explore the impact of nurse responses to patients’ and family members’ emotional cues and concerns during the chemotherapy education consultation.

Methods

51 cancer patients and 13 nurses participated in this study. Nurse-delivered chemotherapy education sessions were audio-recorded, and patients completed the EORTC QLQ-C30 V3.0 questionnaire before the education. The audio records were transcribed and coded.

Results

Patients expressed their emotions more than family members, but patients’ cues decreased when family were present. Patients with lower emotional wellbeing (greater psychological distress) prior to the consultation did not express more cues/concerns. Nurses responded to patients’ and families’ cues equally in a cue-facilitative fashion. Facilitative responses were associated with decreased patients’ cues.

Conclusion

Family presence appears to hinder patients’ cues/concerns. Nurses’ PS responses were associated with less cues/concerns by patients.

Practice implication

The current study challenges the common assumption that a higher number of cues is indicative of effective consultation, and indicates the influence of family in patients’ cues/concerns.