E-mail in patient–provider communication: A systematic review

Objective

To review systematically the role of e-mails in patient–provider communication in terms of e-mail content, and perspectives of providers and patients on e-mail communication in health care.

Methods

A systematic review of studies on e-mail communication between patients and health providers in regular health care published from 2000 to 2008.

Results

A total of 24 studies were included in the review. Among these studies, 21 studies examined e-mail communication between patients and providers, and three studies examined the e-mail communication between parents of patients in pediatric primary care and pediatricians. In the content analyses of e-mail messages, topics well represented were medical information exchange, medical condition or update, medication information, and subspecialty evaluation. A number of personal and institutional features were associated with the likelihood of e-mail use between patients and providers. While benefits of e-mails in enhancing communication were recognized by both patients and providers, concerns about confidentiality and security were also expressed.

Conclusion

The e-mail is transforming the relationship between patients and providers. The rigorous exploration of pros and cons of electronic interaction in health care settings will help make e-mail communication a more powerful, mutually beneficial health care provision tool.

Practice implications

It is important to develop an electronic communication system for the clinical practice that can address a range of concerns. More efforts need to be made to educate patients and providers to appropriately and effectively use e-mail for communication.     

Can self-management programmes change healthcare utilisation in COPD?: A systematic review and framework analysis

ObjectiveThe study aims to evaluate the ability of self-management programmes to change the healthcare-seeking behaviours of people with Chronic Obstructive Pulmonary Disease (COPD), and any associations between programme design and outcomes.MethodsA systematic search of the literature returned randomised controlled trials of SMPs for COPD. Change in healthcare utilisation was the primary outcome measure. Programme design was analysed using the Theoretical Domains Framework (TDF).ResultsA total of 26 papers described 19 SMPs. The most common utilisation outcome was hospitalisation (n = 22). Of these, 5 showed a significant decrease. Two theoretical domains were evidenced in all programmes: skills and behavioural regulation. All programmes evidenced at least 5 domains. However, there was no clear association between TDF domains and utilisation. Overall, study quality was moderate to poor.ConclusionThis review highlights the need for more alignment in the goals, design, and evaluation of SMPs. Specifically, the TDF could be used to guide programme design and evaluation in future.Practice implicationsPractices have a reasonable expectation that interventions they adopt will provide patient benefit and value for money. Better design and reporting of SMP trials would address their ability to do so.     

Preoperative patient education for open-heart patients: A source of anxiety?

OBJECTIVE: The purpose of this study was to assess the impact of preoperative patient education on anxiety and recovery of the Lebanese patients undergoing open-heart surgery. METHODS: This quasi-experimental study was conducted at a large hospital in Beirut, which is a university hospital. All patients who were admitted to the cardiac surgery unit and who met the inclusion criteria were randomly assigned to as experimental or a control group. The patients in the experimental group (n = 57) received a special educational session on their admission day and had a tour of the cardiac surgery unit. The control group (n = 53) followed the routine hospital protocol, which encompassed almost no preoperative education or a tour. Anxiety was assessed using the Beck Anxiety Inventory while recovery was measured by physiological outcomes, days of hospital stay, and presence of complications. A Multivariate Analysis of Covariance (MANCOVA) was performed with adjustment for potential confounding variables. RESULTS: Borderline statistical significance was noted for the experimental group in terms of preoperative and postoperative anxiety. The experimental group had a shorter time from awakening to extubation. CONCLUSION: Unlike most studies published previously, which noted the benefits of preoperative patient education, this study with the Lebanese clients, failed to support earlier findings. PRACTICE IMPLICATIONS: The results suggest that patient education should not be initiated before assessing the patient's cultural and social background.     

Do participation and personalization matter? A model-driven evaluation of an Internet-based patient education intervention for fibromyalgia patients

Objectives

To evaluate the effectiveness of an Internet-based patient education intervention, which was designed upon principles of personalization and participatory design.

Methods

Fifteen months after the first release of the website, 209 fibromyalgia patients recruited through health professionals completed an online questionnaire to assess patients’ use of the website, health knowledge, self-management behavior, and health outcomes. These constructs were combined into an a-priory model that was tested using a structural equation modeling approach.

Results

Results show that the usage of certain tools of the website – designed and personalized involving the end users – impacts patients’ health knowledge, which in turn impacts self-management. Improvements in self-management ultimately lower the impact of Fibromyalgia Syndrome leading to better health outcomes.

Conclusion

This study empirically confirmed that the adoption of a participatory approach to the design of eHealth interventions and the use of personalized contents enhance the overall effectiveness of systems.

Practice implications

More time and effort should be invested in involving patients in the preliminary phases of the development of Internet-based patient education interventions and in the definition of models that can guide the systems’ evaluation beyond technology-related variables such as usability, accessibility or adoption.     

A systematic review of surgeon–patient communication: Strengths and opportunities for improvement

Objective

Effective communication is critical to patient satisfaction, outcomes of care and malpractice prevention. Surgeons need particularly effective communication skills to discuss complicated procedures and help patients make informed choices. We conducted a systematic review of the literature on surgeon–patient communication.

Methods

Searches were conducted in MEDLINE, PsycINFO, and Sociological Abstract. Two reviewers screened citations and full-text articles. Quality was appraised using the Critical Appraisal Skills Program tool. Studies were categorized into content of communication, patient satisfaction, relationship of communication to malpractice, and duration of visits.

Results

2794 citations and 74 full-text articles, 21 studies and 13 companion reports were included. Surgeons spent the majority of their time educating patients and helping them to make choices. Surgeons were generally thorough in providing details about surgical conditions and treatments. Surgeons often did not explore the emotions or concerns of patients. Potential areas of improvement included discussing some elements of informed decision making, and expressing empathy.

Conclusion

Surgeons can enhance their communication skills, particularly in areas of relative deficiency. Studies in primary care demonstrate communication programs are effective in teaching these skills.

Practice implications

These can be adapted to surgical training and ultimately lead to improved outcomes and satisfaction with care.     

Can public reporting impact patient outcomes and disparities? A systematic review

ObjectiveRecent US healthcare reforms aim to improve quality and access. We synthesized evidence assessing the impact that public reporting (PR), which will be extended to the outpatient setting, has on patient outcomes and disparities.MethodsA systematic review using PRISMA guidelines identified studies addressing the impact of PR on patient outcomes and disparities.ResultsOf the 1970 publications identified, 25 were relevant, spanning hospitals (16), nursing homes (5), emergency rooms (1), health plans (2), and home health agencies (1). Evidence of effect on patient outcomes was mixed, with 6 studies reporting a favorable effect, 9 a mixed effect, 9 a null effect, and 1 a negative effect. One study found a mixed effect of PR on disparities.ConclusionThe evidence of the impact of PR on patient outcomes is lacking, with limited evidence that PR has a favorable effect on outcomes in nursing homes. There is little evidence supporting claims that PR will have an impact on disparities or in the outpatient setting.Practice implicationsHealth systems should collect information on patient-relevant outcomes. The lack of evidence does not necessarily imply a lack of effect, and a research gap exists regarding patient-relevant outcomes and PR.     

Meniscal repair in patients age 40 years and older: A systematic review of 11 studies and 148 patients

Purpose

The purpose of this review is to evaluate published outcomes for reported failure rates following meniscus repair in patients age 40?years or older.

Can public reporting impact patient outcomes and disparities? A systematic review

Objective

Recent US healthcare reforms aim to improve quality and access. We synthesized evidence assessing the impact that public reporting (PR), which will be extended to the outpatient setting, has on patient outcomes and disparities.

Methods

A systematic review using PRISMA guidelines identified studies addressing the impact of PR on patient outcomes and disparities.

Results

Of the 1970 publications identified, 25 were relevant, spanning hospitals (16), nursing homes (5), emergency rooms (1), health plans (2), and home health agencies (1). Evidence of effect on patient outcomes was mixed, with 6 studies reporting a favorable effect, 9 a mixed effect, 9 a null effect, and 1 a negative effect. One study found a mixed effect of PR on disparities.

Conclusion

The evidence of the impact of PR on patient outcomes is lacking, with limited evidence that PR has a favorable effect on outcomes in nursing homes. There is little evidence supporting claims that PR will have an impact on disparities or in the outpatient setting.

Practice implications

Health systems should collect information on patient-relevant outcomes. The lack of evidence does not necessarily imply a lack of effect, and a research gap exists regarding patient-relevant outcomes and PR.     

Does systemic leukocyte filtration affect perioperative hemorrhage in cardiac surgery? A systematic review and meta-analysis

Cardiopulmonary bypass causes a systemic inflammatory reaction. Activation of leukocytes is an important part of this process, and is known to directly contribute to the development of postoperative coagulopathy, and thus hemorrhage. The removal of leukocytes from the cardiopulmonary bypass circulation, using specialized filters, has been proposed as one method for attenuating this inflammatory response. However, there is no consensus on its effectiveness. We used meta-analytical techniques to systematically assess the literature reporting on the potential effect of systemic leukofiltration on perioperative hemorrhage. Random effects modeling was used to calculate overall estimate, and heterogeneity was assessed. Systemic leukofiltration made no significant impact on chest tube drainage in the first 24 hours (weighted mean difference [WMD], x23.9 ml; 95% confidence interval [CI], x95.48-47.61; p = 0.51) or on the total packed red cell transfusion requirements of each patient (WMD, 7.84 ml; 95% CI, x80.13-95.81; p = 0.86). The studies performed in this area thus far are highly heterogeneous, due in part to relatively poor-quality design and inadequate matching of their study groups. Although further high-quality trials on systemic leukofiltration may be appropriate, other strategies to reduce the coagulopathy associated with cardiopulmonary bypass should be sought and evaluated.     

Does improving patient–practitioner communication improve clinical outcomes in patients with cardiovascular diseases? A systematic review of the evidence

Objective

To conduct a systematic literature review appraising the effects of interventions to improve patient–practitioner communication on cardiovascular-related clinical outcomes.

Methods

Databases were searched up to March 27, 2013 to identify eligible studies that included interventions to improve patient and/or practitioner communication skills and assessment of a cardiovascular-related clinical outcome in adults ≥18 years of age.

Results

Fifteen papers were reviewed: the primary focus in seven studies was the patient; seven included a practitioner-focused intervention and one targeted both. Two patient-focused and two practitioner-focused studies demonstrated a beneficial effect of the intervention compared to a control group. Patient-focused studies were designed to improve patients’ information-seeking and question-asking skills with their practitioner. Practitioner-focused studies were designed to either improve practitioner's general patient-centered communication or risk communication skills.

Conclusion

Few interventions targeting patient–practitioner communication have assessed the impact on cardiovascular-related clinical outcomes, limiting the ability to determine effectiveness. Additional rigorous research supported by theoretical frameworks and validated measurement is needed to understand the potential of patient–practitioner communication to improve cardiovascular-related clinical outcomes.

Practice implications

Investments in communication skills trainings in medical education and practice are needed in order to attain the full potential of patient-centered care on cardiovascular-related clinical outcomes.     

Physician–patient–companion communication and decision-making: A systematic review of triadic medical consultations

Objective

To systematically review quantitative and qualitative studies exploring physician–adult patient–adult companion (triadic) communication and/or decision-making within all medical encounters.

Methods

Studies were identified via database searches and reference lists. One author assessed eligibility of studies, verified by two co-authors. Data were extracted by one author and cross-checked for accuracy. Two authors assessed the quality of included articles using standardized criteria.

Results

Of the 8409 titles identified, 52 studies were included. Summary statements and tables were developed for each of five identified themes. Results indicated companions regularly attended consultations, were frequently perceived as helpful, and assumed a variety of roles. However, their involvement often raised challenges. Patients with increased need were more often accompanied. Some companion behaviours were felt to be more helpful (e.g. informational support) and less helpful (e.g. dominating/demanding behaviours), and preferences for involvement varied widely.

Conclusion

Triadic communication in medical encounters can be helpful but challenging. Based on analysis of included studies, preliminary strategies for health professionals are proposed.

Practice implications

Preliminary strategies for health professionals include (i) encourage/involve companions, (ii) highlight helpful companion behaviours, (iii) clarify and agree upon role preferences of patient/companions. Future studies should develop and evaluate specific strategies for optimizing triadic consultations.     

Effect of question prompt lists for cancer patients on communication and mental health outcomes—A systematic review

ObjectiveTo provide a systematic review on the effects of question prompt lists (QPL) in oncological settings.MethodsA systematic literature search was conducted in Medline, PsycINFO and the Cochrane Collaboration. Randomized controlled studies (RCTs) that evaluated QPL-only interventions were included. Risk of bias of included studies was evaluated using the Cochrane RoB 2 tool. Data concerning effects on communicative processes in patient-physician relationship and psychological outcomes were analyzed.Results10 RCTs met the inclusion criteria. Results suggest that QPLs lead to a shift of topics discussed. There were weak indications that QPL interventions increase anxiety shortly before and after consultations, but may decline anxiety during follow-up. Patients consistently perceive QPLs as more helpful than usual information sheets. QPL-only interventions show limited impact on communicative processes and psychological outcomes. They help not to forget or discuss important questions.ConclusionWith a better integration in patient-physician communication QPLs may become a useful tool for patients and physicians. Future research is needed to investigate if there is greater benefit from QPL interventions in specific settings.Practice implicationsQPLs are an inexpensive tool to influence communicative processes positively in oncological consultations.     

Promoting men’s knowledge of cancer risk reduction: A systematic review of interventions

Objective

To critically appraise and discuss evidence from interventions designed to increase men's knowledge about cancer risk reduction.