Communication Assessment Based on Person-Centered Care: Mixed Methods Analysis

Enhancing students’ preparedness to care for older people: A mixed methods analysis

Preparing Preclinical Medical Students for Routine Code Status Discussions: A Mixed-Methods Study

To understand women's views of and values placed on the uterus. This was a multicenter, mixed methods, prospective cohort study at seven medical centers across the United States involved with the Society of Gynecologic Surgeons' Collaborative Research in Pelvic Surgery Consortium network. Adults with a uterus and a benign gynecologic condition with no intention for pregnancy were recruited. Chart review and patient questionnaires, including the validated VALUS (Value of Uterus) instrument, were completed. Semi-structured audio interviews were performed in a subset of participants to identify themes associated with values of the uterus. Interview transcripts were thematically analyzed using the grounded theory approach until saturation was reached. Qualitative data were collected from 40 participants; 36 (90.0%) completed the VALUS questionnaire, and 20 (50.0%) completed semi-structured interviews. The median age was 51 years, and patients mostly identified as White race (75.0%). Participants' gynecologic conditions included urinary incontinence (57.5%), pelvic pain (42.5%), pelvic organ prolapse (40.0%), and various other gynecologic conditions. Based on the VALUS score, 55.6% (20/36) placed a high value on the uterus and 44.4% (16/36) placed a low value on the uterus. When asked about the value of the uterus, some participants viewed it as an organ for reproduction and fertility and their personhood or womanhood, whereas others thought of it as an organ of no value. Recurring themes around considerations before a hysterectomy procedure included a lack of knowledge regarding the physiologic role of the uterus beyond reproduction, the desire for more knowledge to make informed decisions and to understand the purpose of the hysterectomy procedure and alternatives. In this multicenter, mixed methods analysis, more than half the participants placed a high value on the uterus. The values of the uterus included fertility, personhood, and womanhood, which often was described as changing with patient's age or life circumstances. Our findings highlight the need to include the patient's values of the uterus to foster person-centered care in the treatment of gynecologic disorders when uterine preservation is an option.

The aging trend in the population, the high rate of hospitalization, the affliction by multiple chronic illnesses, and the increased vulnerability of older people when hospitalized undoubtedly require a person-centered approach to healthcare—an approach that values a person’s participation in the healthcare relationship, supports shared decision making and mutual understanding, and respects a person’s values, preferences, and beliefs. However, despite widespread recognition that the adoption of such a clinical practice paradigm is paramount, its implementation and development are still challenging for various health systems and professionals worldwide. The implementation strategy for such a healthcare paradigm must be based on each country’s health system organization and practice contexts, as well as the professionals involved. The present work aims to provide guidelines for the understanding of the state of development of person-centered practice in the daily care of hospitalized older adults with chronic illnesses within the internal medicine department of a secondary hospital in an urban area of Portugal. We focus on the characterization of (i) the perceptions of a multidisciplinary team working at an inpatient hospital department of person-centered practice, (ii) the perceptions of hospitalized older adults with chronic illnesses about person-centered practice, (iii) the work culture of an inpatient hospital department with a high prevalence of older adults with chronic illnesses, (iv) the Person-Centred Practice Framework at the organizational and structural levels of the healthcare system, and (v) the elements that influence the implementation of person-centered practice at the individual, organizational, and structural levels in this specific hospital context. To this end, a mixed-methods analysis with a convergent design was planned to use questionnaire instruments to collect data in parallel and independently from distinct samples of health professionals and older inpatient adults within this department. Furthermore, health policies and strategic plans will be analyzed to identify and evaluate references and guidelines for the practice of person-centered care. Studying the dimensions of clinical practice in this specific healthcare context following the Person-Centred Practice Framework can allow us to understand the extent of its development in terms of prerequisites, care environment, care processes, and the macro-context of the healthcare system. Therefore, it is possible to identify and characterize the dimensions achieved and those that need to be improved and, thus, establish a starting point for the definition of new strategies to advance practice towards person-centeredness and monitor changes in healthcare practice.

Person-Centered Oncologic Care and Choices (P-COCC) combines an advance care planning (ACP) value-focused patient interview with a care goal video decision aid. Our randomized study showed that P-COCC was acceptable but increased participant distress, compared with video-alone and usual care study arms. This mixed methods approach explores the ACP values in the P-COCC arm and their relationship to the distress phenomenon. Qualitative thematic analysis of the 46 audio-recorded P-COCC interview transcripts with advanced gastrointestinal cancer patients was performed by multiple reviewers. Quantitative (Likert scale) changes in ACP values were compared across study arms. ACP themes and value change were analyzed in participants with increased distress. Transcript analysis resulted in thematic saturation and identified eight distinct themes on ACP values relating to end-of-life wishes, communication needs, and psychosocial supports. Of 98 participants (33 P-COCC, 43 videos, 22 usual care) who completed the change in value measure, there was no difference detected with P-COCC compared with either video (p = 0.052) or usual care (p = 0.105) arms alone, but P-COCC led to a frequency distribution of more change in personal values compared with the other study arms combined (p = 0.043). Among the subset of P-COCC participants with increased distress, there was no statistical relationship with change in values. The ACP paradigm P-COCC both informs and supports patients in individualized, value-based decision-making. Distress is not associated with changes in ACP values and may be a necessary, at least transient, byproduct of discussing sensitive but pertinent topics about end-of-life medical care.

Purpose To explore how mealtime planning and delivery practices in inpatient rehabilitation influence therapeutic mealtime experiences. Methods This multiple case study used convergent mixed methods analysis of case-specific data across two metropolitan general rehabilitation sites. Interviews, patient reported experience measures, and a chart audit were conducted at two timepoints for participants. Within-case analysis involved descriptive and qualitative analysis, and across-case analysis involved identifying patterns and differences across cases, with findings organised to Donabedian’s structure-process-outcome model. Results The dining room was the most discussed mealtime structure to promote therapeutic mealtime experiences, enabling access to care, therapy activity, and social engagement. Mealtime structures with built-in flexibility and staff knowing their patients supported tailoring of experiences and enabled person-centred care. Compassionate and attentive interactions with staff created a genuine approach to care, positively influencing patients’ psychosocial well-being. Most patients self-initiated using mealtimes for additional therapeutic activity, but mealtimes were also a time of rest and an opportunity to maintain personhood. Conclusion Mealtimes have substantial potential to contribute positively to patients’ rehabilitation and offer clinicians opportunities to engage patients in rehabilitation. Flexible mealtime systems enable staff to provide person-centred care, but improvements are needed to ensure this is delivered consistently for all patients.

A locally-adapted, multisensory, psychosocial intervention called Namaste Care program was developed to improve the daily life of persons with advanced dementia (PwAD) through arranging meaningful activities and physical interactions by healthcare staff (Namaste Carers). Congruent with Asian values, the families of PwAD were invited to participate in Namaste Care sessions. The study aimed to explore the influence of Namaste Care on cognitive status and quality of life (QOL) of PwAD, and perceptions and attitudes of caregivers and Namaste Carers toward dementia care were determined. A total of 10 individuals, including patient-caregiver dyads (n = 4) and Namaste Carers (n = 6) participated in a program in a tertiary hospital in Singapore. Quality of Life in Late-Stage Dementia (QUALID) scale and Severe Impairment Rating Scale (SIRS) were employed to evaluate QOL and cognition, respectively, in the pre- and post-survey program in patient-caregiver dyads. Namaste Carers’ knowledge and attitudes toward PwAD were assessed using the Questionnaire on Palliative Care for Advanced Dementia (qPAD). Caregivers and Namaste carers were interviewed post-program separately. A concurrent explanatory mixed-method analysis was done. The mean age of PwAD was 84 years, with 75% (n = 3) patients on enteral tube feeding. Namaste carers were nurses with an average experience of 4.1 years in dementia care. On comparison of pre- and post-program scores of PwAD, QUALID scores showed a decrease (indicating an improvement in the QOL), while the SIRS scores were increased (indicating an improved cognitive response). Namaste Carers scored high on qPAD, reflecting the good understanding and a positive attitude toward PwAD. Thematic analysis of 10 interview transcripts from caregivers and Namaste Carers revealed three themes: the polarizing paradigm of care in advanced dementia; pre-eminence of the Asian family values, and theme of “small actions make a big difference”. Namaste Care served as a bridge between the person-centered care approach and the biomedical model of dementia care. Namaste Care with family participation may be the cornerstone of PwAD to receive culturally-appropriate personalized care and serve as a premise for the operationalization of person-centered care in Asian societies, and undeniably across the world.

To create a curriculum innovation for early preclinical medical students to explore personal perspectives by listening to and learning from the lived experience of community-living older adults. Tell Me Your Story (TMYS) paired first-year medical students (MS1s) with community-dwelling older adult partners (OAPs) residing in the independent living portion of a continuing care retirement community (CCRC) for a half-day educational experience. MS1s conducted 1-hour semi-structured interviews with their OAP and then formed small groups with geriatric faculty members to explore experiences and views that were either reinforced or challenged. The authors evaluated the effectiveness of this exercise using post-activity surveys. A mixed-methods analysis of 7 years of data (2013-2019) was conducted. TMYS had 1251 MS1 participants from 2013 to 2019. Students completed 1052 surveys for a response rate of 84%. During the semi-structured interview with OAP, the frequency of issues discussed included relationships (94%), professionalism/art of medicine (91%), healthcare accessibility (83%), death/dying/grieving/loss (72%), nutrition (69%), ethics (64%), and cultural competence (61%). Exactly 97% (n=1023) responded that the overall organization was "good, very good or excellent." The most prominent themes identified by student responses highlighted person-centered care, patient perspective, life experience/personal stories, and doctor-patient relationship. Fifty-three faculty members completed the post-program survey. Exactly 100% (53/53) rated the quality of this exercise as an educational experience high. TMYS was highly valued by students and provided an important experiential learning activity in preclinical medical education. Themes related to person-centered care emerged from the intervention.

The co-creation and sharing of documentation of person-centered care is important, but challenging in clinical practice. Online access to health records is considered essential to increase patient participation and empowerment in person-centered care provision. The aims of this study were (1) to identify the extent of person-centered content in medical inpatient records and discharge letters; (2) to describe the characteristics of the language and rhetoric used in discharge letters. This was a concurrent, mixed-methods study involving a deductive, quantitative analysis of person-centered content in 69 Patient Accessible Electronic Health Records from patients with pituitary tumors, and an iterative, qualitative language analysis of a nested sample of 57 discharge letters. Both the content and language of inpatient records were mostly patient-centered. Records were concerned with the documentation of symptoms and medical and care interventions. There was little person-centered documentation of patients’ preferences, wishes and needs, and shared decision-making. In the discharge letters, written for the patients, some physicians had attempted to write in a person-centered way, using plain language and a narrative. However, most wrote in a style that was reflective of their discourse community, using abbreviations and medical terms. Established norms for documentation in healthcare are a barrier to person-centered documentation. Patients’ needs and preferences about documentation should be explored to increase understanding of how person-centered documentation can be achieved in clinical practice.

Background: Parkinson’s Disease (PD) is the second most prevalent neurodegenerative disease and the fastest-growing neurological condition globally (1). PD has several symptoms that impact quality of life, community participation and general health and wellbeing (2). Early identification of symptoms is essential when providing timely care within a multidisciplinary integrated care service to ensure optimal patient outcomes (3). There is no consistent pathway to report clinical information accurately and promptly on PD progression. The study explores the viability of a speech-based diagnostic tool by identifying essential requirements to report disease progression in Parkinson’s Disorder (PD). Early identification of PD is essential when providing timely care within a multidisciplinary integrated care service to ensure optimal patient outcomes (3). Speech-based diagnostic tools have the potential to diagnose, monitor, and predict PD progression objectively. Method: This project employed a mixed qualitative method data gathering and analysis. Participants are health and social care staff working in community-integrated care. The stakeholders’ current perspectives on the viability of a speech-based diagnostic tool for PD was explored through surveys, focus groups and interviews. This was then compared to a relevant public policy document to consolidate outcomes. Results: A ground theory approach generated multiple themes including reliability, ease of use, attitudes to technology, interoperability, training, privacy and costs. Although the accuracy of current speech-based devices is still being developed, training and awareness can be acquired to improve attitudes towards speech-based technology. Biases and internal motivations can affect the potential use of technologies that may benefit People with Parkinson’s Disease (PwPD). The study confirmed that interoperable systems and integrated pathways are crucial in successful digital health innovations to provide high-quality person-centred care. Health staff wants transparency on how the device analyses speech to ensure safe, and evidence-based practice. The preference of PwPD not to know further progression of the disease was consistently identified. Learning and next steps: The increasing global prevalence of PD as a debilitating disease necessitates maximising available resources to ensure accurate diagnosis, regular monitoring, and integrated intervention. A speech-based digital tool used in an integrated service model can improve clinical outcomes and contribute to a better quality of life for PwPD. However, issues are raised regarding the reliability, comfort, usability, and privacy of this technology. A co-design approach with PwPD, carers and staff is recommended in digital health innovation in an international context to ensure users’ preferences and lived experiences are included in the design, implementation and ongoing evaluations. More extensive, high-quality, varied speech sets from PwPD must be generated for speech-based diagnostics to mature. National Institute for Health and Care Excellence. Parkinson’s Disease: How common is it? [Internet]. 2023 [cited 2023 Aug 6]. Available from: https://cks.nice.org.uk/topics/parkinsons-disease/background-information/prevalence/#:~:text=The lifetime risk of being,some point in their lifetime. Parkinson’s U K. The incidence and prevalence of Parkinson’s in the UK [Internet]. Parkinson’s UK. 2017 [cited 2022 Oct 1]. p. 1–6. Available from: https://www.parkinsons.org.uk/sites/default/files/2018-01/CS2960 Incidence and prevalence report branding summary report Published 2017.pdf NICE. Parkinson’s NICE guidelines. 2017;97(5):1118–36. Available from: https://www.parkinsons.org.uk/sites/default/files/2018-10/Parkinson%27s NICE Guidelines 2017.pdf%0Ahttps://www.nice.org.uk/terms-and-%0Ahttps://www.nice.org.uk/guidance/ph27/resources/weight-management-before-during-and-after-pregnancy-pdf-1996242046405

BackgroundStatutory duty of candour (SDC) requires healthcare services by law to provide the patient or their family or carer who experiences a serious adverse patient safety event (SAPSE) with a written account of the facts, an apology, and the steps being taken to prevent reoccurrence. To date, the impact of SDC implementation has been understudied. As part of a state-wide evaluation of the impacts of SDC in the two years since its implementation in Victoria, Australia, this study focuses on staff and service delivery impacts of SDC.MethodsA mixed-methods design was employed, synthesising data from a 21-item survey with interview data. Health service staff working in Victorian health settings since SDC implementation in 2022 were recruited via state health agencies, professional organisations and social media. Survey data were subject to quantitative analysis using statistical software, with inductive content analysis applied to free text items. Reflexive thematic analysis was undertaken with the interview dataset.ResultsA total of 170 respondents completed the survey, 25 of whom further participated in a follow-up interview. Survey participants were clinician managers (30%), nurses (24%), doctors (17%), allied health professionals (10%), and others (18%), primarily working in Victorian public (80%) and private (11%) hospitals. Staff reported greater awareness of SDC among staff with managerial responsibilities than frontline staff, with perceived gaps in staff knowledge about SDC and communication skills inhibiting practice. Seven themes further characterised the benefits, implementation challenges and implications of SDC: Promoting organisational accountability; Inconsistent event identification and review; Threshold for SDC is subject to interpretation; Prescriptive processes inhibit person-centred care; Context-specific implementation requirements; Adjusting to policy change; and Capacity and capability for implementation.ConclusionImplementing SDC has contributed to greater structure, consistency and routine inclusion of patient and family perspectives when examining patient safety events. Opportunities for improvement identified by respondents and interviewees included developing person-centered and context-sensitive timeframes for communication, relaxing legalistic documentation requirements, findings ways to more consistently apply SAPSE definitions, and addressing the cultural implications and administrative burden of SDC requirements.

As HIV becomes a chronic condition, it is critical for research to include the perspectives of long-term HIV survivors who face the challenges of managing both HIV and aging. We created SHARE (Survivors of HIV Advocating for Research Engagement), a nationwide research advisory board for long-term survivors. SHARE’s goal is to incorporate long-term HIV survivor voices into research to influence person-centered care for long-term survivors. Through SHARE, board members have built research capacity through research methods training culminating in the board conducting a community needs assessment to learn community-directed priorities for HIV and aging. Following the needs assessment, each board member worked to identify and conduct research dissemination activities within their own communities to engage others in conversations about aging and HIV and educate on opportunities for greater research involvement. In this paper presentation, the speakers describe the process of building capacity among SHARE members so that they could serve as research champions through community dissemination efforts. The presenters will describe the methods of community dissemination including lunch and learns, webinars, infographics, podcasts, photovoice, and advocacy. Mixed-methods analysis of the impact of research dissemination will be presented including changes in community member knowledge about research, willingness to participate in research studies, and understanding of tools to find and use research. The presenters will also share data from SHARE board member self-reflection on the challenges and opportunities for researchers to engage community member in dissemination activities that are tailored to the community and can influence adoption of research among end users.

e24163 Background: A novel, patient-verified summary documenting nurse-led discussions assessing health-related values of newly-diagnosed cancer patients has been implemented in outpatient gastrointestinal (GI) oncology clinics, but the content of these discussions has not previously been analyzed. Methods: Three interdisciplinary coders met and reviewed values summaries for 40 patients. Phase One meetings consisted of identifying key domains to guide line-by-line coding with ATLAS.ti software, codebook generation, and quality assurance of codebook fidelity. Phase Two meetings consisted of independent review and code categorization, followed by three successive consensus meetings of coders to identify themes. Results: Content analysis of 40 patient values summary documents revealed 5 distinct themes: Family, friends, and faith as sources of strength; strong family ties predominate definitions of living well. Despite this, patients stated that communication with loved ones about values and goals was limited; 35% of patients had not discussed core values prior to nurse-led discussion. Patients emphasized information processing and communication preferences as important definitions of selfhood. Patients defined treatment goals as survival and maintenance or return to “normal life” for as long as possible. When asked about treatment preferences during potential future crisis, patients emphasized quality of life over survival. Conclusions: Early, nurse-led values discussions provide important and unique data that are informative and actionable by clinicians in the delivery of person-centered care. Thematic analysis reveals that while family and friends are important, patients often had not discussed core values or care preferences with them. Although patients desire to live longer, treatment preferences during crisis are also shaped by expected quality of life from interventions. Assessment and creation of patient values summaries captures nuanced data that can facilitate discussion with loved ones and play a key role in surrogate decision-making during moments of crisis. Further mixed-methods analysis of patient variables ( e.g., age, stage) modifying values and impact on patient-reported outcomes is warranted.