Desired Level Of Involvement Research Articles

Self-Management of Health Care Among Youth: Implications for Policies on Transitions of Care

PurposeTransitions from pediatric to adult health care are important milestones for youth. In surveys, providers report that youth lack the motivation or skills to manage their care independently, a prerequisite for successful transitions. To assess the validity of this belief, we surveyed youth regarding their current and desired level of involvement in their care. MethodsIn 2017–2018, we conducted a national text message survey of youth aged 14–24 years. The survey included three open-ended questions assessing participants' independence on three health care tasks (scheduling appointments, attending appointments, and picking up prescriptions) and one open-ended question assessing their desire to be more, less, or equally involved in their care as they are now. We qualitatively analyzed free-text responses to identify themes. ResultsAmong 1,214 eligible participants, 805 (66.3%) completed all four questions and were included in the sample. Forty-one percent of youth reported wanting to be more involved in their care. Among young adults aged 18–24 years, 22% were not fully independent on the three health care tasks and reported wanting to be less involved or equally as involved as they are currently. ConclusionMany youth should be viewed as partners in health care transitions instead of as barriers, but some youth are at high risk for failed transitions. Policymakers and providers should promote routine screening of youth for their current levels of engagement in care and desire to be more involved.

We Want to be More Involved: Student Perceptions of Students as Partners Across the Degree Program Curriculum

Engaging students-as-partners is gaining momentum in the higher education sector. This study explores undergraduate students’ perceptions of how involved they were in partnership activities across their degree programs, and whether this matched their desired level of involvement in such practices. Analysis of a quantitative study of 268 students showed statistically significant differences between perceived levels of importance and involvement for all the partnership practices (n=18) investigated in our survey. These results highlight that the students in this study want to be more substantially involved in partnership practices across their degree program. We argue against the consumerist rhetoric about the role of students as passive learners and advocate for greater inclusion of partnership activities that foster active student participation in shaping the university curricula. We discuss implications for Students as Partners in relation to the progressive development of university curricula and assessment practices along with future research directions.

What Is Shared in Shared Decision Making? Complex Decisions When the Evidence Is Unclear

Patient involvement in decisions is central to patient-centered care. Yet many important decisions must be made in complex, ambiguous clinical situations in which all possible options cannot be known, evidence is inadequate to inform patients' preferences fully, and/or patients are unclear about their desired level of involvement. In these situations, preferences are shaped by affect, framing, and "collaborative cognition" among clinicians, patients, and their families; thus, decisions are often relational, dynamic, iterative, provisional, and/or conditional. Clinicians can help patients achieve greater autonomy by engaging both intuitive and deliberative decision-making processes ("whole mind") and involving others in exploring, clarifying, and co-constructing patients' preferences ("shared mind"). Clinical and interpersonal relationships can promote effective decision making through developing a shared attentional focus, tailoring information, and identifying conditions under which provisional preferences might change. Information technology and health systems offer untapped potential to deepen the relationships and conversations within which decisions are made.

The Effects of Medical Music Therapy on Patient Satisfaction: As Measured by the Press Ganey Inpatient Survey

Satisfaction of patients receiving medical treatment is currently a driving factor in healthcare reform for both quality of care and economic reasons. Numerous studies have examined factors that influence patient satisfaction and identified those with significant positive outcomes. Factors related to increased patient satisfaction include shorter waiting times (Eilers, 2004), level of received (Barry & Henderson, 1996; Fallowfield, Baum, & Maguire, 1986; Ludwich-Rosenthal & Neufeld, 1993; Martelli, Auerbach, Alexander, & Mercuri, 1987), physician friendliness (Auerbach, Clore, Kiesler, Orr, Pegg, Quick, et al., 2002), and experiencing a match between desired and actual level of involvement in decisions affecting one's care (Campbell, Auerbach, & Kiesler, 2007). Research has shown that when patients feel their needs are being met with regard to decision making, amount of received, and interpersonal relationships, they are generally more satisfied (Kiesler & Auerbach, 2006).Although every patient has unique needs, certain types of patients have been identified with regard to seeking, decision making, and interpersonal relationships. Understanding how a patient's personality type influences their preferences for medical treatment is one way in which health care personnel can help increase patient satisfaction and improve health outcomes.Some patients prefer to receive high levels of about their treatment. These patients have been termed monitors or information seekers. Other patients, also called blunters or information avoiders prefer low levels of (Miller & Mangan, 1983). Patients who received their desired level of reported lower pain after surgery (Martelli, Auerbach, Alexander, & Mercuri, 1987), less anxiety and more adaptive coping behaviors (Ludwick-Rosenthal & Neufeld, 1993), and lower levels of physiological arousal to the impending procedure (Miller & Mangan, 1983). Additionally, when making decisions about medical treatment, some patients prefer to play an active or autonomous role, making decisions on their own while others prefer to play a passive role, letting the doctor or other healthcare providers make the decisions. Still others prefer a collaborative or shared role, in which the patient and the doctor work together to make the decision (Kiesler & Auerbach, 2006).Although varying reports indicate that there is no clear dominance of one role type over the others, many studies report high discrepancies between patients' desired role and their enacted role. On average, fewer than 50% of patients reported agreement between preferred and actual role (Barry & Henderson, 1996; Bilodeau & Degner, 1996; Chappie, Shah, Caress, & Kay, 2003; Gattellari, Voigt, Butow, & Tattersall, 2002; Keating, Guadagnoli, Landrum, Borbas, & Weeks, 2002). Arora (2000) noted a trend toward better outcomes, including positive affect, health outlook, and reduced depression and fatigue, for patients who prefer an active role when they receive their desired level of involvement. An earlier study (Brody et al., 1989) revealed that patients who reported playing an active role in their treatment reported lower levels of illness concern and a greater sense of control over their illness. There was no activity by role interaction, indicating that patients who report active involvement may have better health outcomes, regardless of their stated preference for level of involvement. Gattellari, Voigt, Butow, and Tattersall (2002) confirmed this finding and suggested that encouraging patient participation may be the safest approach to ensuring patient satisfaction. The level of agreement between the physician's and the patient's beliefs about shared involvement or control has been reported to be low (Crawford et al., 1997; Faden, Becker, Lewis, Freeman, & Faden, 1981), suggesting that increased communication between physicians and patients and more opportunities for patient involvement are warranted. …

Experiences of self‐care in patients with colorectal cancer: a longitudinal study

This paper is a report of a study to explore patients' experiences of self-care during a 6-month course of chemotherapy treatment for colorectal cancer. A greater degree of patient involvement in self-care is increasingly being encouraged, however, little is known about patients' experiences of being actively involved in their self-care. Semi-structured interviews were carried out with 11 patients at the beginning and end of their treatment for colorectal cancer in a Scottish cancer centre between March 2005 and June 2006. The ways in which participants were actively involved in managing the impact of undergoing chemotherapy treatment and their understandings of the meaning of self-care were explored. Patients carried out self-care in order to preserve their self-identity and maintain a sense of normality. Self-care activities intended to manage both the physical and emotional impact of undergoing treatment included the use of medications and nutritional supplements and reducing food intake, information-seeking and -sharing experiences with fellow patients and rationalizing the purpose and effects of their chemotherapy treatment. Nurses have an important role to play in ensuring that patients' perspectives and priorities for self-care, in particular what they do, why they do it and what it means to them, and that they are listened to, in order to help them achieve their desired level of involvement in self-care. Interventions to promote self-care should focus on helping people to preserve their self-identity, as well as managing the emotional toll and physical side effects associated with cancer treatment.

Prevention in Routine General Practice: Activity Patterns and Potential Promoting Factors

Background. Primary care physicians have a unique opportunity to deliver preventive services, but a desired level of involvement is not always attained.Methods. We analyzed self-reported preventive activity in a stratified random sample of 635 primary care physicians to determine how often they deliver effective interventions for the prevention of cardiovascular diseases, cancer, and acquired immunodeficiency syndrome as well as to assess factors associated with a greater implementation of preventive activity in routine practice.Results. More than 63% reported to ask about tobacco use or alcohol consumption or to check blood pressure to most of their new patients. On the other hand, only 33% asked about intravenous drug use, 14% about sexu ally transmitted diseases, and 6% about the number of sexual partners and less than 33% reported to have an appropriate criterion for any periodic preventive activity in routine daily practice. Correlates of high preventive activity included group practice, specific register of preventive activities, participation in the Program of Preventive Activities of the Spanish Society of Community and Family Medicine, and specific nursing consultation.Conclusions. Organizational factors could be used to improve preventive activity which is far from being an adequate component of routine general practice especially with regard to human immunodeficiency virus infection and periodic preventive activity for chronic diseases.

Ideology and commitment in family life: A case study of runners

As part of a large study concerned with various aspects of marathon running 24 marathon runners and 17 of their spouses or partners were interviewed in depth. The interviews which lasted an hour or more explored in particular the degree of involvement, the motives for taking part in full or half marathon events and the impact which participation had on the runners and their families. The data showed a complex relationship existed between a desired level of involvement and what was achieved within the constraint of family and work commitments. The data also suggested that for the runners with families a number of different strategies were adopted in order to secure the necessary time to train for full or half marathon events. Three broad strategies were identified, taking time, buying time and sharing time, and each of these notions is discussed.