Explanation Of Test Results Research Articles

Experienced hearing aid users’ perspectives of assessment and communication within audiology: a qualitative study using digital methods

Objective To explore experienced hearing aid users’ perspectives of audiological assessments and the patient–audiologist communication dynamic during clinical interactions. Design A qualitative study was implemented incorporating both an online focus group and online semi-structured interviews. Sessions were audio-recorded and transcribed verbatim. Iterative-inductive thematic analysis was carried out to identify themes related to assessment and communication within audiology practice. Study samples Seven experienced hearing aid users took part in an online focus group and 14 participated in online semi-structured interviews (age range: 22 − 86 years; 9 males, 11 females). Results Themes related to assessment included the unaided and aided testing procedure and relating tests to real world hearing difficulties. Themes related to communication included the importance of deaf aware communication strategies, explanation of test results and patient centred care in audiology. Conclusion To ensure hearing aid services meet the needs of the service users, we should explore user perspectives and proactively adapt service delivery. This approach should be ongoing, in response to advances in hearing aid technology. Within audiology, experienced hearing aid users’ value (1) comprehensive, relatable hearing assessment, (2) deaf aware patient–audiologist communication, (3) accessible services and (4) a personalised approach to recommend suitable technology and address patient specific aspects of hearing loss.

1010 Individuals with Metabolic Syndrome and Unrecognized Sleep Apnea Can Be Identified by an Employer-Sponsored Healthcare Program and At-Home Sleep Study

Abstract Introduction Obstructive sleep apnea (OSA) is common in individuals with metabolic syndrome (MetS) and increases risk of cardiovascular (CVD) events. Once recognized, therapeutic interventions can reduce OSA severity and associated CVD risk. Of the 25 million Americans with OSA, 80% are unaware of their disease. To facilitate and improve diagnosis of OSA, diagnostic devices for at-home OSA testing have been developed in clinical studies and approved by FDA. We evaluated an employer-sponsored healthcare outreach program and at-home OSA testing as a means of identifying individuals likely to have OSA and referring them into care. Methods Nine-hundred individuals with MetS, positive OSA Berlin questionnaire score and no prior diagnosis of OSA, as determined by annual workplace screening and health claims, were invited to participate in the sleep program. Those who agreed to participate (9.9%) received a diagnostic device for at-home OSA testing. Apnea-hypoapnea index (AHI) results recorded on returned diagnostic devices were evaluated by a sleep specialist. A telephone consultation with a program physician then provided each participant with an explanation of test results and referral into care. Based on AHI we identified individuals with moderate (AHI 16-30) to severe (AHI >30) OSA and referred them to care. Results Of the 89 participating individuals, 21% had 3 MetS components, 53% had 4 components, and 20% had 5 components; 30% were diabetic; 83% had hypertension; and >50% were obese. Moderate to severe OSA was diagnosed in 52 (58%) of participants. Of those, 50% had moderate OSA and 50%, had severe OSA. Among individuals with moderate to severe OSA, 29 (56%) had a physician consultation and were referred to treatment. Conclusion A personalized employer-sponsored healthcare outreach program identified individuals with unrecognized OSA and referred them into care. Support

Does the delivery of diagnostic news affect the likelihood of whether or not patients ask questions about the results? A conversation analytical study.

BackgroundAsymmetries in knowledge and competence in the medical encounter often mean that doctor‐patient communication can be compromised. This study explores this issue and examines whether the likelihood of patient question asking is increased following the delivery of diagnostic test results. It also examines whether that likelihood is related to the way in which the test results are delivered.ObjectiveTo examine when and how patients initiate questions following diagnostic news announcements.MethodsWe audio‐recorded oncology consultations (n = 47) consisting of both first consultations and follow‐up consultations with patients with different types of cancer, at a leading UK teaching hospital. From the primary sample, we identified 30 consultations based on a basic count of the frequency of patient questions and their positioning in relation to diagnostic announcements. This subset of 30 consultations consisted of a mix of first and follow‐up consultations.ResultsOur data demonstrate how the design and delivery of diagnostic news announcements can either discourage or provide the opportunity for a patient‐initiated question in the next turn of talk. We identified two types of announcement. Q+ generally provided for a patient‐initiated question as a relevant next turn following the news announcement, whereas Q− did not. Q+ was sometimes followed up with the explanation of test results, which appeared to encourage further patient questions.ConclusionThe design and delivery of diagnostic news announcements can make a patient‐initiated question more or less appropriate, in the next turn of talk. In addition, showing and explaining test results can encourage further opportunities for patients’ questions.

Areas and factors associated with patients' dissatisfaction with glaucoma care.

ObjectiveThe aim of this study was to evaluate patients’ dissatisfaction with overall and specific aspects of a tertiary glaucoma service and to determine their independent factors, including intraocular pressure (IOP) and visual acuity (VA).MethodsPatients, aged ≥21 years, from a specialist glaucoma service in a tertiary eye hospital in Singapore for at least 6 months, were recruited for this cross-sectional study between March and June 2014. All consenting patients completed a 7-area glaucoma-specific satisfaction questionnaire and one item related to satisfaction with overall glaucoma care. We determined the top three areas of dissatisfaction and overall dissatisfaction with the glaucoma service. We also explored the independent factors associated with overall and specific areas of patients’ dissatisfaction with their glaucoma care, including VA and IOP by using logistic regression models.ResultsOf the 518 patients recruited, 438 (84.6%) patients completed the study. Patients’ dissatisfaction with the overall glaucoma service was 7.5%. The three areas of glaucoma service with the highest dissatisfaction rates were as follows: 1) explanation of test results (24.8%); 2) explanation of glaucoma complications (23.7%); and 3) advice on managing glaucoma (23.5%). Patients who were dissatisfied with the overall service had a worse mean VA compared with satisfied patients (logarithm of the minimum angle of resolution =0.41±0.43 vs 0.27±0.49, p=0.005), whereas mean IOP remained well-controlled in both the groups (13.55±2.46 mmHg vs 14.82±2.86 mmHg, p=0.014). In adjusted models, factors associated with overall dissatisfaction with glaucoma care included a pre-university education and above (odds ratio [OR] =8.06, 95% CI =1.57–41.27) and lower IOP (OR =0.83, 95% CI =0.71–0.98).ConclusionAlthough less than one tenth of glaucoma patients were dissatisfied with the overall glaucoma service, one in four patients were dissatisfied with three specific aspects of care. A lower IOP, ironically, and education level were associated with overall dissatisfaction. Improving patients’ understanding of glaucoma test results, glaucoma complications, and disease management may increase patient satisfaction levels.

Potential Health Risks from Uranium in Home Well Water: An Investigation by the Apsaalooke (Crow) Tribal Research Group

Exposure to uranium can damage kidneys, increase long term risks of various cancers, and cause developmental and reproductive effects. Historically, home well water in Montana has not been tested for uranium. Data for the Crow Reservation from the United States Geological Survey (USGS) National Uranium Resource Evaluation (NURE) database showed that water from 34 of 189 wells tested had uranium over the Environmental Protection Agency (EPA) Maximum Contaminant Level (MCL) of 30 μg/L for drinking water. Therefore the Crow Water Quality Project included uranium in its tests of home well water. Volunteers had their well water tested and completed a survey about their well water use. More than 2/3 of the 97 wells sampled had detectable uranium; 6.3% exceeded the MCL of 30 μg/L. Wells downgradient from the uranium-bearing formations in the mountains were at highest risk. About half of all Crow families rely on home wells; 80% of these families consume their well water. An explanation of test results; associated health risks and water treatment options were provided to participating homeowners. The project is a community-based participatory research initiative of Little Big Horn College; the Crow Tribe; the Apsaalooke Water and Wastewater Authority; the local Indian Health Service Hospital and other local stakeholders; with support from academic partners at Montana State University (MSU) Bozeman.

Behavioral Patterns and the Role of Ethnicity in Patient Awareness of Multiple Myeloma and the Psychophysical Impact of Its Treatment

Background: There is a significant variation in disease incidence and outcomes among Multiple Myeloma (MM) patients (pts) from different ethnic backgrounds. Currently, there is a paucity of data regarding the influence of demographics and ethnicity on behavioral patterns of pts, their attitudes, beliefs, and knowledge about MM and its treatment, which could in turn affect outcomes. We conducted a questionnaire-based study to examine behavioral patterns of MM pts, especially focusing on ethnic minorities and how this may impact patient awareness and symptom complex related to the disease and its treatment.Methods: Apaper-basedquestionnaire consisting of 61 questions encompassing four broad categories was provided to participating pts at the University of Southern California Medical Centers. These included demographics, disease/treatment related quality of life (QoL), satisfaction regarding treatment, and satisfaction regarding treating physician/healthcare staff. Information on clinical characteristics and MM-related treatment was collected through an IRB-approved protocol. Pts were stratified by age, gender, and ethnicity (Hispanics vs. Non-Hispanics). Any missing patient responses were withdrawn from the final analysis of that question. Categorical and continuous variables were compared among groups using Chi-square and Kruskal-Wallis tests, respectively. All statistical analysis utilized SAS software (v9.3) with a two-sided significance level of 0.05.Results: A total of 89 pts (males: 40, females: 49) from March 2012 to October 2013 responded to the questionnaire of the 100 pts that were consented (81%). Median age was 59 (range: 23-81) years and 43 (48%) pts were Hispanic while 46 (52%) were Non-Hispanic. Baseline clinical characteristics are shown in Table 1A. As compared to Non-Hispanics, Hispanic pts were less likely to have completed college (70% vs. 30%, p<0.001), attend myeloma support groups (90% vs. 10%, p=0.026), feel they had sufficient disease/treatment-related information (72% vs. 22.5%, p<0.001). Hispanic pts were more likely to report being unemployed/without any income (57.5% vs. 9%, p<0.001), have 3-4 people living in the house (57.5% vs. 26 %, p=0.009), feeling ill (43% vs. 21%, p=0.029), have concern about deterioration in clinical condition (66% vs. 41%, p=0.022), and inability to work due to symptoms from MM or its treatment (38.6% vs. 11.9%, p=0.005) when compared to Non-Hispanics. With respect to MM treatment, Hispanic pts were less likely to report that side effects were as expected (34% vs. 57%, p=0.036) and believe that treating staff worked towards the same goal (88% vs. 100%, p=0.020) as them. Hispanic pts also reported a lower level of satisfaction with their doctor /treatment staff, as compared to Non-Hispanic pts and this difference was statistically significant as shown in Table 1B. Using gender as the stratification factor, we noted that female pts were more likely to report lack of energy (p=0.037), pain (p=0.010), satisfaction with discussion on emotional health (p=0.012) as compared to males. With age as the stratification factor, patients < 60 years of age were less likely to report expected effectiveness from treatment (p=0.031), satisfaction regarding appropriateness of treatment (p=0.008) or explanation of test results by their doctor (p=0.036), and were more likely to worry about deterioration in their condition (p=0.014). We did not find a statistically significant association between age, gender, or ethnicity and response to initial myeloma treatment.Conclusions: We found a significant association between MM patient ethnicity and the pts responses to questions pertaining to their QoL, satisfaction with treatment and treating physician. This difference in disease/treatment related knowledge and attitudes may be related to socio-cultural and behavioral patterns and may contribute to factors such as treatment compliance, effectiveness and symptom complex burden amongst others, that can impact outcomes among ethnic subgroups of MM pts. Efforts to mitigate these differences should focus on improving methods of patient education, spread more awareness among ethnic minorities, integration of psychosocial care into cancer therapy and promoting health psychology research. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Patient-initiated questions: How can doctors encourage them and improve the consultation process? A qualitative study

ObjectiveTo investigate the circumstances under which patients initiate direct questions in oncology consultations.DesignConversation analysis of 47 consultations between oncologists and patients with cancer.SettingAn oncology clinic at a teaching hospital in...

Talking to Parents About Genetics

Talking to Parents About Genetics

Breath-alcohol analyzers and simulator solutions: a commentary on a deficient explanation of test results

Breath-alcohol analyzers and simulator solutions: a commentary on a deficient explanation of test results

Patient Expectations of Emergency Department Care: Phase II – A Cross-Sectional Survey

To explore emergency department (ED) patient expectations regarding staff communication with patients, wait times, the triage process and information management. We conducted a cross-sectional English-language telephone survey among patients aged 18 years or older who visited the EDs in the Calgary Health Region in 2002. Survey items were based on a preceding qualitative study. Of the 941 surveys, 837 were analyzed. Patients placed the highest importance on the explanation of test results (96.5%), a description of circumstances that would require the patient to return to the ED (94.4%), the use of plain language (92.1%) and the reason for the tests (90.8%). Seventy-six percent of patients felt that ED staff should update patients every 30 minutes or less, 51.3% expected patients with non-life threatening problems should wait <1 hour, and 58.3% expected that the tests should be done within 1 hour. Almost two-thirds of the patients (64.4%) believed that the most serious patients should be seen first; 59.3% felt that the seriousness of medical concern should be determined by a triage nurse, and 63.9% thought that their personal health records should be immediately available to the emergency physician without their consent. The actual length of stay was significantly longer than expected length of stay for all patient groups, with Canadian Emergency Department Triage and Acuity Scale Levels IV and V patients expecting a shorter wait than patients in more urgent triage groups. Triage level effects on other expectations were not observed. ED patient expectations appear to be similar across all triage levels. Patients value effective communication and short wait times over many other aspects of care. They have expectations for short wait times that are met infrequently and are currently unattainable in many Canadian EDs. Although it may be neither feasible nor desirable to meet all patient expectations, increased focus on wait times and staff communication may increase both ED efficiency and patient satisfaction.

The Patient’s Right to clear Communications in Health and Mental Health Delivery Service

ABSTRACT Persons from minority groups often are at a linguistic disadvantage in (Philadelphia, Pennsylvania, Nov. 22, 1975) the language and culture of the physician or psychoanalyst, who may be unaware of problems of understanding. Patients have certain language rights in medical care. (1) The right to human dignity in the medical relationship is jeopardized by, for example, a specialized professional vocabulary, the different cultural background of doctor and working-class patient, and the asymmetrical status of doctor and patient, where the doctor as the superior controls the conversation. During taped medical interviews with black, inner-city residents, the patients adopted their best English and tried to use medical terminology to avoid embarrassment. (2) The right to know what is wrong with their bodies involves the doctor's ability and desire to communicate and the patient's ability to understand. Even common medical terms may not be understood by ghetto residents. (3) The right to know why certain tests or treatments are given is important to the patient's peace of mind and dignity. (4) The patient's right to make decisions about alternative treatment must be maintained through clear explanation of test results and alternative treatments. It is suggested that medical schools include training in personal interviewing and minority languages and cultures and, if possible, that they recruit working-class doctors. (CHK)