Improve Patient Participation Research Articles

Comparison of Demographics: National Amyotrophic Lateral Sclerosis Registry and Clinical Trials Data.

To characterize the participant demographics in the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database compared with the web-portal National Amyotrophic Lateral Sclerosis (ALS) Registry (the Registry). Demographics and ALS symptom information were compared between the self-reported registrant data in the Registry web portal (2010-2021) and the latest available PRO-ACT data (updated August 2022), which is a collection of clinical trials data. Greater percentages of younger (≤ 59years old) but smaller percentages of older (60 + years old) participants were represented in PRO-ACT compared to Registry. Enrollment for minority race groups was greater in the Registry portal data, but race information was largely missing/unknown in PRO-ACT database. Median age at the time of diagnosis and age at the time of symptom onset were significantly higher for Registry enrollees compared to the participants of PRO-ACT. Symptom onset sites were similarly reported, but duration between self-noted symptom onset and diagnosis was slight, but significantly longer for the Registry enrollees (11 vs. 9months). Hispanic were as likely as non-Hispanic to participate in research studies, based on the Registry data. There was a notable difference in the age distribution and minority representation of enrollees between the PRO-ACT and Registry study populations. Age distribution in the PRO-ACT database skewed to a younger and less diverse cohort. Despite the clinical heterogeneity and complex disease mechanism of ALS, identifying the underrepresented demographic niche in the PRO-ACT and Registry study populations can help improve patient participation and criteria for patient selection to enhance generalizability.

A randomized controlled trial of shared decision-making treatment planning process to enhance shared decision-making in patients with MBC

PurposeOpportunities exist for patients with metastatic breast cancer (MBC) to engage in shared decision-making (SDM). Presenting patient-reported data, including patient treatment preferences, to oncologists before or during a treatment plan decision may improve patient engagement in treatment decisions.MethodsThis randomized controlled trial evaluated the standard-of-care treatment planning process vs. a novel treatment planning process focused on SDM, which included oncologist review of patient-reported treatment preferences, prior to or during treatment decisions among women with MBC. The primary outcome was patient perception of shared decision-making. Secondary outcomes included patient activation, treatment satisfaction, physician perception of treatment decision-making, and use of treatment plans.ResultsAmong the 109 evaluable patients from December 2018 to June 2022, 28% were Black and 12% lived in a highly disadvantaged neighborhood. Although not reaching statistical significance, patients in the intervention arm perceived SDM more often than patients in the control arm (63% vs. 59%; Cramer’s V = 0.05; OR 1.19; 95% CI 0.55–2.57). Among patients in the intervention arm, 31% were at the highest level of patient activation compared to 19% of those in the control arm (V = 0.18). In 82% of decisions, the oncologist agreed that the patient-reported data helped them engage in SDM. In 45% of decision, they reported changing management due to patient-reported data.ConclusionsOncologist engagement in the treatment planning process, with oncologist review of patient-reported data, is a promising approach to improve patient participation in treatment decisions which should be tested in larger studies.Trial registrationNCT03806738.

Standardized Reproductive Endocrinology and Infertility Consultation for Pediatric and Adolescent Oncology Patients.

Purpose: To investigate the role of formal reproductive endocrinology and infertility (REI) consultation in fertility preservation counseling in a pediatric/adolescent oncology patient population. Methods: Retrospective chart review was performed at an academic adult hospital from 2021 to 2022. Pre- and postpubertal patients admitted to the pediatric/adolescent oncology service with cancer diagnoses and imminent gonadotoxic chemotherapy plans were included. Baseline characteristics were collected, including patient age, sex, race, language, insurance, and cancer diagnosis. Primary outcomes were formal REI consultation and fertility preservation election. Results: Nineteen of 58 eligible patients received a formal REI consultation. Patients were more likely to elect fertility preservation if they received a consult. Females were more likely to receive a consult than males and more likely to elect fertility preservation. Patients of age ≥16 years were more likely to receive consultation than younger patients. However, all patients of age <16 years who received a consult elected fertility preservation. There was no difference in consultation based on race, language, or insurance. Thirteen of 19 patients who received an REI consultation elected fertility preservation. Ten of 11 female elections were ovarian suppression, an unproven method of fertility preservation. The two male elections were semen cryopreservation. Conclusion: Underutilization of formal REI consults and a relative lack of proven fertility preservation elections may shed light on a need for increased fertility preservation awareness among young oncology patients and the providers who care for them. A streamlined process that automates formal REI consultation for all eligible patients may maximize the potential for comprehensive counseling and improve patient participation in fertility preservation.

Co-design of an intervention to improve patient participation in discharge medication communication.

Patients can experience medication-related harm and hospital readmission because they do not understand or adhere to post-hospital medication instructions. Increasing patient medication literacy and, in turn, participation in medication conversations could be a solution. The purposes of this study were to co-design and test an intervention to enhance patient participation in hospital discharge medication communication. In terms of methods, co-design, a collaborative approach where stakeholders design solutions to problems, was used to develop a prototype medication communication intervention. First, our consumer and healthcare professional stakeholders generated intervention ideas. Next, inpatients, opinion leaders, and academic researchers collaborated to determine the most pertinent and feasible intervention ideas. Finally, the prototype intervention was shown to six intended end-users (i.e. hospital patients) who underwent usability interviews and completed the Theoretical Framework of Acceptability questionnaire. The final intervention comprised of a suite of three websites: (i) a medication search engine; (ii) resources to help patients manage their medications once home; and (iii) a question builder tool. The intervention has been tested with intended end-users and results of the Theoretical Framework of Acceptability questionnaire have shown that the intervention is acceptable. Identified usability issues have been addressed. In conclusion, this co-designed intervention provides patients with trustworthy resources that can help them to understand medication information and ask medication-related questions, thus promoting medication literacy and patient participation. In turn, this intervention could enhance patients' medication self-efficacy and healthcare utilization. Using a co-design approach ensured authentic consumer and other stakeholder engagement, while allowing opinion leaders and researchers to ensure that a feasible intervention was developed.

Determining the Appropriateness and Acceptability of a Reduced Postradiotherapy Surveillance Practice in Breast Cancer Patients: Results of a Longitudinal Observational Study

Postradiotherapy surveillance, which aims to detect and treat radiation injury, is important from the patient’s perspective, but also from the radiation oncologist’s perspective. Unfortunately, patient nonattendance increases over the course of five years. The aim of the study was to investigate the appropriateness and acceptability of reduced versus usual (conventional) postradiotherapy surveillance in breast cancer patients. A total of 192 consecutive patients with curatively irradiated breast cancer from two selected treatment years were included in our study, of whom 65 were offered six (after three months, 12 months, 24 months, 36 months, 48 months, and 60 months) and 127 were offered four follow-up appointments (after three months, 12 months, 36 months, and 60 months). Their patient-, tumour- and treatment-related characteristics were analysed, as well as follow-up events and attendance rates. The reduced four-meeting surveillance practice shows similar results to the traditional six-meeting practice in terms of appropriateness and acceptability, with significantly higher attendance rates at 36 and 60 months (p=0.014 and 0.013, respectively) when the individual moments are compared on a one-to-one basis. The patient-, tumour-, and treatment-related variables examined did not show an effect on the attendance rate. There was also no significant difference between the two cohorts in the detection of follow-up events (such as recurrence) and late radiation effects. In conclusion, this retrospective study provides scientific support for the trend towards a risk-adjusted, reduced surveillance practice in radiation oncology. In particular, four postradiotherapy follow-up visits seem to be appropriate and accepted in breast cancer patients after curative postoperative breast irradiation. This reduced postradiotherapy surveillance practice has the advantage of saving time for the patient and resources for the healthcare system without compromising quality; it could also improve patient participation. We, therefore, recommend it as an appropriate standard for breast cancer patients.

Patient information handover between care providers

The handover of patient information between care providers is a big challenge. Important information is easily missed or the interpretation may differ among care providers. Structured transfer methods are used in the hospital to avoid this.&#x0D; In the hospital AZ Sint-Lucas (Ghent; Belgium), we have implemented three different methods based on literature. First, during the handover we use the SBAR-method. Whit this method, patient information about ‘Situation-Background-Assessment-Recommendation’ is given to each other. The Second, in line with the SBAR is the ‘Identification-Situation-Background-Assessment-Recommendation-Readback’ (ISBARR) method we use for the telephone communication between nurses and physicians. So there is extra focus on the ‘identification’ of the care provider and ‘readback’ of the physician orders. As a third method, ‘Bedside shift reporting’ (BSR) is used on the nurse departments in the hospital. This means that the handover is carried out in the room of the patient which improves patient participation on the nursing wards. In general, it gives patients more chance to interact with nurses, providing them more notice of the information that is handed over. During the patient intake, the BSR method is explained to the patient and his preference for BSR is noted in the patient file.&#x0D; Several months we did observations on the nursing wards during the handover moments from the early to the late shifts. The focus of these observations was on the performance of BSR and the use of the SBAR method. After the observations feedback was given immediately to the nurses and findings were documented in a report. These observations indicated which wards used the methods on a daily basis and what the points of attention were, to plan additional support or training.&#x0D; For physicians, file scans are used to evaluate whether they consistently create tour notes. There is a noticeable increase of the fill-in rate since the implementation of the central patient file across the different specialties. The central patient file was enrolled in several stages over the specialties from 2017 until 2019. In 2021 the integrated patient file over the different discipline was introduced, where patient information is shared between the different care providers. In the integrated patient file, the component 'multidisciplinary communication' was positively received. In this component findings about the patient or questions addressed to the physician can be noted. Physicians can also note certain instructions aimed at the nurse in this component. The findings in this component are often further discusses verbally between the responsible nurse and the attending physician.&#x0D; In sum, we can conclude that a good documentation in the integrated patient file and the use of different methods like SBAR can help us to provide a structured patient handover, reducing the risk that crucial information will be lost during handover. Nevertheless, further monitoring is needed.&#x0D;

Competing discourses as barriers to change in rehabilitation nursing: a discourse analysis.

The power of action research to create change by anchoring research results in practice was challenged in an action research project at a specialized rehabilitation unit for persons with acquired spinal cord injury. Despite the co-researchers' new insights, approaches, and actions supporting patient participation, it was not possible to change the basic conditions for the practicing of nursing. We aimed to raise awareness of the mechanisms that govern barriers by exploring these barriers as experienced by nurses in their effort to change their practice to improve patient participation. We used Fairclough's critical discourse analysis drawing on Foucault's practical systems; ethics (identity, relation to oneself), power (action, relation to others), and knowledge (representation, aspects of the world), which he combines with discourse-analytical concepts. Our discourse analysis of the empirical data at micro-level uncovers the nature of barriers to change in practice. In addition, our analysis at macro-level unveils how these practices are embedded in larger historical, societal, and institutional discourses. This identified two current discourses: a biomedical discourse and a biopsychosocial discourse. In the light of these two discourses, the nurses at micro-level saw themselves as strong agents for the best rehabilitation by acting in accordance with the biopsychosocial discourse. But they were unable to find the time and space to do so due to tasks, structures, and practices specified by an organization dominated by the biomedical discourse.

Patients involvement in the discharge process from hospital to home: A patient's journey.

The aims of the study were to gain insight in the transfer process from hospital to homecare or rehabilitation centre from a patient's perspectives and to describe the experienced involvement, information provision and information needs patients. A multiple case study with a phenomenological approach. Observations and interviews were employed, between May 2019 and August 2019, to capture the patient's perspectives and experiences on involvement, information provision and needs. Observations were executed during the discharge process from hospital to homecare (n = 6) or revalidation centre (n = 1) and during admission interviews with community nurses (n = 6). Interviews were conducted at the patient's home and the revalidation centre. Eight themes were identified within three phases of the transfer process. The Sign-up phase contained two themes: 'organizing follow-up care' and 'planning the moment of discharge from the hospital'. The two themes in the Transfer phase were, 'verbal information provision' and 'written information provision'. Four themes were identified in the End phase: 'nursing supplies', 'medication', 'the electronic patient portal' and 'continuation of (para)medical care'. Patient participation in the transition process from the hospital to follow-up care can be improved. This study indicates that unsafe situations could be prevented by patient involvement and clear perceptions of the role and responsibilities of patients, family and healthcare professionals. Patient and family involvement has the potential to improve transition of care and techniques for shared decision-making can be applied to a greater extent. This paper highlights that patients and families should be acknowledged as key figures in the transfer process and gives direction to healthcare professionals on how to increase involvement in the transfer process by actively inviting patients to participate in the transfer process. COREQ guidelines for qualitative reporting. No patient or public contribution. This paper gives insights in patients' and families' perspectives on transition of nursing care and their involvement during the whole transfer process. This paper gives direction how to improve patient participation during the discharge process from hospital to follow-up care.

A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study.

Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction. Digital health interventions show promise as a supporting tool for re-enablement. The main goal of this mixed methods study was to examine the usability of the AIMS platform from the perspectives of both patients and clinicians. The aim of this study was to evaluate a re-enablement platform that we have developed that uses a holistic systems approach to address the de-enablement that occurs in hospitalized inpatients, with the older adult population most at risk. The Active and Independent Management System (AIMS) platform is anticipated to deliver improved patient participation in recovery and self-management through education and the ability to track rehabilitation progression in hospital and after patient discharge. Two well-known instruments were used to measure usability: the System Usability Scale (SUS) with 10 items and, for finer granularity, the User Experience Questionnaire (UEQ) with 26 items. In all, 26 physiotherapists and health care professionals evaluated the AIMS clinical portal; and 44 patients in hospital for total knee replacement, total hip replacement, or dynamic hip screw implant evaluated the AIMS app. For the AIMS clinical portal, the mean SUS score obtained was 82.88 (SD 13.07, median 86.25), which would be considered good/excellent according to a validated adjective rating scale. For the UEQ, the means of the normalized scores (range -3 to +3) were as follows: attractiveness=2.683 (SD 0.100), perspicuity=2.775 (SD 0.150), efficiency=2.775 (SD 0.130), dependability=2.300 (SD 0.080), stimulation=1.950 (SD 0.120), and novelty=1.625 (SD 0.090). All dimensions were thus classed as excellent against the benchmarks, confirming the results from the SUS questionnaire. For the AIMS app, the mean SUS score obtained was 74.41 (SD 10.26), with a median of 77.50, which would be considered good according to the aforementioned adjective rating scale. For the UEQ, the means of the normalized scores were as follows: attractiveness=2.733 (SD 0.070), perspicuity=2.900 (SD 0.060), efficiency=2.800 (SD 0.090), dependability=2.425 (SD 0.060), stimulation=2.200 (SD 0.010), and novelty=1.450 (0.260). All dimensions were thus classed as excellent against the benchmarks (with the exception of novelty, which was classed as good), providing slightly better results than the SUS questionnaire. The study has shown that both the AIMS clinical portal and the AIMS app have good to excellent usability scores, and the platform provides a solid foundation for the next phase of research, which will involve evaluating the effectiveness of the platform in improving patient outcomes after total knee replacement, total hip replacement, or dynamic hip screw.

Perspective; recommendations for improved patient participation in decision-making for geriatric patients in acute surgical settings

Geriatric patients often present to the hospital in acute surgical settings. In these settings, shared decision-making as equal partners can be challenging. Surgeons should recognize that geriatric patients, and frail patients in particular, may sometimes benefit from de-escalation of care in a palliative setting rather than curative treatment. To provide more person-centred care, better strategies for improved shared decision-making need to be developed and implemented in clinical practice. A shift in thinking from a disease-oriented paradigm to a patient-goal-oriented paradigm is required to provide better person-centred care for older patients. We may greatly improve the collaboration with patients if we move parts of the decision-making process to the pre-acute phase. In the pre-acute phase appointing legal representatives, having goals of care conversations, and advance care planning can help give physicians an idea of what is important to the patient in acute settings.When making decisions as equal partners is not possible, a greater degree of physician responsibility may be appropriate. Physicians should tailor the “sharedness” of the decision-making process to the needs of the patient and their family.

Mobile Assessments to Improve Screening and Novel Patient Engagement to Diagnose and Manage Maternal Mental Health (MIND) Study Midpoint Analysis: Compliance Rate of Antenatal Screening [ID: 1363058

INTRODUCTION: One in five to seven birthing people are affected by perinatal mood disorders. While screening for gestational diabetes is well defined, the efficacy of standardized assessment of mood disorders is less understood. Between 2018 and 2020, screening at an academic center was highly variable, demonstrating need for improvement. Remote surveillance using novel integrated technology was used to improve patient participation in routine antenatal screening. METHODS: A prospective observational cohort of 81 patients from two clinical sites in the Babyscripts (BRx) Maternal Mental Health Module received digital Edinburgh Postnatal Depression Scale (EPDS) screening at 12 and 28 weeks of gestation. The control group consisted of 81 randomly selected patients who received in-person standardized screening from 2018 to 2020. In a midpoint analysis, EPDS completion was assessed at weeks 12 and 28 in the intervention group and compared to the control group using χ2 analysis. The study was reviewed and exempted by the George Washington University IRB. RESULTS: The BRx treatment group totaled 45 patients enrolled prior to week 14 and 74 patients enrolled prior to week 30. At week 14, 38% of BRx patients (17/45) had completed an EPDS survey, compared with 10% of patients in the control group (8/81). At week 30, 36% of BRx patients (27/74) had completed an EPDS survey, compared with 21% of control (17/81). Improved EPDS response rates of the BRx cohort were statistically significant at both assessments (P&lt;.01 and P=.03). CONCLUSION: Remote mood screening resulted in significantly higher rates of adherence in the first and second trimesters as compared to standard methods. In the next phase of analysis, we plan to assess adherence of screening through 12 months postpartum. Future analysis is planned to determine noninferiority as compared to in-office methods among a larger cohort. We hypothesize that novel telehealth mood screenings will help to sustain engagement with providers and reduce time to intervention.

Factors affecting sports participation after total hip arthroplasty.

The purpose of this study was to investigate the rate of return to sports after total hip arthroplasty (THA) in patients who regularly participate in sports and evaluate the factors that can affect the return to sports. In total, 165 patients who had been continuously participating in sports prior to surgery were included from a total of 401 patients who underwent THA from 2015 to 2018. The mean follow-up was 3.3 (range, 2-6) years. Demographics, medical history, surgical parameters, functional outcomes, and anxiety about complications at the final follow-up were compared between the patients who participated in the same sports as before surgery (S group) and those who could not (N group). The overall return to sports rate was 79% for 68 (41%) and 97 (59%) patients in the S and N groups, respectively. The most common sports that patients participated in post-operatively were walking (76 patients, 46%) and swimming (37 patients, 22%), followed by muscle training (25 patients, 15%). There were significant differences between the groups in the following patient factors: sex, primary disease, post-operative Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire outcome, and anxiety about falls and dislocation. In the evaluation of factors affecting return to sports using logistic regression analysis, male sex (odds ratio 3.66, 95% confidence interval 1.13-11.19, p = 0.029) and anxiety of dislocation (odds ratio 3.42, 95% confidence interval 1.58-7.42, p < 0.01) were extracted as independent risk factors. Careful patient guidance and rehabilitation, in addition to accurate surgical procedures, will improve patient participation in sports.

Best-Worst Scaling Survey of Inpatients' Preferences in Medical Decision-Making Participation in China.

This study assesses inpatients' preferences for participating in medical decision-making and determines the factors' rankings in order of importance and whether they vary for respondents with different characteristics. Case 1 best-worst scaling (BWS) was used for the study design. Thirteen attributes influencing inpatient medical decision-making participation were identified based on a literature review and interview results. A balanced incomplete block design was used to form choice sets for the BWS questionnaire for a cross-sectional study examining inpatients' preferences for participating in medical decision-making. Based on results from 814 inpatient participants, the three most important factors influencing inpatients' medical decision-making participation were inpatients' trust in physicians, physicians' professional expertise, and physicians' attitudes. The mixed logit model results reflect the significant heterogeneity in respondents' preferences for shared decision-making. To facilitate resource allocation, improve the physician-patient relationship, and encourage patient decision-making participation more actively and effectively, decision-makers should emphasize patients' trust, enhance physicians' ability to diagnose and treat diseases, and improve their attitudes toward providing care and communication from the perspectives of patients, physicians, and the social environment. Further research is needed on the heterogeneity of patients' preferences for participating in medical decision-making and how to improve patient participation.

The patient’s experience of participation when admitted for elective surgical procedures: an interview study

ABSTRACT Purpose To describe the patient’s experience of participation in their care when admitted for elective surgical procedures. Materials and methods A purposive sample of 14 patients who had undergone elective surgery was included in semi-structured individual interviews at a university hospital. The data was analysed using qualitative content analysis. Results One theme was identified: Creating a meaningful relationship to enable participation in the care, based on three categories; Abilities, willingness, and a lack of experience affect participation, A professional approach with an open communication and individualized information, and The importance of structural factors. Conclusions To meet the patient’s individual needs and wishes regarding participation, meaningful relationships need to be created between patient and healthcare personnel. The results also indicate that the patients have insufficient knowledge about their role regarding participation. To improve patient participation, its meaning needs to be clarified individually to the patient, emphasizing the importance to be active involved in his or her own care.

Spectacle compliance postcataract surgery significantly improved vision function-related quality of life of adult patients in India: Evidence from a multicenter longitudinal cohort study.

Cataract is the leading cause of avoidable blindness globally. This study aims to measure the changes in Vision function-related quality of life (VFQoL) before and after cataract surgery and identify the predictors of an improvement in these outcomes. A multicenter, longitudinal cohort study was conducted. Patients with first eye cataracts were interviewed before and 6 months after cataract surgery. Multiple classification analysis (MCA) was performed to assess variation in the intensities of mean change scores for general function, psychosocial impact, and visual function with select factors. A total of 747 participated in the baseline assessment. The 6-month follow-up rate was 86.5%. The mean general function, psychosocial impact, and visual function scores were 35.3 (±8.6), 12.5 (±3.4), and 8.3 (±3) in the baseline and 17 (±5.3), 6 (±2.2) and 3.8 (±1.3) in the follow-up assessments, respectively. In MCA, patients using spectacles postsurgery (β 0.111) and those having a very good postoperative visual acuity (β 0.098) had the most impact on general function. Patients reporting no ocular complaints postsurgery had a relatively higher effect on the psychosocial impact, (β 0.168) and similarly, patients using spectacles postsurgery and those aged 70 and older had the most impact on the visual function scores (β 0.146 and 0.126), respectively. Cataract surgery is associated with meaningful improvements in vision and VFQoL in general. The determinants of better VFQoL include the usage of spectacles postsurgery. Strategies to further improve patient participation in postoperative review visits are needed for spectacle provision and patient education regarding spectacle use and compliance is imparted during such visits.

Patient participation in tele-emergencies - experiences from healthcare professionals in northern rural Sweden.

Telemedicine provides opportunities for access to health care in remote and underserved areas. In parts of northern rural Sweden telemedicine is used to connect a remote physician by a video-conference system to an emergency room, staffed by nurses during on-call hours. This can be called 'tele-emergency'. Patient participation, often described as mutual information exchange, a trustful relationship and involvement in decision-making, is challenged in emergency care by short encounters, deteriorating patients and a stressful work situation. Nevertheless, patient participation may be important for the patients' experience. Healthcare professionals (HCPs) have been identified as 'gatekeepers' for patient participation, therefore putting their perspective in focus is important. As emergency care in rural areas is increasingly turning toward telemedicine, patient participation in tele-emergencies needs to be better understood. The aim of this study was to explore and characterise HCPs' perspectives of patient participation in tele-emergencies in northern rural Sweden. A qualitative design based on interviews was used. HCPs working in cottage hospitals in northern rural Sweden were included. Semi-structured interviews were performed, first, in multidisciplinary groups of three informants. Later, because of limited experience of tele-emergencies in the groups, individual interviews with HCPs with substantial experience were added. A qualitative content analysis of the interview transcripts was conducted. A total of 44 HCPs from northern inland Sweden participated in the interviews. The content analysis resulted in two themes, six categories and 19 subcategories. Theme 1, 'To see, understand, and to build trust through the digital barrier', contains descriptions of the interpersonal relationship between the patient and the HCPs, and the challenges when interacting with the patient during a tele-emergency. The informants also described a need for boundaries between the professional team and the patient. The categories in theme 1 are 'understanding the patient's point of view', 'building a trustful relationship', and 'needing a private space without the patient'. Theme 2, 'The (im)balance of power - tele-emergency reinforces the positions', mirrors the power asymmetry in the patient-professional relationship, and the potential impact of the tele-emergency on the different roles. Tele-emergencies were described as a risk that potentially could weaken the patient's position, but also as providing an opportunity to share power. Categories in theme 2 are 'medical conditions limit patient participation', 'patient involvement in decision-making requires understanding' and 'the inferior patient and the superior professionals'. This study sheds light on patient participation in tele-emergencies in a remote rural setting from the HCP's perspective. The tele-emergency set-up affected patient participation by interfering with familiar patient-HCP relationships and changing group dynamics in interactions with the patient. Due to the extensive changes of the conditions for patient participation imposed in tele-emergencies, suggestions for actions improving patient participation are made.

Making medication communication visible in community pharmacies-pharmacists' experience using a question prompt list in the patient meeting.

Even though patient engagement in the pharmacy encounter is low, few studies focus on activating patients. A Question Prompt List (QPL) has been used successfully in other parts of healthcare to encourage patients to raise their questions and concerns. For a QPL to be useful in a pharmacy setting, it first must be considered valuable and be accepted by pharmacists. To investigate the experience of community pharmacists using a QPL in counseling patients about prescribed medications. An explorative, qualitative study was conducted in 2020. A QPL, for use in pharmacy counseling, was developed based on previous literature. Semi-structured interviews were held with pharmacists. A thematic analysis approach was conducted, and the analytical framework Technology Acceptance Model (TAM) was used. Data were collected in 7 Swedish community pharmacies in interviews with 29 purposefully selected pharmacists. Three themes were identified: Perceived usefulness: the impact of the QPL on patient activation in the encounter, Perceived ease of use of the QPL in pharmacies, and Increasing the perceived usefulness and ease of use of the QPL. The pharmacists perceived patients as more active in the meeting when using the QPL. The list focused the conversation on medications, which the pharmacists appreciated from a professional point of view. They described the QPL as a useful tool that could easily be integrated into the dispensing process and required little training; however, challenges described were, for example, time constraints and stress. Pharmacists reported that using a QPL improved patient participation in the encounter. Encouraging counseling on medications was seen as beneficial from a professional point of view. In the early adoption phase, the QPL was easy to implement and did not increase the pharmacists' workload. A QPL appears to be a promising tool for pharmacists to improve the quality of the consultation experience.

Effects of eHealth Interventions on Quality of Life and Psychological Outcomes in Cardiac Surgery Patients: Systematic Review and Meta-analysis.

BackgroundPatients undergoing heart surgery may experience a range of physiological changes, and the postoperative recovery time is long. Patients and their families often have concerns about quality of life (QoL) after discharge. eHealth interventions may improve patient participation, ensure positive and effective health management, improve the quality of at-home care and the patient's quality of life, and reduce rates of depression.ObjectiveThe purpose of this study was to evaluate the effects of eHealth interventions on the physiology, psychology, and compliance of adult patients after cardiac surgery to provide a theoretical basis for clinical practice.MethodsWe conducted systematic searches of the following 4 electronic databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Mean (SD) values were used to calculate the pooled effect sizes for all consecutive data, including QoL, anxiety, and depression. Where the same results were obtained using different instruments, we chose the standardized mean difference with a 95% CI to represent the combined effect size; otherwise, the mean difference (MD) with a 95% CI was used. Odds ratios were used to calculate the combined effect size for all dichotomous data. The Cohen Q test for chi-square distribution and an inconsistency index (I2) were used to test for heterogeneity among the studies. We chose a fixed-effects model to estimate the effect size if there was no significant heterogeneity in the data (I2≤50%); otherwise, a random-effects model was used. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2).ResultsThe search identified 3632 papers, of which 19 met the inclusion criteria. In terms of physical outcomes, the score of the control group was lower than that of the intervention group (MD 0.15, 95% CI 0.03-0.27, I2=0%, P=.02). There was no significant difference in the mental outcomes between the intervention and control groups (MD 0.10, 95% CI –0.03 to 0.24, I2=46.4%, P=.14). The control group’s score was lower than that of the intervention group for the depression outcomes (MD –0.53, 95% CI –0.89 to –0.17, I2=57.1%, P=.004). Compliance outcomes improved in most intervention groups. The results of the sensitivity analysis were robust. Nearly half of the included studies (9/19, 47%) had a moderate to high risk of bias. The quality of the evidence was medium to low.ConclusionseHealth improved the physical component of quality of life and depression after cardiac surgery; however, there was no statistical difference in the mental component of quality of life. The effectiveness of eHealth on patient compliance has been debated. Further high-quality studies on digital health are required.Trial RegistrationPROSPERO CRD42022327305; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327305

Participation of inpatients in multidisciplinary team meetings: An explorative study of mental healthcare workers' perception

AimTo explore the perception of mental healthcare workers about participation of inpatients during multidisciplinary team meetings (MTMs) and to determine which demographic and contextual factors are associated with this perception. MethodsA cross-sectional multicentre study in 17 psychiatric hospitals with 701 mental healthcare workers was performed between 29 April and 19 May 2019. For measuring the perception of the mental healthcare workers, the Patient Participation during Multidisciplinary Team meetings Questionnaire was used. Results93 % of the mental healthcare workers indicate that they are willing to allow patients to participate in a MTM. Most mental healthcare workers prefer an active role for the patient when participating in a MTM (93 %) and a collaborative role for the patient when making decisions in a MTM (75 %). Level of education, discipline, experience with patient participation in MTMs, working in a team where patient participation is applied, and recent training on patient participation, are associated with the mental healthcare worker's perception on patient participation in MTMs. ConclusionMental healthcare workers report a great willingness to involve inpatients in MTMs. However, social workers, nurses, and pedagogues feel less competent and are less positive about the effects of patient participation in MTMs. Mental healthcare workers with recent training in patient participation and experience in patient participation in MTMs feel more competent and believe more often that the patient should fulfil a more autonomous role when participating in a MTM. These results can be used to understand and improve patient participation in MTMs in mental healthcare.

Self-reported Professional Competence Among Swedish Contact Nurses in Cancer Care: A Cross-sectional Study

Background: Since 2011, patients in Swedish cancer care have been offered a contact nurse (CN). The CN role is to improve patient participation, care continuity, and provide information and manage patients’ symptoms and needs across the whole continuum of the cancer pathway. A competence profile for the CN role is yet to be developed, and it is important to assess CNs’ self-reported competence to assure that they are well equipped for the role. Objectives: To assess self-reported professional competence among contact nurses working in Swedish cancer care and relate the findings to education level and clinical experience. Methods: The Nurse Professional Competence scale short form (35 items) was used to assess the nurses’ professional competence. Data were collected through a web-based survey in 2017 in 2 regional cancer centers in Sweden. Results: One hundred eight CNs participated in the study and reported highest scores in “value-based nursing care” and lowest scores in “development, leadership, and organization of nursing care.” Higher age, extended clinical work experience, and academic degree were significantly associated with higher competence. Conclusions: CNs with extensive work experience and CNs with an academic degree reported higher scores concerning their generic competence. There is a need in future studies to assess CNs’ specific competence in cancer care. Implications for Practice: There is room for improvement in the competence development of CNs, primarily in the areas of leadership and organization of nursing care. What is Foundational: CNs’ competence regarding leadership and organization should be improved, preferably as part of academic education.