Improve Patient Understanding Research Articles

The M-CHooSe pilot: the acceptability and utilisation of the nurse-led, general practice clinic co-located 'Mater CALD Healthcare Coordinator Service' for patients from multicultural backgrounds.

Patients from culturally and linguistically diverse (CALD) backgrounds often have unmet healthcare coordination needs. We aimed to evaluate the acceptability, utilisation and perceived benefits of the Mater CALD Health Coordinator Service (M-CHooSe), a pilot, nurse-led, general practice co-located, healthcare coordination service for patients from CALD backgrounds. M-CHooSe began in March 2020 at five Brisbane (Queensland) sites. Process and service user data were collected over 12months at one site. A survey evaluated primary healthcare professionals' perceived benefits of the service. Another survey of M-CHooSe nurses examined indicators of service complexity. In total, 206 individuals accessed M-CHooSe over the 12-month period. Commonly delivered services included health service advocacy, chart reviews and health system navigation, including addressing social determinants. M-CHooSe nurses reported frequently performing tasks such as following up with external health services and performing health and social care system coordination. M-CHooSe benefits reported by primary healthcare professionals included better patient access to external health services and improved patient understanding of their conditions and treatments. Patients were accepting of referrals to M-CHooSE. Primary healthcare professionals also reported a variety of benefits to themselves and their patients because of M-CHooSe. M-ChooSe highlights the potential of a healthcare coordination service for multicultural patients to improve healthcare equity, accessibility, and system efficiency. This project demonstrates the potential value of coordination services to increase patient access and uptake of existing health and social care services for modern Australian communities, thus improving the efficiency and effectiveness of our health system. Further investigations, including user experience, opinions and cost analyses, will be required to confirm the promising benefits of embedding M-CHooSe into usual care.

The use of anatomical models in an Orthopaedic clinic aids in patient education

Background: One of the World Health Organisation strategies to achieve patient centered care is for patients to be able to effectively give informed consent. Well-informed patients are also likely to be more compliant and have better treatment outcomes. Aims and Objectives: Our study looks at using anatomical models as adjuncts in consultations to determine if they would be useful in improving patient understanding and satisfaction. Study Design/Methods: A survey of patients was carried out at a single Orthopaedic foot and ankle clinic in Singapore, to investigate if patients felt that the use of anatomical models aided in their understanding of their medical condition, foot and ankle anatomy, and surgical procedures offered, if any. 2 different anatomical models were used, depending on the context of the consultation. All conditions encountered were included. Institutional Review Board approval was not required for this study. Results: 30 patients were surveyed in total, all of whom agreed that the models were useful in helping them understand their medical condition and foot and ankle anatomy better. Of the 19 patients who were counselled regarding surgery, 18 felt that the models improved their understanding of the proposed procedures. 26 patients would like similar models to be used in other Orthopaedic clinics, although 3 would not, and 1 was not sure. On the whole, 19 patients found the models very useful, and 11 patients found them useful. Conclusion: Anatomical models are a cost-effective method of contributing to patient education compared to other alternatives, and we would advocate the use of models in other Orthopaedic clinics during consultations for counselling and taking informed consent.

The impact and value of a pharmacist within a persistent pain management service

AbstractA model of a pharmacist‐led consultation clinic within a Persistent Pain Management Service (PPMS) has recently been implemented to improve accessibility to medication review, promote opioid stewardship and reduce high‐risk medication‐taking behaviours. This audit aims to determine the impact of a pharmacist on opioid de‐escalation and the perceived value of pharmacist interventions. This audit was conducted at an outpatient PPMS between 30/10/19 and 25/3/20. Pharmacist interventions and deprescribing plans from 1:1 consultation with patients were communicated in writing to general practitioners (GPs) for actioning. Opioid consumption was quantified using oral morphine equivalent daily dose (oMEDD). Self‐rated patient, GP and PPMS staff questionnaires were used to assess perception of value and impact of pharmacist service. Thirty‐five patients were included. Mean oMEDD reduced from 86.2mg to 73.4mg (p < 0.0001) after a mean of 64 days. Pharmacist consultation resulted in improved patient understanding of medication roles in chronic noncancer pain (CNCP) (self‐rated score: 6.4 increased to 8.0 on a 10‐point scale, p < 0.0001) and improved confidence to safely administer medications (7.2 increased to 8.7, p < 0.0001). There was 100% patient satisfaction. GP questionnaire data (n = 18) indicated 90% of GPs plan to implement at least one recommendation. GP’s indicated recommendations were valuable, practical and clear (rated 4.1, 4.1 & 4.4, respectively, on a 5‐point scale). Pharmacist service was associated with reduced opioid intake and improved patient understanding regarding roles and harms of medications in CNCP. Pharmacist interventions were routinely implemented and valued by GPs.

Effect of Individualized Preventive Care Recommendations vs Usual Care on Patient Interest and Use of Recommendations

This randomized clinical trial examines the feasibility and acceptability of a decision-making tool for increasing patient interest in individualized recommendations for preventive care services. To pilot a tool to help patients compare life expectancy gains from evidence-based preventive services. This randomized clinical trial examined patient and physician responses to a pilot decision tool incorporating personalized risk factors at 3 US primary care clinics between 2017 and 2020. Eligible patients were between ages 45 to 70 years with 2 or more high-risk factors. Patients were followed-up after 1 year. The gain in life expectancy associated with guideline adherence to each recommended preventive service was estimated. Personalized estimates incorporating risk factors in electronic health records were displayed in a physician-distributed visual aid. During development, physicians discussed individualized results with patients using shared decision-making (SDM). During the trial, patients were randomized to receive individualized recommendations or usual care (nonmasked, parallel, 1:1 ratio). Primary outcome was patient interest in individualized recommendations, assessed by survey. Secondary outcomes were use of SDM, decisional comfort, readiness to change, and preventive services received within 1 year. The study enrolled 104 patients (31 development, 39 intervention, 34 control), of whom 101 were included in analysis (mean [SD] age, 56.5 [5.3] years; 73 [72.3%] women; 80 [79.2%] Black patients) and 20 physicians. Intervention patients found the tool helpful and wanted to use it again, rating it a median 9 of 10 (IQR, 8-10) and 10 of 10 (8-10), respectively. Compared with the control group, intervention patients more often correctly identified the service least likely (18 [46%] vs 0; P = .03) to improve their life expectancy. A greater number of patients also identified the service most likely to improve their life expectancy (26 [69%] vs 10 [30%]; P = .07), although this result was not statistically significant. Intervention patients reported greater mean [SD] improvement in SDM (4.7 [6.9] points) and near-term readiness to change (13.8 points for top-3-ranked recommendations). Point estimates indicated that patients in the intervention group experienced greater, although non-statistically significant, reductions in percentage of body weight (-2.96%; 95% CI, -8.18% to 2.28%), systolic blood pressure (-6.42 mm Hg; 95% CI, -16.12 to 3.27 mm Hg), hemoglobin A1c (-0.68%; 95% CI, -1.82% to 0.45%), 10-year atherosclerotic cardiovascular disease risk score (-1.20%; 95% CI, -3.65% to 1.26%), and low-density lipoprotein cholesterol (-8.46 mg/dL; 95% CI, -26.63 to 9.70 mg/dL) than the control group. Nineteen of 20 physicians wanted to continue using the decision tool in the future. In this clinical trial, an individualized preventive care decision support tool improved patient understanding of primary prevention and demonstrated promise for improved shared decision-making and preventive care utilization. ClinicalTrials.gov Identifier: NCT03023813.

Site-Specific Education Using Digital Media to Improve Patient Understanding of the Radiotherapy Trajectory: An Interventional Study

PurposeThe study assessed the effectiveness of a site-specific video educational material in improving patient understanding and confidence regarding radiation therapy trajectory. Methods and MaterialsA quasi experimental longitudinal pretest posttest study was conducted at a referral radiation therapy center from May 2020 to September 2020. It included 52 adult patients admitted for a first course radical radiation therapy. One generic and 6 site-specific (breast, pelvis, head and neck, brain, chest and abdomen, and bladder) animated cartoon videos were developed in house to provide concise overview of the overall patient's trajectory in radiation therapy, with full visual description of the procedures and specific preparation measures. A 14-item questionnaire was designed to assess pre- and postintervention levels of understanding and confidence of patients, with calculation of and an understanding and confidence score (UCS), range 0-14. ResultsThe mean (standard deviation) UCS in pre- and postintervention was 9.36 (2.48) and 11.92 (1.34) out of 14, respectively, indicating a mean increase of 2.57 subsequent to the intervention (P < .001). The effect size was large with a Cohen's d = 1.01. Of the 14 dimensions explored, 8 were observed to have remarkable improvement, notably understanding the purpose of the tattoo mark, reason of daily or weekly imaging, and what to expect with radiation therapy. Participants with poor reading ability had greater increase in UCS (ΔUCS = 4.25 vs ≤2.33) and in 5 out of 8 dimensions with remarkable improvement. ConclusionsThe use of digital educational material in radiation oncology meets the urgent need for providing patients with concise and site-specific information, while sparing extra hospital visits to meet education coordinators during the COVID-19 crisis. Additional studies are warranted to assess both the clinical and long-term effectiveness of the educational material, using a longitudinal controlled design.

Does the I-PSS Accurately Assess Urinary Function in Prostate Cancer Patients? Evidence From a Study of Nursing Verification of Patient Answers

The International Prostate Symptom Score (I-PSS) is a widely used tool for the evaluation of patient-reported lower urinary tract symptoms (LUTS). Urologists and Radiation Oncologists frequently use the I-PSS to help determine a prostate cancer patient's eligibility for a type of treatment, and to follow up quality-of-life outcomes after treatment. I-PSS is also used to define clinical trial eligibility criteria, and is a common means of comparing patient-reported outcomes between studies. The I-PSS is almost 30 years old and has not been modified in the light of contemporary understandings of patient communication. We sought to assess the degree of patient understanding of I-PSS questions by nursing verification at the time of the patient visit.Men with prostate cancer self-completed an online I-PSS questionnaire approximately one week prior to their visit with the physician. On the day of the visit, a nurse reviewed each I-PSS question with the patient to ensure they understood it, and then verified patient answers. Patient initial scores and nurse-verified scores were recorded, and the results analyzed for discrepancies.I-PSS scores were recorded for 105 men. Complete concordance between patient and nursing scores on all questions was reported for 62 men (59%; 95% C.I. 49%, 69%). The frequency of discordance was highest for urgency (20%), incomplete emptying (22%) and frequency (21%), with lower rates for intermittency (17%), nocturia (15%), weak stream (12%) and straining (7.6%). There was evidence that patients overstated scores compared to nurses for frequency (P = 0.010), weak stream (P = 0.036) and incomplete emptying (P = 0.012); for other domains, there was no evidence for either nurse or patient scores being higher (P≥0.3 for all). For incomplete emptying, nurse scores were lower for 19 men, 15 of whom had a score reduced to zero; for frequency, scores were lower for 14, with 7 reduced to zero.Patient I-PSS scores were moderately concordant with scores obtained after nursing review and verification. Some men appear to have had a poorer understanding of the questionnaire, particularly with respect to items concerning incomplete emptying and frequency. Consideration should be given to rewording the I-PSS to improve patient understanding.

1368 TED Talks and Fragmin Shots: Venous Thromboembolism Prophylaxis (VTEP) in a busy Emergency Surgical Unit (ESU) - A Quality Improvement Project

Abstract VTE results in &amp;gt; 30,000 deaths/ year. Surgical inpatients are at 25% risk of developing VTE. National guidelines state all surgical admissions must be risk assessed for VTE within 24 hours. Aim Evaluate our current practice of VTEP. Create and disseminate interactive tutorials for healthcare professionals (HCPs). Improve patient understanding and adherence to VTEP. Method A baseline audit analysed existing VTEP measures. Inclusion criteria: all ESU admissions, age &amp;gt;18. Parameters included ensuring completion of VTE risk assessment (VTERA) proformas; scrutinizing low-molecular-weight heparin (LMWH) and TED stockings (TEDs) prescriptions; observing patients’ TEDs use and reasons for non-adherence. Subsequently, plan-do-study-act (PDSA) cycles were performed. Results Baseline [September 2020] (n = 93): VTERA complete: 54%; LMWH (57%) and TEDs (37%) prescribed; 26% wearing TEDs; 42% deemed TEDs unnecessary. PDSA Cycle 1 [October 2020] (n = 68): Educational poster displayed in clinical areas. VTERA complete (73.5%), LMWH (75%) and TEDs (53%) prescribing improved. Only 29% wearing TEDs. PDSA Cycle 2 [November 2020] (n = 55): Implementation of VTE e-learning module and inter-professional educational tutorials. HCPs (n = 25) felt more knowledgeable (pre:3.4/5, post:5/5) and confident (pre: 3.2/5, post: 4.7/5) on VTEP. All parameters improved, except patients wearing TEDs (31%). PDSA Cycle 3 [December 2020]: Initial patient questionnaire (n = 30) revealed - 33% misconstrued LMWH use; &amp;gt;50% deemed TEDs unnecessary. A patient information leaflet was created and distributed alongside TEDs. Upon re-audit (n = 72), we noted significant improvement in patient adherence to TEDs (64%), alongside sustained improvement in all other parameters. Conclusions Our initiative highlights the necessity of empowering both patients and the multidisciplinary team in achieving optimum rates of VTEP.

978 Improving Satisfaction in Patients with Learning Disabilities

Abstract Aim Patients with learning disabilities (LD) are less satisfied because they do not fully understand their surgical management. Poor communication between doctors &amp; LD patients leaves them unhappy &amp; reluctant to seek further help. We aimed to improve satisfaction in 90% of patients. Method In one year in a midlands DGH 201 patients with an LD were admitted. Interviews were conducted which highlighted key problems. Multiple ideas were reviewed, and the simple but effective intervention was a brightly coloured prompt sheet with 4 questions placed in the patient notes: Have you explained: A simple scale tracked the patient &amp; carer satisfaction over 8 weeks as the prompt sheets were introduced to patient notes by the learning disability nurses. Results A 90% increase in patient satisfaction was not achieved but considerable positive feedback was. Moreover, the LD nurses witnessed an increased use of hospital passports among doctors as well as improved patient-doctor communication. A small target population restricts the rapid collection of large amounts of data. The patient satisfaction measure was qualitative, and a 10-point scale would have detailed smaller changes. Lack of carer continuity also made it difficult to collect consistent data. Conclusions The role of learning disability nurses is key to improving patient understanding and satisfaction, but they can be assisted by channelling and maintaining initiatives to raise awareness of the needs of these patients.

Risks and rewards of increasing patient access to medical records in clinical ophthalmology using OpenNotes

BackgroundThe implementation of OpenNotes and corresponding increase in patient access to medical records requires thorough assessment of the risks and benefits of note-sharing. Ophthalmology notes are unique among medical records in that they extensively utilize non-standardized abbreviations and drawings; they are often indecipherable even to highly-educated clinicians outside of ophthalmology. No studies to date have assessed ophthalmologist perceptions of OpenNotes.MethodsA cross-sectional study was conducted from 4/28 to 5/12/2016. A survey was distributed to 30 clinicians (25 ophthalmologists, three optometrists, two nurses) in the University of Colorado’s Department of Ophthalmology to evaluate provider attitudes towards granting patients access to online medical records.ResultsMany clinicians felt patients would have difficulty understanding their records and may be unnecessarily alarmed or offended by them. Some clinicians worried their workload would increase and feared having to change the way they document. Perceived benefits of OpenNotes included improving patient understanding of their medical conditions, strengthening patient–physician trust, and enhancing patient care. Many perceived risks and benefits of note-sharing were associated with conceptions of the ideal clinician–patient relationship.ConclusionsClinicians in ophthalmology perceived both benefits and consequences of increasing patient access to ophthalmic records, and there were significant correlations between these perceptions and their conceptions of the clinician–patient relationship. This is the first study to assess potential ophthalmology provider attitudes toward sharing ophthalmic records. Although limited in sample size and power, this study demonstrates some ways patient-accessible ophthalmic records can affect the clinical practice of ophthalmology and emphasizes the unique challenges of OpenNotes in ophthalmology.

Qol-O-07 - The role of illness perception in patients with cutaneous T-cell lymphoma

Illness perception describes patients' internal beliefs about their illness and their resulting psychosocial impact. This concept is important because it can give healthcare providers a tool to identify issues that may need to be addressed with their patients, but few studies have investigated illness perception in cutaneous T-cell lymphomas (CTCLs). CTCL is a chronic and often debilitating group of malignancies that can have an indolent but remitting course. Treatment options may also be burdensome to the patient; therefore, it is important to gain an understanding of CTCL patients' beliefs about their disease and how those beliefs impact their quality of life (QOL). Moreover, the COVID-19 pandemic offers a unique opportunity to investigate how significant disruptions in access to healthcare have impacted illness perception and QOL. The objectives of this study are to identify disease understanding in patients with CTCL, investigate the impact additional education modalities have on disease understanding, and whether disparities exist between specific groups of patients. This study also aims to determine how the COVID-19 pandemic impacted healthcare-related QOL in this population. CTCL patients of the Johns Hopkins Hospital above the age of 18 are recruited for this study. Patients are given an electronic survey containing the Illness Perception Questionnaire-Revised (IPQ-R), Skindex-29, FACT-G7, and selected questions based on the Household Pulse survey to assess COVID impact on QOL. Patients are then randomly selected to view an educational PowerPoint with educational material on CTCL, in addition to verbal education routinely given during their visit. Follow-up responses to these questions will be collected at 2 and 6 months after the initial survey. In this ongoing study, we anticipate a total sample size of 100 patients. Thus far, initial survey responses have been collected from 39 patients, 60% who identified as male and 40% who identified as female. 44% of patients identified as "White," 36% identified as "Black/African American," 10% as "Hispanic/Latino," 8% as "Asian," and 2% as "Other." 34% of patients were Stage 1B at time of survey. Most patients (22.99 + 4.2) perceived their diseases to be chronic but endorsed a high sense of personal control (21.61 + 4.2) and therapeutic control (18.98 + 2.6) over their conditions. Patients between 40-59 demonstrated higher disease consequence, as did patients within the Black/African American patient group. Illness coherence was also significantly higher for White patients when compared to Black/African American patients. Therefore, it appears that patients 40-59 may be more emotionally and practically affected by their disease, potentially because these patients are at the highest level of work and life productivity. Further, these results indicate that a gap may exist within the Black/African American community that may negatively affect these patients' QOL. The outcomes from additional initial and follow-up surveys from this ongoing study will provide insight into the use of additional educational modalities to improve patient understanding of CTCL, with the goal of addressing common patient misconceptions about the disease, improving educational resources, and identifying actionable paths to diminish the inequities identified by this study.

A systematic review of the clinical value and applications of three-dimensional virtual reconstructions in renal tumors.

Three-dimensional (3D) virtual reconstruction (VR) in the medical sciences has emerged as a novel, exciting and effective tool, with promising results for patients, trainees, and even experienced surgeons. The purpose of this review is to summarize the information on the clinical value and applications of 3D VR in renal tumors published in the last ten years. A literary search of PubMed-MEDLINE databases was performed to identify studies reporting the clinical application and usefulness of 3D VR models in renal tumors. Thirty-seven studies were found to meet the selection criteria and were included in the analysis. Most studies have provided a quantitative assessment focused on the accuracy of 3D VR models in replication of anatomy and renal tumor, on measuring 3D tumor volume and on the clinical value and utility of 3D VR in pre-surgical planning and simulation of renal procedures, with significant reductions of intraoperative complications. Fourteen studies provided a qualitative assessment of the usefulness of 3D VR models, with results showing an improved patient understanding of renal anatomy and pathology, improved undergraduate and postgraduate urology education. Moreover, 3D printing technology is a novel technique, and we are currently in the dynamic era, expanding into new surgical nephron-sparing procedures and the development of printed kidneys for transplantation.

Home viewing of educational video improves patient understanding of Mohs micrographic surgery.

Educational videos improve patient knowledge of wound care and skin cancer. However, the effect of viewing an educational video at home before undergoing Mohs micrographic surgery (MMS) has not been demonstrated. To evaluate the use of an educational video to improve patient understanding of MMS. Patients scheduled to undergo MMS were randomized to receive standard patient education, or standard patient education with an additional video developed by the authors. The educational material was posted to patients along with the details of their MMS appointment. Both groups answered questionnaires to assess their knowledge of MMS, and to measure their anxiety and satisfaction. Patients who watched the educational video scored higher on the knowledge questionnaire than did patients in the control group (0.8, 95% CI 0.3 to 1.4, P < 0.01), but were not statistically less anxious (-0.7, 95% CI -2.6 to 1.3, P = 0.50). Overall, patients undergoing MMS were satisfied. Home viewing of an educational video before MMS can improve patient understanding.

Understanding Immunotherapy Terminology: An Analysis of Provider-Patient Conversations.

Immunotherapy terminology is complex and can be difficult for patients to understand, threatening informed consent. The aims of this exploratory study are to determine whether patients understand immunotherapy terminology and if the provider defining the term improves patient understanding. Conversations between oncology providers and patients discussing immunotherapy were observed(n=39), and technical terms used were noted. With consent, patients were interviewed post-conversation to assess their understanding of these terms(n=39). Comparisons of the terms were conducted using chi-square tests, Fisher's exact tests, or ANOVA where appropriate. 'Immunotherapy' was the most difficult for participants to understand with 48.7% (19/39) correctly defining immunotherapy. 'Immunotherapy agents' was understood 53.8% (14/26) of the time. 'Immune system' was well understood (88.5%;23/26). Providers defined immunotherapy in 97.4% of conversations. There was no correlation between having immunotherapy defined in the conversation, and the likelihood of a correct definition (p=0.487). 'Immune system' was defined in 92.3% of conversations (n=26), and defining it in the conversation was correlated with increased patient understanding (p=0.009). Our results indicate that patients have difficulty understanding some immunotherapy terminology. Since patient understanding of key terminology is crucial for informed consent and patient care, it is essential to implement interventions to improve understanding.

MP19-15 LISTENING TO WOMEN: A QUALITATIVE ANALYSIS OF WOMEN’S EXPERIENCES WITH MESH MID-URETHRAL SLING SURGERY

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP19)1 Sep 2021MP19-15 LISTENING TO WOMEN: A QUALITATIVE ANALYSIS OF WOMEN’S EXPERIENCES WITH MESH MID-URETHRAL SLING SURGERY Pansy Uberoi, Wai Lee, Kathleen Kobashi, Alvaro Lucioni, Donna Berry, and Una Lee Pansy UberoiPansy Uberoi More articles by this author , Wai LeeWai Lee More articles by this author , Kathleen KobashiKathleen Kobashi More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , Donna BerryDonna Berry More articles by this author , and Una LeeUna Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002004.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Existing stress urinary incontinence (SUI) research focuses on clinical outcomes, which may differ from and overlook key concepts of importance to patients. When patient perspectives are sought, an understanding of what is most important to women is gained. We sought to understand patient experiences including knowledge, attitudes, and beliefs regarding mesh mid-urethral sling (MUS) surgery and outcomes. METHODS: Patients who had undergone placement of a mesh MUS between January 2014 and December 2018 at a single institution by one of three female pelvic medicine and reconstructive surgery (FPMRS) specialists were invited to participate in semi-structured focus groups or individual interviews. Discussions were recorded and transcribed. Two investigators individually analyzed data for themes using inductive and deductive content analysis aided by NVivo software, four researchers reached consensus on the themes. RESULTS: Eleven women participated, mean age 61 years (range 39-88). Themes and illustrative quotations are listed in the table. Women discussed barriers related to undergoing surgical intervention for SUI, such as embarrassment associated with discussing SUI symptoms, encountering physicians who were not empathetic, and personally needing to advocate for themselves for appropriate referrals. Women recounted specific urinary leakage events that led to their decision to pursue surgical intervention for SUI. Most women expressed satisfaction with the improvement in SUI specific symptoms, while others associated non-SUI symptoms with their surgical outcomes, such as changes in bowel habits and urinary frequency. Despite not having complications related to MUS surgery, some women recounted higher than expected post-operative pain levels and surprise by the ability to palpate the sling vaginally. CONCLUSIONS: Women experienced barriers to SUI care and attributed de novo non-SUI symptoms to their MUS surgery. Appreciating patients’ knowledge, concerns, and expectations regarding SUI can inform FPMRS surgeons on how to better meet patient needs and improve patient understanding when discussing MUS surgery. Listening to understand women's perspectives can improve the informed consent process and surgical counseling for MUS surgery. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e333-e333 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pansy Uberoi More articles by this author Wai Lee More articles by this author Kathleen Kobashi More articles by this author Alvaro Lucioni More articles by this author Donna Berry More articles by this author Una Lee More articles by this author Expand All Advertisement Loading ...

Empowering patients: simplifying discharge instructions

Patients who do not have enough information about their discharge plans have decreased treatment compliance, decreased patient safety, increased emergency department (ED) recidivism, and poor satisfaction. This project aimed to...

Methods of 3D printing models of pituitary tumors

BackgroundPituitary adenomas can give rise to a variety of clinical disorders and surgery is often the primary treatment option. However, preoperative magnetic resonance imaging (MRI) does not always reliably identify the site of an adenoma. In this setting molecular (functional) imaging (e.g. 11C-methionine PET/CT) may help with tumor localisation, although interpretation of these 2D images can be challenging. 3D printing of anatomical models for other indications has been shown to aid surgical planning and improve patient understanding of the planned procedure. Here, we explore the potential utility of four types of 3D printing using PET/CT and co-registered MRI for visualising pituitary adenomas.MethodsA 3D patient-specific model based on a challenging clinical case was created by segmenting the pituitary gland, pituitary adenoma, carotid arteries and bone using contemporary PET/CT and MR images. The 3D anatomical models were printed using VP, MEX, MJ and PBF 3D printing methods. Different anatomical structures were printed in color with the exception of the PBF anatomical model where a single color was used. The anatomical models were compared against the computer model to assess printing accuracy. Three groups of clinicians (endocrinologists, neurosurgeons and ENT surgeons) assessed the anatomical models for their potential clinical utility.ResultsAll of the printing techniques produced anatomical models which were spatially accurate, with the commercial printing techniques (MJ and PBF) and the consumer printing techniques (VP and MEX) demonstrating comparable findings (all techniques had mean spatial differences from the computer model of < 0.6 mm). The MJ, VP and MEX printing techniques yielded multicolored anatomical models, which the clinicians unanimously agreed would be preferable to use when talking to a patient; in contrast, 50%, 40% and 0% of endocrinologists, neurosurgeons and ENT surgeons respectively would consider using the PBF model.Conclusion3D anatomical models of pituitary tumors were successfully created from PET/CT and MRI using four different 3D printing techniques. However, the expert reviewers unanimously preferred the multicolor prints. Importantly, the consumer printers performed comparably to the commercial MJ printing technique, opening the possibility that these methods can be adopted into routine clinical practice with only a modest investment.

B-PO04-198 ATRIAL FIBRILLATION ABLATION SHARED DECISION-MAKING TOOL IMPROVED PATIENT KNOWLEDGE BUT NOT SATISFACTION WITH THE DECISION-MAKING PROCESS

Shared decision-making (SDM) tools are increasingly employed for procedural decisions. SDM tools are required prior to implantable cardioverter defibrillator and Watchman implantation, though their benefit beyond traditional pre-procedural counseling is uncertain. We developed a SDM tool for atrial fibrillation ablation (AFA), then tested its impact on patient procedural knowledge and patient satisfaction with decision-making involvement. Patients scheduled for an initial AFA were included. Each patient had previously participated in a traditional office visit discussion reviewing risks, benefits, and alternatives. Patients were randomized to experimental and control groups. A separate pre-procedure virtual visit allowed physician and patient to review the SDM tool or a control tool. The control tool outlined the patient experience during the ablation, without additional risk/benefit information. The assigned tool was then mailed to the patient. All patients completed a quiz immediately pre-ablation including 10 true-false questions testing AFA risk and benefit knowledge, and 5 questions assessing patient satisfaction and perceived involvement in procedural decision-making. Student’s t-tests were used to compare groups. 16 patients were randomized to the SDM tool and 11 to the control group. The two groups were similar in age, educational level, and ethnicity. The experimental group included 31% women, the control group, 55% (p=0.25). Virtual visit duration was 10.8 minutes for SDM patients and 8.6 for controls (p=0.04). The experimental group performed better on knowledge-based questions (66% correct vs 54% correct, p=0.04). Patient satisfaction did not differ significantly between groups, with the experimental group averaging 4.69/5 and the control 4.45 (p=0.08). The AFA SDM tool significantly improved patient procedural knowledge compared to traditional pre-procedural discussion alone. Virtual visits with SDM patients were longer than control patient visits, with the SDM tool triggering additional discussion. Prolonged virtual visits and improved patient understanding did not significantly enhance patient satisfaction with the decision-making process.

Videos improve patient understanding of chemotherapy terminology in a rural setting.

It is critical patients understand the terms used to describe oncology treatments; however, even basic chemotherapy terminology can be misunderstood. Rural communities tend to have especially low levels of health literacy compared with nonrural communities. To address low health literacy in rural communities, this study tested rural participants' understanding of previously developed educational chemotherapy videos that were designed for an underserved urban population. Participants were also asked for feedback to determine if the videos could be improved. Fifty English-speaking patients who reside in counties classified as rural according to the Rural-Urban Continuum Code designations (RUCC 4-9) participated in the study. Participants were asked to define 6 chemotherapy terms before and after viewing a short, animated video explaining the term in English. Rates of correct and incorrect definitions provided by participants were also compared with previously published results from an urban cohort. All participants had statistically significantly higher rates of correct definitions for all 6 terms following the video intervention. Palliative chemotherapy understanding improved the most (10% correct prevideo and 76% postvideo intervention). For each video, the majority of participants (77%-92%) suggested no changes to the videos. Given the prevalence of low health literacy in rural communities, it is important to have effective educational interventions to improve the understanding of basic oncology-treatment terminology. This study found that short, educational videos, originally designed for an underserved urban population, can significantly improve understanding of commonly misunderstood chemotherapy terminology in a rural setting as well. Chemotherapy terminology can be confusing to patients. Understanding can be especially difficult in areas with low health literacy, such as underserved urban and rural communities. To address this concern, previously developed short, animated videos describing basic chemotherapy terminology were found to improve patient understanding in an underserved urban setting. In this study, the videos were tested in a rural population and their effectiveness was established. Participants in the rural setting were significantly more likely to correctly define all 6 tested terms after watching the videos. Educational tools for high-need populations are essential to ensure patients can understand the treatment they receive.

Quality of life assessments in clinical practice using either the EORTC-QLQ-C30 or the SEIOQL-DW: a randomized study

BackgroundEffective patient-physician communication can improve patient understanding, agreement on treatment and adherence. This may, in turn, impact on clinical outcomes and patient quality of life (QoL). One way to improve communication is by using patient-reported outcome measures (PROMs). Heretofore, studies of the impact of using PROMs in clinical practice have mostly evaluated the use of standardized PROMs. However, there is reason to believe that individualized instruments may be more appropriate for this purpose.The aim of this study is to compare the effectiveness of the standardized QoL-instrument, the European Organization for Research and Treatment of Cancer Quality of Life C-30 (EORTC-QOL-C30) and the individualized QoL instrument, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), in clinical practice.MethodsIn a prospective, open-label, controlled intervention study at two hospital out-patient clinics, 390 patients with gastrointestinal cancer were randomly assigned either to complete the EORTC-QOL-C30 or the SEIQoL-DW immediately before the consultation, with their responses being shared with their physician. This was repeated in 3–5 consultations over a period of 4–6 months. The primary outcome measure was patients’ health-related QoL, as measured by FACIT-G. Patients’ satisfaction with the consultation and survival were secondary outcomes.ResultsThere was no significant difference between the groups with regard to study outcomes. Neither intervention instrument resulted in any significant changes in health-related QoL, or in any of the secondary outcomes, over time. This may reflect either a genuine lack of effect or sub-optimization of the intervention. Since there was no comparison to standard care an effect in terms of lack of deterioration over time cannot be excluded.ConclusionsFuture studies should focus on the implementation process, including the training of physicians to use the instruments and their motivation for doing so. The effects of situational use of standardized or individualized instruments should also be explored. The effectiveness of the different approaches may depend on contextual factors including physician and patient preferences.

P485 Development and implementation of a remote monitoring tool for real-world assessment of mild, moderate and severe infectious complications in Inflammatory Bowel Disease patients

Abstract Background Immunomodulators and biologicals are cornerstones in the current management of Inflammatory Bowel Disease (IBD), but are associated with increased risk of infections. Post-marketing surveillance studies are important to assess the risk for infectious side effects in real-world populations, yet mainly focus on severe infections. Data on mild and moderate infections in IBD patients are scarce, primarily since self-limiting infections and infections treated by the general practitioner are not systematically captured in surveillance registries. Mild and moderate infections take longer to clear in immunosuppressed patients, have a large impact on (work) disability and quality of life, and potentially precede severe infections. In the current study, we aimed to develop and implement a remote monitoring tool for real-world assessment of infections in IBD patients. Methods Through a structured iterative process with input from IBD specialists, nurse practitioners, and a comprehensive literature review, a 7-item Questionnaire comprising 15 different types of infections (covering e.g. upper/lower respiratory tract; urinary tract; eye; and skin infections) was developed to measure Patient-Reported Infections (PRIQ) with a recall period of 3 months. Infection severity was defined as either mild (self-limiting or requiring topical/local treatment), moderate (requiring oral antibiotic, antiviral or antifungal drugs) or severe (requiring hospitalization and/or IV treatment). To ascertain comprehensiveness and comprehensibility in the intended study population prior to implementation, in three rounds a total of 36 randomly selected IBD patients visiting the outpatient clinic were interviewed individually until saturation was reached. Results Overall, patient understanding of the PRIQ was good and cognitive interviews did not result in reduction of questionnaire-items. Analysis of feedback from interviews resulted in addition of definitions to certain response options (e.g. definition for antivirals) and minor linguistic adjustments to further improve patient understanding. A total of three patients (8.3%) raised concerns on the recall period of 3 months, which after expert consensus, did not result in alteration of the recall period. Next, the PRIQ was digitized and implemented in myIBDcoach, an established telemedicine platform for management of IBD. Conclusion We developed a remote monitoring tool (PRIQ) to assess patient-reported infections in IBD and ascertained patient understanding through cognitive interviewing. A prospective multicentre study using the myIBDcoach platform is ongoing to validate the PRIQ and subsequently report the risk of mild and moderate infections across different treatment regimens in IBD patients (NCT04151420).