Increase Patient Participation Research Articles

Participatory Decision Making, Asthma Action Plans, and Use of Asthma Medication: A Population Survey

Use of controller asthma medication and possession of asthma action plans remains suboptimal. Our aim was to investigate the association of the propensity of physicians to involve patients in their care (participatory decision-making style) and their asthma management in a representative population sample of 3015 adults. Current doctor-diagnosed asthma was reported by 393 (13.0%). People who rated their doctors as more participatory were significantly more likely to report more regular use of controller medications and possession of a written asthma action plan, but not less asthma morbidity. Possession of a written action plan was associated with more participatory interactions (OR 2.3; 95% CI 1.1–4.7, for upper tertile scores compared to lowest tertile); more severe symptoms (OR 4.8; 95% CI 1.7–13.0), being female (OR 2.2; 95% CI 1.2–4.3), those with higher education, and residence outside the metropolitan area (OR 2.1; 95% CI 1.1–4.0). Increasing patient participation in their own care is associated with better asthma management, independent of asthma symptoms. Longitudinal studies are needed to examine if increasing participation in decisions can also improve asthma outcomes.

Perceptions of clinical trial participation between community practitioners and older cancer patients

8260 Background: Older cancer patients are underrepresented in clinical trials. As the number of older cancer patients treated in community practices increases, understanding the interaction of community practitioners and patients' perception of barriers to participate in clinical trials may help increase patient participation. Methods: Community practitioners and elderly patients (age 70 and older) were surveyed on their perception of clinical trial participation. Phase I asked practitioners to rate the degree various factors impact their decision to consider a patient for clinical trials participation. Phase II involved surveying elderly patients to rate the degree these similar factors impact their willingness to consider clinical trials participation. Results: Preliminary data identified several factors impacting practitioners' decision to consider an older patient for clinical trial participation. The factors include: patient's existing co-morbid conditions, high toxicity potential to treatment with older patients; patients not having adequate home assistance; study designs not specific to elderly patients; compensation for trial conduct not correspond to amount of work required to enroll elderly patients. Practitioners surveyed stated that elderly cancer patients are routinely offered clinical trials; this was not reflective of recent data which showed that patients age 70 and older comprise only 20% of clinical trials participants (Talarico et al, 2003). Conclusions: The lack of data involving elderly participation in clinical trials data suggests that researchers and clinicians need to work together to build a consensus on how to operationalize clinical trials in the elderly population. The patient survey phase is ongoing with the aim to provide complementary data to help better understand and address clinical trials participation issues from both practitioner and patient perspectives. Information on potential similarities and differences with these groups can help influence the design of future clinical trials involving elderly patients with cancer. No significant financial relationships to disclose.

Perceptions of clinical trial participation between community practitioners and older cancer patients

8260 Background: Older cancer patients are underrepresented in clinical trials. As the number of older cancer patients treated in community practices increases, understanding the interaction of community practitioners and patients' perception of barriers to participate in clinical trials may help increase patient participation. Methods: Community practitioners and elderly patients (age 70 and older) were surveyed on their perception of clinical trial participation. Phase I asked practitioners to rate the degree various factors impact their decision to consider a patient for clinical trials participation. Phase II involved surveying elderly patients to rate the degree these similar factors impact their willingness to consider clinical trials participation. Results: Preliminary data identified several factors impacting practitioners' decision to consider an older patient for clinical trial participation. The factors include: patient's existing co-morbid conditions, high toxicity potential to treatment with older patients; patients not having adequate home assistance; study designs not specific to elderly patients; compensation for trial conduct not correspond to amount of work required to enroll elderly patients. Practitioners surveyed stated that elderly cancer patients are routinely offered clinical trials; this was not reflective of recent data which showed that patients age 70 and older comprise only 20% of clinical trials participants (Talarico et al, 2003). Conclusions: The lack of data involving elderly participation in clinical trials data suggests that researchers and clinicians need to work together to build a consensus on how to operationalize clinical trials in the elderly population. The patient survey phase is ongoing with the aim to provide complementary data to help better understand and address clinical trials participation issues from both practitioner and patient perspectives. Information on potential similarities and differences with these groups can help influence the design of future clinical trials involving elderly patients with cancer. No significant financial relationships to disclose.

Patient-physician communication.

Patient-physician communication is a vital element of the process of care. In numerous studies, communication behaviors during the medical interaction have been significantly associated with a variety of patient satisfaction and health outcomes. The purpose of this review is to synthesize recent findings in the area of patient-physician communication, particularly as they relate to patients with rheumatic disease. Although there is scant research on the medical interaction with patients with rheumatic disease specifically, there is a large body of literature examining patient-doctor communication in other chronic diseases. Because many of the findings of studies conducted in patients with other diseases can be extended to patients with rheumatic disease, this review also covers the most salient literature published in the past year on patient-doctor communication in chronic diseases in general, in addition to covering publications in the field of rheumatology. The literature reviewed shows that patients' expectations of medical encounters are not always fulfilled and that patients desire increased participation and information sharing. Establishing patient-centered care is a challenging goal, but fortunately, recent studies show that physicians can be trained, irrespective of the years in practice, to provide patient-centered care and increase patient participation and satisfaction with care.

Exploring doctor and patient views about risk communication and shared decision-making in the consultation.

There have been significant conceptual developments regarding shared decision-making (SDM) and assessments of people's hypothetical preferences for involvement in treatment or care decisions. There are few data on the perceptions of patients and professionals about SDM in actual practice. To explore, from paired doctor-patient interviews, participants' perceptions of SDM in the consultation and the level of consensus between the participants in the consultation process. Qualitative analysis of semi-structured interview data. Twenty general practitioners received training packages in 'risk communication' (RC) and 'SDM' to use as tools within the consultation. Forty patients with one of four conditions, for which a range of treatment options is available, were selected. Patient/doctor pairs were interviewed separately following consultations at four stages -'baseline' [general practitioner's (GP) usual consultation style], SDM training, RC alone, and both RC and SDM training. Interviews were transcribed and analysed using NVivo software. Risk communication interventions by doctors appeared to result in a greater perception of decisions being made in the consultation. High levels of satisfaction with consultations were evident before application of the interventions and did not change after the interventions. Doctors' and patients' perceptions of the consultations were highly congruent at all phases of the study. Shared decision-making and RC approaches were helpful in selected consultations and showed no detrimental effects to patients. However, the use of RC and SDM made only small differences to decision-making in consultations within the population studied. Increasing patient participation may be seen as more ethically justifiable than the traditional paternalistic approach but this needs to be set against the additional training costs incurred.

General practitioners’ views on shared decision making: a qualitative analysis

Despite rhetoric about increasing partnership in the consultation, shared decision making (SDM) is not necessarily happening in practice. As patient involvement in decision making cannot be achieved without general practitioners’ (GPs) co-operation, attention to their concerns is essential. Previous research has used simulated patients to explore this area. Here, data from consultations and interviews with patients and GPs were used in focus group discussions enabling GPs to ground their views of the practical application of SDM in their own and other participants’ real life practice. The following ideas were discussed; what constitutes SDM in practice, negotiation about treatment, perceptions of patients’ viewpoints and perceived barriers to SDM. Agreement with SDM in theory may not translate into practice. The process outlined is being developed in order to establish whether the techniques could provide a supportive environment in which GPs can make changes to their practice to increase patient participation.

Increasing patient participation in reproductive health consultations: an evaluation of “Smart Patient” coaching in Indonesia

Paternalistic models of health care, social distance between patients and providers, and cultural norms discourage patients from playing an active role in health consultations. This study tested whether individual coaching can give family planning patients the confidence and communication skills to talk more openly and more vigorously with providers. Educators met with 384 Indonesian women in clinic waiting rooms and coached them on asking questions, expressing concerns, and seeking clarification. An analysis of audiotaped consultations found that patients who received coaching articulated significantly more questions and concerns than others. Coaching narrowed differentials in active communication by patient type, age, and assertiveness, but it widened differentials by patient education and socioeconomic class. The discontinuation rate at 8 months was lower in the intervention than the control condition, but the difference was only marginally significant.

Pre-operative patient teaching in an acute care ward in Hong Kong: A case study

Many nurses have acknowledged that adequate pre-operative teaching can alleviate patients’ anxiety, increase patient participation in their own care, and minimize post-operative complications. However, the organization and degree to which pre-operative patient teaching featured in nurses’ practice varies in different acute care settings. A case study design was used to explore the practice of pre-operative teaching in a surgical ward of an acute general hospital in Hong Kong. Seventeen registered nurses working on the ward were interviewed and observed in order to explore how they conduct a pre-operative teaching program and the difficulties encountered by them in carrying out pre-operative teaching on this acute care setting. The findings of this study indicate that pre-operative teaching workshops are organized and conducted by nurses from the operating theatre, in the day surgery center. Ward nurses were not actively involved in this pre-operative teaching.The results of this study present some similarities to a study with the similar design in Australia. There are also issues unique to the Hong Kong context. This case study was to review Hong Kong nurses’ current practices of pre-operative teaching and to understand the cultural, conceptual and management factors influencing the practice in pre-operative teaching.

Beyond the 4Ps: using relationship marketing to build value and demand for pharmacy services.

More than a decade ago, Hepler and Strand1,2 introduced the concept that the therapeutic relationship between pharmacist and patient was an integral component of pharmaceutical care. They saw pharmaceutical care as “a covenantal relationship between a patient and a pharmacist in which the pharmacist performs drug use control functions (with appropriate knowledge and skill) governed by the awareness of and commitment to the patient’s interest.”1,3 An empathetic and trusting pharmacist–patient relationship is now widely recognized as the cornerstone of pharmaceutical care. Far less appreciated, however, is how important the pharmacist–patient relationship is for successfully marketing pharmacy-based clinical services. Close collaborative relationships with patients, physicians, and other potential partners (i.e., other stakeholders in patient care) are the keys to creating and sustaining demand for pharmacy services on a long-term basis. Ideally, a network of mutually rewarding relationships should form the foundation of a pharmaceutical care marketing plan. In the pharmacy setting, interactions are increasingly anonymous, as more prescriptions are being filled through Internet pharmacies and automated refill programs. Pharmaceutical care, however, emphasizes a patient-centered focus that is mutually rewarding to all parties. Similarly, relationship-centered marketing focuses on the pharmacist-patient bond and represents a major shift in practice from traditional marketing, which emphasizes discrete (one sale at a time) and often impersonal exchanges between organizations and customers. In this article, we describe how to use relationship marketing to create and maintain a network of productive relationships with selected groups of patients and other partners to expand the delivery of pharmaceutical care services. The article also draws upon the first-hand experience of one of the authors (McDonough) and other pharmacists at Main at Locust Pharmacy in Davenport, Iowa, who used this innovative marketing approach to increase patient participation in a Weight Control and Wellness Program in their pharmacy clinic.

Using Quality of Life Measurement to Enhance Interdisciplinary Collaboration

The use of quality of life (QOL) measurement in the End-Stage Renal Disease (ESRD) setting can be useful to measure the impact of interventions on outcomes. Using QOL results can also increase patient participation in care planning and, thus, increase patient satisfaction with care. Clinical indicators can be developed to trigger further assessment of various patient needs.

Prospective evaluation of cancer clinical trial accrual patterns: identifying potential barriers to enrollment.

Well-conducted cancer clinical trials are essential for improving patient outcomes. Unfortunately, only 3% of new cancer patients participate in clinical trials. Barriers to patient accrual in cancer clinical trials must be identified and overcome to increase patient participation. We prospectively tracked factors that potentially affected patient accrual into cancer clinical trials at the University of California Davis Cancer Center. Oncologists seeing new outpatients were asked to complete questionnaires regarding patient characteristics and the physician's decision-making on patient eligibility, protocol availability, and patient opinions on participation. Statistical analysis was performed to correlate these parameters with subsequent protocol accrual. There were 276 assessable patients. At the initial visits, physicians did not consider clinical trials in 38% (105/276) of patients principally because of a perception of protocol unavailability and poor performance status. Physicians considered 62% (171/276) of patients for participation in clinical trials. Of these, only 53% (91/171) had an appropriate protocol available for site and stage of disease. Seventy-six of 90 patients (84%) with available protocols met eligibility criteria for a particular study. Only 39 of 76 patients (51%) agreed to participate in cancer clinical trials, for an overall accrual rate of 14% (39/276). The remainder (37/76, 49%) declined trial participation despite meeting eligibility criteria. The most common reasons were a desire for other treatment (34%), distance from the cancer center (13%), patient refusal to disclose reason (11%), and insurance denial (8%). Patients with private insurance were less likely to enroll in clinical trials compared to those with government-funded insurance (OR, 0.34; P =.03; 95% CI, 0.13 to 0.9). Barriers to cancer clinical trial accrual can be prospectively identified and addressed in the development and conduct of future studies, which may potentially lead to more robust clinical trials enrollment. Investigation of patient perceptions regarding the clinical trials process and the role of third party-payers is warranted.

Nurses can help involve public in decision making

RCN Institute director applauds increased patient participation in NHS planning

Pre-operative teaching: how does a group of nurses do it?

Studies have revealed that adequate pre-operative instructions alleviate anxiety, increase patient participation in their care and minimize the development of post-operative complications. However, other researches have found that there are discrepancies between nurses’ perceptions of patient’s pre-operative needs and patients’ actual needs. The aim of this study is to gain insight into how a group of surgical ward nurses organize and implement their pre-operative teaching, and the difficulties they have encountered. It explores how a group of surgical ward nurses conduct pre-operative teaching to their patients. It has found that their training, rote learning, and the timing of patient admissions have all affected how participating nurses organize and implement their pre-operative teaching to their patients. This case study acts as an exemplar to other nurses, to stimulate reflection on their own practice.

GLAUCOMA IN THE NEW MILLENNIUM

It has been estimated that at the start of the new millennium, there will be more than 66 million cases of glaucoma worldwide, bringing it into second place in the world blindness league. 49,66 In Western countries, approximately 50% of those who have glaucoma actually know it, 49 and in underdeveloped countries, this figure is probably much more. It would be reasonable to suggest that the prevalence of glaucoma and blindness from the disease is no better at the start of the third millennium than it was at the start of the second. The ophthalmologic community cannot be too complacent about this contribution to global health. This article looks at the current position of glaucoma management from the perspective of the ophthalmologist and the patient, and then suggests what changes might occur in the next millennium. The problem is first approached from the ophthalmologist's perspective, and definitions, methods of diagnosis, and methods of treatment are discussed. Second, increasing patient participation in the management of their disease is anticipated, so how this will affect our concept of success in terms of visual preservation and risk is analyzed. All views of the future carry risk, but if some of the suggestions contained in this article are correct, then this article will have succeeded in its purpose.

The Role of The Registered Dietitian In The Development and Implementation of a Multi-Disciplinary Action Plan For Use With Congestive Heart Failure Patients In An Acute Care Setting

A group of sixteen healthcare professionals (including physicians, pharmacists, registered nurses, respiratory therapists, medical records personnel, and a registered dietitian (RD) were organized to design and implement a Multi-disciplinary Action Plan (MAP) for the purpose of increasing quality and consistency of care in Congestive Heart Failure (CHF) patients based on national standards for best practice. Other goals of the MAP included increased patient participation in care, and decreased medical costs by standardization of care and appropriate use of resources. The MAP design team was directed by a team of five physicians, with expertise ranging from cardiology to family practice. The team collaborated weekly over a five week period on formulating a physician order set, the actual MAP, and patient education care plan; the latter outlined the day to day treatment processes for the patient with the CHF diagnosis. The role of the RD was to provide specialized information on the Medical Nutrition Therapy care plan for the patient, the nutrition education component, necessary diet restrictions, and possible drug-nutrient interactions with medications used in treatment. The RD also assisted with the implementation phase of MAP use by educating staff, marketing the MAP to other physicians, as well as continuing to serve as a resource in the development of other MAPs. Outcomes on MAP effectiveness will be continually measured by specific clinical indicators (i.e. readmission rates, length of stay), patient, physician, and staff surveys, as well as the patient's ability to demonstrate specific teaching plan information.

The decision-making process for the treatment of abnormal uterine bleeding.

This pilot study was conducted to investigate the treatment decision-making process of patients and physicians for abnormal uterine bleeding (AUB). Frequently, women with AUB are referred for hysterectomy without diagnostic workup, alternative therapeutic management, or patient input (i.e., patient treatment preferences). Variations in treatment strategies used for patients may be related to a number of factors external to the patient's underlying disease. However, little is known about which factors are most influential or about the extent to which they influence physicians' and patients' decisions. We prospectively followed the management and treatment of 52 women with complaints of AUB and examined differences in treatment among these patients. Extensive previsit interviews were conducted with these women to identify each patient's symptoms, health status, functional status, and preferences for and expectations of treatment. We then conducted telephone interviews within a week of the visit and again 9-12 months later to determine the treatment plan, patient level of participation in and satisfaction with the treatment, symptoms, and functional status. Overall, our findings suggest that patients want to be involved in making treatment decisions and that when women were presented with alternatives to hysterectomy, many chose alternative medical therapy or other surgical procedures. In addition, women reported that these alternative treatments produced significant improvement in symptom intensity and functioning. Increased patient participation in decision making enhanced patient satisfaction. These findings suggest that hysterectomy rates may be decreased by offering women alternative treatments and by finding ways to increase women's participation in their treatment decisions.

Examining patient participation in medical consultations: A combined quantitative and qualitative approach

Abstract This study used a combination of quantitative and qualitative analytic approaches to examine the nature of patient participation in medical consultations. The hospital clinic interviews of 101 rheumatology outpatients were analysed using the Verbal Response Mode coding scheme. Patient participation was, in general, low throughout the consultation. In addition, high patient participation was significantly correlated with low satisfaction-with-treatment scores. Qualitative analysis of transcripts from high and low participation patients showed that increased patient participation often reflected distress, dissatisfaction with prior care, and was more common with diagnostic uncertainty on the part of the doctor. Low participation reflected low emotion content and more diagnostic certainty. The results are discussed in terms of the inconsistent and methodological difficulties in examining patient participation in the medical interview.

The changing role of the consumer in health care quality

Traditionally, health care quality has been provider defined and focused, even though consumers define and evaluate health care quality. And, there is no relationship between consumer and provider perceptions of quality. Importantly, consumers use their evaluations when they decide to sue, recommend or return for services, and comply with treatment regimens. This article examines the changing role of the consumer in health care quality, explicates the need for a change in the health care paradigm, and suggests strategies for increasing patient participation in health care planning and quality assessment.

Statutory Requirements for Disclosure of Breast Cancer Treatment Alternatives

Therapeutic options for breast cancer, particularly for early-stage disease, and increased patient participation in medical decision-making have oriented state legislatures toward ensuring that women with breast cancer have adequate information about treatment alternatives. Currently, 18 states have enacted statutes regarding physician disclosure of treatment alternatives to breast cancer patients. This paper reviews these statutes in the context of the requirements imposed on the physician as health care provider and the content of medical information presented to the patient as a consequence of the laws. State statutes were identified through the National Cancer Institute's State Cancer Legislative Database, and the statutory requirements were analyzed. For statutes requiring development of a written summary of treatment alternatives, the most recent summary was obtained through the responsible state agency, and informational content was analyzed for relevance to treatment decisions in early-stage disease. As a group, these laws address informed consent for treatment, physician behavior within the patient-physician relationship, and the medical information upon which treatment decisions are based. Individual statutes vary in the scope of the issues addressed, particularly in the responsibility placed on physicians, and treatment option summaries developed in response to this legislation vary widely in content and scope. Despite broad implications of these statutes in oncology practice, little is known about their effects on breast cancer care. Additional research is needed to define the impact of these statutes on breast cancer care, as such legislation is considered by other states for this and other diseases.

Radiotherapy in the curative treatment of breast cancer: current status and future trends an opinion sample of radiation oncologists active in breast cancer research

A questionnaire regarding the current practice of breast cancer radiotherapy and possible future trends in this field was filled out by 13 radiation oncologists active in breast cancer research. In the opinion of this small group, radiotherapy is presently included in the initial treatment of the large majority of early breast cancers, particularly in the framework of breast-conserving therapy, which is currently used in >50%. of these patients. Indications for post-mastectomy irradiation vary greatly among respondents, as do attitudes toward the potentially negative aspects of adjuvant radiotherapy. Most respondents feel that their future practices will be significantly influenced by an increase in screen-detected cancers, the aging of the population, the increasing influence of medical oncologists, participation in clinical trials, and increased patient participation in treatment decisions. An increase is foreseen in the use of breast-conserving approaches, radiotherapy, and systemic therapies, and a decrease in the use of both total mastectomy and axillary dissection. Most respondents feel that there will be a modest decrease in the percentage of conservatively operated patients receiving radiotherapy. A future role is seen for neo-adjuvant chemotherapy, at least in well-defined subgroups, increasing the number of patients offered breast-conserving approaches. Most respondents expect that irradiation of lymph nodal areas will gain new credibility and be used more often. No majority opinion could be elicited regarding ways of improving the therapeutic ratio in breast cancer radiotherapy.