Levels Of Patient Participation Research Articles

Cervical Total Disc Replacement in Athletes: A Systematic Review.

Systematic review. To perform a systematic review to describe clinical characteristics, outcomes, and return to play after cervical total disc replacement (cTDR) in athletes. The role of cTDR in treating athletes with symptomatic cervical degenerative disc disease is undefined. A systematic search using MEDLINE through PubMed, EMBASE, and the Cochrane Library was conducted to identify all relevant literature. Data regarding study type, country in which the study was conducted, sample size, mean age, sex, type of sport, level of patient participation in sports, surgical indication, levels operated, type of implant, duration of follow-up, reoperations, surgical complications, extent of postoperative return to sports (RTSs), time to RTSs, and outcome notes were extracted from the included studies and analyzed. Seven studies, including 4 case series and 3 case reports, and a total of 57 cTDR cases, were included. There was significant heterogeneity among the cTDR cases in terms of chosen sport and level of participation. Prestige LP was utilized in 51 out of 57 (89.5%) cases and 53 out of 57 (93%) cases were single-level. No reoperations were noted at a mean follow-up of 51.6 months. All patients returned to sports postoperatively. Return to training and competition occurred at a mean of 10.1 weeks and 30.7 weeks postoperatively, respectively. The available evidence regarding cTDR in athletes indicates that these patients RTSs at high rates, with return to training occurring around 10 weeks and return to competition occurring around 30 weeks. Clinical outcomes in these patients are like those reported for the general population. Low-level evidence, small numbers of cases, heterogeneity in chosen sport and participation level, and predominance of a single implant type limit the conclusions that can be drawn from the current literature on this patient population.

Physicians’ perceptions of patient participation in the myocardial infarction pathway

Myocardial infarction is an acute, frightening and life-threatening condition for patients who are affected. They need plain and simple information about the disease and the treatment, yet patient participation might be challenging in acute situations. Previous studies have shown that patient participation leads to improved patient satisfaction, cooperation with healthcare professionals and better management of the disease. Physicians have a key role in facilitating patient participation in the healthcare services. This study explores physicians’ perceptions of patient participation in the myocardial infarction pathway. In 2018 we interviewed nine experienced physicians in Norway working in different phases of the pathway. Hermeneutics was chosen as the underpinning analytical framework. Four themes illustrated patient participation in the myocardial infarction pathway. Paternalism characterised the acute phase. During hospitalisation the physicians perceived a lack of continuity in physician–patient communication. In the discharge phase, the physicians focused on strengthening health literacy. In the rehabilitation phase, dialogue and shared decision making was central to achieving treatment adherence. We found variations in the level of patient participation along the different phases of the myocardial infarction pathway. Strengthening continuity to ensure patient participation and collaboration between healthcare professionals is essential. The physicians proposed introducing checklists for patient information to enhance interprofessional collaboration and strengthen patient participation.

OP82 Patient Involvement In Health Technology Assessment

IntroductionPatients are increasingly involved in the decision-making process for health technology assessment (HTA), but the question of at what stage they can be involved is still controversial. In Kazakhstan, the HTA process began in 2010. Over the past 2 years, implementation of a project to develop a priority-setting tool based on evidence-informed deliberative processes has made it possible to discuss the participation of patients in HTA. We explored the possibilities of participation of patients or a patient-oriented group in the HTA process.MethodsStructured interviews were held with eight people with interests in HTA. Two were representatives of universities, two from a patient-oriented group, two experts in HTA, and two physicians. Interviews were held online by mobile phone or Zoom for 25–30 minutes. Question structures were formed based on the report ‘Patient Involvement in Health Technology Assessment in Europe 2010’. Seven stages were considered.ResultsAll participants partially or completely agreed with the involvement of patients at the HTA stages of identification and prioritization. One or two did not agree with their involvement at the HTA assessment, information production, internal and external review, and diffusion and dissemination stages. Challenges for patient involvement in HTA can be related to other commitments for patients and their carers, lack of financial affordability, conflict of interest, and lack of capacity of the HTA agency to involve them. Five participants agreed on challenges for patients to being meaningfully involved in decision-making on health technologies. These included understanding which institution makes the decisions, finding an interlocutor within the decision-making body, and understanding the decision-making process. Other issues were technical and language difficulties, lack of commitment from decision-makers and the legal or policy framework for patient involvement in HTA decision-making.ConclusionsPatients can participate in HTA, but the HTA agency must first prepare and agree on the level of patient participation, and develop measures to reduce barriers such as language difficulties, and patient obligations.

Interventions, Participative Role, Barriers, and Facilitators for Involvement in eHealth Communication for People Undergoing Hemodialysis: Protocol for a Scoping Review

BackgroundeHealth interventions have been shown to offer people living with chronic kidney disease the opportunity of embracing dialysis therapies with greater confidence, the potential to obtain better clinical outcomes and increased quality of life, and diverse and flexible designs and delivery options. eHealth interventions or solutions can offer one-way information without the possibility for dialogue, as with most mobile apps. eHealth interventions intending to enable two-way communication between patients undergoing hemodialysis and health professionals are the focus of this review. eHealth communication interventions that enable two-way communication between patients undergoing hemodialysis and health professionals is an emerging field, but issues relating to participation in eHealth communication for patients undergoing hemodialysis are scarcely described. The current conceptualization of this issue is too scattered to inform the development of future interventions. In this scoping review, we want to assemble and examine this scattered knowledge on participation in two-way eHealth communication for patients undergoing hemodialysis.ObjectiveWe want to understand the participative role of people living with chronic kidney disease undergoing hemodialysis in available communicative eHealth interventions and to understand which barriers and facilitators exist for patient involvement in eHealth communication with health professionals.MethodsA scoping review methodology is guiding this study. Peer-reviewed primary studies, including quantitative, qualitative, and mixed methods study designs will be included. A systematic search for published studies, dissertations, and theses at the doctoral level in the English language will be conducted in five databases (MEDLINE, Embase, CINAHL, Scopus, and ProQuest Dissertations and Theses). The included literature will focus on adult (18 years or older) patients undergoing hemodialysis who are involved in eHealth communication with health professionals. Data on the type of eHealth communication interventions, the participative role, and barriers and facilitators for the involvement in eHealth communication for people undergoing hemodialysis will be extracted independently by two reviewers. The extracted data will be collected in a draft charting table prepared for the study. Any discrepancies between the reviewers will be solved through discussion or with a third reviewer.ResultsResults are anticipated by the spring of 2023 and will be presented in tabular format along with a narrative summary. The anticipated results will be presented in alignment with the objectives of the study, presenting findings on the participative role of patients undergoing hemodialysis in eHealth communication interventions.ConclusionsWe anticipate that this study will inform on eHealth communication interventions and the level of patient participation in eHealth communication for patients undergoing hemodialysis. The systematized overview will possibly identify research gaps and motivate further development of eHealth communication to ensure patient participation. The findings will be of interest to key stakeholders in clinical care, research, development, policy, and patient advocacy.International Registered Report Identifier (IRRID)PRR1-10.2196/38615

Development and psychometric testing of the patient participation in bedside handover survey.

When handover is conducted at the patient's bedside, active patient participation can be encouraged, which may improve the safety and quality of care. There is a need for valid and reliable tools to measure patient perceptions of participation in bedside handover, to ensure the rising number of implementation and improvement efforts are consistently and effectively evaluated. The aim of this study is to systematically develop and evaluate the psychometric properties of a self-report survey to measure patients' perceptions of participation in bedside handover. In Phase 1, our team developed a conceptual framework and item pool (n = 130). In Phase 2, content validity was assessed with four health consumers, four nurses and four researchers. Next, 10 current hospital inpatients tested the survey for end-user satisfaction. In Phase 3, 326 inpatients completed the survey, allowing exploratory factor analysis, reliability analyses and convergent/divergent validity analyses to occur. Phase 1 and 2 resulted in a 42-item survey. In Phase 3, 321 surveys were available for analysis. Exploratory factor analysis revealed a three-factor solution, with 24 items, which matched our conceptual framework. The three factors were: 'Conditions for patient participation in bedside handover', 'Level of patient participation in bedside handover' and 'Evaluation of patient participation in bedside handover'. There was strong evidence for factor reliability and validity. Additionally, the correlation between factors was strong. This study furthers our conceptual understandingby showing that nurse facilitating behaviours are a strong precursor for patient participation and perceived handover outcomes, justifying the need for nursing training. A robust survey has been developed to measure patient perceptions of participation in bedside handover, which can effectively evaluate this approach to care. Engaging consumers and nurses as research team members was invaluable in ensuring that the survey is acceptable for end-users. A health consumer and nurse partnered as members of the research team from study inception to dissemination.

Games of uncertainty: the participation of older patients with multimorbidity in care planning meetings \u2013 a qualitative study

BackgroundActive patients lie at the heart of integrated care. Although interventions to increase the participation of older patients in care planning are being implemented in several countries, there is a lack of knowledge about the interactions involved and how they are experienced by older patients with multimorbidity. We explore this issue in the context of care-planning meetings within Norwegian municipal health services.MethodsThis qualitative study drew on direct observations of ten care-planning meetings and an interview with each patient right after the meeting. Following a stepwise-deductive induction approach, the analysis began inductively and then considered the interactions through the lens of game theory.ResultsThe care-planning interactions were influenced by uncertainty about the course of the disease and how to plan service delivery. In terms derived from game theory, the imaginary and unpredictable player ‘Nature’ generated uncertainty in the ‘game’ of care planning. The ‘players’ assessed this uncertainty differently, leading to three patterns of game. 1) In the ‘game of chance’, patients viewed future events as random and uncontrollable; they felt outmatched by the opponent Nature and became passive in their decision-making. 2) In the ‘competitive game’, participants positioned themselves on two opposing sides, one side perceiving Nature as a significant threat and the other assigning it little importance. The two sides negotiated about how to accommodate uncertainty, and the level of patient participation varied. 3) In the ‘coordination game’, all participants were aligned, either in viewing themselves as teammates against Nature or in ascribing little importance to it. The level of patient participation was high.ConclusionsIn care planning meetings, the level of patient participation may partly be associated with how the various actors appraise and respond to uncertainty. Dialogue on uncertainty in care-planning interventions could help to increase patient participation.

Communication in high risk ante-natal consultations: a direct observational study of interactions between patients and obstetricians

BackgroundEffective communication is crucial to any doctor-patient consultation, not least in pregnancy where the outcome affects more than one person. While higher levels of patient participation and shared decision making are recognised as desirable, there is little agreement on how best to achieve this. Most previous research in this area is based on reported data such as interviews or surveys and there is a need for more fine-grained analysis of authentic interaction. This study aimed to identify the discourse characteristics and patterns that exemplify effective communication practices in a high-risk ante-natal clinic.MethodsWe video-recorded 20 consultations in a high-risk ante-natal clinic in a large New Zealand city with patients attending for the first time. Post-consultation interviews were conducted with the 20 patients and 13 obstetricians involved. Discourse analysis of the transcripts and videos of the consultations was conducted, in conjunction with thematic analysis of interview transcripts.ResultsMost patients reported high quality communication and high levels of satisfaction; the detailed consultation analysis revealed a range of features likely to have contributed. On the clinician side, these included clear explanations, acknowledgement of the patient’s experience, consideration of patient wishes, and realistic and honest answers to patient questions. On the patient side, these included a high level of engagement with technical aspects of events and procedures, and appropriate questioning of obstetricians.ConclusionsThis study has demonstrated the utility of combining direct observation of consultations with data from patient experience interviews to identify specific features of effective communication in routine obstetric ante-natal care. The findings are relevant to improvements needed in obstetric communication identified in the literature, especially in relation to handling psychosocial issues and conveying empathy, and may be useful to inform communication training for obstetricians. The presence of the unborn child may provide an added incentive for parents to develop their own health literacy and to be an active participant in the consultation on behalf of their child. The findings of this study can lay the groundwork for further, more detailed analysis of communication in ante-natal consultations.

Men\u2019s view on participation in decisions about prostate-specific antigen (PSA) screening: patient and public involvement in development of a survey

BackgroundProstate-Specific Antigen (PSA) screening for early detection of prostate cancer (PCa) may prevent some cancer deaths, but also may miss some cancers or lead to unnecessary and potentially harmful treatment. Therefore, involving patients in decision-making about PSA screening is recommended. However, we know little about the attitude of men regarding participation in decisions about PSA screening and how to assess such attitudes. The purpose of this paper is to describe patient and public participation in the development of a national, web-based case vignette survey for studying men’s view on participation in decision-making about PSA screening.MethodsThe project group developed a first draft plan for the survey, its vignettes and choice of measurements. This included multiple vignette variants representing various levels of patient participation in decision-making about PSA screening with different outcomes. Additionally, it included questions on respondents’ satisfaction with imagined courses of health care, their propensity to initiate a malpractice complaint, their own health care experiences, socio-demography, personality, and preferences for control regarding health care decision-making. Following feedback from a workshop with academic peers on the draft plan, a group of 30 adult men was engaged to help develop case vignette versions and questionnaire items by providing feedback on structure, comprehension, response patterns, and time required to complete the survey. Furthermore, a panel of three patients with PCa experience was assembled to assist development through a separate review-and-feedback process.ResultsBased on reviews of survey drafts, the large group made further suggestions about construction of the survey (e.g. clarification and modification of case vignette versions, deletion of items and adjustment of wording, instructions to guide respondents, replacement of technical terms, and optimization of sequence of survey elements). The patient panel ensured fine-tuning of vignette versions and questionnaire items and helped review the internet version of the survey.ConclusionsPatient and public involvement during various phases of the survey development helped modify and refine survey structure and content. The survey exemplifies a way to measure health care users’ satisfaction with imagined courses of health care and wish to complain, taking into account their characteristics.

A relação médico-doente

Introdução. Podemos referir que a comunicação pode e deve ser vista como um dos principais ingredientes dos cuidados médicos. Neste trabalho de revisão é avaliado o estabelecimento da relação entre o médico e o doente, relação esta que permite que duas pessoas, anteriormente desconhecidas entre si, estabeleçam uma ligação que permita um grau de intimidade suficiente que possibilite o conhecimento do doente como um todo, bem como permita a participação deste no estabelecimento das metas e objetivos para o atingimento do seu estado de saúde. Materiais e Métodos. Usados para a realização deste sucinto artigo de revisão, foi realizada uma pesquisa bibliográfica na PUBMED, tendo sido usadas as palavras-chave definidas como base no MeSH. As Bases da relação médico-doente assentam em 4 pilares: a confiança, o conhecimento, o respeito e a lealdade, tendo estes elementos um forte impacto nesta relação e na sua natureza, chegando mesmo a ter impacto nos resultados do tratamento no doente. Os Modelos de relação médico-doente consistem em três modelos-base: a) o modelo de atividade-passividade; b) o de orientação-cooperação; e, c) o de participação mútua, envolvendo diferentes níveis de participação do doente na tomada de decisão e na participação na escolha dos tratamentos. Os modelos de prática médica: da antiguidade aos dias de hoje passaram por uma transição ao longo dos anos. Nos primórdios, era predominantemente centrada em um modelo de atividade-passividade até ao modelo vigente nos dias de hoje, o modelo de participação mútua. Observações finais. Podemos verificar que os componentes da comunicação identificados como sendo mais eficazes, podem ser usados como base para o desenvolvimento de currículos de educação médica bem como para programas de educação de doentes.

ADAPTING A COLLABORATIVE CARE MODEL TO FACILITATE REDUCTION OF HIGH DOSES OF PRESCRIPTION OPIOIDS IN COMMUNITY DWELLING ELDERS

Introduction In 2008, the Pennsylvania Department of Aging (PA DoA) and its pharmacy benefits programs for low- to low-middle income older Pennsylvanians—the Pharmaceutical Assistance Contract for the Elderly (PACE) and PACE Needs Enhancement Tier (PACENET)—partnered with the University of Pennsylvania (Penn) to establish a telephone-delivered clinical service that supported geriatric patients and their primary care providers in delivering mental health care integrated within the primary care setting. This evidence-based collaborative care service improved outcomes for elderly Pennsylvanians with disorders of mood or cognition. In the context of the current opioid epidemic, PACE/PACENET and Penn agreed to pilot a new telephone-delivered collaborative care service to help geriatric patients with chronic pain who receive continuing prescriptions for very high doses of opioids. Objectives: To report preliminary findings from a pilot project that adapted an existing collaborative care service to facilitate reduction of high doses of prescription opioids in community dwelling elders. The principle aims were to measure levels of patient participation and engagement, and to determine the extent to which engaged patients and their prescribers achieve opioid dose reduction. Methods Patient Sample: From May through October 2018, a convenience sample of elderly patients receiving chronic opioid prescriptions for > 120 mg morphine-equivalent dose (MED) was referred by PACE/PACENET to the Penn collaborative care service. Clinical Intervention: Patients who agree to participate undergo comprehensive assessments of mental health, cognition, sleep, pain, and functional status by a Behavioral Health Lab (BHL) technician. Measures include the Patient Health Questionnaire-9 (PHQ-9); Generalized Anxiety Disorder -7 (GAD-7); Blessed Orientation-Memory-Concentration test (BOMC); Insomnia Severity Index (ISI); Pain intensity, interference with Enjoyment of life, and interference with General activity (PEG); pain self-efficacy questionnaire (PSEQ); and Veterans RAND 12-item Health Survey (VR-12) for mental and physical function. A follow up baseline interview with a BHL clinician (LSW or RN) includes self-reported daily opioid dose, assessment of medical-psychiatric co-morbidity, other medications and pain treatment modalities, and identification of unmet biopsychosocial needs. The BHL clinician engages the patient in individualized treatment planning, with emphasis on goals of opioid dose reduction to safer levels. Modalities of treatment offered include but are not limited to (1) behavioral pain management, (2) general medication education, (3) reinforcing positive health behaviors, (4) addressing barriers to change, (5) scheduling positive activities, and (6) relaxation techniques. Summary reports are sent to prescribers with recommendations for pain care management and opioid dose reduction. Program Evaluation: “Participation” was defined as patient agreement to participate in the initial health assessment with a BHL technician. “Engagement” was defined as completion of the baseline health assessment and at least two follow-up contacts with a BHL clinician. “Substantial dose reduction” was defined as at least 20% reduction from the self-reported baseline MED within the first 12 weeks of program engagement. Results 71 patients were referred over the first 5 months, 3 of whom were unable to participate due to communication barriers. Of the remaining 68 eligible patients, 49 (72%) participated in the initial health assessment. Of these participants, 25 (36.8% of eligibles) had at least 2 follow-up contacts with a BHL clinician and were considered “engaged” in the program. Participants’ mean age was 73.9 years (range, 65-87); 61.5% were male; 94.2% were White, 1.9% were Black; 96.2% were non-Hispanic, 1.9% were Hispanic. Participants’ mean PHQ-9 score was 8.3; mean GAD-7 score 4.3; mean BOMC score 4.1; and mean ISI score was 6.3. Mean baseline PEG and PSEQ scores were 7.1 and 6.0, respectively. Mean VR 12 mental health score was 47.4 indicating average overall functioning, and VR-12 physical score was 20.4 indicating low overall functioning. Of the 25 engaged patients, 21 (84%) achieved dose reductions, with a mean MED of 420 mg on initial assessment and 276 mg at the last contact. 36% of engaged individuals achieved dose reductions of >20%. Conclusions In this pilot program for elderly patients taking very high doses of prescription opioids, we found a high rate of participation in the initial assessment, and a moderate rate of engagement in follow-up. Although 36% of the engaged patients achieved substantial opioid dose reductions, these patients were still receiving unsafe doses. Nevertheless, these findings suggest that it is possible to adapt a collaborative care model to help some older adults achieve substantial reductions from high doses of prescription opioids. This research was funded by Pennsylvania Department of Aging

OP14 Progress In Use Of Telerehabilitation For Persons With COPD

IntroductionTelerehabilitation shows promise in many fields though strong evidence of benefit has been limited. We reviewed progress in the use of telerehabilitation for persons with chronic obstructive pulmonary disease (COPD). A challenge in caring for persons with this condition is the ability to achieve high levels of patient participation and compliance with rehabilitation processes.MethodsRelevant publications were identified through literature searches from November 2009 to May 2018. We selected those that described studies of telerehabilitation in the management of COPD and reported clinical or administrative outcomes. Study quality was assessed using an approach that considers both study performance and study design. Judgments were made on whether the telerehabilitation application had been successful, if reported outcomes were clinically significant, and if further data were needed to establish the application as suitable for routine use.ResultsTwenty-five publications, on 26 studies, were selected. Twelve were of high or good quality. In 11 studies the telemedicine application was successful. Nine studies had unsuccessful applications, and for six studies success was unclear. Further data before routine use would be required or desirable for all successful applications. In many studies there were difficulties associated with availability of skilled mentors, motivational support for patients and access to reliable remote monitoring and communication technology.ConclusionsVarious types of telerehabilitation are potentially helpful in the management of COPD. Availability and access to these technologies should improve. However, in management of this clinically challenging condition their use must be linked to suitable training and education of patients with COPD and timely support for them from healthcare professionals.

Patient Engagement in Randomized Controlled Tai Chi Clinical Trials among the Chronically Ill.

Physicians encounter various symptom-based complaints each day. While physicians strive to support patients with chronic illnesses, evidence indicates that patients who are actively involved in their health care have better health outcomes and sometimes lowers costs. This article is to analyze how patient engagement is described when complex interventions such as Tai Chi were delivered in Randomized Controlled clinical Trials (RCTs). It reviews the dynamic patient- physician relationship in chronic illness management and to illustrate the patient engagement process, using Tai Chi as an example intervention. RCTs are considered the gold standard in clinical research. This study is a qualitative analysis of RCTs using Tai Chi as an intervention. A systematic literature search was performed to identify quality randomized controlled clinical trials that investigated the effects of Tai Chi. Selected clinical trials were classified according to research design, intervention style, patient engagement, and outcomes. Patient engagement was classified based on levels of patient participation, compliance, and selfmanagement. The chronic health conditions included in this paper are Parkinson's disease, polyneuropathy, hypertension, stroke, chronic insomnia, chronic heart failure, fibromyalgia, osteoarthritis, central obesity, depression, deconditioning in the elderly, or being pre-clinically disabled. We found that patient engagement, as a concept, was not well defined in literature. It covers a wide range of related terms, such as patient involvement, participation, shared decision- making, patient activation, adherence, compliance, and self-management. Tai Chi, as a very complex practice system, is to balance all aspects of a patient's life; however, the level of patient engagement is difficult to describe using conventional clinical trial design. To accurately illustrate the effect of a complex intervention, novel research design must explore ways to measure patient engagement in the intervention in order to clarify its specific role on health.

Self-management in patients with diabetes and chronic kidney disease is associated with incremental benefit in HRQOL

AimsThere is insufficient and inconsistent data regarding the association between diabetes self-management, the process of facilitating the knowledge, skill, and ability necessary for diabetes self-care, and health-related quality of life (HRQOL) in people with diabetes and moderate to severe chronic kidney disease (CKD). MethodsIn a cross sectional study, participation in diabetes self-management assessed by the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire and HRQOL was examined in 308 patients with diabetes and CKD (stages 3 to 5) recruited from outpatient diabetes and renal clinics of 4 public tertiary hospitals. Associations were examined by Pearson correlation coefficients and hierarchical multiple regression after controlling for potential confounders. An examination of trend across the levels of patient participation in self-management was assessed using a non-parametric test for trend. ResultsThe median age and interquartile range (IQR) of patients were 68 and 14.8years, respectively with 59% of the population being over 65years old and 69.5% male. The median durations of diabetes and CKD were 18years (IQR-17) and 5years (IQR-8) respectively. General diet, exercise and medication taking were positively associated with at least one HRQOL subscale (all p<0.05) but diabetes specific diet, blood sugar testing and foot checking were not. As levels of participation in self-management activities increased there was a graded increase in mean HRQOL scores across all subscales (p for trend <0.05). ConclusionsIn people with diabetes and moderate to severe CKD, participation in diabetes self-management activities, particularly those focused on general diet, exercise and medication taking, was associated with higher HRQOL.

Implementing cardiometabolic health checks in general practice: a qualitative process evaluation.

BackgroundA stepwise screening approach for the detection and management of cardiometabolic disease is proposed in various primary care guidelines. The aim of this study was to explore the implementation of a cardiometabolic health check as perceived by the involved caregivers and patients.MethodsQualitative process evaluation of the implementation of a cardiometabolic screening programme in a multidisciplinary primary healthcare centre in Eindhoven, the Netherlands, in which 1270 patients had participated. We explored the caregivers’ experiences though focus group discussions and collected patients’ experiences through a written questionnaire containing two open-ended questions. We analyzed our data using a thematic content analysis based on grounded theory principles.ResultsFive general practitioners, three practice nurses and five medical receptionists participated in the focus groups. Additionally we collected experiences of 657 (52% of 1270) participating patients through an open-ended questionnaire.GPs were enthusiastic about offering a health check and preferred systematic screening over case-finding, both in terms of yield and workload. The level of patient participation was high and most participants were enthusiastic about the health check being offered by their GP. Despite their enthusiasm, the GPs realized that they lacked experience in the design and implementation of a structured, large-scale prevention programme. This resulted in suboptimal instruction of the involved practice nurses and medical receptionists. The recruitment strategy was unnecessarily aggressive. There were shortcomings in communicating the outcomes of the health check to the patients and there was no predefined follow-up programme. Based on our findings we developed a checklist that can be used by designers of similar health checks.ConclusionsA number of fundamental issues may arise when GPs organize a systematic screening programme in their practice. These issues are related to the preparation of the involved staff, the importance of integration with everyday clinical practice, the approach of healthy patients and the provision of adequate follow-up programmes. The identified challenges and recommendations can be taken into account during future screening programmes.

Why do hospital mastectomy rates vary? Differences in the decision-making experiences of women with breast cancer.

Background:Hospital mastectomy rates vary. This study explores the relationship between mastectomy rates and breast cancer patients’ consultation and decision-making experiences with specialist clinicians.Methods:Qualitative semi-structured interviews were conducted with 65 patients from three purposively selected breast units from a single UK region. Patients provided with a choice of breast cancer surgery (breast conservation therapy (BCT) or mastectomy) were purposively recruited from high, medium and low case-mix-adjusted mastectomy rate units.Results:Low mastectomy rate unit patients’ consultation and decision-making experiences were markedly different to those of the medium and high mastectomy rate breast units. Treatment variation was associated with patients’ perception of the most reassuring and least disruptive treatment; the content and style of information provision (equipoise or directed); level of patient participation in decision making; the time and process of decision making and patient autonomy in decision making. The provision of more comprehensive less directive information and greater autonomy, time and support of independent decision making were associated with a lower uptake of BCT.Conclusion:Variation in hospital mastectomy rates was associated with differences in the consultation and decision-making experiences of breast cancer patients. Higher mastectomy rates were associated with the facilitation of more informed autonomous patient decision making.

Principles of Soft Tissue Treatment

Definition: treatment primarily directed at affecting or changing soft tissues. Two primary types of passive soft tissue movements are reviewed. Levels of patient participation in treatment and soft tissue technique variables are presented. Treatment goals for acute, subacute and chronic conditions are outlined.

Smoking intervention for cardiac patients: in search of more effective strategies.

Smoking cessation greatly reduces morbidity and mortality associated with coronary artery disease (CAD). This paper presents details of an individually delivered smoking intervention program for patients with CAD that had been shown to be effective in a previously reported randomized clinical trial. Treatment components include inpatient counseling, followed by a single outpatient visit and follow-up by telephone. This approach compared to traditional outpatient group intervention engenders much higher levels of patient participation and is suitable to the special needs of cardiac patients.

Patient initiative and responsibility

This study investigates the effectiveness (in terms of rates of reinfection) of encouraging gonorrhea patients in public treatment facilities to become more involved in disease prevention and control. Two approaches to interviewing patients that require different levels of patient participation in disease control are compared (epidemiological case-finding versus motivational-responsibility interviewing). The issue of patient participation is viewed in the context of the actualities of venereal disease treatment as this responsibility is met in public clinics, with such features as heavy caseloads, brevity of treatment time and many stigma-associated factors acting both on patient and medical practitioner and other clinic staff members. The theoretical framework is based on contemporary conceptions about the partially contrary motivations and interests in general of patient and practitioner when they meet in the medical treatment setting. Results indicate that reinfection rates are lower for male patients (but not female patients) receiving the motivational-responsibility interview. Alternative explanations for the interview group-reinfection relationship are considered, and possible reasons for the lack of a relationship among women are suggested. It is concluded that efforts aimed at increasing patient involvement can be effective in gonorrhea prevention and control.