Patient-centered Care Research Articles

Enhancing Professional Awareness of Informed Consent : Safeguarding the Rights of Patients and Practitioners.

Informed consent is a crucial communication process between doctors and patients for obtaining patients' approval before initiating medical treatment. It is derived from the legal principles of medical contracts and requires doctors to explain the treatment process to patients. Surgeons should be aware of informed consent not only to avoid unnecessary litigation risks but also to provide patients with the right to self-determination. The aim of the study is to help surgeons in Korea understand the legal doctrine on informed consent for practical application. This article reviews the legal doctrine of IC according to 4W1H-why, who, what, when, and how-with judicial cases to communicate effectively with patients in clinical settings. Regardless of seniority or rank, doctors may provide competent patients with information to protect their rights to self-determination. Informed consent should be advanced for patients to consider, discuss with significant others, and determine whether or not to undergo medical treatment. At that stage, patients need to be informed of the necessity, risks, and so on. The most common method of informed consent is an oral explanation utilizing certain forms for documentation. However, the informed consent of patients can be exempted on certain occasions. Optimal informed consent, when implemented, leads to patient-centered care, which significantly improves patient satisfaction and outcomes. Ultimately, it not only protects doctors from litigation risks but also upholds patients' autonomy.

Environmental and patient safety: Advances in radiological techniques to reduce radiation exposure

The growing concern for environmental and patient safety in medical imaging has driven significant advancements in radiological techniques aimed at reducing radiation exposure. This review explores these developments, emphasizing the dual focus on minimizing harm to patients and addressing the broader environmental impact of radiological practices. Recent innovations include the optimization of imaging protocols, the introduction of low-dose imaging technologies, and the integration of advanced software algorithms that enhance image quality while reducing the need for higher radiation doses. The implementation of iterative reconstruction techniques, for instance, has allowed for significant dose reductions in computed tomography (CT) scans without compromising diagnostic accuracy. Additionally, the use of alternative imaging modalities such as magnetic resonance imaging (MRI) and ultrasound, which do not involve ionizing radiation, is increasingly recommended where clinically appropriate, further mitigating radiation risks. Furthermore, the shift towards personalized imaging protocols, where radiation doses are adjusted based on individual patient characteristics, marks a critical advance in patient safety. This approach not only reduces unnecessary exposure but also enhances the overall effectiveness of diagnostic procedures. Environmental safety considerations have also led to the development of more sustainable radiological practices, including the safe disposal of radioactive materials and the reduction of energy consumption in imaging facilities. These efforts are aligned with broader healthcare initiatives to lower the carbon footprint of medical practices. The advancements in radiological techniques to reduce radiation exposure reflect a growing commitment to patient-centered care and environmental stewardship in healthcare. As technology continues to evolve, ongoing research and collaboration between medical professionals, physicists, and environmental scientists will be crucial in furthering these goals. By continuing to innovate and implement safer radiological practices, the medical community can significantly mitigate the risks associated with radiation exposure, ensuring better health outcomes for patients and reducing the environmental impact of radiological services.

Improving Maternal and Infant Outcomes through Enhanced Midwifery Practices

Improving maternal and infant health outcomes remains a critical challenge in healthcare systems worldwide. This study investigates the role of enhanced midwifery practices in improving these outcomes by examining various interventions and approaches that midwives can implement. Using a mixed-methods approach, data were collected from 150 midwives across different healthcare settings, including urban and rural areas, over a six-month period. The research focused on key factors such as the application of evidence-based care, continuity of care, patient education, and culturally sensitive practices. The results show that midwifery practices emphasizing patient-centered care, continuous monitoring, and active collaboration with other healthcare professionals significantly improved maternal outcomes, such as reduced rates of complications during labor and delivery, as well as lower instances of postpartum hemorrhage. Moreover, infants born under these enhanced practices showed better health metrics, including higher Apgar scores and reduced neonatal mortality rates. One notable finding was the positive impact of culturally sensitive practices in communities with diverse populations, where understanding and integrating cultural beliefs into care plans led to increased patient satisfaction and improved health outcomes. Despite these findings, the study also highlights certain limitations, such as the restricted geographical scope and the need for further research to explore the long-term effects of these enhanced practices. Nevertheless, this research provides evidence that by adopting comprehensive and patient-centered midwifery approaches, maternal and infant health outcomes can be significantly improved. Future studies with larger sample sizes and broader geographical coverage are recommended to further validate these results.

Treatment Escalation Plans: A Snapshot Review on Acute Medical Wards

Abstract Background In medical care, Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) orders serve as vital tools in determining whether CPR should be administered to patients, particularly those with progressive life-limiting illnesses or approaching the end of life. Failure to make timely and appropriate CPR-related decisions and treatment escalation plans can lead to the risk of administering futile or inappropriate treatments. Methods Admission booklets in our centre prompt clinicians to indicate whether a patient was for CPR or not as part of the admission process, with further instructions to fill out a DNA CPR form if applicable. We conducted a chart review on acute medical wards to assess the frequency and adequacy of DNA CPR decision-making and communication. Data was collected by three investigators on a structured proforma and anonymised. Data analysis was conducted using Excel. Results Data was collected on 67 patients, with a mean age of 76.6. Of those 67, only six had CPR status indicated on admission, with five specified for resuscitation and one not for resuscitation. A total of 14 patients went on to have DNA CPR forms filled out during admission, but in only five cases were these decisions discussed with the patients themselves. The main reasons for lack of patient involvement in the discussions included confusion and cognitive impairment. Documentation regarding discussions with next of kin was present in eight cases. Conclusion Our snapshot review underscores the importance of early discussions regarding treatment escalation plans and DNA CPR decisions. Our findings reveal that these discussions are not occurring as frequently as advised, and when decisions are made, they are not adequately communicated with patients or those close to them. There is an urgent need for further training on the legal aspects and ethical considerations surrounding DNA CPR decisions to ensure better patient-centered care and decision-making.

Community Specialist Teams: Are We Making an Impact? Insights from General Practitioners

Abstract Background Within our catchment area, General Practitioners (GPs) are the primary source of referral to community specialist teams (CSTs) for older adults and are key stakeholders in supporting the integrated care pathway. We sought to evaluate their experience to inform service development. Methods GPs across four healthcare networks were invited to complete an online questionnaire evaluating their experience of the CSTs for older adults. Results Twenty-eight GPs responded. Of these, 85.7% (24) found the referral criteria clear, and 89.3% (25) reported ease of access to the service. However, 50% (14) were uncertain about when to refer patients to primary care alone versus the CST. A significant majority, 96.5% (27), felt the service positively impacted the health and well-being of referred patients, and 92.9% (26) were satisfied with communication regarding patient care plans and progress. Identified strengths of the service included the multidisciplinary approach to providing comprehensive, patient-centered care and effective communication with both GPs and patients. Areas for improvement included enhancing access for specialist teams to community radiology and increasing staffing levels to ensure timely assessments. Regarding the impact on unscheduled and emergency care, 71.4% (20) reported a reduced need to refer to the acute medical unit, and 35.7% (10) reported a reduced need to refer to the emergency department due to the ability to refer to CSTs. Conclusion GPs value the CST service for the quality of assessment and intervention their patients receive. Targeted areas for operational and clinical improvement include provision of diagnostics and role distinction from primary care teams. This survey also suggests CSTs are providing an alternative care pathway and point of contact for older patients in crisis, resulting in a reduction in unscheduled and emergency care utilisation. The role of the CSTs should be supported and enhanced and warrants more detailed exploration.

Integrated Care in Action: A Case Study of Collaborative Multidisciplinary Approach for Older Adults in Ireland

Abstract Background In Ireland, the healthcare landscape is evolving with frameworks which emphasize community-based care, such as Enhanced Community Care and the National Integrated Care Programme for Older Persons. Our Integrated Care Team for Older Persons (ICPOP) service exemplifies this shift by providing intensive, immediate multidisciplinary care to frail adults, aiming to maintain their independence in their homes and communities. Methods In the case study we describe service users journey with ICPOP. The case study illustrates the transition from fragmented care to a collaborative, patient-centred approach. ICPOP employs a structured process involving comprehensive assessment, goal setting, weekly multidisciplinary team meetings, stakeholder liaison, and detailed discharge reports. This approach focuses on early supported discharge and close coordination with local MDT teams, fostering effective communication and shared decision-making. Results This case study demonstrates the effectiveness of ICPOP's multidisciplinary model. Key factors contributing to this success include physical co-location, shared goals and vision, mutual trust, and established relationships among professionals. Furthermore, the integration of Allied Health Professionals (AHPs) within community teams enriches the care continuum and enhances outcomes for older adults. Conclusion To further enhance integrated care delivery, digital solutions are crucial. Implementing shared electronic health records and facilitating access to medical findings can streamline communication and improve care coordination. Additionally, prioritizing written discharge summaries for clients can ensure continuity of care and empower patients and their families in the post-discharge phase. This patient journey underscores the importance of collaborative, patient-centred care models in achieving the objectives of Sláintecare leading to better outcomes for older adults in Ireland.

A Systematic Review Of Medication Knowledge In Older Adults

Abstract Background Medication knowledge, as defined by six aspects, is the person's awareness of their medication name, dose, purpose, adverse drug reaction (ADR), administration schedule and special instructions, is essential in the older patient's treatment journey. This review aimed to assess medication knowledge in older adults. Methods A systematic search of six electronic databases, grey literature and citation indexes included studies conducted in any setting or any country on those 65 or older, published over the last ten years, reporting primary data with full-text access, and assessing patients' six aspects of medication knowledge. Joanna Briggs Institute Critical appraisal tool was used to evaluate quality of studies. Results Of the 67871 articles searched, only 10 cross-sectional studies were included. Medication knowledge data was collected from pharmacies, community, general practices and outpatient clinics. Surveys used face-to-face interviews and electronic, written, and mail questionnaires. Five studies assessed knowledge on single medications. None assessed all six aspects of medication knowledge. One study assessed five aspects, while the rest assessed fewer aspects. The percentage of those who knew their medication names ranged from 41.9% to 97%, dose 19.4%, purpose 15% to 90%, administration schedule 65% to 92.6%, ADR 42% to 80% and special instructions 32.4% to 94.8%. Data lacked the source of medication knowledge or evidence of a patient-centred care approach. There were repeated calls for further education and research. Conclusion Research indicates that older adults have a mixed knowledge of their medications, with some areas well grasped and others lacking. Additionally, it appears that medication knowledge is not thoroughly evaluated initially. Despite ongoing advice to employ all six aspects of medication knowledge for assessment and education enhancement, no progress is seen in older adults' medication knowledge. Therefore, there's a need for better research that anticipates the application of these six aspects, concentrating on education for older adults or their caregivers through patient-centred methods.

“Into the Abyss” – Exploring Healthcare Professionals Experience of Transitions of Care from Stroke Early Supported Discharge Services in Ireland

Abstract Background Early Supported Discharge (ESD) is a key component of the stroke rehabilitation pathway. Evidence suggests that ongoing needs persist for people with stroke at the end of ESD, however little is known about the transition from ESD to other services. As such, the aim of this study was to explore healthcare professionals’ (HCPs) experiences of transitions of care from ESD services, in the Republic of Ireland. This was achieved through the following objectives: 1) Discussion of HCPs experience of transition from ESD, including ongoing needs of people with stroke and referral pathway utilisation; 2) Exploration of barriers and facilitators to ESD transition; 3) Discussion of potential solutions to barriers experienced. Methods A qualitative descriptive design was implemented using semi-structured interviews with HCPs working in ESD. Interviews took place online from November 2023 to January 2024 and were audio and video recorded and transcribed, via Microsoft Teams. Analysis of interview transcripts utilised an inductive coding approach through implementation of Braun and Clarke’s six step approach to thematic analysis. Results Nine HCPs took part in this study. A variety of ongoing needs and current referral pathways were described. Three key themes were identified: 1) “Into the Abyss”: Lack of a coordinated care pathway after ESD, 2) Role of communication and integrated information sharing in transition of care from ESD and 3) Facilitating care transition from ESD: current practices and future solutions. Conclusion This study highlights that at present, services in Ireland appear insufficient to cater to the ongoing needs of people with stroke after ESD. The roll out of community neurorehabilitation teams nationally and developing integrated communication systems are key areas for development, which warrant consideration by relevant stakeholders in order to optimise patient-centred care for this cohort.

“What Matters To Me?” Responses from Older People in the Acute Setting

Abstract Background The ‘What Matters to Me’ question has been used in many areas of the healthcare. In the context of older persons, the focus is typically on improving patient-centred care in long stay settings or in people living with dementia. It is also synonymous with end-of-life decisions. The question is contextual in itself and can elicit a wide range of responses. In this abstract, it was included in the Comprehensive Geriatric Assessment (CGA) in a section about future care and responses were anticipated to be relevant to that subject. Methods The Older Person Specialist Nursing Team developed a CGA document for use in acute care. The “What Matters To Me?” question was included with the intention of discovering and recording older persons’ end of life plans and wishes. The responses to this question were extracted from a random 30 completed CGAs. Results A total of 24 responses were gathered, some participants provided multiple answers. Not documented n=6, 3 themes were identified from the responses; Home; Free time and Worries/Concerns. Return home was the most frequently expressed response; n=13. Other responses identified were enjoyment, pass times and pets; n=9. Worries/Concerns were identified in broad terms; “I’m worried out the future” n=7. Conclusion “What matters” in this context was a broad query and responses may have been influenced by participants current health status, location and fear of the future and the subjectivity of the question and the practitioner. Participants did not mention dying a concern but did allude to the future in a broad context. The “What Matters To Me” question will now be in the social information section and the Older Person Specialist Nursing Team are considering a targeted question related to end-of-life plans and wishes.

An Evaluation of the Maternal Patient Experience through Natural Language Processing Techniques: The Case of Twitter Data in the United States during COVID-19

The healthcare sector constantly investigates ways to improve patient outcomes and provide more patient-centered care. Delivering quality medical care involves ensuring that patients have a positive experience. Most healthcare organizations use patient survey feedback to measure patients’ experiences. However, the power of social media can be harnessed using artificial intelligence and machine learning techniques to provide researchers with valuable insights into understanding patient experience and care. Our primary research objective is to develop a social media analytics model to evaluate the maternal patient experience during the COVID-19 pandemic. We used the “COVID-19 Tweets” Dataset, which has over 28 million tweets, and extracted tweets from the US with words relevant to maternal patients. The maternal patient cohort was selected because the United States has the highest percentage of maternal mortality and morbidity rate among the developed countries in the world. We evaluated patient experience using natural language processing (NLP) techniques such as word clouds, word clustering, frequency analysis, and network analysis of words that relate to “pains” and “gains” regarding the maternal patient experience, which are expressed through social media. The pandemic showcased the worries of mothers and providers on the risks of COVID-19. However, many people also shared how they survived the pandemic. Both providers and maternal patients had concerns regarding the pregnancy risks due to COVID-19. This model will help process improvement experts without domain expertise to understand the various domain challenges efficiently. Such insights can help decision-makers improve the patient care system.

Are Patient-Centered Care, Healthcare Consumerism, and Trust in Physicians Compatible?: Positioning Analysis of the Patient-Provider Relationship

ABSTRACT Patient-centered care and healthcare consumerism are dominant models of the patient-provider relationship. Positioning theory was applied to examine consumers’ and physicians’ positions on patient-centered care and healthcare consumerism, along with their attitudes toward direct-to-consumer healthcare service advertising and trust in the medical profession. Surveys were conducted with a convenience sample of consumers and physicians respectively. Patient-centered care was the only theoretical construct that both consumers and physicians unequivocally embraced. Both groups were either ambivalent or skeptical of the other three concepts. Between the two groups, physicians exhibited a stronger endorsement of patient-centered care and more negative attitudes toward advertising than consumers. When the relationships among the theoretical constructs were examined, a negative correlation between patient-centered care and consumerism was found among consumers. Also, patient-centered care and trust were negatively correlated in both groups. Implications of these findings are discussed for strategic communication, consumer and physician education, and future research.

Improving patient care in the emergency department in a selected hospital: a study on patient centered care

Background: Patient-centred care is founded on the principle of active patient and family engagement at all levels of care, enabling them to take ownership of treatment decisions. As patients are best positioned to understand their unique needs and priorities, their involvement is crucial. This study seeks to evaluate the patient centered care delivered by the healthcare providers, specifically doctors and nurses in the emergency department setting. Methods: A Questionnaire-based method was employed to collect data from a sample of 72 patients in the emergency department, assessing patient centered care in the selected tertiary care teaching hospital. The study was conducted between 1st May 2023 to 31st May 2023. Results: The study revealed that patients rated their care experience as very good, achieving high ratings across various dimensions, with the following mean and standard deviation scores: “Patient preference” 4.06±1.13, “Physical comforts” 3.99±1.04, “Coordination of care” 4.03±1.06. “Information and education” 4.08 ±1.06, “Communication” 4.06±1.07, with respect to “Continuity and Transition” 4.13±1.07 and “Family and Friends” 4.24±1.08. These ratings demonstrate a high level of satisfaction with care quality. Conclusions: Patient centered care is a healthcare approach that prioritizes patient needs and values. Its about working together with patients to provide flexible and personalized care. This study found that emergency department staff understand the importance of patient centered care and its benefit for patients and healthcare organisations.

Content that Promotes Intent to Change: Asynchronous and Synchronous Professional Development for Family Doctors in Continuing Medical Education

Background In 2020, a medical school in northern Ontario launched “Overcoming Barriers to Safe Opioid Prescribing,” a continuing professional development program consisting of an asynchronous online module followed by a series of optional synchronous videoconferences, which together formed a virtual community of practice (VCoP). The videoconferences followed a structured format, where a case study was introduced by one of the participants from their practice, followed by group reflections on the case and the development of strategies for implementing the learnings in their practices. Methods Mixed methods data was collected from participants utilizing a variety of tools and at different times before, during and after their engagement in the program. Qualitative data analysis produced a list of key themes that were cross-validated by anonymized, aggregated program evaluation data to identify further, module-specific themes. Results This paper examines the learning experiences and outcomes of primary care providers that participated in the online modules and synchronous videoconferences and proposes content design strategies that led to these educational experiences. The online module created a baseline of knowledge, increased participants’ familiarity with practice guidelines, comfort and confidence in prescribing and deprescribing behaviours, and increased participants’ familiarity with tools, resources, and strategies for safe opioid prescribing in their practices. The synchronous videoconferences developed a community of learning through modeling, experiential learning and the sharing of experiences and best practices. Conclusions The combination of the online module and synchronous videoconferences led to an increase in the intent to change practice, particularly with enhanced the principles of patient-centred care through their focus on practical, real-world strategies and physician-patient communication techniques. Participants noted that the foundational knowledge and resources provided in the online course was supported and contextualized through the synchronous discussions.

Healthcare professionals’ perspectives on the barriers and facilitators of integrated childhood obesity care

BackgroundBoth the causes and consequences of childhood obesity can be complex. To provide healthcare that is suitably tailored to the specific needs of children with obesity integrated care is required. The objective of this study was to explore the perceived barriers and facilitators of healthcare professionals (HCPs) in providing integrated care for children with obesity, to support them in tailoring the healthcare approach.MethodsIn this qualitative study, semi-structured in-depth interviews were conducted with 18 healthcare professionals with experience in childhood obesity care; pediatricians, youth healthcare nurses and a youth healthcare physician. A two-phased thematic content analysis was performed: an inductive analysis with open and selective coding and a deductive analysis with axial coding using the patient-centered care model by Stewart.ResultsOverall, the healthcare professionals defined the etiology of obesity as complex, and experienced the integrated care as complicated. The results fit into the four theme-structure of the patient-centered care model, with the integrated care system as an additional fifth theme. The main barriers were perceived within the sub-themes of illness and healthcare experiences, and sensitivity over talking about weight-related issues. The main facilitators were perceived within the sub-themes of conducting a biomedical, psychosocial and lifestyle assessment, tailoring the approach to families’ situation and investing in a family-professional relationship. Weight stigma appeared to be an underlying barrier for healthcare professionals that impacted, both explicitly and implicitly, upon all themes.ConclusionsHealthcare professionals providing integrated care for children with obesity, experience this type of care as complicated and comprising many barriers and facilitators regarding the four themes of the patient-centered care model and the fifth theme of the integrated care system. This paper demonstrates the patient-centered care model could prove helpful structuring a tailored approach within integrated care. This approach supports healthcare professionals in adopting a broad perspective towards individual and environmental factors and investing in the relationship, with respect to the sensitivity and complexity of childhood obesity.

Integrating palliative care into multiple myeloma management : Optimizing quality of life across the disease continuum.

Multiple myeloma (MM) poses significant challenges due to its complex symptomatology and evolving treatment landscape. While therapeutic advances have improved survival outcomes, holistic management of MM requires addressing the numerous physical and psychosocial needs of patients. Palliative care (PC) offers acomprehensive approach to symptom management and supportive care on aphysical, psychosocial and spiritual level; however, its role in MM remains underexplored. This retrospective single-center study examines the outcome of 22 MM patients admitted to the Division of Palliative Medicine at the Medical University of Vienna. We investigated reasons for admission, symptom severity, functional status, length of stay and overall survival. Most common reasons for palliative care unit (PCU) admission were nutritional problems (82%), fatigue (77%) and pain (68%). Median ECOG score at PCU admission was 3. The timepoint within the timeline of myeloma disease at which hospitalization took place varied greatly. Some patients were hospitalized shortly after diagnosis, other patients after many years of active disease and therapy. Median time from MM initial diagnosis to first PCU stay was 4.3years (range 0.6-23.8 years). The median length of hospital (PCU) stay was 11days (range 1-127days) and 45% of patients died during PCU hospitalization. The reduction in symptom burden as aresult of the inpatient stay in the PCU is reflected in the PERS2ON score, which was measured on the day of admission (median23 days, range 6-32days) and on the day of discharge (median16 days, range 7-20days). PC interventions effectively addressed the complex symptom burden experienced by patients with MM. Multidimensional approaches encompassing physical, psychological and social domains proved instrumental in optimizing quality of life. Integrating PC principles into MM management paradigms is essential to prioritize patient-centered care across the disease continuum.

Exploring the factors influencing the health-related quality of life in patients experiencing adverse drug reactions: a cross-sectional study

BackgroundThis study aimed to assess the factors influencing health-related quality of life (HRQoL) in patients experiencing adverse drug reactions (ADRs) at a tertiary care public sector hospital. A cross-sectional study was conducted over a period of 18 months, and included both male and female patients aged 18 years and above. Patients who visited the outpatient and inpatient departments with complaints associated with ADRs were included in this study. HRQoL data were collected using the EuroQol—5 Dimension—5 Level (EQ-5D-5L) questionnaire to assess five dimensions of health on a five-level scale. Descriptive statistics, t-tests, and analysis of variance were used to analyze the data. Multivariate regression analysis was performed to identify the potential determinants of HRQoL.ResultsA total of 316 patients were included in the study among these participants, of which 54% were female, and 65% were from rural areas. The majority (68%) of the patients had moderately severe ADRs, and 63% of the participants had an income < 2.5 lakh Indian rupees (3009 USD). The mean EQ-5D-5L and EuroQoL Visual Analog Scale (EQ VAS) scores of the study participants were 0.714 and 69.73, respectively. The variables ADR severity, income, and age showed a significant difference (p < 0.05) in HRQoL.ConclusionThis study provides insights into HRQoL among patients with ADRs and identifies the determinants of HRQoL. The findings of this study will contribute to improving patient-centered care and optimizing patient outcomes.

Managing Postembolization Syndrome Through a Machine Learning-Based Clinical Decision Support System: A Randomized Controlled Trial.

Although transarterial chemoembolization has improved as an interventional method for hepatocellular carcinoma, subsequent postembolization syndrome is a threat to the patients' quality of life. This study aimed to evaluate the effectiveness of a clinical decision support system in postembolization syndrome management across nurses and patient outcomes. This study is a randomized controlled trial. We included 40 RNs and 51 hospitalized patients in the study. For nurses in the experimental group, a clinical decision support system and a handbook were provided for 6 weeks, and for nurses in the control group, only a handbook was provided. Notably, the experimental group exhibited statistically significant improvements in patient-centered caring attitude, pain management barrier identification, and comfort care competence after clinical decision support system implementation. Moreover, patients' symptom interference during the experimental period significantly decreased compared with before the intervention. This study offers insights into the potential of clinical decision support system in refining nursing practices and nurturing patient well-being, presenting prospects for advancing patient-centered care and nursing competence. The clinical decision support system contents, encompassing postembolization syndrome risk prediction and care recommendations, should underscore its role in fostering a patient-centered care attitude and bolster nurses' comfort care competence.

A shared journey: evaluating a patient-assessed measure of self-management of chronic conditions in an Australian setting.

Background Patient Assessment of Care in Chronic Conditions (PACIC+), included in some Australian guidelines, has been shown reliable for measuring patient engagement and perception of their care in primary care settings. Various studies have focussed on PACIC+ use in specific conditions. This study aims to expand PACIC+ to measure patient empowerment to self-manage their chronic condition and validate it in the broader Australian primary care population. This study aims to evaluate internal consistency and reliability of PACIC+ and six new supplementary items proposed to assess patient wellbeing and empowerment to self-manage their chronic condition. Methods A repeated-measures correlation design study assessed the expanded PACIC+ over three time-points. Particpants were patients with at least one chronic disease, referred by consultant physician, or recruited by advertisement posters in hospital clinic areas. Results PACIC+ (26-item) had acceptable internal consitency (Cronbach's alpha 0.96). Test-retest reliability (Time-1 and 2, P r (48)=0.43; and New supplementary items: Confidence r (48)=0.54; Understanding r (48)=0.62; Support r (48)=0.43; Overall Health r (48)=0.42; Overall Health Change r (48)=-0.31, P =0.03; and Acute Episodes of Care in 1-month r (48)=0.42, P Conclusions The expanded PACIC+ is an improved psychometric tool providing for the patient's voice in a shared health journey. It is a valid, reliable tool to monitor and measure self-management of chronic conditions in Australian population clinic and primary healthcare settings.

A Parallel-Group, Randomized Trial Examining Impact of Colposcopy Results Delivery by a Nurse Liaison on Patient-Reported Outcomes and Adherence

ObjectivesCervical cancer is on the rise in Canada. Addressing patient anxiety and improving patient understanding of colposcopy and results may improve adherence. This randomized controlled trial examined the impact of colposcopy results delivery by a Nurse Liaison versus the referring primary care provider (PCP) on patient anxiety, and secondary outcomes including patient satisfaction, knowledge of diagnosis, and 9-month adherence to follow-up. MethodsPatients ≥18 years old presenting for initial appointment at the study colposcopy clinic were randomized 1:1 to an intervention group (Nurse Liaison) versus a control group (PCP). After receiving colposcopy results, participants completed online measures of anxiety (State-Trait Anxiety Inventory), health care satisfaction scales (Patient Satisfaction Questionnaire-18, Health Anxiety Inventory, Visit-Specific Satisfaction Questionnaire-9), self-reported colposcopy diagnosis, and demographics. Chart review at 9 months assessed adherence to recommended colposcopy follow-up. Groups were compared on continuous and categorical variables, controlling for diagnosis severity and trait anxiety. ResultsThe intervention group had significantly lower state anxiety with State-Trait Anxiety Inventory-state mean scores of 37.3 versus 40.7 in controls (P = 0.03). Intervention group participants were more likely to correctly report their diagnosis (84% vs. 66.3%, P = 0.003). Questionnaire responders were more likely to be in the intervention group and had a higher proportion of cervical intraepithelial neoplasia 2+ pathology. There were no differences in demographics, patient satisfaction, or adherence to follow-up between groups. ConclusionsDirect delivery of colposcopy results by a trained Nurse Liaison was associated with decreased patient anxiety around colposcopy results, and increased patient knowledge regarding diagnosis. This model may be considered to improve patient-centred care.

Physicians’ training and patient education initiative to improve quality of care decision communication at the emergency department

BackgroundDiscussions about care decisions, including code status documentation and advance care planning, are crucial components of patient-centred care. However, due to numerous barriers, these discussions are often avoided by both...