Patient Centeredness Research Articles

FACTORS ASSOCIATED WITH THE PERSON-CENTERED CLINICAL METHOD IN PRIMARY HEALTH CARE: A STUDY IN PORTO ALEGRE, BRAZIL

Background. The medical approach is influenced by several factors present at the patient, doctor, health service, society, and culture levels. Purpose. The purpose of this paper is to establish the degree of person-centeredness of care attributed by patients to the clinical approach of physicians from a primary health care (PHC) service and to ascertain its association with variables related to the care recipient. Methods. This cross-sectional study was conducted with a sample of patients (n = 408) with hypertension and/or diabetes treated at 12 health centers belonging to a PHC network in the city of Porto Alegre, Rio Grande do Sul, Brazil. The degree of person-centered clinical method (PCCM) orientation was measured by the “Patient Perception of Patient-Centeredness” (PPPC) questionnaire. Results. The variables “educational attainment” and “duration of follow-up with the same physician” were significantly associated with a higher prevalence of low overall PPPC scores (corresponding to higher patient centeredness) assigned to physicians by the patients (PR = 1.04, 95% CI = 1.02–1.06, p-value < 0.001 and PR = 1.01, 95% CI = 1.00–1.02, p-value = 0.032, respectively). On the other hand, the variables “living alone” and “fair/poor/very poor self-perception of health” were significantly associated with a lower prevalence of person centeredness (PR = 0.83, 95% CI = 0.72–0.96, p-value = 0.011 and PR = 0.88, 95% CI = 0.77–1.00, p-value = 0.041, respectively). Conclusions. These findings demonstrate that clinical approaches to people with a high level of social vulnerability require improvement, and that the length of follow-up provided by one physician can be an indicator of the extent to which providers are able to deliver person-centered care.

Shared Decision-Making in Preventive Activities

Shared Decision-Making in Preventive Activities Abstract. Shared Decision-Making (SDM) is particularly useful in conditions where decisions are preference-sensitive, i.e., where preferences and values of patients are crucial for the further proceeding. This typically applies to conditions where the potential benefit and the potential harm are similar. Preventive activities are characterized by the fact that there is no current burden of disease and the benefit to expect is far in the future. Therefore, it is preference-sensitive if the current effort really pays off. The procedure of SDM in (preventive) counselling can be classified into three steps: Team Talk, Option Talk and Decision Talk. For every step, we present examples of how to talk. After an overview of the current evidence, we present four examples of how to apply SDM in preventive conditions: quit-smoking counselling, lifestyle coaching, vaccination counselling and screening for cancer. Finally, we focus on the role of activated patients and point out the opportunity for SDM during check-up examinations. For all these implementation issues useful tools and links are presented. In summary, important elements of SDM, such as patient centeredness, clarifying needs/goals and shared responsibility, are crucial for the entire spectre of caring for patients, not only for prevention.

Palliative care phenotypes among critically ill patients and family members: intensive care unit prospective cohort study

ObjectiveBecause the heterogeneity of patients in intensive care units (ICUs) and family members represents a challenge to palliative care delivery, we aimed to determine if distinct phenotypes of palliative care...

Providing palliative care at home aligns with the professional identity of paramedics: a qualitative study of paramedics and palliative health care providers.

An innovative program, 'Paramedics Providing Palliative Care at Home,' was implemented in Nova Scotia, Canada in 2015. Roles like this are part of an evolving professional identity; role discordance or lack of clarity not only hinders professionalization but may impair the wellbeing, and career longevity of paramedics. This study explored the alignment of providing palliative support at home with paramedic professional identity. Qualitative description was employed, with thematic analysis of focus groups with paramedics and palliative health care providers. Recruitment posters were sent through the professional college (paramedics) and program managers (health care providers). Focus groups followed a semi-structured guide, discussing understanding of and experiences with the role and its alignment with professional identity. Challenges to paramedic palliative support and fit with professional identify were explored. Thematic content analysis was ongoing while focus groups were being conducted, until no new codes were found. Codes were combined, sorted into categories, and ultimately, agreed-upon themes. Saturation of themes was reached. Eleven paramedics and twenty palliative health care providers participated. Four themes reflected paramedic's expanded role: (1) patient centeredness and job satisfaction with provision of palliative support, (2) a bridging role, (3) paramedic as advocate and educator, (4) provision of psychosocial support. Four themes reflected paramedic's professional identity: (1) evolution of paramedicine as a skilled clinical profession, (2) helping people and communities, (3) paramedic skill set aligns with work in palliative care, and (4) changing paramedic mindset. Paramedics and palliative health care providers highlighted the provision of palliative care as part of a positive growth of paramedicine as a health profession, and a good fit with professional identity. Novel roles like this are important in the evolution of our health care system faced with increasing pressures to get the right care with the right provider at the right time.

Linking work engagement of emergency physicians to patient centricity in underdeveloped regions

Orientation: Health facilities in underdeveloped regions present their challenges in terms of research, especially regarding the work engagement (WE) of health workers, in this case, emergency physicians. Adjustments to existing research models are needed to obtain accurate responses. Patient centricity (PC) as a new term in healthcare is the estimated variable in this study.Research purpose: This study aimed to examine the relationship between the antecedents of WE and PC in emergency physicians who worked at hospitals in underdeveloped regions in Indonesia, incorporating WE as a mediator.Motivation for the study: Studies linking WE to PC have never been established. Furthermore, studies regarding WE have never been carried out in underdeveloped regions, and most of them are only limited to job resources as a benchmark.Research design/approach, and method: A quantitative survey was conducted through a purposive sampling technique to collect data from emergency physicians in hospitals in East Nusa Tenggara. There are 183 eligible respondents, whose responses were analysed through partial least squares structural equation modelling (PLS-SEM).Main findings: The direct link to WE was found to be predominated by physician autonomy and public service motivation. It was found that WE positively and significantly connected to PC. The PLS-predict resulted in large cross-validated redundancy for this model.Practical/managerial implications: This study has implications for policymakers and hospital management in developing personal and job resources in optimising PC through WE.Contribution/value-add: This study will show a new approach where WE can estimate PC, and this model can be replicated and tested in a larger population of physicians.

Definition of a tool to assess shared decision-making (SDM) on women with breast cancer: A value-based approach.

Background and AimsIn oncology, there is increasing talk of personalized treatment and shared decision‐making (SDM), especially when multiple treatment options are available with different outcomes depending on patient preference. The present study aimed to define the set of main dimensions and relative tools to assess the Value brought to patients from a Breast Cancer's Clinical pathway structured according to a dynamic SDM framework.MethodsStarting from our previous systematic review of the literature, a deep search of the main evidence‐based and already validated questionnaires was carried out. In the second phase, to corroborate this grid, a Delphi survey was conducted to assess each questionnaire identified for each dimension, against the following seven value‐based criteria: Clinical Benefit, Safety, Care Team Well Being, Patient Reported Outcomes Measures, Green Oncology, Impact on Health Budget, and Genomic Profile.ResultsThe resulting 7‐dimension questionnaire is composed of 72 questions. Of these, some quantitatively and objectively assess the evolution of the patient's disease state, whereas others aim to ask patients about their active involvement in decisions affecting them and to investigate whether they were free to explore their preferences. Furthermore, to frame the analyzed phenomenon at the right time, for each questionnaire section, the specific, evidence‐based timing of administration is indicated.ConclusionThe resulting questionnaire is validated in its entirety and it is composed of a set of questions and relative time point for data collections to assess the Value brought to patients undertaking a Breast Cancer's Clinical pathway, structured according to a dynamic SDM framework. It constitutes a quantitative instrument to integrate patient centeredness with a personalized perspective in the care management of women with breast cancer.

Patient Design: The Importance of Including Patients in Designing Health Care.

A paradigm shift is underway in the patient-clinician relationship, driven by irreversible changes in information access, yet the model under which clinicians are trained, care is conducted, and care delivery is designed has not changed significantly even though we call it “patient centered.” Humanity endured centuries in which even doctors had little idea what the patient’s problem really was. Science slowly solved that, and for a century, only doctors could know what was worth knowing. Today, the rise of the internet and digital health has led to the end of that era. We are already witnessing early signs of the era of participatory health: genuinely empowered people living their lives and managing their health according to their own priorities, in partnership and consultation with physicians as needed. This may feel like a threat to the physician’s sacred role, but it is no more so than when physicians adopted informed consent and then shared decision-making. In the 2010s, many pharmaceutical, medical, and health care companies started to use patient centricity as a mantra. We argue that to drive this paradigm change fully into existence, we need to shift “patient centricity” from a relatively passive process, driven by industry needs, into a far more active, collaborative process driven by both parties’ needs and preferences. To build this new world of practice and workflow, we simply must engage with patients as true partners. To achieve medicine’s new potential, it must be optimized around the wants and priorities of the ultimate stakeholder—the party that has the most at stake in how it all plays out: the patient. Patient design is the approach that can make it happen.

Educational perspectives in emergency paramedicine : Interdisciplinary discourse on education, professional practice, and challenges in the field of emergency medical services

Societal developments that result in an increase in geriatric, psychosocial, and subacute (i.e. not time-critical) emergencies are changing the demands on emergency care and posing challenges to the system of emergency care and emergency medical services (EMS). The training of emergency paramedics (NotSan) lays the foundation for finding aqualified systemic response to evolving patient needs and requirements. By extending and strengthening their competencies, NotSan are to be understood as basic emergency care providers. Their training should therefore be further developed in terms of evidence-based and patient-centered care in order to increase their competency to act and to achieve demand-oriented holistic (outpatient) care. New EMS resources such as community paramedics (GNFS) and telemedical support systems offer opportunities to strengthen competencies in patient care. The guiding principles of care should be patient safety and patient centeredness. In addition to increasing the basic competencies and equipment of existing EMS resources as well as continuous training opportunities, innovative cross-sectoral and cross-professional care concepts are necessary and must be supported.

Creation of a tool to evaluate supportive care.

The absence of a specific tool to evaluate the impact of supportive care in general and socioesthetics (SE) in particular is undoubtedly at the origin of the lack of published research based on scientific standards. We developed a supportive-care, patient-reported outcome questionnaire using the multistep methods, following COSMIN recommendations. The Patient Centricity Questionnaire (PCQ) was developed using the standardized methodology for designing patient-reported outcome (PRO) questionnaires according to the following steps: elaboration of the questionnaire, measurement properties of the questionnaire, internal and external validation, test-retest validation and translation, cross-cultural adaptation, and cognitive debriefing. A multidisciplinary work group was designed including professionals, such as physicians, public health experts, sociologists, supportive-care experts, and socioestheticians. Our questionnaire includes 11 items. It is scored by adding each Visual Analogue Scale [VAS], making it range from 0 to 110, with a higher benefit when the score is higher. The Cronbach's α coefficient is 0.88 for the entire questionnaire. As the questionnaire is a reflection of the patient's feelings, it is quite natural that the name "Patient Centricity Questionnaire" (PCQ) was retained and validated by the Scientific Committee. The PCQ correlated negatively and moderately with the Perceived Stress Scale [PSS], positively and moderately with the mental dimension of the Short Form-12, and poorly with the Well Beng 12 [WB12], the physical dimension of the SF-12, and the satisfaction VAS. Constructed according to the recommendations, the PCQ meets the prerequisite for this type of questionnaire. Its short format and simplicity of use allow it to be used by a large number of people. The PCQ is a simple, reliable, easy-to-use, and validated tool for research teams, making it possible for randomized studies to prove the impact of supportive care in general and SE in particular, on the patient's quality of life.

Can interprofessional education change students’ attitudes? A case study from Lebanon

BackgroundInterprofessional collaboration is key to improving the health of individuals and communities. It is supported by provision of Interprofessional education (IPE) which has recently emerged in the Middle East region. This study investigated changes in healthcare students’ attitudes towards interprofessional collaboration after undertaking the Interprofessional Education and Collaboration (IPEC) course.MethodsA paper-based anonymous survey using the Interprofessional Attitude Scale (IPAS) was administered to a sample of 346 health students (nursing, medicine, and public health) pre/post undertaking the IPEC course. Less than half of the students provided a post response, with pre/post survey results of 111 pairs subsequently matched and analyzed.ResultsResults showed elevated pre-course scores, an improvement in students’ attitudes towards the interprofessional biases domain of the IPAS, and a slight decline in their scores in the remaining 4 domains (team roles and responsibilities, patient centeredness, community centeredness, and diversity and ethics). These changes were not statistically significant, except for the patient centeredness domain (p = 0.003**).ConclusionsThe study provided important results about attitudes towards interprofessional collaboration. These findings are essential because our institution is one of few in Lebanon that provides this mandatory course to a large group of health professionals. Future studies should investigate these changes in attitude scores in a larger sample size, and how these attitudes would influence collaboration post-graduation.

Developing Patient-Centered Real-World Evidence: Emerging Methods Recommendations From a Consensus Process

ObjectivesThe Joint ISPOR-ISPE Special Task Force on Real-World Evidence included patient/stakeholder engagement as a recommended good procedural practice when designing, conducting, and disseminating real-world evidence (RWE). However, there are no guidelines describing how patient experience data (PED) can be applied when designing real-world data (RWD) studies. This article describes development of consensus recommendations to guide researchers in applying PED to develop patient-centered RWE. MethodsA multidisciplinary advisory board, identified through recommendations of collaborators, was established to guide development of recommendations. Semistructured interviews were conducted to identify how experienced RWD researchers (n = 15) would apply PED when designing a hypothetical RWD study. Transcripts were analyzed and emerging themes developed into preliminary methods recommendations. An eDelphi survey (n = 26) was conducted to refine/develop consensus on the draft recommendations. ResultsWe identified 13 recommendations for incorporating PED throughout the design, conduct, and translation of RWE. The recommendations encompass themes related to the development of a patient-centered research question, designing a study, disseminating RWE, and general considerations. For example, consider how patient input can inform population/subgroups, comparators, and study period. Researchers can leverage existing information describing PED and may be able to apply those insights to studies relying ontraditional RWD sources and/or patient registries. ConclusionsApplying these emerging recommendations may improve the patient centricity of RWE through improved relevance of RWE to patient communities of interest and foster greater multidisciplinary participation and transparency in RWD research. As researchers gather experience by applying the methods recommendations, further refinement of these consensus recommendations may lead to “best practices.”

Care of the dying – medical student confidence and preparedness: mixed-methods simulation study

ObjectivesOf all doctors, Foundation Year 1 trainees spend the most time caring for dying patients yet report poor preparation and low confidence in providing this care. Despite documented effectiveness of...

O-088 Main drivers in patient treatment decision-making. A systematic review

Abstract Study question What do infertility patients value most when making treatment decisions? Summary answer Patients’ treatment decision-making was mostly based on effectiveness, followed by safety, burden, costs and patient centeredness. What is known already Couples may undergo several infertility treatments that differ in effectiveness, side-effects, administration and cost. This underpins why patients need to be involved in the treatment decision. In order to improve this process, we need to understand what treatment attributes patients value most. Study design, size, duration We searched Medline and Embase up to January 24, 2022. Discrete choice experiments (DCEs), surveys, questionnaires or conjoint analyses (CA) were included. Studies on fertility preservation were excluded, as well as studies that did not describe attributes relating to two or more of the following: costs, safety, burden, effectiveness, genetic parenthood and patient centeredness. Participants/materials, setting, methods Participants were men and women with unfulfilled child-wish in the fertile age range. All analyses were performed on an intention-to-treat basis. We extracted the absolute and relative importance of the attributes from each study. The methodological quality of the studies was evaluated using the assessment constructed by Mandeville or a checklist of the center for Evidence-Based Management, depending on design. Main results and the role of chance The search generated 99 studies. Twelve studies were included: ten DCEs and two survey studies, in all DCEs trade-offs were studied. In total 2902 patients participated in the studies, ranging per study from 71 to 925. The majority of the studies were from the Netherlands (67%). Most articles used five attributes (42%) usually attributes related to burden, cost and effectiveness. Women represented 63% of the participants. The mean age of the participants was 34 years (SD 2.4). Patients’ treatment decision-making was mostly based on effectiveness, followed by safety, burden, costs and patient centeredness. Results suggest that women are prepared to trade - off some effectiveness for better safety, less burden and patient centeredness. When safety was evaluated, the safety of the child was considered more important than that of the mother. Burden (cancellations, number of injections, number of hospital visits, time) was more often accepted by women when gaining effectiveness, safety or lower costs. Also non-genetic parenthood did not have an impact on decision-making. Concerning patient centeredness, ‘information provision’ and ‘physician attitude’ were considered most important, followed by involvement in decision-making, and being treated by the same physician. Limitations, reasons for caution The main limitation of this review is the heterogeneity in questionnaires and methodology. Studies varied in the number of attributes, kinds of attributes and levels. Wider implications of the findings Results of this study can be used in future preference studies, as well as in patient-centered approaches. Trial registration number Not applicable

O-202 Online fertility workup with video consultation for infertile patients; a randomized controlled trial

Study questionIs an online consultation for fertility work-up as effective as regular consultation in terms of patient centeredness and shared decision making?Summary answerThis study shows no significant differences in level of patient-centeredness and shared decision making for an online fertility work-up compared to a regular appointment.What is known alreadyCouples who suffer from involuntarily childlessness can experience a high psychological burden and treatment for their infertility has a high impact on their daily life. Most optimally, patients receive personalized information and undergo diagnostic testing for fertility work-up, with as little as possible interference in their personal life. Two recent studies already evaluated the use of video-consulting to further modernize current fertility care, with positive results. However, more well-designed research is needed to expand and carefully evaluate the idea of an online fertility work-up for patients with an unfulfilled child wish.Study design, size, durationThis is a single-center non-blinded randomized controlled trial of 84 heterosexual patient couples. Patients were followed up from the start of the fertility work-up until three months after completion of the work-up.After the work-up, a questionnaire was send through an online research program consisting of a modified version of the Patient-Centered Questionnaire-Infertility (PCQ-I) to measure patient-centeredness and the CollaboRATE questionnaire to evaluate the level of shared decision making.Participants/materials, setting, methodsThe study population consisted of infertile couples, who were referred to a fertility clinic for the first time. Couples were randomized between a regular fertility work-up, consisting of two face-to-face appointments of in total 45 minutes, and an online fertility work-up. The latter consisted of online recommendations and diagnostic tests, based on patient specific characteristics from an anamnesis questionnaire, followed by a 30 minute video consultation with a fertilitydoctor to discuss results and treatment advice.Main results and the role of chanceOf the 84 included patients, 75 questionnaires were returned for this abstract (89%). The mean score on the total PCQ-I was 2.66 (SD 0.20), on a scale of 0-3, for the online fertility work-up versus 2.57 (SD 0.29) for the control group. This was not statistically significant (p = 0.147). Also the different subscales of the PCQ-I did not show statistically differences between the two groups, but there was a positive trend for the online fertility work-up on the subscale ‘Information and Communication’ (2.85 (SD 0.21) vs 2.72 (SD 0.31); p = 0.055).On the CollaboRATE questionnaire, no significant differences in experienced level of shared decision making were found between the two groups (means between 7.52 – 7.91 on a ten point Likert scale).During seven video consultations (17%) some technical difficulties were experienced, for example the video worked but there was no sound. For 62% of the couples in the intervention group the time for preparation for the online fertility workup was less than five minutes, while the majority of the patients in the control group (52%) spend at least 60-90 minutes on their appointment in the fertility clinic.Limitations, reasons for cautionThis study was performed during the COVID-19 pandemic, when patients were more used to online meetings. The preferences of patient post pandemic might be different. At this point we have not yet evaluated whether online fertility consultation leads to different conclusions and treatment advices than regular fertility care.Wider implications of the findingsIn our study online fertility work-up with video consultation is perceived as good as a regular work-up, therefore future patients should be offered a choice between the two methods. Considering the rapid development of online technology, online fertilitycare may develop further. It is important that developments undergo thorough scientific evaluation.Trial registration numberNL8554

Implementation and Evaluation of COVIDCare@Home, a Family Medicine-Led Remote Monitoring Program for Patients With COVID-19: Multimethod Cross-sectional Study.

BackgroundCOVIDCare@Home (CC@H) is a multifaceted, interprofessional team-based remote monitoring program led by family medicine for patients diagnosed with COVID-19, based at Women’s College Hospital (WCH), an ambulatory academic center in Toronto, Canada. CC@H offers virtual visits (phone and video) to address the clinical needs and broader social determinants of the health of patients during the acute phase of COVID-19 infection, including finding a primary care provider (PCP) and support for food insecurity.ObjectiveThe objective of this evaluation is to understand the implementation and quality outcomes of CC@H within the Quadruple Aim framework of patient experience, provider experience, cost, and population health.MethodsThis multimethod cross-sectional evaluation follows the Quadruple Aim framework to focus on implementation and service quality outcomes, including feasibility, adoption, safety, effectiveness, equity, and patient centeredness. These measures were explored using clinical and service utilization data, patient experience data (an online survey and a postdischarge questionnaire), provider experience data (surveys, interviews, and focus groups), and stakeholder interviews. Descriptive analysis was conducted for surveys and utilization data. Deductive analysis was conducted for interviews and focus groups, mapping to implementation and quality domains. The Ontario Marginalization Index (ON-Marg) measured the proportion of underserved patients accessing CC@H.ResultsIn total, 3412 visits were conducted in the first 8 months of the program (April 8-December 8, 2020) for 616 discrete patients, including 2114 (62.0%) visits with family physician staff/residents and 149 (4.4%) visits with social workers/mental health professionals. There was a median of 5 (IQR 4) visits per patient, with a median follow-up of 7 days (IQR 27). The net promoter score was 77. In addition, 144 (23.3%) of the patients were in the most marginalized populations based on the residential postal code (as per ON-Marg). Interviews with providers and stakeholders indicated that the program continued to adapt to meet the needs of patients and the health care system.ConclusionsFuture remote monitoring should integrate support for addressing the social determinants of health and ensure patient-centered care through comprehensive care teams.

Factors influencing the quality and functioning of oncological multidisciplinary team meetings: results of a systematic review

BackgroundDiscussing patients with cancer in a multidisciplinary team meeting (MDTM) is customary in cancer care worldwide and requires a significant investment in terms of funding and time. Efficient collaboration and communication between healthcare providers in all the specialisms involved is therefore crucial. However, evidence-based criteria that can guarantee high-quality functioning on the part of MDTMs are lacking. In this systematic review, we examine the factors influencing the MDTMs’ efficiency, functioning and quality, and offer recommendations for improvement.MethodsRelevant studies were identified by searching Medline, EMBASE, and PsycINFO databases (01–01-1990 to 09–11-2021), using different descriptions of ‘MDTM’ and ‘neoplasm’ as search terms. Inclusion criteria were: quality of MDTM, functioning of MDTM, framework and execution of MDTM, decision-making process, education, patient advocacy, patient involvement and evaluation tools. Full text assessment was performed by two individual authors and checked by a third author.ResultsSeventy-four articles met the inclusion criteria and five themes were identified: 1) MDTM characteristics and logistics, 2) team culture, 3) decision making, 4) education, and 5) evaluation and data collection. The quality of MDTMs improves when the meeting is scheduled, structured, prepared and attended by all core members, guided by a qualified chairperson and supported by an administrator. An appropriate amount of time per case needs to be established and streamlining of cases (i.e. discussing a predefined selection of cases rather than discussing every case) might be a way to achieve this. Patient centeredness contributes to correct diagnosis and decision making. While physicians are cautious about patients participating in their own MDTM, the majority of patients report feeling better informed without experiencing increased anxiety. Attendance at MDTMs results in closer working relationships between physicians and provides some medico-legal protection. To ensure well-functioning MDTMs in the future, junior physicians should play a prominent role in the decision-making process. Several evaluation tools have been developed to assess the functioning of MDTMs.ConclusionsMDTMs would benefit from a more structured meeting, attendance of core members and especially the attending physician, streamlining of cases and structured evaluation. Patient centeredness, personal competences of MDTM participants and education are not given sufficient attention.

PCR1 Assessing Patient Reported Outcomes and Perceptions to Incorporate Real-World Patient Perspective in Oncology Treatment

Remote monitoring platforms can enable patient centricity in routine care, thereby systematically bringing patient perspectives to the treatment experience. The objective of this study is to assess patient-reported outcomes and treatment preferences in a real-world treated oncology population, and how this information can be routinely gathered at point-of-care.

Associations between stuttering avoidance and perceived patient-centeredness of health care interactions

PurposeTo determine the relationships between (1) stuttering severity and (2) avoidance of speaking on patient centeredness of healthcare system interactions in a sample of persons who stutter. MethodsThis quantitative study utilized cross-sectional electronic surveys to assess the experiences of one-hundred-twenty-two adults who stutter in the United States with primary care physicians. The surveys evaluated: (1) self-reported stuttering severity and avoidance of speaking; and (2) self-reported patient-centeredness of healthcare interactions. We used multivariate linear regression to model relationships between independent and dependent variables, controlling for age, gender, patient-provider relationship duration, race/ethnicity, the presence of comorbid conditions, and household income. ResultsPatient self-reported avoidance of speaking was significantly negatively associated with self-reported patient-centeredness of healthcare interactions. Patient self-reported stuttering severity was not significantly associated with patient-centeredness. ConclusionOur findings present evidence that internal non-observable behaviors among persons who stutter, such as avoiding speaking, are associated with negative impact on healthcare interactions. Speech-language pathologists may want to discuss healthcare challenges with their clients and elicit communication barriers to inspire positive interactions within the healthcare system.

Patient-centered care in immuno-oncology: current progress & opportunities when considering safety & tolerability

Patient centricity has previously been defined as “putting the patient first in an open and sustained engagement of the patient to respectfully and compassionately achieve the best experience and outcome for that person and their family” [1] or more succinctly: “No decision about me, without me”. But what does patient centricity look like in practice, and what benefits can it bring – both to the patient themselves and to other stakeholders in the cancer immunotherapy space?

Patient-Centered Core Impact Sets: What They are and Why We Need Them.

A quote attributed to Mark Twain states, “What gets us into trouble is not what we don’t know. It’s what we know for sure that just ain’t so.” The growing focus on patient centricity has revealed a misalignment between what patients report as important to them about their disease and/or treatment, and the data collected in research and care. Decisions across healthcare are made using an evidence base most stakeholders acknowledge is inadequate. Patients might report that what is important to them are everyday life impacts, concepts that can be very different from the more typical clinical outcomes we often track. In this paper, we encourage expanding current thinking to all “impacts,” not only health outcomes, but also the other equally (and sometimes more important) concerns patients report as important to them. We propose that a patient-centered core impact set be developed for each disease or condition of interest, and/or subpopulation of patients. A patient-centered core impact set begins with gathering from patients and caregivers an inventory of all impacts disease and treatments have on a patient’s (and carers’ and families’) life. Then, through a formal prioritization process, a core set of impacts is derived, inclusive of but extending beyond relevant health outcomes. We offer several recommendations on how to move the goal of a patient-centered core impact set forward through collaboration, leadership, and establishment of a patient-centered core impact set development blueprint with supporting tools.