Patient Experience Research Articles

CORR Insights®: Can We Enhance Shared Decision-making for Periacetabular Osteotomy Surgery? A Qualitative Study of Patient Experiences.

CORR Insights®: Can We Enhance Shared Decision-making for Periacetabular Osteotomy Surgery? A Qualitative Study of Patient Experiences.

Impact of teaching modality on soft skill development: Oral health literacy awareness skills assessed using standardized patient experiences.

Health literacy awareness is a crucial skill for health professionals, yet training may be lacking. Didactic lectures may improve health literacy awareness in future health professionals, however, compressed curricula may lead educators to consider the incorporation of eLearning into the delivery of health literacy education. E-modules have been shown to engage learners, yet little is known about their effectiveness in instilling behavioral change in learners' clinical communication skills. This study aimed to shed light on the impact of learning modality on dental students' ability to learn and translate soft skills into clinical settings. An e-module on health literacy awareness was created by the researchers with an equivalent lecture developed. Fifty-six dental students were randomly assigned to a control or intervention cohort (lecture or e-module) and all cohorts participated in standardized patient experiences to be assessed in a simulated but authentic patient care scenario. Pre- and post-intervention scores, simulation scores, and learner reflections were compared. Fifty-six students participated in the study. Post-intervention health literacy awareness knowledge increased for both intervention cohorts. In clinical simulation, intervention cohorts scored significantly higher on nearly all variables, with the lecture cohort scoring consistently better than e-learners. Both lecture and e-learning are effective learning modalities for promoting health literacy awareness, but dental students learning the subject via lecture may translate certain newly acquired soft skills more effectively in clinical scenarios.

A Relationship between Physical Infrastructure and Patient Satisfaction: A Case Study of Kantipur Dental Hospital

This study investigates the impact of physical infrastructure on patient satisfaction at Kantipur Dental Hospital, a prominent dental care facility in Nepal. With the increasing demand for high-quality healthcare services, understanding the factors influencing patient satisfaction is crucial for healthcare providers. The research aims to explore how various aspects of the hospital’s infrastructure—specifically, the use of state-of-the-art equipment, cleanliness and hygiene, sterilization practices, and convenient location—affect patients' perceptions of care quality. A quantitative research design was employed, utilizing a structured questionnaire distributed to 117 patients who had received treatment at Kantipur Dental Hospital within the last six months. The questionnaire measured patients' perceptions of the clinic's infrastructure and their overall satisfaction, with a focus on two key dimensions: confidence after treatment and the acceptability of service fees. Data analysis was conducted using Spearman’s rho correlation to assess the relationships between the perceived infrastructure variables and patient satisfaction outcomes. The findings reveal significant positive correlations between perceptions of the hospital's physical infrastructure and patient satisfaction. Specifically, the use of modern equipment and a clean, hygienic environment were strongly associated with increased patient confidence post-treatment. Furthermore, the accessibility of the hospital location was also found to influence perceptions of service fee acceptability. Notably, while sterilization practices contributed positively to patient confidence, they did not significantly impact fee perceptions, suggesting that patients prioritize cleanliness and modernity in their overall evaluation of care. These results underscore the critical role of physical infrastructure in enhancing patient satisfaction at Kantipur Dental Hospital. The study recommends that healthcare facilities continue to invest in modern technology and maintain high standards of cleanliness to foster patient confidence and satisfaction. This research provides valuable insights for clinic management and policy-makers, emphasizing that improving physical infrastructure is essential for delivering quality healthcare services and ensuring positive patient experiences.

A qualitative study on the dyadic coping experience of human papillomavirus-infected patients of childbearing age and their spouses.

China's recent policy initiatives and dedication of resources to heighten the public's awareness of cancer risks have led to increased cervical cancer screening and testing for human papillomavirus (HPV) which has resulted in a greater number of people diagnosed with HPV. The psychological stress experienced by women of childbearing age who are infected with HPV is also felt by their spouses, as the close relationship between spouses results in intertwined psychological distress and health statuses. Therefore, this study aimed to explore the dyadic coping experience of HPV-infected patients of childbearing age and their spouses in China and to provide a research basis for marital interventions for the disease. From July 2022 to January 2023, we used a purposive sampling method to select 11 pairs of HPV-infected patients of childbearing age and their spouses from a tertiary hospital. We conducted in-depth interviews with the patients and their spouses and analyzed the data using Colaizzi's seven-step method. We identified three main themes and eight subthemes: (a) stress perception (including negative psychological reactions, emotional relationship deterioration, and family social role imbalance), (b) stress communication (including enhancing communication awareness and changing communication methods), and (c) stress adjustment (including supporting each other emotionally, facing the disease together, and seeking social support). Health care professionals should assess the stress experienced by patients and their spouses. Moreover, they should encourage them to better cope with the disease as a team. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Surgical Recovery Through the Lens of Patients with Colorectal Disease: A Qualitative Study in an Enhanced Recovery after Surgery Setting.

As perioperative care shifts to a more patient-centered model, understanding needs and experiences of patients is vital. Gaining such insight can enhance the alignment of care with patient priorities, encouraging adherence to recovery-oriented interventions. We aimed to explore patient-defined recovery and the elements that modify the recovery process for patients with colorectal disease under Enhanced Recovery After Surgery (ERAS) care. A qualitative study was conducted at an ERAS-participating hospital in Alberta, Canada, between April 2018 to June 2019. A co-design focus group set the research direction and semi-structured interviews were conducted postoperatively in hospital or within 3 months post-discharge. Diverse patient ages and colorectal conditions were targeted through purposive sampling. Interviews were transcribed verbatim and analyzed through manifest and latent content analysis. Twenty patients with mean age 62 (SD:13) years and 45% with cancer (n=17 interview, n=2 focus group and interview, n=1 focus group only) were enrolled. Recovery was defined by patients as the return to normal routines and four themes were identified. First, Phases of recovery: recovery was described as multidimensional phases distinctively as early, late/long-term, and the endpoint. Second, Recovery facilitators: recovery was supported through positive mindsets, conscious recovery, and taking an active role. Third, Recovery barriers: recovery was hindered by negative mindsets and treatment side-effects. Finally, Recovery catalysts: communication, autonomy, and expectations facilitated active or passive recovery. Our patient-oriented recovery model may contribute a new dimension to the ERAS framework by capturing patients' recovery experiences. Further research is encouraged to explore its value in enhancing patient-centered care within ERAS.

Relativity, Rank, and the US News Health's Cardiology, Heart, and Vascular Surgery Best Hospitals.

Virtually anything can be ranked; the US News and World Report (USNWR or US News) ranks the top 50 hospitals specializing in cardiology, heart, and vascular surgery. Here the authors propose validating the effectiveness of rankings by comparing differences among the USNWR metrics across the top 50 hospitals. The ranking system for the top 50 hospitals specializing in cardiology, heart, and vascular surgery was derived from 16 variant scores. Each hospital's scores were collected from the USNWR. Hospitals were categorized into quintiles consisting of 10 institutions (1-10, 11-20, etc). An analysis of variance/χ2 comprehensive statistical analysis was run alongside a Wilcoxon/Kruskal-Wallis test to compare statistical outcomes. A significant threshold was deemed to be P < 0.05. Significant differences were noted between quintiles for advanced technologies (P = 0.05), US News specialty score (P < 0.001), number of patient referrals (P = 0.004), and expert opinion (P < 0.001). Non-statistically significant differences were found among patient experience, public transparency, Society of Thoracic Surgery transparency, American College of Cardiology transparency, recognition as a magnet hospital, and nursing staffing. Interestingly, a large variance was noted in the average number of referrals between the first quintile (13,371) and the last (6690). Expert opinion plays a critical role in the reputation of the USNWR's top 10 hospitals in cardiology, heart, and vascular surgery. Although many have argued about the merits of USNWR hospital rankings, taken together, rankings fill a strong customer demand and are sticky.

Implementation of digital remote postoperative monitoring in routine practice: a qualitative study of barriers and facilitators.

Remote monitoring can strengthen postoperative care in the community and minimise the burden of complications. However, implementation requires a clear understanding of how to sustainably integrate such complex interventions into existing care pathways. This study aimed to explore perceptions of potential facilitators and barriers to the implementation of digital remote postoperative monitoring from key stakeholders and derive recommendations for an implementable service. A qualitative implementation study was conducted of digital remote postoperative wound monitoring across two UK tertiary care hospitals. All enrolled patients undergoing general surgery, and all staff involved in postoperative care were eligible. Criterion-based purposeful sampling was used to select stakeholders for semi-structured interviews on their perspectives and experiences of digital remote postoperative monitoring. A theory-informed deductive-inductive qualitative analysis was conducted; drawing on normalisation process theory (NPT) to determine facilitators for and barriers to implementation within routine care. There were 28 semi-structured interviews conducted with patients (n = 14) and healthcare professionals (n = 14). Remote postoperative monitoring was perceived to fulfil an unmet need in facilitating the diagnosis and treatment of postoperative complications. Participants perceived clear benefit to both the delivery of health services, and patient outcomes and experience, but some were concerned that this may not be equally shared due to potential issues with accessibility. The COVID-19 pandemic demonstrated telemedicine services are feasible to deliver and acceptable to participants, with examples of nurse-led remote postoperative monitoring currently supported within local care pathways. However, there was a discrepancy between patients' expectations regarding digital health to provide more personalised care, and the capacity of healthcare staff to deliver on these. Without further investment into IT infrastructure and allocation of staff, healthcare staff felt remote postoperative monitoring should be prioritised only for patients at the highest risk of complications. The COVID-19 pandemic has sparked the digital transformation of international health systems, yet the potential of digital health interventions has yet to be realised. The benefits to stakeholders are clear, and if health systems seek to meet governmental policy and patient expectations, there needs to be greater organisational strategy and investment to ensure appropriate deployment and adoption into routine care. NCT05069103.

Evaluation and mitigation of cognitive biases in medical language models.

Increasing interest in applying large language models (LLMs) to medicine is due in part to their impressive performance on medical exam questions. However, these exams do not capture the complexity of real patient-doctor interactions because of factors like patient compliance, experience, and cognitive bias. We hypothesized that LLMs would produce less accurate responses when faced with clinically biased questions as compared to unbiased ones. To test this, we developed the BiasMedQA dataset, which consists of 1273 USMLE questions modified to replicate common clinically relevant cognitive biases. We assessed six LLMs on BiasMedQA and found that GPT-4 stood out for its resilience to bias, in contrast to Llama 2 70B-chat and PMC Llama 13B, which showed large drops in performance. Additionally, we introduced three bias mitigation strategies, which improved but did not fully restore accuracy. Our findings highlight the need to improve LLMs' robustness to cognitive biases, in order to achieve more reliable applications of LLMs in healthcare.

Replacing hospital nurse consultations with home-based nurse consultations for severe spasticity patients on intrathecal baclofen: a qualitative study

Aim This qualitative study explored the experiences of patients, caregivers and healthcare professionals after replacing hospital consultations with a home service solution for patients treated for severe spasticity with intrathecal baclofen. Method Semi-structured interviews were conducted with six patients, six caregivers and six healthcare professionals. The data were analysed using interpretative phenomenological analysis. Results Four themes were identified: 1) Caregivers’ new role and contribution to treatment, 2) Hospital consultations in home settings changed the balance of power, 3) A compassionate relationship, and 4) Contextual care for patients. Conclusion The home-based consultations improved caregivers’ understanding of the treatment and helped them to become active spokespersons for the patient by contributing important information about the patient’s perspectives and the effects of the treatment. The balance of power shifted towards a more equitable dynamic between patients and nurses during home consultations, facilitated by greater involvement of the patient perspective. The nurses’ working conditions changed, but patients and caregivers appreciated the shift in treatment setting.

From worries to resilience: a qualitative study of the psychosocial experiences of diverse adolescents and young adults with heart failure and their caregivers.

Despite advances in treatment and outcomes for paediatric heart failure, both physical and psychosocial comorbidities remain notable among this patient population. We aimed to qualitatively describe the psychosocial experiences of adolescent and young adults with heart failure and their caregivers' perceptions, with specific focus on personal challenges, worries, coping skills, and resilience. Structured, in-depth interviews were performed with 16 adolescent and young adults with heart failure and 14 of their caregivers. Interviews were recorded and transcribed. Content analysis was performed, and themes were generated. Transcripts were coded by independent reviewers. Ten (63%) adolescent and young adults with heart failure identified as male and six (37.5%) patients self-identified with a racial or ethnic minority group. Adolescent and young adults with heart failure generally perceived their overall illness experience more positively and less burdensome than their caregivers. Some adolescent and young adults noted specific worries related to surgeries, admissions, major complications, death, and prognostic/treatment uncertainty, while caregivers perceived their adolescent and young adult's greatest worries to be around major complications and death. Adolescent and young adults and their caregivers were able to define and reflect on adolescent and young adult experiences of resilience, with many adolescent and young adults expressing a sense of optimism and gratitude as it relates to their medical journey. This study is the first of its kind to qualitatively describe the psychosocial experiences of a racially and socioeconomically diverse sample of adolescent and young adults with heart failure, as well as their caregivers' perceptions of patient experiences. Findings underscore the importance of identifying distress and fostering resilient processes and outcomes in young people with advanced heart disease.

Cost barriers to medication access in Australia: an analysis of the Patient Experience Survey incontext.

Cost barriers to medication access in Australia: an analysis of the Patient Experience Survey incontext.

Complications and 30-Day Readmission Rates After Lobectomy for Lung Cancer: A Single-Center Pre-enhanced Recovery After Surgery (ERAS) Assessment in Vietnam

Background: This study investigated complications and 30-day readmission rates following lobectomy for lung cancer in a pre-enhanced recovery after surgery (ERAS) program setting at the University Medical Center Ho Chi Minh City, aiming to identify key areas for improvement. Methods: A retrospective analysis was conducted on 99 patients who underwent lobectomy for lung cancer. Data on patient demographics, surgical details, and postoperative outcomes were collected. Complications were categorized using the Clavien-Dindo classification system, and statistical analyses were performed using STATA software. Results: Among the 99 surveyed patients, 53.5% were male, and 46.5% were female, with the majority being over 60 years old. The postoperative complication rate was 19.2% (30.9% reduction with multimodal pain relief, P = 0.001), and the 30-day readmission rate was 13.1% (19.4% reduction with physical therapy before surgery, P = 0.008). High-risk complication factors included open surgery (42.9%) compared to video-assisted thoracoscopic surgery (VATS) (11.8%) (P = 0.026) and vomiting after surgery (46.7%, P = 0.008). Conclusions: The findings underscore the necessity of integrating ERAS principles to enhance postoperative care and outcomes in lung cancer surgery. Implementing ERAS protocols could potentially reduce complications and readmissions, improving patient experiences and surgical efficacy. Future research will focus on applying these insights within the ERAS framework to optimize lobectomy outcomes.

The role of human factors engineering in patient safety.

To explore the collaboration between human factors (HFs) experts and clinicians in order to improve perioperative patient safety. Recent recommendations to integrate human factors into anesthesia in the United Kingdom emphasizes the value of applying disciplines outside of medicine to optimize the patient experience. Human factors engineering is underutilized worldwide. Patient safety would benefit from collaboration with HF experts to design resilient systems. Healthcare organizations must consider HF to develop and implement user-centered solutions to improve safety for patients and professionals.

An evaluation of oral surgery referrals to aid development of an integrated service in South West England.

Introduction The number of oral surgery referrals from primary to secondary care has increased, resulting in longer waiting times. A study suggests two-thirds of patients referred to secondary care for oral surgery could be treated by dentists with enhanced skills.Aims To help inform the development of an integrated oral surgery service in South West England by assessing the proportion of inappropriate referrals to Bristol Dental Hospital.Methods A total of 100 non-consecutive written referrals to oral surgery were analysed. Multiple variables were collected, including the complexity of the treatment requested (Level 1, 2 or 3) and patient and referrer locations.Results In total, 94 referrals were included in the analysis: 17% were Level 1 complexity, 35% Level 2, and 48% Level 3. Additionally, 17% of referrals were inappropriate. Almost half (52%) (Levels 1 and 2) could have been treated in primary care. Many referrals had missing clinical details or unacceptable-quality radiographs.Conclusion An effective integrated oral surgery managed clinical network in South West England could reduce waiting times in secondary care and potentially improve patient experience. An electronic referral management system could also improve the quality of referral information.

Breakfast habits in patients using levothyroxine: patient experiences and preferences

Abstract Background Levothyroxine (LT4) is recommended to be ingested in a fasting state, 30-60 minutes before breakfast to avoid interactions with food and drugs. In clinical practice, we noticed that this instruction may be inconvenient for patients. Therefore, we aimed to evaluate patient experiences and preferences concerning the recommended fasting administration of LT4. Methods Patients using LT4 were invited to complete a questionnaire. Regression analyses were performed to identify patient characteristics associated with taking LT4 close to or together with food and/or interfering drugs, feeling burdened with postponing breakfast, and preferring non-fasting LT4 ingestion. Results Out of 463 invited patients, 410 completed the questionnaire (88.6%). Of them, 76.8% was female and median age was 57 years (IQR:43-67). Nearly all patients (97.3%) reported to have received instruction on fasting LT4 ingestion, but only 30% adhered to this. Non-fasting LT4 intake was associated with use of co-medication (OR2.82;95%CI:1.77-4.47), treatment duration &amp;gt;1 year (OR1.76;95%CI:1.02-3.04), and male sex (OR1.67;95%CI:1.03-2.70). Approximately half of the patients reported to be burdened with postponing breakfast and the majority (60.5%) expressed their preference for non-fasting LT4 ingestion. Interestingly, 25% omitted breakfast and 13.4% forgot their medication because of the fasting requirement. Furthermore, the majority (68.2%) of patients that used interfering drugs stated not to be instructed to separate these drugs from LT4. Conclusions This study highlights the burden associated with fasting LT4 ingestion, leading to non-adherence, irregular LT4 intake and omitting breakfast. Given the clear preferences towards non-fasting LT4 ingestion, further research into alternative non-fasting administration methods is warranted.

Narrative Review: Telemedicine Quality after the COVID-19 Public Health Emergency: Time to Reevaluate?

OBJECTIVE: This narrative review explores concerns and potential solutions for improving the quality of synchronous telemedicine visits for high utilizers like primary care, particularly after the COVID-19 pandemic. METHODS: A literature review identified studies published within the past 10 years focusing on telemedicine quality, primary care, and related aspects like liability, virtual exams, and patient safety. RESULTS: Despite the surge in popularity of telemedicine visits, concerns regarding their quality linger. These concerns encompass various aspects of the patient experience, administrative processes, and potential safety risks. Limitations in physical exam capabilities and the lack of readily available vital signs during telemedicine visits raise concerns about the accuracy of diagnoses. This is particularly true for situations requiring a more comprehensive physical assessment. Incomplete documentation due to abbreviated patient histories, missing physical exam findings, and the reliance on generic templates pose liability risks. This lack of thorough information makes it challenging to accurately capture the patient's condition and raises concerns about the quality of care provided. Patients themselves have expressed concerns about accuracy of a virtual visit, thus raising questions about the effectiveness of telemedicine in building rapport and ensuring clear communication. From an administrative standpoint, fears of misdiagnosis due to the limitations of virtual exams, inconsistencies in insurance coverage for telemedicine services, and unclear reimbursement standards for thorough visits continue to pose challenges. These uncertainties create ambiguity and make it difficult for healthcare providers to fully embrace telemedicine as a viable option. Finally, although mirroring in-person visit protocols for patient safety is considered crucial, many organizations currently lack standardized measures to ensure safety throughout the entire telemedicine journey. This includes potential risks during scheduling, appointment execution, and post-visit follow-up, highlighting the need for more robust safety protocols specifically designed for the telemedicine setting. Addressing these concerns is essential for ensuring the quality and sustainability of telemedicine integration. CONCLUSION: While telemedicine offers significant benefits, improving quality is essential for its sustainable integration into primary care. Standardizing protocols, educating clinicians and patients, implementing comprehensive physical exam procedures, and ensuring patient safety throughout the visit are key areas for improvement. Continuous monitoring and data analysis are crucial for identifying and addressing weaknesses and ensuring quality telemedicine care.

'The MRI-scan says it is completely normal': Reassurance attempts in clinical encounters among patients with chronic musculoskeletal pain.

In clinical guidelines for patients with chronic musculoskeletal pain, reassurance is a key element. The purpose of reassuring patients is to change their views on their illness and, thereby, their actions. However, when symptoms persist without pathological findings, reassurance can be difficult to achieve. Drawing on observations of nineteen naturally occurring hospital consultations with chronic musculoskeletal pain patients, followed by individual interviews with both patients and clinicians, we study how they interact in relation to reassurance. Our main aim is to explore the ways in which clinicians explicitly attempt to provide reassurance, and how patients receive these attempts, before reflecting on facilitating and hindering factors for successful reassurance in relation to the sociocultural context in which their interaction takes place. Through a thematic analysis, four dominating elements of explicit reassurance were identified: (1) education through visualisation, (2) validation through technological findings, (3) validation through physical examination and (4) normalising pain. To gain a deeper understanding of the reassurance process, we then narratively explored dialogical extracts containing these elements. The analysis shows a potential lack of congruence between what patients experience, and the biomedical knowledge clinicians rely on. Despite employing a combination of affective and cognitive modes of reassurance, clinicians tend to build their final conclusions not on patients experiences but on biomedical knowledge, which is knowledge that holds epistemic primacy for themselves. In that sense, their efforts to reassure the patients might also be a way in which they seek to reassure themselves.

Analysis of the Availability of Laboratory Tests to the Number of Requests for Tests and Its Implications on Patient Satisfaction

This study aims to analyze the availability of laboratory tests based on the number of test requests and their implications for patient satisfaction. Health laboratories are a vital component of healthcare services, providing accurate laboratory test results to support patient diagnosis and treatment. The availability of fast and accurate laboratory tests plays a crucial role in speeding up diagnosis and treatment, which ultimately impacts patient satisfaction. However, many healthcare facilities face challenges in providing adequate laboratory test availability, such as limitations in equipment, expertise, and inefficient procedures. This study employs a literature review approach to collect, analyze, and synthesize information from various relevant sources. The findings reveal that the availability of fast and accurate laboratory services can enhance patient satisfaction, while limitations in availability can lead to dissatisfaction and increased waiting times. Therefore, effective laboratory management is essential to improve service quality and patient experience in hospitals. This research is expected to provide valuable insights for improving the healthcare system, particularly in laboratory management.

Exploring Patient Experiences with Dental Anxiety Management Techniques in Dentistry

Dental anxiety is a prevalent issue affecting patients and dental healthcare providers alike, leading to avoidance of treatment and poor oral health outcomes. This study investigates dental anxiety management techniques and their effectiveness in promoting patient comfort, improving oral behavior, and increasing satisfaction during dental care. The research was conducted in Davao City, Philippines, utilizing a qualitative, descriptive phenomenological approach through in-depth interviews with eight participants who experienced dental anxiety. Key findings reveal that dental anxiety stems from unfamiliarity with procedures, negative experiences, and anticipation of pain. Patients reported heightened anxiety due to the sight and sound of dental tools and past negative encounters, often leading to long-term avoidance of care. Effective management strategies, such as deep breathing and distraction techniques, significantly improved patient satisfaction and oral health behavior, fostering better engagement with dental care. The study underscores the importance of patient-centered communication and personalized care in addressing dental anxiety, calling for enhanced integration of mental health considerations in dental practices.

Culture and ICD-11 personality disorder: Implications for clinical practice across diverse ethnic groups.

Personality disorder (PD) in ICD-11 is defined primarily by self and interpersonal dysfunction and optionally by other qualifiers. This definition is inseparable from relativism of cultural determinants. This review aimed to synthesize the relevant aspects of the influence of culture on clinical practice and health management for this condition, aligning them to the ICD-11 PD model. In Scopus, we systematically searched for studies that included the text strings: cultur* | personality AND (disorder* OR patholog*) without any restrictions on publication date or language or other exclusion criteria, up to November 2022. Evidence suggests that cultural variables in ethnic groups (Western and non-Western) such as the individualist/collectivist philosophy, historical/generational trauma, immigration, acculturation, religion, and gender influence the etiology, semiology, epidemiology, evaluation, diagnosis, treatment, and management of health services for ICD-11 PD. We discuss the limitations and propose future lines of research on this topic based on our knowledge and experience. In this review, we provide the scientific community and clinicians with relevant cultural information to guide their practice and propose strategies to manage PD from the ICD-11 model. More research is needed using mixed study methodologies on stigma, the experiences of patients, clinicians, and health agencies, to reduce the care gaps and achieve a culturally comprehensive, inclusive, and competent use of this new model.