Patient Information Materials Research Articles

Written patient information materials used in general practices fail to meet acceptable quality standards

BackgroundPatient information materials and decision aids are essential tools for helping patients make informed decisions and share in decision-making. The aim of this study was to investigate the quality of the written patient information materials available at general practices in Styria, Austria.MethodsWe asked general practitioners to send in all patient information materials available in their practices and to answer a short questionnaire. We evaluated the materials using the Ensuring Quality Information for Patients (EQIP-36) instrument.ResultsA total of 387 different patient information materials were available for quality assessment. These materials achieved an average score of 39 out of 100. The score was below 50 for 78% of all materials. There was a significant lack of information on the evidence base of recommendations. Only 9 % of the materials provided full disclosure of their evidence sources. We also found that, despite the poor quality of the materials, 89% of general practitioners regularly make active use of them during consultations with patients.ConclusionBased on international standards, the quality of patient information materials available at general practices in Styria is poor. The vast majority of the materials are not suitable as a basis for informed decisions by patients. However, most Styrian general practitioners use written patient information materials on a regular basis in their daily clinical practice. Thus, these materials not only fail to help raise the health literacy of the general population, but may actually undermine efforts to enable patients to make shared informed decisions. To increase health literacy, it is necessary to make high quality, evidence-based and easy-to-understand information material available to patients and the public. For this, it may be necessary to set up a centralized and independent clearinghouse.

Is medical ionizing radiation negligible or neglected? How to interact with patients?

Abstract Issue Medical exposure is in France, the first source of artificial exposure of populations to ionizing radiation (IR). The use of ionizing radiation in diagnosis, (CT scan) is steadily increasing. With IR, nothing is visible, nothing is lost, everything is cumulative and transformed. How to explain it to patients and how to answer their questions? How, in this area, can patients become empowered? The radiologists have already produced information materials for patients. Explaining the different types of exams is easy, explaining the dose is more complex; doses are not expressed with the same units. In addition, since the organs do not all have the same sensitivity to ionizing radiation, the addition of doses delivered does not always make sense. The comparison of doses delivered with the natural exposure to ionizing radiation makes it understandable. Specific awareness campaigns such as ’for lumbago radio, this is not always the right scenario’ were launched. One of the main rule of radioprotection is the justification of the act in relation to the expected benefit. Both general practitioners and patients can influence the decision by asking simple questions. An awareness campaign on this theme is planned by HERCA (European HEad of Radiation protection Competent Authorities) in Europe in November 2019. It aims to reduce inappropriate exams by breaking habits. It is aimed mainly to general practitioners. Results The French Nuclear Safety Authority will decline this campaign for both general practitioners and patients. This campaign is based on the most common questions such as: If I have already made a diagnosis, what is the added value of a radiological examination?Why should I have another radiological examination?Why refer my patient for an X-ray or CT if another examination can be done that does not use ionizing radiation?Why is it important to ask if pregnancy is a possibility? Lessons Illustrative documents will be presented at the congress Key messages Risks related to medical exposure to ionizing radiation are not sufficiently explained. A European campaign of recognized authorities and the involvement of patients should help reinforce the messages of the French campaign.

Anesthesiological perspectives on perioperative management in continuous subcutaneous insulin infusion (CSII): stop or continue?

Perioperative handling of insulin pumps (CSII) is inconsistent. The aims of this study were aliterature search addressing this clinical question, analysis of data found and aproposal for perioperative management recommendations for clinical practice. A systematic search was conducted in PubMed and Clinical Research Network. A total of 11publications on CSII in perioperative medicine were identified. According to the evidence CSII guarantees perioperative glycemic stability under certain clinical situations. The use of CSII could be continued in patients undergoing elective non-cardiac minor surgery with fasting for up to one meal only. International guidelines on surgery in diabetes do not address the use of perioperative CSII. There is no nationwide register data for CSII, the use of which could be around 18%. Based on the search results, ahospital internal protocol for perioperative management with CSII and patient information material were designed. Growing evidence for improved patient outcome with perioperative CSII usage warrants interdisciplinary transfer of knowledge and experiences on intensified insulin therapy and patient empowerment.

Assessment of Quality of Life in Postmenopausal Women with Early Breast Cancer Participating in the PACT Trial: The Impact of Additional Patient Information Material Packages and Patient Compliance

Background: Breast cancer patients’ self-understanding of their disease can impact their quality of life (QoL); the relationship between compliance and QoL is poorly understood. Patients and Methods: The Patient’s Anastrozole Compliance to Therapy (PACT) program, a prospective, randomized study, investigated the effect of additional patient information material (IM) packages on compliance with adjuvant aromatase inhibitor (AI) therapy in postmenopausal women with hormone receptor-positive early breast cancer. The QoL subanalysis presented here examined the impact of IM packages on QoL and the association between QoL and compliance. European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-BR23 questionnaires were completed at baseline, 12 and 24 months, or study termination to assess health-related QoL and disease-related symptoms. Results: Of the 4,844 patients randomized to standard therapy or standard therapy + IM packages (1:1), 4,253 were available for QoL analysis. No difference in QoL was observed between groups at baseline. IM packages did not have a statistically significant impact on patient QoL at the 12- or 24-month follow-up. Compliant patients experienced improvement in multiple items across the QLQ-C30 and QLQ-BR23 scales at 12 months. However, those results should be interpreted carefully due to limitations in the statistical analyses. Conclusions: Provision of IM packages did not influence patients’ QoL or satisfaction with care during AI therapy. Compliant patients appear to experience improved QoL compared to noncompliant patients, perhaps indicating a more self-empowered perception of their condition.

Improving recruitment to a study of telehealth management for COPD: a cluster randomised controlled \u2018study within a trial\u2019 (SWAT) of a multimedia information resource

BackgroundGood quality information is critical for valid informed consent to trials, but current paper-based consent procedures are potentially unwieldy and can be difficult to comprehend, which may deter people from participating. Multimedia resources may be able to provide more accessible and user-friendly information.We aimed to test whether offering access to a multimedia information resource alongside standard, printed patient information impacted on recruitment rates by conducting a pragmatic ‘study within a trial’ (SWAT) embedding a trial of a multimedia resource within an existing trial.MethodsThe PSM COPD study involved people with mild symptoms of chronic obstructive pulmonary disease (COPD) recruited from primary care being randomised to a nurse-delivered telephone health coaching intervention, or usual primary care.For the SWAT of recruitment procedures, practices recruiting participants were cluster randomised to use either the standard printed patient information materials or standard printed patient information materials with access to a multimedia information resource.The multimedia resource was developed by patient and public involvement (PPI) contributors and researchers, and included study-specific information (e.g. study purpose, risks), and generic information about trials (e.g. confidentiality, randomisation). We developed a list of components and used animations as well as video clips of patients discussing their experiences of participation, matched to these components.The primary outcome was the proportion of participants randomised.ResultsNine point six percent of those receiving standard printed patient information materials and access to the multimedia information resource were recruited, compared to 10.8% in those receiving standard printed materials alone (odds ratio (OR) = 0.844, 95% confidence interval (CI) 0.58 to 1.22).We also found no effects on the proportion of people responding to the invitation (OR = 1.02, 95% CI 0.79 to 1.33) or retention in the trial at 6 (ORs 0.84, 95% CI 0.57 to 1.22) and 12 months after randomisation (ORs 0.80, 95% CI 0.54 to 1.18), respectively.ConclusionsThe study suggests no benefits of access to a multimedia information resource alongside patient information materials on recruitment. This may reflect the limited engagement of patients with the multimedia resource. Further uses of multimedia resources will need to explore how content can be explicitly matched to user needs and preferences and methods to encourage engagement to see if effects can be enhanced. More SWATs of multimedia into ongoing trials will provide a more precise estimate of effect, and explore further how effects vary by trial context and recruitment process, intervention, and patient population.Trial registrationCurrent controlled trials ISRCTN 06710391. Registered on 21 November 2013.SWAT registrationSWAT 23: Systematic Techniques for Assisting Recruitment to Trials (MRC START). Registered on 11 January 2012.

Do guidelines help us to deviate from their recommendations when appropriate for the individual patient? A systematic survey of clinical practice guidelines.

Clinical practice guidelines (CPG) were introduced to summarize the best scientific evidence available. Thereby, CPG were meant to support evidence-based medicine (EBM). However, besides evidence, EBM also asks for patients' preferences and physicians' experiences to be considered when coming to therapeutic decisions. Thus, deviations from CPG recommendations are sometimes necessary when practicing EBM. We wanted to examine whether CPG support deviations from their recommendations when appropriate. For operationalization, we asked whether absolute effect sizes (AES) for benefit and/or harm of suggested therapies were provided along with the respective CPG recommendation. This systematic survey comprised the most common CPG on chronic coronary heart disease (CCHD) and type 2 diabetes mellitus (T2DM) from English- and German-speaking countries. Only CPG recommendations on pharmacotherapy were evaluated. If AES of a recommended therapy were reported, we rated how easily findable they were within the CPG. Moreover, we assessed whether the CPG provided patient information material and whether this material supplied AES allowing patients to determine the effects to be expected. In the 13 CPG surveyed, 144 recommendations on pharmacotherapy were identified. For 108 recommendations (75%), no AES for benefit and/or harm were reported. Thirty-one recommendations (22%) were accompanied by one or more AES for either benefit or harm. Along with five recommendations (3%), one or more AES for both benefit and harm were given. AES were considered easy to find for three of these 36 recommendations (8%). Patient information material was provided in three of the 13 CPG (23%) accounting for AES in one occasion only. Current CPG on T2DM and CCHD do not sufficiently offer AES for benefits and harms of recommended therapies. Thus, they lack satisfactory information to support deviations from CPG recommendations. Consequently, CPG in their present form do not adequately facilitate EBM.

Availability and quality assessment of online nutrition information materials for pelvic cancer patients in the UK.

Written information can be an essential source of support in the promotion of lifestyle changes after a cancer diagnosis. This study aimed to identify and assess the quality of available online patient information materials (PIMs) in relation to diet and nutrition for patients with pelvic cancer. The online sources of the National Health Service, cancer centres and charitable organisations throughout the UK were searched. Content was assessed using an evidence-based checklist, and readability with two validated formulas. Consumer feedback was sought through patient and public involvement (PPI) groups. Forty PIMs were identified; four were designed specifically for pelvic cancers (bladder, bowel, prostate) and 36 were generic (relevant for all cancers). Most PIMs had a good content score, with PIMs from charities scoring higher overall than PIMs from cancer centres [32 (4) vs. 23 (11), p<0.001]. Seventy-three percent of PIMs had a readability score within acceptable levels (6th-8th grade; reading ability of 11-14year-olds). PPI contributors found most PIMs useful and comprehensive but lacking specific information needed to meet individual needs. There is limited availability of online PIMs for cancer survivors and even fewer tailored to pelvic cancers. Most materials have comprehensive content and acceptable readability. Some PIMs may require improvement.

Implementation of an organisation-wide health literacy approach to improve the understandability and actionability of patient information and education materials: A pre-post effectiveness study

ObjectiveLimited examples exist globally of coordinated, organisation-wide health literacy approaches to systematically improve the understandability and actionability of patient health information. Even fewer have been formally evaluated. The aim of this study was to use the Patient Education Materials Assessment Tool (PEMAT) to evaluate the effectiveness of an organisation-wide, evidence-based approach to improve the understandability and actionability of patient information materials in regional health service in New South Wales, Australia. MethodsTwo independent raters (blinded to the document version) evaluated pre- and post-implementation versions of 50 randomly-selected patient information materials using the PEMAT, with differences in understandability and actionability analysed using paired samples tests. ResultsMean (±SD) overall scores for understandability increased significantly by 5% (95% CI 2–8; p = 0.002) up to 77%±10%, and mean actionability (±SD) increased significantly by 4% (95% CI 0–8; p = 0.046) up to 56%±22%. ConclusionThese results demonstrate that organisation-wide approaches with standardised processes for staff to prepare, review and store written patient information and education materials can be successfully implemented to address the impacts and risks of low health literacy. Practice implicationsThe success of this approach provides a framework for other health organisations to work in partnership with patients to make health information more understandable and actionable.

Information Gaps in Package Inserts Cause Insufficient Patient Information on Correct Handling of Transdermal Patches

The multi-step administration process of transdermal patches requires sufficient knowledge and skills of patients to prevent administration errors. The package insert is an easily accessible information source that reaches the patient automatically with drug dispensing. However, information gaps potentially limit their suitability as appropriate patient information material. Package inserts of all transdermal patches available on the German drug market were analyzed for medication administration recommendations. In total, 81 package inserts were analyzed including buprenorphine (N = 13), fentanyl (N = 33), granisetron (N = 1), glyceroltrinitrate (N = 2), nicotin (N = 4), oxybutynin (N = 1), rivastigmin (N = 10), rotigotin (N = 2), scopolamin (N = 1), and hormone preparations with estradiol, estradiol hemihydrate, ethinyl estradiol, gestodene, levonorgestrel, norelgestromin, and norethindrone acetate (N = 14). None of the package inserts included all 28 administration recommendations that were previously identified as relevant through a systematic literature search. In particular, information was lacking on transdermal patch-specific characteristics such as mechanism of drug absorption, monitoring, storage, and disposal. The package inserts insufficiently inform patients on correct transdermal patch administration and thus, comprehensive patient education by healthcare professionals is required. In the long-term, regulatory requirements for package inserts should include standardized and dosage form-specific recommendations for correct medication administration.

Attitudes, Practices, and Barriers of Malaysian Community Pharmacists Toward Provision of Weight Management Services.

In Malaysia, sharp increment in the prevalence of obesity over the last four decades has been documented. Community pharmacists (CPs) are strategically placed to tackle obesity by providing weight managements services (WMS) to general public. This study assessed the attitudes, practices and perceived barriers of Malaysian CPs to the provision of WMS. A cross-sectional, descriptive survey was conducted, and responses related to attitudes, practices and perceived barriers of CPs were collected using five-point Likert scale. A total of 550 pharmacists who worked across six states of Malaysia (Selangor, Federal Territory of Kuala Lumpur, Pulau Pinang, Johor, Sabah, and Melaka) participated in this study. Most of the CPs strongly agreed that over eating (n = 312, 56.7%) and sedentary lifestyles (n = 297, 54.0%) contribute to obesity and overweight. Most of them also strongly agreed that exercise training is an effective weight reduction strategy (n = 285, 51.9%), but they were generally not in favor of surgery (n = 231, 42% disagreed/strongly disagreed). CPs generally perceived barriers related to a lack of staff to provide WMS (n = 308, 56.0% agreed/strongly agreed) and ethical and legal issues associated with sales of products/drugs for obesity management (n = 285, 51.9% agreed/strongly agreed). Sociodemographic and practice characteristics such as age group, type of pharmacy, highest education qualification, and employment status of CPs influenced the attitudes, practices and perceived barriers associated with WMS. In terms of age, CPs who were aged less then 30 years expressed significantly stronger agreement that medication adherence is beneficial for weight loss compared to those CPs between 41–50 years. Additionally, CPs who were pharmacy owners provided significantly more frequent BMI measurement and patient information materials as part of their weight management practices compared to CPs who worked as a part timer/locum. This study could be taken as a baseline study on Malaysian CPs’ perceptions on WMS.

Spanish Language Pelvic Floor Disorders Patient Information Handouts: How Readable Are They?

This study aimed to determine the readability of commonly available patient information materials for pelvic floor disorders written in Spanish and compare their readability based on type of content and source. Spanish patient information handouts, including pamphlets from the National Institutes of Health, International Urogynecology Association, American Congress of Obstetricians and Gynecologists, online printable handouts, and industry-sponsored brochures were assessed for readability. Online materials for patients were obtained from Google searches using key words (pelvic floor disorders, urogynecology, patient information handouts, Spanish). Reading difficulty was assessed using INFLESZ v1.0, (Barrio-Cantalejo IM, Spain) a free software developed to calculate the readability of Spanish written texts. Three index scales were used: Flesch-Szigriszt Index, Word correlation Index, and the Fernandez-Huerta Index. Forty patient information handouts were analyzed. All pamphlets analyzed had readability scores within the "average" to "very difficult" reading difficulty levels as per the index scales used. None of the analyzed pamphlets met the sixth grade reading level criteria suggested by the National Institutes of Health and American Medical Association, including government-developed materials. There were no differences in readability scores between type of leaflet content or source. Current available free, industry-, organization-, and government-provided reading materials in Spanish do not serve the Spanish-speaking only or low English-speaking literacy population. Future work should aim to simplify the language in such documents to the suggested sixth grade reading level.

Development of culturally sensitive Pain Neuroscience Education for first-generation Turkish patients with chronic pain: A modified Delphi study

BackgroundPain Neuroscience Education (PNE) has been recognized as an efficacious approach for chronic pain, but evidence for these findings have mainly been gathered in Caucasian patient populations. In recent years, it has been proposed that the treatment of pain and patient information materials should be culturally sensitive for different ethnic populations and cultures since cultural variations in pain beliefs and cognitions. ObjectivesTo culturally adapt PNE material for first-generation Turkish patients with chronic pain. DesignA modified Delphi study with three consecutive rounds. MethodA total of 10 participants (8 experts and 2 first-generation Turkish patients with chronic pain) were recruited for this study. Three online questionnaire rounds were conducted to synthesize the perspectives and to reach agreement on the suggested PNE materials. ResultsResults on multiple-choice questions from the first round revealed that the compatibility of the visual information and the clarity of the message obtained lower scores. Examples, visual information (illustrations, pictures), and metaphors in the teaching materials and the home education leaflet were revised based on suggestions in Rounds 1 and 2. In Round 3, respondents reached an acceptable agreement level for the clinical usefulness of the PNE teaching materials and the home education material. ConclusionsCulturally sensitive PNE materials were produced for first-generation Turkish patients. Since the results of the present study only reveal perspectives of the experts, further validation of education materials may be required before they are recommended for Turkish patients in clinical practices.

Analysis of the quality of patient therapeutic education and information in a high complexity reference hospital

Background and objectivesThe application and monitoring of quality criteria in information and therapeutic patient education can identify areas to improve care. The objectives of this study were: (1) To analyze the characteristics of patient information materials, educational activities, and self-management programs, and (2) to determine health care provider (HCP) proposals on therapeutic patient education. Materials and methodsUsing a cross-sectional study, an online questionnaire was sent to hospital departments in a high complexity reference hospital from September to December 2013 to record: (a) information materials, (b) patient educational activities, and self-management program characteristics, (c) HCP proposals. The materials were analyzed using Health Promoting Hospitals (HPH) recommendations. Results(1) An analysis was performed on 258 materials (leaflets [54%]) for chronic patients (86%), acute patients (7%), and the general population (7%). More than half (55%) lacked the authors, and 43% the year issued, and 69% followed HPH recommendations. (2) An evaluation was made of 70 educational activities and 37 self-management programs addressed to patients/relatives with diabetes/obesity, musculoskeletal disorders, COPD/asthma, pelvic-floor disorders, transplantation, bowel-inflammation/liver disease, hypertension, cancer, heart failure, acquired immune deficiency syndrome, chronic renal insufficiency, splenectomy, anticoagulation and older-patient dependence. The structure, process and outcome evaluation varied. (3) HCP proposals included: standardization of materials criteria, web accessibility, list of accredited websites, cross-sectional use, and HCP training in self-management education. ConclusionsThe online questionnaire showed the weaknesses and strengths of patient information and education, and can be used to monitor their quantity and quality. These results help in the definition of a useful model to improve patient information and education policies.

The effect of optimised patient information materials on recruitment in a lung cancer screening trial: an embedded randomised recruitment trial

BackgroundWritten participant information materials are important for ensuring that potential trial participants receive necessary information so that they can provide informed consent. However, such materials are frequently long and complex, which may negatively impact patient understanding and willingness to participate. Improving readability, ease of comprehension and presentation may assist with improved participant recruitment. The Systematic Techniques for Assisting Recruitment to Trials (MRC START) study aimed to develop and evaluate interventions to improve trial recruitment. This study aimed to assess the effectiveness of an optimised participant information brochure and cover letter developed by MRC START regarding response and participant recruitment rates.MethodsWe conducted a study within a trial (SWAT) embedded in the EarlyCDT Lung Cancer Scotland (ECLS) trial that aimed to assess the effectiveness of a new test in reducing the incidence of patients with late-stage lung cancer at diagnosis compared with standard care. Potential participants approached for ECLS were randomised to receive the original participant information brochure and accompanying letter (control group) or optimised versions of these materials which had undergone user testing and a process of re-writing, re-organisation and professional graphic design (intervention group). The primary outcome was the number of patients recruited to ECLS. The secondary outcome was the proportion of patients expressing an interest in participating in ECLS.ResultsIn total, 2262 patients were randomised, 1136 of whom were sent the intervention materials and 1126 of whom were sent the control materials. The proportion of patients enrolled and randomised into ECLS was 180 of 1136 (15.8%) in the intervention group and 176 of 1126 (15.6%) in the control group (OR = 1.016, 95% CI, 0.660 to 1.564). The proportion of patients who positively responded to the invitation was 224 of 1136 (19.7%) in the intervention group and 205 of 1126 (18.2%) in the control group (OR = 1.103, 95% CI, 0.778 to 1.565).ConclusionsOptimised patient information materials made little difference to the proportion of patients positively responding to a trial invitation or to the proportion subsequently randomised to the host trial.Trial registrationClinicalTrials.gov, NCT01925625. Registered on 15 August 2015.Study Within A Trial, SWAT-23. Registered on 12 April 2016.

Systematic development of CHEMO-SUPPORT, a nursing intervention to support adult patients with cancer in dealing with chemotherapy-related symptoms at home

BackgroundGiven the great symptom burden associated with chemotherapy on the one hand and generally poor self-management of symptoms by cancer patients on the other hand, our aim was to develop a nursing intervention to reduce symptom burden in adult cancer patients treated with chemotherapy and to support them in dealing with their various symptoms at home.MethodsDevelopment of the intervention was guided by the Intervention Mapping Approach and included following steps: needs assessment, formulation of proximal programme objectives, selection of methods and strategies, production of programme components, and planning for implementation and evaluation of the intervention. A panel of multidisciplinary healthcare professionals (n = 12) and a panel of patients and family caregivers (n = 7) were actively involved developing the intervention at each stage.ResultsFor the intervention, four patient performance objectives relating to self-management were advanced. Self-efficacy and outcome expectations were selected as key determinants of dealing with chemotherapy-related symptoms. As methods for supporting patients, motivational interviewing and tailoring were found to fit best with the change objectives and determinants. Existing patient information materials were re-designed after panel input to reinforce the new intervention approach.ConclusionThe intervention mapping approach, including active involvement of the intervention providers and receivers, informed the design of this nursing intervention with two or more contacts. Further evaluation is needed to gain insight into the potential effects, feasibility and mechanisms of this complex intervention.

Evaluation of a program for routine implementation of shared decision-making in cancer care: study protocol of a stepped wedge cluster randomized trial

BackgroundShared decision-making (SDM) has become increasingly important in health care. However, despite scientific evidence, effective implementation strategies, and a prominent position on the health policy agenda, SDM is not widely implemented in routine practice so far. Therefore, we developed a program for routine implementation of SDM in oncology by conducting an analysis of the current state and a needs assessment in a pilot study based on the Consolidated Framework for Implementation Research (CFIR). Based on these results, the main aim of our current study is to evaluate the process and outcome of this theoretically and empirically grounded multicomponent implementation program designed to foster SDM in routine cancer care.MethodsWe use a stepped wedge design, a variant of the cluster randomized controlled trial. The intervention to be implemented is SDM. Three participating clinics of one comprehensive cancer center will be randomized and receive the multicomponent SDM implementation program in a time-delayed sequence. The program consists of the following strategies: (a) SDM training for health care professionals, (b) individual coaching for physicians, (c) patient activation strategy, (d) provision of patient information material and decision aids, (e) revision of the clinics’ quality management documents, and (f) critical reflection of current organization of multidisciplinary team meetings. We will conduct a mixed methods outcome and process evaluation. The outcome evaluation will consist of four measurement points. The primary outcome is adoption of SDM, measured by the 9-item Shared Decision Making Questionnaire. A range of other implementation outcomes will be assessed (i.e., acceptability, readiness for implementing change, appropriateness, penetration). The implementation process will be evaluated using stakeholder interviews and field notes. This will allow adapting interventions if necessary.DiscussionThis study is the first large study on routine implementation of SDM conducted in German cancer care. We expect to foster implementation of SDM at the enrolled clinics. Insights gained from this study, using a theoretically and empirically grounded approach, can inform other SDM implementation studies and health policy developments, both nationally and internationally.Trial registrationclinicaltrials.gov, NCT03393351. Registered 8 January 2018.

Monitoring the Situation: Implementation of a Patient Information Monitor in a Radiation Therapy Department Waiting Room

The waiting room experience can drive patient satisfaction and affect outlook on encounters with healthcare professionals and quality of care. Patient education initiatives in waiting areas can improve overall patient experience in the primary care setting. A recent survey conducted in the radiation therapy department of a large metropolitan cancer centre revealed patients and their families were dissatisfied with the waiting room experience. Patients reported a lack of distraction and a desire for more information on available resources. The aim of this initiative was to evaluate the impact of a patient information monitor on the experience of patients and families visiting the radiation therapy department at our centre. This initiative was executed by a pre-existing patient experience working group with representation from different areas within the department including administration, treatment delivery, specialty areas, research and education. A brainstorming session was held and five categories of content were identified: 1) Organizational Information (e.g. parking services), 2) Resources Available (e.g. family and supportive services), 3) Trivia and Random Facts, 4) Brain Teasers, and 5) Scenic Photos. Categories were assigned to group members for content development. Template pages were created using Microsoft PowerPoint™ to ensure consistency and uniformity of content presentation. Where possible, information from existing patient education and information materials was used verbatim. To avoid repetition during a patient visit, a minimum of one hour of content was required, with each page of content displayed for 30 seconds for a total of 120 pages. Sample pages were sent to various stakeholders for review, including patient education experts, patient representatives and interprofessional groups. Once the monitor was on display, 50 patients and caregivers were approached for their reaction and feedback on the content. Development and upload of content is labour intensive. This is compounded by the volume of content required to reduce repetition. Additionally, content needs to be reviewed periodically to ensure information is accurate and up-to-date. Currently, there is a single monitor positioned in the middle of the radiation therapy waiting area. Only 21 of the 50 individuals approached for feedback had noticed the monitor. However, 29% (6/21) of patients that noticed the monitor found the Organizational and Resource content informative and helpful while 48% (10/21) enjoyed the distraction provided by the Scenic Photos, Trivia and Brain Teasers. The experience of patients and families in the radiation therapy waiting room is an important component of overall patient experience in our department. In the radiation therapy department, the patient information monitor serves as an easily accessible source of information and distraction for our patients and families. In the future, additional monitors in different locations could increase the number of individuals that benefit from this initiative.

Sustainable reduction of antibiotic-induced antimicrobial resistance (ARena) in German ambulatory care: study protocol of a cluster randomised trial

BackgroundDespite many initiatives to enhance the rational use of antibiotics, there remains substantial room for improvement. The overall aim of this study is to optimise the appropriate use of antibiotics in German ambulatory care in patients with acute non-complicated infections (respiratory tract infections, such as bronchitis, sinusitis, tonsillitis and otitis media), community-acquired pneumonia and non-complicated cystitis, in order to counter the advancing antimicrobial resistance development.MethodsA three-armed cluster randomised trial will be conducted in 14 practice networks in two German federal states (Bavaria and North Rhine-Westphalia) and an added cohort that reflects standard care. The trial is accompanied by a process evaluation.Each arm will receive a different set of implementation strategies. Arm A receives a standard set, comprising of e-learning on communication with patients and quality circles with data-based feedback for physicians, information campaigns for the public, patient information material and performance-based additional reimbursement. Arm B receives this standard set plus e-learning on communication with patients and quality circles with data-based feedback tailored for non-physician health professionals of the practice team and information material for tablet computers (culture sensitive). Arm C receives the standard set as well as a computerised decision support system and quality circles in local multidisciplinary groups.The study aims to recruit 193 practices which will provide data on 23,934 patients each year (47,867 patients in total).The outcome evaluation is based on claims data and refers to established indicators of the European Surveillance of Antimicrobial Consumption Network (ESAC-Net). Primary and secondary outcomes relate to prescribing of antibiotics, which will be analysed in multivariate regression models. The process evaluation is based on interviews with surveys among physicians, non-physician health professionals of the practice team and stakeholders. A patient survey is conducted in one of the study arms. Interview data will be qualitatively analysed using thematic framework analysis. Survey data of physicians, non-physician health professionals of the practice team and patients will use descriptive and exploratory statistics for analysis.DiscussionThe ARena trial will examine the effectiveness of large scale implementation strategies and explore their delivery in routine practice.Trial registrationISRCTN, ISRCTN58150046. Registered 24 August 2017.

Assessment of quality of nutrition information materials for pelvic cancer patients in the UK

Assessment of quality of nutrition information materials for pelvic cancer patients in the UK

Use of Plain-Language Guidelines to Promote Health Literacy

Research problem: Studies by the American Institute of Medicine and the European Health Literacy Survey describe considerable levels of either inadequate or problematic health literacy. This health literacy problem is intensified when frontline healthcare practitioners must rely on printed education materials to compensate for the lack of time to instruct patients about their health management. Applying plain-language guidelines to health promotion materials may increase their effectiveness, particularly for patients with low health literacy. Research questions: 1. In what ways have plain-language guidelines been applied in health information materials for patients with varying degrees of health literacy, according to recent studies? 2. Have studies found that materials that apply plain-language guidelines are effective in health information promotion? Methodology: This article presents the findings from an integrative literature review of research into the use of plain language to promote health literacy. The systematic review identified scholarly, evidence-based studies that included reference to the use of plain-language guidelines. This article describes the detailed selection process and characterizes the corpus of articles along four dimensions: objectives, methodology, plain-language guidelines used, and findings. Results and conclusions: The review identified 13 articles that explored the use of plain-language guidelines in health literacy promotion. Analysis of these articles demonstrates that plain-language guidelines could play a strategic role in educating patients. Use of plain language could help healthcare practitioners to communicate critical and sometimes very complex health information effectively.