Patient Participation In Treatment Research Articles

An Evaluation of the Health Economics of Postnatal Depression Prevention and Treatment Strategies in China: A Cost-Effectiveness Analysis.

The primary objectives of this study are to assess the cost-effectiveness of early postnatal screening and prenatal psychological interventions for the prevention and treatment of postpartum depression (PPD) among Chinese pregnant women. Additionally, we aim to explore the most cost-effective prevention and treatment strategies for PPD in China. We used TreeAge 2019 to construct a decision tree model, with the model assuming a simulated queue size of 10,000 people. The model employed Monte Carlo simulation to assess the cost-effectiveness of PPD prevention and treatment strategies. Transfer probabilities were derived from published studies and meta-analyses. Cost and effectiveness data were obtained from published sources and relevant studies. Incremental cost-effectiveness ratios (ICERs) were used to describe the results, with willingness-to-pay (WTP) thresholds set at China's gross domestic product (GDP) per capita. Compared to the usual care group, the cost per additional quality-adjusted life year (QALY) for the early postnatal screening group and the prenatal psychological interventions is USD 6840.28 and USD 3720.74, respectively. The cure rate of mixed treatments for PPD has the greatest impact on the model, while patient participation in treatment has a minor impact on the cost-effectiveness of prevention and treatment strategies. Both early postnatal screening and prenatal psychological interventions are found to be highly cost-effective strategies for preventing and treating PPD in China. Prenatal psychological interventions for pregnant women are the most cost-effective prevention and treatment strategy. As such, from the perspective of national payers, we recommend that maternal screening for PPD be implemented in China to identify high-risk groups early on and to facilitate effective intervention.

Current situation of shared decision making in osteoporosis: A comprehensive literature review of patient decision aids and decision drivers.

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microstructural deterioration of bone tissues, resulting in bone fragility and increased fracture risk. It is the most common bone-related disease in the population. However, the proportion of patients who start treatment but discontinue it during the first year is very high (around 50%). Endeavors are made to promote patient participation in treatment by implementing patient decision aids (PDA), whose function is to help the patient make disease-related decisions. We aim to summarize the characteristics of the currently available PDA for osteoporosis, as well as deciding factors. Comprehensive review of the literature. Currently, eleven PDAs can be found for osteoporosis. These PDA have different characteristics or options such as information about treatments tailored to patient needs, graphic information of the results (to facilitate understanding), personal histories (learning), tests to check the knowledge acquired, provision of evidence, clinical practice guidelines or a final summary to share with their doctor. Only five of these PDAs can be considered complete since they provide relevant disease information and therapeutic options to the patient, promote patient's reflection and foment patient-physician discussion. This study provides an update on the current state of decision making on osteoporosis and available PDA, which can help engage the patient through shared decision-making by considering, among other things, patient preferences. Physicians should consider PDA, as it may promote adherence and effectiveness of treatment.

Prevalence of social risks among oncology patients in an integrated health care delivery system.

128 Background: Social risks and needs can affect oncology treatment and outcomes, and some may be amenable to intervention before or during treatment. We surveyed Kaiser Permanente Northern California (KPNC) oncology patients to estimate prevalence of social risks among cancer patients. Methods: Adults undergoing treatment at KPNC infusion centers between 11/2021 – 05/2022 completed a print questionnaire that included questions about recent (past 3 month) financial strains, living, relationship, and transportation situation, and different aspects of social support. Results: A total of 767 patients completed surveys in English. Respondents were 63% female, median age 63y, and majority White (61% White, 19% Asian, 11% Latino, 7% Black) and college-educated (28% some college, 45% ≥ bachelor’s degree). About 20% lived alone, 35% were not in a committed relationship, 13% reported they did not usually get the social or emotional support they needed, and 3% often felt lonely or socially isolated. Approximately 24% said they had no one to help them with daily activities (shopping, cooking, transportation, etc.), 8% reported need for more help with daily activities, and 8% indicated that lack of transportation made it hard to get to medical appointments. Patients with no one to help them were more likely to indicate needing more help (14% vs. 6%). Additionally, while undergoing treatment, 6% were also acting as a primary caregiver to someone who was frail, chronically ill, or had a disability. Approximately 18% had experienced at last one recent financial strain, including trouble paying for medical/dental needs (9%), debts (8%), utilities (6%), food (5%), housing (3%), phone/internet (3%), or transportation (2%). Conclusions: Many patients lack adequate emotional and instrumental social support and may also be experiencing difficulties paying for recommended or essential medical and dental needs while undergoing cancer treatment. These findings highlight the importance of incorporating social risk screening into the oncology intake process so that this information is available to the oncology team for care planning and referral to institutional and community resources. In this way, the oncology care team may be able to improve social support and reduce financial and other barriers that may impact patient participation in treatment and treatment outcomes.

Patients and neurologists have different perceptions of multiple sclerosis symptoms, care and challenges

Background: Basic steps in the management of patients with Multiple Sclerosis (MS), such as good patient understanding of the disease and active participation in its management are extremely important, as they directly influence treatment adherence and success. Therefore, this study aimed to evaluate the perception of MS patients and neurologists pertaining to the most common disease symptoms, disabilities that impact on quality of life, and patient concerns and difficulties during medical visits, as information that can be used to improve the doctor-patient relationship. Methods: A cross-sectional study involving two groups: the first composed of neurologists and the second of patients. Participants of the first group were selected by a Steering Committee (15 predetermined neurologists representing each region of Brazil and specialized in MS and neuroimmunological disorders, who also assumed the role of creating the survey and questionnaire). Participants of the second group were selected following dissemination of a questionnaire on the AME's social networks (Amigos Múltiplos pela Esclerose, a non-governmental organization to support patients with MS). Questions about sociodemographic data, disease impact on quality of life, symptoms perception, and concerns and issues regarding disease care were put to both groups. Results: A total of 317 patients and 182 neurologists answered the questionnaires. Significant divergences were found between the perceptions of patients and neurologists in relation to orientation and information given during medical appointments, and also regarding patient participation in treatment and therapy choice. Considering the topic assessing impact on quality of life, more than 70% of neurologists perceived that autonomy to work and travel, and future planning were aspects that most affected patient lives, however, almost 50% of patients reported that disease monitoring did not affect their life in any way. Analysis of data regarding MS symptoms revealed neurologists to consider physical symptoms, such as ambulation issues, imbalance, falls and urinary incontinence, to be those most interfering with patient quality of life, whereas patients considered non-physical symptoms, such as fatigue, pain, cognitive and memory problems to be more significant. Patients with primary progressive MS complained more about ambulation issues, imbalance and falls (p<0.05), when compared to patients with other disease phenotypes. Conclusion: Significant differences in disease perception were found in this study. While neurologists tended to overestimate the consequences and symptoms of the disease, for most patients, the disease impact on activities did not appear to be as significant, with more complaints regarding non-physical symptoms. Although neurologists described involving patients in treatment decisions and providing them with appropriate orientation during medical appointments, the opposite was reported by patients. These results may help to improve treatment adherence and disease outcomes by redefining the doctor-patient relationship.

Cognitive dysfunction in first-episode schizophrenia and its correlation with negative symptoms and insight.

Background:Cognitive dysfunction in schizophrenia is a well-known feature and can adversely affect the patient participation in treatment and rehabilitation. Studies have shown its relationship to the severity of negative symptoms and level of insight also. Not many Indian studies are available on this in first-episode schizophrenia, and hence, this study was undertaken.Materials and Methods:Eight-five cases of first-episode schizophrenia fulfilling inclusion criteria were included in the study after ethical clearance, informed consent, and stabilization of acute symptoms. All were assessed using psychosocial pro forma, Addenbrooke's Cognitive Examination-III Scale, positive and negative syndrome scale, and schedule for the assessment of insight. Data analysis was done using Statistical Package for Social Sciences Version 20:0.Results:Cognitive dysfunction was seen in 40% of patients. Maximum dysfunction was in the memory domain followed by fluency domain and language domain was relatively well preserved. A significant negative correlation was observed between cognitive function and negative symptoms, but a significant positive correlation was seen with insight.Conclusion:Cognitive dysfunction is present in a significant proportion of schizophrenia in the first episode itself. Early assessment will facilitate appropriate interventions directed at insight and cognitive rehabilitation.

Questionnaire measuring patient participation in health care: Scale development and psychometric evaluation.

Patient participation in treatment and care is often encouraged and is desirable because of its proven positive impact on treatment, quality of care and patient safety. To develop an instrument to measure patient participation in health care and to investigate the measurement properties of the Patient Participation Questionnaire (PPQ). A literature review was conducted to develop a model of patient participation. The PPQ was constructed consisting of 17 items organized into four subscales. Psychometric evaluation of factor structure, convergent construct validity by hypothesis testing and analyses of internal consistency using Cronbach's alpha were performed on data from a hospitalised mixed group of patients with cardiac disease, pulmonary disease and cancer (N=378 patients). Confirmatory factor analysis did not show a clear model fit, which is why an exploratory factor analysis was performed, suggesting a different four subscale structure consisting of a total of 16 items. The four subscales were labelled Shared decision power, Adapted and individualized knowledge, Collaboration and Human approach. There were strong ceiling effects on all items. Analysis of convergent construct validity showed a moderate correlation (0.59) between the PPQ and another instrument measuring patient participation. Internal consistency for the total PPQ score was high: 0.89. In a mixed group of patients with cardiac disease, pulmonary disease and cancer, the PPQ showed promising psychometric properties in terms of factor structure, convergent construct validity and internal consistency. The PPQ may be used to shed light on the experience of patient participation and guide quality improvements.

Learning to stand tall: Idiopathic scoliosis, behavioral electronics, and technologically-assisted patient participation in treatment, c. 1969-1992.

Drawing on the archives of American learning psychologist Neal E. Miller, this article investigates the role of instrumentation in the expansion and diversification of the behavior therapy domain from the late 1960s to the early 1990s. Through the case of Miller's research on the use of biofeedback to treat idiopathic scoliosis, it argues that the post-World War II adoption of electronic technology by behavioral psychologists contributed to extending their subject matter to include physiological processes and somatic conditions. It also enabled a technologically-instrumented move outside the laboratory through the development of portable ambulatory treatment devices. Using the example of the Posture-Training Device that Miller and his collaborators invented for the behavioral treatment of idiopathic scoliosis, this paper considers how electromechanical psychological instrumentation illustrated a larger and ambiguous strategic shift in behavior therapy from an orientation toward external control to one of self-control.

Four categories of patient participation in treatment and their linkage to decision-making in a structure of 81 models

We clarify patient participation by developing a systematic structure of 3&lt;sup&gt;4&lt;/sup&gt;=81 models spanned out by three subcategories for each of four categories. Choosing a qualitative descriptive research design, and applying purposive sampling, four doctors, seven nurses, and seven patients were selected to ensure a broad representative sample with experts of varying ages and sexes from medicine and nursing. The preferences of these were mapped onto the theoretical structure. Applying content analysis, meaning units were identified, condensed and coded. The four categories information dissemination, formulation of options, integration of information and control were shown to be exhaustive, and mutually exclusive through time causing a topdown process where one occurs before the other through four stages. The three subcategories specify how patients, healthcare professionals, or both, operate within each category. That is, either patients are active in some sense that is specified, or healthcare professionals are active in some sense, or both are active. Delineating a structure of 3&lt;sup&gt;4&lt;/sup&gt;=81 models, based on four categories and three subcategories, gives a richer structure than what has earlier been available. This almost all-embracing structure enables pinpointing the exact nature of any culture involved in care of patients, which illuminates how the culture reflects or can potentially be altered to reflect values of patient care that we respect.

Predictors of Dental Patients’ Satisfaction in a Greek Sample

Aims: To evaluate patien t factors, provider factors, and factors related to the patient - provider experience which may predict patient satisfaction with dental appointments. Study Design : A cross - sectional design was used. Place and Duration of Study: Data were gathered from denta l students and their patients at Aristotle University of Thessaloniki, Greece between October, 2010 and April, 2011. Methodology: Data from 157 dental students and 484 of their patients were included. Patients completed questionnaires including the Patient Communication Style Scale, the Patient Assessment Questionnaire, and the Dental Visit Satisfaction Scale, and items measuring the patient’s prior experience with his/her student dentist. Dental students completed questionnaires included the Toronto Compos ite Empathy Scale and the Attitudes Toward Patient Education Scale. Participants also provided demographic information, and the type of dental treatment received was recorded. Results: Patient satisfaction was associated with student communication skills ( P <.001) and dyadic congruence about patient participation in treatment - planning ( P <.001). Empathy was

Treatment components for upper limb rehabilitation after stroke: a survey of UK national practice

Purpose: The aim of this study was to delineate the type of treatment currently provided to rehabilitate the upper limb following stroke in order to inform the treatment protocol for a control arm of a future pragmatic clinical trial of assistive technologies. Method: A national survey of stroke teams was conducted. Using open-ended, free script questions, the survey was designed to capture the important components of treatment that are most commonly used to treat patients described as mild, moderate or severely impaired following stroke. Stroke teams were targeted within the 28 geographical areas covered by the Stroke Improvement Networks. Result: Treatment descriptions were returned by 53 stroke teams from 20 of the 28 geographical areas. In total, 998 treatment components were provided – 289 for mildly, 403 for moderately and 306 for severely impairment patients following stroke). These captured five substantive treatment categories in terms of most active, moderately active and non-active patient participation in treatment as well as assistive technologies and other. Conclusion: From the treatment components described, the highest number of treatment components was listed for the moderately impaired patient. The treatment components used by the units surveyed are quite consistent with the 2012 Clinical Guidelines for Stroke.Implications for RehabilitationThe survey captured five substantive categories of treatment that describe most active patient participation, moderately active patient participation, non-active patient participation, assistive technology and other.Overall, the treatment components described by the units are quite consistent with the 2012 UK Clinical Guidelines for Stroke.Assistive technologies were not widely used in the units surveyed but when used constraint-induced movement therapy was most commonly used with mildly impaired patients and electrical stimulation was most common with moderately and severely impaired patients.

AB1398 Biofeedback therapy in complex treatment of systemic sclerosis

BackgroundVarious methods of non-medicinal therapy of systemic sclerosis (SS) were offered, but any of them does not allow achieving desirable success. It is known that active participation of patient in...

Measuring patient participation in surgical treatment decision‐making from healthcare professionals' perspective

To develop, empirical test, and validate an instrument measuring patient participation in surgical treatment decision-making from healthcare professionals' perspective. Since the advent of New Public Management in many Western countries, patient participation in healthcare decision-making has been considered to be a best practice. A common notion is that well-educated and well-informed public want to choose their own treatments and providers and want to ask questions about the quality of their health services. Survey. A self-report-measuring instrument was designed and administered to 620 healthcare professionals. Items were developed, validated and tested by 451 nurses and physicians working in six surgical wards in a University Hospital in Norway. A 16-item scale with the following four dimensions was developed: information dissemination, formulation of options, integration of information and control. Factor analysis procedures and reliability testing were performed. A one-way, between-groups analysis of variance was conducted to compare doctors' and nurses' opinions on four dimensions of patient participation in surgical treatment decision-making. This article shows that patient participation in surgical treatment decision-making can be measured by a 16-item scale and four distinct dimensions. The analysis demonstrated a reasonable level of construct validity and reliability. Nurses and physicians have a positive attitude towards patient participation overall, but the two groups differ in the extent to which they accept the idea of patient participation in treatment decision-making. The instrument can be a tool for managers and healthcare professionals in the implementation of patient participation in clinical practice. Data from the instrument can be useful to identify health services being provided and what areas that could strengthen patient participation.

Giving rheumatology patients online home access to their electronic medical record (EMR): advantages, drawbacks and preconditions according to care providers

Technology enables patients home access to their electronic medical record (EMR), via a patient portal. This study aims to analyse (dis)advantages, preconditions and suitable content for this service, according to rheumatology health professionals. A two-phase policy Delphi study was conducted. First, interviews were performed with nurses/nurse practitioners (n = 9) and rheumatologists (n = 13). Subsequently, collected responses were quantified, using a questionnaire among the interviewees. The following advantages of patient home access to the EMR were reported: (1) enhancement of patient participation in treatment, (2) increased knowledge and self-management, (3) improved patient–provider interaction, (4) increased patient safety, and (5) better communication with others. Foreseen disadvantages of the service included: (1) problems with interpretation of data, (2) extra workload, (3) a change in consultation content, and (4) disturbing the patient–provider interaction. Also, the following preconditions emerged from the data: (1) optimal security, (2) no extra record, but a patient-accessible section, (3) no access to clinical notes, and (4) a lag time on the release of lab data. Most respondents reported that data on diagnosis, medication, treatment plan and consultations could be released to patients. On releasing more complex data, such as bodily examinations, lab results and radiological images the opinions differed considerably. Providing patients home access to their medical record might be a valuable next step into patient empowerment and in service towards the patient, provided that security is optimal and content and presentation of data are carefully considered.

Nurses’ perceptions of patient participation in hemodialysis treatment

The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses' power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions.

Brukerperspektiv i norsk forskning om innlagte psykiatriske pasienter. En litteraturgjennomgang

The current Norwegian national plan for mental health and other public documents emphasizes the need to include patient experiences and patient participation in treatment and organising psychiatric care. However, it is not clear whether this should apply to psychiatric research involving psychiatric inpatients, and Norwegian research that rely on the experiences of psychiatric inpatients seems scattered. There is a need to summarize this field, and the aim of the present analysis was to review Norwegian research based on psychiatric inpatients' experiences since 1970. A main finding is that during the 1970s the field was dominated by social scientists with fewer such studies in the 1980s while nursing scientists dominated the field since 2000. The relative absence of psychiatric inpatient's voices in psychiatric research may reflect a bio-medical approach to mental illnesses. A critical or relativist paradigm will on the other side nurture such research. Important aspects of the lives of psychiatric inpatients concern being locked up, experiencing organizational changes, and stigmatization as a psychiatric patient. Knowledge of these aspects may be gained only by asking patients themselves.

Improving public addiction treatment through performance contracting: The Delaware experiment

In fiscal 2002, Delaware replaced traditional cost-reimbursement contracts with performance-based contracts for all outpatient addiction treatment programs. Incentives included 90% capacity utilization and active patient participation in treatment. One of the programs failed to meet requirements. Strategies adopted by successful programs included extended hours of operation, facility enhancements, salary incentives for counselors, and two evidence-based therapies (MI and CBT). Average capacity utilization from 2001 to 2006 went from 54% to 95%; and the average proportion of patients' meeting participation requirements went from 53% to 70%--with no notable changes in the patient population. We conclude that properly designed, program-based contract incentives are feasible to apply, welcomed by programs and may help set the financial conditions necessary to implement other evidence-based clinical efforts; toward the overall goal of improving addiction treatment.

Cultural influences on the physician–patient encounter: The case of shared treatment decision-making

Objective In this paper we discuss the influence of culture on the process of treatment decision-making, and in particular, shared treatment decision-making in the physician–patient encounter. We explore two key issues: (1) the meaning of culture and the ways that it can affect treatment decision-making; (2) cultural issues and assumptions underlying the development and use of treatment decision aids. Methods This is a conceptual paper. Based on our knowledge and reading of the key literature in the treatment decision-making field, we looked for written examples where cultural influences were taken into account when discussing the physician–patient encounter and when designing instruments (decision aids) to help patients participate in making decisions. Results Our assessment of the situation is that to date, and with some recent exceptions, research in the above areas has not been culturally sensitive. Conclusion We suggest that more research attention should be focused on exploring potential cultural variations in the meaning of and preferences for shared decision-making as well as on the applicability across cultural groups of decision aids developed to facilitate patient participation in treatment decision-making with physicians. Practice implications Both patients and physicians need to be aware of the cultural assumptions underlying the development and use of decision aids and assess their cultural sensitivity to the needs and preferences of patients in diverse cultural groups.

Patients with Cancer: their approaches to participation in treatment plan decisions

The aim of this study was to explore experiences of participation in treatment planning decisions from the perspective of patients recently treated for colorectal cancer. Ten patients were purposively selected and interviewed. Constant comparative analysis, the core concept of grounded theory, was used. The dimensions were developed and organized into the main theme of 'compliant participation in serious decisions', which was composed of the two variations: complying with participation; and complying without participation. Complying with participation was characterized by feelings of self-confidence and self-competence and by open dialogue between the participants, significant others and the physician. Complying without participation was characterized by participants' feelings of uncertainty and distress, and of being rushed into submitting to decisions without having time to reflect on the information provided or the opportunity to influence the treatment and care process. To participate (or choosing not to participate) builds on open and affirming dialogue, information and knowledge about the illness. Patient participation in treatment and care decision making is interpreted as a health promoting way of coping with illness.

Implementing Programs for Chronic Illness Management: The Case of Hypertension Services

This article describes the process by which HealthSystem Minnesota (a vertically integrated health care organization), functioning in a competitive managed care environment, has been implementing a hypertension services program. The program involves a team approach to care, with emphasis on patient participation in treatment; decentralized care delivery by nurse coordinators at primary care practice sites; ongoing training and education for patients and providers; and the continuous monitoring and evaluation of patient outcomes and satisfaction. JOB-LEVEL ISSUES: A variety of issues, such as the role and responsibilities of the nurse coordinator, became evident as the program moved towards operational status at four primary care practice sites, which prolonged the implementation period. PROCESS-LEVEL ISSUES: Issues relating to work process changes were more complicated to resolve and required, in some cases, changes in the proposed model. The most significant process-level issues related to educating physicians about the program to secure their participation and support. ORGANIZATION-LEVEL ISSUES: Such issues, which were the most difficult for program implementors to anticipate and resolve, included an organizational culture that emphasized decision making autonomy at primary practice sites. In part, the difficulty encountered in resolving organization-level issues reflected the implementors' lack of awareness of the strength or complexity of the environmental pressures facing the organization, as well as a lack of sensitivity to nuances relating to organizational culture. Two groups of hypertensive patients--at the implementation and comparison sites--will be compared with respect to satisfaction with care, clinical outcomes, and costs. Expansion of the model to patients with other chronic conditions is under consideration.

Principles of Soft Tissue Treatment

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