Patient Perceptions Of Care Research Articles

Management of cranial Diabetes Insipidus in a tertiary centre - clinical outcomes and patient perception of care

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Assessing oncology patient and provider telehealth experience.

284 Background: Due to COVID-19, telehealth volume at our comprehensive cancer center rose from less than 5% of exam visits to over 25% in April 2020. We sought to understand the experience of telehealth and compare it to in-person experiences for patients and providers (physicians, nurse practitioners, and physician assistants) to identify areas for improvement. Methods: A multidisciplinary team adapted our existing patient satisfaction survey to incorporate telehealth, defined as phone and video exam visits. A technology section was created to assess aspects unique to telehealth. Questions about the patient-provider experience were the same for telehealth and in-person visits. A provider experience survey was conducted during a two-week period in May and June 2020. The provider survey aligned questions with the patient survey to compare the perceptions of the provider-patient interaction. Results: Patient experience scores for in-person and telehealth visits were comparable, with a slightly higher mean score for in-person visits. The mean scores for patient perception of care given at our cancer center was 97.5 (n=11,969) and 96.9 (n=4670) and the likelihood to recommend was 97.8 (n=12,072) and 97.4 (n=4,398) for in-person and telehealth, respectively, between June and December 2020. Patient feedback prioritized addressing technical barriers. We implemented several interventions and increased the telehealth technology section mean scores from 93.2 (n=1,095) to 95.2 (n=700) between June and December 2020. When comparing the percent of respondents scoring good or very good, provider scores showed sizable gaps between in-person and telehealth experiences on all questions (see table). The question “degree to which the care team was well coordinated” had the largest difference between in-person and telehealth scores for both patients and providers. Several interventions to adapt staffing and workflows have been implemented to improve care telehealth coordination. Conclusions: While patients reported similar satisfaction between in-person and telehealth visits, increasing coordination remains vital to improving the experience for both patients and providers. Furthermore, understanding the gap in the provider experience between in-person and telehealth is critical for successful adoption of telehealth as a long-term strategy for healthcare delivery.[Table: see text]

Healthcare worker mental models of patient care tasks in the context of infection prevention and control.

Understanding the cognitive determinants of healthcare worker (HCW) behavior is important for improving the use of infection prevention and control (IPC) practices. Given a patient requiring only standard precautions, we examined the dimensions along which different populations of HCWs cognitively organize patient care tasks (ie, their mental models). HCWs read a description of a patient and then rated the similarities of 25 patient care tasks from an infection prevention perspective. Using multidimensional scaling, we identified the dimensions (ie, characteristics of tasks) underlying these ratings and the salience of each dimension to HCWs. Adult inpatient hospitals across an academic hospital network. In total, 40 HCWs, comprising infection preventionists and nurses from intensive care units, emergency departments, and medical-surgical floors rated the similarity of tasks. To identify the meaning of each dimension, another 6 nurses rated each task in terms of specific characteristics of tasks. Each HCW population perceived patient care tasks to vary along 3 common dimensions; most salient was the perceived magnitude of infection risk to the patient in a task, followed by the perceived dirtiness and risk of HCW exposure to body fluids, and lastly, the relative importance of a task for preventing versus controlling an infection in a patient. For a patient requiring only standard precautions, different populations of HCWs have similar mental models of how various patient care tasks relate to IPC. Techniques for eliciting mental models open new avenues for understanding and ultimately modifying the cognitive determinants of IPC behaviors.

Association of Provider Perspectives on Race and Racial Health Care Disparities with Patient Perceptions of Care and Health Outcomes.

Purpose: Research suggests that providers contribute to racial disparities in health outcomes. Identifying modifiable provider perspectives that are associated with decreased racial disparities will help in the design of effective educational interventions for providers.Methods: This cross-sectional study investigated the association between primary care provider (PCP) perspectives on race and racial disparities with patient outcomes.Results: Study participants included 40 PCPs (70% White, 30% racial minority) caring for 55 patients (45% White, 55% Black) with type 2 diabetes mellitus. Associations of provider perspectives on race and racial disparities with patient variables (Interpersonal Processes of Care [IPC] Survey, which measures patient's ratings of their provider's interpersonal skills; medication adherence; glycemic control) were measured using Spearman correlation coefficients. Results suggest that Black patients of providers who reported greater skill in caring for Black patients had more positive perceptions of care in three of four IPC subdomains (Spearman correlation coefficients of −0.43, 0.44, 0.46, all with p<0.05); however, Black patients of providers who believe that racial disparities are highly prevalent had more negative perceptions of care in three of four IPC subdomains (Spearman correlation coefficients of 0.38, −0.53, −0.51, all with p<0.05). These same provider characteristics had no correlation with outcomes of medication adherence and hemoglobin A1c (HbA1c) or among White patients.Conclusion: Findings suggest that Black patients of providers who felt better equipped to take care of Black patients had a better experience. Therefore, educational interventions for providers may be most effective if they focus on skill development rather than increasing awareness about racial disparities alone.

48-LB: Associations between Health Literacy and Patient Perceptions of Care in Poorly Controlled Diabetes

Background: Low health literacy (HL) is a barrier to improving health outcomes in patients with type 2 diabetes (T2DM). The Newest Vital Sign (NVS) is a validated, short questionnaire for assessing HL. The relationship between NVS HL and patient-reported diabetes behavioral and patient-provider interaction measures, particularly among patients with poor glycemic control, is currently unknown. Methods: Cross-sectional analysis of baseline data of 248 Veterans with poorly controlled T2DM (maintenance of hemoglobin A1c (HbA1c) ≥8.5% despite engagement with diabetes care) from a randomized trial of a telehealth intervention. NVS was collected at baseline, along with other demographic, clinical, and psychosocial metrics. We used multivariable regression with restricted cubic splines for continuous covariates to explore associations between baseline NVS and four measures (Diabetes Knowledge Questionnaire (DKQ), Diabetes Self-Management Questionnaire (DSMQ), Perceived Competence Scale (PCS), and Healthcare Climate Questionnaire (HCCQ)). Results: The sample had a mean age of 58.1 (SD = 8.3) years, was 78.6% male and 76.2% non-White. Average HbA1c was 9.8 (SD = 1.5) and average NVS was 3.4 (SD = 2.0). After adjusting for demographic, clinical, and psychosocial factors, NVS was significantly associated (linearly) with DKQ and PCS scores, but not DSMQ or HCCQ scores. For every 1-point increase in NVS, the DKQ score increased by 0.33 (95% CI 0.13, 0.52, P = 0.0010) and PCS score decreased by 0.11 (95% CI -0.21, -0.0081, P = 0.034), indicating that higher HL is associated with higher diabetes knowledge and lower perceived competence. Conclusions: The direct association of NVS HL with DKQ scores is consistent with literature using other HL metrics among general T2DM populations; however, the indirect association of NVS HL with PCS scores is less intuitive, suggesting a possible misplaced confidence among patients with higher HL yet poor glycemic control despite diabetes care engagement. Disclosure E. A. Kobe: None. J. German: None. D. Soliman: None. A. Alexopoulos: None. A. S. Jeffreys: None. D. Edelman: None. C. Coffman: None. M. Crowley: None. Funding National Center For Advancing Translational Sciences (TL1TR002555 to E.A.K.); U.S. Department of Veterans Affairs (IIR 16-213 to M.C.)

Burnout and its relationship to self-reported quality of patient care and adverse events during COVID-19: A cross-sectional online survey among nurses.

AimsTo assess nurses' burnout and its association with their perceived quality of patient care and occurrence of adverse events (AEs) during COVID‐19.BackgroundBurnout is a serious problem among nursing staff internationally with negative impacts on the quality of care and patient safety.MethodsWe conducted a cross‐sectional online study among 1,004 Iranian nurses through the convenience sampling technique. Data were collected using the Maslach Burnout Inventory, five items of questions related to self‐reported poor patient care quality and estimated occurrence of AEs.ResultsPrevalence of high burnout among nurses was 31.5%. The risk of AEs ranged from 26.1% to 71.7%. Self‐reported quality of patient care was found to be poor. A positive correlation was found between emotional exhaustion and depersonalization scores and patient care quality, whereas a negative correlation was found between personal accomplishment scores and all poor care item scores. Depersonalization was found to increase the risk of the onset of all AEs (odds ratio [OR] = 1.06–1.08). Also, Personal accomplishmentreduced the risk of occurrence of ‘medication errors’ (OR = 0.99) and the onset of ‘patient and their family verbal abuse’ (OR = 0.97).ConclusionsOur findings confirmed the hypothesis that a higher degree of burnout is correlated with a perceived higher number of AEs and reduced perceived patient care quality.Implications for Nursing ManagementReducing burnout among nurses through implementing interventions may be an effective strategy to enhance patient care quality and reduce the number of AEs in Iranian public hospitals. Therefore, in order to minimize work burnout, primary approaches include access to psychosocial support, including Web‐based services, psychological first aid, mental support hotlines and self‐care techniques during the COVID‐19 pandemic.

Swedish registered nurses' perceptions of caring for patients with intellectual and developmental disability: A qualitative descriptive study.

Patients with intellectual and developmental disability (IDD) are often misinterpreted and misunderstood. Studies show that, in general, healthcare professionals have limited knowledge about IDD, and registered nurses (RNs) often report feeling unprepared to support this group of patients. Therefore, more knowledge about how to adequately address care for this patient group is warranted. This qualitative study employs an interpretative descriptive design to explore and describe Swedish RNs' perceptions of caring for patients with IDD, here in a home-care setting. Twenty RNs were interviewed between September 2018 and May 2019, and the resulting data were analysed through an inductive qualitative content analysis. The study adheres to consolidated criteria for reporting qualitative research (COREQ). Our analysis found that nurses' perceptions of caring for patients with an IDD could be understood from three overarching categories: nursing held hostage in the context of care, care dependent on intuition and proven experience and contending for the patients' right to adequate care. Our findings show that the home-care context and organisation were not adjusted to the needs of the patients. This resulted in RNs feeling unable to provide care in accordance with their professional values. They also explained that they had not mastered the available augmentative and alternative communication tools, instead using support staff as interpreters for their patients. Finally, on a daily basis, the RNs caring for this group of patients took an active stance and fought for the patients' right to receive the right care at the right time by the right person. This was particularly the case with issues involving psychiatric care.

Exploring nurses' experiences of value congruence and the perceived relationship with wellbeing and patient care and safety: a qualitative study.

BackgroundValues are of high importance to the nursing profession. Value congruence is the extent to which an individual’s values align with the values of their organisation. Value congruence has important implications for job satisfaction.AimThis study explored nurse values, value congruence and potential implications for individual nurses and organisations in terms of wellbeing and patient care and safety.MethodFifteen nurses who worked in acute hospital settings within the UK participated in semi-structured telephone interviews. Thematic analysis was utilised to analyse the data.ResultsFour themes were identified: organisational values incongruent with the work environment; personal and professional value alignment; nurse and supervisor values in conflict; nurses’ values at odds with the work environment. Perceived value incongruence was related to poorer wellbeing, increased burnout and poorer perceived patient care and safety. The barriers identified for nurses being able to work in line with their values are described.ConclusionsValue congruence is important for nurse wellbeing and patient care and safety. Improving the alignment between the values that organisations state they hold, and the values implied by the work environment may help improve patient care and safety and support nurses in practice.

A patients\u2019 view of OA: the Global Osteoarthritis Patient Perception Survey (GOAPPS), a pilot study

BackgroundGlobally, osteoarthritis (OA) is the third condition associated with disability. There is still poor treatment in OA but science holds the key to finding better treatments and a cure. It is essential to learn what’s important to patients from them to implement the most effective OA management. The OA Patients Task Force, conducted the Global OA Patient Perception Survey (GOAPPS)-the first global survey made by patients to analize the quality of life (QoL) & patient perceptions of care. The goal was to collect data on OA patients’ perception of OA to understand patients’ needs and expectations to improve OA management.MethodsObservational, cross-sectional study by online survey data collection from six countries, translated into three languages. The questionnaire was comprised of 3 sections: patient demographics and clinical symptomology characteristics; relationship with physicians: perception of attention, treatment, and information provided; and OA impact on daily activity and QoL. The results of the survey were evaluated using the Limited Data Set. The survey results were analyzed using descriptive statistics to characterize the patients’ answers. Additionally, Cronbach’s alpha was calculated to determine internal consistency validity.ResultsA total of 1512 surveys were completed in 6 countries. 84.2% of respondents reported pain/tenderness and 91.1% experienced limitations to physical activities. 42.3% of patients were not satisfied with their current OA treatment. 86% had comorbidities, especially hypertension, and obesity. 51.3 and 78% would like access to additional drug or additional non-drug/non-surgical treatments respectively. 48.2% of patients perceived their QoL to be affected by OA. The Cronbach’s alpha was 0.61.ConclusionsOA has a significant impact on patients’ daily activities and their desire to play an active role in managing this disease. Patients are seeking additional treatments, especially no pharmacological/no surgical treatments stressing the need for investing in clinical research, implementing OA preventive measures, and managing interventions to improve the healthcare value chain in OA.

Impact of Physician Attire on Perception of Patient Care is Different for Patients and Family Members on an Inpatient Palliative Care Ward

Shimizu, Atsushi MD PhD; Takeuchi, Mitsue MD; Kurosaki, Fumio MD PhD; Tamba, Kaichiro MD PhD; Sata, Naohiro MD PhD; Kawarai Lefor, Alan MD MPH PhD FACS Author Information

2. IMPACT OF X+Y SCHEDULING ON FACULTY PERCEPTIONS OF RESIDENT EDUCATION - RESULTS FROM THE PEDIATRIC X+Y SCHEDULING COLLABORATIVE

Background Traditional half-day per week continuity clinic experiences can lead to fragmented education in both the inpatient and outpatient arenas. Five pediatric residency programs were granted the ability from the ACGME in 2018 to create true X+Y scheduling models where residents see continuity clinic patients in blocks rather than half-day per week experiences. Objective Assess the impact X+Y scheduling has on pediatric faculty perceptions of patient care and other educational experiences. Methods Surveys were sent via REDCap to faculty of the five participating X+Y pilot programs both prior to and 12 months after implementing an X+Y scheduling model. The surveys elicited the clinical focus of the faculty (general pediatrics, hospital medicine, or other subspecialties). Questions were then tailored to the area of clinical focus to determine the impact continuity clinic schedules had on general pediatrics, hospitalist, and subspecialty rotation experiences using a 5-point Likert scale. Data were analyzed using z-tests for proportion differences for those answering Agree or Strongly Agree between baseline and post-implementation respondents. Results 384 faculty members were sent the survey with 51% response pre-implementation and 32% response at 12 months. Each general pediatrics faculty outcome was improved in the X+Y model compared to traditional clinic schedules (p Conclusions General pediatric and hospitalist faculty perceive improved patient continuity and enhanced educational opportunities in X+Y scheduling compared to traditional half-day per week continuity clinics. Hospitalist and other subspecialty faculty note no significant impact on educational time after X+Y schedule implementation.

80. X+Y SCHEDULING IMPROVES SEVERAL ASPECTS OF RESIDENT EDUCATION YEAR 1 RESULTS FROM THE PEDIATRIC X+Y SCHEDULING COLLABORATIVE

Background Traditional half-day per week continuity clinic experiences can lead to fragmented education in both the inpatient and outpatient arenas. Five pediatric residency programs were granted the ability from the ACGME in 2018 to create true X+Y scheduling models where residents see continuity clinic patients in “blocks” rather than half-day per week experiences. Objective Assess the impact X+Y scheduling has on pediatric resident perceptions of patient care and other educational experiences. Methods Surveys were sent via REDCap to pediatric residents of the five participating X+Y pilot programs both prior to and 12 months after implementing an X+Y scheduling model. Survey questions measured resident perception of outpatient continuity, clinic schedule satisfaction, and the impact continuity clinic schedules had on inpatient and subspecialty rotation experiences using a 5-point Likert scale. Data were analyzed using z-tests for proportion differences for those answering Agree or Strongly Agree between baseline and post-implementation respondents. Results 126 out of 183 residents responded to the pre survey and 122 out of 259 residents responded to the post-implementation survey. Each outcome measure evaluated showed significant difference (p Conclusions Residents perceive improved patient continuity and better quality of inpatient handoffs along with enhanced educational opportunities in X+Y scheduling compared to traditional half-day per week continuity clinic scheduling.

Development, Reliability, and Validity of the Perceptions of Brain Injury Survey.

The purpose of this study was to assess psychometric properties of the Perceptions of Brain Injury Survey (PBIS), an instrument designed to assess nurses' perceptions and preparation to care for patients with traumatic brain injury (TBI). We adapted two instruments to create the PBIS, and 724 nurses completed the PBIS at three hospitals. Final instrument has 66 items and is composed of four subscales, which can be used independently. Results showed Cronbach's alpha for the overall scale was excellent (.93) and alphas for each composite subscale were acceptable to excellent (.73-.93). Findings also suggest good discriminant validity and evidence of external validity. The PBIS is a reliable and valid measure for assessing nurses' perceptions of caring for patients with TBI in practice or research.

Clinical characteristics and health care received among patients with type 2 diabetes attending secondary and tertiary healthcare facilities in Mwanza Region, Tanzania: a cross-sectional study

BackgroundTanzania is among the sub-Saharan African countries facing a tremendous increase in the burden of type 2 diabetes mellitus. In order to provide diabetes health care services, the government has established diabetes care clinics in secondary and tertiary healthcare facilities. However, previous studies have demonstrated a disparity in availability of supplies and equipment for provision of diabetes health care services at these healthcare facilities. This study aims to assess the clinical characteristics and health care received among patients with type 2 diabetes attending secondary and tertiary healthcare facilities in Mwanza Region, Tanzania.MethodsA cross-sectional study was conducted in Mwanza Region from June to September, 2018.Three hundred and thirty patients were selected by systematic random sampling from three healthcare facilities. A structured questionnaire was utilized to collect information on patient characteristics, health care received and patient perception of care. Patient blood pressure, blood glucose, weight and height were measured during the study. Percentages, chi-square tests and multivariable analysis were conducted to obtain the proportions, make comparisons and determining the correlates of tertiary-level healthcare facility.ResultsApproximately half of respondents (54.5%) were from secondary healthcare facilities. The prevalence of hypertension (63.3%), hyperglycemia (95.8%) and obesity (93.3%) were high. The prevalence of hyperglycemia was slightly higher at secondary-level healthcare facility (p = 0.005). The proportion of respondents recently diagnosed with diabetes (≤ 10 years) was significantly higher at tertiary-level healthcare facility (p = 0.000). The prevalence of diabetes related complications was higher at tertiary-level healthcare facility (80.7% versus 53.3%, p = 0.000). Assessments of body weight, blood pressure, blood glucose, feet and eye examination were conducted on a monthly basis at all facilities. None of the respondents had undergone lipid profile testing. All of the respondents (100%) received care from a nurse during diabetes clinic visits and half of the respondents (49.7%) also received care from a clinician. Relatively young patients, married and recently diagnosed patients were more likely to attend clinic at tertiary facilities. Tertiary-level healthcare facilities were more likely to have patients with complications and to have a dietitian available at the clinic.

The impact of obesity in rehabilitation: a mismatch between staff perception and hospital outcomes

Purpose To establish the prevalence of obesity in an inpatient rehabilitation setting, examine its impact on hospital outcomes, and explore staff perceptions of caring for patients with obesity. Methods A retrospective audit of inpatients admitted to a sub-acute rehabilitation hospital over 12 months. Hospital outcomes included length of stay (LOS), Functional Independence measure (FIM), and discharge destination. Linear regression models were used to determine whether obesity was associated with hospital outcomes. Staff working on rehabilitation wards were invited to complete a survey exploring their perceptions on caring for those who are obese. Results Of 1280 episodes of care, 359 (28%) patients were classified as obese with a body mass index ≥30 kg/m2. Obesity was not associated with LOS or functional improvement after controlling for age, gender, and admission FIM. One hundred and twelve hospital staff (response rate 71%) completed the survey. Most rated their bariatric care knowledge as average (45%) or good (36%). The majority (60%) perceived that patients with obesity have longer LOS than those who are non-obese. Conclusion One-third of patients admitted to inpatient subacute rehabilitation were classified as obese. Whilst obesity was not associated with poorer hospital outcomes, staff perceived that obesity negatively impacts on care requirements and LOS. Implications for rehabilitation A third of patients admitted to a public, inpatient rehabilitation setting may be classified as obese based on their body mass index. Although staff perceived that obesity negatively impacts on length of stay and functional gains, there was no evidence that obesity was associated with poorer hospital outcomes. Patients who are classified as obese were able to achieve comparable hospital outcomes including length of stay in the rehabilitation setting to those who are not obese.

Oncology Nursing Considerations when Developing Outpatient Staffing and Acuity Models.

Objectives include review of existing benchmarks and nurse-sensitive indicators relevant to the ambulatory care setting. Applying the data to existing ambulatory staffing models with consideration of multiple clinic settings that include medical oncology, infusion, and stem cell transplant clinics. And to describe key considerations needed to optimize oncology care efficiently with an acuity-based staffing model. Published literature indexed in PubMed, CINAHL, textbooks. In today's complex oncology environment, optimization and utilization of outpatient facilities is essential in providing high-quality care and improving satisfaction of patients as well as providers and staff. Nurse leaders should utilize benchmarking data to ensure staffing levels are appropriate, given the size and scope of their facility. Staff nurses should be engaged to ensure that acuity tools are developed in accordance with their experiences and perceptions of patient care.

The impact of Maryland all-payer model on patient satisfaction of care: A one-way analysis of variance (ANOVA)

ABSTRACT The purpose of this study was to assess if patient satisfaction, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) significantly differ by year in the Maryland Global Payment implementation cycle. Data on inpatient ratings of hospital services was acquired from The Centers for Medicare and Medicaid Services (CMS). A non-experimental correlational design was used to examine the outcome and predictor variables during three points in time. A one-way analysis of variance (ANOVA) analyzed patient satisfaction scores of nine variables on the HCAHPS survey. The dataset included patient’s average satisfaction scores of hospitals by states. Maryland’s hospital data were extracted and manipulated with a pivot table from the HCAHPS original dataset for analysis. Communication about medicines was the only statistically significant difference observed during the study (F(2, 123) = 3.592, p = .030). The findings of this study can encourage healthcare providers and policymakers to place a high value on the creation and implementation of payment models to improve patient perception of care and, consequently, the quality of healthcare services.

Abstract P5-10-03: Perceptions of somatic genomic testing in patients with metastatic breast cancer: Psychosocial factors, emotional well-being, and genetic comprehension

Abstract Background: Little is known regarding the effect of somatic tumor genomic testing on patient perceptions and psychological well-being. We previously demonstrated that patient perceptions of care can be negatively affected if their next cancer treatment is not supported by the genomic test. To further understand this, we investigated psychological effects of genomic testing, as well as sociodemographic and genomic comprehension factors that may attenuate these effects. Methods: In a prospective, single institution, single-arm trial, patients with metastatic breast cancer underwent next-generation sequencing (NGS) using Foundation Medicine at study entry, with sequencing results released to providers at time of next disease progression. We evaluated patient survey data before and after NGS, including questions about psychosocial characteristics, genetic comprehension, and perceived risks and expectations of the genomic testing. We evaluated psychosocial characteristics using 4 validated psychology measures: the Center for Epidemiologic Studies Depression Scale (CES-D), the Beck Anxiety Inventory (BAI), the Trust in Physician Scale (TPS), and the Communication and Attitudinal Self-Efficacy scale for Cancer (CASE-cancer). CASE-cancer measures self-efficacy, how confident patients are in their ability to navigate their cancer care. Genetic comprehension was assessed with a 7-question objective measure and a 6-question subjective measure. No formal genetic education was provided, but the informed consent process included an introduction to NGS. We included exploratory questions on perceived risks and expectations of NGS. Results: Among the 58 patients who completed the pre-NGS survey, we found high rates of depression (38%) and anxiety (47%) using validated metrics. Depression and anxiety were positively correlated (Pearson’s r=0.61; p&amp;lt;0.0001) but both were negatively correlated with self-efficacy (Pearson’s r=-0.43 and -0.42 for depression and anxiety, respectively; p=0.001 for both). Baseline genetic knowledge was significantly lower for non-white and lower income status patients (p=0.04 and 0.001, respectively). Genetic knowledge was not associated with any of the 4 validated psychological measures. The validated psychological measures were not associated with demographic characteristics, treatment decisions, or number of treatment options offered by the NGS test. The average time between pre-test and post-test surveys was 7.6 months. Additionally, the validated psychology measures did not significantly change from pre- to post-study (n=40 patients). However, there was a strong trend of self-efficacy decreasing from pre- to post-NGS testing (p=0.05). Subjectively, patients gained confidence in their ability to teach others about genetics from the start (33% “confident”) to the end of study (46%). Yet, objective comprehension of genetics remained modest throughout the study, with an average score of 72% in both the pre- and post-NGS surveys. The exploratory patient perception questions revealed that 33% of patients felt learning their cancer had a high chance of progressing would be too much to cope with emotionally. Conclusions: This is the first study, to our knowledge, to longitudinally evaluate multiple validated psychological metrics in MBC. NGS did not have a significant effect on depression, anxiety, or trust, but there was a trend towards decreased self-efficacy. This may be influenced by the already high rates of depression, anxiety, and trust in this population. In this study, patient genetic knowledge was limited and associated with race and income. These findings raise important questions about how to support MBC patient emotional well-being and how to improve comprehension of somatic genomic testing in future studies. Citation Format: Elizabeth J Adams, Sarah Asad, Mahmoud Abdel-Rasoul, Raquel E Reinbolt, Robert Wesolowski, Kaitlyn Tolliver, Susan Gillespie, Katherine A Collier, Anne Noonan, Sargar Sardesai, Jeffrey VanDeusen, Nicole Williams, Charles L Shapiro, Erin R Macre, Bhuvaneswari Ramaswamy, Clara N Lee, Maryam B Lustberg, Daniel G Stover. Perceptions of somatic genomic testing in patients with metastatic breast cancer: Psychosocial factors, emotional well-being, and genetic comprehension [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-10-03.

Mindfulness instruction for community-hospital physicians for burnout and patient care: A pilot study

BackgroundConcern for the high prevalence and pervasive negative effects of clinician burnout has led to greater focus on clinician wellness programs, such as Mindfulness-Based Stress Reduction (MBSR). Our goal was to study MBSR feasibility and potential impact on clinician burnout, clinician–patient communication, and patient care and safety at a community hospital. MethodsAn eight-week MBSR program was offered for voluntary participation to clinicians at a community hospital. Pre–post surveys used validated scales and open-ended questions to assess participants’ levels of burnout, stress, mindfulness, communication behaviors, and perceived patient care and safety. T-tests were used to compare pre–post-program scale differences, and qualitative analysis identified themes from open-ended survey items. ResultsA total of 26 clinicians participated. Pre–post ratings showed significant improvements in personal burnout (p < .001), client-related burnout (p = .02), perceived stress (p < .001), and mindfulness (p = .01). Nearly all, 84% reported an improvement in self-care, 68% reported improved patient care, 50% reported improved patient communication, and 29% reported an increase in quality and safety of patient care. Qualitative analysis showed three themes of improvement in: emotional availability of the clinician, shared decision making and partnership with patients, and job satisfaction. ConclusionMBSR in a community hospital was feasible and suggests benefits related to reducing stress and burnout, as well as perceived improvement in clinician’s quality and safety of patient care. Given the serious negative effects of clinician burnout on patients, physicians, and the workplace, implementation of MBSR programs for clinicians should be considered.

A Means to an End:: Impacting Patient Satisfaction Through Nursing Strategic Initiatives

•Improving nursing job satisfaction improves the perceived patient care experience. •Utilizing professional practice models helps to improve nursing satisfaction. •Health care leaders must advocate for nurses in order to improve patient care. Patient satisfaction is a vital metric that is reflective of the quality of care that health care organizations provide. Research studies have demonstrated a strong association between nursing and patient satisfaction scores, leading health care organizations to prioritize initiatives that positively impact nursing satisfaction. Challenges in today’s evolving health care—leadership changes, patient–nurse staffing ratios, burnout, and insufficient professional development opportunities—may negatively impact nursing satisfaction. This article calls on health care leaders to identify strategic solutions aimed at enhancing the patient experience through improving nursing satisfaction. Patient satisfaction is a vital metric that is reflective of the quality of care that health care organizations provide. Research studies have demonstrated a strong association between nursing and patient satisfaction scores, leading health care organizations to prioritize initiatives that positively impact nursing satisfaction. Challenges in today’s evolving health care—leadership changes, patient–nurse staffing ratios, burnout, and insufficient professional development opportunities—may negatively impact nursing satisfaction. This article calls on health care leaders to identify strategic solutions aimed at enhancing the patient experience through improving nursing satisfaction. Sarah Margrave, MSN, is the Occupational Health Clinic Nurse Manager at Naval Branch Health Clinic Kings Bay, GA. She can be reached at [email protected] . Dagoberto Salinas, MSN, is a Hospital Corpsman Basic Instructor at Navy Medicine Training Support Center, Joint Base San Antonio, Fort Sam Houston, Texas.