Patient Preferences Research Articles

A conceptual framework for integrating digital transformation in healthcare marketing to boost patient engagement and compliance

This paper presents a conceptual framework for integrating digital transformation in healthcare marketing to enhance patient engagement and compliance with treatment regimens. As healthcare systems evolve, the adoption of digital technologies has become imperative for fostering meaningful interactions between patients and providers. The proposed framework emphasizes leveraging digital marketing techniques, data analytics, and personalized communication strategies to strengthen patient-provider relationships and improve health outcomes. At the core of the framework is the use of digital marketing techniques, including social media outreach, content marketing, and mobile applications, to reach patients effectively. These tools facilitate the dissemination of vital health information and resources, enabling patients to make informed decisions about their care. By utilizing data analytics, healthcare organizations can gain insights into patient behaviors, preferences, and demographics, allowing for the customization of marketing efforts to meet the specific needs of diverse patient populations. Personalized communication strategies are pivotal in this framework, as they empower healthcare providers to deliver tailored messages that resonate with individual patients. This personalization fosters a sense of connection and trust, encouraging patients to engage actively in their treatment plans. By utilizing patient data, providers can send reminders, educational content, and motivational messages that enhance treatment adherence and compliance. Moreover, the framework addresses the importance of feedback loops, where healthcare organizations continuously gather and analyze patient responses to marketing efforts. This iterative process allows for the optimization of strategies, ensuring they remain effective and relevant over time. By fostering a culture of engagement, organizations can cultivate long-term relationships with patients, ultimately leading to improved health outcomes. In conclusion, this conceptual framework serves as a strategic guide for healthcare organizations aiming to harness digital transformation in their marketing efforts. By integrating digital marketing techniques, data analytics, and personalized communication strategies, organizations can enhance patient engagement, improve treatment adherence, and positively impact overall health outcomes.

Utilization patterns and preferences of telemedicine services in the post-Covid-19 era in Israel

Abstract Background While telemedicine can streamline healthcare delivery, suboptimal use may compromise care quality and access. Given the increased adoption of these services during and after the Covid-19 pandemic, understanding best practices through examination of utilization patterns and patient preferences is crucial. This study estimated utilization rates, patient preferences and perceptions of response received for different physician-encounter channels for common clinical and administrative scenarios. Methods Cross-sectional telephone survey in Hebrew or Arabic of 519 Israelis who contacted a doctor in the past year for clinical or administrative needs. Data collected during April-June 2023, focused on chosen contact channel, reasons for choice, perceived response adequacy, and hypothetical future preferences. Findings 78% of encounters with family physician for clinical need were in-person, with lower rates for phone (16%) or messaging (6%); in-person dominated with encounters with specialists (94%). Conversely, for administrative needs, more used phone (15%) or messaging (48%), though 37% still preferred in-person encounter. Video usage was negligible (<1%). Main reasons for in-person choice were perceived need for physical exam, habit, or negative perception of remote service quality. Convenience/exam-free needs drove phone/messaging use. While most patients were satisfied with their chosen channels, phone consultations had lower future preference rates. Conclusions Matching channel to need is crucial. Physical exams require in-person visits, though they are not always required and many stick with in-person out of habit; remote options like messaging can streamline administrative tasks. Patient education could address habits and help familiarize patients with new options. Optimizing phone visits and promoting video options could enhance adoption due to their benefits. Key messages • In-person visits are preferred for clinical needs, while messaging/phone are underutilized for administrative tasks, highlighting missed opportunities for convenient telemedicine options. • Addressing patient habits and perceptions around remote healthcare channels is crucial for optimizing telemedicine adoption and streamlining care delivery.

Safety in Teletriage by Nurses and Physicians in the US and Israel - a Tale of 2 Systems

Abstract Background The safety of telemedicine in general and telephone triage (teletriage), in particular, have been a focus of concern since the 1970s. Inadequate telehealth systems may compromise patient safety. Objectives Our aim was to explore ways that developed teletriage systems produce safe outcomes by examining key system components and questioning long-held assumptions. Methods We examined safety by performing a narrative review of the literature using key terms concerning patient safety in teletriage. In addition, we conducted system analysis of 2 typical formal systems, physician led and nurse led, in Israel and the United States, respectively, and evaluated those systems’ respective approaches to safety. Additionally, we conducted in-depth interviews with representative physicians and 1 nurse using a qualitative approach. Results The review of literature indicated that research on various aspects of telehealth and teletriage safety is still sparse and of variable quality, producing conflicting and inconsistent results. The interviews with health care professionals demonstrated several challenges encountered during teletriage, mainly making diagnosis from a distance, treating unfamiliar patients, a stressful atmosphere, working alone, and technological difficulties. However, they reported using several measures that help them make accurate diagnoses and reasonable decisions, thus keeping patient safety, such as using their expertise and intuition, using structured protocols, and considering non-medical factors and patient preferences (Shared Decision-Making). Conclusions Remote encounters about acute, worrisome symptoms are time sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important in the field of teletriage, which has a high potential for error. There is a need identifying safe systems to guide developers and clinicians about needed improvements. Key messages • Patient safety and safe professional practice are extremely important in the field of teletriage. • We need to guide developers and clinicians about needed improvements in teletriage systems.

Effective deep brain stimulation for obsessive-compulsive disorder after failed anterior capsulotomy: illustrative cases.

Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by recurrent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) performed to relieve distress related to the obsessions. For patients with severe illness refractory to first-line pharmacotherapy and psychotherapy, neurosurgical treatments such as deep brain stimulation (DBS) and stereotactic lesioning are an option. The choice between DBS and lesioning is often driven by patient preference, but these options are not mutually exclusive. Here, the authors highlight the success of one surgical therapy (DBS) after the failure of another (lesioning). Two patients with severe, treatment-refractory OCD underwent DBS lead implantation targeting the ventral capsule/ventral striatum after they did not attain any worthwhile benefit from a previous anterior capsulotomy. Both patients showed significant improvement (≥ 35% reduction in Yale-Brown Obsessive-Compulsive Scale [YBOCS] score) of their OCD symptoms at the long-term follow-up after DBS. One patient experienced a 37% reduction in symptom severity as measured by the YBOCS, and the other patient experienced a 47% reduction. DBS and lesioning procedures are both effective surgical options for patients with intractable OCD. In these cases, the authors demonstrate that DBS can be utilized even after a lesioning procedure in nominally the same target (ventral portion of the anterior limb of the internal capsule). https://thejns.org/doi/10.3171/CASE24289.

Implementing a novel selection criteria and pathway for same-day discharge after TAVI

Abstract Background The expansion in indications for transcatheter aortic valve implantation (TAVI) has fuelled an increase in demand worldwide. Prolonged waiting lists and waiting list mortalities are not infrequent and often arise from limited hospital capacity and infrastructure. Approaches to address this have included procedural modifications – ‘minimalist TAVI’ and more recently the development of pathways to facilitate early discharge post-TAVI, such as same-day discharge (SDD) post-procedure. Purpose This study aims to evaluate the safety and effectiveness of a novel SDD pathway a large volume tertiary referral cardiac centre. Methods A new SDD pathway was established between March 2023 and February 2024 at a large-volume tertiary cardiac centre in UK. All patients accepted for TAVI were screened for SDD suitability based on three factors: 1) availability of adequate social support, (defined as presence of able-bodies adult individual to assist in home recovery), 2) technically suitable for transfemoral approach and 3) presence of previous pacemaker or low risk for conduction abnormalities (defined as no baseline conduction disturbances). Following TAVI, patients were deemed suitable for SDD if they were clinically stable, the procedure was technically successful and there were no procedural complications. Demographic, clinical, procedural and outcome data were collected for all patients enrolled onto the SDD pathway and reasons for non-SDD were identified. Ethical approval was obtained in accordance with local institutional policies. Results From March 2023 to February 2024, 81 out of 305 patients (26.6%) were enrolled onto the SDD pathway (median age 82 years old, 66.7% male, median STS risk score 2.34%). Indications for TAVI were severe native aortic stenosis (74/81, 91.4%), severe native aortic regurgitation (2/81, 2.5%) and severe surgical valve degeneration (5/81, 6.2%). SDD was feasible for 58/81 (71.6%) of patients, with 10/81 (12.3%) discharged the following day and 13/81 (16.0%%) requiring >24 hours hospital admission (Figure 1). Reasons for non-SDD included new conduction abnormality (10/81, 12.3%), vascular complication (6/81, 7.4%), acute stroke (3/81, 3.7%), patient preference (2/81, 2.5%) and haemodynamic instability (2/81, 2.5%). Out of the 58 SDD patients, 25/58 (43.1%) had no previous permanent pacemaker system and in these patients a balloon-expandable valve was selected for 24/25 (96.0%) of patients (Figure 2). Conclusions Patient selection based on the presence of social support at home, low risk of conduction abnormalities or previous pacemaker combined with appropriate valve selection can facilitate a safe and effective SDD post-TAVI programme.

Impact of coronary revascularization on clinical outcomes of post-acute myocardial infarction patients with left ventricular thrombus

Abstract Background Left ventricular thrombus (LVT) is an uncommon, but dangerous complication seen in post-acute myocardial infarction (AMI). With advances in percutaneous coronary intervention (PCI) techniques, the incidence of post-AMI LVT has declined in the contemporary era. However, a minority of patients do not undergo coronary revascularisation due to medical contraindications or patient preference. This study aimed to evaluate the clinical characteristics and outcomes of post-AMI LVT patients treated with and without coronary revascularisation. Methods This was a retrospective study of 263 consecutive post-AMI patients diagnosed with LVT from November 2012 to January 2021, retrieved from a echocardiography database. Patients were stratified by the presence or absence of revascularisation treatment. Baseline clinical characteristics, treatment and outcomes data were collected and analysed. Results The median follow-up duration was 2.9 years (IQR: 0.9 – 4.7). A majority of post-AMI LVT patients underwent revascularisation via PCI (71.5%, n = 188), CABG (4.2%, n = 11) or thrombolysis (0.4%, n = 1). Unrevascularised patients (24.0%, n = 63) were older (p <0.001), more likely to be female (p <0.001), and had more co-morbidities such as previous stroke (p <0.001), heart failure (p = 0.001), chronic kidney disease (p = 0.020), and malignancy (p = 0.021). More unrevascularised patient had NSTEMI (p < 0.001), and significantly fewer were treated with triple therapy (p < 0.001). Incidence of LVT resolution was lower (p < 0.001) while all-cause mortality was higher (p < 0.001) for unrevascularised patients on univariate survival analyses. On multivariable Cox regression, revascularisation status was not an independent predictor of LVT resolution, bleeding, stroke, or all-cause mortality outcomes. Conclusion While unrevascularised post-AMI LVT patients had poorer outcomes compared to revascularised patients overall, revascularisation status itself was not independently associated with poorer clinical outcomes. Optimising medical therapy such as triple therapy remains a key treatment goal for post-AMI LVT patients.

The cardiovascular polypill strategy (acetyl salicylic acid, atorvastatin, ramipril) as baseline treatment after a cardiovascular event supported by compelling evidence: a global expert consensus

Abstract Background The SECURE trial demonstrated that the CV-polypill strategy (acetylsalicylic acid [ASA]+atorvastatin+ramipril) reduces CV mortality by 33% in patients with acute myocardial infarction (MI) compared to standard care over 3 years (median). The 2023 ACS ESC Guidelines recommend the polypill strategy to improve outcomes and treatment adherence. The CV-polypill inclusion in the 2023 World Health Organization's essential medicines list signifies its effective and affordable response to a global secondary prevention healthcare requirement. Purpose To reach consensus among medical experts from various countries regarding key implementation aspects of the CV-polypill strategy (ASA+atorvastatin+ramipril) as baseline preventive treatment after a CV event (CVe) in routine clinical practice. Methods A two-round modified Delphi method was employed. A questionnaire consisting of 30 evidence-based statements was developed and validated with input from 8 distinguished cardiologists. The Delphi panel, 50 physicians from 19 countries across Europe, Latin America, and Asia, used a three-point Likert scale to establish their agreement and perceived importance of the statements. Consensus was reached when ≥80% agreed or deemed statements 'very important' or 'important. Statements without consensus in the first round underwent refinement based on evidence and panellists’ feedback in the second round. Persistent disagreements were resolved in a face-to-face meeting with experts. Descriptive statistics were applied. Results 38/50 panellists participated in round 1, and 37/50 in round 2. 31/38 were cardiologists. 28/38 routinely prescribed the CV-polypill strategy. 97.4% of panellists believed that the 24% relative risk reduction in major CVe over 3 years (median), attained with the CV-polypill strategy (ASA+atorvastatin+ramipril) compared to standard care could replicate in clinical practice while maintaining equal safety (97.4%). Unanimous consensus (100%) supported initiating the CV-polypill strategy as baseline preventive treatment upon hospital discharge or at first follow-up. Its efficacy and safety were also acknowledged for stroke (94.7%), peripheral artery disease (92.1%), and both genders (84.2%). 89.5% supported CV-polypill affordability for preventing CHD events and strokes. Algorithms for initiation (97.3%) and transition (97.4%) to the CV-polypill strategy from cardioprotective drugs, considering patient preferences (97.5%), were confirmed. A unanimous consensus (100%) affirmed the positive impact of the simplified CV-polypill treatment on patient satisfaction, with 94.7% recognizing its convenience (Figure 1). Conclusions Skilled medical experts across continents reached consensus on critical implementation aspects and strongly endorse the early use of the CV-polypill strategy (ASA+atorvastatin+ramipril). This adoption aims to reduce CVD recurrence, improve prognosis, and potentially enhance affordability in CVD treatment after a CVe.Consensus on CV polypill implementation

The impact of discontinuing proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors on clinical outcomes

Abstract Background/Introduction Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors have demonstrated efficacy in lowering low-density lipoprotein cholesterol (LDL-C) levels and reducing the risk of cardiovascular events. Despite these advantages, some patients are unable to continue the use of PCSK9 inhibitors due to financial or other reasons. Limited clinical studies have been conducted to investigate the clinical outcomes of patients discontinuing PCSK9 inhibitors for various reasons. Purpose This study aims to specifically investigate patients who were unable to continue PCSK9 inhibitors, with a particular focus on those discontinuing due to financial or other reasons. The primary objective is to assess the impact of discontinuation on major adverse cardiovascular events (MACE). Methods This study focused on 205 Japanese patients who received PCSK9 inhibitors between July 2016 and December 2023. The clinical outcomes of patients who continued or discontinued PCSK9 inhibitors were comprehensively compared. The primary endpoint was major adverse cardiovascular events (MACE), encompassing cardiovascular death, coronary revascularization, target lesion revascularization (TLR), and fatal or non-fatal myocardial infarction (MI). Results Among 205 patients (median age: 69 years; interquartile range [IQR]: 60-76 years 68% male), the median follow-up was 413 days (IQR, 49-1148 days). At one year, the median LDL-C was 43mg/dL, and 158 patients (77%) achieved LDL-C <70 mg/dL. During the follow-up, 64% (131 patients) continued PCSK9 inhibitors, while 36% (74 patients) discontinued. Of the discontinuation group, 30% (22 patients) cited financial problems, 24% (18 patients) clinical stability, and 12% (9 patients) patient preference. Multivariate Cox regression analysis revealed that the group discontinuing PCSK9 inhibitors had a higher incidence of MACE than the group that continued (hazard ratio: 1.84; 95% confidence interval: 1.02 to 3.55; p=0.05). Conclusions This study suggests an increased risk of MACE when PCSK9 inhibitors are discontinued for financial or other reasons. This insight is vital for healthcare management and decision-making among medical practitioners.PCSK9: continuation vs discontinuation

Patient control preferences prior to discharge after cardiac surgery

Abstract Background The impact of patient preferences and participation in the acute recovery period prior to discharge after cardiac surgery is not well understood. Although there is a plethora of literature describing pre and post discharge interventions to support patients’ recovery there is minimal evidence demonstrating the effectiveness of specific interventions that optimise recovery or patient preferences for participation in decision making related to this period of transition from hospital to home. Purpose The aim of this study was to explore patient preferences for participation in discharge planning. Methods This study took place in a major metropolitan hospital in Victoria, Australia with a population base of over 1 million people that provides over 100,000 episodes of care and approximately 850 cardiothoracic procedures annually. We recruited consecutive adult patients, able to understand and speak English who were being discharged home after cardiac surgery. Prior to discharge, a Registered Nurse conducted a semi-structured interview following patient consent where patients were asked to complete the 5 item Control Preferences Scale (CPS) in relation to 3 discharge planning questions. With each question patients were asked to rate their preferred and actual role in the decision-making process. The CPS has 5 cards each portraying a role in treatment decision making; active (1-2), collaborative (3) or passive (4-5) participation to determine what level of control patients’ desire in relation to their care. Results From 196 patients undergoing cardiac surgery 63 (32.1%) were eligible and agreed to participate. When asked about making plans for discharge 9 (14.3%) patients’ preference was to have an active role in this process, 25 (39.7%) preferred a collaborative approach and 29 (46.1%) a passive approach. Patients perceived their actual role was active (n = 10, 15.9%), collaborative (n = 17, 27.0%) or passive (n = 36, 57.1%). When asked about deciding when to go home 9 (14.3%) patients’ preference was to have an active role in this process, 18 (28.6%) preferred a collaborative approach and 36 (57.1%) preferred a passive approach. Patients perceived their actual role was active (n = 8, 12.7%), collaborative (n = 13, 20.6%) or passive (n = 42, 66.6%). When asked about their preferred role in deciding where they go when discharged 21 (33.4%) patients’ preference was to have an active role in this process, 19 (30.2%) preferred a collaborative approach and 23 (36.5%) a passive approach. Patients perceived their actual role was passive (n = 24, 38.1%), collaborative (n = 16, 25.4%) or passive (n = 23, 36.5%). Conclusion Patient preferences for control were congruous with their perceived experience of involvement in decision making which indicates patients’ preference for control is taken into account by clinicians managing the discharge planning process in this setting.

Perspectives on Drug Product Design Among Patients with Lung Cancer in the United Kingdom.

The use of oral anticancer medications has become more prevalent in cancer therapy. This is particularly the case in the management of advanced non-small cell lung cancer (NSCLC). However, when the treatment delivery interaction between the patient and the healthcare provider is removed, the risk of non-adherence increases. Insights into patient preferences can allow drug product formulation scientists to design more patient-centric medications that may promote an increase in adherence which, in turn, may lead to more beneficial health outcomes. We conducted an advisory board with patients with NSCLC in the United Kingdom to elicit and understand preferences for drug product attributes related to appearance, instructions, and modality. The advisory board was preceded by a quantitative preference survey that included three object-case best-worst scaling exercises and was followed by administering the same survey to a broader group of patients to confirm the results. Patients strongly prefer once-daily dosing over more frequent dosing, regardless of the number of pills because taking tablets or capsules multiple times each day can disrupt daily activities. In addition, patients place high importance on surface smoothness because a rough surface implies decreased swallowability. Finally, food restrictions involving directions regarding taking medication with or without food represent difficulties for patients with cancer. Results of the follow-up survey confirmed these results. Drug developers should attempt to limit the dosing of these medications to once-daily regimens, avoid surface roughness, and develop formulations that can be taken without regard to the timing of meals to the greatest extent possible.

Environmental therapy: interface design strategies for color graphics to assist navigational tasks in patients with visuospatial disorders through an analytic hierarchy process based on CIE color perception

IntroductionEnvironmental therapy theory has been applied in the research of disease prevention, and the effectiveness of using color and graphic designs to assist patients with spatial orientation has been confirmed. Visual-spatial impairments are common symptoms associated with cognitive decline. However, the interaction and driving factors between these impairments and spatial color and graphic designs remain unclear.MethodsThis paper first discusses the correlation between the characteristics of visual-spatial impairments and environmental factors and then investigates the color preferences of such patients based on the CIE 1976 color system and the Analytic Hierarchy Process (AHP). Subsequently, the paper explores spatial design strategies conducive to spatial orientation from the perspective of adaptability to pathological characteristics, utilizing case study analysis.Results(1) Pathological characteristics of visual-spatial impairments (such as difficulties in spatial orientation and spatial neglect) are related to environmental factors; (2) Emotional attachment factors play a key role in patients’ perception of satisfaction with environmental colors; (3) Color associations have the potential to strengthen spatial memory. Additionally, interface designs with high luminance, low saturation, and clear color differentiation facilitate patients’ recognition of space.DiscussionThis paper posits that spatial interface design is a feasible approach to assist with spatial orientation, and it achieves this through a mediating process that progresses from influencing visual stimuli to cognitive memory and then to behavioral orientation. The article provides insights into the operational feasibility of this method.

Implementation of digital patient decision support tools for Atrial Fibrillation treatment: systematic review

Abstract Background/ Introduction Treating atrial fibrillation (AF) involves complex decisions. Digital patient decision-support tools can facilitate shared decision making by significantly reducing decisional conflict and improving patient knowledge [1,2]. Yet, implementation in clinical practice is lagging [3]. Purpose To systematically review trials of digital patient decision-support tools for AF treatment decisions, focusing on factors influencing their implementation in clinical practice. Methods We conducted a systematic review following Cochrane methods. EMBASE, MEDLINE and Scopus were searched from 2005 to 2023. Eligible randomised controlled trials and quasi-experimental trials that evaluated digital patient decision-support tools for AF treatment decisions were included. Two independent reviewers screened title and abstract, extracted data and assessed risk of bias. The implementation outcomes included a description of when and how the tool was used, as well as its characteristics and user satisfaction. Results Thirteen articles reporting on eleven studies (5 RCTs and 6 quasi-experimental trials) met the inclusion criteria (2,714 participants; mean age 71±4.2 years; 26% women; 92% with non-valvular AF, remaining not reported). Risk of bias was low for 2 studies, moderate for one and high for seven studies. All tools (n=11) focused on anticoagulation choice (1: warfarin vs no warfarin; 1: aspirin vs warfarin; 7: Direct Oral Anticoagulants (DOAC) vs antiplatelet or warfarin; 2: unspecified choice). The tools were used either pre-visit (at home or in the waiting room) or during the consultation (n=5). Tools were delivered using a mobile application (n=4), web-based application (n=5), or a desktop (n=2). Of the eleven tools, 2 could automatically calculate individualized stroke risk using data from electronic health records. Most articles reported favourable user feedback regarding use of the digital patient decision-support tools, such as high perceived usefulness, user-friendliness, and overall satisfaction. No significant difference was found in encounter times between intervention and control arms (2 RCTs). Four tools were publicly available and 3 were implemented in healthcare delivery beyond research. Conclusion Despite demonstrated efficacy in reducing decisional conflict and improving patient knowledge, as well as positive clinician and patient experience, only 3 tools were implemented in clinical practice beyond their trial. Future tools could better leverage digital capabilities to integrate with Electronic Health Records, automate stroke and bleeding risk calculations, and personalise content based on patient values and preferences. Additional robust trials and implementation studies are warranted to understand barriers and enablers to the use of these tools.

Right-Siting Care and Decongesting Specialist Outpatient Clinics - A Singapore Case Study

Abstract Issue Globally, Specialist Outpatient Clinics (SOCs) face a growing burden due to rising chronic diseases. This strain on resources leads to long appointment wait times (LAWTs), delaying diagnoses and treatments. This is particularly of concern in countries with rapidly ageing populations such as Singapore. Description The Right-Site Care Program is a healthcare transformation initiative implemented by individual healthcare clusters within Singapore to improve access to timely SOC care by directing patients to the most appropriate care level (right-siting). This transitions stable chronic disease patients to primary care providers (PCPs) for ongoing management. A standardised approach utilises evidence-based guidelines for patient selection, followed by identification and transfer of suitable patients to PCPs. This multi-center program offers a real-world example of healthcare system optimisation for chronic disease management. Results A multi-source data analysis, including program reports and peer-reviewed studies from participating healthcare clusters, was conducted to evaluate program impact. The analysis focused on LAWTs, patient outcomes and implementation challenges. Right-siting yielded mixed results across various conditions. Right-sited patients had better survival rates, likely due to closer monitoring and management of chronic conditions with higher total outpatient attendance frequencies. (1) Improvements were particularly significant for diabetes mellitus patients who successfully transitioned to PCPs. (2) However, challenges such as patient scepticism about PCP competence and a preference for specialist care have been identified. (3) Lessons learned Right-siting care can improve patient outcomes for certain chronic diseases. The program’s impact varied across different chronic diseases, highlighting the need for tailored strategies. Educational interventions addressing patient concerns can facilitate smoother patient transitions and program success. Key messages • Right-siting care shows promise, with improved patient outcomes for conditions like diabetes mellitus. • Patient education is crucial to overcome patient scepticism and preference for specialists.

Patient-reported outcomes of chimeric antigen receptor T-cell therapy in hematologic malignancies: a systematic review and meta-analysis

Few studies evaluated patient-reported outcomes (PROs) for patients with hematologic malignancies receiving with Chimeric Antigen Receptor T (CAR-T) cell therapy. We performed a systematic review and meta-analysis to evaluate the benefits of CAR-T cell therapies focused on PROs. A systematic literature searched from PubMed, Cochrane, and the Web of Science from inception to September 2023. Study selection and data extraction were conducted independently by two reviewers based on pre-specified criteria. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist was used to evaluate the methodological quality of the included studies. The random-effects model was employed to calculate the combined effect and 95% Confidence intervals. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and the protocol was registered with PROSPERO (CRD42024586706). We identified 20,110 studies. Of those, 15 studies with 16 different PRO measures (PROMs) were included in the meta-analysis. CAR-T cell therapy improved PROs in the six domains of general health status, pain, fatigue, depression, social function, and cognitive function: from the general health status (SMD: 0.57, 95% CI: 0.34 to 0.81) to cognitive function (SMD: 0.25, 95% CI: 0.14 to 0.37). The current meta-analysis shows that CAR-T cell therapy produces clinically meaningful differences in PROs. These results suggest that the professional perspective and patient values and preferences should be weighed equally when considering CAR-T cell therapy for hematologic malignancies.

Preferences for genetic interventions for SCA and Huntington’s disease: results of a discrete choice experiment among patients

BackgroundAlthough genetic interventions are on the horizon for some polyglutamine expansion diseases, such as subtypes of spinocerebellar ataxia (SCA) and Huntington’s disease (HD), the patients’ preferences regarding these new therapies are unclear. This study aims to get insight into what extent different characteristics of genetic interventions affect the preferences of patients with SCA and HD with regard to these interventions.MethodsManifest and premanifest patients with SCA or HD were recruited online by platforms of patient associations. The respondents conducted a questionnaire that included a discrete choice experiment (DCE). The experimental design included 24 choice sets, but these were divided into three blocks of eight to reduce the number of tasks per respondent. Each choice set included two alternative treatments and consisted of four attributes (mode and frequency of administration, chance of a beneficial effect, risks, and follow-up), each with three or four different levels. The forced choice-elicitation format was used. Data were analyzed by using a multinominal logistic regression model.ResultsResponses of 216 participants were collected. The mode and frequency of administration of a genetic intervention, as well as the chance of a beneficial effect both influence the choice for a genetic intervention. Respondents less prefer repeated lumbar punctures compared to a single operation. As expected, a higher beneficial effect of treatment was preferred. Risks and follow-up did not influence the choice for a genetic intervention.ConclusionsThe results can be used for the design and implementation of future genetic interventional trials as well as of patient-centered care pathways for rare movement disorders such as SCA and HD.

Global variations in coronary revascularisation and acute myocardial infarction mortality between 2006-2020: a longitudinal, population-level analysis of 16 high-income nations from the OECD database

Abstract Background Revascularisation options for ischaemic heart disease (IHD) includes either, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Whilst PCI remains the preferred choice in ST-elevation myocardial infarction (STEMI)(1), several landmark trials have questioned its universal superiority (2,3), thus prompting re-evaluation of guidelines. A wide-scale contemporary overview of revascularisation trends is lacking. Purpose To examine the evolving pattern in PCI and CABG rates, alongside mortality from acute myocardial infarction (AMI) across a group of 16 high-income countries between 2006 and 2020. Methods Standardized PCI and CABG procedure rates alongside AMI age-standardised mortality rate (ASMR) were obtained from the Organisation for Economic Co-operation and Development (OECD) database. Data from 2006-2020 was extracted for; Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, United Kingdom (UK). Together, these countries are commonly known as the European Union (EU) 15+ and represent a cluster of high-income nations with comparable levels of health expenditure. Procedural trends including the estimated annual percentage change (EAPC) were evaluated using Joinpoint analysis whilst Locally Weighted Scatterplot Smoothing (LOESS) models was used to analysis trends in AMI mortality. Results Over 15 years, 14.0 million PCI and 2.8 million CABG procedures were recorded in total. PCI rates varied amongst nations (Figure 1), however showed an overall increase in 11 countries, led by Finland (+36.0%). The steepest increase was observed in France between 2012-2018 (EAPC 5.4, 95% CI: 4.8 – 6.1). The greatest overall decrease in PCI was observed in Luxemburg (-33.5%). The fastest decrease was seen during 2018-2020 in the UK (EAPC -7.2, 95% CI: -9.7 – -4.6). CABG rates declined overall in 15 countries (Figure 1), with Luxembourg (-71.3%), experiencing the largest fall and showing the steepest decline between 2014-2018 (EAPC -20.7, 95% CI: -28.3 – -12.3). Ireland was the only country to show an increase in CABG rate (+16.3%). Throughout the study period, the PCI-to-CABG ratio increased (Figure 2A), whilst AMI mortality decreased consistently across all countries (Figure 2B). Conclusion Despite evidence supporting CABG over PCI in specific scenarios, CABG rates have declined, and PCI rates have increased. This trend may be influenced by several factors including patient preference for less invasive procedures and advancements in interventional techniques. The varied use of PCI among these nations, alongside a sustained decline in AMI mortality rates, may be expected given the importance of optimal medical therapy in the management of IHD. The results further highlight the significance of factors beyond revascularisation in driving improved outcomes.PCI and CABG rates between 2006 and 2020PCI to CABG ratio and AMI mortality rate

Envisioning telemedicine in the EU health systems: Insights from policy experts and cancer patients

Abstract Background Conducted as part of WP4 (Sustainability) of the eCAN Joint Action, the aim of this foresight exercise was to understand how telemedicine services in EU-Member States (MS) could be implemented in a patient-centric way to tackle cancer. Methods Based on a literature review, we identified factors that impact on the implementation of telemedicine in EU MS; these were integrated to an online survey. Health policy experts were invited to rank 34 factors using a 7-point Likert scale to better understand the barriers and facilitators of telemedicine services at the health system level, whilst patient associations ranked 28 other factors to capture end-users’ view. Next, survey respondents were invited to a foresight workshop to collect qualitative data and gain a forward-looking perspective. Results 20 health policy experts working in digital health across 14 EU MS, predominantly from Ministries of Health, and 8 cancer patient associations from 5 EU MS responded to the surveys. For a sustainable integration of telemedicine services in the EU, policy experts recommend developing a clear legal framework, embracing a hybrid healthcare model, and enhancing digital literacy. They stress the importance of telemedicine as a complementary tool, advocating for solid IT infrastructure, privacy safeguards, and the integration of health equity. Similarly, cancer patients emphasise the importance of being able to choose between telemedicine and in-person visits, focusing on personal interaction. They advocate for the involvement of patients in the design and testing of telemedicine services, ensuring solutions meet their preferences. Conclusions Policy experts and patients are in favour of hybrid models for cancer care. Recommended public health actions include: i) develop legal frameworks to complement in-person care with telemedicine; ii) boost digital literacy and IT infrastructure, ensuring privacy and health equity; and iii) involve patients in design for tailored services. Key messages • Both the EU Member States and cancer patients view telemedicine as a useful and complementary tool, however, not as a replacement for in-person healthcare services. • Both the EU Member States and cancer patients champion telemedicine with a focus on equity, privacy, digital literacy and a hybrid model of care that respects patient preferences for cancer treatment.

Ethical Dilemmas in Home Palliative Care

Abstract Background In the past two decades, there has been a noticeable shift towards home-based care, reflecting the broader trend among OECD countries to prioritize a comprehensive approach to health and well-being. This approach emphasizes preventive and proactive measures, often relying on home-based care delivered by multidisciplinary teams providing both curative and palliative care. However, the unique nature of providing care in a home environment raises ethical questions among healthcare providers, necessitating high levels of attentiveness and sensitivity from the caregiving team to address them effectively. Research Objectives This study aims to identify ethical challenges encountered by a multidisciplinary team, as perceived by managers of an organization offering home palliative services in Israel. Methods A qualitative study was conducted, involving interviews with nine key managers to explore prevalent ethical issues in delivering home-based care. Findings Thematic analysis unveiled common ethical dilemmas in providing Home Palliative Care. These dilemmas include balancing patient preferences with professional obligations, addressing the needs of both patients and their families, navigating caregiver-patient relationships, understanding patients’ cultural backgrounds, and advocating for home care as the preferred option while considering alternative treatment approaches. Conclusions Home palliative care poses ethical dilemmas for caregiving teams. It’s imperative for organizations in the home care sector to devise strategies aimed at assisting teams in navigating these challenges while upholding the autonomy and dignity of patients within their home environment. Key messages • Home-based care faces ethical challenges, requiring strategies to balance patient preferences and professional duties. • Ethical home hospice care needs strategies that respect patient autonomy and dignity.

Delivering shared decision-making before transcatheter aortic valve implantation using digital and remote techniques to enhance patient engagement and convenience

Abstract Introduction Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement for patients with aortic stenosis. However, the choice between TAVI, surgery, wait and watch or conservative management needs to be based upon multiple factors including comorbidity, life expectancy, anatomy, local experience and, critically, informed patient preference. In this context, engaging patients in a shared decision-making (SDM) process becomes essential, but this practice is generally underused. Purpose To comply with both international guidance and the National Institute for Health and Care Excellence (NICE) UK recommendations, in January 2023 we established a formal SDM pathway for TAVI, utilising digital solutions as much as possible to minimise the logistic impact for both hospital and patients. We aimed to quantitatively measure the compliance of the digital SDM meeting from the patients’ perspective with the NICE recommended essential and enhanced discussion standards. Methods Patients are contacted when the multidisciplinary heart team recommends TAVI, then offered digital or, where appropriate, physical patient decision aids and a link to a TAVI-specific explanatory video. One week later, patients are invited to a virtual comprehensive SDM meeting where a specialist nurse discusses aortic stenosis and treatment options with the patient as per the NICE recommended standards, allowing time for questioning and review. From December 2022 to June 2023, a custom developed questionnaire was administered to 20 patients prior to, and 28 patients after the implementation of the SDM meeting protocol, directly addressing the patients’ perception of adherence to the NICE standards. This was provided to the patients after the TAVI procedure via an online tool. The answers to the 12 core questions were converted into a Likert scale (1 to 5) and the global satisfaction scores for the 2 patient groups, reported as the average Likert score across the 12 questions, were compared with the Wilcoxon Rank-Sum Test. Results The global satisfaction score was significantly higher for the post-SDM group than for the pre-SDM group (mean 4.27 vs 3.55, p<0.001). The percentage of patients who gave positive (Likert 4-5) responses to each individual question was consistently higher in the post-SDM group. The percentage of patients giving negative (Likert 1-2) responses was substantially lower in the post-SDM group. Conclusions The SDM pathway and the virtual tools provided proved effective in delivering SDM in compliance with international guidance and NICE recommended standards from the patient’s perspective. A similar approach leveraging digital technology to minimise cost and enhance patient convenience could be implemented for other treatments and across other institutions.Questionnaire results

Biologics and oral systemic treatment preferences in patients and physicians for moderate-to-severe atopic dermatitis: a discrete choice experiment in the United Kingdom and Germany

Background: As the available treatments for moderate-to-severe atopic dermatitis (AD) expand, understanding patient and physician preferences becomes crucial for informed decision-making. Objective: To quantify patient and physician preferences for biologics and oral systemic AD treatment attributes. Materials and methods: We conducted a cross-sectional, online discrete choice experiment (DCE) involving 306 AD patients and 206 physicians throughout the United Kingdom and Germany. Qualitative interviews identified the key attributes for inclusion in the DCE. Each choice task comprised two hypothetical patient profiles. Data were analyzed using a random-parameters logit model. Results: Results indicated a significant emphasis on efficacy, with reducing sleep disturbance and itch ranking first and second among patients, and the reverse for physicians. Time to itch relief was the third most important efficacy attribute for both groups, but relatively more important for patients than for physicians. For both groups, the risk of eye problems was the most important safety concern of those included. Mode of administration was not of great importance compared to efficacy and safety attributes. Conclusions: Our findings suggest patients prioritize sleep disturbance, an attribute not captured in prior preference studies in AD, time to itch relief and itch. These findings emphasize the importance of addressing sleep-related issues, whilst also targeting fast itch control, to enhance patients’ well-being.