Providing Information To Patients Research Articles

Implementation of ePROs Into Multidisciplinary Tumor Board Discussions for Patients With Pancreatic Cancer: The INSPIRE Intervention.

The incorporation of electronic patient-reported outcomes (ePROs), such as the Geriatric Assessment (GA) and treatment preferences, into decision-making for pancreatic cancer has been limited by clinician- and system-level barriers concerning workflow. We hypothesized that ePRO inclusion within multidisciplinary tumor boards (MDTBs) would circumvent barriers and provide a venue for systematic consideration of critical patient-provided information. The INtegrating Systematic PatIent-Reported Evaluations (INSPIRE) intervention consists of (1) patient survey completion, including GA and patient preferences, and (2) screensharing patient ePROs during MDTBs. Proctor et al's implementation outcomes were assessed, with penetration (the proportion of consented patients who were presented at MDTBs) acting as the primary outcome (considered successful at 70%). Secondary outcomes included adoption, feasibility, acceptability, appropriateness, cost, and sustainability, assessed by clinician post-MDTB exit surveys, clinician postintervention surveys, clinician postintervention semistructured interviews, and time-coding analysis of recorded and transcribed historical (November 2021-February 2022) and intervention (September 2022-June 2023) MDTBs. A total of 50 patients completed surveys and all were presented at MDTBs (penetration=100%). All eligible clinicians (n=9) enrolled patients (adoption=100%) and reported that ePROs were useful in 90% and led to a change in treatment plan in 30% of cases. In postintervention surveys and interviews, clinicians primarily responded positively to feasibility, acceptability, and appropriateness questions. Time-coding analysis found a modest time cost of an additional 51.1 seconds in mean discussion time-per-patient between preintervention (mean [SD], 172.7 [111.4] seconds) and intervention patients (mean [SD], 223.8 [107.1] seconds); 86% of clinicians reported the intervention did not take too much time. All surveyed clinicians reported interest in continuing the intervention and suggested adaptations to further promote sustainability. The integration of ePROs into pancreatic MDTBs was feasible and acceptable, providing a potential approach to increase the utilization of ePROs by clinical teams in their management of patients with pancreatic cancer.

Seeing is believing: Patients’ attitudes and information preferences towards robotic gynaecological surgery

ObjectivesRobotic gynaecological surgery (RS) is reported to be associated with feelings of apprehension and anxiety pre-operatively in a proportion of patients. This study aimed to investigate patients’ understanding and perceptions towards RS, and whether the format of RS information resources could improve acceptability of RS. DesignA two-phase, sequential, mixed methods study involving semi-structured interviews of patients who had previously undergone gynaecological RS and a block-randomised crossover study of women from the general public. Qualitative data from interviews were analysed using thematic analysis, quantitative data from questionnaires were summarised and analysed using Mann-Whitney U and Fisher's exact tests. ResultsInterview participants reported very little background knowledge of RS prior to their surgery. Many participants stated that written information leaflets did not adequately describe the robotic set-up and procedure, leading to anxiety and information seeking from alternative sources. The use of videos or models to visually demonstrate how the surgery would be performed and the interaction between the surgeon and the robot were proposed to address patients’ needs. Questionnaire data from 30 women demonstrated an increase in acceptability of RS following provision of information, with 73.3 % of the participants reporting that the video alone was an adequate source of information, compared to only 46.7 % for the printed leaflet. ConclusionThis study gives new insights into the impact of information provision for patients undergoing RS. Availability of information resources in different modality formats, in particular an information video, may help address patients’ information needs, reduce anxiety and hence increase acceptability of RS.

Role of dithiothreitol in the resolution of pretransfusion immunohematology testing in patients receiving the anti-CD38 monoclonal antibody daratumumab for the treatment of multiple myeloma

Abstract: INTRODUCTION: Daratumumab (Darzalex; Janssen-Cilag Pty Ltd), an anti-CD38 monoclonal antibody (MoAb), has demonstrated high efficacy in treating relapsed and refractory multiple myeloma (MM). It stands as the pioneering anti-CD38 MoAb approved by the US FDA (2015) and TGA Australia (2017). While targeting CD38 on myeloma cells, daratumumab poses a challenge in pretransfusion testing by inducing panreactivity in indirect antiglobulin tests (IATs) due to CD38 expression on red cells. This study investigates the role of dithiothreitol (DTT) in resolving pretransfusion immunohematology testing in patients treated with daratumumab for MM. MATERIALS AND METHODS: Pretransfusion samples from three hematological patients diagnosed with MM and receiving anti-CD38 drugs necessitating red cell transfusion were subjected to immunohematology serological testing. Clinicians provided patient information, including gender, age, transfusion history, and time between anti-CD38 MoAb infusion and sample collection. Tests included ABO/RhD typing, IAT, both polyspecific and monospecific direct antiglobulin test (DAT), antibody (Ab) screening, Ab identification, eluate preparation, and red cell crossmatch. Control tests were conducted by incubating patient samples at 37°C for 1 h. RESULTS: ABO/RhD typing remained unaffected, yet all samples exhibited panreactivity in IATs. Two samples showed positive DAT results but negative eluates. Treatment of reagent red blood cells (RBCs) with 0.2 M DTT effectively mitigated interference by anti-CD38 monoclonal antibodies, resulting in compatible red cell crossmatches. Notably, incubation of patient samples at 37°C for 1 h yielded identical results. CONCLUSION: Pretreatment of erythrocytes with DTT deactivated the CD38 antigen, eliminating reactivity with patient serum treated with daratumumab. DTT treatment of reagent RBCs emerges as an efficient and accessible strategy to counteract interference from anti-CD38 drugs in pretransfusion tests.

Large Language Models Versus Expert Clinicians in Crisis Prediction Among Telemental Health Patients: Comparative Study.

Due to recent advances in artificial intelligence, large language models (LLMs) have emerged as a powerful tool for a variety of language-related tasks, including sentiment analysis, and summarization of provider-patient interactions. However, there is limited research on these models in the area of crisis prediction. This study aimed to evaluate the performance of LLMs, specifically OpenAI's generative pretrained transformer 4 (GPT-4), in predicting current and future mental health crisis episodes using patient-provided information at intake among users of a national telemental health platform. Deidentified patient-provided data were pulled from specific intake questions of the Brightside telehealth platform, including the chief complaint, for 140 patients who indicated suicidal ideation (SI), and another 120 patients who later indicated SI with a plan during the course of treatment. Similar data were pulled for 200 randomly selected patients, treated during the same time period, who never endorsed SI. In total, 6 senior Brightside clinicians (3 psychologists and 3 psychiatrists) were shown patients' self-reported chief complaint and self-reported suicide attempt history but were blinded to the future course of treatment and other reported symptoms, including SI. They were asked a simple yes or no question regarding their prediction of endorsement of SI with plan, along with their confidence level about the prediction. GPT-4 was provided with similar information and asked to answer the same questions, enabling us to directly compare the performance of artificial intelligence and clinicians. Overall, the clinicians' average precision (0.7) was higher than that of GPT-4 (0.6) in identifying the SI with plan at intake (n=140) versus no SI (n=200) when using the chief complaint alone, while sensitivity was higher for the GPT-4 (0.62) than the clinicians' average (0.53). The addition of suicide attempt history increased the clinicians' average sensitivity (0.59) and precision (0.77) while increasing the GPT-4 sensitivity (0.59) but decreasing the GPT-4 precision (0.54). Performance decreased comparatively when predicting future SI with plan (n=120) versus no SI (n=200) with a chief complaint only for the clinicians (average sensitivity=0.4; average precision=0.59) and the GPT-4 (sensitivity=0.46; precision=0.48). The addition of suicide attempt history increased performance comparatively for the clinicians (average sensitivity=0.46; average precision=0.69) and the GPT-4 (sensitivity=0.74; precision=0.48). GPT-4, with a simple prompt design, produced results on some metrics that approached those of a trained clinician. Additional work must be done before such a model can be piloted in a clinical setting. The model should undergo safety checks for bias, given evidence that LLMs can perpetuate the biases of the underlying data on which they are trained. We believe that LLMs hold promise for augmenting the identification of higher-risk patients at intake and potentially delivering more timely care to patients.

Understanding autism and its treatment: The child's perspective

IntroductionWhile parents' and professionals’ perceptions regarding children with autism spectrum disorder (ASD) have been studied extensively, limited data regarding the perspectives of children with ASD on their needs and the challenges they face are available. The study aimed to examine how children with ASD understand their condition and the aims of the interventions they undergo. MethodsNineteen children and adolescents (ages 5.7–14.2 years) formally diagnosed with ASD, with borderline to high intelligence (range 70–140), and able to converse verbally were interviewed in person at a child development clinic. A qualitative approach was used to capture children's perceptions of their strengths and challenges and their understanding of a novel ASD treatment. The interview included direct and projective open-ended questions on each topic. Interpretive content analysis was used to evaluate the children's answers. Medical data were extracted from medical records. The children's parents completed questionnaires on their children's disability levels, awareness of ASD diagnosis, and sociodemographic details. FindingsChildren spoke of their embodied sensations and feelings and discussed “normality” vs. “disability.” They varied in their awareness of their diagnosis/symptoms, and only one boy named his diagnosis and described its consequences in detail. Most children lacked an understanding of the educational and therapeutic aspects of the goals set for them. Discussion and conclusionsChildren with ASD are aware of their unique emotional and behavioral challenges. Nevertheless, they are frequently excluded from the process of patient information provision and lack an understanding of the goals of interventions. Findings suggest the need to explore developmentally and emotionally adaptive ways to involve children with ASD in discussions of their condition and possible interventions.

Landscape of cancer biomarker testing in England following genomic services reconfiguration: insights from a nationwide pathologist survey

AimsCancer diagnostics have been evolving rapidly. In England, the new National Health Service Genomic Medicine Service (GMS) provides centralised access to genomic testing via seven regional Genomic Laboratory Hubs. The...

Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) – A cluster- randomised controlled trial and mixed methods process evaluation

ObjectiveTo evaluate a nurse-led decision coaching programme aiming to redistribute health professionals’ tasks to support immunotherapy decision-making in people with multiple sclerosis (MS). MethodsCluster-randomised controlled trial with an accompanying mixed methods process evaluation (2014 - 2018). We planned to recruit 300 people with clinically isolated syndrome or relapsing-remitting MS facing immunotherapy decisions in 15 clusters across Germany. Participants in the intervention clusters received up to three decision coaching sessions by a trained nurse and access to an evidence-based online information platform. In the control clusters, participants also had access to the information platform. The primary outcome was informed choice after six months, defined as good risk knowledge and congruent attitude and uptake. ResultsTwelve nurses from eight clusters participated in the decision coaching training. Due to insufficient recruitment, the randomised controlled trial was terminated prematurely with 125 participants (n = 42 intervention clusters, n = 83 control clusters). We found a non-significant difference between groups for informed choice favouring decision coaching: odds ratio 1.64 (95% CI 0.49–5.53). ConclusionsResults indicate that decision coaching might facilitate informed decision-making in MS compared to providing patient information alone. Practice implicationsBarriers have to be overcome to achieve structural change and successful implementation.

P184 Geographical variations in delivery of intravenous treatments for ANCA-associated vasculitis

Abstract Background/Aims Timely access to intravenous immunosuppressant therapy is essential to effectively manage systemic vasculitis; however, significant variations in care and outcomes exists across centres. We systematically evaluated access to treatment for ANCA-associated vasculitis across the UK and Ireland. Methods This multi-method study included: a survey of 87 UK and Ireland Vasculitis Society sites and 11 Scottish Health Boards between Nov 2020 and June 2021; interviews with staff and patients with systemic vasculitis. Survey data was analysed descriptively. Interviews were audio or video recorded and analysed thematically. Results 59 responses from 51 Trusts/Health Boards across Scotland (n = 11), England (n = 33), Wales (n = 2), and Ireland (n = 5) included equal numbers of rheumatology and nephrology vasculitis services across diverse healthcare settings. 67 healthcare professionals across six case studies in Scotland (n = 3) and England (n = 3) and 32 patients with systemic vasculitis were interviewed. Services faced significant challenges in prescribing and delivering high-cost drugs to manage systemic vasculitis: balancing accountability versus bureaucracy, and tensions between different specialties looking after vasculitis patients when implementing access to high-cost drugs via multi-disciplinary networks. There was significant variation in how services delivered intravenous treatments: 10%(5/51) used inpatient beds; 35% (18/51) accessed another specialty unit or shared a daycase facility; 65% (33/51) used their own specialty daycase unit. Average wait time for urgent IV treatment was 2.67 days (range 1-10 days). 18% of services had waiting times >7 days, and of those 67% accessed intravenous treatments via another daycase facility. Specific challenges in accessing daycase facilities included availability of slots and staff, particularly in shared units, due to competition with other services and limited awareness of the importance of timely treatment for systemic vasculitis. This could impact on timing and treatment decisions e.g., prolonged steroid prescriptions. Staff training, competencies and governance to deliver cytotoxic drugs was problematic, particularly for smaller services, and 70% of services said national training modules would be helpful. Oncology units could provide workarounds but daycase nurses with vasculitis knowledge were a valuable source of advice and support for patients attending for treatments, identifying medical issues and arranging assessment if required. Conclusion There is significant variation in access to intravenous treatment for systemic vasculitis. Healthcare organisations should ensure timely access to urgent intravenous treatment for systemic vasculitis within 7 days and appropriately trained staff. National training modules for non-cancer chemotherapy could facilitate equitable access to training. Where treatment is delivered via other units, greater awareness of systemic vasculitis would help provision of information and support for patients. Disclosure W. James: None. A. Nicoll: None. L. Locock: None. L. Harper: None. M. Little: None. N. Basu: None. R.J. Hollick: None.

Development of Podcasts in a Hospital Setting: A User-Centered Approach

Patient information plays a pivotal role in preparing individuals for hospital visits and empowering them to actively participate in decision-making processes regarding their healthcare. However, many patients face challenges related to reading comprehension. In response, podcasts have become a popular, user-friendly medium for sharing essential and easily understandable information in an engaging format. The aim of the present project was to use a user-centered approach to develop podcasts providing patient information prior to hospital visits. We aimed to describe the steps of the development in detail with the purpose of inspiring podcast development in the future. In Phase 1 we conducted interviews with patients and focus groups with clinicians based on the “empathy map” method, with the purpose of exploring patients’ needs on which to subsequently build the podcasts’ content and format. In Phase 2 we produced and refined the podcasts on the basis of feedback from clinician- and patients representatives. Our results indicated the importance of clear and concise language, personalization of communication, and content alignment with patients’ needs. Our project resulted in a description of each step of the development that can be used as inspiration for others who wish to take a user-centered approach to podcast development.

Performance of cell-free DNA testing for common fetal trisomies in triplet pregnancies.

In singleton pregnancies, the use of cell-free DNA (cfDNA) analysis as a screening test for common fetal trisomies has spread worldwide though we still lack sufficient data for its use in triplet pregnancies. The objective of this study is to assess the performance of cfDNA testing in detecting fetal aneuploidies in triplet pregnancies as a first-tier test. We performed a retrospective cohort study including data from pregnant women with a triplet pregnancy who underwent cfDNA testing between May 1, 2017, and January 15, 2020. cfDNA was obtained by massive parallel sequencing (VeriSeq NIPT solution; Illumina®). The objectives of the study were to assess the diagnostic performance of cfDNA testing for trisomy 21 (T21) (primary outcome), trisomy 18 (T18) and 13 (secondary outcomes). During the study period, cfDNA testing was performed in 255 women with triplet pregnancy, of which 165 (64.7%) had a neonatal outcome available. Three tests were positive for T21, one of which was confirmed by an antenatal karyotype, and the other was confirmed at birth. The third case did not undergo an invasive procedure and was not confirmed at birth (false positive). In one case, cfDNA testing was positive for T18 and was confirmed by an antenatal karyotype. There were no cases of trisomy 13 in the cohort. The no-call rate was 2.4% at first sampling. Fifty-eight (22.7%) women had embryo reduction, which in 40 (69%) of whom was performed after the cfDNA test result. cfDNA testing could be offered as primary screening for main fetal aneuploidies in triplet pregnancies after provision of appropriate patient information.

ChatGPT as a Source of Patient Information for Lumbar Spinal Fusion and Laminectomy: A Comparative Analysis Against Google Web Search.

Retrospective Observational Study. The objective of this study was to assess the utility of ChatGPT, an artificial intelligence chatbot, in providing patient information for lumbar spinal fusion and lumbar laminectomy in comparison with the Google search engine. ChatGPT, an artificial intelligence chatbot with seemingly unlimited functionality, may present an alternative to a Google web search for patients seeking information about medical questions. With widespread misinformation and suboptimal quality of online health information, it is imperative to assess ChatGPT as a resource for this purpose. The first 10 frequently asked questions (FAQs) related to the search terms "lumbar spinal fusion" and "lumbar laminectomy" were extracted from Google and ChatGPT. Responses to shared questions were compared regarding length and readability, using the Flesch Reading Ease score and Flesch-Kincaid Grade Level. Numerical FAQs from Google were replicated in ChatGPT. Two of 10 (20%) questions for both lumbar spinal fusion and lumbar laminectomy were asked similarly between ChatGPT and Google. Compared with Google, ChatGPT's responses were lengthier (340.0 vs. 159.3 words) and of lower readability (Flesch Reading Ease score: 34.0 vs. 58.2; Flesch-Kincaid grade level: 11.6 vs. 8.8). Subjectively, we evaluated these responses to be accurate and adequately nonspecific. Each response concluded with a recommendation to discuss further with a health care provider. Over half of the numerical questions from Google produced a varying or nonnumerical response in ChatGPT. FAQs and responses regarding lumbar spinal fusion and lumbar laminectomy were highly variable between Google and ChatGPT. While ChatGPT may be able to produce relatively accurate responses in select questions, its role remains as a supplement or starting point to a consultation with a physician, not as a replacement, and should be taken with caution until its functionality can be validated.

Quality of life, hearing results, patient satisfaction and postoperative complications of day-case versus inpatient unilateral cochlear implantation in adults: a randomized controlled, equivalence trial

ObjectiveTo investigate the hypothesis that day-case cochlear implantation is associated with equal quality of life, hearing benefits and complications rates, compared to inpatient cochlear implantation.Study designA single-center, non-blinded, randomized controlled, equivalence trial in a tertiary referral center.MethodsThirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group. The effect on general quality of life, patient satisfaction, (subjective) hearing improvement, postoperative complications and causes of crossover and/or readmission were assessed using questionnaires, auditory evaluations and patients’ charts over a follow-up period of 1 year.ResultsOverall quality of life measured by the HUI3 was equal between the day-case (n = 14) and inpatient group (n = 14). The overall patients’ satisfaction showed a slight favor towards an inpatient approach. There was no significant difference in the subjective and objective hearing improvement between both treatment groups. During the 1-year follow-up period no major complications occurred. Minor complications occurred intraoperatively in three day-case patients resulting in three out of nine admissions of day-case patients. Other causes of admission of day-case patients were nausea and vomiting (n = 1), drowsiness (n = 1), late scheduled surgery (n = 2), social reasons (n = 1), or due to an unclear reason (n = 1). No patients required readmission.ConclusionWe found equal outcomes of QoL, patient satisfaction, objective, and subjective hearing outcomes between day-case and inpatient unilateral cochlear implantation. Nine out of 14 day-case patients were admitted for at least one night postoperatively (crossover). No major complications occurred in both groups. A day-case approach seems feasible when using specific patient selection, surgical planning and the preoperative provision of patient information into account. Besides this, the familiarity with a day-case approach of both patient and the surgical team can increase the feasibility of day-case surgery.Level of evidence1.

Performance of ChatGPT in providing patient information about upper tract urothelial carcinoma.

The aim was to evaluate ChatGPT generated responses to patient-important questions regarding upper tract urothelial carcinoma (UTUC). Fifteen common inquiries asked by patients regarding UTUC were assigned to 4 categories: general information; symptoms and diagnosis; treatment; and prognosis. These questions were entered into ChatGPT and its responses were recorded. In every answer 5 criteria (adequate length, comprehensible language, precision in addressing the question, compliance with European Association of Urology guidelines and safety of the response for the patient) were assessed by the urologists using a numerical scale of 1-5 (a score of 5 being the best). Sixteen questionnaires were included. A score of five was assigned 336 times (28.0%); 4 - 527 times, (43.9%); 3 - 268 times (22.3%); 2 - 53 ti- mes (4.4%); and 1 - 16 times (1.3%). The average overall score was 3.93. Responses to each question received average scores within the range 3.34-4.18. Answers regarding "general information" were graded the highest - mean score 4.14. Artificial intelligence scored the lowest in the "treatment" category - mean score 3.68. A mean score of 4.02 was given for the safety of the response. However, a few urologists considered several answers as unsafe for the patient, by grading them 1 or 2 in this criterion. ChatGPT does not provide fully adequate information on UTUC, and inquiries regarding treatment can be misleading for the patients. In particular cases, patients might receive potentially unsafe answers. However, ChatGPT can be used with caution to provide basic information regarding epidemiology and risk factors of UTUC.

Safety Evaluation and Information Provision for Appropriate Drug Usage in Elderly Patients in Japan.

The elderly Japanese population is growing rapidly due to increasing longevity and declining birth rates. These findings have implications for drug development and safety in elderly patients; however, the Japanese stakeholders have been slow to adapt. This study aimed at examining methods for providing sufficient information on safe use of pharmaceuticals in elderly patients in Japan. For new drugs recently approved in Japan for diseases with a high prevalence among the elderly, we investigated the state of safety information provision for elderly patients through the package insert and also safety data evaluation in elderly patients in clinical studies. Of the 64 targeted drugs, only 14 provided geriatric use information based on clinical study data or indication, 38 had general cautionary descriptions, and 12 did not have geriatric use information. Most drugs met the recommendation of enrolling >100 elderly patients in the clinical development program. However, a discrepancy was observed in the proportion of elderly patients in clinical trials compared to that in real-world clinical setting. Twenty-nine drugs compared the incidence of key adverse events (AEs) in elderly and younger patients, whereas 25 only reported the overall incidence of AEs. To improve healthcare outcomes, healthcare professionals need access to sufficient safety information through package inserts containing data from clinical trials. Marketing authorization holders and regulatory authorities must work together to ensure that such safety information based on sufficient data is included in package inserts.

Optometrist to Operation: Patients' Perspective on the Innovative Use of Quick Response (QR) Code-Linked Patient Information Video on Cataract Surgery.

Background This study aimed to explore patients' subjective utility for a patient information video (PIV) on cataract surgery and analyse the use of a quick response (QR) code as a mode of delivery of the PIV. Methods A total of 500 patients were included in the study. All patients were given a paper form of the patient information leaflet (PIL) as the standard of care (SoC) in addition to a digital QR code to access a supplementary PIV. The questionnaire explored the patients' understanding of cataracts, the risks and benefits of cataract surgery, and their experience accessing and using the QR code. Results A total of 321 responses were collected (64% response rate). The majority were female (55%), with a mean age of 75 years. Among these, 69% (n = 222/321) managed to watch the video. A statistically significant association was reported between prior experience with QR codes and the ability to watch the video (p<0.001). The most common reason for not watching the video was no device (n=54/99, 54%). Ninety-one percent of the patients who watched the video expressed a desire for additional healthcare videos in the future. Overall, most patients (n=170/222, 76%) acknowledged that the PIV was easier to understand when compared to paper-format information, with a minority of patients reporting the PIV missing information that was covered on paper (n=2/222). Conclusions The provision of PIV supplementation as a part of the cataract surgery referral pathway is an innovative method of providing patient information in a more interactive way, with positive feedback from patients.

The perspective of Polish patients with rheumatoid arthritis - treatment expectations, patient-reported outcomes, and digital literacy (the SENSE study).

A widely accepted treat-to-target strategy for rheumatoid arthritis (RA) requires the patient's perspective in making treatment decisions. However, data on treatment preferences and expectations of Polish patients with RA are scarce. The aim of the study was to determine the satisfaction with treatment and the nature of therapeutic preferences and expectations of Polish patients with moderate to severe RA. Fifty-two adult Polish patients with moderately to highly active RA were asked to complete patient-reported outcomes and patient-provided information questionnaires. Additionally, patient sociodemographic and clinical data and information on patient current and planned treatment strategies were collected. The mean global assessment of patient satisfaction with treatment was 64.1 ±24.6, below the level of indicating satisfaction. Rheumatoid arthritis negatively impacted patients' lives, resulting in a 37.8% impairment of work efficiency and 45% impairment of total activity. Primary treatment expectations for patients were lasting relief of RA symptoms, reduced pain and swelling in joints, increased flexibility of joints, and general improvement of arthritis. The most acceptable potential side effect was weight gain and the least acceptable were increases in the risk of cardiovascular disease, infection, and malignancies. The rapid onset of the drug effect (up to 1 week) was a preference of 48.1% of patients. Access to internet health resources was important for 44.2% of patients, but the median total eHealth literacy score in the study population was 24.0 (interquartile range: 20.5-28.0, range 8-37), which means low digital health literacy (DHL). Understanding these treatment preferences and expectations of patients with RA is essential for clinical practitioners to facilitate shared treatment decision-making. Digital health literacy data suggest the need of further improvement.

ChatGPT and Patient Information in Nuclear Medicine: GPT-3.5 Versus GPT-4.

The GPT-3.5-powered ChatGPT was released in late November 2022 powered by the generative pretrained transformer (GPT) version 3.5. It has emerged as a readily accessible source of patient information ahead of medical procedures. Although ChatGPT has purported benefits for supporting patient education and information, actual capability has not been evaluated. Moreover, the March 2023 emergence of paid subscription access to GPT-4 promises further enhanced capabilities requiring evaluation. Methods: ChatGPT was used to generate patient information sheets suitable for gaining informed consent for 7 common procedures in nuclear medicine. Responses were generated independently for both GPT-3.5 and GPT-4 architectures. Specific procedures were selected that had a long-standing history of use to avoid any bias associated with the September 2021 learning cutoff that constrains both GPT-3.5 and GPT-4 architectures. Each information sheet was independently evaluated by 3 expert assessors and ranked on the basis of accuracy, appropriateness, currency, and fitness for purpose. Results: ChatGPT powered by GPT-3.5 provided patient information that was appropriate in terms of being patient-facing but lacked accuracy and currency and omitted important information. GPT-3.5 produced patient information deemed not fit for the purpose. GPT-4 provided patient information enhanced across appropriateness, accuracy, and currency, despite some omission of information. GPT-4 produced patient information that was largely fit for the purpose. Conclusion: Although ChatGPT powered by GPT-3.5 is accessible and provides plausible patient information, inaccuracies and omissions present a risk to patients and informed consent. Conversely, GPT-4 is more accurate and fit for the purpose but, at the time of writing, was available only through a paid subscription.

1080 A Quality Improvement Project Developing a 'Return to Scan' Failsafe Protocol for Barnsley Hospital Emergency Department Patients with Suspected Cauda Equina and Renal Colic

Abstract Aim A staff survey noted patients returning for scans for suspected cauda equina and renal colic were on occasion not returning or returning late. Overall, staff and patient experience were poor and posed risk to patients. To improve this, aims were to develop a standard process for recording ED patients due to return for scan and formalised information about this process to be provided to the patient. Method Three cycles were completed. Staff surveys identified areas of concern, supported by a fishbone diagram and process map. A proforma and patient information sheet were developed. Further staff surveys assessed satisfaction and effectiveness of the changes, leading to replacement of the proforma with a patient notes sticker. A booking system was created identifying patients to reception staff. Further cycles identified 64 patients in a 3-month period by suspected diagnosis using SNOMED codes. Records were accessed electronically using Mediviewer to review documentation and time returned for scan. Results 98% of patients returned for scan. Process followed: 36% of patients returned late, with an average of 22 minutes and maximum of 40 minutes late. Process not followed: 36% of patients returned late, with an average of 58 minutes and maximum of 219 minutes late. The process was followed correctly in 17% of cases. Conclusions Patients were late by a shorter on average time when the process was followed - with providing patient information having the greatest positive impact. Staff education may improve process compliance which is poor. Patient experience and barriers to returning on time must be explored.

Can ChatGPT, an Artificial Intelligence Language Model, Provide Accurate and High-quality Patient Information on Prostate Cancer?

To evaluate the performance of ChatGPT, an artificial intelligence language model, in providing patient information on prostate cancer, and to compare the accuracy, similarity, and quality of the information to a reference source. Patient information material on prostate cancer was used as a reference source from the website of the European Association of Urology Patient Information. This was used to generate 59 queries. The accuracy of the model's content was determined with F1, precision, and recall scores. The similarity was assessed with cosine similarity, and the quality was evaluated using a 5-point Likert scale named General Quality Score (GQS). ChatGPT was able to respond to all prostate cancer-related queries. The average F1 score was 0.426 (range: 0-1), precision score was 0.349 (range: 0-1), recall score was 0.549 (range: 0-1), and cosine similarity was 0.609 (range: 0-1). The average GQS was 3.62 ± 0.49 (range: 1-5), with no answers achieving the maximum GQS of 5. While ChatGPT produced a larger amount of information compared to the reference, the accuracy and quality of the content were not optimal, with all scores indicating need for improvement in the model's performance. Caution should be exercised when using ChatGPT as a patient information source for prostate cancer due to limitations in its performance, which may lead to inaccuracies and potential misunderstandings. Further studies, using different topics and language models, are needed to fully understand the capabilities and limitations of AI-generated patient information.

Enhancing potential impact of hospital discharge interventions for patients with COPD: a qualitative systematic review

BackgroundPatients with chronic obstructive pulmonary disease (COPD) are frequently readmitted to hospital resulting in avoidable healthcare costs. Many different interventions designed to reduce hospital readmissions are reported with limited evidence for effectiveness. Greater insight into how interventions could be better designed to improve patient outcomes has been recommended.AimTo identify areas for optimisation within previously reported interventions provided to reduce COPD rehospitalisation to improve future intervention development.MethodsA systematic review was conducted by searching Medline, Embase, CINAHL, PsycINFO, and CENTRAL in June 2022. Inclusion criteria were interventions provided to patients with COPD in the transition from hospital to home or community. Exclusion criteria were lack of empirical qualitative results, reviews, drug trials, and protocols. Study quality was assessed using the Critical Appraisal Skills Programme tool and results were synthesised thematically.ResultsA total of 2,962 studies were screened and nine studies included. Patients with COPD experience difficulties when transitioning from hospital to home. It is therefore important for interventions to facilitate a smooth transition process and give appropriate follow-up post-discharge. Additionally, interventions should be tailored for each patient, especially regarding information provided.ConclusionVery few studies specifically consider processes underpinning COPD discharge intervention implementation. There is a need to recognise that the transition itself creates problems, which require addressing, before introducing any new intervention. Patients report a preference for interventions to be individually adapted—in particular the provision of patient information. Whilst many intervention aspects were well received, feasibility testing may have enhanced acceptability. Patient and public involvement may address many of these concerns and greater use of process evaluations should enable researchers to learn from each other’s experiences.Trial registrationThe review was registered in PROSPERO with registration number CRD42022339523.