scholarly journals What patients with lung cancer with comorbidity tell us about interprofessional collaborative care across healthcare sectors: qualitative interview study

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e036495
Author(s):  
Jasmin Bossert ◽  
Johanna Forstner ◽  
Matthias Villalobos ◽  
Anja Siegle ◽  
Corinna Jung ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Information Exchange ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Active Role ◽  
Advanced Lung Cancer ◽  
Care Providers ◽  
Qualitative Interview Study ◽  
Registration Number ◽  
Communication Approach

BackgroundPatients with lung cancer with comorbidity often require treatment and care by different health professionals, in different settings and at different points in time during the course of the disease. In order to organise and coordinate healthcare efficiently, effective information exchange and collaboration between all involved care providers are required. The aim of this study was to assess the views of patients with advanced lung cancer with comorbidity regarding coordination of treatment and care across healthcare sectors.MethodsThis qualitative study, as part of the main study, The Heidelberg Milestones Communication Approach, used face-to-face guide-based semistructured interviews with patients with advanced lung cancer and their informal caregivers to explore cross-sectoral information exchange and collaboration in Germany. All generated data were audio-recorded, pseudonymised and transcribed verbatim. Data analysis was performed using qualitative content analysis to structure data into themes and subthemes. All data were managed and organised in MAXQDA.ResultsIn 15 interviews, participants reported that cross-sectoral collaboration functioned well, if treatments occurred as planned. However, treatment gaps were experienced, especially regarding medication and regimen. As a result, participants felt insecure and obliged to take responsibility for the coordination of healthcare. Patients reported to be in favour of an active patient role but felt that healthcare coordination should still be a responsibility of a care provider. A more intensive information exchange, potentially by using an electronic platform, was expected to strengthen cross-sectoral collaboration.ConclusionPatients with lung cancer are uncertain about their role in the coordination of treatment and care across healthcare sectors. Healthcare providers should be more aware of care recipients’ willingness of taking on a more active role in healthcare coordination.Trial registration numberDRKS00013469.

scholarly journals How to decide adequately? Qualitative study of GPs’ view on decision-making in self-referred and physician-referred emergency department consultations in Berlin, Germany

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026786 ◽  
Author(s):  
Sarah Oslislo ◽  
Christoph Heintze ◽  
Martina Schmiedhofer ◽  
Martin Möckel ◽  
Liane Schenk ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Qualitative Study ◽  
Qualitative Content Analysis ◽  
Wide Spectrum ◽  
Influencing Factor ◽  
Primary Care Providers ◽  
Ambulatory Setting ◽  
Care Providers ◽  
Registration Number

ObjectivesPatients with acute symptoms present not only to general practitioners (GPs), but also frequently to emergency departments (EDs). Patients’ decision processes leading up to an ED self-referral are complex and supposed to result from a multitude of determinants. While they are key providers in primary care, little is known about GPs’ perception of such patients. This qualitative study explores the GPs’ view regarding motives and competences of patients self-referring to EDs, and also GPs’ rationale for or against physician-initiated ED referrals.DesignQualitative study with semi-structured, face-to-face interviews; qualitative content analysis.SettingGP practices in Berlin, Germany.Participants15 GPs (female/male: 9/6; mean age 53.6 years).ResultsThe interviewed GPs related a wide spectrum of factors potentially influencing their patients’ decision to visit an ED, and also their own decision-making in potential referrals. Considerations go beyond medical urgency. Statements concerning patients’ surmised rationale corresponded to GPs’ reasoning in a variety of important areas. For one thing, the timely availability of an extended spectrum of diagnostic and therapeutic options may make ED services attractive to both. Access difficulties in the ambulatory setting were mentioned as additional triggers for an ED visit initiated by a patient or a GP. Key patient factors like severity of symptoms and anxiety also play a major role; a desire for reassurance may lead to both self-referred and physician-initiated ED visits. Patients’ health competence was prevailingly depicted as limited, with the internet as an important influencing factor. Counselling efforts by GP were described as crucial for improving health literacy.ConclusionsHealth education could hold promise when aiming to reduce non-urgent ED consultations. Primary care providers are in a key position here. Amelioration of organisational shortages in ambulatory care, for example, limited consultation hours, might also make an important impact, as these trigger both self-referrals and GP-initiated ED referrals.Trial registration numberDRKS00011930.

Perspectives of health care providers on the role of culture in the self-care of patients with chronic heart failure: a qualitative interview study conducted in Israel

2020 ◽  
Author(s):  
Adam Joensson ◽  
Emilie Cewers ◽  
Jean Marc Weinstein ◽  
Tuvia Ben Gal ◽  
Anna Stromberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Health Care Providers ◽  
Healthcare Providers ◽  
Self Care ◽  
Cultural Background ◽  
Care Providers ◽  
Qualitative Interview Study ◽  
Specific Barriers

Abstract Background: Self-care is recognized as important behaviour in chronic diseases such as heart failure (HF). The cultural background of patients with HF is one of the factors that can be considered to affect their adherence to self-care. The cultural background of the health care providers might also influence their view on self-care behaviour and the education they provide. The aim of this study was to describe health care providers' perceptions of the role of culture in self-care and how those perceptions shape their experiences and their practices.Methods: A qualitative study was performed in Israel, a country with a culturally diverse population. Data was collected using semi-structured interviews with 12 healthcare providers from different cultural backgrounds, selected by purposeful sampling, from two hospitals in Israel. Interviews were audio recorded and transcribed verbatim. Data was analysed using content analysis.Results: Healthcare providers experienced cultural background influenced their patients’ self-care behaviour. Perceived cultural-specific barriers to self-care such as: dietary traditions interfering with the recommended HF diet, willingness to undertake self-care and beliefs conflicting with medical treatment were identified. Healthcare providers described that they adapted their patient education and care based on the cultural background of the patients. Shared cultural background, awareness and knowledge of differences were described as positively influencing self-care education, while cultural differences could complicate this process. These findings are encapsulated within four categories regarding perceptions of health care providers: ‘Culture permeates self-care behaviours’, ‘Culture influence the way care is provided’, ‘Mutual cultural background impacts the mindset to address self-care’ and ‘Culture is only a small piece of the puzzle...’Conclusions: Cultural-specific barriers for self-care were perceived by health care providers and they identified that their own cultural background shapes their experiences and their practices.

A longitudinal communication approach in advanced lung cancer: A qualitative study of patients’, relatives’ and staff's perspectives

2017 ◽  
Vol 27 (2) ◽  
pp. e12794 ◽  
Author(s):  
M. Villalobos ◽  
K. Coulibaly ◽  
K. Krug ◽  
M. Kamradt ◽  
M. Wensing ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Qualitative Study ◽  
Advanced Lung Cancer ◽  
Communication Approach

Incentives to Reduce Salt Intake Resulting From Women’s Experiences: A Qualitative Study

2021 ◽  
pp. 0272684X2199137
Author(s):  
Tahere Soltani ◽  
Seyed Saeed Mazloomy Mahmoodabad ◽  
Ali Akbar Vaezi ◽  
Azadeh Nadjarzadeh ◽  
Seyedeh Mahdieh Namayandeh ◽  
...  
Keyword(s):  
Salt Intake ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Educational Interventions ◽  
Care Providers ◽  
Staff Support ◽  
Individual Interviews ◽  
Salt Consumption ◽  
Reduced Salt ◽  
Self Protection

Introduction Over consumption of salt adversely affects health and is associated with some diseases. Salt over consumption has been reported to be higher in Asian countries including Iran. This research aimed to identify the facilitative factors of reduced salt consumption among 20–65 year-old women to develop effective educational interventions. Methods: This research used qualitative content analysis. We included 42 (31 women aged 20–65 years residing in Hamidia, Yazd and 11 healthcare providers) using Purposeful sampling method. Data were collected through focal group discussions (three groups of 6) and in-depth semi-structured individual interviews with 24 Participants. Data analysis was done using Graneheim and Lundman’s approach. Results: Motivators and facilitators were extracted. The former consisted of sub-categories: physical fitness and healthcare, obtaining others’ approval, family cooperation and support, internal motivators, contextual motivators and healthcare staff support. Sub-categories of the latter were gaining more information from different instructions, willingness to acquire self-protection skills and nutritional advice. These factors affected to reduce the salt intake among women. Conclusion: In the light of the qualitative results of motivating and facilitating factors, it is essential to enhance internal motivators and increase access to information via different communicative channels in community including schools, medical care providers and public associations. It is also necessary to pave the way for more family and medical staff support, provide appropriate educational and advertising programs, raise women’s awareness and change their attitude and behavior with this concern.

scholarly journals Implementation of patient-centred care: which system-level determinants matter from a decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e050054
Author(s):  
Carmen Leidner ◽  
Vera Vennedey ◽  
Hendrik Hillen ◽  
Lena Ansmann ◽  
Stephanie Stock ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Healthcare System ◽  
Information Exchange ◽  
Social Care ◽  
Qualitative Content Analysis ◽  
Decision Makers ◽  
System Level ◽  
Patient Centred Care ◽  
Qualitative Interview Study ◽  
Health And Social Care

ObjectivesThe healthcare system is characterised by a high degree of complexity and involves various actors at different institutional levels and in different care contexts. To implement patient-centred care (PCC) successfully, a multidimensional consideration of influencing factors is required. Our qualitative study aims to identify system-level determinants of PCC implementation from the perspective of different health and social care organisations (HSCOs).DesignA qualitative study using n=20 semistructured face-to-face interviews with n=24 participants was carried out between August 2017 and May 2018. Interview data were analysed based on concepts of qualitative content analysis using an inductive and deductive approach.Setting and participantsInterviews were conducted with clinical and managerial decision makers from multiple HSCOs in the model region of Cologne, Germany. Participants were recruited via networks of practice partners and cold calling.ResultsThis study identified various determinants on the system level that are associated with PCC implementation. Decision makers described external regulations as generating an economically controlled alignment of the healthcare system. The availability and qualification of staff resources and patient-related incentives of financial resources were identified as an eminent requirement for providers to deliver PCC. Participants considered the strict separation of financing and delivery of healthcare into inpatient and outpatient sectors to be a barrier to PCC. Interorganisational collaboration and information exchange were identified as facilitators of PCC, as they enable continuous patient care cycles.ConclusionThe results showed the necessity of enforcing paradigm changes at the system level from disease-centredness to patient-centredness while aligning policy and reimbursement decisions directly with patient needs and values. A systematic, long-term planned strategy that extends across all organisations is lacking, rather each organisation seeks its own possibilities to implement PCC activities under external restrictions.Trial registration numberDRKS00011925

scholarly journals Superior vena cava resection and plastic repair as a part of surgical and combined treatment of lung cancer

2021 ◽  
Vol 67 (1) ◽  
pp. 59-63
Author(s):  
Evgeny Levchenko ◽  
Stepan Ergnyan ◽  
Vitalii Shutov ◽  
Nikolai Krotov ◽  
Nikita Levchenko ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Combined Treatment ◽  
Vena Cava ◽  
Long Term Results ◽  
Advanced Lung Cancer ◽  
Care Providers ◽  
Venous Resection ◽  
Reconstructive Operations

This article summarizes our own experience of reconstructive operations with resection and plastic repair of the superior vena cava in the field of locally advanced lung cancer surgery. Both technical aspects and methodological approaches of this type of combined interventions are described in detail. Data from 45 patients who underwent wedge (21) and circular (24) superior vena cava resections were analyzed. In most (65%) cases, venous resection and reconstruction were combined with multi-organ resections of other anatomical structures of the chest cavity. 87% of patients received combined treatment in different directions. Postoperative complications were registered in 40% of cases, and the mortality rate was 13%. The unfavorable postoperative prognostic factors were followings: old age, pneumonectomy, combination of vein angioplasty with carinal resection. The 5-year survival rate was 18.5%, with a median survival of 19.4 + 4.6 months. The results allow us to recommend such operations in highly specialized clinics that have extensive experience in tracheobronchial angioplastic surgery and highly-qualified anesthesia care providers. Multimodal treatment allows to achieve satisfactory long-term results.

scholarly journals Health care professionals’ experiences of how an eHealth application can function as a value-creating resource - a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Catharina Carlqvist ◽  
Heidi Hagerman ◽  
Markus Fellesson ◽  
Mirjam Ekstedt ◽  
Amanda Hellström
Keyword(s):  
Health Care ◽  
Value Creation ◽  
Health Care Professionals ◽  
Qualitative Content Analysis ◽  
Active Role ◽  
Formation Processes ◽  
Structured Interviews ◽  
A Value ◽  
Number Of Patients ◽  
Qualitative Interview Study

Abstract Background The number of patients with one or more chronic conditions is increasing globally. One strategy to achieve more sustainable care for these patients is by implementing use of home-based eHealth applications. Such services support patients to take on a more active role as value-creating co-producers of their own care, in collaboration with health care professionals. Health care professionals have a key role in the value creation process, but little is known about value formation within eHealth interactions, especially from their perspective. Therefore, this study aimed to provide a deeper understanding of how an eHealth application can function as a value-creating resource from the perspective of health care professionals. Methods Semi-structured interviews were conducted with thirteen health care professionals (nurses, physicians and first-line managers). Qualitative content analysis was used to analyze the interviews. Results The findings indicate that value formation processes are strongly influenced by the organizational preconditions and by the usability and functionality of technology. The experiences of the health care professionals indicated that value was conceptualized in dimensions of meaningfulness, building of relationships, building safety and feelings of trust. Although these dimensions were mainly expressed in a positive way, such as perceived improvement of medical care, accessibility and continuity, they also had a negative side that caused value destruction. This was primarily due to patient difficulties in using the application or making measurements. Subsequent efforts at value recovery resulted in value creation, but were often time-consuming for the professionals. Conclusions This study contributes by extending conceptualizations of value to the role of health care professionals and by highlighting technology as sometimes facilitating and sometimes hampering value formation processes. The findings indicate that the eHealth application was a value-creating resource, facilitating proactive communication and supporting patients’ engagement and control over their self-care. However, for the application to become a more valuable resource in practice and counteract inequity in care, it needs to be further developed to be adapted to the needs and preconditions of patients.

scholarly journals Perceived barriers and enablers for preventing the spread of carbapenem producing gram-negative bacteria during patient transfers: a mixed methods study among healthcare providers

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Eline van Dulm ◽  
Wendy van der Veldt ◽  
Katja Jansen-van der Meiden ◽  
Gerry van Renselaar ◽  
Lian Bovée ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Information Exchange ◽  
Healthcare Providers ◽  
Mixed Methods Study ◽  
Gram Negative Bacteria ◽  
Care Providers ◽  
Gram Negative ◽  
Patient Transfers ◽  
Carbapenem Resistant ◽  
Precautionary Measures

Abstract Background Antimicrobial resistance (AMR) increasingly threatens public health. Carbapenem-producing gram-negative bacteria (CPB) pose the biggest threat. The risk for CPB spread is heightened during the transfer of a CPB-positive patient between different healthcare institutions or healthcare providers. We aimed to gain insight into the frequency of CPB-positive patients in the Dutch provinces of Noord-Holland (NH) and Flevoland (FL). Secondly, we aimed to obtain a deeper understanding of the communication between healthcare providers during transfers of CPB-positive patients and explore possible communication-related risk situations for CPB spread. Methods This mixed-methods study consisted of a quantitative and qualitative section. For the quantitative section, 14 laboratories that provide diagnostics in NH and FL voluntarily reported carbapenem-producing Enterobacteriaceae (CPE) positive patients between February 2018 and February 2019. Additionally, two laboratories reported carbapenem-resistant Acinetobacter spp. (CRA) and carbapenem-resistant Pseudomonas aeruginosa (CRP) positive patients. For the qualitative section, healthcare providers of reported patients were interviewed about information exchange during patient transfers, precautionary measures and knowledge and beliefs concerning CPB. Results In total, 50 CPE-positive, 10 CRA-positive and 4 CRP-positive patients were reported during the inclusion period. Eighteen index-specific and 2 general interviews were conducted with 20 different care providers of 9 patients. The interviews revealed that, in most cases, information concerning the patient was transferred timely, but often a standardized method for sharing the information within and between institutions was lacking. Factors that enhanced care providers’ motivation to adhere to precautionary measures were taking responsibility for the health of other patients, (pregnant) colleagues and for ones own health. Factors that reduced motivation were not acknowledging the relevance of the precautionary measures, a perceived negative impact of the measures on patients’ recovery, differences in precautionary measures between healthcare settings and incomprehension for changes in precautionary measures. Conclusions CPB-positivity occurred more frequently than expected in the Dutch provinces of NH and FL. Standardizing the transference of information concerning CPB-positive patients, implementing transmural agreements, training personnel on CPB knowledge and procedures, launching a national website on CPB and assigning one or several designated employees for CPB within healthcare institutions could improve communication between healthcare providers and thereby decrease the risk of CPB transmission.

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