Assessing patient values first: Creating a platform for advance care planning (ACP) in the adult oncology population.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 99-99
Author(s):  
Sabrina Q. Mikan ◽  
Cynthia Taniguchi ◽  
J. Russell Hoverman ◽  
Susan Ash-Lee ◽  
Deb Harrison ◽  
...  
Keyword(s):  
Metastatic Cancer ◽  
Healthcare Providers ◽  
Cancer Center ◽  
Extensive Literature ◽  
Major Step ◽  
Patient Centered ◽  
Cross Sectional ◽  
Centered Care ◽  
Patient Values ◽  
Eol Care

99 Background: Patients, families and healthcare providers can be apprehensive about having end-of-life (EOL) conversations. However, asking patients about personal values regarding their healthcare goals may create a platform for more in depth conversations. A quantitative instrument to assess patient values and ACP readiness was developed and validated to complement a process for identifying patients appropriate for ACP. Methods: Recruitment was conducted at seven cancer center sites in The US Oncology Network over a 90-day pilot study period. Of 871 identified patients, 301 Texas Oncology patients engaged in ACP. A cross-sectional descriptive design was used in 301 metastatic cancer patients. Sixty-three participants completed the questionnaire. The 13-item instrument was created after an extensive literature review regarding EOL choices and interventions using a 5-point Likert scale. Descriptive statistics were examined, in addition to analysis of the relationships between items using Pearson’s r correlations. Results: Participants were primarily female (59%) and Caucasian (95%); with a mean age of 66 years. Sixty-eight percent reported it "Very Important" to be told they were dying. There was a significant association between willingness to discuss feelings about dying and being told by their physician when dying, (r= 0.373, p<0.01). Sixty-two percent reported it "Very Important" to be able to choose their EOL care location. EOL care location and level of burden for caregivers were significantly associated (r= 0.315, p<0.05). Also, 76% reported being able to select the person who makes EOL decisions for them as "Very Important." Conclusions: Recent studies have shown the importance of assessment of patient healthcare values in the metastatic oncology population. The values and readiness instrument allows healthcare providers to understand the patient’s wishes early in the course of care. ACP can be guided through review of the validated instrument in the adult metastatic population. This provides appropriate weight to both sides of the care equation and is a major step toward creating patient-centered care. Further development of the instrument is needed in this population.

Healthcare Providers’ Attitudes, Knowledge, and Practice Behaviors for Educating Patients About Advance Directives: A National Survey

2018 ◽  
Vol 36 (5) ◽  
pp. 387-395 ◽  
Author(s):  
Frances R. Nedjat-Haiem ◽  
Tamara J. Cadet ◽  
Anup Amatya ◽  
Shiraz I. Mishra
Keyword(s):  
Online Survey ◽  
Survey Design ◽  
Healthcare Providers ◽  
Medical Decision ◽  
Cross Sectional Survey ◽  
Patient Centered ◽  
Cross Sectional ◽  
Practice Behaviors ◽  
Centered Care ◽  
Seriously Ill Patients

Background: Advance care planning for end-of-life care emerged in the mid-1970’s to address the need for tools, such as the advance directive (AD) legal document, to guide medical decision-making among seriously ill patients, their families, and healthcare providers. Objective: Study aims examine providers’ perspectives on AD education that involve examining (1) a range of attitudes about educating patients, (2) whether prior knowledge was associated with practice behaviors in educating patients, and (3) specific factors among healthcare providers such as characteristics of work setting, knowledge, attitudes, and behaviors that may influence AD education and documentation. Design: To examine providers’ views, we conducted a cross-sectional, online survey questionnaire of healthcare providers using social media outreach methods for recruitment. Methods: This study used a cross-sectional survey design to examine the proposed aims. Healthcare providers, recruited through a broad approach using snowball methods, were invited to participate in an online survey. Logistic regression analyses were used to examine providers’ views toward AD education. Results: Of 520 participants, findings indicate that most healthcare providers said that they were knowledgeable about AD education. They also viewed providing education as beneficial to their practice. These findings suggest that having a positive attitude toward AD education and experiencing less organizational barriers indicate a higher likelihood that providers will educate patients regarding ADs. Conclusion: Various disciplines are represented in this study, which indicates that attitudes and knowledge influence AD discussions. The importance of AD discussions initiated by healthcare providers is critical to providing optimal patient-centered care.

Needs and Perspectives of Cancer Center Stakeholders for Access to Patient Values in the Electronic Health Record

2021 ◽  
pp. OP.20.00644 ◽  
Author(s):  
Anjali V. Desai ◽  
Rajiv Agarwal ◽  
Andrew S. Epstein ◽  
Gilad J. Kuperman ◽  
Chelsea L. Michael ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Patient Centered Care ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Health Record ◽  
Patient Centered ◽  
Centered Care ◽  
Electronic Health ◽  
Patient Values ◽  
Institutional Stakeholders

QUESTION ASKED: What is the most important information that diverse institutional stakeholders at a comprehensive cancer center need to know about patients to provide patient-centered care, and what is the best way to display this information in a new single-location feature in the electronic health record (EHR)? SUMMARY ANSWER: Thematic content analysis of semistructured interviews with a large and diverse group of institutional stakeholders at our comprehensive cancer center revealed themes informing design and development of the Patient Values Tab EHR feature, generated enthusiasm and buy-in for this digital innovation, created a sense of awareness among future users, and paved the way for implementation. WHAT WE DID: Qualitative data were collected through in-person, guide-based, audio-recorded, individual interviews with a total of 110 stakeholders representing a wide range of disciplines and professions, as well as others involved in administration of the hospital or clinics within our cancer center. WHAT WE FOUND: Respondents felt that to facilitate the delivery of patient-centered care, information in the following categories should be displayed: the patient's personhood, support system and resources, social history, communication preferences, future planning, end of life, and illness and treatment understanding. Other important themes that arose in the interviews included implementation considerations, improved communication and relationship building, and privacy implications. BIAS, CONFOUNDING FACTORS, DRAWBACKS, REAL-LIFE IMPLICATIONS: Since this study was conducted at a single dedicated cancer center, generalizability of findings across other healthcare settings merits further investigation. It is possible that non–English-speaking clinicians and patients, who were not interviewed, might have different needs or perspectives. We designed our Patient Values Tab for our institution's EHR (Allscripts); however, this display feature can be configured in other EHR software. By interviewing a large and varying sample of stakeholders and rigorously analyzing their responses, we obtained robust results to inform the development and implementation of this innovative EHR feature centralizing key information needed to enhance patient-centered cancer care. The introduction of the new Patient Values Tab at this well-known cancer center signals the importance of patient personhood and values throughout the institution and advances the use of the EHR as a driver of the delivery of patient-centered care throughout the illness.

“How I kept track of it of course was my business”: Cancer patient self-monitoring as self-stylized work

2013 ◽  
Vol 12 (5) ◽  
pp. 355-361 ◽  
Author(s):  
Carol J. Hermansen-Kobulnicky ◽  
Mary Anne Purtzer
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Cancer Center ◽  
Structured Interviews ◽  
Patient Centered ◽  
Work Lives ◽  
Self Monitoring ◽  
Centered Care ◽  
Cancer Experience ◽  
Present Opportunity

AbstractObjectives:Self-monitoring behaviors of cancer patients benefit patients, caregivers, and providers, and yet the phenomenon of self-monitoring from the cancer-patient perspective has not been studied. We examined cancer patients' self-monitoring preferences and practices, focusing on the meaning of self-monitoring within the cancer experience.Methods:Semi-structured interviews were conducted among adult cancer patients who had been seen at least once at a rural United States cancer center. Questions sought out the meaning of self-monitoring and its practical aspects. Qualitative data were analyzed by adapting the four-stepped method by Giorgi for empirical phenomenological analysis.Results:Twenty participants were interviewed (11 women and 9 men). Transcribed interviews revealed that cancer patient self-monitoring is self-stylized work that ranges from simple to complex, while being both idiosyncratic and routine. Participants reported using tools with systems for use that fit their distinctive lives for the purpose of understanding and using information they deemed to be important in their cancer care. Three conceptual categories were discerned from the data that help to elucidate this self-stylized work as fitting their individual priorities and preferences, reflecting their identities, and being born of their work lives.Significance of results:Findings highlight patients' unique self-monitoring preferences and practices, calling into question the assumption that the sole use of standardized tools are the most effective approach to engaging patients in this practice. Self-monitoring efforts can be validated when providers welcome or adapt to patients' self-stylized tools and systems. Doing so may present opportunity for improved communications and patient-centered care.

Practices and Perceptions of Family Centered Care among Healthcare Providers: A Cross-sectional Study in a Pediatric Hospital

2018 ◽  
Vol 43 ◽  
pp. e18-e25 ◽  
Author(s):  
Immacolata Dall'Oglio ◽  
Michela Di Furia ◽  
Emanuela Tiozzo ◽  
Orsola Gawronski ◽  
Valentina Biagioli ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Family Centered Care ◽  
Pediatric Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Centered Care ◽  
Family Centered

Caring for Patients with Service Dogs: Information for Healthcare Providers

2016 ◽  
Vol 22 (1) ◽  
Author(s):  
Michelle Krawczyk
Keyword(s):  
Emotional Support ◽  
Healthcare Providers ◽  
Background Information ◽  
Future Research ◽  
Service Dogs ◽  
Patient Centered ◽  
Service Dog ◽  
Healthcare Settings ◽  
Centered Care

People with disabilities use various assistance devices to improve their capacity to lead independent and fulfilling lives. Service dogs can be crucial lifesaving companions for their owners. As the use of service dogs increases, nurses are more likely to encounter them in healthcare settings. Service dogs are often confused with therapy or emotional support dogs. While some of their roles overlap, service dogs have distinct protection under the American Disabilities Act (ADA). Knowing the laws and proper procedures regarding service dogs strengthens the abilities of healthcare providers to deliver holistic, patient-centered care. This article provides background information about use of dogs, and discusses benefits to patients and access challenges for providers. The author reviews ADA laws applicable to service dog use and potential challenges and risks in acute care settings. The role of the healthcare professional is illustrated with an exemplar, along with recommendations for future research and nursing implications related to care of patients with service dogs.

Thoughts About Meanings of Compliance, Adherence, and Concordance

2020 ◽  
Vol 33 (4) ◽  
pp. 358-360
Author(s):  
Jacqueline Fawcett
Keyword(s):  
Conceptual Model ◽  
Patient Autonomy ◽  
Healthcare Providers ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Or Groups ◽  
Health Related Behaviors ◽  
Centered Care ◽  
Health Related

The purpose of this essay is to explore the meanings of the widely used terms compliance and adherence and the less widely used term concordance and to raise questions about the appropriateness of these terms when used to describe individuals’ or groups’ health-related behaviors. Discussion focuses on how recognition of how the meanings of these terms has uncovered the failure to honor nursing’s emphasis on person/patient-centered care due to power imbalances between healthcare providers and patents and the subsequent lack of patient autonomy. Consideration of these problems with existing terms could facilitate identification of a potentially more appropriate term based on the language of a nursing conceptual model and/or theory.

Patients’ and Families’ Satisfaction with Visiting Policies in Cardiac Intensive Care Units

2016 ◽  
Vol 9 (1) ◽  
pp. 67 ◽  
Author(s):  
Shiva Khaleghparast ◽  
Soodabeh Joolaee ◽  
Majid Maleki ◽  
Hamid Peyrovi ◽  
Behrooz Ghanbari ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Simple Random Sampling ◽  
Vital Role ◽  
Patient Centered ◽  
Cross Sectional ◽  
The Family ◽  
Centered Care ◽  
Cardiac Intensive Care ◽  
Cross Sectional Design

<p><strong>BACKGROUND: </strong>Families play a vital role in the recovery of patients admitted to Intensive Care Units. They can help patients to adapt themselves to the crisis and feel more satisfied.</p><p><strong>OBJECTIVE: </strong>In this study, we examined the patients’ and families’ satisfaction with the current visiting policies in Cardiac Intensive Care Units in the largest Cardiovascular Medical and Research Center of Iran.</p><p><strong>METHOD:</strong> This research used<strong> </strong>a cross-sectional design with a simple random sampling. To do so, 303 patients admitted to those Cardiac Intensive Care Units and their families responded to a two-part questionnaire between September 2014 and March 2015. The inclusion criteria for patients were aged between 18 and 85, acceptable general status to respond to the questions of the questionnaire, and having one of the cardiac diseases symptoms. Intention to attend was the only inclusion criterion for the family members.</p><p><strong>RESULTS:</strong> The results showed that 167(55.1%) of the participants were dissatisfied with the limited visiting policies of the Cardiac Intensive Care Units, while the satisfaction rate was 43(14.2%). The remaining participants (30.7%) were slightly satisfied with the visiting policies in Cardiac Intensive Care Units.</p><p><strong>CONCLUSIONS: </strong>Patient-centered care is an expectation among patients and their families in the Cardiac Intensive Care Units. It seems that a change in visiting policies is necessary.</p>

Understanding the interaction between physicians and pharmacists as a method of quality improvement.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 90-90
Author(s):  
Jessica Lynn Fontaine Calder ◽  
Vivian Choy ◽  
Denise Kwan ◽  
Sophia Li ◽  
Melissa Lo ◽  
...  
Keyword(s):  
Health Information System ◽  
Oral Chemotherapy ◽  
Professional Communication ◽  
Cancer Center ◽  
Patient Centered ◽  
System A ◽  
Medication Delivery ◽  
Centered Care ◽  
Pharmacy Technicians ◽  
Physician Order Entry

90 Background: Pharmacists and pharmacy technicians are essential to safe medication delivery. Filling prescriptions can be time consuming when the prescription is not complete or clear and requires inter-professional communication. To improve the quality and efficiency of dispensing medication we performed an audit of callbacks to physicians in the outpatient pharmacy associated with our cancer center with a focus on oral chemotherapy. Methods: The Princess Margaret is one of the largest cancer centers in the world, with an outpatient pharmacy on the premises that fills over 70,000 prescriptions a year. The pharmacists have access to the hospital’s Health Information System and chemotherapy prescribing system. A Prescription Audit Form was developed to track the mode of oral chemotherapy prescription (handwritten, preprinted, computerized physician order entry (CPOE), verbal) and reason for callback. The form was implemented from February 10th until March 7th, 2014 with coded data collection. The form was incorporated into the normal workflow of the outpatient pharmacy and concurrently used to document pharmacy interactions for billing purposes. Results: A total of 5,546 prescriptions were filled with 1,166 prescriptions for oral chemotherapy. Nine percent of prescriptions for oral chemotherapy required a callback to a physician and accounted for 32% of the total callbacks made to physicians. Of the 1,166 oral chemotherapy prescriptions; 39% were refills, 34% were handwritten, 22% were CPOE, 4% were verbal, 1% were preprinted, and 1% were not documented. The top two reasons for callbacks were; drug interaction (32%) and incorrect dose (24%). In the 9% of cases where the physician was contacted to clarify a prescription, the prescription was changed 43% of the time. Conclusions: Understanding the reasons for callbacks can be used to determine optimal data fields required in oral chemotherapy prescribing. Ensuring that prescriptions are appropriately completed will reduce the number of callbacks to physicians - significantly impacting the workflow and efficiency of the pharmacy. Reducing unnecessary callbacks will allow the pharmacy team to deliver timely, safe and effective patient centered care.

scholarly journals Formação de cuidadores de idosos institucionalizados

2019 ◽  
Vol 13 (5) ◽  
pp. 1216
Author(s):  
Vitor Emanuel Sousa da Silva ◽  
Kaiza Vilarinho da Luz ◽  
Dalton Kaynnan de Prado Costa ◽  
André Ricardo Ferreira da Silva Rocha ◽  
Rosângela Nunes Almeida ◽  
...  
Keyword(s):  
The Elderly ◽  
Cross Sectional Study ◽  
Health Care Education ◽  
Patient Centered ◽  
Cross Sectional ◽  
Calidad De Vida ◽  
Caregiver Quality ◽  
Centered Care ◽  
Qualitative Descriptive ◽  
Elderly Caregivers

RESUMOObjetivo: analisar a formação dos cuidadores de idosos institucionalizados. Método: trata-se de um estudo qualitativo, descritivo e transversal. Realizou-se com dez cuidadores de instituição de longa permanência (ILP), utilizando-se um instrumento semiestruturado. Submeteram-se os dados coletados à Análise de Discurso. Resultados: registra-se que predominaram as cuidadoras do gênero feminino, casadas, com idade média de 42 anos, e que o período médio de atuação na área foi de 7,1 anos. Sabe-se que 90% tinham formação em cuidador de idoso e elencaram, como dificuldades, colocar a fralda, dar banho, a comunicação e as estratégias para interagir com a teimosia dos idosos, bem como as demandas dos idosos e a sobrecarga de peso e de trabalho. Conclusão: concluiu-se que há a necessidade de se qualificar bem e atualizar a formação do cuidador profissional para que este possa executar a sua práxis com segurança, efetividade, eficiência e atenção centrada no paciente. Descritores: Saúde do Idoso; Cuidador; Qualidade de Vida; Atenção Primária à Saúde; Educação; Ensino.ABSTRACT Objective: to analyze the training of institutionalized elderly caregivers. Method: this is a qualitative, descriptive and cross-sectional study. It was carried out with ten caregivers of long-term institution (LTI), using a semi-structured instrument. The collected data were submitted to Speech Analysis. Results: it is recorded that the female carers, married, with a mean age of 42 years, predominated, and that the average period of performance in the area was 7.1 years. It is known that 90% had training in elderly caregivers and listed, as difficulties, putting diapers, bathing, communication and strategies to interact with the stubbornness of the elderly, as well as the demands of the elderly and the overload of weight and of work. Conclusion: it was concluded that there is a need to qualify well and update the training of the professional caregiver so that they can perform their praxis with safety, effectiveness, efficiency and patient-centered care. Descriptors: Elderly Health; Caregiver; Quality of life; Primary Health Care; Education; Teaching.RESUMEN Objetivo: analizar la formación de los cuidadores de ancianos institucionalizados. Método: se trata de un estudio cualitativo, descriptivo y transversal. Se realizó con diez cuidadores de institución de larga permanencia (ILP), utilizando un instrumento semiestructurado. Se sometieron los datos recogidos al Análisis de Discurso. Resultados: se registra que predominaron las cuidadoras del género femenino, casadas, con edad promedio de 42 años, y que el período promedio de actuación en el área fue de 7,1 años. Se sabe que el 90% tenía formación en cuidador de anciano y enumeró, como dificultades, colocar el pañal, bañar, la comunicación y las estrategias para interactuar con la terquedad de los ancianos, así como las demandas de los ancianos y la sobrecarga de peso y de trabajo. Conclusión: se concluyó que hay la necesidad de calificar bien y actualizar la formación del cuidador profesional para que éste pueda ejecutar su praxis con seguridad, efectividad, eficiencia y atención centrada en el paciente. Descritores: Salud del Anciano; Cuidadores; Calidad de Vida; Atención Primaria de Salud; Educación; Enseñanza.

scholarly journals Advancing Health Equity During the COVID-19 Pandemic through Digital Medical Interpretation Platforms

2021 ◽  
Author(s):  
Nazia Sharfuddin ◽  
Pamela Mathura ◽  
Emily Ling ◽  
Ellen Bruseker ◽  
Areej Rajeh ◽  
...  
Keyword(s):  
Health Equity ◽  
Clinical Assessment ◽  
Limited English Proficiency ◽  
Healthcare Providers ◽  
Accurate Information ◽  
Clinical Workflow ◽  
Patient Centered ◽  
Medical Interpretation ◽  
Centered Care ◽  
Improving Accuracy

Abstract Background: Medical Interpretation Services (MIS) is the gold-standard that should be used during clinical assessments with patients who have limited English proficiency (LEP) or have hearing loss. The COVID-19 pandemic has highlighted the urgent need for clear, concise medical communication between patients and clinicians to prevent the spread of COVID-19 and ensure public safety. Cost of MIS is covered by the provincial health authority in Alberta; however, it is not consistently utilized across the province.Aim: To implement digital MIS in the Emergency Department (ED) of one urban teaching hospital, improving accuracy of clinical assessment and to provide patient-centered communication. Methods: Applying quality improvement methodology, an intervention comprised of digital MIS technology and education was trialed for 6 months. To assess intervention effect, the number of MIS minutes and calls were measured monthly and a questionnaire was developed and administered to determine ED healthcare providers’ awareness, technology accessibility and perception of MIS integration into the clinical workflow. Results: Digital MIS was utilized consistently in the ED from the beginning of the COVID-19 pandemic (March 2020) and over the subsequent six months. The cost avoidance due to digital MIS usage was estimated to be $19,612.16. ED healthcare providers indicated that digital MIS helped smooth communication with patients and reduced the time it took to gather and provide accurate information. Conclusion: Providing digital MIS access, education and training is a means to advance health equity, by improving accuracy of clinical assessment and patient-centered care in the ED.

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