bims-paceca 2022-04-03 papers

bims-paceca

Biomed News

on Patient-centred care

Issue of 2022‒04‒03
fifteen papers selected by
Rob Penfold
Queensland Health

Shared Decision-Making in Cardiovascular Practice.
Perspectives of residents on shared decision making in medication management: A qualitative study.
Patients Who Reviewed a Decision Aid Prior to Major Orthopaedic Surgery Reported Higher Trust in Their Surgeon.
Implementation of a patient-centered mobile shared decision making platform and healthcare workers' evaluation: a case in a medical center.
Midwives' experiences of facilitating informed decision-making - a narrative literature review.
Shared Decision Making Among Older Adults With Advanced CKD.
Ready for SDM- evaluation of an interprofessional training module in shared decision making - A cluster randomized trial.
Implementation of a Web-Based Tool for Shared Decision-making in Lung Cancer Screening: Mixed Methods Quality Improvement Evaluation.
Patient-reported outcome measures for medication-related quality of life: A scoping review.
Optimising GPs' communication of advice to facilitate patients' self-care and prompt follow-up when the diagnosis is uncertain: a realist review of 'safety-netting' in primary care.
Treatment decision making (TDM): a qualitative study exploring the perspectives of patients with chronic haematological cancers.
Exploring the relation between clinician ratings and patient-reported experience and outcomes.
Patients' and clinicians' experiences of remote consultation? A narrative synthesis.
A systematic review and recommendations for prom instruments for older people with frailty in emergency care.
Peer support for people with chronic conditions: a systematic review of reviews.

Cardiol Rev. 2022 Mar 29.

Shared Decision-Making in Cardiovascular Practice.

Lloyd W Klein, H Vernon Anderson, Joaquin Cigarroa.

Clinical decisions are optimally made collaboratively, with patients and clinicians working together to review all available information and treatment options. A comprehensive dialogue that identifies and brings into focus individual patient goals within the context of the evidence base is the ideal approach. Shared decision-making (SDM) is essential to making choices about treatment preferences and characterizes the optimal practice of evidence-based medicine and good patient care. By supporting patient autonomy and engagement, the patient and family become partners in their health care. Decisions surrounding whether or not to proceed with diagnostic and therapeutic procedures after fully discussing appropriate alternatives are best made considering both the evidence base and patient goals. The central feature of SDM is that a clinician and a patient engage in a dialogue to jointly make decisions, with reciprocated sharing of information which both find beneficial to reach the best decision. SDM entails much more than patient education or informed consent: there must be bi-directional transfer of knowledge, discussion of patient preference, and a process of deliberation reaching consensus. Patient decision aids (PDAs) have been shown to improve patient understanding of options and risks, enhance the patient's involvement and focus their comprehension of treatment preferences. PDAs also may be of value in strengthening the physician- patient relationship. The need to emphasize SDM should be integrated into the quality process at every level to make it meaningful, not an apparently arbitrary obstacle that requires discovery of a shrewd work-around. A more patient-oriented consideration of the benefits of symptom relief and improved quality-of-life, in addition to survival and freedom from adverse events, could only be beneficial.

DOI: https://doi.org/10.1097/CRD.0000000000000434
Int Psychogeriatr. 2022 Mar 31. 1-11

Perspectives of residents on shared decision making in medication management: A qualitative study.

Mouna J Sawan, Yun-Hee Jeon, Sarah N Hilmer, Timothy F Chen.

  OBJECTIVES: Shared decision making is the process in which the person, their representative, and health care professional share information with each other, participate in the decision-making process, and agree on a course of action. At present, very little is known about shared decision making (SDM) in medication management from the perspective of long-term care facility residents. The objective of this study was to identify residents' beliefs, motivation, and aspects of the environment that facilitate or impede SDM.DESIGN: A qualitative study was conducted using face-to-face semi-structured interviews, and data analysis was carried out using a thematic approach.
SETTING: Six long-term care facilities in Sydney, Australia.
PARTICIPANTS: Thirty-one residents.
RESULTS: Enablers to resident involvement in SDM were resident beliefs in exercising their right to take part in medication-related decisions, preference to maintain control over decisions, and motivation to raise concern about medication. Residents were not motivated to be involved in SDM if they believed they had no control over life circumstance, perceived that medications were necessary, or experienced no problems with their medications. Participation in SDM was hindered by limitations in opportunities for resident involvement, engagement with staff and primary care physician to discuss issues related to medications, and continuity of care with their regular physician.
CONCLUSION: This study highlights that the residents' beliefs in control over decisions and concerns about medication are a significant function of the SDM process. It is important that residents are given the choice to take part in SDM, their beliefs and values regarding SDM are understood, and the culture of the care facility respects residents' right to participate in SDM.

Keywords:  decision making; deprescribing; long-term care; medications; patient education; patient–physician communication

DOI:  https://doi.org/10.1017/S1041610222000205
JB JS Open Access. 2022 Jan-Mar;7(1):pii: e21.00149. [Epub ahead of print]7(1):

Patients Who Reviewed a Decision Aid Prior to Major Orthopaedic Surgery Reported Higher Trust in Their Surgeon.

Suzanne Brodney, Karen Sepucha, Yuchiao Chang, Ben Moulton, Michael J Barry.

Decision aids (DAs) are utilized to ensure that patients are informed and involved in the decision-making process. Although DAs improve decision quality, other aspects of the decision-making process, such as trust and regret, are seldom measured. The objective of the present study was to determine whether patients given a DA prior to orthopaedic surgery had greater trust and lower regret at 6 months postoperatively.Methods: Consecutive patients were identified who underwent a hip or knee replacement or spine surgery from October 2018 to January 2020 and were subsequently surveyed at 6 months postoperatively. Outcomes included the Trust in the Surgical Decision and Decision Regret Scales. The primary analysis compared scores of patients who reviewed at least some of the DA to those who had not received or reviewed it. A sensitivity analysis compared patients with a DA order who reported reviewing it to those who did not. Multivariable models analyzed whether DA exposure predicted trust or regret. An exploratory mediation analysis examined the direct and indirect effects of DA exposure, including through the Shared Decision Making Process score.
Results: The response rate was 56% (700 of 1,253). In the primary analysis, the proportion of patients who reported complete trust was 50.9% among those with no DA review and 63.8% among those with DA review (adjusted odds ratio, 1.62; 95% confidence interval, 1.11 to 2.36). A nonsignificant effect was observed comparing a DA order (59.9%) versus no DA order (51.4%; adjusted odds ratio, 1.30; 95% confidence interval, 0.80 to 2.11). Regret was unrelated to DA exposure. In the mediation analysis, 19.3% (95% confidence interval, 3.1% to 35.4%) of the effect of DA review on trust could be attributed to increased shared decision making.
Conclusions: Patients who reviewed a DA prior to orthopaedic surgery reported higher trust in their surgeons.
Clinical Relevance: Providing patients with a DA prior to orthopaedic surgery can improve trust in the surgeon. Improving trust between patients and surgeons may improve communication and help patients make better health decisions.

DOI: https://doi.org/10.2106/JBJS.OA.21.00149
Inform Health Soc Care. 2022 Mar 29. 1-12

Implementation of a patient-centered mobile shared decision making platform and healthcare workers' evaluation: a case in a medical center.

Chang-Chih Tsai, Chung-Feng Liu, Hung-Jung Lin, Tzu-Chi Lin, Kuang-Ming Kuo, Jing-Jia Lin, Chia-Jung Chen, Mei-Chuan Lee.

  Shared decision making is a patient-centered clinical decision-making process that allows healthcare workers to share the existing empirical medical outcomes with patients before making critical decisions. This study aims to explore a project in a medical center of developing a mobile SDM in Taiwan. Chi Mei Medical Center developed the mobile SDM platform and conducted a survey of evaluation from healthcare workers. A three-tier platform that based on cloud infrastructure with seven functionalities was developed. The survey revealed that healthcare workers with sufficient SDM knowledge have an antecedent effect on the three perceptive factors of acceptance of mobile SDM. Resistance to change and perceived ease of use show significant effect on behavioral intention. We provided a comprehensive architecture of mobile SDM and observed the implementation in a medical center. The majority of healthcare workers expressed their acceptancem; however, resistance to change still present. It is, therefore, necessary to be eliminated by continuously promoting activities that highlight the advantages of the Mobile SDM platform. In clinical practice, we validated that the mobile SDM provides patients and their families with an easy way to express their concerns to healthcare workers improving significantly their relationship with each other.

Keywords:  Shared decision making; computer-assisted decision making; healthcare workers; mobile platforms; patient-centered care; resistance to change

DOI:  https://doi.org/10.1080/17538157.2022.2054344
Midwifery. 2022 Mar 23. pii: S0266-6138(22)00074-2. [Epub ahead of print]109 103322

Midwives' experiences of facilitating informed decision-making - a narrative literature review.

Joy Kloester, Suzanne Willey, Helen Hall, Gabrielle Brand.

  BACKGROUND: Informed decision-making is a vital component of midwifery philosophy and a core recommendation of the global respectful maternity care charter; however, women and midwives report a lack of informed decision-making in actual practice. Research reveals informed decision-making improves physical and mental health outcomes for women, regardless of childbearing experience, and is a protective factor for midwives' job satisfaction. There is currently little known about midwives' experiences of facilitating informed decision-making, and associated barriers.OBJECTIVE: To critically appraise and synthesize the best qualitative evidence exploring midwives' experiences of facilitating women's informed decision-making.
METHODS: A systematic search of key databases and grey literature for qualitative research in English language published between 2010-2019. Quality assessment followed CASP guidelines and this review is reported in accordance with PRISMA guidelines. Thirteen studies were included in the final review. Data were synthesised narratively.
RESULTS: Midwives were shown to have a strong desire to facilitate informed decision-making, yet reported a disparity between philosophy and practice due to multiple barriers. Barriers included; lack of specific knowledge and training, fear of blame and litigation, structural constraints including lack of time and fragmented models of midwifery care, and multidisciplinary philosophical disparities.
CONCLUSION: Existing literature identifies informed decision-making is the gold-standard in providing safe and respectful maternity care, yet this review demonstrates that it is not well executed in actual practice. Midwives recognise this disparity and identify barriers which require urgent education, research, policy and practice solutions.

Keywords:  Informed Consent; Informed Decision-Making; Midwife; Midwifery Philosophy; Respectful Maternity Care; Women

DOI:  https://doi.org/10.1016/j.midw.2022.103322
Am J Kidney Dis. 2022 Mar 26. pii: S0272-6386(22)00578-9. [Epub ahead of print]

Shared Decision Making Among Older Adults With Advanced CKD.

Rebecca Frazier, Sarah Levine, Thalia Porteny, Hocine Tighiouart, John B Wong, Tamara Isakova, Susan Koch-Weser, Elisa J Gordon, Daniel E Weiner, Keren Ladin.

  RATIONALE & OBJECTIVE: Older adults with advanced chronic kidney disease (CKD) face difficult decisions about dialysis initiation. Although shared decision-making (SDM) can help align patient preferences and values with treatment options, the extent to which older CKD patients experience SDM remains unknown.STUDY DESIGN: A cross-sectional analysis of patient surveys examining decisional readiness, treatment options education, carepartner support, and SDM.
SETTING & PARTICIPANTS: Adults ages 70 years and older with non-dialysis advanced CKD from Boston, Chicago, San Diego, and Portland (Maine).
PREDICTORS: Decisional readiness factors, treatment options education, and carepartner support.
OUTCOMES: Primary: SDM measured by the SDM-Q-9 instrument, with higher scores reflecting greater SDM. Exploratory: Factors associated with SDM.
ANALYTICAL APPROACH: We used multivariable linear regression models to examine the associations between SDM and predictors, controlling for demographic and health factors.
RESULTS: Among 350 participants, mean age was 78 ± 6 years, 58% were male, 13% identified as Black, and 48% had diabetes. Mean SDM-Q-9 score was 52 ± 28. SDM item agreement ranged from 41% of participants agreeing that "My doctor and I selected a treatment option together" to 73% agreeing that "My doctor told me that there are different options for treating my medical condition." In multivariable analysis adjusted for demographics, lower eGFR and diabetes, being "well informed" and "very well informed" about kidney treatment options, having higher decisional certainty, and attendance at a kidney treatment options class were independently associated with higher SDM-Q-9 scores.
LIMITATIONS: The cross-sectional study design limits the ability to make temporal associations between SDM and the predictors.
CONCLUSION: Many older CKD patients do not experience SDM when making dialysis decisions, emphasizing the need for greater access to and delivery of education for individuals with advanced CKD.

Keywords:  chronic kidney disease; dialysis; education; older adults; shared-decision making

DOI:  https://doi.org/10.1053/j.ajkd.2022.02.017
Patient Educ Couns. 2022 Mar 17. pii: S0738-3991(22)00128-8. [Epub ahead of print]

Ready for SDM- evaluation of an interprofessional training module in shared decision making - A cluster randomized trial.

Simone Kienlin, Dawn Stacey, Kari Nytrøen, Alexander Grafe, Jürgen Kasper.

  OBJECTIVE: Ready for SDM was developed in Norway as a comprehensive modularized curriculum for health care providers (HCP). The current study evaluated the efficacy of one of the modules, a 2-hour interprofessional SDM training designed to enhance SDM competencies.METHODS: A cluster randomized controlled trial was conducted with eight District Psychiatric Centres randomized to wait-list control (CG) or intervention group (IG). Participants and trainers were not blinded to their allocation. The IG received a 2-hour didactic and interactive training, using video examples. The primary outcome was the agreement between the participants' and an expert assessment of patient involvement in a video recorded consultation. The SDM-knowledge score was a secondary outcome.
RESULTS: Compared to the CG (n = 65), the IG (n = 69) judged involvement behavior in a communication example more accurately (mean difference of weighted T, adjusted for age and gender:=-0.098, p = 0.028) and demonstrated better knowledge (mean difference=-0.58; p = 0.014). A sensitivity analysis entering a random effect for cluster turned out not significant.
CONCLUSION: The interprofessional group training can improve HCPs' SDM-competencies.
PRACTICE IMPLICATIONS: Addressing interprofessional teams using SDM communication training could supplement existing SDM training approaches. More research is needed to evaluate the training module's effects as a component of large-scale implementation of SDM.

Keywords:  Communication skills; Curriculum; Inter-professional Education; Randomized controlled trial; Shared decision-making

DOI:  https://doi.org/10.1016/j.pec.2022.03.013
JMIR Hum Factors. 2022 Apr 01. 9(2): e32399

Implementation of a Web-Based Tool for Shared Decision-making in Lung Cancer Screening: Mixed Methods Quality Improvement Evaluation.

Julie Lowery, Angela Fagerlin, Angela R Larkin, Renda S Wiener, Sarah E Skurla, Tanner J Caverly.

  BACKGROUND: Lung cancer risk and life expectancy vary substantially across patients eligible for low-dose computed tomography lung cancer screening (LCS), which has important consequences for optimizing LCS decisions for different patients. To account for this heterogeneity during decision-making, web-based decision support tools are needed to enable quick calculations and streamline the process of obtaining individualized information that more accurately informs patient-clinician LCS discussions. We created DecisionPrecision, a clinician-facing web-based decision support tool, to help tailor the LCS discussion to a patient's individualized lung cancer risk and estimated net benefit.OBJECTIVE: The objective of our study is to test two strategies for implementing DecisionPrecision in primary care at eight Veterans Affairs medical centers: a quality improvement (QI) training approach and academic detailing (AD).
METHODS: Phase 1 comprised a multisite, cluster randomized trial comparing the effectiveness of standard implementation (adding a link to DecisionPrecision in the electronic health record vs standard implementation plus the Learn, Engage, Act, and Process [LEAP] QI training program). The primary outcome measure was the use of DecisionPrecision at each site before versus after LEAP QI training. The second phase of the study examined the potential effectiveness of AD as an implementation strategy for DecisionPrecision at all 8 medical centers. Outcomes were assessed by comparing absolute tool use before and after AD visits and conducting semistructured interviews with a subset of primary care physicians (PCPs) following the AD visits.
RESULTS: Phase 1 findings showed that sites that participated in the LEAP QI training program used DecisionPrecision significantly more often than the standard implementation sites (tool used 190.3, SD 174.8 times on average over 6 months at LEAP sites vs 3.5 SD 3.7 at standard sites; P<.001). However, this finding was confounded by the lack of screening coordinators at standard implementation sites. In phase 2, there was no difference in the 6-month tool use between before and after AD (95% CI -5.06 to 6.40; P=.82). Follow-up interviews with PCPs indicated that the AD strategy increased provider awareness and appreciation for the benefits of the tool. However, other priorities and limited time prevented PCPs from using them during routine clinical visits.
CONCLUSIONS: The phase 1 findings did not provide conclusive evidence of the benefit of a QI training approach for implementing a decision support tool for LCS among PCPs. In addition, phase 2 findings showed that our light-touch, single-visit AD strategy did not increase tool use. To enable tool use by PCPs, prediction-based tools must be fully automated and integrated into electronic health records, thereby helping providers personalize LCS discussions among their many competing demands. PCPs also need more time to engage in shared decision-making discussions with their patients.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02765412; https://clinicaltrials.gov/ct2/show/NCT02765412.

Keywords:  academic detailing; clinical decision support; implementation; lung cancer; quality improvement; screening; shared decision-making

DOI:  https://doi.org/10.2196/32399
Res Social Adm Pharm. 2022 Mar 10. pii: S1551-7411(22)00058-4. [Epub ahead of print]

Patient-reported outcome measures for medication-related quality of life: A scoping review.

Kadesha A James, Lauren Cadel, Sander L Hitzig, Sara J T Guilcher.

  BACKGROUND: Medication use is common for the prevention and treatment of many health conditions. Understanding the impact of medication-taking on quality of life is important, as it could contribute to better care plans and improve shared decision-making between patients and healthcare providers.OBJECTIVE: To systematically identify and summarize the extent of literature on patient-reported outcome measures (PROMs) for medication-related quality of life (QoL).
METHODS: Medline, Embase, PsycINFO, and Health and Psychosocial Instruments databases were searched until May 17, 2021 for peer-reviewed, original research articles that included a PROM for medication-related QoL and reported its psychometric properties. Study selection were completed by pairs with a third reviewer resolving any conflicts. Data were extracted by the study team using a form in Microsoft Excel. Extracted data were summarized descriptively and tabulated numerically.
RESULTS: We screened 8,878 records, including 170 full-text articles, of which 86 met the criteria for inclusion. We identified 80 unique PROMs. Over half (n = 53) described measuring treatment satisfaction and less than one quarter measured medication related-QoL more broadly. Most of the included PROMs were targeted towards populations with specific health conditions including cancer (n = 9) and diabetes (n = 8), as well as individuals taking medication for non-specific conditions (n = 7). The most reported psychometric properties were internal consistency (n = 75) and construct validity (n = 77). All PROMs but one (n = 79) assessed physical health but fewer assessed other QoL dimensions (e.g., autonomy, interactions with providers).
CONCLUSIONS: We found that the PROMs were designed for condition-specific or medication-specific populations, with few for general medication-related QoL. Future research should focus on assessing medication-related QoL measures for broader populations such as those with disabilities, multimorbidity, or experiencing polypharmacy. There needs to be more guidance on how to implement the use of PROMs in clinical settings, as well as to ensure consistency around terminology related to QoL.

Keywords:  Drug therapy; Medication therapy management; Patient reported outcome measure; Psychometrics; Quality of life; Scoping review

DOI:  https://doi.org/10.1016/j.sapharm.2022.03.003
BMJ Qual Saf. 2022 Mar 30. pii: bmjqs-2021-014529. [Epub ahead of print]

Optimising GPs' communication of advice to facilitate patients' self-care and prompt follow-up when the diagnosis is uncertain: a realist review of 'safety-netting' in primary care.

Claire Friedemann Smith, Hannah Lunn, Geoff Wong, Brian D Nicholson.

  BACKGROUND: Safety-netting has become best practice when dealing with diagnostic uncertainty in primary care. Its use, however, is highly varied and a lack of evidence-based guidance on its communication could be harming its effectiveness and putting patient safety at risk.OBJECTIVE: To use a realist review method to produce a programme theory of safety-netting, that is, advice and support provided to patients when diagnosis or prognosis is uncertain, in primary care.
METHODS: Five electronic databases, web searches, and grey literature were searched for studies assessing outcomes related to understanding and communicating safety-netting advice or risk communication, or the ability of patients to self-care and re-consult when appropriate. Characteristics of included documents were extracted into an Excel spreadsheet, and full texts uploaded into NVivo and coded. A random 10% sample was independently double -extracted and coded. Coded data wasere synthesised and itstheir ability to contribute an explanation for the contexts, mechanisms, or outcomes of effective safety-netting communication considered. Draft context, mechanism and outcome configurations (CMOCs) were written by the authors and reviewed by an expert panel of primary care professionals and patient representatives.
RESULTS: 95 documents contributed to our CMOCs and programme theory. Effective safety-netting advice should be tailored to the patient and provide practical information for self-care and reconsultation. The importance of ensuring understanding and agreement with advice was highlighted, as was consideration of factors such as previous experiences with healthcare, the patient's personal circumstances and the consultation setting. Safety-netting advice should be documented in sufficient detail to facilitate continuity of care.
CONCLUSIONS: We present 15 recommendations to enhance communication of safety-netting advice and map these onto established consultation models. Effective safety-netting communication relies on understanding the information needs of the patient, barriers to acceptance and explanation of the reasons why the advice is being given. Reduced continuity of care, increasing multimorbidity and remote consultations represent threats to safety-netting communication.

Keywords:  communication; decision making; patient safety; primary care; risk management

DOI:  https://doi.org/10.1136/bmjqs-2021-014529
BMJ Open. 2022 Mar 29. 12(3): e050816

Treatment decision making (TDM): a qualitative study exploring the perspectives of patients with chronic haematological cancers.

Dorothy McCaughan, Eve Roman, Alexandra Smith, Russell Patmore, Debra Howell.

  OBJECTIVES: Haematological malignancies are the fifth most common cancer in the UK, with chronic subtypes comprising around a third of all new diagnoses. These complex diseases have some similarities with other cancers, but often require different management. Surgical resection is not possible, and while some are curable with intensive chemotherapy, most indolent subtypes are managed with non-aggressive intermittent or continuous treatment, often over many years. Little is known about the views of patients with chronic haematological cancers regarding treatment decision making (TDM), a deficit our study aimed to address.SETTING AND DESIGN: Set within the Haematological Malignancy Research Network (HMRN: www.hmrn.org), an ongoing population-based cohort that provides infrastructure to support evidence-based research, HMRN data were augmented by qualitative information from in-depth interviews. Data were analysed for thematic content, combining inductive and deductive approaches. Interpretation involved seeking meaning, salience and connections within data.
PARTICIPANTS: Thirty-five patients with four chronic subtypes: chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma, and myeloma. Ten relatives were present and contributed to varying extents.
RESULTS: Five themes were discerned: (1) Preference for clinician recommendations; (2) Factors implicated in patient involvement in TDM; (3) Perceptions of proactive/non-proactive approaches to TDM; (4) Experiences of TDM at various points in the disease trajectory; (5) Support from others. Our principal finding relates to a strong preference among interviewees for treatment recommendations from haematologists, based on trust in their expertise and perceptions of empathetic patient-clinician relationships.
CONCLUSION: Interviewees wanted to be involved in TDM to varying extents, contingent on complex, inter-related factors, that are dynamic and subject to change according to differing clinical and personal contexts. Patients may benefit from clinicians assessing their shifting preferences for involvement on multiple occasions. Strong preferences for acceptance of recommendations was associated with cancer complexity, trust in clinician expertise and positive perceptions of patient-clinician relationships.

Keywords:  CHEMOTHERAPY; Leukaemia; Lymphoma; Myeloma; Organisation of health services; QUALITATIVE RESEARCH

DOI:  https://doi.org/10.1136/bmjopen-2021-050816
Int J Qual Health Care. 2022 Mar 31. 34(Supplement_1): ii98-ii104

Exploring the relation between clinician ratings and patient-reported experience and outcomes.

Shlomo Mendlovic, David Roe, Geffen Markusfeld, Jan Mainz, Solvejg Kristensen, Gil Goldzweig.

  BACKGROUND: Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly recognized as important ways for patients to be more actively involved in their treatment and enhance shared decision-making.OBJECTIVE: The current study investigated the associations between PROMs, PREMs and various symptoms measures reported by clinicians and psychiatric patients.
METHOD: One hundred and twenty people admitted to a psychiatric hospital completed two PREMs, one PROM (the shortened version of the Manchester Short Assessment of Quality of Life scale) and Effects of Symptoms on Daily Functioning (the Sheehan Disability Scale), the Patient Clinical Global Impression and the Modified Colorado Symptom Index. Their psychiatrists rated them using the Global Assessment of Functioning scale, the Health of the Nation Outcome Scales and the Therapist Clinical Global Impression.
RESULTS: There was a strong correlation between patient's evaluation of their quality of life (PROM), experience of their care (PREM) and the overall severity of their condition and their progress. The pattern of correlation between patients' and clinicians' measures revealed a three-layer structure representing a continuum from inner experience to external presentation of experiences.
CONCLUSION: Together these findings help identify and emphasize various domains of subjective experiences and their relation to external ratings.

Keywords:  mental health; patient-reported experiences; patient-reported outcomes; psychiatry

DOI:  https://doi.org/10.1093/intqhc/mzac004
J Adv Nurs. 2022 Apr 01.

Patients' and clinicians' experiences of remote consultation? A narrative synthesis.

Helen Walthall, Sue Schutz, Joanne Snowball, Raluca Vagner, Nicola Fernandez, Emilia Bartram.

  AIMS: To identify, evaluate and summarize evidence of patient and clinician experiences of being involved in video or telephone consultations as a replacement for in-person consultations.DESIGN: Narrative synthesis.
DATA SOURCES: Medline; EMBASE; EMCARE; CINAHL and BNI. Searching took place from January 2021 to April 2021. Papers included were published between 2013 and 2020.
REVIEW METHODS: Papers were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized tool from Joanna Briggs Institute.
RESULTS: Seven qualitative studies were included, from five countries and from the perspective of patients, relatives, administrators, nurses, physiotherapists and physicians. We developed two main themes: Pragmatic Concerns and Therapeutic Concerns. Each theme contained two categories: Pragmatic Concerns: (a) the convenience of non-face to face consultations; (b) using technology and equipment in a consultation; Therapeutic Concerns (c) building therapeutic relationships; and (d) embracing benefits and addressing challenges.
CONCLUSION: This narrative synthesis presents the existing evidence on clinician and patient experience of participating in non-face to face consultations. Experiences are varied but largely focus on communication and forming relationships, using the technology successfully and the ability for patients to self-manage with support from clinicians who are not in-person. More high-quality studies are required to explore the experiences of patients and clinicians accessing remote consultations as a result of global implementation post-SARS-CoV-2 pandemic to identify any learning and education opportunities.
IMPACT: Health care staff can provide high-quality care through video or telephone appointments as well as face to face appointments. This review has, however, identified that the evidence is limited and weak in this area and recommends there is research further to inform practice and influence future care.

Keywords:  SARS-CoV-2; narrative synthesis; nursing; technological communication; telehealth; telemedicine; telephone consultation; video consultation

DOI:  https://doi.org/10.1111/jan.15230
J Patient Rep Outcomes. 2022 Apr 01. 6(1): 30

A systematic review and recommendations for prom instruments for older people with frailty in emergency care.

James David van Oppen, Abdullah Alshibani, Timothy John Coats, Blair Graham, Patricia Holch, Jagruti Lalseta, Nicola Mackintosh, Vivien Richardson, Peter Riley, Jose M Valderas, Simon Paul Conroy.

  INTRODUCTION: The current service metrics used to evaluate quality in emergency care do not account for specific healthcare outcome goals for older people living with frailty. These have previously been classified under themes of 'Autonomy' and 'Functioning'. There is no person-reported outcome measure (PROM) for older people with frailty and emergency care needs. This study aimed to identify and co-produce recommendations for instruments potentially suitable for use in this population.METHODS: In this systematic review, we searched six databases for PROMs used between 2010 and 2021 by older people living with frailty receiving acute hospital care. Studies were reviewed against predefined eligibility criteria and appraised for quality using the COSMIN Risk of Bias checklist. Data were extracted to map instrument constructs against an existing framework of acute healthcare outcome goals. Instrument face and content validity were assessed by lay collaborators. Recommendations for instruments with potential emergency care suitability were formed through co-production.
RESULTS: Of 9392 unique citations screened, we appraised the full texts of 158 studies. Nine studies were identified, evaluating nine PROMs. Quality of included studies ranged from 'doubtful' to 'very good'. Most instruments had strong evidence for measurement properties. PROMs mainly assessed 'Functioning' constructs, with limited coverage of 'Autonomy'. Five instruments were considered too burdensome for the emergency care setting or too specific for older people living with frailty.
CONCLUSIONS: Four PROMs were recommended as potentially suitable for further validation with older people with frailty and emergency care needs: COOP/WONCA charts, EuroQol, McGill Quality of Life (Expanded), and Palliative care Outcome Scale.

Keywords:  Emergency medicine; Frailty; Geriatrics; Patient satisfaction; Patient-reported outcome measure; Person-centred care

DOI:  https://doi.org/10.1186/s41687-022-00438-x
BMC Health Serv Res. 2022 Mar 31. 22(1): 427

Peer support for people with chronic conditions: a systematic review of reviews.

Dean M Thompson, Lesley Booth, David Moore, Jonathan Mathers.

  BACKGROUND: People with chronic conditions experience functional impairment, lower quality of life, and greater economic hardship and poverty. Social isolation and loneliness are common for people with chronic conditions, with multiple co-occurring chronic conditions predicting an increased risk of loneliness. Peer support is a socially driven intervention involving people with lived experience of a condition helping others to manage the same condition, potentially offering a sense of connectedness and purpose, and experiential knowledge to manage disease. However, it is unclear what outcomes are important to patients across the spectrum of chronic conditions, what works and for whom. The aims of this review were to (1) collate peer support intervention components, (2) collate the outcome domains used to evaluate peer support, (3) synthesise evidence of effectiveness, and (4) identify the mechanisms of effect, for people with chronic conditions.METHODS: A systematic review of reviews was conducted. Reviews were included if they reported on formal peer support between adults or children with one or more chronic condition. Data were analysed using narrative synthesis.
RESULTS: The search identified 6222 unique publications. Thirty-one publications were eligible for inclusion. Components of peer support were organised into nine categories: social support, psychological support, practical support, empowerment, condition monitoring and treatment adherence, informational support, behavioural change, encouragement and motivation, and physical training. Fifty-five outcome domains were identified. Quality of life, and self-efficacy were the most measured outcome domains identified. Most reviews reported positive but non-significant effects.
CONCLUSIONS: The effectiveness of peer support is unclear and there are inconsistencies in how peers are defined, a lack of clarity in research design and intervention reporting, and widely variable outcome measurement. This review presents a range of components of peer support interventions that may be of interest to clinicians developing new support programmes. However, it is unclear precisely what components to use and with whom. Therefore, implementation of support in different clinical settings may benefit from participatory action research so that services may reflect local need.

Keywords:  Chronic conditions; Peer support; Review of reviews; Systematic review

DOI:  https://doi.org/10.1186/s12913-022-07816-7