Patient involvement

患者参与
  • 文章类型: Journal Article
    背景:患者直接访问其基于网络的患者门户,包括实验室测试结果,变得越来越普遍。对于患者来说,数字实验室结果可能具有挑战性,这可能会导致焦虑,混乱,和不必要的医生咨询。实验室结果可以以不同的格式呈现,但是关于这些演示格式如何影响患者对信息的处理的证据有限。
    目的:本研究旨在综合提供数字实验室检查结果的有效格式的证据,重点关注与患者信息处理相关的结果,包括情感感知,感知的幅度,认知知觉,沟通的感知,decision,行动,和记忆。
    方法:搜索在3个数据库中进行(PubMed,WebofScience,和Embase)从成立到2023年5月31日。我们包括定量的,定性,以及描述或比较向患者提供诊断实验室测试结果的格式的混合方法文章。两名审阅者独立地提取并综合了所使用的文章和演示格式的特征。纳入文章的质量由2名独立审稿人使用混合方法评估工具进行评估。
    结果:共纳入18项研究,在研究设计和使用的主要结局方面存在异质性。文章的质量从差到优不等。大多数研究(n=16,89%)使用模拟测试结果。最常用的表示格式是具有参考范围的数值(n=12),带彩色块的水平线条(n=12),或具有数值的水平线条的组合(n=8)。所有研究都检查了感知作为一种结果,虽然在1和3篇文章中研究了动作和记忆,分别。总的来说,参与者的满意度和可用性是最高的测试结果时,使用水平线条与彩色块。添加参考范围或个性化信息(例如,目标范围)进一步增加参与者的感知。此外,水平线条显着降低了参与者搜索信息或联系医生的倾向,与参考范围的数值进行比较。
    结论:在这篇综述中,我们综合了实验室测试结果的有效呈现格式的现有证据.使用具有参考范围或个性化目标范围的水平线条增加了参与者的认知感知和交流感知,同时减少了参与者与医生联系的趋势。动作和记忆被研究的频率较低,因此,无法得出关于这些结果的单一首选格式的结论。因此,建议使用带有参考范围或个性化目标范围的水平线条,以增强患者对实验室检查结果的信息处理。进一步的研究应集中在现实生活中的设置和不同的演示格式,并结合与患者信息处理相关的结果。
    BACKGROUND: Direct access of patients to their web-based patient portal, including laboratory test results, has become increasingly common. Numeric laboratory results can be challenging to interpret for patients, which may lead to anxiety, confusion, and unnecessary doctor consultations. Laboratory results can be presented in different formats, but there is limited evidence regarding how these presentation formats impact patients\' processing of the information.
    OBJECTIVE: This study aims to synthesize the evidence on effective formats for presenting numeric laboratory test results with a focus on outcomes related to patients\' information processing, including affective perception, perceived magnitude, cognitive perception, perception of communication, decision, action, and memory.
    METHODS: The search was conducted in 3 databases (PubMed, Web of Science, and Embase) from inception until May 31, 2023. We included quantitative, qualitative, and mixed methods articles describing or comparing formats for presenting diagnostic laboratory test results to patients. Two reviewers independently extracted and synthesized the characteristics of the articles and presentation formats used. The quality of the included articles was assessed by 2 independent reviewers using the Mixed Methods Appraisal Tool.
    RESULTS: A total of 18 studies were included, which were heterogeneous in terms of study design and primary outcomes used. The quality of the articles ranged from poor to excellent. Most studies (n=16, 89%) used mock test results. The most frequently used presentation formats were numerical values with reference ranges (n=12), horizontal line bars with colored blocks (n=12), or a combination of horizontal line bars with numerical values (n=8). All studies examined perception as an outcome, while action and memory were studied in 1 and 3 articles, respectively. In general, participants\' satisfaction and usability were the highest when test results were presented using horizontal line bars with colored blocks. Adding reference ranges or personalized information (eg, goal ranges) further increased participants\' perception. Additionally, horizontal line bars significantly decreased participants\' tendency to search for information or to contact their physician, compared with numerical values with reference ranges.
    CONCLUSIONS: In this review, we synthesized available evidence on effective presentation formats for laboratory test results. The use of horizontal line bars with reference ranges or personalized goal ranges increased participants\' cognitive perception and perception of communication while decreasing participants\' tendency to contact their physicians. Action and memory were less frequently studied, so no conclusion could be drawn about a single preferred format regarding these outcomes. Therefore, the use of horizontal line bars with reference ranges or personalized goal ranges is recommended to enhance patients\' information processing of laboratory test results. Further research should focus on real-life settings and diverse presentation formats in combination with outcomes related to patients\' information processing.
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  • 文章类型: Journal Article
    背景:当患者进入急诊科(ED)时,腹痛是最常见的主诉之一。不幸的是,这些患者中的许多人在初次出院后不久再次接受ED.这些患者的观点尚未被探索。
    目的:本研究旨在探讨因急性腹痛再次入院的ED患者是如何经历初次入院的,出院后的时间,以及重新接纳的原因。
    方法:本研究采用现象学-解释学方法进行了定性探索性设计。对14例因急性腹痛再次入院的患者进行了半结构化的个人电话访谈。
    结果:分析显示四个主题:1)住院期间易受伤害,2)住院期间信息的含义,3)未经诊断出院,4)重新接纳以寻求救济。尽管患者病情脆弱,但患者希望获得更多知识和更好的交流。患者在疼痛时出院,国内局势的不确定性导致了对卫生专业人员的不信任。
    结论:患者因急性腹痛而首次入院的经历是孤独,与医疗保健专业人员的接触最少,缺乏信息和参与疼痛管理。出院与微不足道的感觉有关,并导致对死亡的恐惧。疼痛是再次入院的主要原因。患者描述了多次再入院是如何被医疗保健专业人员认真对待的。
    BACKGROUND: Abdominal pain is one of the most common complaints when patients are admitted to emergency departments (ED). Unfortunately, many of these patients are readmitted to the ED shortly after initial discharge. The perspectives of these patients have not yet been explored.
    OBJECTIVE: The study aimed to explore how patients readmitted with acute abdominal pain in the ED experienced their initial admission, the time after discharge, and the cause of readmission.
    METHODS: The study had a qualitative explorative design with a phenomenological-hermeneutic approach. Semi-structured individual telephone interviews were conducted with 14 patients readmitted with acute abdominal pain.
    RESULTS: The analysis showed four themes: 1) being vulnerable during hospitalisation, 2) the meaning of information during hospitalisation, 3) discharged without being diagnosed, and 4) readmitted in the pursuit of relief. The patients wanted more knowledge and better communication despite their vulnerable condition. Patients were discharged whilst still in pain, and uncertainty of the situation at home contributed to mistrust of the health professionals.
    CONCLUSIONS: Patients\' experience of the first ED admission due to acute abdominal pain was loneliness, minimal contact with healthcare professionals, and lack of information and involvement in pain management. Discharge was associated with feelings of insignificance and contributed to a fear of death. Pain was the main reason for readmission. Patients described how multiple readmissions contributed to being taken seriously by healthcare professionals.
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  • 文章类型: Journal Article
    背景:患者参与本科教育已被证明有助于学生技能发展,补充他们的教学培训。越来越多的教育计划实施了系统的患者参与课程,以符合专业和监管机构的要求,并确保更多地关注患者护理。本范围审查旨在确定和总结有关患者在本科生联合健康教育计划中的整合及其相关益处的文献。
    方法:此范围审查是使用对电子数据库MEDLINE的全面文献检索进行的,EMBASE和CINAHL。该研究是使用系统评价和荟萃分析的首选报告项目(PRISMA)指南进行和报告的。纳入标准包括英语和相关健康教育。排除标准超出了2011年至2023年的日期范围,非联合医疗计划,和教学过程中的临床暴露。文献评论和评论也被排除在外。
    结果:共有19项研究纳入范围审查。这些论文中的大多数研究了使患者参与课程交付的本科课程,而少数涉及患者的反馈交付和正式评估。其他形式的患者参与是通过课程共同设计。跨机构,证据表明患者参与对学生的好处,病人,和教育计划,以改善以人为本的护理。
    结论:患者参与课程交付和学生评估为学生和患者提供了宝贵的教学和学习经验。患者参与还确保将以人为本的护理原则纳入教育计划。提供了研究结果摘要,以更好地为患者和促进者做好准备,并增强对所有参与者的益处。
    BACKGROUND: Patient participation in undergraduate education has been proven to contribute to student skills development complementing their didactic training. An increasing number of educational programs have implemented systematic patient engagement in curriculum to comply with the requirements of professional and regulatory bodies and to ensure greater focus on patient care. This scoping review aims to identify and summarize literature on the integration of patients and associated benefits in undergraduate allied health education programs.
    METHODS: This scoping review was conducted using a comprehensive literature search of the electronic databases MEDLINE, EMBASE and CINAHL. The study was carried out and reported using the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidance for Systematic reviews and Meta Analyses. Inclusion criteria included English language and allied health education. Exclusion criteria were outside the date range of 2011 to 2023, non-allied health programs, and clinical exposure during didactic courses. Literature reviews and commentaries were also excluded.
    RESULTS: A total of nineteen studies were included in the scoping review. The majority of these papers examined undergraduate programs that engaged patients in curriculum delivery while a few involved patients in feedback delivery and formal assessment. Other forms of patient involvement were through curriculum co-design. Across institutions, evidence suggested the benefits of patient involvement to students, patients, and educational programs for improved delivery of person-centred care.
    CONCLUSIONS: Patient involvement in curriculum delivery and student assessment provided valuable teaching and learning experiences for students and patients. Patient engagement also ensured that person-centered care principles were integrated into education programs. Summary of findings are provided to better prepare patients and facilitators for their role and to enhance the benefits to all participants.
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  • 文章类型: Journal Article
    背景:通常,研究人员和临床医生确定了肉瘤研究的议程.然而,患者参与可以对研究产生有意义的影响.因此,肉瘤患者倡导全球网络(SPAGN)的患者驱动研究网络(PPRN)建立了优先级设定合作伙伴关系(PSP)。这种伙伴关系的主要目标是确定研究和患者宣传主题的优先事项。
    方法:在此PSP的第一阶段,包括来自世界各地的264名肉瘤患者和护理人员,使用在线调查确定了23个关于肉瘤的研究主题和15个患者倡导主题。在第二阶段,参与者被要求填写前五名和前三名的研究和患者宣传主题,分别。此外,收集社会人口统计学特征和肉瘤特征。社交媒体渠道,使用当地的全国患者倡导团体和SPAGN网站分发调查.
    结果:总计,671名患者(75%)和护理人员(25%)参加了这项调查。排名最高的五个研究课题与肉瘤的原因有关(43%),预后和复发风险(40%),肉瘤的特定亚型(33%),免疫治疗的作用,靶向治疗和联合治疗(30%),和遗传方面(30%)。排名最高的三个患者宣传主题是改善肉瘤的诊断过程(39%),获得肿瘤DNA分析(37%)和建立国际肉瘤登记(37%)。
    结论:该肉瘤PSP已确定了研究和患者倡导的优先事项,为研究人员提供指导,协助资助机构评估项目相关性,并授权患者倡导者代表患者和护理人员的需求。
    BACKGROUND: Typically, researchers and clinicians determine the agenda in sarcoma research. However, patient involvement can have a meaningful impact on research. Therefore, the Patient-Powered Research Network (PPRN) of the Sarcoma Patient Advocacy Global Network (SPAGN) set up a Priority Setting Partnership (PSP). The primary objective of this partnership is to identify priorities for research and patient advocacy topics.
    METHODS: In the first phase of this PSP, including 264 sarcoma patients and carers from all over the world, 23 research topics regarding sarcomas and 15 patient advocacy topics were identified using an online survey. In the second phase, participants were asked to fill in a top five and a top three of research and patient advocacy topics, respectively. Additionally, sociodemographic characteristics and sarcoma characteristics were collected. Social media channels, local national patient advocacy groups and the SPAGN website were used to distribute the survey.
    RESULTS: In total, 671 patients (75%) and carers (25%) participated in this survey. The five highest ranked research topics were related to causes of sarcoma (43%), prognosis and risk of recurrence (40%), specific subtypes of sarcoma (33%), the role of immunotherapy, targeted therapy and combined therapy (30%), and hereditary aspects (30%). The three highest ranked patient advocacy topics were improving the diagnostic process of sarcoma (39%), access to tumor DNA analysis (37%) and establishing an international sarcoma registry (37%).
    CONCLUSIONS: This sarcoma PSP has identified priorities for research and patient advocacy, offering guidance for researchers, assisting funding agencies with assessing project relevance and empowering patient advocates to represent the needs of patients and carers.
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  • 文章类型: Journal Article
    背景:患者的作用越来越大,家庭成员和照顾者作为顾问,加拿大卫生系统设置的合作者和合作伙伴。然而,对这一角色的补偿不是系统化的。当提供时,它在两种类型中都不同(例如,一次性酬金,工资)和金额。Further,患者伴侣对赔偿的广泛看法仍然未知。我们旨在描述提供补偿的患者合作伙伴的类型和频率以及他们对补偿的态度。
    方法:本研究使用来自加拿大患者伴侣研究(CPPS)调查的数据。该调查收集了那些自我认定为在加拿大卫生系统工作的患者合作伙伴的经验和观点。三个问题是关于赔偿的,询问提供了哪些类型的补偿参与者,如果他们拒绝赔偿,以及他们是否感到得到了充分的补偿。后两个问题除了基于菜单和缩放响应选项外,还包括开放文本注释。对所有问题执行基本频率,并通过归纳定性内容分析对开放文本评论进行分析。
    结果:共有603人参加了CPPS调查。大多数受访者从未或很少提供薪水(81%),酬金(64%),礼品卡(80%)或物质礼物(93%),而至少有时会提供一半的会议注册和费用。499名受访者中,共有129名(26%)表示拒绝赔偿。在511名受访者中,一半感到总是或经常得到充分的补偿,只有一半有时,很少或从不。开放式文本评论显示出积极的一面,对赔偿的矛盾和消极态度。态度是由对他们角色的看法构成的,回馈卫生系统的情绪,承认的感觉,实际考虑,公平、公平和问责关系的价值观。
    结论:我们的研究结果证实,在加拿大,补偿没有标准化。一半的受访者经常感到补偿不足。患者伴侣对什么是适当的补偿有不同的看法,包括个人考虑,例如对志愿服务的偏好,以及更广泛的关注,如促进患者伙伴关系的公平。组织应努力确保薪酬做法是明确的,透明和关注患者合作伙伴的独特环境。
    两名患者合作伙伴是CPPS研究团队的成员,他们充分参与了从项目构思到知识翻译的所有研究阶段。他们是这份手稿的共同作者。该调查是与患者合作伙伴共同设计和试点测试的,调查参与者是患者合作伙伴。
    BACKGROUND: There is a growing role for patients, family members and caregivers as consultants, collaborators and partners in health system settings in Canada. However, compensation for this role is not systematized. When offered, it varies in both type (e.g., one-time honorarium, salary) and amount. Further, broad-based views of patient partners on compensation are still unknown. We aimed to describe the types and frequency of compensation patient partners have been offered and their attitudes towards compensation.
    METHODS: This study uses data from the Canadian Patient Partner Study (CPPS) survey. The survey gathered the experiences and perspectives of those who self-identified as patient partners working across the Canadian health system. Three questions were about compensation, asking what types of compensation participants had been offered, if they had ever refused compensation, and whether they felt adequately compensated. The latter two questions included open-text comments in addition to menu-based and scaled response options. Basic frequencies were performed for all questions and open-text comments were analyzed through inductive qualitative content analysis.
    RESULTS: A total of 603 individuals participated in the CPPS survey. Most respondents were never or rarely offered salary (81%), honorarium (64%), gift cards (80%) or material gifts (93%) while half were offered conference registration and expenses at least sometimes. A total of 129 (26%) of 499 respondents reported refusing compensation. Of 511 respondents, half felt adequately compensated always or often, and half only sometimes, rarely or never. Open-text comments revealed positive, ambivalent and negative attitudes towards compensation. Attitudes were framed by perceptions about their role, sentiments of giving back to the health system, feelings of acknowledgement, practical considerations, values of fairness and equity and accountability relationships.
    CONCLUSIONS: Our findings confirm that compensation is not standardized in Canada. Half of survey respondents routinely feel inadequately compensated. Patient partners have diverse views of what constitutes adequate compensation inclusive of personal considerations such as a preference for volunteering, and broader concerns such as promoting equity in patient partnership. Organizations should attempt to ensure that compensation practices are clear, transparent and attentive to patient partners\' unique contexts.
    UNASSIGNED: Two patient partners are members of the CPPS research team and have been fully engaged in all study phases from project conception to knowledge translation. They are co-authors of this manuscript. The survey was co-designed and pilot tested with patient partners and survey participants were patient partners.
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  • 文章类型: Journal Article
    背景:基于价值的医疗保健(VBHC)专注于增加患者的价值。医院旨在通过医疗条件的价值改善(VI)团队实施VBHC。为了确定患者对价值的看法,在这些团队中,患者的集体参与非常重要.因此,我们评估了患者参与VI团队的现状,并分享了经验教训。
    方法:这项混合方法研究在荷兰的7家合作医院进行。调查问卷(公众和患者参与评估工具)是根据研究背景量身定做的,由VI团队成员完成(来自76个不同VI团队的n=147),并使用描述性统计数据进行分析。此外,与VI团队成员进行了30次半结构化访谈,并通过主题分析进行了分析。数据是在2022年2月至2023年1月之间收集的,并通过将定量结果映射到访谈主题来进行三角测量。
    结果:76个包括VI组的38个使用患者参与的形式报告。许多受访者(71%)表示缺乏明确的患者参与策略和目标。多名VI团队成员认为,患者参加VI团队需要特定的知识和技能。但这引起了对参与患者代表性的担忧。此外,虽然患者表示他们经历了某种程度的等级制度,他们还表示,他们对此并不感到受限制。最后,患者对他们的参与感到满意,感觉像平等的VI团队成员(100%),但是他们确实提到了VI团队对他们的投入缺乏反馈。
    结论:结果暗示在VI团队中没有充分实施患者参与。应制定指南,提供有关如何包括一组具有代表性的患者的信息,使用哪些方法,如何评估患者参与的影响,以及如何向参与的患者提供反馈。
    两名患者顾问是研究小组的成员,并参加了研究小组会议。他们作为研究伙伴参与研究的所有阶段,包括起草议定书(例如,起草采访指南和选择测量仪器),解释结果并撰写本文。
    BACKGROUND: Value-based healthcare (VBHC) focusses on increasing value for patients. Hospitals aim to implement VBHC via value improvement (VI) teams for medical conditions. To determine the patient\'s perspective on value, collective patient participation is important in these teams. We therefore evaluated the current state of patient participation in VI teams and share lessons learned.
    METHODS: This mixed-methods study was conducted at seven collaborating hospitals in the Netherlands. A questionnaire (the public and patient engagement evaluation tool) was tailored to the study\'s context, completed by VI team members (n = 147 from 76 different VI teams) and analysed with descriptive statistics. In addition, 30 semistructured interviews were held with VI team members and analysed through thematic analysis. Data were collected between February 2022 and January 2023 and were triangulated by mapping the quantitative results to the interview themes.
    RESULTS: Thirty-eight of the 76 included VI teams reported using a form of patient participation. Many respondents (71%) indicated a lack of a clear strategy and goal for patient participation. Multiple VI team members believed that specific knowledge and skills are required for patients to participate in a VI team, but this led to concerns regarding the representativeness of participating patients. Furthermore, while patients indicated that they experienced some level of hierarchy, they also stated that they did not feel restricted hereby. Lastly, patients were satisfied with their participation and felt like equal VI team members (100%), but they did mention a lack of feedback from the VI team on their input.
    CONCLUSIONS: The results imply the lack of full implementation of patient participation within VI teams. Guidelines should be developed that provide information on how to include a representative group of patients, which methods to use, how to evaluate the impact of patient participation, and how to give feedback to participating patients.
    UNASSIGNED: Two patient advisors were part of the research team and attended the research team meetings. They were involved as research partners in all phases of the study, including drafting the protocol (e.g., drafting interview guides and selecting the measurement instrument), interpreting the results and writing this article.
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  • 文章类型: Journal Article
    目的:本研究旨在证明患者的依从性,可行性,以及远程健康监测在伤口或引流出院的手术患者中的可接受性。
    方法:这是一项横断面可行性研究。乳房术后,塑料,使用方便采样招募有伤口和/或手术引流的肝胆患者。对照组给予常规护理,包括每日电话随访。干预组使用移动伤口应用程序拍摄伤口和引流图像,报告排水量和症状。通过测量实际与预期患者条目的百分比来评估依从性,通过比较异常和意外住院的检测来评估可行性,通过干预组护士和患者的主观反馈来评估可接受性。
    结果:招募了59名患者,对照组30例,干预组29例。9名专业护士参与了患者出院后的护理。肝胆疾病的平均依从率,乳房和整形患者占89.9%,分别为89.5%和75.9%。干预组的4例患者(13.8%)和对照组的6例患者(20.1%)被标记为具有潜在异常。至于意外的医院就诊,干预组2例(6.9%),对照组1例(3.4%).25名患者和9名专科护士回应了反馈调查。22名患者(88%)没有面临任何应用问题。18名患者(72%)更喜欢通过应用程序自我报告症状,而不是打电话给护士,并报告感到安全,因为他们知道自己被远程监控。大多数护士发现该应用程序既方便又省时(n=7,78%),通过图片进行监控比电话交谈更准确(n=8,89%)。
    结论:结果表明,带伤口或引流的手术患者使用移动应用程序是可行的,并且可以作为可行的监测工具。
    OBJECTIVE: This study aimed to demonstrate the compliance, feasibility, and acceptability of telehealth monitoring among surgical patients discharged with wounds or drains.
    METHODS: This is a cross-sectional feasibility study. Post-surgical breast, plastic, and hepatobiliary patients with wounds and/or surgical drains were recruited using convenience sampling. The control group received conventional care which consisted of daily telephone follow-up. The intervention group used a mobile wound application to take wound and drain images, report drainage amount and symptoms. Compliance was assessed by measuring the percentage of actual to expected patient entries, feasibility was assessed by comparing detection of abnormalities and unexpected hospital visits, and acceptability was assessed by subjective feedback from nurses and patients from the intervention group.
    RESULTS: 59 patients were recruited, with 30 patients in the control group and 29 patients in the intervention group. 9 specialty nurses were involved in the patients\' post-discharge care. The mean compliance rate for the hepatobiliary, breast and plastic patients were 89.9 %, 89.5 % and 75.9 % respectively. 4 patients from the intervention group (13.8 %) and 6 patients from the control group (20.1 %) were flagged as having potential abnormalities. As for unexpected hospital visits, there were 2 (6.9 %) in the intervention group and 1 (3.4 %) in the control group. 25 patients and 9 specialty nurses responded to the feedback survey. 22 patients (88 %) did not face any application issues. 18 patients (72 %) preferred to self-report symptoms via the application rather than to call the nurses and reported feeling safe knowing that they are remotely monitored. Most nurses found the app convenient and timesaving (n = 7, 78 %), with monitoring through pictures as more accurate than phone conversation (n = 8, 89 %).
    CONCLUSIONS: The results suggest that use of a mobile application by surgical patients discharged with wounds or drains is feasible and serves as a viable monitoring tool.
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  • 文章类型: Journal Article
    背景:先前的研究表明,从业者和患者之间的共同决策(SDM)增强了理想的治疗依从性。本研究采用了医疗保健中SDM的多方法方法,以加强这一论点的理论和方法论依据。作为研究设计,将自我报告的调查项目和实验小插图合并在一份电子问卷中。该技术旨在分析先前经验和当前有关SDM的偏好对遵循医疗建议的意图的影响。
    方法:使用从芬兰养老金领取者联合会成员(N=1610)收集的定量数据,这项研究的重点是作为医疗保健消费者的重要且不断增长的老年人群.在评估疫苗接种和疾病治疗的预期依从性时,使用了插图插图。取决于决策风格在重复的场景中有所不同。在学科内研究设计中,每个研究对象充当自己的对照。
    结果:研究结果表明,SDM与预期的治疗和疫苗接种依从性相关。SDM在临床中的回顾性经验和前瞻性愿望都支持患者对疫苗接种和治疗的预期依从性,同时降低了假性依从性的可能性。SDM与预期依从性之间的关联不受受访者感知健康的影响。然而,研究发现,预期依从性和决策风格之间的关联在治疗和疫苗接种方案之间存在差异.
    结论:SDM能够实现老年人预期的治疗依从性。因此,多方法研究强调了SDM在各种医疗保健中的重要性。研究结果进一步暗示,SDM研究受益于结合自我报告方法和实验研究设计的问卷。鼓励使用各种类型的书面和插图场景进行进一步的交叉验证研究。
    BACKGROUND: Previous studies have shown that shared decision-making (SDM) between a practitioner and a patient strengthens the ideal of treatment adherence. This study employed a multi-method approach to SDM in healthcare to reinforce the theoretical and methodological grounds of this argument. As the study design, self-reported survey items and experimental vignettes were combined in one electronic questionnaire. This technique aimed to analyze the effects of previous experiences and the current preferences regarding SDM on the intentions to follow-through with the medical recommendations.
    METHODS: Using quantitative data collected from the members of the Finnish Pensioners\' Federation (N = 1610), this study focused on the important and growing population of older adults as healthcare consumers. Illustrated vignettes were used in the evaluation of expected adherence to both vaccination and the treatment of an illness, depending on the decision-making style varying among the repeated scenarios. In a within-subjects study design, each study subject acted as their own control.
    RESULTS: The findings demonstrated that SDM correlates with expected adherence to a treatment and vaccination. Both the retrospective experiences and prospective aspirations of SDM in clinical encounters supported the patients\' expected adherence to vaccination and treatment while decreasing the probability of pseudo-compliance. The association between SDM and expected adherence was not affected by the perceived health of the respondents. However, the associations among the expected adherence and decision-making styles were found to differ between the treatment and vaccination scenarios.
    CONCLUSIONS: SDM enables expected treatment adherence among older adults. Thus, the multi-method study emphasizes the importance of SDM in various healthcare encounters. The findings further imply that SDM research benefits from questionnaires combining self-report methods and experimental study designs. Further cross-validation studies using various types of written and illustrated scenarios are encouraged.
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  • 文章类型: Journal Article
    背景:系统综述(SRs)中的患者参与(PI)有助于提高SRs的质量并增强研究过程的可信度。同时,SR中的PI带来了挑战,例如需要额外的时间。虽然来自英语国家的几个组织和工作组为SR中的PI提供了建议,德国缺乏利益相关者的最新见解,包括研究人员和患者。指出了他们的观点,由于语言障碍和组织差异,德国SR的PI可能会有所不同。为了分享和讨论利益相关者在德国的经验,促进了一个讲习班。本文总结了研讨会的结果,以阐明利益相关者对德国SR中PI关键方面的看法。
    方法:世界咖啡馆是在2023年循证医学网络会议上进行的。所有经验级别的参与者无需事先注册即可参加。所获得的数据是在一个迭代过程中叙述地总结的,并制定了所讨论主题的框架。
    结果:22名参与者,主要是研究人员,参加了。与会者为SR中的PI制定了一些一般条件,例如时间和透明度。所描述的大多数任务涉及SR的应用阶段和初始阶段。用简单的德语开发培训和信息材料被认为至关重要。外部资助的SR和患者招募的应用阶段被认为特别具有挑战性。
    结论:制定的几个方面,如时间和透明度,与早期的工作是一致的。SR的项目开始,然而,到目前为止,文献中还没有明确描述为特别重要。这一阶段对德国的SR项目可能更为重要,因为预计研究人员将为患者开发信息材料。由于德国PI的组织程度较低,因此申请阶段和患者招募都被认为特别具有挑战性。
    结论:WorldCafé的参与者描述了许多涉及SR项目开始的方面。这强调了SR中的PI需要被描述为一个过程。将SR的各个阶段与PI的各个阶段交织在一起的过程模型,理想情况下,包括每个阶段的最佳实践,可能有很大的价值。关于德国的具体情况,更大程度的PI组织,即由机构协调,可以帮助管理挑战,如患者招募。
    BACKGROUND: Patient involvement (PI) in systematic reviews (SRs) can help to improve the quality of SRs and enhance the credibility of the research process. At the same time, PI in SRs poses challenges such as the need for extra time. While several organizations and working groups from English-speaking countries provide recommendations for PI in SRs, there is a lack of current insights from stakeholders in Germany, including researchers and patients. Eliciting their perspectives is indicated, as PI in SRs in Germany might differ due to language barriers and organizational dissimilarities. For sharing and discussing stakeholders\' experiences in Germany, a workshop was facilitated. This paper summarizes the results of the workshop to elucidate stakeholders\' perspectives on key aspects of PI in SRs in Germany.
    METHODS: A World Café was conducted at the 2023 conference of the Network for Evidence-based Medicine. Participants at all levels of experience could take part without prior registration. The data obtained was summarized narratively in an iterative process, and a framework of the topics discussed was developed.
    RESULTS: 22 participants, predominantly researchers, took part. Participants formulated several general conditions for PI in SRs such as time and transparency. The majority of the tasks described referred to the application phase and the initial phase of a SR. The development of training and information materials in plain German language was deemed essential. The application phase of an externally funded SR and patient recruitment were considered as particularly challenging.
    CONCLUSIONS: Several of the formulated aspects such as time and transparency are consistent with earlier work. The project start of a SR, however, has so far not been explicitly described in the literature as being of particular importance. This phase might be even more crucial to SR projects in Germany since researchers are expected to develop information materials for patients. Both the application phase and patient recruitment could be considered particularly challenging due to a lower degree of organisation of PI in Germany.
    CONCLUSIONS: World Café participants described many aspects referring to the project start of a SR. This underlines that PI in SRs needs to be described as a process. A process model intertwining the phases of a SR with the respective phases of PI, ideally including best practices for each phase, could be of great value. With respect to the specific context in Germany, a greater degree of organization of PI, i.e. coordinated by an institution, could help to manage challenges such as patient recruitment.
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  • 文章类型: Journal Article
    目前医疗保健的趋势是让患者积极参与自己的治疗;然而,在实践中,医疗保健提供者可能会坚持家长式的观点,这可能不符合与患者参与相关的理想。当提供者谈论他们所经历的交互麻烦的服务遭遇时,这种紧张关系可能变得可见。在这项实证定性研究中,我们利用Bamberg的叙事定位分析来探索医疗保健提供者如何在关于这种令人不安的交流的叙述中构建患者的角色。数据包括对医疗保健提供者的20次录音采访。我们发现了两种类型的叙述,其中医疗保健提供者对相互困扰的患者交流的看法与他们对患者的内隐评估始终相关。在第一,活跃的病人被认为是理想的,有问题的病人是被动的。在第二个,患者的过度活跃被认为会干扰医疗服务的提供。虽然提供者对患者被动性的抱怨是从患者参与理想的角度毫无问题地提出的,关于患者过度活跃的抱怨很难解释,因为他们固有的家长式的内涵。因此,我们得出的结论是,需要培训和干预措施,旨在培养医疗保健提供者对转变文化模式的关键意识,包括患者的参与理想和提供者反映家长式倾向的能力。
    The current trend in healthcare is to actively involve patients in their own treatment; however, in practice, healthcare providers may adhere to paternalistic views, which may not align with ideals related to patient involvement. This tension may become visible when providers talk about service encounters that they experienced as being interactionally troubling. In this empirical qualitative study, we utilize Bamberg\'s narrative positioning analysis to explore how healthcare providers construct patients\' roles in narratives about such troubling exchanges. Data consist of 20 audio-recorded interviews with healthcare providers. We found two types of narratives in which healthcare providers\' perceptions of interactionally troubling patient exchanges were consistently related to their implicit evaluations of patients along a continuum of activeness versus passiveness. In the first, an active patient was considered ideal, and the problematic patient was one who is passive. In the second, a patient\'s over-activeness was thought to interfere with the healthcare delivery. While providers\' complaints about patient passiveness were unproblematically presented from the perspective of the patient participation ideal, complaints about patient over-activeness were difficult to account for due to their inherent connotations with paternalism. Thus, we conclude that there is a need for training and interventions aiming to develop healthcare providers\' critical awareness of shifting cultural models, including patient involvement ideals and providers\' capacity to reflect paternalistic tendencies.
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