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JAMA Network Open Oct 2021Although imaging has become a standard tool of modern medicine, its widespread use has been paralleled by an increasing cumulative radiation dose to patients despite...
IMPORTANCE
Although imaging has become a standard tool of modern medicine, its widespread use has been paralleled by an increasing cumulative radiation dose to patients despite technological advancements and campaigns calling for better awareness and minimization of unnecessary exposures.
OBJECTIVE
To assess patients' knowledge about medical radiation and related risks.
DESIGN, SETTING, AND PARTICIPANTS
A survey study of hospitals in Italy was conducted; all patients in waiting rooms for medical imaging procedures before undergoing imaging examinations at 16 teaching and nonteaching hospitals were approached to take the survey. The survey was performed from June 1, 2019, to May 31, 2020.
MAIN OUTCOMES AND MEASURES
Survey respondents' basic knowledge of ionizing radiation levels and health risks, earlier imaging tests performed, and information and communication about radiation protection issues.
RESULTS
Among 3039 patients invited to participate, the response rate was 94.3% (n = 2866). Participants included 1531 women (53.4%); mean (SD) age was 44.9 (17.3) years. Of the 2866 participants, 1529 (53.3%) were aware of the existence of natural sources of ionizing radiation. Mammography (1101 [38.4%]) and magnetic resonance imaging (1231 [43.0%]) were categorized as radiation-based imaging modalities. More than half of the 2866 patients (1579 [55.1%]; P = .03) did not know that chest computed tomography delivers a larger dose of radiation than chest radiography, and only 1499 (52.3%) knew that radiation can be emitted after nuclear medicine examinations (P = .004). A total of 667 patients (23.3%) believed that radiation risks were unrelated to age, 1273 (44.4%) deemed their knowledge about radiation risks inadequate, and 2305 (80.4%) preferred to be informed about radiation risks by medical staff. A better knowledge of radiation issues was associated with receiving information from health care professionals (odds ratio [OR], 1.71; 95% CI, 1.43-2.03; P < .001) and having a higher educational level (intermediate vs low: OR, 1.48; 95% CI, 1.17-1.88; P < .001; high vs low: OR, 2.68; 95% CI, 2.09-3.43; P < .001).
CONCLUSIONS AND RELEVANCE
The results of this survey suggest that patients undergoing medical imaging procedures have overall limited knowledge about medical radiation. Intervention to achieve better patient awareness of radiation risks related to medical exposures may be beneficial.
Topics: Adult; Female; Health Knowledge, Attitudes, Practice; Humans; Italy; Male; Middle Aged; Patients; Perception; Radiation Exposure; Radiation, Ionizing; Surveys and Questionnaires
PubMed: 34643721
DOI: 10.1001/jamanetworkopen.2021.28561 -
AMA Journal of Ethics Dec 2023Turfing is a colloquialism that refers to what clinicians do to patients whose needs do not fit neatly and tidily into typical clinical placement protocols, especially...
Turfing is a colloquialism that refers to what clinicians do to patients whose needs do not fit neatly and tidily into typical clinical placement protocols, especially during inpatient admissions from a hospital's emergency department. This term and this practice are both clinically and ethically problematic because a patient is rarely, if ever, "turfed" to their advantage. Ethically speaking, turfing constitutes deferral of responsibility for a patient's admission or care to colleagues. This article suggests when and under which circumstances it is clinically and ethically appropriate to defer a patient's care and suggests why turfing happens despite its negative influence on both physicians and patients.
Topics: Humans; Hospitalization; Emergency Service, Hospital; Physicians; Inpatients; Students
PubMed: 38085991
DOI: 10.1001/amajethics.2023.885 -
Family Medicine Jan 2015
Topics: Adaptation, Psychological; Attitude of Health Personnel; Female; Hope; Humans; Learning; Motivation; Patients; Physician-Patient Relations; Physicians, Family
PubMed: 25646881
DOI: No ID Found -
Family Medicine Jan 2015
Topics: Health Personnel; Hospitalization; Hospitals; Humans; Patients; Professional-Patient Relations
PubMed: 25646880
DOI: No ID Found -
BMC Health Services Research Apr 2020Shared decision-making (SDM) can advance patient satisfaction, understanding, goal fulfilment, and patient-reported outcomes. We lack clarity on whether this...
BACKGROUND
Shared decision-making (SDM) can advance patient satisfaction, understanding, goal fulfilment, and patient-reported outcomes. We lack clarity on whether this physician-focused literature applies to community rehabilitation, and on the integration of SDM policies in healthcare settings. We aimed to understand patient and provider perceptions of shared decision-making (SDM) in community rehabilitation, particularly the barriers and facilitators to SDM.
METHODS
We used a focused ethnography involving 14 community rehabilitation sites across Alberta, including rural, regional-urban and metropolitan-urban sites. We conducted semi-structured interviews that asked participants about their positive and negative communication experiences (n = 23 patients; n = 26 providers).
RESULTS
We found SDM experiences fluctuated between extremes: Getting Patient Buy-In and Aligning Expectations. The former is provider-driven, prescriptive and less flexible; the latter is collaborative, inquisitive and empowering. In Aligning Expectations, patients and providers express humility and openness, communicate in the language of ask and listen, and view education as empowering. Patients and providers described barriers and facilitators to SDM in community rehabilitation. Facilitators included geography influencing context and connections; consistent, patient-specific messaging; patient lifestyle, capacity and perceived outlook; provider confidence, experience and perceived independence; provider training; and perceptions of more time (and control over time) for appointments. SDM barriers included lack of privacy; waitlists and financial barriers to access; provider approach; how choices are framed; and, patient's perceived assertiveness, lack of capacity, and level of deference.
CONCLUSIONS
We have found both excellent experiences and areas for improvement for applying SDM in community rehabilitation. We proffer recommendations to advance high-quality SDM in community rehabilitation based on promoting facilitators and overcoming barriers. This research will support the spread, scale and evaluation of a new Model of Care in rehabilitation by the provincial health system, which aimed to promote patient-centred care.
Topics: Alberta; Anthropology, Cultural; Community Health Services; Decision Making, Shared; Female; Health Personnel; Humans; Male; Patients; Qualitative Research; Rehabilitation
PubMed: 32306972
DOI: 10.1186/s12913-020-05223-4 -
European Journal of Human Genetics :... Jun 2023As ambitions to 'mainstream' genetic and genomic medicine in the UK advance, patients are increasingly exposed to information about genomic data. Unlike the results of...
As ambitions to 'mainstream' genetic and genomic medicine in the UK advance, patients are increasingly exposed to information about genomic data. Unlike the results of many other medical investigations which are linked to the time of sample collection, genomic testing provides immortal data that do not change across time, and may have relevance for relatives and generations far beyond the patient's own lifespan. This immortality raises new ethical challenges for healthcare professionals, patients and families alike, such as ensuring consent for possible future interpretations; determining when genomic data are best sought (at birth, on illness etc) and reinterpreted; and balancing the confidentiality of patients and duties of care towards others. This paper reports on qualitative work exploring the perspectives of patients and relatives participating in genomic testing, and suggests that their engagements with this immortality are shaped by: the contrast between the simplicity of sample provision and information gathered; understandings of heritability; and notions of genomic data as a collective resource. We discuss the implications this holds for practice and argue that the immortality of genomic data must take a more prominent position in patient and healthcare professional interactions.
Topics: Infant, Newborn; Humans; Patients; Genome; Confidentiality; Genomics
PubMed: 37002328
DOI: 10.1038/s41431-023-01325-9 -
JAMA Network Open Jun 2021Early discussion of end-of-life (EOL) care preferences improves clinical outcomes and goal-concordant care. However, most EOL discussions occur approximately 1 month...
IMPORTANCE
Early discussion of end-of-life (EOL) care preferences improves clinical outcomes and goal-concordant care. However, most EOL discussions occur approximately 1 month before death, despite most patients desiring information earlier.
OBJECTIVE
To describe successful navigation and missed opportunities for EOL discussions (eg, advance care planning, palliative care, discontinuation of disease-directed treatment, hospice care, and after-death wishes) between oncologists and outpatients with advanced cancer.
DESIGN, SETTING, AND PARTICIPANTS
This study is a secondary qualitative analysis of outpatient visits audio-recorded between November 2010 and September 2014 for the Studying Communication in Oncologist-Patient Encounters randomized clinical trial. The study was conducted at 2 US academic medical centers. Participants included medical, gynecological, and radiation oncologists and patients with stage IV malignant neoplasm, whom oncologists characterized as being ones whom they "…would not be surprised if they were admitted to an intensive care unit or died within one year." Data were analyzed between January 2018 and August 2020.
EXPOSURES
The parent study randomized participants to oncologist- and patient-directed interventions to facilitate discussion of emotions. Encounters were sampled across preintervention and postintervention periods and all 4 treatment conditions.
MAIN OUTCOMES AND MEASURES
Secondary qualitative analysis was done of patient-oncologist dyads with 3 consecutive visits for EOL discussions, and a random sample of 7 to 8 dyads from 4 trial groups was analyzed for missed opportunities.
RESULTS
The full sample included 141 patients (54 women [38.3%]) and 39 oncologists (8 women [19.5%]) (mean [SD] age for both patients and oncologists, 56.3 [10.0] years). Of 423 encounters, only 21 (5%) included EOL discussions. Oncologists reevaluated treatment options in response to patients' concerns, honored patients as experts on their goals, or used anticipatory guidance to frame treatment reevaluation. In the random sample of 31 dyads and 93 encounters, 35 (38%) included at least 1 missed opportunity. Oncologists responded inadequately to patient concerns over disease progression or dying, used optimistic future talk to address patient concerns, or expressed concern over treatment discontinuation. Only 4 of 23 oncologists (17.4%) had both an EOL discussion and a missed opportunity.
CONCLUSIONS AND RELEVANCE
Opportunities for EOL discussions were rarely realized, whereas missed opportunities were more common, a trend that mirrored oncologists' treatment style. There remains a need to address oncologists' sensitivity to EOL discussions, to avoid unnecessary EOL treatment.
Topics: Adult; Advance Care Planning; Aged; Aged, 80 and over; Communication; Female; Humans; Male; Middle Aged; Neoplasms; Oncologists; Patient Care Planning; Patients; Physician-Patient Relations; Qualitative Research; Terminal Care; United States
PubMed: 34110395
DOI: 10.1001/jamanetworkopen.2021.13193 -
Scientific Reports Dec 2021Surgery is traditionally a male-dominated field, and gender differences exist despite the growing numbers of female surgeons. A handful of studies have evaluated the...
Surgery is traditionally a male-dominated field, and gender differences exist despite the growing numbers of female surgeons. A handful of studies have evaluated the condition in Asian societies. We aimed to examine the difference between female and male surgeons in urology, general surgery, and gynecology by analyzing a nationwide, population-based database. We identified surgeons with a clinical experience of six to thirteen years between 1995 to 2013 from the National Health Insurance Research Database. We collected patient numbers and revenue per month in outpatient and inpatient care, as well as monthly numbers of surgeries conducted by female and male surgeons in urology, general surgery, and gynecology, for analysis. Original student's t-test and wilcoxon rank sum test was used to compare the differences between female and male surgeons, and p values less than 0.05 were considered statistically significant. Female urologists and general surgeons had a significantly higher ratio of female patients in Taiwan. Female urologists had patient numbers, revenues, and numbers of surgeries comparable to male urologists. In contrast, female general surgeons had significantly less involvement in outpatient and inpatient care and had low monthly revenues. Female general surgeons contradictorily performed more oncological surgeries per month than males. However, the difference in numbers of oncological surgeries was not significant after excluding breast cancer surgeries. Female gynecologists had a similar amount of outpatients and outpatient revenue but significantly less inpatient care and numbers of surgeries per month. A gender-based gap exists among surgeons in Taiwan. The gap between females and males appeared narrower in urology than in general surgery and gynecology. Management of diseases related to female sex organs, including breast, were more common among female surgeons. Efforts should be made to decrease gender stereotypes, to ensure that patients receive the best care regardless of the sex of the surgeons.
Topics: Clinical Decision-Making; Female; Humans; Inpatients; Male; Outpatients; Patient Care; Practice Patterns, Physicians'; Sex Factors; Surgeons; Taiwan
PubMed: 34887512
DOI: 10.1038/s41598-021-03289-6 -
BMC Research Notes Jan 2018In order to improve privacy, quality, and coordination of care, a patient pager system was introduced to notify patients of daily treatment in the Department of...
OBJECTIVE
In order to improve privacy, quality, and coordination of care, a patient pager system was introduced to notify patients of daily treatment in the Department of Radiation Oncology. One hundred patients undergoing daily radiation therapy prospectively participated in a six-question survey addressing the paging service, privacy prior to pager use, and demographics. Twelve radiation therapists also participated in a survey addressing privacy and workflow.
RESULTS
Survey results from all patient participants revealed that convenience, privacy, ease of use, desire for use for consults and return visits were highly rated as very good to excellent. The top three categories were "ease of use," "convenience" and "privacy." Nineteen patients had the experience of our waiting room prior to introduction of the patient pagers and highly rated "privacy," "efficiency," and "satisfaction." Twelve radiation therapists participated and rated workflow related categories fair to good. Only patient privacy was rated as very good to excellent. Thus, patients and staff highly rated the paging system for privacy protection and satisfaction. However, it did not change overall workflow. Our study shows clinics should prioritize privacy in the waiting room to address the emotional needs of patients and improve satisfaction.
Topics: Female; Hospital Communication Systems; Hospital Departments; Humans; Male; Middle Aged; Patient Satisfaction; Patients; Privacy; Prospective Studies; Radiation Oncology; Surveys and Questionnaires
PubMed: 29357904
DOI: 10.1186/s13104-018-3164-5 -
BMC Health Services Research Aug 2023Focusing on patients' perceived values is essential for patient-centered health care. Only by identifying the patient's preferred values can we better meet their needs...
BACKGROUND
Focusing on patients' perceived values is essential for patient-centered health care. Only by identifying the patient's preferred values can we better meet their needs and provide them with valuable medical services. This study aimed to construct and validate a research model to obtain an overall quantification of patient value during outpatient encounters.
METHODS
The development of the research model was based on the reviewed literature, and an initial theoretical framework was formed by an expert panel discussion. A scale questionnaire for all the items was adapted from previous research related to patient value, verified using a presurvey, and thus used for data collection for this study. The structural equation model was used to determine and evaluate the research model of the values patients perceived during outpatient encounters.
RESULTS
572 eligible respondents who completed outpatient visits from a typical public hospital in China participated in this study from November 2020 to February 2021. We constructed the patient perceived value (PPV) model to identify core values, which includes eight dimensions and 29 items in terms of functional value (installation, efficiency, price, service quality), emotional value (interactive, control), and social value (accessibility, image) from two subgroups of patient value outside and in the outpatient visit process. Cronbach's alpha for the whole model was 0.950. The confirmatory factor analysis showed that the PPV model fits well, with a correlation of 0.83 between the two subgroups.
CONCLUSION
It is essential to recognize the values based on patients' perceptions and experiences throughout the entire visit process. Our findings offer targeted insights for healthcare administrators, enabling them to holistically optimize outpatient service processes and continually enhance the quality of outpatient medical services from the patient's perspective.
Topics: Humans; Outpatients; Hospitals, Public; Ambulatory Care; Empirical Research; China; Patient Satisfaction; Surveys and Questionnaires
PubMed: 37568157
DOI: 10.1186/s12913-023-09817-6