Nurses' Perceptions of Prognosis-Related Communication.

CN115 - Communication of genetic information to family members in hereditary cancers and healthcare providers’ role

OBJECTIVE To understand the knowledge and attitudes of rural Chinese physicians, patients, and village health workers (VHWs) toward diabetic eye disease and glaucoma. METHODS Focus groups for each of the 3 stakeholders were conducted in 3 counties (9 groups). The focus groups were recorded, transcribed, and coded using specialized software. Responses to questions about barriers to compliance and interventions to remove these barriers were also ranked and scored. RESULTS Among 22 physicians, 23 patients, and 25 VHWs, knowledge about diabetic eye disease was generally good, but physicians and patients understood glaucoma only as an acutely symptomatic disease of relatively low prevalence. Physicians did not favor routine pupillary dilation to detect asymptomatic disease, expressing concerns about workflow and danger and inconvenience to patients. Providers believed that cost was the main barrier to patient compliance, whereas patients ranked poorly trained physicians as more important. All 3 stakeholder groups ranked financial interventions to improve compliance (eg, direct payment, lotteries, and contracts) low and preferred patient education and telephone contact by nurses. All the groups somewhat doubted the ability of VHWs to screen for eye disease accurately, but patients were generally willing to pay for VHW screening. The VHWs were uncertain about the value of eye care training but might accept it if accompanied by equipment. They did not rank payment for screening services as important. CONCLUSIONS Misconceptions about glaucoma's asymptomatic nature and an unwillingness to routinely examine asymptomatic patients must be addressed in training programs. Home contact by nurses and patient education may be the most appropriate interventions to improve compliance.

A Systems Approach to Morbidity and Mortality Conference

Identification of Leadership Behaviors that Impact General Surgery Junior Residents’ Well-being: A Needs Assessment in a Single Academic Center

BACKGROUND AND OBJECTIVES:Twelve “good death” principles have been identified that apply to Westerners. This study aimed to review the TFHCOP good death perception to determine its validity for Muslim patients and health care providers, and to identify and describe other components of the Muslim good death perspective.SUBJECTS AND METHODS:Participants included 284 Muslims of both genders with different nationalities and careers. We used a 12-question questionnaire based on the 12 principles of the TFHCOP good death definition, followed by face-to-face interviews. We used descriptive statistics to analyze questionnaire responses. However, for new themes, we used a grounded theory approach with a “constant comparisons” method.RESULT:On average, each participant agreed on eight principles of the questionnaire. Dignity, privacy, spiritual and emotional support, access to hospice care, ability to issue advance directives, and to have time to say goodbye were the top priorities. Participants identified three main domains. The first domain was related to faith and belief. The second domain included some principles related to self-esteem and person>s image to friends and family. The third domain was related to satisfaction about family security after the death of the patient. Professional role distinctions were more pronounced than were gender or nationality differences.CONCLUSION:Several aspects of «good death,» as perceived by Western communities, are not recognized as being important by many Muslim patients and health care providers. Furthermore, our study introduced three novel components of good death in Muslim society.

Migraine is a complicated genetically influenced disorder characterized by episodes of moderate-to-severe headache. It has a prevalence rate of 10% per year worldwide and accounts for 7% of all neurological disorders worldwide. This prevalence is 6% among males and 18% among females. Despite the high prevalence of the illness, it is misdiagnosed and mistreated by healthcare professionals. Therefore, this study aimed to compare physicians' and pharmacists' knowledge, attitudes, and practices regarding migraine management. This descriptive cross-sectional study was performed in major public healthcare facilities and well-established community pharmacy chains in Lahore. A purposive sampling technique was used to recruit participants. Data were collected using a self-administered questionnaire and analyzed by calculating descriptive statistics and a chi-square test. The results showed that 61.67% of physicians were males and 60.00% of pharmacists were females with five years or less of working experience. Most healthcare professionals were well aware of the episode duration, definition of chronic migraine, and its types (physicians = 70.00%, 72.78%, 78.33%; pharmacists = 75.71%, 67.14%, 71.43%, respectively) and provided patients with information regarding migraine triggers, drugs causing migraine, side effects of drugs, and guidance to prevent side effects. Moreover, most healthcare providers considered prevention and acute treatments as a part of a broader approach to managing chronic migraine and considered prescribing preventive medicines at lower doses to minimize potential side effects. The knowledge of physicians and pharmacists was significantly different regarding migraine-associated symptoms, preference for nonpharmacological interventions to alleviate symptoms of chronic migraine, and consideration of prevention and acute treatments as part of the broader approaches to managing chronic migraine (p < 0.05). The study concluded that the physicians' and pharmacists' knowledge, attitudes, and practices were good. However, healthcare professionals' knowledge significantly differs regarding migraine-associated symptoms, preference for nonpharmacological interventions to alleviate symptoms of chronic migraine, and consideration of prevention and acute treatments as part of the broader approaches to managing chronic migraine.

How the physician communicates with patient plays a major role in patient satisfaction, consequences of treatment, psycho- logical effects, medical costs, clinical competence of physicians, and even complaints about physicians. The present re- search is an interventional study, which has been conducted to investigate effect of training communication skills on knowledge and attitudes of family physicians and patients' satisfaction. Sample group consists of 80 individuals among fami- ly physicians and patients. Physicians were chosen randomly, and divided into two intervention and control groups. By using questionnaire, knowledge and attitudes of family physicians and patients' satisfaction in both intervention and control groups were measured. Then, intervention group was attended in educational workshop of communication skills. After two months training, knowledge and attitudes of family and patients' satisfaction were remeasured. The results of tests with using t-tests via SPSS software were analyzed, and mentioned significant (p˂0.05). There was no significant difference on average scores of knowledge and attitudes of family physicians and patients' satisfaction in intervention and control groups before in- volvement of educational workshop. After intervention, there was a significant difference between intervention and control groups. Patients were more satisfied with female, less-experienced and young physicians. The results of this study indicated that training communication skills can have a significant effect on knowledge and attitudes of family physicians and pa- tients' satisfaction. According to important role of patient-physician communication skills, necessity of developing education for patient-physician communication skills is confirmed in curriculum of Iranian medical students.

Thyroid disorders are important and growing health problems worldwide. However, considering real life, assessment of knowledge and attitudes of physicians towards thyroid diseases in primary care is lacking. The study aimed to determine the difference in knowledge and attitudes of Family physicians (FPs), General Practitioners (GPs) and internists in primary care settings of Ministry of Health and Population (MOHP) towards Hypo and hyperthyroidism before and after medical education. This study is a pre-post interventional study done in primary health care facilities on 70 physicians from the three medical disciplines. Doctors were interviewed at their work place with a questionnaire consisting of personal data of the doctor and twenty questions about knowledge and attitudes towards thyroid disorders then they were handled the ideal answers according to the guidelines and the interview was repeated after two months. This study revealed that the mean age of physicians was 34±7.8, the mean duration of work was 6.8±5 years. The pre- interventional knowledge of internists was superior to family physicians and general practitioners. There was a highly significant change of physician knowledge (from 4.1±1.4 to 8±1.6) after intervention and there was a weakly significant change in attitude (from 3.1±0.9 to 3.2±0.9 and from 3.1±1.5 to 3.3±1.6 respectively) among general practitioners and family physicians after intervention. It was concluded that doctors from the three medical disciplines had a significant change in their responses to knowledge questions after intervention. So, it’s a must to train doctors in primary care how-to pick-up cases of thyroid disorders and how to manage them according to the guidelines and when they need to refer these cases.

10539 Background: Significant challenges exist in recruiting newly diagnosed ductal carcinoma in situ (DCIS) patients to participate in presurgical intervention trials. Perceived motivators and barriers to participation have not been formally studied from the patient or healthcare provider (HCP) perspective. Based on our experience in the Promise Study (NCT02694809), we hypothesized that delaying surgery and concern for side effects are barriers to trial participation and that access to new treatments and financial benefits are motivators. To improve recruitment, we conducted focus groups to better understand barriers and motivators for trial participation in our patient population. Methods: Three focus groups with post-menopausal women (PMW) without history of DCIS, one focus group with patients previously treated for DCIS, and two HCP focus groups were conducted. Due to COVID-19, the focus groups took place online via videoconferencing and included participants from across the United States. A third-party facilitator generated discussion on predetermined topics including knowledge of DCIS, clinical trial recruitment materials, hormone replacement therapy, healthcare delivery and clinical trials during COVID-19, and perceived motivators and barriers to trial participation in general and specifically for women with DCIS. Here, we focus on comparing perceived influential factors for patient participation in DCIS clinical trials in PMW and HCP focus groups. Qualitative thematic analysis was completed on focus group transcripts in NVivo. Results: PMW had no knowledge of DCIS prior to the focus groups and believed DCIS should be removed promptly. PMW believed barriers to DCIS clinical trial participation included the potential for the study drug to cause harm, distrust of medicine, and the fact that DCIS is not life-threatening. PMW identified helping future DCIS patients, accessing better treatment, and easing anxiety as motivators for DCIS trial participation. HCPs believed patients were motivated by increased monitoring by the medical team, financial incentive, and access to newer treatment. HCPs believed that delays in DCIS surgery, the potential for the intervention to be harmful or ineffective, and the trial causing patient anxiety were barriers. Neither group emphasized time commitment as a barrier to DCIS trial participation. PMW were not motivated by financial incentives. Conclusions: Knowledge about DCIS is lacking in PMW. PMW and HCPs agreed that the risk of harm caused by study interventions is a deterrent to trial participation and that access to superior treatment is a motivator. However, PMW and HCPs did not agree on other motivators and barriers which could lead to missed recruitment opportunities. Providing educational materials on DCIS and addressing motivators and barriers to clinical trial participation may increase recruitment to presurgical DCIS trials. Clinical trial information: NCT02694809.

IntroductionThe quality of care and patient satisfaction is closely linked with dignity, which is a crucial component of therapy and care. However, there is very little study on dignity in the context of mental health care. Planning for ongoing patient care might benefit from an understanding of the notion of dignity by exploring the experiences of patients, caregivers and companions of patients who have a history of hospitalization in mental health institutions. To retain patients' dignity while they were being treated in mental wards, this study sought to understand the experiences of patients, caregivers and companions of patients.Materials and MethodsThis investigation was qualitative. Semistructured interviews and focus groups were utilized to collect the data. The purposeful sampling method was employed for participant recruitment, which continued until data saturation. Two focus group discussions and 27 interviews were conducted. Participants included 8 patients, 2 patients' family members (companions), 3 psychologists, 4 nurses and 11 psychiatrists. Two focus group discussions were held with seven family members or companions of patients. Thematic analysis was used for data analysis.ResultsThe primary theme that emerged was the infringement of patients' dignity, through negative guardianship, dehumanization and violations of their rights. Subthemes included dehumanization, worthlessness and namelessness, patient rights violations and stripping patients of authority.ConclusionOur results suggest that, regardless of the severity of the illness, the nature of psychiatric illness significantly compromises patients' dignity. Mental health practitioners, due to their sense of guardianship, may unintentionally treat patients with mental health disorders, thus compromising the patient's dignity.Patient or Public ContributionThe research team's experiences as a psychiatrist, doctor and nurse informed the study's objectives. Nurses and psychiatrists who work in the healthcare industry designed and conducted the study. The primary authors, who are healthcare providers, collected and analysed the required data. Furthermore, the entire study team contributed to the writing of the manuscript. Study participants were involved in the data collection and analysis.

Health care reform should be driven by the goals of better patient experience, improved population health, lower per capita costs, and improved provider satisfaction. Electronic consultation (eConsult) services have been adopted by several jurisdictions in the United States, Canada, and Europe to improve access to specialists by primary care providers (PCPs) and are being heralded as a key component for delivery of coordinated care. The primary intent of an eConsult service is to provide PCPs with efficient, timely, direct access to specialist expertise to help guide the management of their patients, reduce the need for unnecessary face-to-face specialty consultations, and improve the quality of the initial face-to-face consultation when needed, through the preconsultative communication.In addition to improving access to care, eConsult services have been praised by PCPs and specialists for their educational value, in particular their ability to enrich practice-based learning. Less recognized, but equally important from the educational perspective, include the abilities of eConsult programs to promote reflection by PCPs and specialists, improve collegiality and professionalism between primary and specialist care, inform continuing professional development activities and maintenance of certification, and enhance training programs' teaching of effective communication and care coordination.As eConsult services become increasingly available, the medical community must leverage the educational opportunities inherent in eConsult programs to further improve the delivery of coordinated specialty care. The educational role of eConsults should be considered as a priority outcome in their evaluation and must be highlighted and optimized in next iterations of eConsult systems design.

Medication costs can lead to financial burdens for patients, creating barriers to effective medication use. Health care provider use of real-time benefit tools (RTBTs) may facilitate cost conversations with patients. We sought to explicate patient views on how RTBTs could be used to improve cost considerations in prescribing decisions. We conducted focus groups to characterize patient perspectives on holding cost conversations with their physicians and to identify factors that would influence the value of RTBTs. We focused on adults aged 50+ who reported trouble paying for their prescriptions. Three groups included patients with conditions requiring high-cost treatments and one group included lower-income patients independent of their medical conditions. Focus groups were recorded, transcribed, coded, and categorized to salient themes employing inductive and deductive approaches using the Health Equity Implementation Framework. Focus groups were conducted from 09/2020-12/2020 including 18 participants representing cancer (n=6), diabetes (n=6), rheumatoid arthritis (n=3), and lower income (n=3). Participants were between 50-74, eight self-identified as Black, 10 as White, and eight reported earning <$50,000/year. We identified five themes regarding cost conversations (medication cost importance, past experiences with cost/cost conversations, perception of physician's role and knowledge, knowledge of existing resources, and influence on decision-making) and four RTBT-use-specific themes (advantages/disadvantages, perceived relevance, data quality concerns, and implementation considerations). Approaches that envision RTBTs as one-size-fits-all technological interventions may underestimate the complexity of incorporating price information into prescribing decisions. Nevertheless, patients highlighted the potential value of accurate, real-time information on medication costs to inform decision-making.

Objective: To explore health care providers’ (HCPs) experiences regarding cervical cancer screening (CCS) among immigrant women, their strategies to facilitate these consultations and their need for further information.Design: Exploratory qualitative design.Setting: HCPs who perform CCS: general practitioners, midwives and private gynaecologists, working in Oslo, Norway.Subjects: We interviewed 26 general practitioners, 3 midwives and 3 gynaecologists.Method: Both focus groups and personal in depth semi structured interviews. Interview transcripts were analysed using a thematic analysis approach.Results: Some of the HCPs’ experiences related to CCS were common for all women regardless of their immigrant background, such as the understanding of routines and responsibilities for prevention. Aspects specific for immigrant women were mainly related to organization, language, health literacy levels, culture and gender. Several strategies targeting organizational (longer consultations), language (using interpreters), health literacy (using anatomy models to explain) and culture (dealing with the expression of pain) were reported.Most HCPs had not previously reflected upon specific challenges linked to CCS among immigrant women, thus the interviews were an eye-opener to some extent. HCPs acknowledged that they need more knowledge on immigrant women’s’ reproductive health.Conclusion: HCPs’ biases, stereotypes and assumptions could be a key provider-level barrier to low uptake of CCS test among immigrants if they remained unexplored and unchallenged. HCPs need more information on reproductive health of immigrant women in addition to cultural awareness.Key PointsThe participation rate of immigrant women to cervical cancer screening in Norway is low, compared to non-immigrants. This might be partly attributed to health care system and provider, and not only due to the women’s preferences. Our focus groups and interviews among health care providers show, that in addition to cultural competence and awareness, they need knowledge on reproductive health of immigrants. We recommend an intervention targeting health care providers to close the gap in cervical cancer screening.

Demographics and meta-analysis of complementary and alternative medicine in health care systems 1. Said Ibrahim Shalaby Department of Complementary Medicine, Medical Division, National Research Center, Cairo, Egypt 2. Mosleh Abd Elrahman Ismail Family Medicine Department, Faculty of Medicine, Suez Canal University, Cairo, Egypt 3. Mohammed Salem Nasrallah Family Medicine Department, Faculty of Medicine, Suez Canal University, Cairo, Egypt 4. Eman Ebraheem Mahmoud Darwish Family Medicine Department, Faculty of Medicine, Suez Canal University, Cairo, Egypt 5. Neelima Gupta # guptagrawal at rediffmail dot com Department of Animal Science, MJP Rohilkhand University, Bareilly 243006, UP, India # : corresponding author DOI http://dx.doi.org/10.13070/rs.en.1.749 Date 2014-04-30 Cite as Research 2014;1:749 License CC-BY Abstract Awareness of Complementary and Alternative Medicine (CAM) among physicians is not widespread. Our objective was to conduct a cross sectional study on primary health care physicians working in 26 primary health care centers and units in Port Said assess the knowledge, attitude and practice of physicians in primary care towards CAM in Port Said, Egypt. The attitude of physicians towards CAM therapy is very supportive if delivered by a specialized and qualified CAM practitioner. According to a questionnaire, 82.1% of physicians defined CAM appropriately and acquired knowledge from television

An evaluation of health communication materials for individuals with disabilities developed by three state disability and health programs