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Introduction The Primary Health Care Corporation (PHCC) in Qatar manages 31 health centres serving a diverse population of over 1.7 million people. PHCC is fully committed to providing people‐centred care. Patients are routinely asked to complete satisfaction surveys. The surveys have shown continued shortcomings in patients' perceptions of communication with staff. PHCC decided to carry out an improvement collaborative among all centres on improving communication with patients. A realist review was carried out to identify possible communication interventions that improve the outcome of patient satisfaction with communication. Most research studies in the review were carried out in Western countries where patient expectations and experiences may differ. Therefore, focus groups of patients and staff were carried out to learn how patients and staff in Qatar perceive communication in the health centres. Methods The purpose of the focus groups was to learn directly how patients and health centre staff experience communication with each other and if the issues experienced could potentially be addressed by the interventions identified in the evidence base. 18 focus groups were carried out, 9 each with patients and multiprofessional staff. Questions were derived from issues raised in research on patient–healthcare professional communication in primary care. Results Patients' main concern was how they are welcomed to a health centre, particularly their desire to be greeted with a smile and welcomed courteously. They also discussed confusion about how the health centres work and a lack of understanding of health‐related information. Staff groups also raised the importance of welcoming patients; they also discussed patients' lack of understanding of healthcare subjects. Some issues were consistent with research findings; others were unique to the Qatar setting. Patients focused on their expectations to be seen quickly, whereas staff were aware of the demands on the service and difficulties in meeting patient expectations. Conclusions The focus groups identified key issues related to patient–healthcare professional communication in primary care centres in Qatar. These issues were used to set priorities for the improvement collaborative on patient‐centred communication involving all the health centres. Patient and Public Contribution PHCC has created and fully implemented a Patient and Family Advisory Group (PFAG), which is a group of patients that closely works with PHCC's leadership to ensure that the patients' voice is heard and that proper collaboration is taking place between patients and PHCC at all levels of its operations (see https://www.phcc.gov.qa/patients-clients/community-engagement). The PFAG was aware of the findings of the patient satisfaction surveys and PHCC's intent to work with patients on improving communication with health centre staff. PHCC also has established a Patient Friends programme in which patients are invited to participate in different activities taking place within PHCC and at each of the health centres. PFAG members and Patient Friends were included among the patients invited to participate in the focus groups. Patients were active participants in half the focus groups. In each of the patient focus groups, the purpose was clearly explained, and patients were invited to add whatever points of discussion they wished to add in addition to the moderator's questions. Patient Friends from all health centres later attended a conference at which findings of the focus groups were openly presented as the basis for the collaborative on improving communication. The Patient Friends then participated equally with staff groups in selecting the patient‐centred communication subjects for improvement via the collaborative and worked as partners with health centre teams on communication improvement projects. Clinical Trial Registration Not applicable. Summary Focus groups with patient and staff groups, which together represent about 70 nationalities, were a useful method for learning how each group perceives communication in primary care settings in Qatar. Patients and staff identified many of the same communication issues. Patients were clear about their expectations to be seen and treated quickly, whereas staff groups were aware of the demand on the primary care system and the difficulties in meeting patient expectations. The focus groups identified potential subjects for improvement of patient–staff communication, including how patients are welcomed when they arrive at a health centre and for a consultation, and patients' needs to better understand their health concerns and management through asking questions and explaining back to a clinician their understanding of what has been explained to them.

Background Waiting for procedures delayed by COVID‐19 may cause anxiety and related adverse consequences. Objective To synthesize research on the mental health impact of waiting and patient‐centred mitigation strategies that could be applied in the COVID‐19 context. Methods Using a scoping review approach, we searched 9 databases for studies on waiting lists and mental health and reported study characteristics, impacts and intervention attributes and outcomes. Results We included 51 studies that focussed on organ transplant (60.8%), surgery (21.6%) or cancer management (13.7%). Most patients and caregivers reported anxiety, depression and poor quality of life, which deteriorated with increasing wait time. The impact of waiting on mental health was greater among women and new immigrants, and those of younger age, lower socio‐economic status, or with less‐positive coping ability. Six studies evaluated educational strategies to develop coping skills: 2 reduced depression (2 did not), 1 reduced anxiety (2 did not) and 2 improved quality of life (2 did not). In contrast, patients desired acknowledgement of concerns, peer support, and periodic communication about wait‐list position, prioritization criteria and anticipated procedure date. Conclusions Findings revealed patient‐centred strategies to alleviate the mental health impact of waiting for procedures. Ongoing research should explore how to optimize the impact of those strategies for diverse patients and caregivers, particularly in the COVID‐19 context. Patient or Public Contribution Six patients and four caregivers waiting for COVID‐19‐delayed procedures helped to establish eligibility criteria, plan data extraction and review a draft and final report.

Background Despite international bodies calling for increased patient and family involvement, these concepts remain poorly defined within literature on critical and intensive care settings. Objective This scoping review investigates the extent and range of literature on patient and family involvement in critical and intensive care settings. Methodological and empirical gaps are identified, and a future agenda for research into optimizing patient and family involvement is outlined. Methods Searches of MEDLINE, CINAHL, Social Work s and PsycINFO were conducted. English‐language articles published between 2003 and 2014 were retrieved. Articles were included if the studies were undertaken in an intensive care or critical care setting, addressed the topic of patient and family involvement, included a sample of adult critical care patients, their families and/or critical care providers. Two reviewers extracted and charted data and analysed findings using qualitative content analysis. Findings A total of 892 articles were screened, 124 were eligible for analysis, including 61 quantitative, 61 qualitative and 2 mixed‐methods studies. There was a significant gap in research on patient involvement in the intensive care unit. The analysis identified five different components of family and patient involvement: (i) presence, (ii) having needs met/being supported, (iii) communication, (iv) decision making and (v) contributing to care. Conclusion Three research gaps were identified that require addressing: (i) the scope, extent and nature of patient involvement in intensive care settings; (ii) the broader socio‐cultural processes that shape patient and family involvement; and (iii) the bidirectional implications between patient/family involvement and interprofessional teamwork.

A paradigm shift is underway in the patient-clinician relationship, driven by irreversible changes in information access, yet the model under which clinicians are trained, care is conducted, and care delivery is designed has not changed significantly even though we call it “patient centered.” Humanity endured centuries in which even doctors had little idea what the patient’s problem really was. Science slowly solved that, and for a century, only doctors could know what was worth knowing. Today, the rise of the internet and digital health has led to the end of that era. We are already witnessing early signs of the era of participatory health: genuinely empowered people living their lives and managing their health according to their own priorities, in partnership and consultation with physicians as needed. This may feel like a threat to the physician’s sacred role, but it is no more so than when physicians adopted informed consent and then shared decision-making. In the 2010s, many pharmaceutical, medical, and health care companies started to use patient centricity as a mantra. We argue that to drive this paradigm change fully into existence, we need to shift “patient centricity” from a relatively passive process, driven by industry needs, into a far more active, collaborative process driven by both parties’ needs and preferences. To build this new world of practice and workflow, we simply must engage with patients as true partners. To achieve medicine’s new potential, it must be optimized around the wants and priorities of the ultimate stakeholder—the party that has the most at stake in how it all plays out: the patient. Patient design is the approach that can make it happen.

Introduction Patients presenting to an emergency department (ED) are typically assessed by a triage nurse and often required to wait for further assessment and care. Ongoing issues of ED overcrowding and prolonged wait times can impact the processes and patients' experiences. A person‐centred approach is recommended. This study aimed to develop a person‐centred care framework for use in the ED triage and waiting room. Methods The multi‐phase research involved a synergistic partnership‐based fully integrated mixed‐methods approach based on person‐centred care principles. Framework development followed target population‐centred and partnership‐based processes of conception, planning and designing. A consumer group was actively involved throughout. Data collection involved two literature reviews, a patient survey and triage nurse survey. Findings were synthesised through focus group sessions and the framework was developed during a collaborative workshop. Results A total of 225 patients and 176 triage nurses responded to the respective surveys. Patients reported the need for better communication, efficiencies and comfort in the waiting room. Nurses identified barriers to person‐centred care, such as workloads, poor environment and long wait times. Strategies for overcoming barriers included enhanced communication, addition of waiting room staff and family involvement. Focus groups recommendations were synthesised as support for staff, systems and processes, environment and facilities, communication and information, and individual care needs, forming the framework elements/components. Practical micro, meso and macro level interventions were also recommended. Conclusions The newly developed framework can now be applied to ED triage settings and inform person‐centred interventions.

Background Migrants experience disparities in healthcare quality, in particular women migrants. Despite international calls to improve healthcare quality for migrants, little research has addressed this problem. Patient-centred care (PCC) is a proven approach for improving patient experiences and outcomes. This study reviewed published research on PCC for migrants. Methods We conducted a scoping review by searching MEDLINE, CINAHL, SCOPUS, EMBASE and the Cochrane Library for English-language qualitative or quantitative studies published from 2010 to June 2019 for studies that assessed PCC for adult immigrants or refugees. We tabulated study characteristics and findings, and mapped findings to a 6-domain PCC framework. Results We identified 581 unique studies, excluded 538 titles/abstracts, and included 16 of 43 full-text articles reviewed. Most (87.5%) studies were qualitative involving a median of 22 participants (range 10–60). Eight (50.0%) studies involved clinicians only, 6 (37.5%) patients only, and 2 (12.5%) both patients and clinicians. Studies pertained to migrants from 19 countries of origin. No studies evaluated strategies or interventions aimed at either migrants or clinicians to improve PCC. Eleven (68.8%) studies reported barriers of PCC at the patient (i.e. language), clinician (i.e. lack of training) and organization/system level (i.e. lack of interpreters). Ten (62.5%) studies reported facilitators, largely at the clinician level (i.e. establish rapport, take extra time to communicate). Five (31.3%) studies focused on women, thus we identified few barriers (i.e. clinicians dismissed their concerns) and facilitators (i.e. women clinicians) specific to PCC for migrant women. Mapping of facilitators to the PCC framework revealed that most pertained to 2 domains: fostering a healing relationship and exchanging information. Few facilitators mapped to the remaining 4 domains: address emotions/concerns, manage uncertainty, make decisions, and enable self-management. Conclusions While few studies were included, they revealed numerous barriers of PCC at the patient, clinician and organization/system level for immigrants and refugees from a wide range of countries of origin. The few facilitators identified pertained largely to 2 PCC domains, thereby identifying gaps in knowledge of how to achieve PCC in 4 domains, and an overall paucity of knowledge on how to achieve PCC for migrant women.

Background Patient participation is key in person-centred care, emphasizing individual choices in treatment. Oral health, integral to overall well-being, is sometimes a neglected part of health. This intervention introduces a novel approach to strengthen person-centred care in homecare settings, employing collaborative, interprofessional teamwork and shared documentation across care organizations. This protocol outlines the design of a cluster-randomized controlled trial (RCT) in Sweden, comparing traditional oral assessments with an interorganizational, team-based oral health care planning model facilitated by a shared digital platform for documentation. The overall aim is to evaluate a person-centred interprofessional and interorganizational model for oral health care planning supported by a digital platform to enable healthy ageing. Methods/design The intervention, co-designed with older adults, academic institutions, healthcare providers in public dental care, and municipal organizations, will undergo ethical approval. The RCT will randomize older adults, dental hygienists (DHs) and nursing assistants (NAs) into two groups. The intervention group will attend a two-day workshop on a person-centred, three-step team-based model, while the control group will continue using standard procedures. Thereafter, the three-step collaborative model will be compared to standard procedures. Primary outcomes will be measured using the Revised Oral Assessment Guide (ROAG) and the General Oral Health Assessment Index (GOHAI). Secondary outcomes include health economic evaluations, participation rates and quality of care assessments. Qualitative studies from theoretical perspectives of change and learning based on interviews with key stakeholders will be conducted in both the test and control groups. Discussion Taking a co-produced approach where theory and practice shape the research iteratively, a person-centred health care planning model supported by a shared digital platform for home settings is evaluated. Anticipated outcomes include improved oral assessments and a deeper understanding of effective person-centred care practices. The co-produced approach of the intervention is also expected to further develop knowledge regarding co-production within domains of healthy ageing from an oral health perspective. As such, the intervention shapes and fosters co-produced person-centred care and healthy ageing. Trial registration ClinicalTrials.gov NCT06310798. Registered on 13 March 2024.

To (1) estimate the relative value of older adults’ healthcare experiences based on the Canadian Patient Experience Survey for Inpatient Care (CPES-IC) using an economic valuation technique, and (2) compare the results with those of a conventional key-driver analysis of healthcare experiences based on bivariate correlations. An online survey of 1,074 Canadians aged 60 and older who had been hospitalized within five years. Participants completed the CPES-IC and a best-worst scaling (BWS) valuation task. BWS data were analyzed using a conditional logit model. These results were compared to a conventional key-driver analysis that estimates importance through Spearman's correlations between experiences and a global rating of overall experience. The valuation approach found that the three experiences most valued by patients were: that staff seemed informed and up-to-date about their hospital care, doctors explained things in a way that they could understand, and that they got all the information they needed about their care and treatment. Three of the top five most valued experiences from the valuation approach were among the top five in the key driver analysis. However, there were noteworthy differences in rank order. The results of the valuation exercise can inform local and/or system level quality improvement efforts by identifying priorities from an economic evaluation point of view, which are different than those based on a conventional key-driver analysis. Given the degree of uncertainty in estimates both the rank order and confidence intervals should be used to guide decision-making.

Background Shared decision making (SDM) has been increasingly implemented to improve health‐care outcomes. Despite the mixed efficacy of SDM to provide better patient‐guided care, its use in surgery has not been studied. The aim of this study was to systematically review SDM application in surgery. Design The search strategy, developed with a medical librarian, included nine databases from inception until June 2019. After a 2‐person title and screen, full‐text publications were analysed. Data collected included author, year, surgical discipline, location, study duration, type of decision aid, survey methodology and variable outcomes. Quantitative and qualitative cross‐sectional studies, as well as RCTs, were included. Results A total of 6060 studies were retrieved. A total of 148 were included in the final review. The majority of the studies were in plastic surgery, followed by general surgery and orthopaedics. The use of SDM decreased surgical intervention rate (12 of 22), decisional conflict (25 of 29), and decisional regret (5 of 5), and increased decisional satisfaction (17 of 21), knowledge (33 of 35), SDM preference (13 of 16), and physician trust (4 of 6). Time increase per patient encounter was inconclusive. Cross‐sectional studies showed that patients prefer shared treatment and surgical treatment varied less. The results of SDM per type of decision aid vary in terms of their outcome. Conclusion SDM in surgery decreases decisional conflict, anxiety and surgical intervention rates, while increasing knowledge retained decisional satisfaction, quality and physician trust. Surgical patients also appear to prefer SDM paradigms. SDM appears beneficial in surgery and therefore worth promoting and expanding in use.