1) The document describes the development of a measure to assess the patient experience of prostate cancer care. Researchers conducted interviews with patients, carers, and healthcare professionals to identify important issues to address.
2) Researchers developed and piloted draft questionnaires across multiple hospitals. They tested the questionnaires for reliability, validity, and sensitivity to change.
3) The finalized questionnaires provide a tool for hospitals to measure aspects of care like information provision, involvement in decisions, and discharge support. Administering the surveys regularly could help identify areas for improvement in prostate cancer services.
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
Documenting Your Clinical Efforts In a Way that Countstatetomika
Liudmila N. Schafer, M.D., F.A.C.P.
Associate Professor
Department of Internal Medicine
Division of Hematology and Oncology
Winthrop P. Rockefeller Cancer Institute
U.A.M.S.
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
Documenting Your Clinical Efforts In a Way that Countstatetomika
Liudmila N. Schafer, M.D., F.A.C.P.
Associate Professor
Department of Internal Medicine
Division of Hematology and Oncology
Winthrop P. Rockefeller Cancer Institute
U.A.M.S.
This PPT is mainly oriented to the Final yr MBBS students who are preparing for their Final exams. The Audit cycle has taken up from Bailey & Love - 24th edition.
The patient handoff is a contemporaneous, interactive process of passing patient-specific information from one caregiver to another to ensure the continuity and safety of patient care. It is well recognized that the handoff is a point of vulnerability where valuable patient information can be distorted and omitted [1, 2]. A plethora of studies in the nursing literature have identified a variety of problems, including incomplete or inaccurate information [3-6], uneven quality [7], repeated interruptions and lack of anticipatory guidance [8]. Many reports have focused on characterizing the weaknesses with non-operative patient handovers, the use of handoff checklists and aviation safety models for specific groups of patients [1,5,9], and the pre- and post-implementation comparisons. [10-12] However, few studies have focused on prospective cohort studies validating and testing patient information management systems such as smart-templates in the setting of handover quality. [10]
Electronic templates containing patient information help to standardize the type of information conveyed during interactions, discourages ambiguous findings,[13] improves provider satisfaction and improves continuity of care.[14] Within the department, we developed the transfer template (T2) to address the issues in provider workflow and efficiency. With the press of a button, the T2 template automatically extracts live information from the anesthetic record, pertinent fields from the PAC note and laboratory values from IView, and provides a concise output of these relevant details.
Enhancing the patient experience in a new purpose-build MDT meeting room with...Cancer Institute NSW
St Vincent’s Head and Neck Clinic is a well-established, multidisciplinary clinic which has provided a co-ordinated team approach to the head and neck patient’s complex needs for over three decades. With the development of a new, purpose-built cancer facility, a clinical redesign project was undertaken, with the aim to further enhancing the patient experience and improving the quality of care for patients attending the weekly Multidisciplinary Head and Neck Clinic.
Standard of care / Standard of Practice / Clinical Guideline/ Clinical Pathway Naz Usmani
A very brief presentation about the clinical process improvements including practices, standards of care , guideline and pathway . I have reflected upon the basic differences between them . Hope it is useful
Our main involvement with your clinical research recruitment program concludes with processing the responses to your mailer. As our staff members direct the respondents to your site, you can begin conducting final interviews to complete the clinical trial recruitment process.
This PPT is mainly oriented to the Final yr MBBS students who are preparing for their Final exams. The Audit cycle has taken up from Bailey & Love - 24th edition.
The patient handoff is a contemporaneous, interactive process of passing patient-specific information from one caregiver to another to ensure the continuity and safety of patient care. It is well recognized that the handoff is a point of vulnerability where valuable patient information can be distorted and omitted [1, 2]. A plethora of studies in the nursing literature have identified a variety of problems, including incomplete or inaccurate information [3-6], uneven quality [7], repeated interruptions and lack of anticipatory guidance [8]. Many reports have focused on characterizing the weaknesses with non-operative patient handovers, the use of handoff checklists and aviation safety models for specific groups of patients [1,5,9], and the pre- and post-implementation comparisons. [10-12] However, few studies have focused on prospective cohort studies validating and testing patient information management systems such as smart-templates in the setting of handover quality. [10]
Electronic templates containing patient information help to standardize the type of information conveyed during interactions, discourages ambiguous findings,[13] improves provider satisfaction and improves continuity of care.[14] Within the department, we developed the transfer template (T2) to address the issues in provider workflow and efficiency. With the press of a button, the T2 template automatically extracts live information from the anesthetic record, pertinent fields from the PAC note and laboratory values from IView, and provides a concise output of these relevant details.
Enhancing the patient experience in a new purpose-build MDT meeting room with...Cancer Institute NSW
St Vincent’s Head and Neck Clinic is a well-established, multidisciplinary clinic which has provided a co-ordinated team approach to the head and neck patient’s complex needs for over three decades. With the development of a new, purpose-built cancer facility, a clinical redesign project was undertaken, with the aim to further enhancing the patient experience and improving the quality of care for patients attending the weekly Multidisciplinary Head and Neck Clinic.
Standard of care / Standard of Practice / Clinical Guideline/ Clinical Pathway Naz Usmani
A very brief presentation about the clinical process improvements including practices, standards of care , guideline and pathway . I have reflected upon the basic differences between them . Hope it is useful
Our main involvement with your clinical research recruitment program concludes with processing the responses to your mailer. As our staff members direct the respondents to your site, you can begin conducting final interviews to complete the clinical trial recruitment process.
Prostate - Excellent Illustrations / Must Watch & Prevent. ery Useful Information. DO NOT MISS to view and read the attached presentation. Please pass it on to your family & friends. Shared via "Sharifah Khatijah Syed Abdul Rahman Al-Attas" <sh_khatijah@yahoo.com
A review of pharmacist-led transition of care systems, specifically post-discharge follow-up phone calls, and the opportunity for pharmacy students to lead a new service. A review of the “Post-Discharge Follow-up Phone Call SPEP Standard Work” project will be provided, including an overview of the methodology, results, and discussion.
Weitzman 2013 Relative patient benefits of a hospital-PCMH collaboration with...CHC Connecticut
Anuj K Dalal presents information on a PCORI research grant: Relative patient benefits of a hospital-PCMH collaboration within an ACO to improve care transitions.
Acute hospitals end of life care best practiceNHSRobBenson
Delivering reliable best practice in an acute hospital setting for patients whose recovery is uncertain. Including details of the AMBER care bundle. Presentation from Anita Hayes and colleagues from England's National End of Life Care Programme as part of the Department of Health's QIPP end of life care workstream seminar series at Healthcare Innovation Expo 2011
A joint presentation on Real People, Real Data at the 2016 International Forum on Quality and Safety in Healthcare in Gothenburg, Sweden. Presented by Leanne Wells of the Consumers Health Forum of Australia; Sam Vaillancourt of St. Michael’s Hospital, Toronto, Canada, and; Dr Paresh Dawda of the Australian National University.
Advancing Team-Based Care: A Team Approach to Prevention and Chronic Illness ...CHC Connecticut
This webinar explored the benefits of teamwork in allowing staff to more effectively deliver preventive services and manage chronic illness. It built on the content from previous webinars to describe how to optimize the core team to provide population management, self-management support and planned care. Infrastructure considerations to improve team-based care were also discussed including training, career ladders, and communication management.
This webinar was present April 21, 2016 3:00 PM.
The Research Design & Conduct Service recently gave a presentation to staff at the Cardiff School of Medicine to let people know about their services, advice and support, which they offer to health professionals who are in the process of developing research projects. The RDCS was funded in 2010 by the National Institute for Social Care and Health Research (NISCHR), part of the Welsh Assembly Government. Their partner organisations are Cardiff and Vale University HB, Cwm Taf HB, Aneurin Bevan HB and Powys Teaching HB.
Learn more about the RDCS by viewing the presentation below and by visiting their website: http://medicine.cf.ac.uk/rdcs/
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
1. Prostate cancer care: improving
measures of the patient
experience
Funded by SDO
Study team
S. Agarwal, R. Baker, A. Colman, L. Crosbee,
R. Kockelbergh1
, K. Mellon, P. Sinfield, K. Sproston2
,
W. Steward, C. Tarrant
1 University Hospitals Leicester
2 National Centre for Social Research
eicester Medical School
epartment of Health Sciences
2. Outline of presentation
• Background
• Developing the measure
• Implications for primary care
• Conclusions
3. Background
• Prostate cancer is second most common
cancer in men (nearly 35,000 men are diagnosed in
the UK each year; 24% of new male cancer diagnoses)
• Range of treatments, and significant side-
effects
• National patient surveys show prostate
cancer care less satisfactory than other
cancer care
• Patient experience v patient satisfaction
4. Developing the measure
Stage 1
Identifying important issues
Stage 2
Developing & piloting the questionnaires
Stage 3
Testing the questionnaires: reliability, validity,
sensitivity to change
Stage 4
Using the questionnaires
5. Stage 1:identifying important issues
Methods
• Literature review
• Questionnaire survey of
Cancer Networks
• Interviews with:
- patients and carers
- health care professionals
- CSC Leads
- Cancer Network staff
- voluntary sector workers
Findings
• Format: a questionnaire,
easy to understand and
complete
• Content: cover all phases of
care, involve carers and
include issues on:
- provision of information
- opportunity for involvement
in discussions
- decision-making
- service delivery (testing,
treatment, monitoring)
6. Findings from patient and carer
interviews (1)
Primary care:
- pre-test information and discussion lacking
- clear explanation of test results and reason for
referral not routinely given
- contact after end of treatment/discharge valued
- on-going support valued e.g. nursing services
Secondary:
- generally positive about facilities, some issues
re parking/waiting/re-arranged appointments
- shock of diagnosis, some poor communication
7. Stage 2: developing and piloting
the questionnaires
Initial version of the questionnaires drafted:
- based on issues identified at stage 1
- five sections covering the whole patient journey
- separate carer questionnaire created
• Reviewed by research team, panel and patients
and carers (PCQ-Pv1 and PCQ-Cv1)
• Revised questionnaires piloted: in 2 hospitals
(150 patients, and 100 carers each time) leading
to (PCQ-Pv2 and PCQ-Cv2). Piloting repeated
leading to (PCQ-Pv3 and PCQ-Cv3).
8. A3. Did the doctor or nurse take your concerns
seriously?
Please tick one box
Yes 1
To some extent 2
No, not really 3
I did not have any concerns 4
A4. Were you given information about being tested
for prostate cancer (e.g. what the tests would
involve, pros and cons of being tested)?
Please tick one box
Yes, I was given enough information 1
Yes, but I would have liked more information 2
No, I was not given any information 3
A5. Did the doctor or nurse explain what would
happen if the results were abnormal?
Please tick one box
Yes 1 No 2
9. Stage 3: testing the questionnaires
• Face validity: interviews of patients and carers
• Postal testing in 5 hospitals involving
865 patients, 595 carers
- test retest reliability (Pearson correlations)
- internal consistency (Cronbach’s alpha)
- sensitivity to change (ANOVA)
- content validity (Principal Components Analysis)
• Lead to PCQ-Pv4 and PCQ-Cv4
10. Stage 4: using the questionnaires
4 hospitals administered the different sections of the
questionnaires:
• Positive feedback about questionnaires and software
• Response rates reasonable: mean 60%, range 49%-67%
• Recommend postal administration
– hospitals may need support to carry out surveys
– face-to-face for hard to reach groups
• Attitudes to patient experience surveys vary: positive,
indifferent, sceptical
– surveys should not be “external stick” but “useful internal tool”
– need all staff to be informed and involved throughout
11. Individual questions: discharge
Hospital 5 Hospital 2 Hospital 4 Total
D15. Before you left hospital or finished
treatment did the doctor or nurse explain
to you what would happen next (e.g.
arrangements for follow-up)?
91%
(53)
96%
(103)
90%
(100)
92%
D16. Did the doctor or nurse give you any
information about who to contact for
advice or support (e.g. specialist nurse,
patient support group)?
95%
(63)
87%
(127)
65%
(116)
80%
D17. Did the doctor or nurse discuss with
you how to manage any potential side
effects of the treatment (e.g. continence,
problems with sex, pain)?
51%
(59)
62%
(115)
51%
(102)
55%
D18. Were you given equipment or
supplies (e.g. continence pads) to use at
home to help you care for yourself?
46%
(26)
61%
(54)
44%
(27)
53%
% of patients giving a positive response, excluding ‘not applicable’ (n)
12. Implications for primary care
• Surveys (national, regional) would provide
results of:
- patients’ and carers’ experience of primary
care
- patients’ and carers’ experience of secondary
care
• PCTs, large practices, assessment centres and
polyclinics may be able to administer sections of
the questionnaires themselves
13. Conclusions
Methods
- willingness to be
involved: patients and
carers*; health
service staff; vol.
sector staff
- difficulties: ethics,
R&D, hospital admin.,
health service staff
Outcomes
- tested and usable
tools to help service
improvement
- lessons learnt for
developing similar
tools for other
conditions
14. Findings from literature review
• Patients have information needs through
many stages of care
• Patients and partners have knowledge
deficits
• Patients want involvement in decisions
• Partners want involvement in discussions
15. Findings from cancer network
survey
•Format: questionnaires (easy to complete
for all)
•Administration: audit departments, patient
groups may be able to help
•Frequency: regularly repeated
•Feedback: to patients and staff
•Problems: resources, response rate, acting
on findings
•Content: cover all of the patient journey and
include carers
16. Findings from patient and carer
interviews 1
Primary care:
-pre-test information and discussion lacking
-clear explanation of test results and reason for
referral not routinely given
- contact after end of treatment/discharge valued
- on-going support valued e.g. nursing services
Secondary:
- generally positive about facilities, some issues
re parking/waiting/re-arranged appointments
- shock of diagnosis, some poor communication
17. Findings from patient and carer
interviews (2)
Secondary:
- information needs and decision making role
of patients needs to be established
- specialist nurse role valued
- anxious to start treatment and want information
about it and the effects
- need information at end of treatment/discharge
re outcome of treatment and support
- monitoring re-assures patients and carers
- carers want to be included in discussions
- carers need access to support
Editor's Notes
A service delivery and organisation funded study to develop a measure of patient experience
3 year study
Brief introduction to prostate cancer, frequency, screening, treatment, survival and side effects
Methods adopted to develop the measure
Potential impact on primary care
Conclusions about the methods and the outcomes
Numbers will grow as life expectancy grows
Recent incidence rates heavily influenced by availability of PSA, but death rates have not changed. Men are more likely to die with prostate cancer than from it
No evidence as to best treatment, side effects include incontinence and impotence
The relative five-year survival rate for men diagnosed in England in 2000–01 was 71%, compared with only 31% for men diagnosed in 1971–75
National Patient Cancer Survey 1999/2000 and National Audit Office 2004 (speed of referral, information about: side effects, success of treatment, support)
A measure of patient experience was required because it is more factual than satisfaction measures and can provide better data to act on
12 hospitals involved in piloting, testing and using the questionnaires
Stage 1
Literature review
Interviews with 35 patients, 10 carers, health service & CN staff , voluntary sector workers
Questionnaire survey of 34 CNs (26 responses)
Stage 2
Drafted initial version of the qnaires based on phase 1. Consisted of a number of sections that cover the patient journey through referral, testing and diagnosis, treatment, discharge and monitoring
2 rounds of piloting: 2 hospitals around 150 patients, and 100 carers each time.
Analysis of distribution of responses to identify potentially non-discriminatory, confusing or unnecessary questions
Questions for which responses showed little variation and high proportion of missing responses were examined and revised or excluded.
Stage 3
Postal test: 5 hospitals 865 patients, 595 carers
Statistically tested reliability, validity and sensitivity to change, 20 patients & 9 carers interviewed to check important issues included
Phase 4
Wrote a user guide and designed web-based software package for data entry and basic analysis
Independent survey: 4 hospitals
Feedback from staff interviews
87 papers
35 patients, 10 carers
Important to consult with all stakeholders involved in using the new measure
Charities: cancerbackup, CBC
Different phases of care:
Initial presentation/tests
Tests at the hospital
Diagnosis and treatment decision
Treatment
Monitoring
Findings will inform the development of the measure
Screening to post treatment
Information is provided but not always at the most suitable times
Many want a collaborative approach
Discussions with hcps
Panel of patients and healthcare professionals and voluntary sector workers
2 rounds of piloting: 2 hospitals around 150 patients, and 100 carers each time.
Analysis of distribution of responses to identify potentially non-discriminatory, confusing or unnecessary questions
Questions for which responses showed little variation and high proportion of missing responses were examined and revised or excluded.
Example questions from Section A: initial concerns and tests
Different style of questions
Very few open ended response options available – easier to complete and to analyse
Answers give evidence to act on
20 patients & 9 carers interviewed to check important issues included
Statistically tested reliability, validity and sensitivity to change,
Questionnaires administered twice
Over 80% of respondents answered the same way in 1st and 2nd mailing
Cronbach Alpha scores for each section were above 0.6, indicating that each section has satisfactory internal consistency
ANOVA: 2 mailings 4 months apart, difference between patients who had and had not experienced changes. Scores were in the right direction but did not reach significance.
Testing (A,B,F); Diagnosis & treatment decision (C,F); Treatment & Monitoring (E,F); short version
User guide written to accompany the questionnaire and software
Looking at each individual question. This slide shows % of patients giving a positive response to a selection of questions about discharge (has relevance for primary care) excluding ‘not applicable’
Info and support at discharge a problem – important for primary care to be aware of this
Results at this level provide detail and would be useful in pinpointing areas where change is needed.
I have presented the results comparatively by hospital, but not suggesting that they should be used in this way – may be more useful for hospitals to set their own standards, and measure any improvement over time against their own scores.
Initial presentation and tests, treatment, monitoring
Essential to developing seamless and patient-centred care: better understanding of whole patient journey so can see what needs patients and carers have in primary care
Sections A (the first time you saw the doctor or nurse); E ( Monitoring)
Importance of involving all stakeholders – input and commitment
*Difficulties in recruiting from ethnic minorities
Problems even when payments for staff time offered
Piloting and testing in appropriate settings so know that the measure works
Measure is tailored for prostate cancer
Standardised so allows comparison
No need for hospitals/Cancer Networks to devise their own measures
Findings will inform the development of the measure
Screening to post treatment
Information is provided but not always at the most suitable times
Many want a collaborative approach
Discussions with hcps
Findings will inform the development of the measure
Screening to post treatment
Information is provided but not always at the most suitable times
Many want a collaborative approach
Discussions with hcps
Findings will inform the development of the measure
Screening to post treatment
Information is provided but not always at the most suitable times
Many want a collaborative approach
Discussions with hcps
Findings will inform the development of the measure
Screening to post treatment
Information is provided but not always at the most suitable times
Many want a collaborative approach
Discussions with hcps