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PubMed2001

The development and validation of a patient-information booklet on ureteric stents.

OBJECTIVE: To report a scientific approach incorporating patient preferences towards the development of a patient-information booklet about ureteric stents. PATIENTS AND METHODS: Phase 1 of the study included 35 adult patients with ureteric stents who were surveyed using semi-structured interviews (four patients) and a questionnaire (31 patients) to assess various issues relating to information given to patients about ureteric stents. In addition, published papers were assessed and clinicians' opinions sought. The results formed the basis for a comprehensive patient-information booklet about ureteric stents that incorporated patients' views and preferences. In phase 2, the booklet was tested and formally validated by inviting 30 patients, a panel of 20 urologists and general practitioners, and five stent manufacturers to assess the booklet for adequacy, coverage and readability of the content. RESULTS: Of the 35 patients, 30 (19 men and 11 women, mean age 49 years, range 20-78) participated in the initial survey; 80% of patients reported dissatisfaction about the information they received. Patients wanted more information about the use, adverse events and effects of stents on daily life; 85% preferred all relevant information about the stents to be in a written format with illustrative drawings. An eight-page booklet was thus developed. The validation study revealed that the booklet matched patients' experiences (approval score of 9/10, range 8-10) and was reported as satisfactory by clinicians and manufacturers. CONCLUSIONS: A validated information booklet on ureteric stents was developed, incorporating patients' expectations and views. This booklet is expected to be an effective tool for patient communication that would help patients cope better with indwelling stents and be useful in counselling patients. A similar approach could be adopted for the development of other patient-information packs.

Adult↗
PubMedDate not supplied

Importance of format and design in print patient information.

PURPOSE: The purposes of this descriptive study were to: identify characteristics of print education materials that healthcare providers report as important to patients; compare whether Physician Data Query (PDQ) information that was provided in its original form, or was redesigned in color and black and white, influenced the distribution of this information; and explore whether providing PDQ information via patient information racks would increase patients' awareness of and use of PDQ information. DESCRIPTION OF STUDY: Forty-four oncology healthcare professionals were asked to complete a survey identifying characteristics that they believed important for effective print educational materials. PDQ statements were reformatted and placed in brochure racks for a 6-month period. The number of statements distributed before and after this time period were compared. Subsequently, PDQ statements were placed sequentially for a 3-week period in brochure racks in the following formats: original form as printed from the computer, redesigned with color print; and redesigned with black ink only. RESULTS: The following characteristics were rated "very important" aspects of print educational materials by oncology healthcare professionals: appropriate reading level; clarity; credibility of the information; whether information is current/up-to-date; and patient acceptance of material. The characteristic receiving the fewest "very important" marks was attractiveness/eye appeal. The reported low marks on attractiveness/eye appeal contradict the concurrent findings that, after the redesign of PDQ statements (change in booklet size, use of color, increase in foot size for text and headings, and inclusion of a vertical bar to separate columns), there was a ninefold increase in the number PDQ statements distributed. Eighty-nine percent of the statements distributed were the redesigned version. The use of color, however, did not appear to make a difference in the number of PDQ statements disseminated after the redesign. CLINICAL IMPLICATIONS: In developing print education materials for cancer patients, the format, design, and placement of materials for patient access need to be considered. There are many valuable educational materials available on computer databases. Downloading the information and placing it in a brochure format may be an ideal approach for providing access to this information. Furthermore, because physicians and nurses have different priorities for printed patient education materials, it is important to involve both groups in the developments of the brochures.

Ambulatory Care Facilities↗
PubMedDate not supplied

Limited literacy revisited implications for patient education.

PURPOSE: It is important to determine whether teaching materials are understood and deemed accurate by the cancer patients being served. The authors used a series of patient participatory interviews to evaluate two brochures: Chemotherapy: What It Is and How It Helps by the American Cancer Society; and Helping Yourself During Chemotherapy: 4 Steps for Patients by the National Cancer Institute. The authors sought to determine whether 1) the brochures were clear; 2) differences in presentation were perceived by patients; and 3) differences influenced respondents' understanding and opinions of the brochures. DESCRIPTION OF STUDY: A qualitative, focus-group methodology was used. Twelve cancer patients, eight of whom were women and six of whom were African American, were recruited from three outpatient clinics. Participants ranged in age from 31 to 62 years of age, and in education from completion of ninth grade to graduate school. Patients participated in a series of five groups, with a series of semistructured questions about content and format being asked of each group. All sessions were audiotaped. The investigators reviewed data both independently and together to identify content and format evaluations. RESULTS: Findings showed that most participants were drawn first by the National Cancer Institute format; the American Cancer Society brochure was seen as having more information; the two brochures were seen as complementary; some confusion arose from the content of both brochures; and the discussions of emotional and sexual aspects were important. CLINICAL IMPLICATIONS: These findings support the need for simple, clearly written brochures rather than brochures of varying literacy levels. The confusion caused by differences in advice given by the two organizations indicates the need to address specific areas in which dissimilarities exist. Finally, the project demonstrates the utility of patient focus groups for evaluation of patient education material.

Adult↗
PubMed2003

Psychosocial intervention for rural women with breast cancer: The Sierra-Stanford Partnership.

OBJECTIVE: This study was initiated by breast cancer survivors living in a rural community in California. They formed a partnership with academic researchers to develop and evaluate a low-cost, community-based Workbook-Journal (WBJ) for improving psychosocial functioning in geographically and economically isolated women with primary breast cancer. DESIGN: A randomized controlled trial was used to compare the WBJ intervention plus educational materials to educational materials alone (usual care). SETTING: One rural cancer center and several private medical, surgical, and radiation oncology practices in 7 rural counties in the Sierra Nevada Foothills of California. PARTICIPANTS: One hundred women with primary breast cancer who were either within 3 months of diagnosis or within 3 months of completing treatment. INTERVENTION: A community-initiated, theoretically-based Workbook-Journal, designed by rural breast cancer survivors and providers as a support group alternative. It included compelling personal stories, local rural resources, coping strategies, and messages of hope. RESULTS: Community recruiters enrolled 83% of the women referred to the study. Retention at 3-month follow-up was 98%. There were no main effects for the WBJ. However, 3 significant interactions suggested that women who were treated in rural practices reported decreased fighting spirit and increased emotional venting and posttraumatic stress disorder symptoms if they did not receive the WBJ. Among women who receive the WBJ, 74% felt emotionally supported. CONCLUSIONS: This community-based Workbook-Journal may be an effective psychosocial intervention for rural, isolated, and low-income women with breast cancer. Community involvement was essential to the success of this project.

Adaptation, Psychological↗
PubMed2002

An epilepsy questionnaire study of knowledge and attitudes in Canadian college students.

PURPOSE: Controversy exists about the relation of societal knowledge and attitudes regarding epilepsy. We conducted a survey to examine knowledge and attitudes, to note gender and occupational influences, and to examine the effect of an informational brochure. METHODS: We administered a standardized questionnaire that noted demographics and examined knowledge and attitudes regarding epilepsy and persons with epilepsy, respectively, to a wide variety of Canadian college students. In a separate class we gave every other student a brochure regarding epilepsy and then administered the questionnaire to both the naïve and brochure-exposed students. RESULTS: Knowledge was patchy and weakest for the approximate prevalence of epilepsy in the population, hereditary epilepsy and several other etiologies, recognition of nonconvulsive seizures as a type of epilepsy, and knowledge of antiepileptic drug-induced teratogenicity. In contrast, attitudes were more uniformly favorable. However, 11 and 14%, respectively, showed negative bias against persons with epilepsy having children and equal opportunity for occupational employment. Women were slightly but significantly more tolerant than men. The brochure-exposed group showed better knowledge but equivalent attitudes compared with the naïve group. CONCLUSIONS: Results compare favorably with surveys in other countries. Although knowledge was patchy, it could be easily improved on with an educational brochure. Attitudes were positive but show some discrepancies from knowledge and a gender effect.

Adult↗
PubMed2001

The effects of patient communication skills training on the discourse of older patients during a primary care interview.

OBJECTIVES: To test the effects of a communication skills training intervention on older patients' discourse during a primary care interview. DESIGN: A quasi-experimental design involving two intervention conditions. SETTING: The Family Practice Center of a university-based clinic. PARTICIPANTS: Thirty-three patients averaging age 72 and 9 family practice physicians. INTERVENTION: A communication skills training booklet received approximately 3 days before the scheduled appointment and a 30-minute face-to-face follow-up session before seeing the physician. MEASUREMENTS: Patients' seeking, providing, and verifying of information were coded from transcripts of the 33 interviews. RESULTS: Trained patients engaged in significantly more seeking and providing of information than untrained patients. Additionally, trained patients obtained significantly more information from physicians than did untrained patients, both in terms of the number of total information units and the number of units per question asked. CONCLUSION: Patient communication skills training appears to be an effective means of enhancing patients' participation in the medical interview without increasing the overall length of the interview.

Aged↗
PubMed1994

Effects of new brochures on blood donor recruitment and retention.

BACKGROUND: Currently, donors may arrive at blood collection sites without prior knowledge of eligibility and deferral criteria. STUDY DESIGN AND METHODS: The effects of distributing newly developed recruitment brochures 2 weeks in advance of blood drives and the provision of brochures on temporary deferral at the taking of health history were examined in four southeastern regional blood collection centers. Twenty-four similar pairs of worksites, with employee-only recruitment, were randomly assigned to a control (C) or experimental (E) group. Information about sponsor recruitment strategies, worksite factors, and first-time, repeat, and temporarily deferred donors was obtained at three collection drives per site over a 1-year period. Drive 1 was used as a baseline. Two weeks before Drives 2 and 3, the recruitment brochures were distributed to all Group E employees, with temporary deferral brochures provided as needed when the health history was taken. RESULTS: No significant differences between groups or drives were found in the total percentage of employees recruited or returning as a result of recruitment or deferral brochure distribution (Wilcoxon's signed rank test and t test). Substantiating previous observations by donor recruiters, the study results showed decreased donations during vacation periods and busier times at the workplace. Loudspeaker announcements led to decreased donations; increased donations followed special appeals in relation to a specific patient, an accident, or a natural disaster. CONCLUSION: The brochures may have encouraged previous donors to return, but their use did not significantly increase the recruitment of new donors or the return of temporarily deferred donors.

Blood Donors↗
PubMed2002

Marketing hand hygiene in hospitals--a case study.

Hand hygiene of healthcare workers is frequently poor despite the efforts of infection control teams to promote hand decontamination as the most important method to prevent transmission of hospital-acquired infections. In this case study, we describe how principles of societal marketing were applied to improve hand hygiene. Pre-marketing analysis of strengths, weaknesses, opportunities and threats to implementation; attention to product, price, promotion and placement; and post-marketing 'customer' surveys were the essential components of the marketing strategy and its implementation. Placement of an alcohol-based gel decontaminant (Spirigel) at the bedside of every patient was widely welcomed in the hospital, and has played a major role in improving hand hygiene of healthcare workers. In the twelve months following the implementation, the decontaminant was used at least 440,000 times. The cost of purchasing the decontaminant was approximately 5000 pounds sterling. Following the introduction of Spirigel, there was a consistent reduction in the proportion of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) in each of the quarters of 2000-2001 compared with 1999-2000. In the period 1999-2000, nearly 50% of the MRSA were hospital acquired compared with 39% in 2000-2001. Similarly, the average incidence of Clostridium difficile associated diarrhoea (CDAD) decreased in each of the quarters in 2000-2001 following the introduction of Spirigel. During this period, there was an average incidence of 9.5 cases of CDAD/1000 admissions compared with 11.5 cases of CDAD/1000 admissions in 1999-2000. This represents a 17.4% reduction in the incidence of CDAD. However, this reduction was not statistically significant (P=0.2). Our case study demonstrates that principles of societal marketing methods can be used effectively to promote and sustain hand hygiene in hospitals. Improvement in hand hygiene will lead to considerable reduction in hospital-acquired infections.

Guideline Adherence↗
PubMed2000

Using focus group methods to develop multicultural cancer pain education materials.

Methods to treat cancer pain effectively have existed for more than 2 decades. However, the effective treatment of cancer pain continues to elude many patients with cancer who suffer from poor management. Although efforts to address the problem of cancer pain in the United States have acknowledged the importance of patient education and advocacy, few endeavors, to date, have attended to the special needs of inner-city, low-literacy, or socioeconomically disadvantaged patients from minority cultural groups. From 1992 to 1995, the Boston Cancer Pain Education Program, funded by the National Cancer Institute and the American Cancer Society, worked collaboratively with community representatives using focus group methods to develop a culturally sensitive, linguistically appropriate cancer pain education booklet in 11 languages and for 11 ethnic groups. The booklet serves as a guide for patients and families and is to be used as a teaching tool by clinicians. The focus group approach was used to develop materials that would empower patients and families to more effectively participate in pain management when working with health care providers from cultures other than their own. Qualitative data analysis methods were used to analyze transcripts of taped focus group sessions. Themes emerged from the data regarding pain and its culturally competent management as well as the group process of booklet development.

Boston↗
PubMed2000

Pain management: an organizational commitment.

Although much has been done to promote pain assessment and management, pain remains a major, yet largely preventable, public health problem in the United States. A strategy that has been proposed to assure optimal pain management is the development of formal means within institutions to evaluate pain management practices and foster improved outcomes. In response to a pain-related patient care problem, South Nassau Communities Hospital recognized the need to undertake more formal methods for managing patients with acute, chronic, and cancer pain. A Pain Management Task Force was charged with the development of a comprehensive pain management program. Its efforts to date and plans for the future position this institution as ready for the Joint Commission for the Accreditation of Healthcare Organizations' pain assessment and management standards that were introduced in 2000.

Hospitals, Community↗
PubMed2003

A study of the effectiveness of a pain management education booklet for parents of children having cardiac surgery.

Parents need education about pain so they can support their hospitalized child and manage their child's pain at home. The purpose of this study was to examine the effectiveness of a pain booklet on parental pain support to children experiencing postoperative pain. A randomized, repeated measures, experimental design using a pain education booklet and a standard care comparison group was used to study parents of 51 children (3 to 16 years of age) having cardiac surgery. Measurement techniques used to assess differences in parental pain management included: attitudes about pain medication, child and parent pain ratings (Oucher), opioids used, recovery, satisfaction, and comfort in communication. Results indicate that children do report moderate levels of pain postoperatively. Parents who were exposed to the pain assessment and management for parents education booklet preoperatively significantly increased their knowledge and attitudes toward pain medication scores from pre- to post-test, whereas those in the control group remained stable. Post-test scores were not significantly different between groups. Child and parent pain ratings were significantly and positively correlated. Practice implications include the use of an educational booklet about pain with parents before surgery to increase their knowledge about and attitudes toward pain management. Additionally, a parent may provide an alternative pain report when a child is unable to or unwilling to self-report their pain.

Adolescent↗
PubMed1997

Development and evaluation of written patient information for endoscopic procedures.

BACKGROUND AND STUDY AIMS: In the process of revising our written patient information, we wanted to incorporate some patient feedback into the text, and to compare the new brochures with the old one in terms of procedure-related anxiety and general patient satisfaction. PATIENTS AND METHODS: A total of 136 patients were asked about their present sources of information and issues they would like more information on. New brochures were developed for upper endoscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP), and 235 consecutive patients were then randomized to receive either the new brochures or the old one. Before the endoscopy procedure, the patients' sources of information, level of anxiety (on a five-point Likert scale) and general satisfaction with the written information was assessed. In addition, 89 patients completed a similar questionnaire after completing the endoscopic procedure, recording their degree of anxiety and discomfort during the procedure, and the appropriateness of the written information they had received. RESULTS: The written brochure was regarded as providing important information by 79% of the patients, while only 31% felt they had received important information from their referring doctor. The general level of anxiety was 2.0 (slightly anxious) with both brochures, with a mean score of 2.1 and 1.9 for the old brochure and the new one, respectively (P = 0.04). Previous endoscopy, male sex and high age were associated with a lower anxiety score. The post-endoscopy response indicated that the patients had received a realistic description of the procedure. The new brochures were rated as "excellent" or "very good" by 87% of the respondents. CONCLUSIONS: We have developed a new set of information brochures which appear to serve the purpose of providing adequate information, without causing patients undue anxiety.

Anxiety↗
PubMed1991

Information requirements and sedation preferences of patients undergoing endoscopy of the upper gastrointestinal tract.

Patients' attitudes to sedation and their information needs before undergoing endoscopy were investigated using a questionnaire. One hundred and two patients completed the study; 32 had undergone endoscopy before. Sixty-six (94%) of the new patients and all follow-up patients knew why they were undergoing the procedure; 65 (93%) new and 28 (88%) follow-up patients understood how the procedure was carried out. Forty-one percent of the new and 25% of the follow-up patients wanted an information booklet about their disease and its management. Most patients chose to be sedated during the endoscopy. The proportion wishing to be sedated did not differ significantly between the new and follow-up patient groups. Sedation and information should be offered to all patients undergoing endoscopy.

Attitude to Health↗