THE POTENTIAL OF TELECOMMUNICATIONS IN CANCER CLINICAL TRIALS: AN OVERVIEW

This review article explores the potential bene?ts and challenges of using telecommunications technology, including telemedicine and mobile health apps, in cancer clinical trials. The author conducted a search of four electronic databases for studies published in English between 2010 and 2021 that evaluated the use of telecommunications technology in adult cancer patients and reported patient outcomes. The studies were grouped based on the type of telecommunications technology used, and the outcomes were synthesized to provide an overview of the potential impact of telecommunications technology on cancer clinical trials. Telecommunications technologies were found to improve patient access and recruitment, data collection, management, and analysis, and enable real-time monitoring of patients' health and adherence to treatment. Telecommunications technologies can also reduce trial costs by minimizing the need for in- person visits and other expenses. However, the implementation of telecommunications technologies in clinical trials is not without challenges, including technical issues, patient acceptance and adherence, regulatory and legal approvals, and variability in healthcare systems. The author suggests that addressing these challenges could lead to improved patient outcomes and better overall health outcomes for cancer patients

La empatía, la comunicación efectiva y la asertividad en la práctica médica actual / Empathy, effective communication and assertiveness in current medical practice

Resumen La empatía, la comunicación efectiva y la asertividad en la práctica médica actual representan habilidades y herramientas necesarias y vigentes en un mundo de grandes avances y realidades tecnológicas que no superan, en nuestra perspectiva, lo indispensable para mantener y fortalecer la relación del profesional de la salud con el paciente, específicamente la relación médico-paciente. Es conveniente identificar y reconocer el hecho de que estas relaciones interpersonales deben ser modificadas mediante el reconocimiento de su bidireccionalidad y deben centrarse en un carácter educativo, de retroalimentación y atención mutua, con una mejora continua de la regla de las "15 C": comunicación, cercanía, comprensión, compasión, confianza, capacidad, consistencia, certificación, creatividad, cooperación/coordinación, compromiso bidireccional y conexión, con las resultantes calidad y calidez.

Abstract Empathy, effective communication and assertiveness in current medical practice represent skills and tools necessary and current, in a world of great advances and technological realities that do not surpass, in our perspective, the indispensable use of such tools to maintain and strengthen the relationship of the health professional with the patient and specifically of the doctor-patient relationship. It is convenient to identify and recognize the fact that these interpersonal relationships must be modified by recognizing their bidirectionality and that they should focus on an educational, feedback and mutual attention, with a continuous improvement of the "15 C" rule: communication, closeness, understanding, compassion, confidence, capacity, consistency, certification, creativity, cooperation/coordination and bidirectional commitment and connection, with the resulting quality and warmth.

Jornada do paciente com lombalgia crônica no Brasil: uma revisão semi-sistemática sobre a melhor abordagem / Patient journey for those with chronic low back pain in Brazil: a semi-systematic review on the best approach

Histórico -O tratamento de pacientes com lombalgia crônica (LC) em muitos países, incluindo o Brasil, é um grande desafio no nível de atendimento primário e especializado. Além disso, as informações sobre epidemiologia e tratamento de pacientes com LC são escassas. O objetivo principal desta revisão semi-sistemática foi a construção de evidências locais sobre a prevalência e o padrão de tratamento da LC. Métodos: Esta revisão semi-sistemática utilizou Medline, Embase e Biosis via plataforma Ovid e recursos adicionais (Google, Google Scholar, Banco de dados de incidência e prevalência, Organização Mundial da Saúde, Ministério da Saúde do Brasil e informações anedóticas de especialistas locais) para identificar literatura relevante entre 2002 e 2020 para mapear a jornada do paciente. Artigos de texto completos e originais do Brasil em inglês contendo dados sobre pontos de contato predefinidos na jornada do paciente (conscientização, triagem, diagnóstico, tratamento, adesão e controle) foram selecionados. Os dados foram obtidos usando uma média simples ou ponderada, conforme aplicável para os componentes da jornada do paciente. Resultados: De 297 registros, incluindo os fornecidos por especialistas locais, oito estudos foram incluídos para análise. A conscientização da LC e da LC-NeP foi de 30,4% e 12%, respetivamente. De acordo com estudos publicados, a adesão e o controle dos sintomas dos pacientes foram estimados com percentual semelhante de 38% e 18%, respetivamente para a LC e a LC-NeP. A prevalência de LC-NeP (3,6%) foi menor que a de LC (20,6%). Com exceção de uma porcentagem comparável da população tratada, para LC (39,1%) e LC-NeP (38%), a porcentagem de pontos de contato restantes foi maior no caso de LC do que no LC-NeP, o que implicava uma melhora no trajeto do paciente para a LC. Conclusão: O estudo destaca a necessidade de melhorar os resultados dos pacientes em nível nacional, medindo esses pontos de contato da jornada do paciente. O resultado deste estudo baseado em evidências é importante para preencher a lacuna de conhecimento do paciente com LC. Portanto, recomenda-se garantir a educação médica contínua, a conscientização do paciente e a restruturação do sistema de saúde brasileiro, ao mesmo tempo em que adota novas práticas sobre o gerenciamento da dor. [au]

Background: Managing patients with chronic low back pain (CLBP) in many countries, including Brazil, is a major challenge at the primary and specialty care level. Moreover, the information about epidemiology and patient management with CLBP is sparse. The primary objective of this semi-systematic review was to build local evidence about the prevalence and management pattern of CLBP. Methods: This semi-systematic review used Medline, Embase, and Biosis via Ovid the platform and additional resources (Google, Google Scholar, Incidence and Prevalence Database, World Health Organization, Brazilian Ministry of Health, and anecdotal information from local experts) to identify relevant literature between 2002­2020 to map the patient journey. Original full-text articles from Brazil in English containing data on pre-defined patient journey touchpoints (awareness, screening, diagnosis, treatment, adherence, and control) were screened. Data were synthesized using a simple or weighted mean, as applicable for patient journey components. Results. Of 297 records including those provided by local experts, eight studies were included for analysis. Awareness of CLBP and CLBP-NeP was 30.4% and 12%, respectively. According to published studies, adherence and symptoms control of patients was estimated with a similar percentage of 38% and 18%, respectively for CLBP and CLBP-NeP. CLBP-NeP prevalence (3.6%) was lower than that of CLBP (20.6%). Except for a comparable percentage of the treated population, for CLBP (39.1%) and CLBP-NeP (38%), the percentage of remaining touchpoints are higher in the case of CLBP than in CLBP-NeP, implying an improved patient journey for CLBP. Conclusion: The study highlights the usefulness to improve patient outcomes at the national level by measuring these mapping patient journey touchpoints. The outcome of this evidence-based study was fruitful to bridges the know-do gap in CLBP patients. Therefore, it is recommended to ensure continuing medical education, patient awareness, and health system preparedness while embracing the emerging insights on pain management. [au]

Engajamento do paciente em programas de quedas hospitalares: percurso para a elaboração de um manual / Patient engagement in hospital falls programs: route to the elaboration of a manual

Resumo: Introdução: Trata-se da elaboração de um manual sobre estratégias de engajamento do paciente e seu acompanhante na identificação do risco de queda e ações de prevenção de quedas em ambiente hospitalar, que faz parte do projeto "Difusão e adoção do programa Fall Tailoring Interventions for Patient Safety - Fall TIPS", que vem sendo desenvolvido em hospital universitário do sul do Brasil. Objetivo: a elaboração de manual sobre estratégias de engajamento do paciente e seu acompanhante em programas de prevenção de queda. Método: Trata-se de uma pesquisa do tipo qualitativa, exploratória, descritiva e de produção tecnológica, composta por duas fases: a) entrevistas com pacientes que apresentaram o evento adverso queda hospitalar durante internação hospitalar, e/ou com seus acompanhantes, analisadas a partir da técnica de análise de conteúdo; e b) produção tecnológica para a elaboração do manual. Resultados: Nas entrevistas realizadas foi possível observar a recorrência de alguns temas principais: "A gente não sabia: dificuldades e inquietações na percepção dos riscos"; "Medo e insegurança: o manejo emocional como ferramenta da clínica no risco de queda"; "Relação da equipe de saúde com os cuidadores como ferramenta de suporte ao engajamento do paciente", que subsidiaram a elaboração do manual. Os resultados evidenciam lacunas na efetividade da comunicação entre os envolvidos no processo de identificação de riscos e manejo das intervenções relacionadas a cuidados seguros e trazem sugestões para superação do desafio por parte dos profissionais da saúde, em desenvolver práticas mais colaborativas. Sem essa abordagem, o paciente desenvolve sentimentos de medo e insegurança, comprometendo o seu cuidado e segurança. Produto e registro: O "Manual sobre Estratégias de Engajamento em Programas de Prevenção de Quedas Hospitalares", registrado na Câmara Brasileira do Livro. Conclusão: O manual subsidia a adoção de estratégias de prevenção à ocorrência de quedas em ambiente hospitalar, levando em consideração a adesão de uma cultura de segurança que conduza a uma prática assistencial de qualidade e, consequentemente, à redução de quedas.

Abstract: Introduction: A manual on strategies for engaging patients and their companions in identifying the risk of falling and actions to prevent falls in the hospital environment was prepared, as a part of the project "Dissemination and adoption of the Fall Tailoring Interventions for program Patient Safety - Fall TIPS", that is being developed in a university hospital in southern Brazil. Objective: the development of a manual on patient and companion engagement strategies in fall prevention programs. Method: A qualitative, exploratory, descriptive and of technological production research was performed, consisting of two phases: a) interviews with patients (and/or their companions), who had experienced a fall during hospitalization. The content analysis technique was used; and b) the production/preparation of the manual. Results: In the interviews results, it was possible to observe the recurrence of the themes: "We didn't know: difficulties and concerns in the perception of risks"; "Fear and insecurity: emotional management as a clinical tool for managing the risk of falling"; "Relationship between the health team and caregivers as a support tool for patient engagement", which supported the preparation of the manual. Also, they showed gaps in communication effectiveness among those involved in the process of identifying risks and managing interventions related to safe care and bring suggestions for overcoming the challenge on the part of health professionals, in developing more collaborative practices. Without this approach, the patient develops feelings of fear and insecurity, compromising their care and safety. Product: The "Manual on Engagement Strategies in Hospital Fall Prevention Programs", it was registered at Câmara Brasileira do Livro. Conclusion: The manual supports the adoption of prevention strategies against the occurrence of falls in the hospital environment, taking into account the adherence of a safety culture that leads to a quality care practice and, consequently, to the reduction of falls.

Tecnologia educativa para promoção de ações de segurança do paciente em uma maternidade / Educational technology to promote patient safety actions in a maternity hospital

Introdução: Potenciais riscos aos pacientes são intrínsecos à assistência à saúde, sendo que na maternidade, a ocorrência de eventos adversos pode repercutir em danos a mulher e ao recémnascido (RN). Diante disso, políticas públicas estabelecem ações de melhoria da assistência por meio da corresponsabilização e participação ativa dos pacientes e acompanhantes no cuidado e na prevenção de incidentes. Nesse contexto, a literatura sugere o desenvolvimento de tecnologias educativas (TE) para aperfeiçoar a comunicação, aumentar a capacidade de escuta e engajar o paciente e família na segurança do paciente (SP). Entretanto, as evidências sobre o desenvolvimento e utilização de TE em busca do maior envolvimento do acompanhante e do paciente na SP na maternidade, especialmente com a participação desses atores são insuficientes. Objetivos de pesquisa: Conhecer as percepções e as experiências de pacientes, acompanhantes e profissionais de saúde da maternidade sobre a participação da paciente e do acompanhante na segurança da paciente e do RN. Objetivo de prática: Elaborar e avaliar uma tecnologia educativa para promoção do envolvimento das pacientes internadas na maternidade e seus acompanhantes nas ações do cuidado seguro. Método: O estudo seguiu os preceitos metodológicos da Pesquisa Convergente-Assistencial e sustentou-se nos fundamentos teóricos de Paulo Freire. Foi realizado na maternidade de um hospital público de Belo Horizonte e a produção de dados foi dividida em três etapas. A primeira etapa subsidiou a construção da cartilha através de entrevistas para conhecer as percepções e o conhecimento dos participantes sobre a SP e a participação da paciente e do acompanhante na segurança; e identificar as barreiras que dificultam colocar em prática as ações de SP. Participaram dessa etapa 13 profissionais de saúde, 11 pacientes e 06 acompanhantes. Na segunda foi desenvolvida a TE em forma de cartilha e na terceira, a mesma foi avaliada pelos participantes. Na última etapa aceitaram continuar participando da pesquisa os 13 profissionais da saúde, 08 pacientes e 05 acompanhantes. A coleta de dados ocorreu por meio de entrevista semiestruturada e registro de diário de campo. A análise dos dados foi realizada pela análise de conteúdo e foram criadas duas categorias provenientes da primeira etapa: Saberes e experiências sobre a segurança da paciente e do RN na maternidade e Desafios para o envolvimento da paciente e acompanhante nas ações de segurança. Resultados: Na primeira categoria os achados evidenciaram que as pacientes e os acompanhantes esboçaram diferentes entendimentos sobre a SP, sendo que a maioria apresentava compreensão limitada sobre o tema e desconhecia como poderiam contribuir para SP. Os profissionais enfatizaram que as pacientes e os acompanhantes se envolvem pouco na SP e poderiam ser mais informados e estimulados pela própria equipe. A segunda categoria apontou as fragilidades para a participação da paciente e acompanhante nas ações de segurança, como a falta de conhecimento, diálogo e escuta, e a posição autoritária de alguns profissionais. Os achados da primeira etapa contribuíram para a construção da TE, no formato de cartilha. Na terceira etapa, os participantes avaliaram a TE como sendo um material importante para impulsionar a participação das pacientes e acompanhantes na SP. Conclusão: O processo interativo e dialogado com os participantes possibilitou a criação da TE como ferramenta importante no envolvimento das pacientes e acompanhantes nas ações de SP. Essa experiência vai ao encontro do pensamento de Paulo Freire que afirma que, o educador deve reconhecer o educando têm saberes, experiências e leituras de mundo próprias, sendo o respeito essencial para influenciar no desenvolvimento de novos saberes.

Potential risks to patients are intrinsic to health care, and in maternity hospitals, the occurrence of adverse events can affect women and newborns (NB). Therefore, public policies establish actions to improve care through co-responsibility and active participation of patients and caregivers in the care and prevention of incidents. In this context, the literature suggests the development of educational technologies (ET) to improve communication, increase listening skills and engage the patient and family in patient safety (PS). However, the evidence on the development and use of ET in search of greater involvement of the companion and the patient in PS in the maternity hospital, especially with the participation of these actors, is insufficient. Research objectives: Know the perceptions and experiences of patients, companions and health professionals in the maternity ward about the participation of the patient and companion in the safety of the patient and the NB. Practice objective Develop and evaluate an educational technology to promote the involvement of patients admitted to the maternity ward and their companions in safe care actions. Method: The study followed the methodological precepts of the Convergent Care Research and was supported by Paulo Freire's theoretical foundations. It was carried out in the maternity of a public hospital in Belo Horizonte and data production was divided into three stages. The first stage supported the construction of the booklet through interviews to learn about the participants' perceptions and knowledge about PS and the patient's and companion's participation in safety; and identify the barriers that make it difficult to put PS actions into practice. Thirteen health professionals, 11 patients and 06 caregivers participated in this stage. In the second, the ET was developed in the form of a booklet and in the third, it was evaluated by the participants. In the last stage, the 13 health professionals, 08 patients and 05 companions agreed to continue participating in the research. Data collection took place through semi-structured interviews and field diary records. Data analysis was performed using content analysis and two categories were created from the first stage: Knowledge and experiences about patient and newborn safety in the maternity ward and Challenges for the involvement of the patient and companion in safety actions. Results: In the first category, the findings showed that patients and caregivers outlined different understandings about PS, and most of them had limited understanding of the topic and did not know how they could contribute to PS. Professionals emphasized that patients and companions are little involved in PS and could be more informed and encouraged by the team itself. The second category pointed out the weaknesses for the participation of the patient and companion in safety actions, such as the lack of knowledge, dialogue and listening, and the authoritarian position of some professionals. The findings of the first stage contributed to the construction of the ET, in the form of a booklet. In the third stage, participants assessed ET as being an important material to boost the participation of patients and caregivers in the PS. Conclusion: The interactive process and dialogue with the participants enabled the creation of ET as an important tool in the involvement of patients and caregivers in PS actions. This experience is in line with the thought of Paulo Freire who states that the educator must recognize that the student has their own knowledge, experiences and readings of the world, with respect being essential to influence the development of new knowledge.

Perceptions And Abilities Related To Patient Engagement In Diabetes Care Among Primary Healthcare Providers In Malaysia: A Qualitative Study

@#Malaysia seeks to transform its public healthcare sector to manage the growing number of people with diabetes. Patient engagement is a critical clinical competency for healthcare providers treating people with diabetes. In this study, we investigate the perceptions of and ability to practice patient engagement among doctors and nurses working in Malaysia’s primary healthcare system. Semi-structured interviews were conducted with nine non-specialist doctors and ten nurses working in primary healthcare clinics. Further, 12 key informants with specialist knowledge about diabetes care and the healthcare system in Malaysia were interviewed. The interviews were analyzed using qualitative content analysis. Three main themes emerged: 1) understanding barriers to self-care and treatment, 2) perceived training needs and skills within patient engagement and empowerment, and 3) challenges to the practice of patient engagement. A range of barriers was identified in healthcare providers’ ability to practice patient engagement. Future efforts should seek to improve competencies within patient engagement, identification of especially psychosocial barriers to self-care and empowerment. Yet, available manpower and time also influence whether patient engagement is practiced.

Nurses' Perception of the Performance and Necessity of Nursing Services for Patients Engagement / 임상간호연구

PURPOSE: This study aimed to investigate the performance of patient engagement nursing services perceived by nurses and necessity in Korea. METHODS: This study was a descriptive research. A total of 205 nurses participated in the study. The Smart Patient Engagement Assessment Checklist was developed by the investigators to assess patient engagement nursing services performance and necessity. The data were collected using online survey. Descriptive analysis and χ² analysis were performed using SPSS 25.0 program. RESULTS: The mean age of participants was 36.6±8.5 years and the mean working experience was 12.92±9.23 years. Seventy eight percent of participants reported that patients and family participated in care as advisors through customer's suggestion or patient satisfaction assessment. The rate of patients' and family's engagement in care as advisors was significantly higher in tertiary hospitals (χ²=28.54, p<.001). About 89% of participants communicated with patients and family to make clinical decisions with a multidisciplinary approach. The rate of communication for multidisciplinary decision making was significantly higher in tertiary hospitals (χ²=6.30, p=.012). With regards to nurses' bedside patient handoff, 22.0% of participants reported that they were performing bedside patient handoff, and there was no significant difference between type of hospitals. About discharge planning, 72.2% of participants reported utilizing discharge checklist. CONCLUSION: Currently, patient engagement nursing services are applied partially in Korea. It seems that care protocols to be applied for patient engagement nursing services are insufficient. Therefore, patient engagement care protocols need to be developed to improve patient's health outcome and safety.

Survey on resident participation in community health management service / 中华全科医师杂志

Objective@#To survey the resident participation in community health management service and its influencing factors.@*Methods@#A survey on the resident participation in community health management service with self-designed questionnaire was conducted during January to March 2018 among residents in one of the subdistricts in Nanjing Gulou district. The questionnaire includes basic information of residents, understanding health management service, and the participation in the health management.@*Results@#Total 500 questionnaire were distributed, 449 copies were retrieved and 402 were valid. The rates of engagement in health archives, management of blood pressure, blood glucose and blood lipids, attending health education, regular health check-up, health follow-ups, and equipping family medicine kits were 62.2% (250/402), 71.0% (286/402), 49.5% (199/402), 59.9% (241/402), 72.6% (292/402), 66.9% (269/402), respectively. The rates of engagement of health archives, attending health education, regular health check-up and equipping family medicine kits for healthy residents were higher than those with chronic diseases (χ2=6.31, 4.09, 10.83, 10.83; P<0.05). The logistic regression analysis suggested that age, income, and understanding health management services were independent influence factors for resident active participation in health management.@*Conclusion@#The survey indicates that the young, high-income and healthy residents are more likely to participate in health management service, and the overall resident participation needs to be further improved.

Survey on resident participation in community health management service / 中华全科医师杂志

Objective To survey the resident participation in community health management service and its influencing factors.Methods A survey on the resident participation in community health management service with self-designed questionnaire was conducted during January to March 2018 among residents in one of the subdistricts in Nanjing Gulou district.The questionnaire includes basic information of residents,understanding health management service,and the participation in the health management.Results Total 500 questionnaire were distributed,449 copies were retrieved and 402 were valid.The rates of engagement in health archives,management of blood pressure,blood glucose and blood lipids,attending health education,regular health check-up,health follow-ups,and equipping family medicine kits were 62.2％ (250/402),71.0％ (286/402),49.5％ (199/402),59.9％ (241/402),72.6％ (292/402),66.9％ (269/402),respectively.The rates of engagement of health archives,attending health education,regular health check-up and equipping family medicine kits for healthy residents were higher than those with chronic diseases (x2=6.31,4.09,10.83,10.83;P＜0.05).The logistic regression analysis suggested that age,income,and understanding health management services were independent influence factors for resident active participation in health management.Conclusion The survey indicates that the young,high-income and healthy residents are more likely to participate in health management service,and the overall resident participation needs to be further improved.

Deliberative democracy in health care: current challenges and future prospects

Background: There is a vast body of literature on deliberative, participative, or engaged democracy. In the area of health care there is a rapidly expanding literature on deliberative democracy as embodied in various notions of public engagement, shared decision-making (SDM), patient-centered care, and patient/care provider autonomy over the past few decades. It is useful to review such literature to get a sense of the challenges and prospects of introducing deliberative democracy in health care. Objective: This paper reviews the key literature on deliberative democracy and SDM in health care settings with a focus on identifying the main challenges of promoting this approach in health care, and recognizing its progress so far for mapping out its future prospects in the context of advanced countries. Method: Several databases were searched to identify the literature pertinent to the subject of this study. A total of 56 key studies in English were identified and reviewed carefully for indications and evidence of challenges and/or promising avenues of promoting deliberative democracy in health care. Results: Time pressure, lack of financial motivation, entrenched professional interests, informational imbalance, practical feasibility, cost, diversity of decisions, and contextual factors are noted as the main challenges. As for the prospects, greater clarity on conception of public engagement and policy objectives, real commitment of the authorities to public input, documenting evidence of the effectiveness of public involvement, development of patient decision supports, training of health professionals in SDM, and use of multiple and flexible methods of engagement leadership suited to specific contexts are the main findings in the reviewed literature. Conclusion: Seeking deliberative democracy in health care is both challenging and rewarding. The challenges have been more or less identified. However, its prospects are potentially significant. Such prospects are more likely to materialize if deliberative democracy is pursued more systematically in the broader sociopolitical domains. (AU)