Radiologist-patient communication of musculoskeletal ultrasonography results: a choice between added value and costs

Background Literature on radiologist-patient communication of musculoskeletal ultrasonography (US) results is currently lacking. Purpose To investigate the patient's view on receiving the results from a radiologist after a musculoskeletal US examination, and the additional time required to provide such a service. Material and Methods This prospective study included 106 outpatients who underwent musculoskeletal US, and who were equally randomized to either receive or not receive the results from the radiologist directly after the examination. Results In both randomization groups, all quality performance metrics (radiologist's friendliness, explanation, skill, concern for comfort, concern for patient questions/worries, overall rating of the examination, and likelihood of recommending the examination) received median scores of good/high to very good/very high. Patients who had received their US results from the radiologist rated the radiologist's explanation and concern for patient questions/worries as significantly higher ( P = 0.009 and P = 0.002) than patients who had not. In both randomization groups, there were no significant differences between anxiety levels before and after the US examination ( P = 0.222 and P = 1.000). Of the 48 responding patients, 46 (95.8%) rated a radiologist-patient discussion of US findings as important. US examinations with a radiologist-patient communication regarding US findings (median = 11.29 min) were significantly longer ( P < 0.0001) than those without (median = 8.08 min). Conclusion Even without communicating musculoskeletal US results directly to patients, radiologists can still achieve high ratings from patients for their communication and empathy. Nevertheless, patient experience can be further enhanced if a radiologist adds this communication to the examination. However, this increases total examination time and therefore costs.

Service evaluation of long acting buprenorphine subcutaneous injection (BUVIDAL) in the west Lothian community addictions service

Aims1. To establish if long acting buprenorphine subcutaneous injection retains patients in treatment.2. To obtain the patient opinion of long acting buprenorphine subcutaneous injection and ascertain if it improved other aspects of their life for example relationships and employment.MethodInformation was gathered from TRAK, the patient record recording system, and Illy, the prescribing system. This allowed data to be gathered on previous opiate substitute treatments and when the patient was commenced on the long acting buprenorphine injection. A patient questionnaire was used to obtain qualitative data on the patient's view of this treatment option.ResultWest Lothian Community Addictions Service starting offering long acting buprenorphine injection as a treatment option in March 2020. Since then there has been a consistent demand from patients to be commenced on this treatment. On 31st January 2021 39/53 (73.6%) of patients who had been commenced on long acting buprenorphine for 6 months had been retained on this treatment. Moreover, 3 patients were lost to treatment due to transfer to Her Majesty's Prison. Patients who were commenced on this treatment option were both new to treatment and those who had previously been difficult to retain on methadone or sublingual buprenorphine. The questionnaire supported the antidotal feedback that patients found this treatment option to be hugely beneficial.ConclusionLong acting buprenorphine injection has been well tolerated by patients and there has been a clear demand for this treatment option from patients accessing the service. It appears that the clarity of mind, that is associated with buprenorphine, has not been a barrier to retention in treatment. We have found the retention rate of the patients on this treatment option has been higher than the median 6 month retention for either methadone or buprenorphine, compared to a recent systematic review. In addition, it has helped patients consider employment, improve relationships and maintain a level of stability that they may not have previously achieved on either methadone or sublingual buprenorphine.

Patient perceptions of joint medical-surgical assessment in a tertiary referral clinic for inflammatory bowel disease

Background Joint medical-surgical inflammatory bowel disease clinics allow simultaneous patient assessment by both a gastroenterologist and surgeon. However, patient perceptions of dual clinician presence have not been adequately assessed. Therefore, this study aimed to evaluate the patient's view of receiving multidisciplinary care in this clinic. Methods Patients attending the medical-surgical inflammatory bowel disease clinic completed questionnaires assessing their attitudes towards the clinic, their overall satisfaction and desired frequency of appointments. Results Responses were received from 44 patients, the majority of whom indicated that attendance at the joint medical-surgical clinical made them feel less anxious about their disease, provided consistent messages regarding their care and minimised the number of trips made to hospital. High levels of satisfaction were reported, with 43% stating they preferred joint clinic attendance for every appointment. Conclusions Effective inflammatory bowel disease management requires coordinated care across specialties. Simultaneous medical-surgical assessment has practical and emotional benefits, without making patients feel overburdened by the presence of more than one clinician. This supports the streamlining of care for patients with inflammatory bowel disease in specific clinical scenarios.

Individualized blended care for patients with colorectal cancer: the patient’s view on informational support

Purpose The number of colorectal cancer patient survivors is increasing. Information and support during and after treatment are requested by patients, but questions remain on what to provide. The aim of this study was to understand what informational needs colorectal cancer patients and survivors have, with a focus on the potential support given by patient peers and the use of blended care. Methods A qualitative study using focus groups was conducted with patients diagnosed at the same hospital at least one year prior to the initiation of the study. The focus group interviews were transcribed verbatim and analyzed using deductive content analysis. Results The need for informational support varied over time and depended on individual patient characteristics. Timing was crucial and patients requested options of blended care and informational support after treatment cessation. The patients felt alone after treatment and requested assistance in communication with their next-of-kin. They also identified the value of peer support, especially to contextualize knowledge provided by healthcare. Conclusion This study showed a need for focus on individualized informational support. Blended care through integrating communication with peers online could be one way to support patients, both to enable shared decision-making as well as to provide person-centered care.

Design Consideration for Window Placement to Provide the View within the Patient's Visual Range

This study argues on the importance of considering the visual capacity of the observers in the placement of the windows to provide views to the natural outdoor environment. In particular, this study explores the mechanism of seeing that involves foveal and peripheral view in defining the patients’ visual capacity in experiencing the spaces of the healing environment. The placement of windows to connect the inside with the outside becomes irrelevant when their placement is not within the patient’s visual range. To examine the patient’s view toward the windows, we performed a 3d simulation of a hospital inpatient room and captured the scenes representing the foveal and peripheral views of the openings from various positions of bed-ridden patients. The region calculation of the opening elements within the captured image reveals the presence of opening within the peripheral range of patients’ view. This study suggests that the design of healing environment should not be based merely on the physical arrangement of interior elements, but should also consider how the elements are experienced within the view of the patient.Seeing

Defining and assessing key behavioral indicators of the Shifting Cultural Lenses model of cultural competence

Models of cultural competence highlight the importance of the sociocultural world that is inhabited by patients, and the question of how best to integrate sociocultural factors into clinical assessment and intervention. However, one significant limitation of such approaches is that they leave unclear what type of in-session therapist behaviors actually reflect cultural competence. We draw on the Shifting Cultural Lenses model to operationalize culturally competent in-session behaviors. We argue that a key component of cultural competence is the collaborative relationship between therapists and patients, in which therapists shift between their own cultural lenses and those of their clients, as they co-construct shared narratives together. Accordingly, we propose that culturally competent therapist behaviors include accessing the client’s views, explicitly presenting their own views as mental health care professionals, and working towards a shared understanding. We further specify the latter set of behaviors as including the practitioner’s integration of the patient’s view, their encouragement of the patient to consider their professional view, and the negotiation of a shared view. We developed a coding system to identify these therapist behaviors and examined the reliability of raters across 11 couple and 4 individual therapy sessions. We assessed whether the behavioral codes varied in expected ways over the first 3 sessions of 2 therapists’ couple therapy as well. Operationalizing the behavioral indicators of the Shifting Cultural Lenses model opens the door to the integration of both process- and content-oriented approaches to cultural competence.