Audiology, an Important Contributor to Interprofessional Holistic Care: An Interprofessional Collaborative Case Example

Purpose: Interprofessional collaboration improves health outcomes, enhances health care satisfaction, and facilitates more effective use of resources. Interprofessional collaborators increasingly understand and value other professions. A.T. Still University provides students from multiple programs with opportunities to develop interprofessional collaboration skills. This research note presents details of one such interprofessional education (IPE) opportunity, a collaborative case. Audiology was part of this case in two ways: Audiologic details of the simulated patient were provided to all students, and audiology students participated in the experience. The results of this involvement are reported. This research note is primarily descriptive in nature; however, the question of whether students viewed their interprofessional competencies as improving following the IPE experience was explored using a validated self-report tool, the Interprofessional Collaborative Competency Attainment Survey (ICCAS). Method: A total of 23 students completed the ICCAS. Additionally, student case presentations were reviewed and audiology-based recommendations were tallied. Results: Highly significant differences ( p ≤ .01) for all 20 items on the ICCAS were observed for differences in self-assessed interprofessional skills knowledge. All but one of the 12 teams made specific recommendations regarding the communication needs of the patient. Conclusions: Students viewed their own competencies related to interprofessional collaboration as improved following the collaborative case experience. Overall, the collaborative case experience was effective in providing students with the opportunity to develop a breadth of skills needed for interprofessional collaboration. Providing audiologic information in the case history prompted all but one team to consider patient communication needs.

A Short Form of the Child/Youth Health Care Questionnaire on Satisfaction, Utilization, and Needs in Children and Adolescents with a Chronic Condition (CHC-SUN-SF/YHC-SUN-SF)

We decided to develop a short-form of the CHC-SUN/YHC-SUN, a questionnaire aiming at assessing health care satisfaction of children and adolescents with chronic health conditions. Data analysis was based on samples from three different studies. Item selection involved statistical analysis and expert consensus. For independent validation purposes, we calculated descriptive statistics on single-item and composite-scale levels and applied classic test theory, confirmatory factor analyses, and correlation analysis to investigate the psychometric properties of the final short-form by different types of reliability and validity. Internal consistency (Cronbach’s Alpha) reached values of a = 0.89 (self-report) and a = 0.92 (parents report), split-half reliability values reached 0.85 (self-report) and 0.91 (parents report). Confirmatory factor analysis indicated no sufficient fit for the single factor solution, whereas the solution with three factors and one higher order factor indicated the best overall fit amongst three competing models. Validity of the short-form measure can be assumed, e.g., as indicated by its association with a single-item measure on general health care satisfaction. The short-form measures of the CHC-SUN for parents (CHC-SUN-SF) and the YHC-SUN self-report version for adolescents (YHC-SUN-SF) feature excellent psychometric performances, provide economical assessments, and are easy-to-administer questionnaires. They should be used whenever brief measures are needed for economic reasons.

Patient-reported care satisfaction and symptom burden in hospitalized patients with cancer.

180 Background: Hospitalized patients with cancer often experience a high symptom burden, which may impact care satisfaction and healthcare utilization. However, research describing these patients’ care satisfaction, symptom burden, and health care use is lacking. We sought to investigate relationships among care satisfaction, physical and psychological symptom burden, and hospital length of stay (LOS) in hospitalized patients with cancer. Methods: We prospectively enrolled patients with cancer and unplanned hospitalizations from 9/2014 to 4/2017. Upon admission, we assessed patients’ care satisfaction (FAMCARE items: satisfaction with care coordination and the speed with which symptoms are treated) as well as their physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms. We used regression models to identify factors associated with care satisfaction, and we also examined associations of care satisfaction with patients’ symptom burden and hospital length of stay (LOS). Results: Among 1,576 participants (median age = 65.0 years [range:19-96], 46.3% female, 70.9% with incurable cancer, 58.4% admitted to a dedicated oncology service), most reported being “satisfied” or “very satisfied” with care coordination (90.1%) and the speed with which symptoms are treated (89.0%). Older age (care coordination: B < 0.01, P = 0.022, speed with which symptoms are treated: B = 0.01, P = 0.001) and admission to a dedicated oncology service (B = 0.20, P < 0.001 for each) were associated with higher care satisfaction. Higher satisfaction with care coordination was associated with lower ESAS-physical (B = -1.28, P = 0.007), ESAS-total (B = -2.73, P < 0.001), PHQ4-depression (B = -0.14, P = 0.022), and PHQ4-anxiety (B = -0.16, P = 0.008) symptoms. Higher satisfaction with the speed with which symptoms are treated was associated with lower ESAS-physical (B = -1.32, P = 0.003), ESAS-total (B = -2.46, P < 0.001), PHQ4-depression (B = -0.14, P = 0.014), and PHQ4-anxiety (B = -0.17, P = 0.004) symptoms. Greater satisfaction with care coordination (B = -0.48, P = 0.040) and the speed with which symptoms are treated (B = -0.44, P = 0.041) were both associated with shorter LOS. Conclusions: Hospitalized patients with cancer report high care satisfaction, which correlates with older age and admission to a dedicated oncology service. Significant associations among higher care satisfaction, lower symptom burden, and shorter hospital LOS highlight the importance of improving symptom management and care coordination in this population.

The Relationship Between Parents' Perceptions of Family-Centered Care and Their Health Care Satisfaction

Aim: This study was conducted to determine the relationship between the perceptions of parents whose children are hospitalized about family-centered care provided in the hospital and their health care satisfaction and the factors affecting them. Methods: This descriptive study was conducted with parents (n=169) of children who were hospitalized in a university hospital in Turkey between May and July 2019. Data were collected with "Child and Family Information Form", "Family-Centered Care Scale" and "PedsQL Health Care Satisfaction Scale". Data were analyzed with descriptive statistics, Mann Whitney U, and Spearman correlation tests. Results: The mean age of the children was 6.86±5.63, 51.5% were male, 56.2% were hospitalized before and 88.2% of parents received information about the care and treatment of their children. There was a positive correlation between the parents’ Family-Centered Care Scale and PedsQL Health Care Satisfaction Scale scores and between the age of the children and age of the mother and the PedsQL Health Care Satisfaction Scale scores, the number of children and Family-Centered Care Scale scores of parents. A statistically significant difference was found between the child's previous hospitalization and median scores of the Family-Centered Care Scale, and between whether parents receive information about the care and treatment of their children and the median scores of the PedsQL Health Care Satisfaction Scale. Conclusion: In this study, as the family-centered care that parents expect was met, their health care satisfaction increased. As the age of children and mothers increased, parents' health care satisfaction increased. Health care satisfaction of parents who received information about treatment and care was found higher. Keywords: family-centered care, patient satisfaction, child, parents

Delivering Bad News: Should Physicians Express their Emotions?

The traditionally assumed medical dictum is that a physician who expresses his or her emotions in font of patients or their families is almost deemed unprofessional. This feeling may be common place, particularly among traditional physicians who still hold the belief that professionalism is endangered if physicians deliver bad news laced with their true emotions. Discussion of this important topic surfaces now and then and are then hidden away without definite answers possibly due to lack of attention by physician's fraternity to dispense with this out-of-date dictum. Though we understand the protection of professionalism is the basis for this practice, the topic is rarely revisited because the community of physicians remains distant from this sensitive issue, in spite of its importance in achieving high care satisfaction from patients and their families. In view of the increased emphasis on enhancing patients’ hospital experiences and satisfaction, the demonstration of sensitivity on the part of physicians in some form as a component of their compassionate care may require renewed attention.

mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer

PURPOSE Late-stage cancer patient symptom control is a national priority in Tanzania. Mobile health promises to improve the reach of a limited pool of palliative care specialists through interprofessional, community-based care coordination. This work assessed the effectiveness of a smartphone- or Web-based app, mPalliative Care Link (mPCL), to extend specialist access via shared data and communication with local health workers. Central to mPCL is the African Palliative care Outcome Scale (POS), adapted for automated mobile symptom assessment and response. METHODS Adult patients with incurable cancer were randomly assigned at hospital discharge to mPCL versus phone-contact POS collection. Sociodemographic, clinical, and POS data were obtained at baseline. Twice-weekly POS responses were collected and managed via mPCL or phone contact with clinician study personnel for up to 4 months, on the basis of study arm assignment. Patient end-of-study care satisfaction was assessed via phone survey. RESULTS Forty-nine patients per arm participated. Comparison of baseline characteristics showed an insignificant trend toward more women ( P = .07) and higher discharge morphine use ( P = .09) in the mPCL group compared with phone-contact and significant between-group differences in cancer types ( P = .003). Proportions of deaths were near equal between groups (mPCL: 27%; phone-contact: 29%). Overall symptom severity was significantly lower in the phone-contact group ( P < .0001), and symptom severity decreased over time in both groups ( P = .0001); however, between-group change in overall symptoms over time did not vary significantly ( P = .34). Care satisfaction was generally high in both groups. CONCLUSION Higher symptom severity scores in the mPCL arm likely reflect between-group sociodemographic and clinical differences and clinical support of phone-contact arm participants. Similar rates of care satisfaction in both groups suggest that mPCL may support symptom-focused care coordination in a more efficient and scalable manner than phone contact. A broader study of mPCL's cost efficiency and utility in Tanzania is needed.

Care Effectiveness and Standards of Dementia Special Care Units for Older Adults with Dementiain Pension Industry

Dementia special care units (D-SCUs) is increasingly becoming the main mode of care for older adults internationally. As little is known about D-SCUs in China, this study aimed to analyze care efficiency and summarize the standards of Chinese D-SCUs.A questionnaire survey and in-depth interviews were conducted between June 2018 and July 2019 in six cities in China. Quantitative data about basic information and care satisfaction were collected from 25 care facilities. Qualitative data about the standards of the D-SCUs were collected fromthree cities that had issued such standards. Data envelopment analysis (DEA) was used to evaluate the care efficiency of D-SCUs, and grounded theory was used to analyze qualitative data.Among the 25 surveyed facilities, 12 had established D-SCUs, of which eight(66.67%) were effective facilities. Thirteen facilities did not establish D-SCUs, of which two(15.38%) were effective facilities.Technical efficiency, pure technical efficiency, and scale efficiency of care facilities with D-SCUs were higher than those of without (P=0.016, P=0.022, and P=0.021, respectively). Standards regarding location, environment, beds, and service items varied among the three cities that had issued standards for D-SCUs.The D-SCU care mode is effective and professional, and can be further promoted in the development of pension industry in China. Further investigation into D-SCUs and related standard is needed.