Gynaecological Cancers in India: The Less Heard Perspectives of Healthcare Providers.

There has been mounting evidence on the role of healthcare providers in chronic illnesses such as cancer. The specific complexities in their roles to enable health are less heard. Gynaecological cancers have several undercurrents beyond the obvious. Semi-structured interviews were conducted with healthcare providers in Southern India (n = 35) and the data presented in this article were collected as a part of a larger study on the role of communication in the management of gynaecological cancers in India. Thematic analysis of the qualitative data provided information on the providers' perspectives of gynaecological cancers. Patient numbers, cost, time, cultural norms, context, and institutional constraints in cancer care provision are just some of the factors impacting care provision. Healthcare providers are typically acknowledged for the criticality of their roles in the continuum of care. However, our research suggests that the psychological harm and challenges they themselves may face in providing that care are severely neglected. Through listening to healthcare provider voices, clear solutions emerge to better support the practice of those who are responsible for cancer care.

Psychometric Properties of a Healthcare Provider Burden Scale: Preliminary Results.

Measures are lacking that assess the clinical burden that healthcare providers perceive in treating chronic conditions. This study presents a preliminary psychometric evaluation of a novel self-report measure of provider burden in the treatment of chronic pain. Data for eight burden items were available from vignette studies examining the effects of patient pain severity and medical evidence on clinical burden and judgments for chronic pain. Participants (N = 922) were 109 physicians and 813 non-physicians, all acting in the role of physician (232 community members without chronic pain, 105 community members with chronic pain, and 476 American Chronic Pain Association members with chronic pain). Factor analyses of burden items yielded one-factor solutions in all samples, with high factor loadings and adequate explained variance. Internal consistency reliability was uniformly high (≥ 0.87). Burden scores were significantly higher among physicians compared to nonphysicians; nonphysician groups did not differ on any burden score. Significant correlations of burden score with indicators of psychosocial complications in patient care supported scale validity. Burden score was not associated with gender, age, or education. Results provide initial support for the psychometric properties of a Healthcare Provider Burden Scale (HPBS). Research utilizing larger and representative healthcare provider groups is needed.

A Preliminary Study of Provider Burden in the Treatment of Chronic Pain: Perspectives of Physicians and People with Chronic Pain.

This study compared perceptions of the burden of patient care and associated clinical judgments between physicians and people with chronic pain (PWCP) in a 2 × 3 × 2 between-subjects design that varied participant type, patient-reported pain severity (4/6-8/10), and supporting medical evidence (low/high). One hundred and nine physicians and 476 American Chronic Pain Association members were randomly assigned to 1 of 6 conditions. Respondents estimated the clinical burden they would assume as the treating physician of a hypothetical patient with chronic low back pain, and made clinical judgments regarding that patient. Physician burden ratings were significantly higher than PWCP ratings, and clinical impressions (eg, trust in pain report, medical attribution) and management concerns (eg, opioid abuse risk) were relatively less favorable. Neither pain severity nor medical evidence affected burden ratings significantly. High medical evidence was associated with more favorable clinical impressions; higher pain severity led to more discounting of patient pain reports. Burden was significantly correlated with a range of clinical judgments. Results indicate that physicians and PWCP differ in their perceptions of provider burden and related clinical judgments in ways that could impact treatment collaboration. Further research is needed that examines provider burden in actual clinical practice. PERSPECTIVE: Physicians and people with chronic pain (PWCP) estimated the clinical burden of patient care and made judgments about a hypothetical patient with chronic pain. Physician burden ratings were higher and clinical judgments less favorable, relative to PWCP respondents. These differences could impact treatment collaboration and merit study in clinical practice.

Measuring time clinicians spend using EHRs in the inpatient setting: a national, mixed-methods study.

OBJECTIVE: To understand hospitals' use of EHR audit-log-based measures to address burden associated with inpatient EHR use. MATERIALS AND METHODS: Using mixed methods, we analyzed 2018 American Hospital Association Information Technology Supplement Survey data (n = 2864 hospitals; 64% response rate) to characterize measures used and provided by EHR vendors to track clinician time spent documenting. We interviewed staff from the top 3 EHR vendors that provided these measures. Multivariable analyses identified variation in use of the measures among hospitals with these 3 vendors. RESULTS: 53% of hospitals reported using EHR data to track clinician time documenting, compared to 68% of the hospitals using the EHR from the top 3 vendors. Among hospitals with EHRs from these vendors, usage was significantly lower among rural hospitals and independent hospitals (P < .05). Two of these vendors provided measures of time spent doing specific tasks while the third measured an aggregate of auditable activities. Vendors varied in the underlying data used to create measures, measure specification, and data displays. DISCUSSION: Tools to track clinicians' documentation time are becoming more available. The measures provided differ across vendors and disparities in use exist across hospitals. Increasing the specificity of standards underlying the data would support a common set of core measures making these measures more widely available. CONCLUSION: Although half of US hospitals use measures of time spent in the EHR derived from EHR generated data, work remains to make such measures and analyses more broadly available to all hospitals and to increase its utility for national burden measurement.

Caregivers Confronted With the Withdrawal of Artificial Nutrition at the End of Life: Prevalence of and Reasons for Experienced Difficulties.

BACKGROUND: Withdrawing artificial nutrition in palliative care is an issue that often leads to ethical dilemmas among health care providers, despite clinical guidelines. OBJECTIVES: To describe the experience of health care providers confronted with the withdrawing of artificial nutrition at the end of life and identifying the factors related to the level of ethical dilemmas. METHODS: Cross-sectional survey questionnaire of all the nurses and nurses' aides working in medicine, surgery, and palliative care departments of a regional hospital and who have already been confronted with the withdrawal of artificial nutrition. RESULTS: Of 818 questionnaires sent, 274 were returned (response rate 33.5%); 60% (163) of the care providers who responded were involved in withdrawing artificial nutrition at the end of life. Among these, 42 (25.8%) had always or often been affected with ethical dilemmas, and 97 (60%) responded that withdrawing artificial nutrition had always or often been preceded by a multidisciplinary discussion. Items significantly associated with a high level of ethical dilemmas were (1) existence of differences in opinion within the health care team, (2) lack of information regarding the indication of the withdrawal of artificial nutrition, (3) feeling uncomfortable with the patient and his or her relatives, (4) guilt, (5) feeling of abandonment of care, and (6) uneasiness. CONCLUSION: Health care providers seem to have a lack of information and consensus regarding the withdrawal of artificial nutrition at the end of life. The ethical dimension of withdrawing artificial nutrition in palliative care has a strong impact on care providers, regardless of the circumstances of the withdrawal.