Effectiveness of computerised decision aids for patients with chronic diseases in shared decision-making: A systematic review and meta-analysis.

AIMS: To synthesise the composition and effectiveness of computer-based patient decision aid (PDAs) in interventions for patients with chronic diseases. DESIGN: A systematic review with meta-analysis. METHODS: Five databases were searched, and only randomised controlled trials (RCTs)were included. This review was conducted with the PRISMA guidelines. The JBI Appraisal Tools for randomised trials were used to assess the risk of bias. We used the random-effects model to conduct meta-analyses. Evidence from RCTs was synthesised using standardised mean differences or mean differences. The GRADE system was employed to assess the certainty of evidence and recommendations. This study was registered on PROSPERO (number: CRD42022369340). DATA SOURCES: PubMed, Embase, Web of Science, CINAHL and Cochrane Library were searched for studies published before October 2022. RESULTS: The review included 22 studies, and most computer-based PDAs reported information on the disease, treatment options, pros and cons and risk comparison and value clarification. The use of computer-based PDAs showed a significant effect on decision conflict and knowledge, but not on decision regret, satisfaction, self-efficacy, anxiety and quality of life. The overall GRADE certainty of evidence was low. CONCLUSION: Although the quality of evidence was low, however, using computer-based PDAs could reduce decision conflict and enhance knowledge when making medical decisions. More research is needed to support the contention above. RELEVANCE TO CLINICAL PRACTICE: Computer-based PDAs could assist health-care providers and patients in the shared decision-making process and improving the quality of decision-making. REPORTING METHOD: This study adhered to PRISMA guidelines. NO PATIENT OR PUBLIC CONTRIBUTION.

The mediating effect of sleep quality and fatigue between depression and renal function in nondialysis chronic kidney disease: a cross-sectional study.

BACKGROUND: Depressive symptoms, fatigue, and poor sleep quality are associated with renal function deterioration in patients with nondialysis chronic kidney disease (CKD-ND). This study was designed to examine whether fatigue and sleep quality are mediators of the association between depression and renal function. METHODS: This study adopted a cross-sectional study design. Patients with CKD-ND aged 20 years or older were recruited by purposive sampling at a medical center in Central Taiwan from December 2020 to July 2021. Data were collected using the Emotional and Social Support Scale, Fatigue Scale, Beck Depression Inventory-II (BDI-II), and Pittsburgh Sleep Quality Index. Medical records were reviewed to obtain the estimated glomerular filtration rate (eGFR) for the next month. The relationships among variables were analyzed using structural equation modeling to assess the goodness-of-fit of the model. Then, the bootstrapping method was used to analyze the mediated effect. RESULTS: Two hundred forty-two participants (mean age 70.5 years and 53% males) were included in the analysis. About 39% of the participants met the criteria for depressive symptoms in BDI-II, and 91% reported having sleep disturbances. Participants' degree of fatigue was not high (20.4 ± 13.3). The average eGFR was 25.45 mL/min/1.73 m 2 (± 13.36). The results showed that fatigue, sleep quality, and eGFR were significantly correlated with depression. The total effect size was - 0.8304 (95% confidence interval [CI], - 0.9602 to - 0.7006), and the indirect effect size was - 0.1738 (95% CI, - 0.2812 to - 0.0651), which was a statistically significant difference, indicating that the model has a mediating effect. According to mediation analysis, fatigue and sleep quality had a significant indirect effect on the relationship between depression and renal function (95% CI, - 0.0587 to - 0.0039). CONCLUSIONS: The findings suggest that fatigue and poor sleep quality may mediate the association between depression and renal function.

Peritoneal dialysis after shared decision-making: the disparity between reality and patient expectations.

BACKGROUND: The current health policy in Taiwan favors peritoneal dialysis (PD) at home. Policy objectives may make healthcare providers give more consideration to the introduction of PD treatment. This study aimed to explore the process of information acquisition and consideration during shared decision-making (SDM) for patients undergoing PD and compare their quality of life expectations before and after PD at home. METHODS: In this qualitative study, 15 patients undergoing PD for < 12 months were purposively recruited from one large PD unit in Taichung, Taiwan. Data were collected between August 2020 and December 2020 using a semi-structured interview. All transcripts were evaluated using thematic analysis. RESULTS: Three themes and seven subthemes were identified following data analysis: 1. sources for information on dialysis treatment, including (a) effect of others' experiences and (b) incomplete information from healthcare providers (HCPs); 2. considerations for choosing PD, including (a) trusting physicians, and (b) maintaining pre-dialysis life; and 3. disparity between pre-and post-PD reality and expectation, including (a) limitation by time and place, (b) discrepancies in expected freedom and convenience, and (c) regret versus need to continue. CONCLUSION: HCPs played an important role in SDM, providing key information that influenced the process. Patients undergoing initial PD at home exhibited a disparity between expectation and reality, which was exacerbated by incomplete information.

Development and testing of the hemodialysis symptom distress scale (HSD-22) to identify the symptom cluster by using exploratory factor analysis.

BACKGROUND: Patients receiving hemodialysis (HD) often experience multiple symptoms concurrently and these symptoms may impact their quality of life. A valid and reliable tool is needed to assess the symptom distress of patients receiving HD in terms of the perspective of symptom clusters. Although many studies have explored symptom clusters related to patients receiving HD, the clusters formed had problems with overlapping, vagueness, lack of cluster-specificity, and difficulty in discerning their common mechanism under the cluster. AIMS: To develop reliable measurement tool to identify the symptom clusters of patients undergoing HD. DESIGN: A cross-sectional descriptive study. METHODS: To examine the physiological properties of the HD symptom distress (HSD) scale, 216 participants were recruited from a HD center of a medical university hospital in southern Taiwan from February 2019 to April 2019. Construct validity was evaluated by exploratory factor analysis (EFA), and the internal consistency and test-retest reliability were estimated by Cronbach's alpha and intraclass correlation coefficient (ICC). RESULTS: The CVI value of the HSD was 0.89. The HSD scale was composed of five factors with 22 items, including insufficient energy/vitality, cardiac-pulmonary distress, sleep disturbance, musculoskeletal distress, and gastrointestinal distress, with factor loading ranging from 0.62 to 0.87, explaining 65.5% of the total variance. Cronbach's alpha coefficient of the HSD total scale was 0.93, and five subscales ranged from 0.73 to 0.89. The test-retest reliability was 0.92 (p < 0.001) by using the intraclass correlation coefficient (ICC) for the HSD-22 scale. CONCLUSION / IMPLICATION: Theoretical testing from our study indicated that the HSD-22 scale had satisfactory validity and reliability. Therefore, this assessment tool can be employed to identify the symptom clusters of patients receiving HD in the clinical setting. Such identification enables healthcare professionals to provide interventions to release patients' symptom distress efficiently.

[Applying Shared Decision Making With End-Stage Renal Disease Patients Undergoing Renal Replacement Therapy to Reduce Decision Making Conflicts].

The shared decision making (SDM) is an innovative, emerging clinical medical decision model in Taiwan. This model allows patients to understand the possible benefits, hazards, and risks of different treatment options and to choose the treatment option that best aligns with their values and preferences, thereby reducing patients' decisional conflicts. The survival rate of patients with end-stage renal disease (ESRD) has improved, in part due to the rapid development of medical technologies and treatment modalities. However, survival requires that patients face the choice conflicts associated with renal replacement therapy. All of the various renal replacement therapy treatment options impact the physical state of patients, cause changes in their daily life, and undermine their normal work and social roles. Patients often deal with conflict, uncertainty, and hesitation when they engage in making decisions about renal replacement therapy, as the course of treatment is long-term and the effects accompany the patients for the remainder of their life. This article discusses the decisional conflicts of ESRD patients in renal replacement therapy and its influencing factors. The authors propose the SDM approach to renal replacement therapy as a care reference for clinical health professionals.

The Roles of Social Support and Health Literacy in Self-Management Among Patients With Chronic Kidney Disease.

AIMS: To investigate the relationships among social support, health literacy, and self-management, and the factors influencing self-management of chronic kidney disease (CKD). DESIGN: Cross-sectional study. METHODS: A random sample of 410 patients was recruited from nephrology clinics. Data were collected using structured questionnaires and chart reviews from January 2013 to February 2014. Hierarchical regression analysis was used to determine the predictive factors of self-management behaviors and ∆R2 to determine each variable's explanatory power. FINDINGS: Health literacy and social support were positively correlated with self-management behaviors. Furthermore, social support, health literacy, and marital status were significant predictors of self-management behaviors. Social support had a relatively greater explanatory power for self-management behaviors than did health literacy. Particularly, healthcare provider support had the greatest influence on patients' self-management behaviors. CONCLUSIONS: Health literacy and social support play independent positive roles in self-management behaviors of patients with CKD, with social support having a particularly dominant role. Further research using a systems approach to improving self-management behaviors is necessary to clarify the role of social support. CLINICAL RELEVANCE: Health literacy and social support are independently and positively related to self-management. Social support, which is a system-level factor, is a relatively stronger and crucial predictor than is health literacy. Nurses have to refine self-management programs to focus on families and adopt a systems approach to help CKD patients improve their self-management behaviors.

Effects of Online Teaching during the COVID-19 Pandemic on Nursing Students' Intention to Join the Nursing Workforce: A Cross-Sectional Study.

Nursing education programs were interrupted and largely moved online as a result of the COVID-19 pandemic. The purpose of this study was to explore Taiwanese nursing students' perspectives on online teaching during the COVID-19 pandemic and whether changes in teaching models have affected their intention to join the nursing workforce. A multi-center cross-sectional survey was conducted. Nursing students at universities and those at 5-year junior colleges were recruited to participate in the study. Data were collected through an online questionnaire survey. A total of 687 students responded to the questionnaire. The results were analyzed using percentages, mean ranks, and nonparametric methods. The results showed that 78.6% of the students agreed that online teaching was more flexible; most students stated that technical problems with computer equipment and stability of the network were large challenges that impeded online teaching. Furthermore, up to 64.8% of the students considered that online courses had affected their preparations for future nursing jobs, especially in terms of a lack of proficiency in nursing skills and inadequacy in actual interactions with patients. Online teaching is a powerful tool for nursing education, but a thoughtful strategy and more proactive approach are necessary to overcome the existing challenges for online teaching.

The effects of narrative pedagogy on increasing nursing students' willingness to practice older people care: A mixed-methods research.

AIM: This study aims to discuss how narrative pedagogy of improving the positive attitude toward older people among nursing students and increasing students' willingness to practice older people's care. BACKGROUND: Considering the progress of population aging, the requirement for nursing manpower in older people care is on the rise. However, related studies have demonstrated that nursing students generally have a negative attitude toward older people, which affects students' willingness to engage in older people's care in the future. DESIGN: This study applied mixed method research design. For the quantitative study design, we have adopted a quasi-experimental study, pretest-posttest design. METHODS: The study adopted purposive sampling. A total of 87 nursing students in two classes of five-year junior college program in northern Taiwan were selected as the study subjects. The students were randomly allocated into an experimental group of 43 subjects and a control group of 44 subjects. The experimental group received narrative pedagogy of geriatric care course for 18 weeks with 2 h per week, the control group received general lectures. This study was conducted between October 2019 and February 2020. The quantitative data were collected using the structured questionnaire. The qualitative data were collected by individual interviews and students' reflective writing. RESULTS: The average scores of the older people's attitude (F=4.60, p < 0.05) and the willingness to care for the older people (F=4.19, p < 0.05) in the experimental group increased significantly, reaching a statistically significant level. According to the adjusted post-test score averages of the two groups, under the control of the pre-test, the Older Adults Attitude Scale (64.02 >60.22) and the post-test of the Older Adults Care Willingness Scale (11.63 >9.93) in the experimental group were significantly higher than those in the control group. In the qualitative analysis, four themes were emerged, which were negative stereotypes about the older people, myth-breaking for prejudice against the older people, new older people impression for replacement and rethinking for older people care. CONCLUSION: Narrative pedagogy is an effective teaching method, which can improve nursing students' older people's positive attitudes and increase students' willingness to practice older people's care.

The Effect of Integrating Service-Learning and Learning Portfolio Construction into the Curriculum of Gerontological Nursing.

BACKGROUND: With the rapid increase in the aging population, a greater number of older individuals will require nursing care in the future. Therefore, it is important for nurses to be willing to engage in gerontological nursing. Nursing students must increase their experience in providing care to older people during their education and must receive education that improves their attitudes toward aging; this will help provide care to the older people, develop positive attitudes toward aging, and increase their empathy and willingness to provide care to older people after graduation. Hence, studies focused on improving the attitude of nursing students toward aging are urgently required. METHODS: In this mixed-method experimental study, participants were interviewed individually and observed to better understand the connection between quantitative and qualitative data. Service learning and learning portfolio constructions were integrated in the gerontological nursing curriculum of an experimental group, whereas traditional gerontological nursing curriculum was provided to a control group. Quantitative data on the nursing students were collected using the attitudes toward aging scale (ATAS) and older people behavioral intention scale (OBIS) and analyzed using descriptive and inferential statistics. RESULT: From the pre- to the post-test, the average ATAS and OBIS scores of the experimental group increased significantly, reaching a statistically significant level. However, the results of the control group indicated that the educational intervention does affect the attitudes toward aging and older people behaviors. A qualitative analysis revealed that educational intervention can improve the students' attitudes toward aging and older people behavioral intention. CONCLUSION: Our study results showed that integrating community older people service and learning portfolio construction into the curriculum can effectively improve the attitudes of nursing students toward aging and older people's behaviors, thus providing substantial assistance to students intending to care for the older people in the future.

The exploration of a screen model for detecting undergraduates at higher risk for developing psychosis: A cross-sectional study in a medical university.

PURPOSE: To examine a screen model for detecting undergraduates with higher risk for developing psychosis (HRDP). DESIGN AND METHODS: A cross-sectional design with convenience sampling was used. The screen model included exploration stage by self-report scales and confirmation stage by face-to-face interviews. FINDINGS: A total of 273 students were detected from 4744 surveys during 4 years. Of them, 120 students with HRDP were identified and 7 had been diagnosed as schizophrenia or bipolar disorders at 12-month follow-up. PRACTICE IMPLICATIONS: This screen model can be used in early detection for undergraduates with HRDP from large general samples.

The Effects of Empowerment Education on Daily Dairy Intake in Community-Dwelling of Older Asian Women.

A scarcity in the intake of dairy products in older women begets a wide range of musculoskeletal problems, especially osteoporosis. However, dairy products are often not consumed in sufficient quantities in Eastern societies. This study used empowerment education to improve daily dairy intake in 68 older Asian women in the community through a quasi-experimental study design. The 34 participants in the experimental group took part in empowerment education programs that included lectures, sharing sessions, situation dramas, and cooking activities, for two hours per week for 6 weeks. The 34 participants in the control group had no interventions. The generalized estimating equation was used to evaluate the intervention's effectiveness. The test was conducted for the two groups at 1 and 12 weeks after the completion of the lessons. We used daily dairy intake self-efficacy, intention, and behavior scale to measure the outcome. The change in the experimental group's daily dairy intake self-efficacy and intention score at post-1 week and post-12 weeks was higher compared to the control group, but the dairy intake behavior was only changed at post-12 weeks. The empowerment education was effective in encouraging older women to change their dairy intake behavior and improved their dairy intake self-efficacy and intentions.

A qualitative study on shared decision-making of patients with chronic kidney disease.

AIM: This study aims to explore the change process among chronic kidney disease patients in shared decision-making. DESIGN: Qualitative research is the design applied. METHOD: Original transcripts from an earlier study involving a purposive sample of 31 patients with chronic kidney disease provided a source of information. The data collection was conducted from August 2017-January 2018. Data analysis applied the thematic analysis method. RESULTS: Three themes were identified: from avoidance to being forced to accept, decision-making process of action and facilitating factors. After making the psychological adjustments necessary for undergoing dialysis treatment, participants experience the process of decision-making action. The improvement of knowledge and ability increases the patient's self-determination consciousness and strengthens confidence in decision-making. The nurse and the patient's family are both important facilitating factors, and they assist through the entire SDM process.

The Effects of a Social Participation App on Seniors.

BACKGROUND: Advancements in medical care have increased the average life span in many countries, resulting in a generally longer postretirement life span. However, retirees may find it difficult to adapt to retirement. Therefore, encouraging retirees to engage with society is important. PURPOSE: In this study, a senior social participation mobile software application (SSP-App) was developed to stimulate social participation among seniors with the goal of improving their social participation intentions and behaviors. METHODS: After developing the SSP-App based on user experiences, a quasi-experimental study was conducted. Participants were recruited from the Keelung Ren'ai Community Center. Next, Random Allocation Software Version 1.0.0 software was used to randomly allocate the participants into experimental and control groups. The 54 participants in the experimental group took part in an SSP-App program, whereas the 53 participants in the control group did not participate in any experimental treatment program. Measurements were conducted at Week 4 (T1) and Week 12 (T2) to evaluate the effects. Data were collected using a demographic datasheet, Geriatric Depression Scale-Short Form, Emotional and Social Support Scale, Social Participation Intention Scale, and Social Participation Behavior Scale. The generalized estimating equations method was used to determine intervention effectiveness. RESULTS: The SSP-App has six main functions, including an activity partner message board, an activity search function that provides information about different activities, a "Seniors Learning Kiosk" that provides useful information, transportation information, an activity planning and reminder system, and a "First-Aid Station." Most participants in the SSP-App precursor test expressed approval. At T1, effects were observed in social participation intention only. However, at T2, effects were observed in both social participation intention and social participation behavior. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The SSP-App developed in this study uses information and communication technology and multiple strategies covering information provision, social support, education, and reminders. Social participation obstacles must be overcome to effectively provide seniors with social participation opportunities and improve their social participation.

Online Team-Based Learning Teaching Strategy for Developing Caring Competencies in Nursing Students under COVID-19 Pandemic Restrictions.

(1) Background: The COVID-19 pandemic impacted education systems globally, and numerous strategies were used to transform education into online learning. Caring is recognized as a core competency in nursing; this competency is difficult to cultivate and measure. This study aimed to explore the effect of online team-based learning (TBL) on cultivating nursing students' caring competency. (2) Method: A mix-methods study design with convenience sampling was used for this study. The intervention was online TBL with field observation. Quantitative data were collected by the modified Peer Caring Measurement (PCM) and analyzed using descriptive and inferential statistics. Qualitative data were collected by dialog in social media and analyzed by content analysis. (3) Result: Both the quantitative and qualitative data showed a significant increase in caring competency. A paired t-test of modified PCM showed significant improvement (p < 0.001), and female students had greater learning performances compared with male students in academic and affective dimensions. Three themes emerged, including that online TBL possesses remarkable benefits, students felt in charge of their learning, and changes in the students' caring competency were revealed. (4) Conclusion: This online TBL strategy works well in teaching and fostering caring in an online environment among nursing students, which is necessary under COVID-19 restrictions.

The Effects of Shared Decision Making on Different Renal Replacement Therapy Decisions in Patients With Chronic Kidney Disease.

BACKGROUND: The prevalence and incidence of end-stage renal disease (ESRD) in Taiwan are the highest of any country in the world. The different renal replacement therapies that are adopted by patients with ESRD significantly affect their social roles and daily life. However, because of the complexities of different renal replacement therapies, patients may be unsure of which to choose. PURPOSE: The aim of this study was to explore the effectiveness of a shared decision-making (SDM) program regarding different renal replacement therapies for patients with chronic kidney disease. METHODS: A quasi-experimental design was conducted at two similar regional hospitals in Miaoli County, Taiwan. One hospital hosted the intervention group, and the other hospital hosted the control group. The 31 participants in the intervention group took part in a SDM program. The 36 control group participants took part in the pre-ESRD care program. Data collection included demographic and disease characteristics, decisional conflict scale, and decision self-efficacy scale. Results were analyzed using independent t test, Fisher's exact test, generalized estimating equation, and paired t tests. RESULTS: The study results revealed that the intervention group experienced a significant increase in decision self-efficacy and a significant decrease in decisional conflict at 1 month after receiving the SDM intervention in comparison to before and immediately after receiving the intervention. Moreover, the intervention group had higher decision self-efficacy and lower decisional conflict than the control group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The SDM program may be an effective intervention for complex decision-making processes, such as the process involved in making renal replacement treatment decisions. The SDM program group intervention improved decisional conflict and decision self-efficacy. Thus, to improve patients' decision-making processes, the application of an SDM program focused on the personal values and opinions of patients with ESRD will be necessary. Physicians and case managers of patients with ESRD should act in complementary and cooperative roles in SDM programs.

The influence of different dialysis modalities on the quality of life of patients with end-stage renal disease: A systematic literature review.

OBJECTIVES: This study aims to generate evidence regarding the relationships of different dialysis modalities with HR-QOL. DESIGN: A systematic review was conducted to investigate the HR-QOL of patients treated with different dialysis modalities. METHODS: A literature search was conducted for English language articles in the CINAHL, Medline and PubMed databases published from January 1990 through May 2016. Specifically, we sought articles that would compare the HR-QOL of hemodialysis (HD) and peritoneal dialysis (PD) patients in terms of physiological, psychological and social functioning, as well as disease symptoms. Thirty-four articles met the study inclusion criteria and were included into the analysis. RESULTS: The research results indicated no significant differences in HR-QOL between HD and PD treatment. However, a higher percentage of patients who received PD had a better HR-QOL in terms of physiological, psychological, social and disease symptoms. CONCLUSIONS: Despite the fact that the results of this study showed no difference in HR-QOL between HD and PD treatment, its review of relevant references can serve as a reference for health professionals. However, patients' conditions must still be taken into account when making suggestions about which dialysis modality a patient should use.