Sharing a written medical summary with patients on the post-admission ward round: A qualitative study of clinician and patient experience.

RATIONALE, AIMS AND OBJECTIVES: Sharing aspects of the traditional medical record with patients has been successful in primary and antenatal care, but has not been investigated in the UK inpatient setting. Our aim was to evaluate the impact on patient and clinician experience of providing patients with a written lay summary of their care-plan in the acute care setting. METHOD: We carried out a qualitative interview study on two acute medicine wards in an NHS University Teaching Hospital for a 4-week period in 2019. A summary record, designed in response to suggestions from doctors and patients from a previous study, was distributed to patients on the first ward round after admission. Eligible participants included all doctors and nurses working on and all patients and their families attending the acute medical units; patients were excluded if they lacked capacity to consent or were under 18. We interviewed 20 patients, 10 relatives, 10 doctors and 7 nurses. RESULTS: Patients felt that the summary improved their ability to remember details about their care so they could more accurately and easily update their relatives. They did not feel that the summary induced anxiety. Patient-doctor communication was improved: patients felt empowered to ask more questions and doctors felt that it solidified their plan and encouraged them to avoid medical jargon. Most patients felt the summary included the 'right' amount of information. Healthcare professionals were more concerned about the risk of breaching confidentiality than patients. Doctors felt that providing summaries was time-consuming; there were differing opinions about whether this was a worthwhile investment of time. Clinicians recognized that the traditional medical record has many roles. CONCLUSIONS: A summary record could empower patients and improve patient-doctor communication but would require additional clinician and administrative time.

Medicine vs Motherhood.

I'm sitting at my desk, trying to concentrate. On anything. It's impossible. No, I should rephrase that, it's "challenging" is the term I've been taught to use. I can't focus. I have no motivation. And it's been like this for nine months.

Families' concerns after bereavement in hospital: what can we learn?

BACKGROUND: Bereavement is a major life event often leading to psychiatric morbidity. Provision of bereavement care is poorly established in general hospital settings. OBJECTIVE: We describe a novel bereavement service in a large secondary care institution and assess its impact. DESIGN AND MEASUREMENTS: In this descriptive study, data from the first year of operation of the service was obtained. The questions from interviews with relatives stemming from the bereavement care service were reviewed and categorized. Potential predictors of requesting a follow-up meeting were analyzed. RESULTS: Of the 1384 bereaved relatives who were written to, 142 requested follow-up and 119 (8.6%) culminated in a bereavement follow-up meeting. The most common questions asked were for further details regarding the diagnosis (29%), why the patient had deteriorated so quickly (28%), what the diagnosis was (24%), and the sequence of events (24%). Relatives of younger patients and those from specialties other than medicine or surgery were more likely to seek bereavement follow-up (p<0.01 in each case). CONCLUSION: A specialized bereavement service is feasible in a large hospital trust and allows follow-up of relatives with ongoing questions and concerns, with the opportunity of reducing severe grief reactions.