What the doctor doesn't know: Discarded patient knowledge of older adults with multimorbidity.

OBJECTIVES: Adherence to treatment has proven to require the involvement of patients in treatment and care planning. This process involves incorporating patient knowledge, or knowledge about the patients' everyday life, into the clinical encounter. This article explores the disclosure practices of such knowledge from older adults with multimorbidity. METHODS: This was an 18-month qualitative study among 14 older adults with multimorbidity living in Denmark. A thematic analysis was applied, focusing on perceptions of patient knowledge and disclosure practices among the participating patients. RESULTS: Older adults with multimorbidity have various reasons for not disclosing personal knowledge. The results present three different domains of what we termed discarded patient knowledge: (1) knowledge that had no direct biomedical relevance from participants' perspective; (2) knowledge considered too private; and (3) knowledge assumed to position one as inferior. DISCUSSION: The participants made judgments on what they believed was welcome in the clinical encounter, framing their knowledge within the purview of biomedicine. Participants' disclosure practices showed that personal knowledge is sometimes not recognized as important for health and care by participants themselves. Knowledge that could have influenced practitioners' understanding of the problem and provided different solutions, is argued to be discarded patient knowledge.

[Involvement of patients has not been fully implemented in Danish health care]. / Patientinddragelse er endnu ikke fuldt implementeret i sundhedsvæsenet.

In Denmark, there is a focus on patient involvement. Health professionals want to involve patients, but have diverse interpretations of what this entails, which complicates knowledge dissemination. Interventions are scattered and diverse, and often do not systematically involve patients' knowledge. Studies have shown that patients want to be involved and contribute with knowledge, but this only happens to a limited degree. Involvement of patients is often limited to involving their resources in the form of self care rather than integrating their knowledge into their treatment and care.

[User involvement in the Danish health care sector]. / Brugerinddragelse i sundhedsvaesenet.

The aim of the health services is to ensure an optimal result for its users. It is documented that involvement has a positive impact on treatment, and in many respects patients take another view on the concept of quality than does health personnel. In Denmark every fifth patient experiences insufficient involvement in his or her own course of treatment - furthermore, the patient perspective is given insufficient attention and there is a general lack of user representation and user surveys in the processes shaping the organization of the health services and cultural issues. A national strategy is needed.

Do surgical patients differ in the way they prioritise aspects of hospital care?

MAIN OBJECTIVE: To investigate whether surgical patients have the same or different priorities within hospital care by examining whether the importance patients ascribe to different aspects of hospital care can be explained by how important they find aspects of hospitalization in general. BACKGROUND: Few studies have investigated patient priorities within hospital care. Knowledge of patient priorities is important for the purpose of making quality improvements in hospital care. In relation to this, it is important to know whether different groups of patients have qualitative different priorities. DESIGN AND SUBJECTS: A postal questionnaire was mailed to 3676 surgical patients after discharge from five Danish hospitals. Out of this figure, 2380 participated in the survey and 1597 were qualified for inclusion in the analyses. ANALYSES: Data was analysed by graphical loglinear Rasch models. Thirty-six hospital care aspects were included in the final model. MAIN RESULTS AND CONCLUSIONS: To a great extent, patients agreed on the prioritised order of the hospital care aspects investigated. Avoidance of errors and professional health care skills had highest priority. Qualitative differences in priorities were mainly found among different age groups; the younger patients found that information was more important than the older patients, who on the other hand found continuity of care to be more important. Quantitative differences were observed, with patients harbouring different views on of the importance of hospital care in general; on average, women rated this slightly more important than men.

[Conditions for foreign doctors' clinical work assessed by Danish health care personnel, patients and foreign doctors]. / Forudsaetninger for udenlandske laegers kliniske arbejde--vurderet af dansk sundhedspersonale, patienter og udenlandske laeger.

INTRODUCTION: Many foreign doctors work in Danish hospitals. This study concerns the opportunities available to and difficulties encountered by these doctors. MATERIALS AND METHODS: A questionnaire concerning guidance available to foreign doctors, their linguistic and professional competence and their cultural backgrounds was sent to foreign doctors, to Danish doctors, to Danish nurses, and to patients in Greater Copenhagen. A total of 1539 questionnaires were sent. RESULTS: 49-57% in each group replied. The majority of both foreign doctors and Danish doctors found that introductory guidance was adequate, but nurses thought otherwise. A large majority of Danish personnel (78-89%) had experienced that they themselves or patients could not understand a foreign doctor. A lesser number of foreign doctors (27-33%) had the same experience with Danish personnel or patients. Foreign doctors' language difficulties gave rise to feelings of insecurity and doubts about professional competence in both Danish personnel and patients (53-69%). Danish personnel estimate that European Union (EU) doctors' professional competence is equal to Danish doctors' professional competence, while non-EU foreign doctors are not so highly esteemed. 90% of patients are of the opinion that foreign doctors are professionally competent. Cultural background can influence clinical practice in the opinion of 50% of Danish personnel and 42% of foreign doctors. CONCLUSION: Insufficient communication is the biggest challenge for foreign doctors, and can influence the evaluation of their professional competence. Cultural differences may influence foreign doctors' cooperation with Danish personnel. Patients are satisfied with treatment given by foreign doctors.

[Are Danish medical students concerned about their future job? A questionnaire study]. / Er danske medicinstuderende bekymrede i relation til deres fremtidige virke? En spørgeskemaundersøgelse.

INTRODUCTION: Knowledge about the thoughts of Danish medical students regarding their job future is limited. The aim of this study was to investigate whether medical students are concerned about their future work, and if so, to describe the types of concerns they have, to what degree they are concerned, possible reasons for and consequences of their concerns; furthermore, to evaluate if gender and semester influate on the concerns. METHOD: A questionnaire was developed based on focus group interviews with medical students. The questionnaire was sent to 596 medical students from 3rd, 8th, and 13th semester at Copenhagen University. RESULTS: The response rate was 69.9%. A substantial number of students (47-90%) were very concerned or concerned to a certain degree with regard to aspects of working life that related to the patient and working conditions. A positive relation was seen between being highly concerned or concerned to a certain degree and daily or often worrying. Possible causes of the concerns were related to their experience through their clinical stays, the curriculum, comments about the job made by medical doctors and others and their own personality. Every sixth student had considered leaving university or refraining from entering clinical training due to these concerns. CONCLUSION: Medical students from 3rd, 8th, and 13th semester are concerned about their future work, especially in relation to the patient, regarding, for example, the risk of committing an error or being incompetent in relation to practical skills, but also work-related concerns are mentioned.

The NORPEQ patient experiences questionnaire: data quality, internal consistency and validity following a Norwegian inpatient survey.

AIMS: This article describes the development of a questionnaire designed for comparisons of patient experiences of hospital care within the Nordic countries. The results of testing for data quality, reliability, and validity are presented following a Norwegian survey. METHODS: Following a literature review and consultation within an expert group six items were developed measuring patient experiences together with two items assessing global satisfaction and perception of incorrect treatment. The questions were included in a questionnaire that was mailed to 500 patients randomly selected from patients receiving inpatient treatment at a large university hospital in Norway. Principal component analysis was used to assess dimensionality. Reliability was assessed by the internal consistency and test-retest methods. Construct validity was assessed by the scale's correlation with variables known to be related to patient experiences. RESULTS: A total of 244 (48.8%) patients responded. Levels of missing data ranged from 0.4% to 2.5%. The six items in the questionnaire that measured important aspects of patient experiences with the services contributed to a single scale with item-total correlations in the range 0.59-0.71 and a Cronbach's alpha of 0.85. The test-retest intraclass correlation was 0.88. CONCLUSIONS: The NORPEQ is a brief measure of patient experiences that covers important aspects of the healthcare encounter. It shows good evidence of reliability and validity and is relatively easy to apply alongside existing national surveys.

How do patients with colorectal cancer perceive treatment and care compared with the treating health care professionals?

BACKGROUND: Patient evaluations are widely used in quality assessment of health services. It is widely recognized that patients and professionals provide a different perspective on quality. However, the extent to which they differ and the conceptual areas in which they differ is not well understood. OBJECTIVES: We sought to examine how well professional and patient assessments of hospital health care correspond. METHODS: We undertook a prospective study in which information from a national clinical register was combined with questionnaires to patients, surgeons, and nurses. The study included 527 patients after surgery for colorectal cancer. The patients and their professionals assessed the same questions. For 336 patients, all questionnaires and register information were available. The response rate was 64%. The main measures were assessments of technical, interpersonal, and organizational aspects of care. Agreement was analyzed by kappa statistic, kappa, and McNemar's test. RESULTS: Comparing assessments of technical surgical care kappa statistic demonstrated moderate-to-almost perfect agreement (0.35

[Patients' attitude towards the hospital system in eastern and western Denmark. Patient involvement, patient orthodoxy and information gathering]. / Patienters indstilling til sygehusvaesenet i Østdanmark og Vestdanmark. Medinddraegelse, autoritetstro og informationssogning.

INTRODUCTION: Based on results from the Danish National Patient Satisfaction Survey (2000, 2002), which showed that patients treated in hospitals in western Denmark (West) had more positive experiences than patients treated in hospitals in eastern Denmark (East), the Unit of Patient Evaluation examined what factors may be creating the regional differences in patients' experiences. MATERIALS AND METHODS: This research is based on qualitative research methods and has decoded the sense ascribed by each patient, based on his or her own understanding, norms and values, to phenomena and experiences during hospitalisation. The research was carried out in four orthopaedic departments, and hip patients were chosen as the target group. In all, 16 interviews with patients, 9 interviews with medical personnel and 4 observations were carried out. RESULTS: All the patients preferred to be informed about their treatment possibilities. Nevertheless, compared to patients in the West, patients in the East had more specific expectations of being involved in their hospitalisation, they had more often tried to get involved and they were less orthodox and more engaged in obtaining information. DISCUSSION: This research indicates that the difference in patients' experiences between eastern and western Denmark may be caused by their different expectations of involvement. An individual patient's evaluation of hospitalisation may be more positive if the patient does not have a high expectation of having his or her individual needs fulfilled.

[Clinical leaders' and staff's assessment of the current quality related to the patient pathways and expectations of and knowledge about accreditation--a baseline evaluation in Copenhagen County]. / Lederes og medarbejderes vurdering, forventninger og kendskab til akkreditering--en førmåling på sygehuse i Københavns Amt.

INTRODUCTION: In the preparation for accreditation in Copenhagen County the commitment of clinical leaders and staff members is crucial. The objectives of these surveys are to examine the leaders' and the staff's assessment of quality improvement and their expectations and knowledge about accreditation, as well as the staff's advice concerning the further planning. MATERIALS AND METHODS: Two surveys among clinical leaders and staff members were carried out. RESULTS: Statistically, significant differences between staff and leaders were found in many areas concerning quality improvement and knowledge about accreditation. Leaders and staff both had high expectations of the use of accreditation as a tool for quality improvement, thus no statistically significant difference between expectations were found. CONCLUSION: The overall positive expectation for accreditation as a tool for quality improvement is an excellent basis for the accreditation process. The different assessments in quality among leaders/staff and positions show the need to involve all personnel in the organization. A survey about patient experiences includes the same subjects as the survey among staff and leaders. A striking discrepancy between the evaluation of quality by patients and by the leaders and staff in specific areas was found; therefore further investigations will be carried out.

[Patients' experiences--indications for treatment quality in breast cancer surgery]. / Patientoplevelser--indikatorer for behandlingskvaliteten i brystkraeftkirurgien.

INTRODUCTION: After the establishment of a centralised unit for the surgical treatment of breast cancer in the county of Copenhagen, Denmark, a number of parameters concerning the quality of patients' in-hospital stay were established. A survey of patients' experiences was done via a questionnaire in which they described their satisfaction level. MATERIALS AND METHODS: Two questionnaires including 43 questions were sent to 400 women recently operated on for primary breast cancer. They were returned by 269 patients, who were included in the study. RESULTS: The patients indicated a high degree of satisfaction with the general aspects of their hospital stay, but problems and possible areas of future improvement were also identified. CONCLUSION: Even with a malignant diagnosis and a short hospital stay, patients may regard the treatment course positively if and when the course is firmly anchored in well-established quality goals.

[The attitude of doctors and nurses towards reporting and handling errors and adverse events]. / Laegers og sygeplejerskers holdninger til rapportering og håndtering af fejl og andre utilsigtede haendelser.

INTRODUCTION: Few studies have been published about the attitudes of doctors and nurses towards reporting and handling adverse events. However, knowledge about staff attitudes is relevant and may be essential to dealing with potential problems and barriers that staff might have, as well as to supporting cultural change in relation to reporting and learning. MATERIALS AND METHODS: From February to March 2002, a questionnaire comprising 133 questions was distributed to 4019 doctors and nurses in four counties in Denmark. This paper deals with only a subset of the results of the survey. RESULTS: Responses were obtained from 703 doctors and 881 nurses, yielding an overall response rate of 51%. Statistical analysis was performed with non-parametric tests (Mann-Whitney, Kruskal-Wallis). The survey shows large differences in attitudes among different staff groups towards reporting adverse events, and errors, in their reasons for not reporting and their degree of distress at the prospect of making mistakes. Doctors are more reluctant (34%) than nurses (21%) to bring up adverse events and errors, indicating as their main reasons: lack of tradition, fear of the press, and the risk of being reprimanded. In contrast to consultants, "non-consultants" (staff specialists and junior doctors), and especially the female members of this group, show a greater agreement with each of the proposed reasons. The thought that one may cause injury to a patient induces 35% of "non-consultants" to consider giving up their job "now and then/often". DISCUSSION: Efforts to improve patient safety culture can become more effective via knowledge about similarities and differences among staff groups that have been uncovered in this survey.

[Patient-experienced quality assessed in two national surveys]. / Patientoplevet kvalitet belyst ved to nationale undersøgelser.

INTRODUCTION: Surveys of patients' experiences can be used for other purposes than to disclose patients' overall satisfaction. They can, for example, also be used to select focus areas in the health care sector. In this article two large national surveys of patient-experienced quality are compared. The advantages and disadvantages of the applied methods and various applications of the surveys are discussed. MATERIALS AND METHODS: The Danish National Patient Satisfaction Survey was based on a questionnaire with questions about patients' experiences. The questionnaires were sent to the patients after discharge. All 62 public Danish hospitals were included. The Patient Reports Survey was based on a questionnaire with questions about whether the patient had received certain services. The questionnaire was given to each patient on the day of discharge and returned before the patient left the hospital. All medical wards were invited to participate in the survey. RESULTS: Despite differences in questions, design and methods, the two surveys showed agreement in the areas where patients experienced flaws in the quality of services. CONCLUSION: In future surveys the advantages and disadvantages of data feedback, inclusion on the basis of data registers, sample sizes and the possibility of being supplied with ward-specific data should be taken into consideration. The advantages and disadvantages of involving employees should be counterbalanced in each survey. The Danish National Patient Satisfaction Survey is suitable for external evaluation and benchmarking between hospitals, while the applied methods in the Patient Reports Survey are best suited to internal self-evaluation and quality improvement within hospital departments.