The complex interplay of physician, patient, and spouse in preoperative counseling for radical prostatectomy: a comparative mixed-method analysis of 30 videotaped consultations.

OBJECTIVES: Spouses of cancer patients play a crucial role in deciding on therapeutic choices. The aim of our study was to assess their role in counseling for radical prostatectomy. METHODS: We analyzed 30 videotaped preoperative consultations prior to radical prostatectomy. Thereof, 14 included the patients' female partner and 16 took place without partner attendance. We performed quantitative and qualitative conversation analysis to compare both settings. RESULTS: Mean age of patients was 61 (47-73) years; 13% (4/30) did not have a partner. Duration of preoperative consultations was 20 (10-32) min. Physicians spoke most of the time (93%, range 71-99%), followed by patients (7%, range 1-20%) and spouses (2%, range 0-8%). Patients whose spouse was present at the consultation tended to have a more averted posture (50% vs. 25%, p = 0.04) and tended to speak less often (5% vs. 8%, p = 0.02). In 4 of 14 (29%) consultations, the spouses tended to be more dominant, speaking more frequently. Qualitative analysis showed several examples of emotional support and helpful contributions by spouses. Difference of opinion occurred when pros and cons of a nerve-sparing approach were discussed. The spouses' impact appeared to influence the final decision of men contemplating a nerve-sparing approach in 1 of 14 conversations. CONCLUSIONS: Spouses appear to play a complex and sometimes ambivalent role in counseling for radical prostatectomy. Especially when discussing a nerve-sparing approach, urologist should focus on the patients' true needs while interacting with both partners. Personalized decision aids might help to identify possible conflicts in advance.Copyright © 2015 John Wiley & Sons, Ltd.

Multimedia support for improving preoperative patient education: a randomized controlled trial using the example of radical prostatectomy.

BACKGROUND: Growing evidence supports the use of multimedia presentations for informing patients. Therefore, we supported preoperative education by adding a multimedia tool and examined the effects in a randomized controlled trial. METHODS: We randomized German-speaking patients scheduled for radical prostatectomy at our center to receive either a multimedia-supported (MME) or a standard education (SE). Outcomes were measured in a structured interview. Primary outcome was patient satisfaction. In addition, we applied validated instruments to determine anxiety and measures of decision-making. Results were given by mean and standard deviation. For comparison of groups we used t test and chi-square test. For an explorative analysis we applied multivariate logistic regression. RESULTS: We randomized 203 patients to receive MME (n=102) or SE (n=101). Complete satisfaction with preoperative education was more frequent in the MME group (69 vs 52%, p=.016) and patients after MME reported more questions (5.7 vs 4.2, p=.018). There was no difference concerning the duration of talks and the number of recalled risks. However, perceived knowledge was higher after MME (1.3 vs 1.6, p=.037). Anxiety and measures of decision-making were comparable. Patients judged the multimedia tool very positive, and 74% of the MME group thought that their preoperative education had been superior to SE. CONCLUSIONS: Multimedia support should be considered worthwhile for improving the informed consent process before surgery (www.germanctr.de; DRKS00000096).

Version changes in medical software: proposing minimal requirements for release notes and a version number convention - an operators' point of view.

Medical software--like any other software--is susceptible to errors. To avoid false system behaviour or attenuate its consequences, system operators need to know about changes in the software. The goal of this proposal is to define terms and minimum requirements regarding documentation for a version change from the operator's point of view, especially in the domain of medical software or software as a medical device (SaMD). The results are a classification of version changes (Upgrade: breaks support for a rollback to a prior version, Major Update: either substantial configuration or user education needed, Minor Update: minor configuration or user information needed, Patch: collection of (small) changes that require neither configuration nor user information.). Additionally, minimal requirements for release notes are determined and a document structure recommended.

[Evidence-based Medicine online for young doctors - a randomised controlled trial]. / Evidenzbasierte Medizin online zum ärztlichen Berufsstart- eine randomisiert-kontrollierte Studie.

INTRODUCTION: Evidence-based Medicine (EbM) was originally developed as a teaching tool for young doctors, but in Germany the last surveys among residents in 2009 and 2011 demonstrated that, across all topics, the largest deficits were seen in the field of EbM. One reason may be a deficit in customised offers for continuing medical education in EbM. In a randomised controlled trial with a wait-control design we investigated a possible gain in knowledge and the acceptance of an online course in EbM for first-year residents. METHODS: All first-year residents at the Hospital of the Goethe University in Frankfurt received the offer to voluntarily take part in an online EbM course. The tutored course consisted of five modules according to the five steps of EbM, each module being complemented by practical tasks. The participants were randomised via telephone to the course right away or after a three-month waiting period. The primary endpoint (i.e., knowledge) was tested via two sets of 13 multiple choice questions before and after the course and after 6 and 12 months. The participants were asked to subjectively evaluate the course by using an A-F grading system and to semiquantitatively assess its level of difficulty; they were also asked to evaluate the usefulness of its content in their clinical setting. RESULTS: 114 out of the 120 randomised participants took part. After 3 months the immediate intervention group (n=58) achieved a median of 10 (95 % confidence interval 10 to 11) correct answers following the course, whereas the waiting intervention group only received a median of 4 (95% confidence interval 4 to 5) correct answers after the three month waiting period (p ≤ 0.0001). The median gain in knowledge for both groups throughout the course was 5 correct answers (p ≤ 0.0001), and this proved to remain constant within a twelve month period. Six months after the course, this course was rated as clinically useful by 96.4 % of the participants, and 38.1% stated that they would volunteer again in further teaching activities. The course received a median grade of B. DISCUSSION AND CONCLUSIONS: A German online EbM course for first-year residents leads to a remarkable and sustainable gain in knowledge, is well marked, and its contents were regarded as clinically relevant. This tutored practical course is applicable to various settings and could provide an important contribution to EbM residency programs.