Patient Confidence and Information Preferences During the Treatment Decision-making Process: Results From a Large Multiple Myeloma Patient Survey Across 12 Countries in Europe and Israel.

BACKGROUND: The relapsing nature of multiple myeloma (MM) means that patients typically receive different and multiple lines of therapy, requiring many treatment decisions over the disease course. The aim of this study was to explore patient confidence and information preferences during the treatment decision-making process. PATIENTS AND METHODS: A multinational, cross-sectional survey enrolled patients with MM. It was co-developed and distributed by Myeloma Patients Europe across 12 countries in Europe and Israel from May 2019 to March 2020. Eligibility criteria included a self-reported diagnosis of MM and being able to recall the decision-making process at the start of their latest treatment line. RESULTS: A total of 1559 patients were included, with complete responses received from 1081 (69%) patients. The median age range was 54 to 64 years; there was an equal gender split and 57% had their latest treatment decision made within the past year. Overall, 54% of patients felt "very confident" in the latest treatment decision. Patients deemed the most important information to be safety/tolerability and treatment effectiveness, but the latter was among the least frequently received. Most patients reported that their primary physician treating MM was their main source for all types of information (range, 62%-94%), with 87% of patients reporting a "very good" or "good" relationship with them. CONCLUSION: Over half of patients felt very confident in their latest treatment decision; however, patients reported not routinely receiving important treatment effectiveness information. Addressing the discrepancies between information that patients receive and consider important may enhance confidence in decision-making.

Advancing the recovery orientation of hospital care through staff engagement with former clients of inpatient units.

OBJECTIVES: This study was undertaken to assess the impact of consumer narratives on the recovery orientation and job satisfaction of service providers on inpatient wards that focus on the treatment of schizophrenia. It was developed to address the paucity of literature and service development tools that address advancing the recovery model of care in inpatient contexts. METHODS: A mixed-methods design was used. Six inpatient units in a large urban psychiatric facility were paired on the basis of characteristic length of stay, and one unit from each pair was assigned to the intervention. The intervention was a series of talks (N=58) to inpatient staff by 12 former patients; the talks were provided approximately biweekly between May 2011 and May 2012. Self-report measures completed by staff before and after the intervention assessed knowledge and attitudes regarding the recovery model, the delivery of recovery-oriented care at a unit level, and job satisfaction. In addition, focus groups for unit staff and individual interviews with the speakers were conducted after the speaker series had ended. RESULTS: The hypothesis that the speaker series would have an impact on the attitudes and knowledge of staff with respect to the recovery model was supported. This finding was evident from both quantitative and qualitative data. No impact was observed for recovery orientation of care at the unit level or for job satisfaction. CONCLUSIONS: Although this engagement strategy demonstrated an impact, more substantial change in inpatient practices likely requires a broader set of strategies that address skill levels and accountability.

(W)righting women: constructions of gender, sexuality and race in the psychiatric chart.

This paper examines the interpretative nature of psychiatry in relation to gender, sexuality and race within the particular time and place of one urban, Canadian, clinical psychiatric setting. We bring women's psychiatric inpatient charts and a critical feminist perspective into dialogue in an effort to focus on gender, sexuality and race in psychiatric narratives on women's madness. The research used a qualitative, retrospective research design to examine the psychiatric narrative as a technique of power as it operates on women. This paper focuses on the overarching theme of 'medicalisation', identified from the analysis of women's psychiatric inpatient charts, including two subthemes: (1) language and composition and (2) decontextualisation. Our analysis suggests that psychiatric chart documentation practices that reproduce gendered, sexualised, and racialised biases and assumptions and decontextualise the social and structural context of women's experiences of madness serve to create the paradox of women's visibility/erasure in psychiatric charts. The paper concludes with an exploration of the significance of women's authorship legitimacy in psychiatric chart documentation.