Patient-Caregiver Portal System in Palliative Oncology: Assessment of Usability and Perceived Benefit.

BACKGROUND: The engagement of family caregivers in oncology is not universal or systematic. OBJECTIVE: We implemented a process intervention (ie, patient-caregiver portal system) with an existing patient portal system to (1) allow a patient to specify their caregiver and communication preferences with that caregiver, (2) connect the caregiver to a unique caregiver-specific portal page to indicate their needs, and (3) provide an electronic notification of the dyad's responses to the care team to inform clinicians and connect the caregiver to resources as needed. METHODS: We assessed usability and satisfaction with this patient-caregiver portal system among patients with cancer receiving palliative care, their caregivers, and clinicians. RESULTS: Of 31 consented patient-caregiver dyads, 20 patients and 19 caregivers logged in. Further, 60% (n=12) of patients indicated a preference to communicate equally or together with their caregiver. Caregivers reported high emotional (n=9, 47.3%), financial (n=6, 31.6%), and physical (n=6, 31.6%) caregiving-related strain. The care team received all patient-caregiver responses electronically. Most patients (86.6%, 13/15 who completed the user experience interview) and caregivers (94%, 16/17 who completed the user experience interview) were satisfied with the system, while, of the 6 participating clinicians, 66.7% agreed "quite a bit" (n=1, 16.7%) or "very much" (n=3, 50%) that the system allowed them to provide better care. CONCLUSIONS: Our findings demonstrate system usability, including a systematic way to identify caregiver needs and share with the care team in a way that is acceptable to patients and caregivers and perceived by clinicians to benefit clinical care. Integration of a patient-caregiver portal system may be an effective approach for systematically engaging caregivers. These findings highlight the need for additional research among caregivers of patients with less advanced cancer or with different illnesses.

Developing an Integrated Caregiver Patient-Portal System.

We have developed an integrated caregiver patient-portal system (i.e., patient-caregiver portal) that (1) allows a patient to identify their primary caregiver and their communication preferences with that caregiver in the healthcare setting; (2) connects the caregiver to a unique portal page to indicate their needs; and (3) informs the healthcare team of patient and caregiver responses to aid in integrating the caregiver. The purpose of this manuscript is to report on the formative phases (Phases I and II) of system development. Phase I involved a pre-assessment to anticipate complexity or barriers in the system design and future implementation. We used the non-adaption, abandonment, scale-up, spread, and sustainability (NASSS) framework and rubric to conduct this pre-assessment. Phase II involved exploring reactions (i.e., concerns or benefits) to the system among a small sample of stakeholders (i.e., 5 palliative oncology patients and their caregivers, N = 10). The purpose of these two phases was to identify system changes prior to conducting usability testing among patient/caregiver dyads in palliative oncology (phase III). Completion of the NASSS rubric highlighted potential implementation barriers, such as the non-uniformity of caregiving, disparities in portal use, and a lack of cost-benefit (value) findings in the literature. The dyads' feedback reinforced several NASSS ratings, including the benefits of connecting caregivers and allowing for caregiver voice as well as the concerns of limited use of patient-portals by the patients (but not the caregivers) and the need for user assistance during stressful health events. One change that resulted from this analysis was ensuring that we provided research participants (users) with detailed guidance and support on how to log in and use a patient-caregiver portal. In future iterations, we will also consider allowing more than one caregiver to be included and incorporating additional strategies to enable caregivers to interact in the system as part of the care team (e.g., via email).

Palliative Care Clinicians' Perspectives of an Integrated Caregiver Patient-Portal System in Oncology.

Background: Despite recommendations and policies to integrate family caregivers into U.S. healthcare settings, caregivers are not systematically involved. Thus, we developed an Integrated Caregiver Patient-Portal system that (1) allows a patient to identify their primary caregiver and their communication preferences; (2) connects the caregiver to a unique portal page to indicate their needs; and 3) informs the care team of dyad responses to aid in integrating the caregiver. Objective: This formative research explored palliative care clinicians' perceptions of the system to inform refinements before usability testing. Methods: We conducted two focus groups with palliative care clinicians (N=11) at an NCI-designated cancer center. Transcripts were analyzed using an integrated approach to specify system benefits and concerns. Results: The most referenced benefits included: Learning information that they might not have known without the system; giving caregivers a voice or a way to express needs; and supporting an ideal model of care. Top concerns included lacking capacity to respond; needing to clarify clinician roles and expertise in responding to caregivers' needs; and ensuring ongoing system adaptability. Conclusions: The clinicians' feedback resulted in revisions including: (1) modifying the caregiver questions; (2) integrating social workers in the response; and (3) adding a text-based report to the care team. Implications for Practice: This formative research provided valuable feedback for portal development, and also contributes more broadly to recommendations related to integrating caregivers in healthcare. Foundational: This research provides practical and logistical relevance to the discussion on how to integrate caregivers into clinical care.

Development of a Disaster Nursing Competencies Assessment Instrument for Baccalaureate Nursing Education.

BACKGROUND: Nursing education must prepare graduates for disasters. The purpose of this study was to develop a list of critical disaster nursing competencies to be assessed as part of baccalaureate nursing education. METHOD: The International Council of Nurses (ICN) and World Health Organization (WHO) Framework of Disaster Nursing Competencies was used to develop an online survey. RNs with experience in disaster nursing and disaster education were asked to divide the disaster competencies into two categories-baccalaureate/entry-level or master's/doctorate-advanced practice level. The results were analyzed using one-sample binomial test. RESULTS: Sixty-five RNs completed the online survey. Fifteen (12%) of the ICN and WHO disaster competencies were categorized as more appropriate for master's/doctorate nursing education. CONCLUSION: This project has developed a list of disaster nursing competencies for use by baccalaureate nursing programs, as well as a list of competencies specific for community and public health nurse educators. [J Nurs Educ. 2019;58(4):229-233.].

Differences in Certification and the Effect on Team Climate Among Community Health Workers in Texas.

The purpose of this study was to compare team climate among Texas community health workers (CHWs)/promotoras who were certified by the 2 different methods: (a) completing a state-approved training program, and (b) providing evidence of work experience (grandfathering). Analysis of survey results found no significant differences in Team Climate Inventory scores between CHWs who were certified either through state-approved training or through work experience. This research provides some preliminary evidence in support of experience-based certification, but there continues to be a need for more research evaluating CHW certification requirements and the impact of state certification of CHWs on population health outcomes.

Assessment of public health core competencies in prelicensure baccalaureate nursing students.

OBJECTIVE: The purpose of this study was to assess the use of the Public Health Foundation's (Public Health Foundation [PHF], ) Competency Assessment for Tier 1 Public Health Professionals to examine prelicensure baccalaureate nursing students' self-reported levels of competence in public health before and after completing community health nursing courses. DESIGN: Prelicensure baccalaureate nursing students enrolled in community health nursing courses completed a pre and postcourse Competency Assessment for Tier 1 Public Health Professionals survey. The survey results were analyzed using nonparametric tests to determine whether there were significant differences in pre and postsurvey scores for the eight domains of public health core competencies, and for an overall competency score. RESULTS: Significant differences were found in the pre and postaggregate mean scores for each of the eight domains of public health core competency, and the overall mean public health competency score. Chi-square testing of pre and postcourse competency found significant difference in the proportion of students who met criteria for self-reported competence in each of the eight domains and overall public health competence. CONCLUSION: The Competency Assessment for Tier 1 Public Health Professionals can assist baccalaureate nursing faculty with assessing precourse learning needs, and postcourse evaluation of self-reported competence in public health.

The impact of state certification of community health workers on team climate among registered nurses in the United States.

A number of states have adopted certification programs for community health workers (CHWs) to improve recognition of CHWs as members of health care teams, increase oversight, and to provide sustainable funding. There has been little research into the impact of state CHW certification on the diffusion and adoption of CHWs into existing health care systems. This study examined the impact of state CHW certification on the perceptions of team climate among registered nurses (RNs) who work with CHWs in states with and without CHW certification programs. The study recruited RNs using a purposeful sampling method and used an online survey, which included the Team Climate Inventory (TCI), and compared the perceptions of team climate between the two groups. The study found no significant differences in the overall mean TCI score or TCI subscale scores between RNs who work in states with CHW certification programs (n = 81) and those who work in states without CHW certification programs (n = 115). There was a statistically significant difference on one survey question regarding whether RNs believe state certification of CHWs improved the ability of their health care team to deliver quality care. More research is needed to assess impact of state certification of CHWs and other factors that influence the diffusion and adoption of CHWs into the current health care system.

Direct-to-patient disclosure of results of mismatch repair screening for Lynch syndrome via electronic personal health record: a feasibility study.

PURPOSE: The adoption of universal mismatch repair screening of colorectal and endometrial cancers has the potential to improve detection of Lynch syndrome, as well as to improve health outcomes among cancer patients and their family members. Electronic patient health records represent an innovative, resource-efficient route of delivering results directly to patients that could be enhanced by multimedia interventions to improve critical downstream outcomes. The current study examines the feasibility and acceptability of this approach. METHODS: Patients hospitalized for resection of colorectal or endometrial cancer were recruited to receive their mismatch repair result via institutional electronic patient health record. Baseline and follow-up assessments were conducted. RESULTS: In all, 74% (49/66) of eligible patients consented, and 81% (29/36) of participants who had a result posted to their electronic patient health record completed follow-up, surpassing feasibility thresholds, with 14% (5/36) receiving an abnormal result. Ratings of the study approach surpassed the acceptability threshold--97% had a mean score of ≥ 4 on a 7-point scale--and were high, regardless of whether the results were normal or abnormal. Ineligibility was more common among non-white patients (P = 0.009) and patients ≥ 65 of age (P = 0.035) due to either low Internet use or access to the Internet. CONCLUSION: Electronic patient health record-based result disclosure for mismatch repair screening is feasible to study and is acceptable to patients, but minority and elderly patients may experience greater barriers to participation.Genet Med 16 11, 854-861.

Creating an instrument to measure people's perception of community capacity in American Indian communities.

The purpose of this study was to develop a measure of community capacity for American Indian communities. The study included development and testing phases to ensure face, content, construct, and predictive validity. There were 500 participants in two southwest tribes who completed a detailed community profile, which contained 21 common items in five dimensions (communication, sense of community, youth, elders, and language/culture). In addition, subscales of women and leadership were included in one tribe each. Confirmatory factor analysis primarily supported the factorial structure of the instruments, and the seven dimensions were found to correlate with previously validated measures of social capital, historical trauma, community influence, and physical health in expected directions.