Decision aids for promoting shared decision-making: A review of systematic reviews.

In the context of shared decision-making (SDM), experts have advocated the use of validated decision aids (DAs) as valuable tools for facilitating SDM in various healthcare scenarios. This comprehensive review attempts to analyze a vast corpus of DA research by performing thorough searches across four prominent databases (PubMed, CINAHL, Embase, and Web of Science). Independent reviewers selected relevant reviews, extracted data, and assessed review quality using the AMSTAR II tool. A total of 34 systematic reviews were identified and evaluated in this review, encompassing a wide range of outcomes associated with using DAs. These outcomes include patient knowledge, patient involvement in SDM, decision conflict, decision regret, satisfaction, and adherence. In addition, DAs positively affect healthcare provider outcomes by increasing satisfaction, reducing decision conflicts, and lengthening clinical consultations. This review highlights the need for additional research in specific contexts such as long-term care, mental health, and reproductive health to better understand the benefits and challenges of implementing DAs in these settings. Such research can contribute to the improvement of SDM practices and patient-centered care.

Long-Term Effects of a COMPASS Program on the Caregiving Journey: 1-Year Follow-Up in a Randomized Controlled Trial.

INTRODUCTION: The number of older adults requiring long-term care (LTC) is increasing rapidly worldwide. The primary family caregivers of LTC recipients experience ongoing burdens and various challenges in their caregiving that adversely affect their own health and also the quality of caring that they provide to their loved ones. As a country becoming a super-aged society, South Korea has been making considerable efforts to improve the long-term effects on caregivers by providing them with support intervention programs. METHODS: This study was designed to assess the long-term effects of a COMPASS program at a national level. The short-term and long-term benefits were compared for the full COMPASS program (comprising 6 individual visits, 3 group-support sessions, and 2 telephone calls) provided to 203 caregivers, as were the long-term benefits between the full COMPASS program and its short form (comprising 3 individual visits and 1 group-support session) provided to 213 caregivers. The effects of the program on the family caregivers were evaluated by measuring their levels of social support received, self-efficacy, depression, burden, and risk to health. RESULTS: The long-term effects of the COMPASS program were greater than those of its short-term effects in reducing depression and risk to health (p = 0.013 and p = 0.002, respectively), whereas there were no significant differences between the short-term and long-term effects of the full COMPASS program on social support, self-efficacy, or burden. Comparing the long-term effects between the two forms of the COMPASS program revealed that the depression of caregivers was improved more by the full program than by the short form (p = 0.022), while there were no significant differences for social support, self-efficacy, burden, or risk to health. CONCLUSION: This study supports providing COMPASS programs to obtain long-term benefits for family caregivers of LTC recipients. Potential approaches that could optimize the long-term benefits of the COMPASS program include supporting caregivers to participate in arts-related hobbies and maintaining follow-up telephone calls after program completion.

Factors Influencing Training Transfer Among Infection Control Professionals Participating in Infectious Disease Training.

INTRODUCTION: Infectious disease training is considered vital in health care systems to improve knowledge, skills, and work performance of infection control professionals. However, the extent to which trainees effectively transfer knowledge, skills, and attitudes that they acquire through training has received little attention. This study aimed to identify factors influencing training transfer of infection control professionals receiving infectious disease training. METHODS: This cross-sectional study selected infection control professionals who completed an infectious disease training program provided by Korea Human Resources Development Institute for Health and Welfare. A self-reported questionnaire was used to collect data on sociodemographic variables, trainee characteristics, training design, work environment, and training transfer. Data analysis was conducted using SPSS (version 26.0). RESULTS: The mean age of the 139 participants was 41.45 years, and 77% were female participants. Regression analysis indicated that the following factors significantly influenced the training transfer of infection control professionals and thereby decrease morbidity and mortality: for trainee characteristics, transfer experience (ß = 0.205, P = 0.012) and motivation to learn (ß = 0.196, P =0.016); for training design, learning objectives (ß = 0.269, P = 0.021), goals (ß = 0.356, P =0.023), and methods (ß = 0.365, P = 0.020); and for the work environment, supervisor support (ß = 0.275, P =0.024) and colleague support (ß = 0.474, P = 0.022). CONCLUSION: Future training programs for improving training transfer should focus more on strategies to improve the motivation for training transfer. Trainees should be guided on (1) how to apply training knowledge in specific clinical contexts to improve their performance and (2) potential methods to get support from their supervisors and colleagues during training.

eHealth interventions for the informal caregivers of people with dementia: A systematic review of systematic reviews.

OBJECTIVES: To systematically synthesize existing evidence on the implementation and effectiveness of eHealth interventions for the informal caregivers of people with dementia. METHODS: A systematic review of systematic reviews was conducted following the Cochrane methodological recommendations. Data were searched from MEDLINE/Ovid, Embase, CINAHL, Web of Science, Cochrane Library, and PsycInfo. Methodological quality was appraised independently using the AMSTAR 2. RESULTS: Nineteen reviews were included. The methodological quality of reviews varied from high to critically low. The eHealth interventions provided multiple components covering informative, psychoeducation, communication, psychotherapeutic, and psychosocial support. Interventions were delivered via the Internet, telephones, and combined technologies. The evidence varied, but was generally positive regarding depression, anxiety, caregiver burden, stress, self-efficacy, knowledge, and skill improvements. No evidence was found on the coping competence of caregivers. CONCLUSIONS: eHealth interventions are widely applied and benefit informal caregivers, but still lacking high methodological quality. More rigorous research is necessary to produce robust evidence for this changing field.

Listening to patients' voices: Applying the design-thinking method for teaching person-centered care to nursing students.

BACKGROUND: Providing a person-centered care (PCC) education program to nursing students is necessary. This study aims to determine the impact of a design-thinking based education program on how nursing students perceive PCC. METHODS: Five 2-h lessons were offered to 105 fourth-year nursing students in South Korea. Each randomly assigned group of eight or nine students was instructed to develop a plan to address the problems/dissatisfaction experienced by patients during hospitalization. The Individualized Care Scale-nurse's version was used to measure student's perception of PCC before and after the education program. RESULTS: After the program the students exhibited significant improvements in how they viewed supporting patient individuality, with that score increasing by 0.44 (from 3.64 to 4.08; p < 0.0001), and maintaining patient individuality while providing care, with that score increasing by 0.34 (from 3.71 to 4.05; p < 0.0001). Among subdomains, the most notable change was in how the students viewed the personal life situation of patients, and its impact on patients' healthcare outcomes. CONCLUSION: This education program, based on the design-thinking approach, was effective in improving the perceptions of nursing students about PCC. Expanding such PCC education programs for nursing school students should therefore be considered.

ICT-based person-centered community care platform (IPC3P) to enhance shared decision-making for integrated health and social care services.

BACKGROUND: Community care is a care model with the aim of shifting care services from being hospital based toward community-based care. Advances in platforms based on information and communications technology (ICT) with a person-centered approach provide the potential to improve the delivery of health and social care services toward community-based settings. OBJECTIVES: The aims of this study were to describe the ICT-Based Person-Centered Community Care Platform (IPC3P) and to determine its impact on health- and social-care-related shared decision-making and quality of life among community residents. METHODS: An online platform was developed with the aim of enhancing community care. The platform had four components: (1) comprehensive health and social needs assessment system, (2) personalized community care planning, (3) needs-based health and social care services delivery, and (4) health community engagement. Community residents were invited to use and evaluate the impact of the IPC3P on their quality of life and shared decision-making regarding health and social care services. They provided feedback about the platform by completing two surveys: at baseline (before using the platform) and 6 months after using the platform. RESULTS: Data of 164 community residents were analyzed in this study. Between baseline and after using the platform, the quality of life reported by the participants increased significantly in all domains, with clear improvements also noted for shared decision-making about health and social care services. The IPC3P received positive feedback from the participants for its usability, familiarity, and ease of use. Some participants also reported their desire for the addition of more functions that support health communities. CONCLUSION: The IPC3P has the potential to enhance the involvement of community residents in their own care. The findings of this study can be used to support the wider implementation of the IPC3P to promote person-centered community care.

"Walking in the patient's shoes": An innovative training method using storytelling to promote knowledge transfer of patient-centered care in hospital: A quasi-experimental study.

OBJECTIVE: To evaluate an onsite patient-centered care (PCC) training program for nurses using a digital patient-storytelling approach. BACKGROUND: PCC is a dominant model for improving the quality of care. Effective strategies for providing PCC training to nurses can yield numerous benefits. DESIGN: A pretest-posttest design was used with a nonrandomized control group METHODS: PCC training program involved participants playing a patient role to experience their hospital journey. Nurses' perception of PCC, compassion and knowledge transfer were measured before (pretest) and after (posttest) PCC training (experimental group). Controls received PCC training only after pretest and posttest evaluations. RESULTS: Changes in PCC perception and compassion were significantly greater in the experimental group (n = 39) than in controls (n = 49; p = .001 and .006, respectively). PCC knowledge transfer was significantly correlated with PCC perception (r = 0.55) and compassion (r = 0.63). CONCLUSIONS: Through the PCC training program, the perceived improvements of the nurses' views on supporting patient individuality and compassion while providing care were revealed. This program is also potential for promoting PCC knowledge transfer into the daily activities of nurses. Therefore, such PCC training programs could be a good beginning in developing a patient-centered culture in healthcare systems.

A predictive model of the perceptions of patient-centered care among nurses in long-term care hospitals: A cross-sectional study.

This study aimed to propose and examine a predictive model of the impacts of organizational and individual factors on the perceptions of patient-centered care (PCC) among nurses working in long-term care hospitals. A cross-sectional study was conducted at six hospitals in South Korea. Data collected from 187 nurses were analyzed using structural equation modeling. Findings showed that the model explained the impacts of the factors on how nurses perceive PCC, it explaining 47% of the variation in PCC. Organizational factors had stronger influences on PCC [innovative organizational culture (ß = 0.34), teamwork (ß = 0.30)] compared to individual factors [compassion (ß = 0.15), self-leadership (ß = 0.07)]. The hypothesized model has potential for determining the factors that influence the perceptions of PCC among nurses working in long-term care hospitals. Further strategies should focus on organizational factors in strategies for improving long-term care nurses' perceptions of PCC.

Implementing Patient and Family Involvement Interventions for Promoting Patient Safety: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aims of the study were to evaluate and to quantify the effects of patient and family involvement (PFI) interventions on patient safety by synthesizing the available global data. METHODS: Four databases were searched to identify relevant studies that have assessed the impact of PFI on patient safety up to March 2019. Reference lists of potential selected articles were also used to identify additional relevant studies. Effect sizes (ESs) were calculated using random and fixed effects models. Statistical heterogeneity was measured using the I2 test. RESULTS: Twenty-two studies met the review criteria. The meta-analysis showed that PFI were beneficial in significantly reducing adverse events (ES = -0.240, P < 0.001), decreasing the length of hospital stay (ES = -0.122, P < 0.001), increasing patient safety experiences (ES = 0.630, P = 0.007), and improving patient satisfaction (ES = 0.268, P = 0.004). However, the PFI interventions did not significantly enhance the perception of patient safety (ES = 0.205, P = 0.09) or the quality of life (ES = 0.057, P = 0.61). Moreover, moderate-to-high heterogeneity was found for all impacts except adverse events (I2 = 0%) and length of hospital stay (I2 = 35%). A funnel plot indicated a low degree of publication bias for the adverse event outcome. CONCLUSIONS: The synthesized evidence in this review demonstrates the benefits of PFI for promoting patient safety. However, further studies should extend the research scope to fill the existing gaps for both the type of PFI interventions and the patient safety outcomes.

Randomized Controlled Trial of the Caregiver Orientation for Mobilizing Personal Assets and Strengths for Self-Care (COMPASS) for Caregiving Journey: A National Family Caregiver Support Program in a Long-Term Care Insurance System.

OBJECTIVES: To investigate the effects of a national support program on family caregivers for long-term care (LTC) recipients. DESIGN: A single-blinded randomized controlled trial compared the 8-week Caregiver Orientation for Mobilizing Personal Assets and Strengths for Self-Care (COMPASS) program consisting of 6 individual in-home, 3 group support, and 2 telephone sessions with a multicomponent intervention, and a control group. SETTING AND PARTICIPANTS: In total, 969 caregivers who were living with LTC recipients assessed as having a high caregiving burden in 12 Korean cities. MEASURES: The primary outcomes were depression, burden, and stress levels of caregivers, the secondary outcomes were caregiver self-efficacy, positive aspects of caregiving, social support, social activities, and health risk behaviors. These outcomes were measured at baseline and after the 8-week program, analyzed using modified intention-to-treat, per-protocol (PP), and non-PP analyses. RESULTS: The modified intention-to-treat analysis revealed significant improvements in burden (effect size, = 0.010, P = .008), depression (ηp2 = 0.012, P = .003), and health risk behaviors (ηp2 = 0.010, P = .012) for the experimental group compared with the control group. However, there were no significant differences between the 2 groups in improving stress (P = .997), social support (P = .234), or social activities (P = .816). The PP analysis indicated that the COMPASS program was successful in increasing positive aspects of caregiving (ηp2 = 0.013, P = .004) and self-efficacy (ηp2 = 0.010, P = .032) compared with the control group. CONCLUSIONS AND IMPLICATIONS: The COMPASS program was effective in family caregivers of LTC recipients in critical aspects of physical and psychological outcomes, especially in demonstrating the important role of participating in group support sessions. It is feasible for the program to become a formal national support program as part of the national insurance system in Republic of Korea.

Patient and family engagement as a potential approach for improving patient safety: A systematic review.

AIMS: To obtain a comprehensive insight of the impact of patient and family engagement on patient safety and identify issues in implementing this approach. BACKGROUND: Patient and family engagement is increasingly emerging as a potential approach for improving patient safety. DESIGN: Mixed method multilevel synthesis. DATA SOURCES: PubMed, CINAHL, Embase, and Cochrance Library (January 2009-April 2018). REVIEW METHODS: The review was conducted according to the principles recommended by the Cochrane Handbook for Systematic Review and in accordance with the PRISMA guidelines. RESULTS: Forty-two relevant studies were identified. Common intervention groups included 'direct care' and 'organization' levels with 'consultation' and 'involvement' approaches, while the 'health system' level and 'partnership and shared leadership' approaches were rarely implemented. Findings revealed positive effects of the interventions on patient safety. Most study participants expressed their willingness to engage in or support patient and family engagement. However, existing gaps and barriers in implementing patient and family engagement were identified. CONCLUSION: Future research should further focus on issuing consensus guidelines for implementing patient and family engagement in patient safety, extending the research scope for all aspects of patient and family engagement and patient safety and identifying priority areas for action that is suitable for each health facility. IMPACT: Policymakers should issue guidelines for implementing patient and family engagement in healthcare systems which would enable healthcare providers to implement patient and family engagement and improve patient safety appropriately and effectively.

Patient- and family-centered care interventions for improving the quality of health care: A review of systematic reviews.

BACKGROUND: Patient- and family-centered care interventions are increasingly being implemented in various settings for improving the quality of health care. However, the huge amounts of information coming from both primary studies and reviews on patient- and family-centered care interventions have made it difficult to identify and use the available evidence effectively. OBJECTIVES: This review aimed to synthesize and evaluate the evidence from published systematic reviews on the effects of patient- and family-centered care interventions. It also aimed to assess the quality of the systematic reviews in order to formulate recommendations for improving the quality of future systematic reviews. DESIGN: Review of systematic reviews. DATA SOURCES: Six databases were searched for relevant published reviews that assessed patient- and family-centered care interventions and were reported on in English in peer-reviewed journals up to September 18, 2017. The reference lists of all selected publications were also used to identify additional eligible studies. REVIEW METHODS: Reviewers independently selected reviews, extracted data, and assessed the methodological quality of the included reviews using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) checklist. These results were presented and discussed among researchers to resolve disagreements and reach a consensus. A narrative approach was adopted to pool the constituent elements of interventions. The review protocol was registered with PROSPERO (registration number CRD42017080427). RESULTS: Twenty-eight reviews published between 2011 and 2017 met the inclusion criteria. The interventions targeted the patients, their family members, and the health-care. The interventions involved the following core outcomes: Regarding patients, they were improving knowledge about their health, increasing skills to manage self-care behaviors, enhancing satisfaction, increasing quality of life, and reducing admissions, readmissions, and length of the hospital stay. Regarding family members, they were reducing the intensity of stress, anxiety, depression, and increasing the satisfaction and relationship with health-care providers. Regarding health-care providers, the interventions could improve job satisfaction and confidence, quality of care, and reduce stress and burnout. The overall methodological quality of the 28 reviews was moderate, with a mean AMSTAR score of 6.79 (SD 1.45). CONCLUSION: This review has provided evidence for the effects of patient- and family-centered care interventions applied to diverse patients, family members, and health-care providers. The evidence indicates that patient- and family-centered care could be a critical approach for improving the quality of health care. Additionally, the quality of future reviews needs to be improved in order to produce reliable evidence in the current era of evidence-based practice.