Respuesta de los autores: Necesidad de un enfoque holístico y cuantitativo para el diagnóstico y mejora de los servicios de urgencia hospitalarios / Reply: Need for a holistic and quantitative approach for diagnosing and improving hospital emergency services

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Barreras y facilitadores para la implementación de la toma de decisiones compartidas en oncología: percepciones de los pacientes / Barriers and facilitators to implementing shared decision-making in oncology: patient perceptions

Objetivo. Conocer, desde el punto de vista del paciente oncológico, quién tomó la decisión sobre su tratamiento, así como las principales barreras y facilitadores que permiten la implementación de la toma de decisiones compartidas (TDC). Material y métodos. Estudio transversal y de asociación a partir de un cuestionario autoadministrado a pacientes oncológicos seleccionados mediante muestreo casual en diferentes consultas oncológicas y periodos aleatorios. Ciento ocho pacientes proporcionaron datos analizables. La información recogida fue sobre variables sociodemográficas y clínicas, sobre quién tomó la decisión sobre el tratamiento y el grado de acuerdo o desacuerdo con diferentes barreras y facilitadores. Resultados. El 38,1% de los pacientes afirmó haber tomado la decisión de manera compartida con su médico. Barreras como el tiempo, la dificultad de comprensión, el paternalismo, la falta de comunicación fluida y el disponer de información previa y frecuentemente errónea influyeron en la implicación en la toma de decisiones. Sin embargo, disponer o no de instrumentos suficientes de ayuda a la decisión o el interés del paciente por participar no influyeron. En lo referente a los facilitadores, la motivación del médico, su percepción de mejora y el interés del enfermo tuvieron una influencia positiva. La excepción la constituyó la posibilidad de incentivar económicamente a los médicos. Conclusiones. La nula o escasa participación percibida por los pacientes oncológicos en las decisiones sobre su salud hace necesario introducir mejoras en el modelo de atención sanitaria que permitan superar barreras y promover una actitud más participativa en el paciente (AU)

Objective. To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented. Material and methods. A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators. Results. More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors. Conclusions. The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient (AU)

[Shared decision making from the perspective of the cancer patient: participatory roles and evaluation of the process]. / La toma de decisiones compartidas desde la perspectiva del paciente oncológico: roles de participación y valoración del proceso.

BACKGROUND: In Spain there is no clear knowledge about the degree to which Shared Decision Making (SDM) is carried out in the normal practice of oncology. Our article analyses the preferred role and the perceived role of oncological patients and measures the SDM process from their perspective. MATERIAL AND METHODS: Descriptive transversal study using a self-conducted questionnaire with patients with different types of cancer. To evaluate the role preferred and perceived by the patient we used The Control Preference Scales (CPS) and to measure SDM we used The nine-item Shared Decision Making Questionnaire (SDM-Q-9). RESULTS: Out of the 132 patients surveyed, only 118 provided analysable data. No evidence was found that sex, age, educational level or type of tumour affected the preferred role or the perceived role. Only 59.3% was in agreement with the role exercised. All of those who preferred a passive role achieved this (21.2%), while out of those who wanted a shared role (78.8%), this was achieved by only 48.39% while the remaining 51.61% played a passive role. None preferred or played an active role. The set of patients evaluated the SDM process with a score of 41.07±5.94, on a scale of 0 to 100, with the highest score of 61.39 ± 13.24 reached by urological patients. CONCLUSIONS: Our study found no evidence that, from the point of view of the oncological patient, the SDM model is being implemented in practice.

[Proposing a physiological model for Emergency Department. Operating principles, classification of overcrowding and guidelines for redesign]. / Una propuesta de modelo fisiológico de servicio de urgencias hospitalario. Principios de funcionamiento, tipificación de la saturación y pautas para el rediseño.

The operation of Emergency Departments (ED) is determined by demand, their own organizational structures and the connection to other medical care levels. When these elements are not simultaneous, it hinders patient flow and decreases capacity, making it necessary to employ a systemic approach to the chain of emergency care as a single operational entity. With this theoretical orientation, we suggest a conceptual model similar to the physiological cardiac output, in which the preload is the demand, the contractile or flow pump is the organizational structure, the afterload is the hospital, the pre-ED valve is primary care and outpatient emergencies, and the post-ED valve is the diagnostic support services and the specialist consultants. Based on this theoretical approach we classify the different types of ED overcrowding and systematise its causes and the different waiting lists that it generates, which can help to redesign the service and avoid its saturation.

Una propuesta de modelo fisiológico de servicio de urgencias hospitalario. Principios de funcionamiento, tipificación de la saturación y pautas para el rediseño / Proposing a physiological model for Emergency Department. Operating principles, classification of overcrowding and guidelines for redesign

El funcionamiento de los servicios de urgencias hospitalarios (SUH) está determinado por la demanda, la estructura organizativa propia y la conexión con los otros niveles asistenciales. La asincronía entre estos elementos dificulta el flujo de pacientes y merma la capacidad, siendo necesario emplear un enfoque sistémico de la cadena asistencial urgente como una entidad funcional única. Con esta orientación presentamos un modelo teórico conceptual, similar al fisiológico del gasto cardíaco, en el que la precarga es la demanda, la bomba contráctil o de flujo la organización interna propia, la poscarga el hospital, la válvula pre-SUH la asistencia primaria y las urgencias extrahospitalarias, y la válvula pos-SUH los servicios de apoyo al diagnóstico y los especialistas consultores. A partir de dicha concepción se clasifican los distintos tipos de saturación del SUH, se sistematizan sus causas y las diferentes colas de espera que generan, lo cual puede ayudar al rediseño del servicio y a prevenir su saturación y colapso (AU)

The operation of Emergency Departments (ED) is determined by demand, their own organizational structures and the connection to other medical care levels. When these elements are not simultaneous, it hinders patient flow and decreases capacity, making it necessary to employ a systemic approach to the chain of emergency care as a single operational entity. With this theoretical orientation, we suggest a conceptual model similar to the physiological cardiac output, in which the preload is the demand, the contractile or flow pump is the organizational structure, the afterload is the hospital, the pre-ED valve is primary care and outpatient emergencies, and the post-ED valve is the diagnostic support services and the specialist consultants. Based on this theoretical approach we classify the different types of ED overcrowding and systematize its causes and the different waiting lists that it generates, which can help to redesign the service and avoid its saturation (AU)

La toma de decisiones compartidas desde la perspectiva del paciente oncológico: roles de participación y valoración del proceso / Shared decision making from the perspective of the cancer patient: participatory roles and evaluation of the process

Fundamento: En España no existe un claro conocimiento sobre el grado en que la Toma de Decisiones Compartidas (TDC) es llevada a la práctica habitual en oncología. Nuestro trabajo analiza el rol preferido y el rol percibido de los pacientes oncológicos y mide el proceso de TDC desde su perspectiva. Material y métodos: Estudio descriptivo transversal mediante cuestionario autoadministrado a pacientes con distintos tipos de cáncer. Para evaluar el rol preferido y percibido por el paciente utilizamos The Control Preference Scales (CPS) y para medir la TDC se utilizó The nine-item Shared Decision Making Questionnaire (SDM-Q-9). Resultados: De los 132 pacientes encuestados, solo 118 proporcionaron datos analizables. No se encontraron evidencias de que el sexo, edad, nivel educativo o tipo de tumor afectaran al rol preferido o al percibido. Solo el 59,3% estaba de acuerdo con el rol ejercido. Todos los que preferían un rol pasivo lo alcanzaban (21,2%), mientras que de los que deseaban uno compartido (78,8%), solo el 48,39% lo lograba y el 51,61% restante desempeñaba uno pasivo. Ninguno prefirió ni ejerció un rol activo. El conjunto de pacientes valoró el proceso de TDC con una puntuación de 41,07±5,94, en una escala de 0 a 100, alcanzando los pacientes urológicos una puntuación máxima de 61,39 ± 13,24. Conclusiones: Nuestro estudio no encuentra evidencias de que, desde el punto de vista del paciente oncológico, el modelo de TDC esté implementado en la práctica (AU)

Background: In Spain there is no clear knowledge about the degree to which Shared Decision Making (SDM) is carried out in the normal practice of oncology. Our article analyses the preferred role and the perceived role of oncological patients and measures the SDM process from their perspective. Material and methods: Descriptive transversal study using a self-conducted questionnaire with patients with different types of cancer. To evaluate the role preferred and perceived by the patient we used The Control Preference Scales (CPS) and to measure SDM we used The nine-item Shared Decision Making Questionnaire (SDM-Q-9). Results: Out of the 132 patients surveyed, only 118 provided analysable data. No evidence was found that sex, age, educational level or type of tumour affected the preferred role or the perceived role. Only 59.3% was in agreement with the role exercised. All of those who preferred a passive role achieved this (21.2%), while out of those who wanted a shared role (78.8%), this was achieved by only 48.39% while the remaining 51.61% played a passive role. None preferred or played an active role. The set of patients evaluated the SDM process with a score of 41.07±5.94, on a scale of 0 to 100, with the highest score of 61.39 ± 13.24 reached by urological patients. Conclusions: Our study found no evidence that, from the point of view of the oncological patient, the SDM model is being implemented in practice (AU)

[Barriers and facilitators to implementing shared decision-making in oncology: Patient perceptions]. / Barreras y facilitadores para la implementación de la toma de decisiones compartidas en oncología: percepciones de los pacientes.

OBJECTIVE: To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented. MATERIAL AND METHODS: A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators. RESULTS: More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors. CONCLUSIONS: The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient.

Análisis comparativo de los sellos de calidad de páginas web sanitarias / Comparative analysis of quality labels of health websites

Introducción. La búsqueda de información sanitaria en Internet es un fenómeno creciente, siendo su principal inconveniente el desconocimiento de la fiabilidad de las páginas consultadas. El objetivo de nuestro trabajo fue analizar y comparar los principales sellos vigentes de calidad de páginas web sanitarias. Material y métodos. Se realizó un estudio observacional transversal mediante una búsqueda en Medline, IBECS, Google y Yahoo realizado los días 8 y 9 de marzo de 2015 tanto en inglés como español. Se utilizaron diferentes palabras clave en función de si la búsqueda se realizaba en bases de datos médicas o en buscadores genéricos. Los sellos se clasificaron en función de su origen, analizando su carácter, año de implantación, existencia de proceso de acreditación, número de categorías, criterios y estándares, posibilidad de autoevaluación, número de niveles de certificación, ámbito de certificación, vigencia, análisis de la calidad de contenidos, cuota, resultados del proceso de acreditación o solicitud, número de webs con sello concedido y sellos obtenidos por el organismo acreditador. Resultados. Se analizaron siete sellos, cinco de origen nacional (WMA, PAWS, WIS, SEAFORMEC y M21) y dos internacional (HONcode y Health Web Site Accreditation). Existía disparidad en la forma de llevar a cabo el proceso de acreditación, llegando algunos a no detallar aspectos fundamentales de dicho proceso o proporcionar información incompleta, desactualizada e incluso inexacta. Los más rigurosos garantizaban el nivel de confianza que las páginas web poseían en relación con los contenidos de información, pero ninguno revisaba la calidad de los mismos. Conclusiones. Aunque los sellos de calidad rigurosos pueden llegar a ser útiles, las deficiencias detectadas en algunos de ellos pueden hacer dudar de su finalidad (AU)

Background. The search for health related information on the Internet is a growing phenomenon, buts its main drawback is the lack of reliability of information consulted. The aim of this study was to analyse and compare existing quality labels of health websites. Material and methods. A cross-sectional study was performed by searching Medline, IBECS, Google, and Yahoo, in both English and Spanish, between 8 and 9 March, 2015. Different keywords were used depending on whether the search was conducted in medical databases or generic search engines. The quality labels were classified according to their origin, analysing their character, year of implementation, the existence of the accreditation process, number of categories, criteria and standards, possibility of self-assessment, number of levels of certification, certification scope, validity, analytical quality of content, fee, results of the accreditation process, application and number of websites granted the seal, and quality labels obtained by the accrediting organisation. Results. Seven quality labels, five of Spanish origin (WMA, PAWS, WIS, SEAFORMEC and M21) and two international ones (HONcode and Health Web Site Accreditation), were analysed. There was disparity in carrying out the accreditation process, with some not detailing key aspects of the process, or providing incomplete, outdated, or even inaccurate information. The most rigorous guaranteed the level of confidence that the websites had in relation to the content of information, but none checked the quality of them. Conclusions. Although rigorous quality labels may become useful, the deficiencies in some of them cast doubt on their current usefulness (AU)

[Comparative analysis of quality labels of health websites]. / Análisis comparativo de los sellos de calidad de páginas web sanitarias.

BACKGROUND: The search for health related information on the Internet is a growing phenomenon, buts its main drawback is the lack of reliability of information consulted. The aim of this study was to analyse and compare existing quality labels of health websites. MATERIAL AND METHODS: A cross-sectional study was performed by searching Medline, IBECS, Google, and Yahoo, in both English and Spanish, between 8 and 9 March, 2015. Different keywords were used depending on whether the search was conducted in medical databases or generic search engines. The quality labels were classified according to their origin, analysing their character, year of implementation, the existence of the accreditation process, number of categories, criteria and standards, possibility of self-assessment, number of levels of certification, certification scope, validity, analytical quality of content, fee, results of the accreditation process, application and number of websites granted the seal, and quality labels obtained by the accrediting organisation. RESULTS: Seven quality labels, five of Spanish origin (WMA, PAWS, WIS, SEAFORMEC and M21) and two international ones (HONcode and Health Web Site Accreditation), were analysed. There was disparity in carrying out the accreditation process, with some not detailing key aspects of the process, or providing incomplete, outdated, or even inaccurate information. The most rigorous guaranteed the level of confidence that the websites had in relation to the content of information, but none checked the quality of them. CONCLUSIONS: Although rigorous quality labels may become useful, the deficiencies in some of them cast doubt on their current usefulness.