Alcuni abstract di articoli che trattano argomenti relativi all'eHealth

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Development and implementation of an evaluation framework for breast reconstruction decision support tool for women considering breast reconstruction following mastectomy

Breast cancer survival has improved significantly, with almost ninety percent of diagnosed women being cured (Australian Institute of Health and Welfare (AIHW) & Cancer Australia, 2012). Despite no survival advantage between breast conserving surgery and mastectomy, there has been an increasing trend back to mastectomy as primary treatment; in addition to an increase in bilateral prophylactic mastectomy in the absence of a breast cancer diagnosis (with or without BRCA mutation) (Dragun et al., 2013; Elmore, Ganschow & Geller, 2010; Jones et al., 2009; Tuttle, Abbott, Arrington & Rueth, 2010). Breast reconstruction has been shown to lessen psychological morbidity and facilitate adjustment to an altered body image resulting from mastectomy (Denford, Harcourt, Rubin & Pusic, 2011; Hill & White, 2008). Few women are prepared for the complexity in considering the personal, clinical and situational factors affecting breast reconstruction decision making. Given the limited research on breast reconstruction patient education or decision making tools, this study aimed to develop a decision support tool for women considering breast reconstruction. An evaluation framework was established to guide the development of a breast reconstruction decision support tool and was implemented over three phases: 1. Phase One undertook a needs analysis to explore the breast reconstruction decision making experiences and information needs of women who had undertaken breast reconstruction. 2. Phase Two developed a breast reconstruction decision support tool through the implementation of an evaluation framework driven by key stakeholders. 3. Phase Three completed implementation of the evaluation framework by conducting summative evaluation of the decision support tool’s value using survey and interview methods. The breast reconstruction decision support tool was found to meet women’s information needs, perceived to be useful throughout a woman’s breast reconstruction experience, and considered an acceptable and useful tool to assist women making decisions about breast reconstruction. This research culminated in a nationally endorsed and accessible source of breast reconstruction information to assist Australian women with their decision making (www.canceraustralia.gov.au/ breastreconstruction)

Developing a digital intervention for cancer survivors: an evidence-, theory- and person-based approach

This paper illustrates a rigorous approach to developing digital interventions using an evidence-, theory- and person-based approach. Intervention planning included a rapid scoping review which identified cancer survivors’ needs, including barriers and facilitators to intervention success. Review evidence (N=49 papers) informed the intervention’s Guiding Principles, theory-based behavioural analysis and logic model. The intervention was optimised based on feedback on a prototype intervention through interviews (N=96) with cancer survivors and focus groups with NHS staff and cancer charity workers (N=31). Interviews with cancer survivors highlighted barriers to engagement, such as concerns about physical activity worsening fatigue. Focus groups highlighted concerns about support appointment length and how to support distressed participants. Feedback informed intervention modifications, to maximise acceptability, feasibility and likelihood of behaviour change. Our systematic method for understanding user views enabled us to anticipate and address important barriers to engagement. This methodology may be useful to others developing digital interventions

Patient-oriented Evidence-based Treatment Decision Support System (TreatQuest®) for Lung Cancer

Involving patients in healthcare decisions makes a significant and enduring difference to healthcare outcomes. One challenge for patients is the lack of evidence-based information and tools to support their decision making. Although patients have access to significant information through internet and other sources, it is not personalized for their specific situation. This dissertation attempts to help patients acquire evidence-based information relevant to their own situation, so they can make a more informed decision in co-operation with their physicians. Lung cancer has been selected as a focus for this study because lung cancer presents very complex decision making situation and is the leading cause of cancer deaths in both men and woman in every ethnic group worldwide. The prototype decision support system for lung cancer is called TreatQuest®. This system allows users to create their own profile, access cases similar to their case, and learn about treatment options. The evidences for the treatment were extracted from public data and knowledge gained from guideline. The effectiveness of patient-oriented evidence-based approach was validated by having a group of patient use the system. TreatQuest® is one of the first system developed to support patient\u27s treatment decision process, which represent the most recent trend in delivery of healthcare services. Results from this study show that such a patient-oriented decision support system provides an effective way to help patient receive more personalized information and make informed treatments. In summary, patient-oriented evidence-based decision support systems such as TreatQuest®, can improve the decision quality for patients. Also, such systems can improve health care decisions that are made with the active participation of fully informed patients. Therefore, patient-oriented evidence-based decision support systems can have significant impact on the healthcare industry

Factors that influence public engagement with eHealth: a literature review

Purpose: Public engagement with eHealth is generally viewed as beneficial. However, despite the potential benefits, public engagement with eHealth services remains variable. This article explores reasons for this variability through a review of published international literature. Methods: A focused search, conducted in January 2009, of three bibliographic databases, MEDLINE, CINAHL and EMBASE, returned 2622 unique abstracts. Results: Fifty articles met the inclusion criteria for the review. Four main types of eHealth service were identified: health information on the Internet; custom-made online health information; online support; and telehealth. Public engagement with these services appears to depend on a number of factors: characteristics of users; technological issues; characteristics of eHealth services; social aspects of use; and eHealth services in use. Conclusions: Recommendations for policy makers, developers, users and health professionals, include: targeting efforts towards those underserved by eHealth; improving access; tailoring services to meet the needs of a broader range of users; exploiting opportunities for social computing; and clarifying of the role of health professionals in endorsement, promotion and facilitation

Adding dimensions to the analysis of the quality of health information of websites returned by Google. Cluster analysis identifies patterns of websites according to their classification and the type of intervention described.

Background and aims: Most of the instruments used to assess the quality of health information on the Web (e.g. the JAMA criteria) only analyze one dimension of information quality, trustworthiness. We try to compare these characteristics with the type of treatments the website describe, whether evidence-based medicine or note, and correlate this with the established criteria. Methods: We searched Google for “migraine cure” and analyzed the first 200 websites for: 1) JAMA criteria (authorship, attribution, disclosure, currency); 2) class of websites (commercial, health portals, professional, patient groups, no-profit); and 3) type of intervention described (approved drugs, alternative medicine, food, procedures, lifestyle, drugs still at the research stage). We used hierarchical cluster analysis to assess associations between classes of websites and types of intervention described. Subgroup analysis on the first 10 websites returned was performed. Results: Google returned health portals (44%), followed by commercial websites (31%) and journalism websites (11%). The type of intervention mentioned most often was alternative medicine (55%), followed by procedures (49%), lifestyle (42%), food (41%) and approved drugs (35%). Cluster analysis indicated that health portals are more likely to describe more than one type of treatment while commercial websites most often describe only one. The average JAMA score of commercial websites was significantly lower than for health portals or journalism websites, and this was mainly due to lack of information on the authors of the text and indication of the date the information was written. Looking at the first 10 websites from Google, commercial websites are under-represented and approved drugs over-represented. Conclusions: This approach allows the appraisal of the quality of health-related information on the Internet focusing on the type of therapies/prevention methods that are shown to the patient

Help: defining the usability requirements of a breast cancer long-term survivorship (LTS) navigator

Indiana University-Purdue University Indianapolis (IUPUI)Long-term survivors (LTSs) of breast cancer are defined as patients who have been in remission for a year or longer. Even after being declared breast-cancer-free, many LTSs have questions that were not answered by clinicians. Although online resources provide some content for LTSs, none, or very little, provide immediate answers to specific questions. Thus, the aim involves proposing specifications for a system, the Health Electronic Learning Platform (HELP), that can assist survivors by becoming an all-inclusive resource for LTSs of breast cancer. To achieve this, relevant information from the literature was used to assess the needs of LTSs. Also, data from a study involving the breast cancer survivor’s forum project that had been filtered to include posts with mentions of features to be added to the website and usability issues encountered. To complete the actual design of the system, a synthesis of the results obtained from these two sources was performed. HELP is simple in terms of its layout and consists of a main search-bar, where LTSs are able to ask questions using their own terms and language. This navigator should not be taken as definitive solution, but instead, should be used as a starting point toward better patient-centered care

Focal Spot, Spring 2006

https://digitalcommons.wustl.edu/focal_spot_archives/1102/thumbnail.jp

Understanding Patient Pathways in the Context of Integrated Health Care Services - Implications from a Scoping Review

Healthcare systems in western countries are continuously working to achieve efficient resource allocation and to improve access to quality medical care. The implementation of standardised care processes promises better integration and coordination of care across several healthcare providers. In this context, an increasing use of the term patient pathway is recognised within official documents provided by health authorities and within scientific publications in recent years. However, a common understanding, distinguishing the term from other pathway approaches such as care- or clinical pathways, is missing. By means of a scoping review we analysed 132 publications in order to clarify key concepts and the understanding of patient pathways. Six common themes in the literature were identified and results show that individualisatio nand care continuity are essential descriptive characteristics. Using this motivation, we discuss the main implications for research and practice by the example of comprehensive cancer care in the European Union