Can a chatbot increase the motivation to provide personal health information?

In healthcare settings, questionnaires are used to collect information from a patient. A standard method for this are paper-based questionnaires, but they are often complex to understand or long and frustrating to fill. To increase motivation, we developed a chatbot-based system Ana that asks questions that are normally asked using paper forms or in face-to-face encounters. Ana has been developed for the specific use case of collecting the music biography in the context of music therapy. In this paper, we compare user motivation, relevance of answers and time needed to answer the questions depending on the data entry method (i.e. app Ana versus paper-based questionnaire). A randomised trial was performed with 26 students of music therapy. The results show that the chatbot is more motivating and answers are given faster than on paper. No differences in answer relevance could be determined between the two means. We conclude that a chatbot could become an additional data entry method for collecting personal health information

Investigating the possibilities of using patient-generated health data in emergency care: an explorative study

AbstractIt is well known that emergency departments (EDs) are exposed to human errors and unintended events due to large patient flow, high work pressure and overload of information. Strategies for providing efficient and effective health care are therefore imperative, and health information technologies are suggested to be one of the solutions. This study sought to investigate if the use of patient-generated health data gathered through a digital patient questionnaire and visualised as a patient-generated journal (PGJ v.1.0) has the potential to improve the care delivered in EDs.MethodsUsing a mixed-method approach, the PGJ (v.1.0) was investigatedfrom key stakeholders’ perspectives. First, we examined the PGJ from a patient perspective via participant observation (n = 18) and interviews (n = 18), supported by statistical data from the PGJ (n = 56). Second, we used questionnaires to explore the physicians’ perspectives (n = 9). Lastly, two interviews were conducted with healthcare leaders from the ED. The data were compared and analysed using descriptive statistics and hermeneutic analysis.Results From the findings, it appears that patients in need of urgent care accept the use of patient-generated data, and patients highly favoured being active in their patient pathway. However, the system needed some adjustments to fit the patients’abilities in urgent situations.The physicians expressed mixed attitudes towards the PGJ: the majority agreed that the system needed some adjustments in order for the full benefits to be gained, but thought that it had potential to improve their work processes when fully developed.Conclusions This study concludes that the use of patient-generated data is well accepted by patients in an urgent setting, and that the PGJ has the potential to improve quality of care in patient pathways by adding value to patient flows as well as clinical workflows. The concept of utilising patient-generated health data in emergency care should therefore be further developed and investigated

Diseño de estrategias para la mejora de la atención ginecobstétrica en los hospitales del Atlántico

Gynecobstetrics departments (GDs) are in charge of diagnosing, monitoring, and treating female reproductive diseases as well as assisting women during pregnancy. Their importance motivates the creation of suitable performance evaluation approaches for identifying weaknesses and designing focused interventions. Therefore, the aim of this paper is two-fold: i) provide an approach for GD performance evaluation and ii) propose interventions tackling the GDs’ weaknesses.The implemented approached for evaluating the overall performance of DGs is a Hybrid decision making model based on FAHP, DEMATEL and TOPSIS. The Fuzzy Analytic Hierarchy Process (FAHP) was first applied to calculate the initial criteria and sub-criteria weights under vagueness. Then, the Decision-Making Trial and Evaluation Laboratory (DEMATEL) was implemented to evaluate interrelations. FAHP and DEMATEL were later combined to estimate the final criteria and sub-criteria weights under vagueness and interdependency. Finally, the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) was used to rank the GDs and detect improvement opportunities. Finally, a case study of a cluster including three GDs is presented to validate the proposed approach, in which performance comparisons were made and the weak points were identified for each GD. From a literary review, the possible causes separating these DGs from the desired performance were identified, and action plans were constructed aimed to improve the healthcare cluster performance.Los departamentos de ginecobstetricia (DG) se encargan de diagnosticar, monitorear, y tratar enfermedades reproductivas femeninas, así como de ayudar a las mujeres durante el embarazo. Su importancia motiva la creación de enfoques adecuados de evaluación del desempeño para identificar debilidades y diseñar intervenciones enfocadas a su mejora. Por lo tanto, el objetivo de este documento es doble: i) proporcionar un enfoque para la evaluación del rendimiento de los DG y ii) proponer intervenciones que afronten las debilidades de los DG. El enfoque utilizado para la evaluación del desempeño de los DG es la implementación de un modelo hibrido de decisión multicriterio basado en FAHP, DEMATEL y TOPSIS. El Proceso de Jerarquía Analítica Difusa (FAHP) se aplicó para calcular los pesos de los criterios y los subcriterios iniciales bajo vaguedad. A continuación, se implementó el Laboratorio de Ensayo y Evaluación de Toma de Decisiones (DEMATEL) para evaluar las interrelaciones. FAHP y DEMATEL se combinaron más tarde para estimar los pesos finales de los criterios y subcriterios bajo vaguedad e interdependencia. Por último, la Técnica de Orden de Preferencia por Similitud a la Solución Ideal (TOPSIS) se utilizó para clasificar los DGs y detectar oportunidades de mejora. Finalmente, se presenta un caso práctico de un clúster que incluye tres DGs para validar la aplicación propuesta, en el cual se compararon los rendimientos de cada uno y se identificaron las falencias presentes. A partir de una revisión literaria, se identificaron las posibles causas que separan a estos DGs del rendimiento deseado y se construyeron planes de acción con el objetivo de mejorar el rendimiento de los DGs del clúster

Aborder les antécédents familiaux de cancer en soins palliatifs : perspectives des intervenants, des apparentés et analyse des outils de collecte des antécédents familiaux

Cette thèse vise à documenter le point de vue des intervenants en soins palliatifs et celui des apparentés de patients décédés de cancer en soins palliatifs sur le fait d’aborder les antécédents familiaux de cancer en fin de vie. Elle vise également à recenser et à proposer une analyse critique des outils de collecte des antécédents familiaux de cancer afin de déterminer dans quelle mesure ils pourraient être utiles aux cliniciens dans la prise en charge du caractère héréditaire des cancers. Trois études ont été réalisées à cet effet. Premièrement, une enquête menée auprès de 94 intervenants en soins palliatifs a permis de confirmer la tenue en fin de vie de discussions relatives aux antécédents familiaux de cancer entre les intervenants, les patients et leurs apparentés. Les intervenants ont majoritairement jugé de telles discussions pertinentes et faisables. Les facteurs susceptibles, de leur point de vue, de faciliter ces discussions en fin de vie ont été identifiés. Ces facteurs incluent des connaissances sur les cancers héréditaires et les enjeux éthiques et légaux associés, un cadre règlementaire (lignes directrices, protocole) ainsi que de l’information sur les ressources spécialisées en oncogénétique vers qui diriger les patients et les apparentés admissibles. Deuxièmement, dans le cadre d’une étude qualitative (groupes de discussion), 13 apparentés ont partagé leurs expériences et perceptions concernant les discussions portant sur les antécédents familiaux de cancer et la réalisation du test génétique en fin de vie. Ils ont rapporté n’avoir jamais discuté de ces sujets pendant le séjour de leur proche en soins palliatifs. Ils ont exprimé leur préférence pour que les antécédents familiaux de cancer soient abordés avant l'arrivée de leur proche en soins palliatifs ou après le décès de celui-ci. Certains sont quand même restés ouverts à une brève notification, en soins palliatifs, sur le caractère héréditaire éventuel du cancer de leur proche. La grande majorité des apparentés consultés ont jugé approprié de prélever des échantillons biologiques auprès du patient en fin de vie dans le but de réaliser un test génétique. Troisièmement, une revue critique de la littérature a été conduite afin de recenser les outils développés pour la collecte des antécédents familiaux de cancer. Une évaluation de ces outils a été faite en ce qui a trait au soutien qu’ils pourraient apporter aux professionnels de la santé iii dans l'évaluation du risque de cancer et l’orientation appropriée des patients et des familles. Soixante-deux outils ont été identifiés. Ce sont en majorité des questionnaires papier, destinés à être autoadministrés par les patients ou les apparentés. Un tiers de ces outils sont électroniques. Un quart peuvent produire des pedigrees et une évaluation du risque de cancer. Un quart peuvent aussi fournir des recommandations de suivi. Un tiers ont été validés en utilisant une référence standard comme comparateur. Six outils prometteurs se sont distingués par la pluralité de leurs fonctions et leur potentiel d’efficience dans l’identification des personnes susceptibles d’être porteuses de mutations prédisposant au cancer. La prise en compte des résultats de la présente thèse pourrait conduire à l’élaboration et la mise en place de mesures destinées à répondre aux besoins et préoccupations des patients, des apparentés et des intervenants en soins palliatifs concernant le caractère héréditaire des cancers. De telles mesures pourraient ultimement favoriser une considération adéquate du caractère héréditaire des cancers au moment jugé le plus opportun dans la trajectoire de soins par les patients, les apparentés et les intervenants.This thesis aimed to explore the perception of palliative care providers and cancer patients’ relatives regarding addressing cancer family history at the end of life. The objective was also to identify the cancer family history collection tools that have been developed thus far and propose an appraisal of the extent to which they might help health care providers in cancer risk management. Three studies were conducted for this purpose. Firstly, a survey conducted among 94 palliative care providers revealed that cancer family history discussions do occur at the end of life between patients, relatives, and providers. Most palliative care providers considered such discussions relevant and feasible. Facilitating factors for these discussions were identified including knowledge of hereditary cancers, familiarity with ethical and legal related issues, availability of a regulatory framework (guidelines, protocol) as well as information about specialized genetic resources for referring patients and their families. Secondly, in a qualitative study (focus groups), 13 family members shared their experiences and perceptions regarding cancer family history discussions and genetic testing at the end of life. They reported having never discussed cancer heritability during their relative’s stay in palliative care, and related that such discussions would be more appropriate during the curative phase of the disease, or following the death of their affected relative. Some family members were open to brief talks about the hereditary aspect of their relative’s cancer in palliative care. Most surveyed family members considered appropriate to perform genetic testing in palliative care patients. Thirdly, a literature review was conducted to identify tools developed for collecting cancer family history. These tools were appraised in terms of the support that they could bring to health care providers in cancer risk assessment and the appropriate referral of patients and their families to genetics clinics. Sixty-two tools were identified. Generally, most of the tools identified are paper-based questionnaires and designed to be self-completed by patients or relatives. One-third of these tools are electronic. One-quarter can produce pedigrees, provide cancer risk assessment, and issue follow-up recommendations. One-third were validated v against a standard reference. Six multifaceted and potentially efficient tools were deemed promising to identify at-risk individuals eligible for referral to genetic testing. Taking into account the findings of this thesis may ultimately lead to appropriately addressing the needs and concerns of patients, their relatives, and palliative care providers. The strategies developed for such a purpose may foster adequate and timely consideration and management of the hereditary component of cancers during the care pathway

Identifying Relevant Evidence for Systematic Reviews and Review Updates

Systematic reviews identify, assess and synthesise the evidence available to answer complex research questions. They are essential in healthcare, where the volume of evidence in scientific research publications is vast and cannot feasibly be identified or analysed by individual clinicians or decision makers. However, the process of creating a systematic review is time consuming and expensive. The pace of scientific publication in medicine and related fields also means that evidence bases are continually changing and review conclusions can quickly become out of date. Therefore, developing methods to support the creating and updating of reviews is essential to reduce the workload required and thereby ensure that reviews remain up to date. This research aims to support systematic reviews, thus improving healthcare through natural language processing and information retrieval techniques. More specifically, this thesis aims to support the process of identifying relevant evidence for systematic reviews and review updates to reduce the workload required from researchers. This research proposes methods to improve studies ranking for systematic reviews. In addition, this thesis describes a dataset of systematic review updates in the field of medicine created using 25 Cochrane reviews. Moreover, this thesis develops an algorithm to automatically refine the Boolean query to improve the identification of relevant studies for review updates. The research demonstrates that automating the process of identifying relevant evidence can reduce the workload of conducting and updating systematic reviews