Health information seeking in the information society

This article discusses an empirical research study exploring Health Information Seeking Behaviours (HISB) of the general public, conducted by Abir Mukherjee for his MSc dissertation in the Library and Information Sciences programme at City University London. The project was carried out in summer 2011 with the general aim of addressing three core research questions to better understand the information seeking and access process this context: 1: What are the reasons that people seek health information? 2: What are the means or resources that people use to find health information? 3: What are the strategies and difficulties for the information seeker? Other concepts examined include the correlation with variables such as age and gender and public perceptions of the terminology used; the internet and impact of social media; proportions of popular reasons behind health searches; the top-ranking search tools employed; and the influence of the information society. Further information, and copies of the full dissertation, may be obtained from Abir Mukherjee or David Bawden

O R I G I N A L P A P E R Cross-national diagnostic analysis of patient empowerment in England and Greece

Abstract Background: Different NHS patient empowerment policies have been adopted in England and Greece; the voluntary sector development and its influence also differ. Although various aspects of patient empowerment have been explored in England, the patient empowerment systems' application is under-researched. In Greece, the few relevant attempts looking at patients' experiences focus on patient satisfaction, with only one study exploring the public hospitals managers' perspectives on user involvement. However, patient empowerment questions may be similar in both countries. Aims and Objectives:The study aimed to explore and compare the general patient empowerment settings in the two countries, with main objectives to: a. identify and explore the relationships of national voluntary and governmental organisations, b. explore the cross-national challenges and facilitators, and make cross-national recommendations. Methodology:This is a cross-national comparative research study. A 'diagnostic analysis' approach, an assessment of potential and actual barriers and facilitators, including the context and potential change, was chosen. The methods used were:-a. a network analysis of national voluntary and governmental organisations; b. semi-structured interviews with key representatives of these, and c. documentary analysis. Results: The network analysis revealed the potential of English organisations to influence more people, with extensive memberships and stronger interrelationship between them than the Greek organisations. Different levels of awareness, knowledge and perceptions of application of the national patient empowerment policies, systems and mechanisms were identified; being generally good in England, limited in Greece. Variable general information provision, with good verbal information in England, and limited, written and verbal, information in Greece was also identified. Although the commonest cross-national perceived challenges were organisational, the Greek culture, professional systems and attitudes were also challenges in Greece. National relevant policies and professional attitudes in England, and integrated working in Greece were perceived facilitators. Changes in professional attitudes and cultures, information awareness / provision, and national drivers were common crossnational facilitators. Greek participants called for better function of patient empowerment systems within hospitals; while hearing the patients 'voice' and non-tokenism were highlighted in England. Conclusions: Notwithstanding its limitations, this analysis identified factors and complexities likely to influence patient empowerment change. The influence of the voluntary sector and well-developed policies in England was evident, while in Greece there was lack of knowledge and awareness. Nonetheless, it seems that the need for better non-tokenistic systems is cross-national

An evaluation of advanced access in general practice

Aims: To evaluate ‘Advanced Access’ in general practice, and assess its impact on patients, practice organisation, activity, and staff.Objectives: To describe the range of strategies that general practices have employed to improve access to care To determine the impact of Advanced Access on the wait for an appointment, continuity of care, practice workload, and demand on other NHS services. To explore the perceptions of different groups of patients, including both users and non-users of services, about the accessibility of care and their satisfaction with access to care in relation to different models of organisation. To explore the trade-offs that patients make between speed of access, continuity of care and other factors when making an appointment in general practice. To explore the perceptions of general practitioners and receptionists about working with the NPDT and implementing changes to practice arrangements to improve access. To assess the impact of the above changes in practice organisation on staff job satisfaction and team climate.Method and results: This research was based on a comparison of 48 general practices, half of which operated Advanced Access appointment systems and half of which did not (designated ‘control’ practices). These practices were recruited from 12 representative Primary Care Trusts (PCTs). From within these 48 practices, eight (four Advanced Access and four control) were selected for in-depth case study using an ethnographic approach. The research was comprised of several component studies. These included: • A survey of all practices in 12 PCTs. Based on this we recruited the 24 Advanced Access and 24 control practices and the 8 case study practices. • An assessment of appointments available and patients seen, based on appointments records • An assessment of continuity of care based on patients’ records • Random phone calls to practices to assess ability to make an appointment by telephone • A questionnaire survey of patients attending the practices • A postal survey of patients who had not attended the surgery in the previous 12 months • A discrete choice experiment to explore trade-offs patients make between access and other factors • A survey of practice staff • Qualitative case studies in 8 practices • Interviews with PCT access facilitators The methods and results for each of these studies are described below, in relation to each of the research objectives.<br/

How doctors record breaking bad news in ovarian cancer

Revealing the diagnosis of cancer to patients is a key event in their cancer journey. At present, there are no minimal legal recommendations for documenting such consultations. We reviewed the Hospital records of 359 patients with epithelial ovarian cancer in the Mersey Area between 1992 and 1994. We identified the following factors: age, hospital, postcode, surgeon, stage of disease and survival. These were compared to information recorded at the time of the interview such as person present, descriptive words used, prognosis, further treatment and emotional response. In 11.6%, there was no information recorded in the notes. The diagnosis was recorded in 304 (94.7%), prognosis in 66 (20.6%) and collusion with relatives in 33 (10.3%). A total of 42 separate words/phrases were identified relating to diagnosis; cancer was recorded in 60 (19.6%). Collusion was three times as common in the patients over 65 years (17.9 vs 5.7%, P=0.001). There was a reduction in the number of diagnostic words recorded in the patients over 65 years (90.3 vs 98.3%, P=0.002) and by type of surgeon (P=0.001). Information was often poorly recorded in the notes. We have shown that the quality of information varies according to patient age, surgeon and specialty

An analysis of first-time enquirers to the CancerBACUP information service: variations with cancer site, demographic status and geographical location

A retrospective comparison of cancer incidence data and, where relevant, population data with 16 955first-time users (patients, relatives and friends) of a national cancer information service (CancerBACUP) during the period April1995 to March 1996 is presented. The number of events observed was compared with the number of events expected, were the nationalrates of cancer incidence and population demographics apply. Standardized incidence ratios (SIRs) (observed – expectedratios) were used to indicate any differences. Statistically significant differences (P< 0.001) in the observed andexpected sex, age and primary site distribution of patients enquired about were found. Statistically significant differences(P< 0.001) were also identified for the age, employment status, socioeconomic class and geographical location offirst-time enquirers (patients, relatives and friends). Enquiries about brain, testis and breast cancers and non-Hodgkin'slymphoma (NHL) were substantially higher than expected; enquiries about bladder, lung, stomach and colorectal cancers were muchlower than expected. As the service is provided via a freephone number, it is available to all, and users might be expected to berandomly distributed across the variables listed. The underlying reasons for the differences identified need to be investigated,and the role of information in the care of cancer patients should be formally evaluated. © 1999 Cancer Research Campaig

Screening for psychological distress in patients with lung cancer: results of a clinical audit evaluating the use of the patient Distress Thermometer

Patients with lung cancer frequently suffer psychological distress and guidelines in the United Kingdom recommend screening of all cancer patients for this problem. The audit investigated use of the Distress Thermometer in terms of staff adherence to locally developed guidelines, patient willingness to use the tool, its impact on referral rates to clinical psychology services and concordance between the tool and the clinical assessment. Use of the Distress Thermometer was audited over a 3-month period in one lung cancer outpatient clinic. Referrals to clinical psychology services in response to clearly delineated referral indicators were assessed. Patient-reported outcomes were compared with practitioner assessment of need during clinical consultations to see whether the tool was measuring distress effectively. Thirty three of 34 patients used the Distress Thermometer during the audit period. Ten reported distress levels above 4 in the emotional or family problems domains. On ten occasions, the clinical interview identified problems not elicited by the Distress Thermometer. Guidelines were adhered to by staff, and patients were offered information about local support services and referral to clinical psychology services where indicated. Whilst all patients were happy to receive written information about further sources of support, none wanted to be referred to psychological services at that time. The Distress Thermometer is acceptable to patients with lung cancer in outpatient settings but it did not increase referrals for psychological support. Staff found it to be a useful tool in opening up communication about patient issues although it should not replace a comprehensive clinical interview

The Role of Health Kiosks in 2009: Literature and Informant Review

Kiosks can provide patients with access to health systems in public locations, but with increasing home Internet access their usefulness is questioned. A literature and informant review identified kiosks used for taking medical histories, health promotion, self assessment, consumer feedback, patient registration, patient access to records, and remote consultations. Sited correctly with good interfaces, kiosks can be used by all demographics but many ‘projects’ have failed to become routine practice. A role remains for: (a) integrated kiosks as part of patient ‘flow’, (b) opportunistic kiosks to catch people’s attention. Both require clear ‘ownership’ to succeed