What do patients and the public know about clinical practice guidelines and what do they want from them? A qualitative study

Background   Guideline producers are increasingly producing versions of guidelines for the public. The aim of this study was to explore what patients and the public understand about the purpose and production of clinical guidelines, and what they want from clinical guidelines to support their healthcare decisions.  Methods  Participants were purposively selected to represent a range of the likely users of patient versions of guidelines, including individuals with health conditions (diabetes and depression), general members of the public, health communication professionals and a group of young people. Participants were asked about their awareness and understanding of clinical guidelines and presented with scenario recommendations, or draft materials from patient guidelines to prompt discussion. Each discussion was facilitated by one or two researchers. All focus groups were recorded and transcribed prior to analysis. Data were analysed using framework analysis.  Results  We ran nine focus groups involving 62 individuals, supplemented by four interviews with people experiencing homelessness. Eight groups were held in Scotland, one in England. The four interviews were held in Scotland. The framework analysis yielded five themes: access and awareness; what patients want to know; properties of guidelines; presenting evidence; and format. Awareness of guidelines was low. Participants emphasised the need for information that enables them to choose between treatment options, including harms. They would like help with this from healthcare professionals, especially general practitioners. Participants differed in their support for the inclusion of numerical information and graphs.  Conclusions  Members of the public want information to help them choose between treatments, including information on harm, particularly to support shared decisions with health professionals. Presenting numerical information is a challenge and layered approaches that present information in stages may be helpful. Ignoring the themes identified in this study is likely to lead to materials that fail to support public and patient healthcare decisions

Additional file 3: of Improving the user experience of patient versions of clinical guidelines: user testing of a Scottish Intercollegiate Guideline Network (SIGN) patient version

Supplementary bar and pie charts. (PDF 144 kb

Implications of long-term conditions for both mental and physical health: comparison of rheumatoid arthritis and schizophrenia.

PURPOSE: To investigate whether people with long term conditions, whatever their specific nature, need to be assessed and treated for the full range of mental, physical and social problems. Main question investigated: that rheumatoid arthritis and schizophrenia will be associated with significantly greater impairment across the subscores of the SF36 scale than in reference general population samples. Specific hypothesis tested: while rheumatoid arthritis and schizophrenia will impair both physical and mental functioning, when comparing the two groups there will be a greater difference between the physical component scores than there will be between the mental/emotional component scores of the short form health survey (SF-36). METHODS: Cross sectional comparison of SF-36 subscore profiles of cohorts of: (1) people with rheumatoid arthritis attending specialist Rheumatology outpatient clinics in five London hospitals (n = 446), and (2) people with schizophrenia treated by community psychiatric teams in four sites in Europe (n = 409). RESULTS: Both groups had greater impairments across the whole spectrum of mental and physical problems assessed by the SF-36 than age specific normative data for the general population. The results also support our hypothesis that, comparing the people with rheumatoid arthritis and schizophrenia, we did find that there is a greater discrepancy between the physical scales than there is between the mental/emotional scales of the SF-36. CONCLUSIONS: These findings show that whether the primary long-term condition is presenting as physical or as mental disorder, the practitioner should ensure that the full range of physical, mental and social problems is assessed and treated

Nursing care about a patient related to pacemaker implantation

Pacemaker implantation is a relatively common treatment of bradyarrhythmias today. This work deals with the nursing care about a patient who undergoes this surgery. The theoretical section summarizes the implantation issue, its indications, available devices and describes the typical course of the implantation. The practical part presents a case report. A fifty-six year old female patient undergoes a pacemaker implantation. She suffers from sick sinus syndrome manifested with bradycardia and palpitations, recently states of weakness and dizziness appeared, there were several collapses. The nursing process is handled according to the Model by M. Gordon. Particular attention is paid to mental state of the patient. Education of is also promoted. The patient must properly understand the reason for pacemaker implantation indication. She must also be advised of the necessary regimen after the surgery, which is an essential part of the treatment. Objectives that were set out in the plan of nursing care were achieved. The patient successfully underwent surgery, she was thoroughly educated and we can expect an increase in the quality of her life