The impact of human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) on nutritional outcomes

Background: Patients undergoing (chemo) radiotherapy for oropharyngeal squamous cell carcinoma (OPSCC) are at high risk of malnutrition during and after treatment. Malnutrition can lead to poor tolerance to treatment, treatment interruptions, poor quality of life (QOL) and potentially reduced survival rate. Human papillomavirus (HPV) is now known as the major cause of OPSCC. However, research regarding its effect on nutritional outcomes is limited. The aim of this study was to examine the relationship between HPV status and nutritional outcomes, including malnutrition and weight loss during and after patients&rsquo; (chemo) radiotherapy treatment for OPSCC. Methods: This was a longitudinal cohort study comparing the nutritional outcomes of HPV-positive and negative OPSCC patients undergoing (chemo) radiotherapy. The primary outcome was nutritional status as measured using the Patient Generated-Subjective Global Assessment (PG-SGA). Secondary outcomes included loss of weight, depression, QOL and adverse events. Results: Although HPV-positive were less likely to be malnourished according to PG-SGA at the beginning of treatment, we found that the difference between malnutrition rates in response to treatment was not significantly different over the course of radiotherapy and 3 months post treatment. HPV-positive participants had significantly higher odds of experiencing &gt;10% weight loss at three months post-treatment than HPV-negative participants (OR = 49.68, 95% CI (2.7, 912.86) p &le; 0.01). Conclusions: The nutritional status of HPV positive and negative patients were both negatively affected by treatment and require similarly intense nutritional intervention. In acute recovery, HPV positive patients may require more intense intervention. At 3- months post treatment, both groups still showed nutritional symptoms that require nutritional intervention so ongoing nutritional support is essential.</jats:p

Designing for palliative care: Three ideas toward an architecture of generosity

Palliative care has a distinct philosophy that is not always reflected in the architecture created for it. From a study conducted to better understand the relationship of the built environment to patient and family experiences of palliative care, this article discusses the benefits of access to nature, the provision of semi-private spaces beyond the patient room, and environments that support the rituals of home. Research methods included semi-structured interviews, an online survey, and an architectural precedent study

Measuring recall of medical information in non-English-speaking people with cancer: A methodology

Background Many patients who require an interpreter have difficulty remembering information from their medical consultations. Memory aids such as consultation audio-recordings may be of benefit to these patients. However, there is no established means of measuring patients’ memory of medical information. Objectives This study aimed to develop a method for eliciting and coding recall of medical information in non-English-speaking patients. Design This method, called Patient-Interpreter-Clinician coding (PICcode), was developed in the context of a phase II trial conducted in two outpatient oncology clinics in Melbourne, Australia, and was refined iteratively through consultation with an expert panel and piloting. Between-coder differences in early versions of the coding system were resolved through discussion and consensus resulting in refinements to PICcode. Results The final version of PICcode involved transcribing, translating and coding of audio-recorded consultations and semi-structured interviews (SSI). The SSIs were designed to elicit patients’ free-recall of medical information. Every unit of medical information in the consultation was identified and categorized in a coding tree. SSIs were coded to identify the extent to which information was recalled from the consultation. Discussion The iterative changes involved in developing PICcode assisted in clarifying precise details of the process and produced a widely applicable coding system. PICcode is the most comprehensively described method of determining the amount of information that patients who use an interpreter recall from their medical consultations. PICcode can be adapted for English-speaking patients and other healthcare populations

Including migrant oncology patients in research : a multisite pilot randomised controlled trial testing consultation audio-recordings and question prompt lists

Background: Oncology patients who are migrants or refugees face worse outcomes due to language and communication barriers impacting care. Interventions such as consultation audio-recordings and question prompt lists may prove beneficial in mediating communication challenges. However, designing robust research inclusive of patients who do not speak English is challenging. This study therefore aimed to: a) pilot test and assess the appropriateness of the proposed research design and methods for engaging migrant populations, and b) determine whether a multi-site RCT efficacy assessment of the communication intervention utilising these methods is feasible. Methods: This study is a mixed-methods parallel-group, randomised controlled feasibility pilot trial. Feasibility outcomes comprised assessment of: i) screening and recruitment processes, ii) design and procedures, and iii) research time and costing. The communication intervention comprised audio-recordings of a key medical consultation with an interpreter, and question prompt lists and cancer information translated into Arabic, Greek, Traditional, and Simplified Chinese. Results: Assessment of feasibility parameters revealed that despite barriers, methods utilised in this study supported the inclusion of migrant oncology patients in research. A future multi-site RCT efficacy assessment of the INFORM communication intervention using these methods is feasible if recommendations to strengthen screening and recruitment are adopted. Importantly, hiring of bilingual research assistants, and engagement with community and consumer advocates is essential. Early involvement of clinical and interpreting staff as key stakeholders is likewise recommended. Conclusion: Results from this feasibility RCT help us better understand and overcome the challenges and misconceptions about including migrant patients in clinical research

Space for recovery after stroke: Exploring the role of the physical environment in inpatient rehabilitation facilities

© 2020 Ruby Adelaide Lipson-SmithThe aim of this thesis was to explore the role of the physical environment of inpatient rehabilitation facilities in stroke recovery. The purpose of rehabilitation is to help stroke survivors to re-learn skills and abilities lost as a result of stroke, or to learn new skills to adapt to their changed condition. Research in other healthcare environments suggests that hospital design can impact patient outcomes, but there is little evidence specific to rehabilitation. This thesis embraces the complexity of rehabilitation environments and explores the physical environment as an essential and integrated component of this complex system. This exploration began with a scoping survey to identify and describe all inpatient rehabilitation facilities in Victoria, Australia. This survey revealed 64 facilities, most of which had not been purpose-built for rehabilitation. Rehabilitation facility design appears to be influenced by evidence from acute medical settings and current design trends, rather than reflecting the unique purpose of rehabilitation. A series of expert elicitation workshops were then conducted to define – for the first time – what is important in the physical environment of inpatient stroke rehabilitation facilities. Thirty experts participated, including policy makers, researchers and designers in learning and healthcare environments, clinical staff, and patients. A Value-Focused Thinking methodology was used to facilitate the workshops. The experts defined 16 criteria thought to be fundamentally important (including efficiency, patient practice, activity and rest, emotional well-being, and safety), and 14 criteria that could be a means to achieving these fundamentally important things. Together, these criteria comprise a framework which can be used to guide research and design in this complex area. This framework informed a multiple-case study in two stroke inpatient rehabilitation facilities. Convergent mixed-methods were used to produce a rich and thorough exploration of the cases. Twenty inpatients from Case 1 participated, and 16 from Case 2. The physical environment was described using field notes, photographs, floor plans, and checklists. Walk-through semi-structured interviews were used to explore patients’ experience of the physical environment. Systematic observation (behavioural mapping) and questionnaires were used to investigate patients’ behaviour and emotional well-being in the environment, and a retrospective audit of patient falls was conducted to investigate patient safety. Four interrelated themes described the patient experience: 1) entrapment and escape; 2) power, dependency, and identity in an institutional environment; 3) the rehabilitation facility is a shared space; and 4) the environment should be legible and patient-centred. Quantitative data revealed that patients spent over 75% of their time in their bedrooms. Comparison between cases suggested that the physical environment played a role in patients’ behaviour, emotional well-being, and safety. Qualitative and quantitative findings were then merged using joint display tables and narrative integration. This robust analytic process produced a new conceptual model of the role of the physical environment in stroke patients’ behaviour, emotional well-being, and safety in rehabilitation, emphasising the importance of variety and interest in the environment, privacy without isolation, and patient-centred design. The findings from this study provide meaningful direction for rethinking rehabilitation facilities and guiding real-world health design practice

Mapping healthcare spaces : a systematic scoping review of spatial and behavioral observation methods

Objective: To provide a taxonomy of spatial observation methods that are commonly used in healthcare environments research and to describe their relative success. Background: Spatial observation is a valuable but resource intensive research method that is often used in healthcare environments research, but which frequently fails to deliver conclusive results. There is no existing catalog of the different spatial and behavioral observation methods that are used in healthcare design research and their benefits or limitations. Methods: The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Ten key databases were searched, and articles were screened by both authors. Results: Across 67 included studies, 79 observation methods were reported. We categorized those into four, distinct methodological approaches, outlining the benefits, limitations, and suitability of each for obtaining different types of results. Common limitations included difficulty generalizing to other contexts and a lack of detailed description during data collection which led to key environment variables not being recorded. More concrete conclusions were drawn when observation methods were combined with complimentary methods such as interview. Conclusions: The relative success of spatial observation studies is dependent on the fit of the method selected relative to the research question, approach, and healthcare setting; any complimentary methods delivered alongside it; and the analysis model employed. This article provides researchers with practical advice to guide the appropriate selection of spatial observation methods

Design Decision Support for Healthcare Architecture: A VR-Integrated Approach for Measuring User Perception

Changing the physical environment of healthcare facilities can positively impact patient outcomes. Virtual reality (VR) offers the potential to understand how healthcare environment design impacts users’ perception, particularly among those with brain injuries like stroke, an area with limited research. In this study, our objective was to forge a new pathway in healthcare environment research by developing a comprehensive, six-module ‘user-centered’ design decision support approach, utilizing VR technology. This innovative method integrated patient engagement, architectural design principles, BIM prototyping, and a sophisticated VR user interface to produce realistic and immersive healthcare scenarios. Forty-four stroke survivors participated, experiencing 32 VR scenarios of in-patient bedrooms, followed by interactive in-VR questions and semi-structured interviews. The results of the approach proved to be comparatively efficient and feasible, provided a high level of immersion and presence for the participants, and effectively elicited extremely rich quantifiable response data, which revealed distinct environmental preferences. Our novel approach to understanding end-user responses to stroke rehabilitation architecture demonstrates potential to inform user-centered evidence-based design decisions in healthcare, to improve user experiences and health outcomes in other healthcare populations and environments

Behavioral mapping of patient activity to explore the built environment during rehabilitation

Aim: To explore the use of a rehabilitation-focused behavioral mapping method to identify changes in patient physical activity, location, and social interaction following the relocation of a rehabilitation ward. Background: Rehabilitation wards are unique healthcare environments where patient activity is encouraged to improve recovery. Little is known about the impact of building design on patient behavior within a rehabilitation setting. We examined this issue when a rehabilitation ward was relocated without altering other aspects of the healthcare service. Method: The setting was a publicly funded inpatient general rehabilitation ward with a separate therapy area. Before and after ward relocation, patient behavior (location, physical, and social activities) was observed at 10-min intervals between 8:00 a.m. and 5:00 p.m. Patients and staff performed their usual activities during data collection. Results: Twenty-three patients participated in the old ward and 24 in the new ward, resulting in 1,150 and 1,200 observation time points, respectively. Patient location and behaviors were similar between wards (p >.05). Participants were in bedrooms for more than half of the observations (67% old ward, 58% new ward), sitting down (62.8% old ward, 59.0% new ward), and alone (42.0% old ward, 38.0% new ward). Design features, such as separation of the therapy area and ward, may have impacted on patient behavior. Conclusions: The rehabilitation-focused behavioral mapping method provided a rich description of relevant patient behaviors, indicating that it is a feasible and useful method for exploring the impact of the built environment in rehabilitation settings

Designing palliative care facilities to better support patient and family care : a staff perspective

Objective: To contribute staff perspectives on the design of palliative care facilities to better align with the philosophy of palliative care, in support of patient, family, and staff well-being. Background: The receipt of palliative care differs from other inpatient experiences owing to its distinct philosophy of care, longer lengths of stay, a greater presence of family members, and more frequent end-of-life events. While research regarding the optimal design of palliative care environments recognizes these differences, this knowledge has been slow to exert change on the guidelines and procurement processes that determine the design solutions possible within these settings. Sustained research attention is required. Methods: An online survey, comprising a series of open-ended questions, elicited the perceptions of palliative care staff regarding the relationship between the physical environment and the distinct philosophy of palliative care. Results: Responses from 89 Australian-based palliative care professionals confirmed the high value that staff place on environments that offer privacy, homeliness, safety, and access to gardens to assist the delivery of optimum care. Conclusions: Our findings illustrate that the implications of privacy and homeliness extend far beyond the patient room and that homeliness is about more than an aesthetic of comfort. This highlights a broader capacity for design to better support the philosophy of palliative care. Importantly, the data reveal a key relationship between staff well-being and the environments in which they work; environments that are unable to match the quality of care that staff aspire to deliver can engender frustration and distress