The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions : A Scoping Review of Reviews

Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (informal caregivers and healthcare professionals) with SM in four chronic diseases and (2) to identify and describe the relevant outcomes for SM interventions from these perspectives. We conducted a mixed-methods scoping review of reviews. We searched three databases until December 2020 for quantitative, qualitative, or mixed-methods reviews exploring patients' and caregivers' preferences or experiences with SM in type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Quantitative data were narratively synthesised, and qualitative data followed a three-step descriptive thematic synthesis. Identified themes were categorised into outcomes or modifiable factors of SM interventions. We included 148 reviews covering T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one disease (n = 5 [3.4%]). We identified 12 main themes. Eight described the process of SM (disease progression, SM behaviours, social support, interaction with healthcare professionals, access to healthcare, costs for patients, culturally defined roles and perceptions, and health knowledge), and four described their experiences with SM interventions (the perceived benefit of the intervention, individualised care, sense of community with peers, and usability of equipment). Most themes and subthemes were categorised as outcomes of SM interventions. The process of SM shaped the perspectives of patients and their caregivers on SM interventions. Their perspectives were influenced by the perceived benefit of the intervention, the sense of community with peers, the intervention's usability, and the level of individualised care. Our findings can inform the selection of patient-important outcomes, decision-making processes, including the formulation of recommendations, and the design and implementation of SM interventions

Learning to make informed health choices: Protocol for a pilot study in schools in Barcelona.

--- - b: - "Introduction:" - "Methods:" - "Ethical considerations:" sup: - th - th i: - ad hoc content: - " The Informed Health Choices (IHC) project has developed learning resources to teach primary school children (10 to 12-year-olds) to assess treatment claims and make informed health choices. The aim of our study is to explore both the students' and teachers' experience when using these resources in the context of Barcelona (Spain). " - " During the 2019-2020 school year, we will conduct a pilot study with 4 " - " and 5 " - "-year primary school students (9 to 11-year-olds) from three schools in Barcelona. The intervention in the schools will include: 1) assessment of the IHC resources by the teachers before the lessons, 2) non-participatory observations during the lessons, 3) semi-structured interviews with the students after a lesson, 4) assessment of the lessons by the teachers after a lesson, 5) treatment claim assessment by the students at the end of the lessons, and 6) assessment of the IHC resources by the teachers at the end of the lessons. We will use " - " questionnaires and guides to register the data. We will perform a quantitative and qualitative analysis of the data to explore understandability, desirability, suitability, usefulness, facilitators and barriers of the resources. The most relevant results will be discussed and some recommendations on how to use, how to adapt (if needed), and how to implement the IHC resources to this context will be agreed. The findings of the contextualization activities could inform the design of a cluster-randomised trial, to determine the effectiveness of the IHC resources in this context prior to scaling-up its use. " - " The study protocol has obtained an approval exemption from the Ethics Committee of the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain).

Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries

Background: Breast cancer clinical guidelines offer evidence-based recommendations to improve the quality of health care for patients with or at risk of suffering breast cancer. Suboptimal adherence to breast cancer guideline recommendations has the potential to negatively affect population health. However, no study has systematically reviewed the impact of breast cancer guideline adherence -as a prognosis factor- on healthcare processes and health outcomes related to breast cancer. The objective of this systematic review is twofold: i) to analyse the impact of adherence to guidelines on health outcomes, and ii) to examine the extent to which adherence to guidelines impacts on health care costs. Methods: We searched for systematic reviews and primary studies in MEDLINE and Embase up to May 2019. Eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and crosschecked by a second author. We used random-effects meta-analyses to examine the impact of adherence to guidelines on overall survival and disease-free survival, and assessed the certainty of evidence with the GRADE approach. Results: We included 21 primary studies. Most were published during the last decade (90%), followed a retrospective cohort design (86%), focused on adherence to treatment guidelines (95%), and were at low (80%) or moderate (20%) risk of bias. Nineteen studies (95%) examined the impact of guideline adherence on health outcomes, while two studies (10%) on healthcare cost. Adherence to guidelines was associated with increased overall survival (HR=0.66 (95% CI 0.58 to 0.75) and disease-free survival (HR=0.35 (95% CI from 0.15 to 0.82), representing 132 fewer deaths (168 fewer to 94 fewer) and 222 fewer recurrences (305 fewer to 55 fewer) per 1,000 patients at 5 years of follow-up (moderate certainty). Adherence to treatment guidelines was associated with higher costs, but adherence to follow-up guidelines was associated with lower costs (low certainty). Conclusions: There is moderate certainty that adherence to breast cancer guidelines is associated with an improved survival. Breast cancer guidelines should be rigorously implemented in the clinical setting.JRC.F.1-Health in Societ

Healthcare providers’ adherence to breast cancer guidelines in Europe: a systematic literature review

Background: Clinical guidelines’ (CGs) adherence supports high quality care. However, healthcare providers do not always comply with CGs recommendations. This systematic literature review aims to assess the extent of healthcare providers’ adherence to breast cancer CGs in Europe, and to identify the factors that impact on healthcare providers’ adherence. Methods: We searched for systematic reviews, and quantitative or qualitative primary studies in MEDLINE and Embase up to May 2019. Eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and crosschecked by a second author. We conducted a narrative synthesis attending to the modality of healthcare process, methods to measure adherence, scope of the CGs, and population characteristics. Results: Out of 8137 references, we included 55 primary studies conducted in eight European countries. Most followed a retrospective cohort design (31/55; 56%) and were at low or moderate risk of bias. Adherence for overall breast cancer care process (from diagnosis to follow-up) ranged from 59% to 67%, for overall treatment process (including surgery, chemotherapy (CT), endocrine therapy (ET), and radiotherapy (RT)) the median adherence was 55% (IQR 49-52%), while for systemic therapy (CT and ET) it was 68% (IQR 69-76%). The median adherence rates for individual process were higher, with a range between 74% (IQR 10-80%) for follow-up to 88% (IQR 84-92%) for RT. Internal factors that potentially impact on healthcare providers’ adherence were their perceptions, preferences, lack of knowledge, or intentional decisions. Conclusions: A substantial proportion of breast cancer patients are not receiving CGs recommended care. Healthcare providers’ adherence to breast cancer CGs in Europe has room for improvement in almost all care processes. CGs development and implementation processes should address the main factors that influence healthcare providers' adherence, especially the patient-related ones.JRC.F.1-Health in Societ

Teaching and learning how to make informed health choices: protocol for a context analysis in Spanish primary schools [version 2; peer review: 2 approved]

Introduction The Informed Health Choices (IHC) project developed learning resources to teach primary school children (10 to 12-year-olds) to assess treatment claims and make informed health choices. The aim of our study is to explore the educational context for teaching and learning critical thinking about health in Spanish primary schools. Methods During the 2020-2021 school year, we will conduct 1) a systematic assessment of educational documents and resources, and 2) semi-structured interviews with key education and health stakeholders. In the systematic assessment of educational documents and resources, we will include state and autonomous communities’ curriculums, school educational projects, and commonly used textbooks and other health teaching materials. In the semi-structured interviews, we will involve education and health policy makers, developers of learning resources, developers of health promotion and educational interventions, head teachers, teachers, families, and paediatric primary care providers. We will design and pilot a data extraction form and a semi-structured interview guide to collect the data. We will perform a quantitative and a qualitative analysis of the data to explore how critical thinking about health is being taught and learned in Spanish primary schools. Conclusion We will identify opportunities for and barriers to teaching and learning critical thinking about health in Spanish primary schools. We will formulate recommendations—for both practice and research purposes—on how to use, adapt (if needed), and implement the IHC resources in this context