Patient participation in nursing bedside handover: a systematic mixed-methods review

Background: Numerous reviews of nursing handover have been undertaken, but none have focused on the patients’ role. Objectives: To explore how patient participation in nursing shift-to-shift bedside handover can be enacted. Design: Systematic mixed-methods review. Data sources: Three search strategies were undertaken in July-August 2016: database searching, backwards citation searching and forward citation searching. To be included, papers had to either be research or quality improvement (QI) projects focusing on the patient role. Fifty-four articles were retrieved, including 21 studies and 25 QI projects. Review methods: Screening, data extraction and quality appraisal was undertaken systematically by two reviewers. Research studies and QI projects were synthesised separately using thematic synthesis, then the results of this synthesis were combined using a mixed-method synthesis table. Results: Segregated synthesis of research of patients’ perceptions revealed two contrasting categories; (1) patient-centred handover and (2) nurse-centred handover. Segregated synthesis of research of nurses’ perceptions included three categories: (1) viewing the patient as an information resource; (2) dealing with confidential and sensitive information; and (3) enabling patient participation. The segregated synthesis of QI projects included two categories: (1) nurse barrier to enacting patient participation in bedside handover; and (2) involving patients in beside handover. Once segregated findings were configured, we discovered that the patients’ role in bedside handover involves contributing clinical information related to their care or progress, which may affect patient safety. Barriers relate to nurses’ concerns for the consequences of encouraging patient participation, worries for sharing confidential and sensitive information and feeling hesitant in changing their handover methods. The way nurses approach patients, and how patient-centred they are, constitute further potential barriers. Strategies to improve patient participation in handover include training nurses, making handovers predictable for patients and involving both patients and nurses throughout the change process. Conclusions: Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses and ensure patients’ viewpoint is captured. Many barriers and strategies identified QI projects were from the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure improved quality of QI projects

Differential delays in breast cancer treatment as a function of racial/ethnic background

17023 Differential delays in breast cancer treatment as a function of racial/ethnic background Background: Multiple studies have identified differences in breast cancer treatment and outcome due to racial/ethnic and socioeconomic factors. The purpose of this study was to investigate treatment disparities, both actual and temporal (i.e. time delay), in patients newly diagnosed with breast cancer as a function of racial/ethnic background. Methods: Patients at two affiliated hospitals newly diagnosed with breast cancer were identified and classified from discharge billing data. Time to treatment was defined as the time in days between biopsy proven diagnosis and initiation of treatment including chemotherapy, radiation therapy, lumpectomy and mastectomy. Nonparametric Analysis of Variance (ANOVA) using the Kruskal-Wallis Test examined differences between race groups based on median time to treatment. Types of treatment were analyzed by the Chi-Square test. Results: A total of 1217 patients were identified over a five-year period. Racial background was classified as White, African American, or Asian/Other. Lumpectomy was performed in 47%, 41%, and 38%, respectively (p = 0.15), while 24%, 23%, and 18% received a mastectomy (p = 0.51). There were no significant differences between the racial groups for types of therapy received. Results from ANOVA (table) showed statistically significant differences between the three race groups in terms of time to mastectomy (p = 0.003) and time to radiation therapy (p=0.043). Results from pairwise comparisons showed that (1) African American patients had a significantly longer time to mastectomy than Whites (p = 0.002), (2) patients in the Asian/Other group had a significantly longer time to radiation than their white counterparts (p = 0.015). Conclusion: This study demonstrates racial differences in time to non-surgical and surgical treatment in a group of ethnically diverse breast cancer patients. [Table: see text] No significant financial relationships to disclose. </jats:p