Barriers and facilitators to the implementation of audio-recordings and question prompt lists in cancer care consultations: A qualitative study

Objective: Question prompt lists (QPLs) and consultation audio-recordings (CARs) are two communication strategies that can assist cancer patients in understanding and recalling information. We aimed to explore clinician and organisational barriers and facilitators to implementing QPLs and CARs into usual care. Methods: Semi-structured interviews with twenty clinicians and senior hospital administrators, recruited from four hospitals. Interviews were recorded, transcribed verbatim and thematic descriptive analysis was utilised. Results: CARs and QPLs are to some degree already being initiated by patients but not embedded in usual care. Systematic use should be driven by patient preference. Successful implementation will depend on minimal burden to clinical environments and feedback about patient use. CARs concerns included: medico-legal issues, ability of the CAR to be shared beyond the consultation, and recording and storage logistics within existing medical record systems. QPLs issues included: applicability of the QPLs, ensuring patients who might benefit from QPL’s are able to access them, and limited use when there are other existing communication strategies. Conclusions: While CARs and QPLs are beneficial for patients, there are important individual, system and medico-legal considerations regarding usual care. Practice implications: Identifying and addressing practical implications of CARs and QPLs prior to clinical implementation is essential

Should Consultation Recording Use be a Practice Standard? A Systematic Review of the Effectiveness and Implementation of Consultation Recordings

Objective: To conduct a systematic review of the effectiveness of consultation recordings, and identify factors contributing to their successful implementation in healthcare settings. Methods: A systematic review was conducted for quantitative studies examining the effectiveness of consultation recordings in healthcare. Two independent reviewers assessed the relevance and quality of retrieved quantitative studies using standardized criteria. Study findings were examined to determine consultation recording effectiveness and to identify barriers and facilitators to implementation. A supplementary review of qualitative evidence was performed to further explicate implementation factors. Results: Of the 3,373 articles retrieved in the quantitative search, 26 satisfied the standardized inclusion criteria (12 randomized controlled trials, 1 quasi-experiment, and 13 cross-sectional studies). The majority of patients found consultation recordings beneficial. Statistically significant evidentiary support was found for the beneficial impact of consultation recordings on the following patient reported outcomes: knowledge, perception of being informed, information recall, decisionmaking factors, anxiety, and depression. Implementation barriers included strength of evidence concerns, patient distress, impact of the recording on consultation quality, clinic procedures, medico-legal issues, and resource costs. Facilitators included comfort with being recorded, clinical champions, legal strategies, efficient recording procedures, and a positive consultation recording experience. Conclusions: Consultation recordings are valuable to patients and positively associated with patient reported outcomes. Successful integration of consultation recording use into clinical practice requires an administratively supported, systematic approach to addressing implementation factors

A survey of students’ attitudes to implementing physical activity in Danish vocational education schools

Abstract Background With the purpose of increasing the level of physical activity (PA) among Danish adolescents the Danish government initiated a large scale vocational school reform in 2015 requiring that vocational schools must ensure that students are physically active 45 min every day. Purpose To investigate how many students’ experience 45 min of PA per day as required by the Danish vocational school reform and to study possible associations between attitudes to PA and different student characteristics for instance students’ self-reported fitness level. Methods Using a cross-sectional questionnaire vocational education students’ attitudes and experiences with PA in school was assessed and combined with background questions about age, gender, self-reported PA in school and self-reported fitness level. Results 678 students with an average age of 17.2 (SD = 2.1) answered all questions. This study showed that Danish vocational school students self-reported 23.6 (SD = 16.6) minutes of PA per day. Only 18.3% of male students and 13.3% of female students self-reported 45 min of PA per day as required by the vocational school reform. This study also showed that Danish vocational school students had a relatively positive attitude to implementing PA in school. Self-reported fit students had a more positive attitude than self-reported unfit students and likewise students in the PA-high group presented a more positive attitude compared to the PA-low group. In addition, significantly more students with PA allocated on their lesson timetable were in the PA-high group. Students that were glad to attend the BP1 in general also had a more positive attitude towards implementing PA in school. Furthermore, students who were highly satisfied with the vocational schools’ facilities for PA were more likely to be in the PA-high group

MOESM1 of A survey of students’ attitudes to implementing physical activity in Danish vocational education schools

Additional file 1. The full dataset

Codebook for rating clinical communication skills based on the Calgary-Cambridge Guide

Background The aim of the study was to confirm the validity and reliability of the Observation Scheme-12, a measurement tool for rating clinical communication skills. Methods The study is a sub-study of an intervention study using audio recordings to assess the outcome of communication skills training. This paper describes the methods used to validate the assessment tool Observation Scheme-12 by operationalizing the crude 5-point scale into specific elements described in a codebook. Reliability was tested by calculating the intraclass correlation coefficients for interrater and intrarater reliability. Results The validation of the Observation Scheme-12 produced a rating tool with 12 items. Each item has 0 to 5 described micro-skills. For each item, the codebook described the criteria for delivering a rating from 0 to 4 depending on how successful the different micro-skills (or number of used jargon words) was accomplished. Testing reliability for the overall score intraclass correlation coefficients was 0.74 for interrater reliability and 0.86 for intrarater reliability. An intraclass correlation coefficient greater than 0.5 was observed for 10 of 12 items. Conclusion The development of a codebook as a supplement to the assessment tool Observation Scheme-12 enables an objective rating of audiotaped clinical communication with acceptable reliability. The Observation Scheme-12 can be used to assess communication skills based on the Calgary-Cambridge Guide

Communication Skills Training: A Means to Promote Time-Efficient Patient-Centered Communication in Clinical Practice

Purpose: We hypothesized that health care providers would behave in a more patient-centered manner after the implementation of communication skills training, without causing the consultation to last longer. Methods: This study was part of the large-scale implementation of a communication skills training program called Clear-Cut Communication With Patients at Lillebaelt Hospital in Denmark. Audio recordings from real-life consultations were collected in a pre-post design, with health care providers\u27 participation in communication skills training as the intervention. The training was based on the Calgary-Cambridge Guide, and audio recordings were rated using the Observation Scheme-12. Results: Health care providers improved their communication behavior in favor of being more patient-centered. Results were tested using a mixed-effect model and showed significant differences between pre- and postintervention assessments, with a coefficient of 1.3 (95% Cl: 0.35–2.3; P=0.01) for the overall score. The consultations did not last longer after the training. Conclusions: Health care providers improved their communication in patient consultations after the implementation of a large-scale patient-centered communication skills training program based on the Calgary-Cambridge Guide. This did not affect the length of the consultations