O R I G I N A L P A P E R Cross-national diagnostic analysis of patient empowerment in England and Greece

Abstract Background: Different NHS patient empowerment policies have been adopted in England and Greece; the voluntary sector development and its influence also differ. Although various aspects of patient empowerment have been explored in England, the patient empowerment systems' application is under-researched. In Greece, the few relevant attempts looking at patients' experiences focus on patient satisfaction, with only one study exploring the public hospitals managers' perspectives on user involvement. However, patient empowerment questions may be similar in both countries. Aims and Objectives:The study aimed to explore and compare the general patient empowerment settings in the two countries, with main objectives to: a. identify and explore the relationships of national voluntary and governmental organisations, b. explore the cross-national challenges and facilitators, and make cross-national recommendations. Methodology:This is a cross-national comparative research study. A 'diagnostic analysis' approach, an assessment of potential and actual barriers and facilitators, including the context and potential change, was chosen. The methods used were:-a. a network analysis of national voluntary and governmental organisations; b. semi-structured interviews with key representatives of these, and c. documentary analysis. Results: The network analysis revealed the potential of English organisations to influence more people, with extensive memberships and stronger interrelationship between them than the Greek organisations. Different levels of awareness, knowledge and perceptions of application of the national patient empowerment policies, systems and mechanisms were identified; being generally good in England, limited in Greece. Variable general information provision, with good verbal information in England, and limited, written and verbal, information in Greece was also identified. Although the commonest cross-national perceived challenges were organisational, the Greek culture, professional systems and attitudes were also challenges in Greece. National relevant policies and professional attitudes in England, and integrated working in Greece were perceived facilitators. Changes in professional attitudes and cultures, information awareness / provision, and national drivers were common crossnational facilitators. Greek participants called for better function of patient empowerment systems within hospitals; while hearing the patients 'voice' and non-tokenism were highlighted in England. Conclusions: Notwithstanding its limitations, this analysis identified factors and complexities likely to influence patient empowerment change. The influence of the voluntary sector and well-developed policies in England was evident, while in Greece there was lack of knowledge and awareness. Nonetheless, it seems that the need for better non-tokenistic systems is cross-national

An evaluation of advanced access in general practice

Aims: To evaluate ‘Advanced Access’ in general practice, and assess its impact on patients, practice organisation, activity, and staff.Objectives: To describe the range of strategies that general practices have employed to improve access to care To determine the impact of Advanced Access on the wait for an appointment, continuity of care, practice workload, and demand on other NHS services. To explore the perceptions of different groups of patients, including both users and non-users of services, about the accessibility of care and their satisfaction with access to care in relation to different models of organisation. To explore the trade-offs that patients make between speed of access, continuity of care and other factors when making an appointment in general practice. To explore the perceptions of general practitioners and receptionists about working with the NPDT and implementing changes to practice arrangements to improve access. To assess the impact of the above changes in practice organisation on staff job satisfaction and team climate.Method and results: This research was based on a comparison of 48 general practices, half of which operated Advanced Access appointment systems and half of which did not (designated ‘control’ practices). These practices were recruited from 12 representative Primary Care Trusts (PCTs). From within these 48 practices, eight (four Advanced Access and four control) were selected for in-depth case study using an ethnographic approach. The research was comprised of several component studies. These included: • A survey of all practices in 12 PCTs. Based on this we recruited the 24 Advanced Access and 24 control practices and the 8 case study practices. • An assessment of appointments available and patients seen, based on appointments records • An assessment of continuity of care based on patients’ records • Random phone calls to practices to assess ability to make an appointment by telephone • A questionnaire survey of patients attending the practices • A postal survey of patients who had not attended the surgery in the previous 12 months • A discrete choice experiment to explore trade-offs patients make between access and other factors • A survey of practice staff • Qualitative case studies in 8 practices • Interviews with PCT access facilitators The methods and results for each of these studies are described below, in relation to each of the research objectives.<br/

The role of religiosity as a coping resource for relatives of critically ill patients in Greece

Critical care hospitalisation is emotionally overwhelming for the relatives of patients. Research has shown that religiosity is an effective coping resource for people with health related problems and has been correlated with better health outcomes. However the processes by which religiosity is utilized and its ejfocts on relatives of critically ill patients have not been adequately explored. This article presents relatives\u27 experiences and processes of religiosity; it is part of a wider grounded theory study on the experiences of critically ill patients\u27relatives in Greece. T wenty-jive relatives of patients in the intensive care units of three public general district hospitals in Athens, Greece, participated in 19 interviews. Religiosity was found tv be the main source of hope, strength and courage for relatives and was expressed with church/monastery attendance, belief in God, praying. and performing religious rituals. Health care professionals should pay attention and understand these aspects of coping.<br /

Health-related religious rituals of the Greek Orthodox Church : their uptake and meanings

AimTo examine the uptake of religious rituals of the Greek Orthodox Church by relatives of patients in critical condition in Greece and to explore their symbolic representations and spiritual meanings.BackgroundPatients and their relatives want to be treated with respect and be supported for their beliefs, practices, customs and rituals. However nurses may not be ready to meet the spiritual needs of relatives of patients, while the health-related religious beliefs, practices and rituals of the Greek Orthodox Christian denomination have not been explored.MethodThis study was part of a large study encompassing 19 interviews with 25 informants, relatives of patients in intensive care units of three large hospitals in Athens, Greece, between 2000 and 2005. In this paper data were derived from personal accounts of religious rituals given by six participants.ResultsRelatives used a series of religious rituals, namely blessed oil and holy water, use of relics of saints, holy icons, offering names for pleas and pilgrimage.ConclusionThrough the rituals, relatives experience a sense of connectedness with the divine and use the sacred powers to promote healing of their patients.Implications for nursing managementNurse managers should recognize, respect and facilitate the expression of spirituality through the practice of religious rituals by patients and their relatives.<br /

Cancer patients' information needs and information seeking behaviour : in depth interview study

Objectives: To explore why cancer patients do not want or seek information about their condition beyond that volunteered by their physicians at times during their illness. Design: Qualitative study based on in-depth interviews. Setting: Outpatient oncology clinics at a London cancer centre. Participants: 17 patients with cancer diagnosed in previous 6 months. Main outcome measures: Analysis of patients' narratives to identify key themes and categories. Results: While all patients wanted basic information on diagnosis and treatment, not all wanted further information at all stages of their illness. Three overarching attitudes to their management of cancer limited patients' desire for and subsequent efforts to obtain further information: faith, hope, and charity. Faith in their doctor's medical expertise precluded the need for patients to seek further information themselves. Hope was essential for patients to carry on with life as normal and could be maintained through silence and avoiding information, especially too detailed or "unsafe" information. Charity to fellow patients, especially those seen as more needy than themselves, was expressed in the recognition that scarce resources, including information and explanations, had to be shared and meant that limited information was accepted as inevitable. Conclusions: Cancer patients' attitudes to cancer and their strategies for coping with their illness can constrain their wish for information and their efforts to obtain it. In developing recommendations, the government's cancer information strategy should attend to variations in patients' desires for information and the reasons for them. <br/