Biomedical subjects

Marjolein Gysels

Publications and source records attributed to Marjolein Gysels.

6 recordsLinked to original sources

PubMed2006

Interactive technologies and videotapes for patient education in cancer care: systematic review and meta-analysis of randomised trials.

GOALS OF WORK: Patients diagnosed with cancer need education as they face complex decisions. There is limited evidence about the impact of new educational technologies for cancer patients. This paper investigates whether interactive technologies and videotapes for patient education in cancer care improve knowledge, satisfaction or other outcomes. METHODS: Literature search of five computerised databases (Medical Literature Analysis and Retrieval System, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Controlled Trials Register and Cochrane Database of Systematic Reviews) and bibliography searches identified relevant randomized controlled trials. Two reviewers independently assessed trial quality. Summary effects for knowledge and satisfaction were calculated using random-effects models (RevMan 4.2 software). Continuous data were summarised as weighted mean differences and dichotomous data as odds ratios, each with their respective 95% confidence interval. Standardised effect sizes for these outcomes were calculated and contrasted. RESULTS: Nine randomised control trials with 1,678 patients were identified. Three evaluated the use of videotapes, and six evaluated computer technologies. Studies were of good-quality design but were variable in instruments, content, populations, outcomes and results. Educational technologies showed improved patient knowledge (effect sizes ranging from 0.12 to 1.03). Satisfaction was improved in some studies, but the overall effect was more equivocal--effect sizes ranged (0.05 to 0.40) of benefit for knowledge and from 0 to 0.40 for satisfaction. CONCLUSIONS: The trials present preliminary evaluations of the technology in North America, the UK and Australia. There is a trend to improved knowledge and satisfaction. The ways in which the interventions are delivered and the extent of communication with a health professional affect patient responses.

Computer-Assisted Instruction↗

PubMed2006

The impact of a breathlessness intervention service (BIS) on the lives of patients with intractable dyspnea: a qualitative phase 1 study.

OBJECTIVE: Disabling breathlessness is the most common symptom of advanced cardiopulmonary disease. It is usually intractable, even when patients receive maximal medical therapy for their underlying condition. A pilot study was undertaken to evaluate a newly formed palliative Breathlessness Intervention Service (BIS). METHODS: The methodology followed the Medical Research Council's Framework for the Evaluation of Complex Interventions (Phase I). Qualitative interviews were completed with patients and relatives who had used the service and clinicians who had referred to it. The focus of the interviews was the participants' experience of using BIS. RESULTS: Patients valued the positive educational approach taken to breathlessness, emphasizing what was possible rather than what had been lost. Non-pharmacological strategies, especially the hand-held fan and exercises, were rated very helpful and new to patients. Participants reiterated that breathlessness was frightening and isolating, exacerbating the disability it caused: the easy access to advice and flexibility of BIS helped to alleviate this. Participants wanted a written record of the advice given. Carers welcomed the focus on their needs. Clinicians valued sharing the management of patients with an intractable problem. SIGNIFICANCE OF RESULTS: This Phase I study has helped to remodel the service rapidly by uncovering the aspects of BIS that users find most valuable and areas that need change or improvement. The BIS needs to provide written information, to reinforce and extend contacts with other agencies to build on support it already provides for patients and carers, and extend its flexibility and accessibility. Providing a "drop-in" service and continuing education after the initial program of contacts is completed could be a useful service development, warranting further evaluation. A qualitative methodology involving service users and referrers can help to shape service development rapidly.

Adult↗

PubMed2004

Communication training for health professionals who care for patients with cancer: a systematic review of training methods.

BACKGROUND: Effective communication is increasingly recognised as a core clinical skill. Many health and social care professionals, however, do not feel adequately trained in communicating and in handling interpersonal issues that arise in the care of patients with cancer. AIM: The aim of this paper was to assess the effectiveness of different training methods used in communication training courses for health professionals. METHOD: We searched six computerised databases and augmented this with follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and training methods were extracted and compared in tabular format. RESULTS: A total of 47 studies potentially assessing communication training were identified. Sixteen papers were included evaluating 13 interventions. Four were randomised controlled trials (RCTs) (grade a); the others were grade III. Eleven interventions trained health professionals; two trained medical students. Interventions for training in communication skills were characterised by the variety of communication approaches used and a diversity of methods. They were applied to health professionals with very different roles, served different purposes and evaluated a variety of outcome measures: behavioural assessments, patient outcomes and professionals' self-report. CONCLUSIONS: The best results are to be expected from a training programme that is carried out over a longer period of time. Learner-centred programmes using several methods combining a didactic component focusing on theoretical knowledge with practical rehearsal and constructive feedback from peers and skilled facilitators proved to be very effective. Small groups encouraged more intensive participation. Training in communication for both medical or nursing students and senior health professionals is advisable.

Communication↗

PubMed2004

Communication training for health professionals who care for patients with cancer: a systematic review of effectiveness.

BACKGROUND: Effective communication is increasingly recognised as a core clinical skill. However, there is evidence that health and social care professionals still lack basic communication skills. PURPOSE: To assess the effectiveness of different communication skills training courses for health professionals in cancer care. METHODS: We searched six computerised databases and augmented this with a follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and results were extracted and compared in tabular format. RESULTS: A total of 47 studies potentially assessing communication training in the area of cancer care were identified. Sixteen papers were included describing 13 interventions. Four were randomised controlled trials (RCTs) (grade I), with samples ranging from 72 to 233 subjects. The others were all grade III. Eleven interventions trained health professionals, two trained medical students. The outcomes measured included communication skills as assessed on audio or video, professionals' self-report and patient assessment. All the interventions demonstrated modest improvements (effect sizes ranged 0.15-2) and one found deterioration in the outcomes measured. CONCLUSION: Communication training improves basic communication skills. Positive attitudes and beliefs are needed to maintain skills over time in clinical practice and to effectively handle emotional situations.

Communication↗

PubMed2004

What methods do stakeholders prefer for feeding back performance data: a qualitative study in palliative care.

OBJECTIVE: To investigate the opinions of stakeholders (service commissioners and providers) on how performance data should be presented, in order to develop effective feedback methods to facilitate the use of these data in decision making. DESIGN: A qualitative analysis of semi-structured face-to-face and telephone interviews. League tables and fictional box plots were presented as an illustrative guide. The themes covered in the interviews were the effectiveness of these two feedback formats, their positive and negative characteristics, and ideas for new and improved feedback mechanisms. PARTICIPANTS: Thirty-six stakeholders representing a range of clinical and non-clinical roles within palliative care and the wider health care system across a variety of statutory and non-statutory organizations from London and the West Midlands. RESULTS: Box plots were received more positively than league tables, and qualitative information was considered more appropriate than pictorial feedback. Conventional methods such as league tables and box plots were judged to lack essential information on which important decisions could be based, such as additional contextual information and the methodological assumptions of the instrument. Both feedback methods were considered useful as an impetus to further discussion. There was a consensus that feedback should be constructive and able to be adapted to the organizational realities in which UK health services function. CONCLUSION: Qualitative research was viewed as the right evidence for gaining an understanding of the quality of end of life care. Stakeholders highlighted the importance of the lay perspective, which requires approaches that illuminate the subjective meanings of patient experience.

Attitude of Health Personnel↗

PubMed2002

Women who sell sex in a Ugandan trading town: life histories, survival strategies and risk.

Little is known about the background of commercial sex workers in Africa. This study investigated how women in a trading town on the trans-Africa highway in southwest Uganda become involved in commercial sex work, which factors contribute to their economic success or lack of success, and what effect life trajectories and economic success have on negotiating power and risk behaviour. Over the course of two years detailed life histories of 34 women were collected through recording open, in-depth interviews, the collection of sexual and income and expenditure diaries, visits to the women's native villages, and participant observation. The women share similar disadvantaged backgrounds and this has played a role in their move into commercial sex. They have divergent experiences, however, in their utilisation of opportunities and in the level of success they achieve. They have developed different life styles and a variety of ways of dealing with sexual relationships. Three groups of women were identified: (1) women who work in the back-street bars, have no capital of their own and are almost entirely dependent on selling sex for their livelihood; (2) waitresses in the bars along the main road who engage in a more institutionalised kind of commercial sex, often mediated by middlemen and (3) the more successful entrepreneurs who earn money from their own bars as well as from commercial sex. The three groups had different risk profiles. Due partly to their financial independence from men, women in the latter group have taken control of sexual relationships and can negotiate good sexual deals for themselves, both financially and in terms of safe sex. The poorer women were more vulnerable and less able to negotiate safer sex. A disadvantaged background and restricted access to economic resources are the major reasons for women gravitating to commercial sex work. Various aspects of personality play a role in utilising income from commercial sex to set up an economic basis that then makes the selling of sex unnecessary. This has implications for interventions, and part of the longer-term solution should lie in improving the economic position of women vis-à-vis men.

Acquired Immunodeficiency Syndrome↗