Do patient and clinician goals align in a prehabilitation setting? A mixed methods study
Notice bibliographique
Résumé
Background.Engaging patients in healthcare can empower them to take an active role in their treatment, improve their understanding of medical decisions, and foster better communication with healthcare providers, ultimately improving treatment adherence, outcomes, and satisfaction.To enhance patient engagement in an Enhanced Recovery After Surgery setting, at the PeriOperative Program (POP) prehabilitation clinic, we co-developed (with patients) a handout that invited patients to outline their preoperative goals and its significance.We explored the following research questions: (1) What are the goals of patients receiving prehabilitation?(2) How well do these goals align with the surgeons' reasons for referral to prehabilitation? ( 3) To what extent does goal alignment influence attainment of surgeons' referral aim. Methods.Using a mixed methods sequential exploratory design, all engagement handouts from September 2021-2023 were evaluated without exclusion.Qualitative responses were transcribed verbatim, and quantitative data on the alignment of patient goals with clinician referrals were collected.Quantitative data on the proportion of patient goals that were completely, partially, or misaligned with surgeon referral were collected concurrently.Qualitative data were analyzed with summative content analysis (NVivo).Quantitative data were analyzed descriptively. Results.A total of 191 patient handouts were reviewed.Surgical indications were lung (38%, n=72) and gastrointestinal diseases (26%, n=49), hernia (19%, n=37), and orthopedic/spinal procedures (17%, n=33).The goal section of the handout was completed by 178 patients and the most frequently reported goals included improving physical health (27%, n=86), simply feeling prepared for surgery (18%, n=56), and improving nutrition (15%, n=49).Rationale for these goals included personal well-being (39%, n=93), to recover well from surgery (20%, n=47), and the well-being of others such as family and friends (15%, n=36).Complete data for alignment were available for 167 patients.Forty-nine percent of patient goals (n=81) partially aligned with their surgeon's referral, 32% (n=55) fully aligned, and 19% (n=31) did not align (P<0.001).Of the goals that did not align with referrals, smoking cessation and weight loss were the most mismatched.When surgeon and patient goals completely aligned, 85% (n=47) of patients met the referral aim, compared to only 16% (n=5) when goals were misaligned (P<0.001). Conclusion.The top patient goals in a prehabilitation program were to improve physical health, feel prepared for surgery, and enhance nutrition, but only a third of these goals completely aligned with clinician referrals.Patients whose goals aligned with their surgeon's showed significantly higher prehabilitation success compared with patients whose goals did not align.Future research should explore ways to better align clinician goals with patient priorities.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,067 | 0,073 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,004 | 0,003 |
| Études des sciences et des technologies | 0,004 | 0,003 |
| Communication savante | 0,005 | 0,004 |
| Science ouverte | 0,002 | 0,004 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».