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BACKGROUND: Coronary artery disease (CAD) is the most prevalent heart disease and a leading cause of death among both men and women. It is worth noting that anxiety is highly prevalent among patients with CAD, and it can significantly affect their overall performance and well-being. This study aimed to determine the impact of self-care training, specifically using the teach-back method, on health anxiety in patients with CAD. MATERIALS AND METHODS: In this randomized controlled clinical trial, a total of 50 patients with coronary artery disorders were selected from the coronary care unit of Rasool Hospital in Ferdows City, Iran, in 2022. The participants were randomly assigned to two groups. The intervention group received self-care training based on the teach-back method, which consisted of three individual sessions lasting 30–45 minutes each, conducted over the course of one week. However, the control group received routine care. To collect data, the researchers utilized Salkovskis et al.’s (2002) health anxiety questionnaire. The collected data were analyzed using the Chi-square test, Fisher’s exact test, independent t-test, and paired t-test at a significance level of P < 0.05. RESULTS: Most participants in the control and intervention groups were female. The mean ages of the intervention and control groups were 47.1 ± 12.83 and 48.1 ± 44.81 years, respectively, with no statistically significant difference (P = 0.67). The results indicated that there was a statistically significant difference in the total mean score (P = 0.000) and mean scores of subscales of health anxiety (awareness of bodily sensations or changes (P = 0.001), feared consequences of having an illness (P = 0.001), and worry about health (P = 0.008)) between the two groups. CONCLUSIONS: The self-care training based on the teach-back method reduced health anxiety in patients with CAD. Therefore, it is recommended to incorporate the teach-back method as an educational approach by nursing team to effectively reduce health anxiety in patients with CAD.

OBJECTIVES: Educational approaches for training physicians in clinical communications vary, and whether physicians apply the communication skills they learn or find them useful in the clinic is not well known. The aim of this study was to determine how first-year residents who received explicit instruction in 7 communication strategies would apply them in a simulation exercise and in clinical practice. METHODS: First-year Internal Medicine residents at an urban teaching hospital received instruction in 7 systematic communication strategies: Ask-Tell-Ask, Teach-back, open-ended questioning, NURSE, open body language, pausing, and plain language. Residents were evaluated on their use of specific communication behaviors associated with the 7 strategies during a simulation exercise of disclosing a medical error to a standardized patient. Control group residents who did the simulation before attending the training program and training group residents who did the simulation after the training were compared. Residents were queried 6 months after the training program on their use of communication strategies during clinical practice. RESULTS: A total of 27 residents participated (n = 13 control group; n = 14 training group). The training group performed behaviors for "establishing patient understanding" significantly more often than the control group. Both groups used non-verbal communication and behaviors for addressing patient emotions at similar levels. Of the 24 residents who responded to the 6-month follow-up questionnaire, 24 (100%) reported using Ask-Tell-Ask, open-ended questioning, and Teach-back, and 22 (92%) reported using NURSE statements and non-verbal communication. Most respondents reported using the strategies in clinical practice often or very often (79%) and found the strategies useful or very useful (96%). CONCLUSION: Providing explicit instruction in systematic communication strategies, particularly those focused on establishing patient understanding, may be an efficient approach for helping early career physicians develop effective communication skills that can be readily implemented during clinical training and practice. [ABSTRACT FROM AUTHOR]

Background: Patients’ adherence to the therapeutic regimen predicts the success of treatment and reduces the complications and severity of the disease. The purpose of this study was to determine the effectiveness of an educational intervention based on Teach-back method with adherence to treatment in patients with type 2 diabetes.Methods: We performed a quasi-experimental study on 90 patients with type 2 diabetes in the control and experimental groups. Data collection tools were a two-part questionnaire which consisted of the demographic information and the Mandaloo treatment adherence questionnaire with 40 questions. An educational intervention was performed for the members of the intervention group. One week and forty days after the intervention, the two groups filled out the treatment adherence questionnaire again. The gathered data were analyzed in SPSS software version 22 using statistical tests of Wilcoxon, Chisquare, Makhli, Ben Foroni, the repeated-measures variance of analysis, and independent t-test. The significance level in this study was considered less than 0.05.Results: The mean scores of adherence to treatment in the training group before the intervention, one week, and forty days after the intervention were 120.52±11.49, 157.60±17.96, and 140.65±18.80, respectively; also, in the control group, the mean scores were 113.38±16.89, 150.67±18.58, and 145.02±18. 47, respectively. There was no difference in terms of adherence to treatment between the control and experiment groups (P=0.164).Conclusion: The findings also showed that adherence to treatment in both groups in all three measurement times was at the fitness level.

Aim: Patient awareness and disease-specific knowledge are essential for shared decision-making of patients with abdominal aortic aneurysms. With this pilot survey, we aimed to figure out the obstacles to patient's awareness about the aortic aneurysm before and after the procedure. Material and Methods: Patients who experienced elective endovascular aortic aneurysm repair (EVAR) in our Cardiovascular Surgery Clinic between 2019 to 2023 were the selected patient cohort. The first 50 patients who visited our outpatient clinic were given a questionnaire about their awareness of the aneurysm disease, disease-specific knowledge, and the comprehensibility of the patient information provided before and after the procedure. Results: The mean age of our patients was 66±6.9. Younger patients were more aware of the situation before the information (p=0.013). Patients anxious about the disease were also more conscious about the aortic aneurysm (p=0.02). Although all patients were given preoperative information and disease-specific information by the same team, 13 patients (26%) could not recall anything about the disease and did not recall what operation was performed and why. Thirty-seven patients (74%) gained awareness about the disease. The patients with at least an educational level above high school gained more awareness than others (p=0.04). Conclusion: The Classical informatory model seems insufficient for gaining awareness and consciousness for older patients and with patients with low level of education. Strengthened patient-practitioner interaction with supplemental technologies (leaflets, interactive media, audio tapes, etc.) may improve these patients' shared decision-making. More prospective research is required in this regard. [Turk J Vasc Surg 2023; 32(2.000): 107-13]

Aim: Patient awareness and disease-specific knowledge are essential for shared decision-making of patients with abdominal aortic aneurysms. With this pilot survey, we aimed to figure out the obstacles to patient's awareness about the aortic aneurysm before and after the procedure. Material and Methods: Patients who experienced elective endovascular aortic aneurysm repair (EVAR) in our Cardiovascular Surgery Clinic between 2019 to 2023 were the selected patient cohort. The first 50 patients who visited our outpatient clinic were given a questionnaire about their awareness of the aneurysm disease, disease-specific knowledge, and the comprehensibility of the patient information provided before and after the procedure. Results: The mean age of our patients was 66±6.9. Younger patients were more aware of the situation before the information (p=0.013). Patients anxious about the disease were also more conscious about the aortic aneurysm (p=0.02). Although all patients were given preoperative information and disease-specific information by the same team, 13 patients (26%) could not recall anything about the disease and did not recall what operation was performed and why. Thirty-seven patients (74%) gained awareness about the disease. The patients with at least an educational level above high school gained more awareness than others (p=0.04). Conclusion: The Classical informatory model seems insufficient for gaining awareness and consciousness for older patients and with patients with low level of education. Strengthened patient-practitioner interaction with supplemental technologies (leaflets, interactive media, audio tapes, etc.) may improve these patients' shared decision-making. More prospective research is required in this regard. [ABSTRACT FROM AUTHOR]

Education for patients with type 2 diabetes is an essential part of the treatment and control process. This study aimed to determine the effect of education based on health literacy strategies on adherence to treatment and quality of life in type 2 diabetic patients. This classic experimental study was performed on 94 patients with type 2 diabetes selected by convenient sampling method and then randomly allocated to intervention and control groups. The research instruments were a demographic information questionnaire, a Diabetes Quality of Life Brief Clinical Inventory, and an adherence to treatment questionnaire in patients with chronic disease. The educational intervention was five sessions of the virtual class of 80-90 min. All respondents completed the tools again two months after the intervention. Independent t-tests and paired t-tests were used for data analysis. The difference in the mean score of quality of life in the intervention group between the time before (53.21 ± 7.6) the intervention and two months after (55.28 ± 6.87) was statistically significant (p˂0.05). Comparison of the mean score of quality of life between the control and intervention groups, before the intervention (p > 0.05) and two months after (p > 0.05), neither showed a statistically significant difference. A comparison of the mean scores of adherence to treatment before (69.31 ± 5.32) and after the intervention (70.59 ± 5.21) showed that there was a statistically significant difference in the intervention group (p˂0.001). Comparison of the mean scores of adherence two months after the intervention revealed that, there is a significant statistical difference between the scores of the two groups (p˂ 0.001). Based on the findings of this study, it seems that providing training sessions based on health literacy strategies can improve the quality of life and adherence to treatment in patients with type 2 diabetes., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval and consent to participate: The respondents were assured that their data would remain confidential. Oral (by phone) and written (by creating a specific option in the online questionnaire for this purpose) informed consent was obtained from the respondents to participate in this research. Also, it has been approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.PHARMACY.REC.1399.036). All methods were carried out in accordance with relevant guidelines and regulations., (© 2024. The Author(s).)

The use of the best teaching method to promote self-care in patients with inflammatory bowel disease (IBD) has not been well defined. Therefore, the current study was conducted to compare the effect of self-care education by two methods of teach-back and a smartphone application. The current clinical trial with a pre- and post-test design was conducted among 78 patients with IBD. Patients were allocated to three groups of application, teach-back and control using a simple blocked randomization. Data were collected using a checklist for demographic information and Inflammatory Bowel Disease Self-efficacy Scale. Collected data were analyzed using SPSS. Participants in all three groups were homogeneous in terms of demographic variables. The mean pretest scores of self-efficacy (SE) in the application, teach-back and control groups were 191.37 ± 49.15, 193.92 ± 45.54 and 192.76 ± 43.12, respectively. The mean post-test scores of SE in the application, teach-back and control groups were 224.51 ± 49.89, 207.48 ± 48.109 and 189.92 ± 40.28, respectively (P = 0.033). The results of the current study showed that self-care education by the application can better improve the mean scores of SE and its four dimensions of managing stress and emotions, managing symptoms and disease, managing medical care and maintaining remission, compared to other methods. It seems that the use of the application as a continuous and cost-effective educational strategy will become widespread in the future for patient education among most healthcare and treatment systems., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

PurposeThis study's purpose was to explore how content and format of children's oral health instruction in the dental clinic is perceived by parents and might affect parents' knowledge and behaviors.MethodsThirty low-income Mexican immigrant parents of children age five years and under were recruited from dental clinics in 2015 to 2016. In-person qualitative interviews in Spanish about their children's and their own experiences of dental care and home oral hygiene practices were conducted, digitally recorded, translated, and transcribed. Data analysis involved iteratively reading text data and developing and refining codes to find common themes.ResultsTwenty-five of 30 parents recalled receiving oral hygiene instruction, and 18 recalled receiving nutrition instruction and were included in analyses. The format and effectiveness of instruction varied. More engaging educational approaches were recalled and described in more detail than less engaging educational approaches. As a result of oral hygiene and nutritional instruction, most parents reported changing their oral hygiene home behaviors for their children; half aimed to reduce purchasing sugary foods and drinks.ConclusionsMost parents recalled receiving oral hygiene and nutrition instruction as part of their child's dental visit and reported incorporating the instruction and recommendations they received into their children's home routine.

Abstract Background Heart failure (HF) patients have difficulties in self-management after discharge. This study aimed to develop a discharge education program for HF patients using the teach-back method (TBM). Methods As a methodological study to develop a program, we applied the analysis, design, development, implementation, and evaluation (ADDIE) model comprised of (1) analysis using EMR data, systematic review, and focus group interviews, (2) design and development of a program draft, (3) tests of program validity using 15 experts, 10 nurses, and 10 patients, and (4) development of the final program. The content validity index (CVI), and understandability and actionability of the educational material were used. Results The discharge education program provides definitions and information about medication, symptom/weight/diet management, physical activity, and other precautions. The educational method uses TBM. The overall CVI for the program was 0.96, and all item CVIs were greater than 0.8. The understandability and actionability were 90.2 and 91.3 % in patients, and 94.6 and 86.8 % in nurses. The contents and methods of the program were appropriate for patients and providers. Conclusions We expect the discharge education program using TBM to enhance self-management among HF patients. The process we used to develop this program could guide researchers and clinical practice.

Background & Aim: Kidney transplantation leads to return to a healthy life and relief from hemodialysis restrictions. The benefits of kidney transplantation have been proven but require constant self-care monitoring throughout one's life and training and support. One of the new methods of training is the teach-back method used to obtain and understand information. This study aimed to determine the impact of self-care education with Teach-Back method on self-esteem in Kidney Transplant Recipients. Methods: In this clinical trial study, 79 renal transplant patients were selected from the clinic of Imam Khomeini Hospital in Urmia in 2016 and were randomly assigned to intervention and control groups. Then, in the intervention group, educational content about self-care with teach-back method was presented during five 60-minute sessions. Data were collected using demographic questionnaire and Rosenberg self-esteem questionnaire. Results: Before intervention, the mean score of self-esteem was not significantly different between the control and intervention groups (P=0.559). After the intervention, the intervention group had a significant increase in the mean score of self-esteem compared to the control group (P=0.001). Conclusion: In this study, self-care education with teach-back method was effective in improving the self-esteem of kidney transplant patients. And it is suggested to use the teach-back method in education of patients with kidney transplantation.

A quasi-experimental study aimed to investigate the effects of both teach-back and blended training methods on the contribution to self-care and perceived care burden among family caregivers of patients with heart failure. Seventy family caregivers of patients with heart failure were randomly allocated to two groups: one receiving the teach-back method and the other receiving the blended training method. Data were collected before, 1 month, and 3 months after the intervention. Data collection included demographic data and two tools: the Caregiver Contribution to Self-Care of Heart Failure Index and the Caregiver Burden Questionnaire for Heart Failure. Both teach-back and blended training methods were effective in educating family caregivers of patients with heart failure requiring home care. However, the teach-back method demonstrated better outcomes for the two concepts examined in this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The role of nurses in educating patients with heart failure is crucial. To ensure effective nursing education, it is vital to integrate new strategies, especially for chronic diseases. The teach-back method (TBM) provides a fresh approach to engaging with patients, effectively overcoming communication barriers, and enhancing long-term educational outcomes., Objective: The objective of this study was to analyze how the implementation of the teach-back method influences the self-care and quality of life of patients living with heart failure., Methods: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) checklist. To ensure thoroughness, an extensive search was carried out across multiple online databases, including PubMed, Web of Science, EMBASE, Scopus, Cochrane Library, CINAHL, and ProQuest. The search spanned from 2000 to August 2023 and employed Medical Subject Headings (MESH) as the basis for keyword selection. No limitations were placed on the language of the studies included in this review. We ensured the inclusion of all relevant articles by searching the gray literature and checking reference lists. Studies which conducted on adults aged ≥ 18 years and diagnosed with heart failure who were not critically ill, receiving dialysis, and waiting for cardiac device implantation was included. We considered all interventional studies. Two reviewers had independently conducted the risk of bias assessment using Cochrane tools. Finally, a narrative synthesis was implemented., Results: The preliminary search conducted in the databases mentioned above yielded a total of 1702 results. After meticulously going through the steps of study selection, a total of 9 studies involving 768 participants were ultimately chosen to be part of this study. Self-care was the subject of investigation in six studies, whereas quality of life was examined in three studies. The majority of studies indicate that the intervention under consideration had a significant impact on self-care. In relation to quality of life, one study failed to achieve statistically significant outcomes, potentially owing to its small sample size., Conclusion: Our systematic review demonstrated that the teach-back method, as an innovative educational technique, holds potential for heart failure patients` education and counseling., Practical Value: The teach-back approach confirms patient understanding. Patient understanding is confirmed through rephrasing the information in their own words., Protocol Registration: The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) at the National Institute for Health Research (No: CRD42023446142)., (© 2024. The Author(s).)

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Patients discharged in the emergency department often have poor understanding of their discharge instructions. Teach-back is a communication method that involves asking patients to explain in their own words what a health care provider just told them. The purpose of this project was to determine whether nurse-led teach-back at discharge could improve patient satisfaction with discharge information. A teach-back method was used to educate patients on what to do if they do not feel better after leaving, using a single site quality improvement design. Patient satisfaction was measured using a standardized benchmark question on whether providers explained what to do if they did not feel better after leaving. The department goal for this question was established as achieving a response of "Yes, definitely" for 64.4% or more of the satisfaction surveys. Patient satisfaction data were collected before and after intervention through a survey given to patients within 24 hours after their visit. A statistical process chart was used to analyze whether the observed improvements coincided with implementation of the teach-back intervention. Although there was an overall increase in post-intervention scores (61%) from baseline scores (59%), there were no special cause variations signaling that the intervention had a significant impact. Teach-back may improve patient satisfaction with discharge information. Future implementation with measures of intervention adoption, fidelity, accountability, and sustainability are needed. [Display omitted] [ABSTRACT FROM AUTHOR]

Cognitive deficits are common in older adults, as a result of both the natural aging process and neurodegenerative disease. Although medical advancements have successfully prolonged the human lifespan, the challenge of remediating cognitive aging remains. The authors discuss the current state of cognitive therapeutic interventions and then present the need for development and validation of more powerful neurocognitive therapeutics. They propose that the next generation of interventions be implemented as closed-loop systems that target specific neural processing deficits, incorporate quantitative feedback to the individual and clinician, and are personalized to the individual's neurocognitive capacities using real-time performance-adaptive algorithms. This approach should be multimodal and seamlessly integrate other treatment approaches, including neurofeedback and transcranial electrical stimulation. This novel approach will involve the generation of software that engages the individual in an immersive and enjoyable game-based interface, integrated with advanced biosensing hardware, to maximally harness plasticity and assure adherence. Introducing such next-generation closed-loop neurocognitive therapeutics into the mainstream of our mental health care system will require the combined efforts of clinicians, neuroscientists, bioengineers, software game developers, and industry and policy makers working together to meet the challenges and opportunities of translational neuroscience in the 21st century.

Objective: Transitions from hospital to home are high-risk episodes. Communication problems between patients/carers and their primary healthcare providers are a central part of the risk. This literature review aimed to identify any existing tools or information (including secondary care instruments) that would facilitate designing new communication instruments for primary care to manage and mitigate risk at discharge.Method: Five databases (Pubmed, Embase, Cinahl, Web of Science and Cochrane) were searched using a three stem approach (primary/transitional care, discharge period, communication). A dual reviewer system was used, following PRISMA guidelines.Results: From 61 full text articles a total of ten tools were found, 25 articles contained other useful content, 19 further tools were found in grey literature. Most material originated from the USA and described hospital-based transitional care interventions.Conclusion: No ready-made patient/provider communication tool for the post-discharge period in primary care was found. Future communication tools should enhance education and engagement of patients so they feel able to initiate communication.Practice Implications: Collating post-discharge communication material is of importance to improving the safety of care transitions and will enable creation of new tools specifically designed for primary care. These tools will improve patient activation ('the knowledge, skills and confidence a person has in managing their own health and care') with the ultimate aim of reducing error and harm in primary care through improved communication of healthcare decisions. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) patients have difficulties in self-management after discharge. This study aimed to develop a discharge education program for HF patients using the teach-back method (TBM). Methods: As a methodological study to develop a program, we applied the analysis, design, development, implementation, and evaluation (ADDIE) model comprised of (1) analysis using EMR data, systematic review, and focus group interviews, (2) design and development of a program draft, (3) tests of program validity using 15 experts, 10 nurses, and 10 patients, and (4) development of the final program. The content validity index (CVI), and understandability and actionability of the educational material were used. Results: The discharge education program provides definitions and information about medication, symptom/weight/diet management, physical activity, and other precautions. The educational method uses TBM. The overall CVI for the program was 0.96, and all item CVIs were greater than 0.8. The understandability and actionability were 90.2 and 91.3 % in patients, and 94.6 and 86.8 % in nurses. The contents and methods of the program were appropriate for patients and providers. Conclusions: We expect the discharge education program using TBM to enhance self-management among HF patients. The process we used to develop this program could guide researchers and clinical practice. [ABSTRACT FROM AUTHOR]

Abstract Background Telehealth professionals require advanced communication skills, in part to compensate for lack of visual cues. Teach-Back is a best practice communication technique that has been recommended but not previously evaluated for consumer telehealth. We aimed to implement Teach-Back at a national maternal and child health telephone helpline. We describe the intervention and report telenurse experiences learning to use Teach-Back. Methods We identified barriers (time, knowledge, skills, beliefs) and enablers (self-reflection) to using Teach-Back, and developed a novel training program to address these, guided by the Theoretical Domains Framework. We engaged maternal and child health telenurses to participate in a “communication skills” study. The intervention had two key components: guided self-reflection and a Teach-Back skills workshop. For the duration of the 7-week study nurses completed brief online surveys following each call, reflecting on both the effectiveness of their communication and perceived caller understanding. At the end of each shift they reflected on what worked well. Teach-Back knowledge, skills, and beliefs were addressed in a 2-h workshop using videos, discussion, and role play. We explored nurses’ experiences of the intervention in focus groups and interviews; and analysed transcripts and comments from the self-reflection surveys using the Framework method. This study forms part of a larger evaluation conducted in 2016. Results In total 16 nurses participated: 15 were trained in Teach-Back, and 13 participated in focus groups or interviews. All engaged with both self-reflection and Teach-Back, although to differing extents. Those who reported acquiring Teach-Back skills easily limited themselves to one or two Teach-Back phrases. Nurses reported that actively self-reflecting (including on what they did well) was useful both for developing Teach-Back skills and analysing effectiveness of the techniques. Most wanted more opportunity to learn how their colleagues manage Teach-Back in different situations, and more visual reminders to use Teach-Back. Conclusions Our theory-informed intervention successfully enabled nurses to use Teach-Back. Guided self-reflection is a low-resource method aligned with nurse professional identity that can facilitate Teach-Back skills learning, and could also be applied to other advanced communication skills for telehealth. Listening to multiple workplace-specific examples of Teach-Back is recommended for future training. Trial registration ACTRN12616000623493 Registered 15 May 2016. Retrospectively registered.

BACKGROUND: Adopting a healthy lifestyle is necessary to maintain and promote health. The aim of this study was to determine the effect of teach-back method on improving the lifestyle of health ambassadors in Urmia. MATERIALS AND METHODS: In this quasi-experimental study, 200 health ambassadors were participated. The research sample was obtained using simple random sampling method. Data collection tool was a questionnaire including demographic characteristics and lifestyle standard. The educational intervention was performed in 4 sessions of 45 min based on the teach-back method. Data were collected through a lifestyle questionnaire before and 3 months after the educational intervention. Then, the data were analyzed by mean and standard deviation, independent t-test, paired t-test, and Chi-square test through SPSS 19. RESULTS: The results showed that 24% of the control group and 21% of the intervention group had a good lifestyle before the educational intervention. After the educational intervention 27% of the control group and 54% of the intervention group were in good lifestyle. The results also showed that the mean score of total lifestyle and all its dimensions in the intervention group increased compared to the control group after the educational intervention and the difference between the mean score of total lifestyle and all its dimensions in the intervention group after the intervention was significant (P < 0.05). CONCLUSIONS: Among health ambassadors, teach-back communication is more effective in improving the lifestyle. Therefore, it is suggested that this method must be used in designing training programs for health ambassadors.

ABSTRACT CONTEXT AND OBJECTIVE: Breaking bad news is one of doctors’ duties and it requires them to have some skills, given that this situation is difficult and distressful for patients and their families. Moreover, it is also an uncomfortable condition for doctors. The aim of this study was to evaluate doctors’ capacity to break bad news, ascertain which specialties are best prepared for doing this and assess the importance of including this topic within undergraduate courses. DESIGN AND SETTING: Observational cross-sectional quantitative study conducted at a university hospital in Belo Horizonte (MG), Brazil. METHODS: This study used a questionnaire based on the SPIKES protocol, which was answered by 121 doctors at this university hospital. This questionnaire investigated their attitudes, posture, behavior and fears relating to breaking bad news. RESULTS: The majority of the doctors did not have problems regarding the concept of bad news. Nevertheless, their abilities diverged depending on the stage of the protocol and on their specialty and length of time since graduation. Generally, doctors who had graduated more than ten years before this survey felt more comfortable and confident, and thus transmitted the bad news in a better conducted manner. CONCLUSION: Much needs to be improved regarding this technique. Therefore, inclusion of this topic in undergraduate courses is necessary and proposals should be put forward and verified.

BACKGROUND: The knowledge level of caregivers and their support for patients can affect the self-care of patients with heart failure (HF). The present study was conducted to compare the effects of teach-back, multimedia, and blended training methods on self-care and social support in patients with HF and on knowledge in their caregivers. MATERIALS AND METHODS: In a randomized clinical trial, a total of 150 HF patient-caregiver dyads were randomly allocated into three equally sized training groups, using a simple number table (n = 50). The study was conducted between May to October 2018 in Sari, northern Iran. In the teach-back, multimedia and blended training groups, patient-caregiver dyads participated in 20–30-min training sessions held face-to-face, using digital video disc (DVD) and combination of teach-back and DVD on 4 consecutive days at the bedside of hospitalized patients in coronary care unit, respectively. Data were collected using the European Heart Failure Self-Care Behaviour Scale and the multidimensional scale of perceived social support for patients. Caregivers' level of knowledge was measured using the HF Knowledge Scale. Data were measured on the first day of hospitalization, 1 day before discharge and 4 and 8 weeks after patients' discharge. Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA). RESULTS: All three educational methods improved self-care behaviors in patients. The comparison of self-care behavior scores in patients with HF among the three groups at different time points showed no statistically significant differences (P > 0.05), except 1 day before discharge (P = 0.04). There were no statistically-significant differences between the teach-back, multimedia and the blended training group in terms of perceived social support at any of the four-time points (P > 0.05). All three training methods improved the level of knowledge of caregivers. However, the score in the blended training groups was higher than the other groups (P < 0.001). CONCLUSION: According to the results of the present study, it seems that all three educational interventions can improve self-care behaviors in HF patients and increase knowledge in their caregivers. However, using the blended training method was associated with better outcomes.

Backround: The CAST Grid has been developed to evaluate the use of closed-loop communication (CLC) in the trauma bay., Methods: The CAST Grid and two validated non-technical team performance assessment tools (the TEAM and T-NOTECHS grids) were completed by 2 independent reviewers based on trauma care simulation videos from a French Level 1 trauma center. Intra- and inter-rater agreements were evaluated for CLC parameters and non-technical performance, and correlations between these parameters were analyzed., Results: The study analyzed 11 videos. The intra- and inter-rater agreement for the number of CLC per minute (CLC/min) was moderate and good, respectively, based on Lin's concordance correlation coefficient [95%CI] (0.57 [-0.40;0.94] and 0.77 [0.33;0.94]). However, the agreement was poor for the percentage of CLC (0.37 [-0.58;0.89] and -0.36 [-0.71;0.14], respectively). The study found that a lower number of CLC/min was correlated with an increased duration of the simulation (r = -0.75 [-0.93; -0.25])., Conclusion: The CAST Grid showed a relatively good inter-rater agreement to quantify the number of CLC/min which was inversely correlated with the duration of care. This tool opens up the possibility of quantifying CLC and allows for new analyses of team functioning and interactions., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Heart failure is one of the most common causes of hospital readmission. Self-care is an essential but challenging task for patients with heart failure, and inadequate self-care is closely related to unplanned readmission and unnecessary health expenditure. Patient-centered education using the teach-back method emerged as a key strategy to prevent patients' adverse events by improving self-care. To evaluate the effects of discharge education using the teach-back method on self-care, self-care efficacy, symptoms of heart failure, caregiver dependency, and unplanned healthcare resource utilization among patients with heart failure. A prospective, two-arm randomized controlled trial. Four adult cardiology units at a tertiary hospital in Seoul, South Korea. A total of 100 patients diagnosed with heart failure and scheduled to be discharged to their homes. The intervention group received the HEART program® in addition to the usual discharge education by a trained nurse before discharge, while the control group received usual discharge education only. The discharge education included the definition of heart failure, medication, symptom management, diet, physical activity, and other precautions. Data on self-care (self-care maintenance; symptom-perception; self-care management), self-care efficacy, symptoms of heart failure, and caregiver dependency were measured at 7-days after discharge (T1), and unplanned healthcare resource utilization (including readmission, emergency room visit, and healthcare professional contacts) was assessed at 1-month after discharge (T2). Outcomes were analyzed with ANCOVA. A total of 94 patients (intervention group = 45, control group = 49) completed outcome measurements at the three-time points. Participants in the intervention group showed a significant improvement in self-care maintenance (F = 11.597, p = 0.001), symptom perception (F = 20.173, p < 0.001), self-care management (F = 7.205, p = 0.009), and self-care efficacy (F = 4.210, p = 0.043) compared to the control group. However, there were no statistically significant differences in symptoms of heart failure, caregiver dependency, and unplanned healthcare resource utilization between the two groups (all ps > 0.05). The findings demonstrated that discharge education using the teach-back method is an effective educational strategy to improve self-care and self-care efficacy in patients with heart failure. We recommend nurses implement discharge education using the teach-back method for patients with heart failure. This study was registered at the Clinical Research Information Service (KCT0004444) on November 15, 2019, and the participant recruitment was initiated in June 2020. [ABSTRACT FROM AUTHOR]

Objective: Assess the effects of feedback reports and implementing a closed-loop communication system on rates of recommendations for additional imaging (RAIs) in thoracic radiology reports., Methods: In this retrospective, institutional review board-approved study at an academic quaternary care hospital, we analyzed 176,498 thoracic radiology reports during a pre-intervention (baseline) period from April 1, 2018, to November 30, 2018; a feedback report only period from December 1, 2018, to September 30, 2019; and a closed-loop communication system plus feedback report (IT intervention) period from October 1, 2019, to December 31, 2020, promoting explicit documentation of rationale, time frame, and imaging modality for RAI, defined as complete RAI. A previously validated natural language processing tool was used to classify reports with an RAI. Primary outcome of rate of RAI was compared using a control chart. Multivariable logistic regression determined factors associated with likelihood of RAI. We also estimated the completeness of RAI in reports comparing IT intervention to baseline using χ 2 statistic., Results: The natural language processing tool classified 3.2% (5,682 of 176,498) reports as having an RAI; 3.5% (1,783 of 51,323) during the pre-intervention period, 3.8% (2,147 of 56,722) during the feedback report only period (odds ratio: 1.1, P = .03), and 2.6% (1,752 of 68,453) during the IT intervention period (odds ratio: 0.60, P < .001). In subanalysis, the proportion of incomplete RAI decreased from 84.0% (79 of 94) during the pre-intervention period to 48.5% (47 of 97) during the IT intervention period (P < .001)., Discussion: Feedback reports alone increased RAI rates, and an IT intervention promoting documentation of complete RAI in addition to feedback reports led to significant reductions in RAI rate, incomplete RAI, and improved overall completeness of the radiology recommendations., (Copyright © 2023 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Objectives: Communication failure is one of the most common causes of adverse events in hospitals and poses a direct threat to patient safety. Research recommends the use of closed-loop communication in interprofessional emergency teams to prevent such events. Multiple studies have examined closed-loop communication during simulation training, but few have investigated its use in clinical practice. The aim of the study was to explore the use of closed-loop communication by anesthesia personnel in real-life interprofessional emergency teams., Methods: This study had a descriptive, cross-sectional design where structured field observations were used to assess anesthesia personnel's use of closed-loop communication in real-life interprofessional emergency teams. A total of 60 interprofessional teams were observed, including 120 anesthesia personnel at a hospital in South-Eastern Norway. Data were analyzed using descriptive statistics., Results: A total of 1626 call outs were registered, in which closed-loop communication was applied in 45%. Closed-loop communication was used more frequently when call outs were directed using eye contact and when the call outs were medication orders. There was no difference in the use of closed-loop communication between nurse anesthetists and anesthesiologists. Closed-loop communication was used more frequently in cardiac arrest teams than in trauma teams., Conclusions: The findings in this study have contributed knowledge about anesthesia personnel's use of closed-loop communication in real-life interprofessional emergency teams and indicate a potential for improvement. Further research is needed about real-life interprofessional emergency teams' communication patterns and potential barriers from using closed-loop communication, with the aim to improve patient safety., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

BACKGROUND. Patients with adverse social determinants of health may be at increased risk of not completing clinically necessary follow-up imaging. OBJECTIVE. The purpose of this study was to use an automated closed-loop communication and tracking tool to identify patient-, referrer-, and imaging-related factors associated with lack of completion of radiologist-recommended follow-up imaging. METHODS. This retrospective study was performed at a single academic health system. A tool for automated communication and tracking of radiologist-recommended follow-up imaging was embedded in the PACS and electronic health record. The tool prompted referrers to record whether they deemed recommendations to be clinically necessary and assessed whether clinically necessary follow-up imaging was pursued. If imaging was not performed within 1 month after the intended completion date, the tool prompted a safety net team to conduct further patient and referrer follow-up. The study included patients for whom a follow-up imaging recommendation deemed clinically necessary by the referrer was entered with the tool from October 21, 2019, through June 30, 2021. The electronic health record was reviewed for documentation of eventual completion of the recommended imaging at the study institution or an outside institution. Multivariable logistic regression analysis was performed to identify factors associated with completion of follow-up imaging. RESULTS. Of 5856 recommendations entered during the study period, the referrer agreed with 4881 recommendations in 4599 patients (2929 women, 1670 men; mean age, 61.3 ± 15.6 years), who formed the study sample. Follow-up was completed for 74.8% (3651/4881) of recommendations. Independent predictors of lower likelihood of completing follow-up imaging included living in a socioeconomically disadvantaged neighborhood according to the area deprivation index (odds ratio [OR], 0.67 [95% CI, 0.54-0.84]), inpatient (OR, 0.25 [95% CI, 0.20-0.32]) or emergency department (OR, 0.09 [95% CI, 0.05-0.15]) care setting, and referrer surgical specialty (OR, 0.70 [95% CI, 0.58-0.84]). Patient age, race and ethnicity, primary language, and insurance status were not independent predictors of completing follow-up ( p > .05). CONCLUSION. Socioeconomically disadvantaged patients are at increased risk of not completing recommended follow-up imaging that referrers deem clinically necessary. CLINICAL IMPACT. Initiatives for ensuring completion of follow-up imaging should be aimed at the identified patient groups to reduce disparities in missed and delayed diagnoses.

Objective Recommended as a 'universal precaution' for improving provider–patient communication, teach-back has a limited evidence base. Discharge from the emergency department (ED) to home is an important high-risk transition of care with potential for miscommunication of critical information. We examined whether teach-back improves: comprehension and perceived comprehension of discharge instructions and satisfaction among patients with limited health literacy (LHL) in the ED. Methods We performed a randomized, controlled study among adult patients with LHL, randomized to teach-back or standard discharge instructions. Patients completed an audio-recorded structured interview evaluating comprehension and perceived comprehension of (1) diagnosis, (2) ED course, (3) post-ED care, and (4) reasons to return and satisfaction using four Consumer Assessment of Healthcare Providers and Systems questions. Concordance with the medical record was rated using a five-level scale. We analyzed differences between groups using multivariable ordinal logistic regression. Results Patients randomized to receive teach-back had higher comprehension of post-ED care areas: post-ED medication (P < 0.02), self-care (P < 0.03), and follow-up instructions (P < 0.0001), but no change in patient satisfaction or perceived comprehension. Conclusion Teach-back appears to improve comprehension of post-ED care instructions but not satisfaction or perceived comprehension. Our data from a randomized, controlled study support the effectiveness of teach-back in a busy clinical setting. Further research is needed to test the utility and feasibility of teach-back for routine use including its impacts on distal outcomes. [ABSTRACT FROM AUTHOR]