Revistas
Revista:
INTERNATIONAL JOURNAL OF MORPHOLOGY
ISSN:
0717-9367
Año:
2023
Vol.:
41
N°:
1
Págs.:
146 - 155
Los estudios de corte transversal (ECT) inician en la década de los 40 en países Europeos. Los ECT corresponden a investigaciones de tipo observacional que permiten estudiar prevalencia de enfermedad, determinar asociación entre variables y el desarrollo de un efecto de interés, conocer propiedades de una prueba diagnóstica, y censar poblaciones; describiendo las características de una población en un momento y lugar determinado. Esto implica, que no se requieren periodos de seguimiento, que no son prospectivos ni retrospectivos; características que permiten que sean más baratos y fáciles de realizar en relación a los estudios longitudinales. Por otro lado, al ser de carácter descriptivo sirven como insumo y evidencia preliminar para estudios de mayor complejidad metodológica, como estudios de cohortes. Sin embargo, tienen limitantes y sesgos que deben ser considerados por los investigadores. El objetivo de este manuscrito fue generar un documento de estudio para revisar características esenciales, fortalezas y debilidades; discutir cuestiones metodológicas de los ECT en ciencias de la salud; y proporcionar algunos ejemplos obtenidos de la literatura, para mejor comprensión del diseño.
Autores:
García Bautista, A.; Kamath, C.; Ayala, N.; et al.
Revista:
MAYO CLINIC PROCEEDINGS. INNOVATIONS, QUALITY & OUTCOMES
ISSN:
2542-4548
Año:
2023
Vol.:
7
N°:
4
Págs.:
248 - 255
Objective: To compare the agreement between patient and clinician perceptions of care-related financial issues.
Patients and Methods: We surveyed patient-clinician dyads immediately after an outpatient medical encounter between September 2019 and May 2021. They were asked to separately rate (1-10) patient¿s level of difficulty in paying medical bills and the importance of discussing cost issues with that patient during clinical encounters. We calculated agreement between patient-clinician ratings using the intraclass correlation coefficient and used random effects regression models to identify patient predictors of paired score differences in difficulty and importance of ratings.
Results: 58 pairs of patients (n=58) and clinicians (n=40) completed the survey. Patient-clinician agreement was poor for both measures, but higher for difficulty in paying medical bills (intraclass correlation coefficient=0.375; 95% CI, 0.13-0.57) than for the importance of discussing cost (¿0.051; 95% CI, ¿0.31 to 0.21). Agreement on difficulty in paying medical bills was not lower in encounters with conversations about the cost of care. In adjusted models, poor patient-clinician agreement on difficulty in paying medical bills was associated with lower patient socioeconomic status and education level, whereas poor agreement on patient-perceived importance of discussing cost was significant for patients who were White, married, reported 1 or more long-term conditions, and had higher education and income levels.
Conclusion: Even in encounters where cost conversations occurred, there was poor patient-clinician agreement on ratings of the patient¿s difficulty in paying medical bills and perceived importance of discussing cost issues. Clinicians need more training and support in detecting the level of financial burden and tailoring cost conversations to the needs of individual patients.
Autores:
Robles-Sanchez, M. A. (Autor de correspondencia); Moharra, M.; Bosch-Farre, C.; et al.
Revista:
JOURNAL OF NEUROSCIENCE NURSING
ISSN:
0888-0395
Año:
2023
Vol.:
55
N°:
5
Págs.:
164 - 170
BACKGROUND: Patients with multiple sclerosis (MS) may experience decisional conflict during treatment choice. Shared decision making (SDM), whereby patients and health professionals, primarily nurses, collaborate in making decisions, reduces this decisional conflict. It requires understanding large amounts of information and may be complex, especially when decisions affect patients' autonomy and quality and prolongation of life. Patient decision aids are tools in facilitating SDM. This study aimed to identify the key elements from the perspective of patients with relapsing-remitting MS to create a patient decision aid in the Spanish sociocultural context. METHODS: This is a qualitative study using focus groups led by a clinical nurse specialist. Semistructured interviews included healthcare needs and demands, the SDM process, and general characteristics of a peer support program. After the transcription of interview recordings, data were analyzed by thematic analysis and a constructivist naturalistic approach. RESULTS: Patients with MS (27) from Spain participated in 4 focus groups of 90 to 120 minutes each. Three overarching themes were identified: information access to sufficient high-quality data; knowledge of available treatment options, including efficacy, adverse effects, frequency, administration route, and the impact on daily life; decision-making role, engaged versus nonengaged patients. The former require support in facilitating their active involvement in decisions, whereas the latter prefer more passive health models. CONCLUSION: The needs identified by patients with relapsing-remitting MS regarding treatment choice in the Spanish setting align with those reported by other studies. The identified themes provide valuable information to design and develop a virtual patient decision aid jointly by clinical MS nurses and patients according to the International Patient Decision Aid Standards Collaboration criteria. This aid will help improve understanding between nurses and patients during SDM and facilitate the process.
Revista:
REVISTA CHILENA DE INFECTOLOGIA
ISSN:
0716-1018
La eficacia y efectividad de una nueva intervención se establece generalmente a través de ensayos clínicos (EC) con asignación aleatoria (AA). Sin embargo, entre otros tantos desafíos metodológicos, el especificar la hipótesis de un EC con AA, sigue siendo un problema complejo de resolver para los investigadores clínicos.
En este manuscrito discutimos las características de tres variantes de los EC con AA: EC de superioridad (ECS), EC de no-inferioridad (ECNI), y EC de equivalencia (ECE).
Estos tres tipos de EC tienen supuestos diferentes sobre los efectos de una intervención, por lo que plantear hipótesis y definir objetivos requiere conocer algunos supuestos subyacentes a estos EC, incluso hasta elementos relacionados con la estimación del tamaño de muestra para cada cual
El objetivo de este manuscrito fue describir las diferencias metodológicas entre ECS, ECNI y ECE
Autores:
Hernández-Leal, MJ; Pérez-Lacasta, M. J.; Carles-Lavila, M. (Autor de correspondencia)
Revista:
JOURNAL OF BREAST CANCER RESEARCH
ISSN:
2769-2418
Año:
2022
Vol.:
2
N°:
1
Págs.:
19 - 22
One of the most recent goals of health programmes in many countries is developing a person-centred
healthcare model; however, strategies to implement it are still scarce, especially in health contexts such
as preventive medicine. In the context of screening programmes, Shared Decision Making (SDM) can be
a good alternative. Research has been carried out in Spain to understand both the local and international
situation through systematic reviews and initiatives ranging from: the creation of Decision Aid (DA)
support tools; the measuring of their effects on users¿ knowledge of the screening risks and benefits;
the writing of manuals for healthcare professionals; the assessment of the patient¿s satisfaction in this
type of relationship with the healthcare professional and, the efficiency of including SDM in a new way
of conducting the screening programme. Nevertheless, efforts have not ensured yet its applicability as a
routine practice in the clinical encounter and therefore, innovations and studies are still being conducted
to make it real.
Autores:
Pons-Rodriguez, A.; Marzo-Castillejo, M.; Cruz-Esteve, I.; et al.
Revista:
ATENCION PRIMARIA
ISSN:
0212-6567
Año:
2022
Vol.:
54
N°:
5
Págs.:
102288
Breast cancer is the leading cause of death in the world among women. The Spanish National Health System (SNHS) introduced population-based breast cancer screening in 1990. As in most European programs, risk is identified on the basis of age and a mammogram is offered every two years to women aged 50¿69 years. Scientific evidence is moving toward personalized screening, based on individual risk. This article presents the clinical trials that will evaluate the efficacy of personalized screening and some studies carried out in our environment on the effect of informing women of the benefits and adverse effects of screening or the acceptability and feasibility of offering personalized screening, in the Shared Decision Making context. The Preventive Activities and Health Promotion Program can help transform screening in our SNHS.
Revista:
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
ISSN:
1660-4601
Año:
2022
Vol.:
19
N°:
3
Págs.:
1406
This study explored the barriers and facilitators to the implementation of a risk-based breast cancer screening program from the point of view of Spanish health professionals. A cross-sectional study with 220 Spanish health professionals was designed. Data were collected in 2020 via a web-based survey and included the advantages and disadvantages of risk-based screening and barriers and facilitators for the implementation of the program. Descriptive statistics and Likert scale responses analyzed as category-ordered data were obtained. The risk-based screening was considered important or very important to reduce breast cancer mortality and promote a more proactive role for women in breast cancer prevention, to increase coverage for women under 50 years, to promote a breast cancer prevention strategy for women at high risk, and to increase efficiency and effectiveness. Switching to a risk-based program from an age-based program was rated as important or very important by 85% of participants. As barriers for implementation, risk communication, the workload of health professionals, and limited human and financial resources were mentioned. Despite the barriers, there is good acceptance, and it seems feasible, from the perspective of health professionals, to implement a risk-based breast cancer screening program in Spain. However, this poses a number of organizational and resource challenges.
Revista:
BMJ OPEN
ISSN:
2044-6055
Año:
2022
Vol.:
12
N°:
2
Págs.:
e052566
Background The Literature is no report support material on Shared Decision-making applied to breast cancer screening that is intended for Spanish health professionals. The researcher created both a handbook and a guide for this topic using an adaption of the Three-talk model.
Objective A Delphi method will be used to reach an agreement among experts on the contents and design of a manual and guide, designed by the research team, and to be used by health professionals in the application of SDM in breast cancer screening.
Design A qualitative study. The content and design of the handbook and the guide was discussed by 20 experts. The Delphi techniques was in an online mode between July and October 2020 and researchers used Google forms in three rounds with open and closed questions. The criterion established for consensus was a coefficient of concordance (Cc) above 75, for questions using a Likert scale of 1¿6¿in which 1 meant `completely disagree¿ and 6 `completely agree¿¿with a cut-off point equal to or higher than 4.
Results Participants considered the Three-talk model suitable for the screening context. The handbook sections and level of detail were considered satisfactory (Cc=90). The summary provided by the clinical practice guide was considered necessary (Cc=75), as it was the self-assessment tool for professionals (Cc=85). Content was added: addressing the limitations of the SDM model; extending the number of sample dialogues for health professionals; providing supplementary resources on using Patient Decisions aids and adding references on communication skills.
Conclusions and applications The first handbook and clinical practice guide providing unique SDM support material for health professionals have been developed. The handbook and guide are useful and innovative as supporting material for health professionals, but training strategies for SDM and a piloting plan for the use of materials are requested, in order to facilitate its implementation.
Revista:
BMJ OPEN
ISSN:
2044-6055
Año:
2022
Vol.:
12
N°:
11
Págs.:
e064488
ObjectiveTo analyse women's stated preferences for establishing the relative importance of each attribute of shared decision-making (SDM) and their willingness to pay (WTP) for more participatory care in breast cancer screening programmes (BCSP).
DesignA discrete choice experiment was designed with 12 questions (choice tasks). It included three attributes: 'How the information is obtained', regarding benefits and harms; whether there is a 'Dialogue for scheduled mammography' between the healthcare professional and the woman; and, 'Who makes the decision', regarding participation in BCSP. Data were obtained using a survey that included 12 choice tasks, 1 question on WTP and 7 socioeconomic-related questions. The analysis was performed using conditional mixed-effect logit regression and stratification according to WTP.
SettingData collection related to BCSP was conducted between June and November 2021 in Catalonia, Spain.
ParticipantsSixty-five women aged between 50 and 60.
Main outcome measuresWomen's perceived utility of each attribute, trade-off on these attributes and WTP for SDM in BCSP.
ResultThe only significant attribute was 'Who makes the decision'. The decision made alone (coefficient=2.879; 95% CI=2.297 to 3.461) and the decision made together with a healthcare professional (2.375; 95% CI=1.573 to 3.177) were the options preferred by women. The former contributes 21% more utility than the latter. Moreover, 52.3% of the women stated a WTP of Euro10 or more for SDM. Women's preferences regarding attributes did not influence their WTP.ConclusionsThe participant women refused a current paternalistic model and preferred either SDM or informed decision-making in BCSP.
Revista:
HORIZONTES DE ENFERMERÍA
ISSN:
1390-6984
Año:
2015
Vol.:
26
N°:
1
Págs.:
77 - 81
En este documento de reflexión, tres estudiantes de la Escuela de Enfermería de la Pontificia Universidad Católica de Chile relatan su experiencia como asistentes al V Encuentro Internacional de Autocuidado, actividad de difusión de carácter científico organizada por la Escuela, en donde se busca generar un espacio de diálogo respecto a e-health y literacidad en salud con profesionales y estudiantes relacionados con la temática. Este artículo tiene por objetivo relatar los beneficios y las problemáticas obtenidos por los autores, quienes resaltan aspectos positivos de esta instancia para el alumnado de pregrado, ya que favorece en la sección de nuevos conocimientos, desarrollo de un pensamiento crítico, generación de redes de apoyo y motivación para introducirse en el área de la investigación. Este último elemento es fundamental para la formación de enfermeros, ya que permite desenvolver nuevos conocimientos y contribuir de esta forma a la práctica clínica y beneficiar a los usuarios en cuidados costo-efectivos, Finalmente mencionar que no hay evidencia de publicaciones anteriores respecto a la importancia de ser partícipe como oyente a congresos, puesto que solo se menciona la relevancia que poseen estos al participar como expositor en los mismos.