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Special Issue "Empowering Patients and Supporting Health Care Providers—New Avenues for High Quality Care and Safety"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (16 July 2021).

Special Issue Editors

Dr. Michela Rimondini
E-Mail Website
Guest Editor
Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy
Interests: communication in healthcare; patient empowerment; human factor in risk management; mixed-method approach
Dr. Isolde Martina Busch
E-Mail Website
Guest Editor
Department of Neuroscience, Biomedical Science and Movement, University of Verona, 37129 Verona, Italy
Interests: patient empowerment; human factor in risk management; meta-analysis; heathcare providers’ well-being

Special Issue Information

Dear Colleagues,

A large body of research suggests that establishing and strengthening patient–provider relationships, characterized by empathy, transparency, respect, and trust, is one of the core elements of healthcare. Promoting these relationships also implies healthcare institutions focusing on and caring for the individual persons that are part of this connection.

However, due to fragmented care and work pathways and time and staff rationing, the human aspects of clinical practice are too often ignored. Indeed, patients whose individual needs are underestimated experience a lack of respect and autonomy. Moreover, healthcare providers are mostly judged by their job performance, potentially leading to stress, compassion fatigue, and burnout.

This trend has heightened the need for a integretive approach to healthcare that empowers patients and supports the healthcare workforce.

This Special Issue aims to publish high-quality, timely research on various aspects of patient empowerment in care and risk management, as well as the impact of patient safety culture, work-related stressors, and unanticipated clinical events on healthcare providers’ wellbeing.

Original research articles applying different study designs and methodologies as well as systematic reviews and meta-analysis are highly encouraged. We also welcome well-focused, concise opinion articles that discuss controvertial issues and make for compelling reading.

Dr. Michela Rimondini
Dr. Isolde Martina Busch
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • patient empowerment
  • patient involvement
  • patient–provider relationship
  • patient safety culture
  • risk management
  • human factors
  • second victim
  • mental health
  • psychological support
  • healthcare providers’ wellbeing

Published Papers (8 papers)

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Research

Article
Patient Safety in the Eyes of Aspiring Healthcare Professionals: A Systematic Review of Their Attitudes
Int. J. Environ. Res. Public Health 2021, 18(14), 7524; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147524 - 15 Jul 2021
Viewed by 362
Abstract
A culture of safety is important for the delivery of safe, high-quality care, as well as for healthcare providers’ wellbeing. This systematic review aimed to describe and synthesize the literature on patient safety attitudes of the next generation of healthcare workers (health professional [...] Read more.
A culture of safety is important for the delivery of safe, high-quality care, as well as for healthcare providers’ wellbeing. This systematic review aimed to describe and synthesize the literature on patient safety attitudes of the next generation of healthcare workers (health professional students, new graduates, newly registered health professionals, resident trainees) and assess potential differences in this population related to years of study, specialties, and gender. We screened four electronic databases up to 20 February 2020 and additional sources, including weekly e-mailed search alerts up to 18 October 2020. Two independent reviewers conducted the search, study selection, quality rating, data extraction, and formal narrative synthesis, involving a third reviewer in case of dissent. We retrieved 6606 records, assessed 188 full-texts, and included 31 studies. Across articles, healthcare students and young professionals showed overwhelmingly positive patient safety attitudes in some areas (e.g., teamwork climate, error inevitability) but more negative perceptions in other domains (e.g., safety climate, disclosure responsibility). Women tend to report more positive attitudes. To improve safety culture in medical settings, health professions educators and institutions should ensure education and training on patient safety. Full article
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Article
Strengthening Critical Health Literacy for Health Information Appraisal: An Approach from Argumentation Theory
Int. J. Environ. Res. Public Health 2021, 18(13), 6764; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18136764 - 23 Jun 2021
Viewed by 540
Abstract
The overload of health information has been a major challenge during the COVID-19 pandemic. Public health authorities play a primary role in managing this information. However, individuals have to apply critical health literacy to evaluate it. The objective of this paper is to [...] Read more.
The overload of health information has been a major challenge during the COVID-19 pandemic. Public health authorities play a primary role in managing this information. However, individuals have to apply critical health literacy to evaluate it. The objective of this paper is to identify targets for strengthening critical health literacy by focusing on the field of argumentation theory. This paper is based on the textual analysis of instances of health information through the lens of argumentation theory. The results show that critical health literacy benefits from: (1) understanding the concept of argument and the supporting reasons, (2) identifying the main argument schemes, and (3) the knowledge and use of the main critical questions to check the soundness of arguments. This study operationalizes the main aspects of critical health literacy. It calls for specific educational and training initiatives in the field. Moreover, it argues in favor of broadening the current educational curricula to empower individuals to engage in informed and quality decision making. Strengthening individuals’ critical health literacy involves interventions to empower in argument evaluation. For this purpose, argumentation theory has analytical and normative frameworks that can be adapted within a lay-audience education concept. Full article
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Article
Communication about Prognosis during Patient-Initiated Second Opinion Consultations in Advanced Cancer Care: An Observational Qualitative Analysis
Int. J. Environ. Res. Public Health 2021, 18(11), 5694; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115694 - 26 May 2021
Viewed by 754
Abstract
Prognostic communication is essential for patients with advanced cancer to enable informed medical decision-making and end-of-life planning. Discussing prognosis is challenging, and might be especially complex for oncologists conducting a second opinion (SO). Survival data are often lacking, and consulting oncologists need to [...] Read more.
Prognostic communication is essential for patients with advanced cancer to enable informed medical decision-making and end-of-life planning. Discussing prognosis is challenging, and might be especially complex for oncologists conducting a second opinion (SO). Survival data are often lacking, and consulting oncologists need to consider previously conveyed information and patients’ relationship with the referring oncologist. We qualitatively investigated how advanced cancer patients and consulting oncologists discuss prognosis during audio-recorded SO consultations (N = 60), including prognostic information received from the referring oncologist. Our results show that patients regularly expressed implicit cues to discuss prognosis or posed explicit questions tentatively. Consulting oncologists were mostly unresponsive to patients’ cues and cautious to prognosticate. They also seemed cautious when patients brought up the referring oncologist. Consulting oncologists checked which prognostic information patients had received from the referring oncologist, before estimating prognosis. They agreed with the first opinion or rectified discrepancies carefully. Altogether, this study exposes missed opportunities for open prognostic discussions in SOs. Consulting oncologists could explicitly explore patients’ information preferences and perceptions of prognosis. If desired, they can provide tailored, independent information to optimise patients’ prognostic awareness and informed medical decision-making. They may additionally support patients in dealing with prognosis and the uncertainties associated with it. Full article
Article
Promoting the Psychological Well-Being of Healthcare Providers Facing the Burden of Adverse Events: A Systematic Review of Second Victim Support Resources
Int. J. Environ. Res. Public Health 2021, 18(10), 5080; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105080 - 11 May 2021
Viewed by 830
Abstract
Given the negative impact of adverse events on the wellbeing of healthcare providers, easy access to psychological support is crucial. We aimed to describe the types of support resources available in healthcare organizations, their benefits for second victims, peer supporters’ experiences, and implementation [...] Read more.
Given the negative impact of adverse events on the wellbeing of healthcare providers, easy access to psychological support is crucial. We aimed to describe the types of support resources available in healthcare organizations, their benefits for second victims, peer supporters’ experiences, and implementation challenges. We also explored how these resources incorporate aspects of Safety I and Safety II. We searched six databases up to 19 December 2019 and additional literature, including weekly search alerts until 21 January 2021. Two reviewers independently performed all methodological steps (search, selection, quality assessment, data extraction, formal narrative synthesis). The 16 included studies described 12 second victim support resources, implemented between 2006 and 2017. Preliminary data indicated beneficial effects not only for the affected staff but also for the peer responders who considered their role to be challenging but gratifying. Challenges during program implementation included persistent blame culture, limited awareness of program availability, and lack of financial resources. Common goals of the support programs (e.g., fostering coping strategies, promoting individual resilience) are consistent with Safety II and may promote system resilience. Investing in second victim support structures should be a top priority for healthcare institutions adopting a systemic approach to safety and striving for just culture. Full article
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Article
Development of a Patient-Oriented Intervention to Support Patient-Provider Conversations about Unnecessary Lower Back Pain Imaging
Int. J. Environ. Res. Public Health 2021, 18(5), 2786; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052786 - 09 Mar 2021
Viewed by 1272
Abstract
Background: despite the efforts of multiple stakeholders to promote appropriate care throughout the healthcare system, studies show that two out of three lower back pain (LBP) patients expect to receive imaging. We used the Choosing Wisely Canada patient-oriented framework, prioritizing patient engagement, to [...] Read more.
Background: despite the efforts of multiple stakeholders to promote appropriate care throughout the healthcare system, studies show that two out of three lower back pain (LBP) patients expect to receive imaging. We used the Choosing Wisely Canada patient-oriented framework, prioritizing patient engagement, to develop an intervention that addresses lower back pain imaging overuse. Methods: to develop this intervention, we collaborated with a multidisciplinary advisory team, including two patient partners with lower back pain, researchers, clinicians, healthcare administrators, and the Choosing Wisely Canada lead for Saskatchewan. For this qualitative study, data were collected through two advisory team meetings, two individual interviews with lower back pain patient partners, and three focus groups with lower back pain patient participants. A lower back pain prescription pad was developed as an outcome of these consultations. Results: participants reported a lack of interactive and informative communication was a significant barrier to receiving appropriate care. The most cited content information for inclusion in this intervention was treatments known to work, including physical activity, useful equipment, and reliable sources of educational material. Participants also suggested it was important that benefits and risks of imaging were explained on the pad. Three key themes derived from the data were also used to guide development of the intervention: (a) the role of imaging in LBP diagnosis; (b) the impact of the patient-physician relationship on LBP diagnosis and treatment; and (c) the lack of patient awareness of Choosing Wisely Canada and their recommendations. Conclusions: the lower back pain patient-developed prescription pad may help patients and clinicians engage in informed conversations and shared decision making that could support reduce unnecessary lower back pain imaging. Full article
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Article
Implementation of Person-Centered Care: A Feasibility Study Using the WE-CARE Roadmap
Int. J. Environ. Res. Public Health 2021, 18(5), 2205; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052205 - 24 Feb 2021
Viewed by 837
Abstract
Background: Person-Centered Care (PCC) is a promising approach towards improved quality of care and cost containment within health systems. It has been evaluated in Sweden and England. This feasibility study examines initial PCC implementation in a rehabilitation hospital for children in Poland. Methods: [...] Read more.
Background: Person-Centered Care (PCC) is a promising approach towards improved quality of care and cost containment within health systems. It has been evaluated in Sweden and England. This feasibility study examines initial PCC implementation in a rehabilitation hospital for children in Poland. Methods: The WE-CARE Roadmap of enablers was used to guide implementation of PCC for patients with moderate scoliosis. A multi-disciplinary team of professionals were trained in the PCC approach and the hospital Information Technology (IT) system was modified to enhance PCC data capture. Semi-structured interviews were conducted with the nine health care professionals involved in the pilot study and three patients/parents receiving care. Transcribed data were analyzed via content analysis. Results: 51 patients and their families were treated via a PCC approach. High proportions of new PCC data fields were completed by the professionals. The professionals were able to implement the three core PCC routines and perceived benefits using the PCC approach. Patients and their families also perceived improved quality care. The WE-CARE framework enablers facilitated PCC implementation in this setting. Conclusions: This feasibility pilot study indicates that the Gothenburg PCC approach can be successfully transferred to a rehabilitation hospital in Poland with favorable perceptions of implementation by both professionals and patients/their families. Full article
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Article
Is Empowerment of Female Radiologists Still Needed? Findings of a Systematic Review
Int. J. Environ. Res. Public Health 2021, 18(4), 1542; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18041542 - 05 Feb 2021
Viewed by 859
Abstract
Considering that radiology is still a male-dominated specialty in which men make up more than two thirds of the workforce, this systematic review aimed to provide a comprehensive overview of the current role of women in radiological imaging, focusing on the main aspects [...] Read more.
Considering that radiology is still a male-dominated specialty in which men make up more than two thirds of the workforce, this systematic review aimed to provide a comprehensive overview of the current role of women in radiological imaging, focusing on the main aspects such as career progression, leadership, academic practice, and perceived discrimination. Three electronic databases were searched up to 21 October 2020. To identify additional records, weekly automatic email alerts were set up on PubMed until December 2020 and reference lists of key studies and included papers were screened. Two reviewers independently performed the search, study selection, quality appraisal, data extraction, and formal narrative synthesis. In case of disagreement, a third reviewer was involved. Across the 61 included articles, women worked more often part-time and held fewer positions of power in hospitals, on editorial boards, and at the academic level (associate and full professors). Women were less often in relevant positions in scientific articles, had fewer publications, and had a lower H-index. Discrimination and sexual harassment were experienced by up to 40% and 47% of female radiologists, respectively. Our study highlights that women in radiology are still underrepresented and play a marginal role in the field, struggling to reach top and leading positions. Full article
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Article
Twelve Years of the Italian Program to Enhance Relational and Communication Skills (PERCS)
Int. J. Environ. Res. Public Health 2021, 18(2), 439; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020439 - 08 Jan 2021
Viewed by 713
Abstract
To describe the experience of the Italian Program to Enhance Relations and Communication Skills (PERCS-Italy) for difficult healthcare conversations. PERCS-Italy has been offered in two different hospitals in Milan since 2008. Each workshop lasts 5 h, enrolls 10–15 interdisciplinary participants, and is organized [...] Read more.
To describe the experience of the Italian Program to Enhance Relations and Communication Skills (PERCS-Italy) for difficult healthcare conversations. PERCS-Italy has been offered in two different hospitals in Milan since 2008. Each workshop lasts 5 h, enrolls 10–15 interdisciplinary participants, and is organized around simulations and debriefing of two difficult conversations. Before and after the workshops, participants rate their preparation, communication, relational skills, confidence, and anxiety on 5-point Likert scales. Usefulness, quality, and recommendation of the program are also assessed. Descriptive statistics, t-tests, repeated-measures ANOVA, and Chi-square were performed. A total of 72 workshops have been offered, involving 830 interdisciplinary participants. Participants reported improvements in all the dimensions (p < 0.001) without differences across the two hospitals. Nurses and other professionals reported a greater improvement in preparation, communication skills, and confidence, compared to physicians and psychosocial professionals. Usefulness, quality, and recommendation of PERCS programs were highly rated, without differences by discipline. PERCS-Italy proved to be adaptable to different hospital settings, public and private. After the workshops, clinicians reported improvements in self-reported competencies when facing difficult conversations. PERCS-Italy’s sustainability is based on the flexible format combined with a solid learner-centered approach. Future directions include implementation of booster sessions to maintain learning and the assessment of behavioral changes. Full article
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