Patient-Reported Needs Following a Referral for Colorectal Cancer Screening

Patients referred for colonoscopy have lots of questions that are not always being answered by primary care clinicians. Many would appreciate being able to access additional information through the the practice’s portal. James W. Mold, MD, MPH

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Abstract

Introduction: Patient-physician communication about colorectal cancer screening can affect screening use, but discussions often lack information that patients need for informed decision making and seldom address personal preferences or barriers. To address this gap, a series of patient focus groups was conducted to guide the development of an online, interactive decision support program. This article presents findings on patient information needs and barriers to colorectal cancer screening after receiving a screening recommendation from a physician, and their perspectives on using electronic patient portals as platforms for health-related decision support.

Methods: Primary care patients with recent colonoscopy or stool testing orders were identified via the centralized data repository of a large Midwestern health system. Seven gender-stratified focus groups (N=45 participants) were convened between April and July 2016. Sessions were audio recorded, transcribed, coded, and analyzed for commonly expressed themes beginning in August 2016.

Results: Findings reveal a consistent need for simple and clear information on colorectal cancer screening. Participants desired step-by-step explanations of the colonoscopy procedure and information about bowel preparation options/alternatives. The desired level of additional information varied: some patients wanted to know about and act on test options, whereas others preferred following their physician-recommended testing path. Fears and concerns were prevalent, particularly about colonoscopy, and patients reported challenges getting these concerns and their informational needs addressed. Finally, they expressed consistent support for using the patient portal to gather additional information from their physician.

Conclusions: Patient portals may offer an opportunity to build sustainable programs for decision support and assistance that are integrated with clinic workflows and processes.

Trial registration: ClinicalTrials.gov NCT02798224.

Author/s:

Dyer, Karen E., Shires, Deirdre A.

Persistent Value of the Stethoscope in the Age of COVID-19

Brian Desmarais — Mon, 22 Jun 2020 15:09:57 +0000

Date Added:

June 22, 2020

Journal/Publication:

The American Journal of Medicine

Publication Date:

June 19, 2020

URL:

Persistent Value of the Stethoscope in the Age of COVID-19

Type:

Best Local Practices

Format:

Article

DOI (1):

https://doi.org/10.1016/j.amjmed.2020.05.018

Keywords

MeSH

Physician-Patient Relations

severe acute respiratory syndrome coronavirus 2

An interesting review of the history and future of the stethoscope including tips for disinfecting one. James W. Mold, MD, MPH

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Abstract

The stethoscope has long been at the center of patient care as well as a symbol of the physician-patient relationship. While advancements in other diagnostic modalities have allowed for more efficient and accurate diagnosis, the stethoscope has evolved in parallel to address the needs of the modern era of medicine. These advancements include sound visualization, ambient noise reduction/cancellation, Bluetooth™ transmission, and computer algorithm diagnostic support. However, despite these advancements, the ever-changing climate of infection prevention, especially in the wake of the COVID-19 pandemic, has led many to question the stethoscope as a vector for infectious diseases. Stethoscopes have been reported to harbor bacteria with contamination levels comparable to a physician's hand. Although disinfection is recommended, stethoscope hygiene compliance remains low. In addition, disinfectants may not be completely effective in eliminating microorganisms. Despite these risks, the growing technological integration with the stethoscope continues to make it a highly valuable tool. Rather than casting our valuable tool and symbol of medicine aside, we must create and implement an effective method of stethoscope hygiene to keep patients safe.

•Stethoscopes are clinically valuable and integral to the doctor-patient connection

•Technological advancement will augment the utility of the stethoscope

•The stethoscope has high utility for assessment of COVID-19 patients

•Pathogen contamination in light of COVID-19 is a concern for the stethoscope

•Innovations in stethoscope hygiene will allow safe auscultation

Author/s:

Vasudevan, R.S., Horiuchi, Y., Torianni, F.J., Cotter, B., Maisel, S.M., Dadwal, S.S., Gaynes, R., Maisel, A.S.