• Communication as care at end of life: an emerging issue from an exploratory action research study of renal end-of-life care for ethnic minorities in the UK

      Wilkinson, Emma; Randhawa, Gurch; Brown, Edwina; Gane, Maria Da Silva; Stoves, John; Warwick, Graham; Akhtar, Tahira; Magee, Regina; Sharman, Sue; Farrington, Ken (Wiley-Blackwell, 2014-09-01)
      South Asian people have a higher risk of developing kidney disease, are disproportionately represented in the patient population requiring renal replacement therapy and wait longer to receive a kidney transplant, compared with white Europeans. As a result, there is a demand for end-of-life care, which meets the needs of this group of patients. Providing end-of-life care to patients from different cultures is a challenge for renal services as there can be barriers to communication in the form of language, delegated decision-making within families and reluctance to discuss death. To explore end-of-life care for South Asians with kidney disease, 16 interviews with patients and 14 focus groups with care providers were conducted at four research sites in the UK with large South Asian populations. Using an action research design the data were analysed thematically and fed back to inform the research in a cyclical manner. If patients are not fully aware of their condition or of what end-of-life care is, it is less likely that they will be able to be involved in decision-making about their care and this is compounded where there are communication barriers. Variations in care provider awareness and experience of providing end-of-life care to South Asian patients, in turn, contributes to lack of patient awareness of end-of-life care. Communication as care at the end of life should be explored further. Researching the South Asian patient experience of end of life highlights many relevant and generalisable issues.
    • Computer-assisted versus oral-and-written dietary history taking for diabetes mellitus

      Wei, Igor; Pappas, Yannis; Car, Josip; Sheikh, Aziz; Majeed, Azeem; University of Edinburgh; Imperial College London (Wiley-Blackwell, 2011-12-07)
      Background: Diabetes is a chronic illness characterised by insulin resistance or deficiency, resulting in elevated glycosylated haemoglobin A1c (HbA1c) levels. Diet and adherence to dietary advice is associated with lower HbA1c levels and control of disease. Dietary history may be an effective clinical tool for diabetes management and has traditionally been taken by oral-and-written methods, although it can also be collected using computer-assisted history taking systems (CAHTS). Although CAHTS were first described in the 1960s, there remains uncertainty about the impact of these methods on dietary history collection, clinical care and patient outcomes such as quality of life. Objectives: To assess the effects of computer-assisted versus oral-and-written dietary history taking on patient outcomes for diabetes mellitus. Search methods: We searched The Cochrane Library (issue 6, 2011), MEDLINE (January 1985 to June 2011), EMBASE (January 1980 to June 2011) and CINAHL (January 1981 to June 2011). Reference lists of obtained articles were also pursued further and no limits were imposed on languages and publication status. Selection criteria: Randomised controlled trials of computer-assisted versus oral-and-written history taking in patients with diabetes mellitus. Data collection and analysis: Two authors independently scanned the title and abstract of retrieved articles. Potentially relevant articles were investigated as full text. Studies that met the inclusion criteria were abstracted for relevant population and intervention characteristics with any disagreements resolved by discussion, or by a third party. Risk of bias was similarly assessed independently. Main results: Of the 2991 studies retrieved, only one study with 38 study participants compared the two methods of history taking over a total of eight weeks. The authors found that as patients became increasingly familiar with using CAHTS, the correlation between patients' food records and computer assessments improved. Reported fat intake decreased in the control group and increased when queried by the computer. The effect of the intervention on the management of diabetes mellitus and blood glucose levels was not reported. Risk of bias was considered moderate for this study. Authors' conclusions: Based on one small study judged to be of moderate risk of bias, we tentatively conclude that CAHTS may be well received by study participants and potentially offer time saving in practice. However, more robust studies with larger sample sizes are needed to confirm these. We cannot draw on any conclusions in relation to any other clinical outcomes at this stage.
    • Emerging technologies for health communication

      Pappas, Yannis; Car, Josip; Hill, Sophie; Imperial College London (Wiley-Blackwell, 2011-09-22)
      The widespread use of consumer-oriented information communication technologies (ICTs) such as cell phones, iPods and other electronic data devices is changing the way consumers think about and interact with healthcare. In light of this technology boom, a new field for researching, planning and implementing ICTs in healthcare has emerged called ‘eHealth’. Effective eHealth implementation requires a patient-centred approach to care, with health professionals utilising technology to share clinical information and guide patient self-care. This may include the use of electronic health records (EHRs), phone and text messaging interactions and web-based communication applications. Anticipated benefits of eHealth are improved patient access and choice, enhanced communication between professionals and improved health outcomes. However, the introduction of ICTs to the complex healthcare environment may also lead to disruptions, distractions or errors. To implement eHealth in a safe and effective way, the development of a comprehensive agenda for research, planning and implementation is essential.