Internet-Based Patient Education:
Download
1 / 20

Internet-Based Patient Education: Facilitating Shared ... - PowerPoint PPT Presentation


  • 1198 Views
  • Uploaded on

Internet-Based Patient Education: Facilitating Shared Decision-Making Between Plastic Surgeons and Women Seeking Breast Reconstruction After Mastectomy Topics in Womens’ Health APHA Poster Session 4076.0, Board #5, 11/18/03. Elizabeth Steinberger RN, MA, MPH UNC School of Public Health

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Internet-Based Patient Education: Facilitating Shared ...' - erika


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Slide1 l.jpg

Internet-Based Patient Education:Facilitating Shared Decision-MakingBetween Plastic Surgeons and Women Seeking Breast ReconstructionAfter MastectomyTopics in Womens’ HealthAPHA Poster Session 4076.0, Board #5, 11/18/03

Elizabeth Steinberger RN, MA, MPH

UNC School of Public Health

Edwin Wilkins MD, MS

University of Michigan Section of Plastic Surgery


Abstract l.jpg
Abstract

The Internet makes it possible to provide especially up-to-date, low-cost, and accessible health education interventions. Shared decision-making theory was used to construct a web site designed to give breast cancer patients complete, balanced, easy-to-understand

information about breast reconstruction options after mastectomy.

In 2000, a pilot prospective cohort study (n=51) evaluated the acceptability and impact of the site. In one clinic, women viewed the web site before seeing the plastic surgeon. In a second clinic, women were given a brochure and a “pencil talk” while consulting the same surgeon. The groups did not vary by age, race, or computer literacy. Knowledge of breast reconstruction options; decision-making anxiety and desire for information; and satisfaction with the provider, length of provider visit, and quality of care likewise did not vary significantly between groups. However, the web group reported feeling more comfortable using computers (p<0.01) and web sites (p<0.009). Moreover, women using the web site reported significantly higher satisfaction with the quality of information (p<0.026) and spent an average of 14.7 minutes less with the surgeon (p<0.0005).

The Web is an acceptable educational venue for breast cancer patients. Internet-based interventions can facilitate shared decision-making between doctors and patients by saving physician time while providing higher quality health information to patients.

Breast Reconstruction Options After Mastectomy: A Consumer’s Guide

http://www.surgery.med.umich.edu/breastrecon.htm


Slide3 l.jpg

What is MBROS?

  • The Michigan Breast Reconstruction Outcome Study (MBROS) is a six-year study (1994-2000) of multiple aspects of breast reconstruction outcomes. During the lifetime of the study, MBROS has assessed a total of 397 actively participating patients from 11 medical centers in the U.S. and Canada. Patients are followed for two years from the date of their breast reconstruction surgeries to determine long-term outcomes of breast reconstruction. MBROS is supported by a grant from the Department of Defense, United States Army Medical Research and Material Command, DAMD 17-94-J-4044.

  • Studies have been completed on:

    • • Psychosocial outcomes of breast reconstruction by procedure and timing of reconstruction.

    • • Patient satisfaction with aesthetic results by procedure type (implants vs.

    • pedicle TRAMS vs. free TRAMS).

    • • Objective, computerized assessments of symmetry of breast reconstruction results by procedure type.

    • • Physical functioning one year after surgery by procedure type.

    • • Mammography after TRAM flap reconstruction.


Web site development purposes and sources l.jpg
Web Site Development:Purposes and Sources

Purposes

1) Provide thorough, accurate, easy-to-understand information about

available breast reconstruction options after mastectomy.

2) Facilitate shared decision-making between plastic surgeons and

women seeking post-mastectomy breast reconstruction.

Sources

Breast Reconstruction Information:

• Unpublished University of Michigan Hospital patient manual on

Breast reconstruction (Wilkins, 1996)

• Published patient education brochures on breast reconstruction

Existing web sites on breast cancer surgery

Input from Former Breast Reconstruction Patients:

• Focus group (n=5) to assess text drafts for relevance and readability.

• Interviews (n=4) to gather personal vignettes of breast reconstruction.


Web site development design l.jpg
Web Site Development: Design

The web site was organized according to the decision tree that must be traversed by patients considering breast reconstruction:


Construction l.jpg

All options portrayed include discussions of equipment and procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.

Construction

HOME

PAGE


Construction 2 l.jpg
Construction (2) procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.

TRAM

(Transverse

Rectus

Abdominus

Muscle)

Flap

Reconstruction

page, showing

procedure,

outcome photos,

and a

vignette.


Construction 3 l.jpg
Construction (3) procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.

Implant

risk page,

listing and

describing

complications

of implants.


Construction 4 l.jpg
Construction (4) procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.

Table

summarizing

breast

replacement

options

after

mastectomy


Slide10 l.jpg

Evaluation: Background procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.

  • Shared medical decision-making theory (Mulley, Lindbergh--prostate cancer surgery). Provide patients with all of the information needed to understand the options, then allow them to choose their treatment in partnership with the doctor.

    • Patients are more likely to be satisfied with the outcome of treatment because:

    • 1) they are invested in the decision-making process;

    • 2) they re better informed about the options; and

    • 3) the option chosen is more likely to suit their values and lifestyle.

  • At the time of creation (1999):

    • 1) No site existed that was solely dedicated to educating patients about breast reconstruction.

    • 2) The feasibility of using Web-based materials to facilitate decision-making about surgery in clinical settings had not yet been tested.

    • (Now sites on breast augmentation also exist and have been evaluated.)


Methods l.jpg
Methods procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.

From January through June 2000, a pilot prospective cohort study (n=51) evaluated

the acceptability and impact of the site. An experimental group of 34 pre-mastectomy

breast cancer patients attending the breast cancer clinic at the University of Michigan

Hospital were instructed to view the web site online in the patient education center or

clinic thirty minutes before their scheduled appointment with the plastic surgeon. A

fesearch assistant taught those who were unfamiliar with computers or the Internet

how to use the site. A control group of 17 pre-mastectomy patients attending a

private breast reconstruction clinic were given a popular brochure on breast

reconstruction options in the waiting room and a “pencil talk” explaining the options

from the same surgeon.

Each patient’s consultation with the plastic surgeon was timed to the nearest minute.

All patients were then given an exit survey to assess their basic knowledge of breast

reconstruction options; their satisfaction with materials, provider, and length of visit;

their anxiety regarding breast reconstruction; and their use of computers and the

Internet. Responses were recorded on five-point Likert scales. After completing

the survey, patients were given a copy of the Consumer’s Guide to Breast

Reconstruction Options after Mastectomy in booklet form to refer to at home.


Research design l.jpg
Research Design procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.


Results l.jpg
Results procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.

Demographics:

Experimental Group

(Web)

Control Group

(Brochure)

Significance

47.3

Age

51.5

p<0.156

Educational

Level

4.0

(college graduate)

3.1

(some college)

p<0.0015

85.3% White,

8.8% Black

75.6% White,

17.6% Black

p<0.597

Race


Results 2 l.jpg
Results (2) procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.

Computer and Internet use:

Experimental Group

(Web)

Control Group

(Brochure)

Significance

Use computer

at home or work

76.4%

70.5%

p<0.690

Use Internet

at home or work

70.6%

70.5%

p<0.961

Comfortable

using computers

1.44*

2.29*

p<0.010

Comfortable

using Internet

1.47*

2.38*

p<0.009

* 1 is high on a 1-5 scale


Slide15 l.jpg

Results (3) procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.

Knowledge, Anxiety, Satisfaction

Knowledge of breast reconstruction options; decision-making anxiety and desire

for information; and satisfaction with the provider, length of provider visit, and

quality of care did not vary significantly between groups.

Significant Results:

Experimental Group

(Web)

Control Group

(Brochure)

Significance

Satisfaction with

information

1.24*

2.00*

p<0.026

Comfort using

Internet

1.47*

2.38*

p<0.009

Minutes spent

with provider

40.0

54.7

p<0.0005

* 1 is high on a 1-5 scale


Significant results 1 satisfaction with information l.jpg
Significant Results: procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients. 1. Satisfaction with Information

“I received very good explanations of my options for replacing or replacing my breast(s) after mastectomy.”

Experimental (Web) group more satisfied with information (p<0.026)


Significant results 2 comfort using internet l.jpg
Significant Results: procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients. 2. Comfort Using Internet

“I feel comfortable using web sites.”

Experimental (Web) group more comfortable using web sites (p<0.009).

Experimental (Web) group also more comfortable using computers (p<0.010).


Significant results 3 time spent with provider l.jpg
Significant Results: procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients. 3. Time Spent With Provider

Time spent with plastic surgeon:

Experimental (Web) group spent less time with plastic surgeon

(40.0 minutes vs. 54.7 minutes, p<0.0005)


Conclusions l.jpg
Conclusions procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.

  • Limitations of the study:

    • 1) Small sample size (n=51)

    • 2) Not randomized to conditions

    • 3) Possible confounders:

  • • Study setting (hospital vs. private clinic)

  • • Educational level (higher for Web group)

  • Conclusions:

  • 1) It is feasible to use web-based educational materials in a clinical setting.

  • 2) Web-based materials provide higher quality information than brochures while

  • saving physician time spent in explanation of options.


Contact information l.jpg
Contact Information procedures, advantages and disadvantages, risks, and an options summary. Some also include vignettes of the personal experiences of former breast reconstruction patients.

For further information contact:

Elizabeth Steinberger RN, MA, MPH

UNC School of Public Health

Rosenau Hall 308, CB#7440

Chapel Hill, NC 27599-7440

[email protected]

Edwin Wilkins MD, MS

Section of Plastic Surgery

University of Michigan Hospital

2130 Taubman Center

1500 East Medical Center Drive

Ann Arbor, MI 48109-0340

[email protected]


ad