The current meta-analysis follows a trend in using theory to understand the mechanisms of complex interventions. We suggest that future efforts focus on interventions that target patient self-efficacy. Authors are encouraged to report comprehensive details of interventions and methods to inform synthesis, replication, and refinement.
ObjectiveThe majority of self-management interventions are designed with a narrow focus on patient skills and fail to consider their potential as “catalysts” for improving care delivery. A project was undertaken to develop a patient self-management resource to support evidence-based, person-centered care for cancer pain and overcome barriers at the levels of the patient, provider, and health system.MethodThe project used a mixed-method design with concurrent triangulation, including the following: a national online survey of current practice; two systematic reviews of cancer pain needs and education; a desktop review of online patient pain diaries and other related resources; consultation with stakeholders; and interviews with patients regarding acceptability and usefulness of a draft resource.ResultFindings suggested that an optimal self-management resource should encourage pain reporting, build patients’ sense of control, and support communication with providers and coordination between services. Each of these characteristics was identified as important in overcoming established barriers to cancer pain care. A pain self-management resource was developed to include: (1) a template for setting specific, measureable, achievable, relevant and time-bound goals of care, as well as identifying potential obstacles and ways to overcome these; and (2) a pain management plan detailing exacerbating and alleviating factors, current strategies for management, and contacts for support.Significance of resultsSelf-management resources have the potential for addressing barriers not only at the patient level, but also at provider and health system levels. A cluster randomized controlled trial is under way to test effectiveness of the resource designed in this project in combination with pain screening, audit and feedback, and provider education. More research of this kind is needed to understand how interventions at different levels can be optimally combined to overcome barriers and improve care.
Context: In 2014, the influenza vaccine uptake in Europe was below 35% among healthcare workers (HCWs). Due to a lack of confidence in vaccination as a result of safety concerns, HCWs increasingly do not take the influenza vaccine. Consequently, there is a rising influenza burden which results in increasing mortality of vulnerable patients and absenteeism in hospitals. This policy brief aims to increase the awareness of HCWs regarding the importance of influenza vaccination uptake, which may result in improved patient and workplace safety. Policy Options: To increase vaccination coverage and reduce vaccine hesitancy among HCWs, a change in attitude towards and knowledge about the influenza vaccine is needed. Two potential approaches are presented in this paper. Firstly, a mandatory vaccination policy is discussed. Practical and ethical challenges of implementing a mandatory vaccination policy are considered. Secondly, information campaigns are described, consisting of three pillars: safety, information, and knowledge. Recommendations: It is recommended to initiate information campaigns focussing on patient safety. Furthermore, a structural approach to increase access to vaccination at the workplace must be taken. Higher vaccination rates of HCWs lead to an improved workplace safety. The recommended information campaign can also be used for other vaccine preventable diseases or in other situations, such as HCWs vaccine hesitancy regarding COVID-19 vaccines. Lessons from the COVID-19 pandemic regarding acceptance of vaccines should be considered for the improvement of future influenza vaccine uptake. Acknowledgments: We would like to thank Kasia Czabanowska for the opportunity to develop this policy brief and Timo Clemens for his guidance and extensive feedback during the writing process
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