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Little attention has been paid to health inequities designed into the physical spaces themselves. Clearly design is an important part of patient care. Design is simultaneously a complex system itself while existing as part of a larger complex (healthcare) system. For example, it is not enough to say that a patient experiences more stress because she/he is being treated in a hospital in a lower income area. The key, here, is that evidence demonstrates design as an important component, systemically, in healthcare. We know this to be true and base re-design efforts on this fact, but only in certain places. The central addition of this study is to point out that hospitals in higher income areas utilize the waiting room’s ecology and its influence on patient stress and care. Efforts to intervene, through design, in waiting room ecology have consequences to equitable access to healthcare. Therefore, this study examines the implications of health inequities designed-into physical space. Additionally, this study seeks to forefront the influence communication ecologies have in addressing health inequities. Innovations in addressing mental health needs in humanitarian settings: A complexity informed Action Research Case Study. Frontiers in Communication: Health Communication. 10.3389/fcomm.2020.601792 para 19, 2020). Thus, the purpose of this paper is to investigate, but also articulate, the ways design decisions impact people unequally and perpetuate health inequalities. To do so, this study investigates the communication ecologies of waiting rooms and their influence on patient stress and health equity and elucidates under-examined systemic components patient stress and well-being.

Rationale & Objective: Electronic health record portals are increasingly emphasized in chronic kidney disease (CKD). However, associations of portal use with clinical and patient-centered outcomes remain unknown. Study Design: Cross-sectional survey (April 2015 to March 2018). Setting & Participants: Nondialysis patients with CKD from nephrology clinics within 1 academic medical center. Exposures: Patient demographics (age, sex, race, ethnicity, education, and income), kidney function. Outcomes: Association between portal use as an outcome and exposures. Additionally, associations of portal use and patient demographics with 4 patient–centered outcomes (CKD-specific knowledge, stress, and 2 self-ratings of health). Analytic Approach: Logistic regression to examine associations between patient portal use, demographics, and kidney function. Linear regression to examine associations between portal use and patient-centered outcomes. Results: Of 245 participants, mean age was 60 ± 17 (SD) years, 182 (77%) were White, 121 (49%) were women, 230 (96%) had a high school education or higher, and 96 (45%) had

Aim: The aim was to qualitatively and quantitatively clarify the stress experiences of patients who were mechanically ventilated in an intensive care unit (ICU) for more than 12 hr. Methods: The participants were adult patients without cognitive impairment who were mechanically ventilated in a general ICU for more than 12 hr. The Japanese version of the ICU Stressful Experiences Questionnaire (ICU‐SEQJ) survey was performed before subjects were discharged from the ICU to collect narratives about how they felt and what they thought during their ICU stay. The results were analyzed in a collective and complementary way by dividing ICU‐SEQJ scores into quartiles and comparing the first (low stress experience group) and third quartiles (high stress experience group). Results: A total of 96 subjects were enrolled in the study, with 25 scoring in the high stress experience group and 24 in the low stress experience group. The high stress experience group had significantly longer duration of intubation, higher amounts of analgesics and sedative drugs, higher C‐reactive protein, lower level of deepest sedation and greater absence of medical history than the low stress experience group. Analysis of the subjects' narratives revealed "Unbearable holistic discomfort", "Pain of being unable to control myself as before" in the high stress experience group and "Responding by giving meaning" in the low stress experience group. Conclusions: Nurses must recognize that long intubation hours and invasive procedures are subjective stress experiences that may cause patients to suffer holistic discomfort and lose their sense of control. [ABSTRACT FROM AUTHOR]

Objectives: Seeking consent for minimal risk research in the ICU poses challenges, especially when the research is time-sensitive. Our aim was to determine the extent to which ICU patients or surrogates support a deferred consent process for a minimal risk study without the potential for direct benefit.Design: Prospective cohort study.Setting: Five ICUs within a tertiary care hospital.Patients: Newly admitted ICU patients 18 years old or older.Interventions: We administered an eight-item verbal survey to patients or surrogates approached for consent to participate in a minimal risk, ICU-based study. The parent study involved noninvasive collection of biosamples and clinical data at the time of ICU admission and again 3 days later. If patients had capacity at the time of ICU admission, or if a surrogate was readily available, consent was sought prior to initial sample collection; otherwise, a waiver of consent was granted, and deferred consent was sought 3 days later. Quantitative and qualitative data were analyzed.Measurements and Main Results: One hundred fifty-seven individuals were approached for consent to participate in the parent study; none objected to the consent process. One hundred thirty-five of 157 (86%) competed the survey, including 94 who consented to the parent study and 41 who declined. Forty-four of 60 individuals (73%) approached for deferred consent responded positively to the question "Did we make the right choice in waiting until now to ask your consent?" three of 60 (5%) responded negatively, and 13 of 60 (22%) made a neutral or unrelated response. The most common reason given for endorsing the deferred consent process was the stress of the early ICU experience 25 of 44 (61%).Conclusions: Most patients and surrogates accept a deferred consent process for minimal risk research in the ICU. For appropriate ICU-based research, investigators and Institutional Review Boards should consider a deferred consent process if the subject lacks capacity and an appropriate surrogate is not readily available. [ABSTRACT FROM AUTHOR]

Patient experience is a widely used indicator for assessing the quality-of-care process during a patient's journey in hospital. However, the literature rarely discusses three components: patient stress, anxiety, and frustration. Furthermore, little is known about what drives each component during hospital visits. In order to explore this, we utilized data from a patient experience survey, including patient- and provider-related determinants, that was administered at a local hospital in Abu Dhabi, UAE. A machine-learning-based random forest (RF) algorithm, along with its embedded importance analysis function feature, was used to explore and rank the drivers of patient stress, anxiety, and frustration throughout two stages of the patient journey: registration and consultation. The attribute 'age' was identified as the primary patient-related determinant driving patient stress, anxiety, and frustration throughout the registration and consultation stages. In the registration stage, 'total time taken for registration' was the key driver of patient stress, whereas 'courtesy demonstrated by the registration staff in meeting your needs' was the key driver of anxiety and frustration. In the consultation step, 'waiting time to see the doctor/physician' was the key driver of both patient stress and frustration, whereas 'the doctor/physician was able to explain your symptoms using language that was easy to understand' was the main driver of anxiety. The RF algorithm provided valuable insights, showing the relative importance of factors affecting patient stress, anxiety, and frustration throughout the registration and consultation stages. Healthcare managers can utilize and allocate resources to improve the overall patient experience during hospital visits based on the importance of patient- and provider-related determinants.

Rationale & Objective: Electronic health record portals are increasingly emphasized in chronic kidney disease (CKD). However, associations of portal use with clinical and patient-centered outcomes remain unknown., Study Design: Cross-sectional survey (April 2015 to March 2018)., Setting & Participants: Nondialysis patients with CKD from nephrology clinics within 1 academic medical center., Exposures: Patient demographics (age, sex, race, ethnicity, education, and income), kidney function., Outcomes: Association between portal use as an outcome and exposures. Additionally, associations of portal use and patient demographics with 4 patient-centered outcomes (CKD-specific knowledge, stress, and 2 self-ratings of health)., Analytic Approach: Logistic regression to examine associations between patient portal use, demographics, and kidney function. Linear regression to examine associations between portal use and patient-centered outcomes., Results: Of 245 participants, mean age was 60 ± 17 (SD) years, 182 (77%) were White, 121 (49%) were women, 230 (96%) had a high school education or higher, and 96 (45%) had <$50,000 annual income. Examining portal use, 159 (65%) used the portal as follows: checking laboratory test results, 157 (99%); managing appointments, 133 (84%); messaging providers, 131 (82%); viewing medical history, 127 (80%); reviewing educational resources, 113 (71%); and renewing prescriptions, 98 (62%). African Americans (OR, 0.34; 95% CI, 0.16-0.72 vs White patients), patients with less formal education (OR, 0.06; 95% CI, 0.01-0.36), and those with lower income (OR, 0.28; 95% CI, 0.13-0.60; and OR, 0.26; 95% CI, 0.12-0.54 comparing income < $25,000 and $25,000-$50,000, respectively, with ≥$50,000) had lower odds of using the portal. In adjusted analysis, only lower income predicted lower portal use. Examining patient-centered outcomes in univariable analysis, portal users had higher knowledge (β = 4.89; P  = 0.02), higher ratings of current health (β = 0.28; P  = 0.03), and lower CKD-related stress (β = -0.18; P  = 0.05). In adjusted analysis, only patient demographics and/or kidney function remained independent predictors of patient-centered outcomes., Limitations: Cross-sectional study design, cannot determine causality., Conclusions: Interventions are needed to ensure that all patients have access to portals to mitigate disparities in care., (© 2021 The Authors.)

Objective: The objective of this prospective RCT was to compare the efficacy of a web-based teaching tool to traditional didactic teaching in IVF patients., Methods: Forty women undergoing their first IVF cycle were randomly allocated to an interactive web-based teaching session or a nurse-led didactic teaching session. The primary outcome measure was participant knowledge regarding the IVF process, risks, and logistics assessed before and after the respective teaching session. Secondary outcomes included patient stress, assessed before and after the respective teaching session, and patient satisfaction, assessed following the respective teaching session and on the day of embryo transfer (following implementation of the teaching protocol)., Results: Both groups demonstrated similar and significant improvements in knowledge and stress after exposure to their respective teaching sessions. The web-based group was significantly more satisfied than the didactic teaching group. Web-based teaching was also shown to be equally effective for participants of high versus low income and education status for knowledge, stress, and satisfaction., Conclusion: This study provides preliminary support for the use of web-based teaching as an equally effective tool for increasing knowledge and reducing stress compared to traditional didactic teaching in IVF patients, with the added benefit of increased patient satisfaction., (Copyright © 2018 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.)