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      Patient journey experiences may contribute to improve healthcare for patients with rare endocrine diseases

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          Abstract

          Patient journeys are instruments developed by EURORDIS, The Voice of Rare Disease Patients in Europe, to collect patients’ experiences; they may identify gaps and areas deserving improvement, as well as elements positively considered by affected persons. As with other patient-reported experiences, they can complete the clinical evaluation and management of a specific disease, improving the often long diagnostic delay, therapy, patient education and access to knowledgeable multidisciplinary teams. This review discusses the utility of such patient-reported experience measures and summarises the experiences of patients with acromegaly, Addison’s disease and congenital adrenal hyperplasia from different European countries. Despite rare endocrine diseases being varied and presenting differently, feelings of not having been taken seriously by health professionals, family and friends was a common patient complaint. Empathy and a positive patient-centred environment tend to improve clinical practice by creating a trustworthy and understanding atmosphere, where individual patient needs are considered. Offering access to adequate patient information on their disease, treatments and outcome helps to adapt to living with a chronic disease and what to expect in the future, contemplating the impact of a disease on patients’ everyday life, not only clinical outcome but also social, financial, educational, family and leisure issues is desirable; this facilitates more realistic expectancies for patients and can even lead to a reduction in health costs. Patient empowerment with patient-centred approaches to these complex or chronic diseases should be contemplated more and more, not only for the benefit of those affected but also for the entire health system.

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          Most cited references18

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          Physicians' communication and perceptions of patients: is it how they look, how they talk, or is it just the doctor?

          Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians' patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians' characteristics, patients' demographic characteristics, physician-patient concordance, and the patient's communication. Physicians (N=29) and patients (N=207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians' communication and affect as well as the patients' participation and affect. Doctors were more patient-centered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians' encounters with black patients revealed communicative difficulties that may lower quality of care for these patients.
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            Measuring what matters to rare disease patients – reflections on the work by the IRDiRC taskforce on patient-centered outcome measures

            Our ability to evaluate outcomes which genuinely reflect patients’ unmet needs, hopes and concerns is of pivotal importance. However, much current clinical research and practice falls short of this objective by selecting outcome measures which do not capture patient value to the fullest. In this Opinion, we discuss Patient-Centered Outcomes Measures (PCOMs), which have the potential to systematically incorporate patient perspectives to measure those outcomes that matter most to patients. We argue for greater multi-stakeholder collaboration to develop PCOMs, with rare disease patients and families at the center. Beyond advancing the science of patient input, PCOMs are powerful tools to translate care or observed treatment benefit into an ‘interpretable’ measure of patient benefit, and thereby help demonstrate clinical effectiveness. We propose mixed methods psychometric research as the best route to deliver fit-for-purpose PCOMs in rare diseases, as this methodology brings together qualitative and quantitative research methods in tandem with the explicit aim to efficiently utilise data from small samples. And, whether one opts to develop a brand-new PCOM or to select or adapt an existing outcome measure for use in a rare disease, the anchors remain the same: patients, their daily experience of the rare disease, their preferences, core concepts and values. Ultimately, existing value frameworks, registries, and outcomes-based contracts largely fall short of consistently measuring the full range of outcomes that matter to patients. We argue that greater use of PCOMs in rare diseases would enable a fast track to Patient-Centered Care. Electronic supplementary material The online version of this article (10.1186/s13023-017-0718-x) contains supplementary material, which is available to authorized users.
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              Understanding the patient privacy perspective on health information exchange: A systematic review

                Author and article information

                Journal
                Endocr Connect
                Endocr Connect
                EC
                Endocrine Connections
                Bioscientifica Ltd (Bristol )
                2049-3614
                13 October 2022
                01 December 2022
                : 11
                : 12
                : e220385
                Affiliations
                [1 ]IIB-Sant Pau , Research Center for Pituitary Diseases, Barcelona, Spain
                [2 ]Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER , Unidad 747), ISCIII, Spain
                [3 ]Department of Endocrinology , Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
                [4 ]Department of Medicine , Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
                [5 ]ePAG & Chair of Danish Addison Patient Association , Aarhus, Denmark
                [6 ]Pediatric Endocrinology , Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
                [7 ]ePAG & Chair SOD ITALIA - Italian Patients Organization for Septo Optic Dysplasia and other Neuroendocrine Conditions , Rome, Italy
                [8 ]Aix-Marseille Université , Institut National de la Santé et de la Recherche Médicale (INSERM), U1251, Marseille Medical Genetics, Institut MarMaRa, Marseille, France
                [9 ]EURORDIS - Rare Diseases Europe , Paris, France
                Author notes
                Correspondence should be addressed to S M Webb: webbsusan4@ 123456gmail.com; swebb@ 123456santpau.cat

                This paper forms part of a special series collated by European Reference Network on Rare Endocrine Conditions celebrating its fifth year. The guest editors for this section are Violeta Iotova, Jérôme Berherat, and George Mastorakos.

                Author information
                http://orcid.org/0000-0001-7052-6436
                Article
                EC-22-0385
                10.1530/EC-22-0385
                9716367
                36228311
                72536ff1-0f92-4666-8313-aaa3fea4efb5
                © The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 08 September 2022
                : 13 October 2022
                Categories
                Review

                health perception,patient journey,addison’s disease,acromegaly,congenital adrenal hyperplasia

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