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      Patient understanding of liver cirrhosis and improvement using multimedia education

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          For patients to engage with the long-term management of liver cirrhosis, sufficient understanding of their condition is essential. The aim of this study was to assess baseline patient knowledge and to test whether a condition-specific multimedia screencast could improve this.


          Service quality improvement study.


          A UK tertiary liver centre. Patients were recruited during 12 general hepatology outpatient clinics.


          Fifty-two patients with liver cirrhosis were included. Sixty-two per cent were male; their median age was 56 years and their median clinic attendance period was 3 years.


          Participants completed a baseline questionnaire assessing their knowledge of the management and complications of cirrhosis. They then watched a tailored screencast discussing this condition, which had been developed by expert hepatologists in collaboration with patient representatives. Knowledge was reassessed using a new copy of the original questionnaire after an interval of at least one month.

          Main outcome measures

          Patient scores on knowledge questionnaires at baseline and follow-up.


          Fifty-two patients achieved a median score of 25.0% before viewing the screencast. Thirty-five patients then completed a follow-up questionnaire after an interval period. The median questionnaire score in this group improved from 25.0% to 66.7%; an increase of 41.7% compared with baseline (p<0.001).


          Despite regular review at a specialist clinic, participants had poor baseline knowledge of liver cirrhosis. Delivering information by screencast led to a significant improvement. We therefore present an effective way to empower patients with accurate, up-to-date and retainable information that can easily be translated to many other conditions.

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          Most cited references 7

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          Patient involvement in healthcare is associated with higher rates of surveillance for hepatocellular carcinoma.

          Surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis, but earlier studies suggest that it is used less than one-third of the time. Patient factors associated with surveillance rates are incompletely understood. The aims of our study were to determine HCC surveillance rates in a tertiary-care center and to identify patient predictors of receiving surveillance. Patients with Child A or B cirrhosis seen in the University of Michigan liver clinics between October 2008 and March 2009 were enrolled to complete a self-administered survey. Surveillance rates and clinical data were extracted from the patient electronic medical record. Of the 160 patients enrolled, 74.4% had HCC surveillance performed in the past year. On multivariate analysis, predictors of receiving surveillance included male sex (odds ratio 7.1, 95% confidence interval, 1.2-43.2) and patient involvement in their care (odds ratio 3.4, 95% confidence interval, 1.5-7.9). Patients expressed high levels of concern regarding HCC, desired more information from their physicians, and wanted to be more involved in their care. HCC surveillance rates in a tertiary-care center were significantly higher than earlier reported rates. Direct patient involvement in decisions regarding HCC surveillance may help to improve surveillance rates.
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            The challenges of conceptualizing patient engagement in health care: a lexicographic literature review

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              Patients' knowledge about 9 common health conditions: the DECISIONS survey.

              To make informed decisions, patients must have adequate knowledge of key decision-relevant facts. To determine adults' knowledge about information relevant to common types of medication, screening, or surgery decisions they recently made. National sample of US adults identified by random-digit dialing. Cross-sectional survey conducted between November 2006 and May 2007. A total of 2575 English-speaking adults aged 40 y or older who reported having discussed the following medical decisions with a health care provider within the previous 2 y: prescription medications for hypertension, hypercholesterolemia, or depression; screening tests for colorectal, breast, or prostate cancer; or surgeries for knee/hip replacement, cataracts, or lower back pain. Participants answered knowledge questions and rated the importance of their health care provider, family/friends, and the media as sources of information. Accuracy rates varied widely across questions and decision contexts. For example, patients considering cataract surgery were more likely to correctly estimate recovery time than those patients considering lower back pain or knee/hip replacement (78% v. 29% and 39%, P < 0.001). Similarly, participants were more knowledgeable of facts about colorectal cancer screening than those who were asked about breast or prostate cancer. Finally, respondents were consistently more knowledgeable on comparable questions about blood pressure medication than cholesterol medication or antidepressants. The impact of demographic characteristics and sources of information also varied substantially. For example, blacks had lower knowledge than whites about cancer screening decisions (odds ratio [OR] = 0.57; 95% confidence interval [CI] = 0.43, 0.75; P = 0.001) and medication (OR = 0.77; 95% CI = 0.60, 0.97; P = 0.03) even after we controlled for other demographic factors. The same was not true for surgical decisions. The questions did not measure all knowledge relevant to informed decision making, were subject to recall biases, and may have assessed numeracy more than knowledge. Patient knowledge of key facts relevant to recently made medical decisions is often poor and varies systematically by decision type and patient characteristics. Improving patient knowledge about risks, benefits, and characteristics of medical procedures is essential to support informed decision making.

                Author and article information

                Frontline Gastroenterol
                Frontline Gastroenterol
                Frontline Gastroenterology
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                July 2017
                19 January 2017
                : 8
                : 3
                : 214-219
                [1 ]School of Medicine, University of Leeds , Leeds, UK
                [2 ]NIHR Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and The University of Nottingham , Nottingham, UK
                [3 ]College of Health and Wellbeing, University of Central Lancashire , Preston, UK
                [4 ]Department of Hepatology, Leeds Teaching Hospitals NHS Trust , Leeds, UK
                Author notes
                [Correspondence to ] Dr Waleed Fateen, NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK; waleed.fateen@
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

                Custom metadata

                Gastroenterology & Hepatology

                liver cirrhosis


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