Far-reaching benefits of digital consent tools revealed - Julie Smith, Content Director of EIDO Healthcare

Digital delivery of information can empower patients to make informed choices about their care, reduce necessary hospital appointments and improve the quality of face-to-face consultations. These are the conclusions of a small research study led by Mr Simon Parsons (Consultant Oesophago-Gastric Surgeon at Nottingham University Hospitals NHS Trust and Honorary Professor, University of Nottingham). The findings were published in an article entitled ‘Digital Informed Consent: Modernising Information Sharing in Surgery to Empower Patients’ in the World Journal of Surgery in December 2022.

The study used EIDO Healthcare’s patient information and digital platform to assess the following:

1. Patient experience of digital information to support informed consent
2. Time spent engaging with the information
3. Patient understanding (using a self-test survey)
4. Self-reported health information, compared to reports produced by health professionals

Patients with symptomatic gallstones (meaning they may need surgery) were sent information about the procedure digitally ahead of their first appointment with a surgeon. The system tracked time spent on the information and the patient completed a multiple-choice quiz at the end to assess their understanding. They could also report on their medical history and submit any questions they might have using free text.

The digital information, taken from the EIDO Healthcare library of patient information, was reviewed and approved by the Plain English Campaign, included an animation and came in accessible formats. Patients liked the multimedia style (text, animation, illustrations), found the information easy to read and felt that the digital delivery was convenient. One patient said:

The process makes me feel responsible for making a good decision about my own healthcare.

If a patient comes to their consultation already informed about the proposed treatment, they can have a more meaningful discussion than if the information is completely new to them. This will ensure that decision making is truly shared and consent is properly informed.
The authors noted that the patient-reported medical histories were accurate. More research in this area could lead to an approach that saves health professionals’ time as they would not need to produce this information themselves. There were no reported disadvantages to the digital delivery, either from patients or health professionals. It is important to note, however, that younger patients were more likely to sign up to the study. Information must always be available to patients in a format that they can access and are comfortable with.

Digital consent solutions will likely become an option for all NHS patients in the future. The research team will continue to measure the impact of these. It is expected that patients and clinicians alike will see an improvement in the informed consent process, and it is hoped that litigation for cases of ‘failure to inform’ will be reduced significantly. EIDO Healthcare took learnings from this study to inform the development of our digital home consent service. Read more on the EIDO website: https://www.eidohealthcare.com/products/inform-digital-home-consent/

You can read the full study on the Springer website: https://link.springer.com/article/10.1007/s00268-022-06846-w#Tab4. The authors of the study acknowledge the limitations due to the small sample size. More research using a larger sample is needed to confirm the findings reported.

Declaration of interest: Mr Simon Parsons, lead author of the article, is Clinical Director of EIDO Healthcare. Join the conversation: follow EIDO Healthcare on LinkedIn: https://tinyurl.com/EIDOLinkedIn Article citation: Parsons SL, Daliya P, Evans P, Lobo DN. Digital Informed Consent: Modernising Information Sharing in Surgery to Empower Patients. World J Surg. 2022 Dec 3. doi: 10.1007/s00268-022-06846-w. Epub ahead of print. PMID: 36463388

Content provided by Julie Smith, Content provided by Julie Smith, Content Director of EIDO Healthcare.
For more information please visit www.eidohealthcare.com.

The NHS and IT after Covid-19 - Steven Cutts BSc Hons, MBBS, FRCS (Tr & Orth)

After World War One, the role of women in British society changed forever. There are people out there who think that we ought to thank the Suffragettes for women’s suffrage. They’re wrong, in comparison to Kaiser Wilhelm II their role was quite minor. Only the pressures and opportunities provided by the world’s first total war compelled government and society to integrate women into the work force on a large scale.

This situation was repeated in the second world war and it’s easy for our own generation to forget just how fantastical certain aspects of the modern working environment would have seemed to people prior to 1914.

At this stage, it’s still an exaggeration to compare the impact of Covid-19 to the Great War but the wildly altered circumstances have changed the way people operate, including people who work in the NHS.

Quite a lot of medical consultations are now being performed on the telephone. Just about everyone has a phone these days and about half of the population has a smart phone. A couple of weeks ago, I tried to contact my own GP for the first time in years and discovered that he was only willing to speak to me on the telephone. A blood test request form was soon despatched to the reception desk and I soon trooped over to pick the thing up without ever having to meet the doctor in person.

The results were entirely normal. In a way, I feel like I’ve wasted the taxpayer’s money but it can be reassuring to hear.

As a medical professional myself, I’d be the first to admit that there are risks associated with this policy. There’s a reason we get taught how to examine people at medical school and it you cut the physical examination out then we will pay a price for it. Sooner or later, major organic pathology is going to be missed by a doctor purely because he hasn’t see or examined the patient. That isn’t to say that there is nothing to be gained by telephone consultations. Those of us who have discovered skype during the lock down can testify to the fact that it represents a different experience from a simple telephone conversation. But if we factor in the relatively cheap and simple cameras that come with the modern lap top computer than the virtual consultation can be taken to a new level. There are an awful lot of minor surgical procedures when it’s useful to at least glance at a post operative wound, say two weeks down the line and then mention in the notes that the wound looked good. For minor hand and wrist surgery, we could inspect a wound quite easily with a skype call. Even a patient sat at a desk in a conventional work place would probably be willing to display their hand to the doctor via a web cam. Being able to store a screen shot of this kind of thing would be even more useful since if the patient developed a problem later on we could compare the next image to the previous one. Right now, it isn’t at all easy to do any of these things.

For self employed patients, the advantages of the virtual clinic are even more obvious. Self employed people only get paid if they do any work. If they find themselves compelled to take half a day of work to see me in the outpatient clinic they could easily lose 10% of their weekly income, purely to sit in a waiting room until it’s OK to be seen at my convenience. Worse still, the treasury loses the tax revenue they would have collected on one of the few groups that are ultimately funding the NHS. In reality, we could easily perform many of these consultations in under five minutes using video conferencing kit that is available on just about every modern lap top and smart phone. The perennial argument about who has to pay for parking in the NHS car park would also fade away since they wouldn’t even have to drive here. Plenty of older, more sedentary patients could avoid having to request a volunteer NHS driver to pick them up.

In practise, if I have any apprehensions at all with a telephone consultation then I usually invite the patient to attend a face to face consultation in a week or two but that isn’t to say that there aren’t a lot of occasions where the telephone alone can do the job. A picture paints a thousand words and patients (or their GPs) who photograph their own pathology with a smart phone and send it by e-mail have huge potential for the future although again – hospital authorities may soon clash with clinicians over the matter of patient confidentiality. Remember that in practise any info we ever take from a patient is confidential and if anyone manages to hack into the digital traffic has committed a major offence.  Quite a lot of musculoskeletal pathology deserves an MRI scan these days and quite a lot of the scans that come back are negative. It takes about six weeks to turn around an MRI scan and what I often find is that within six weeks the forces of nature have corrected the patient’s pathology and their aches and pains have simply gotten better. It’s an expensive way to give nature another six weeks but it often works. If we ring a person at home to tell them that their MRI scan is normal and they respond by saying that their aches and pains have resolved without treatment then it’s hard to say how much resources we’ve actually saved.

Long before Covid came on the scene, nosocomial infections were an issue in health care and if you don’t even turn up in the hospital at all then you’re never going to catch anything in the hospital waiting room, let alone when you actually see your doctor.

Content provided by Steven Cutts BSc Hons, MBBS, FRCS (Tr & Orth)Medical Consultant, Orthopaedics and Trauma Surgery, James Paget, University Hospitals, NHS Foundation Trust

100% of victims experience coercive control - #NOMORE Domestic Abuse - Clare Walker: Domestic Abuse Consultant

What we need to understand about coercive control

Coercive Control is the bedrock of domestic abuse, I describe it as the ‘carbon monoxide’ in an abusive dynamic, in terms of health and wellbeing its far-reaching impacts are yet to be fully qualified. But what is known, is that Coercive Control creates more damage than the ‘traditional view’ of what domestic abuse is.

Coercive control and criminal law

Coercive Control has been enshrined in Law for the past seven years in the Serious Crimes Act 2015 under s76 and in more recent years the Domestic Abuse Act 2021, but society still hasn’t fully got to grips with identifying Coercive Control. A lack of understanding of what Coercive Control is, is reflected in our services interventions and service user’s pathways to services.

This leaves victims; be they primary (adult) or secondary (children), to try to make sense of it themselves, with no informed guidance or appropriate intervention; generally speaking. It is estimated that as few as 20% of victims would potentially be seen regularly through A&E, these victims suffer significant and frequent violent assaults.

Victims who end up as stats in our Domestic Homicide Reviews may have been a part of the above referred to 20%. But more often, they are victims of Coercive Control. We hear all the time references to the perpetrator as being a regular or even upstanding member of society. Perpetrators are far from stupid; they do not see themselves as perpetrators either – they see their actions as justified. The combination of all these aspects creates a whole system that enables further harm and therefore we need to change our systems, policies, practices, as well as our collective understanding. The key processes that take place in Coercive Control are humiliation, intimidation, degradation, and isolation. These serve to deplete a victim - all of this can be achieved without physical violence and more often is.

Perpetrators

Implementing Coercive Control is a conscious and intended practice by a perpetrator, their behaviours are staged events, a perpetrator does not ‘lose it’, they are always in control. A perpetrator aims to gain and maintain power and control over their victim. These behaviours escalate both in the relationship and post-separation, for female victims of male abuse, the first year is a significantly higher risk time period. A perpetrator doesn’t behave this way post-separation through heartbreak, it is driven by a determination to control. The global current and historical data demonstrate the significant and known level of risk post-separation specifically (but not solely) for a female victim of a male perpetrator. For a male victim of a female perpetrator, their risk reduces once the victim has left, that is not to say the abuse stops.

The V.O.I.C.E Programme is the solution…VOICE: Victims of Intimate Coercive Experience

This is what victims & professionals have long been waiting for! In partnership, myself, Cathy Press and Rachel Williams, have created The VOICE Programme. This is a psycho-educational look at domestic abuse through an intersectional lens. Victims who attend this course gain a deeper;

• understanding of domestic abuse in various contexts
• tools for their own recovery
• learning of how trauma impacts and manifests

Most don’t understand their own feelings, equally many professionals’ mis-diagnose the issue and end up pathologising the victim. For professionals The VOICE Programme is an informative, victim focused, educational, trauma-informed practice with therapeutic tools woven throughout. For victims attending, it is a bountiful safe exploration of trauma, grounding resource techniques and self-care tools.

VOICE is for all genders and sexualities of victims, but in practice largely works with heterosexual female victims, due to the prevalence for that group, as well as the barriers for victims outside of that framework and provision. Knowing what constitutes as abuse, enables a clearer understanding of how it impacts a victim’s health & well-being. For many victims and professionals’ alike, impacts are always far wider and deeper than what is generally known or understood. When living with domestic abuse, whether adult or child, instinctive responses in the amygdala are triggered. Victims are effectively dining out on adrenalin and cortisol 24/7, during the relationship and more so, after the relationship.
Health impacts such as; a racing mind, disordered thoughts, anxiety, hair loss, headaches and migraine, adrenal dysfunction, moderate to severe weight loss or gain, self-harming, thyroid imbalance, heart palpitations, impacts on menstrual cycle; irregular, heavier or stopping. Fibromyalgia, digestive issues, bowel movement issues and many more. There is no requirement for physical or sexual assault for any of these listed, to be achieved. Which is why the World Health Organisation defines domestic abuse as; “…the world’s leading preventable cause of death, disability and illness…”

Coercive control creates enduring health impacts

Depression • Anxiety • Agoraphobia • PTSD • Eating Disorders • Suicidal Behaviour • Self-harm • Alcohol/Substance Misuse • Continuous High Alert • Sleep Disruption/Deprivation • Digestive Problems • Repeated Terminations • Multiple Pregnancies • Miscarriages • Still-Births • STI’s

Systemic changes across all sectors are needed

We need systemic changes across all sectors for coercive and controlling behaviours to be recognised, meaningfully addressed, and appropriately responded too. All sectors and society as a whole look to the primary victim to stop the abuse, we have a very victim-blaming culture. Perpetrators are invisible in our processes and interventions. Victims are driven instinctively to stay safe, to stay alive; others assume this as complicity. Examples being; ‘she chooses to stay’ ‘she must like it’ ‘why doesn’t she leave’ ‘ why does she keep taking him back’ In all these biased beliefs statements that people say, there is rarely the question asked; ‘why does he do it’ ‘why doesn’t he leave her alone’ ‘it can’t be that bad, or he would be arrested’. Leaving victims to not be recognised as victims by services, but also not believed when they do recognise it.

Because of the confusion caused by Coercive Control, victims can often be in relationships with perpetrators for decades, suffering no end of sexual, emotional, psychological abuse, financial & economic abuse, and torture.

Intersectionality

In my work as an Expert Witness, I see more victims from outside of the stereotypes, victims across all Class, location, educational attainment and socio-economic status. These victims experience barriers to accessing services, and more broadly, by applying an intersectional view of society, further barriers can be identified.

Race and Culture
Cultural practices in our diverse communities, are frequently misrepresented and misunderstood. A victim in this context has the barrier of a misinformed view of their cultural practice, and oversight to this being used to control the victim. Often professionals place inaction, under the banner of ‘cultural sensitivity’ or ‘hard to reach’. Victims in this context can be left to endure the abuse alone.

LGBT+
Similarly, in our LGBT+ communities, there is an assumption and ignorance which comes out in practices, not least because of the rigid heteronormative thinking and pathways to access support, risks are assessed incorrectly due to using tools created for female victims of male abuse. These factors alone are demonstrated in our rates of engagement with, and from this community, creating a barrier to accessing services.

Gender
Heterosexual male victims have barriers to accessing services due to gender stereotypes and assumptions, and similarly to victims in the LGBT+ community being assessed with tools created for female victim of male abuse.

Older Persons
Being an ‘older person’ creates additional barriers to accessing support and protection, due to the assumptions of what age a person can be a victim or a perpetrator. It is only of more recent years that domestic abuse services have offered support to victims in this age category, if there are additional health support needs creating a carer and dependant dynamic between the victim and perpetrator; this also adds a further barrier. Many victims in this age category go under the radar during life and in death.

Disabilities
For victims who have additional mental ill health, physical and sensory impairments, emotional wellbeing, or medical health needs, the barriers to accessing services for this communities of people is multiple. Some barriers are created by assumptions that people in this community can’t also be victims or perpetrators of abuse.

These are just some examples of barriers experienced by victims identifying as being of the many minority groups across our society. But ultimately, wherever we sit in society and whatever community we identify, abuse should never be tolerated. We have domestic legislation to protect additional to our Human Rights Act. A victim’s Human Rights are breached every day by their perpetrator, and often, our system enables that.

"VOICE so far has already been invaluable on my journey of self-healing after years of suffering domestic abuse. It enlightens survivors to understand what they have endured and process how it has affected them on so many levels. It also empowers you to finally move towards a safer future"

Clare Walker is a Domestic Abuse Consultant with over 25 years of experience, working in the field, nationally and internationally; professionals training, University Lecturing, guest speaking at conferences, events, and webinars, Expert Witness and Domestic Homicide Review Chair.

Clare’s work enables, educates, and empowers people, and creates a deeper understanding of the complexities of domestic abuse. Being able to understand Human Behaviour and to identify an individual’s intention from verbal and non-verbal communication is what enables a broader and clearer understanding when looking at the complexities of a domestic abuse dynamic. Without doing so, we frequently facilitate continued abuse, because we wrongly identify the issue from what we are presented with.

This framework applies to primary (adult) or secondary (children) victims as well as the perpetrator. Clare uses this format in all areas of her work, drawing on various evidenced-based models and research to demonstrate a victim’s lived experience, as well as a perpetrator’s intention and motivation, either in situ, post-relationship, or historically.

Clare Walker is a Domestic Abuse Consultant with over 25 years of experience, working in the field, nationally and internationally. This includes; professionals training, University Lecturing, and guest speaking at conferences, events, and webinars.

Clare is also an Expert Witness and Domestic Homicide Review Chair, and provides direct support to victims. Clare does a great deal of campaigning to highlight the constant pandemic that is domestic abuse. Check out her No More Campaign page and blog on the website.

Clare’s work enables, educates, and empowers people, and creates a deeper understanding of the complexities of domestic abuse. Being able to understand Human Behaviour and to identify an individual’s intention from verbal and non-verbal communication is what enables a broader and clearer understanding when looking at the complexities of a domestic abuse dynamic. Without doing so, we frequently facilitate continued abuse, because we wrongly identify the issue from what we are presented with.

This framework applies to primary (adult) or secondary (children) victims as well as the perpetrator. Clare uses this format in all areas of her work, drawing on various evidenced-based models and research to demonstrate a victim’s lived experience, as well as the perpetrator’s intention and motivation, either in situ, post-relationship, or historically.

For more information about Clare’s work, please visit: www.clarewalkerconsultancy.com

Or find them on:
Twitter: @clarewalker3
Facebook: DomesticAbuseConsultant
LinkedIn: clarewalkerconsultancy
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YouTube: ClareWalkerConsultancy