Nurses/Doctors/Teachers: How to explain stats/research studies in 60 seconds or less?

[WhyNot]

OK, the time isn’t really important, but I need to know how to teach someone what some studies mean, while that someone is not highly educated in math and/or science, she’s in pain (and on painkillers which make her a little fuzzy minded) and highly emotional.

I’ve got a patient getting home health care who has a very severe (stage IV) pressure ulcer. We (her health care team) strongly believe that it’s time to start negative pressure therapy (“a wound vac”) but she doesn’t want it. I’ve found a couple of studies showing decreased hospitalization rates, decreased healing times, etc with the treatment we’re recommending vs. the treatment she’s getting now, but I’m not sure how to explain them to her and be both simple and accurate.
Schwien T, Gilbert J, Lang C. Pressure ulcer prevalence and the role of negative pressure wound therapy in home health quality outcomes.
Ostomy Wound Management. 2005 Sep;51(9):47-60.:

Abstract

Home health agencies, challenged to demonstrate quality while containing costs, are motivated to find best practices for managing patient and wound care. The effects of different wound therapies on frequency of hospitalization and emergent care, two prominent quality measures, have not been studied. A retrospective study was conducted to determine the prevalence of Stage III and Stage IV pressure ulcers in the home health population and to quantify the impact of negative pressure wound therapy in reducing acute care hospitalizations and emergent care in general, and wound infection or deteriorating wound status in particular. Data from 1.94 million OASIS start-of-care assessments in 2003 and 2004 were evaluated to estimate pressure ulcer prevalence and a retrospective matched group analysis compared patients using (n = 60) and not using (n = 2,288) negative pressure wound therapy. In 2003, 6.9% and in 2004, 7% of patients had pressure ulcers at start of care. Of these, 23% were Stage III or Stage IV and 31% were “not healing.” In the matched analysis group, it was found that compared to comparison group patients, those receiving negative pressure wound therapy experienced lower rates of hospitalization (35% versus 48%, P less than .05), hospitalization due to wound problems (5% versus 14%, P less than .01), and emergent care for wound problems (0% versus 8%, P = .01). To offset potential limitations in generalizability and increase practical application of these results, further research is needed with a larger, nationally representative sample to compare other quality outcomes as well as the cost of providing negative pressure wound therapy to other specific wound care modalities.

Early versus late initiation of negative pressure wound therapy: examining the impact on home care length of stay.:

Abstract

Because of the high cost of some wound management regimens, payors may require that moist wound therapies be used before other treatment approaches, such as negative pressure wound therapy (NPWT), are implemented but few studies have investigated the effect of delayed initiation of NPWT on patient outcomes. To examine the impact of early versus late initiation of NPWT on patient length of stay in home health care, a nonrandomized, retrospective analysis was performed on the Outcome and Assessment Information Set (OASIS) information for home care patients with NPWT-treated Stage III or Stage IV pressure ulcers (N = 98) or surgical wounds (N = 464) gathered between July 2002 and September 2004. Early initiation of NPWT following the start of home care was defined as <30 days for pressure ulcers and <7 days for surgical wound patients. Median duration of NPWT was 31 days (range 3 to 169) for pressure ulcers and 27 days (range 5 to 119) for the surgical wound group. Median lengths of stay in the early treatment groups were 85 days (range 11 to 239) for pressure ulcers and 57 days (range 7 to 119) for the surgical group versus 166 days (range 60 to 657) and 87 days (range 31 to 328), respectively, for the late treatment pressure ulcer and surgical groups (P < 0.0001). After controlling demographic patient variables, regression analysis indicated that for each day NPWT initiation was delayed, almost 1 day was added to the total length of stay (beta = 0.96, P <0.0001 [pressure ulcers]; beta = 0.97, P <0.0001 [surgical wounds]). Early initiation of NPWT may be associated with shorter length of stay for patients receiving home care for Stage III or Stage IV pressure ulcers or surgical wounds. Additional studies to ascertain the cost-effectiveness of treatments and treatment approaches in home care patients are needed.

Any suggestions? I don’t want to bully her into saying yes, but I want to be certain she knows what she’s saying no to.

[yams]

Why doesn’t she want it? Instead of bringing out studies, can you ask her what she knows/understands and why she is refusing, and then you can better clarify what negative pressure is, why you, as the health team, think it is time for negative pressure, etc. If someone is in pain and highly emotional, I would think that hearing the thoughts and opinions of the people on her personal health care team would be more swaying than some statistics done in some study by people she’s never heard of.

love
yams!!

[DSeid]

Based on what you provided:

"Using this technique earlier rather than later or not at all would make it more likely that you can stay out of the hospital, maybe as much as three times as likely, and heal faster. The biggest issue with it is the cost.

What concerns do you have about it?"

This does not sound like someone who needs or who wants the study details. Instead you need to find out what her concerns actually are (which may be more emotional ones and while not necessarily rational very real and cogent to her) and address those. What is she scared of? Does it represent a path to becoming machine dependent, a path to being on a vent? Some other reason?

On preview, yeah, what yams!! said.

[WhyNot]

Thank you. That helps me feel like I’m on the right track, since that’s how I’ve approached it thus far. My adding the study info in really to make sure I’ve covered therational benefits/risks, so I feel that her informed refusal is truly informed. I’m not legally responsible for getting the informed consent (her MD is), but I do feel ethically responsible for making sure she’s got the information, y’know?

Her main argument against it is “I don’t want that tube thing sticking out’ my back.” Which…I can’t really argue against. I get it. She’s already got a Foley tube sticking out her nethers, she’s already wheelchair and bedbound and has to have someone else help her for absolutely everything, including turning over. This whole thing absolutely totally sucks for her, a relatively young and, until a recent stroke, independent woman.

The other emotional aspect is that she was given the impression by the wound care consultant that if she got the wound vac, the consultant would become her nurse, and she doesn’t want to lose me as her nurse. Got that one tidied up and corrected before I left yesterday, reassuring her that I will receive training from the wound vac company and will continue to be her nurse if/when that’s what she chooses. Asked her to sleep on it before she let herself get attached to a decision. I’m on my way there now to see what’s up for her today. I won’t overwhelm her with numbers, but I will share with her that I looked up a few studies, and repeat what DSeid said.

[Kerrigan]

The new Wound Vac tubing is quite flexible. Were she to have it on her back or butt, it’s not like the tubing is going to stick straight out like a tail–it can be adjusted for positioning and not be incredibly conspicuous while she’s, say, up and about in a wheelchair.

That’s what I pictured when you mentioned “that tube thing sticking out.” Maybe she is too? And if she’s laying in bed and not right on top of the Vac dressing, she wouldn’t even notice the tubing.

[Mean_Mr.Mustard]

Better than studies, Whynot, whynot her some before & after photos of wounds that have improved from VAC therapy? I bet the VAC rep has some.
mmm