You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Association of Patient Recall, Satisfaction, and Adherence to Content of an Electronic Health Record (EHR)–Generated After Visit Summary: A Randomized Clinical Trial
Abstract 1:
Objective : Most electronic health record ( EHR ) systems have the capability of generating a printed after-visit summary ( AVS ) , but there has been little research on optimal content . We conducted a qualitative study and a r and omized trial to underst and the effect of AVS content on patient recall and satisfaction . Methods : Adult primary care patients ( n = 272 ) with at least 1 chronic condition were r and omly assigned to 4 AVS content conditions : minimum , intermediate , maximum , or st and ard AVS . Demographics and health literacy were measured at an index clinic visit . Recall and satisfaction were measured by telephone 2 days and 2 to 3 weeks after the clinic visit . Results : Average age was 52 years ; 75 % of patients were female , 61 % were Hispanic , and 21 % were African American , and 64 % had adequate health literacy . Average medication recall accuracy was 53 % at 2 days and 52 % at 3 weeks , with no significant difference among groups at either time . Satisfaction with  AVS  content was high and did not differ among groups . Recall of specific content categories was low and unrelated to group assignment . Health literacy was unrelated to recall and satisfaction . Conclusion : Primary care patients like to receive an AVS , but the amount of information included does not affect content recall or satisfaction with the information


Title 2:
Barriers to self-management of diabetes: a qualitative study among low-income minority diabetics.
Abstract 2:
OBJECTIVES Diabetes self-management is a key element in the overall management of diabetes . Identifying barriers to disease self-management is a critical step in achieving optimal health outcomes . Our goal was to explore patients ' perceptions about barriers to self-management of diabetes that could possibly help explain poor health outcomes among minority patients . STUDY DESIGN Four focus groups were conducted among 31 predominately African American patients with diabetes who were enrolled in the Baltimore Cardiovascular Partnership Study , a NIH-funded multiyear prospect i ve partnership study . The topic guide consisted of a series of open-ended questions about knowledge of current health status , medication use , continuity of care , blood glucose level and nutrition . RESULTS The focus groups confirmed that previously reported barriers to self-management persisted and identified new concerns that could be associated with poor health outcomes among minority patients with diabetes .  Attitudes , perceptions and behaviors surrounding diabetes and self-management of the condition did vary across individuals , however , the variation appeared to reflect the individual 's knowledge and opinions rather than patient 's age , sex , or culture . The primary barrier to diabetes self-management result ed from lack of knowledge of target blood glucose and blood pressure . Several participants found some of the health information to be quite confusing . CONCLUSIONS Diabetes is a major public health concern and the lack of awareness of target blood glucose and blood pressure further complicates the problem . The limited health literacy seen in this study could help explain several of the barriers to self-management . The barriers to self-management identified in this qualitative study are amenable to intervention that could improve health outcomes


Title 3:
Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation
Abstract 3:
Introduction Older , chronically ill patients with limited health literacy are often under-engaged in managing their health and turn to the emergency department ( ED ) for healthcare needs . We tested the impact of an ED-initiated coaching intervention on patient engagement and follow-up doctor visits in this high-risk population . We also explored patients ’ care-seeking decisions . Methods We conducted a mixed- methods study including a r and omized controlled trial and in-depth interviews in two EDs in northern Florida . Participants were chronically ill older ED patients with limited health literacy and Medicare as a payer source . Patients were assigned to an evidence -based coaching intervention ( n= 35 ) or usual post-ED care ( n= 34 ) . Qualitative interviews ( n=9 ) explored patients ’ reasons for ED use . We assessed average between-group differences in patient engagement over time with the Patient Activation Measure ( PAM ) tool , using logistic regression and a difference-in-difference approach . Between-group differences in follow-up doctor visits were determined . We analyzed qualitative data using open coding and thematic analysis . Results PAM scores fell in both groups after the ED visit but fell significantly more in “ usual care ” ( average decline −4.64 ) than “ intervention ” participants ( average decline −2.77 ) ( β=1.87 , p=0.043 ) . There were no between-group differences in doctor visits . Patients described well-informed reasons for ED visits including onset and severity of symptoms , lack of timely provider access , and immediate and comprehensive ED care . Conclusion The coaching intervention significantly reduced declines in patient engagement observed after usual post-ED care . Patients reported well-informed reasons for ED use and will likely continue to make ED visits unless strategies , such as ED-initiated coaching , are implemented to help vulnerable patients better manage their health and healthcare


Title 4:
Nutrition Literacy among Cancer Survivors: Feasibility Results from the Healthy Eating and Living Against Breast Cancer (HEAL-BCa) Study: a Pilot Randomized Controlled Trial
Abstract 4:
Knowledge of nutrition among breast cancer patients is insufficient , despite their motivation to seek valid information about healthy food choices . This study examines the feasibility of nutrition education workshops for cancer survivors , to inform the design of a multi-center intervention . Fifty-nine female English-speaking breast cancer patients , who had completed treatment , were enrolled . Participants were r and omized to the intervention or control group . The intervention group attended six nutrition education sessions , and the control group received brochures . Measurements were done at baseline and 3-month follow-up and included the Assessment Instrument for Breast Cancer ( NLit-BCa ) , fruit/vegetable and general health literacy screeners . Height and weight were measured . Changes in nutrition literacy , health literacy , and food intake from baseline to follow-up ( within-group change ) were calculated for both groups ( effect sizes were reported as Cohen ’s d ) . Participants were mostly white , with a mean age of 58 years , BMI of 31.6 kg/m2 , and had college degrees .  Follow-up rates were high ( 89 % = control and 77 % = intervention group ) . At baseline , participants scored high for most NLit-BCa assessment components except food portions in both groups . At the 3-month follow-up , effect sizes ( d ) on the NLit-BCa ranged from −0.5 to 0.16 . The study met its recruitment goals within 6 months . Focus groups indicated that ( a ) attending six sessions was acceptable , ( b ) patients found social/emotional support , ( c ) improvements should include information for special diets and booster sessions . This pilot study suggests that the intervention was acceptable and that scaling up of this intervention is feasible and could provide benefit to breast cancer survivors


Title 5:
A qualitative study of patients' goals and expectations for self-management of COPD.
Abstract 5:
BACKGROUND Chronic obstructive pulmonary disease ( COPD ) is an illness that affects patients on multiple levels , both physically and psychologically . While there is a growing body of evidence for the efficacy of self-management among patients with COPD , little evidence is available on the optimal content and methods for delivering self-management support . AIMS The purpose of this study was to address gaps in the literature on self-management support by examining patients ' responses to questions about goals , needs , and expectations regarding self-management using qualitative methods in a broadly representative sample of patients with moderate to severe COPD . By focusing on patients ' perceptions of their needs , we hoped to guide development of cognitive-behavioural interventions for self-management support . METHODS Patients > 45 years of age with a physician diagnosis of COPD were recruited as part of a larger r and omised controlled trial design ed to determine the effectiveness of a lifestyle behavioural intervention to increase physical activity . In-depth interviews were conducted at baseline data collection using 10 st and ardised open-ended questions tailored to examine factors relevant to self-management support including concerns , fears , learning needs , barriers , facilitators , and goals . All interviews were audio recorded and analysed using qualitative methods . Responses were coded by three raters into thematic categories . RESULTS A sample of 47 interviews with patients of mean age 68.4 years , 53 % male , 87 % white were used in the analysis . The distribution of spirometric impairment based on percent predicted forced expiratory volume in 1 second ( FEV1 ) was moderate ( 57.5 % ) , severe ( 31.9 % ) , and very severe ( 10.6 % ) . In response to questions targeting needs and goals for care , three main themes ( loss , fear , and desire for improved care ) and seven associated sub-themes were identified . Because of breathlessness and fatigue as well as symptoms from conditions other than COPD , patients reported the loss of ability to participate in pleasurable and necessary activities of daily living and the desire to recover at least some of their functioning . They expressed problems with social isolation and uncertainty about their prognosis , as well as the hope to improve . In addition , fearful experiences associated with uncontrolled breathlessness and a wish for greater underst and ing and knowledge about treatment were major concerns . CONCLUSIONS These qualitative results suggest that the content of self-management support for patients with COPD should focus on addressing patients ' fears associated with the uncertainty , progression , and suffering of their disease , their expectations about overcoming or replacing losses , their needs for improved health literacy and their desire for improved care . These responses indicate areas where cognitive-behavioural intervention should focus in order to enhance patient self-efficacy , motivation , and behavioural change for improved self-management


Title 6:
Mapping patients’ experiences after stroke onto a patient-focused intervention framework
Abstract 6:
Background : Stroke patients ’ involvement in the rehabilitation process including decision making has made significant advances clinical ly over the past two decades . However , development of patient-focused interventions in stroke rehabilitation is a relatively under developed area of research . The aim of this study was to interpret the explanations that patients gave of their experience after stroke and how these may vali date an already established patient-focused intervention framework – the Quest for quality and improved performance ( QQUIP ) ( 2006 ) that includes seven quality improvement goals . Methods : A r and om purposive sample of eight stroke patients was interviewed between 3 and 6 months following discharge . Patients ’ reports of their experience after stroke were obtained using in-dept semi-structured interviews and analysed using Qualitative Content Analysis . Results : Explanations given by patients included both positive and negative reports of the stroke experience . Regardless of consequences as a result of physical , psychological and social impairments , there were other life style disruptions that were reported by all patients such as taking new medication and adverse effects of these , experiencing increasing fatigue , difficulties with social activities and situations and having to make changes in health behaviours and lifestyle . Some of the core themes that emerged reflected the aims of QQUIP improvement goals that include improving health literacy , clinical decision-making , self-care , patient safety , access to health advice , care experience and service development . Discussion : Further recommendations based on the findings from this study would be to consider using the QQUIP framework for developing intervention studies in stroke rehabilitation care that are person-centred . This framework provides a template that is equipped to address some of the main concerns that people have following the experience of stroke and also focuses on improving quality of care . Implication s for Rehabilitation Consideration for the use of established patient focused frameworks for improving the design and development of rehabilitation stroke interventions . Identify patients ’ main concerns following the experience of stroke and its result ing consequences in developing stroke rehabilitation interventions Greater need to move from a provider-led model of care towards a more favourably balanced view that includes patient participation and involvement in their self management of the rehabilitation programme
Patient perspectives were categorized into four key themes : ( 1 ) Support system ; ( 2 ) Patient self-management ; ( 3 ) Capacities of HCPs ; ( 4 ) Barriers in healthcare systems . "
The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for ( future ) HCPs , and contribute to better person-centred care for patients with LHL