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Digital health literacy is linked to attitudes regarding the ethical aspects of digital health among patients with dermatologic comorbidities
(Public Library of Science (PLoS), 2025)
Ruelas-Villavicencio, Ana Lilia
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Contreras-Yáñez, Irazú
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Gómez-Ruiz, Roxana Paola
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Zagaglia Del Valle, María Clara
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Malagón-Liceaga, Andrea
Introduction: Digital health literacy (DHL), also known as eHealth literacy, refers to an individual’s ability to locate, understand, evaluate, and apply health information from electronic sources to make informed health decisions. This skill is increasingly regarded as essential for navigating the modern healthcare landscape, promoting health equity, and improving health outcomes. The study objective was to establish an association between DHL and dermatologic outpatients’ attitudes regarding ethical aspects of digital health. Additionally, we validated a questionnaire designed to assess these bioethical attitudes. Patients and methods: This cross-sectional study was performed in two phases (April 2024-December 2024). Phase-1 consisted of validating the Bioethical Attitudes toward Digital Health questionnaire (BADH). Phase-2 evaluated the association between the eHEALS (it assesses a person’s ability to use digital health resources) and BADH scores. Three convenience samples of consecutive patients were used: S-1 included 46 patients who participated in a pilot testing, S-2 included 100 patients who participated in the BADH validation and S-3 included 120 patients and was used to investigate the association between DHL and bioethical attitudes. Descriptive statistics and multiple linear regression analysis were used. Results: The 8-item BADH was found to be feasible, valid, and reliable. The exploratory factor analysis revealed a two-factor structure, consisting of trust and privacy dimensions, which accounted for 59.8% of the total variance. This structure was subsequently validated through confirmatory factor analysis. The BADH reliability was confirmed with a Cronbach’s alpha of 0.686 and ICC of 0.684 (95% CI: 0.581–0.770). A positive linear association was identified between the eHEALS and the BADH scores (β = 0.465, 95%CI: 0.218–0.450, p < 0.001). This relationship was evident with the trust dimension of the BADH (β = 0.526, 95%CI: 0.206–0.379, p < 0.001), but not with the privacy dimension. Conclusions: DHL is associated with individual moral positions regarding digital health, particularly those concerning trust. The BADH questionnaire has adequate psychometric properties. ©The authors ©Public Library of Science (PLoS) ©PLOS one.
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Mental health-related, existential, and biological factors are associated with the desire to hasten death in Mexican cancer patients undergoing palliative care: A single-center study
(Public Library of Science (PLoS), 2025)
Rodríguez-Mayoral, Oscar
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Monreal-Carrillo, Edith
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Contreras-Yáñez, Irazú
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Allende-Pérez, Silvia
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Agazzi, Evandro
Introduction: The wish to hasten death (WTHD) is a clinically significant phenomenon that arises from complex suffering. It has been predominantly studied in Caucasian populations, emphasizing the importance of gaining more diverse cultural perspectives. This study explores the factors associated with the WTHD in Mexican cancer patients receiving palliative care from one academic center, with a specific focus on its connection to dignity.“. Patients and methods: The study, a cross-sectional research conducted between October 12, 2023, and August 30, 2024, involved patients with confirmed cancer diagnoses who were attending a palliative care service. Patients had applied the Patient Dignity Inventory (PDI), Schedule of Attitudes Toward Hastened Death (SAHD), Brief Edinburgh Depression Scale (BEDS), EORTC QLQ-C15-PAL to assess health-related quality of life, Karnofsky Performance Status Scale (KPSS) to assess functional capacity, and the Edmonton Symptom Assessment System. A PDI score ≥55 indicated a fractured sense of dignity (DPD), while a SAHD score ≥1 indicated the WTHD. Factors associated with the WTHD were identified using multiple logistic regression analysis. The study was approved by the IRB. Results: The study included 302 primarily middle-aged (54.5 [45–64]) females (225 [74.5%]), with 9 years of education. They reported high severity of well-being (7 [1–7]) and tiredness (3 [0–6]). Their median KPSS score showed independence (80 [70–80]), despite impacts across all EORTC QLQ-C15-PAL dimensions. DPD was noted in 110 patients (36.5%). The most frequent diagnoses were breast cancer (114 [38%]), lung cancer (33 [11%]), and gastrointestinal cancer (28 [9%]). The WTHD was found in 94 patients (31.1%). Factors significantly associated included tiredness score (OR: 1.147, 95% CI: 1.044–1.261, p = 0.004), BEDS score (1.181, 1.085–1.284, p ≤ 0.001) and a DPD (1.979, 1.038–3.772, p = 0.04). Conclusions: The WTHD was found in one out of every three Mexican cancer patients receiving palliative care and was linked to biological-, mental health-, and existential-related factors. ©The authors ©Public Library of Science (PLoS) ©PLOS one
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Reduced quality of life impacts knowledge and type of informed consent in rheumatoid arthritis patients
(Clinical and Experimental Rheumatology S.A.S, 2019)
Pascual-Ramos, Virginia
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Contreras-Yáñez, Irazú
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Ruiz, Daniel
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Casas-Martínez, María-de-la-Luz
Objectives: Informed consent (IC) is an ethical process required in human subject research. Primary objective was to determine factors associated to poor knowledge of IC content (PK) in patients from an early rheumatoid arthritis cohort. Methods: The cohort initiated in 2004, had assistant and research purposes (NCT03389711). At inclusion, each patient selected 1 of 4 options of the IC form; options ranged from broad consent (patient’s data could be used for research) to patient denied to have his/her data used. Once enrolled, patients had regular assessments. Up to May 2017, the cohort had 146 patients with (median, range) follow-up of 8.8 years, (4.3-11.9) and 143 agreed to participate in a cross-sectional study; patients had scheduled rheumatic evaluations; additionally, a social worker applied a questionnaire that addressed objective described. PK was established by the borderline performance method. Multiple regression models were applied to investigate factors associated to PK. Results: At cohort inclusion, patients were primarily middle-aged (38.3±13.1 years) females (88.9%), with high disease activity (DAS28: 5.8 [4.6-6.8)] and poor quality of life (SF-36: 42 [29-59]). All the patients gave broad IC. At study entry, 35-41.3% of them had PK; longer follow-up and lower SF-36 scores at cohort inclusion, were associated to PK. In addition, 79.7% of the patients had DAS28-remission and 67.1% had SF-36 scores within normal range; interestingly, only 49% of the patients considered broad re-consent and these patients had poorer SF-36 emotional subscore than their counterpart (79±23 vs. 87±1, p=0.02). Conclusions: Poor quality of life impacts the autonomy of RA patients. © The authors © Clinical and Experimental Rheumatology ©
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Validation of the Mexican version of the Schedule of Attitudes Toward Hastened Death in patients undergoing palliative care in Mexico
(2023)
Rodríguez-Mayoral, Oscar
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Galindo-Vázquez, Oscar
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Espinoza-Bello, Marcos
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Allende-Pérez, Silvia
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Pascual-Ramos, Virginia
Objectives The Schedule of Attitudes Toward Hastened Death (SAHD) has emerged as a valid and reliable tool to assess the wish to hasten death (WTHD) among patients diagnosed with advanced cancer; however, the instrument has never been culturally adapted and validated for patients in Mexico. This study sought to validate and abbreviate the SAHD tool for use among patients attending the Palliative Care Service of the Instituto Nacional de Cancerología in Mexico. Methods The SAHD was culturally adapted from a previously published validation in patients from Spain. Eligible patients included Spanish literate subjects treated as outpatients in the Palliative Care Service, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-3. Patients were asked to answer the Mexican version of SAHD (SAHD-Mx) instrument and the Brief Edinburgh Depression Scale (BEDS). Results A total of 225 patients were included in the study. Median positive response in the SAHD-Mx was 2 (range 0-18). Positive correlation was identified between the SAHD-Mx scale and ECOG performance status (r = 0.188, p = 0.005), as well as BEDS (r = 0.567, p < 0.001). SAHD-Mx displayed strong internal consistency (alpha = 0.85) and adequate reliability from test-retest phone interviews (r = 0.567, p < 0.001). Using the confirmatory factor analysis model, a factor was identified and the number of items was reduced to 6, including items 4, 5, 9, 10, 13, and 18. Significance of results The SAHD-Mx emerges as an adequate tool, with appropriate psychometric characteristics, for assessing WTHD among patients diagnosed with cancer undergoing palliative care in Mexico.. © The Author(s), 2023. Published by Cambridge University Press.
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Attitudes about principle of autonomy in Hispanic patients from a dynamic early rheumatoid arthritis cohort
(Clinical and Experimental Rheumatology S.A.S., 2019)
Pascual-Ramos, Virginia
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Contreras-Yáñez, Irazú
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Ruiz, Daniel
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Casas-Martínez, María-de-la-Luz
Objetives: In 2004, we began assembling an incidental cohort of patients with recent-onset rheumatoid arthritis (RA). In February 2018, we performed a cross-sectional study with the objective to investigate patients' attitudes/knowledge regarding the autonomy principle. Methods: Patients currently attending the cohort (n=146) were invited to participate. A 4-dimensional questionnaire was administered, and a rheumatologic evaluation performed in the 143 patients who agreed to participate. Dimension-4 (D-4) included 7 multiple-choice (strongly agree-strongly disagree) sentences, 3 of which were related to patients' rights/obligations about health-related decisions (group-1), and 4 additional sentences challenged physician's recommendations (group-2). The D-4 score was considered a surrogate of knowledge autonomy (KA). Additionally, the surveyor scored KA with a Likert scale (poor, borderline and superior), and a cut-off point for poor KA was set using Borderline methodology. Mann-Whitney U-tests and logistic regression analysis were used. The study received IRB approval. RESULTS: At the time the questionnaire was administered, mean (±SD) patient age was 46.9 (±13.6) years, and median (interquartile range) cohort follow-up time was 8.8 (4.3-11.9) years. Fifty-one patients (35.6%) had poor KA; increased age (OR: 0.97, 95% CI: 1.004-1.063, p=0.023) was associated with better KA. Patients more frequently agreed-strongly agreed with group-1 sentences than they did with group-2 sentences (86.7% vs. 58%, p≤0.001). The results were reproduced in the subpopulations with sufficient KA (98.9% vs. 88%, p=0.007) and poor KA for patients in whom the gap was extreme (64.9% vs. 3.9%, p≤0.001). Conclusions: Hispanic RA patients' sense of autonomy suggests paternalism in the physician-patient relationship. © The authors © Clinical and Experimental Rheumatology
Scopus© Citations 7 33 1
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Factors associated with the quality of the patient-doctor relationship: a cross-sectional study of ambulatory Mexican patients with rheumatic diseases
(2021)
Pascual-Ramos, Virginia
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Contreras-Yáñez, Irazú
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Ortiz-Haro, Ana Belén
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Molewijk, Albert Christiaan
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Obrador, Gregorio
Background: The patient-doctor relationship (PDR) is a complex phenomenon with strong cultural determinants, which impacts health-related outcomes and, accordingly, does have ethical implications. The study objective was to describe the PDR from medical encounters between 600 Mexican outpatients with rheumatic diseases and their attending rheumatologists, and to identify factors associated with a good PDR. Methods: A cross-sectional study was performed. Patients completed the PDRQ-9 (Patient-Doctor Relationship Questionnaire, 9 items), the HAQ-DI (Health Assessment Questionnaire Disability Index), the Short-Form 36 items (SF-36), a pain–visual analog scale, and the Ideal Patient Autonomy Scale. Relevant sociodemographic, disease-related, and treatment-related variables were obtained. Patients assigned a PDRQ-9 score to each patient-doctor encounter. Regression analysis was used to identify factors associated with a good PDR, which was defined based on a cutoff point established using the borderline performance method. Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
Scopus© Citations 4 23 2
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Concordance among patients and physicians about their ideal of autonomy impacts the patient-doctor relationship: A cross-sectional study of Mexican patients with rheumatic diseases
(2020)
Pascual-Ramos, Virginia
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Contreras-Yáñez, Irazú
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Ortiz-Haro, Ana Belén
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Molewijk, Albert Christiaan
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Obrador, Gregorio
Introduction: In patient-doctor interaction both parties play a role. Primary objective was to determine if the concordance among rheumatologists and their patients of their ideal of autonomy was associated with a better patient-doctor relationship. Secondary objective was to describe factors associated to a patient paternalistic ideal of autonomy (PPIA). Materials and methods: This cross-sectional study had 3 steps. Step-1 consisted in translation/cultural local adaption of Ideal Patient Autonomy Scale (IPAS), a 14-items Dutch questionnaire. Step-2 consisted of IPAS validity and reliability in 201 outpatients. Step-3 consisted of the application of IPAS and the patient-doctor relationship questionnaire (PDRQ) to 601 outpatients with a medical encounter, and of IPAS to the 21 attending rheumatologists. Each patient-physician encounter was classified into with/without concordance in the ideal of autonomy and PRDQ scores were compared (Man Whitney U test). Regression analysis was used for associations. ©PLOS One
Scopus© Citations 3 19 2

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