The Relationship Between the Physician-Patient Relationship, Physician Empathy, and Patient Trust

A Clinical Research Interaction Scale for Racial and Ethnic Minority Participants

Importance

Patient-staff interactions in clinical trials may influence future enrollment decisions among racial and ethnic minority patients, who remain underrepresented in clinical research. A scale that measures common patient-staff interactions encountered by racial and ethnic minority patients in clinical trials may help improve patient experience and enrollment outcomes.

Objective

To develop and validate a scale that measures common interactions encountered by racial and ethnic minority patients in clinical trials.

Design, Setting, and Participants

This mixed-methods survey study involved interviews and online surveys for data collection between April 1, 2023, and June 30, 2024. Adult (aged ≥18 years) racial and ethnic minority patients were interviewed to identify common interactions with research staff. The survey was validated across potential clinical trial participants and among former clinical trial participants.

Main Outcomes and Measures

Fit statistics for exploratory factor analysis and confirmatory factor analysis were used to confirm the validity of the scale. Structural equation modeling coefficients were used to assess the validity of the scale for measuring patients' trust toward the research staff and willingness to participate in future studies.

Results

The sample include 1113 participants. The scale item derivation cohort comprised 16 racial and ethnic minority participants with clinical trial experience (mean [SD] age, 44.9 [12.9] years; 10 female [62.5%]; 3 identifying as Asian or Pacific Islander [18.8%], 9 as Black [56.3%], 3 as Latino [18.8%], and 1 as multiracial [6.3%]). The scale structure validation cohort of potential clinical trial participants comprised 479 survey respondents (mean [SD] age, 35.5 [11.9] years; 219 women [45.7%]; 1 identifying as American Indian [0.2%], 59 as Asian or Pacific Islander [12.3%], 266 as Black [55.5%], 59 as Latino [12.3%], and 86 as multiracial [19.7%]). The concurrent validation cohort included 618 participants (mean [SD] age, 45.3 [16.3] years; 53% male; 63 identifying as Asian or Pacific Islander [10.2%], 228 as Black [36.9%], 75 as Latino [12.1%], 223 as White [36.1%], and 29 as multiracial [4.7%]). The 22-item Clinical Research Interaction Scale had high reliability (α = 0.96) and validity (comparative fit index, 0.92; Tucker-Lewis index, 0.91; root mean square error of approximation, 0.08). Patient experience of frequent low-quality interactions was significantly associated with lowered trust toward research staff (β, -0.56; 95% CI, -0.74 to -0.37), which in turn significantly lowered patients' willingness to return to the site for future studies (β, 0.80; 95% CI, 0.70-0.90).

Conclusions and Relevance

These findings suggest that low-quality interactions with research staff may reduce racial and ethnic minority patients' willingness to return for future studies, mediated by lowered trust toward the staff. The Clinical Research Interaction Scale may be a useful tool to improve the experience and enrollment outcomes for racial and ethnic minorities in clinical trials.

What Encourages Patients to Recommend Their Doctor After an Online Medical Consultation? The Influence of Patient-Centered Communication, Trust, and Negative Health Information Seeking Experiences

The doctor-patient relationship in China has become increasingly tense, with patients lacking trust in doctors. Meanwhile, online healthcare flourished, accelerated by the COVID-19 pandemic. This study utilized the direct and indirect pathway model of clinician-patient communication to health outcomes and online trust theory to examine the associations between online patient-centered communication (OPCC), benevolence and ability trust in doctors, negative online health information seeking experiences, and willingness to recommend doctors. The findings revealed that benevolence and ability trust mediated the relationship between OPCC and willingness to recommend doctors. Additionally, when participants had a high level of negative online health information seeking experiences, OPCC had a stronger effect on ability trust; meanwhile, the mediation effect of ability trust between the relationship of OPCC and willingness to recommend was stronger. This study also discussed theoretical and practical implications.

SEM model analysis of diabetic patients' acceptance of artificial intelligence for diabetic retinopathy

AIMS

This study aimed to investigate diabetic patients' acceptance of artificial intelligence (AI) devices for diabetic retinopathy screening and the related influencing factors.

METHODS

An integrated model was proposed, and structural equation modeling was used to evaluate items and construct reliability and validity via confirmatory factor analysis. The model's path effects, significance, goodness of fit, and mediation and moderation effects were analyzed.

RESULTS

Intention to Use (IU) is significantly affected by Subjective Norms (SN), Resistance Bias (RB), and Uniqueness Neglect (UN). Perceived Usefulness (PU) and Perceived Ease of Use (PEOU) were significant mediators between IU and other variables. The moderating effect of trust (TR) is non-significant on the path of PU to IU.

CONCLUSIONS

The significant positive impact of SN may be caused by China's collectivist and authoritarian cultures. Both PU and PEOU had a significant mediation effect, which suggests that impressions influence acceptance. Although the moderating effect of TR was not significant, the unstandardized factor loading remained positive in this study. We presume that this may be due to an insufficient sample size, and the public was unfamiliar with AI medical devices.

Impact of COVID-19 on door-to-wire time in ST-segment elevation myocardial infarction treatment: the role of digital communication

INTRODUCTION

ST-segment elevation myocardial infarction (STEMI) is a life-threatening cardiovascular emergency necessitating rapid reperfusion. During the COVID-19 pandemic, healthcare providers faced the challenge of ensuring timely STEMI interventions while managing the risk of viral transmission in hospitals. This study aims to analyze changes in the door-to-wire (D-to-W) time for STEMI treatment across three pandemic phases-early pre-epidemic phase (Group C), initial lockdown phase (Group A), and intermediate normalization phase (Group B). It also examines the impact of digital communication tools, collectively referred to as "InterNet+" (e.g., Twitter, WeChat), on treatment processes.

METHODS

Based on data of 630 STEMI patients treated in Chest Pain Center in a particular hospital in China from 2019 to 2020, changes in D-to-W time in different groups are measured. Time intervals in STEMI treatment process are also predicted by Bayesian statistics approach. The study investigated the influence of InterNet+ utilization before and after the pandemic through a questionnaire-based assessment.

RESULTS

For transfer-non-emergency- treatment, the time from first-electrocardiogram to preliminary-diagnosis in Group-A is significantly longer than that in Groups-B and -C (p = 0.004, p = 0.004); the time from decision-on-intervention to catheterization-room-activation in Group-A and -B is significantly longer than that in Group-C (p = 0.003, p < 0.001). For transfer-emergency- treatment, the time from first-medical-contact to arterial-puncture in Group-A and -B is remarkably shorter than that in Group-C (p = 0.006). Meanwhile, Bayesian method performs well in forecasting time intervals, so it can provide effective assistance for STEMI treatment. The findings from the questionnaire indicated that physicians perceived a significant association between the optimal management of STEMI and an increased frequency of InterNet+ tool usage following the pandemic (p = 0.019).

CONCLUSIONS

The treatment and management of STEMI patients have been in dilemmas and various time intervals of D-to-W are inevitably prolonged during the COVID-19 pandemic. The implementation of InterNet + tools proved essential for minimizing delays in D-to-W and FMC-to-W times, offering a valuable strategy for enhancing STEMI care amid ongoing pandemic challenges.

CLINICAL TRIAL NUMBER

Not applicable.

[Artificial intelligence in breast imaging : Hopes and challenges]

CLINICAL/METHODICAL ISSUE

Artificial intelligence (AI) is being increasingly integrated into clinical practice. However, the specific benefits are still unclear to many users.

STANDARD RADIOLOGICAL METHODS

In principle, AI applications are available for all imaging modalities, with a particular focus on mammography in breast diagnostics.

METHODICAL INNOVATIONS

AI promises to filter examinations into negative and clearly positive findings, and thereby reduces part of the radiological workload. Other applications are not yet as widely established.

PERFORMANCE

AI methods for mammography, and to a lesser extent tomosynthesis, have already reached the diagnostic quality of radiologists.

ACHIEVEMENTS

Except for second-opinion applications/triage in mammography, most methods are still under development.

PRACTICAL RECOMMENDATIONS

Currently, most AI applications must be critically evaluated by potential users regarding their maturity and practical benefits.

Using virtual patients to enhance empathy in medical students: a scoping review protocol

INTRODUCTION

Empathy is a crucial skill that enhances the quality of patient care, reduces burnout among healthcare professionals, and fosters professionalism in medical students. Clinical practice and standardized patient-based education provide opportunities to enhance empathy, but a lack of consistency and reproducibility as well as significant dependency on resources are impediments. The COVID-19 pandemic has further restricted these opportunities, highlighting the need for alternative approaches. Virtual patients through standardized scenarios ensure consistency and reproducibility while offering safe, flexible, and repetitive learning opportunities unconstrained by time or location. Empathy education using virtual patients could serve as a temporary alternative during the COVID-19 pandemic and address the limitations of traditional face-to-face learning methods. This review aims to comprehensively map existing literature on the use of virtual patients in empathy education and identify research gaps.

METHODS

This scoping review will follow the Joanna Briggs Institute's guidelines and be reported according to PRISMA-P. The search strategy includes a comprehensive search across databases such as PubMed (MEDLINE), CINAHL, Web of Science, Scopus, ERIC, Google, Google Scholar, and Semantic Scholar, covering both published and gray literature without language restrictions. Both quantitative and qualitative studies will be included. Two independent researchers will screen all titles/abstracts and full texts for eligibility. Data will be extracted to summarize definitions of empathy, characteristics of virtual patient scenarios, and methods for measuring their impact on empathy development. Results will be presented in narrative and tabular formats to highlight key findings and research gaps.

DISCUSSION

As this review analyzes existing literature, ethical approval is not required. Findings will be actively disseminated through academic conferences and peer-reviewed publications, providing educators and researchers with valuable insights into the potential of virtual patients to enhance empathy in medical education. This study goes beyond the mere synthesis of academic knowledge by contributing to the advancement of medical education and clinical practice by clarifying virtual patient scenario design and evaluation methods in empathy education. The findings provide a critical foundation for our ongoing development of a medical education platform aimed at enhancing empathy through the use of virtual patients.

Emotions and feelings in neuroscience education across career stages: a qualitative study with views from alumni, junior and senior academics

INTRODUCTION

Emotions and feelings are crucial components of our lives. However, their role in medical education scholarship, including in neuroscience education, has been overlooked. Moreover, their impact has been understudied in academia, especially across career stages. We explored emotions and feelings in the context of neuroscience education and across different career stages.

METHODS

This work is based on a project exploring the value of learning in postgraduate education, drawing on data from nineteen semi-structured interviews with university alumni and academics. Eight alumni (six females and two males) and eleven academics from a UK-based STEM-intensive institution participated in the study. Alumni refers to former students who have completed the MSc in neuroscience at a STEM-intense institution within the last six years. Lecturers and Senior Lecturers in neuroscience have been labelled as junior academics, whereas Readers and Professors have been labelled senior academics.

RESULTS

The alumni recognised their master experience was intense and challenging, yet acknowledged that enjoyment and stress are two faces of the same coin. Many cited their peers as an inspiration to go beyond the limits but only one student mentioned gratitude, which was never mentioned by the academics. At least one alumnus and one junior academic mentioned trust and confidence, but not the senior academics. Anxiety and confidence (and lack of) dominated the interviews with junior academics, who used intense words when discussing the pleasures of science. Conversely, the senior academics dedicated few words to emotions and feelings, never talked about anxiety, trust or gratitude, and very briefly mentioned the reward linked to sharing their knowledge with the next generations.

DISCUSSION

This work epitomises the importance of exploring emotions and feelings in neuroscience education. Talking more openly about emotions and reducing the pervasive narration of 'success stories' might be directions to follow, along with stressing the importance of cultivating self-efficacy, trust and gratitude since the early stages. Meetings between students and supervisors can play a key role in developing self-trust among the students. More focus should be placed on supporting the transition process between postgraduate studies and the subsequent steps of the academic ladder.

Instruments evaluating the duration and pace of clinical encounters: A scoping review

OBJECTIVE

Hurried encounters in clinical settings contribute to dissatisfaction among both patients and clinicians and may indicate and contribute to low-quality care. We sought to identify patient- or clinician-reported instruments concerning this experience of time in clinical encounters.

METHODS

We searched multiple databases from inception through July 2023. Working in duplicate without restrictions by language or clinical context, we identified published instruments or single items measuring perceptions of time adequacy in clinical encounters. We characterized these by time domain (perceived duration or pace of the encounter), responder (patient or clinician), and reference (experience of care in general or of a particular encounter).

RESULTS

Of the 96 instruments found, none focused exclusively on perception of time adequacy in clinical encounters. Nonetheless, these instruments contained 107 time-related items. Of these, 81 items (77 %) measured the perception of the encounter duration, assessing whether there was adequate consultation time overall or for specific tasks (e.g., listening to the patient, exploring psychosocial issues, formulating the care plan). Another 19 (18 %) assessed encounter pace, and 7 (7 %) assessed both duration and pace. Pace items captured actions perceived as rushed or hurried or the perception that patients and clinicians felt pressed for time or rushed. Patients were the respondents for 76 (71 %) and clinicians for 24 (22 %) items. Most patient-reported items (48 of 76) referred to the patient's general care experience.

CONCLUSION

There are existing items to capture patient and clinician perceptions of the duration and/or pace of clinical encounters. Further work should ascertain their ability to identify hurried consultations and to detect the effect of interventions to foster unhurried encounters.

PRACTICE IMPLICATIONS

The available items assessing patient and clinician perceptions of duration and pace can illuminate the experience of time adequacy in clinical encounters as a target for quality improvement interventions. These items may capture unintended consequences on perceived time for care of interventions to improve healthcare access and efficiency.

Visual hermeneutics as a tool to introduce empathy and core physician attributes in doctor-patient relationship for first-year medical undergraduate students

BACKGROUND

The doctor-patient relationship is essential for effective patient care, yet medical education often neglects to nurture the quality such as empathy during the initial years of training. Doctor-patient relationship is one of the modules taught in first year as part of mandatory AETCOM (Attitude, Ethics, and Communication) course in the undergraduate Indian medical curriculum. Hermeneutics, a method of interpretation, can play a vital role in introducing observational and reflective thinking skills. This study aimed to introduce empathy concepts and attributes of a good physician to first-year medical students through the use of paintings and visual hermeneutics to enhance their understanding of the doctor-patient relationship.

METHODS

A newly developed and validated educational module on the "Doctor-patient relationship" was administered to 250 first-year undergraduate medical students at Kasturba Medical College Manipal. The session was structured into three key steps: INTRODUCTION: Presenting Sir Luke Fildes' famous painting, The Doctor.

SELF-UNDERSTANDING AND INTERPRETATION

Encouraging students to analyse and interpret the painting.

DEBRIEFING

Facilitating discussions to consolidate learning. The session's effectiveness was evaluated using the initial two levels of the Kirkpatrick evaluation model. The learners feedback regarding the usefulness of the session was captured using a validated questionnaire, while reflective writing assignments were used to explore students' learnings from the intervention.

RESULTS

Student feedback was overwhelmingly positive, with participants expressing that the session significantly enhanced their understanding of professional qualities and empathy in the doctor-patient relationship, rating their overall learning experience at 8.63 out of 10. Students expressed that the use of painting and interactive discussions greatly enriched their capacity to connect with emotional and ethical dimensions of medical practice. Reflective writing revealed the importance of building trust, demonstrating professional conduct, and maintaining empathy and compassion in clinical interactions.

CONCLUSION

Introducing a visual hermeneutics approach has the potential to cultivate empathy and foster a deeper understanding of the doctor-patient relationship. Introducing this approach during the formative years of medical training can nurture compassionate and virtuous conduct, reinforcing students' commitment to delivering empathetic and competent care throughout their medical careers.

TRIAL REGISTRATION

The institutional ethics committee approved the conduct of the study [IEC180/2023].

The relationship between self-efficacy, learning burnout, willingness to fulfill the contract and empathy of rural-oriented tuition-waived medical students of China: a cross-sectional study

BACKGROUND

The empathy of rural-oriented tuition-waived medical students (RTMSs) is closely related to the construction of good doctor-patient relationship and the quality of rural medical and health services. The purpose of this study is not only to explore the relationship between self-efficacy, learning burnout, willingness to fulfill the contract and empathy, but also to explore the mediating role of self-efficacy between learning burnout and empathy, and between willingness to fulfill the contract and empathy.

METHODS

Four hundred ninety-five rural-oriented tuition-waived medical students from 3 medical universities in Shandong Province were selected as research subjects, and General self-efficacy scale (GSES), Learning burnout of university student (LBUS), Willingness to fulfill the contract scale and Jefferson Scale of Physician Empathy-student version (JSPE-S) were used to investigate. SPSS 25.0 and AMOS 24.0 were used for statistical analysis and path analysis of the data.

RESULTS

The willingness to fulfill the contract of rural-oriented tuition-waived medical students has a direct positive impact on self-efficacy (β = 0.11, P < 0.05) and empathy (β = 0.27, P < 0.001), and a significant direct negative impact on learning burnout (β = -0.25, P < 0.001). Learning burnout has a significant direct negative impact on self-efficacy (β = -0.34, P < 0.001), while self-efficacy has a significant direct positive impact on empathy (β = 0.22, P < 0.001). Learning burnout has no direct impact on empathy (β = -0.09, P = 0.109). Self-efficacy has a significant mediating effect between willingness to fulfill the contract and empathy (95% CI: 0.02-0.41), and also has a significant mediating effect between learning burnout and empathy [95% CI: -0.41- (-0.11)]. Learning burnout has no mediating effect between willingness to fulfill the contract and empathy (95% CI: -0.02-0.42).

CONCLUSION

This study found that learning burnout and willingness to fulfill the contract are important factors affecting rural-oriented tuition-waived medical students' empathy, both of which can influence empathy through the mediating role of self-efficacy. This provides positive suggestions for medical colleges to improve the empathy of students, which is of great practical significance for continuously improving the service quality of general practitioners and ultimately realizing the development of high-quality rural medical and health undertakings. In addition, it also provides an important theoretical reference for the formulation of empathy intervention measures and broadens the direction of rural-oriented tuition-waived medical students' research in the future.

Measurement of Dehumanization, Self-Dehumanization, and Empathy as Mediating Factors Among Healthcare Professionals

BACKGROUND

Dehumanization refers to the tendency of individuals or groups to attribute fewer human characteristics to other individuals or groups (referred to as hetero-dehumanization) or to themselves (referred to as self-dehumanization). This phenomenon currently seems to predominate in the medical and nursing professions. Indeed, healthcare environments facilitate latent forms of dehumanization due to their structure, organization, and inherent professional demands. This study aimed to investigate the association between hetero- or self-dehumanization and personality traits of healthcare professionals, as well as the possible key mediating role of empathy in this relationship.

METHODS

A total of 1150 healthcare employees were recruited for the current study with a mean age of 45.13 years. Data were collected through a questionnaire completed by health professionals.

RESULTS

Statistically significant relationships were found between self- and hetero-dehumanization and most personality traits (extraversion, agreeableness, conscientiousness). A mediation analysis revealed that empathy mediates the effects of personality traits on hetero- and self-dehumanization.

CONCLUSIONS

The present study addresses the vital role of personality traits of healthcare professionals on dehumanizing oneself or patients, offering insights into improving therapeutic relationships through the cultivation of empathy.

Education for Healthcare Providers: Impact of Academic Detailing on Reducing Misinformation and Strengthening Influenza Vaccine Recommendations

BACKGROUND

Recommendations from a trusted healthcare provider have been shown to be the most effective intervention for encouraging patients to be vaccinated. However, providers have reported feeling less prepared to address vaccination questions and having less time to discuss vaccines with patients than before the COVID-19 pandemic. Providers may benefit from a brief update about the available influenza vaccines and vaccination guidelines. Academic detailing is an evidence-based approach for preparing healthcare providers to discuss getting vaccinated with patients.

METHODS

An academic detailing presentation was developed using influenza statistics, vaccination recommendations, and recent local and national immunization rate data. Academic detailing was conducted with physicians and community pharmacy personnel in Yakima County, Washington, between November 2023 and January 2024. Yakima County is designated as a medically underserved area due to a lack of providers. A pre-detailing survey was conducted to evaluate participant knowledge of current ACIP recommendations and gather opinions about local resident vaccination barriers. A post-detailing survey was conducted to gather participants' opinions about the value of detailing.

RESULTS

Prior to the training, 73% of providers believed it was important to discuss influenza vaccination with patients, but only 52% felt confident in combating misinformation. Healthcare providers believed misinformation and vaccine hesitancy are the most common barriers for Yakima County patients, but recent survey results showed that online scheduling systems, long wait times, and limited appointment hours were the predominant issues reported locally. Two out of 12 community pharmacy personnel and zero resident physicians correctly named all three preferentially recommended influenza vaccines for patients 65 years and older. Overall, 96% of detailing participants reported that the session was valuable, 87% believed it would help them combat vaccine misinformation, and 65% reported planning to have more conversations with patients about influenza vaccination after participating.

CONCLUSION

Physicians and community pharmacy immunizers found the influenza vaccines academic detailing to be valuable. Staying up to date on vaccination guidelines can prepare providers to be confident in having informed conversations with patients about getting vaccinated.

The associations between emotional empathy, emotional intelligence, and COVID-19-related stress among nursing students: a cross-sectional study

BACKGROUND

The COVID-19 pandemic has variably affected the stress levels among students. Nursing students, as the reserve force of medical resources and the successors of frontline nursing staff, warrant particular attention regarding their stress levels. This study investigates the relationship between emotional empathy, emotional intelligence, and COVID-19-related stress in nursing students and examines the masking role of emotional intelligence in this relationship.

METHODS

A cross-sectional study was conducted from March to June 2023 using multi-stage sampling method to recruit 1126 nursing students from a medical university. Participants completed a demographic information questionnaire, the COVID-19 Student Stress Questionnaire, the Multidimensional Emotional Empathy Scale, and the Trait Meta-Mood Scale. Data were analyzed using t-tests/ one-way ANOVA, Pearson correlations, multiple linear regression, and the PROCESS macro program to examine the relationships between emotional empathy, emotional intelligence, and COVID-19-related stress, as well as the masking role of emotional intelligence.

RESULTS

Statistically significant differences were observed in COVID-19-related stress scores among nursing students from different residential areas (P < 0.05); Emotional empathy was significantly positively correlated with emotional intelligence and its dimensions. Emotional empathy also showed a significant positive correlation with COVID-19-related stress. Emotional intelligence and its dimensions were significantly negatively correlated with COVID-19-related stress; Emotional empathy and emotional intelligence were significant predictors of COVID-19-related stress; Emotional intelligence and its dimensions demonstrated a masking effect on the relationship between emotional empathy and COVID-19-related stress, with total effect sizes of -0.023 for emotional intelligence, -0.021 for emotional attention, -0.017 for emotional clarity, and - 0.018 for emotional repair.

CONCLUSION

Emotional empathy and emotional intelligence were significant predictors of COVID-19-related stress among nursing students. Emotional intelligence masked the impact of emotional empathy on COVID-19-related stress. Schools should implement stress management programs for nursing students that focus on enhancing emotional intelligence and moderating excessive emotional empathy. These programs are particularly crucial during public health emergencies to reduce stress levels and promote mental well-being.

CLINICAL TRIAL NUMBER

Not applicable.

The Impact of Medical Risk Perception on Patient Satisfaction: The Moderating Role of Shared Decision-Making

Purpose

The perception of medical risks is ubiquitous, influencing patients' healthcare experiences, yet the "black box" of this influencing process is seldom explored. This study explores the relationship between medical risk perception, trust, and patient satisfaction while taking shared decision-making as a moderator.

Methods

A stratified random sample of 450 inpatients from a tertiary public hospital in Guangzhou was selected for investigation, from June 2023 to September 2023. A moderated mediation model was tested using the PROCESS program, wherein medical risk perception was linked to patient satisfaction through trust, with shared decision-making acting as the moderating variable.

Results

Medical risk perception had a significant negative predictive effect on patient satisfaction (β = -0.383, p < 0.001), and after introducing the mediating variable, the negative predictive effect of medical risk perception on patient satisfaction remained significant (β = -0.237, p < 0.001). Trust partially mediated the relationship between medical risk perception and patient satisfaction, with the mediating effect accounting for 37.86% of the total effect. The interaction term between medical risk perception and shared decision-making (β = 0.211, p < 0.001) significantly predicted trust.

Conclusion

This study confirmed the mediating and moderating effects of trust and shared decision-making on the relationship between medical risk perception and patient satisfaction. The theoretical model constructed based on the theory of information asymmetry provides strategies and methods for healthcare managers to improve the quality of healthcare services and alleviate tensions in doctor-patient relationship.

Patient experience and satisfaction with shared decision-making: A cross-sectional study among outpatients

OBJECTIVES

This study aimed to investigate how doctor-patient communication, trust in doctors impacted patients' experience and satisfaction in shared decision-making (SDM).

METHODS

This study is based on the data from a cross-sectional survey (n = 12,401) conducted in 27 public specialist outpatient clinics in Hong Kong.

RESULTS

The multivariable regression models revealed that doctors' better communication skills were associated with lower decision-making involvement (odd ratio, 0.75 [95 % CI, 0.88-0.94], P < .001) but higher satisfaction with involvement (odd ratio, 6.88 [95 % CI, 5.99-7.93], P < .001). Similarly, longer consultation durations were associated with reduced involvement in decision-making (odd ratio, 0.71 [95 % CI, 0.66-0.73], P < .001) but increased satisfaction with involvement (odd ratio, 1.91 [95 % CI, 1.80-2.04], P < .001). Trust in doctors significantly mediated these associations, except for the association between consultation duration and patients' satisfaction with decision-making involvement.

CONCLUSION

Doctors' better communication skills and longer consultations might not necessarily increase patient involvement in SDM but correlated with increased satisfaction with involvement. Trust in doctors emerged as a mediator for participation and satisfaction in decision-making.

PRACTICE IMPLICATIONS

Clinics should consider patients' preferences and capabilities when tailoring communication strategies about decision-making and optimizing patient satisfaction.

Exploratory analysis of factors influencing hospital preferences among the Lebanese population: a cross-sectional study

OBJECTIVES

The primary aim of this research is to uncover the underlying factors that shape hospital selection criteria among individuals in Lebanon.

DESIGN

Cross-sectional study.

SETTING

A survey was circulated across social media platforms and messaging applications in Lebanon from February to May 2023. This questionnaire aimed to gauge participants' opinions on the importance of various factors in their hospital selection process.

PARTICIPANTS

A total of 746 participants filled out the survey. We targeted Lebanese adults who were not hospitalised at the time of survey submission.

MAIN OUTCOME MEASURES

We performed an exploratory factor analysis to examine the underlying structure of our 70-question survey. Reliability analysis was conducted using Cronbach's alpha and McDonald's omega. Factor scores were derived by aggregating raw scores and computing the mean.

RESULTS

The survey results identified eight key factors that accounted for 58.02% of the total variance, with excellent sampling adequacy (Kaiser-Meyer-Olkin=0.921, Bartlett's p<0.001). These factors exhibited good internal consistency, as indicated by Cronbach's alpha values for each factor. Ranked by importance for hospital selection, the factors are: staff qualities (α=0.773), administrative services (α=0.801), reputation (α=0.773), ease of access (α=0.704), room attributes (α=0.796), architectural and physical surroundings (α=0.828), luxury amenities (α=0.849) and affiliation and ownership (α=0.661).

CONCLUSION

This paper highlights the hospital characteristics that people may value before selecting a hospital. This insight provides an opportunity for hospital managers to refine their services, ensuring better resonance with people's anticipations. Beyond this, it sheds light on areas where hospitals could strategically invest to elevate their competitive edge in the healthcare market.

Investigation and analysis of the status of cancer health popularization in China, 2023

BACKGROUND

Cancer presents a significant public health challenge in China, necessitating broad collaboration across society. The Chinese government has articulated a goal to increase the overall five-year survival rate for cancer by 15% by 2030. Achieving this objective requires not only advances in medical technology, but also an improvement in the dissemination of knowledge pertaining to cancer prevention and treatment.

AIM

To provide a comprehensive understanding of the status of cancer prevention and level of popularization in China in 2023.

METHODS

From January 2023 to May 2023, online questionnaires were distributed to 3000 participants, including medical personnel, patients with cancer, their families, and the general public. There were 2711 valid responses, covering the entire nation.

RESULTS

A total of 1020 medical personnel and 1691 patients with cancer, their family members, and the general public participated in the survey. Among medical personnel, 93.2% had popularized cancer health. Commonly addressed topics included cancer prevention (85.9%) and cancer screening (77.8%). Primary challenges included time constraints (73.9%), insufficient personnel and material support (66.7%), and uncertainty as to where to begin (49.3%). Among patients with cancer, their family members, and the general public, 93.4% reported reading or watching cancer science popularization materials and 56.9% expressed a desire for deeper understanding. The most sought-after topics in cancer science popularization included cancer screening (80.2%) and cancer prevention (75.8%). The greatest challenge encountered in accessing cancer health popularization was an abundance of misinformation (67.5%).

CONCLUSION

Most clinical doctors, patients, family, and the general public wish to participate in cancer education. However, improvement in the quality of content in cancer prevention and treatment education is required.

The effectiveness of Balint groups at improving empathy in medical and nursing education: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Empathy is crucial for patient health. The Balint group is a commonly used method for empathy training. However, the impact of Balint groups on empathy remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess the impact of Balint groups on empathy training among medical and nursing students, as well as doctors and nurses.

METHODS

This review involved searching multiple databases for relevant articles. Rigorous eligibility criteria were applied during the screening of titles and abstracts, and during the selection of records. Following a full-text eligibility evaluation, two reviewers independently extracted data from the final selection of studies, and a meta-analysis was conducted. The standardized mean difference (SMD) was calculated to assess the systematic outcomes.

RESULTS

A total of 11 studies were included in this systematic review and meta-analysis. Participants in Balint groups demonstrated a significant increase in empathy than those in the control group (SMD = 1.46, 95% confidence interval [CI] 0.86-2.06; p < 0.001). Studies conducted in China (SMD = 2.13, 95% CI 1.27-2.99; p < 0.001) revealed a greater impact of Balint groups on empathy than those conducted in France (SMD = 0.24, 95% CI 0.12-0.37; p < 0.001). The impact of Balint groups was significantly greater among physicians (SMD = 2.50, 95% CI 1.79-3.21; p < 0.001) and nurses (SMD = 2.88, 95% CI 1.34-4.43; p < 0.001) compared to medical students (SMD = 0.71, 95% CI = 0.35-1.06; p < 0.001). Participants who attended ten or more sessions (SMD = 2.37, 95% CI 1.35-3.39; p < 0.001) demonstrated better outcomes compared to those who attended fewer than ten sessions (SMD = 0.79, 95% CI 0.30-1.29; p < 0.01).

CONCLUSION

Balint groups are effective for empathy training among doctors, nurses, and medical students. Future research should incorporate patient-led measurements to evaluate empathy and ascertain the long-term impact of Balint groups on empathy training.

TRIAL REGISTRATION

PROSPERO registration number CRD42023488247.

Counseling lifestyle medicine in oncology: A qualitative analysis of interprofessional patient-nurse-physician interactions

OBJECTIVES

Counseling plays a key role in promoting health behaviors, providing evidence-based information, and supporting patients with cancer during and after treatment. This study aimed to evaluate an interprofessional counseling service on Complementary and Integrative Health (CIH) for patients being treated at Comprehensive Cancer Centers (CCCs) in Southern Germany.

METHODS

Patients participating in the CCC-Integrativ study received three CIH counseling sessions within three months in addition to their conventional cancer treatment. Medical and nursing staff participated in a study-specific blended learning training program before conducting the counseling. As part of the process evaluation, 30 audio-recorded counseling sessions were transcribed verbatim and analyzed by conducting a content analysis using MAXQDA 2020.

RESULTS

Throughout the counseling, patients were conceded to address various health issues, which mainly revolved around symptom management interlaced with the areas of nutrition, exercise, and relaxation. The interprofessional teams conducted the counseling in a structured and patient-oriented manner. They worked together to motivate the patients to apply procedures from the CIH field independently, even if patients sometimes experienced difficulties in implementation.

CONCLUSIONS

Interprofessional collaboration improved healthcare quality, as patients received comprehensive and evidence-based advice on their supportive needs and lifestyle issues. Both professions could equally contribute their areas of knowledge and expertise and apply them to the benefit of the patients.

PRACTICE IMPLICATIONS

Providing an integrative counseling service and adequate training on interpersonal communication and CIH for healthcare professionals will improve patient-centered care.

Zoom Improv is accessible and enhances medical student empathy

BACKGROUND

Empathy declines during medical training, despite its importance.

METHODOLOGY

In this randomized controlled trial, we assessed the impact of Zoom improv on medical student empathy using a concurrent mixed-methods approach. Quantitative assessment with three survey tools and qualitative assessment by content analysis of Zoom session field notes were conducted.

RESULTS

Zoom improv participants had higher empathy scores in perspective-taking and fantasy and lower scores in personal distress compared with the control group. Medical students who participated in Zoom improv exercised emotional expression, active listening, and giving "gifts," which apply to healthcare settings in which affirming team members with empathic concern can advance communication, patient rapport, and teamwork.

DISCUSSION

This pilot study highlights promising findings for the incorporation of Zoom improv in medical education, including enhanced empathy, self-reflection, and understanding how these skills impact work in healthcare. Future studies may expand on the optimal timing to teach improv. Future studies conducted on virtual platforms may also further investigate our finding that the fantasy domain of empathy increases after Zoom improv sessions, whereas this increase in fantasy was absent from previous in-person studies. Given the increase in telehealth and virtual medical visits, exercising empathy skills through a screen during training may be an important addition to medical curricula.

Do patients prefer a human doctor, artificial intelligence, or a blend, and is this preference dependent on medical discipline? Empirical evidence and implications for medical practice

Today the doctor-patient relationship typically takes place in a face-to-face setting. However, with the advent of artificial intelligence (AI) systems, two further interaction scenarios are possible: an AI system supports the doctor's decision regarding diagnosis and/or treatment while interacting with the patient, or an AI system could even substitute the doctor and hence a patient interacts with a chatbot (i.e., a machine) alone. Against this background, we report on an online experiment in which we analyzed data from N = 1,183 people. The data was collected in German-speaking countries (Germany, Austria, Switzerland). The participants were asked to imagine they had been suffering from medical conditions of unknown origin for some time and that they were therefore visiting a health center to seek advice from a doctor. We developed descriptions of patient-doctor interactions (referred to as vignettes), thereby manipulating the patient's interaction partner: (i) human doctor, (ii) human doctor with an AI system, and (iii) an AI system only (i.e., chatbot). Furthermore, we manipulated medical discipline: (i) cardiology, (ii) orthopedics, (iii) dermatology, and (iv) psychiatry. Based on this 3 × 4 experimental within-subjects design, our results indicate that people prefer a human doctor, followed by a human doctor with an AI system, and an AI system alone came in last place. Specifically, based on these 12 hypothetical interaction situations, we found a significant main effect of a patient's interaction partner on trust, distrust, perceived privacy invasion, information disclosure, treatment adherence, and satisfaction. Moreover, perceptions of trust, distrust, and privacy invasion predicted information disclosure, treatment adherence, and satisfaction as a function of interaction partner and medical discipline. We found that the situation in psychiatry is different from the other three disciplines. Specifically, the six outcome variables differed strongly between psychiatry and the three other disciplines in the "human doctor with an AI system" condition, while this effect was not that strong in the other conditions (human doctor, chatbot). These findings have important implications for the use of AI in medical care and in the interaction between patients and their doctors.

Sharing Unpleasant Health Information with Patients: A baseline study exploring physician attitudes, practices and adherence to the SPIKES protocol at a tertiary hospital in Muscat, Oman

Objectives

This study aimed to investigate the knowledge, attitude and experiences in sharing unpleasant health information and adherence to the SPIKES protocol among physicians at a tertiary hospital in Muscat, Oman.

Methods

This cross-sectional study was conducted at the Sultan Qaboos University Hospital from August to October 2022. An electronic, self-administered questionnaire was used to gather data from physicians across various departments.

Results

A total of 89 physicians completed the questionnaire (response rate = 22.3%). Most participants (n = 86, 96.6%) recognised the need for additional training in the delivery of unpleasant health information ('bad news'), with 78.7% (n = 70) expressing their willingness to undertake such training. Additionally, 32.6% (n = 29) reported negative experiences due to improper delivery of bad news, with an equal proportion admitting to disclosing bad news to patients' family without their consent. The majority (n = 77, 86.5%) demonstrated a high level of overall adherence to the SPIKES protocol, with 59.6-85.4%, 12.4-34.8% and 1.1-11.2% reported usually, sometimes and never following specific steps of the protocol, respectively. Marital status (P = 0.015) and qualifications (P = 0.032) were the only variables that were associated with adherence level, with married physicians and those with board and/or fellowship certificates reporting significantly better adherence compared to their counterparts.

Conclusion

Physicians in Oman encounter challenges in delivering unpleasant health information, underscoring the interplay of cultural influences, training and adherence to protocols. To address these challenges, targeted and frequent training programmes are recommended, starting from undergraduate medical education and extending to continuous opportunities for physicians at various career levels.

The Influence of Doctor-Patient Communication on Patients' Trust: The Role of Patient-Physician Consistency and Perceived Threat of Disease

Purpose

To investigate the influence mechanism of doctor-patient communication on patients' trust, especially the mediating role of patient-physician consistency and the moderating role of perceived threat of disease.

Methods

A total of 699 patients in Guangzhou, China was investigated by questionnaire. The main effect, mediating effect, and moderating effect of the model was verified by SPSS23.0 and LISREL8.71 statistical software.

Results

It was revealed that doctor-patient communication has a significant positive effect on patients' trust. The consistency between patient and physician partially mediates the relationship between doctor-patient communication and patients' trust. Additionally, the perceived threat of the disease moderates the psychological process through which doctor-patient communication affects patients' trust.

Conclusion

Both doctor-patient communication and patient-physician consistency have predictive effects on patients' trust. Doctor-patient communication is not only a direct influence on patient trust but also an indirect influence mediated by patient-physician consistency. Perceived threat of disease moderates the psychological process through which doctor-patient communication affects patients' trust. Specifically, compared to a high level of perceived threat of disease, a low level of perceived threat of disease can enhance the effect of doctor-patient communication on patients' trust. The results of this study underscore the importance of doctor-patient communication and the value of patient-physician consistency for building patients' trust. To foster a harmonious doctor-patient relationship, medical colleges should place great emphasis on cultivating medical students' communication skills. Hospitals should enhance on-the-job training and provide institutional support for doctors, encourage agreements between doctors and patients regarding disease diagnosis and decision-making, and be attentive to patients' perceived threat of disease, particularly for those with high level of perceived threat of disease.

Concordance in the healthcare context: A concept analysis

Background

The concept of concordance and its usage are indicative of patient-centered healthcare, which encourages an equitable collaboration between patients and clinicians. However, there is a lack of clarity in understanding concordance, and an analysis of this concept is warranted.

Objective

This paper seeks to explore the essence of the concordance concept in the healthcare context.

Methods

Walker and Avant's eight-step method of concept analysis was applied. A literature search was conducted using concordance AND concord as keywords on CINAHL, MEDLINE, PubMed, ProQuest, Cochrane database, and ScienceDirect databases, published between 2006 and 2022.

Results

The attributes of concordance include communication process, therapeutic partnership, and agreement on treatment regimens. Antecedents of concordance comprise provider-patient relationship, patients' beliefs, healthcare providers' characteristics, and complexity of treatment plans. Consequences are improved adherence and compliance, improved clinical outcomes, and better quality of life.

Conclusion

This paper offers clarification of concordance by presenting its antecedents, attributes, and consequences. The findings serve as a basis for developing assessments and nursing interventions to promote patient concordance. Nurses can use the findings to encourage concordance by establishing a trusty relationship during health encounters that respects patients' beliefs and effectively communicating to improve patients' understanding in dealing with complex treatment plans.

Initial Validation of a Patient-Reported Compassion Measure in a Mandarin-Speaking Long-Term Care Patient Population

Background and Purpose: Compassion is increasingly considered essential to quality nursing care and is a concept that is strongly embedded across cultures, including Chinese culture. The Patient Compassion Model (PCM) depicts the unique yet overlapping domains of compassion. The Sinclair Compassion Questionnaire (SCQ) was directly developed and validated from this empirical model. In this study, we sought to establish initial validation of a translated SCQ among Mandarin-speaking patients by assessing the transferability of the PCM and the clinical sensibility of the SCQ. Methods: Forward and back-translation of the PCM and SCQ were performed in accordance with World Health Organization guidelines. Qualitative interviews were used to assess the transferability of the PCM with conceptualizations of compassion within a Chinese context. Cognitive interviews were conducted to assess the clarity, readability, wording, questions, and response scales of the Mandarin translation of the SCQ. Qualitative data were analyzed using constant comparative analysis, and cognitive interviews were analyzed using framework analysis. Results: The original categories of the PCM were verified in this Mandarin-speaking patient population. Specifically, participants' understanding of compassion is described as consisting of healthcare provider virtues, emphasizing the importance of a virtuous response that sought to understand the individual and their unique needs, to relationally communicate from a place of shared humanity and to ameliorate suffering. Participants were able to answer, comprehend, and endorse all 15 Mandarin SCQ items, resulting in no modifications to the Mandarin SCQ. Conclusions: This study provides initial validation of the Mandarin SCQ and PCM. Future studies should consider further establishing the validity and reliability of the Mandarin SCQ among a larger Chinese patient population.

The association between empathy and burnout in medical students: a systematic review and meta-analysis

BACKGROUND

Burnout levels in medical students are higher than in other student groups. Empathy is an increasingly desired outcome of medical schools. Empathy is negatively associated with burnout in physicians. Our objective was to quantitatively review the available literature on associations between empathy and burnout in medical students, and to explore associations between specific empathy aspects (cognitive and affective) and burnout sub-dimensions (emotional exhaustion, depersonalization and personal accomplishment).

METHODS

A comprehensive search of the literature published up until January 2024 was undertaken in the PubMed, EMBASE, CINAHL, The Cochrane Library, and PsycINFO databases. Two independent reviewers screened 498 records and quality-rated and extracted data from eligible studies. The effect size correlations (ESr) were pooled using a random-effects model and between-study variation explored with meta-regression. The review was preregistered with PROSPERO (#CRD42023467670) and reported following the PRISMA guidelines.

RESULTS

Twenty-one studies including a total of 27,129 medical students published between 2010 and 2023 were included. Overall, empathy and burnout were negatively and statistically significantly associated (ESr: -0.15, 95%CI [-0.21; -0.10], p < .001). When analyzing sub-dimensions, cognitive empathy was negatively associated with emotional exhaustion (ESr: -0.10, 95%CI [-0.17; -0.03], p = .006) and depersonalization (ESr: -0.15, 95%CI [-0.24; 0.05], p = .003), and positively associated with personal accomplishment (ESr: 0.21, 95%CI [0.12; 0.30], p < .001). Affective empathy was not statistically significantly associated with emotional exhaustion, depersonalization or personal accomplishment. Supplementary Bayesian analysis indicated the strongest evidence for the positive association between cognitive empathy and personal accomplishment. Response rate and gender moderated the relationship so that higher response rates and more male respondents strengthen the negative association between empathy and burnout.

CONCLUSION

Greater empathy, in particular cognitive empathy, is associated with lower burnout levels in medical students. This appears to be primarily driven by cognitive empathy's positive association with personal accomplishment.

PROTOCOL REGISTRATION

#CRD42023467670.

Factors Associated with College Students' Attitudes Toward Telehealth for Primary Care

Introduction: Establishing routine primary care visits helps to prevent serious health issues. College students are less likely than the general population to have a regular primary care provider and engage in routine health visits. Recent research provides evidence that telehealth is a convenient alternative to in-person primary care and that college students are comfortable using this technology, suggesting that telehealth has the potential to mitigate this disparity. As attitudes toward telehealth are one critical precursor to behavioral intention and actual utilization of telehealth, the goal of this study was to investigate which factors predict positive or negative attitudes toward telehealth. Methods: Data for this study were collected from a sample of 621 college students at a large southeastern university between September 19, 2022 and December 19, 2022. Results: The study found that college students who reported more trust in physicians, less medical mistrust, and less discrimination in health care settings reported more positive attitudes toward telehealth. Conclusions: These findings suggest that health care providers' skills in delivering patient-centered culturally informed care and building trust and rapport with patients might promote more positive attitudes toward telehealth and, potentially, greater overall utilization of health care services (including both telehealth and in-person services) among college students. This study lays the foundation for future research to examine psychological mechanisms underlying individuals' utilization of telehealth.

A model of contributors to a trusting patient-physician relationship: a critical review using a systematic search strategy

BACKGROUND

The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model.

METHODS

A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable.

RESULTS

Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services.

DISCUSSION

Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.

Barriers to diverse clinical trial participation in Duchenne muscular dystrophy: Engaging Hispanic/Latina caregivers and health professionals

BACKGROUND

Despite the increasing availability of clinical trials in Duchenne muscular dystrophy, racial/ethnic minorities and other populations facing health disparities remain underrepresented in clinical trials evaluating products for Duchenne. We sought to understand the barriers faced by Hispanic/Latino families specifically and underrepresented groups more generally to clinical trial participation in Duchenne.

METHODS

We engaged two participant groups: Hispanic/Latino caregivers of children with Duchenne in the US, including Puerto Rico, and health professionals within the broader US Duchenne community. Caregiver interviews explored attitudes towards and experiences with clinical trials, while professional interviews explored barriers to clinical trial participation among socio-demographically underrepresented families (e.g., low income, rural, racial/ethnic minority, etc.). Interviews were analyzed aggregately and using a thematic analysis approach. An advisory group was engaged throughout the course of the study to inform design, conduct, and interpretation of findings generated from interviews.

RESULTS

Thirty interviews were conducted, including with 12 Hispanic/Latina caregivers and 18 professionals. We identified barriers to clinical trial participation at various stages of the enrollment process. In the initial identification of patients, barriers included lack of awareness about trials and clinical trial locations at clinics that were less likely to serve diverse patients. In the prescreening process, barriers included ineligibility, anticipated non-compliance in clinical trial protocols, and language discrimination. In screening, barriers included concerns about characteristics of the trial, as well as mistrust/lack of trust. In consent and recruitment, barriers included lack of timely decision support, logistical factors (distance, time, money), and lack of translated study materials.

CONCLUSIONS

Numerous barriers hinder participation in Duchenne clinical trials for Hispanic/Latino families and other populations experiencing health disparities. Addressing these barriers necessitates interventions across multiple stages of the clinical trial enrollment process. Recommendations to enhance participation opportunities include developing clinical trial decision support tools, translating prominent clinical trials educational resources such as ClinicalTrials.gov, fostering trusting family-provider relationships, engaging families in clinical trial design, and establishing ethical guidelines for pre-screening potentially non-compliant patients.

Antecedents of rapport and its mediating role on relational cohesion in patient-physician interaction

Increasing competition in healthcare services, it is imperative that physicians and family-care practitioners seek ways to attract and retain patients. Building relationships with existing patients is one sure way to continued patronage and increased clientele. The purpose of this paper is to examine antecedents of rapport and its influence on perceived relationships in the context of patient-physician interaction. Study using cross-sectional survey method with structured questionnaire was used for data collection. Structural Equation Modeling was used for analyzing the data collected from 326 patients residing in Karnataka, India. The finding suggests that respect, responsibility and understanding have significant influence on relational cohesion with rapport acting as mediating variable. The results add to the empirical validity of the relationship among rapport, respect & relationship, as it is required to understand studied in Indian context. The finding provides new directions for both healthcare professionals and institutions in their endeavor of building relationships with their customers (Patients) by emphasizing the need for developing 'rapport' as an integral part of service interaction. Future research like longitudinal and experimental studies can provide more conclusive evidence regarding the influence of service behaviour on rapport.

Exploring the dynamics of physician-patient relationships: Factors affecting patient satisfaction and complaints

This review identifes the factors influencing the relationship between physicians and patients that can lead to patients' dissatisfaction and medical complaints. Utilizing a systemic approach 92 studies were retrieved which included quantitative, qualitative, and mixed method studies. Through a thematic analysis of the literature, we identified three interrelated main themes that can influence the relationship between physicians and patients, patients' satisfaction, and the decision to file a medico-legal complaint. The main themes include patient and physician characteristics; the interpersonal relationship between physicians and patients; and the health care system and policies, with relevant subthemes. These themes are demonstrated in a descriptive model. The review suggests areas of focus for physicians who may wish to increase their awareness around the potential sources of relational problems with their patients. Identifying these issues may assist in improvements in the therapeutic relationship with patients, can reduce their medico-legal risk, and enhance the quality of their clinical practice. The findings can also be utilized to support andragogical principles for medical learners. The article can serve as a structured framework to identify potential problems and gaps to design and test effective interventions to mitigate these potential relational problems between physician-patient.

A survey on the willingness of outpatients to participate in fundus examination procedures conducted by ophthalmology training residents in China: A cross-sectional study

Background and Aims

The National Standardized Training for Resident Doctors (STRD) in mainland China encounters many challenges in its implementation. To investigate whether outpatients are willing to undergo indirect ophthalmoscopy examination conducted by ophthalmology residents in the ophthalmology STRD program in China.

Methods

This study conducted a cross-sectional survey at the Eye Hospital of Wenzhou Medical University between September 2021 and September 2023. A cohort of 300 initial outpatients requiring indirect ophthalmoscopy examinations were enlisted from the outpatient department. Based on whether the patients are willing to undergo an indirect ophthalmoscopy examination by resident doctors, patients were divided into two groups: Group 1 (willing) and Group 2 (unwilling), and their questionnaire responses were comparatively analyzed.

Results

A total of 261/300 (87%) valid questionnaires were returned in the survey, which included 149 males and 112 females. No notable gender difference (p = 0.400) or disparity in medical expense categories (p = 0.786) was observed between the two groups. However, variables such as outpatient marital status (p = 0.002), the presence of training faculty during fundus examinations with residents and outpatients (p < 0.001), the demeanor of training residents toward patients (p < 0.001), and the quality of doctor-patient communication (p < 0.001) significantly varied between the groups.

Conclusion

The level of outpatients' cooperation with ophthalmology residents during fundus examinations in the Chinese ophthalmology STRD program was observed to be low. Enhancing the presence of training faculty during examinations and enhancing the communication skills of training residents could significantly improve this situation.

Race differences in patient trust and distrust from audio-recorded cardiology encounters

OBJECTIVE

Many have reported racial disparities in self-reported trust in clinicians but have not directly assessed expressions of trust and distrust in physician-patient encounters. We created a codebook to examine racial differences in patient trust and distrust through audio-recorded cardiologist-patient interactions.

METHODS

We analyzed data from a randomized controlled trial of audio-recorded outpatient cardiology encounters (50 White and 51 Black patients). We created a codebook for trust and distrust that was applied to recordings between White cardiologists and White and Black patients. We assessed differences in trust, distrust, and guardedness while adjusting for patient age, sex, and first appointment with the cardiologist.

RESULTS

Compared to White patients, Black patients had significantly lower expressions of trust ([IRR] [95 % CI]: 0.59 [0.41, 0.84]) and a significantly lower mean guarded/open score ([β] [95 % CI] -0.38 [-0.71, -0.04]). There was no statistically significant association between race and odds of at least one distrustful expression (OR [95 % CI] 1.36 [0.37, 4.94]).

CONCLUSION AND PRACTICE IMPLICATIONS

We found that coders can reliably identify patient expressions of trust and distrust rather than relying on problematic self-reported measures. Results suggest that White clinicians can improve their communication with Black patients to increase expressions of trust.

Cross-Cultural Adaptation and Validation of the Perception of the Doctor-Patient Relationship (PREMEPA) Questionnaire in Chronic Multi-Pathological Patients

OBJECTIVE

To conduct a cross-cultural adaptation and validation in Primary Care of the PREMEPA doctor-patient relationship perception questionnaire.

DESIGN

Descriptive, cross-sectional study, using self-administered questionnaires. Qualitative validation: an adapted version of the original questionnaire, was adapted to our culture. The process consisted of the evaluation, cross-cultural adaptation and consensus of a group of experts. The questionnaire was piloted on a sample of 32 patients diagnosed with at least 2 chronic pathologies.

MEASURES

Cognitive piloting, comprehensibility assessment, content validation and internal consistency analysis using Cronbach's alpha coefficient. Quantitative validation: the internal consistency, construct validity and validity of the questionnaire were studied by means of a confirmatory factor analysis developed in a multicenter study, randomly selecting 202 patients with at least 2 chronic pathologies.

RESULTS

Content validity of the new Spanish version was confirmed to be adequate. Comprehensibility and internal consistency (Cronbach's α coefficient = 0.78) were adequate. The confirmatory factor analysis showed good dimensionality, factor relationship and internal consistency, as well as acceptable construct validity. The final result was a 13-item questionnaire consisting of 2 dimensions, which explain 58.5% of the variance: participation in decision-making (accounting for 45.2% of the variance) and person-centered communication (encompassing courtesy, empathy, humanity, and trust).

CONCLUSIONS

This adapted version of the PREMEPA questionnaire can be considered valid for use in the Spanish population with a history of chronic pathology. This version of PREMEPA provides a new instrument to understand and improve chronic patient care, which can improve the doctor-patient relationship, encouraging adherence to treatment and enhancing health outcomes.

Should Providers Engage in Religious Discussions, and If They Should, Then with Whom?

AbstractPatients' spiritual views and, more generally, the meaning they feel in their lives is often, if not always, most important to them, especially when they have serious illness. Yet there are no standard requirements for providers to explore with patients their spiritual needs. Providers' views regarding their both taking initiatives to explore with patients needs and then to discuss with them their religious concerns if they want this vary widely. This piece explores, then, the extent to which providers should take these initiatives and, if they have this interest, whether as providers they should carry on these discussions or refer these patients, always, to clergy persons, as some providers adamantly advocate because they have expertise in this area that providers lack. This piece goes on to discuss whether providers believe they should have these discussions even when their patients' beliefs differ greatly from their own. In exploring this question, examples involving patients with Muslim, Hindu, and Christian beliefs are considered. Beliefs reported by some people from Germany and Israel regarding physician-assisted dying also are reported and compared, illustrating that patients' and people's beliefs cannot be reliably just inferred. Practical approaches, finally, are suggested.

Review of Muslim Patient Needs and Its Implications on Healthcare Delivery

BACKGROUND

In the rapidly changing environment of healthcare, striving toward health equity and providing patient-centered care is imperative to the patient's experience. To achieve these goals, a comprehensive understanding of the diverse patient populations seeking these services, their needs, and the multitude of religious, cultural, and structural elements that impact their well-being is required. Muslim patients represent a considerable demographic, both in number and complexity of religious and cultural beliefs and practices. This scoping review examines the intersection of religion and cultural values with healthcare delivery in the context of the Muslim patient experience.

OBJECTIVES

The objective of this review is to identify key concepts and challenges that impact the Muslim patient experience.

SEARCH METHODS

The research databases Cochrane Library, OVID Medline, and PubMED were used to conduct a comprehensive systemic review of original, empirical peer-reviewed publications with the following search terms: "Muslim healthcare," "Muslim patient," and "Muslim experience."

SELECTION CRITERIA

Inclusion and exclusion criteria were used to narrow down articles to those that addressed Muslim patient needs and their healthcare experience.

RESULTS

A total of 21 articles met the criteria of this scoping review. Five central topics were identified during thematic analysis: Ramadan and Fasting, Barriers in the Patient-Physician Relationship, Trauma and Perceived Discrimination, Mental Health Awareness and Stigma, and Awareness of Advanced Care Planning.

CONCLUSION

This scoping review demonstrates that in order to provide patient-centered care addressing the unique needs of Muslim patients, religious and cultural values need to be explored under the frameworks of cultural humility and structural competency.

Acceptability and use of an online health priorities self-identification tool for older adults: A qualitative investigation

Objective

To examine the use of a web-based, self-directed health priorities identification tool for older adults with multiple chronic conditions (MCCs).

Methods

We recruited a gender- and racially-diverse, highly educated sample of older adults with MCCs to engage with our My Health Priorities tool, then complete a semi-structured interview. Thematic analysis was used to examine interview transcripts.

Results

Twenty-one participants shared perspectives on the acceptability and use of the tool. Three themes (with eleven subthemes) were generated to describe: website user experience feedback, the content of the health priorities identification process, and the tool's capacity to empower communication and decision making.

Conclusion

Participants found this tool acceptable and easy to use, describing a variety of benefits of the priorities self-identification process and offered suggestions for refinement and broader implementation. Older adults with limited internet navigation abilities or misconceptions about the self-directed process may benefit from clinicians clarifying the purpose of the process or initiating priorities-aligned discussions.

Innovation

This novel tool can help older adults with MCCs define what matters most for their health and healthcare, informing a variety of health decisions. This tool may enable and motivate patients to lead health priorities decision-making discussions with clinicians and care partners.

Trust as a dyadic mechanism of action: a call to explore patient-provider relationships in the twenty-first century

Background: There is general agreement that trust between patients and providers influences patient knowledge, behaviors, and adherence to provider-recommendations--with subsequent impacts on patient health-related outcomes and provider practices. There is less academic agreement on the processes by which trust is formulated and changed over time and how trust with ongoing healthcare providers can influence health-related outcomes over time.Methods: This opinion draws on social constructionism and symbolic interactionism to posit the possibility that trust can emanate through the communication process, during which a patient and provider transmit and attend to words, images, and paralanguage to convey their states of being and to induce responses, usually acknowledgement, suasion, or physical behaviors, from one another.Results: Theoretical bases for this construct are provided as are qualitative, quantitative, and mixed measurement approaches for multiple healthcare settings.Conclusions: A mechanistic approach to understand how trust is established through patient-provider communication and how trust informs patient health-related outcomes can contribute over time to improve communication in healthcare encounters.

Enhancing doctor-patient relationships in community health care institutions: the Patient Oriented Four Habits Model (POFHM) trial-a stepped wedge cluster randomized trial protocol

BACKGROUND

The poor relationship between doctors and patients is a long-standing, global problem. However, current interventions tend to focus on the training of physicians, while patient-targeted interventions still need to be improved. Considering that patients play a significant role in outpatient consultations, we developed a protocol to assess the effectiveness of the Patient Oriented Four Habits Model (POFHM) in improving doctor-patient relationships.

METHODS

A cross-sectional incomplete stepped-wedge cluster randomized trial design will be conducted in 8 primary healthcare institutions (PHCs). Following phase I of "usual care" as control measures for each PHC, either a patient- or doctor-only intervention will be implemented in phase II. In phase III, both patients and doctors will be involved in the intervention. This study will be conducted simultaneously in Nanling County and West Lake District. The primary outcomes will be evaluated after patients complete their visit: (1) patient literacy, (2) sense of control and (3) quality of doctor-patient communication. Finally, a mixed-effects model and subgroup analysis will be used to evaluate the effectiveness of the interventions.

DISCUSSION

Fostering good consultation habits for the patient is a potentially effective strategy to improve the quality of doctor-patient communication. This study evaluates the implementation process and develops a rigorous quality control manual using a theoretical domain framework under the collective culture of China. The results of this trial will provide substantial evidence of the effectiveness of patient-oriented interventions. The POFHM can benefit the PHCs and provide a reference for countries and regions where medical resources are scarce and collectivist cultures dominate.

TRIAL REGISTRATION

AsPredicted #107,282 on Sep 18, 2022; https://aspredicted.org/QST_MHW.

Exploring the Relationship Between Intolerance of Uncertainty and Trust in Physicians from Spousal and Parent-Child Perspectives

OBJECTIVE

The present study aimed to probe the intergenerational transmission of intolerance of uncertainty (IU) and trust in physicians. Besides, through the actor-partner interdependence model (APIM), the predictive effect of parents' IU on their own and their spouses' trust in physicians was examined. A mediation model was further constructed to probe the mechanisms by which parents' IU affects children's trust in physicians.

METHODS

The Intolerance of Uncertainty Scale-12 (IUS-12) and the Wake Forest Physician Trust Scale (WFPTS) were employed to conduct the questionnaire survey among 384 families (each family with a father, mother, and one child).

RESULTS

IU and trust in physicians were found to be intergenerationally transmitted. The results of the APIM analyses showed that fathers' total IUS-12 scores negatively predicted their own (β = -0.419, p < 0.01) and mothers' (β = -0.235, p < 0.01) total WFPTS scores. Mothers' total IUS-12 scores negatively predicted their own (β = -0.353, p < 0.01) and fathers' (β = -0.138, p = 0.017) total WFPTS scores. The results of mediation analyses indicated that parents' total WFPTS scores and children's total IUS-12 scores mediated the effect of parents' total IUS-12 scores on children's total WFPTS scores.

CONCLUSION

The public's IU is a crucial influencing factor of their trust in physicians. Besides, the IU between couples and between parents and children could be mutually affected. On the one hand, husbands' IU could affect their own and their wives' trust in physicians, and vice versa. On the other hand, parents' IU and trust in physicians could affect their children's IU and trust in physicians, respectively.

The Role of an Exoskeleton Simulation of Senescence in Health Sciences Education

Background

Education in the formation of human capital in health constantly presents challenges. New tools in the emerging contexts may strengthen empathic attitudes. We developed an educational intervention that included a senescence simulator and assessed its impact on perception and attitudes in healthcare students.

Methods

A cross-sectional comparative study was conducted that assessed acquired knowledge and self-perception using a semistructured survey administered before and after the demonstration and intervention using the simulator and reported the experience through the role of the patient and caregiver. The data were analyzed statistically to identify the demographic characteristics and differences between the groups of students. The data were analyzed statistically to identify the demographic characteristics and differences between the groups of students in the responses pre-post intervention, using statistical software (IBM SPSS Statistics 26.0).

Results

Of the 256 participants surveyed before the intervention, 93.8% described cognitive deterioration as a significant disability and 53.1% considered the health system to be inadequate in meeting the needs of older individuals. Only 59.8% stated that the current academic training meets the educational requirements for the care of the elderly. In total, 98.9% of the participants reported that the simulator changed their perception by increasing their empathy. In total, 76.2% showed greater sensitivity to older adults and 79.3% reported that the experiential learning consolidated their professionalizing perspective. Among the younger participants (aged 18-20 years), sensitivity and reorientation toward pursuing an associated graduate degree were higher after the intervention (p=0.01).

Conclusions

Educational strategies, such as the senescence simulator, offer an experiential intervention that strengthens the knowledge and attitudes toward older individuals. During the pandemic emergency, it proved to be a useful educational strategy in consolidating caring behavior as a hybrid educational tactic. The senescence simulation enabled the participants to widen their educational and professional schemes to encompass the care of the older population.

Doctor Attributes That Patients Desire during Consultation: The Perspectives of Doctors and Patients in Primary Health Care in Botswana

Doctor attributes contribute significantly to the quality of the doctor–patient relationship, consultation, patient satisfaction, and treatment outcomes. However, there is a paucity of research on this topic in many settings in developing countries, including Botswana, where accessibility and availability of care itself are a challenge. The study examined doctor attributes that patients in Botswana desire from the perspectives of doctors and patients in selected public clinics located in four health districts of Botswana. We used a qualitative design and conducted face-to-face interviews with 32 adult patients and 17 doctors selected through the purposive sampling technique. Interviews were audio-recorded and transcribed. Data analysis followed the six steps of qualitative thematic data analysis. We found both discordance and congruence between the doctors and patients on key attributes that patients desire in a doctor during consultation. Both agreed that effective communication and listening skills were key desirable doctor attributes that improve the doctor–patient relationship. Conducting the consultation in the language of the patients enhances effective communication. Doctors cited clinical expertise and competence as key desirable doctor attributes, whereas patients cited interpersonal and social attributes including kindness, empathy, and respect as key doctor attributes that increase trust in the doctor. However, patients expected the doctor to have clinical knowledge, which they perceived as essential to improve doctor–patient interaction and health outcomes. The findings highlight a need to enhance the interpersonal and communication skills of doctors to improve the quality of doctor–patient interactions. To optimise and enhance the consultation, continuing professional development should be adopted as a strategy to improve the communication and interpersonal skills of doctors.

Doctors' and Patients' Perceptions of Impacts of Doctors' Communication and Empathy Skills on Doctor-Patient Relationships During COVID-19

BACKGROUND

During the COVID-19 pandemic, the performance of Chinese doctors may have led to improved doctor-patient relationships (DPRs). However, it is unclear how doctors and patients perceived the impact of doctors' communication and empathy skills on DPRs during the COVID-19 pandemic.

OBJECTIVE

To examine the perceptions of doctors and patients on how doctors' communication skills and empathy skills influence DPRs during COVID-19.

MAIN MEASURES

Doctors' and patients' perceptions of doctors' communication skills were measured using the Chinese version of the SEGUE Framework. To measure empathy skills and DPRs, the Jefferson Scale of Empathy and Difficult Doctor-Patient Relationship Questionnaire were administered to doctors, and the Consultation and Relational Empathy Measure and Patient-Doctor Relationship Questionnaire were administered to patients.

RESULTS

A total of 902 doctors and 1432 patients in China were recruited during the pandemic via online or offline surveys (overall response rate of 69.8%). Both doctors and patients rated doctors' empathy skills as more impactful on DPRs than communication skills. Doctors believed that only their empathy skills influenced DPRs. But patients believed that there was a significant bi-directional relationship between doctors' communication and empathy skills and these two skills interacted to directly and indirectly influence DPRs, and doctors' empathy had a greater mediating effect than their communication.

CONCLUSIONS

During COVID-19, there were both similarities and differences between Chinese doctors' and patients' views on how doctors' communication and empathy skills influenced DPRs. The greater effect of doctors' empathy skills suggests that both doctors and patients attach more importance to doctors' empathy in doctor-patient interactions. The bi-directional effect on patient outcomes suggests that both doctors' communication and empathy skills are important to patients' perceptions of DPRs.

Relationship between self-care compliance, trust, and satisfaction among hypertensive patients in China

Introduction

Hypertension is a growing public health concern worldwide. It is a leading risk factor for all-cause mortality and may lead to complications such as cardiovascular disease, stroke, and kidney failure. Poor compliance of hypertensive patients is one of the major barriers to controlling high blood pressure. Compliance is not ideal among Chinese patients, and increasing patient self-care compliance with hypertension is necessary.

Methods

This article analyzes the status of self-care compliance, trust, and satisfaction among Chinese hypertensive patients using cross-sectional data from Zhejiang Province. We use a multi-group structural equation model (MGSEM) to compare the interrelationships across genders.

Results

The study's findings show that the average trust, satisfaction, and compliance scores are 3.92 ± 0.55, 3.98 ± 0.61, and 3.33 ± 0.41, respectively. Female patients exhibit higher average total scores for trust and compliance than male patients. The SEM results indicate that trust has a direct positive association with compliance [β = 0.242, 95% CI: (0.068, 0.402)] and satisfaction [β = 0.260, 95% CI: (0.145, 0.367)], while their satisfaction is not directly associated with compliance. The results of MGSEM show that trust has an indirect effect on compliance in the male group through satisfaction [β = 0.051, P < 0.05, 95% CI: (0.012, 0.116)]. In the female group, trust has a direct effect on satisfaction [β = 0.235, P < 0.05, 95% CI: (0.041, 0.406)] and compliance [β = 0.319, P < 0.01, 95% CI: (0.086, 0.574)].

Discussion

This study reveals the mechanisms of self-care compliance, trust, and satisfaction among Chinese hypertensive patients. Its findings may serve as a reference for guiding primary healthcare providers to improve hypertension patients' compliance and implement gender-targeted health interventions.

Patient Trust in Physicians Matters-Understanding the Role of a Mobile Patient Education System and Patient-Physician Communication in Improving Patient Adherence Behavior: Field Study

BACKGROUND

The ultimate goal of any prescribed medical therapy is to achieve desired outcomes of patient care. However, patient nonadherence has long been a major problem detrimental to patient health and, thus, is a concern for all health care providers. Moreover, nonadherence is extremely costly for global medical systems because of unnecessary complications and expenses. Traditional patient education programs often serve as an intervention tool to increase patients' self-care awareness, disease knowledge, and motivation to change patient behaviors for better adherence. Patient trust in physicians, patient-physician relationships, and quality of communication have also been identified as critical factors influencing patient adherence. However, little is known about how mobile patient education technologies help foster patient adherence.

OBJECTIVE

This study aimed to empirically investigate whether and how a mobile patient education system (MPES) juxtaposed with patient trust can increase patient adherence to prescribed medical therapies.

METHODS

This study was conducted based on a field survey of 125 patients in multiple states in the United States who have used an innovative mobile health care system for their health care education and information seeking. Partial least squares techniques were used to analyze the collected data.

RESULTS

The results revealed that patient-physician communication and the use of an MPES significantly increase patients' trust in their physicians. Furthermore, patient trust has a prominent effect on patient attitude toward treatment adherence, which in turn influences patients' behavioral intention and actual adherence behavior. Based on the theory of planned behavior, the results also indicated that behavioral intention, response efficacy, and self-efficacy positively influenced patients' actual treatment adherence behavior, whereas descriptive norms and subjective norms do not play a role in this process.

CONCLUSIONS

Our study is one of the first that examines the relationship between patients who actively use an MPES and their trust in their physicians. This study contributes to this context by enriching the trust literature, addressing the call to identify key patient-centered technology determinants of trust, advancing the understanding of patient adherence mechanisms, adding a new explanation of the influence of education mechanisms delivered via mobile devices on patient adherence, and confirming that the theory of planned behavior holds in this patient adherence context.

Understanding of empathetic communication in acute hospital settings: a scoping review

OBJECTIVE

Empathy and empathy education have been reviewed a number of times through systematic reviews and meta-analyses; however, the topic of 'empathetic communication' remains poorly understood when considering engaging in hospital-based research. Therefore, this scoping review aimed to explore the existing literature concerning empathetic communication in hospital settings and to evaluate the definitions presented.

DESIGN

Scoping review.

DATA SOURCES

Systematic searches of the PubMed, CINAHL, Cochrane, PsycINFO, and PsycArticles databases were conducted.

STUDY SELECTION

All English studies in which empathetic communication in hospital settings were explored. The search terms used included empathy, communication, hospital settings, providers, and consumers.

DATA EXTRACTION

Data were assessed through the use of a pre-set analysis tool.

RESULTS

After conducting the searches, 419 articles were identified, of which 26 were included in this review. No single article specifically defined the term 'empathetic communication'; however, 33 unique definitions of 'empathy' were identified, of which 23 considered communication to be a component of empathy. There was a considerable lack of consistency between the empathy definitions, with some classifying communication in empathy as an ability and others classifying it as a dynamic process.

CONCLUSION

Future and contextually focused research is needed to develop a consistent and clear definition of empathetic communication and empathy within a hospital setting to better build positive healthcare cultures.

PRACTICE IMPLICATIONS

Inconsistencies between definitions of empathy in empathetic communication research could reduce the efficacy of future research gains and impact the translation of research findings into clinical practice.

Patient Toward Physician Occupational Stigma Scale: Development of the Chinese Version

BACKGROUND/OBJECTIVE

Physicians' occupational stigma could eradicate physician-patient trust, threatening physicians' social status and occupational reputation. Hitherto, there has been no scale obtaining good psychometric properties to assess patients' stigma toward physicians. The present study aimed to develop the Patient toward Physician Occupational Stigma Scale (PPOSS) and examine its reliability and validity.

METHODS

The questionnaire comprising sociodemographic information and the PPOSS were employed to survey 645 Chinese patients in two phases. In Sample 2, the Wake Forest Physician Trust Scale (WFOTS), the Intolerance of Uncertainty Scale-12 (IUS-12), and the Brief Illness Perception Questionnaire (BIPQ) were tested.

RESULTS

The PPOSS includes 19 items subsumed into three dimensions of stereotype, discrimination, and prejudice. According to the results of confirmatory factor analysis (CFA), the three-factor model fitted well (χ2/df=2.065, RMSEA=0.057, SRMR=0.045, RFI=0.904, CFI=0.956, IFI=0.956, PNFI=0.779, PCFI=0.811). The PPOSS was significantly negatively correlated with the WFOTS, and significantly positively correlated with the IUS-12 and the BIPQ. The Cronbach's alpha coefficients for the total scale and each dimension were between 0.87 and 0.94, and the split-half reliability coefficients were between 0.84 and 0.93. Besides, the PPOSS had the measurement invariance across gender.

CONCLUSION

With its satisfactory psychometric properties, the PPOSS can be used as an effective instrument to assess patients' stigma toward physicians.