Patient focused interventions and communication in the surgical clinic: a systematic review and meta-analysis

Caring for the LGBTQIA+ Patient: A Best-Practices Primer on Language, Sexual Function Considerations, and Health Disparities in Gynecologic Care

Despite representing a growing percentage of the global population, queer patients (i.e., lesbian, gay, bisexual, transgender, intersex, and/or asexual; LGBTQIA+) continue to experience significant disparities in gynecologic healthcare. Common barriers to inclusive care include discriminatory healthcare experiences, difficulty finding identity-affirming providers, and systemic lack of competency in addressing queer-specific medical needs. Such barriers arise out of heteronormative assumptions, limited provider training, and insufficient understanding of diverse sexual and gender identities. This narrative review examines gynecologic care considerations for lesbian, gay, bisexual/pansexual, asexual, intersex, and transgender patients. We review research documenting how queer patients delay or avoid healthcare due to fear of judgment, discrimination, and inadequate provider understanding. Our review highlights unique healthcare needs across different queer identities, including inclusive and culturally-sensitive sexual health screening that includes (but is not centered solely on) queer-specific sexual practices; considerations for transgender patients undergoing gender-affirming care; and incorporating intersectionality into assessment, treatment planning, and delivery. Finally, we make direct recommendations for caring for queer patients, including developing inclusive intake processes; training healthcare teams in affirming, non-discriminatory practices; using gender-neutral language; recognizing the diversity of sexual and gender identities; and addressing minority stress and its impacts on health.

The Role of Pre-surgery Clinical Communication on Metabolic and Bariatric Surgery Outcomes: A Prospective Study

BACKGROUND

Research shows that a positive doctor-patient relationship plays an important role in patient outcomes. However, the influence of their communication during the pre-surgery preparatory consultation (PC) for metabolic and bariatric surgery (MBS) remains unclear. The goal of this study was to inspect the association between patients' perceptions of doctor-patient communication (DPC) in the PC for MBS and the results of the MBS.

METHODS

This prospective cross-sectional study included 89 adult patients undergoing MBS at a hospital. Before the surgery, patients' perspectives regarding DPC were assessed with the Communication Assessment Tool (CAT). One month after the surgery, participants' levels of well-being were assessed through the 36-Item Short Form Survey (SF-36). Other clinical data were obtained through patients' electronic records. Data were analyzed with regression models.

RESULTS

In the adjusted models, associations with the quality of doctor-patient communication (p < 0.05) were found for the following outcomes: weight loss, body mass index decrease, and patient well-being regarding bodily pain and social functioning. Significant differences (p < 0.05) were also found for digestive complaints and for patient perception of physician post-surgery support.

CONCLUSIONS

DPC in the preparatory consultation has a positive effect on the clinical results of MBS. More studies are necessary for inspection of the generalizability of these findings.

e-Health education for patients and health professionals in the field of vascular disease

e-Health, defined as "the use of new information and communication technologies (ICT) to improve or support health and health care," has grown in popularity over recent years as a cost-efficient, rapidly adaptable tool to deliver health care education to a wide audience. In the field of vascular disease, for which early detection and risk factor management may greatly influence patient outcomes, application of e-Health educational resources may provide innovative solutions to facilitate evidence-based and patient-centered care provision of care; to enable patients to take a more active role in the management of their long-term vascular health conditions; and to augment their preparation for, and recovery from, surgical procedures.

'I wasn't made to feel like a nut case after all': A qualitative story completion study exploring healthcare recipient and carer perceptions of good professional caregiving relationships

BACKGROUND

Professional caregiving relationships are central to quality healthcare but are not always developed to a consistently high standard in clinical practice. Existing literature on what constitutes high-quality relationships and how they should be developed is plagued by dyadic conceptualisations; discipline, context and condition-specific research; and the absence of healthcare recipient and informal carer voices. This study aimed to address these issues by exploring how healthcare recipients and carers conceptualise good professional caregiving relationships regardless of discipline, care setting and clinical condition.

DESIGN

A qualitative story completion approach was used. Participants completed a story in response to a hypothetical stem that described a healthcare recipient (and, in some instances, carer) developing a good relationship with a new healthcare provider. Stories were analysed using reflexive thematic analysis.

PARTICIPANTS

Participants were 35 healthcare recipients and 37 carers (n = 72 total).

RESULTS

Participants' stories were shaped by an overarching discourse that seeking help from new providers can elicit a range of unwanted emotions for both recipients and carers (e.g., anxiety, fear, dread). These unwanted emotions were experienced in relation to recipients' presenting health problems as well as their anticipated interactions with providers. Specifically, recipient and carer characters were fearful that providers would dismiss their concerns and judge them for deciding to seek help. Good relationships were seen to develop when healthcare providers worked to relieve or minimise these unwanted emotions, ensuring healthcare recipients and carers felt comfortable and at ease with the provider and the encounter. Participants positioned healthcare providers as primarily responsible for relieving recipients' and carers' unwanted emotions, which was achieved via four approaches: (1) easing into the encounter, (2) demonstrating interest in and understanding of recipients' presenting problems, (3) validating recipients' presenting problems and (4) enabling and respecting recipient choice. Participants' stories also routinely oriented to temporality, positioning relationships within recipients' and carers' wider care networks and biographical and temporal contexts.

CONCLUSION

The findings expand our understanding of professional caregiving relationships beyond dyadic, static conceptualisations. Specifically, the findings suggest that high-quality relationships might be achieved via a set of core healthcare provider behaviours that can be employed across disciplinary, context and condition-specific boundaries. In turn, this provides a basis to support interprofessional education and multidisciplinary healthcare delivery, enabling different healthcare disciplines, specialties, and teams to work from the same understanding of what is required to develop high-quality relationships.

PATIENT OR PUBLIC CONTRIBUTION

The findings are based on stories from 72 healthcare recipient and carer participants, providing rich insight into their conceptualisations of high-quality professional caregiving relationships.

Shared decision making in sarcopenia treatment

The implementation of shared decision making (SDM) in management of sarcopenia is still in its nascent stage, especially compared to other areas of medical research. Accumulating evidence has highlighted the importance of SDM in older adults care. The current study overviews general SDM practices and explores the potential advantages and dilemmas of incorporating these concepts into sarcopenia management. We present common patient decision aids available for sarcopenia management and propose future research directions. SDM can be effectively integrated into daily practice with the aid of structured techniques, such as the "seek, help, assess, reach, evaluate" approach, "making good decisions in collaboration" questions, "benefits, risks, alternatives, doing nothing" tool, or "multifocal approach to sharing in shared decision making." Such techniques fully consider patient values and preferences, thereby enhancing adherence to and satisfaction with the intervention measures. Additionally, we review the barriers to and potential solutions to SDM implementation. Further studies are required to investigate measurement and outcomes, coordination and cooperation, and digital technology, such as remote SDM. The study concludes that sarcopenia management must go beyond the single dimension of "Paternalism" choice. Integrating SDM into clinical practice offers promising opportunities to improve patient care, with patient-centered care and partnership of care approaches positively impacting treatment outcomes.