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Kim JY, Botto E, Ford RM. A Clinical Research Interaction Scale for Racial and Ethnic Minority Participants. JAMA Netw Open 2025; 8:e259481. [PMID: 40358951 PMCID: PMC12076173 DOI: 10.1001/jamanetworkopen.2025.9481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Accepted: 03/09/2025] [Indexed: 05/15/2025] Open
Abstract
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.
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Affiliation(s)
- Jennifer Y. Kim
- Tufts School of Medicine, Boston, Massachusetts
- Tufts Center for the Study of Drug Development, Tufts School of Medicine, Boston, Massachusetts
| | - Emily Botto
- Tufts School of Medicine, Boston, Massachusetts
- Tufts Center for the Study of Drug Development, Tufts School of Medicine, Boston, Massachusetts
| | - Ruby Madison Ford
- Tufts School of Medicine, Boston, Massachusetts
- Tufts Center for the Study of Drug Development, Tufts School of Medicine, Boston, Massachusetts
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Krenn VT, Bönigk MS, Trampuz A, Liebisch M, Perka C, Meller S. Coping with chronic periprosthetic joint infection after failed revision of total knee and hip arthroplasty: a qualitative study on patient's experiences in treatment and healing. PLoS One 2025; 20:e0319509. [PMID: 40073045 PMCID: PMC11902299 DOI: 10.1371/journal.pone.0319509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 02/03/2025] [Indexed: 03/14/2025] Open
Abstract
Periprosthetic joint infections (PJI), along with the extensive medical and surgical interventions required for treatment, impose a substantial psychological burden on patients. Given the need for patients to adapt to long-term physical limitations and ongoing medical challenges, this qualitative study aims to explore the nature of psychological coping amongst patients with chronic cases of PJI. A total of 18 patients (8 men and 10 women, aged 55 to 92) who underwent a total knee or hip arthroplasty revision due to chronic PJI were recruited at a single academic institution between August 2022 and July 2023. Semi-structured interviews were conducted at two timepoints and analyzed using thematic analysis. We identified the nature of coping with PJI as patients' process-orientation towards healing. This encapsulates constant adaptation to challenges and losses in day-to-day life, managing expectations and proactively developing a sense of self-efficacy during treatment and healing. Patients expressed uncertainty and unpredictability to treatment trajectories and getting a feeling of being stuck, where health and well-being oscillates between progression and regression. These experiences contributed to unstable relationships with healthcare practitioners which were influenced by loss of trust and perceived treatment failures. A holistic view on patients, taking them seriously in their concerns and providing clear information were identified as crucial factors in shaping a positive patient-physician relationship. Acknowledging the fluctuating nature of chronic PJI treatment, physicians should adopt a process-oriented approach that promotes step-by-step healing while maintaining a positive patient-physician relationship. Recognizing the profound psychological impact, we propose the establishment of a new subdiscipline, namely 'Psycho-Endoprosthetics', to facilitate interdisciplinary collaborations for research and practice in septic surgery.
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MESH Headings
- Humans
- Male
- Female
- Aged
- Middle Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/psychology
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/psychology
- Prosthesis-Related Infections/psychology
- Prosthesis-Related Infections/etiology
- Prosthesis-Related Infections/surgery
- Adaptation, Psychological
- Aged, 80 and over
- Qualitative Research
- Reoperation/psychology
- Chronic Disease
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Affiliation(s)
- Vincent Tilo Krenn
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Empowerment Research Institute GmbH, Magdeburg, Germany
| | - Maria Sarah Bönigk
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Liebisch
- Faculty of Psychology, Sigmund Freud University, Vienna, Austria
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Meller
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Halperin SJ, Dhodapkar MM, McLaughlin WM, Santos E, Medvecky MJ, Grauer JN. After Anterior Cruciate Ligament Surgery, Variables Associated With Returning to the Same Surgeon If a Subsequent Antrior Cruciate Ligament Surgery Is Needed? J Am Acad Orthop Surg Glob Res Rev 2025; 9:01979360-202501000-00002. [PMID: 39761541 PMCID: PMC11692955 DOI: 10.5435/jaaosglobal-d-24-00349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 11/07/2024] [Indexed: 01/11/2025]
Abstract
INTRODUCTION Anterior cruciate ligament reconstructions (ACLrs) unfortunately can require revision ACLr, or contralateral ACLr may be indicated (together subsequent ACLr). This study aimed to examine the rate of and factors associated with returning to the same surgeon. METHODS Patients who underwent ACLr and subsequent ACLr within 3 years were abstracted from the PearlDiver database. Patient factors and surgical factors were examined. Factors independently associated with changing the surgeon were examined. RESULTS Overall, 63,582 ACLr patients were identified with 2,823 (4.4%) having a subsequent ACLr. These subsequent ACLrs were performed by the same surgeon for 1,329 (47.1%) and by a different surgeon for 1,494 (52.9%). Factors independently associated with changing surgeons were 90-day adverse events after index surgery (odds ratio [OR] 1.95), longer time to second surgery (OR 1.61), and second surgery on the ipsilateral knee (OR 1.28). Notably, sex, comorbidity, depression, psychoses, and insurance plan were not correlated with choosing changing surgeons. CONCLUSION Over half of the patients who required a subsequent ACLr changed surgeons. Changing surgeons was associated with adverse events after index surgery, ipsilateral revisions, longer time to surgery, and patient age. However, there should be confidence that the other assessed factors were not associated with the decision to change surgeons.
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Affiliation(s)
- Scott J. Halperin
- From the Yale Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Meera M. Dhodapkar
- From the Yale Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - William M. McLaughlin
- From the Yale Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Estevao Santos
- From the Yale Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Michael J. Medvecky
- From the Yale Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jonathan N. Grauer
- From the Yale Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Westheimer JL, Smith RP, Iacobelli P, Oh H, Tezino L, Khan R, Broussard J, Meltzer G, Obeid N, Cunningham S, Boland RJ, Patriquin MA. The state of (mis) trust: Human-centered technology development & implementation in intensive mental health settings. J Affect Disord 2024; 367:318-323. [PMID: 39226937 DOI: 10.1016/j.jad.2024.08.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/05/2024]
Abstract
Innovative technology-based solutions in mental healthcare promise significant improvements in care quality and clinical outcomes. However, their successful implementation is profoundly influenced by the levels of trust patients hold toward their treatment providers, organizations, and the technology itself. This paper delves into the complexities of building and assessing patient trust within the intensive mental health care context, focusing on inpatient settings. We explore the multifaceted nature of trust, including interpersonal, institutional, and technological trust. We highlight the crucial role of therapeutic trust, which comprises both interpersonal trust between patients and providers, and institutional trust in treatment organizations. The manuscript identifies potential key barriers to trust, from sociocultural background to a patient's psychopathology. Furthermore, it examines the concept of technological trust, emphasizing the influence of digital literacy, socio-economic status, and user experience on patients' acceptance of digital health innovations. By emphasizing the importance of assessing and addressing the state of trust among patients, the overarching goal is to leverage digital innovations to enhance mental healthcare outcomes within intensive mental health settings.
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Affiliation(s)
| | | | | | - Hyuntaek Oh
- The Menninger Clinic, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | | | | - Robert J Boland
- The Menninger Clinic, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | - Michelle A Patriquin
- The Menninger Clinic, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey VA Medical Center, Houston, TX, USA.
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Brouwers SJ, Janssens GE, Spiegel T. Attitudes towards geroprotection: measuring willingness, from lifestyle changes to drug use. FRONTIERS IN AGING 2024; 5:1440661. [PMID: 39564522 PMCID: PMC11573782 DOI: 10.3389/fragi.2024.1440661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 09/30/2024] [Indexed: 11/21/2024]
Abstract
Introduction Geroprotection is an emerging field of research focused on devising strategies for combating the mechanisms of ageing. This study held three aims: 1) to explore the willingness to utilise five different geroprotective measures (i.e., exercise, supplements, intermittent fasting, metformin, and rapamycin use), 2) to explore whether the willingness differs based on respondents' sociodemographic characteristics and 3) to explore the association between trust in medical institutions and willingness to utilise different geroprotective measures. Methods A questionnaire was used to assess the attitudes of a sample of the Dutch population by way of both convenience and snowball sampling (final N = 178). Descriptive data and bivariate correlations were used in the analyses. Results Relatively high social acceptance of both exercise (66%) and supplements (82%) was found, whereas intermittent fasting (30%), metformin (26%), and rapamycin (10%) were less supported. Males were significantly more likely to be open to exercise and women to supplement use. Trust in medical institutions correlated significantly with the willingness to start metformin. Discussion Exploratory research can only provide a first step in understanding the social acceptance of geroprotection measures. Nevertheless, this study clearly illustrates more well-known measures promoted by public health policy are also more accepted and used. Public health campaigns could consider the sex differences in the uptake of exercise and supplements, and future research may want to delve deeper into the role of facilitating trust relations between medical institutions and the public in promoting the use of geroprotective drugs.
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Affiliation(s)
- Sam J Brouwers
- Department of Sociology, Utrecht University, Utrecht, Netherlands
| | - Georges E Janssens
- Laboratory Genetic Metabolic Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism Institute, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Tali Spiegel
- Department of Sociology, Utrecht University, Utrecht, Netherlands
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Halperin SJ, Dhodapkar MM, Pathak N, Joo PY, Luo X, Grauer JN. Following carpel tunnel release, what factors affect whether patients return to the same or different hand surgeon for a subsequent procedure? PLoS One 2024; 19:e0312159. [PMID: 39436931 PMCID: PMC11495619 DOI: 10.1371/journal.pone.0312159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/02/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Following carpal tunnel release (CTR), patients may be indicated for subsequent hand surgery (contralateral CTR and/or trigger finger release [TFR]). While surgeons typically take pride in patient loyalty, the rate of returning to the same hand surgeons has not been previously characterized. METHODS Patients undergoing CTR were isolated from 2010-2021 PearlDiver M151 dataset. Subsequent CTR or TFR were identified and characterized as being performed by the same or different surgeon, with patient factors associated with changing to a different surgeon determined by multivariable analyses. RESULTS In total, 1,121,922 CTR patients were identified. Of these, subsequent surgery was identified for 307,385 (27.4%: CTR 289,455 [94.2%] and TFR 17,930 [5.8%]). Of the patients with a subsequent surgery, 257,027 (83.6%) returned to the same surgeon and 50,358 (16.4%) changed surgeons. Multivariable analysis found factors associated with changing surgeon (in order of decreasing odds ration [OR]) to be: TFR as the second procedure (OR 2.98), time between surgeries greater than 2-years (OR 2.30), Elixhauser-Comorbidity Index (OR 1.14 per 2-point increase), and male sex (OR 1.06), with less likely hood of changing for those with Medicare (OR 0.95 relative to commercial insurance) (p<0.001 for each). Pertinent negatives included: age, Medicaid, and having a 90-day adverse event after the index procedure. CONCLUSIONS Over fifteen percent of patients who required a subsequent CTR or TFR following CTR did not return to the same surgeon. Understanding what factors lead to outmigration of patients form a practice may help direct efforts for patient retention.
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Affiliation(s)
- Scott J. Halperin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Meera M. Dhodapkar
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Neil Pathak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Peter Y. Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Xuan Luo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
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Choi H, Kim RJY, Park SY, Lee J, Song Y. Determinants of Dentist-Patient Relationships: A Scoping Review. Int Dent J 2024; 74:1078-1088. [PMID: 38553329 PMCID: PMC11561496 DOI: 10.1016/j.identj.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 09/20/2024] Open
Abstract
OBJECTIVES The dentist-patient relationship (DPR) is considered to be a key element in dental clinical settings. This scoping review aimed to examine the extent of previous research on DPR, focussing on its determinants for the reification of the construct. METHODS This research was directed by the guidance for systematic scoping reviews from the Joanna Briggs Institute. The inclusion/exclusion criteria were based on participants of general adults and dentists, the concept of determinants of DPR, and the context of dental health care encounters. A literature search was performed in 6 major electronic databases in July 2023. Key information from included articles was extracted to chart the results, mainly to identify the determinants of DPR. Each determinant of DPR was classified according to the conceptual model of DPR. RESULTS A total of 1727 records were initially identified, and 16 articles were included in the review. Nine studies used a quantitative method and 7 were nonempirical articles. All but 2 articles were from the perspective of patients. Factors were grouped into 6 main domains: dentist, patient, society/environment, clinical structure, clinical process, and outcome. Amongst the 6 domains of DPR, most determining factors were related to the clinical process. "Communication" was most frequently counted, at 8 times, followed by "trust" (frequency, 6). At the patient level, "dental fear/anxiety" was frequently used to measure DPR. CONCLUSIONS Previous literature about DPR indicated a few common and dentistry-specific determinants from the patient perspective. Further studies are encouraged to develop a more comprehensive framework and evaluation scale of DPR.
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Affiliation(s)
- Hyejin Choi
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Ryan Jin-Young Kim
- Department of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea; Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Shin-Young Park
- Department of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea; Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Jihyun Lee
- Department of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea; Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Youngha Song
- Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea; Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, South Korea; Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia.
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Xu H, Ruan Y, Okita T, Tabata M, Kadooka Y, Asai A. Reflections from Chinese and Japanese Physicians on Medical Disputes. Asian Bioeth Rev 2024; 16:683-709. [PMID: 39398454 PMCID: PMC11464652 DOI: 10.1007/s41649-024-00294-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 10/15/2024] Open
Abstract
Physician-patient disputes are a major problem in healthcare. Physician-patient conflicts, workplace violence, and direct involvement in disputes have a significant negative impact on the well-being of physicians. China and Japan have similar cultures but differing healthcare systems. The present study aimed to examine and compare the experiences and perceptions of Chinese and Japanese physicians regarding medical disputes. Qualitative descriptive content analysis was performed for 18 cases from each country to assess the major issues involved in each case and their impact on the physicians. Common issues in medical disputes for both countries included monetary motives of patients and/or families, violence/threats from patients and/or families, the inability of patients and/or families to understand the risk of complications, and the uncertainties of medicine. The serious impact of medical disputes on the mental health and professionalism of physicians was also an issue shared by physicians of both countries. There were, however, differences in the magnitude and frequency of these issues between the two countries. Pre-existing distrust of physicians among patients and/or families was noted only by Chinese physicians, and insufficient information disclosure by physicians was noted only by Japanese physicians. In conclusion, there were similarities and differences between the two countries in the perceptions of physicians regarding medical disputes. Our analysis revealed differing healthcare situations due to cultural and institutional differences as well as universal problems intrinsic to medicine. Based on our results, we propose several key principles to improve the physician-patient relationship.
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Affiliation(s)
- Hua Xu
- Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1, Seiryocho, Aoba-Ku, Sendai, Miyagi Prefecture 980-8575 Japan
| | - Yining Ruan
- Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1, Seiryocho, Aoba-Ku, Sendai, Miyagi Prefecture 980-8575 Japan
| | - Taketoshi Okita
- Division of Philosophy and Ethics, Department of Culture and Medicine, School of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Masao Tabata
- Patient Safety Management Office, Tohoku University Hospital, Sendai, Japan
| | - Yasuhiro Kadooka
- Department of Bioethics, Faculty of Life Sciences, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Atsushi Asai
- Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1, Seiryocho, Aoba-Ku, Sendai, Miyagi Prefecture 980-8575 Japan
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Hsu D, Rassbach C, Leaming-Van Zandt K, Morrow A, Rubenstein J, Tatem A, Turner DA, Poitevien P, Barone MA. Competency based medical education and trust in the learning environment. Curr Probl Pediatr Adolesc Health Care 2024; 54:101640. [PMID: 38876832 DOI: 10.1016/j.cppeds.2024.101640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Affiliation(s)
- Deborah Hsu
- Stanford University School of Medicine, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Palo Alto CA, United States.
| | - Carrie Rassbach
- Stanford University School of Medicine, Department of Pediatrics, Division of Hospital Medicine, Palo Alto CA, United States
| | - Katherine Leaming-Van Zandt
- Penn State College of Medicine, Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Hershey PA, United States
| | - Asha Morrow
- Baylor College of Medicine, Department of Pediatrics, Division of Pediatric Emergency Medicine, Houston TX, United States
| | - Jared Rubenstein
- Baylor College of Medicine, Department of Pediatrics, Division of Palliative Care, Houston TX, United States
| | - Andria Tatem
- Eastern Virginia Medical School and Children's Hospital of the King's Daughters, Department of Pediatrics, Norfolk VA, United States
| | - David A Turner
- American Board of Pediatrics, Chapel Hill NC, United States
| | - Patricia Poitevien
- Brown University Warren Alpert Medical School and Hasbro Children's Hospital, Department of Pediatrics, Division of Pediatric Hospital Medicine, Providence RI, United States
| | - Michael A Barone
- Brown University Warren Alpert Medical School and Hasbro Children's Hospital, Department of Pediatrics, Division of Pediatric Hospital Medicine, Providence RI, United States
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Kim L, Hermansen AM, Cook K, Siden H. Exploring What Motivates Parents of Children Living With Medical Complexity to Participate in Research. Child Care Health Dev 2024; 50:e13331. [PMID: 39300755 DOI: 10.1111/cch.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 07/23/2024] [Accepted: 08/27/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND The study aimed to understand the experience of and identify the motivations for parents participating in health research for their children with medical complexity (CMC). Patient-oriented research strategies are increasingly important in health research to ensure that the voices of patients and parents help shape and direct research programmes. To bring a family-centred and patient-oriented focus to our research and objectives, we asked parents about their experiences when they participated in healthcare research related to their child with CMC. METHODS A parent partner, who also has a CMC, interviewed 12 parents (11 mothers and 1 father) of children living with medical complexity to understand their motivations to participate in healthcare research for their child. The parent partner conducted and transcribed the interviews and led our data analysis. Interpretive phenomenological analysis (IPA) was used to inform our data coding and analytic process. RESULTS Parents described numerous reasons for their participation in research about their children. These motivations landed within four main themes: feeling helpless and hopeful, child-centred motivation, being part of something good and forming a relationship with the research team. In addition to these themes, parents highlighted factors that influenced their ability or desire to participate, such as time, capacity and the level of invasiveness for their child. Ultimately, the reflections by parents emphasized their unique lives in caring for their CMC and the need to integrate their lived experiences with the research they engage in. CONCLUSION This study offers important insights for healthcare teams who want to engage parents of CMC to participate in research. Understanding parents' motivation to participate in research can help researchers create richer engagement and more meaningful experiences for themselves and their participants, thereby bolstering research programmes.
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Affiliation(s)
- Laesa Kim
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | | | - Karen Cook
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Harold Siden
- Canuck Place Children's Hospice, BC Children's Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Consolandi M. Philosophy leading the way: An interdisciplinary approach to study communication of severe diagnoses. PLoS One 2024; 19:e0305937. [PMID: 39038006 PMCID: PMC11262668 DOI: 10.1371/journal.pone.0305937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/06/2024] [Indexed: 07/24/2024] Open
Abstract
This paper explores a brand-new interdisciplinary approach applied to an enduring problem: the communication of severe diagnoses. The moment when physicians explain the diagnosis to patients and their relatives is sensitive, particularly for a disease that is rarely diagnosed early. The first part of the article is dedicated to the context of this delicate doctor-patient interaction. With this framework in mind, the paper delves into the innovative interdisciplinary methodology developed in the pilot study Communi.CARE, conducted in a hospital in Northern Italy, which focuses on the diagnosis of pancreatic ductal adenocarcinoma (PDAC). SARS-CoV-2 impact on the study development is highlighted. The study aims to explore the topic by combining different areas of expertise, including medicine, philosophy, sociology, and psychology. The contribution of philosophy is here presented as essential: it has a leading role in the conception of the study, its development, and the elaboration of results. It is shown throughout the study, from methodology to the analysis of results. Strengths and weaknesses of the methodology are discussed. In conclusion, further philosophical considerations on effective and ethical communication in this delicate context are recommended.
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Affiliation(s)
- Monica Consolandi
- Fondazione Bruno Kessler, Center for Digital Health and Well Being, Unit of Intelligent Digital Agents, Trento, Italy
- Consultant, Pontifical Academy for Life, Vatican City, Rome, Italy
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Schlegel EC, Pickler RH, Tate JA, Williams KP, Smith LH. The EMeRGE theory of emerging adult-aged women's sexual and reproductive health self-management: A grounded theory study. J Adv Nurs 2024; 80:510-525. [PMID: 37533185 PMCID: PMC10834842 DOI: 10.1111/jan.15814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 06/26/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
AIMS To explore how emerging adult-aged women self-manage their sexual and reproductive health and to generate a grounded theory of these self-management processes. DESIGN Grounded theory methods using a constructivist approach. METHODS Between September 2019 and September 2020, 18- to 25-years-old women (n = 13) were recruited from a 4-year university, a 2-year community college, and neighbourhoods surrounding the institutions of higher education. Individual interviews were transcribed verbatim and qualitatively analysed using a constant comparative method and inductive coding. RESULTS The theory purports that core processes of sexual and reproductive health self-management used by the women in this study included both passive and (re)active processes. These processes expanded upon and/or maintained the women's accessible sexual and reproductive health knowledge, behaviour and beliefs, defined as the sexual and reproductive health repertoire. The processes appeared to be cyclical and were often initiated by a catalysing event or catalyst and resulted in conversations with confidantes, or trusted individuals. A catalyst was either resolved or normalized by expanding or maintaining the sexual and reproductive health repertoire. CONCLUSION The resulting theory, EMeRGE Theory, offers insight into the complex and cyclical processes emerging adult-aged women use to simultaneously develop and adapt their foundational sexual and reproductive health knowledge, behaviours and beliefs. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This explication of emerging adult-aged women's sexual and reproductive health self-management processes can be used by nurses and nurse researchers to better address this population's unique health needs. IMPACT The EMeRGE Theory provides valuable guidance for future exploratory and intervention research aimed at improving the health and well-being of emerging adult-aged women. REPORTING METHOD The authors adhered to the Consolidated Criteria for Reporting Qualitative studies (COREQ) in preparation of this publication. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Emma C Schlegel
- Center for Nursing Research, Scholarship and Innovation, College of Nursing, Michigan State University, East Lansing, Michigan, USA
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Rita H Pickler
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Judith A Tate
- Center for Aging, Self-Management and Complex Care, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Laureen H Smith
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, USA
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Aijaz M, Lewis VA, Murray GF. Advancing equity in challenging times: A qualitative study of telehealth expansion and changing patient-provider relationships in primary care settings during the COVID-19 pandemic. Digit Health 2024; 10:20552076241233148. [PMID: 38434791 PMCID: PMC10906055 DOI: 10.1177/20552076241233148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Objective The patient-provider relationship is critical for achieving high-quality care and better health outcomes. During the COVID-19 pandemic, primary care practices rapidly transitioned to telehealth. While telehealth provided critical access to services for many, not all patients could optimally utilize it, raising concerns about its potential to exacerbate inequities in patient-provider relationships. We investigated technical and workforce-related barriers to accessing telehealth and the impacts on patient-provider relationships for vulnerable populations. Methods Qualitative, semi-structured interviews from May 2021 to August 2021 with 31 individuals (medical directors, physicians, and medical assistants) working at 20 primary care practices in Massachusetts, North Carolina, and Texas. Thematic analysis to better understand how barriers to using telehealth complicated patient-provider relationships. Results Interviewees shared challenges for providers and patients that had a negative effect on patient-provider relationships, particularly for vulnerable patients, including older adults, lower socio-economic status patients, and those with limited English proficiency. Providers faced logistical challenges and disruptions in team-based care, reducing care coordination. Patients experienced technological challenges that made accessing and engaging in telehealth difficult. Interviewees shared challenges for patient-provider relationships as commonly used telephone-only telehealth reduced channels for non-verbal communication. Conclusion This study indicates that barriers to virtual interaction with patients compared to in-person care likely led to weaker personal relationships that may have longer-term effects on engagement with and trust in the healthcare system, particularly among vulnerable patient groups. Additional support and resources should be available to primary care providers to optimize telehealth utilization.
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Affiliation(s)
- Monisa Aijaz
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Valerie A Lewis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Genevra F Murray
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
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Katzman JG, Gallagher RM. Pain: The Silent Public Health Epidemic. J Prim Care Community Health 2024; 15:21501319241253547. [PMID: 38742616 PMCID: PMC11095171 DOI: 10.1177/21501319241253547] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
More than 50 million Americans suffer from chronic pain, costing our society an estimated 565 to 635 billion dollars annually. Its complexity and training deficits in healthcare providers result in many patients receiving ineffective care. Large health inequities also exist in access to effective pain care for vulnerable populations. The traumatic history of indigenous people and people of color in regards to the experience of pain care perpetuates a lack of trust in the healthcare system, causing many to hesitate to seek medical treatment for painful events and conditions. Other vulnerable populations include those with sickle cell disease or fibromyalgia, whose experience of pain has not been well-understood. There are both barriers to care and stigma for patients with pain, including those taking prescribed doses of long-term opioids, those with known substance use disorder, and those with mental health diagnoses. The suffering of patients with pain can be "invisible" to the clinician, and to one's community at large. Pain can affect all people; but those most vulnerable to not getting effective care may continue to suffer in silence because their voices are not heard. Since 1973, pain societies around the globe have worked tirelessly to bring clinicians together to advance pain and opioid education, research, and patient care. These improvements consist of pain education, integrative treatment, and the understanding that a therapeutic alliance is critical to effective pain management. Pain education for both pre and post-licensure health professionals has increased substantially over the last decade. In addition, integrative and interdisciplinary approaches for clinical pain management are now considered best practices in pain care for patients with moderate to severe pain in addition to the development of a strong therapeutic alliance.
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Affiliation(s)
- Joanna G. Katzman
- University of New Mexico School of Medicine, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico, Albuquerque, USA
- Public Health Initiatives Project ECHO, Albuquerque, USA
| | - Rollin Mac Gallagher
- American Academy of Pain Medicine, Chicago, IL, USA
- Center for Health Equities Research and Promotion (CHERP), Michael J Crescenz VA Medical Center, Philadelphia, USA
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15
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Mick I, Freger SM, van Keizerswaard J, Gholiof M, Leonardi M. Comprehensive endometriosis care: a modern multimodal approach for the treatment of pelvic pain and endometriosis. Ther Adv Reprod Health 2024; 18:26334941241277759. [PMID: 39376635 PMCID: PMC11457249 DOI: 10.1177/26334941241277759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 08/08/2024] [Indexed: 10/09/2024] Open
Abstract
Endometriosis is a prevalent gynecological disease, leading to chronic pain and inflammation, affecting 1 in 10 individuals presumed female at birth. The diagnostic journey is often arduous, marked by neglect of the right diagnosis and prolonged wait times, significantly compromising the quality of life among those affected. This review provides a nuanced exploration of endometriosis-associated pain management, encompassing medical, surgical, and holistic approaches, all guided by accurate and refined diagnostics. Our paramount goal is to empower physicians as key figures in confronting this intricate challenge with a patient-centric approach, ultimately aiming to improve treatment and quality of life. Acknowledging each patient's unique needs, we emphasize the importance of tailoring a spectrum of options informed by current literature and insights gleaned from our experience in a high-volume tertiary endometriosis center. It is imperative to recognize endometriosis as a complex and chronic disease, often occurring with co-morbid conditions and nuanced complexities, necessitating a long-term personalized multimodal approach for each case. In addition, incorporating principles such as patient autonomy, profound respect for diverse experiences, and practical education on treatment choices is pivotal in enhancing treatment outcomes and overall patient satisfaction.
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Affiliation(s)
- Ido Mick
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Shay M. Freger
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON L8N 3Z5, Canada
| | | | - Mahsa Gholiof
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Mathew Leonardi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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Chen H, Jiesisibieke ZL, Chien CW, Chen PE, Tung TH. The association between abusive behaviour and physician-patient relations: a systematic review. Public Health 2023; 224:26-31. [PMID: 37703693 DOI: 10.1016/j.puhe.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 06/09/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE This systematic review aims to explore the association between abusive behaviour and physician-patient relations in healthcare settings. STUDY DESIGN Systematic review. METHODS We searched for related studies on databases such as PubMed, Embase, and the Cochrane library, without restrictions on language, from inception until July 15, 2022. The risk of bias and the methodological quality was evaluated using the Newcastle-Ottawa Scale and Risk of Bias in Non-randomised Studies of Interventions tool. RESULTS Ten studies were included in this systematic review, the participants of which were physicians and patients. The research from all the studies highlighted the detrimental effects of abusive behaviour on the relationship between physicians and patients, regardless of who the abusers were. CONCLUSIONS Abusive behaviour in a clinical setting has a negative influence on the physician-patient relationship, whoever the perpetrator might be. The research sheds light on the importance of teaching communication skills to physicians and training them to manage conflicts and aggressive behaviours in healthcare settings.
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Affiliation(s)
- Haixiao Chen
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Zhejiang University, Linhai 317000, PR China.
| | - Zhu Liduzi Jiesisibieke
- School of Public Health, The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, PR China.
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, PR China.
| | - Pei-En Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan; Taiwan Association of Health Industry Management and Development Taipei, Taiwan.
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, PR China.
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Butler C. The Role of Diversity, Equity, and Inclusion Principles in Enhancing the Quality of Urologic Resident Education and Advancing Gender Diverse Care. Urol Clin North Am 2023; 50:541-547. [PMID: 37775213 DOI: 10.1016/j.ucl.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
This article will review the history of trans and gender diverse individuals in the medical field and suggest relevant content and methods to include in a diversity, equity, and inclusion curriculum. The hope is that the inclusion of these methods will help combat the barriers in place to receiving equitable and fair urologic care.
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Affiliation(s)
- Christi Butler
- University of California San Francisco, 400 Parnassus Avenue, 6th Floor, San Francisco, CA 94143, USA.
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van der Kraan YM, Paap D, Lennips N, Veenstra ECA, Wink FR, Kieskamp SC, Spoorenberg A. Patients' Needs Concerning Patient Education in Axial Spondyloarthritis: A Qualitative Study. Rheumatol Ther 2023; 10:1349-1368. [PMID: 37523038 PMCID: PMC10469151 DOI: 10.1007/s40744-023-00585-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Within the EULAR recommendations, patient education (PE) is stated as the basis of the management of axial spondyloarthritis (axSpA). However, educational needs are scarcely qualitatively studied in axSpA. Therefore, we aimed to explore experiences and needs of PE in patients with axSpA. METHODS A phenomenological approach was used, with semi-structured in-depth interviews with patients with axSpA including broad variation in characteristics. Thematic analysis was applied. To enhance credibility, data saturation, research triangulation, peer debriefing, member checking, theoretical notes, and bracketing were performed. RESULTS Three interrelated themes regarding PE were identified from 20 interviews: illness perception, content, and 'availability'. Illness perception affects how patients experience and process PE, which consequently influences coping strategies. Prognosis, treatment, and coaching to self-management were identified as the most important content of PE. Regarding 'availability', face-to-face PE is preferred for exploring needs, supplemented by self-education, which can be freely applied. Additionally, sufficient time and a comprehensible amount of information were important and participants emphasized the need for axSpA-tailored information for relatives and friends. Participants reported a trusting patient-healthcare provider (HCP) relationship, and multidisciplinary and interdisciplinary attunement between HCPs as prerequisites for effective PE. CONCLUSIONS This first qualitative study exploring patients' experiences and needs of PE in axSpA revealed that prognosis, treatment, and coaching to self-management are important regarding content, and the combination of face-to-face contact and self-education the preferred modalities. It seems essential that patients' illness perceptions are taken into account for effective PE. These results add relevant insights for future PE guidelines in axSpA.
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Affiliation(s)
- Yvonne M van der Kraan
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands.
| | - Davy Paap
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
- Department of Physiotherapy, School of Health, Saxion University of Applied Sciences, 7513 AB, Enschede, The Netherlands
| | - Niels Lennips
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Else C A Veenstra
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Freke R Wink
- Department of Rheumatology, Medical Center Leeuwarden, 8934 AD, Leeuwarden, The Netherlands
| | - Stan C Kieskamp
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
| | - Anneke Spoorenberg
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, PO Box 30 001, 9700 RB, Groningen, The Netherlands
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Abstract
Prior research has documented how important it is to patients to be able to trust their physicians. In this essay, we introduce physician perspectives on the importance of earning patients' trust. We conducted twelve semistructured interviews in late 2022, eleven with physicians and one with a patient-experience expert. Physicians described earning patients' trust as crucial for working effectively with patients, with several saying that it was as important as having medical knowledge. Physicians also expressed that feeling a patient trusting them is professionally rewarding and fulfilling. To build trust with patients, physicians reported, they make the medical interaction all about the patient, express their belief in their patients, share their personal experiences, and use other strategies identified in previous literature: communicating effectively, being compassionate, and demonstrating competence. Physicians also reported experiencing challenges in building trust with patients, most often because of patients' lack of trust in other levels of the health care system and because of having inadequate time to spend with patients. Additionally, Black and Brown physicians described how patients' bias often blocks trust.
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Noda CH, Brown D, Kopar PK. The Surgeon as a Professional: Changes and Challenges Over Time. Ann Surg 2023; 278:179-183. [PMID: 36541583 DOI: 10.1097/sla.0000000000005778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In this article, we seek to use a case-study discussion of a woman seeking treatment guidance for an elective, complex surgical ailment to discuss how professionalism has changed within the past century and where it may be headed with specific regard for the medical profession and surgeons. BACKGROUND Traditionally, professionals were those who possessed a certain knowledge base, committed to an ╗altruistic mission through serving the general populace while adhering to certain performance standards that were established by other members of the field. In the 20th century, we saw certain abuses from those who held positions of power within medicine including the Tuskegee Syphilis and Nuremberg trials calling into question the trust the public has placed within professional actors. With many competing opinions and forces shaping the medical profession, including the prominent dissemination of health care information making access to both true and misinformation more rampant than ever before, discussion about the evolving nature of the medical profession is important. METHODS/RESULTS We conducted a literature review to investigate the historical context of the physician-patient relationship with regard for the surgeon. Our work suggests that the core structure of a professional is a foundation rooted in moral excellence that merits trust from the client. In medicine, further efforts at healing from prior abuses necessitates an emphasis on ethical principles, as well as communicating this commitment not only to the patient but also to the society at large. We emphasize the importance of these changes through a case-based discussion.
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Affiliation(s)
- Christopher H Noda
- Department of Surgery, Barnes-Jewish Hospital, Center for Humanism and Ethics in Surgical Specialties, Washington University School of Medicine, St. Louis, MO
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21
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Abd-Elsayed AA, Marcondes LP, Loris ZB, Reilly D. Painful Diabetic Peripheral Neuropathy - A Survey of Patient Experiences. J Pain Res 2023; 16:2269-2285. [PMID: 37425223 PMCID: PMC10329444 DOI: 10.2147/jpr.s409876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose An online survey was conducted in the USA to obtain information about the knowledge and experiences of patients with painful diabetic peripheral neuropathy (pDPN). Patients and Methods 506 adults with diabetes and pDPN affecting the feet for ≥6 months, for which pain medication had been prescribed for ≥6 months, completed an online survey questionnaire in March 2021. Results 79% of respondents had type 2 diabetes, 60% were male, 82% were Caucasian and 87% had comorbidities. Pain was significant to severe in 49% of respondents, and 66% had disability due to nerve pain. Anticonvulsants, over-the-counter pills and supplements were the most commonly used medications. Topical creams/patches were prescribed in 23% of respondents. 70% had tried multiple medications for their pain. 61% of respondents had to see ≥2 doctors before receiving a correct diagnosis of pDPN. 85% of respondents felt that the doctor understood their pain and its impact on their life. 70% had no difficulty finding the information they wanted. 34% felt insufficiently informed about their condition. A medical professional was the primary, and most trusted, source of information. Frustration, worry, anxiety and uncertainty were the most commonly reported emotions. Respondents were generally eager to find new medications for pain relief and desperate for a cure. Lifestyle changes because of nerve pain were most commonly associated with physical disabilities and sleep disturbance. Better treatments and freedom from pain were the overriding perspectives when considering the future. Conclusion Patients with pDPN are generally well informed about their pain and trust their doctor but remain unsatisfied with their current treatment and struggle to find a lasting solution for their pain. Early identification and diagnosis of pain in diabetics, and education about treatments, is important to minimize the impact of pain on quality of life and emotional well-being.
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Affiliation(s)
- Alaa A Abd-Elsayed
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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22
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Yuan S, John D, Shambhunath S, Humphris G. A scoping review to explore patient trust in dentistry: the definition, assessment and dental professionals' perception. Br Dent J 2023:10.1038/s41415-023-5882-x. [PMID: 37286716 DOI: 10.1038/s41415-023-5882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/13/2023] [Accepted: 03/02/2023] [Indexed: 06/09/2023]
Abstract
Background A trusting dentist-patient relationship is pivotal in providing person-centred care. This scoping review aims to identify how trust is defined, measured and perceived by dental professionals.Methods The Joanna Briggs Institute framework was adopted. A search strategy was developed using MeSH (Medical Subject Headings) terms and key words. Medline/PubMed, Embase, PsycINFO and CINAHL were searched. Data were synthesised using thematic analysis.Findings In total, 16 studies were included that frequently used quantitative research methodology. Only four studies provided definition of trust. Many studies employed either Dental Trust Scale or Dental Beliefs Survey to measure dentist-patient trust, although others developed their own items. Limited research suggested that the dental professionals appreciated communication was paramount to building a trusting relationship with patients.Conclusion No consensus was found on the definition of trust, nor on a preferred assessment tool to measure dentist-patient trust. The limited evidence intimated that dental professionals acknowledged the importance of effective communication in building a trusting alliance with patients. The scarcity of relevant research highlights the need for more robust investigations of trust in dental care.
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Affiliation(s)
- Siyang Yuan
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HN, Scotland, United Kingdom.
| | - Deepti John
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HN, Scotland, United Kingdom
| | - Shambhunath Shambhunath
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HN, Scotland, United Kingdom
| | - Gerry Humphris
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HN, Scotland, UK; School of Medicine, University of St Andrews, North Haugh, St Andrews, Fife, KY16 9TF, Scotland, United Kingdom
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Daggett A, Abdollahi S, Hashemzadeh M. The Effect of Language Concordance on Health Care Relationship Trust Score. Cureus 2023; 15:e39530. [PMID: 37366455 PMCID: PMC10290885 DOI: 10.7759/cureus.39530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Various barriers exist for Limited English Proficient (LEP) patients in the United States healthcare system, including language barriers. To address language access, interpreters have been used as well as physicians who speak the same language (language concordance), with unknown effect. By studying the strength of patient-physician relationships under different communication parameters, such as the use of a variety of language services, we can better understand healthcare interactions and move toward optimizing patient care and health outcomes. This study investigates the importance of language-concordant care in LEP populations to build trusting patient-physician relationships. OBJECTIVE To determine whether Spanish-speaking patients who receive health care from language-concordant (in this study, Spanish-speaking) physicians have higher total trust scores on the Health Care Relationship (HCR) Trust scale than patients who use professional or ad hoc interpreters. METHODS This is a prospective survey conducted on Spanish-speaking adult patients coming to family and internal medicine outpatient clinics in the Phoenix, AZ, metro area. Of 214 recruited subjects, 176 completed the survey. Primary outcomes of the study: measured total mean Health Care Relationship (HCR) trust score among three groups (language concordant, professional interpreter, ad hoc interpreter). Secondary outcomes of the study: variance of trust scores among three groups for individual survey items. Results: The group with language concordant providers had a mean trust score of 48.73, significantly higher than the mean for the group with ad hoc interpreters with a mean of 45.53 (p = 0.0090). Patients with a professional interpreter also had a higher mean trust score of 48.27 than the ad hoc interpreters (p = 0.0119). There were several individual questions where the professional language groups had statistically significantly higher HCR trust scores than the ad hoc interpreter group in terms of their trust in specific instances, i.e., involving the patient in discussing treatment options, making the patient feel worthy of the doctor's time, and their doctor telling them the whole truth. There were no differences in overall mean scores or individual scores for the two professional language groups (language concordant providers and professional interpreters). CONCLUSIONS The results reinforce the current understanding that professionally acknowledged and trained speakers of a second language in the medical setting allow for the formation of stronger patient-physician relationships, specifically in terms of a patient's trust in their physician. In addition to continuing to increase the availability of high-quality interpreters, the same effort should be placed on increasing the diversity of languages spoken by physicians to foster trusting patient-physician relationship formation.
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Affiliation(s)
- Alexandria Daggett
- Pediatrics, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | | | - Mehrtash Hashemzadeh
- Biostatistics, University of Arizona College of Medicine - Phoenix, Phoenix, USA
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Manuel Román-Belmonte J, De la Corte-Rodríguez H, Adriana Rodríguez-Damiani B, Carlos Rodríguez-Merchán E. Artificial Intelligence in Musculoskeletal Conditions. ARTIF INTELL 2023. [DOI: 10.5772/intechopen.110696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Artificial intelligence (AI) refers to computer capabilities that resemble human intelligence. AI implies the ability to learn and perform tasks that have not been specifically programmed. Moreover, it is an iterative process involving the ability of computerized systems to capture information, transform it into knowledge, and process it to produce adaptive changes in the environment. A large labeled database is needed to train the AI system and generate a robust algorithm. Otherwise, the algorithm cannot be applied in a generalized way. AI can facilitate the interpretation and acquisition of radiological images. In addition, it can facilitate the detection of trauma injuries and assist in orthopedic and rehabilitative processes. The applications of AI in musculoskeletal conditions are promising and are likely to have a significant impact on the future management of these patients.
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Dewan T, Birnie K, Drury J, Jordan I, Miller M, Neville A, Noel M, Randhawa A, Zadunayski A, Zwicker J. Experiences of medical traumatic stress in parents of children with medical complexity. Child Care Health Dev 2023; 49:292-303. [PMID: 35947493 PMCID: PMC10087969 DOI: 10.1111/cch.13042] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/25/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Parents of children with medical complexity (CMC) experience high levels of stress and adverse mental health outcomes. Pediatric medical traumatic stress (PMTS) could be an important contributor that has not yet been explored. PMTS describes parents' reactions to their child's illness and medical treatment and can lead to post-traumatic stress symptoms. This is the first study to describe the experiences and impact of PMTS among parents of CMC. METHODS We conducted semi-structured interviews with 22 parents of CMC. Reflexive thematic analysis was used to generate themes that described the experiences of PMTS and potential contributing factors in the healthcare setting. Themes were validated by study participants. RESULTS Parents experienced a spectrum of events and circumstances that impacted PMTS. These corresponded to three major themes: (a) the distinctive context of being the parent of a CMC, (b) interactions with healthcare providers that can hurt or heal and (c) system factors that set the stage for trauma. The consequences of repeated PMTS were a common point of emphasis among all the themes. Parents identified numerous changes that could mitigate PMTS such as acknowledgement of trauma and provision of proactive mental health support. CONCLUSIONS Our study highlights the issue of PMTS among parents of CMC and presents opportunities to mitigate their traumatic experiences. Supporting the integration of trauma-informed care practices, increasing awareness of PMTS and advocating for parental mental health services could better support parents and families.
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Affiliation(s)
- Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Katie Birnie
- Department of Anesthesia and Pain Medicine, University of Calgary, Calgary, Canada
| | | | | | - Megan Miller
- Rotary Flames Children's Hospice and Palliative Care Service, Calgary, Canada
| | | | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Alam Randhawa
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Anna Zadunayski
- Department of Pediatrics, University of Calgary, Calgary, Canada
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Marterre B, Hinshaw DB, Shinall MC. Spirituality in Surgery-A Double-Edged Scalpel. Am Surg 2023:31348231157805. [PMID: 36786501 DOI: 10.1177/00031348231157805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Investigating, respecting, and working with surgical patients' spiritualities is as critical a skill as the proficient technical performance of operations. When spirituality is ignored, sacred patient values remain undiscovered, authentic trust is hindered, and healthy shared decision-making processes suffer. These are instances when the other edge of the spiritual scalpel comes back to cut us as surgeons, but more importantly, upon withdrawal of spiritual understanding, it deeply injures our patients and their families. Spiritual screening, spiritual history taking, engaged, active listening, and big-picture prognostic truth-telling while promoting hope are critical skills for efficacious whole-person surgical care and the healing of our surgical patients' suffering-in all aspects of their humanity. These skills require surgeon introspection and vulnerability, however, as well as regular practice, and can be quite difficult; frequently leading to understandable discomfort, particularly when the surgeon does not share the patient's spiritual orientation or religious commitments. This literature-based essay addresses all of these issues, providing surgeons with a variety of new spiritual tools for their holistic armamentarium to promote healing, rather than further injury.
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Affiliation(s)
- Buddy Marterre
- Departments of Internal Medicine (Section on Palliative Care) and General Surgery, 528756Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Daniel B Hinshaw
- Department of Surgery, 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | - Myrick C Shinall
- Department of Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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27
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Kulchar RJ, Chen K, Moon C, Srinivas S, Gupta A. Telemedicine, safe medication stewardship, and COVID-19: Digital transformation during a global pandemic. JOURNAL OF INTERPROFESSIONAL EDUCATION & PRACTICE 2022; 29:100524. [PMID: 35935734 PMCID: PMC9342857 DOI: 10.1016/j.xjep.2022.100524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Telemedicine may provide equitable, accessible, and affordable healthcare to individuals globally. Recently tele-medicine has emerged as a vital resource for interdisciplinary healthcare professionals to provide critical medical care on the frontlines during the combined COVID-19 pandemic and the drug and opioid crisis. With the recent 2020 expansion of insurance coverage of telemedicine services by the United States Centers for Medicare & Medicaid Services, there has been an uptick in the need to understand how to comprehensively train physicians and health care professionals on telemedicine during a public health crisis. This study gathered 98 survey responses from interdisciplinary healthcare professionals regarding their telemedicine experience, focusing on trends of use with the drug and opioid crisis during the COVID-19 pandemic. The results demonstrate that during the COVID-19 pandemic, telemedicine provided a novel, innovative way to address an unmet need in healthcare and may aid to improve safe medication stewardship (SaMS) practice guidelines. Further expanded population-based research and randomized clinical trials are necessary to confirm these preliminary recommendations and form best practices for use in digital health and telemedicine. In addition, further studies will confirm the benefits of interdisciplinary healthcare professionals' engagement in harm reduction strategies via telemedicine to address improving safe medication use.
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Affiliation(s)
- Rachel J Kulchar
- Department of Chemistry, Princeton University, Princeton, NJ, USA
| | - Kaitlyn Chen
- Department of Anthropology, Princeton University, Princeton, NJ, USA
| | - Christina Moon
- Department of Sociology, Princeton University, Princeton, NJ, USA
| | | | - Anita Gupta
- Distinguished Fellow of the National Academies of Practice, USA
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Impacts of Internet Use on Chinese Patients' Trust-Related Primary Healthcare Utilization. Healthcare (Basel) 2022; 10:healthcare10102114. [PMID: 36292561 PMCID: PMC9602738 DOI: 10.3390/healthcare10102114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 11/04/2022] Open
Abstract
Background: The internet has greatly improved the availability of medical knowledge and may be an important avenue to improve patients’ trust in physicians and promote primary healthcare seeking by reducing information asymmetry. However, very few studies have addressed the interactive impacts of both patients’ internet use and trust on primary healthcare-seeking decisions. Objective: To explore the impact of internet use on the relationship between patients’ trust in physicians and primary healthcare seeking among Chinese adults 18 years of age and older to understand the varieties of effects in different cities. Methods: Generalized linear mixed models were applied to investigate the interactive impacts of internet use and patients’ trust in physicians on primary healthcare seeking using pooled data from the China Family Panel Study of 2014 to 2018. We also compared these effects based on different levels of urbanization, ages, and PHC services. Results: Overall, a higher degree of patients’ trust (p < 0.001) was able to directly predict better primary healthcare seeking, and internet use significantly increased the positive effect of patients’ trust on primary healthcare seeking (p < 0.001). However, the marginal effect analysis showed that this effect was related to the level of patients’ trust and that internet use could reduce the positive effect of patients’ trust on primary healthcare seeking when the individual had a low level of trust (≤ 3 units). Further, the heterogeneity analysis indicated that the benefits from internet use were higher in cities with high urbanization, high aging, and high PHC service levels compared to cities with low levels of these factors. Conclusions: The internet use may enhance patients’ trust-related PHC utilization. However, this impact is effective only if patients’ benchmark trust remains at a relatively high level. Comparatively, the role of internet use is more effective in areas with high urbanization, high aging and high PHC level. Thus, with increasing accessibility to the internet, the internet should be regulated to disseminate correct healthcare information. Moreover, in-depth integration of the internet and PHC should be promoted to provide excellent opportunities for patient participation, and different strategies should be set according to each city’s characteristics.
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29
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Guille C, Hall C, King C, Sujan A, Brady K, Newman R. Listening to women and pregnant and postpartum people: Qualitative research to inform opioid use disorder treatment for pregnant and postpartum people. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100064. [PMID: 36845990 PMCID: PMC9948937 DOI: 10.1016/j.dadr.2022.100064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022]
Abstract
Background The diagnosis of Opioid Use Disorder (OUD) during pregnancy has increased 2-to-5-fold over the past decade and barriers to treatment are significant. Technology-based solutions have the potential to overcome these barriers and deliver evidence-based treatment. However, these interventions need to be informed by end-users. The goal of this study is to gain feedback from peripartum people with OUD and obstetric providers about a web-based OUD treatment program. Methods Qualitative interviews were conducted with peripartum people with OUD (n = 18) and focus groups were conducted with obstetric providers (n = 19). Feedback from these interviews informed the development of text message-based screening, brief phone-based intervention and referral to treatment program, called Listening to Women and Pregnant and Postpartum People (LTWP). Once developed, further qualitative interviews with peripartum people with OUD (n = 12) and obstetric providers (n = 21) were conducted to gather feedback about the LTWP program. Results Patients reported that a relationship with a trusted provider is paramount for treatment engagement. Providers reported that time constraints and complex patient needs prohibit them from treating OUD and that evidence-based Screening, Brief Intervention and Referral to Treatment (SBIRT) are not implemented effectively in routine prenatal care. Neither patients nor providers were enthusiastic about our web-based intervention for OUD; thus, results were used to guide the development of LTWP to improve implementation of SBIRT during prenatal care. Conclusions End-user informed, technology-enhanced SBIRT has the potential to improve the implementation of SBIRT during routine prenatal care, and in turn, improve maternal and child health.
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Affiliation(s)
- Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Casey Hall
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Courtney King
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
| | - Ayesha Sujan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Psychological and Brain Sciences, Indiana University – Bloomington, Bloomington, IN, USA
| | - Kathleen Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Psychological and Brain Sciences, Indiana University – Bloomington, Bloomington, IN, USA
| | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
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30
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Wong YK, Low KL, Pooke TG. Factors Associated With Dimensions of Patients' Trust in Chiropractic Doctors in the International Medical University Healthcare Chiropractic Center: An Exploratory Study. J Chiropr Med 2022; 21:83-96. [PMID: 35774631 PMCID: PMC9237594 DOI: 10.1016/j.jcm.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to investigate the association between patients' sociodemographic factors (age, sex, ethnicity, and education background) and dimensions of patients' trust in chiropractic doctors in Malaysia. Methods This cross-sectional study was conducted in the International Medical University Healthcare Chiropractic Center with a total of 302 respondents. Self-administered questionnaires were enclosed in an envelope and passed to participants by the researchers. Descriptive statistics are presented in tables and figures. Each dimension of the patients' trust was compared against the sociodemographic factors. The variables included were sex, age, ethnicity, and education background, along with their dimensions of trust. Results There were 106 male respondents (35.1%) and 196 female respondents (64.9%) between 21 and 40 years of age. In all of the trust dimensions, education background was the only statistically significant variable (P < .05). Conclusion Several sociodemographic factors were associated highly with the trust dimensions explored. Patients' education background was the only sociodemographic factor to show a statistically significant relationship to all 10 trust dimensions. Sex, age, and ethnicity showed significant associations with some of the trust dimensions explored in this study.
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Affiliation(s)
- Yi Kai Wong
- Chiropractic Department, Centre for Complementary and Alternative Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Ka Lok Low
- Chiropractic Department, Centre for Complementary and Alternative Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Tamara Gien Pooke
- Chiropractic Department, Centre for Complementary and Alternative Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
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31
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Wu Q, Jin Z, Wang P. The Relationship Between the Physician-Patient Relationship, Physician Empathy, and Patient Trust. J Gen Intern Med 2022; 37:1388-1393. [PMID: 34405348 PMCID: PMC9086002 DOI: 10.1007/s11606-021-07008-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A trusting physician-patient relationship is an essential component of high-quality care. OBJECTIVE To explore the relationship between the physician-patient relationship, physician empathy, and patient trust. DESIGN Cross-sectional survey. PARTICIPANTS A total of 3289 patients (response rate 68.6%) from 103 hospitals in eastern, central, and western China completed surveys. MAIN MEASURE Physician empathy, patient trust, and physician-patient relationship were measured by the Chinese version of Consultation and Relational Empathy Scale, Wake Forest Physician Trust Scale, and Patient-Doctor Relationship Questionnaire, respectively. Bootstrapped mediation analysis was performed. KEY RESULTS There were moderate to strong correlations between physician empathy, patient overall trust, and patient trust in physician's benevolence and competence, and the physician-patient relationship (r = 0.49-0.75, P < 0.01 for all). Patients' evaluation of physician-patient relationship was predicted by their perception of physician empathy, patient overall trust, and trust in the physician's benevolence. Mediation analysis showed that the indirect effect of physician empathy on physician-patient relationship through patient overall trust was significant (β = 0.18, 95% CI: 0.15-0.21) and that the mediation effect of patient trust in physician's benevolence was significant (β = 0.24, 95% CI: 0.20-0.28), though the mediation effect of patient trust in physician's competence was not (β = 0.01, 95% CI: -0.02 to 0.02). CONCLUSIONS Patients' perception of physician empathy influences their evaluation of the physician-patient relationship both directly and indirectly via patient trust in the physician's benevolence. These findings underline the importance of patient belief in physician benevolence and empathy in building trustful and harmonious relationships between physicians and patients.
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Affiliation(s)
- Qing Wu
- Faculty of Education, East China Normal University, Shanghai, 200062, China.,School of Psychiatry, Wenzhou Medical University, Zhejiang Province, Wenzhou, 325035, China
| | - Zheyu Jin
- College of Education, Shanghai Normal University, Shanghai, 200234, China
| | - Pei Wang
- Faculty of Education, East China Normal University, Shanghai, 200062, China. .,School of Psychiatry, Wenzhou Medical University, Zhejiang Province, Wenzhou, 325035, China.
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32
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Chegini Z, Kakemam E, Behforoz A, Lotfollah-Zadeh F, Jafari-Koshki T, Khodayari Zarnag R. Impact of Patient Communication Preferences on the Patient Trust in Physicians: A Cross-Sectional Study in Iranian Outpatient's Clinics. J Patient Exp 2022; 9:23743735211069809. [PMID: 35024443 PMCID: PMC8744186 DOI: 10.1177/23743735211069809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There are widely emerging concerns that patient confidence in physicians is diminishing as physician-patient communication is threatened globally. This study aimed to assess patient communication preferences and their impact on patient trust in physicians. A cross-sectional study was conducted among outpatient clinics of 2 public and private hospitals in Tabriz, Iran. A total of 704 patients were selected conveniently. Of the 704 patients, 6.39% had low trust, 36.79% moderate trust, 35.37% had a high trust, and 21.45% had blind trust in physicians. Overall patient communication preference score was more in a private clinic rather than a public one (P = .008). Patients of private hospitals and those who were living in rural areas have been shown to have more trust in physicians. Patients' trust in physicians showed a significant association with patient communication preference (B = 0.58; 95% CI: 0.53-0.63, P < .001).
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Affiliation(s)
- Zahra Chegini
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Edris Kakemam
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Behforoz
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Lotfollah-Zadeh
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tohid Jafari-Koshki
- Molecular Medicine Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Rahim Khodayari Zarnag
- School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Gelfman DM. Thank you for letting me be your physician. PATIENT EDUCATION AND COUNSELING 2021; 104:2888-2889. [PMID: 33602574 DOI: 10.1016/j.pec.2021.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
I believe this article emphasizes how emotionally valuable receiving patients' trust is to the practicing physician. It also gives new insight into understanding the emotional loss a physician may experience when leaving private practice, even if they remain active in medicine. Finally, for those entering medicine, it explains the profound personal satisfaction they can experience from long term trusting relationships with patients.
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Affiliation(s)
- Daniel M Gelfman
- Division of Clinical Affairs, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA.
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Shree R, Hatfield-Timajchy K, Brewer A, Tsigas E, Vidler M. Information needs and experiences from pregnancies complicated by hypertensive disorders: a qualitative analysis of narrative responses. BMC Pregnancy Childbirth 2021; 21:743. [PMID: 34724906 PMCID: PMC8561882 DOI: 10.1186/s12884-021-04219-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/06/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Incorporation of the patient voice is urgently needed in a broad array of health care settings, but it is particularly lacking in the obstetrical literature. Systematically derived information about patients' experience with hypertensive disorders of pregnancy (HDP), most notably preeclampsia, is necessary to improve patient-provider communication and ultimately inform patient-centered care and research. We sought to examine the information needs and experiences of individuals with pregnancies complicated by hypertensive disorders. METHODS We conducted a qualitative content analysis of narrative-responses to an open-ended question from the Preeclampsia Registry (TPR), an online registry hosted by the Preeclampsia Foundation. Individuals were invited to enroll in TPR via social media, web searches, and newsletters. We restricted our analysis to participants who self-reported a history of HDP and responded to the open-ended question, "Is there any information that you could have had at the time of this pregnancy that would have been helpful?". Available responses from July 2013 to March 2017 were included. Narrative responses were coded, reconciled, and thematically analyzed by multiple coders using an inductive approach. Our main outcome measures included participants' expressed needs and additional concerns with respect to their HDP pregnancy. RESULTS Of 3202 enrolled participants, 1850 completed the survey and self-reported having at least one pregnancy complicated by HDP, of which 895 (48.4%) responded to the open-ended question. Participants delivered in the United States (83%) and 27 other countries. Compared to non-responders, responders reported more severe HDP phenotypes and adverse offspring outcomes. We identified three principal themes from responses: patient-identified needs, management and counseling, and potential action. Responses revealed that participants' baseline understanding of HDP, including symptoms, management, therapeutic strategies, and postpartum complications, was demonstrably lacking. Responders strongly desired improved counseling so that both they and their providers could collaboratively diagnose, appropriately manage, and robustly and continuously communicate to facilitate a partnership to address any HDP complications. CONCLUSIONS Participants' responses regarding their HDP experience provide indispensable insight into the patient's perspectives. Our study suggests that improved education regarding possible HDP complications and transparency about the consideration of HDP and its associated outcomes during an evaluation are needed, and efforts to implement these strategies should be sought. TRIAL REGISTRATION The Preeclampsia Registry: NCT02020174.
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Affiliation(s)
- Raj Shree
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Washington, 1959 NE Pacific Street, Box 356460, Seattle, WA 98195 USA
| | - Kendra Hatfield-Timajchy
- Health Scientist, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Alina Brewer
- Preeclampsia Foundation, Predictive Laboratories, Inc., Melbourne, FL USA
| | | | - Marianne Vidler
- Department of Obstetrics & Gynecology, British Columbia Children’s Hospital Research Institute, University of British Columbia, Vancouver, BC Canada
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Linzer M, Neprash H, Brown R, Williams E, Audi C, Poplau S, Prasad K, Khullar D. Where Trust Flourishes: Perceptions of Clinicians Who Trust Their Organizations and Are Trusted by Their Patients. Ann Fam Med 2021; 19:521-526. [PMID: 34750127 PMCID: PMC8575506 DOI: 10.1370/afm.2732] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 04/01/2021] [Accepted: 04/13/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Trust is an essential component of health care. Clinicians need to trust organizational leaders to provide a safe and effective work environment, and patients need to trust their clinicians to deliver high-quality care while addressing their health care needs. We sought to determine perceived characteristics of clinics by clinicians who trust their organizations and whose patients have trust in them. METHODS We used baseline data from the Healthy Work Place trial, a randomized trial of interventions to improve work life in 34 Midwest and East Coast primary care clinics, to identify clinic characteristics associated with high clinician and patient trust. RESULTS The study included 165 clinicians with 1,132 patients. High trust by clinicians with patients who trusted them was found for 34% of 162 clinicians with sufficient data for modeling. High clinician-high patient trust occurred when clinicians perceived their organizational cultures to have (1) an emphasis on quality (odds ratio [OR] 4.95; 95% CI, 2.02-12.15; P <.001), (2) an emphasis on communication and information (OR 3.21; 95% CI, 1.33-7.78; P = .01), (3) cohesiveness among clinicians (OR 2.29; 95% CI, 1.25-4.20; P = .008), and (4) values alignment between clinicians and leaders (OR 1.86; 95% CI, 1.23-2.81; P = .003). CONCLUSION Addressing organizational culture might improve the trust of clinicians whose patients have high trust in them.
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Affiliation(s)
- Mark Linzer
- Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN
| | | | - Roger Brown
- University of Wisconsin School of Nursing, Madison, WI
| | | | - Crystal Audi
- Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN
| | - Sara Poplau
- Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN
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36
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Greene J, Ramos C. A Mixed Methods Examination of Health Care Provider Behaviors That Build Patients' Trust. PATIENT EDUCATION AND COUNSELING 2021; 104:1222-1228. [PMID: 32994105 DOI: 10.1016/j.pec.2020.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patient trust in health care providers is associated with better health behaviors and utilization, yet provider trust has not been consistently conceptualized. This study uses qualitative methods to identify the key health provider behaviors that patients report build their trust, and data from a national U.S. survey of adults to test the robustness of the qualitative findings. METHODS In this mixed methods study, we conducted 40 semi-structured interviews with a diverse sample to identify the provider behaviors that build trust. We then analyzed a nationally representative survey (n = 6,517) to examine the relationship between respondents' trust in their usual provider and the key trust-related behaviors identified in the qualitative interviews. RESULTS Interviewees reported that health providers build trust by communicating effectively (listening and providing detailed explanations), caring about their patients (treating them as individuals, valuing their experience, and showing commitment to solving their health issues), and demonstrating competence (being knowledgeable, thorough, and solving their health issues). Trust in one's provider was highly correlated with all eight survey items measuring communication, caring, and competence. CONCLUSIONS To build trust with patients, health providers should actively listen, provide detailed explanations, show caring for patients, and demonstrate their knowledge.
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Affiliation(s)
- Jessica Greene
- Marxe School of Public and International Affairs, Baruch College, City University of New York, 135 East 22nd St., Room 816D, New York, NY, 10010, USA.
| | - Christal Ramos
- Health Policy Center, The Urban Institute, 500 L'Enfant Plaza SW, Washington, DC, 20024, USA.
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Wachs D, Lorah V, Boynton A, Hertzler A, Nichols B, Kraft J, Wang J, Dang I, Kalekas P, Vanier C. Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty. J Patient Exp 2021; 8:23743735211007700. [PMID: 34179422 PMCID: PMC8205358 DOI: 10.1177/23743735211007700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to explore patient perceptions of primary care
providers and their offices relative to their physician’s philosophy (medical
degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal
medicine vs family medicine), US region, and gender (male vs female). Using the
Healthgrades website, the average satisfaction rating for the physician, office
parameters, and wait time were collected and analyzed for 1267 physicians. We
found female doctors tended to have lower ratings in the Midwest, and staff
friendliness of female physicians were rated lower in the northwest. In the
northeast, male and female MDs were rated more highly than DOs. Wait times
varied regionally, with northeast and northwest regions having the shortest wait
times. Overall satisfaction was generally high for most physicians. Regional
differences in perception of a physician based on gender or degree may have
roots in local culture, including proximity to a DO school, comfort with female
physicians, and expectations for waiting times.
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Affiliation(s)
- Daliah Wachs
- Integrative Family Medicine, Genesis Communications Network, Las Vegas, NV, USA
| | | | | | | | | | | | - Jerry Wang
- Touro University Nevada, Henderson, NV, USA
| | - Ivy Dang
- Touro University Nevada, Henderson, NV, USA
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Kiger ME, Meyer HS, Varpio L. "It is you, me on the team together, and my child": Attending, resident, and patient family perspectives on patient ownership. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:101-109. [PMID: 33263864 PMCID: PMC7952476 DOI: 10.1007/s40037-020-00635-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/27/2020] [Accepted: 11/05/2020] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Patient ownership is an important element of physicians' professional responsibility, but important gaps remain in our understanding of this concept. We sought to develop a theory of patient ownership by studying it in continuity clinics from the perspective of residents, attending physicians, and patients. METHODS Using constructivist grounded theory, we conducted 27 semi-structured interviews of attending physicians, residents, and patient families within two pediatric continuity clinics to examine definitions, expectations, and experiences of patient ownership from March-August 2019. We constructed themes using constant comparative analysis and developed a theory describing patient ownership that takes into account a diversity of perspectives. RESULTS Patient ownership was described as a bi-directional, relational commitment between patient/family and physician that includes affective and behavioral components. The experience of patient ownership was promoted by continuity of care and constrained by logistical and other systems-based factors. The physician was seen as part of a medical care team that included clinic staff and patient families. Physicians adjusted expectations surrounding patient ownership for residents based on scheduling limitations. DISCUSSION Our theory of patient ownership portrays the patient/family as an active participant in the patient-physician relationship, rather than a passive recipient of care. While specific expectations and tasks will vary based on the practice setting, our findings reframe the way in which patient ownership can be viewed and studied in the future by attending to a diversity of perspectives.
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Affiliation(s)
- Michelle E Kiger
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
- Department of Pediatrics, Wright-Patterson Medical Center, Dayton, OH, USA.
| | - Holly S Meyer
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Radl-Karimi C, Nicolaisen A, Sodemann M, Batalden P, von Plessen C. Under what circumstances can immigrant patients and healthcare professionals co-produce health? - an interpretive scoping review. Int J Qual Stud Health Well-being 2020; 15:1838052. [PMID: 33112713 PMCID: PMC7599002 DOI: 10.1080/17482631.2020.1838052] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Immigrant patients run a risk of receiving lower quality of care. Co-production, as the concept of how to collaboratively create valuable healthcare service for the patient, offers a new perspective that might help. The scoping review aimed at identifying and analysing factors facilitating co-production between immigrant patients and healthcare professionals. METHODS We searched seven scientific databases for peer-reviewed publications of all study designs. Two reviewers independently screened the publications for eligibility and performed data extraction. Data were analysed by applying an inductive, interpretive approach for data synthesis. RESULTS Fifteen publications were included for analysis. We identified six factors hat facilitate co-production: 1) prioritizing co-production in the organization, 2) providing a safe environment that promotes trust and patience, 3) using a language the patient understands, 4) respecting the patient's knowledge and priorities, 5) improvising with knowledge and courage, and 6) engaging in self-reflection. CONCLUSIONS The scoping review illustrated that co-production with immigrant patients can be successful if the system and professionals are interested and prepared. Immigrant patients could be a valuable source of information and powerful co-producers of their own health. The study contributed to a growing body of research on patient-professional co-production in healthcare and might also prove relevant for other disadvantaged patient groups.
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Affiliation(s)
- Christina Radl-Karimi
- OPEN Odense Patient Data Explorative Network, University of Southern Denmark and Odense University Hospital, Odense C, Denmark
| | - Anne Nicolaisen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Morten Sodemann
- Migrant Health Clinic, Odense Universitetshospital, Odense C, Denmark
- Center for Global Health, University of Southern Denmark, Odense C, Denmark
| | - Paul Batalden
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Christian von Plessen
- Direction générale de la santé, Unisanté, Lausanne, Switzerland
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Affiliation(s)
- Ken Wu
- Dr. Wu is an editorial fellow at the Journal
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Song Y, Luzzi L, Brennan DS. Trust in dentist‐patient relationships: mapping the relevant concepts. Eur J Oral Sci 2020; 128:110-119. [DOI: 10.1111/eos.12686] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2020] [Indexed: 01/26/2023]
Affiliation(s)
- YoungHa Song
- Australian Research Centre for Population Oral Health Adelaide Dental School The University of Adelaide Adelaide SA Australia
| | - Liana Luzzi
- Australian Research Centre for Population Oral Health Adelaide Dental School The University of Adelaide Adelaide SA Australia
| | - David S. Brennan
- Australian Research Centre for Population Oral Health Adelaide Dental School The University of Adelaide Adelaide SA Australia
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Rasiah S, Jaafar S, Yusof S, Ponnudurai G, Chung KPY, Amirthalingam SD. A study of the nature and level of trust between patients and healthcare providers, its dimensions and determinants: a scoping review protocol. BMJ Open 2020; 10:e028061. [PMID: 31980505 PMCID: PMC7044948 DOI: 10.1136/bmjopen-2018-028061] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The aim of this scoping review is to systematically search the literature to identify the nature and or level of trust between the patient, the users of health services (eg, clients seeking health promotion and preventive healthcare services) and the individual healthcare providers (doctors, nurses and physiotherapists/ occupational therapists), across public and private healthcare sectors, at all levels of care from primary through secondary to tertiary care. It also aims to identify the factors that influence trust between patients, users of health services (clients) and providers of healthcare at all levels of care from primary care to tertiary care, and across all health sectors (public and private). The study will also identify the tools used to measure trust in the healthcare provider. METHODS AND ANALYSIS The scoping review will be conducted based on the methodology developed by Arksey and O'Malley's scoping review methodology, and Levac et al 's methodological enhancement. An experienced information specialist (HM) searched the following databases MEDLINE, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature. The search terms were both keywords in the title and/or abstract and subject headings (eg, MeSH, EMTREE) as appropriate. Search results were downloaded, imported and stored into a 'Refworks' folder specifically created for reference management. The preliminary search was conducted between 7 December 2017 and 14 December 2017. Quantitative methods using content analysis will be used to categorise study findings on factors associated with trust between patients, clients and healthcare providers. The collection of studies will be also examined for heterogeneity. Qualitative analysis on peer reviewed articles of qualitative interviews and focus group discussion will be conducted; it allows clear identification of themes arising from the data, facilitating prioritisation, higher order abstraction and theory development. A consultation exercise with stakeholders may be incorporated as a knowledge translation component of the scoping study methodology. ETHICS AND DISSEMINATION Ethical approval will be obtained for the research project from the Institutional Review Board. The International Medical University will use the findings of this scoping review research to improve the understanding of trust in healthcare, in its endeavour to improve health services delivery in its healthcare clinics and hospitals, and in its teaching and learning curriculum. The findings will also help faculty make evidence based decisions to focus resources and research as well as help to advance the science in this area. Dissemination of the results of the scoping review will be made through peer-reviewed publications, research reports and presentations at conferences and seminars.
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Affiliation(s)
- Supathiratheavy Rasiah
- Community Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Safurah Jaafar
- Community Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Safiah Yusof
- Nutrition and Dietetics, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Gnanajothy Ponnudurai
- Human Biology, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
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Affiliation(s)
- Carlos A Pellegrini
- Professor and Chair Emeritus, Department of Surgery, University of Washington
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Abstract
Purpose
The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process.
Design/methodology/approach
The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling.
Findings
This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment.
Research limitations/implications
The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment.
Practical implications
The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement.
Originality/value
The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.
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Marterre B, Clayville K. Navigating the Murky Waters of Hope, Fear, and Spiritual Suffering: An Expert Co-Captain's Guide. Surg Clin North Am 2019; 99:991-1018. [PMID: 31446923 DOI: 10.1016/j.suc.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
How can surgeons deliver compassionate, holistic care to patients who are beyond cure? Interacting emotionally and understanding hope, fear, and spiritual suffering is key. Responsibly reframing hope to underlying meanings, and away from specific outcomes, is critical. Facilitating moves from cure to comfort to a peaceful dying process requires some retooling of the surgical toolbox. Surgeons possess a unique set of skills, including imagination and an undying sense of hope. Surgeons who have the courage to delve into their emotions and sustain realistic hope for their patients, all the way to the end, will reap deep personal and professional rewards.
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Affiliation(s)
- Buddy Marterre
- Surgical Palliative Care, Department of General Surgery, Wake Forest Baptist Health, 5th Floor, Watlington Hall, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Kristel Clayville
- Zygon Center for Religion and Science, MacLean Center for Clinical Medical Ethics, 1100 East 55th Street, Chicago, IL 60615, USA
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Meynen G. Ethical Issues to Consider Before Introducing Neurotechnological Thought Apprehension in Psychiatry. AJOB Neurosci 2019; 10:5-14. [PMID: 31070550 DOI: 10.1080/21507740.2019.1595772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
When it becomes available, neuroscience-based apprehension of subjective thoughts is bound to have a profound impact on several areas of society. One of these areas is medicine. In principle, medical specialties that are primarily concerned with mind and brain are most likely to apply neurotechnological thought apprehension (NTA) techniques. Psychiatry is such a specialty, and the relevance of NTA developments for psychiatry has been recognized. In this article, I discuss ethical issues regarding the use of NTA techniques in psychiatric contexts. First, I consider the notion of neurotechnological "thought apprehension," as well as some limitations of present-day NTA applications. Next, I identify ethical priorities for its possible future use in psychiatry. The topics I explore concern key (bio)ethical issues: confidentiality, trust and distrust, consent and coercion, and, finally, responsibility. I conclude that mental health-related use of NTA entails some specific ethical concerns that deserve careful attention before introducing these technologies in psychiatric practice.
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Affiliation(s)
| | - Gwen Darien
- National Patient Advocate Foundation, Washington, DC
| | - David Meyers
- Agency for Healthcare Research and Quality, Rockville, Maryland
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LeBlanc TW, Marron JM, Ganai S, McGinnis MM, Spence RA, Tenner L, Tap WD, Hlubocky FJ. Prognostication and Communication in Oncology. J Oncol Pract 2019; 15:208-215. [DOI: 10.1200/jop.18.00647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Sabha Ganai
- Southern Illinois University School of Medicine, Springfield, IL
| | | | | | - Laura Tenner
- University of Texas Health Cancer Center at San Antonio, San Antonio, TX
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Gu L, Deng J, Xu H, Zhang S, Gao M, Qu Z, Zhang W, Tian D. The impact of contract service policy and doctor communication skills on rural patient-doctor trust relationship in the village clinics of three counties. BMC Health Serv Res 2019; 19:187. [PMID: 30902058 PMCID: PMC6431061 DOI: 10.1186/s12913-019-3875-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background Trust is regarded as the cornerstone of the doctor-patient relationship in the world of medicine; it determines the decisions patients make when choosing doctors and influences patients’ compliance with recommended treatments. In China, patient-doctor trust acts as a thermometer measuring harmony in the doctor-patient relationship. The objective of this study is to explore the relationship between the contract service and patient-doctor trust-building in 25 village clinics of rural China. Method The research was carried out in village clinics in rural China. A simple random sampling method was used to choose clinics and subjects. Based on feasibility and financial support, we chose three counties as our study settings: Dafeng District, Jiangsu Province; Yinan County, Shandong Province; and Wufeng Tujia Autonomous County, Hubei Province. Twenty-five village clinics and 574 subjects were selected in the three areas from the contract service and patient list. Descriptive statistics, t-tests, MANOVA, SEM, and multiple regression statistical analysis were employed to analyze the data. Result Statistical analysis showed that contract service directly and indirectly influenced patient-doctor trust-building in village clinics. The patient perception of doctor communication skills was a mediator in the relationship between contract service policy and patient-doctor trust-building. Conclusions Building patient-doctor trust is important in developing and enhancing rural health. The policy of contract service plays a significant role in building relationships. Well-developed communication skills of doctors contribute to the implementation of the contract service policy and to establishing patient-doctor trust.
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Affiliation(s)
- Linni Gu
- School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China
| | - Jianjun Deng
- Institute of Developmental Psychology, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China
| | - Huiwen Xu
- Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY, 14642, USA
| | - Shengfa Zhang
- School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China
| | - Min Gao
- School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China
| | - Zhiyong Qu
- School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China
| | - Weijun Zhang
- School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China.
| | - Donghua Tian
- School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing, 100875, China.
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Affiliation(s)
- Santosh G Honavar
- Editor, Indian Journal of Ophthalmology, Centre for Sight, Road No. 2, Banjara Hills, Hyderabad - 500 034, Telangana, India
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