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Wang YF, Lee YH, Lee CW, Lu JY, Shih YZ, Lee YK. The Physician-Patient Communication Behaviors Among Medical Specialists in a Hospital Setting. HEALTH COMMUNICATION 2024; 39:1235-1245. [PMID: 37161370 DOI: 10.1080/10410236.2023.2210379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Effective physician-patient communication builds robust physician-patient relationships and reduces medical disputes. However, much is unknown about the differences that exist in the communication behaviors of physicians in different departments. Using a mixed-methods research approach, the researchers used Roter Interaction Analysis System to uncover the communication behaviors of internists, surgeons, family physicians, and emergency physicians at a regional hospital in Taiwan. Semi-structured interviews were conducted to collect the communication experiences of 20 physicians from the internal medicine, surgery, family medicine, and emergency departments. The characteristics were presented through descriptive statistics, bar charts, and dendrograms. Physician-patient communications consisted of four dimensions, 10 factors, and 31 behaviors. The characteristics are as follows: (1) Internists need to improve their overall performance in terms of physician-patient communication behaviors; (2) Surgeons performed well in building relationships through non-verbal methods; (3) Family physicians excelled in facilitation and patient activation. (4) Emergency physicians performed well in patient education and counseling. The characteristics of the aforementioned communication behaviors among internists, surgeons, family physicians, and emergency physicians can be used to construct indicators of physician-patient communication in each department and to develop patient-centered healthcare services in the future.
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Affiliation(s)
- Yi-Fen Wang
- Department of Senior Citizen Services, National Tainan Junior College of Nursing
| | - Ya-Hui Lee
- Department of Adult & Continuing Education, National Chung Cheng University
| | - Chen-Wei Lee
- Department of Emergency Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University
| | - Jing-Yi Lu
- Department of Healthcare Administration, Asia University
| | - Yu-Ze Shih
- Department of Adult & Continuing Education, National Chung Cheng University
| | - Yi-Kung Lee
- Department of Emergency Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- School of Medicine, Tzu Chi University
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Gabay G, Ornoy H, Gere A, Moskowitz H. Personalizing Communication of Clinicians with Chronically Ill Elders in Digital Encounters-A Patient-Centered View. Healthcare (Basel) 2024; 12:434. [PMID: 38391809 PMCID: PMC10888115 DOI: 10.3390/healthcare12040434] [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: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Chronically ill elderly patients are concerned about losing the personal connection with clinicians in digital encounters and clinicians are concerned about missing nonverbal cues that are important for the diagnosis, thus jeopardizing quality of care. AIMS This study validated the expectations and preferences of chronically ill elderly patients regarding specific communication messages for communication with clinicians in telemedicine. METHODS The sample comprised 600 elderly chronically ill patients who use telehealth. We used a conjoint-based experimental design to test numerous messages. The outcome variable is elder patient expectations from communication with clinicians in telemedicine. The independent variables were known categories of patient-clinician communication. Respondents rated each of the 24 vignettes of messages. RESULTS Mathematical clustering yielded three mindsets, with statistically significant differences among them. Members of mindset 1 were most concerned with non-verbal communication, members of mindset 2 prefer communication that enhances the internal locus of control, and members of mindset 3 have an external locus of control and strongly oppose any dialogue about their expectations from communication. CONCLUSIONS The use of the predictive algorithm that we developed enables clinicians to identify the belonging of each chronically ill elderly patient in the clinic to a sample mindset, and to accordingly personalize the communication in the digital encounters while structuring the encounter with greater specificity, therefore enhancing patient-centered care.
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Affiliation(s)
- Gillie Gabay
- Faculty of Social Sciences, Achva Academic College, Arugot 7980400, Israel
| | - Hana Ornoy
- Faculty of Business, Ono Academic College, Kiryat Ono 5545173, Israel
| | - Attila Gere
- Institute of Food Science and Technology, Hungarian University of Agriculture and Life Sciences, 1118 Budapest, Hungary
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Pavlova A, Paine SJ, Cavadino A, O'Callaghan A, Consedine NS. Do I care for you more when you really need help? An experimental test of the effect of clinical urgency on compassion in health care. Br J Health Psychol 2024; 29:59-79. [PMID: 37648902 DOI: 10.1111/bjhp.12687] [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: 01/31/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES To experimentally investigate whether more urgent patient presentations elicit greater compassion from health care professionals than less urgent, facilitating future research and thinking to address systemic barriers to compassion in health care. DESIGN This is a pre-registered online study with an experimental, within-subjects repeated-measure study design. Two clinical vignettes that systematically varied the urgency of patient presentation were utilized. Both vignettes depicted a patient with difficult behaviours typically associated with lower compassion. METHODS Health care professionals (doctors, nurses and allied health practitioners) recruited from all 20 District Health Boards across Aotearoa/New Zealand completed two vignettes in a counterbalanced order. Paired-sample t-tests were used to test the effect of the presentation urgency on indices of compassion. RESULTS A total of 939 participants completed the vignettes (20% doctors, 47%, nurses and 33% allied health professionals). As expected, participants reported greater care and motivation to help the more urgent patient. However, the more urgent patient was also perceived as less difficult, and exploratory analyses showed that perceived patient difficulty was associated with lower caring and motivation to help, particularly in the less urgent patient. CONCLUSIONS This is the first work to experimentally test the relationship between the urgency of patient presentation and compassion in health care. Although the association between urgency and difficulty is complex, our findings are consonant with evolutionary views in which urgent distress elicits greater compassion. A system-wide orientation towards efficiency and urgency may exacerbate this 'bias' which must be addressed to ensure more equitable compassion in health care.
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Affiliation(s)
- Alina Pavlova
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anne O'Callaghan
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | - Nathan S Consedine
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Rawal S. Physician empathy in patient empowerment … and patient empowerment in physician empathy. MEDICAL EDUCATION 2023; 57:694-696. [PMID: 37150535 DOI: 10.1111/medu.15098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023]
Abstract
Rawal argues for the importance of physician empathy in fostering patient engagement and empowerment, being mindful of tools that may facilitate patient empowerment but pose risks of physician burnout and loss of empathy.
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Affiliation(s)
- Surabhi Rawal
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
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5
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Street RL. The ecology of shared decision-making: The simple and the complex. PATIENT EDUCATION AND COUNSELING 2023; 112:107766. [PMID: 37087921 DOI: 10.1016/j.pec.2023.107766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Richard L Street
- Patient Education and Counseling and Department of Communication and Journalism, Texas A&M University, College Station, TX, USA.
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Reid HW, Parente V, Gupta MD, Hantzmon S, Olsen MK, Yang H, Jackson LR, Johnson KS, Pollak KI. Examining the relationship between clinician communication and patient participatory behaviors in cardiology encounters. PATIENT EDUCATION AND COUNSELING 2022; 105:3473-3478. [PMID: 36137906 PMCID: PMC9903298 DOI: 10.1016/j.pec.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Examine the association of coder ratings of cardiologist behaviors and global scores of cardiologist communication style with patient participation in clinic encounters. METHODS We coded transcripts of clinic encounters for patient participatory behaviors: asking questions, assertive statements, and expressing negative emotions; clinician behavior counts: reflective statements, open-ended questions, empathic statements, and eliciting questions. We used general linear regression models to examine associations of mean number of patient participatory behaviors with clinician behaviors. RESULTS Our sample included 161 patients of 40 cardiologists. Patient female gender was associated with on average 2.1 (CI: 0.06, 4.1; p = 0.04) more patient participatory behaviors. In an adjusted model, clinician reflective statements were associated with on average 0.3 (CI: 0.04, 0.4; p = 0.02) more patient participatory behaviors. A clinician making at least one empathic statement was associated with on average 3.7 (CI: 0.2, 7.1; p = 0.04) more patient participatory behaviors. CONCLUSIONS These results demonstrate that some individual clinician behaviors are associated with higher patient participation in cardiology encounters. PRACTICE IMPLICATIONS Clinician reflective and empathic statements may be important targets in communication training to increase patient participation. SECTION Communication Studies.
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Affiliation(s)
| | - Victoria Parente
- Department of Pediatrics, Duke University School of Medicine, Durham, USA
| | - Maya Das Gupta
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, USA
| | - Sarah Hantzmon
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, USA
| | - Maren K Olsen
- Duke University Department of Biostatistics and Bioinformatics, Durham Veterans Affairs Health Care System, Durham, USA; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, USA
| | - Hongqiu Yang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Kimberly S Johnson
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, USA; Center for Aging and Human Development, Duke University School of Medicine, Durham, USA; Geriatrics Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, USA
| | - Kathryn I Pollak
- Cancer Prevention and Control Program, Duke Cancer Institute, Durham, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, USA
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Santi D, Spaggiari G, Romeo M, Ebert R, Corradini F, Baraldi C, Granata ARM, Rochira V, Simoni M, Gavioli L, Niemants NSA. Qualitative and quantitative analysis of doctor-patient interactions during andrological consultations. Andrology 2022; 10:1240-1249. [PMID: 35785424 PMCID: PMC9540423 DOI: 10.1111/andr.13225] [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: 04/08/2022] [Revised: 06/06/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although a trustworthy connection between doctor and patient is crucial in clinical practice, it could be hindered by different cultural and linguistic backgrounds. Moreover, an effective doctor-patient interaction could be even more challenging in andrological fields, in which psychological and social components are predominant. AIM To analyse the doctor-patient relationship in the andrological field, applying both qualitative and quantitative analyses. METHODS monocentric, cross-sectional, observational study was performed between May and December 2018. During the study, all patients aged >18 years attending the Modena Andrology Unit for couple infertility or erectile dysfunction were enrolled and the doctor-patients interaction recorded. Patients were divided into two groups depending on their medical seeking and were further divided between native and non-native speakers of Italian. All patients underwent a routine andrological examination. Every first medical consultation was audio-recorded and transcribed using "ELAN" software for socio-linguistic analysis. Transcriptions underwent qualitative analysis through conversation analysis. Then, quantitative analyses were performed, and interaction parameters underwent correlation analyses. RESULTS Twenty-five patients were enrolled. The analysis of the andrological interview allowed to recognize five consecutive phases, following a semi-standardized pattern. Patients without linguistic barriers and with infertility problems showed more autonomous contribution during the consultation. No difference arose in sexual dysfunctions group. Doctor's explanations were frequent, but when linguistic barrier was present or Italian patients seemed less talkative, explanations were shorter, and doctors tried to use other conversational mechanisms to promote understanding. Patient's variables were significantly lower compared to the doctor, considering the number of turns (p = 0.025) and their minimum (p = 0.032), maximum (p<0.001), and average durations (p<0.001). Only patient's latency was significantly higher than the doctor's (p = 0.001). CONCLUSION This is the first attempt to analyse the doctor-patient relationship in andrology using authentic audio-recorded consultations. The results confirmed that a patient-centred communication must be applied also in andrological consultations. However, the topics discussed may require more "medical formulation" to be acceptable to the participants in this context. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Daniele Santi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Giorgia Spaggiari
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Marilina Romeo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Riccardo Ebert
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Federico Corradini
- Department of Studies on Language and Culture, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudio Baraldi
- Department of Studies on Language and Culture, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio R M Granata
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Vincenzo Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Manuela Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Laura Gavioli
- Department of Studies on Language and Culture, University of Modena and Reggio Emilia, Modena, Italy
| | - Natacha S A Niemants
- Department of Interpretation and Translation, Alma Mater Studiorum - University of Bologna, Campus of Forlì, Italy
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Tvedten OG, Croker A, Lawrence M, Williams K, Perry N, Croker J. Personalised written consultation summaries for patients: An 'up-close, in-depth, inside-out' exploration of a rheumatologist's patient-centred strategy. PATIENT EDUCATION AND COUNSELING 2022; 105:2362-2370. [PMID: 34920911 DOI: 10.1016/j.pec.2021.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The importance of ensuring that patients understand and remember information from rheumatology consultations is well recognised. However, literature focuses on 'one-size-fits-all' information resources. In this qualitative study our 'upclose, in-depth, inside-out' exploration sought to understand the personalised written consultation summary, a rheumatologist's patient-centred strategy developed through ongoing reflection. METHODS A research team of a rheumatologist, practice nurse, two patients, registrar and researcher used a participatory research approach, collaborative inquiry Semistructured interviews were undertaken with 29 patients. Data analysis was dialogical and iterative, moving from descriptive to conceptual. RESULTS Implicit within the personalised written consultation summary were domains and actions of: INVOLVEMENT in the process (contributing to the content, clarifying and negotiating the content, being present as it is written), CONTINUITY of information (taking the summary, sharing it with others, storing it at home) and SECURITY for ongoing management (owning the summary, being reminded about management plans, having a basis for re-checking). CONCLUSION Aligned with the findings are patient-centred intentions for health literacy, personal health information management and medication adherence. The second highlights an important theoretical basis for patient-centred rheumatology strategies beyond consultations. PRACTICE IMPLICATIONS A model and reflective questions are presented to inform ongoing reflections about patient-centred information strategies.
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Affiliation(s)
- Olav Gjønnes Tvedten
- University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia; Hunter New England Local Health District, Tamworth, NSW 2340, Australia
| | - Anne Croker
- University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia.
| | | | | | - Narelle Perry
- Rheumatology Practice, Tamworth, NSW 2340, Australia
| | - Jim Croker
- University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia; Hunter New England Local Health District, Tamworth, NSW 2340, Australia; Rheumatology Practice, Tamworth, NSW 2340, Australia
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Predictors of Physician Compassion, Empathy, and Related Constructs: a Systematic Review. J Gen Intern Med 2022; 37:900-911. [PMID: 34545471 PMCID: PMC8452146 DOI: 10.1007/s11606-021-07055-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Compassion in healthcare provides measurable benefits to patients, physicians, and healthcare systems. However, data regarding the factors that predict care (and a lack of care) are scattered. This study systematically reviews biomedical literature within the Transactional Model of Physician Compassion and synthesizes evidence regarding the predictors of physician empathy, compassion, and related constructs (ECRC). METHODS A systematic literature search was conducted in CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, OvidJournals, ProQuest, Web of Science, and Scopus using search terms relating to ECRC and its predictors. Eligible studies included physicians as participants. Methodological quality was assessed based on the Cochrane Handbook, using ROBINS-I risk of bias tool for quantitative and CASP for qualitative studies. Confidence in findings was evaluated according to GRADE-CERQual approach. RESULTS One hundred fifty-two included studies (74,866 physicians) highlighted the diversity of influences on compassion in healthcare (54 unique predictors). Physician-related predictors (88%) were gender, experience, values, emotions and coping strategies, quality of life, and burnout. Environmental predictors (38%) were organizational structure, resources, culture, and clinical environment and processes. Patient-related predictors (24%) were communication ease, and physicians' perceptions of patients' motives; compassion was also less forthcoming with lower SES and minority patients. Evidence related to clinical predictors (15%) was scarce; high acuity presentations predicted greater ECRC. DISCUSSION The growth of evidence in the recent years reflects ECRC's ongoing importance. However, evidence remains scattered, concentrates on physicians' factors that may not be amenable to interventions, lacks designs permitting causal commentary, and is limited by self-reported outcomes. Inconsistent findings in the direction of the predictors' effects indicate the need to study the relationships among predictors to better understand the mechanisms of ECRCs. The current review can guide future research and interventions.
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Kothawala S, Wang Y, Gupta SK. Impact of Patient Engagement and Social Determinants of Health on Care of Eosinophilic Gastrointestinal Disorders Patients. J Pediatr Gastroenterol Nutr 2022; 74:272-276. [PMID: 34620761 DOI: 10.1097/mpg.0000000000003318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
ABSTRACT The purpose of this study was to identify factors that influence eosinophilic gastrointestinal disorders (EGID) patients to switch gastroenterologists, assess the prevalence of social determinants of health (SDoH) in EGID patients, and the impact of SDoH on provider switching. 191 patients/caregivers participated in this cross-sectional, online study distributed through Patient Advocacy Groups. The 35-question survey took about 20 minutes to complete and was divided into three sections: demographics; 10 questions about provider switching; and nine-domain SDoH screen.Patients with EGIDs often switch providers, most commonly due to dissatisfaction with engagement in decision making. Additionally, these patients commonly have SDoH, some of which are associated with increased provider switching. Our results highlight the need to mindfully engage patients in decision-making and disease management. Providers also need to look beyond the "clinic space" and into SDoH. These low-cost/high-impact changes in provider behavior can promote continuity of care and patient engagement.
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Affiliation(s)
| | - Yanzhi Wang
- University of Illinois College of Medicine, Peoria, IL
| | - Sandeep K Gupta
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Riley Hospital for Children/Indiana University School of Medicine, and Community Health Network Indianapolis, IN
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Nouri S, Street RL, Barnes DE, Shi Y, Volow AM, Li B, Alexander SC, Sudore RL. Empowering patients with the PREPARE advance care planning program results in reciprocal clinician communication. J Am Geriatr Soc 2022; 70:585-591. [PMID: 34758115 PMCID: PMC8821241 DOI: 10.1111/jgs.17540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The patient-directed PREPAREforYourCare.org program empowers patients to participate in advance care planning (ACP) discussions with clinicians. Our goal was to determine whether PREPARE could reciprocally increase clinician ACP communication. METHODS In a secondary analysis of two trials evaluating the efficacy of PREPARE plus an easy-to-read advance directive (AD) versus an AD alone, patients were included if they were ≥55 years old, English- or Spanish-speaking, and had ≥2 chronic conditions. We audio-recorded postintervention primary care visits and used the validated clinician-patient participation coding scheme to calculate the number of clinician ACP utterances concerning information-giving, recommendations, or supportive talk. We examined differences by study arm using mixed effects negative binomial models, stratifying by language. To assess possible mediation, we adjusted for active patient participation (e.g., asking questions or stating preferences). RESULTS Three hundred ninety-three visits were audio-recorded (177 in PREPARE arm and 216 in AD-only arm). Recordings included 179 clinicians (mean 2.2 [SD 1.9] patients each). Patients' mean age was 66 ± 8 years, 31% had limited health literacy, and 25% were Spanish-speaking. Exactly 67% of recordings included information-giving, 85% recommendations, and 62% supportive talk. PREPARE resulted in 51% more clinician supportive talk versus the AD alone (mean 4.5 [8.9] vs. 2.9 [6.0] utterances; incidence rate ratio 1.51 [95% CI 1.02-2.24]). Effects were most pronounced among Spanish speakers. There were no differences in information-giving or recommendations. After adjusting for active patient participation, no differences in supportive talk remained. CONCLUSIONS The patient-directed PREPARE program was associated with greater clinician supportive ACP communication with older adults compared with an AD alone; the effect was most pronounced among Spanish speakers and was mediated by active patient participation. Thus, PREPARE helps patients be more engaged communicators, which in turn encourages clinicians to be more supportive of patients. Enhanced patient-clinician communication represents an important mechanism by which PREPARE may decrease disparities in ACP.
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Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Richard L. Street
- Michael E. DeBakey VA Medical Center, Houston, Texas,Department of Medicine, Health Services Research, Baylor College of Medicine, Houston, Texas,Texas A&M University, College Station, Texas
| | - Deborah E. Barnes
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Ying Shi
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, United States,San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Aiesha M. Volow
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Brookelle Li
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | - Rebecca L. Sudore
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States,Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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12
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Lim HM, Dunn AG, Lim JR, Abdullah A, Ng CJ. Association between online health information-seeking and medication adherence: A systematic review and meta-analysis. Digit Health 2022; 8:20552076221097784. [PMID: 35586836 PMCID: PMC9109497 DOI: 10.1177/20552076221097784] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background The evidence of the impact of online health information-seeking (OHIS) on
health outcomes has been conflicting. OHIS is increasingly recognised as a
factor influencing health behaviour but the impact of OHIS on medication
adherence remains unclear. Objectives We conducted a systematic review and meta-analysis to examine the
associations between OHIS and medication adherence. Methods We searched Medline, Embase, Web of Science, Scopus, CINAHL and Psychology
and Behavioural Science Collection for studies published up to December
2020. The inclusion criteria were studies that reported the associations of
OHIS and medication adherence, quantitative design, reported primary data
only, related to any health condition where medications are used and
conducted on patients either in clinical or community settings. A
meta-analysis was used to examine the association between OHIS and
medication adherence. Results A total of 17 studies involving 24,890 patients were included in this review.
The study designs and results were mixed. In the meta-analysis, there was no
significant association (n = 7, OR 1.356, 95% CI 0.793-2.322, p = 0.265), or
correlation (n = 4, r = -0.085, 95% CI −0.572-0.446, p = 0.768) between OHIS
and medication adherence. In the sub-group analysis of people living with
HIV/AIDS, OHIS was associated with better medication adherence (OR 1.612,
95% CI 1.266-2.054, p < 0.001). Conclusions The current evidence of an association between OHIS and medication adherence
is inconclusive. This review highlights methodological issues on how to
measure OHIS objectively and calls for in-depth exploration of how OHIS
affects health decisions and behaviour.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jing Ran Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore
- Duke-NUS Medical School, Singapore
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Clark M, Kennard A, Watson DA. Attitudes, practices, and experiences of medical specialists towards email communication with their patients. Intern Med J 2021; 53:590-598. [PMID: 34779570 DOI: 10.1111/imj.15627] [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: 07/26/2021] [Revised: 10/07/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The medical profession has been slow in embracing email as a means of improving communication with patients. AIM To explore the attitudes, practices, and experiences of senior medical specialists towards email communication with their patients. METHODS A cross-sectional qualitative interview of 30 medical staff specialists employed by Canberra Health Services, administered via one-on-one interviews conducted between June and August 2020 (several months into the COVID-19 pandemic). MAIN OUTCOME MEASURES Comments extracted from the interviews were categorised into five domains: (1) Integration of email use with patients, (2) Issues addressed via email, (3) Benefits of email communication, (4) Concerns and barriers to email communication, and (5) Practice pointers for email use with patients. RESULTS Regular email correspondence with patients was not widespread. The main benefits identified were improved efficiency and flexibility, especially in the context of managing chronic disease and patient follow-up. Participants also identified barriers, including time commitments, privacy and confidentiality, patient expectations, and potential for misuse. Most participants were hesitant to endorse email with patients in their practices, citing concerns over the utility and safety of the medium and lack of established protocols and recommendations for email usage. CONCLUSIONS There is a want and need for comprehensive and accessible professional guidance on email use with patients. Our results indicate opportunities to inform good clinical practice in respect of doctor-patient relationships, clinical workloads, and risk management. There is also a need for formal guidelines on emailing with patients. The COVID-19 pandemic has heightened the need for such guidelines. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Morgan Clark
- Medical School, College of Health and Medicine, The Australian National University
| | - Alice Kennard
- Department of Nephrology, Canberra Health Services, and Medical School, College of Health and Medicine, The Australian National University
| | - D Ashley Watson
- Department of Infectious Diseases, Canberra Health Services, and Medical School, College of Health and Medicine, The Australian National University, Australian Capital Territory, Australia
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Das Gupta K, Gregory G, Meiser B, Kaur R, Scheepers-Joynt M, McInerny S, Taylor S, Barlow-Stewart K, Antill Y, Salmon L, Smyth C, McInerney-Leo A, Young MA, James PA, Yanes T. Communicating polygenic risk scores in the familial breast cancer clinic. PATIENT EDUCATION AND COUNSELING 2021; 104:2512-2521. [PMID: 33706980 DOI: 10.1016/j.pec.2021.02.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe the communication of polygenic risk scores (PRS) in the familial breast cancer setting. METHODS Consultations between genetic healthcare providers (GHP) and female patients who received their PRS for breast cancer risk were recorded (n = 65). GHPs included genetic counselors (n = 8) and medical practitioners (n = 5) (i.e. clinical geneticists and oncologists). A content analysis was conducted and logistic regression was used to assess differences in communication behaviors between genetic counselors (n = 8) and medical practitioners (n = 5). RESULTS Of the 65 patients, 31 (47.7 %) had a personal history of breast cancer, 18 of whom received an increased PRS (relative risk >1.2). 25/34 unaffected patients received an increased PRS. Consultations were primarily clinician-driven and focused on biomedical information. There was little difference between the biomedical information provided by genetic counselors and medical practitioners. However, genetic counselors were significantly more likely to utilize strategies to build patient rapport and counseling techniques. CONCLUSIONS Our findings provide one of the earliest reports on how breast cancer PRSs are communicated to women. PRACTICE IMPLICATIONS Key messages for communicating PRSs were identified, namely: discussing differences between polygenic and monogenic testing, the multifactorial nature of breast cancer risk, polygenic inheritance and current limitation of PRSs.
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Affiliation(s)
- Kuheli Das Gupta
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Gillian Gregory
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Rajneesh Kaur
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Maatje Scheepers-Joynt
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
| | - Simone McInerny
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
| | - Shelby Taylor
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2065, Australia
| | - Yoland Antill
- Familial Cancer Clinic, Cabrini Health, Melbourne, VIC 3144, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3800, Australia
| | - Lucinda Salmon
- Clinical Genetics Service, Austin Hospital, Melbourne, VIC 3084, Australia
| | - Courtney Smyth
- Familial Cancer Clinic, Monash Medical Centre, Melbourne, VIC 3168, Australia
| | - Aideen McInerney-Leo
- The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Mary-Anne Young
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC 3000, Australia; Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, 2010, Australia
| | - Paul A James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and the Royal Melbourne Hospital, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic, 3052, Australia
| | - Tatiane Yanes
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia; The University of Queensland Diamantina Institute, Dermatology Research Centre, The University of Queensland, Brisbane, QLD, Australia.
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15
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de Looper M, van Weert JCM, Schouten BC, Bolle S, Belgers EHJ, Eddes EH, Smets EMA. The Influence of Online Health Information Seeking Before a Consultation on Anxiety, Satisfaction, and Information Recall, Mediated by Patient Participation: Field Study. J Med Internet Res 2021; 23:e23670. [PMID: 34255657 PMCID: PMC8290326 DOI: 10.2196/23670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/04/2020] [Accepted: 01/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Today, many cancer patients engage in online health information seeking (OHIS). However, little is known about how patients differ in their OHIS levels. In addition, OHIS might influence patient participation during a consultation with a physician, which might mediate the effects on patient outcomes. OBJECTIVE The aim of this study is twofold: first, to provide insight into which personal characteristics and psychosocial factors affect patients' OHIS levels and, second, to test the hypothesis that the effects of OHIS on patient outcomes are mediated by patient participation during the consultation. METHODS Patient participation was operationalized in terms of patients' absolute word count; the relative contribution of the patient, compared with the health care provider; and the number of questions and assertions expressed during the consultation. The patient outcomes measured were anxiety after the consultation, satisfaction with the consultation, and information recall. Participants in this study were patients recently diagnosed with colorectal cancer recruited from 6 hospitals in the Netherlands (n=90). Data were collected using questionnaires and audio-recorded consultations of patients with health care providers before their surgery. RESULTS The results showed that younger patients, higher educated patients, patients with a monitoring coping style, and patients who experienced more cancer-related stress engaged more in OHIS. In turn, OHIS was related to patient participation in terms of the patient's absolute word count but not to the relative contribution to the consultation or expressing questions and assertions. We did not find a relation between OHIS and anxiety and OHIS and recall mediated by patient participation. However, we found that patients' absolute word count significantly mediated the positive association between OHIS and patients' satisfaction with the consultation. CONCLUSIONS Results indicate positive implications of OHIS for patients' care experience and, therefore, the importance of helping patients engage in OHIS. However, the results also suggest that OHIS is only successful in increasing a single aspect of patient participation, which might explain the absence of relations with anxiety and recall. The results suggest that more beneficial effects on patient outcomes may be achieved when health care providers support patients in OHIS.
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Affiliation(s)
- Melanie de Looper
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | - Barbara C Schouten
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Eric H Eddes
- Deparment of Surgery, Deventer Hospital, Deventer, Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Public Health, Amsterdam, Netherlands
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Provider Personal and Demographic Characteristics and Patient Satisfaction in Orthopaedic Surgery. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202104000-00004. [PMID: 33835991 DOI: 10.5435/jaaosglobal-d-20-00198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patient satisfaction has increasingly been used to assess physician performance and quality of care. Although there is evidence that patient satisfaction is associated with patient-reported health outcomes and communication-related measures, there is debate over the use of patient satisfaction in reimbursement policy. Patient characteristics that influence satisfaction have been studied, but the effects of personal and demographic characteristics of physicians on patient satisfaction have yet to be explored. METHODS Outpatient satisfaction scores from 11,059 patients who rated 25 orthopaedic surgeons from a single institution were studied. In this study, we sought to explore the relationship between nonmodifiable physician characteristics, such as sex and race, and patient satisfaction with outpatient orthopaedic surgery care, as expressed in the Press Ganey Satisfaction Scores. Univariate logistic regression models were used to test the associations between each provider characteristic and patient satisfaction on the Press Ganey patient satisfaction questionnaire. RESULTS Three nonmodifiable physician personal and demographic characteristics were markedly associated with lower patient satisfaction scores across overall satisfaction, communication, and empathy domains: (1) female gender, (2) Asian ethnicity, and (3) being unmarried. Asian ethnicity reduced the odds of receiving a 5-star rating for likelihood to recommend the provider by nearly 40%, but none of these nonmodifiable physician personal and demographic characteristics affected the likelihood to recommend the practice. DISCUSSION Sex, ethnicity, and marital status are nonmodifiable provider characteristics, each associated with markedly lower odds of receiving a 5-star rating on Press Ganey patient satisfaction survey. These data reveal inherent patient biases that negatively affect physician-patient interactions and may exacerbate the lack of diversity in orthopaedic surgery. More research is necessary before using patient satisfaction ratings to evaluate surgeons or as quality measures that affect reimbursement policies.
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Linn AJ, Schouten BC, Sanders R, van Weert JCM, Bylund CL. Talking about Dr. Google: Communication strategies used by nurse practitioners and patients with inflammatory bowel disease in the Netherlands to discuss online health information. PATIENT EDUCATION AND COUNSELING 2020; 103:1216-1222. [PMID: 32098743 DOI: 10.1016/j.pec.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study explores how patients with Inflammatory Bowel Disease (IBD) and nurse practitioners (NPs) in the Netherlands communicate about online health information-seeking. METHODS We analyzed 165 consultations of patients at the start of maintenance treatment using grounded theory. Consultations in which the words; internet, website, Google, Googled, webpages, online (forum/blog/platform) or a website was mentioned, were included. Segments were identified and analyzed that represented a discussion about online health information-seeking (n = 87). We coded the initiator, initiation and reaction communication strategy. RESULTS Half of the sample was female, most patients were moderately to highly educated and aged on average 48 years. One third of the consultations included a discussion about online health information-seeking. Seventeen communication initiation and reactions strategies were identified. Patients and NPs were equally as likely to initiate a neutral discussion about online health information-seeking. Patients repeatedly reacted with disclosing their concerns. NPs responded by taking patients' online health information-seeking seriously or affirming patients' beliefs. CONCLUSION This exploration makes a unique contribution by demonstrating that NPs particularly adopt a patient-centered communication style while communicating about patients' online health information-seeking. PRACTICE IMPLICATIONS Results of this study could guide interventions to train providers in talking about patients' online health information-seeking.
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Affiliation(s)
- Annemiek J Linn
- University of Amsterdam, Amsterdam School of Communication Research (ASCoR), Amsterdam, the Netherlands.
| | - Barbara C Schouten
- University of Amsterdam, Amsterdam School of Communication Research (ASCoR), Amsterdam, the Netherlands
| | - Remco Sanders
- University of Amsterdam, Amsterdam School of Communication Research (ASCoR), Amsterdam, the Netherlands
| | - Julia C M van Weert
- University of Amsterdam, Amsterdam School of Communication Research (ASCoR), Amsterdam, the Netherlands
| | - Carma L Bylund
- University of Amsterdam, Amsterdam School of Communication Research (ASCoR), Amsterdam, the Netherlands
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18
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Denton CP, Laird B, Moros L, Flores JLL. Challenges in physician-patient communication for optimal management of systemic sclerosis-associated interstitial lung disease: a discourse analysis. Clin Rheumatol 2020; 39:2989-2998. [PMID: 32285258 PMCID: PMC7497349 DOI: 10.1007/s10067-020-05063-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/13/2020] [Accepted: 03/23/2020] [Indexed: 11/22/2022]
Abstract
Introduction Systemic sclerosis (SSc) is a rare, potentially life-threatening condition. The prognosis is difficult to predict, and treatment is complex. This can be difficult to understand or explain, posing challenges for effective physician-patient communication. Our study assessed communication between physicians and patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) to identify information gaps and needs. Methods Twenty-three 20-min consultations between physicians (rheumatologists, pulmonologists) and patients (19 real, 4 actors) with diagnosed SSc-ILD across 6 countries were observed and recorded. Interactional sociolinguistic discourse analysis was used to understand the pattern and meaning of communication, whether the needs of both participants were met, and the level of understanding between participants. Results In most consultations, patients were given little opportunity to explain their concerns or ask questions. Physicians used plain language but would revert to medical terminology for complex issues. Patients would also use medical terminology, despite not fully understanding the terms, which led to some physicians mistakenly believing that patients had a better understanding than they did. Differences in cognitive models between physicians and patients were often responsible for misunderstandings. However, during effective consultations, patients were invited to tell their story, and physicians used techniques to check and demonstrate understanding, express empathy and build rapport. Conclusions Communication challenges between physicians and patients limit joint understanding of SSc-ILD and may result in both parties misunderstanding important information and patients being less aware of self-help management approaches. Strategies should be developed with physicians to facilitate effective communication and increase patient understanding and support.
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Affiliation(s)
- Christopher P Denton
- Division of Medicine, Department of Inflammation, Centre for Rheumatology and Connective Tissue Diseases, Royal Free and University College Medical School, University College London, London, UK.
| | | | - Lizette Moros
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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19
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Patients' treatment preferences for potentially resectable tumors of the head of the pancreas. HPB (Oxford) 2020; 22:265-274. [PMID: 31501009 DOI: 10.1016/j.hpb.2019.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/15/2019] [Accepted: 06/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The primary aim of this study was to assess if patients with potentially resectable ductal adenocarcinoma (PDAC) of the head of the pancreas would choose a Whipple procedure versus palliative chemotherapy. METHODS A cohort of adults with radiological resectable PDAC was enrolled at a tertiary Canadian teaching hospital. Participants were informed about treatment options, expected outcomes, and adverse events using data from the most recent scientific literature. Probability trade-off (PTO) was used to elicit treatment preferences. RESULTS Surgery was preferred by all participants except one (96.7% vs. 3.3%; P = 0.0001). For 90% of participants preferring surgery, the main reason was the hope of being cured (P = 0.001). If the risk of perioperative mortality was higher than 57%, the risk of perioperative morbidity higher than 85% and the survival benefit was less than 4 months, half of the participants preferred palliative chemotherapy. The likelihood of needing blood transfusions, the length of hospital stay, and long-term consequences such as diabetes or pancreatic exocrine insufficiency were negligible concerns to participants. CONCLUSIONS Informed patients with early-stage PDAC prefer resection over palliative chemotherapy. The dominating factor influencing their decision is the hope of a cure that overshadow the risks of complications, mortality and recurrent disease.
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20
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Mitchell KM, Holtz BE, McCarroll A. Patient-Centered Methods for Designing and Developing Health Information Communication Technologies: A Systematic Review. Telemed J E Health 2019; 25:1012-1021. [PMID: 30576258 DOI: 10.1089/tmj.2018.0236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Chronic disease management and maintaining healthy behaviors to prevent disease are important lifelong considerations. Adherence to prescribed management and behaviors often falls short of physician recommendations, which can result in negative health outcomes. Information communication technologies (ICTs) offer an approach to combat this issue. However, uptake and sustainability of ICTs have mixed results. One reason could be that technologies are often created without an understanding of the complexities of patient needs. Therefore, the intent of this study is to explore the current landscape of patient-centered design and development of health ICTs through a systematic review. Materials and Methods: Systematic literature searches were conducted in the databases EBSCO, PubMed, and Web of Science between October 2016 and February 2017. Each paper was critically evaluated for each data extraction classification, and was categorized based on the chronic disease or health focus, method of patient-centered design, resulting themes, and use of theory. Results: The study search resulted in 3,748 articles total. After duplicates and articles not meeting criteria were removed, 57 articles were selected for assessment. Four main themes emerged: participant experience, technological requirements, behavioral and knowledge components, and social components. Conclusions: Adhering to chronic disease management and healthy behaviors are both crucial to attain positive health outcomes. ICTs can play an interesting role in aiding disease management and healthy behavior promotion, but involving end-users and applying a theoretical foundation in the design and development of these technologies should be considered.
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Affiliation(s)
- Katharine M Mitchell
- Department of Advertising and Public Relations, Michigan State University, East Lansing, Michigan
| | - Bree E Holtz
- Department of Advertising and Public Relations, Michigan State University, East Lansing, Michigan
| | - Alexis McCarroll
- Department of Media and Information, Michigan State University, East Lansing, Michigan
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Pel-Littel RE, Buurman BM, van de Pol MH, Yilmaz NG, Tulner LR, Minkman MM, Scholte Op Reimer WJM, Elwyn G, van Weert JCM. Measuring triadic decision making in older patients with multiple chronic conditions: Observer OPTION MCC. PATIENT EDUCATION AND COUNSELING 2019; 102:1969-1976. [PMID: 31279614 DOI: 10.1016/j.pec.2019.06.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/24/2019] [Accepted: 06/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To develop a valid and reliable tool to measure triadic decision making between older adults with multiple chronic conditions (MCC), their informal caregivers and geriatricians. METHODS Video observational study with cross-sectional assessment of interaction during medical consultations between geriatricians (n = 10), patients (n = 108) and informal caregivers (68) by three calibrated raters at the geriatric outpatient department of two Dutch hospitals. The Observer OPTIONMCC instrument was developed, based on the 'Dynamic model of SDM in frail older patients' and the 'Observing Patient Involvement in Decision Making - 5 item scale' (Observer OPTION-5). RESULTS Factor analysis confirms that it is acceptable to regard the new scale as a single construct. The 7-item single factor solution explained 62.76% of the variability for geriatricians, 61.60% of the variability for patients and 54.32% of the variability for informal caregivers. The inter-rater ICC for the total Observer OPTIONMCC score was .96, .96, and .95 (resp. geriatricians, patients, informal caregivers), with values ranging from .60 to .95 for individual items, showing good levels of agreement. CONCLUSION AND PRACTICE IMPLICATIONS We conclude that Observer OPTIONMCC is sufficiently valid and reliable to be used for the assessment of triadic SDM in populations of older patients with MCC.
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Affiliation(s)
- Ruth E Pel-Littel
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Vilans, Center of expertise for long-term care, Utrecht, the Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, Amsterdam, the Netherlands; ACHIEVE, Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marjolein H van de Pol
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nida G Yilmaz
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Linda R Tulner
- Department of Geriatric Medicine, MC Slotervaart, Amsterdam, the Netherlands
| | - Mirella M Minkman
- Vilans, Center of expertise for long-term care, Utrecht, the Netherlands; TIAS School for Business and Society, Tilburg University, Tilburg, the Netherlands
| | - Wilma J M Scholte Op Reimer
- ACHIEVE, Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, USA
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
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Cowell I, McGregor A, O'Sullivan P, O'Sullivan K, Poyton R, Schoeb V, Murtagh G. How do physiotherapists solicit and explore patients' concerns in back pain consultations: a conversation analytic approach. Physiother Theory Pract 2019; 37:693-709. [PMID: 31392911 DOI: 10.1080/09593985.2019.1641864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Guidelines advocate that non-specific chronic low back pain (NSCLBP) be considered within a multi-dimensional bio-psychosocial (BPS) framework. This BPS approach advocates incorporating the patient's perspective as part of the treatment process. 'Agenda setting' has been introduced as the key to understanding patients' concerns in medical encounters; however, this has received little attention in physiotherapy. This study explored how physiotherapists solicit and respond to the agenda of concerns that patients with NSCLBP bring to initial encounters. Method: The research setting was primary care. Twenty initial physiotherapy consultations were video-recorded, transcribed and analyzed using conversation analysis, a qualitative observational method. Both verbal and non-verbal features of the interaction were considered. Results: This data highlights a spectrum of communication styles ranging from more physiotherapist-focused, where the physiotherapists did not attend to patients' concerns, to a more patient-focused style, which provided greater opportunities for patients to voice their concerns. On occasions, patients were willing to pursue their own agenda when their concern was initially overlooked. Conclusion: This study provides empirical evidence on communication patterns in physiotherapy practice. A more collaborative style of communication with a shared conversational agenda provided patients with the conversational space to describe their concerns more fully.
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Affiliation(s)
- Ian Cowell
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alison McGregor
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Bentley Perth, WA, Australia.,Bodylogic Physiotherapy, Shenton Park, Perth, WA, Australia
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland.,Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ross Poyton
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Veronika Schoeb
- School of Health Sciences (HESAV), University of Applied Sciences and Arts, Western Switzerland (HES-SO), Lausanne, Switzerland
| | - Ged Murtagh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Wang MJ, Hung LC, Lo YT. Glycemic control in type 2 diabetes: role of health literacy and shared decision-making. Patient Prefer Adherence 2019; 13:871-879. [PMID: 31213781 PMCID: PMC6538834 DOI: 10.2147/ppa.s202110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/05/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Improving glycemic control requires that patients actively participate in decisions about how to best live with the disease and adapt to the realities of self-care. Limited health literacy (HL) is related to poorer health outcomes and may make it difficult for patients to participate in shared decision-making (SDM). As such, understanding the relationship between HL and SDM and its impact on diabetes control is an urgent issue. Methods: A cross-sectional survey was conducted among outpatients with type 2 diabetes in a regional teaching hospital. Purposive sampling was used to recruit eligible 372 patients via self-administered questionnaires. HbA1C values were obtained from each patient's laboratory assay. Results: Among the 372 participants, 50.4% of patients preferred physician decision-making, 39.3% preferred SDM, and 10.3% preferred patient decision-making. The physician explaining the illness in colloquial language, having adequate time for discussion, and encouragement from the healthcare provider were the major factors influencing patients' involvement in SDM. Interactive HL and critical HL had positive correlations with patients' perceived involvement in SDM. Educational attainment and HL were positively related. The HbA1C values for patient decision-making and physician decision-making were approximately 1.4 times and 1.24 times higher than those of SDM, respectively. Conclusion: SDM led to better glycemic control. HL increased patients' perceived involvement in SDM. Therefore, it is necessary to improve levels of HL based on the educational attainment of patients. Physicians explaining illness in colloquial language is the key factor in promoting patients' perceived involvement in SDM.
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Affiliation(s)
- Ming-Jye Wang
- Department of Secretariat, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Correspondence: Ming-Jye Wang Department of Secretariat, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Lane 442, Sec. 1, Jingguo Rd., Hsinchu300, TaiwanTel +886 3532 6151 Ext. 8897Fax +886 3532 9157Email
| | - Li-Chen Hung
- Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Yi-Ting Lo
- Department of Development and Planning, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
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Cherry MG, Fletcher I, Berridge D, O'Sullivan H. Do doctors' attachment styles and emotional intelligence influence patients' emotional expressions in primary care consultations? An exploratory study using multilevel analysis. PATIENT EDUCATION AND COUNSELING 2018; 101:659-664. [PMID: 29102062 DOI: 10.1016/j.pec.2017.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/28/2017] [Accepted: 10/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate whether and how doctors' attachment styles and emotional intelligence (EI) might influence patients' emotional expressions in general practice consultations. METHODS Video recordings of 26 junior doctors consulting with 173 patients were coded using the Verona Coding Definition of Emotional Sequences (VR-CoDES). Doctors' attachment style was scored across two dimensions, avoidance and anxiety, using the Experiences in Close Relationships: Short Form questionnaire. EI was assessed with the Mayer-Salovey-Caruso Emotional Intelligence Test. Multilevel Poisson regressions modelled the probability of patients' expressing emotional distress, considering doctors' attachment styles and EI and demographic and contextual factors. RESULTS Both attachment styles and EI were significantly associated with frequency of patients' cues, with patient- and doctor-level explanatory variables accounting for 42% of the variance in patients' cues. The relative contribution of attachment styles and EI varied depending on whether patients' presenting complaints were physical or psychosocial in nature. CONCLUSION Doctors' attachment styles and levels of EI are associated with patients' emotional expressions in primary care consultations. Further research is needed to investigate how these two variables interact and influence provider responses and patient outcomes. PRACTICE IMPLICATIONS Understanding how doctors' psychological characteristics influence PPC may help to optimise undergraduate and postgraduate medical education.
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Affiliation(s)
- M Gemma Cherry
- Department of Psychological Sciences, University of Liverpool, UK.
| | - Ian Fletcher
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Damon Berridge
- Swansea University Medical School, Swansea University, UK
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Keystrokes, Mouse Clicks, and Gazing at the Computer: How Physician Interaction with the EHR Affects Patient Participation. J Gen Intern Med 2018; 33:423-428. [PMID: 29188544 PMCID: PMC5880755 DOI: 10.1007/s11606-017-4228-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/12/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Evidence is mixed regarding how physicians' use of the electronic health record (EHR) affects communication in medical encounters. OBJECTIVE To investigate whether the different ways physicians interact with the computer (mouse clicks, key strokes, and gaze) vary in their effects on patient participation in the consultation, physicians' efforts to facilitate patient involvement, and silence. DESIGN Cross-sectional, observational study of video and event recordings of primary care and specialty consultations. PARTICIPANTS Thirty-two physicians and 217 patients. MAIN MEASURES Predictor variables included measures of physician interaction with the EHR (mouse clicks, key strokes, gaze). Outcome measures included active patient participation (asking questions, stating preferences, expressing concerns), physician facilitation of patient involvement (partnership-building and supportive talk), and silence. KEY RESULTS Patients were less active participants in consultations in which physicians engaged in more keyboard activity (b = -0.002, SE = 0.001, p = 0.02). More physician gaze at the computer was associated with more silence in the encounter (b = 0.21, SE = 0.09, p = 0.02). Physicians' facilitative communication, which predicted more active patient participation (b = 0.65, SE = 0.14, p < 0.001), was not related to EHR activity measures. CONCLUSIONS Patients may be more reluctant to actively participate in medical encounters when physicians are more physically engaged with the computer (e.g., keyboard activity) than when their behavior is less demonstrative (e.g., gazing at EHR). Using easy to deploy communication tactics (e.g., asking about a patient's thoughts and concerns, social conversation) while working on the computer can help physicians engage patients as well as maintain conversational flow.
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Krystallidou D, Remael A, de Boe E, Hendrickx K, Tsakitzidis G, van de Geuchte S, Pype P. Investigating empathy in interpreter-mediated simulated consultations: An explorative study. PATIENT EDUCATION AND COUNSELING 2018; 101:33-42. [PMID: 28764894 DOI: 10.1016/j.pec.2017.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To explore i) the ways in which empathic communication is expressed in interpreter-mediated consultations; ii) the interpreter's effect on the expression of empathic communication. METHODS We coded 9 video-recorded interpreter-mediated simulated consultations by using the Empathic Communication Coding System (ECCS) which we used for each interaction during interpreter-mediated consultations. We compared patients' empathic opportunities and doctors' responses as expressed by the patients and doctors and as rendered by the interpreters. RESULTS In 44 of the 70 empathic opportunities there was a match between the empathic opportunities as expressed by the patients and as rendered by the interpreters. In 26 of the 70 empathic opportunities, we identified 5 shift categories (reduced emotion, omitted emotion, emotion transformed into challenge, increased challenge/progress, twisted challenge) in the interpreter's rendition to the doctor. These were accompanied by changes in the level of empathy and in the content of the doctors' empathic responses. CONCLUSION The interpreters' renditions had an impact on the patients' empathic opportunities and on the doctors' empathic responses in one third of the coded interactions. PRACTICE IMPLICATIONS Curricula with a focus on intercultural communication and/or empathy should consider the complexity of interpreter-mediated interaction and the interpreter's impact on the co-construction of empathy.
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Affiliation(s)
- Demi Krystallidou
- Faculty of Arts (Sint Andries Campus), University of Leuven, Sint-Andriesstraat 2, B-2000, Antwerp, Belgium.
| | - Aline Remael
- Department of Applied Linguistics, University of Antwerp, Antwerp, Belgium
| | - Esther de Boe
- Department of Applied Linguistics, University of Antwerp, Antwerp, Belgium
| | - Kristin Hendrickx
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | | | | | - Peter Pype
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
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Fried TR, Niehoff KM, Street RL, Charpentier PA, Rajeevan N, Miller PL, Goldstein MK, O’Leary JR, Fenton BT. Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing. J Am Geriatr Soc 2017; 65:2265-2271. [PMID: 28804870 PMCID: PMC5641237 DOI: 10.1111/jgs.15042] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. DESIGN Randomized clinical trial. SETTING Primary care clinics at a Veterans Affairs Medical Center. PARTICIPANTS Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128). INTERVENTION TRIM extracts information on medications and chronic conditions from the EHR and contains data entry screens for information obtained from brief chart review and telephonic patient assessment. These data serve as input for automated algorithms identifying medication reconciliation discrepancies, potentially inappropriate medications (PIMs), and potentially inappropriate regimens. Clinician feedback reports summarize discrepancies and provide recommendations for deprescribing. Patient feedback reports summarize discrepancies and self-reported medication problems. MEASUREMENTS Primary: subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) related to shared decision-making; clinician and patient communication. Secondary: changes in medications. RESULTS 29.7% of TRIM participants and 15.6% of control participants provided the highest PACIC ratings; this difference was not significant. Adjusting for covariates and clustering of patients within clinicians, TRIM was associated with significantly more-active patient communication and facilitative clinician communication and with more medication-related communication among patients and clinicians. TRIM was significantly associated with correction of medication discrepancies but had no effect on number of medications or reduction in PIMs. CONCLUSION TRIM improved communication about medications and accuracy of documentation. Although there was no association with prescribing, the small sample size provided limited power to examine medication-related outcomes.
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Affiliation(s)
- Terri R. Fried
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
- Department of Medicine (Program on Aging), Yale School of Medicine, New Haven, CT
| | - Kristina M. Niehoff
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
| | - Richard L. Street
- Department of Communication, Texas A&M University, College Station, TX
- Houston Center for Quality of Care and Utilization Studies, Baylor College of Medicine, Houston, TX
| | | | - Nallakkandi Rajeevan
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT
| | - Perry L. Miller
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT
| | - Mary K. Goldstein
- Palo Alto Geriatrics Research Education and Clinical Center (GRECC) and Medical Service, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Medicine (Center for Primary Care and Outcomes Research), Stanford University, Stanford, CA
| | - John R. O’Leary
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT
- Program on Aging, Yale School of Medicine, New Haven, CT
| | - Brenda T. Fenton
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT
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Spence AD, Khasawneh M, Allen PB, Addley J. Communication of alcohol and smoking lifestyle advice to the gastroenterological patient. Best Pract Res Clin Gastroenterol 2017; 31:597-604. [PMID: 29195680 DOI: 10.1016/j.bpg.2017.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/08/2017] [Accepted: 09/16/2017] [Indexed: 02/07/2023]
Abstract
Effective communication between healthcare staff and patients is central to development of the patient-professional relationship. Many barriers influence this communication, often resulting in patients' lack of understanding and retention of information, particularly affecting advice regarding lifestyle habits, such as alcohol consumption and smoking. Alcohol and smoking misuse are potentially modifiable risk factors known to adversely affect a variety of gastroenterological conditions and improvements in communication with patients regarding this is an important management component. This review discusses the clinical impact of these factors and how healthcare professionals can improve communication. We discuss how enhancing verbal communication skills through medical training leads to greater outcomes in patient satisfaction and adherence to treatment and advice. In addition, with the rapid digitalisation of society, platforms such as social media and smartphone applications may be considered as adjuncts to traditional forms of communication.
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Affiliation(s)
- Andrew D Spence
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
| | - Mais Khasawneh
- South Eastern Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Patrick B Allen
- South Eastern Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Jennifer Addley
- South Eastern Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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Street RL, Mazor KM. Clinician-patient communication measures: drilling down into assumptions, approaches, and analyses. PATIENT EDUCATION AND COUNSELING 2017; 100:1612-1618. [PMID: 28359660 DOI: 10.1016/j.pec.2017.03.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/31/2017] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To critically examine properties of clinician-patient communication measures and offer suggestions for selecting measures appropriate to the purposes of research or clinical practice assessment. METHODS We analyzed different types of communication measures by focusing on their ontological properties. We describe their relative advantages and disadvantages with respect to different types of research questions. RESULTS Communication measures vary along dimensions of reporter (observer vs. participant), focus of measurement (behavior, meaning, or quality), target, and timing. Observer coded measures of communication behavior function well as dependent variables (e.g., evaluating communication skill interventions, examining variability related to gender or race), but are less effective as predictors of perceptions and health outcomes. Measures of participants' judgments (e.g., what the communication means or how well it was done) capture patients' or clinicians' experiences (e.g., satisfaction) and can be useful for predicting outcomes, especially in longitudinal designs. CONCLUSION In the absence of a theoretically coherent set of measures that could be used across research programs and applied setting, users should take steps to select measures with properties that are optimally matched to specific questions. PRACTICE IMPLICATIONS Quality assessments of clinician-patient communication should take into account the timing of the assessment and use measures that drill down into specific aspects of patient experience to mitigate ceiling effects.
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Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA; Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Houston VA Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA.
| | - Kathleen M Mazor
- Department of Medicine, Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
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Johnson DM, Russell RS, White SW. Perceptions of care quality and the effect on patient satisfaction. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2016. [DOI: 10.1108/ijqrm-08-2015-0121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This research models the impact of patient perceptions of care quality on overall patient satisfaction in a rural healthcare organization over a three-year time period. The purpose of this paper is to determine if the factors that influence perceptions of service quality change over time and if the change affects overall patient satisfaction.
Design/methodology/approach
Data were collected for three fiscal years (2012-2014) using a 36-question, Likert-scaled attitudinal survey. Multiple regression analysis was performed to identify which constructs of five different service quality dimensions were statistically significant in predicting overall patient satisfaction. Paired comparison of means and ANOVA F-tests highlighted significant differences across years and demographics.
Findings
Multiple regression models of overall patient satisfaction over a three-year time period had significant repeat variables, indicating salience of the dimensions and constructs of service quality that predict patient satisfaction. However, some dimensions of service quality did not remain significant from one year to another, indicating there may be a gap in the patient service cycle over an extended time frame.
Originality/value
This paper explored the sequential relationship between patient satisfaction survey data and perceptions of service quality over a multi-year time frame. The research focussed on outpatient medical clinics, while the majority of previous studies have focussed on acute care or inpatient stays. A longitudinal study is especially relevant for outpatient clinics where continuity of care is important.
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Discrepancies between Patients' Preferences and Educational Programs on Oral Anticoagulant Therapy: A Survey in Community Pharmacies and Hospital Consultations. PLoS One 2016; 11:e0146927. [PMID: 26765105 PMCID: PMC4713069 DOI: 10.1371/journal.pone.0146927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/23/2015] [Indexed: 11/29/2022] Open
Abstract
Background Oral anticoagulation therapy is increasingly used for the prevention and treatment of thromboembolic complications in various clinical situations. Nowadays, education programs for patients treated with anticoagulants constitute an integrated component of their management. However, such programs are usually based on the healthcare providers’ perceptions of what patients should know, rather than on patients’ preferences. Objective To investigate patients’ viewpoints on educational needs and preferred modalities of information delivery. Methods We conducted an observational study based on a self-administered questionnaire. To explore several profiles of patients, the study was designed for enrolling patients in two settings: during outpatient consultations in a cardiology department (Saint Antoine Hospital, Paris, France) and in community pharmacies throughout France. Results Of the 371 patients who completed the questionnaire, 187 (50.4%) were recruited during an outpatient consultation and 184 (49.6%) were recruited in community pharmacies. 84.1% of patients were receiving a vitamin K antagonist and 15.6% a direct oral anticoagulant. Patients ranked 16 of 21 (76.2%) questionnaire items on information about their treatment as important or essential; information on adverse effects of treatment was the highest ranked domain (mean score 2.38, 95% CI 2.30–2.46). Pharmacists (1.69, 1.58–1.80), nurses (1.05, 0.95–1.16), and patient associations (0.36, 0.29–0.44), along with group sessions (0.85, 0.75–0.95), the internet (0.77, 0.67–0.88), and delivery of material at the patient’s home (1.26, 1.14–1.38), were ranked poorly in terms of delivering educational material. Conclusion This study revealed substantial discrepancies between patient preferences and current educational programs. These findings should be useful for tailoring future educational programs that are better adapted to patients, with a potential associated enhancement of their effectiveness.
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Russell RS, Johnson DM, White SW. Patient perceptions of quality: analyzing patient satisfaction surveys. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2015. [DOI: 10.1108/ijopm-02-2014-0074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Healthcare facilities are entering an era of increased oversight and heightened expectations concerning both reduced costs and measureable quality. The US Affordable Care Act requires healthcare organizations to collect certain metrics, including patient assessments of quality, in order to monitor and improve the quality of healthcare. These metrics are used as a basis for graduated insurance reimbursements, and are available to consumers as an aid in selecting healthcare providers and insurance plans. The purpose of this paper is to provide healthcare providers with the analytic capabilities to better understand quality of care from the patient’s point of view.
Design/methodology/approach
– This research examines patient satisfaction data from a multi-specialty Medical Practice Group, and uses regression analysis and paired comparisons to provide insight into patient perceptions of care quality.
Findings
– Results show that variables related to Access, Moving Through the Visit, Nurse/Assistant, Care Provider and Personal Issues significantly impact overall assessments of care quality. In addition, while gender and type of care provider do not appear to have an impact on overall patient satisfaction, significant differences do exist based on age group, specialty of the physician and clinic type.
Originality/value
– This study differs from most academic research as it focusses on medical practices, rather than hospitals, and includes multiple clinic types, medical specialties and physician types in the analysis. The study demonstrates how analytics and patient perceptions of quality can inform policy decisions.
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Asan O, Montague E. Using video-based observation research methods in primary care health encounters to evaluate complex interactions. INFORMATICS IN PRIMARY CARE 2015; 21:161-70. [PMID: 25479346 DOI: 10.14236/jhi.v21i4.72] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this paper is to describe the use of video-based observation research methods in primary care environment and highlight important methodological considerations and provide practical guidance for primary care and human factors researchers conducting video studies to understand patient-clinician interaction in primary care settings. METHODS We reviewed studies in the literature which used video methods in health care research, and we also used our own experience based on the video studies we conducted in primary care settings. RESULTS This paper highlighted the benefits of using video techniques, such as multi-channel recording and video coding, and compared "unmanned" video recording with the traditional observation method in primary care research. We proposed a list that can be followed step by step to conduct an effective video study in a primary care setting for a given problem. This paper also described obstacles, researchers should anticipate when using video recording methods in future studies. CONCLUSION With the new technological improvements, video-based observation research is becoming a promising method in primary care and HFE research. Video recording has been under-utilised as a data collection tool because of confidentiality and privacy issues. However, it has many benefits as opposed to traditional observations, and recent studies using video recording methods have introduced new research areas and approaches.
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Affiliation(s)
- Onur Asan
- Division of General Internal Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Enid Montague
- Division of General Internal Medicine and Geriatrics Feinberg School of Medicine, Northwestern University, 750 North Lake Shore Drive, Chicago, IL 60611, USA.
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Cancer patients' emotional distress, coping styles and perception of doctor-patient interaction in European cancer settings. Palliat Support Care 2015; 14:204-11. [PMID: 26155817 DOI: 10.1017/s1478951515000760] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE As a part of a European study, we cross-culturally examined the rate of emotional distress and maladaptive coping and their association with cancer patients' satisfaction with their interactions with the physician responsible for their care. METHODS Cancer patients (n = 302) from one Middle European (Austria) and two Southern European (Italy, Spain) countries completed the NCCN Distress Thermometer (DT), the Mini-Mental Adjustment to Cancer (Mini-MAC) Anxious Preoccupation (AP) and Hopelessness (H) sub-scales, and the Physician Patient Satisfaction with Doctors Questionnaire (PSQ). RESULTS The prevalence of emotional distress (DT caseness) was 60% (26.1% mild, 18.8% moderate, and 14.9% severe distress). Maladaptive coping (Mini-MAC cases) was found in 22.8% (hopeless cases), and 22.5% (anxious preoccupation cases). PSQ-MD was significantly correlated with Mini-MAC/H and Mini-Mac/AP, while PSQ-PS was negatively correlated with Mini-MAC/H. DT cases and those with higher levels of hopelessness reported higher scores on PSQ-MD and lower on PSQ-PS than non-cases. Some differences were found between countries both as far as patients' coping and perception of the interaction with doctors. In hierarchical multiple regression analysis, after adjusting for socio-demographic and medical variables, Mini-MAC/H significantly predicted the scores on PSQ-MD (positive direction) and PSQ-PS (negative direction). SIGNIFICANCE OF RESULTS The study confirms that about one out of three cancer patients have moderate to high level of emotional distress and about one out of four, clinically significant maladaptive coping. Also, patients showing hopelessness and distress tended to perceive their doctors as both disengaged and less supportive. These results highlights the need for physicians to monitor their patient's level of distress and coping mechanisms and to adjust their own relational and communication style according to patients' psychological condition. Also, cross-cultural issues should be taken into account when exploring psychosocial variables and cancer patients' perception of and satisfaction with the interaction with their doctors.
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Arnetz JE, Zhdanova L. Patient involvement climate: views and behaviours among registered nurses in myocardial infarction care. J Clin Nurs 2014; 24:475-85. [DOI: 10.1111/jocn.12629] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Judith E Arnetz
- School of Medicine; Wayne State University; Detroit MI USA
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
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Okken V, van Rompay T, Pruyn A. When the world is closing in: effects of perceived room brightness and communicated threat during patient-physician interaction. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2014; 7:37-53. [PMID: 24554314 DOI: 10.1177/193758671300700104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study proposes that room brightness creates impressions of a more spacious environment and that this perception positively impacts feelings and behaviors during high-threat conversations in particular. BACKGROUND To a large extent healthcare providers depend on their patients' willingness to disclose information. In addition to characteristics related to the physician and topic of conversation, research indicates that environmental factors influence patients' affective experiences and self-disclosure. METHODS A two-factor between-subjects experimental design was used in which participants (n = 90) were presented with a scenario describing a patient-physician encounter varying in communicated threat. Subsequently, participants were exposed to a picture in which room brightness was manipulated. Next, patient comfort, experienced spaciousness, and self-disclosure intentions were measured. RESULTS An effect of brightness was found on affective experiences and self-disclosure intentions. In addition, the predicted interaction was obtained between brightness and communicated threat on these measures. Analyses confirmed that perceived spaciousness mediates the relationship between room brightness and self-disclosure intentions. CONCLUSIONS The study confirms that brightness impacts self-disclosure intentions. Additionally, this relationship is influenced by psychological circumstances, with a more pronounced need for spaciousness when in an anxious state of mind. The results suggest that the physical environment can be used as a tool to improve active participation. In addition, the results stress the importance of attending to the patient's state of mind in creating the right atmosphere. KEYWORDS Lighting, patients, physicians, satisfaction.
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Affiliation(s)
- Vanessa Okken
- CORRESPONDING AUTHOR: Vanessa Okken, University of Twente, Department of Corporate and Marketing Communication, P.O. Box 217, 7500 AE Enschede, The Netherlands; ; 0031 53 489 3287, 0031 53 489 4259 (fax)
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Molinari M, De Coutere S, Krahn M, Helton S, Urbach DR. Patients' preferences and trade-offs for the treatment of early stage hepatocellular carcinoma. J Surg Res 2014; 189:57-67. [PMID: 24650457 DOI: 10.1016/j.jss.2014.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 01/27/2014] [Accepted: 02/11/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radio frequency ablation (RFA) and hepatic resection (HR) provide similar survival for early stage hepatocellular carcinoma (ES-HCC). Although RFA has a higher recurrence rate, HR is associated with an increased risk of complications and death. When multiple treatments are available, patients should be enabled to direct their preferred therapy. Yet there is lack of knowledge on patients' preferences for the treatment of ES-HCC. The objective of this study was to assess treatment preferences between HR and RFA for ES-HCC. METHODS A cohort of 75 cirrhotic adults was educated about the natural history of HCC, treatment options, and the risks and the benefits of HR and RFA. Probability trade-off interviews were used to elicit participants' preferences between the two treatments and strength of their decisions. RESULTS RFA was preferred by 70% of participants (P = 0.001) who identified the risk of perioperative morbidity and mortality of HR as the main reasons for their decision. Participants changed their minds if HR could provide better 5 (≥15%) and 3-y disease-free survival (≥10%) when compared with RFA. Their preference also changed when RFA had a median ≥8% risk for complications, ≥5% for mortality, ≥8% for nonradical therapy, and ≥5% for tumor seeding. CONCLUSIONS Informed cirrhotic patients prefer RFA for the treatment of ES-HCC. Participants who preferred RFA were more concerned about the risks of perioperative morbidity and mortality of HR than long-term cancer outcomes. Patients' values and attitudes toward risks and benefits for the treatment of ES-HCC should be explicitly elicited and included in multidisciplinary treatment decisions.
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Affiliation(s)
- Michele Molinari
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Sarah De Coutere
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Murray Krahn
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Scott Helton
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
| | - David R Urbach
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Dijkstra H, Albada A, Klöckner Cronauer C, Ausems MGEM, van Dulmen S. Nonverbal communication and conversational contribution in breast cancer genetic counseling: are counselors' nonverbal communication and conversational contribution associated with counselees' satisfaction, needs fulfillment and state anxiety in breast cancer genetic counseling? PATIENT EDUCATION AND COUNSELING 2013; 93:216-223. [PMID: 23786807 DOI: 10.1016/j.pec.2013.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/28/2013] [Accepted: 05/19/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The current study aimed to examine how counselors' nonverbal communication (i.e. nonverbal encouragements and counselee-directed eye gaze) and conversational contribution (i.e. verbal dominance and interactivity) during the final visit within breast cancer genetic counseling relate to counselee satisfaction, needs fulfillment and anxiety. METHODS Breast cancer counselees (N=85) completed questionnaires measuring satisfaction, needs fulfillment and anxiety after the final consultation and anxiety before the initial visit. Consultations were videotaped. Counselor nonverbal encouragements and counselee-directed eye gaze were coded. Verbal dominance and interactivity were measured using the Roter Interaction Analysis System (RIAS). RESULTS More counselor nonverbal encouragements and higher counselor verbal dominance were both significantly related to higher post-visit anxiety. Furthermore, counselor verbal dominance was associated with lower perceived needs fulfillment. No significant associations with eye gaze and interactivity were found. CONCLUSION More research is needed on the relationship between nonverbal encouragements and anxiety. Given the unfavorable association of counselor verbal dominance with anxiety and needs fulfillment, more effort could be devoted to involve counselees in the dialog and reduce the counselor's verbal contribution during the consultation. PRACTICE IMPLICATIONS Interventions focused on increasing counselees' contribution in the consultation may be beneficial to counselees.
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Affiliation(s)
- Henriëtta Dijkstra
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Street RL, De Haes HCJM. Designing a curriculum for communication skills training from a theory and evidence-based perspective. PATIENT EDUCATION AND COUNSELING 2013; 93:27-33. [PMID: 23890580 DOI: 10.1016/j.pec.2013.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/23/2013] [Accepted: 06/08/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Because quality health care delivery requires effective clinician-patient communication, successful training of health professionals requires communication skill curricula of the highest quality. Two approaches for developing medical communication curricula are a consensus approach and a theory driven approach. We propose a theory-driven, communication function framework for identifying important communication skills, one that is focused on the key goals and outcomes that need to be accomplished in clinical encounters. We discuss 7 communication functions important to medical encounters and the types of skills needed to accomplish each. DISCUSSION The functional approach has important pedagogical implications including the importance of distinguishing the performance of a behavior (capacity) from the outcome of that behavior in context (effectiveness) and the recognition that what counts as effective communication depends on perspective (e.g., observer, patient). CONCLUSION Consensus and theory-driven approaches to medical communication curricula are not necessarily contradictory and can be integrated to further enhance ongoing development and improvements in medical communication education. PRACTICE IMPLICATIONS A functional approach should resonate with practicing clinicians and continuing education initiatives in that it is embraces the notion that competent communication is situation-specific as clinicians creatively use communicative skills to accomplish the key goals of the encounter.
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Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, USA.
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Dental care providers' and patients' perceptions of the effect of health information technology in the dental care setting. J Am Dent Assoc 2013; 144:1022-9. [DOI: 10.14219/jada.archive.2013.0229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Laws MB, Taubin T, Bezreh T, Lee Y, Beach MC, Wilson IB. Problems and processes in medical encounters: the cases method of dialogue analysis. PATIENT EDUCATION AND COUNSELING 2013; 91:192-9. [PMID: 23391684 PMCID: PMC3622168 DOI: 10.1016/j.pec.2012.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 12/21/2012] [Accepted: 12/28/2012] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To develop methods to reliably capture structural and dynamic temporal features of clinical interactions. METHODS Observational study of 50 audio-recorded routine outpatient visits to HIV specialty clinics, using innovative analytic methods. The comprehensive analysis of the structure of encounters system (CASES) uses transcripts coded for speech acts, then imposes larger-scale structural elements: threads--the problems or issues addressed; and processes within threads--basic tasks of clinical care labeled presentation, information, resolution (decision making) and Engagement (interpersonal exchange). Threads are also coded for the nature of resolution. RESULTS 61% of utterances are in presentation processes. Provider verbal dominance is greatest in information and resolution processes, which also contain a high proportion of provider directives. About half of threads result in no action or decision. Information flows predominantly from patient to provider in presentation processes, and from provider to patient in information processes. Engagement is rare. CONCLUSIONS In this data, resolution is provider centered; more time for patient participation in resolution, or interpersonal engagement, would have to come from presentation. PRACTICE IMPLICATIONS Awareness of the use of time in clinical encounters, and the interaction processes associated with various tasks, may help make clinical communication more efficient and effective.
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Affiliation(s)
- M Barton Laws
- Brown University, Department of Health Services, Policy & Practice, USA.
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Asan O, Montague E. Technology-mediated information sharing between patients and clinicians in primary care encounters. BEHAVIOUR & INFORMATION TECHNOLOGY 2013; 33:259-270. [PMID: 26451062 PMCID: PMC4594863 DOI: 10.1080/0144929x.2013.780636] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The aim of this study was to identify and describe the use of electronic health records for information sharing between patients and clinicians in primary care encounters. This topic is particularly important as computers and other technologies are increasingly implemented in multi-user health care settings where interactions and communication between patients and clinicians are integral to interpersonal and organizational outcomes. METHOD An ethnographic approach was used to classify the encounters into distinct technology-use patterns based on clinicians` interactions with the technology and patients. Each technology-use pattern was quantitatively analysed to assist with comparison. Quantitative analysis was based on duration of patient and clinician gaze at EHR. FINDINGS Physicians employed three different styles to share information using EHRs: Active information-sharing, in which a clinician turns the monitor towards the patient and uses the computer to actively share information with the patient;Passive information-sharing, when a clinician does not move the monitor, but the patient might see the monitor by leaning in if they choose; andTechnology withdrawal, when a clinician does not share the monitor with the patient. CONCLUSION A variety of technology-mediated information-sharing styles may be effective in providing patient-centred care. New EHR designs may be needed to facilitate information sharing between patients and clinicians.
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Affiliation(s)
- Onur Asan
- University Wisconsin-Madison, Industrial and Systems Engineering, Madison, WI
| | - Enid Montague
- University Wisconsin-Madison, Industrial and Systems Engineering, Madison, WI
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[Patient-centered communication in the physician-patient relationship]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 55:1106-12. [PMID: 22936477 DOI: 10.1007/s00103-012-1528-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
As a result of increasing demands for more patient-centeredness in the German health care system, physician-patient communication has been subject to transformation. Physicians are being requested to take into account their patients' communicative needs, including information, shared decision making, and emotional support, more vigorously than they had been in the past. A cooperative model of the physician-patient relationship is considered most suitable for fulfilling these needs and for empowering patients to make informed decisions regarding their own health care. However, a large body of evidence exists-particularly regarding communication between cancer patients and their doctors-that shows that patients' needs are not adequately addressed or met. This potential for optimization is all the more important because targeting patients' needs during doctor-patient communication not only improves patients' satisfaction with the communication, quality of life, and well-being, but may also produce better treatment outcomes.
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Chang CL, Park BK, Kim SS. Conversational analysis of medical discourse in rehabilitation: a study in Korea. J Spinal Cord Med 2013; 36:24-30. [PMID: 23433331 PMCID: PMC3555101 DOI: 10.1179/2045772312y.0000000051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The purpose of this study is to conduct an analysis of actual communicative behaviors, including nonverbal ones, between physicians and patients in rehabilitation. DESIGN Sixteen videotaped physician-patient interactions in a rehabilitation center in Korea were transcribed. And three coders placed utterances in transcripts into categories while watching the videotapes. RESULTS Consistent with results of previous studies, patient active communicative behaviors varied considerably depending on individual patients. The findings revealed that, on average, patients' active communicative behaviors were less than 9% of patients' total utterances. In particular, almost half of the patients (N = 7) did not even ask one single question. The results also showed that physicians' empathic communicative acts averaged less than 3% of physicians' total utterances. In addition, among physicians' nonverbal behaviors, eye-contact showed significant correlation with physician empathic listening and supportive talks. CONCLUSIONS The findings of this study indicated a considerable lack of empathic communicative behaviors of physicians in Korea. This might have led to infrequent use of active communicative behaviors by patients. In addition, the importance of physician's partnership for enhancement of active communicative behaviors of patients was demonstrated. To better serve patients, physicians who wish to improve their communication should first identify components of their empathic communicative behaviors that need improvement and then attempt to refine their skills.
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Affiliation(s)
- Chulhun Ludgerus Chang
- Department of Laboratory Medicine, School of Medicine, Pusan National University, Busan, Republic of Korea
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Street RL, Elwyn G, Epstein RM. Patient preferences and healthcare outcomes: an ecological perspective. Expert Rev Pharmacoecon Outcomes Res 2012; 12:167-80. [PMID: 22458618 DOI: 10.1586/erp.12.3] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This article examines the nature of patients' preferences for healthcare and whether clinician accommodation of patient preferences influences health outcomes. First, we provide a conceptualization of patient preferences along with their key attributes. Second, we review research on the relationship between health outcomes and patient preferences for treatments and for the process of care (e.g., preferred involvement in decision-making). Third, following a critique of this literature, we present an ecological model of patient preferences that, while acknowledging that patient preferences may emerge from various contexts (e.g., family or media exposure), we focus on the important role that clinical encounters and patients' health-related experiences play in the elicitation and construction of patient preferences. Fourth, we propose two pathways, one behavioral (adherence) and the other psychological (sense of autonomy or satisfaction with decision), through which meeting patient preferences could lead to better health outcomes. Fifth, we discuss how preferences can be elicited and clarified through patient-centered conversations. We conclude with implications for future research and clinical practice.
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Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, TX 77843-74234, USA.
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ten Klooster PM, Oostveen JCM, Zandbelt LC, Taal E, Drossaert CHC, Harmsen EJ, van de Laar MAFJ. Further validation of the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale in patients with osteoarthritis. PATIENT EDUCATION AND COUNSELING 2012; 87:125-130. [PMID: 21889864 DOI: 10.1016/j.pec.2011.07.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 07/21/2011] [Accepted: 07/22/2011] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To examine the structural validity, internal consistency, test-retest reliability, and construct validity of the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale in patients with osteoarthritis (OA). METHODS A cross-sectional sample of 224 outpatients with OA completed a survey containing the Dutch PEPPI-5 and other standardized measures assessing perceived health-management skills, general self-efficacy, social support, and health-related quality of life. A subsample of 100 patients completed the PEPPI-5 again approximately 3 weeks later. RESULTS Confirmatory factor analysis demonstrated good fit for a unidimensional model of the PEPPI-5. Additionally, the scale showed high internal consistency (α=0.92) and fair test-retest reliability (ICC=0.68). As hypothesized, the PEPPI-5 was strongly correlated with perceived health-management skills, moderately with social support and psychosocial aspects of health, and not with physical aspects of health. Contrary to expectations, however, it was not correlated with general self-efficacy. CONCLUSION The Dutch PEPPI-5 demonstrated adequate validity and reliability in patients with OA. PRACTICE IMPLICATIONS The PEPPI-5 is a brief and appropriate tool for measuring self-efficacy of patients with OA to interact with their physicians. Additional research into its sensitivity to change is needed before it can be confidently recommended as an outcome measure in intervention studies.
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Affiliation(s)
- Peter M ten Klooster
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
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Verlinde E, De Laender N, De Maesschalck S, Deveugele M, Willems S. The social gradient in doctor-patient communication. Int J Equity Health 2012; 11:12. [PMID: 22409902 PMCID: PMC3317830 DOI: 10.1186/1475-9276-11-12] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 03/12/2012] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE In recent years, the importance of social differences in the physician-patient relationship has frequently been the subject of research. A 2002 review synthesised the evidence on this topic. Considering the increasing importance of social inequalities in health care, an actualization of this review seemed appropriate. METHODS A systematic search of literature published between 1965 and 2011 on the social gradient in doctor-patient communication. In this review social class was determined by patient's income, education or occupation. RESULTS Twenty original research papers and meta-analyses were included. Social differences in doctor-patient communication were described according to the following classification: verbal behaviour including instrumental and affective behaviour, non-verbal behaviour and patient-centred behaviour. CONCLUSION This review indicates that the literature on the social gradient in doctor-patient communication that was published in the last decade, addresses new issues and themes. Firstly, most of the found studies emphasize the importance of the reciprocity of communication.Secondly, there seems to be a growing interest in patient's perception of doctor-patient communication. PRACTICE IMPLICATIONS By increasing the doctors' awareness of the communicative differences and by empowering patients to express concerns and preferences, a more effective communication could be established.
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Affiliation(s)
- Evelyn Verlinde
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
- Verlinde Evelyn, Department of Family Medicine and Primary Health Care, Ghent University, UZ-1 K3, De Pintelaan 185, B-9000 Ghent, Belgium
| | - Nele De Laender
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | | | - Myriam Deveugele
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
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Naik AD, Street RL, Castillo D, Abraham NS. Health literacy and decision making styles for complex antithrombotic therapy among older multimorbid adults. PATIENT EDUCATION AND COUNSELING 2011; 85:499-504. [PMID: 21251788 PMCID: PMC3101294 DOI: 10.1016/j.pec.2010.12.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 11/25/2010] [Accepted: 12/18/2010] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To evaluate the effect of functional health literacy (FHL) on preferences for decision-making; and among those initially preferring a passive decision-making role, to explore how preferences change if their physician actively encourages their involvement. METHODS Consecutive older adults with cardiovascular disease receiving complex antithrombotic therapy completed a comprehensive assessment including measures of FHL and preferences for shared decision making. RESULTS Half of all participants had inadequate or marginal FHL. Those with inadequate FHL were more likely (P=0.01) to prefer passive rather than active decision making styles even after controlling for age, education, and numeracy. However, 40% of patients preferring passive styles had adequate FHL and these patients were significantly more likely to change their preference to more active styles (odds ratio=7.17, P<.01) if their physician "was more supportive or encouraged participation". CONCLUSIONS Screening FHL can provide insight into patients' preferences for active participation in decision making. Clinicians' encouragement of participation can increase engagement by patients with adequate FHL. PRACTICE IMPLICATIONS We propose an algorithm for screening FHL and preferences for participating in decisions about complex medication regimens.
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Affiliation(s)
- Aanand D Naik
- Houston HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
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Zimmermann C, Del Piccolo L, Bensing J, Bergvik S, De Haes H, Eide H, Fletcher I, Goss C, Heaven C, Humphris G, Kim YM, Langewitz W, Meeuwesen L, Nuebling M, Rimondini M, Salmon P, van Dulmen S, Wissow L, Zandbelt L, Finset A. Coding patient emotional cues and concerns in medical consultations: the Verona coding definitions of emotional sequences (VR-CoDES). PATIENT EDUCATION AND COUNSELING 2011; 82:141-8. [PMID: 20430562 DOI: 10.1016/j.pec.2010.03.017] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 01/25/2010] [Accepted: 03/27/2010] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To present the Verona Coding Definitions of Emotional Sequences (VR-CoDES CC), a consensus based system for coding patient expressions of emotional distress in medical consultations, defined as Cues or Concerns. METHODS The system was developed by an international group of communication researchers. First, consensus was reached in different steps. Second, a reliability study was conducted on 20 psychiatric consultations. RESULTS A Cue is defined as a verbal or non-verbal hint which suggests an underlying unpleasant emotion that lacks clarity. A Concern is defined as a clear and unambiguous expression of an unpleasant current or recent emotion that is explicitly verbalized with or without a stated issue of importance. The conceptual framework sets precise criteria for cues and concerns and for whom (health provider or patient) elicits the cue/concern. Inter-rater reliability proved satisfactory (agreement 81.5%, Cohen's Kappa 0.70). CONCLUSION The VR-CoDES CC will facilitate comparative research on provider-patient communication sequences in which patients express emotional distress. PRACTICE IMPLICATIONS The VR-CoDES CC may be used to help clinicians in recognizing or facilitating cues and concerns, thereby improving the recognition of patients' emotional distress, the therapeutic alliance and quality of care for these patients.
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Affiliation(s)
- Christa Zimmermann
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy.
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Ye J, Rust G, Fry-Johnson Y, Strothers H. E-mail in patient-provider communication: a systematic review. PATIENT EDUCATION AND COUNSELING 2010; 80:266-73. [PMID: 19914022 PMCID: PMC4127895 DOI: 10.1016/j.pec.2009.09.038] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 09/03/2009] [Accepted: 09/16/2009] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To review systematically the role of e-mails in patient-provider communication in terms of e-mail content, and perspectives of providers and patients on e-mail communication in health care. METHODS A systematic review of studies on e-mail communication between patients and health providers in regular health care published from 2000 to 2008. RESULTS A total of 24 studies were included in the review. Among these studies, 21 studies examined e-mail communication between patients and providers, and three studies examined the e-mail communication between parents of patients in pediatric primary care and pediatricians. In the content analyses of e-mail messages, topics well represented were medical information exchange, medical condition or update, medication information, and subspecialty evaluation. A number of personal and institutional features were associated with the likelihood of e-mail use between patients and providers. While benefits of e-mails in enhancing communication were recognized by both patients and providers, concerns about confidentiality and security were also expressed. CONCLUSION The e-mail is transforming the relationship between patients and providers. The rigorous exploration of pros and cons of electronic interaction in health care settings will help make e-mail communication a more powerful, mutually beneficial health care provision tool. PRACTICE IMPLICATIONS It is important to develop an electronic communication system for the clinical practice that can address a range of concerns. More efforts need to be made to educate patients and providers to appropriately and effectively use e-mail for communication.
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Affiliation(s)
- Jiali Ye
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA 30310, USA.
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