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Geurts EMA, Pittens CACM, Boland G, van Dulmen S, Noordman J. Persuasive communication in medical decision-making during consultations with patients with limited health literacy in hospital-based palliative care. PATIENT EDUCATION AND COUNSELING 2022; 105:1130-1137. [PMID: 34456095 DOI: 10.1016/j.pec.2021.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Both patients in the palliative phase of their disease and patients with limited health literacy (LHL) have an increased risk of being influenced by healthcare providers (HCPs) when making decisions. This study aims to explore to what extent persuasive communication occurs during shared decision-making (SDM) by (1) providing an overview of persuasive communication behaviours relevant for medical decision-making and (2) exemplifying these using real-life outpatient consultations. METHODS An exploratory qualitative design was applied: (1) brief literature review; (2) analysis of verbatim extracts from outpatient consultations and stimulated recall sessions with HCPs; and (3) stakeholder meetings. RESULTS 24 different persuasive communication behaviours were identified, which can be divided in seven categories: biased presentation of information, authoritative framing, probability framing, illusion of decisional control, normative framing, making assumptions and using emotions or feelings. CONCLUSIONS Persuasive communication is multi-faceted in outpatient consultations. Although undesirable, it may prove useful in specific situations making it necessary to study the phenomenon more in depth and deepen our understanding of its mechanisms and impact. PRACTICE IMPLICATIONS Awareness among HCPs about the use of persuasive communication needs to be created through training and education. Also, HCPs need help in providing balanced information.
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Affiliation(s)
- Esther M A Geurts
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands; Department of Social Medicine, Maastricht University, Maastricht, The Netherlands.
| | | | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
| | - Janneke Noordman
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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van Dulmen S, Peereboom E, Schulze L, Prantl K, Rookmaaker M, van Jaarsveld BC, Abrahams AC, Roodbeen R. The use of implicit persuasion in decision-making about treatment for end-stage kidney disease. Perit Dial Int 2021; 42:377-386. [PMID: 34212786 DOI: 10.1177/08968608211027019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There are various options for managing end-stage kidney disease. Each option impacts the lives of patients differently. When weighing the pros and cons of the different options, patients' values, needs and preferences should, therefore, be taken into account. However, despite the best intentions, nephrologists may, more or less deliberately, convey a treatment preference and thereby steer the decision-making process. Being aware of such implicit persuasion could help to further optimise shared decision-making (SDM). This study explores verbal acts of implicit persuasion during outpatient consultations scheduled to make a final treatment decision. These consultations mark the end of a multi-consultation, educational process and summarise treatment aspects discussed previously. METHODS Observations of video-recorded outpatient consultations in nephrology (n = 20) were used to capture different forms of implicit persuasion. To this purpose, a coding scheme was developed. RESULTS In nearly every consultation nephrologists used some form of implicit persuasion. Frequently observed behaviours included selectively presenting treatment options, benefits and harms, and giving the impression that undergoing or foregoing treatment is unusual. The extent to which nephrologists used these behaviours differed. CONCLUSION The use of implicit persuasion while discussing different kidney replacement modalities appears diverse and quite common. Nephrologists should be made aware of these behaviours as implicit persuasion might prevent patients to become knowledgeable in each treatment option, thereby affecting SDM and causing decisional regret. The developed coding scheme for observing implicit persuasion elicits useful and clinically relevant examples which could be used when providing feedback to nephrologists.
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Affiliation(s)
- Sandra van Dulmen
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud institute for health sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Emma Peereboom
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands
| | - Lotte Schulze
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands
| | - Karen Prantl
- Dutch Kidney Patients Association, Bussum, The Netherlands
| | - Maarten Rookmaaker
- Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands
| | - Brigit C van Jaarsveld
- Department of Nephrology, Amsterdam University Medical Centers, VU Amsterdam, The Netherlands.,Diapriva Dialysis Center, Amsterdam, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands
| | - Ruud Roodbeen
- Department of Communication in healthcare, Nivel (Netherlands institute for health services research), Utrecht, The Netherlands.,Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, The Netherlands
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Rubinelli S, Ort A, Zanini C, Fiordelli M, Diviani N. Strengthening Critical Health Literacy for Health Information Appraisal: An Approach from Argumentation Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136764. [PMID: 34201894 PMCID: PMC8269373 DOI: 10.3390/ijerph18136764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022]
Abstract
The overload of health information has been a major challenge during the COVID-19 pandemic. Public health authorities play a primary role in managing this information. However, individuals have to apply critical health literacy to evaluate it. The objective of this paper is to identify targets for strengthening critical health literacy by focusing on the field of argumentation theory. This paper is based on the textual analysis of instances of health information through the lens of argumentation theory. The results show that critical health literacy benefits from: (1) understanding the concept of argument and the supporting reasons, (2) identifying the main argument schemes, and (3) the knowledge and use of the main critical questions to check the soundness of arguments. This study operationalizes the main aspects of critical health literacy. It calls for specific educational and training initiatives in the field. Moreover, it argues in favor of broadening the current educational curricula to empower individuals to engage in informed and quality decision making. Strengthening individuals’ critical health literacy involves interventions to empower in argument evaluation. For this purpose, argumentation theory has analytical and normative frameworks that can be adapted within a lay-audience education concept.
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Affiliation(s)
- Sara Rubinelli
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland; (A.O.); (C.Z.); (N.D.)
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland;
- Correspondence:
| | - Alexander Ort
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland; (A.O.); (C.Z.); (N.D.)
| | - Claudia Zanini
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland; (A.O.); (C.Z.); (N.D.)
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland;
| | - Maddalena Fiordelli
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland;
- Institute of Public Health, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Nicola Diviani
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Luzern, Switzerland; (A.O.); (C.Z.); (N.D.)
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland;
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Tseng EK, Mukerji G, Weinerman A, Fuller J, McLeod A, Wong BM, Kuper A, Stroud LS. Choosing Words Wisely: Residents' Use of Rhetorical Appeals in Conversations About Unnecessary Tests. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:275-282. [PMID: 31517680 DOI: 10.1097/acm.0000000000002980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To characterize how residents employ rhetorical appeals (i.e., the strategic use of communication to achieve specifiable goals) when discussing unnecessary diagnostic tests with patients. METHOD In 2015, senior hematology residents from 10 Canadian universities participating in a national formative objective structured clinical examination (OSCE) completed a resource stewardship communication station. In this communication scenario, a standardized patient (SP) portrayed a patient requesting unnecessary thrombophilia testing following early pregnancy loss. The authors performed a thematic analysis of audio transcripts using a qualitative description approach to identify residents' rhetorical appeals to logic (rational appeals), credibility, and emotion. RESULTS For persuasive communication, residents (n = 27) relied primarily on rational appeals that fit into 3 categories (with themes) focused on medical evidence (poor utility, professional guidelines and recommendations), avoidance of harm (insurance implications, unnecessary or potentially harmful interventions, patient anxiety), and reassurance to patient (normalizing, clinical pretest probability, criteria for reconsidering testing). Appeals to credibility and emotion were rarely used. CONCLUSIONS In an OSCE setting, residents relied predominantly on rational appeals when engaging SPs in conversations about unnecessary tests. These observations yield insights into how recent emphasis within residency education on appropriate test utilization may manifest when residents put recommendations into practice in conversations with patients. This study's framework of rational appeals may be helpful in designing communication curricula about unnecessary testing. Future studies should explore rhetoric about unnecessary testing in the clinical environment, strategies to teach and coach residents leading these conversations, and patients' preferences and responses to different appeals.
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Affiliation(s)
- Eric K Tseng
- E.K. Tseng is assistant professor, Department of Medicine, University of Toronto, and staff physician, Division of Hematology/Oncology, St. Michael's Hospital, Toronto, Ontario, Canada. G. Mukerji is assistant professor, Department of Medicine, University of Toronto, and staff physician, Division of Endocrinology, Women's College Hospital, Toronto, Ontario, Canada. A. Weinerman is assistant professor, Department of Medicine, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. J. Fuller is assistant professor, Department of History and Philosophy of Science, University of Pittsburgh, Pittsburgh, Pennsylvania, and research associate, African Centre for Epistemology and Philosophy of Science, University of Johannesburg, Johannesburg, South Africa. A. McLeod is assistant professor, Department of Medicine, University of Toronto, and staff physician, Division of Hematology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. B.M. Wong is associate professor, Department of Medicine, and associate director, Centre for Quality Improvement and Patient Safety, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. A. Kuper is associate professor, Department of Medicine, and education scientist, Wilson Centre for Education, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. L.S. Stroud is associate professor, Department of Medicine, and centre researcher, Wilson Centre for Education, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Zisman-Ilani Y, Shern D, Deegan P, Kreyenbuhl J, Dixon L, Drake R, Torrey W, Mishra M, Gorbenko K, Elwyn G. Continue, adjust, or stop antipsychotic medication: developing and user testing an encounter decision aid for people with first-episode and long-term psychosis. BMC Psychiatry 2018; 18:142. [PMID: 29788933 PMCID: PMC5963160 DOI: 10.1186/s12888-018-1707-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND People with psychosis struggle with decisions about their use of antipsychotics. They often want to reduce the dose or stop, while facing uncertainty regarding the effects these decisions will have on their treatment and recovery. They may also fear raising this issue with clinicians. The purpose of this study was to develop and test a shared decision making (SDM) tool to support patients and clinicians in making decisions about antipsychotics. METHODS A diverse editorial research team developed an Encounter Decision Aid (EDA) for patients and clinicians to use as part of the psychiatric consultation. The EDA was tested using 24 semistructured interviews with participants representing six stakeholder groups: patients with first-episode psychosis, patients with long-term psychosis, family members, psychiatrists, mental health counselors, and administrators. We used inductive and deductive coding of interview transcripts to identify points to revise within three domains: general impression and purpose of the EDA; suggested changes to the content, wording, and appearance; and usability and potential contribution to the psychiatric consultation. RESULTS An EDA was developed in an iterative process that yielded evidence-based answers to five frequently asked questions about antipsychotic medications. Patients with long-term psychosis and mental health counselors suggested more changes and revisions than patients with first-episode psychosis and psychiatrists. Family members suggested more revisions to the answers about potential risks of stopping or adjusting antipsychotics than other respondents. CONCLUSIONS The EDA was perceived as potentially useful and feasible in psychiatric routine care, especially if presented during the consultation.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Rehabilitation Sciences, College of Public Health, Temple University, 1700 North Broad St., Philadelphia, PA 19122 USA
| | - David Shern
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | | | - Julie Kreyenbuhl
- The Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD USA
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD USA
| | - Lisa Dixon
- Columbia University Medical Center, New York, NY USA
- New York State Psychiatric Institute, New York, USA
| | - Robert Drake
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH USA
| | - William Torrey
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Manish Mishra
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH USA
| | - Ksenia Gorbenko
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH USA
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Abstract
Informed consent is a communicative process of sharing information with patients, which helps assure their understanding of the information provided and asks for their permission to proceed. Informed consent allows a patient or a patient's family to use his or her own value system to determine the need for a particular procedure or test. Asking a patient for permission to treat requires the provider to respect the patient's autonomy through allowing him or her to be an active part of the decision-making process. Consent in the pediatric emergency department can be a complex process. Parental consent is generally required for medical evaluation and treatment of pediatric patients, but in the pediatric emergency department, there are exceptions to this rule. If the provider determines that a parent's refusal of consent places the child at risk of harm, then consent is not necessary. By using the concepts of Emergency Medical Treatment and Active Labor Act, in emergent situations, consent may not be necessary. Finally, adolescents are often deeply concerned about privacy-their acceptance of appropriate care is often based on this promise of confidentiality. In the emergency department, adolescents can therefore be treated for issues relating to reproductive care without parental consent. It is important for the emergency department physician to understand the rules surrounding the care of pediatric patients to avoid compromising their privacy and ultimately their well-being and medical care.
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Ayuandini S. How variability in hymenoplasty recommendations leads to contrasting rates of surgery in the Netherlands: an ethnographic qualitative analysis. CULTURE, HEALTH & SEXUALITY 2017; 19:352-365. [PMID: 27594422 DOI: 10.1080/13691058.2016.1219919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hymenoplasty is surgery to alter the shape of the hymen membrane in the vaginal canal, commonly performed to minimise the aperture. This medical operation is often requested by women who expect that their virginity will be under scrutiny, particularly during their first sexual encounter on their wedding night. Despite increasing demand for the surgery all over the globe, there is no one standard of practice in performing hymenoplasty. In the Netherlands, the manner in which medical consultations concerning the procedure take place depends heavily on the consulting physician. This paper looks at two different approaches to hymenoplasty consultation in the Netherlands: a pedagogical philosophy adopted in a public hospital and a practical approach employed by a private clinic. Each approach culminates in a contrasting result: patients in one medical establishment are twice as likely to undergo hymenoplasty than those visiting the other.
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Affiliation(s)
- Sherria Ayuandini
- a Anthropology Department , Washington University in St. Louis , St. Louis , USA
- b Sociology Department , Universiteit van Amsterdam , Amsterdam , the Netherlands
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Reach G. Patient education, nudge, and manipulation: defining the ethical conditions of the person-centered model of care. Patient Prefer Adherence 2016; 10:459-68. [PMID: 27103791 PMCID: PMC4829190 DOI: 10.2147/ppa.s99627] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Patient education (PE) is expected to help patients with a chronic disease to manage their lives and give them the possibility of adopting, in an appropriate manner, beneficial changes in health behaviors that are prescribed by their physicians. It is aimed at delineating, agreeing on, and implementing a patient's personal action plan and is therefore an essential constituent of the person-centered model of care. The aim of this article is to examine the idea that PE may sometimes be a manipulation that is organized for the good of patients in a paternalistic framework. Theoretically, PE differs from manipulation by addressing the reflective intelligence of patients in full light and helping them make autonomous choices. In this article, we examined some analogies between PE and nudge (ie, techniques used to push people to make good choices by organizing their environment). This analysis suggests that PE is not always as transparent and reflective as it is supposed to be and that unmasking these issues may be useful for improving the ethical quality of educational practice that must be performed in a framework of a trusting patient-doctor relationship. Under this condition, PE may sometimes represent a form of persuasion without being accused of patient deception and manipulation: trust is therefore the core of the person-centered model of care.
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Affiliation(s)
- Gérard Reach
- Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital AP-HP, Bobigny, France
- EA 3412, Centre de Recherche en Nutrition Humaine Ile-de-France (CRNH-IDF), Paris 13 University, Sorbonne Paris Cité, Bobigny, France
- Correspondence: Gérard Reach, Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital AP-HP, 125 Rue de Stalingrad, Bobigny 93000, France, Tel +33 1 4895 5158, Fax +33 1 4895 5560, Email
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Zanini C, Sarzi-Puttini P, Atzeni F, Di Franco M, Rubinelli S. Building bridges between doctors and patients: the design and pilot evaluation of a training session in argumentation for chronic pain experts. BMC MEDICAL EDUCATION 2015; 15:89. [PMID: 25986603 PMCID: PMC4469318 DOI: 10.1186/s12909-015-0374-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Shared decision-making requires doctors to be competent in exchanging views with patients to identify the appropriate course of action. In this paper we focus on the potential of a course in argumentation as a promising way to empower doctors in presenting their viewpoints and addressing those of patients. Argumentation is the communication process in which the speaker, through the use of reasons, aims to convince the interlocutor of the acceptability of a viewpoint. The value of argumentation skills for doctors has been addressed in the literature. Yet, there is no research on what a course on argumentation might look like. In this paper, we present the content and format of a training session in argumentation for doctors and discuss some insights gained from a pilot study that examined doctors' perceived strengths and limitations vis-à-vis this training. METHODS The training session (eight hours) combined different aspects from prominent theories of argumentation and was designed to strengthen doctors' argumentative discussion skills. A convenient, self-selected sample of 17 doctors who were experts in the field of chronic pain participated in the training and evaluated it via a feedback form and semi-structured interviews. RESULTS The participants found that the training session gave a structure to types of communication they use to interact with their patients, and taught them techniques that can increase their effectiveness. Moreover, it provided tools to help address some of the challenges of modern doctor-patient interactions, including dealing with patients' unrealistic expectations and medically inaccurate beliefs, and reaching agreement when there are differences of opinion. CONCLUSIONS This study enriches the research in the field of medical education. In line with the findings of studies that explore the value of argumentation in different fields, argumentative discussion skills can be applied by doctors to express their views and to account for the views of patients without patronizing the interaction. In this paper, we provide a basis to reflect on the value of argumentation in enhancing patients' right to autonomy and self-determination in interactions with their doctors.
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Affiliation(s)
- Claudia Zanini
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne, Nottwil, Switzerland.
- Swiss Paraplegic Research, Lucerne, Nottwil, Switzerland.
| | | | - Fabiola Atzeni
- Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.
| | - Manuela Di Franco
- Department of Internal Medicine, Sapienza University of Rome, Rome, Italy.
| | - Sara Rubinelli
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne, Nottwil, Switzerland.
- Swiss Paraplegic Research, Lucerne, Nottwil, Switzerland.
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Salmon P. Argumentation and persuasion in patient-centred communication. PATIENT EDUCATION AND COUNSELING 2015; 98:543-544. [PMID: 25835579 DOI: 10.1016/j.pec.2015.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK.
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Labrie NHM, Schulz PJ. Exploring the relationships between participatory decision-making, visit duration, and general practitioners' provision of argumentation to support their medical advice: results from a content analysis. PATIENT EDUCATION AND COUNSELING 2015; 98:572-577. [PMID: 25746127 DOI: 10.1016/j.pec.2015.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/13/2015] [Accepted: 01/28/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE General practitioners' medical recommendations are not always accepted by their patients. As patients bring their own beliefs, knowledge, and preferences to the medical encounter, their opinions concerning diagnosis and treatment may deviate from their doctors'. Aiming to convince their patients of the acceptability of their advice, doctors can advance arguments. Few quantitative studies have been conducted focusing on general practitioners' provision of argumentation and little is known about the relationship between the use of argumentation and characteristics of the medical visit, such as (participatory) decision-making and visit duration. This study seeks to explore these relationships. METHODS An observational study of seventy, randomly drawn videos of general practice consultations was conducted. A theory-based codebook was developed. Two independent coders analyzed doctors' provision of argumentation, their decision-making style, and the duration of each visit. RESULTS General practitioners' provision of argumentation was found to be associated with lengthier visits and a more participatory decision-making style. In addition, visit duration and participatory decision-making appeared associated. CONCLUSION These results suggest that the use of argumentation may contribute toward achieving patient-centered care through communication. PRACTICE IMPLICATIONS As a result, the findings underscore the potential relevance of developing courses focusing on doctors' argumentation skills.
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Affiliation(s)
- Nanon H M Labrie
- Institute of Communication & Health, University of Lugano, Switzerland.
| | - Peter J Schulz
- Institute of Communication & Health, University of Lugano, Switzerland.
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Lafata JE, Wunderlich T, Flocke SA, Oja-Tebbe N, Dyer KE, Siminoff LA. Physician use of persuasion and colorectal cancer screening. Transl Behav Med 2015; 5:87-93. [PMID: 25729457 DOI: 10.1007/s13142-014-0284-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The impact of patient-physician communication on subsequent patient behavior has rarely been evaluated in the context of colorectal cancer (CRC) screening discussions. We describe physicians' use of persuasive techniques when recommending CRC screening and evaluate its association with patients' subsequent adherence to screening. Audio recordings of N = 414 periodic health examinations were joined with screening use data from electronic medical records and pre-/post-visit patient surveys. The association between persuasion and screening was assessed using generalized estimating equations. According to observer ratings, primary care physicians frequently use persuasive techniques (63 %) when recommending CRC screening, most commonly argument or refutation. However, physician persuasion was not associated with subsequent screening adherence. Physician use of persuasion may be a common vehicle for information provision during CRC screening discussions; however, our results do not support the sole reliance on persuasive techniques if the goal is to improve adherence to recommended screening.
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Affiliation(s)
- Jennifer Elston Lafata
- Henry Ford Health System, MI, USA, Detroit, MI USA ; Virginia Commonwealth University, Richmond, VA USA
| | - Tracy Wunderlich
- Henry Ford Health System, MI, USA, Detroit, MI USA ; Oakland University, Detroit, MI USA
| | | | | | - Karen E Dyer
- Virginia Commonwealth University, Richmond, VA USA
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Suurmond J, Seeleman C, Essink-Bot ML. Analyzing Fallacies in Argumentation to Enhance Effectiveness of Educational Interventions: The Case of Care Providers' Arguments Against Using Professional Interpretation. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2015; 35:249-254. [PMID: 26953855 DOI: 10.1097/ceh.0000000000000003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Although research has shown that professional interpreters improve health care to patients who do not speak the same language as their care provider, care providers underuse professional interpretation services. To get more insight into the reasons of care providers to underuse professional interpreters, we studied fallacies in their arguments. Fallacies in reasoning may explain why care providers avoid changing their behavior even if they are aware of evidence in favor of such behavior. METHODS We did a secondary analysis of interviews about immigrant patients with care providers collected in two studies on in-hospital pediatric care. Interviews (N = 37) were held in 2009, in the Netherlands. Interviews were analyzed using a contextual approach to fallacious argumentation: a method that can identify fallacies as "wrong" arguments compared with the context in they are made. RESULTS We identified six main fallacies that care providers used to argue that they prefer not to use a professional interpreter while having free access to professional interpreters: 1) There are also some negative side effects to using professional interpreters, 2) there is no language problem, 3) it is such an enormous hassle to organize it, 4) I am a good doctor, 5) my medical information is not complex, and 6) patients do not want it. DISCUSSION Familiarizing care providers with these fallacies can raise their awareness of the wrong arguments to defend their underuse of professional interpreters and can be made part of their training.
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Affiliation(s)
- Jeanine Suurmond
- Drs. Suurmond, Seeleman, and Essink-Bot: Department of Public Health, Academic Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
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Humphris G, Entwistle V, Eide H, Visser A. The science of health communication: impressions from the International Conference on Communication in Healthcare in St Andrews, Scotland, UK. PATIENT EDUCATION AND COUNSELING 2013; 92:283-285. [PMID: 23962541 DOI: 10.1016/j.pec.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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