1
|
Li H, Li L, Liu T, Tan M, He W, Luo Y, Zhong X, Zhang L, Sun J. Risk management and empirical study of the doctor-patient relationship: based on 1790 litigation cases of medical damage liability disputes in China. BMC Health Serv Res 2024; 24:521. [PMID: 38664671 PMCID: PMC11044444 DOI: 10.1186/s12913-024-10952-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Compensation for medical damage liability disputes (CMDLD) seriously hinders the healthy development of hospitals and undermines the harmony of the doctor-patient relationships (DPR). Risk management in the DPR has become an urgent issue of the day. The study aims to provide a comprehensive description of CMDLD in China and explore its influencing factors, and make corresponding recommendations for the management of risks in the DPR. METHODS This study extracted data from the China Judgment Online - the official judicial search website with the most comprehensive coverage. Statistical analysis of 1,790 litigation cases of medical damage liability disputes (COMDLD) available from 2015 to 2021. RESULTS COMDLD generally tended to increase with the year and was unevenly distributed by regions; the compensation rate was 52.46%, the median compensation was 134,900 yuan and the maximum was 2,234,666 yuan; the results of the single factor analysis showed that there were statistically significant differences between the compensation for different years, regions, treatment attributes, and trial procedures (P < 0.05); the correlation analysis showed that types of hospitals were significantly negatively associated with regions (R=-0.082, P < 0.05); trial procedures were significantly negatively correlated with years (R=-0.484, P < 0.001); compensat- ion was significantly positively correlated with years, regions, and treatment attributes (R = 0.098-0.294, P < 0.001) and negatively correlated with trial procedures (R=-0.090, P < 0.01); regression analysis showed that years, treatment attributes, and regions were the main factors affecting the CMDLD (P < 0.05). CONCLUSIONS Years, regions, treatment attributes, and trial procedures affect the outcome of CMDLD. This paper further puts forward relevant suggestions and countermeasures for the governance of doctor-patient risks based on the empirical results. Including rational allocation of medical resources to narrow the differences between regions; promoting the expansion and sinking of high-quality resources to improve the level of medical services in hospitals at all levels; and developing a third-party negotiation mechanism for medical disputes to reduce the cost of medical litigation.
Collapse
Affiliation(s)
- Hui Li
- School of Health Care Management, Anhui Medical University, 230032, Hefei, China
| | - Limin Li
- School of Health Care Management, Anhui Medical University, 230032, Hefei, China
| | - Tong Liu
- School of Health Care Management, Anhui Medical University, 230032, Hefei, China
| | - Meiqiong Tan
- The Second Clinical Medical College, Anhui Medical University, 230032, Hefei, China
| | - Wanwan He
- The Second Clinical Medical College, Anhui Medical University, 230032, Hefei, China
| | - Yuzhu Luo
- The Second Clinical Medical College, Anhui Medical University, 230032, Hefei, China
| | - Xuerong Zhong
- The Second Clinical Medical College, Anhui Medical University, 230032, Hefei, China
| | - Liping Zhang
- School of Marxism, Anhui Medical University, 230032, Hefei, China.
| | - Jiangjie Sun
- School of Health Care Management, Anhui Medical University, 230032, Hefei, China.
- School of Management, Hefei University of Technology, 230039, Hefei, China.
| |
Collapse
|
2
|
Dube AR, Ortega P, Hardin DM, Hardin K, Martinez F, Shah M, Naimi BR, Esteban-González AI, Dickmeyer J, Ruggiero D, Abraham V, Diamond LC, Cowden JD. Improving Assessment and Learning Environments for Graduate Medical Trainees to Advance Healthcare Language Equity. J Gen Intern Med 2024; 39:696-705. [PMID: 38093027 DOI: 10.1007/s11606-023-08527-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/02/2023] [Indexed: 03/28/2024]
Abstract
Language-appropriate care is critical for equitable, high-quality health care, but educational standards to assure graduate medical trainees are prepared to give such care are lacking. Detailed guidance for graduate medical education is provided by the Accreditation Council for Graduate Medical Education through the following: (1) an assessment framework for competencies, subcompetencies, and milestones for trainees and (2) the Clinical Learning Environment Review (CLER) Pathways for assessment of trainees' learning environments. These tools do not include a robust framework to evaluate trainees' abilities to offer language-appropriate care. They also do not address the learning environment's potential to support such care. A multidisciplinary group of linguistic, medical, and educational experts drafted a new subcompetency with milestones and an expanded CLER Pathway to highlight the importance of equitable care for patients who prefer languages other than English. These resources offer residency and fellowship programs tools to guide assessment, curriculum development, and learning-environment improvements related to language-appropriate care. Recognizing that programs have unique needs and resources, we propose a range of initial actions to address language equity. A focus on language diversity in the learning environment can have a broad and lasting impact on care quality, patient safety, and health equity.
Collapse
Affiliation(s)
- Amanda R Dube
- Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Pilar Ortega
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | | | - Francisco Martinez
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Madhura Shah
- Boston University School of Medicine, Boston, MA, USA
| | | | | | - Jodi Dickmeyer
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Veronica Abraham
- F Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Lisa C Diamond
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John D Cowden
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| |
Collapse
|
3
|
Wets C, Bracke P, Delaruelle K, Ceuterick M. 'Through a kaleidoscope': A Foucauldian discourse analysis of Belgian policy regarding patients with a migration background and depression in general practices. Health (London) 2023:13634593231211519. [PMID: 38049974 DOI: 10.1177/13634593231211519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
A higher prevalence of depression is found among patients with a migration background within the Belgian population. Nevertheless, this group is underrepresented in ambulant and residential mental health care services. Since general practitioners (GPs) have a crucial gatekeeping role, this led some researchers to investigate the possibility of a provider bias influencing GPs' assessment and referral of depressed patients with a migration background. However, GPs' accounts may be influenced by wider professional discourses present at the policy level, which are inevitably linked to institutions regulating the conduct of GPs. Therefore, this study applied a Foucauldian discourse analysis (a) to identify broader professional discourses in Belgian policy documents regarding patients with a migration background and depression in general practices, (b) to examine how patients with a migration background are discursively positioned and (c) to investigate which different balances of power in the relationship between GPs and patients with a migration background are demonstrated in the identified discourses. We identified three recurring discourses: (a) the othering discourse, (b) the health literacy discourse, and (c) the person-centred discourse. Our analysis demonstrated that the former two discourses illustrate the perpetuation of a biomedical discourse. While the last discourse is aligned with a counter-discourse associated with the person-centred care model in health care. Consequently, our analysis demonstrated the construction of a contradictory discursive framework throughout the various policy documents on which GPs might rely when speaking about patients with a migration background suffering from depression.
Collapse
|
4
|
Cooper Z, Cleary S, Stelmach W, Zheng Z. Patient engagement in perioperative settings: A mixed method systematic review. J Clin Nurs 2023; 32:5865-5885. [PMID: 37073113 PMCID: PMC10946744 DOI: 10.1111/jocn.16709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/31/2023] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Patient engagement has emerged as a key focus in the research literature to facilitate patients' recovery. The term is commonly used by researchers, yet without working definitions. This lack of clarity is further complicated by the interchangeable use of a few terms. OBJECTIVES This systematic review aimed at identifying how patient engagement was conceptualised and operationalised in perioperative settings. METHODS MEDLINE, EMBASE, CINAHL and the Cochrane Library were searched for publications in English discussing patient engagement during the perioperative phase. Three reviewers conducted study selection and methodological assessment using Joanna Briggs Institute mixed methods review framework. Reflexive thematic analysis was used to analyse qualitative data and descriptive analysis for quantitative data. FINDINGS Twenty-nine studies were included with a total sample of 6289. Study types included qualitative (n = 14) and quantitative (n = 15) with different types of surgery. Sample sizes ranged from n = 7 to n = 1315. Only 38% (n = 11) of included studies offered an explicit definition. Four themes associated with operationalisation included provision of information, which was most studied theme, communication, decision-making and action-taking behaviours. All four themes were interconnected and co-dependent on each other. CONCLUSIONS Patient engagement in perioperative settings is a complex and multifaceted concept. The conceptual void in the literature calls for more theoretically informed and comprehensive approaches to researching surgical patient engagement. Future research should aim to better understand the factors that influence patient engagement, as well as the impact of different forms of engagement on patient outcomes through the whole surgical journey of a patient.
Collapse
Affiliation(s)
- Zahra Cooper
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM)RMIT UniversityVictoriaBundooraAustralia
| | - Sonja Cleary
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM)RMIT UniversityVictoriaBundooraAustralia
| | - Wanda Stelmach
- Department of SurgeryNorthern HealthVictoriaEppingAustralia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM)RMIT UniversityVictoriaBundooraAustralia
| |
Collapse
|
5
|
Leij-Halfwerk S, van Uden D, Jooren SJA, van den Brink G. Cultural competence of dutch physician assistants: an observational cohort study. BMC MEDICAL EDUCATION 2023; 23:142. [PMID: 36869323 PMCID: PMC9983151 DOI: 10.1186/s12909-023-04112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Current cultural competence training needs were assessed as baseline measurement in Dutch physician assistant (PA) students and PA alumni that were not specifically trained in cultural competence. In particular, differences in cultural competency between PA students and PA alumni were assessed. METHODS In this cross-sectional, observational cohort study knowledge, attitude, and skills and self-perceived overall cultural competence were assessed in Dutch PA students and alumni. Demographics, education and learning needs were collected. Total cultural competence domain scores as well as percentage of maximum scores were calculated. RESULTS A total of 40 PA students and 96 alumni (female:75%; Dutch origin:97%) consented to participate. Cultural competence behavior was moderate in both groups. In contrast, general knowledge and exploration of patients' social context were insufficient, i.e., 53% and 34%, respectively. Self-perceived cultural competence was significantly higher in PA alumni (6.5 ± 1.3, mean ± SD) than in students (6.0 ± 1.3; P < 0.05). Low heterogeneity among PA students and educator exists. Seventy percent of the respondents considers cultural competence important and the majority expressed a need for cultural competence training. CONCLUSIONS Dutch PA students and alumni have moderate overall cultural competence, but insufficient knowledge and exploring social context. Based on these outcomes the curriculum of the master of science program for physician assistant will be adapted.Emphasis should be made to increase the diversity of PA students to stimulate cross-cultural learning and developing a diverse PA workforce.
Collapse
Affiliation(s)
- Susanne Leij-Halfwerk
- Master Physician Assistant, HAN University of Applied Sciences, Verlengde Groenestraat 75, 6525EJ, Nijmegen, The Netherlands.
- Diakonessenhuis Hospital, Herculesplein 32-34, 3584 AA Utrecht, P.O. Box 80250, 3508 TG, Utrecht, The Netherlands.
| | - Daniëlla van Uden
- Master Physician Assistant, HAN University of Applied Sciences, Verlengde Groenestraat 75, 6525EJ, Nijmegen, The Netherlands
| | - Sophie J A Jooren
- Master Physician Assistant, HAN University of Applied Sciences, Verlengde Groenestraat 75, 6525EJ, Nijmegen, The Netherlands
| | - Geert van den Brink
- Master Physician Assistant, HAN University of Applied Sciences, Verlengde Groenestraat 75, 6525EJ, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Parker MN, Lavender JM, Schvey NA, Tanofsky-Kraff M. Practical Considerations for Using the Eating Disorder Examination Interview with Adolescents. Adolesc Health Med Ther 2023; 14:63-85. [PMID: 36860931 PMCID: PMC9969870 DOI: 10.2147/ahmt.s220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular considerations regarding the EDE that warrant attention, including in its use with adolescents. The aims of this paper are therefore to: 1) provide a brief overview of the interview itself, as well as a description of its origin and underlying conceptual framework; 2) describe relevant factors for administering the interview with adolescents; 3) review potential limitations regarding use of the EDE with adolescents; 4) address considerations for using the EDE with pertinent subpopulations of adolescents who may experience distinct eating disorder symptoms and/or risk factors; and 5) discuss the integration of self-report questionnaires with the EDE. Advantages of using the EDE include the ability for interviewers to clarify complex concepts and mitigate inattentive responding, enhanced orientation to the interview timeframe to improve recall, increased diagnostic accuracy compared to questionnaires, and accounting for potentially salient external factors (eg, food/eating rules imposed by a parent/guardian). Limitations include more extensive training requirements, greater assessment burden, variable psychometric performance across subgroups, lack of items evaluating muscularity-oriented symptoms and avoidant/restrictive food intake disorder diagnostic criteria, and lack of explicit consideration for salient risk factors other than weight and shape concerns (eg, food insecurity).
Collapse
Affiliation(s)
- Megan N Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA,The Metis Foundation, San Antonio, TX, USA,Correspondence: Jason M Lavender, Military Cardiovascular Outcomes Research Program, 4301 Jones Bridge Road, Building 17, Suite 2A, Bethesda, MD, 20814, USA, Email
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA
| |
Collapse
|
7
|
Shabnam J, Timm HU, Nielsen DS, Raunkiaer M. Development of a complex intervention (safe and secure) to support non-western migrant patients with palliative care needs and their families. Eur J Oncol Nurs 2023; 62:102238. [PMID: 36459811 DOI: 10.1016/j.ejon.2022.102238] [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: 09/20/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE International evidence supports the benefits of early use of palliative care, although the best use of services is often under-utilised among Danish migrants. The study aims to develop a theoretically informed, evidence-based intervention to increase support in palliative care service provision among non-western migrant patients with a life-threatening disease and their families in Denmark. METHODS The overall approach was guided by the United Kingdom Medical Research Council framework for developing and evaluating complex interventions by involving stakeholders for example patients, family caregivers, and healthcare professionals. The intervention was developed iteratively by incorporating theory and evidence. Evidence was synthesized from a systematic review, semi-structured interviews, and group discussions with patients (n = 8), family caregivers (n = 11), healthcare professionals (n = 10); and three workshops with migrants (n = 5), social and healthcare professionals (n = 6). The study took place in six different settings in two regions across Denmark. RESULTS The safe and secure complex intervention is a healthcare professional (e.g. nurse, physiotherapist, or occupational therapist) led patient-centred palliative care intervention at the basic level. The final intervention consists of three components 1. Education and training sessions, 2. Consultations with the healthcare professional, and 3. Coordination of care. CONCLUSION This study describes the development of a supportive palliative care intervention for non-western migrant patients with palliative care needs and their families, followed by a transparent and systematic reporting process. A palliative care intervention combining multiple components targeting different stakeholders, is expected that safe and secure is more suitable and well customized in increasing access and use of palliative care services for non-western migrant families in Denmark.
Collapse
Affiliation(s)
- Jahan Shabnam
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Helle Ussing Timm
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, K, Denmark; University Hospitals Center for Health Research (UCSF), Rigshospital, Denmark.
| | - Dorthe Susanne Nielsen
- Geriatric Department G, Odense, Odense University Hospital, Kløvervænget 23, 5000, Odense C, Denmark.
| | - Mette Raunkiaer
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| |
Collapse
|
8
|
Leung DSY, Ku BHB. Health-seeking, intercultural health communication, and health outcomes: An intersectional study of ethnic minorities' lived experiences. J Adv Nurs 2023; 79:1856-1867. [PMID: 36703289 DOI: 10.1111/jan.15568] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/28/2023]
Abstract
AIMS To explore ethnic minorities' lived experiences of health-seeking and healthcare utilization in Hong Kong, and to examine the impact of intersectionality of sociocultural identities on intercultural health communication. DESIGN Qualitative exploratory design. METHODS Data collection methods were semi-structured interviews, unstructured observations, and unstructured informal group discussions. Twenty-five informants, including eight Pakistanis, seven Nepalese, five Indians, four Bangladeshis and one Sri Lankan, were recruited using the snowball sampling method and individually interviewed between 25th June and 23rd September 2019. RESULTS Sixteen females and nine males, aged 21-76 years, were in the study. Two-thirds could communicate in English, but eight required interpreters. Thematic analysis reveals four factors affecting intercultural health communication: healthcare professionals' cultural insensitivity, red-tapism and ethnic minorities' language improficiency and/or deficiency in medical knowledge. Health professionals' workplace stress and cultural insensitivity prompt ineffective intercultural communication, making ethnic minority patients feel disrespected despite having adopted the Hong Kong culture. The intersectionality of sociocultural identities plus health professionals' blocking behaviours results in health inequalities. CONCLUSION The unequal power relationship between health professionals and ethnic minority patients may lead to dehumanizing and depersonalized experiences for patients, as humanity is the heart and soul of medicine. Therefore, the government should raise healthcare providers' cultural sensitivity and diversity awareness, and offer ethno-specific care and more interpretation services. IMPACT The study addresses health inequalities among Hong Kong ethnic minority patients with different sociocultural identities. About the impact of ineffective intercultural health communication on health inclusion and health outcomes, policies and practices should ameliorate health professionals' cultural sensitivity, awareness of the unequal power relationship and respect for diversity. PATIENT OR PUBLIC CONTRIBUTION Referred by organizations serving ethnic minorities, the minority patients shared their lived experiences in health-seeking.
Collapse
Affiliation(s)
- Dion Sik-Yee Leung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Ben Hok-Bun Ku
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| |
Collapse
|
9
|
"Don't let me be misunderstood": communication with patients from a different cultural background. Pediatr Nephrol 2023; 38:643-649. [PMID: 35930048 PMCID: PMC9842546 DOI: 10.1007/s00467-022-05573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 01/21/2023]
Abstract
In recent years, migration and the social changes associated with it have increasingly become the focus of scientific interest. The diversity of cultures in hospitals poses a major challenge. Medical teams are often confronted with language barriers and different concepts of illness, health, and healing. The field is wide, and in addition to foreign language skills, primarily human skills such as self-awareness, communication, and empathy are demanded. Religion also plays a role in medical care for patients with a foreign cultural background. This work is intended to provide an overview of the scientifically based necessary skills in dealing with this patient clientele and to give an insight into the personal experiences of the authors. After many years of dealing with intercultural care of patients, this experience has shown one thing above all: Sometimes, it is beyond language and just needs humanity.
Collapse
|
10
|
Alpert EN, Clark T, Garcia-Alcaraz C, Eddington SN, Carrizosa C, Haughton J, de la Torre CL, Garcia-Bigley F, Arredondo EM, Ramers C, Nodora J, Wells KJ. Comparing Latino Community Members' and Clinical Staff's Perspectives on Barriers and Facilitators to Colorectal Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1645-1653. [PMID: 33893616 PMCID: PMC8536794 DOI: 10.1007/s13187-021-02007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
Latinos in the United States have low rates of colorectal cancer (CRC) screening even though CRC is the third leading cause of cancer death among Latinos. This qualitative study aimed to understand and compare the perspectives of clinical staff (CS) and Latino community members (LCMs) in an urban Southern California community regarding barriers and facilitators of CRC screening. Through purposive sampling, 39 LCMs (mean age: 59.4 years, 79.5% female) were recruited to participate in one of five focus groups, and 17 CS (mean age: 38.8 years, 64.7% female) were recruited to participate in semi-structured in-depth interviews, along with a demographic survey. Interviews and focus group recordings were transcribed verbatim, translated, and analyzed using direct content analysis. Demographic data were summarized using descriptive statistics. Findings suggest that CS and LCMs have both similar and opposing perspectives with regard to barriers and facilitators of CRC screening. Themes discussed included attitudes towards CRC screening, CRC knowledge, access to resources, commitments and responsibilities, social support, vicarious learning, patient-provider communication, trust, and social relationships. Study findings can be used to guide interventions and policies to improve access to CRC screening among LCMs.
Collapse
Affiliation(s)
- Elizabeth N Alpert
- San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA
- UC San Diego Moores Cancer Center, San Diego, CA, USA
| | - Tatiana Clark
- San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA
| | | | | | | | - Jessica Haughton
- San Diego State University Research Foundation, San Diego, CA, USA
| | | | | | - Elva M Arredondo
- San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA
| | | | | | - Kristen J Wells
- San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120-4913, USA.
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| |
Collapse
|
11
|
Uhlin K, Persson E, Stålnacke BM, Löfgren M. Healthcare professionals' experiences and perspectives of team-based interdisciplinary pain rehabilitation with immigrants requiring an interpreter. A qualitative study. Disabil Rehabil 2022:1-12. [PMID: 35996890 DOI: 10.1080/09638288.2022.2111608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE There is a lack of knowledge about interprofessional rehabilitation for culturally diverse patients with chronic pain. This study explores experiences of healthcare professionals developing and working with rehabilitation with patients in need of an interpreter and their experience of working with interpreters. METHODS Twelve healthcare professionals at two Swedish specialist rehabilitation centres were interviewed. Grounded theory principles were used for the data collection and analysis. RESULTS The main category "Demanding and Meaningful Work" represents three concurrently interacting categories: "Frustration" includes the informants' doubts regarding the benefits of the rehabilitation, lack of care for patients and cultural dissonance between professionals and patients. "Challenges" describes problems in the rehabilitation work due to the need for interpreted mediated communication, the complexity in health status and social aspects among the patients. "Solutions" represents practical working methods and personal approaches developed by the informants for managing frustrations and challenges. CONCLUSIONS The informants' frustration and challenges when working with a new group of patients, vulnerable and different in their preconceptions, led to new solutions in working methods and approaches. When starting a pain rehabilitation programme for culturally diverse patients, it is important to consider the rehabilitation team's need for additional time and support.IMPLICATIONS FOR REHABILITATIONHealthcare professionals who encounter immigrants with chronic pain need resources to develop their own skills in order to handle complex ethical questions as the patients represent a vulnerable patient group with many low status identitiesIn order to adapt rehabilitation programmes to patient groups with different languages and pre-understandings of chronic pain, there is a need for a team with specific qualities, i.e., close cooperation, an innovative atmosphere, time and also support from expertsFor appropriate language interpretation it is important to have a professional interpreter and a healthcare professional who are aware of and adopt the rules, possibilities and restrictions of interpretationThe rehabilitation of patients in need of language interpretation needs more time and organisation compared to the rehabilitation of patients who speak the national language.
Collapse
Affiliation(s)
- Karin Uhlin
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Elisabeth Persson
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Britt-Marie Stålnacke
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Monika Löfgren
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| |
Collapse
|
12
|
Chapman CR, Woo NT, Maluf KS. Preferred Communication Strategies Used by Physical Therapists in Chronic Pain Rehabilitation: A Qualitative Systematic Review and Meta-Synthesis. Phys Ther 2022; 102:6623303. [PMID: 35778939 PMCID: PMC9455645 DOI: 10.1093/ptj/pzac081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/12/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Lack of clarity regarding effective communication behaviors in chronic pain management is a barrier for implementing psychologically informed physical therapy approaches that rely on competent communication by physical therapist providers. This study aimed to conduct a systematic review and meta-synthesis to inform the development of a conceptual framework for preferred communication behaviors in pain rehabilitation. METHODS Ten databases in the health and communication sciences were systematically searched for qualitative and mixed-method studies of interpersonal communication between physical therapists and adults with chronic pain. Two independent investigators extracted quotations with implicit and explicit references to communication and study characteristics following Standards for Reporting Qualitative Research and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodological quality for individual studies was assessed with Critical Appraisal Skills Programme, and quality of evidence was evaluated with GRADE-CERQual. An inductive thematic synthesis was conducted by coding each quotation, developing descriptive themes, and then generating behaviorally distinct analytical themes. RESULTS Eleven studies involving 346 participants were included. The specificity of operationalizing communication terms varied widely. Meta-synthesis identified 8 communication themes: (1) disclosure-facilitating, (2) rapport-building, (3) empathic, (4) collaborative, (5) professional accountability, (6) informative, (7) agenda-setting, and (8) meta-communication. Based on the quality of available evidence, confidence was moderate for 4 themes and low for 4 themes. CONCLUSION This study revealed limited operationalization of communication behaviors preferred by physical therapists in chronic pain rehabilitation. A conceptual framework based on 8 communication themes identified from the literature is proposed as a preliminary paradigm to guide future research. IMPACT This proposed evidence-based conceptual framework for preferred communication behaviors in pain rehabilitation provides a framework for clinicians to reflect on their own communication practices and will allow researchers to identify if and how specific communication behaviors impact clinical outcomes.
Collapse
Affiliation(s)
- Chelsea R Chapman
- Joint Doctoral Program in Public Health, San Diego State University and University of California San Diego, San Diego, California, USA
| | - Nathan T Woo
- Department of Communication, University of Arizona, Tucson, Arizona, USA
| | | |
Collapse
|
13
|
Derksen C, Kötting L, Keller FM, Schmiedhofer M, Lippke S. Psychological Intervention to Improve Communication and Patient Safety in Obstetrics: Examination of the Health Action Process Approach. Front Psychol 2022; 13:771626. [PMID: 35250715 PMCID: PMC8894763 DOI: 10.3389/fpsyg.2022.771626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/19/2022] [Indexed: 01/23/2023] Open
Abstract
Background Human failure and a lack of effective communication are the main reasons for preventable adverse events, compromising patient safety in obstetrics. In order to improve safety, team and communication interventions have been implemented but lack feasibility in obstetric care. Psychological models such as the health action process approach might help to improve interventions. Methods In a cross-sectional online survey with N = 129 healthcare workers (Study 1) and a paper-pencil survey with N = 137 obstetric healthcare workers at two obstetric university hospitals (Study 2), associations of social-cognitive variables were tested in a path analysis and a multiple regression. Preliminary results informed a communication training for all obstetric healthcare workers. A repeated-measures MANOVA was used to compare pre- and post-intervention data. Results Social-cognitive variables were associated according to model suggestions (β = –0.26 to 0.45, p < 0.05) except for planning in the first study. Triggers of adverse events were associated (β = –0.41 to 0.24, p < 0.05) with communication behavior (Study 2), action self-efficacy and planning (Study 1), as well as barriers to effective communication (both studies). The intervention was rated positively (M = 3.3/4). Afterward, fewer triggers were reported and coping self-efficacy increased. There were group differences regarding hospital, experience, and time. Discussion The health action process approach was examined in the context of safe communication in obstetrics and can be used to inform interventions. A theory-based, short training was feasible and acceptable. Perceived patient safety improved but communication behavior did not. Future research should aim to test a more comprehensive psychological communication intervention in a thorough RCT design.
Collapse
Affiliation(s)
- Christina Derksen
- Health Psychology and Behavioral Medicine, Psychology and Methods, Jacobs University Bremen, Bremen, Germany
- *Correspondence: Christina Derksen,
| | - Lukas Kötting
- Health Psychology and Behavioral Medicine, Psychology and Methods, Jacobs University Bremen, Bremen, Germany
| | - Franziska Maria Keller
- Health Psychology and Behavioral Medicine, Psychology and Methods, Jacobs University Bremen, Bremen, Germany
| | - Martina Schmiedhofer
- Health Psychology and Behavioral Medicine, Psychology and Methods, Jacobs University Bremen, Bremen, Germany
- Coalition for Patient Safety e.V., Berlin, Germany
| | - Sonia Lippke
- Health Psychology and Behavioral Medicine, Psychology and Methods, Jacobs University Bremen, Bremen, Germany
| |
Collapse
|
14
|
Mosed H, Periord M, Caboral-Stevens M. A concept analysis of intercultural communication. Nurs Forum 2021; 56:993-999. [PMID: 34076902 DOI: 10.1111/nuf.12622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/22/2021] [Accepted: 05/20/2021] [Indexed: 06/12/2023]
Abstract
AIM To explore the concept of intercultural communication. BACKGROUND As global migration increases, countries around the world are starting to see diversity among their population. With this increasing multicultural society, effective communication is crucial, particularly in the area of healthcare. Intercultural nursing requires nurses to care for patients of various cultural backgrounds by considering their cultural needs. It is critical for nurses to be able to communicate effectively with patients of various cultures to provide care that is holistic and culturally appropriate to the diverse population. METHODS Walker and Avant's eight-step approach to concept analysis. RESULTS Intercultural communication in nursing is face-to-face, verbal or nonverbal communication that occurs between people of different cultures. Its defining attributes are (1) meeting between language and culture for a specific purpose and (2) face-to-face (in-person or virtual) human interaction between individuals from different cultures. Antecedents of intercultural communication in nursing are globalization, technology, and social environment. Consequences include reduced ethnocentrism and negative stereotyping. Empirical referents depict the existence of the concept, which includes several tools developed as a means to measure or evaluate intercultural communication. CONCLUSION This study presented the defining attributes, antecedents and consequences, model case, and empirical referents of intercultural communication.
Collapse
Affiliation(s)
- Hameedah Mosed
- School of Nursing, AGPCNP Program, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Madison Periord
- School of Nursing, AGPCNP Program, Eastern Michigan University, Ypsilanti, Michigan, USA
| | | |
Collapse
|
15
|
Engagement of Ethnic-Minority Consumers with Electronic Word of Mouth (eWOM) on Social Media: The Pivotal Role of Intercultural Factors. JOURNAL OF THEORETICAL AND APPLIED ELECTRONIC COMMERCE RESEARCH 2021. [DOI: 10.3390/jtaer16070144] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Social network sites (SNS) facilitate eWOM communication among consumers of different cultures. Building on contact theory and the theory of planned behavior, we propose a conceptual framework that integrates intercultural factors as predictors of minority consumers’ engagement with eWOM communicated by and to individuals of the dominant culture on social media. A partial least squares (PLS) analysis on data collected from the Israeli-Arab minority shows that intercultural factors (i.e., acculturation, social interaction, and language proficiency) are antecedents of minority consumer engagement with eWOM. However, this relationship is mediated by consumer beliefs (attitudes, subjective norms, and perceived behavioral control) concerning this behavior, and moderated by the cultural distance between minority and dominant culture consumers. The findings help marketers plan marketing communications that engage audiences meaningfully and generate positive eWOM when targeting ethnic-cultural minorities. The current study contributes to our understanding of minority consumers’ engagement with eWOM communicated by and to members of the hegemonic culture. It further contributes to consumer engagement theory and acculturation research by supporting the post-assimilationist view. The proposed model is highly valuable in light of the importance of the concept of consumer engagement in marketing research.
Collapse
|
16
|
Simon MA, Tom LS, Taylor S, Leung I, Vicencio D. 'There's nothing you can do … it's like that in Chinatown': Chinese immigrant women's perceptions of experiences in Chicago Chinatown healthcare settings. ETHNICITY & HEALTH 2021; 26:893-910. [PMID: 30691290 PMCID: PMC6933085 DOI: 10.1080/13557858.2019.1573973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/24/2018] [Indexed: 06/09/2023]
Abstract
Objectives: Chinese American women living in linguistically isolated communities are among the least likely to utilize healthcare services. Qualitative research methods can help identify health system vulnerability points to improve local healthcare delivery for this population.Design: We conducted 6 focus groups among 56 Chinese-speaking adult women in Chicago's Chinatown between July and August 2014 to explore their perceptions of experiences receiving medical care and interacting with healthcare providers in Chinatown healthcare settings.Results: Health system/clinic infrastructure and patient-provider communications were perceived barriers to care at Chinatown healthcare settings. Chinese participants reported long wait times, difficulty scheduling appointments, and poor front desk customer service. Communication difficulties at Chinatown healthcare settings involved language barriers with non-Chinese-speaking providers, but consideration for healthcare providers, provider demeanor, and reliance on provider recommendation also hindered patient-provider communications.Conclusions: Findings improve understanding of barriers to care experienced by Chinese immigrant women in one urban Chinatown community.
Collapse
Affiliation(s)
- Melissa A. Simon
- Departments of Obstetrics & Gynecology and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, USA
| | - Laura S. Tom
- Departments of Obstetrics & Gynecology and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Shaneah Taylor
- Departments of Obstetrics & Gynecology and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Ivy Leung
- Chinese American Service League, Chicago, USA
| | | |
Collapse
|
17
|
Silvera-Tawil D, Pocock C, Bradford D, Donnell A, Freyne J, Harrap K, Brinkmann S. Enabling Nurse-Patient Communication With a Mobile App: Controlled Pretest-Posttest Study With Nurses and Non-English-Speaking Patients. JMIR Nurs 2021; 4:e19709. [PMID: 34406964 PMCID: PMC8373371 DOI: 10.2196/19709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 12/17/2020] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is growing concern regarding the implications of miscommunication in health care settings, the results of which can have serious detrimental impacts on patient safety and health outcomes. Effective communication between nurses and patients is integral in the delivery of timely, competent, and safe care. In a hospital environment where care is delivered 24 hours a day, interpreters are not always available. In 2014, we developed a communication app to support patients' interactions with allied health clinicians when interpreters are not present. In 2017, we expanded this app to meet the needs of the nursing workforce. The app contains a fixed set of phrases translated into common languages, and communication is supported by text, images, audio content, and video content. OBJECTIVE This study aims to evaluate the efficacy of the communication app to support nursing staff during the provision of standard care to patients from non-English-speaking backgrounds when an interpreter is not available. METHODS This study used a one-group pretest-posttest sequential explanatory mixed methods research design, with quantitative data analyzed using inferential statistics and qualitative data analyzed via thematic content analysis. A total of 134 observation sessions (82 pretest and 52 posttest) of everyday nurse-patient interactions and 396 app use sessions were recorded. In addition, a total of 134 surveys (82 pretest and 52 posttest) with nursing staff, 7 interviews with patients, and 3 focus groups with a total of 9 nursing staff participants were held between January and November 2017. RESULTS In the absence of the app, baseline interactions with patients from English-speaking backgrounds were rated as more successful (t80=5.69; P<.001) than interactions with patients from non-English-speaking backgrounds. When staff used the app during the live trial, interactions with patients from non-English-speaking backgrounds were rated as more successful than interactions without the app (F2,119=8.17; P<.001; η2=0.37). In addition, the level of staff frustration was rated lower when the app was used to communicate (t80=2.71; P=.008; r=0.29). Most participants indicated that the app assisted them in communicating. CONCLUSIONS Through the use of the app, a number of patients from non-English-speaking backgrounds experienced better provision of standard care, similar to their English-speaking peers. Thus, the app can be seen as contributing to the delivery of equitable health care.
Collapse
Affiliation(s)
- David Silvera-Tawil
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Marsfield, Australia
| | | | - DanaKai Bradford
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Pullenvale, Australia
| | | | - Jill Freyne
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Marsfield, Australia
| | - Karen Harrap
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | | |
Collapse
|
18
|
Atinga RA, Akosen G, Bawontuo V. Perceived characteristics of outpatient appointment scheduling association with patient satisfaction and treatment adherence: An innovation theory application. Hosp Pract (1995) 2021; 49:298-306. [PMID: 34121573 DOI: 10.1080/21548331.2021.1942878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite the growing interest in Appointment scheduling (APS) in hospitals of developing countries, empirical assessment of their effectiveness in improving patients' experiences and adherence to treatment remains limited. We drew on the attributes of an innovation theory to hypothesize and test the extent to which perceived attributes of APS: relative advantage, compatibility, and complexity influences patient satisfaction and treatment adherence in a neurology clinic of a large Teaching Hospital in Ghana. METHODS A structured questionnaire was used to collect cross-sectional data from a sample of 295 scheduled patients visiting the clinic for follow-up care. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to analyze the hypothesized direct relationships of the APS attributes with patient satisfaction and treatment adherence, and the moderating effect of cordial doctor-patient communication in the relationships. RESULTS While the compatibility of APS with patient preference was positively associated with patient satisfaction (p < 0.01) and adherence to treatment (p < 0.01), the reverse was observed for complexity of the APS system (p < 0.01). We also found statistically significant relationship of patient satisfaction with treatment adherence (p < 0.01) which was positively moderated by cordial doctor-patient communication. CONCLUSION Findings suggest that making the APS system more compatible with patient preference can greatly improve upon patient experience satisfaction and adherence to medical treatment for effective therapeutic outcomes. PRACTICE IMPLICATION In the light of its benefits to patient care and outcomes, APS should be given priority over walk-in services in specialty clinics of developing countries.
Collapse
Affiliation(s)
- Roger A Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Box Lg 78, University of Ghana Business School, Accra, Ghana
| | - Gifty Akosen
- Department of Public Administration and Health Services Management, University of Ghana Business School, Box Lg 78, University of Ghana Business School, Accra, Ghana
| | - Vitalis Bawontuo
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Sunyani, Ghana
| |
Collapse
|
19
|
Rossi MG, Vegni E, Menichetti J. Misunderstandings in ART Triadic Interactions: A Qualitative Comparison of First and Follow-Up Visits. Front Psychol 2021; 12:641998. [PMID: 34177696 PMCID: PMC8222821 DOI: 10.3389/fpsyg.2021.641998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Misunderstandings in medical interactions can compromise the quality of communication and affect self-management, especially in complex interactions like those in the assisted reproductive technology (ART) field. This study aimed to detect and describe misunderstandings in ART triadic visits. We compared first and follow-up visits for frequency, type, speakers, and topics leading to misunderstandings. Methods We purposively sampled 20 triadic interactions from a corpus of 85 visits. We used a previously developed coding scheme to detect different types of misunderstandings (i.e., with strong, acceptable, and weak evidence). We analyzed also the different topics leading to strong misunderstandings (direct expressions of lack of understanding, pragmatic alternative understandings, semantic alternative understandings) to provide insights about the contents of the consultation that may need particular attention and care. Findings We detected an overall number of 1078 misunderstandings in the 20 selected visits. First visits contained almost two-third of the misunderstandings (n = 680, 63%). First visits were particularly rich in misunderstandings with acceptable evidence (e.g., clarifications and checks for understanding), compared to follow-up visits. In first visits, doctors’ turns more frequently than couples’ turns contained misunderstandings, while in follow-up visits it was the other way around. Looking at the couple, the majority of the misunderstandings were expressed by the woman (n = 241, 22%) rather than by the man (n = 194, 18%). However, when weighting for their number of turns, 9% of the men’s turns included an expression of misunderstanding, compared to the 7% of the women’s turns. Finally, more than half of the misunderstandings with strong evidence were about history-taking and treatment-related topics, and while the history-taking ones were particularly frequent in first visits the treatment-related ones were more present in follow-up visits. Discussion Findings indicate that first visits may deserve particular attention to avoid misunderstandings, as they are the moment where a shared understanding can be harder to reach. In particular, misunderstandings happening in first visits seem mostly related to physicians having to reconstruct the clinical history of patients, while those in the follow-up visits seem to reflect residual and unsolved doubts from the couple, especially concerning treatments.
Collapse
Affiliation(s)
- Maria Grazia Rossi
- Instituto de Filosofia da Nova, Faculdade de Ciências Sociais e Humanas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Elena Vegni
- Santi Paolo and Carlo Hospital, University of Milan, Milan, Italy
| | - Julia Menichetti
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
20
|
Sasegbon A, Vasant DH. Understanding racial disparities in the care of patients with irritable bowel syndrome: The need for a unified approach. Neurogastroenterol Motil 2021; 33:e14152. [PMID: 33835634 DOI: 10.1111/nmo.14152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/23/2021] [Indexed: 12/14/2022]
Abstract
Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut-brain interaction, which significantly erodes the quality of life of those it affects. Recent studies have confirmed that its prevalence varies quite markedly between countries, implying that it is affected by cultural and socioeconomic factors. In an important study, Silvernale at al. have recently reported racial disparities including potential referral biases, with reduced opportunities to access specialist care and differing patterns of healthcare utilization affecting ethnic minority populations with IBS. Similar disparities have also been reported for other gastrointestinal disorders. In this paper, we, therefore, discuss the potential implications of such disparities and how they can impact clinical outcomes, and discuss ways in which this problem could be addressed, and highlighting areas for future research.
Collapse
Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Dipesh H Vasant
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK.,Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
21
|
Phillips S, Wyatt LC, Turner MM, Trinh-Shevrin C, Kwon SC. Patient-provider communication patterns among Asian American immigrant subgroups in New York City. PATIENT EDUCATION AND COUNSELING 2021; 104:1049-1058. [PMID: 33097362 PMCID: PMC8021612 DOI: 10.1016/j.pec.2020.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/22/2020] [Accepted: 10/02/2020] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Patient-provider communication is essential for patient-centered care, yet Asian American immigrant populations face barriers. We aim to describe: 1) patient-reported communication-related characteristics for 16 disaggregated Asian American subgroups; and 2) the association of patient comprehension of provider communication with socio-demographics, language proficiency and concordance, and perceived cultural sensitivity in this population. METHODS Descriptive statistics are presented for 1269 Asian American immigrants responding to cross-sectional, venue-sampled surveys conducted in New York City. Logistic regression models examine predictors of low comprehension of provider communication. RESULTS Approximately 11% of respondents reported low comprehension of provider communication: lowest among South Asians and highest among Southeast Asians. Eighty-four percent were language-concordant with their provider, 90.1% agreed that their provider understood their background and values, and 16.5% felt their provider looked down on them. Low comprehension of provider communication was significantly associated with Southeast Asian subgroup, less education, limited English proficiency, public health insurance, patient-provider language discordance, and perceived low cultural understanding. CONCLUSION Among our sample, language and cultural sensitivity are associated with comprehension of provider communication. PRACTICE IMPLICATIONS Strategies improving language access and cultural sensitivity may be important for Asian immigrant patients. These could include interpretation services, bilingual community-based providers, and cultural sensitivity training.
Collapse
Affiliation(s)
| | - Laura C Wyatt
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Monique M Turner
- Department of Communication, Michigan State University, East Lansing, MI, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Simona C Kwon
- Department of Population Health, New York University School of Medicine, New York, NY, USA.
| |
Collapse
|
22
|
Jager M, den Boeft A, Versteeg-Pieterse A, Leij-Halfwerk S, Pelgrim T, van der Sande R, van den Muijsenbergh M. Observing cultural competence of healthcare professionals: A systematic review of observational assessment instruments. PATIENT EDUCATION AND COUNSELING 2021; 104:750-759. [PMID: 33191059 DOI: 10.1016/j.pec.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Observational instruments are preferred for assessment of cultural competence. The aim of the current study is to identify observational instruments to assess cultural competence in healthcare providers and dieticians specifically and assess their psychometric properties. METHODS A systematic review was conducted in Cinahl, Cochrane, EMBASE, PsycInfo, Pubmed, and Web of Science using search terms related to cultural competency and measurement properties. Methodological quality of the selected studies of observational cultural competence instruments in dieticians, other healthcare professionals and psychological counsellors and the measurement properties of instruments were assessed using the COSMIN checklist. RESULTS From 11,913 articles, six articles on five instruments were selected. Instruments were targeted at health professionals and counsellors only, and designed for face-to-face communication (n = 4) or verbal responses to videotaped simulated interactions (n = 1). The instruments' content varied largely, with main focus on attitude, and little on knowledge and skills. The measurement properties were suboptimal. CONCLUSION No observational instrument are available to evaluate cultural competence of dieticians. Studies on psychometric properties of instruments targeted at other health professionals lack methodological rigour. PRACTICE IMPLICATIONS Future work should focus on developing an instrument that encompasses both 'general' cultural competences necessary for all healthcare professionals and dietetic specific competences.
Collapse
Affiliation(s)
- Mirjam Jager
- HAN University of Applied Sciences, Nutrition and Dietetics, Nijmegen, the Netherlands; HAN University of Applied Sciences, Primary and Community Care, Nijmegen, the Netherlands; Radboud University Medical Centre, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Andrea den Boeft
- University Medical Centre Utrecht, Internal Medicine and Dermatology, Department of Dietetics, Utrecht, the Netherlands
| | | | - Susanne Leij-Halfwerk
- HAN University of Applied Sciences, Nutrition and Dietetics, Nijmegen, the Netherlands
| | - Thomas Pelgrim
- HAN University of Applied Sciences, Primary and Community Care, Nijmegen, the Netherlands
| | - Rob van der Sande
- HAN University of Applied Sciences, Primary and Community Care, Nijmegen, the Netherlands; Radboud University Medical Centre, Department of Primary and Community Care, Nijmegen, the Netherlands
| | - Maria van den Muijsenbergh
- Radboud University Medical Centre, Department of Primary and Community Care, Nijmegen, the Netherlands; Pharos, National Centre of Expertise on Health Disparities, Utrecht, the Netherlands
| |
Collapse
|
23
|
Hinnant A, Boman CD, Hu S, Ashley RR, Lee S, Dodd S, Garbutt JM, Cameron GT. The Third Rail of Pediatric Communication: Discussing Firearm Risk and Safety in Well-Child Exams. HEALTH COMMUNICATION 2021; 36:508-520. [PMID: 31833783 PMCID: PMC7771016 DOI: 10.1080/10410236.2019.1700883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This research endeavors to understand how pediatricians and parents discuss - or do not discuss - firearm risks for children during well-child visits. Through individual semi-structured interviews with 16 pediatric providers and 20 parents, the research explores discursive barriers to open conversation, perspectives on anticipatory guidance, and new ideas for culturally competent messaging. The research focuses particularly on how parents' and providers' perspectives on firearm risk communication are tied to cultural norms and expectations. One salient theme that emerged is that the American Academy of Pediatrics recommendation that pediatricians ask parents about ownership status is deemed undesirable by pediatricians and parents because of the delicate intercultural setting. Born out of pediatric and parent experiences, and mindful of culturally salient barriers, this study offers alternative strategies for discussing firearm risk in well-child exams.
Collapse
Affiliation(s)
| | | | - Sisi Hu
- School of Journalism, University of Missouri
| | | | | | - Sherry Dodd
- Department of Pediatrics, Washington University School of Medicine
| | - Jane M Garbutt
- Departments of Medicine and Pediatrics, Washington University School of Medicine
| | | |
Collapse
|
24
|
Blackwell L, Gower NT, Patel R. Experiences of language barriers by homoeopathy student interns providing health services at the University of Johannesburg. Health SA 2021; 26:1491. [PMID: 33936785 PMCID: PMC8063548 DOI: 10.4102/hsag.v26i0.1491] [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: 06/03/2020] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background South Africa is a multilingual society, and therefore, the likelihood of healthcare providers (HCPs), including students training to be HCPs, encountering language barriers with patients is high. Aim To explore and describe the experiences of homoeopathy student interns regarding language barriers in the delivery of health services and to provide guidance towards overcoming language barriers in homoeopathic practice at the University of Johannesburg (UJ). Setting The interviews and focus group discussions were conducted in English and at a private location that was convenient for the participants in Johannesburg, Gauteng. Methods This qualitative study used a phenomenological approach. Ten individual interviews were conducted with registered homoeopathy student interns (HSIs) from the UJ. The central question: ‘What has your experience been regarding language barriers between you and your patients at the UJ Homoeopathy clinics?’ was asked and responses were recorded and transcribed for later analysis. The interview results were presented to a focus group for discussion to validate findings that arose from the analysis and to provide an opportunity to add any insight, comment or recommendations that were not expressed in individual interviews and verification of emergent themes. Results Participants described how language barriers create challenges in understanding between patients and HSIs. Descriptions of the experiences of the intrapersonal and interpersonal effects that are associated with language barriers were provided. Participants also described the influence of language barriers on the various aspects of the health service process. Finally, participants described the mitigation of language barriers through various strategies. Conclusion Participants reported their experiences of language barriers as challenging. Language barriers were found to adversely affect the various aspects of the health service process as well as the practitioner’s personal feelings and the patient–practitioner relationship. Language acquisition and awareness modules introduced early on in the syllabus is a proposed solution to the mitigation of language barriers.
Collapse
Affiliation(s)
- Lorna Blackwell
- Department of Complementary Medicine, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Neil T Gower
- Department of Complementary Medicine, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Reshma Patel
- Department of Complementary Medicine, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
25
|
Intercultural Communication between Long-Stay Immigrants and Catalan Primary Care Nurses: A Qualitative Approach to Rebalancing Power. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062851. [PMID: 33799637 PMCID: PMC7999544 DOI: 10.3390/ijerph18062851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022]
Abstract
There is a gap between the preferences of immigrant patients and their experiences with intercultural communication. This study aims to explore the experiences and perspectives of long-stay immigrants on intercultural communication in encounters with primary care (PC) nurses. Participants were selected by purposive sampling at the Maresme Primary Care Center. A focus group and five in-depth interviews with long-stay immigrants from eight countries were carried out. Data collection was guided by a script previously validated by a group of experts. We conducted a qualitative analysis following Charmaz's approach, and data saturation was reached with 11 patients (one focus group and five interviews). Long-stay immigrants would like closer and more personalized communication exchanges with greater humanity, as well as polite and respectful manners as they perceive signs of an asymmetrical care relationship. Those who had negative communication experiences tried to justify some of the behaviors as a result of having free access to public health services. This is one of the few existing studies from the point of view of long-stay immigrants. Achieving effective intercultural communication requires a process of self-reflection, awareness-raising and commitment, both on a personal and institutional level, to eliminate the asymmetry in the nurse-patient relationship. Nurses should be trained in person-centered intercultural communication.
Collapse
|
26
|
Zakaria M, Karim R, Rahman M, Cheng F, Xu J. Disparity in physician-patient communication by ethnicity: evidence from Bangladesh. Int J Equity Health 2021; 20:65. [PMID: 33627120 PMCID: PMC7903718 DOI: 10.1186/s12939-021-01405-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background Physician-patient communication behavior (PPCB) is the primary process by which medical decision-making occurs and health outcome depends. Physician-patient communication differences may partly from the ethnic disparities. To examine this problem, this study aims to explore whether physician-patient communication differs by ethnicity during primary care medical consultations. Methods The study was conducted among the Bengali and ethnic minority patients (N = 850) who visited a physician for medical consultations. Data were collected using a structured post-consultation questionnaire. T-test was conducted to compare the communication between the Bengali and ethnic minority patients. Multiple linear regression analyses were performed to identify the factors associated with favorable communication behavior from the physicians. Results Bengali patients received more supportive communication behaviors from the Bengali doctors than that of ethnic minority patients including physicians’ cheerful greetings, encouraging patients to express health problems and asking questions, listening carefully, responding to questions and concerns, explaining to patients about medical examination procedures, medication, probable side effects, discussing treatment options, involved the patients in decisions, and spending adequate time. Results of linear regression showed that respondents’ level of education, internet use, knowledge about the health issue, having a pre-organized plan about the content of medical consultation, information seeking about the health problem, visiting female doctors, and a quiet ambience of the doctor’s room are significantly associated with a better PPCB score for the Bengali patients. In contrast, age, being the resident of an urban area, perception of affecting a minor health problem, having a pre-organized plan about the content of medical consultation, patients’ involvement in physicians’ decision-making about the treatment, and talking time resulted in better physician-patient communication for the ethnic minority patients. Conclusion This study suggests that reducing disparity in the socio-economic status of the ethnic minority groups through development programs and educating healthcare providers on how to use patient-centered communication skills to engage with their patients is one solution to improve equity in the delivery of healthcare and ensure than patients are receiving high-quality treatment, no matter their race or ethnicity.
Collapse
Affiliation(s)
- Muhammad Zakaria
- Department of Communication and Journalism, University of Chittagong, Chittagong, 4331, Bangladesh
| | - Rezaul Karim
- Department of Communication and Journalism, University of Chittagong, Chittagong, 4331, Bangladesh
| | - Murshida Rahman
- Department of English, Hamdard University Bangladesh, Munshiganj, 1510, Bangladesh
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Junfang Xu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| |
Collapse
|
27
|
van Eenennaam RM, Kruithof WJ, van Es MA, Kruitwagen-van Reenen ET, Westeneng HJ, Visser-Meily JMA, van den Berg LH, Beelen A. Discussing personalized prognosis in amyotrophic lateral sclerosis: development of a communication guide. BMC Neurol 2020; 20:446. [PMID: 33308184 PMCID: PMC7734773 DOI: 10.1186/s12883-020-02004-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Personalized ENCALS survival prediction model reliably estimates the personalized prognosis of patients with amyotrophic lateral sclerosis. Concerns were raised on discussing personalized prognosis without causing anxiety and destroying hope. Tailoring communication to patient readiness and patient needs mediates the impact of prognostic disclosure. We developed a communication guide to support physicians in discussing personalized prognosis tailored to individual needs and preferences of people with ALS and their families. METHODS A multidisciplinary working group of neurologists, rehabilitation physicians, and healthcare researchers A) identified relevant topics for guidance, B) conducted a systematic review on needs of patients regarding prognostic discussion in life-limiting disease, C) drafted recommendations based on evidence and expert opinion, and refined and finalized these recommendations in consensus rounds, based on feedback of an expert advisory panel (patients, family member, ethicist, and spiritual counsellor). RESULTS A) Topics identified for guidance were 1) filling in the ENCALS survival model, and interpreting outcomes and uncertainty, and 2) tailoring discussion to individual needs and preferences of patients (information needs, role and needs of family, severe cognitive impairment or frontotemporal dementia, and non-western patients). B) 17 studies were included in the systematic review. C) Consensus procedures on drafted recommendations focused on selection of outcomes, uncertainty about estimated survival, culturally sensitive communication, and lack of decisional capacity. Recommendations for discussing the prognosis include the following: discuss prognosis based on the prognostic groups and their median survival, or, if more precise information is desired, on the interquartile range of the survival probability. Investigate needs and preferences of the patients and their families for prognostic disclosure, regardless of cultural background. If the patient does not want to know their prognosis, with patient permission discuss the prognosis with their family. If the patient is judged to lack decisional capacity, ask the family if they want to discuss the prognosis. Tailor prognostic disclosure step by step, discuss it in terms of time range, and emphasize uncertainty of individual survival time. CONCLUSION This communication guide supports physicians in tailoring discussion of personalized prognosis to the individual needs and preferences of people with ALS and their families.
Collapse
Affiliation(s)
- Remko M van Eenennaam
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willeke J Kruithof
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Michael A van Es
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Esther T Kruitwagen-van Reenen
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Henk-Jan Westeneng
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anita Beelen
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands. .,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
| |
Collapse
|
28
|
Jiang Y, Shi L, Cao J, Zhu L, Sha Y, Li T, Ning X, Hong X, Dai X, Wei J. Effectiveness of clinical scenario dramas to teach doctor-patient relationship and communication skills. BMC MEDICAL EDUCATION 2020; 20:473. [PMID: 33243247 PMCID: PMC7689996 DOI: 10.1186/s12909-020-02387-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 11/19/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND The doctor-patient relationship in China has deteriorated in recent years, and poor doctor-patient communication is one of the main reasons. How to effectively carry out doctor-patient communication training originated from the West among Chinese medical students still to be studied. In the past decade, Peking Union Medical College has adopted clinical scenario drama to teach doctor-patient relationship and clinical communication skills. The aim of this study was to introduce clinical scenario dramas and evaluate its effectiveness in promoting doctor-patient relationships and clinical communication skills through students' self-perceptions in Chinese medical students. METHODS This study was a retrospective, self-controlled study and conducted from March 2009 to October 2018. Doctor-patient relationship and communication skills training were administered to all sixth-year medical students, which involved lectures and various clinical scenario dramas. The program totaled 24 h, of which each class session was 3 h, with 8 sessions in total. All students were requested to complete an anonymous 5 likert self-rating survey including self-confidence in using communication skills and self-perceived learning attitude and ability before and at the end of the course. In addition, they were requested to evaluate the curriculum after completion of the course. RESULTS Clinical scenario dramas helped students improve their self-confidence in clinical communication skills except for psychosomatic history taking (p < 0.05). The interests for participation in clinical scenario dramas were higher compared to attending lectures (4.39 ± 0.610 Vs 4.07 ± 0.831, p<0.01). Study participants were highly satisfied in the course setting, teaching instructors and content (4.61 ± 0.546, 4.65 ± 0.535, 4.63 ± 0.534). The self-evaluation results demonstrated that clinical scenario dramas improved the learning ability of medical students (p < 0.05). CONCLUSION The use of clinical scenario dramas was helpful in teaching doctor-patient communication skills.
Collapse
Affiliation(s)
- Yinan Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730 PR China
| | - Lili Shi
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730 PR China
| | - Jinya Cao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730 PR China
| | - Liming Zhu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730 PR China
| | - Yue Sha
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730 PR China
| | - Tao Li
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730 PR China
| | - Xiaohong Ning
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng District, Beijing, 100730 PR China
| | - Xia Hong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730 PR China
| | - Xiaoyan Dai
- International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng District, Beijing, 100730 PR China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730 PR China
| |
Collapse
|
29
|
Goldstein P, Losin EAR, Anderson SR, Schelkun VR, Wager TD. Clinician-Patient Movement Synchrony Mediates Social Group Effects on Interpersonal Trust and Perceived Pain. THE JOURNAL OF PAIN 2020; 21:1160-1174. [PMID: 32544602 PMCID: PMC7722052 DOI: 10.1016/j.jpain.2020.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/24/2020] [Accepted: 03/22/2020] [Indexed: 12/19/2022]
Abstract
Pain is an unfortunate consequence of many medical procedures, which in some patients becomes chronic and debilitating. Among the factors affecting medical pain, clinician-patient (C-P) similarity and nonverbal communication are particularly important for pain diagnosis and treatment. Participants (N = 66) were randomly assigned to clinician and patient roles and were grouped into C-P dyads. Clinicians administered painful stimuli to patients as an analogue of a painful medical procedure. We manipulated the perceived C-P similarity of each dyad using groups ostensibly based on shared beliefs and values, and each patient was tested twice: Once with a same group clinician (concordant, CC) and once with a clinician from the other group (discordant, DC). Movement synchrony was calculated as a marker of nonverbal communication. We tested whether movement synchrony mediated the effects of group concordance on patients' pain and trust in the clinician. Movement synchrony was higher in CC than DC dyads. Higher movement synchrony predicted reduced pain and increased trust in the clinician. Movement synchrony also formally mediated the group concordance effects on pain and trust. These findings increase our understanding of the role of nonverbal C-P communication on pain and related outcomes. Interpersonal synchrony may be associated with better pain outcomes, independent of the specific treatment provided. PERSPECTIVE: This article demonstrates that movement synchrony in C-P interactions is an unobtrusive measure related to their relationship quality, trust toward the clinician, and pain. These findings suggest that interpersonal synchrony may be associated with better patient outcomes, independent of the specific treatment provided.
Collapse
Affiliation(s)
- Pavel Goldstein
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado; The School of Public Health, University of Haifa, Israel
| | | | | | - Victoria R Schelkun
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire; Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado.
| |
Collapse
|
30
|
Rossi MG, Macagno F. Coding Problematic Understanding in Patient-provider Interactions. HEALTH COMMUNICATION 2020; 35:1487-1496. [PMID: 31460797 DOI: 10.1080/10410236.2019.1652384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article proposes a coding scheme for identifying and assessing linguistic evidence of problematic understanding in health-care provider communication with patients affected by type 2 diabetes mellitus. Drawing on the existing literature in pragmatics and linguistics, the scheme is grounded on the distinctions between the different types of linguistic evidence of the occurrence of a misunderstanding or a problematic understanding, divided into three levels (stronger, acceptable and weak) based on their probative force. The application of the scheme is illustrated through a pilot study, conducted on an Italian corpus of 46 transcripts of videotaped consultations between six health-care providers and 13 patients affected by diabetes mellitus type 2. The most frequent types of linguistic evidence of problematic understanding were the categories of "acceptable" (amounting to 58% of the total) and the "strong" evidence (35%). Patients' problematic understanding was detected to occur significantly more frequently than health-care providers. Providers were also found to be significantly more aware of possible misunderstandings, tending to verify more frequently the correctness of their own interpretations. This pilot study represents a first step in the process of developing a productive evidence-based tool for detecting problematic understanding, which can be used for implementing linguistic strategies for helping prevent the risk of misunderstandings in health-care communication. Our findings show that misunderstandings are widespread between patients and that some linguistic strategies may be more effective than others in preventing the risk of misunderstandings, suggesting possible directions of research for improving health-care providers' communicative skills.
Collapse
|
31
|
Sungur H, Yılmaz NG, Chan BMC, van den Muijsenbergh METC, van Weert JCM, Schouten BC. Development and Evaluation of a Digital Intervention for Fulfilling the Needs of Older Migrant Patients With Cancer: User-Centered Design Approach. J Med Internet Res 2020; 22:e21238. [PMID: 33104008 PMCID: PMC7652697 DOI: 10.2196/21238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 01/23/2023] Open
Abstract
Background Older migrant patients with cancer face many language- and culture-related barriers to patient participation during medical consultations. To bridge these barriers, an eHealth tool called Health Communicator was developed in the Netherlands. Essentially used as a digital translator that can collect medical history information from patients, the Health Communicator did not include an oncological module so far, despite the fact that the prevalence of Dutch migrant patients with cancer is rising. Objective This study aims to systematically develop, implement, and conduct a pilot evaluation of an oncological module that can be integrated into the Health Communicator to stimulate patient participation among older Turkish-Dutch and Moroccan-Dutch patients with cancer. Methods The Spiral Technology Action Research model, which incorporates 5 cycles that engage key stakeholders in intervention development, was used as a framework. The listen phase consisted of a needs assessment. The plan phase consisted of developing the content of the oncological module, namely the question prompt lists (QPLs) and scripts for patient education videos. On the basis of pretests in the do phase, 6 audiovisual QPLs on patient rights, treatment, psychosocial support, lifestyle and access to health care services, patient preferences, and clinical trials were created. Additionally, 5 patient education videos were created about patient rights, psychosocial support, clinical trials, and patient-professional communication. In the study phase, the oncological module was pilot-tested among 27 older Turkish-Dutch and Moroccan-Dutch patients with cancer during their consultations. In the act phase, the oncological model was disseminated to practice. Results The patient rights QPL was chosen most often during the pilot testing in the study phase. Patients and health care professionals perceived the QPLs as easy to understand and useful. There was a negative correlation between the tool’s ease of use and patient age. Patients reported that using the module impacted the consultations positively and thought they were more active compared with previous consultations. Health care professionals also found patients to be more active than usual. Health care professionals asked significantly more questions than patients during consultations. Patients requested to see the patients’ rights video most often. Patients rated the videos as easy to understand, useful, and informative. Most of the patients wanted to use the tool in the future. Conclusions Older migrant patients with cancer, survivors, and health care professionals found the oncological module to be a useful tool and have shown intentions to incorporate it into future consultation sessions. Both QPLs and videos were evaluated positively, the latter indicating that the use of narratives to inform older, low-literate migrant patients with cancer about health-related topics in their mother tongue is a viable approach to increase the effectiveness of health care communication with this target group.
Collapse
Affiliation(s)
- Hande Sungur
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, Netherlands
| | - Nida Gizem Yılmaz
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Brittany Ming Chu Chan
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, Netherlands
| | | | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, Netherlands
| | - Barbara C Schouten
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
32
|
Benis A, Barak Barkan R, Sela T, Harel N. Communication Behavior Changes Between Patients With Diabetes and Healthcare Providers Over 9 Years: Retrospective Cohort Study. J Med Internet Res 2020; 22:e17186. [PMID: 32648555 PMCID: PMC7448191 DOI: 10.2196/17186] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/19/2020] [Accepted: 06/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Health organizations and patients interact over different communication channels and are harnessing digital communications for this purpose. Assisting health organizations to improve, adapt, and introduce new patient-health care practitioner communication channels (such as patient portals, mobile apps, and text messaging) enhances health care services access. OBJECTIVE This retrospective data study aims to assist health care administrators and policy makers to improve and personalize communication between patients and health care professionals by expanding the capabilities of current communication channels and introducing new ones. Our main hypothesis is that patient follow-up and clinical outcomes are influenced by their preferred communication channels with the health care organization. METHODS This study analyzes data stored in electronic medical records and logs documenting access to various communication channels between patients and a health organization (Clalit Health Services, Israel). Data were collected between 2008 and 2016 from records of 311,168 patients diagnosed with diabetes, aged 21 years and over, members of Clalit at least since 2007, and still alive in 2016. The analysis consisted of characterizing the use profiles of communication channels over time and used clustering for discretization purposes and patient profile building and then a hierarchical clustering and heatmaps to visualize the different communication profiles. RESULTS A total of 13 profiles of patients were identified and characterized. We have shown how the communication channels provided by the health organization influence the communication behavior of patients. We observed how different patients respond differently to technological means of communication and change or don't change their communication patterns with the health care organization based on the communication channels available to them. CONCLUSIONS Identifying the channels of communication within the health organization and which are preferred by each patient creates an opportunity to convey messages adapted to the patient in the most appropriate way. The greater the likelihood that the therapeutic message is received by the patient, the greater the patient's response and proactiveness to the treatment will be. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/10734.
Collapse
Affiliation(s)
- Arriel Benis
- Faculty of Technology Management, Holon Institute of Technology, Holon, Israel.,Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
| | | | - Tomer Sela
- Online Division, Clalit Health Services, Tel-Aviv, Israel
| | - Nissim Harel
- Faculty of Sciences, Holon Institute of Technology, Holon, Israel
| |
Collapse
|
33
|
Krystallidou D, Vaes L, Devisch I, Wens J, Pype P. Study protocol of OncoTolk: an observational study on communication problems in language-mediated consultations with migrant oncology patients in Flanders (Belgium). BMJ Open 2020; 10:e034426. [PMID: 32513878 PMCID: PMC7282320 DOI: 10.1136/bmjopen-2019-034426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/11/2020] [Accepted: 04/28/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Effective doctor-patient communication in oncology settings can be challenging due to the complexity of the cancer disease trajectory. The challenges can become greater when doctors and patients do not share a common language and need to rely on language mediators. The aim of this study is to provide evidence-based recommendations for healthcare professionals, patients and language mediators on how to interact with each other during language-mediated consultations in oncology settings. METHODS AND ANALYSIS A systematic review of the literature on communication problems in monolingual and multilingual oncology settings will be conducted. Thirty language-mediated consultations with Turkish-speaking or Arabic-speaking cancer patients, language mediators and Dutch-speaking oncologists/haematologists will be video-recorded in three urban hospitals in Flanders, Belgium. All participants will be interviewed immediately after the consultation and 2 weeks after it by means of video-stimulated recall. Multimodal interaction analysis will be combined with qualitative content analysis to allow for the identification of communication practices when communication problems occur. ETHICS AND DISSEMINATION The study has been approved by the following ethics committees: Ghent University Hospital, Antwerp University Hospital, Antwerp Hospitals Network (ZNA). Results will be published via (inter)national peer-reviewed journals and the findings of the study will be communicated using a comprehensive dissemination strategy aimed at healthcare professionals, patients and language mediators.
Collapse
Affiliation(s)
| | - Lena Vaes
- Faculty of Arts, Sint Andries Campus, KU Leuven, Antwerp, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ignaas Devisch
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Johan Wens
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| |
Collapse
|
34
|
Warth J, Puth MT, Zier U, Beckmann N, Porz J, Tillmann J, Weckbecker K, Bosma H, Weltermann B, Münster E. Patient-physician communication about financial problems: A cross-sectional study among over-indebted individuals. PLoS One 2020; 15:e0232716. [PMID: 32369528 PMCID: PMC7199951 DOI: 10.1371/journal.pone.0232716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background About every tenth household across Europe is unable to meet payment obligations and living expenses on an ongoing basis and is thus considered over-indebted. Previous research suggests that over-indebtedness reflects a potential cause and consequence of psychosomatic health problems and limited access to care. However, it is unclear whether those affected discuss their financial problems with general practitioners. Therefore, this study examined patient-physician communication about financial problems in general practice among over-indebted individuals. Methods We conducted a cross-sectional survey among clients of 70 debt advice agencies in North Rhine-Westphalia, Germany, in 2017. We assessed the prevalence of patient-physician communication about financial problems and its association with patient characteristics using descriptive statistics and logistic regression analysis. Of 699 individuals who returned the questionnaire (response rate:50.2%), we included 598 respondents enrolled in statutory health insurance with complete outcome data in the analyses. Results Conversations about financial problems with general practitioners were reported by 22.6% (n = 135) of respondents. Individuals with a high educational level were less likely to report such conversations than those with medium educational level (aOR 0.11; 95%CI 0.01–0.83) after adjustment for other sociodemographic characteristics, health status and measures of financial distress. Those without a migrant background(aOR 2.09; 95%CI 1.32–3.32), the chronically ill(aOR 1.90; 95%CI 1.16–3.13) and individuals who reported high financial distress(aOR 2.15; 95%CI 1.22–3.78) and cutting on necessities to pay for medications(aOR 1.86; 95%CI 1.12–3.09) were more likely to discuss financial problems than their counterparts. Conclusions Few over-indebted individuals discussed financial problems with their general practitioner. Patients’ health status, coping strategies and perception of financial distress might contribute to variations in disclosure of financial problems. Thus, enhancing communication and screening by routine assessment of financial problems in clinical practice can help to identify vulnerable patients and promote access to health care and social services and well-being for all.
Collapse
Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- * E-mail:
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Niklas Beckmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Birgitta Weltermann
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Bonn, Germany
| |
Collapse
|
35
|
Jager M, den Boeft A, Leij-Halfwerk S, van der Sande R, van den Muijsenbergh M. Cultural competency in dietetic diabetes care-A qualitative study of the dietician's perspective. Health Expect 2020; 23:540-548. [PMID: 32045075 PMCID: PMC7321725 DOI: 10.1111/hex.13019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/04/2019] [Accepted: 12/12/2019] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Diabetes type 2 is more prevalent in ethnic minorities in the Netherlands, and outcomes of health care in general are worse compared to other Dutch patients. The purpose of this study is to explore the experiences of dieticians and the knowledge, skills and attitudes they consider to be important for effective dietetic care in migrant patients. METHODS Semi-structured interviews were held with 12 dieticians, of various ages, ethnic backgrounds and experience. The interview guide was based on Seeleman's cultural competence model and the Dutch dietetic consultation model. Interviews were transcribed, coded and thematically analysed, revealing 7 main themes. RESULTS Dieticians were uncertain whether their care fulfilled their migrant patients' needs. They experienced language differences as a major barrier for retrieving information and tailoring advice to the patient's needs. Furthermore, dieticians feel they lack cultural knowledge. An open and respectful attitude was considered important for effective care. The communication barrier hindered building a trusting relationship; however, few dieticians mentioned a need for communication training. They expressed a need for cultural competence training, specifically to acquire cultural knowledge. CONCLUSION Dieticians struggle with providing dietetic care for migrant diabetes patients due to communication barriers and difficulty in building a trusting relationship. They are conscious of their lack of cultural knowledge, and acknowledge the need for an open and respectful attitude and essential communication skills in order to collect and convey information. They seem unaware of the impact of low (health) literacy. Cultural competence training is needed for effective dietetic care for migrants.
Collapse
Affiliation(s)
- Mirjam Jager
- Nutrition and Dietetics, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Primary and Community Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Andrea den Boeft
- Internal Medicine and Dermatology, Department of Dietetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Susanne Leij-Halfwerk
- Nutrition and Dietetics, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Rob van der Sande
- Primary and Community Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Pharos, National Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| |
Collapse
|
36
|
Rauscher EA, Hesse C, Campbell-Salome G. Applying Family Communication Patterns to Patient-provider Communication: Examining Perceptions of Patient Involvement, Satisfaction, and Medical Adherence. JOURNAL OF HEALTH COMMUNICATION 2020; 25:180-189. [PMID: 32116144 DOI: 10.1080/10810730.2020.1728596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study investigates patient perceptions of patient-provider communication and family communication patterns theory (FCPT). Using FCPT, the study predicts that family communicative environment relates to patient perceptions of patient involvement in care as well as patient satisfaction and medical adherence. Further, this study tests new measures of conformity orientation (warm and cold conformity) to investigate the multi-faceted nature of the variable. The results show significant relationships between FCPT and patient perceptions and outcomes. Specifically, warm conformity was the strongest and most reliable predictor of patient perceptions and outcomes across the three FCPT variables tested in the model. Additionally, results show differences between how warm and cold conformity predict patient perception and outcome variables. Finally, tests of the interaction between conversation orientation and both types of conformity indicate relationships between interaction variables and patient involvement in care, but not satisfaction or adherence. Practical implications and future research ideas are also discussed.
Collapse
Affiliation(s)
- Emily A Rauscher
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Colin Hesse
- Department of Speech Communication, Oregon State University, Corvallis, OR, USA
| | | |
Collapse
|
37
|
McKivett A, Paul D, Hudson N. Healing Conversations: Developing a Practical Framework for Clinical Communication Between Aboriginal Communities and Healthcare Practitioners. J Immigr Minor Health 2019; 21:596-605. [PMID: 30066058 DOI: 10.1007/s10903-018-0793-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In recognition of the ongoing health disparities experienced by Aboriginal and Torres Strait Islander peoples (hereafter Aboriginal), this scoping review explores the role and impact of the clinical communication process on Aboriginal healthcare provision. A medical education lens is applied, looking at the utility of a tailored clinical communication framework to assist health practitioners work more effectively with Aboriginal peoples and communities. The initial framework, building on existing communication guides, proposes four domains: content, process, relational and environmental. It places emphasis on critical self-reflection of the health practitioner's own cultural identity and will be guided by collective Aboriginal worldviews in select Australian settings. Using a two-eyed seeing approach the framework will be developed and tested in health professional education. The aim of this research journey is to enable health practitioners to have more effective healthcare conversations with Aboriginal peoples, working toward more socially just and equitable healthcare interactions and outcomes.
Collapse
Affiliation(s)
- Andrea McKivett
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia.
| | - David Paul
- School of Medicine Fremantle, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Nicky Hudson
- University of Adelaide, Adelaide, SA, Australia
- University of Newcastle, Newcastle, NSW, Australia
- University of Wollongong, Wollongong, NSW, Australia
| |
Collapse
|
38
|
Kumar K, Stack RJ, Adebajo A, Adams J. Health-care professionals' perceptions of interacting with patients of South Asian origin attending early inflammatory arthritis clinics. Rheumatol Adv Pract 2019; 3:rkz042. [PMID: 31768498 PMCID: PMC6862933 DOI: 10.1093/rap/rkz042] [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: 06/20/2019] [Revised: 10/06/2019] [Indexed: 11/13/2022] Open
Abstract
Objective The aim was to explore the perceptions of rheumatology health-care professionals (HCPs) of interacting with patients of South Asian origin attending early inflammatory arthritis clinics. Methods We used face-to-face semi-structured interviews, designed in partnership with a clinician partner, to interview 10 HCPs involved in the running of early inflammatory arthritis clinics across seven centres in the UK. Data were recorded, transcribed by an independent company and analysed using inductive thematic analysis. Results Three emerging themes were identified that characterized consulting experiences of HCPs: varied approaches were used in early inflammatory arthritis clinic; the challenges for rheumatology HCPs in managing and delivering information to patients of South Asian origin in early inflammatory arthritis clinics; and moving towards good practice, the views on managing future patients of South Asian origin in early inflammatory arthritis clinics. Overall, HCPs found that they required additional skills to support the engagement and management for patients of South Asian origin living with inflammatory arthritis. The HCPs felt that they were less effective in addressing self-management issues for this patient group, and they found it difficult to determine adherence to medication. In such consultations, HCPs perceived that their own limitation of inadequate training contributed towards poor consultations. Conclusion For the first time, our data demonstrate that the management of patients of South Asian origin in early inflammatory arthritis clinics is under-served. To address this, HCPs have identified training needs to improve knowledge and skills in engaging with and supporting patients of South Asian origin. These findings provide a good direction for future research.
Collapse
Affiliation(s)
- Kanta Kumar
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Rebecca J Stack
- Department of Psychology, Nottingham Trent University, Nottingham
| | - Ade Adebajo
- Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield
| | - Jo Adams
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
39
|
Villalobos AVK, Phillips S, Zhang Y, Crawbuck GSN, Pratt-Chapman ML. Oncology healthcare provider perspectives on caring for diverse patients fifteen years after Unequal Treatment. PATIENT EDUCATION AND COUNSELING 2019; 102:1859-1867. [PMID: 31056266 DOI: 10.1016/j.pec.2019.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/12/2019] [Accepted: 04/26/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The purpose of this study was to provide a snapshot of U.S. oncology provider perspectives on caring for diverse patients, including self-rated awareness, comfort, skills, practices, challenges, facilitators, and barriers. METHODS An online survey was administered to a convenience sample of multidisciplinary oncology providers. Descriptive statistics and bivariate analyses were computed for Likert-style items to investigate differences by level of past diversity training. Qualitative content analysis was conducted on open-response questions. RESULTS Roughly one-third (36.7%) of the 406 survey respondents reported receiving high levels of past diversity training, with statistically significant differences by training amount for self-rated skills and select awareness and practice items (p < 0.05). Key challenges qualitatively described included language barriers (n = 143) and alternative health beliefs (n = 52). Knowledge and training (n = 62), interpretation services (n = 53), and staff attitudes (n = 46) were the most frequently mentioned factors affecting culturally sensitive care. CONCLUSION Fifteen years after the publication of Unequal Treatment, the National Academies' landmark report on healthcare disparities, oncology healthcare providers have ongoing challenges caring for diverse patients and opportunities to implement recommendations from the report. PRACTICE IMPLICATIONS Content of diversity trainings should focus on identified gaps and practical challenges. Multi-level supports are needed, including resources and training for oncology providers.
Collapse
Affiliation(s)
- Aubrey V K Villalobos
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington DC, 20037, USA
| | - Serena Phillips
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington DC, 20037, USA
| | - Yuqing Zhang
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington DC, 20037, USA
| | - Graham S N Crawbuck
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington DC, 20037, USA
| | - Mandi L Pratt-Chapman
- Institute for Patient-Centered Initiatives and Health Equity, The George Washington University Cancer Center, 2600 Virginia Avenue NW, Suite 300, Washington DC, 20037, USA.
| |
Collapse
|
40
|
Bobb SC, Mello K, Turco E, Lemes L, Fernandez E, Rothermich K. Second Language Learners' Listener Impressions of Foreigner-Directed Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3135-3148. [PMID: 31412215 DOI: 10.1044/2019_jslhr-s-18-0392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background According to sociolinguistic frameworks such as Communication Accommodation Theory, English native speakers modify their speech to meet the communicative needs of non-native speakers (Beebe & Giles, 1984). However, when foreigner-directed speech is used inappropriately, it may lead to overaccommodation, which in turn can act counterproductively toward communicative goals. Purpose To date, much of the research on foreigner-directed speech toward non-native speakers has focused on its acoustic parameters, but few studies have examined how second language learners interpret it emotionally and pragmatically. Method This study asked 36 English second language learners to listen to four types of speech accommodation styles (casual, clear, infant-directed, and foreigner-directed) spoken by four different speakers. Their task was to evaluate the extent to which the speaker was easy to understand, competent, condescending, friendly, and respectful. Results Acoustic analyses of the speech stimuli showed that speakers used distinct acoustic cues for each speech accommodation style, for example, slower speech rate for foreigner-directed speech. The rating results show that second language learners of English judged casual speech as least intelligible, least competent, and least friendly compared to all other speech types. Respectfulness ratings show that participants perceived casual speech as less respectful compared to clear speech and infant-directed speech, but not foreigner-directed speech. However, no effects were found for condescension. Conclusion The results suggest second language learners in the current experiment generally perceived speech accommodation positively.
Collapse
Affiliation(s)
- Susan C Bobb
- Department of Psychology, Gordon College, Wenham, MA
| | - Kristin Mello
- Department of Psychology, Gordon College, Wenham, MA
| | - Emily Turco
- Department of Psychology, Gordon College, Wenham, MA
| | - Larissa Lemes
- Department of Psychology, Gordon College, Wenham, MA
| | | | - Kathrin Rothermich
- Department of Communication Sciences & Disorders, East Carolina University, Greenville, NC
| |
Collapse
|
41
|
Graetz D, Fasciano K, Rodriguez-Galindo C, Block SD, Mack JW. Things that matter: Adolescent and young adult patients' priorities during cancer care. Pediatr Blood Cancer 2019; 66:e27883. [PMID: 31207103 DOI: 10.1002/pbc.27883] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Adolescents and young adults (AYAs) experience cancer while balancing emerging identity and life goals. We investigated AYAs' priorities during cancer, including psychosocial concerns, cure-directed therapy, and potential late effects. METHODS We surveyed 203 cancer patients aged 15-29 treated at Dana-Farber Cancer Institute, Boston, Massachusetts, and their oncologists. Patients were approached and rated the importance of aspects of treatment, outcomes, and life during therapy. Response options were "extremely," "very," "somewhat," "a little important," or "not at all important." Ratings of "extremely" or "very important" were used as indicators of strong priorities. RESULTS Patients' three most frequent priorities were cure (97%), being good to the people they care about (95%), and having supportive people around them (94%). Most prioritized being with family (90%), returning to school/work (89%), maintaining relationships with friends (88%), and feeling normal (85%). Fewer prioritized minimizing long-term (78%) and acute side effects (68%) and fertility (59%). Many participants (88%) said that cure influenced their decisions "a great deal," while fewer were influenced by side effects (32%), fertility (36%), or relationships (16%). Most patients (85%) thought their oncologist understood what was most important to them when treatment started. CONCLUSION Nearly all AYA cancer patients prioritize cure, while maintaining social relationships and a sense of normalcy. These priorities influence decisions they make about treatment to differing degrees, with cure influencing decision-making for most patients. Although the priority of cure is well established, recognizing other AYA priorities allows providers to optimally support these patients from the time of diagnosis.
Collapse
Affiliation(s)
- Dylan Graetz
- St. Jude Children's Research Hospital, Departments of Hematology and Oncology, Memphis, Tennessee
| | - Karen Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carlos Rodriguez-Galindo
- St. Jude Children's Research Hospital, Department of Oncology and Global Pediatric Medicine, Memphis, Tennessee
| | - Susan D Block
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Departments of Psychiatry and Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer W Mack
- Dana Farber Cancer Institute/Boston Children's Hospital, Department of Pediatric Oncology and Division of Population Sciences, Boston, Massachusetts
| |
Collapse
|
42
|
Jager MJ, van der Sande R, Essink-Bot ML, van den Muijsenbergh METC. Views and experiences of ethnic minority diabetes patients on dietetic care in the Netherlands - a qualitative study. Eur J Public Health 2019; 29:208-213. [PMID: 30204883 PMCID: PMC6426026 DOI: 10.1093/eurpub/cky186] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Diabetes type 2 is more prevalent in people from ethnic minorities in the Netherlands, and outcomes of care are worse compared with other Dutch people. Dieticians experience difficulties in managing these groups in self-management and adherence to dietary advice. The aim of this study was to explore the views regarding a healthy diet and dietetic care among ethnic minority type 2 diabetes patients. Methods Semi-structured interviews were held with 12 migrants with diabetes from Turkey, Morocco, Iraq and Curacao, who visited a dietician. Inclusion went on until saturation was reached. The interview guide was based on the Attitudes, Social influence and self-Efficacy (ASE) model and Kleinman’s explanatory model of illness. Interviews were held in the language preferred by the respondent. Transcripts were coded and thematically analyzed. Results Several respondents expected a more rigorous, directive and technical approach of the dietician. All respondents acknowledged the importance of a healthy diet. What they considered healthy was determined by culturally influenced ideas about health benefits of specific foods. Important hindrances for dietary change were lack of self-efficacy and social support. Social influences were experienced both as supportive and a hindrance. Conclusions Migrant diabetic patients’ opinions about healthy food are determined by culturally influenced ideas rather than by dietary guidelines. Dutch dietary care is not tailored to the needs of these patients and should take into account migrants’ expectations, cultural differences in dietary habits and specifically address the role of family.
Collapse
Affiliation(s)
- Mirjam J Jager
- Nutrition and Dietetics, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - Rob van der Sande
- Primary and Community Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Maria E T C van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Prevention and care programme, Pharos, National Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| |
Collapse
|
43
|
Azad GF, Singh V, Kalb L, Pinkett-Davis M, Landa R. Child and Family Characteristics that Predict Autism Spectrum Disorder Specialty Clinic Appointment Attendance and Alignment with Providers. J Autism Dev Disord 2019; 49:3060-3072. [PMID: 31030311 DOI: 10.1007/s10803-019-04027-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined factors contributing to initial appointment attendance, alignment between parents' pre-visit and clinicians' diagnostic impressions, and family commitment to follow-ups at an autism spectrum disorder (ASD) specialty clinic. Sample sizes were n = 6558 (initial), n = 1430 (alignment), and n = 1353 (follow-up). Parents completed surveys and clinicians provided their ASD diagnostic impressions. When children were not receiving intervention, families were less likely to keep their initial appointment. Families residing long distances and having older children were less likely to keep their initial and follow-up appointments. African American families were less likely to keep their initial appointment and expressed initial doubts with providers about the diagnosis. Findings suggest that some children are not getting diagnostic clarity or accessing timely services.
Collapse
Affiliation(s)
- Gazi F Azad
- Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Vini Singh
- Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
| | - Luke Kalb
- Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Melanie Pinkett-Davis
- Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
| | - Rebecca Landa
- Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 North Broadway, Baltimore, MD, 21205, USA
| |
Collapse
|
44
|
Yılmaz NG, Schouten BC, Schinkel S, van Weert JCM. Information and participation preferences and needs of non-Western ethnic minority cancer patients and survivors: A systematic review of the literature. PATIENT EDUCATION AND COUNSELING 2019; 102:631-650. [PMID: 30594322 DOI: 10.1016/j.pec.2018.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/10/2018] [Accepted: 11/21/2018] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To provide an overview of information and participation preferences and needs of non-Western ethnic minority cancer patients living in Western countries. METHODS A systematic literature review was conducted using the databases PsycINFO, PubMed, CINAHL, and EMBASE. Thematic analysis was carried out to synthesize data, allowing for identification of important themes and synthesis of both qualitative and quantitative studies. RESULTS Forty-four papers were included. Non- Western ethnic minority cancer patients/survivors have high information preferences and needs regarding topics ranging from diagnosis to treatment and from prevention to the healthcare system. Younger, female, and unmarried patients/survivors, and patients with better language proficiency reported higher information preferences. Latin-American and African-American patients/survivors primarily prefer shared or active participation. Asian and Middle-Eastern patients/survivors prefer primarily passive participation. Younger patients, and those with a higher level of education and acculturation were more likely to prefer active or shared participation. CONCLUSION Further (quantitative) research on factors associated with patients' preferences is needed in order to better understand the underlying reasons of information and participation preferences and needs of diverse non-Western ethnic minority cancer patients. PRACTICE IMPLICATIONS To better fulfil ethnic minority patients'/survivors' preferences and needs healthcare providers should elaborate upon these and tailor their information- provision accordingly.
Collapse
Affiliation(s)
- Nida Gizem Yılmaz
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, the Netherlands; Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Barbara C Schouten
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Sanne Schinkel
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| |
Collapse
|
45
|
Liu J, Yu W, Ding T, Li M, Zhang L. Cross-sectional survey on job satisfaction and its associated factors among doctors in tertiary public hospitals in Shanghai, China. BMJ Open 2019; 9:e023823. [PMID: 30826758 PMCID: PMC6429855 DOI: 10.1136/bmjopen-2018-023823] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Doctors in public hospitals in China face considerable pressure and excessive workloads, which are likely to predispose them to job dissatisfaction. We explored the job satisfaction of doctors and examined the influence of diverse sociodemographic characteristics. DESIGN This was a cross-sectional study. SETTING Eleven tertiary public hospitals in Shanghai, China. PARTICIPANTS The questionnaire was designed based on the fifth National Health Service General Research, which was based on the Minnesota Satisfaction Questionnaire. Questionnaires were administered to 897 doctors randomly (using random number tables) and 730 were returned completed (response rate=81.4%). Doctors who volunteered and provided informed, written consent participated. PRIMARY OUTCOME MEASURES The dependent variable was doctors' job satisfaction. RESULTS Statistical analyses were conducted using SPSS and SAS. Overall, 64.8% of participants were dissatisfied with their jobs. Factors that were statistically significant to doctors' job satisfaction in the univariate analysis were entered into the logistic regression analysis, including doctors' professional title, department, work hours, work requirements (reflected as the number of patients they diagnosed and treated monthly), life and work stress, and the types of patients that doctors treated or expected to treat. The results of the logistic regression analysis suggested that doctors' job satisfaction was related to their professional title, types of patients that doctors treated or expected to treat, as well as their work stress. CONCLUSIONS There is an urgent need for public hospitals in China to establish a more reasonable promotion and management system for doctors, encourage patients to accept the two-way referral, pay more attention to less-experienced staff and help doctors release their work stress.
Collapse
Affiliation(s)
- Jiazhen Liu
- Shanghai Information Center for Health, Shanghai Municipal Commission of Health and Family Planning, Shanghai, China
| | - Wenya Yu
- College of Military Health Service Management, Second Military Medical University, Shanghai, China
| | - Tao Ding
- College of Military Health Service Management, Second Military Medical University, Shanghai, China
| | - Meina Li
- College of Military Health Service Management, Second Military Medical University, Shanghai, China
| | - Lulu Zhang
- College of Military Health Service Management, Second Military Medical University, Shanghai, China
| |
Collapse
|
46
|
Heywood AE, López-Vélez R. Reducing infectious disease inequities among migrants. J Travel Med 2019; 26:5198602. [PMID: 30476162 DOI: 10.1093/jtm/tay131] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND migration has reached unprecedented levels, with 3.6% of the world's population living outside their country of birth. Migrants comprise a substantial proportion of high-income country populations, are at increased risk of a range of infectious diseases, compared to native-born populations and may experience worse health outcomes due to barriers accessing timely diagnoses and treatment. Poor access to essential healthcare services can be attributed to several factors, including language and cultural barriers and lack of specific inclusive health policies. METHODS This review draws on evidence from the immigrant health and travel medicine literature, with a focus on infectious disease risks. It presents strategies to reduce barriers to healthcare access through health promotion and screening programs both at the community and clinic level and the delivery of linguistically and culturally competent care. The Methods: Salud Entre Culturas (SEC) 'Health Between Cultures' project from the Tropical Medicine Unit at the Hospital Ramon y Cajal in Madrid is described as an effective model of care. RESULTS For those providing healthcare to migrant populations, the use of community-consulted approaches are considered best practice in the development of health education, health promotion and the delivery of targeted health services. At the clinic-level, strategies optimizing care for migrants include the use of bilingual healthcare professionals or community-based healthcare workers, cultural competence training of all clinic staff, the appropriate use of trained interpreters and the use of culturally appropriate health promotion materials. CONCLUSIONS Multifaceted strategies are needed to improve access, community knowledge, community engagement and healthcare provider training to provide appropriate care to migrant populations to reduce infectious disease disparities.
Collapse
Affiliation(s)
- Anita E Heywood
- Level 3, Samuels Building, School of Public Health and Community Medicine, UNSW Sydney, NSW, Australia
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Department of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| |
Collapse
|
47
|
Umeh KF. Ethnic inequalities in doctor-patient communication regarding personal care plans: the mediating effects of positive mental wellbeing. ETHNICITY & HEALTH 2019; 24:57-72. [PMID: 28385036 DOI: 10.1080/13557858.2017.1315056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE There is limited understanding of ethnic inequalities in doctor-patient communication regarding personal care plans (PCPs). This study investigated the mediating effects of positive mental wellbeing on differences in PCP-related doctor-patient communication amongst South Asian and Caucasian UK residents. DESIGN Data from 10,980 respondents to the 2013 Health Survey for England was analysed using bootstrapping methods. Constructs from the WEMWBS (Warwick and Edinburgh Mental Wellbeing Scale) (Stewart-Brown, S., and K. Janmohamed. 2008. Warwick, UK) were assessed as mediators of relations between ethnicity and several doctor-patient communication variables, including PCP-related interactions; (a) had a PCP-related discussion about a long-term condition with a doctor/nurse, and (b) had this conversation within the past year, (c) agreed to a PCP with a health professional; and (d) talked to a doctor in the past 2 weeks. RESULTS Bootstrapped mediation analysis (Hayes, A. F. 2013. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-based Approach. New York, NY: The Guilford Press) showed that three positive mind-sets mediated associations between ethnicity and doctor-patient contact, including PCP-related communication. Being able to make up one's mind (ab = -0.05; BCa CI [-0.14, 0.01]) mediated the effect of ethnicity on agreeing to a PCP, while having energy to spare (ab = 0.07; BCa CI [-0.04, 0.12]), and feeling good about oneself (ab = 0.03; BCa CI [0.01, 0.07]), mediated ethnic effects on talking to a doctor during the past fortnight. The mediating effect of reported energy persisted after controlling for medical history, perceived health, and other covariates. CONCLUSIONS Ethnic disparities in doctor-patient interaction, including PCP-related communication, are partly explained by positive mental wellbeing. Gauging positive psychological moods in patients, particularly self-worth, self-perceived vigour and decisiveness, are relevant to addressing ethnic inequalities in doctor-patient communication. As PCPs may have direct implications for patient health it is important for health professionals to address deficits in psychological functioning that may precipitate ethnic inequalities in setting up PCPs.
Collapse
Affiliation(s)
- Kanayo F Umeh
- a School of Natural Sciences & Psychology , Liverpool John Moores University , Liverpool , UK
| |
Collapse
|
48
|
Lloyd CE, Wilson A, Holt RIG, Whicher C, Kar P. Language matters: a UK perspective. Diabet Med 2018; 35:1635-1641. [PMID: 30103276 DOI: 10.1111/dme.13801] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 01/04/2023]
Abstract
AIM To review the existing evidence regarding the use of language in clinical encounters. BACKGROUND Awareness of the importance of language in clinical encounters is mostly lacking or located within broader discussions on communication. METHODS A scoping study was conducted to review existing research that could increase our understanding of the role language plays as well as identify gaps in knowledge and inform the development of a position statement on language in diabetes care. RESULTS Evidence shows that, although carefully chosen language can have a positive effect, there is a potential negative impact of language on people's experiences of diabetes care. The use of stigmatizing and discriminatory words during communication between healthcare practitioners and people with diabetes can lead to disengagement with health services as well as sub-optimal diabetes self-management. Clinical encounters can be compromised where language barriers exist or where there is limited understanding of cultural differences that may have an impact on diabetes self-management. What little empirical evidence there is shows that training can improve language and communication skills. CONCLUSION This review raises a number of questions that are being addressed by the NHS England Language Matters Group, which has developed a set of recommendations to support the use of appropriate language in clinical encounters.
Collapse
Affiliation(s)
- C E Lloyd
- School of Health, Wellbeing and Social Care, Open University, Milton Keynes
| | - A Wilson
- School of Health, Wellbeing and Social Care, Open University, Milton Keynes
| | - R I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton
| | - C Whicher
- Southern Health NHS Foundation Trust, Southampton
| | - P Kar
- NHS Trust, NHS England, London, UK
| |
Collapse
|
49
|
Norris AE, Matsuda Y, Altares Sarik D, Pettigrew J. Implementation Quality: Implications for Intervention and Translational Science. J Nurs Scholarsh 2018; 51:205-213. [PMID: 30466163 DOI: 10.1111/jnu.12449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Implementation quality (IQ), a critical concept for translational science, measures the discrepancy between an intervention's intended design and its implementation. Quantifying the impact of IQ on intervention outcomes informs efforts to improve intervention translatability. The purpose of this article is to define and describe IQ and its dimensions (content adherence, quality of delivery, and engagement) with a focus on individualized interventions being delivered in research and practice settings. APPROACH We apply IQ concepts from intervention science in two contexts: (a) an intervention currently being investigated in an efficacy trial, and (b) a practice situation involving the application of evidence-based practice guidelines during clinic visits. IQ measurement approaches are presented using a study protocol, progress notes, interdisciplinary meeting notes, or clinical guidelines, depending upon whether the intervention is delivered during a research study or a clinical encounter. CONCLUSIONS The investigators describe the necessary infrastructure and support for capturing IQ data and the subsequent complexities and challenges of collecting, measuring, and analyzing these data. Understanding IQ is critical to advancing translational science. Such understanding informs application of appropriate IQ measures, and promotes effective translation of evidence-based interventions into practice. Policy changes are needed to promote IQ assessment to ensure high-quality clinical encounters during which interventions are effectively delivered. CLINICAL RELEVANCE In both research and practice settings, the conceptualization and measurement of IQ will improve patient outcomes by advancing translational science and integrating evidence-based interventions into nursing practice.
Collapse
Affiliation(s)
- Anne E Norris
- Professor, School of Nursing and Health Studies, University of Miami, Coral Gables, FL,, USA
| | - Yui Matsuda
- Beta Tau, Assistant Professor, School of Nursing and Health Studies, University of Miami, Coral Gables, FL,, USA
| | | | - Jonathan Pettigrew
- Assistant Professor, Hugh Downs School of Human Communication, Arizona State University, Tempe, AZ,, USA
| |
Collapse
|
50
|
Deimling Johns L, Power J, MacLachlan M. Community-Based Mental Health Intervention Skills: Task Shifting in Low- and Middle-Income Settings. ACTA ACUST UNITED AC 2018. [DOI: 10.1037/ipp0000097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is a global need to provide human resources for health in low- and middle-income countries. To increase access to care, task shifting has been implemented in community-based rehabilitation (CBR) programs where skills and responsibilities are transferred to local people with shorter and more focused training. Through realist review and synthesis, this research aimed to consolidate the literature when considering (a) what skills CBR workers are reportedly using and/or being trained in relating to mental health, (b) how different settings affect how these task shifting programs work, and (c) the evidence of effectiveness when community health workers come from within the community itself. A total of 11 databases (PubMed, ABI/Inform Global, CINAHL, Cochrane, Emerald, Google Scholar, PsycINFO, SAGE, Science Direct, Scopus, and Web of Science) were systematically searched for specific terms relating to mental health, CBR, and low- and middle-income country. A total of 27 publications were identified as fitting the criteria (4 qualitative, 20 quantitative including 10 randomized controlled trials, and 3 noninvestigatory editorials). Core skills have been identified along with themes that affect how programs work in particular contexts. The use of task shifting in this area may be a potentially viable option for increasing access to mental health care. This resulted in the development of a theory to explain the outcomes being observed. When Task-shifting mental health intervention skills collaboration, harnessing resources available within the community, and the provision of ongoing supervision interact to influence awareness gains, social bonding, the building of trust, and the development of skills and understanding within the community itself. This effects intervention buy-in, overall effectiveness and sustainability, mental health symptoms and local empowerment. These findings can be considered when developing training programs for CBR mental health workers, as well as policy and intervention program design.
Collapse
Affiliation(s)
| | - Jessica Power
- Centre for Global Health, Trinity College Dublin, University of Dublin
| | | |
Collapse
|