1
|
Arnold SRC, Huang Y, Lawson LP, Higgins JM, Hwang YI(J, Richdale A, Trollor JN. Development of the Impact of Diagnosis Scale-Revised (IODS-R). Assessment 2024; 31:908-919. [PMID: 37700577 PMCID: PMC11092292 DOI: 10.1177/10731911231196486] [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] [Indexed: 09/14/2023]
Abstract
No tools quantify the experience, psychological, and practical impact of receiving a diagnosis from a non-deficit perspective. Autism is increasingly late diagnosed in adulthood. The Impact of Diagnosis Scale (IODS) was initially developed for borderline personality disorder. We aimed to develop a revised version suitable for autistic adults and potentially other diagnostic groups. Following a trial of a preliminary revision, the researchers and autistic research advisors co-produced an expanded pool of 46 items, scored on 7-point Likert-type scale, within 6 hypothesized domains. Scale reduction processes were applied to data from 125 formally diagnosed autistic adults. Following iterative rounds of factor analysis using maximum likelihood estimation with Promax rotation, 22 items were retained across 4 domains to comprise the IODS-R. The IODS-R adds new understanding to the experience of receiving an autism diagnosis in adulthood. It may be useful for evaluating diagnostic services and other diagnostic groups.
Collapse
Affiliation(s)
- Samuel R. C. Arnold
- School of Psychology, Western Sydney University, Bankstown, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, New South Wales, Australia
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Yunhe Huang
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Lauren P. Lawson
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Julianne M. Higgins
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Ye In (Jane) Hwang
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- School of Population Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, Australia
| | - Amanda Richdale
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Julian N. Trollor
- Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia
- The Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| |
Collapse
|
2
|
Consolandi M. Toward a digitalized medicine: the Covid-19 pandemic as a disclosure of the importance of digital communication in the clinical world. THEORETICAL MEDICINE AND BIOETHICS 2024:10.1007/s11017-024-09667-1. [PMID: 38760577 DOI: 10.1007/s11017-024-09667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/19/2024]
Abstract
This paper focuses on the importance of digital communication between medical teams and patients and their families when mediated by technological tools. Medicine is changing following the fourth industrial (the digital) revolution: from CAT scans, to X-rays, to UV radiation, to electronic records, to treatment tracking apps, to telemedicine, and the use of AI in doctors' decision-making processes. The COVID-19 pandemic highlighted both the fruitful and problematic sides of this medical evolution. Digital tools such as tablets, smartphones, and video calling apps proved to be essential. Accordingly, I analyze three cases that reveal the helpfulness and the limitations of new communication technologies: on physicians and non-hospitalized patients, on families and patients, and on healthcare professionals and patients' families. Since the medical relationship is not only clinical but also relational and human, one must pay attention to the communicative dimensions of it to remain at least partly human-e.
Collapse
Affiliation(s)
- Monica Consolandi
- Intelligent Digital Agents Unit (IDA)-Center for Digital Health and Wellbeing, Fondazione Bruno Kessler, Trento, Italy.
| |
Collapse
|
3
|
Ameworwor ER, Amu H, Dowou RK, Kye-Duodu G, Amu S, Bain LE. Exploring therapeutic communication in managing chronic non-communicable diseases: a mixed-method study in Ghana. Arch Public Health 2024; 82:36. [PMID: 38486334 PMCID: PMC10938704 DOI: 10.1186/s13690-024-01263-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Globally, the burden of chronic non-communicable diseases is increasing rapidly and approximately one in three of all adults suffer from multiple chronic conditions. Therapeutic communication plays a crucial role in achieving curative, preventive, and promotive goals regarding chronic disease management. We examined therapeutic communication between health professionals and patients with chronic non-communicable diseases at the Ho Teaching Hospital. METHODS We adopted a concurrent mixed-methods approach. The quantitative aspect of the study was descriptive while the qualitative was explanatory. The quantitative study was conducted among 250 patients. The qualitative data was collected among eight health professionals. A stratified sampling and simple random sampling methods were used to recruit patients for the quantitative survey while purposive and convenient sampling was used for the qualitative aspect of the study. The quantitative data was collected using a semi-structured questionnaire while the qualitative data was collected using an in-depth interview guide. The quantitative data were analyzed using STATA v17 and the qualitative data were analyzed thematically using Atlas ti. The major themes that emerged were, therapeutic communication practices, barriers to therapeutic communication and possible solutions to good therapeutic communication. RESULTS We found that 37% patients were 60 years and above with 53.2% being females. It was noted that 36.4% of patients have had tertiary-level education. We found that 59.2% of patients reported having good therapeutic communication with health professionals. We, however, noted that male participants were 92% less likely to practice good therapeutic communication compared with females (aOR = 0.92,95% Cl = 0.46-1.84). Health professionals' activities to ensure good therapeutic practices included their capacity to listen, build rapport with their patients, and clarify information. We found that the major facilitators of good therapeutic communication included trust in the health professionals (90.4%), conducive environment (93.2%), using simple and plain language by health professionals (92.0%) We found that there are myriad of barriers that impede communication process. This included language, health professionals' inability to break terminologies, and the unconscious state of patients. CONCLUSIONS The study revealed that there was good therapeutic communication between health professionals and patients with CNCDs. Nevertheless, it was also identified that ineffective therapeutic communication between health professionals and their patients due to barriers like language could lead to dissatisfaction with care, misdiagnosis, and noncompliance to treatment regimen. For Ghana as a country to achieve SDG target 3.4 by reducing mortality due to NCDs and improve wellbeing of patients by 2030, it will be imperative on Ghana Health Service to design communication strategy training for health professionals that could help improve therapeutic communication between patients and health professionals.
Collapse
Affiliation(s)
- Ethel Rhodaline Ameworwor
- Department of Epidemiology and Biostatistics, Fred Newton Binka School of Public Health, University of Health and Allied Science, Hohoe, Ghana.
| | - Hubert Amu
- Department of Population and Behavioural Sciences, Fred Newton Binka School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, Fred Newton Binka School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Gideon Kye-Duodu
- Department of Epidemiology and Biostatistics, Fred Newton Binka School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | - Selasi Amu
- Department of midwifery, School of Nursing and Midwifery, University of Health and Allied School, Ho, Ghana
| | - Luchuo Engelbert Bain
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| |
Collapse
|
4
|
Jenstad LM, Howe T, Breau G, Abel J, Colozzo P, Halas G, Mason G, Rieger C, Simon L, Strachan S. Communication between healthcare providers and communicatively-vulnerable patients with associated health outcomes: A scoping review of knowledge syntheses. PATIENT EDUCATION AND COUNSELING 2024; 119:108040. [PMID: 37951163 DOI: 10.1016/j.pec.2023.108040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE Summarize literature on provider-patient communication linked to health outcomes in communicatively-vulnerable patient populations. METHODS Scoping review of reviews: systematically searched six databases. INCLUSION CRITERIA systematic searches and syntheses of literature; one or more providers and communicatively-vulnerable patients; synchronous in-person communication; intermediate or health outcome linked to communication. RESULTS The search yielded 14,615 citations; 47 reviews - with wide range of providers, communication vulnerabilities, communication practices, and health outcomes - met inclusion criteria. Methodology included qualitative, quantitative, and mixed approaches. Quality ranged from very low to high. Six categories of communication practices linked to health outcomes were identified: 1) motivation-based; 2) accommodation of language, culture, gender, sexual identity, and other concordance with the patient; 3) cultural adaptations of interventions; 4) use of interpreters; 5) other provider-patient communication practices; 6) patient communication practices. CONCLUSION Communication practices were studied in a wide range of providers, with common themes regarding best practices. A unique finding is the role of the patient's communication practices. The specificity of communication practices studied is heterogeneous, with many reviews providing insufficient details. PRACTICE IMPLICATIONS Motivation-based practices and culturally- and linguistically-appropriate care have impacts on patient outcomes across a range of settings with different professions and communicatively-vulnerable groups.
Collapse
Affiliation(s)
- Lorienne M Jenstad
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Tami Howe
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Genevieve Breau
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, London SE10 9LS, UK.
| | - Jennifer Abel
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Paola Colozzo
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Gayle Halas
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Glenda Mason
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Caroline Rieger
- Department of Central, Eastern and Northern European Studies, University of British Columbia, Vancouver, Canada
| | - Leora Simon
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Shaelyn Strachan
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
5
|
Kanan P, Siribumrungwong B, Tharavanij T, Orrapin S, Napunnaphat P. The needs of patients with diabetes for the prevention and treatment of foot complications in Thailand: A qualitative descriptive study. BELITUNG NURSING JOURNAL 2023; 9:586-594. [PMID: 38130669 PMCID: PMC10731426 DOI: 10.33546/bnj.2835] [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: 07/26/2023] [Revised: 08/21/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
Background Inadequate diabetes self-management leads to foot infections and lower extremity amputations. Effective self-care, supported by nurse-provided information, is crucial, particularly in foot care. However, the current approach in Thailand focuses more on what nurses want patients to know rather than addressing patients' actual needs. Consequently, nurses might misunderstand their patients' perspectives. Hence, nurses need to grasp patients' needs for successful foot care behavior. Objective This study aimed to explore the needs of patients with diabetes regarding the prevention and treatment of foot complications. Methods The study employed a qualitative descriptive design. Thirty participants classified as high risk for foot ulcers were purposively selected from Thailand's university hospitals. Focus group discussions were used for data collection between June and July 2021. Verbatim transcription and content analysis were carried out for data analysis. Results Four emergent themes highlighted patients' needs: 1) information-giving, 2) proactive foot screening with foot-care affirmation, 3) foot care services, and 4) relieving foot burdens and limb loss. Conclusion Nurses should change their mindset to care for and continually understand patients' needs. This involves adapting educational strategies like the teach-back method and coaching while providing skill training. Offering diverse service platforms, both online and onsite education programs and counseling, is essential. Additionally, ensuring accessibility and affordability, such as establishing after-hours clinics and supplying foot care toolkits, remains crucial.
Collapse
Affiliation(s)
- Piyawan Kanan
- Faculty of Nursing, Thammasat University, Pathum Thani, Thailand
| | | | | | | | | |
Collapse
|
6
|
Rodríguez-Nogueira Ó, Balaguer JM, Nogueira López A, Merino JR, Zamora-Conesa V, Moreno-Poyato AR. Adaptation of the person centered therapeutic relationship patient version (PCTR-PT) to a version for physiotherapists (PCTR-PHYS) and evaluation of its psychometric properties. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e2007. [PMID: 37070170 DOI: 10.1002/pri.2007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND AND PURPOSE The therapeutic relationship is a central component for developing person-centered care within physiotherapy services. However, it is necessary to understand how this relationship is perceived by both parties involved. The Person Centered Therapeutic Relationship-Patient scale (PCTR-PT) was constructed to identify patients' perceptions. No instruments are currently available to correlate patients' and physiotherapists' perceptions of the therapeutic relationship. This study sought to adapt the PCTR-PT to develop a version for physiotherapists, the Person Centered Therapeutic Relationship Scale for Physiotherapists (PCTR-PHYS) and to determine its psychometric properties. METHODS A three-stage study was performed: (1) item generation, (2) pretesting of the questionnaire, (3) analysis of psychometric properties. Factor validity and psychometric properties were analyzed by confirmatory factor analysis (CFA). Convergent validity was calculated. Internal consistency was verified using the Cronbach's alpha coefficient. The intraclass correlation coefficient (ICC) was used to examine temporal stability. RESULTS Thirty-three physiotherapists participated in two rounds of cognitive interviews and 343 participated in the analysis of psychometric properties. The CFA confirmed the four-structure model. Reliability of the tool was confirmed by Cronbach's alpha (α = 0.863) for all four dimensions, as all were above 0.70, ranging from 0.704 (relational bond) and 0.898 (therapeutic communication). Test-retest was performed with 2-week intervals, indicating an appropriate stability for the scale (ICC = 0.908). DISCUSSION The Person Centered Therapeutic Relationship Scale for Physiotherapists is a useful, valid and applicable instrument to evaluate the person-centered therapeutic relationship during physiotherapy interventions. It will enable the comparison of patients' and physiotherapists' perceptions. To provide person-centered care in physiotherapy services, there is a clear need to incorporate specific resources into clinical practice to evaluate the quality of the therapeutic relationship from the perspective of both the persons being treated and the professionals providing care.
Collapse
Affiliation(s)
- Óscar Rodríguez-Nogueira
- Department of Nursing and Physiotherapy, SALBIS Research Group, Universidad de León, Ponferrada, León, Spain
| | - Jaume Morera Balaguer
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Alicante, Spain
| | - Abel Nogueira López
- Department of Physical Education and Sports, Universidad de León, León, Spain
| | - Juan Roldán Merino
- Campus Docent Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Víctor Zamora-Conesa
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Alicante, Spain
| | - Antonio R Moreno-Poyato
- Mental health, psychosocial and complex nursing care research group (NURSEARCH), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Escola d´Infermeria Departament d'Infermeria de Salut Pública, Salut Mental I Materno Infantil, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
7
|
Cox C, Fritz Z. What is in the toolkit (and what are the tools)? How to approach the study of doctor-patient communication. Postgrad Med J 2023; 99:631-638. [PMID: 37319157 PMCID: PMC10464852 DOI: 10.1136/postgradmedj-2021-140663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022]
Abstract
Doctor-patient communication is important, but is challenging to study, in part because it is multifaceted. Communication can be considered in terms of both the aspects of the communication itself, and its measurable effects. These effects are themselves varied: they can be proximal or distal, and can focus on subjective measures (how patients feel about communication), or objective measures (exploring more concrete health outcomes or behaviours). The wide range of methodologies available has resulted in a heterogeneous literature which can be difficult to compare and analyse. Here, we provide a conceptual approach to studying doctor-patient communication, examining both variables which can controlled and different outcomes which can be measured. We present methodologies which can be used (questionnaires, semistructured interviews, vignette studies, simulated patient studies and observations of real interactions), with particular emphasis on their respective logistical advantages/disadvantages and scientific merits/limitations. To study doctor-patient communication more effectively, two or more different study designs could be used in combination. We have provided a concise and practically relevant review of the methodologies available to study doctor-patient communication to give researchers an objective view of the toolkit available to them: both to understand current research, and to conduct robust and relevant studies in the future.
Collapse
Affiliation(s)
- Caitríona Cox
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Zoë Fritz
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| |
Collapse
|
8
|
Olson EM, Falde SD, Wegehaupt AK, Polley E, Halvorsen AJ, Lawson DK, Ratelle JT. Dismissal disagreement and discharge delays: Associations of patient-clinician plan of care agreement with discharge outcomes. J Hosp Med 2022; 17:710-718. [PMID: 35942985 DOI: 10.1002/jhm.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many hospitalized patients do not understand or agree with their clinicians about their discharge plan. However, the effect of disagreement on discharge outcomes is unknown. OBJECTIVE To measure the correlation between patient-clinician care agreement and discharge outcomes. DESIGN A prospective cohort study was performed from September 2019 to March 2020 (Rochester, MN, USA). SETTING AND PARTICIPANTS Internal medicine patients and their primary clinician (resident, advanced practice clinician or attending) hospitalized from September 2019-March 2020 at Mayo Clinic Hospital. Participants were independently surveyed following hospital day #3 ward rounds regarding the goals of the hospitalization and discharge planning. MAIN OUTCOME AND MEASURES Patient-clinician agreement for main diagnosis, patient's main concern, and four domains of discharge planning was assessed. Readiness for hospital discharge, delayed discharge, and 30-day readmission was measured. Then, associations between patient-clinician agreement, delayed discharge, and 30-day readmissions were analyzed using multivariable logistic regression. RESULTS Of the 436 patients and clinicians, 17.7% completely agreed about what needs to be accomplished before dismissal, 40.8% agreed regarding discharge date, and 71.1% agreed regarding discharge location. In the multivariable model, patient-clinician agreement scores were not significantly correlated with discharge outcomes. Patient-clinician agreement on discharge location was higher for those discharged to home (81.5%) versus skilled nursing facility (48.5%) or assisted living (42.9%) (p < .0001). The agreement on the expected length of stay was highest for home-goers (45.9%) compared to skilled nursing (32.0%) or assisted living (21.4%) (p = .004). CONCLUSIONS Patients and their clinicians frequently disagree about when and where a patient will go after hospitalization, particularly for those discharged to a skilled nursing facility. While disagreement did not predict discharge outcomes, our findings suggest opportunities to improve effective communication and promote shared mental models regarding discharge earlier in the hospital stay.
Collapse
Affiliation(s)
- Emily M Olson
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel D Falde
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Eric Polley
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | | | - Donna K Lawson
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John T Ratelle
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
9
|
Van Scoy LJ, Scott AM, Green MJ, Witt PD, Wasserman E, Chinchilli VM, Levi BH. Communication Quality Analysis: A user-friendly observational measure of patient-clinician communication. COMMUNICATION METHODS AND MEASURES 2022; 16:215-235. [PMID: 37063460 PMCID: PMC10104441 DOI: 10.1080/19312458.2022.2099819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Communication Quality Analysis (CQA) is a rigorous transcript-based coding method for assessing clinical communication quality. We compared the resource-intensive transcript-based version with a streamlined real-time version of the method with respect to feasibility, validity, reliability, and association with traditional measures of communication quality. Simulated conversations between 108 trainees and 12 standardized patients were assessed by 7 coders using the two versions of CQA (transcript and real-time). Participants also completed two traditional communication quality assessment measures. Real-time CQA was feasible and yielded fair to excellent reliability, with some caveats that can be addressed in future work. CQA ratings were moderately correlated with traditional measures of communication quality, suggesting that CQA captures different aspects of communication quality than do traditional measures. Finally, CQA did not exhibit the ceiling effects observed in the traditional measures of communication quality. We conclude that real-time CQA is a user-friendly method for assessing communication quality that has the potential for broad application in training, research, and intervention contexts and may offer improvements to traditional, self-rated communication measures.
Collapse
Affiliation(s)
- Lauren Jodi Van Scoy
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
- Department of Humanities, Penn State College of Medicine, Hershey, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Allison M Scott
- Department of Communication; University of Kentucky, Lexington, USA
| | - Michael J. Green
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
- Department of Humanities, Penn State College of Medicine, Hershey, USA
| | - Pamela D. Witt
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State College of Medicine, Hershey, USA
- Department of Pediatrics Penn State College of Medicine, Hershey, USA
| |
Collapse
|
10
|
Richard C, Lussier MT, Roberge D, Lavoie MÈ, Turner J. Applying a multidimensional approach to understanding clinical conversations: A deprescribing case study in primary care. PATIENT EDUCATION AND COUNSELING 2022; 105:2590-2598. [PMID: 35197203 DOI: 10.1016/j.pec.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe and evaluate the contribution of multiple coding approaches applied to a clinical conversation on deprescribing in primary care (PC). METHODS Seven distinct coding approaches were applied to one audiotaped consultation. Only exchanges related to deprescribing a benzodiazepine (BZD) were coded for: content, interaction, arguments, connectors, transitions, orientation towards deprescribing and concordance with a deprescribing algorithm. A discursive map presents the unfolding of the exchanges. RESULTS The deprescribing conversation was broken down into 31 utterances divided into three segments: opening (n = 6), development (n = 16) and closing (n = 9). The family physician dominated the last two segments and most of her utterances were favorable to BZD deprescribing while the patient's utterances were generally unfavorable in the first two segments. The number of distinct codes assigned to utterances varied according to the coding approach. The map illustrates how each utterance can be viewed through different lenses revealing the dynamics and complexity of the deprescribing conversation. CONCLUSION This multidimensional methodological approach with its proposed way of presenting results, either quantitatively or qualitatively, and its map offer a comprehensive evaluation of the deprescribing process in this PC setting. PRACTICE IMPLICATIONS This novel multidimensional coding approach has potential to be applied to a range of other topics in clinical communications.
Collapse
Affiliation(s)
- Claude Richard
- Direction de l'enseignement universitaire et de la recherche, Centre intégré de santé et des services sociaux de Laval, 1755 René Laënnec, Laval, Québec H7M 3L9, Canada
| | - Marie-Thérèse Lussier
- Direction de l'enseignement universitaire et de la recherche, Centre intégré de santé et des services sociaux de Laval, 1755 René Laënnec, Laval, Québec H7M 3L9, Canada; Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université de Montréal, Pavillon Roger-Gaudry, 2900, boul. Édouard-Montpetit, Montréal, Québec H3T 1J4, Canada.
| | - Denis Roberge
- Direction de l'enseignement universitaire et de la recherche, Centre intégré de santé et des services sociaux de Laval, 1755 René Laënnec, Laval, Québec H7M 3L9, Canada
| | - Marie-Ève Lavoie
- Direction de l'enseignement universitaire et de la recherche, Centre intégré de santé et des services sociaux de Laval, 1755 René Laënnec, Laval, Québec H7M 3L9, Canada
| | - Justin Turner
- Faculté de pharmacie, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec H3C 3J7, Canada; Centre de recherche Institut universitaire de gériatrie de Montréal, 4565, Chemin Queen-Mary, Montréal, Québec H3W 1W5, Canada; Centre for Medicine Use and Safety, School of Pharmacy and Pharmaceutical Sciences, Monash University, 318 Royal Parade, Parkville, Victoria 3052, Australia
| |
Collapse
|
11
|
Drossman DA, Chang L, Deutsch JK, Ford AC, Halpert A, Kroenke K, Nurko S, Ruddy J, Snyder J, Sperber A. A Review of the Evidence and Recommendations on Communication Skills and the Patient-Provider Relationship: A Rome Foundation Working Team Report. Gastroenterology 2021; 161:1670-1688.e7. [PMID: 34331912 DOI: 10.1053/j.gastro.2021.07.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Over several decades, changes in health care have negatively impacted meaningful communication between the patient and provider and adversely affected their relationship. Under increasing time pressure, physicians rely more on technology than face-to-face time gathering data to make clinical decisions. As a result, they find it more challenging to understand the illness context and fully address patient needs. Patients experience dissatisfaction and a diminution of their role in the care process. For patients with disorders of gut-brain interaction, stigma leads to greater care dissatisfaction, as there is no apparent structural basis to legitimize the symptoms. Recent evidence suggests that practical communication skills can improve the patient-provider relationship (PPR) and clinical outcomes, but these data are limited. METHODS The Rome Foundation convened a multidisciplinary working team to review the scientific evidence with the following aims: a) to study the effect of communication skills on patient satisfaction and outcomes by performing an evidence-based review; b) to characterize the influence of sociocultural factors, health care system constraints, patient perspective, and telehealth on the PPR; c) to review the measurement and impact of communication skills training on these outcomes; and d) to make recommendations to improve communication skills training and the PPR. RESULTS Evidence supports the fact that interventions targeting patient-provider interactions improve population health, patient and provider experience, and costs. Communication skills training leads to improved patient satisfaction and outcomes. The following are relevant factors to consider in establishing an effective PPR: addressing health care system constraints; incorporating sociocultural factors and the role of gender, age, and chronic illness; and considering the changing role of telehealth on the PPR. CONCLUSIONS We concluded that effective communication skills can improve the PPR and health outcomes. This is an achievable goal through training and system change. More research is needed to confirm these findings.
Collapse
Affiliation(s)
- Douglas A Drossman
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, and the Rome Foundation, Chapel Hill, North Carolina.
| | - Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases, G. Opopenbhemer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, Calfornia
| | - Jill K Deutsch
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Albena Halpert
- Gastroenterology,Harvard University Health Services, Boston, Massachusetts
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Johannah Ruddy
- Center for Education and Practice of Biopsychosocial Care and Rome Foundation, Raleigh, North Carolina
| | - Julie Snyder
- Gastrointetinal Psychology Service, Boston University, Harvard Medical School, Boston, Massachusetts
| | - Ami Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
12
|
McCabe E, Miciak M, Roduta Roberts M, Sun HL, Gross DP. Measuring therapeutic relationship in physiotherapy: conceptual foundations. Physiother Theory Pract 2021; 38:2339-2351. [PMID: 34632921 DOI: 10.1080/09593985.2021.1987604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The "therapeutic relationship" in physiotherapy refers to the beneficial or healing relationship between the patient and physiotherapist. Interest in researching therapeutic relationships in physiotherapy is growing and there is a need for a measure of therapeutic relationship with a strong conceptual foundation. Body of paper:We begin with a general discussion of the state of therapeutic relationship measurement in physiotherapy research - notably, how current research is based on measures borrowed and adapted from psychotherapy. Then, we introduce Miciak's physiotherapy therapeutic relationship framework, discuss why it offers a solid foundation for measurement development, and describe the key concepts in the framework. We then discuss various approaches to measuring therapeutic relationship, illustrating how Miciak's framework could be used to inform their development. We end by discussing current challenges in measuring therapeutic relationship and how these could be addressed.
Collapse
Affiliation(s)
- Erin McCabe
- Faculty of Rehabilitation Medicine, 3-48 Corbett Hall,University of Alberta, Edmonton, Alberta, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, 3-48 Corbett Hall,University of Alberta, Edmonton, Alberta, Canada
| | - Mary Roduta Roberts
- Department of Occupational Therapy, University of Alberta, 2-64 Corbett Hall, Edmonton,Alberta, Canada
| | - Haowei Linda Sun
- Division of Hematology, Department of Medicine, 4-112 Clinical Sciences Building, University of Alberta, Edmonton, Canada
| | - Douglas P Gross
- Department of Physical Therapy, 2-50 Corbett Hall, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
13
|
Mazor KM, King AM, Hoppe RB, D'Addario A, Musselman TG, Tallia AF, Gallagher TH. Using crowdsourced analog patients to provide feedback on physician communication skills. PATIENT EDUCATION AND COUNSELING 2021; 104:2297-2303. [PMID: 33715944 DOI: 10.1016/j.pec.2021.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/12/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Effective physician-patient communication is important, but physicians who are seeking to improve have few opportunities for practice or receive actionable feedback. The Video-based Communication Assessment (VCA) provides both. Using the VCA, physicians respond to communication dilemmas depicted in brief video vignettes; crowdsourced analog patients rate responses and offer comments. We characterized analog patients' comments and generated actionable recommendations for improving communication. METHODS Physicians and residents completed the VCA; analog patients rated responses and answered:"What would you want the provider to say in this situation?" We used qualitative analysis to identify themes. RESULTS Forty-three participants completed the VCA; 556 analog patients provided 1035 comments. We identified overarching themes (e.g., caring, empathy, respect) and generated actionable recommendations, incorporating analog patient quotes. CONCLUSION While analog patients' comments could be provided directly to users, conducting a thematic analysis and developing recommendations for physician-patient communication reduced the burden on users, and allowed for focused feedback. Research is needed into physicians' reactions to the recommendations and the impact on communication. PRACTICE IMPLICATIONS Physicians seeking to improve communication skills may benefit from practice and feedback. The VCA was designed to provide both, incorporating the patient voice on how best to communicate in clinical situations.
Collapse
Affiliation(s)
- Kathleen M Mazor
- Meyers Primary Care Institute, United States; University of Massachusetts Medical School, United States.
| | - Ann M King
- National Board of Medical Examiners, United States
| | - Ruth B Hoppe
- College of Human Medicine, Michigan State University, United States
| | | | | | - Alfred F Tallia
- Department of Family Medicine, Rutgers, Robert Wood Johnson Medical School, United States
| | | |
Collapse
|
14
|
Röttele N, Schlett C, Körner M, Farin-Glattacker E, Schöpf-Lazzarino AC, Voigt-Radloff S, Wirtz MA. Variance components of ratings of physician-patient communication: A generalizability theory analysis. PLoS One 2021; 16:e0252968. [PMID: 34111197 PMCID: PMC8191893 DOI: 10.1371/journal.pone.0252968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background The ratings of physician-patient communication are an important indicator of the quality of health care delivery and provide guidance for many important decisions in the health care setting and in health research. But there is no gold standard to assess physician-patient communication. Thus, depending on the specific measurement condition, multiple sources of variance may contribute to the total score variance of ratings of physician-patient communication. This may systematically impair the validity of conclusions drawn from rating data. Objective To examine the extent to which different measurement conditions and rater perspectives, respectively contribute to the variance of physician-patient communication ratings. Methods Variance components of ratings of physician-patient communication gained from 32 general practitioners and 252 patients from 25 family practices in Germany were analyzed using generalizability theory. The communication dimensions “shared decision making”, “effective and open communication” and “satisfaction” were considered. Results Physician-patient communication ratings most substantially reflect unique rater-perspective and communication dimension combinations (32.7% interaction effect). The ratings also represented unique physician and rater-perspective combinations (16.3% interaction effect). However, physicians’ communication behavior and the observed communication dimensions revealed only a low extent of score variance (1% physician effect; 3.7% communication dimension effect). Approximately half of the variance remained unexplained (46.2% three-way interaction, confounded with error). Conclusion The ratings of physician-patient communication minimally reflect physician communication skills in general. Instead, these ratings exhibit primarily differences among physicians and patients in their tendency to perceive shared decision making and effective and open communication and to be satisfied with communication, regardless of the communication behavior of physicians. Rater training and assessing low inferential ratings of physician-patient communication dimensions should be considered when subjective aspects of rater perspectives are not of interest.
Collapse
Affiliation(s)
- Nicole Röttele
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Christian Schlett
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrea C. Schöpf-Lazzarino
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Markus A. Wirtz
- Department of Research Methods, Freiburg University of Education, Freiburg, Germany
| |
Collapse
|
15
|
Matlock DD, Fukunaga MI, Tan A, Knoepke C, McNeal DM, Mazor KM, Glasgow RE. Enhancing Success of Medicare's Shared Decision Making Mandates Using Implementation Science: Examples Applying the Pragmatic Robust Implementation and Sustainability Model (PRISM). MDM Policy Pract 2020; 5:2381468320963070. [PMID: 33117890 PMCID: PMC7570787 DOI: 10.1177/2381468320963070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/30/2020] [Indexed: 12/16/2022] Open
Abstract
The Centers for Medicare and Medicaid Services (CMS) has mandated shared decision making (SDM) using patient decision aids for three conditions (lung cancer screening, atrial fibrillation, and implantable defibrillators). These forward-thinking approaches are in response to a wealth of efficacy data demonstrating that decision aids can improve patient decision making. However, there has been little focus on how to implement these approaches in real-world practice. This article demonstrates how using an implementation science framework may help programs understand multilevel challenges and opportunities to improve adherence to the CMS mandates. Using the PRISM (Pragmatic Robust Implementation and Sustainability Model) framework, we discuss general challenges to implementation of SDM, issues specific to each mandate, and how to plan for, enhance, and assess SDM implementation outcomes. Notably, a theme of this discussion is that successful implementation is context-specific and to truly have successful and sustainable changes in practice, context variability, and adaptation to context must be considered and addressed.
Collapse
Affiliation(s)
- Daniel D Matlock
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Mayuko Ito Fukunaga
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Andy Tan
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chris Knoepke
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Demetria M McNeal
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Kathleen M Mazor
- Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Russell E Glasgow
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado
| |
Collapse
|
16
|
Dryden EM, Hyde JK, Wormwood JB, Wu J, Calloway R, Cutrona SL, Elwyn G, Fix GM, Orner MB, Shimada SL, Bokhour BG. Assessing Patients' Perceptions of Clinician Communication: Acceptability of Brief Point-of-Care Surveys in Primary Care. J Gen Intern Med 2020; 35:2990-2999. [PMID: 32748346 PMCID: PMC7572926 DOI: 10.1007/s11606-020-06062-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Improving patient-centered (PC) communication is a priority in many healthcare organizations. Most PC communication metrics are distal to the care encounter and lack clear attribution, thereby reducing relevance for leaders and clinicians. OBJECTIVE We assessed the acceptability of measuring PC communication at the point-of-care. DESIGN A brief patient survey was conducted immediately post-primary care appointments at one Veterans Affairs Medical Center. Audit-feedback reports were created for clinicians and discussed in qualitative interviews. PARTICIPANTS A total of 485 patients completed the survey. Thirteen interviews were conducted with clinicians and hospital leaders. MAIN MEASURE(S) Measures included collaboRATE (a 3-item tool measuring PC communication), a question about how well needs were met, and overall visit satisfaction. Data were analyzed using descriptive statistics to characterize the mean and distribution of collaboRATE scores and determine the proportion of patients giving clinicians a "top score" on each item. Associations among responses were examined. Interviews focused on the value of measuring PC communication and were analyzed using a framework approach. KEY RESULTS The proportion of patients giving PC communication "top scores" ranged from 41 to 92% for 16 clinicians who had ≥ 25 completed surveys. Among patients who gave "top scores" for PC communication, the odds of reporting that needs were "completely met" were 10.8 times higher (p < .001) and the odds of reporting being "very satisfied" with their care were 13.3 times higher (p < .001) compared with patients who did not give "top scores." Interviewees found clinician-specific feedback useful; concerns included prioritizing this data when other measures are used to evaluate clinicians' performance. Difficulties improving PC communication given organizational structures were noted. Recommendations for interventions included peer-to-peer education and mentoring by top-scoring clinicians. CONCLUSIONS Assessing provider communication at the point-of-care is acceptable and useful to clinicians. Challenges remain to properly incentivize and support the use of this data for improving PC communication.
Collapse
Affiliation(s)
- Eileen M Dryden
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
| | - Justeen K Hyde
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Jolie B Wormwood
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Juliet Wu
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Rodney Calloway
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Sarah L Cutrona
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Gemmae M Fix
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Michelle B Orner
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Stephanie L Shimada
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Barbara G Bokhour
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
17
|
Peimani M, Nasli-Esfahani E, Stewart AL, Shakibazadeh E, Yekaninejad MS, Garmaroudi G. Patient-physician communication in the context of diabetes care: Adaptation and assessment of psychometric properties of a Persian version of the interpersonal process of care survey (P-IPC). Diabetes Res Clin Pract 2020; 162:108109. [PMID: 32194218 DOI: 10.1016/j.diabres.2020.108109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 02/15/2020] [Accepted: 03/03/2020] [Indexed: 11/26/2022]
Abstract
AIMS To examine the psychometric characteristics and explore the preliminary validity of the Persian version of the Interpersonal Processes of Care Survey (P-IPC) to assess patient-physician communication in the context of diabetes care. METHODS After adapting, translating, examining content validity, and pretesting the questionnaire, it was administered to 300 patients with diabetes. Confirmatory factor analysis identified the factor structure (scales). Variability, item-scale correlations, reliability, and construct validity of the final scales were examined. RESULTS Factor analysis supported the hypothesized second-order factor model with 27 of the 29 items:11 first-, and 7 second-order common factors. Scale scores were calculated for the 7 second-order factors. Internal-consistency reliability for the 7 scales ranged from 0.60 to 0.90 and 2-week test-retest correlations ranged from 0.89 to 0.96. The communication and interpersonal style domains of the P-IPC demonstrated high ceiling effects suggesting good patient-physician communication. The P-IPC scales differentiated between patients in the language-concordant and language-discordant groups, and patterns of correlations with three patient satisfaction measures corresponded to hypotheses. CONCLUSION The P-IPC includes all of the second-order scales identified in the original IPC. Evidence of its reliability and validity suggest it can be useful for assessing patient-physician communication in the context of diabetes care.
Collapse
Affiliation(s)
- Maryam Peimani
- Department of Health Education & Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Anita L Stewart
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, CA, United States; Institute for Health & Aging, University of California San Francisco, San Francisco, CA, United States.
| | - Elham Shakibazadeh
- Department of Health Education & Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Gholamreza Garmaroudi
- Department of Health Education & Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
18
|
"Being in Control of My Asthma Myself" Patient Experience of Asthma Management: A Qualitative Interpretive Description. PHARMACY 2018; 6:pharmacy6040121. [PMID: 30445719 PMCID: PMC6306748 DOI: 10.3390/pharmacy6040121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/22/2022] Open
Abstract
Asthma control can be achieved with effective and safe medication use; however, many patients are not controlled. Patients’ perceptions of asthma, asthma treatment, and pharmacist roles can impact patient outcomes. The purpose of this study was to explore patients’ experiences and patient–pharmacist relationships in asthma care. Qualitative Interpretive Description method guided the study. Semi-structured individual interviews were conducted with 11 patients recruited from personal contacts, pharmacies, and asthma clinics. Categories and themes were identified using inductive constant comparison. Themes indicated patients had a personalized common sense approach to asthma management, “go-to” health care provider, and prioritized patient–pharmacist relationships. Patients described their illness experiences and asthma control based on personal markers similar to the common sense model of self-regulation. Patients chose a family physician, asthma specialist, respiratory therapist, or pharmacist as an expert resource for asthma management. Patient perceived pharmacists’ roles as information provider, adviser, or care provider. Pharmacists who develop a collaborative relationship with their asthma patients are better positioned to provide tailored education and self-management support. Inviting patients to share their perspective could increase patient engagement and uptake of personalised asthma action plans to achieve asthma control.
Collapse
|
19
|
Robertson-Jones TA, Tissue MM, Connolly M, Gallups SF, Bender CM, Rosenzweig MQ. Exploring Racial Differences in Patient Centeredness of Care (PCC) During Breast Cancer (BC) Chemotherapy Clinical Visits. J Racial Ethn Health Disparities 2018; 6:94-100. [PMID: 29971577 DOI: 10.1007/s40615-018-0503-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The communication patterns between clinician and patient, described as the patient centeredness of care (PCC), may be a critically important etiology of breast cancer (BC) racial disparity. The purpose of this prospective, comparative pilot study was to qualitatively explore and code for PCC during the clinical visit of women undergoing BC chemotherapy and compare by race. METHODS Age-matched Black and White women were recruited. Audio recordings of clinical visits conducted prior to any cycle (except first) chemotherapy infusion were obtained and transcribed. Transcripts were blindly reviewed by three independent coders assigning PCC scores, ranging from 1 to 5, with lower scores indicating better PCC. Consensus was reached among reviewers via discussion. RESULTS Dyads consisted of five Black (mean age 47) and five White (mean age 45) women undergoing BC chemotherapy. Twenty-four recordings were analyzed, 13 White and 11 Black. For all 22 PCC items, the mean scores were worse for Black women with significant differences (compared by chi-square analysis) noted for 6/22 items (27%). CONCLUSIONS Qualitatively exploring clinician and patient communication patterns during the chemotherapy clinical visits informs the understanding of racial differences for symptom assessment, reporting, and management. These pilot findings inform future research exploring racial disparity in cancer treatment dose intensity.
Collapse
Affiliation(s)
- Tinnikkar Angel Robertson-Jones
- Hampton University School of Nursing, E. Tyler St. & Emancipation Drive, William Freeman Hall, Room 110, Hampton, VA, 23668, USA
| | - Madison M Tissue
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Mary Connolly
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Sarah Frazier Gallups
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Catherine M Bender
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Margaret Quinn Rosenzweig
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA. .,Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15216, USA.
| |
Collapse
|
20
|
Lafata JE, Shay LA, Winship JM. Understanding the influences and impact of patient-clinician communication in cancer care. Health Expect 2017; 20:1385-1392. [PMID: 28636108 PMCID: PMC5689225 DOI: 10.1111/hex.12579] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patient-clinician communication is thought to be central to care outcomes, but when and how communication affects patient outcomes is not well understood. OBJECTIVE We propose a conceptual model and classification framework upon which the empirical evidence base for the impact of patient-clinician communication can be summarized and further built. DESIGN We use the proposed model and framework to summarize findings from two recent systematic reviews, one evaluating the use of shared decision making (SDM) on cancer care outcomes and the other evaluating the role of physician recommendation in cancer screening use. KEY RESULTS Using this approach, we identified clusters of studies with positive findings, including those relying on the measurement of SDM from the patients' perspective and affective-cognitive outcomes, particularly in the context of surgical treatment decision making. We also identify important gaps in the literature, including the role of SDM in post-surgical treatment and end-of-life care decisions, and those specifying particular physician communication strategies when recommending cancer screening. CONCLUSIONS Transparent linkages between key conceptual domains and the influence of methodological approaches on observed patient outcomes are needed to advance our understanding of how and when patient-clinician communication influences patient outcomes. The proposed conceptual model and classification framework can be used to facilitate the translation of empirical evidence into practice and to identify critical gaps in knowledge regarding how and when patient-clinician communication impacts care outcomes in the context of cancer and health care more broadly.
Collapse
Affiliation(s)
- Jennifer Elston Lafata
- UNC Lineberger Comprehensive Cancer Center and UNC Eshelman School of PharmacyThe University of North CarolinaChapel HillNCUSA
| | | | - Jodi M. Winship
- School of MedicineVirginia Commonwealth UniversityRichmondVAUSA
| |
Collapse
|
21
|
Street RL. The many "Disguises" of patient-centered communication: Problems of conceptualization and measurement. PATIENT EDUCATION AND COUNSELING 2017; 100:2131-2134. [PMID: 28619273 DOI: 10.1016/j.pec.2017.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To critically examine different approaches to the measurement of patient-centered communication. METHODS Provides a critique of 7 different measures of patient-centered communication with respect to differences in their assumptions about what constitutes patient-centeredness and in their approaches to measurement. RESULTS The measures differed significantly with regard to whether the measure captured behavior (what the interactants did) or judgment (how well the behavior was performed), focused on the individual clinician or on the interaction as a whole, and on who makes the assessment (participant or observer). A multidimensional framework for developing patient-centered communication measures is presented that encompasses the patient's perspective and participation, the biopsychosocial context of the patient's health, the clinician-patient relationship, quality of information-exchange, shared understanding, and shared, evidence-based decision-making. CONCLUSIONS The state of measurement of the patient-centered communication construct lacks coherence, in part because current measures were developed either void of a conceptual framework or from very different theoretical perspectives. PRACTICE IMPLICATIONS Assessment of patients' experiences with quality of communication in medical encounters should drill down into specific domains of patient-centeredness.
Collapse
Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, United States; Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Houston VA Center for Innovations in Quality, Effectiveness and Safety, United States.
| |
Collapse
|