Measuring patient-centered communication in Patient–Physician consultations: Theoretical and practical issues

From community to scale: Using community engagement to develop and validate a patient-informed cancer communication scale

OBJECTIVE

Racial disparities in clinical communication quality are well-established but most clinical communication assessment tools are created without the collaboration of racially-diverse patient populations. Our objective was to collaborate with Black and White cancer survivors, caregivers, and advocates to develop and validate a tool to assess physicians' patient-centered communication.

METHODS

A panel of Black and White cancer survivors, caregivers, and advocates (n = 11) and researchers observed and discussed video-recorded patient-physician cancer clinical interactions to generate and refine a list of physician communication behaviors considered critical for high-quality patient-centered communication. Raters applied the 22-item scale (Patient-Informed Cancer Communication Scale; PICCS) assessing physicians' patient-centered communication to video-recorded interactions (n = 61) from a larger study. We determined constructs using scale development and factor analysis and validated the scale through correlation with existing scales.

RESULTS

Factor analysis identified five factors: treatment options; clinical relationship; prognosis and goals of treatment; explanations; and context. Treatment options, prognosis and goals of treatment, and the full scale correlated with a validated patient active participation scale. Clinical relationship and context correlated with a validated physicians' patient-centered communication scale.

CONCLUSION

This community-engaged research produced a reliable and valid scale to assess physician patient-centered communication in the context of Black and White people with cancer.

PRACTICE IMPLICATIONS

With further validation work, this scale can be used to train and assess physician communication quality when discussing cancer treatment in diverse cancer patient populations.

What Encourages Patients to Recommend Their Doctor After an Online Medical Consultation? The Influence of Patient-Centered Communication, Trust, and Negative Health Information Seeking Experiences

The doctor-patient relationship in China has become increasingly tense, with patients lacking trust in doctors. Meanwhile, online healthcare flourished, accelerated by the COVID-19 pandemic. This study utilized the direct and indirect pathway model of clinician-patient communication to health outcomes and online trust theory to examine the associations between online patient-centered communication (OPCC), benevolence and ability trust in doctors, negative online health information seeking experiences, and willingness to recommend doctors. The findings revealed that benevolence and ability trust mediated the relationship between OPCC and willingness to recommend doctors. Additionally, when participants had a high level of negative online health information seeking experiences, OPCC had a stronger effect on ability trust; meanwhile, the mediation effect of ability trust between the relationship of OPCC and willingness to recommend was stronger. This study also discussed theoretical and practical implications.

The importance of patient engagement in the multimodal treatment of MASLD

Metabolic dysfunction-associated steatotic liver disease (MASLD) is often regarded in society as a disease caused by personal lifestyle and dietary choices. Healthcare providers who have empathy and are able to explain the disease trajectory can better engage with people with MASLD and actively work with them to improve their metabolic health on a sustainable basis. Non-invasive tests can assist in this process, but healthcare providers must ensure they explain their advantages and limitations. Discussing and setting lifestyle goals are priorities before initiating specific pharmacological treatment, since living a healthy lifestyle will remain the backbone of the multimodal management of MASLD. In this review, we discuss challenges and opportunities to actively engage with people living with MASLD in a multimodal treatment framework as a healthcare provider.

Gothenburg direct observation tool for assessing person-centred care (GDOT-PCC): evaluation of inter-rater reliability

OBJECTIVE

To assess the inter-rater reliability of the Gothenburg direct observation tool-person-centred care in assessing healthcare professionals' competency in delivering person-centred care (PCC).

DESIGN

Observational, fully-crossed inter-rater reliability study.

SETTING

The study was conducted between October and December 2022 at the participants' homes or offices.

PARTICIPANTS AND METHODS

Six health professionals individually rated 10 video-recorded, simulated consultations against the 53-item, 15-domain tool covering four major areas: PCC activities, clinician manner, clinician skills and PCC goals. Cronbach's α was used to assess internal consistency. Intraclass correlations (ICC) and 95% CI were computed for the domains.

RESULTS

Two domains (planning and documentation and documentation) were excluded from analyses due to insufficient evaluable data. Cronbach's α was acceptable (>0.70) for all evaluated domains. ICC values were high (ICC ≥0.75) for 11 of the 13 domains; however, CIs were generally wide and the lower bounds fell within the good range (ICC=0.60-0.74) for six domains and fair agreement (ICC=0.40-0.59) for the remaining six. The ICC for the domain patient perspective was non-informative due to its wide CIs (ICC=0.74 (0.39-0.92)).

CONCLUSION

ICC estimates for most domains were comparable to or exceeded those reported for similar direct observation tools for assessing PCC, suggesting that they may reliably be used in, for example, education and quality improvement applications. Reliability for the domains planning and documentation and documentation needs to be assessed in studies sampling more documentation behaviours. Reliability for the patient perspective domain may owe to methodological issues and should be reassessed in larger, better-designed studies.

Adherence to Hydroxyurea Therapy for Pediatric Sickle Cell Anemia in Tanzania: Evidence from Bugando Medical Centre

Hydroxyurea is effective in reducing the severity of Sickle cell anemia (SCA) symptoms, yet adherence remains challenging, particularly in resource-limited settings. Bugando Medical Centre, a major healthcare provider, faces undocumented adherence issues among its pediatric SCA patients. This study aims to evaluate the adherence rate to hydroxyurea therapy among caregivers of children with SCA at Bugando Medical Centre and identify factors contributing to non-adherence. This analytical cross-sectional study involved 172 participants. Data were analyzed using Stata version 15 and modified Poisson regression determined the association between exposures and adherence to hydroxyurea treatment. More than half (68.6%) of the children were aged between 1 and 10 years, with a median age of 8 years (IQR: 5-12). Good adherence to hydroxyurea was observed in 23.8% of participants, while 76.2% showed moderate to poor adherence. Children aged 1-10 years were twice as likely to have good adherence compared to those aged 11-17 years (aPR = 2.98, 95% CI = 1.18, 7.47). Children of caregivers with secondary education had a 41% higher chance of good adherence (aPR = 1.41, 95% CI = 1.19, 2.87) compared to those with primary education. Additionally, children of caregivers with college/university education had a 92% higher chance of good adherence (aPR = 1.92, 95% CI = 1.09, 4.63) compared to those with primary education. Participants with good knowledge of hydroxyurea had a 55% higher chance of good adherence (aPR = 1.55, 95% CI = 1.10, 4.78) compared to those with poor knowledge. Factors such as the child's age and caregiver's educational level are associated with good adherence to hydroxyurea treatment. Despite these associations, overall adherence rates are low, highlighting the need for targeted interventions to enhance knowledge and awareness about the importance of adherence to hydroxyurea treatment.

Exploring empathy and patient-centered communication behaviors of third-year medical students during a clinical skills examination

A previous study of third-year medical students' empathy during a clinical skills assessment found that SPs rated female students higher than males, and male Black/African-Americans received the lowest empathy scores. Our objective was to analyze students' patient-centered communication behaviors (PCCBs) to better understand those reported gender and racial/ethnic differences in empathy scores.

METHODS

We examined 63 videos from the parent study, using discourse and content analysis to identify PCCBs during standardized patient (SP) encounters. Then, we determined which PCCBs significantly correlated with SP empathy ratings. Finally, we examined whether those significant PCCBs differed across third-year medical students' gender and race/ethnicity.

RESULTS

We identified 18 PCCBs, six of which significantly correlated with SP empathy ratings. Generally, women tended to use patient-centered communication than men, while Black/African American men used less than Asian/Pacific Islander or white men.

CONCLUSION

In this exploratory, multiple methods study, we analyzed student discourse to better understand the reported gender and racial/ethnic differences in SP empathy scores. We found suggestions of gender and racial differences in behaviors related to patient-centered communication that need to be confirmed in larger, better-powered studies.

PRACTICE IMPLICATIONS

If our findings are corroborated, understanding gender and race/ethnicity differences in PCCBs may help medical educators teach students patient-centered communication (PCC) in a more diverse, culturally situated way. Beneficial actions would include developing faculty to teach PCC with a multi-cultural emphasis and recruiting more minority faculty in our medical schools to model effective communication and empathy skills. In addition, the PCCBs we identified through discourse analysis in this study can provide educators with a tool for teaching doctor-patient communication. Educators can review students' video encounters to provide specific and actionable feedback to promote PCC and empathy.

Toward a therapeutic relationship: A randomized control trial of the physical environment and client-centered communication in genetic counseling

Genetic counselors routinely provide service in many environments, including counseling-type and medical-type rooms; in this study, counseling environments are characterized by office décor that facilitates discussion around a seated table, while medical environments include an exam table and separate seating. Outside of the genetic counseling context, manipulation of the environment can influence client comfort in disclosing personal information, well-being, and overall satisfaction with clinician communication. However, there is little known about how clients experience genetic counseling in one environment versus the other and how that might influence their evaluation of genetic counselor communication. To explore the extent to which the physical environment influences client perceptions, we video recorded two simulated sessions addressing the same genetic counseling topic with two contrasting styles of communication (more and less patient-centered) in front of a greenscreen background. Videos were digitally placed in counseling and medical environments such that the same verbal and nonverbal communication was presented in the two environments, creating a total of four videos (e.g., a 2 × 2 experimental design). Participants (N = 861) were randomly assigned to observe one of the four videos and respond as if they were the client in the video (e.g., as analog clients). Overall, participants rated the less patient-centered communication more favorably (p < 0.05 across variables), contrary to our expectations. Structural equation modeling revealed that perceptions of nonverbal communication mediated the relationship between communication style and perceptions of the counselor's encouragement of participation in the session and the therapeutic bond. Results offer insight into how the physical environment might influence communication in genetic counseling, illustrating new avenues for improving client-counselor communication in this context.

Perceptions of Patient-Clinician Communication Among Adults With and Without Serious Illness

Importance

High-quality, person-centered patient-clinician communication is critical in health care and may be less effective for patients with serious illness. Little is understood about differences in patient-clinician communication experiences of adults with and without serious illness.

Objectives

To determine whether perceptions of patient-clinician communication experiences differ between adults with and without serious illness.

Design, Setting, and Participants

This population-based cross-sectional survey was fielded from April 20 to May 31, 2021, and data were analyzed from January 27, 2023, to December 10, 2024. Participants included a nationally representative sample of US English- or Spanish-speaking adults, including people from historically marginalized groups (eg, Black and Hispanic or Latino individuals, people with low income), responding to an online or telephone survey.

Exposure

Participants were categorized by serious illness status. Participants with serious illness replied yes to (1) having a diagnosis from a list of medical conditions and (2) reporting feeling sicker or having decreased functionality during the last year.

Main Outcomes and Measures

The survey asked about community partner-derived measures of patient-clinician communication experiences, including trusting clinicians, feeling afraid to speak up, and being unsure about next steps. Multivariable logistic regression models were used to estimate the association of serious illness with these communication experiences, adjusting for sociodemographic characteristics. Percentages were weighted according to the National Opinion Research Center's statistical weighting methods to account for differences in nonresponse.

Results

Of 6126 individuals invited, 1847 (30.2%) completed the survey and were included in analysis (mean [SD] age, 48.4 [17.5] years); 950 (51.8%) identified as female; 191 (11.9%) identified as Black and 287 (16.7%) as Hispanic; and 434 (17.8%) had an annual income less than $30 000 (here called low income). Among respondents, 363 participants (18.5%) had serious illness (mean [SD] age, 50.2 [18.1] years; 218 [64.5%] female; 34 [12.4%] Black; 54 [16.4%] Hispanic; 131 [27.3%] with low income), and 1484 (81.5%) had no serious illness (mean [SD] age, 48.0 [17.4] years; 732 [48.9%] female; 157 [11.8%] Black; 233 [16.7%] Hispanic; 303 [15.6%] with low income). Compared with adults without serious illness, adults with serious illness were more likely to report leaving a visit unsure about next steps (adjusted odds ratio [AOR], 2.30; 95% CI, 1.62-3.27); being afraid to ask questions or speak up (AOR, 2.18; 95% CI, 1.55-3.08); believing they were talked down to or made to feel inferior (AOR, 1.90; 95% CI, 1.24-2.91); and believing that they were treated unfairly by clinicians (AOR, 3.26; 95% CI, 2.43-4.38).

Conclusions and Relevance

In this cross-sectional study, adults with serious illness more often had worse patient-clinician communication experiences. Further research is needed to better understand and develop interventions to improve perceptions of patient-clinician communication experiences for adults with serious illness.

Influence of teaching a structured and humanized method of care on the perception of medical student attitudes in the doctor-patient relationship

INTRODUCTION

The humanization of care can be defined, in a generic way, as the act of making an empathetic and respectful approach to patients. This study proposed to evaluate the perception of attitudes of medical students regarding the doctor-patient relationship, after implementation of teaching a humanized and structured care method.

MATERIALS AND METHODS

Single-blind, randomized controlled experimental study that evaluated medical students in relation to patient care, based on a pre-post design, using the Patient-Practitioner Orientation Scale (PPOS). This scale has been validated to assess patient-centered attitudes, as the prime outcome measure. The intervention, with a group of randomized students, included teaching the structured and humanized method of patient care, denominated the SEAGULL (Subjective, Exams, Analysis, Goal, Ultimate Action), and was carried out at the university outpatient clinic.

RESULTS

Fifty-nine medical students participated in the study, with a mean age of 21.3 years (SD = 2.8) and a higher prevalence of female students (71.2%). The increase in the final scores was greater in the intervention group (p = 0.025) when comparing means of the total PPOS scores. The intervention group presented a larger effect size and higher mean scores (d = 0.49, Δ = +0.38, p<0.001) than the control group (d = 0.21, Δ = + 0.10, p = 0.004). It is noteworthy that the analysis of the initial and final means of the PPOS scores of the sharing domain revealed larger effect sizes in the intervention group compared to the control group (Δ = +0.42, d = 0.63; p<0.001).

DISCUSSION AND CONCLUSION

The findings showed that training in the use of the SEAGULL structured method led to a significant increase in PPOS scores related to the humanization of care by these students, with emphasis on the domain of sharing information, power, and responsibility with patients.

The PainSMART project: Protocol for a research program on effectiveness, mechanisms of effect and patient-practitioner experiences of the PainSMART-strategy as an adjunct to usual primary care physiotherapy management for musculoskeletal pain

BACKGROUND

Musculoskeletal pain (MSKP) disorders entail a significant burden for individuals and healthcare systems. The PainSMART-strategy has been developed aiming to reduce divergences between patients and healthcare practitioners in their understanding of MSKP by providing a shared basis for communication and to facilitate patients' self-management of MSKP. The objective of the PainSMART-project is to evaluate the effects of the PainSMART-strategy as an adjunct to usual physiotherapy management compared to usual physiotherapy management alone.

METHODS

The PainSMART-project is a research program with a collective suite of studies utilising mixed methods, centred around a randomised controlled trial (ClinicalTrials.gov NCT06187428). Subjects: Adults (18 years or older) seeking primary care for MSKP who are triaged and booked for an initial physiotherapy consultation at five primary care physiotherapy departments within the Swedish public healthcare regions of Östergötland and Jönköping. A total of 490 subjects will be randomised to receive one of two possible interventions.

INTERVENTIONS

Both groups will receive usual physiotherapy management for benign MSKP. The intervention group will also receive the PainSMART-strategy consisting of an educational film, reflection and reinforcement of the film's key messages prior to the initial physiotherapy consultation and a patient-practitioner discussion based on the film.

OUTCOME

The primary outcome is 1) between group mean change over time from baseline to 24 hours post initial physiotherapy consultation and baseline to 3 months regarding self-reported average pain intensity and pain self-efficacy. Secondary outcomes include similar measurements for MSKP illness perception, reassurance of benign nature, pain coping, physical activity, analgesic medication use, sick leave, healthcare use and direct healthcare costs. Physiotherapist and patient reported experience measures and qualitative evaluation of the effects of the PainSMART-strategy on communication at the initial physiotherapy consultation will also be explored.

DISCUSSION

This study will investigate potential added effects of PainSMART-strategy upon usual primary care physiotherapy for MSKP.

The application of artificial intelligence in health communication development: A scoping review

This scoping review explores the integration of Artificial Intelligence (AI) with communication, behavioral, and social theories to enhance health behavior interventions. A systematic search of articles published through February 2024, following PRISMA guidelines, identified 28 relevant studies from 13,723 screened. These studies, conducted across various countries, addressed health issues such as smoking cessation, musculoskeletal injuries, diabetes, chronic diseases and mental health using AI-driven tools like chatbots and apps. Despite AI's potential, a gap exists in aligning technical advancements with theoretical frameworks. The proposed AI Impact Communications Model (AI-ICM) aims to bridge this gap, offering a road map for future research and practice.

Patient-Clinician Communication Interventions Across Multiple Primary Care Sites: A Cluster Randomized Clinical Trial

Importance

Despite various attempts to improve patient-clinician communication, there has been limited head-to-head comparison of these efforts.

Objective

To assess whether clinician coaching (mobile application or in-person) is more effective than reminder posters in examination rooms and whether mobile app use is noninferior to in-person coaching.

Design, Setting, and Participants

A cluster randomized clinical trial with 3 arms. A total of 21 primary care clinics participated in 3 health systems in the US; participants were patients and primary care clinicians with clinic visits between August 28, 2019, and December 31, 2021. Data were analyzed from August 4, 2022, to November 10, 2024. Data analysis was based on intention to treat.

Interventions

In-person coaching of clinicians with standardized patient instructor training (high-touch), mobile application-based coaching (high-tech), and posters placed in examination rooms encouraging shared decision-making (AskShareKnow [ASK]). Before visits, patients in the high-touch and high-tech groups were prompted to inform their clinicians of the most important matter for discussion using online check-in.

Main Outcomes and Measures

The primary outcome was a patient engagement measure (CollaboRATE) of patient perceptions of communication and shared decision-making during the visit. Difference-in-differences mixed-effect regression with random intercepts for primary care clinician were used for analyses. Secondary outcomes included the net promoter score (patient's likelihood of recommending this clinician to others) and patient's confidence in managing their health.

Results

Participants included 4852 patients with a median age of 54 years (IQR, 39-66 years); 63.6% were women. A total of 114 clinicians (median age range, 40-59 years; 48 were women [42.1%]) participated. The 3 interventions did not differ significantly in probability of CollaboRATE top score (marginal difference, high-tech vs ASK, -0.021; 95% CI, -0.073 to 0.030; high-touch vs ASK, -0.018, 95% CI, -0.069 to 0.033; high-tech vs high-touch, -0.003, 95% CI, -0.057 to 0.052; P = .14). Patients in the high-tech group were less likely to recommend their clinician to others than patients in the high-touch group (difference in marginal probability, -0.056; 95% CI, -0.118 to 0.019; P = .04). After 3 months, patients in the high-tech group had a significantly lower score than patients in the high-touch group (mean difference, -0.176; 95% CI, -0.341 to -0.011; P = .04) in confidence in managing their health.

Conclusions and Relevance

This cluster randomized clinical trial found no evidence of intervention effects, although there were differences across systems. Some secondary outcomes suggested positive effect of clinicians receiving in-person coaching. Alternative outcome measures of patient engagement may be needed.

Trial Registration

ClinicalTrials.gov Identifier: NCT03385512.

Optimizing Patient Engagement in Treatment for Opioid Use Disorder: Primary Care Team Perspectives on Influencing Factors

BACKGROUND

Opioid use disorder (OUD) care engagement rates in primary care (PC) settings are often low. Little is known about PC team experiences when delivering OUD treatment and potential factors that influence their capacity to engage patients in treatment. Exploring PC team experiences may inform needed supports that can optimize OUD care delivery and improve outcomes for patients with OUD.

OBJECTIVE

We explored multidisciplinary PC team perspectives on barriers and facilitators to engaging patients in OUD treatment.

DESIGN

Qualitative study using in-depth interviews.

PARTICIPANTS

Primary care clinical teams.

APPROACH

We conducted semi-structured interviews (n = 35) with PC team members involved in OUD care delivery, recruited using a combination of criterion and maximal variation sampling. Data collection and analysis were informed by existing theoretical literature about patient engagement, specifically that patient engagement is influenced by factors across individual (patient, provider), interpersonal (patient-provider), and health system domains. Interviews were professionally transcribed and doubled-coded using a coding schema based on the interview guide while allowing for emergent codes. Coding was iteratively reviewed using a constant comparison approach to identify themes and verified with participants and the full study team.

KEY RESULTS

Analysis identified five themes that impact PC team ability to engage patients effectively, including limited patient contact (e.g., phone, text) in between visits, varying levels of provider confidence to navigate OUD treatment discussions, structural factors (e.g., schedules, productivity goals) that limited provider time, the role of team-based approaches in lessening discouragement and feelings of burnout, and lack of shared organizational vision for reducing harms from OUD.

CONCLUSIONS

While the capacity of PC teams to engage patients in OUD care is influenced across multiple levels, some of the most promising opportunities may involve addressing system-level factors that limit PC team time and collaboration and promoting organizational alignment on goals for OUD treatment.

New Evidences About Multidimensionality of the Patient-Practitioner Orientation Scale (PPOS) Construct in Undergraduate Medical Students

Background

Patient-centered care is becoming a paradigm in medicine. The Patient-Practitioner Orientation Scale (PPOS) is the only tool that measures the patient-centered attitude of healthcare students and professionals. Despite its spread, PPOS has had a poor process of scale modelling and validation and previous studies raised concerns about its psychometric robustness.

Objective

This study aims to investigate the PPOS psychometric properties, factor structure, and construct validity on a large sample of undergraduate medical students.

Methods

Participants of this cross-sectional single-center study are 1543 first-year medical students. PPOS item validity (internal consistency, test-retest reliability), factor structure (explorative principal axis factoring), and construct validity (convergent-discriminant validity, between-groups invariance) have been investigated.

Results

A three-factor not clearly defined solution explaining 34.4% of the variance and containing 14 items out of 18 was retained. Internal consistency was questionable for factor 1 (a = 0.657), poor for factor 2 (a = 0.566), and unacceptable for factor 3 (a = 0.399). Item-total correlations for factor 1 and factor 2 were > 0.3, except for item 6 (ITC = 0.218) and item 12 (ITC = 0.283). Item total-correlations for factor 3 were all < 0.3. Test-retest reliability was acceptable for factor 1 (ICC = 0.704) and factor 2 (ICC = 0.789) and questionable for factor 3 (ICC = 0.661). Construct validity and measurement invariance across groups were satisfactory.

Conclusion

Findings in this study corroborate previous evidences about PPOS psychometric limitations and provide new evidence about the multidimensionality of patient-centeredness construct.

Patients' Use of Electronic Health Records Facilitates Patient-Centered Communication: Findings From the 2017 Health Information National Trends Survey

BACKGROUND

Patient-centered communication refers to interaction between patients and health professionals that considers patients' preferences and empowers patients to contribute to their own care. Research suggests that patient-centered communication promotes patients' satisfaction with care, trust in physicians, and competence in their abilities to manage their health.

OBJECTIVE

The study aims to explore the role of patients' use of electronic health records (EHRs) in promoting patient-centered communication. Specifically, we investigated how health information efficacy mediates the association of EHR use with patient-centered communication and whether and how the relationship between EHR use and health information efficacy varies according to patients' perceived social support levels.

METHODS

We conducted mediation and multigroup analyses using nationally representative data from the Health Information National Trends Survey 5 cycle 1 conducted in the United States (N=3285). Among respondents, we analyzed those who received care from health professionals over the previous year (2823/3285, 85.94%).

RESULTS

EHR use by patients was associated with high levels of health information efficacy (unstandardized coefficient=0.050, SE 0.024; P=.04). In turn, health information efficacy was positively related to patient-centered communication (unstandardized coefficient=0.154, SE 0.024; P<.001). The indirect pathway from EHR use to patient-centered communication, mediated by health information efficacy, was statistically significant (unstandardized coefficient=0.008, SE 0.004; P=.04). Among patients with high social support (2349/2823, 83.21%), EHR use was not significantly associated with health information efficacy (unstandardized coefficient=0.038, SE 0.026; P=.15), although health information efficacy was linked to high levels of patient-centered communication (unstandardized coefficient=0.151, SE 0.030; P<.001). The indirect relationship in this group was not significant (unstandardized coefficient=0.006, SE 0.004; P=.11). However, among those with low social support (474/2823, 16.79%), EHR use was positively associated with health information efficacy (unstandardized coefficient=0.155, SE 0.048; P=.001), which in turn relates to high levels of patient-centered communication (unstandardized coefficient=0.137, SE 0.050; P=.01). The indirect pathway was also significant (unstandardized coefficient=0.021, SE 0.010; P=.03).

CONCLUSIONS

Patients who use EHRs may build health information efficacy, which seems to promote communication between patients and health care providers. This indirect pathway was not detected among patients with high social support. However, among those with low social support, EHR use seems to enhance health information efficacy, which may in turn facilitate patient-centered communication. Given the nature of the dataset used, the findings of this study are more relevant to the United States than other contexts.

Primary care team perspectives on approaches to engaging patients in treatment for opioid use disorder

INTRODUCTION

Engagement is a critical component of successful treatment for opioid use disorder (OUD). However, rates of patient engagement in OUD treatment, especially in outpatient settings, are variable and often low. Little is known about the specific strategies members of primary care teams use to initiate and encourage ongoing participation in OUD treatment. In a national cohort of primary care clinics in the U.S., we explored the perspectives of primary care team members on the meaning of and approaches to OUD treatment engagement.

METHODS

We conducted semi-structured interviews with 35 providers from multidisciplinary primary care teams in an existing national cohort of 13 clinics across seven states. Teams were delivering OUD treatment via the Collaborative Care Model, a model that combines primary care providers (PCP), behavioral health care managers (BHCM) and consulting psychiatric providers (CPP) in a structured way to provide patient-centered, team-based, and measurement-based care. Interview participants included 14 PCPs, 13 BHCMs, and 8 CPPs. Interviews asked open-ended questions about provider experiences and practices that aided or hindered patient engagement in OUD treatment. Interview transcripts were double-coded by trained qualitative researchers and analyzed using a combination of deductive and inductive approaches to identify themes.

RESULTS

Two themes emerged that describe provider perspectives on the meaning of engagement: 1) qualifying engagement by the volume of contact with patients, and 2) the need for more multidimensional measures of engagement. Six themes emerged that characterized provider engagement practices: 1) creating an environment of disclosure, 2) normalizing OUD treatment, 3) offering gentle but persistent outreach, 4) providing human connection and encouragement, 5) tailoring treatment to patient needs, and 6) avoiding stigmatizing responses. Analysis identified multiple replicable strategies that providers used to support these engagement practices.

CONCLUSIONS

Providers consistently apply a range of strategies when trying to engage patients in OUD treatment. Specific engagement strategies used embodied compassion and pragmatism, hallmarks of patient-centered care. Further research is needed to understand the impact of scaling engagement approaches across all care settings.

The Effects of Safe Zone Badges in Physicians' Online Biographies: Evidence from an Experimental Study

Earning digital badges to showcase a person's expertise or knowledge are becoming increasingly popular. A healthcare provider's displaying of a Safe Zone badge within their online profile may offer prospective patients a cue as to the kind of care they might receive if they selected that particular provider. Prior research indicates LGBTQ+ individuals are looking for these types of cues within providers' biographies to make their selections. A between subjects, 2 (Safe Zone badge present/absent) x 2 (male/female doctor) online experiment was conducted (n = 658). Results revealed a main effect for the presence of the Safe Zone badge. Participants had greater anticipated satisfaction, liking, were more likely to view the provider as approachable, and were more willing to schedule an appointment with the provider displaying a Safe Zone badge.

Healthcare Providers' Resilience Communication: A New Type of Patient-Centered Communication

Patient-centered communication (PCC) is considered a key component of quality healthcare, with reported levels of PCC rising over the last decade. However, engagement with patient emotions and uncertainty have been slower to rise, and healthcare providers at times use PCC behaviors to manipulate patients. Healthcare providers' use of the communication theory of resilience's (CTR) processes could benefit patients. A cross-sectional survey in the United States (N = 486) tested associations between CTR processes and patient satisfaction and perceived physical and mental health. All five core CTR processes were positively correlated with patient outcomes. When controlling for traditional PCC behaviors: (a) crafting normalcy, identity anchors, and alternative logics were positively related to patient satisfaction, (b) no processes were related to perceived mental health, and (c) communication networks, alternative logics, and productive action were positively related to perceived physical health. Condition severity moderated three associations. At moderate-high severity, crafting normalcy and communication networks were positively related to perceived mental health, and crafting normalcy was positively related to perceived physical health. Findings extend CTR into the patient-provider relationship and demonstrate the practical potential of CTR processes for improving patient outcomes. The study also forwards a measure of healthcare provider resilience communication (HPRC).

Comorbid Dementia and Cancer Therapy Decision-Making: A Scoping Review

Comorbid dementia complicates cancer therapy decision-making in older adults. We aimed to synthesize the recent literature (<5 years) on the challenges associated with cancer therapy decision-making among older people living with dementia (PLWD) and their caregivers. Of the 20,763 references, 8767 had their title and abstract screened, and eight met the inclusion criteria. Six studies were qualitative, one study employed mixed methods, and one study was quasi-experimental. Most studies were conducted in the UK (89%) and reported homogeneity in race and geography. Breast (56%) and prostate (45%) were the most frequent reported cancers. Five studies (56%) reported multiple types of dementia, with two (22%) indicating stages. The studies indicated that communication between patients, caregivers, and clinical teams might alleviate stress caused by worsening health prospects and potential ethical concerns. Information from this review can lead to better-informed, patient-centered treatment decision processes among older PLWD and cancer, their caregivers, and clinicians.

Healthcare providers' narratives about interactionally troubling patient exchanges: Accounting for and against an active patient role

The current trend in healthcare is to actively involve patients in their own treatment; however, in practice, healthcare providers may adhere to paternalistic views, which may not align with ideals related to patient involvement. This tension may become visible when providers talk about service encounters that they experienced as being interactionally troubling. In this empirical qualitative study, we utilize Bamberg's narrative positioning analysis to explore how healthcare providers construct patients' roles in narratives about such troubling exchanges. Data consist of 20 audio-recorded interviews with healthcare providers. We found two types of narratives in which healthcare providers' perceptions of interactionally troubling patient exchanges were consistently related to their implicit evaluations of patients along a continuum of activeness versus passiveness. In the first, an active patient was considered ideal, and the problematic patient was one who is passive. In the second, a patient's over-activeness was thought to interfere with the healthcare delivery. While providers' complaints about patient passiveness were unproblematically presented from the perspective of the patient participation ideal, complaints about patient over-activeness were difficult to account for due to their inherent connotations with paternalism. Thus, we conclude that there is a need for training and interventions aiming to develop healthcare providers' critical awareness of shifting cultural models, including patient involvement ideals and providers' capacity to reflect paternalistic tendencies.

Cluster randomised trial of a health system strengthening approach applying person-centred communication for the prevention of female genital mutilation in Guinea, Kenya and Somalia

INTRODUCTION

There is limited evidence on effective health systems interventions for preventing female genital mutilation (FGM). This study tested a two-level intervention package at primary care applying person-centred communication (PCC) for FGM prevention.

METHODS

A cluster randomised trial was conducted in 2020-2021 in 180 antenatal care (ANC) clinics in Guinea, Kenya and Somalia. At baseline, all clinics received guidance and materials on FGM prevention and care; at month 3, ANC providers at intervention sites received PCC training. Data were collected from clinic managers, ANC providers and clients at baseline, month 3 and month 6 on primary outcomes, including delivery of PCC counselling, utilisation of level one materials, health facility preparedness for FGM prevention and care services and secondary outcomes related to clients' and providers' knowledge and attitudes. Data were analysed using multilevel and single-level logistic regression models.

RESULTS

Providers in the intervention arm were more likely to deliver PCC for FGM prevention compared with those in the control arm, including inquiring about clients' FGM status (adjusted OR (AOR): 8.9, 95% CI: 6.9 to 11.5; p<0.001) and FGM-related beliefs (AOR: 9.7, 95% CI: 7.5 to 12.5; p<0.001) and discussing why (AOR: 9.2, 95% CI: 7.1 to 11.9; p<0.001) or how (AOR: 7.7, 95% CI: 6.0 to 9.9; p<0.001) FGM should be prevented. They were more confident in their FGM-related knowledge (AOR: 7.0, 95% CI: 1.5 to 32.3; p=0.012) and communication skills (AOR: 1.8; 95% CI: 1.0 to 3.2; p=0.035). Intervention clients were less supportive of FGM (AOR: 5.4, 95% CI: 2.4 to 12.4; p<0.001) and had lower intentions of having their daughters undergo FGM (AOR: 0.3, 95% CI: 0.1 to 0.7; p=0.004) or seeking medicalised FGM (AOR: 0.2, 95% CI: 0.1 to 0.5; p<0.001) compared with those in the control arm.

CONCLUSION

This is the first study to provide evidence of an effective FGM prevention intervention that can be delivered in primary care settings in high-prevalence countries.

TRIAL REGISTRATION AND DATE

PACTR201906696419769 (3 June 2019).

Are the content and usability of a new direct observation tool adequate for assessing competency in delivering person-centred care: a think-aloud study with patients and healthcare professionals in Sweden

OBJECTIVE

To evaluate the content and usability of a new direct observation tool for assessing competency in delivering person-centred care based on the Gothenburg Centre for Person-Centred Care (gPCC) framework.

DESIGN

This is a qualitative study using think-aloud techniques and retrospective probing interviews and analyzed using deductive content analysis.

SETTING

Sessions were conducted remotely via Zoom with participants in their homes or offices.

PARTICIPANTS

11 participants with lengthy experience of receiving, delivering and/or implementing gPCC were recruited using purposeful sampling and selected to represent a broad variety of stakeholders and potential end-users.

RESULTS

Participants generally considered the content of the four main domains of the tool, that is, person-centred care activities, clinician manner, clinician skills and person-centred care goals, to be comprehensive and relevant for assessing person-centred care in general and gPCC in particular. Some participants pointed to the need to expand person-centred care activities to better reflect the emphasis on eliciting patient resources/capabilities and psychosocial needs in the gPCC framework. Think-aloud analyses revealed some usability issues primarily regarding difficulties or uncertainties in understanding several words and in using the rating scale. Probing interviews indicated that these problems could be mitigated by improving written instructions regarding response options and by replacing some words. Participants generally were satisfied with the layout and structure of the tool, but some suggested enlarging font size and text spacing to improve readability.

CONCLUSION

The tool appears to satisfactorily cover major person-centred care activities outlined in the gPCC framework. The inclusion of content concerning clinician manner and skills was seen as a relevant embellishment of the framework and as contributing to a more comprehensive assessment of clinician performance in the delivery of person-centred care. A revised version addressing observed content and usability issues will be tested for inter-rater and intra-rater reliability and for feasibility of use in healthcare education and quality improvement efforts.

Perioperative Patient-Initiated Communication in Gender-Affirming Mastectomy

Background: Gender-affirming mastectomy (GAM) improves the psychosocial functioning and quality of life of transgender and non-binary (TGNB) individuals. However, the perioperative period is often marked by emotional stress, concerns about surgical outcomes, and physical discomfort. While inpatient procedures provide multiple opportunities to engage with and educate patients, outpatient surgeries, such as GAM, pose a unique challenge as patients are followed for <24 h postoperatively. Given the heightened emotional and psychological distress related to gender dysphoria TGNB individuals often experience, addressing these gaps can significantly improve outcomes. This study aims to characterize patient and surgical characteristics associated with patient-initiated communication (PIC) frequency in this population. Methods: A single-center retrospective review of TGNB patients undergoing GAM from February 2018 to November 2022 was conducted. Demographics, surgical characteristics, and frequency of and reasons for perioperative PIC (30 days before and after surgery) were recorded. The primary outcome was the incidence of perioperative PIC. The secondary outcomes included (1) the rationale for PIC and (2) patient and surgical characteristics associated with PIC. Results: A total of 352 patients were included. Of these, 285 (74.6%) initiated communication in the perioperative period, totaling 659 PICs. The median age was 25.0 (interquartile range [IQR]: 9.0) years. The median body mass index (BMI) was 28.5 (IQR: 8.5) kg/m2. The mean number of PICs was 0.7 ± 1.3 preoperatively and 1.3 ± 1.7 postoperatively (p < 0.001). The most frequent preoperative PIC subjects were administrative issues (AI; n = 66, 30.7%), preoperative requirements (n = 43, 20.0%), and cost and insurance (n = 33, 15.0%). The most frequent postoperative PIC subjects were wound care (n = 77, 17.3%), AI (n = 70, 15.0%), activity restrictions (n = 60, 13.5%), drainage (n = 56, 12.6%), and swelling (n = 37, 8.3%). Collectively, older patients (β = 0.234, p = 0.001), those with a history of major depressive disorder or generalized anxiety disorder (2.4 ± 3.0 vs. 1.7 ± 1.9; p = 0.019), and those without postoperative drains (n = 16/17, 94.1% vs. n = 236/334, 70.7%; p = 0.025) engaged in higher levels of PIC. There were no significant associations between other patient characteristics, perioperative details, or complications and PIC frequency. Conclusions: Perioperative PIC is prevalent among the majority of GAM patients at our institution, with age, psychiatric diagnosis, and postoperative drain use identified as significant predictors. To mitigate PIC frequency, it is crucial to ensure adequate support staffing and provide comprehensive postoperative instructions, particularly concerning activity restrictions and drainage management. These interventions may reduce PICs in high-volume centers. Further research should investigate targeted interventions to further support TGNB patients during the perioperative period.

Climate-sensitive health counselling in Germany: a cross-sectional study about previous participation and preferences in the general public

BACKGROUND

In response to climate change (CC), medicine needs to consider new aspects in health counselling of patients. Such climate-sensitive health counselling (CSHC) may include counselling patients on preventing and coping with climate-sensitive diseases or on leading healthy and climate-friendly lifestyles. This study aimed to identify previous participation in and preferences for CSHC as well as associated sociodemographic and attitudinal factors among the general public in Germany.

METHODS

We conducted a cross-sectional study in a population-based online panel in five German federal states (04-06/2022). We performed descriptive statistics and multivariable regression analysis to assess prior participation in CSHC and content preferences regarding CSHC, as well as associations between sociodemographic variables and general preference for CSHC.

RESULTS

Among 1491 participants (response rate 47.1%), 8.7% explicitly reported having participated in CSHC, while 39.9% had discussed at least one CSHC-related topic with physicians. In the studied sample, 46.7% of participants would like CSHC to be part of the consultation with their physician, while 33.9% rejected this idea. Participants aged 21 to 40 years (versus 51 to 60), individuals alarmed about CC (versus concerned/cautious/disengaged/doubtful/dismissive), and those politically oriented to the left (vs. centre or right) showed greater preference for CSHC in the multivariable regression model. Most participants wanted to talk about links to their personal health (65.1%) as opposed to links to the health of all people (33.2%).

CONCLUSIONS

Almost half of the participants in this sample would like to receive CSHC, especially those who are younger, more alarmed about CC and more politically oriented to the left. More research and training on patient-centred implementation of CSHC is needed.

Perceptions of metabolic syndrome management utilization in relation to patient experience and health-related quality of life

Background

One factor for the poor health outcomes among adult people with metabolic syndrome (MetS) is poor utilization of disease management resources, which may be attributable to prior experience with pharmacists (PEwP) and perceptions of disease management resource utilization (PMU). Therefore, understanding patients' experience could be critical to improving their perceptions and promoting health outcomes.

Objectives

The study explored the influence of PEwP and PMU on the health-related quality of life (HRQoL) of people with MetS.

Methods

Data on perceptions of healthcare, medication, and pharmacy services utilization, PEwP, and HRQoL were collected using validated tools via an electronic survey. Chi-square and ordinal regression tests were used to predict the association between PMU, PEwP, and HRQoL. Also, mediation analysis through Haye's model 4 explored the direct and indirect relationship of PMU and PEwP on HRQoL.

Results

A total of 706 completed surveys were collected and used for analyses. On average, respondents reported three comorbidities. Of the respondents, 72.0% had good PEwP, while 32.6% had good PMU. Comparatively, 38.4% of those with good PEwP had good PMU, compared to 17.3% of those with poor PEwP. Also, 47.0% of those with good PMU had good HRQoL compared to 35.3% with poor PMU. The odds of having fair or good PMU were nearly triple (OR = 2.97, p < 0.001) among those with good PEwP compared to those with poor PEwP. Also, respondents with good PMU had 58% (OR = 1.58, p = 0.008) higher odds of having fair or good HRQoL. Analysis through bootstrap indicated a significant relationship (BootCI = -0.072, -0.022) between PEwP and HRQoL via respondents' PMU.

Conclusions

MetS individuals with good experience and PMU were more likely to have good HRQoL. Prior experience with pharmacists influenced PMU and indirectly impacted HRQoL. Therefore, pharmacists must consider patients' experience and management utilization perceptions to promote health outcome among people with MetS, while implementing interventions.

The potential influence of patient-centered communication, online provider communication, and social determinants of health on cancer screening

OBJECTIVE

To understand how breast and cervical cancer screening are influenced by communicating with a healthcare provider, patient activation, and social determinants of health.

METHOD

Data were from the National Cancer Institute's Health Information National Trends Survey, focusing on women with no history of cancer at least 21 years old (N = 1466) to study cervical cancer screening and those at least 40 years old (N = 1114) to study breast cancer screening. Variables included patient-centered communication, electronic healthcare communication, patient activation, race/ethnicity, education, health insurance status, Appalachian residence, and financial insecurity.

RESULTS

Electronic communication predicted both cancer screens, but especially for White women. Patient-centered communication influenced cervical cancer screening only for women with insurance. It only influenced mammography for those without insurance. Patient activation did not influence either cancer screen behavior.

CONCLUSION

These data demonstrate more nuance is needed to parse potential effects of advocated-for healthcare behaviors. Use of publicly available datasets from can be informative but are limited methodologically.

PRACTICE IMPLICATIONS

Healthcare providers and systems should promote use of patient portals and other electronic means of interaction outside regular clinical visits for all patients. However, attention needs to be paid to the unequal benefits they afford to patients.

The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study

OBJECTIVES

In middle-income countries, poor physician-patient communication remains a recognized barrier to enhancing healthcare quality and patient satisfaction. This study investigates the influence of provider-patient communication skills on healthcare quality and patient satisfaction in the rural primary healthcare setting in China.

METHODS

Data were collected from 504 interactions across 348 rural primary healthcare facilities spanning 21 counties in three provinces. Using the Standardized Patient method, this study measured physician-patient communication behaviors, healthcare quality, and patient satisfaction. Communication skills were assessed using the SEGUE questionnaire framework. Multivariate linear regression models and multivariate logistic regression models, accounting for fixed effects, were employed to evaluate the impact of physicians' communication skills on healthcare quality and patient satisfaction.

RESULTS

The findings indicated generally low provider-patient communication skills, with an average total score of 12.2 ± 2.8 (out of 24). Multivariate regression models, which accounted for physicians' knowledge and other factors, demonstrated positive associations between physicians' communication skills and healthcare quality, as well as patient satisfaction (P < 0.05). Heterogeneity analysis revealed stronger correlations among primary physicians with lower levels of clinical knowledge or more frequent training.

CONCLUSION

This study emphasizes the importance of prioritizing provider-patient communication skills to enhance healthcare quality and patient satisfaction in rural Chinese primary care settings. It recommends that the Chinese government prioritize the enhancement of provider-patient communication skills to improve healthcare quality and patient satisfaction.

The Physician-Patient Communication Behaviors Among Medical Specialists in a Hospital Setting

Effective physician-patient communication builds robust physician-patient relationships and reduces medical disputes. However, much is unknown about the differences that exist in the communication behaviors of physicians in different departments. Using a mixed-methods research approach, the researchers used Roter Interaction Analysis System to uncover the communication behaviors of internists, surgeons, family physicians, and emergency physicians at a regional hospital in Taiwan. Semi-structured interviews were conducted to collect the communication experiences of 20 physicians from the internal medicine, surgery, family medicine, and emergency departments. The characteristics were presented through descriptive statistics, bar charts, and dendrograms. Physician-patient communications consisted of four dimensions, 10 factors, and 31 behaviors. The characteristics are as follows: (1) Internists need to improve their overall performance in terms of physician-patient communication behaviors; (2) Surgeons performed well in building relationships through non-verbal methods; (3) Family physicians excelled in facilitation and patient activation. (4) Emergency physicians performed well in patient education and counseling. The characteristics of the aforementioned communication behaviors among internists, surgeons, family physicians, and emergency physicians can be used to construct indicators of physician-patient communication in each department and to develop patient-centered healthcare services in the future.

Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey

BACKGROUND

The use of simulated patients (SPs) to assess medical students' clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students' medical interview.

METHODS

This longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment's internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT's 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach's alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson's correlation coefficient.

RESULTS

Of the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach's alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity.

CONCLUSIONS

Evidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students.

Exploring the dynamics of physician-patient relationships: Factors affecting patient satisfaction and complaints

This review identifes the factors influencing the relationship between physicians and patients that can lead to patients' dissatisfaction and medical complaints. Utilizing a systemic approach 92 studies were retrieved which included quantitative, qualitative, and mixed method studies. Through a thematic analysis of the literature, we identified three interrelated main themes that can influence the relationship between physicians and patients, patients' satisfaction, and the decision to file a medico-legal complaint. The main themes include patient and physician characteristics; the interpersonal relationship between physicians and patients; and the health care system and policies, with relevant subthemes. These themes are demonstrated in a descriptive model. The review suggests areas of focus for physicians who may wish to increase their awareness around the potential sources of relational problems with their patients. Identifying these issues may assist in improvements in the therapeutic relationship with patients, can reduce their medico-legal risk, and enhance the quality of their clinical practice. The findings can also be utilized to support andragogical principles for medical learners. The article can serve as a structured framework to identify potential problems and gaps to design and test effective interventions to mitigate these potential relational problems between physician-patient.

Communication Matters: The Role of Patient-Centered Communication in Improving Old Adults' Health Competence and Health Outcomes

Research has demonstrated links between patient-centered communication (PCC) and patients' health outcomes. However, little is known about the underlying processes that may mediate the relationship. This study is one of the first to examine the influence of PCC on older adults' health outcomes, as well as the mediation role of health competence, from a longitudinal perspective. With a general basis of Street et al.'s pathway model, we proposed and tested mediation pathways linking patient-centered communication to the older population's general and mental health, mediated by health competence. Data from 2011, 2017 and 2020 iterations of the Health Information National Trends Survey (HINTS) were used for this study. This study focused on older adults aged 60 and above. Results indicated that after controlling participants' age, gender, education, income and race, PCC is related to the older people's health outcomes either directly or indirectly, irrespective of time series. Specifically, health competence was found to significantly mediate the associations between PCC and the older adults' general health or mental health over the three iterations. Noteworthily, findings from this study also revealed that different dimensions of PCC might exert different influences on older patients' health competence and health outcomes.

Patient and Provider Perspectives on Processes of Engagement in Outpatient Treatment for Opioid Use Disorder: A Scoping Review

Effective treatment for opioid use disorder (OUD) is available, but patient engagement is central to achieving care outcomes. We conducted a scoping review to describe patient and provider-reported strategies that may contribute to patient engagement in outpatient OUD care delivery. We searched PubMed and Scopus for articles reporting patient and/or provider experiences with outpatient OUD care delivery. Analysis included: (1) describing specific engagement strategies, (2) mapping strategies to patient-centered care domains, and (3) identifying themes that characterize the relationship between engagement and patient-centered care. Of 3,222 articles screened, 30 articles met inclusion criteria. Analysis identified 14 actionable strategies that facilitate patient engagement and map to all patient-centered care domains. Seven themes emerged that characterize interpersonal approaches to OUD care engagement. Interpersonal interactions between patients and providers play a pivotal role in encouraging engagement throughout OUD treatment. Future research is needed to further evaluate promising engagement strategies.

Medical encounters with patients diagnosed with cancer: The association between physicians' behavior and perceived patient centered care and anxiety

PURPOSE

To evaluate the association between physicians' behavior and cancer patients' perceived patient-centered care (PCC) and anxiety following medical encounters.

METHODS

A prospective study design with 100 encounters, including 100 cancer patients and 22 oncology/surgery physicians, was performed between November 2019 and July 2021. Before the medical encounters, patients were asked to complete the validated State-Trait Anxiety Inventory (STAI), and physicians and patients completed sociodemographic and clinical data. During the medical encounters, structured 'real-time' observations of the physicians' behaviors were performed using the Four Habits Coding Scheme (4HCS). Following the medical encounters, patients were asked to re-complete the STAI and to fill the validated Perceived PCC questionnaire.

RESULTS

Mean 4HCS was positively associated with perceived PCC (β = 0.351, p < 0.001) and contributed 10.5% to the total 25.3% explained variance beyond the sociodemographic and clinical variables. Of the 4HCS sub scales, 'Demonstrate Empathy' displayed the lowest correlation with perceived PCC as compared to informational behaviors. In contrast, mean 4HCS was not associated with post-meeting anxiety (p > 0.05).

CONCLUSION

Our 'in-vivo' observations of medical encounters expands on previous studies in educational settings in showing how physicians' behaviors impact real patients' experience. The findings may provide a more accurate picture of physicians' supportive and unsupportive behaviors that impact on perceived PCC and anxiety. Patients may prefer their physicians to focus on the informational content related to their disease trajectory rather than focusing on empathy with their emotions. Physicians should be trained in ways to support patients on how to regain emotional control in stressful medical situations.

A neuropsychological feedback model for memory clinic trainees

Memory clinics that specialize in evaluating and treating cognitive decline in older adults are increasingly common and serve as an important training setting for neuropsychology practicum students, interns, and postdoctoral residents. Following a neuropsychological evaluation, trainees are tasked with sharing results, diagnoses, and treatment recommendations, a practice referred to as feedback. Despite the importance and complexity of providing feedback in this setting, no specific model of feedback delivery exists to guide trainees when learning this crucial skill within a memory clinic. The following article presents a feedback model for memory clinic trainees and details its development based on best practices available in the literature. The feedback model aims to promote trainees' confidence in their clinical skills and increase patient and visit partner understanding of evaluation results. It is also our hope that this model will advance the field of education within neuropsychology.

Communication model in Chinese online medical consultations: Insights and implications

OBJECTIVE

To comprehensively analyze and further enhance the established E4 communication model for online medical counseling in Chinese settings, by proposing the novel E5 model. Additionally, it aims to evaluate the performance of Chinese doctors in fulfilling the E5 model.

METHODS

Through thematic analysis and grounded theory of 500 online medical consultations in China, we developed the extended E5 model from the E4 model. We identified four dimensions of patient attitudes and behaviors using Stanford Topic Modeling Toolbox, then employed Chi-square analysis to investigate their influence on doctors' performance of E5 model.

RESULTS

Our study illustrates that the extended E5 model, with its operable strategies, accurately mirrors the nuanced dynamics of online medical counseling in China, significantly varying in doctors' execution in response to the four identified dimensions of patient attitudes and behaviors.

CONCLUSION

The extended E5 model, coupled with insights into patient attitudes and behaviors, provides a comprehensive framework for understanding and enhancing communication in China's online healthcare context.

PRACTICE IMPLICATIONS

The findings highlight the necessity for doctor training in the E5 model for effective online communication. Furthermore, fostering conducive relationship between patients and doctors could potentially boost doctors' E5 performance.

Building Authentic Connection in the Patient-Physician Relationship

INTRODUCTION/OBJECTIVES

Delivering optimal patient care is impacted by a physician's ability to build trusting relationships with patients. Identifying techniques for rapport building is important for promoting patient-physician collaboration and improved patient outcomes. This study sought to characterize the approaches highly skilled primary care physicians (PCPs) use to effectively connect with diverse patients.

METHODS

Using an inductive thematic analysis approach, we analyzed semi-structured interview transcripts with 10 PCPs identified by leadership and/or colleagues for having exceptional patient communication skills. PCPs practiced in 3 diverse clinic settings: (1) academic medical center, (2) Veterans Affairs clinic, and (3) safety-net community clinic.

RESULTS AND CONCLUSIONS

The thematic analysis yielded 5 themes that enable physicians to establish connections with patients: Respect for the Patient, Engaged Curiosity, Focused Listening, Mutual Participation, and Self-Awareness. Underlying all of these themes was a quality of authenticity, or a state of symmetry between one's internal experience and external words and actions. Adopting these communication techniques while allowing for adaptability in order to remain authentic in one's interactions with patients may facilitate improved connection and trust with patients. Encouraging physician authenticity in the patient-physician relationship supports a shift toward relationship-centered care. Additional medical education training is needed to facilitate authentic connection between physicians and patients.

The Effects of Patient-Centered Communication on Patient Engagement, Health-Related Quality of Life, Service Quality Perception and Patient Satisfaction in Patients with Cancer: A Cross-Sectional Study in Türkiye

INTRODUCTION

Patient-centered communication is a type of communication that takes place between the provider and the patient.

OBJECTIVES

It is aimed to reveal the effects of patient-centered communication on patient engagement, health-related quality of life, perception of service quality and patient satisfaction.

METHOD

The study was conducted by applying multiple regression analysis to the data obtained from 312 patients with cancer treated in a training and research hospital affiliated to the Ministry of Health in Diyarbakır, Türkiye.

RESULTS

More than half of the patients were female and had stage 4 cancer. Different types of cancer were detected (breast cancer, cancer of the digestive organs, lymphatic and hematopoietic cancer, cancer of the genital organs, cancer of the respiratory organs, etc.). It can be stated that the average values obtained by patients from patient-centered communication and its sub-dimensions are high. There are positive, moderate and low and significant relationships between the overall patient-centered communication and patient engagement, patient satisfaction, service quality perception and quality of life. It was statistically revealed that patient-centered communication positively affected patient engagement, health-related quality of life, service quality perception, and patient satisfaction.

CONCLUSION

Patient-centered communication positively affects various short and medium-term health outcomes and this study offers suggestions for improving patient-provider communication.

Listening to the Voices of Mothers Who Participated in a Video Feedback Intervention for Postpartum Depression

Postpartum depression (PPD) symptoms can negatively influence mother-infant interactions. Video-Feedback Interaction Guidance for Improving Interactions Between Depressed Mothers and their Infants (VID-KIDS) is a parenting intervention that allows mothers experiencing PPD symptoms to observe and improve their interactions with their infants. VID-KIDS has also positively influenced infants' stress (cortisol) patterns. There is limited research on maternal perspectives of interventions like VID-KIDS. In this hermeneutic study, four mothers were interviewed to increase understanding of the VID-KIDS experience. Key findings included: 1) VID-KIDS provided an opportunity for mothers with PPD symptoms to positively transform their identity; 2) VID-KIDS provided a chance to witness the mother-infant relationship forming and improve maternal mental health t, and; 3) VID-KIDS provided a space for mothers to dialogue about their experience with PPD symptoms authentically. VID-KIDS promoted healing from PPD as mothers experienced a transformation in how they perceived themselves and their relationships with their infants.

How do provider communication strategies predict online patient satisfaction? A content analysis of online patient-provider communication transcripts

Objective

As a result of the growing access to the Internet, online medical platforms have gained increased popularity in China. However, which strategies doctors should use to improve their online communication with patients remains understudied. Drawing upon the performance-evaluation-outcome (PEO) model, the present study seeks to develop a typology of patient-centered communication (PCC) strategies online and identify those strategies that can increase patient satisfaction.

Methods

We employed the data crawling technique to access text-based patient-provider transcripts through a large medical consultation platform in China and coded 9140 conversational turns of doctors.

Results

Our analysis revealed 15 PCC strategies that Chinese doctors often used online. In addition, several strategies were found to enhance patient satisfaction including information provision, making diagnosis, information appraisal, emotion expression, emotion recognition and support, in-depth discussion of medical treatments, providing coping strategies, and enabling self-management.

Conclusion

Chinese patients may have developed multiple needs, which they expect to fulfill through their interactions with doctors. Technological affordances of online medical platforms may pressure doctors to adapt their communication strategies to patients' needs. Our findings develop the PEO model from the perspective of patient-provider communication strategies and add a perspective centering on patients' needs to the scholarship on patient satisfaction. In addition, these results provide practical implications on how to improve patient-provider communication online.

Rating communication skills in dental practice: the impact of different sociodemographic factors

BACKGROUND

Communication abilities are essential for the successful operation of a dental business and significantly influence outcomes, compliance, and patient satisfaction.

AIMS AND METHODS

The aim of our study was to evaluate the knowledge and practice of doctor-patient communication among Jordanian dentists. This evaluation was conducted through a survey based on the key components of the Calgary Cambridge Observation Guides. Additionally, the impact of several sociodemographic characteristics on communication abilities was investigated. This cross-sectional study was conducted from January to June 2022. The data collection tool was an online questionnaire developed by the researchers, consisting of three sections: self-reported demographic and professional data, the practice of doctor-patient communication, and knowledge of doctor-patient communication.

RESULTS

The study included 305 dentists, comprising 106 males and 199 females, with a mean age of 32.9 ± 9.0 years. The mean score for communication skills knowledge was 41.5, indicating a moderate level of communication skills knowledge. Female dentists demonstrated significantly higher communication scores compared to their male counterparts, and those working in the private sector scored significantly higher than those in the governmental sector or in both sectors (P ≤ 0.05). In general, older and more experienced dentists exhibited better communication skills. Educational level had a positive impact on certain communication skills items. 58.4% believed that communication skills can always be developed and improved through training sessions, while 48.9% reported never having attended such courses. 95.1% believed that training courses on communication skills are always necessary as part of the educational curriculum. The main obstacles that may deter dentists from considering communication skills courses were limited time (62.3%), course availability (37.7%), cost (28.2%), and perceived lack of importance (8.2%).

CONCLUSION

Among a sample of Jordanian dentists, there appears to be a discrepancy between knowledge and self-reported practices regarding communication abilities. In certain crucial, evidence-based areas of doctor-patient communication, there are fundamental deficiencies. Considering the significant role dentists play in oral health and prevention, communication skills should be a top educational priority for them.

Patients' perceptions of climate-sensitive health counselling in primary care: Qualitative results from Germany

BACKGROUND

Climate change is the greatest threat to global health in the twenty first century, yet combating it entails substantial health co-benefits. Physicians and other health professionals have not yet fully embraced their responsibilities in the climate crisis, especially about their communication with patients. While medical associations are calling on physicians to integrate climate change into health counselling, there is little empirical evidence about corresponding perceptions of patients.

OBJECTIVES

This study aimed to explore primary care patients' perceptions of climate-sensitive health counselling.

METHODS

From July to December 2021, 27 qualitative interviews with patients were conducted and analysed using thematic analysis. A purposive sampling technique was applied to identify patients who had already experienced climate-sensitive health counselling in Germany.

RESULTS

Patients' perceptions of climate-sensitive health counselling were characterised by a high level of acceptance, which was enhanced by stressing the link between climate change and health, being credible concerning physician's own climate-friendly lifestyle, building upon good therapeutic relationships, creating a sense of solidarity, and working in a patient centred manner. Challenges and risks for acceptance were patients' disinterest or surprise, time constraints, feared politicisation of consultations, and evoking feelings of guilt and shame.

CONCLUSION

These findings suggest that primary care patients can accept climate-sensitive health counselling, if it follows certain principles of communication, including patient-centredness. Our findings can be useful for developing communication guidelines, respective policies as well as well-designed intervention studies, which are needed to test the health and environmental effects of climate-sensitive health counselling.

Communicative Pathways Predicting Adherence in Type II Diabetic Patients: A Mediation Analysis

Type II diabetes is a chronic health condition and its successful management requires effective patient-provider communication. Responding to a call to model pathways between provider communication and patient health outcomes, this study tested four models of type II diabetic patient adherence with four mediators. Given the complex nature of type II diabetic care, patient adherence was conceptualized as wellness, screening, medication, and treatment adherence. Mediators included patient understanding, agreement, trust, and motivation. A sample of U.S. patients with type II diabetes patients who were both under the care of a medical provider and taking medication for their type II diabetes completed online surveys (n = 793). Findings indicated that the relationships between patient-centered communication and adherence outcomes were mediated by proximal outcomes. The results contribute to the understanding of patient-centered communication, adherence behaviors, and proximal outcomes of patient understanding, agreement, trust, and motivation. Findings indicate that relationships between patient-centered communication and wellness adherence is mediated by patient motivation, patient-centered communication and screening adherence is mediated by patient agreement, trust, and motivation, and patient-centered communication and treatment adherence is mediated by patient agreement, trust, and motivation. The discussion addresses theoretical and practical implications and directions for future research.

Patient-doctor interactions around alternative and complementary medicine in the context of oncology care in a Latin American country

OBJECTIVE

To characterize doctor-patient communication patterns around the use of complementary and alternative medicines (CAM) in the context of oncology care in Colombia.

METHODS

A qualitative study was conducted using snowball sampling until data saturation was reached. We included oncology specialists and cancer patients who were in active treatment. Semi-structured interviews were conducted following a guide designed for each group of participants. An analysis based on open coding was performed to identify thematic areas. The coherence of emerging categories was verified by contrasting the data set within the content of the participants' reports and existing literature.

RESULTS

In total, 10 oncologists and 16 cancer patients were included, representing diverse professional fields and cancer diagnoses, respectively. Communication patterns comprise themes regarding the beginning of the interaction (i.e., patient's anticipations), the patient-doctor relationship (i.e., confidence), the characteristics of the message (i.e., synthetic vs explanatory), the communication styles (i.e., confrontational vs conciliatory), and the closing of the interaction (i.e., continuity vs. end of communication). In addition, extrinsic factors influencing communication were found to be related to participants (i.e., knowledge, cultural background) and context (i.e., institutional procedures).

CONCLUSIONS

The low frequency of communication contrasts to the increasing use of CAM. Divergent perspectives between doctors and patients could limit shared decision-making on the use of CAM. Enhanced knowledge and education on CAM for both actors is fundamental to improve their interaction and to move away from paternalistic and confrontational communication, particularly in a world region with cultural backgrounds that influence the use of CAM.

"It's All in Your Head": A Meta-Synthesis of Qualitative Research About Disenfranchising Talk Experienced by Female Patients with Chronic Overlapping Pain Conditions

Interactions between female patients with chronic pain and their medical providers in which providers question or contest the "realness" or nature of their illness experience (e.g. "It's all in your head") have been reported extensively in the extant qualitative literature, particularly for poorly understood ("contested") chronic pain syndromes. Many terms have been offered to describe this talk (e.g. invalidating, dismissive), resulting in conceptual fragmentation and isolated silos of research which together report about one communicative phenomenon. To rectify this fragmentation, the present study offers a meta-synthesis which explores, analyzes, and integrates the findings of 82 qualitative interview studies representing the patient-provider communication experiences of 2,434 female patients living with one or more of 10 chronic overlapping pain conditions (COPCs). COPCs are costly, gendered, and poorly understood. From the meta-synthesis, three key concepts are identified: (1) Functions of disenfranchising talk: Discrediting, silencing, and stereotyping; (2) Effects of disenfranchising talk: Harmed agency, credibility; access to care, support, and resources; and perception of patient-provider relationship; and (3) Responses to disenfranchising talk: Submission, critique, and resistance. Findings confirm the centrality of gender in the experience of disenfranchising talk, underscore the need to adopt an intersectional approach to the study of this talk along additional axes of race and class, and offer heuristic value toward conceptually unifying research about female COPC patients' experiences of disenfranchising talk from providers.

Enhancing patient-centred care in Taiwan's dental education system: Exploring the feasibility of doctor-patient communication education and training

Background/purpose

Improved communication can optimize treatment outcomes and patient satisfaction. Findings emphasize the need for tailored communication strategies based on patient characteristics. Implementing communication courses can enhance patient-centered care and reduce conflicts. Therefore, this study examined the feasibility of integrating doctor-patient communication education in Taiwan's dental education system.

Materials and methods

Using interviews and questionnaires, we conducted descriptive statistics and generalized linear mixed-effects model analysis on the importance of doctor-patient communication from the dentist and patient perspectives.

Results

More than 600 patient surveys and four interviewed dentists with 20+ years of experience stressed doctor-patient communication in dentistry. Patients' age and income were positively related to the emphasis on physician-patient communication but negatively associated with dental assistants' communication. Dentists valued communication education but differed in its execution and importance.

Conclusion

It is recommended to initiate dentist-patient communication education during university studies and continue its practice to adapt to the changing societal dynamics. Individuals with higher socioeconomic status and older age show a greater appreciation for dentist-patient communication, potentially driven by self-promotion, thereby highlighting the diverse nature of doctor-patient relationships. Based on our findings, we suggest to implement the doctor-patient communication courses in Taiwan.

Conceptualization of patient-centered care in Latin America: A scoping review

INTRODUCTION

Patient-centered care (PCC) has been declared as a desirable goal for health care in Latin American countries, but a coherent definition of what exactly PCC entails for clinical practice is missing. This article's aim was to identify how PCC is conceptualized in Latin American countries.

METHODS

Scientific databases (MEDLINE, EMBASE, PsycINFO, CINAHL, Scielo, Scopus, Web of Science) and webpages of the ministries of health were searched, and experts were contacted for suggestions of literature. References were included if they contained one of a range of a priori defined keywords related to PCC in the title, were published between 2006 and 2021, and were carried out in or concerned Latin America. Definitions of PCC were extracted from the included articles and analyzed using deductive and inductive coding. Deductive coding was based on the integrative model of patient-centeredness, which unites the definitions of PCC in the international literature (mainly North America and Europe) and proposes 16 dimensions describing PCC.

RESULTS

Thirty-two articles were included in the analysis and about half of them were from Brazil. Numerous similarities were found between the integrative model of patient-centeredness and the definitions of PCC given in the selected literature. The dimensions of the integrative model of patient-centeredness that were least and most prominent in the literature were physical support and patient information, respectively. A differentiation between PCC and family-centered care (FCC) was observed. Definitions of PCC and FCC as well as their cited references were diverse.

CONCLUSION

A considerable overlap between the conceptualization of PCC in Latin America and the integrative model of patient-centeredness has been identified. However, there are substantial differences between countries in Latin America regarding the emphasis of research on PCC versus FCC and diverse conceptualizations of PCC and FCC exist.

PATIENT CONTRIBUTION

This scoping review takes the patient's perspective based on the integrative model of patient-centeredness. Due to the study being a review, no patients, neither caregivers, nor members of the public, were involved.

How Physicians Tackle Internet-Misinformed Patients: Going Beyond Traditional Patient-Centered Communication - A Study Protocol

Background

The proliferation of misleading and irrelevant health information on the Internet has become a significant public concern. Inappropriate use of online materials can cause harm to patients' health and quality of life. While close attention has been paid to health campaigns and education programs that aim to disseminate accurate health knowledge, the role of physicians, who directly communicate with patients in medical encounters and provide personalized information, has been overlooked. Therefore, this study focuses on physicians and their communication strategies with internet-misinformed patients (IMPs).

Objective

This study aims to understand the communicative strategies physicians use to tackle IMPs and explore connections between physicians' communicative strategies and patient-centered communication.

Methods

Approximately 10 to 15 physicians from diverse cultural backgrounds, including Ticino (an Italian-speaking region in Switzerland), Milan and China will be interviewed. Interviews will be conducted in-person or online through video conferencing software programs. Physicians will be asked about their experiences with IMPs, communicative strategies for addressing patients' misconceptions, balancing patient preferences, decision-making obstacles, and envisioning an ideal relationship with them. A thematic analysis will be utilized to analyze data, employing a general inductive approach.

Discussion

The results will provide valuable insights into effective clinical communication strategies that address patients' misuse of internet materials and inform policymakers and healthcare providers about the limitations and applicability of patient-centered communication in the current digital era.

ADCC's Improving Goal Concordant Care Initiative: Implementing Primary Palliative Care Principles

BACKGROUND

High-quality, timely goals of care communication (GOCC) may improve patient and caregiver outcomes and promote care that is consistent with patient preferences.

PROBLEM

Cancer patients, and their loved ones, appreciate GOCC; however, oncologists often lack formal communication training, institutional support and structures necessary to promote the delivery, documentation, and longitudinal follow-up of GOCC.

PROPOSED SOLUTION

The Alliance of Dedicated Cancer Centers (ADCC), representing 10 U.S. academic cancer hospitals, undertook the Improving Goal Concordant Care Initiative (IGCC). This national, 3-year implementation initiative was designed in Fall 2019 by a workgroup of quality, oncology, and palliative care leaders, as well as patient and family advisory committee members (PFAC). IGCC addresses systemic gaps by requiring four core components for participation: 1) Implementation of a formal communication skills training (CST) program, 2) Structured GOCC documentation in the electronic medical record that is visible to all clinicians, 3) Expectations regarding the timing and patient populations for GOCC, and 4) Implementation of a measurement framework.

METHOD

Dyads of palliative and oncology leaders committed to attend regularly scheduled, ADCC-led, virtual meetings during the design and implementation phase, incorporating PFAC feedback at every stage. Using the RE-AIM framework, we describe process and outcome evaluation measures defined by implementation and measures workgroups and collected routinely, including: CST completion; trainee evaluation response rate, trainee-reported quality of CST, trainee changes in self-efficacy and distress; percent of high-priority patients participating in GOCC, and patient-reported response to the "Heard and Understood" scale (HU). IGCC's impact will be assessed using claims-based utilization metrics near the end of life (EOLM) and followed longitudinally. Qualitative evaluations near the completion of IGCC will provide insight into perceived barriers, enabling factors, and sustainability.

OUTCOMES

Implementation of all IGCC components has begun at all sites. ADCC-wide, 35% of MD/DOs have completed CST (range by site: 8%-100%). CST is highly rated; in Quarter 3, 2022, 93%-100%, 90%-100% and 87%-100% of respondents reported above average to excellent CST quality, likelihood to use the skills and likelihood to recommend CST to others, respectively. Clinician self-efficacy and distress ratings are expected in late 2023. All sites have identified patient populations and continue to refine automated triggers and timelines; uptake of GOCC documentation has been slow. Eight of 10 sites have submitted patient-reported HU data. EOLM data are expected for all sites in early 2024.

LESSONS LEARNED

Flexibility in implementation with shared definitions, measures, and learnings about approaches optimizes the ability of all centers to collaborate and make progress in improving GOCC. Flexibility adds to the complexity of understanding intervention effectiveness, the critical intervention components and the fidelity necessary to achieve specific outcomes.

Digital technology in medical visits: a critical review of its impact on doctor-patient communication

With the rapid advances of digital technology, computer-mediated medical practices are becoming increasingly dominant in medical visits. However, the question of how to ensure effective, patient-centered communication in this transition remains crucial. In this mini-review, we explore this topic by reviewing quantitative and survey-based studies, as well as discursive-interactional studies that focus on the visit as a communicative event. The review is organized into four sections: the introductory section provides a brief synthesis of the two main models used in medical practice and describes the effects of patient-centered communication practices on patients' health and well-being. The second section presents and discusses qualitative and quantitative studies that assess the effect of technology on medical interaction and its impact on patient-centered communication. The third section focuses on whether and how the digital medical record represents a "potential communication risk" during doctor-patient interactions and explores how certain pen-and-paper literacy practices could help mitigate these challenges. In the concluding section, we outline and analyze three key considerations for utilizing technologies to foster and enhance patient-centered communication during medical visits.

Coaching to strengthen critical success factors in integrative care for chronic fatigue patients: the Patient Needs-Resources Model

Theoretical and empirical studies discover that an integrative approach is particularly important in chronic disorders and multiple long-term conditions, such as chronic fatigue. Chronic fatigue syndrome (CFS) is a classic example of a potentially severe, multisystemic illness with a wide diversity of symptoms and the corresponding diagnostic complexity. The prevalence of CFS-like syndromes expanded in the context of the COVID-19 pandemic, increasing the disorder and treatment burden. Thus, this article aimed to draw attention to the possibilities to strengthen the integrative approach to diagnosing and treating chronic disorders and multiple long-term conditions. The main critical success factors identified for integrative approaches were: a holistic approach, that provides a more comprehensive diagnostic and personalized treatment strategy, a multidisciplinary team, and patient engagement. The strengths and weaknesses of these factors were explored and coaching was identified as a potential unifying and reinforcing element. Coaching has a wide spectrum of manifestations clearly representing a holistic approach, that has been successfully used in multidisciplinary team building. Moreover, coaching exposes support addressing the patient engagement issues identified by the Patient Needs-Resources Model (PN-R Model) such as low levels of self-efficacy, optimism, and subjective well-being. Coaching may assist patients to identify and prioritize their goals, becoming aware of their personal resources, developing strategies for managing symptoms, and building skills to increase their self-efficacy and active engagement in the treatment process. Therefore, the authors emphasize coaching as a perspective element of optimization of patient care, that requires additional theoretical and long-term empirical research.