Rebuilding patient-physician trust in China

Confidence in China's healthcare system: a focus on lower-middle class

BACKGROUND

During the post-pandemic era, there has been growing anxiety regarding health security, especially among the middle class worldwide. The public's confidence in the healthcare system encompasses their expectations and perceptions of the healthcare system's ability to meet their needs without financial hardship. This study aims to examine the disparities of confidence and to identify potential vulnerable subgroups.

METHODS

Adopting the China General Social Survey (CGSS) 2021, we performed multivariate logistic regression to analyze the associations between confidence level and socioeconomic classes, controlling for demographics.

RESULTS

Among all respondents (n = 2341), 71% reported confidence. However, respondents identified as lower-middle class had the least likelihood of reporting confidence (OR = 0.64, p = 0.006) compared to the lowest social class. De facto married respondents had 21% lower odds of confidence (OR = 0.78, p = 0.046) compared to unpartnered respondents.

CONCLUSIONS

Our findings reveal that, contrary to expectations, the lower-middle class in China-rather than the lowest social strata-exhibits the least confidence in the healthcare system. This low confidence appears closely linked to heightened insecurity about downward social mobility stemming from catastrophic healthcare expenditure. Moreover, married individuals also revealed low level of confidence in the healthcare system. These results underscore the urgent need for universal healthcare policies in China and similar emerging economies that specifically address the unique health security concerns of the lower-middle class and consider the dynamics inherent in marriages and families associated.

Health information acquisition and lifestyle choices among cancer survivors in China: Examining the roles of patient-centered communication, patient trust, and system trust

Guided by the health information model and pathway model of health communication, this study investigates the relationship between different health information acquisition (seeking/scanning) and healthy lifestyle behaviors in a nationally representative, cross-sectional sample of cancer survivors (N = 567) in China. A moderated mediation model was employed to explore the mediating roles of patient-centered communication (PCC) and patient trust in physicians in the relationship between health information acquisition and healthy lifestyle behaviors. The study also examined the moderating role of system trust. Results indicate that health information seeking and scanning positively correlate with healthy lifestyle behaviors (i.e. fruit and vegetable consumption) via PCC and patient trust. Moreover, system trust positively moderates the relationship between health information seeking and PCC. These findings contribute to health communication and psychology literature and highlight the importance of patient-centered care in managing self-health, especially within the Chinese healthcare context.

How is patient trust transferred from online medical platforms to offline?

Introduction

The function of the internet medical platform has expanded from online consultation to offline diagnosis and treatment appointment, forming a complete service process combining online and offline, improving the patient's medical experience and promoting the transfer of online trust to offline. However, the existing studies pay insufficient attention to the dynamic and multi-stage characteristics of online medical trust, especially the lack of in-depth discussion on the trust transfer of patients from online to offline.

Methods

This study builds a patient trust transfer model based on relevant theories, and analyzes the influence mechanism of online reputation feedback on patients' online and offline trust combined with text mining technologies such as sentiment analysis. The research adopts the multi-dimensional analysis method, comprehensively considers the online and offline scenarios, and reveals the key drivers of trust transfer through large-scale data analysis.

Results

The study found that doctors' online reputation feedback and interaction quality were important factors affecting patients' trust transfer. Positive online interaction and high-quality reputation feedback significantly enhanced patient trust and promoted the transfer of online trust to offline. The trust transfer process is dynamic and multi-stage, and the influencing factors of different stages are different. The study also revealed the significant difference in trust mechanism between online medicine and traditional medicine.

Discussion

This study revealed the formation and transfer mechanism of trust in online health care by building a trust transfer model, filling the gap in related research. The results provide practical guidance for the online medical platform to optimize the service process and enhance the trust of patients. In the future, we can further explore the trust transfer mechanism under different cultural backgrounds to promote the globalization of Internet medicine.

Association between workplace violence from patients and the mental health status of healthcare workers in Zhuhai China: a cross-sectional study

Objective

Workplace violence (WPV) poses a serious occupational risk. This study aims to explore the association between WPV from patients and the occurrence of insomnia, depression, and anxiety among healthcare workers.

Methods

Information about the WPV from patients was collected by a self-designed questionnaire. Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Insomnia Severity Index (ISI) were used for the assessment of mental health. Logistic regression was used to explore the association between WPV from patients and insomnia, depression, and anxiety. Mediation analysis was used to evaluate the mediation effect of depression and anxiety on the relationships between WPV from patients and insomnia.

Results

Of 10,413 included healthcare workers, 40.05% experienced verbal violence, 6.44% experienced physical violence from patients in the past year. There is a significant association between verbal violence and insomnia (OR = 1.780, 95% CI: 1.591-1.990), depression (OR = 1.823, 95% CI: 1.640-2.026), and anxiety (OR = 1.831, 95% CI: 1.606-2.087), as well as physical violence (insomnia: OR = 1.220, 95% CI: 1.002-1.481; depression: OR = 1.274, 95% CI: 1.052-1.540; anxiety: OR = 1.316, 95% CI: 1.058-1.630). Moreover, depression and anxiety mediated the relationship between WPV and insomnia, the mediated proportion was 62.21% in the association between verbal violence and insomnia, and 60.22% in the association between physical violence and insomnia.

Conclusions

The association between WPV from patients and heightened risks of mental health issues emphasizes the necessity of supportive work environments. Recognizing the mediating role of depression and anxiety stresses the significance of tailored mental health training for healthcare staff.

Impact of China's primary healthcare reforms on utilisation, payments and self-reported health: a quasi-experimental analysis of a middle-aged and older cohort 2011-2018

Background

Comprehensive health reforms aimed at strengthening primary healthcare (PHC) are infrequently adopted and often poorly evaluated in low-income and middle-income countries. China launched a system-wide PHC reform with a staggered roll-out between 2014 and 2018 with multiple components: (1) gatekeeping via tiered reimbursement, (2) a family physician scheme and (3) a two-way referral system between PHC facilities and hospitals. This study examines the reform impacts on health service utilisation, out-of-pocket expenditures, health outcomes and health inequalities.

Methods

The staggered roll-out of the reforms in 125 cities across China was identified using web-scraping. Using longitudinal data (2011-2018) from the China Health and Retirement Longitudinal Study (a cohort aged ≥45), this study adopted a difference-in-differences method to assess the reform's impacts on: (1) visits to PHC facilities, (2) hospitalisation, (3) out-of-pocket expenditures (OOPEs) and (4) self-reported health. Subgroup analyses were conducted by rural/urban populations and wealth quartiles.

Results

The reform had small and short-lived impacts-a 7.8% increase in the probability of visiting PHC facilities (95% CI 0.3 to 15.2), a 10.2% increase in reporting good health (95% CI 0.6 to 19.8) and an 873.9 Chinese Yuan (US$129.1) increase in average annual OOPEs (95% CI 57.9 to 1689.9) in the first year of reform implementation. There was no impact on hospitalisation. Increases in PHC utilisation were only found in rural and lower-income populations.

Conclusions

China's PHC reforms had some modest, temporary impacts on increasing primary care utilisation and self-reported health. However, further interventions are needed to transition away from the hospital-centric health system and to increase financial protection and health equity in China.

After Anterior Cruciate Ligament Surgery, Variables Associated With Returning to the Same Surgeon If a Subsequent Antrior Cruciate Ligament Surgery Is Needed?

INTRODUCTION

Anterior cruciate ligament reconstructions (ACLrs) unfortunately can require revision ACLr, or contralateral ACLr may be indicated (together subsequent ACLr). This study aimed to examine the rate of and factors associated with returning to the same surgeon.

METHODS

Patients who underwent ACLr and subsequent ACLr within 3 years were abstracted from the PearlDiver database. Patient factors and surgical factors were examined. Factors independently associated with changing the surgeon were examined.

RESULTS

Overall, 63,582 ACLr patients were identified with 2,823 (4.4%) having a subsequent ACLr. These subsequent ACLrs were performed by the same surgeon for 1,329 (47.1%) and by a different surgeon for 1,494 (52.9%). Factors independently associated with changing surgeons were 90-day adverse events after index surgery (odds ratio [OR] 1.95), longer time to second surgery (OR 1.61), and second surgery on the ipsilateral knee (OR 1.28). Notably, sex, comorbidity, depression, psychoses, and insurance plan were not correlated with choosing changing surgeons.

CONCLUSION

Over half of the patients who required a subsequent ACLr changed surgeons. Changing surgeons was associated with adverse events after index surgery, ipsilateral revisions, longer time to surgery, and patient age. However, there should be confidence that the other assessed factors were not associated with the decision to change surgeons.

Knowledge, attitudes and practices among patients with impacted wisdom teeth towards teeth extraction in Jinan, Shandong Province, China: a cross-sectional study

OBJECTIVES

This study aimed to assess the knowledge, attitudes and practices (KAP) of patients with impacted wisdom teeth towards tooth extraction, with the intention of identifying both gaps and opportunities for improved dental health education and practices.

DESIGN

A cross-sectional study using a web-based questionnaire.

SETTING

The study was conducted at the Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, and Jinan Stomatological Hospital.

PARTICIPANTS

This study included responses from 3467 individuals presenting with impacted wisdom teeth at the study settings between March and May 2023.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcomes measured were the levels of KAP towards wisdom teeth extraction among participants. Knowledge was assessed on a scale of 0-11, attitudes on a scale of 10-50 and practices on a scale of 11-55. Secondary outcomes included the exploration of associations between knowledge, attitudes and practices using structural equation modelling.

RESULTS

Participants demonstrated a mean knowledge score of 9.1±1.4, mean attitude score of 38.0±2.7 and mean practice score of 41.7±8.2. The analysis using a structural equation model revealed a direct effect of knowledge on attitudes (path coefficient=2.042, p<0.001) and a direct effect of attitudes on practices (path coefficient=1.460, p<0.001).

CONCLUSIONS

The findings suggest that patients with impacted wisdom teeth possess adequate knowledge and favourable attitudes towards teeth extraction, which positively influences their practices. However, tailored interventions are still needed to further enhance KAP regarding this procedure in this population.

Following carpel tunnel release, what factors affect whether patients return to the same or different hand surgeon for a subsequent procedure?

BACKGROUND

Following carpal tunnel release (CTR), patients may be indicated for subsequent hand surgery (contralateral CTR and/or trigger finger release [TFR]). While surgeons typically take pride in patient loyalty, the rate of returning to the same hand surgeons has not been previously characterized.

METHODS

Patients undergoing CTR were isolated from 2010-2021 PearlDiver M151 dataset. Subsequent CTR or TFR were identified and characterized as being performed by the same or different surgeon, with patient factors associated with changing to a different surgeon determined by multivariable analyses.

RESULTS

In total, 1,121,922 CTR patients were identified. Of these, subsequent surgery was identified for 307,385 (27.4%: CTR 289,455 [94.2%] and TFR 17,930 [5.8%]). Of the patients with a subsequent surgery, 257,027 (83.6%) returned to the same surgeon and 50,358 (16.4%) changed surgeons. Multivariable analysis found factors associated with changing surgeon (in order of decreasing odds ration [OR]) to be: TFR as the second procedure (OR 2.98), time between surgeries greater than 2-years (OR 2.30), Elixhauser-Comorbidity Index (OR 1.14 per 2-point increase), and male sex (OR 1.06), with less likely hood of changing for those with Medicare (OR 0.95 relative to commercial insurance) (p<0.001 for each). Pertinent negatives included: age, Medicaid, and having a 90-day adverse event after the index procedure.

CONCLUSIONS

Over fifteen percent of patients who required a subsequent CTR or TFR following CTR did not return to the same surgeon. Understanding what factors lead to outmigration of patients form a practice may help direct efforts for patient retention.

Patient- and family-reported experiences of their treating teams in early psychosis services in Chennai, India and Montreal, Canada

BACKGROUND

Cross-cultural psychosis research has mostly focused on outcomes, rather than patient and family experiences. Therefore, our aim was to examine differences in patients' and families' experiences of their treating teams in early intervention services for psychosis in Chennai, India [low- and middle-income country] and Montreal, Canada [high-income country].

METHODS

Patients (165 in Chennai, 128 in Montreal) and their families (135 in Chennai, 110 in Montreal) completed Show me you care, a patient- and family-reported experience measure, after Months 3, 12, and 24 in treatment. The measure assesses the extent to which patients and families view treating teams as being supportive. A linear mixed model with longitudinal data from patient and family dyads was used to test the effect of site (Chennai, Montreal), stakeholder (patient, family), and time on Show me you care scores. This was followed by separate linear mixed effect models for patients and families with age and gender, as well as symptom severity and functioning as time-varying covariates.

RESULTS

As hypothesized, Chennai patients and families reported more supportive behaviours from their treating teams (β=4.04; β= 9, respectively) than did Montreal patients (Intercept =49.6) and families (Intercept=42.45). Higher symptom severity over follow-up was associated with patients reporting lower supportive behaviours from treating teams. Higher levels of positive symptoms (but lower levels of negative symptoms) over follow-up were associated with families reporting lower supportive behaviours from treating teams. There was no effect of time, age, gender and functioning.

CONCLUSIONS

The levels to which treating teams are perceived as supportive may reflect culturally shaped attitudes (e.g., warmer attitudes towards healthcare providers in India vis-à-vis Canada) and actual differences in how supportive treating teams are, which too may be culturally shaped. Being expected to be more involved in treatment, Chennai families may receive more attention and support, which may further reinforce their involvement. Across contexts, those who improve over follow-up may see their treating teams more positively.

Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians' Views on Access, Expectations, and Communication

BACKGROUND

Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China.

OBJECTIVE

We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care.

METHODS

We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero).

RESULTS

Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients' expectations and the reality of limitations regarding both physicians' availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care.

CONCLUSIONS

This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients' expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults.

The association between abusive behaviour and physician-patient relations: a systematic review

OBJECTIVE

This systematic review aims to explore the association between abusive behaviour and physician-patient relations in healthcare settings.

STUDY DESIGN

Systematic review.

METHODS

We searched for related studies on databases such as PubMed, Embase, and the Cochrane library, without restrictions on language, from inception until July 15, 2022. The risk of bias and the methodological quality was evaluated using the Newcastle-Ottawa Scale and Risk of Bias in Non-randomised Studies of Interventions tool.

RESULTS

Ten studies were included in this systematic review, the participants of which were physicians and patients. The research from all the studies highlighted the detrimental effects of abusive behaviour on the relationship between physicians and patients, regardless of who the abusers were.

CONCLUSIONS

Abusive behaviour in a clinical setting has a negative influence on the physician-patient relationship, whoever the perpetrator might be. The research sheds light on the importance of teaching communication skills to physicians and training them to manage conflicts and aggressive behaviours in healthcare settings.

Analysis on the relationship between professional identity and turnover intention among general practitioners: The mediating role of job burnout

OBJECTIVE

We aimed to understand the current situation and contributory factors associated with professional identity, turnover intention and job burnout among general practitioners (GPs) in eastern, central and western China.

METHODS

A total of 3244 GPs from community health service institutions in 12 provinces of China were recruited, from October 2017 to February 2018. Demographic information such as sex, region and mode of employment was sought, and issues regarding job burnout, professional identity and turnover intention of GPs were measured with the corresponding scale, and softwares such as SPSS and AMOS were used. T-test, analysis of variance, and covariance matrix were used for analysis.

RESULTS

The average total scores of job burnout, turnover intention and professional identity of GPs in China were 44.12, 15.07 and 51.23, respectively. The results of intermediary effect analysis showed that in the GPs group, there were differences in the distribution of the three indicators. Professional identity had a significant negative effect on job burnout (β = -0.373), while job burnout had a significant positive effect on turnover intention (β = 0.528), and job burnout had an indirect effect in the relationship between professional identity and turnover intention. Job burnout played an intermediary role in professional identity and turnover intention.

CONCLUSIONS

The turnover intention of GPs in China has improved, but it is still at a high level. Job burnout plays an intermediary role between professional identity and turnover intention.

Effects of connection-based physician-patient relationships on perceptions of outcome: A vignette experiment

OBJECTIVES

To investigate the effects of media reports of medical outcomes and connection-based medicine on trust in physicians. In "connection-based medicine," people use personal connections to obtain better medical resources.

METHODS

Vignette experiments were used to investigate attitudes toward physicians among 230 cancer patients and their families (Sample 1) and a cross-validated sample of 280 employees from various industries (Sample 2).

RESULTS

For both samples, negative media reports were associated with lower trust in physicians; when the reports were positive, the participants generally perceived physicians as more competent and trustworthy. However, with negative reports, patients and families perceived connection-based physicians as less right and professional than non-connection-based physicians; the public (represented by the employee sample) perceived connection-based physicians as less right than non-connection-based physicians and negative outcomes to be caused more by connection-based physicians than non-connection-based physicians.

CONCLUSIONS

Medical reports can influence the perception of a physician's traits, which are important for trust. Positive reports promote evaluation of Rightness, Attribution, and Professionalism, whereas negative results may elicit the opposite effect, especially for connection-based physicians.

PRACTICAL IMPLICATIONS

Positive media images of physicians can help facilitate trust. Connection-based medical treatment should be reduced to improve access to medical resources in China.

Association between acculturation and physician trust for internal migrants: A cross-sectional study in China

BACKGROUND

Physician trust is a critical determinant of the physician-patient relationship and is necessary for an effective health system. Few studies have investigated the association between acculturation and physician trust. Thus, this study analyzed the association between acculturation and physician trust among internal migrants in China by using a cross-sectional research design.

METHODS

Of the 2000 adult migrants selected using systematic sampling, 1330 participants were eligible. Among the eligible participants, 45.71% were female, and the mean age was 28.50 years old (standard deviation = 9.03). Multiple logistic regression was employed.

RESULTS

Our findings indicated that acculturation was significantly associated with physician trust among migrants. The length of stay (LOS), the ability of speaking Shanghainese, and the integration into daily life were identified as contributing factors for physician trust when controlling for all the covariates in the model.

CONCLUSION

We suggest that specific LOS-based targeted policies and culturally sensitive interventions can promote acculturation among Shanghai's migrants and improve their physician trust.

Social implications of Covid-19: Its impact on general trust, political trust, and trust in physicians in China

Motivated by current debates over the relationship between epidemic and trust, this paper estimates the short-term effects of the Covid-19 pandemic on general trust, political trust, and trust in physicians in China. Using an individual-level national longitude dataset, results from the Difference-in-Difference estimation show that greater exposure to Covid-19 risks significantly decreased general and political trust among the Chinese population, except for the younger generation (age 8-22). Higher exposure to Covid-19 in malleable ages of trust formation (age 8-22) may worsen individuals' general trust but improve their trust in local officials and physicians. Results from heterogeneity tests reveal that Covid-19 exacerbated general trust among the vulnerable groups, whereas their political trust was stable.

Socioeconomic inequality in public satisfaction with the healthcare system in China: a quantile regression analysis

Background

As China pursues better social equality and improvement in public services (healthcare), public satisfaction has been considered as a key performance indicator. There is a great need to better understand the disparities and inequalities in the public satisfaction with its healthcare system.

Methods

Based on Chinese General Social Survey (CGSS) 2015 ( a set of nationally representative survey data, the most recent wave containing information about public satisfaction with the healthcare system), this study utilizes the quantile regression method to analyze how the public satisfaction at high or low quantile of the score distribution varies according to the socio-economic status and healthcare system performance indicators, especially in rural areas.

Results

This study found that, at the highest percentile, better Self-Reported-Health (SRH) is associated significantly with a lower satisfaction score (coefficient -4.10, P < 0.01). High socioeconomic status (especially "above average" group) has higher satisfaction scores at both mean (coefficient 3.74, P<0.01) and median (coefficient 3.83, P<0.01). This effect is also significant across the lower quantiles of the satisfaction levels. West and Middle region (the less developed regions) tended to be more satisfied, whereas those in Northeast reported a large negative effect (coefficient -7.07, P < 0.01) at the median. While rural residents generally reported higher levels of satisfaction, rural residents’ preference regarding hospital beds and primary care access seems generally to be opposite to that of urban residents.

Conclusion

Our findings suggest that the ongoing healthcare reform needs to integrate more preventive care to meet the healthy residents’ expectation and demands. More attention should be guided to the vulnerable healthcare system in the Northeast region, which has a stagnant local economy. Outcome-based quality care is especially preferred in rural healthcare, in addition to improvement of utilization and access. In addition, the “pro-rich” inequality is an ongoing concern about the system.

Explicating the Cognitive Process of a Physician's Trust in Patients: A Moderated Mediation Model

Trust is considered a critical factor in the physician-patient relationship. However, little is known about the development and impact of physicians trusting their patients. A model that is premised on the integrated model of organizational trust was proposed in this article to reveal the cognitive processes involved in physicians' trust, with perceived integrity and the ability of the patient as antecedents and the physicians' communication efficacy as the outcome. A cross-sectional survey of 348 physicians in Zhejiang province, China, revealed that a physician's trust in a patient mediated the relationship between the physicians' perception of the integrity and ability of the patient, and the physician's communication efficacy. The physicians' educational backgrounds and work experience were also found to moderate an indirect effect: a lower level of education and longer work experience intensified the impact of the perceived integrity and ability of the patient on the physician's trust, while shorter work experience made the association between the physician's trust and communication efficacy more salient. This paper provided implications for both physician and patient sides.

A Socio-ecological Framework for Understanding Workplace Violence in China's Health Sector: A Qualitative Analysis of Health Workers' Responses to an Open-ended Survey Question

Workplace violence (WPV) in the health sector is a global public health issue. The magnitude of WPV is a particular concern in China's health system. To examine the potential causes of WPV, we analyzed 3,045 qualitative responses to an open-ended question in a survey with health workers in the Zhejiang province, China. We adapted a four-level socio-ecological framework (societal/systemic, community/organizational, interpersonal, and individual) to thematically analyze the data. Ten sub-themes emerged. Within the societal/systemic level, we identified three sub-themes: (a) lack of legislation against WPV, (b) suboptimal accessibility and affordability of health services due to maldistributed health resources, commercialized health services, and inadequate health insurance, and (c) unregulated mass media reports. Within the community/organizational level, three sub-themes emerged: (a) lack of supportive health facility leadership, (b) inaction by government authorities, and (c) inefficient law enforcement agencies. Within the interpersonal level, two sub-themes were identified: (a) poor provider-patient communication and (b) distrust between health workers and patients. Finally, we identified the personal characteristics of health workers (e.g., competence and professionalism) and patients (e.g., sociodemographic background and expectations/satisfaction) as two individual-level sub-themes.We recognized interactions among different levels. The weak state of Chinese legislation in this area and lack of high-level political will and guidance (societal/systemic) has left health facilities and law enforcement agencies (community/organizational) unclear about how to address WPV. The maldistribution of quality health resources (societal/systemic) has led to overcrowded outpatient clinics at higher-level care facilities (community/organizational). In light of the insufficient government funding and profit-oriented health services (societal/systemic), health workers were motivated to seek profits by providing unnecessary services, which compromised their professionalism (individual). Provider-patient relationships deteriorated (interpersonal), and patients sometimes held unrealistically high expectations associated with high medical expenses (individual). We propose multisectoral prevention strategies to address WPV in the health sector at all levels using a socio-ecological framework.

The red packet phenomenon from the perspective of young Chinese doctors: a questionnaire study

BACKGROUND

In China, informal payments in the medical profession, which workers in the public health care system receive from patients in the course of performing profession-related activities, are usually referred to as "red packets" (Hongbao ). The phenomenon of red packets is widespread and has become one of the most negative factors affecting the doctor-patient relationship in China. Our study aims to explore the situation concerning the phenomenon of red packets in China after the "Red Packet Ban".

METHODS

A questionnaire was developed including general demographic characteristics, asking whether they had ever been offered red packets, whether they had ever accepted red packets, their reasons for accepting the first red packet and so on. We recruited a total of 413 doctors to complete this questionnaire and conducted in-depth telephone interviews with 18 doctors from the initial group.

RESULTS

Our data shows that 73 doctors claimed to have accepted red packets, accounting for 17.7% (73/413) of all respondents and 27.8% (73/263) of doctors who had been provided with red packets. 23.2% of red packets were offered after the operation and 67.1% of the doctors declared that the main reason for accepting the red packet was that they "refused the red packets more than once, but the patients/family members were sincere and it was difficult to refuse." The total amount of the red packets they received each month accounted for no more than 5% of their income.

CONCLUSIONS

(1) The acceptance of red packets does exist among young doctors in China, but shows a significant decrease compared to previous studies. (2) There has been a sharp rise in the proportion of gratitude red packets. (3) Patients should also be educated regarding their behaviour in providing red packets.

The Relationship Between the Physician-Patient Relationship, Physician Empathy, and Patient Trust

BACKGROUND

A trusting physician-patient relationship is an essential component of high-quality care.

OBJECTIVE

To explore the relationship between the physician-patient relationship, physician empathy, and patient trust.

DESIGN

Cross-sectional survey.

PARTICIPANTS

A total of 3289 patients (response rate 68.6%) from 103 hospitals in eastern, central, and western China completed surveys.

MAIN MEASURE

Physician empathy, patient trust, and physician-patient relationship were measured by the Chinese version of Consultation and Relational Empathy Scale, Wake Forest Physician Trust Scale, and Patient-Doctor Relationship Questionnaire, respectively. Bootstrapped mediation analysis was performed.

KEY RESULTS

There were moderate to strong correlations between physician empathy, patient overall trust, and patient trust in physician's benevolence and competence, and the physician-patient relationship (r = 0.49-0.75, P < 0.01 for all). Patients' evaluation of physician-patient relationship was predicted by their perception of physician empathy, patient overall trust, and trust in the physician's benevolence. Mediation analysis showed that the indirect effect of physician empathy on physician-patient relationship through patient overall trust was significant (β = 0.18, 95% CI: 0.15-0.21) and that the mediation effect of patient trust in physician's benevolence was significant (β = 0.24, 95% CI: 0.20-0.28), though the mediation effect of patient trust in physician's competence was not (β = 0.01, 95% CI: -0.02 to 0.02).

CONCLUSIONS

Patients' perception of physician empathy influences their evaluation of the physician-patient relationship both directly and indirectly via patient trust in the physician's benevolence. These findings underline the importance of patient belief in physician benevolence and empathy in building trustful and harmonious relationships between physicians and patients.

Gender differences in response to medical red packets (Hongbao, monetary gifts): a questionnaire study on young doctors in China

BACKGROUND

The acceptance of informal payments by doctors is usually viewed as unethical behavior. However, in China, such behavior is a common practice. In this study, we focus on the gender differences in accepting red packets (informal payments) by young doctors in China.

METHODS

A total of 413 young doctors were selected for the study, all of whom were grouped by gender. The questionnaire was designed to include general demographic characteristics, whether they had ever been offered red packets, whether they had ever accepted red packets, the reasons for accepting red packets and so on. Wilcoxon rank-sum test, Pearson's chi-squared test, univariable and multi-variable logistic regressions were used for all analyses by Stata 17.0 SE and p-value < 0.05 was considered statistically significant.

RESULTS

Compared to women, men were more likely to be offered red packets (69.5% [180/259] vs.53.9% [83/154]), and the odds ratio (OR) was statistically significant after adjusting for age, education, position and geographical areas (adjusted OR 1.81, p = 0.012). In terms of the question of whether or not they had accepted red packets, more male doctors answered "yes" compared to female doctors (33.3% [60/180] vs.15.7% [13/83], adjusted OR 2.80, p = 0.004). However, among those who had accepted red packets, we found that only 42.0% [25/60] of male doctors considered that it was normal to accept such red packets, compared to 85.0% [11/13] of women (adjusted OR 12.01, p = 0.023).

CONCLUSION

The study revealed that Chinese patients and their families were more likely to offer red packets to male doctors. Secondly, among doctors who had been offered red packets, male doctors were more likely to accept red packets than female doctors. In addition, among doctors who had accepted red packets, female doctors were more likely to believe that it was not morally wrong to accept such red packets.

What are the Bad Habits and Behaviors of Inconsiderate Doctors in Chinese Inhabitants’ Mind? A Cross-Sectional Study

Purpose

This study aims to 1) investigate inhabitants’ perceptions of doctors’ inconsiderate behaviors during diagnosis and treatment, 2) explore the factors influencing inhabitants’ attitudes toward doctors’ professional reputation, and 3) examine the status of doctors’ inconsiderate behaviors and inhabitants’ attitudes and behaviors toward these doctors in China.

Patients and Methods

A cross-sectional online survey was conducted with 2050 participants from over 30 Chinese cities, from March to June 2018. In total, 1598 valid questionnaires were obtained (with an effective response rate of 77.95%). Data were analyzed using descriptive statistics, exploratory factor analysis, and logistic linear regression analysis.

Results

We developed a questionnaire comprising of 15 items regarding doctors’ inconsiderate behaviors based on inhabitants’ perspectives (Cronbach’s alpha was 0.944). Additionally, we identified the factors that influence the attitudes of inhabitants regarding doctors’ professional reputation, such as frequency of medical consultations, medical expenses, education catalog, and type of medical insurance. A majority of the participants highly valued Chinese doctors’ professional reputation (87.55%), and trusted them (86.29%). However, about 60.27% of the participants reported a pessimistic-like judgment on the current doctor–patient relationship (DPR) in China. Participants believed that Chinese doctors received a high income (20.47%), maintained a high social status (23.46%), and had a heavy workload (59.95%). Furthermore, about 54.88% of participants reported that they would not engage in aggressive behaviors against doctors during a dispute. Lastly, about 26.66% of participants reported that they would act rationally when they were dissatisfied with their doctors.

Conclusion

Impassive emotions and improper actions of doctors toward patients jointly contributed to the disrepute of Chinese doctors. Although DPR was becoming tense, Chinese inhabitants held a positive evaluation of doctors’ professional reputation. While an improvement in the economic situation and reputation of doctors enhanced the DPR, there remains an urgent need to improve the working environment in regard to future Chinese health reforms.

The effects of the COVID-19 pandemic, risk perception, and perceived social support on public trust in physicians in China: A latent transition analysis

A population-based, longitudinal study was conducted among 29 provinces in mainland China to investigate how public trust in physicians (PTP) changed since the outbreak of COVID-19 and how the resulting lockdown and social support contributed to its restoration. The baseline sample (n = 3,233) was obtained during the period of the most rapid progression of COVID-19 (February 1 to 9, 2020, T1). Follow-up (n = 1,380) took place during the recovery period (March 17 to 24, T2). Latent profile models and a latent transition model were estimated. Participants were classified into either a moderate trust (21% at T1; 45% transition into high at T2) or a high trust (79% at T1; 88% remained in the high group) group in the latent profile. A latent transition from moderate to high trust was observed in locked-down regions and among those with higher social support. Social support moderated the transition from low to high trust. The current study showed that the epidemic outbreak and lockdown experience in China were associated with increased PTP; furthermore, public trust can be restored during a public health emergency. Attention should be paid to assure that social support and risk management strategies maintain PTP.

Trust in Healthcare during COVID-19 in Europe: vulnerable groups trust the least

Aim

We examined predictors of trust in the healthcare system during the COVID-19 pandemic in 27 European countries.

Subjects and methods

We used population-based data drawn from the Living, working and COVID-19 survey (N = 21,884, 52% female, ages 18 to 92 years) covering 27 European countries dated June and July 2020. Multilevel linear regression, linear regression, and regression-tree analyses were conducted.

Results

We found that most participants tended to trust the healthcare system, although a substantial part could still be classified as distrusting (approx. 21%). Multiple variables, including being middle-aged or of older age, being female, lower levels of education, unemployment, worse general health status, having income difficulties, having unmet needs for healthcare, no healthcare contact during the COVID-19 pandemic, higher mental distress, and loneliness, were significantly associated with lower levels of trust. Among these variables mental distress, income difficulties, and unmet needs for healthcare emerged as especially important and, across European regions and countries, consistent predictors for lower trust in the healthcare system during the COVID-19 pandemic.

Conclusions

Medically vulnerable subgroups, such as individuals with unmet healthcare needs, higher levels of mental distress, and older age, as well as people living in socially and economically vulnerable situations, such as higher levels of loneliness and financial difficulties, were the least trusting of the healthcare system during the COVID-19 pandemic. As these vulnerable subgroups are also at highest risk for contracting COVID-19 and experiencing negative COVID-19-related outcomes, more targeted prevention and intervention efforts should be implemented in these groups.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01705-3.

Impact of Patient Communication Preferences on the Patient Trust in Physicians: A Cross-Sectional Study in Iranian Outpatient's Clinics

There are widely emerging concerns that patient confidence in physicians is diminishing as physician-patient communication is threatened globally. This study aimed to assess patient communication preferences and their impact on patient trust in physicians. A cross-sectional study was conducted among outpatient clinics of 2 public and private hospitals in Tabriz, Iran. A total of 704 patients were selected conveniently. Of the 704 patients, 6.39% had low trust, 36.79% moderate trust, 35.37% had a high trust, and 21.45% had blind trust in physicians. Overall patient communication preference score was more in a private clinic rather than a public one (P = .008). Patients of private hospitals and those who were living in rural areas have been shown to have more trust in physicians. Patients' trust in physicians showed a significant association with patient communication preference (B = 0.58; 95% CI: 0.53-0.63, P < .001).

Examining patient trust towards physicians between clinical departments in a Chinese hospital

The purpose of this cross-sectional survey study is to quantitatively examine the differences in patient trust towards physicians between four different clinical departments in a Chinese hospital. Using a validated modified Chinese version of the Wake Forest Physician Trust Scale, we measured patient trust in each department, and also collected data on patient demographics. A total of 436 patients or family members were surveyed in the departments of emergency medicine, pediatrics, cardiology, and orthopedic surgery. Significant differences were found between the departments, especially between pediatrics (trust score 43.23, range 11–50) and emergency medicine and cardiology (trust scores 45.29 and 45.79, respectively with range of 11–50). The average total score across all four departments was 44.72. There are indications that specifically comparing departments, such as patient demographics or department structure, could be helpful in tailoring patient care to improve physician-patient relationships.

Clinician's attitude to enteral nutrition with percutaneous endoscopic gastrostomy: a survey in China

BACKGROUND

Percutaneous endoscopic gastrostomy (PEG) is recommended for long-term enteral nutrition. However, long-term nasogastric (NGT) feeding is still commonplace in China. We surveyed Chinese clinicians' opinions toward PEG feeding in order to identify the potential barriers to acceptancy of PEG feeding.

METHODS

A self-reported questionnaire was developed and distributed to 600 doctors. Five-point Likert scales were used for most responses.

RESULTS

Of 525 respondents, the mainly nutritional support method was NGT while PEG was less used. Doctors working in the tertiary class A hospitals and radiotherapy department were more likely to choose PEG feeding (p = 0.000). Overall, 241 (46%) participants did not know PEG and 284 (54%) have different understanding degree of PEG. Age (p = 0.002), working life (p = 0.044) and professionalism (p = 0.005) were significantly related to the understanding of PEG. Levels of agreement was high (score of 3.47) for using PEG in patients with prolonged stroke-associated dysphagia. There was high agreement level in the statement that PEG was unnecessary when NGT could sustain the basic needs of patients, though better outcome can be predicted with PEG feeding. The highest scoring factor (score of 3.91) that influenced clinicians' choice of PEG was resistance from patients and families and the second one was the poor cooperation among departments (score of 3.80).

CONCLUSIONS

Doctors' insufficient knowledge of PEG feeding, resistance from patients and families, poor cooperation among departments, all these factors leading physicians to prefer more conservative treatment to avoid disputes rather than better ones.

The cycle of commodification: migrant labour, welfare, and the market in global China and Vietnam

China and Vietnam have experienced waves of labour and welfare reform since both countries shifted to market socialism, pursuing a development model that depends on the labour of millions of rural–urban migrants in global factories. Their similar development trajectories are productive for theorizing the relationship between labour and welfare. This article conceptualises the two countries’ distinctive regime of migrant labour welfare as integral to a cycle of commodification that encompasses the overlapping processes of commodification, de-commodification and re-commodification of labour. After decades of collectivized labour under state socialism, the cycle begins with the commodification of labour through market reforms that led to mass rural–urban migration and the rise of the global factory alongside the dismantling of the former socialist welfare system. It was then followed by de-commodification attempts aimed at providing forms of social protection that offset the labour precarity caused by decades of labour market liberalisation. Despite the emergence of new universal welfare programs, the market has increasingly intruded into social protection, especially through financialized products targeted at the labouring masses who must compensate for the failings of public welfare programs. As such, these welfare regimes are undergoing a process of re-commodification in which the protection of labour is re-embedded into the market as a commodity to be consumed by the migrant workers with their meagre wages. The “cycle of commodification” offers an analytical framework to understand welfare regimes as a social and political field that keeps evolving in response to the changing global valuation of labour.

'There's nothing you can do … it's like that in Chinatown': Chinese immigrant women's perceptions of experiences in Chicago Chinatown healthcare settings

Objectives: Chinese American women living in linguistically isolated communities are among the least likely to utilize healthcare services. Qualitative research methods can help identify health system vulnerability points to improve local healthcare delivery for this population.Design: We conducted 6 focus groups among 56 Chinese-speaking adult women in Chicago's Chinatown between July and August 2014 to explore their perceptions of experiences receiving medical care and interacting with healthcare providers in Chinatown healthcare settings.Results: Health system/clinic infrastructure and patient-provider communications were perceived barriers to care at Chinatown healthcare settings. Chinese participants reported long wait times, difficulty scheduling appointments, and poor front desk customer service. Communication difficulties at Chinatown healthcare settings involved language barriers with non-Chinese-speaking providers, but consideration for healthcare providers, provider demeanor, and reliance on provider recommendation also hindered patient-provider communications.Conclusions: Findings improve understanding of barriers to care experienced by Chinese immigrant women in one urban Chinatown community.

General Perception of Doctor-Patient Relationship From Patients During the COVID-19 Pandemic in China: A Cross-Sectional Study

The doctor–patient relationship (DPR) is essential in the process of medical consultations and treatments. Poor DPR may lead to poor medical outcomes, medical violence against doctors, and a negative perception of the healthcare system. Little is known about how DPR is affected during this novel coronavirus disease 2019 (COVID-19) pandemic. This cross-sectional study aimed to explore the DPR during the COVID-19 pandemic. There were 1,903 participants in China (95% response rate) who were recruited during the pandemic online via convenience and snowball sampling. Several questionnaires were used to evaluate participants' attitudes toward DPR, including the Patient–Doctor Relationship Questionnaire (PDRQ-9), Chinese Wake Forest Physician Trust Scale (C-WFPTS), a survey on medical violence against doctors, factors that affect and improve DPR, and general trust in medical services. Results revealed that DPR improved, and doctor–patient trust increased compared to participants' retrospective attitude before the pandemic. In addition, patients' violence against doctors decreased during the pandemic. Better doctor–patient trust and lower violence toward doctors are related to better DPR. Furthermore, we found that the main factors that could improve DPR include communication between doctors and patients, medical technology and services, and medical knowledge for patients. This study helped to better understand DPR in China, which may contribute to future health policies and medical practices in order to improve DPR and doctor–patient trust.

The Current State of Doctors' Communication Skills in Mainland China from the Perspective of Doctors' Self-evaluation and Patients' Evaluation: A Cross-Sectional Study

OBJECTIVE

To assess doctors' communication skills in mainland China using the SEGUE Framework.

METHODS

A survey on doctors' communication skills with doctors (n = 1361) and patients (n = 1757) from 14 provinces in eastern, central and western China was conducted.

RESULTS

The doctors' self-evaluation scores were higher than patients' evaluations (p < .001). The scores of female doctors were higher than males (p = .022). Both doctors' self-evaluations and patients' evaluations indicated that the scores of doctors in tertiary hospitals were higher than those in primary hospitals.

CONCLUSION

Doctors' communication skills don't match patients' needs. Female doctors are more empathetic and patient than male doctors and consequently have better communication skills. Doctors in tertiary hospitals have better communication skills because tertiary hospitals provide more training opportunities in communication skills and have better medical services and management.

PRACTICE IMPLICATIONS

This study confirms the applicability of the SEGUE Framework to doctors and patients in mainland China. The effectiveness of cultivating doctors' communication skills should be evaluated through feedback from the perspective of both doctors and patients. Medical institutes need to prioritize patients' needs and provide training in doctors' communication skills to address the discrepancy in the perceptions of doctors and patients.

The mediating effect of media usage on the relationship between anxiety/fear and physician-patient trust during the COVID-19 pandemic

OBJECTIVE

Our study explored whether and how media usage can mediate the path from anxiety and fear to physician-patient trust.

DESIGN

Study 1 was a population-based, longitudinal study using nationally representative data from 29 provinces in mainland China. The baseline sample (N = 3233) was obtained from February 1 to 9, 2020. Follow-up (N = 1380) took place during March 17 to 24, 2020. Study 2 was a machine learning-based sentiment analysis in which data were captured from Sina Weibo, a Chinese microblogging website, among the most popular official, unofficial, and health-related media accounts. The screened blogs from November to December 2019 and February to March 2020 were scored by Google APIs for positivity and magnitude.

MAIN OUTCOME MEASURES

Physician-patient trust.

RESULTS

Study 1 showed fear and anxiety affected changes in physician-patient trust through media usage, the indirect effect of which was 0.14 (0.03) and the 95% CI was [0.08, 0.19]. Study 2 indicated a more positive image of physicians after the outbreak compared to before [F (2, 3537) = 3.646, p = 0.026, partial η²=0.002].

CONCLUSION

The negative impact of anxiety and fear on physician-patient trust was mediated by media use, which can be explained by the more positive media image during the pandemic.

Measuring Public Reaction to Violence Against Doctors in China: Interrupted Time Series Analysis of Media Reports

Background

Violence against doctors in China is a serious problem that has attracted attention from both domestic and international media.

Objective

This study investigates readers’ responses to media reports on violence against doctors to identify attitudes toward perpetrators and physicians and examine if such trends are influenced by national policies.

Methods

We searched 17 Chinese violence against doctors reports in international media sources from 2011 to 2020. We then tracked back the original reports and web crawled the 19,220 comments in China. To ascertain the possible turning point of public opinion, we searched violence against doctors–related policies from Tsinghua University ipolicy database from 2011 to 2020, and found 19 policies enacted by the Chinese central government aimed at alleviating the intense patient–physician relationship. We then conducted a series of interrupted time series analyses to examine the influence of these policies on public sentiment toward violence against doctors over time.

Results

The interrupted time series analysis (ITSA) showed that the change in public sentiment toward violence against doctors reports was temporally associated with government interventions. The declarations of 10 of the public policies were followed by increases in the proportion of online public opinion in support of doctors (average slope changes of 0.010, P<.05). A decline in the proportion of online public opinion that blamed doctors (average level change of –0.784, P<.05) followed the declaration of 3 policies.

Conclusions

The government’s administrative interventions effectively shaped public opinion but only temporarily. Continued public policy interventions are needed to sustain the reduction of hostility toward medical doctors.

Patient-provider relationships in China: A qualitative study on the perspectives of healthcare students and junior professionals

BACKGROUND

Mistrust and conflicts in patient-provider relationships (PPR) have become prevalent in China. The frequency of verbal and physical violence against healthcare workers has been increasing, but few interventions seem to be effective. Limited prior research has focused on the perspectives of healthcare professionals in training. This paper aimed to understand their viewpoints and conceptualize potentially actionable areas for future policy interventions.

METHODS

We analyzed de-identified training registration data of a convenience sample of 151 healthcare students and 38 junior professionals from 20 provinces in China. One open-ended question in the registration form asked the participant to comment on PPRs in China. We used qualitative thematic coding to analyze the narrative data. All answers were categorized into three overarching frames: patients, providers, and external agencies/regulations. Frequently mentioned themes in each frame were evaluated to generate an overall theoretical framework.

FINDINGS

Although fewer than 25% indicated that current PPRs are "good" or acceptable, 98% of respondents were optimistic about the future improvement of these relationships. The leading factors of PPRs mentioned as patient-relevant were eroding trust in the physician, unrealistic expectations, and ineffective communication. The provider-relevant themes highlighted were poor service quality, ineffective communication, and heavy workload. Leading themes relevant to external agencies or regulations were dysfunctional administration system, negative media reports, and disparity in healthcare resource distribution.

INTERPRETATION

Healthcare professionals in training had a negative view of the current situation but had confidence in future improvement. Patient, provider, and societal factors all contributed to the tension between patients and providers. All aspects of the healthcare sector should be carefully considered when contemplating policy or social interventions to improve the patient-provider relationship.

Barriers to Low-Dose CT Lung Cancer Screening among Middle-Aged Chinese

PURPOSE

The current study aims to explore the barriers for middle-aged Chinese to learn about and uptake low-dose computed tomography (LDCT) lung cancer screening.

METHODS

Data were collected via an online survey in December 2019. Final valid sample included 640 respondents, aged 40-60 years old, from 21 provinces of China. We performed multiple linear regressions to test the potential barriers to LDCT scan.

FINDINGS

Cost concerns, distrust in doctors, fears of disease, lack of knowledge, and optimistic bias are negatively associated with the intention to learn about and uptake LDCT scan.

IMPLICATIONS

Our study contributes to understanding the negative predictors of middle-aged Chinese to get LDCT lung cancer scans. Future campaign programs should help audiences to build comprehensive understandings about lung cancer and LDCT scan. To better promote LDCT scan in China, the government should fund more trial programs continuously and public efforts should be made to rebuild the patient-doctor trust.

Process Evaluation of a Clustered Randomized Control Trial of a Comprehensive Intervention to Reduce the Risk of Cardiovascular Events in Primary Health Care in Rural China

Background: Cardiovascular disease (CVD) is a major public health challenge in China. This study aims to understand the processes of implementing a comprehensive intervention to reduce CVD events in areas of drug therapy, lifestyle changes, and adherence support in a clustered randomized controlled trial (cRCT). This trial consisted of 67 clusters spanning over 3 years in Zhejiang Province, China. Method: A qualitative process evaluation was nested within the cRCT conducted in 9 township hospitals with 27 healthcare providers, 18 semi-structured interviews, and 23 observational studies of clinical practices within the intervention arm. Results: Effective and repeated trainings using an interactive approach were crucial to improve the prescribing behaviour of family doctors and their patient communication skills. However, the awareness of patients remained limited, thus compromising their use of CVD preventive drugs and adoption of healthy lifestyles. Health system factors further constrained providers’ and patients’ responses to the intervention. Financial barrier was a major concern because of the low coverage of health insurance. Other barriers included limited doctor–patient trust and suboptimal staff motivation. Conclusion: Our study suggests the feasibility of implementing a comprehensive CVD risk reduction strategy in China’s rural primary care facilities. However, health system barriers need to be addressed to ensure the success and sustainability of the intervention.

Caring in community nursing practice: Inductive content analysis reveals an inter-dynamic system between patients and nurses

AIMS AND OBJECTIVES

To examine the understanding of caring in the practice of community nursing from the perspectives of patients and nurses.

BACKGROUND

An increasing population of patients with chronic disease has produced a need for humanistic caring in communities. As a result, caring has become a core value of community nursing professionals. However, community nurses meet many difficulties in trying to practice person-centred care with their clients. Furthermore, most community nurses-especially in China-lack systematic education and training about caring because the practical meaning of caring in community practice is unknown.

DESIGN

The qualitative study described herein employed inductive content analysis.

METHODS

Eleven community patients with chronic disease and fifteen community nurses who were nominated as a caring nurse from different community clinics in Beijing, China, participated in thirty-one interviews during January to August in 2018. Nine documents from the interviewed nurses were collected. Both interview data and documents were analysed using strategies of inductive content analysis. The COREQ checklist was used.

RESULTS

Patients and their corresponding nurses described a wide range of caring experiences that were generalised into 28 concepts. Caring emerged as an inter-dynamic system that comprised the foundation and quality of a caring relationship, the caring philosophy and behaviours of interactions, and positive feedback from caring interactions. A relationship-based framework of caring in community nursing practice was constructed.

CONCLUSIONS

Identifying this systematic concept of caring provides insights that are applicable to the creation of targeted management, education and practice interventions to ultimately enhance the quality of community health care-in China or elsewhere.

RELEVANCE TO CLINICAL PRACTICE

The systematic understanding of caring in community nursing practice will inform nurses in community health clinics, their educators and their managers on how to provide care to community patients and how to develop caring competence for community nurses.

Modified decision-making rule supported by scheduled telephone follow-up reduces head computed tomography utilization in children with mild traumatic brain injury: A cohort study

Unnecessary computed tomography utilization is common in children with a mild traumatic head injury. It is valuable to find a reasonable strategy for the patient's management.The aim of this study was to investigate the effect of scheduled telephone follow-up on computed tomography utilization in children with a mild head injury.A 2-year cohort study was performed. Children diagnosed with mild traumatic brain injury (TBI) were evaluated with a scoring system upon their arrival and during 1 month of scheduled telephone follow-ups by nurses. The rates of head computed tomography utilization, delayed imaging, and delayed diagnosis were analyzed.The rate of computed tomography utilization was 64.3% and 46.1% (P = .00) in the retrospective and prospective study periods, respectively. During the prospective study period, there were no differences in the rates of delayed imaging (2.3% vs. 2.2%, P = .814) or the rates of delayed diagnosis of significant radiological findings (0.1% vs 0.2%, P = .672) in cases with versus without immediate computed tomography.Adoption of a modified decision-making rule supported by scheduled telephone follow-up can reduce head computed tomography utilization without increasing the rate of missed or delayed diagnosis of clinically significant TBI in children with mild TBI.

Breaking bad news about cancer in China: Concerns and conflicts faced by doctors deciding whether to inform patients

OBJECTIVES

We aimed to explore how doctors in China decide whether to inform cancer patients about diagnosis and prognosis.

METHODS

We conducted in-depth, semi-structured interviews with 24 doctors and residents from a leading hospital in Hunan, China. Data were analyzed by content analysis.

RESULTS

Doctors routinely told the family about cancer first, then withheld information from patients if the family did not want to tell the patient. Three main themes emerged in relation to hiding bad news from patients: 1) fear that most patients lack resilience to cope with bad news; 2) fear of direct or legal conflict with the family, and 3) a value conflict between respecting the patient's "right to know" and respecting the family's interest in protecting the patient.

CONCLUSIONS

Doctors consider decisions to withhold information from cancer patients to be a non-ideal but necessary compromise of the patient's "right to know." Culturally adjusted training and guidelines could help with including the patient in information disclosure while still respecting China's cultural value of family decision-making.

PRACTICE IMPLICATIONS

Future training and guidelines should help doctors mediate between patient and family interests and understand changing laws and regulations. Other important elements include reflection, senior mentorship, self-awareness, and building trust.

Prediction of cause-specific disability-adjusted life years in China from 2018 through 2021: a systematic analysis

OBJECTIVE

We aimed to predict population composition, mortality, sociodemographic index (SDI), and cause-specific disability-adjusted life year (DALY) rate in China from 2018 through 2021.

STUDY DESIGN

Using the time series method autoregressive integrated moving average (ARIMA) models on all available data, mainly Statistics Year Report by the Global Burden of Disease Study 2017, we predicted populations, deaths, DALYs attributable to disease conditions, and injuries (causes) for China from 2018 through 2021 at levels 0, 1, 2, and 3.

METHODS

The time series method ARIMA models was used on history data.

RESULTS

The predicted total population and SDI in China are increasing from 2018 through 2021. The under-5 mortality is decreasing; from 10.24% to 0.65% in the period 1990-2021. The all-cause DALY rate decreases. The top causes of DALY rate are non-communicable diseases (level 1), cardiovascular diseases (level 2), and stroke (level 3). For the leading 22 level 2 causes in 2018, the trend of ranking in 2021 is as follows: unchanged, 15; increasing, 4; and decreasing, 3. For the leading 169 level 3 causes in 2018, the trend of ranking in 2021 is: as follows: unchanged, 49; increasing, 63; and decreasing 57.

CONCLUSIONS

Cause-specific and time-dependent health policy should be steered to reduce the major burden focuses and to improve population health.

Long-term multidisciplinary integrative therapy management resulted in favorable outcomes for ovarian cancer during pregnancy: a case report and literature review

Background

Ovarian cancer during pregnancy is relatively rare and treatment strategies are inexperienced in surgery and chemotherapy. Multidisciplinary management of advanced epithelial ovarian cancer in pregnant patients with strong desire of fertility including sufficient mental and medical understanding, perioperative consideration, intraoperative decision, chemotherapy sensitivity and follow-up after treatment can gain successful outcomes for both maternal disease and fetus’s development.

Case presentation

A 34-year-old primigravidae was diagnosed with advanced epithelial ovarian tumor and then first cytoreductive surgery to resect macroscopical lesions and protect the uterus for fetus was performed following with four chemotherapy courses (docetaxel and carboplatin) before delivery and four other chemotherapy courses after delivery. Chemotherapy drugs were decided by sensitivity test and the patient’s anaphylaxis. Second surgery involved cesarean section with a healthy offspring and secondary cytoreductive surgery. Operative strategies were considered to gain a balance of disease and risk for fetus. Psychosocial support was provided during the course of diagnosis and treatment for a healthy coping situation. This patient relapsed 19 months after the last chemotherapy course and was treated by additional adjuvant therapy to a clinical remission. The 33-month baby boy has no evidence with disease until now. The follow-up of both mother and baby is still continuing.

Conclusions

Ovarian cancer during pregnancy has low incidence which must increase in future as women delay reproduction age. Ovarian cancer cytoreductive surgery and chemotherapy have limitation to handle conditions under a desire of fetus protection. Multidisciplinary treatment model is a therapeutic solution and a challenge for gynecological surgeons, medical oncologists, pathologists, obstetricians, neonatologists, pharmacists, anesthetist, and psychologists.

Psychosocial Factors Affecting Artificial Intelligence Adoption in Health Care in China: Cross-Sectional Study

Background

Poor quality primary health care is a major issue in China, particularly in blindness prevention. Artificial intelligence (AI) could provide early screening and accurate auxiliary diagnosis to improve primary care services and reduce unnecessary referrals, but the application of AI in medical settings is still an emerging field.

Objective

This study aimed to investigate the general public’s acceptance of ophthalmic AI devices, with reference to those already used in China, and the interrelated influencing factors that shape people’s intention to use these devices.

Methods

We proposed a model of ophthalmic AI acceptance based on technology acceptance theories and variables from other health care–related studies. The model was verified via a 32-item questionnaire with 7-point Likert scales completed by 474 respondents (nationally random sampled). Structural equation modeling was used to evaluate item and construct reliability and validity via a confirmatory factor analysis, and the model’s path effects, significance, goodness of fit, and mediation and moderation effects were analyzed.

Results

Standardized factor loadings of items were between 0.583 and 0.876. Composite reliability of 9 constructs ranged from 0.673 to 0.841. The discriminant validity of all constructs met the Fornell and Larcker criteria. Model fit indicators such as standardized root mean square residual (0.057), comparative fit index (0.915), and root mean squared error of approximation (0.049) demonstrated good fit. Intention to use (R²=0.515) is significantly affected by subjective norms (beta=.408; P<.001), perceived usefulness (beta=.336; P=.03), and resistance bias (beta=–.237; P=.02). Subjective norms and perceived behavior control had an indirect impact on intention to use through perceived usefulness and perceived ease of use. Eye health consciousness had an indirect positive effect on intention to use through perceived usefulness. Trust had a significant moderation effect (beta=–.095; P=.049) on the effect path of perceived usefulness to intention to use.

Conclusions

The item, construct, and model indicators indicate reliable interpretation power and help explain the levels of public acceptance of ophthalmic AI devices in China. The influence of subjective norms can be linked to Confucian culture, collectivism, authoritarianism, and conformity mentality in China. Overall, the use of AI in diagnostics and clinical laboratory analysis is underdeveloped, and the Chinese public are generally mistrustful of medical staff and the Chinese medical system. Stakeholders such as doctors and AI suppliers should therefore avoid making misleading or over-exaggerated claims in the promotion of AI health care products.

Contemporary invasive management and in-hospital outcomes of patients with non-ST-segment elevation myocardial infarction in China: Findings from China Acute Myocardial Infarction (CAMI) Registry

BACKGROUND

Few studies have investigated the use of invasive strategy for patients with non-ST-segment elevation myocardial infarction (NSTEMI) in China. We aimed to describe the contemporary pattern of management, medically and invasively, in patients with NSTEMI across China.

METHODS

Using data of China Acute Myocardial Infarction Registry, we analyzed the baseline characteristics, in-hospital medication, index coronary angiography (CAG) and revascularization by stratification of gender, age, and risk assessment. Primary outcomes included in-hospital major adverse cardio-cerebral events (MACCE, a composite of all-cause death, myocardial (re)infarction, and stroke) and length of stay (LOS).

RESULTS

A total of 10,266 NSTEMI patients were enrolled between January 2013 and November 2016. Dual antiplatelet therapy and statins were prescribed in 92.9% and 92.1% of overall patients respectively. CAG was performed in 45.6% of these patients, and 40.9% had an index revascularization. Female, older or higher risk patients were less likely to receive CAG or revascularization. The rates of CAG were 67.9% in the provincial-level, 46.2% in the prefectural, and 12.1% in the county-level hospitals. Of those patients undergoing revascularization, 77.0% (1,156/1,501) very-high-risk patients received urgent revascularization and 16.2% (440/2,699) high-risk patients underwent early revascularization as recommended. The overall in-hospital MACCE was 6.7%, and the median LOS was 10 (6) days. Revascularization was associated with reduction for in-hospital MACCE regardless of risk and age.

CONCLUSION

Invasive management was underused and profoundly deferred among patients with NSTEMI in China. The risk-treatment paradox, procedure deferral and medical resources distribution imbalance may represent opportunities for improvement.

Doctors' Job Satisfaction and Its Relationships With Doctor-Patient Relationship and Work-Family Conflict in China: A Structural Equation Modeling

The objective of this study was to evaluate the relationship of doctors’ job satisfaction with doctor-patient relationship and work-family conflict in China. The data came from a cross-sectional survey in Hubei province, which was part of China’s Fifth National Health Services Survey conducted in 2013. The survey in Hubei covered 54 secondary and tertiary general hospitals distributed in 20 counties. Of the 1080 questionnaires, 908 were included into our analysis. After surviving from reliability and validity tests, structural equation modeling was applied for further analysis with SPSS 20.0 and Mplus 7.0. The results showed that the average score of job satisfaction is 19.61 out of 30 points, indicating a relatively low level of doctors’ job satisfaction in Hubei province. Work-family conflict was found to have negative impact on doctors’ job satisfaction, and good doctor-patient relationship was found to have positive impact on their job satisfaction. Therefore, hospital administrators and policy makers should make effort to design and implement strategies that focus on meliorating doctor-patient relationship and balancing doctors’ work and family life to further improve their job satisfaction.

How Medic-Patient Communication and Relationship Influence Chinese Patients' Treatment Adherence

The deterioration of medic-patient relation in China raises the question about its impact on patients' adherence to medical instructions. This study focuses on how the quantity and quality of medic-patient communication influences their relationship, and how the perceived relationship at individual level, institution level, and society level influences patients' treatment adherence, through a survey conducted in a city of Southern China (N = 597, Response rate = 66%). The results of path analysis show that consulting time is positively associated with patients' relationship with individual doctors and the whole medical system, as well as their satisfaction with hospital. Unpleasant experience of having disputes with medical workers is negatively associated with the medic-patient relationship at all of the three levels and causes conditional nonadherence. The more positive medic-patient relationship perceived by the patients, the more likely they will display unconditional adherence.

Practice of informed consent in Guangdong, China: a qualitative study from the perspective of in-hospital patients

OBJECTIVE

This study aimed to investigate the practice of informed consent in China from the perspective of patients.

DESIGN

A qualitative study using in-depth interviews with in-hospital patients focusing on personal experience with informed consent.

SETTING

Guangdong Province, China.

PARTICIPANTS

71 in-hospital patients in rehabilitation after surgical operations were included.

RESULTS

Medical information is not actively conveyed by doctors nor effectively received by patients. Without complete and understandable information, patients are unable to make an autonomous clinical decision but must sign an informed consent form following the doctor's medical arrangement. Three barriers to accessing medical information by patients were identified: (1) medical information received by patients was insufficient to support their decision-making, (2) patients lacked medical knowledge to understand the perceptions of doctors and (3) patient-doctor interactions were insufficient in clinical settings.

CONCLUSIONS

Informed consent is implemented as an administrative procedure at the hospital level in China. However, it has not been embedded in doctors' clinical practices because, from the perspective of patients, doctors do not fulfil the obligation of medical information provision. As a result, the informed part of informed consent was neglected by individual doctors in China. Reforming medical education, monitoring the process of informed consent in clinical settings and redesigning medical institutional arrangements are pathways to restoring the practice of informed consent and patient-centred models in China.