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Magnussen HJ, Kjeken I, Pinxsterhuis I, Sjøvold TA, Feiring M. Dialogued into being: Constructing knowledge about hand osteoarthritis from a polyphony of voices in healthcare encounters. Int J Qual Stud Health Well-being 2024; 19:2330221. [PMID: 38498812 PMCID: PMC10949837 DOI: 10.1080/17482631.2024.2330221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE Multiple knowledge sources inform healthcare. In healthcare encounters, patients and health professionals' ideas intersect to understand illness and disease. Exploring what is thought of as legitimate knowledge, and where those reflections come from is central to the process of improving and developing healthcare. Within this context, we aim to explore how knowledge about hand osteoarthritis (OA) is constructed and negotiated in clinical consultations. METHODOLOGY The article is based on interviews with 21 patients and 14 health professionals in combination with observation in 16 clinical consultations. Reflexive thematic analysis was used to interpret the data. RESULTS We generated four themes from codes to tell an interpretive story about how hand OA meaning-making is "talked into being" in patient-provider encounters: from the dominant voice of health professionals, from patients as knowers in the chronic healthcare dialogue, from health professionals and patients constructing knowledge together and from the construction of knowledge in hybrid positions when patients are health professionals and health professionals have hand OA. CONCLUSION New knowledge about hand OA is co-constructed in the situated context of the clinical encounter through a polyphony of voices-some of which are dominant, while others occupy the periphery-within and between the interactants in dialgue.
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Affiliation(s)
- Hege Johanne Magnussen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Kjeken
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- REMEDY - Centre for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Irma Pinxsterhuis
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Marte Feiring
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- REMEDY - Centre for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
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Olde Wolsink-van Harlingen A, Groen-van de Ven L, Vissers K, Hasselaar J, Jukema J, Uitdehaag M. Challenges to Exploring the Patient Perspective in Palliative Care Conversations: A Qualitative Study Among Chronic Obstructive Pulmonary Disease and Chronic Heart Failure Patients and Their Health Care Professionals. Palliat Med Rep 2024; 5:150-161. [PMID: 38596696 PMCID: PMC11002561 DOI: 10.1089/pmr.2023.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/11/2024] Open
Abstract
Objectives The aim of this study was to reveal the challenges faced in exploring the patient's perspective as experienced by patients with chronic obstructive pulmonary disease or chronic heart failure and their health care professionals (HCPs), including the circumstances under which these challenges are experienced during palliative care conversations. Methods This is a qualitative, explorative study in the Netherlands using purposive sampling to create diversity in demographic variables of both patients and HCPs. Semistructured interviews with 12 patients and 7 HCPs were carried out with the use of topic lists. All interviews were audiorecorded, verbatim transcribed, and thematically analyzed. Results Patients find it challenging to express their wishes, preferences, and boundaries and say what is really preoccupying them, especially when they do not feel a good connection with their HCP. HCPs find it challenging to get to know the patient and discuss the patient's perspective particularly when patients are not proactive, open or realistic, or unable to understand or recall information. Conclusions Patients and HCPs seem to share the same aim: patients want to be known and understood and HCPs want to know and understand the patient as a unique individual. At the same time, they seem unable to personalize their conversations. To move beyond this impasse patients and HCPs need to take steps and be empowered to do so.
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Affiliation(s)
- Annet Olde Wolsink-van Harlingen
- Research Group Smart Health, Saxion University of Applied Sciences, Deventer/Enschede, the Netherlands
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc University Medical Center, Nijmegen, the Netherlands
| | - Leontine Groen-van de Ven
- Research Group Living Well with Dementia, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc University Medical Center, Nijmegen, the Netherlands
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc University Medical Center, Nijmegen, the Netherlands
- Nivel Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Jan Jukema
- Research Group Smart Health, Saxion University of Applied Sciences, Deventer/Enschede, the Netherlands
| | - Madeleen Uitdehaag
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc University Medical Center, Nijmegen, the Netherlands
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Lehtinen M, Voutilainen L, Peräkylä A. 'Is it in your basic personality?' Negotiations about traits and context in diagnostic interviews for personality disorders. Health (London) 2023; 27:1033-1058. [PMID: 35608173 PMCID: PMC10588267 DOI: 10.1177/13634593221094701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
What does it mean to claim that somebody's personality is disordered? The aim in this paper is to examine how the process of diagnosing personality disorders (PD) unfolds on a practical level. We take an in-depth look at PD interviews, paying close attention to the occasional discrepancies in the clinicians' and the patients' approaches to generalising the behaviour of patients to describe their personality. Clinicians are guided by the medical model and structured interviews in their approach. We regard the interview situation as interplay between the institution, the clinician and the patient - and the final diagnosis as an interactional construction between them. Our data consists of video-recorded interviews in Finland with 10 adult patients and three psychiatric nurses. The collection was compiled from 22 excerpts in which the participants orient differently to the generalisability of personality traits. Our observations show that, in these interviews, patients frequently make sense of their behaviour differently from what is expected - not as a reflection of their personality traits, but as an outcome of many situational factors. Our understanding leads us to emphasise the importance of making visible the practices that shape the diagnostic process in psychiatry.
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Affiliation(s)
| | | | - Anssi Peräkylä
- University of Helsinki, Finland; Freiburg Institute for Advanced Studies, Germany
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Ramsey SM, Brooks J, Briggs M, Hallett CE. Voiceless and vulnerable: An existential phenomenology of the patient experience in 21st century British hospitals. Nurs Inq 2023; 30:e12588. [PMID: 37501278 DOI: 10.1111/nin.12588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
Current health policy, high-profile failures and increased media scrutiny have led to a significant focus on patient experience in Britain's National Health Service (NHS). Patient experience data is typically gathered through surveys of satisfaction. The study aimed to support a better understanding of the patient experience and patients' expression of it through consideration of the aspects of the patient experience on NHS wards which are by their nature impossible to capture through patient satisfaction surveys. Existential phenomenology was used to develop an in-depth exploratory narrative, expressed through the voices of the participants. Data collection involved in-depth face-to-face interviews with 12 purposively sampled participants, with analysis by means of hermeneutics. Though the individuality of each experience was apparent and cannot be overemphasised, common factors emerging from the data included uncertainty and unexpectedness, suffering and finitude, the futility of feedback and bureaucracy and absurdity. Overall, participants demonstrated how their individual personalities and expectations affected their response both to illness or injury and to their hospital admissions, highlighting feelings of vulnerability and voicelessness as a response to hospitalisation. The findings of this study provide useful insight into the patient experience on British hospital wards, and the value of an existential-phenomenological approach is demonstrated.
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Affiliation(s)
- Sarah M Ramsey
- Trafford General Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jane Brooks
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Michelle Briggs
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Christine E Hallett
- School of Music, Humanities and Media, The University of Huddersfield, Huddersfield, UK
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He YZ, Liao PC, Chang YT. Enhancing patient-centred care in Taiwan's dental education system: Exploring the feasibility of doctor-patient communication education and training. J Dent Sci 2023; 18:1830-1837. [PMID: 37799875 PMCID: PMC10548035 DOI: 10.1016/j.jds.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/02/2023] [Indexed: 10/07/2023] Open
Abstract
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.
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Affiliation(s)
- Yi-Zhou He
- School of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Pei-Chun Liao
- School of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Yung-Ta Chang
- School of Life Science, National Taiwan Normal University, Taipei, Taiwan
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Zhang C, Chor W. Realizing Holism in Traditional Chinese Medicine (TCM) Consultations through the Voice of TCM (VOTCM): An Interactional Analytical Approach. HEALTH COMMUNICATION 2023; 38:275-284. [PMID: 34278899 DOI: 10.1080/10410236.2021.1950292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In recent years, doctor-patient communication in the context of traditional Chinese medicine (TCM) has attracted increasing attention. Highly influenced by ancient Chinese philosophy, TCM is unique in its exemplification of Chinese wisdom, particularly with respect to how the idea of zhěngtǐguān () (lit. whole body concept), realized as "the idea of the whole" or simply "holism," is valued and realized in TCM consultations. Adopting an interactional analytical approach, our study aims to illustrate how TCM doctors and patients co-construct a medical consultation that can exemplify the idea of holism. Based on a spoken corpus of Mandarin Chinese totaling 443 minutes in length, this paper identifies instances of what can be labeled as the voice of TCM (VOTCM) in a typical TCM consultation that reflect the idea of holism and describes and analyzes the communicative routines that are specific to these TCM consultations. It is observed that the steps and strategies involved in the consultation not only illustrate the collaborative co-construction of holism but also point to the holistic aspect of TCM philosophy, particularly topics related to the different body parts and the lifeworld. The diagnostic explanations provided by doctors and the co-topical talks between doctors and patients at various stages of the consultation also play an important role in the co-construction and realization of holism.
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Affiliation(s)
- Chenjie Zhang
- Department of English Language and Literature, Hong Kong Baptist University
| | - Winnie Chor
- Department of English Language and Literature, Hong Kong Baptist University
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Reliability and validity testing of the medicines related - consultation assessment tool for assessing pharmacists' consultations. Int J Clin Pharm 2023; 45:201-209. [PMID: 36394786 PMCID: PMC9938801 DOI: 10.1007/s11096-022-01489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Demonstrating a person-centred approach in a consultation is a key component of delivering high-quality healthcare. To support development of such an approach requires training underpinned by valid assessment tools. Given the lack of a suitable pharmacy-specific tool, a new global consultation skills assessment tool: the medicines related-consultation assessment tool (MR-CAT) was designed and tested. AIM This study aimed to test the validity and reliability of the MR-CAT using psychometric methods. METHOD Psychometric testing involved analysis of participants' (n = 13) assessment of fifteen pre-recorded simulated consultations using the MR-CAT. Analysis included discriminant validity testing, intrarater and interrater reliability testing for each of the five sections of the MR-CAT and for the overall global assessment of the consultation. Analysis also included internal consistency testing for the whole tool. RESULTS Internal consistency for the overall global assessment of the consultation was good (Cronbach's alpha = 0.97). The MR-CAT discriminated well for the overall global assessment of the consultation (p < 0.001). Moderate to high intrarater reliability was observed for the overall global assessment of the consultation and for all five sections of the MR-CAT (rho = 0.64-0.84) in the test-retest analysis. Moderate to good interrater reliability (Kendall's W = 0.68-0.90) was observed for the overall global assessment of the consultation and for all five sections of the MR-CAT. CONCLUSION The MR-CAT is a valid and reliable tool for assessing person-centred pharmacist's consultations. Moreover, its unique design means that the MR-CAT can be used in both formative and summative assessment.
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MacLeod A, Luong V, Cameron P, Burm S, Field S, Kits O, Miller S, Stewart WA. Case-Informed Learning in Medical Education: A Call for Ontological Fidelity. PERSPECTIVES ON MEDICAL EDUCATION 2023; 2:120-128. [PMID: 37063601 PMCID: PMC10103732 DOI: 10.5334/pme.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023]
Abstract
Case-informed learning is an umbrella term we use to classify pedagogical approaches that use text-based cases for learning. Examples include Problem-Based, Case-Based, and Team-Based approaches, amongst others. We contend that the cases at the heart of case-informed learning are philosophical artefacts that reveal traditional positivist orientations of medical education and medicine, more broadly, through their centering scientific knowledge and objective fact. This positivist orientation, however, leads to an absence of the human experience of medicine in most cases. One of the rationales for using cases is that they allow for learning in context, representing aspects of real-life medical practice in controlled environments. Cases are, therefore, a form of simulation. Yet issues of fidelity, widely discussed in the broader simulation literature, have yet to enter discussions of case-informed learning. We propose the concept of ontological fidelity as a way to approach ontological questions (i.e., questions regarding what we assume to be real), so that they might centre narrative and experiential elements of medicine. Ontological fidelity can help medical educators grapple with what information should be included in a case by encouraging an exploration of the philosophical questions: What is real? Which (and whose) reality do we want to simulate through cases? What are the essential elements of a case that make it feel real? What is the clinical story we want to reproduce in case format? In this Eye-Opener, we explore what it would mean to create cases from a position of ontological fidelity and provide suggestions for how to do this in everyday medical education.
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Affiliation(s)
- Anna MacLeod
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Victoria Luong
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paula Cameron
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Burm
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Simon Field
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Kits
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephen Miller
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Wendy A. Stewart
- Department of Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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Rønneberg M, Mjølstad BP, Hvas L, Getz L. Perceptions of the medical relevance of patients` stories of painful and adverse life experiences: a focus group study among Norwegian General Practitioners. Int J Qual Stud Health Well-being 2022; 17:2108560. [PMID: 35983640 PMCID: PMC9397424 DOI: 10.1080/17482631.2022.2108560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose Adverse life experiences increase the risk of health problems. Little is known about General Practitioners’ (GPs') thoughts, clinical concepts, and work patterns related to eliciting, including, or excluding their patients’ stories of painful and adverse life experiences. We wanted to explore GPs’ perceptions of the medical relevance of stories of painful and adverse life experiences, and to focus on what hinders or facilitates working with such stories. Method Eighteen Norwegian GPs participated in three focus group interviews. The interviews were analysed using reflexive thematic analysis. Results The participating GPs’ views on the clinical relevance of patients’ painful and adverse experiences varied considerably. Our analysis revealed two distinct stances: a confident-accepting stance, and an ambivalent-conditional stance. GPs encountered barriers to exploring such stories: scepticism on behalf of the medical discipline; scepticism on behalf of the patients; and, uncertainty regarding how to address stories of painful and adverse experiences in consultations. Work with painful stories was best facilitated when GPs manifested personal openness and prepared availability, within the context of a doctor-patient relationship based on trust. Conclusions Clearer processes for handling biographical information and life experiences that affect patients’ health are needed to facilitate the work of primary care physicians.
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Affiliation(s)
- Marianne Rønneberg
- Tingvoll Healthcare Centre, Tingvoll, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Bente Prytz Mjølstad
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lotte Hvas
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Linn Getz
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Aengst J, Walker-Stevenson G, Harrod T, Ivankovic J, Neilson J, Guise JM. Uncomfortable yet necessary: The impact of PPE on communication in emergency medicine. Int J Qual Health Care 2022; 34:6854825. [PMID: 36448555 PMCID: PMC9782918 DOI: 10.1093/intqhc/mzac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/09/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The efficacy of pre-hospital emergency services is heavily dependent on the effective communication of care providers. This effective communication occurs between providers as part of a team and also among providers interacting with family members and patients. The COVID-19 pandemic introduced a number of communication challenges to emergency care, which are primarily linked to the increased use of personal protective equipment (PPE). OBJECTIVE We sought to analyze the impacts of the COVID-19 pandemic on emergency medical service (EMS) workers and pre-hospital care delivery. METHODS We conducted focus groups and one-on-one interviews with fire-based EMS first responders between September 2021 and 2022. Interviews included questions about job-related stress, EMS skills, work experiences and changes during COVID-19. Interviews were recorded, independently dual coded and analyzed for themes. RESULTS Two hundred twenty-three first responders participated in 40 focus groups and 40 lead paramedics participated in individual interviews. We found that additional use of PPE was reported to have significantly impaired efficiency and perceptions of quality of care-among EMS team members and also between EMS workers and patients. EMS personnels also experienced on-scene hostility on arrival (from both families and other agencies). Extensive use of PPE muffles voices, obscures facial expressions and can cause team members to have difficulty recognizing and communicating with one another and can be a barrier to showing empathy and connecting with patients. Creative solutions such as putting a hand on someone's shoulder, wearing name tags on suits and explaining rationale for perceived delays were mentioned as methods to transcend these barriers. The appearance of providers in heavy PPE can be unsettling and create barriers to human connection, particularly for pediatric patients. CONCLUSION Human connection is an important element of health-care delivery and healing. These findings shed light on new skills that are needed to initiate and maintain human connection in these times of PPE use, especially full-body PPE. Awareness of the communication and empathy barriers posed by PPE is the first step to improving provider-patient interactions in pre-hospital EMS. Additionally, 'communication-friendly' adaptations of PPE equipment may be an important area for future research and development in manufacturing and the health-care industry.
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Affiliation(s)
- Jennifer Aengst
- Department of Anthropology, Portland State University, P.O. Box 751, Portland, OR 97207, USA
| | - Grace Walker-Stevenson
- Address reprint requests to: Grace Walker-Stevenson, Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. Tel: +503-494-3666; Fax: +503-494-2391; E-mail:
| | - Tabria Harrod
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jonathan Ivankovic
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jacob Neilson
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jeanne-Marie Guise
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
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Cassidy PR. Beyond emotional support: predictors of satisfaction and perceived care quality following the death of a baby during pregnancy. J Perinat Med 2022; 50:832-843. [PMID: 35468664 DOI: 10.1515/jpm-2021-0489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/27/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate which objective (actions/interventions) and subjective (perceptions of care quality) outcomes of care following stillbirth or termination of pregnancy predict perceived care quality. METHODS A cross-sectional descriptive study using an anonymous online survey. The population was women who had experienced a stillbirth or termination of pregnancy from ≥16 weeks of gestation, in the Spanish health system. Multiple sequential regression analysis was used to identify predictors of perceived care quality (satisfaction, willingness to recommend, competence and ability to provide loss-focused care). RESULTS Results from 610 women were analysed. A significant regression equation (p<0.001) was found in each of the objective only and objective-subjective models. In the case of overall care (satisfaction-recommend composite), 72.0% of variance (adj. R2) was explained. In general, subjective evaluations of care are more potent predictors of perceived care quality than objective care interventions (e.g. autopsy performed). Feeling free to 'express emotions', 'teamwork between doctors and nurses/midwives', and 'being well-informed of all steps and procedures' were the three strongest predictors, followed by perception of 'medical negligence'. Information provision and loss-focused interventions had the weakest influence, except in the specific 'loss-focused' model. CONCLUSIONS The results indicate that the 'atmosphere' of care is a transversal dimension related to the context of loss and trauma and has the single greatest influence on perceptions of care quality. It is necessary to use a specific 'loss-focused' care variable to adequately capture perceptions of the quality of bereavement care and a custom scale to measure the influence of care interventions on perceived quality.
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Affiliation(s)
- Paul Richard Cassidy
- Complutense University of Madrid, Umamanita (Stillbirth and Neonatal Death Charity), Carrer Major 3, 17133, Girona, Spain
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Santi D, Spaggiari G, Romeo M, Ebert R, Corradini F, Baraldi C, Granata ARM, Rochira V, Simoni M, Gavioli L, Niemants NSA. Qualitative and quantitative analysis of doctor-patient interactions during andrological consultations. Andrology 2022; 10:1240-1249. [PMID: 35785424 PMCID: PMC9540423 DOI: 10.1111/andr.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/06/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although a trustworthy connection between doctor and patient is crucial in clinical practice, it could be hindered by different cultural and linguistic backgrounds. Moreover, an effective doctor-patient interaction could be even more challenging in andrological fields, in which psychological and social components are predominant. AIM To analyse the doctor-patient relationship in the andrological field, applying both qualitative and quantitative analyses. METHODS monocentric, cross-sectional, observational study was performed between May and December 2018. During the study, all patients aged >18 years attending the Modena Andrology Unit for couple infertility or erectile dysfunction were enrolled and the doctor-patients interaction recorded. Patients were divided into two groups depending on their medical seeking and were further divided between native and non-native speakers of Italian. All patients underwent a routine andrological examination. Every first medical consultation was audio-recorded and transcribed using "ELAN" software for socio-linguistic analysis. Transcriptions underwent qualitative analysis through conversation analysis. Then, quantitative analyses were performed, and interaction parameters underwent correlation analyses. RESULTS Twenty-five patients were enrolled. The analysis of the andrological interview allowed to recognize five consecutive phases, following a semi-standardized pattern. Patients without linguistic barriers and with infertility problems showed more autonomous contribution during the consultation. No difference arose in sexual dysfunctions group. Doctor's explanations were frequent, but when linguistic barrier was present or Italian patients seemed less talkative, explanations were shorter, and doctors tried to use other conversational mechanisms to promote understanding. Patient's variables were significantly lower compared to the doctor, considering the number of turns (p = 0.025) and their minimum (p = 0.032), maximum (p<0.001), and average durations (p<0.001). Only patient's latency was significantly higher than the doctor's (p = 0.001). CONCLUSION This is the first attempt to analyse the doctor-patient relationship in andrology using authentic audio-recorded consultations. The results confirmed that a patient-centred communication must be applied also in andrological consultations. However, the topics discussed may require more "medical formulation" to be acceptable to the participants in this context. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Daniele Santi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Giorgia Spaggiari
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Marilina Romeo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Riccardo Ebert
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Federico Corradini
- Department of Studies on Language and Culture, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudio Baraldi
- Department of Studies on Language and Culture, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio R M Granata
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Vincenzo Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Manuela Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Laura Gavioli
- Department of Studies on Language and Culture, University of Modena and Reggio Emilia, Modena, Italy
| | - Natacha S A Niemants
- Department of Interpretation and Translation, Alma Mater Studiorum - University of Bologna, Campus of Forlì, Italy
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13
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Brodahl KØ, Storøy HLE, Finset A, Pedersen R. The first steps towards professional distance: A sequential analysis of students' interactions with patients expressing emotional issues in medical interviews. PATIENT EDUCATION AND COUNSELING 2022; 105:1237-1243. [PMID: 34949468 DOI: 10.1016/j.pec.2021.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Explore sequential patterns in students' interactions with patients expressing emotional concerns in a medical interview. METHODS Concepts and principles from conversation analysis (CA) were used to examine the turn-by-turn sequential organization of student actions in eleven video-taped medical interviews. We used results from an earlier coding with an interaction analysis system (VR-CoDES) in a previously published paper as a point of reference. RESULTS By using CA instead of VR-CoDES as our primary investigative method we observed that student turns previously coded as elicitations to simulated patients' expressions of emotion were often preceded by subtle patient initiatives. Students encouraged further elaboration by displaying their understanding of the emotional issue as a story telling still in progress. Students' expressions of understanding however, gave little room for further elaboration. Finally, students often addressed emotional issues as a medical issue and offered professional advice. CONCLUSIONS Students' actions seemed specifically designed to display interest in the patients' initiatives to talk about emotional experiences without departing from their initial interview task or violating norms for professional conduct. PRACTICE IMPLICATIONS Educators and practitioners should reconsider how the medical interview may shape expectations for professional conduct and can thereby unintentionally restrict students' empathy development.
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Affiliation(s)
| | | | - Arnstein Finset
- Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway
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14
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Lydahl D, Britten N, Wolf A, Naldemirci Ö, Lloyd H, Heckemann B. Exploring documentation in Person-centred care: A content analysis of care plans. Int J Older People Nurs 2022; 17:e12461. [PMID: 35393772 PMCID: PMC9540033 DOI: 10.1111/opn.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Person-centred care is a growing imperative in healthcare, but the documentation of person-centred care is challenging. According to the Gothenburg Framework of Person-centred Care, care should be documented in continuously revised care plans and based on patients' personally formulated goals and resources to secure a continuous partnership. OBJECTIVES This study aimed to examine care plans produced within a randomised controlled trial that tested a person-centred care intervention in older people with acute coronary syndrome. Nurses with training in the theory and practice of person-centred care had written the care plans. METHODS We conducted a secondary analysis of care plans developed in a randomised controlled trial for assessing person-centred care in patients with acute coronary syndrome (Myocardial Infarct [MI] or unstable angina pectoris). The study sample included 84 patients, with three care plans for each patient from inpatient (T1), outpatient (T2) and primary care (T3), that is, a total of 252 care plans. We conducted a descriptive quantitative content analysis of the care plans to examine the reported patients' life-world and medical/health resources and goals. RESULTS The analysis illustrates the differences and overlaps between life-world and medical/health goals and resources. The documented goals and resources change over time: life-world goals and resources decreased with time as medical/health goals and resources documentation increased. CONCLUSIONS This paper illustrates that in the setting of a randomised controlled trial, nurses with training in person-centred care recorded fewer life-world and more medical/health goals over time. Placing life-world goals at the top of the goal hierarchy enables alignment with medical/health goals. Further research should explore whether the goals and resources documented in care plans accurately reflect patients' wishes as they transition along the care chain. TRIAL REGISTRATION Swedish registry, Researchweb.org, ID NR 65 791.
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Affiliation(s)
- Doris Lydahl
- Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden
| | - Nicky Britten
- University of Exeter Medical School, Exeter, UK.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Axel Wolf
- Centre for Person-Centred Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anaesthetics, Surgery and Intensive Care, Sahlgrenska University Hospital, Östra, Gothenburg, Sweden.,Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | | | - Helen Lloyd
- School of Psychology, University of Plymouth, Plymouth, UK
| | - Birgit Heckemann
- Centre for Person-Centred Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anaesthetics, Surgery and Intensive Care, Sahlgrenska University Hospital, Östra, Gothenburg, Sweden
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15
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Cederberg M, Fors A, Ali L, Goulding A, Mäkitalo Å. The interactive work of narrative elicitation in person-centred care: Analysis of phone conversations between health care professionals and patients with common mental disorders. Health Expect 2022; 25:971-983. [PMID: 35148442 PMCID: PMC9122427 DOI: 10.1111/hex.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/29/2021] [Accepted: 01/09/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Narratives play a central part in person-centred care (PCC) as a communicative means of attending to patients' experiences. The present study sets out to explore what activities are performed and what challenges participants face in the interactive process of narrative elicitation, carried through in patient-professional communication in a remote intervention based on PCC. METHODS Data were gathered from a randomized controlled trial (RCT) in a Swedish city where health care professionals (HCPs) conducted remote PCC for patients on sick leave due to common mental disorders. A sample of eleven audio-recorded phone conversations between HCPs and patients enroled in the RCT were collected and subjected to conversation analysis. RESULTS Three interactive patterns in narrative elicitation were identified: Completed narrative sequences driven by the patient, question-driven narrative sequences guided by the HCP, and narrative sequences driven as a collaborative project between the patient and the HCP. In the question-driven narrative sequences, communication was problematic for both participants and they did not accomplish a narrative. In the other two patterns, narratives were accomplished but through various collaborative processes. CONCLUSION This study provides insight into what challenges narrative elicitation may bring in the context of a remote PCC intervention and what interactive work patients and HCP need to engage in. Importantly, it also highlights tensions in the ethics of PCC and its operationalization, if the pursuit of a narrative is not properly balanced against the respect for patients' integrity and personal preferences. Our findings also show that narrative elicitation may represent an interactive process in PCC in which illness narratives are jointly produced, negotiated and transformed. PATIENT OR PUBLIC CONTRIBUTION Stakeholders, including patient representatives, were involved in the design of the main study (the RCT). They have been involved in discussions on research questions and dissemination throughout the study period. They have not been involved in conducting the present study.
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Affiliation(s)
- Matilda Cederberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Psychiatric Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anneli Goulding
- Region Västra Götaland, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Mäkitalo
- Department of Education, University of Oslo, Oslo, Norway.,Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden
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16
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Eigeland JA, Jones L, Sheeran N, Moffitt RL. Critical physician behaviors in the formation of a good physician-patient relationship: Concept mapping the perspective of patients with chronic conditions. PATIENT EDUCATION AND COUNSELING 2022; 105:198-205. [PMID: 34023173 DOI: 10.1016/j.pec.2021.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A robust physician-patient relationship has been linked to better health outcomes for a range of chronic conditions. Our study aimed to identify physician behaviors patients consider contribute to good physician-patient relationships. METHOD Fifty patients with a chronic condition and a self-reported good physician-patient relationship were interviewed using the Critical Incidents technique and asked to describe observable behaviors that contributed to their good physician-patient relationship. A sub-sample of 30 participants rated the importance of each behavior and sorted them into self-labelled, mutually exclusive, and conceptually homogenous categories. Multivariate concept mapping with hierarchal cluster analysis was performed. RESULTS Patients reported 65 behaviors, which were grouped into six overarching domains: valuing the whole person, investigation and future planning, collaboration and empowerment, validation and emotional support, politeness and courtesy, and professionalism. CONCLUSION Results indicate patients with chronic conditions have a broader conceptualization and identified additional behaviors that reflect components of the physician-patient relationship than has been identified in researcher and practitioner based models. PRACTICE IMPLICATIONS Practitioners could utilize these concrete behaviors when forming relationships with their patients. These behaviors could also be incorporated into a tool designed to teach and assess the physician-patient relationship.
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Affiliation(s)
| | - Liz Jones
- School of Applied Psychology, Griffith University, Brisbane, Australia.
| | - Nicola Sheeran
- School of Applied Psychology, Griffith University, Brisbane, Australia.
| | - Robyn L Moffitt
- Psychology, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.
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17
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Westlake D, Ekman I, Britten N, Lloyd H. Terms of engagement for working with patients in a person-centred partnership: A secondary analysis of qualitative data. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:330-340. [PMID: 33955640 DOI: 10.1111/hsc.13406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Evidence is emerging of the potential of person-centred approaches to create partnerships between professionals and patients while also containing healthcare costs. This is important for enhancing outcomes in individuals with complex needs, who consistently report poor experiences with care. The shift towards person-centred care (PCC) is, however, a radical departure from the norm, with increased expectations of both professional and patient. Although there have been studies on the ways in which health care professionals can modify practice to enhance PCC, not all patients welcome changes to their care delivery or understand the aim of the new approach. Without engagement and understanding from the patient, a PCC approach will fail to initiate. Few studies explore how, why and in what circumstances patients become more involved in their care and what professionals can do to enhance participation. We conducted a secondary analysis of qualitative data to examine this issue. Data were collected between 2014 and 2018 from primary care-based PCC projects across the southwest of England. Supported by people with experience (practitioners and those receiving treatment), theory building workshops developed an explanatory framework that identified contextual factors and mechanisms likely to contribute to effective engagement. Our results show that engagement in a care partnership is achieved through trust and a patient's sense of candidacy. Shared understanding of purpose, clarity of expectations and power sharing were found to facilitate trusted relationships between professional and patient and encourage candidacy. Only then is it possible to develop goals that are meaningful to the patient. Our theory of engagement applies to professionals and patients alike but places the initial burden of responsibility on those who hold the most power: the professional and the system. This theory has the potential to explain patient engagement in PCC and a range of other service interventions, treatments and intervention research.
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Affiliation(s)
- Debra Westlake
- National Institute for Health Research, Applied Research Collaboration South West Peninsula (PenARC), Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Inger Ekman
- Centre for Person-Centred Care University of Gothenburg (GPCC), Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicky Britten
- National Institute for Health Research Applied Research Collaboration Southwest Peninusula (PenARC), University of Exeter Medical School, St. Luke's Campus, Exeter, UK
| | - Helen Lloyd
- National Institute for Health Research, Applied Research Collaboration South West Peninsula (PenARC), Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
- School of Psychology, Plymouth University, Plymouth, UK
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18
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Dahm MR, Williams M, Crock C. 'More than words' - Interpersonal communication, cognitive bias and diagnostic errors. PATIENT EDUCATION AND COUNSELING 2022; 105:252-256. [PMID: 34045088 DOI: 10.1016/j.pec.2021.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
During the diagnostic process, clinicians may make assumptions, prematurely judge or diagnose patients based on their appearance, their speech or how they are portrayed by other clinicians. Such judgements can be a major source of diagnostic error and are often linked to unconscious cognitive biases - faulty quick-fire thinking patterns that impact clinical reasoning. Patient safety is profoundly influenced by cognitive bias and language, i.e. how information is presented or gathered, and then synthesised by clinicians to form and communicate diagnostic decisions. Here, we discuss the intricate links between interpersonal communication, cognitive bias, and diagnostic error from a patient's, a linguist's and clinician's perspective. We propose that through patient engagement and applied health communication research, we can enhance our understanding of how the interplay of communication behaviours, biases and errors can impact upon the patient experience and diagnostic error. In doing so, we provide new avenues for collaborative diagnostic error research striving towards healthcare improvements and safer diagnosis.
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Affiliation(s)
- Maria R Dahm
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia.
| | | | - Carmel Crock
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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19
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Mehretie Adinew Y, Kelly J, Marshall A, Smith M. Care Providers' Perspectives on Disrespect and Abuse of Women During Facility-Based Childbirth in Ethiopia: A Qualitative Study. Int J Womens Health 2021; 13:1181-1195. [PMID: 34876861 PMCID: PMC8643202 DOI: 10.2147/ijwh.s333863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background It is increasingly evident that disrespect and abuse of women during facility-based childbirth is a violation of a woman’s rights and a deterrent to the use of life-saving maternity care. Understanding care providers’ perspectives of disrespect and abuse during facility-based childbirth is an essential element to aid in fully comprehending the problem and its underlying complexities. Objective To explore care providers’ perspectives of disrespect and abuse during facility-based childbirth. Methods This study used a qualitative descriptive design involving fifteen in-depth, semi-structured, interviews conducted between 5 October 2019 and 25 January 2020 in north Showa zone of Oromia region, central Ethiopia. Purposive sampling enabled health care professionals working in maternity units of health facilities who have direct involvement in care of women during pregnancy and labor to be recruited. Thematic analysis using Open Code software was used to explore the perspectives of participants. Results Four themes were identified. 1) Disrespect and abuse breaches professional standards, 2) Disrespectful and abusive actions are justified at times to save the mother and her baby, 3) Disrespect and abuse is used as a tool to assert power, and 4) Disrespect and abuse arise from health system deficiencies. Conclusion Disrespect and abuse is triggered by underlying beliefs about risk versus care, provider attitudes, stress and burnout, and health service structural issues including a lack of medicines and supplies. A number of strategies could improve the quality of maternity care, including training providers how to manage difficult and complex situations, addressing root causes of disrespect and abuse, and increasing access to resources.
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Affiliation(s)
- Yohannes Mehretie Adinew
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia.,College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Janet Kelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Amy Marshall
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Morgan Smith
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
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20
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Doblytė S. The vicious cycle of distrust: Access, quality, and efficiency within a post-communist mental health system. Soc Sci Med 2021; 292:114573. [PMID: 34814026 DOI: 10.1016/j.socscimed.2021.114573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 10/08/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
Trust -a critical mechanism to manage vulnerability amidst uncertainty- may greatly influence healthcare practices, and consequently, its objectives. Building upon the work of Jürgen Habermas and the framework of trust chains, the aim of this article is to unpack how trust dynamics between the state, the provider, and the service user shape the functioning of mental healthcare in one of the former Soviet states -Lithuania. The case is of interest to medical sociology due to the region's historical and contemporary context. By drawing on in-depth interviews with healthcare providers and users, I demonstrate how the chains of reciprocal distrust underpin the workings of the mental health system and how the actors in turn employ a range of responses to such distrust. The instances of trusting relations nevertheless demonstrate how trust might facilitate the strive for mental healthcare that is more accessible, efficient, and of higher quality.
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21
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Fudge N, Swinglehurst D. Keeping in balance on the multimorbidity tightrope: A narrative analysis of older patients' experiences of living with and managing multimorbidity. Soc Sci Med 2021; 292:114532. [PMID: 34810031 PMCID: PMC8783047 DOI: 10.1016/j.socscimed.2021.114532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 11/19/2022]
Abstract
Primary care management of patients with multimorbidity in the UK is underpinned by clinical guidelines, quality standards and measurable targets which govern practices of risk management and disease control. There is concern that standardised approaches may not always be appropriate for older patients living with multimorbidity. Using a narrative approach, we elicited the voices of older people living with multiple conditions in order to rethink chronicity, and consider what their accounts might mean for reconfiguring care practices. Within an ethnographic study of multimorbidity and polypharmacy, we conducted in-depth interviews, based on the Biographical Narrative Interpretive Method, with 24 participants aged 65 to 94. Participants were recruited from three general practices in England. All had two or more chronic conditions and were prescribed ten or more medicines. Our analysis draws on Bakhtinian theory, tracing the multiple ways in which participants voiced living with multimorbidity. In this paper, we focus on 'keeping in balance' which emerged as a key meta-conceptualisation across our dataset. Adopting the metaphor of the 'multimorbidity tightrope' we explore the precarity of patients' experiences and show their struggle to create coherence from within a deeply ambiguous living situation. We consider how and to what extent participants' narrative constructions co-opt or resist normative biomedical framings of multimorbidity. Our analysis foregrounds the complex ways in which patients' voices and values may sometimes be at odds with those promoted within professional guidelines. Narrative approaches may offer significant potential for reorienting healthcare towards enabling patients to live a flourishing life, even when facing significant adversity.
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Affiliation(s)
- Nina Fudge
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Deborah Swinglehurst
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
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22
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Forsey J, Ng S, Rowland P, Freeman R, Li C, Woods NN. The Basic Science of Patient-Physician Communication: A Critical Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S109-S118. [PMID: 34348382 DOI: 10.1097/acm.0000000000004323] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Strong verbal communication skills are essential for physicians. Despite a wealth of medical education research exploring communication skills training, learners struggle to become strong communicators. Integrating basic science into the curriculum provides students with conceptual knowledge that improves learning outcomes and facilitates the development of adaptive expertise, but the conceptual knowledge, or "basic science," of patient-provider communication is currently unknown. This review sought to address that gap and identify conceptual knowledge that would support improved communication skills training for medical trainees. METHOD Combining the search methodology of Arksey and O'Malley with a critical analytical lens, the authors conducted a critical scoping review of literature in linguistics, cognitive psychology, and communications to determine: what is known about verbal communication at the level of word choice in physician-patient interactions? Studies were independently screened by 3 researchers during 2 rounds of review. Data extraction focused on theoretical contributions associated with language use and variation. Analysis linked patterns of language use to broader theoretical constructs across disciplines. RESULTS The initial search returned 15,851 unique studies, and 271 studies were included in the review. The dominant conceptual groupings reflected in the results were: (1) clear and explicit language, (2) patient participation and activation, (3) negotiating epistemic knowledge, (4) affiliative language and emotional bonds, (5) role and identity, and (6) managing transactional and relational goals. CONCLUSIONS This in-depth exploration supports and contextualizes theory-driven research of physician-patient communication. The findings may be used to support future communications research in this field and educational innovations based on a solid theoretical foundation.
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Affiliation(s)
- Jacquelin Forsey
- J. Forsey is a PhD candidate, Rehabilitation Sciences Institute, University of Toronto, and a fellow, Wilson Centre, Toronto, Ontario, Canada
| | - Stella Ng
- S. Ng is associate professor, Faculty of Medicine, University of Toronto, and director of research, Centre for Faculty Development, St. Michael's Hospital, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-1433-6851
| | - Paula Rowland
- P. Rowland is assistant professor, Department of Occupational Therapy, University of Toronto, and scientist, Wilson Centre, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-8054-7142
| | - Risa Freeman
- R. Freeman is vice chair of education and scholarship, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Connie Li
- C. Li is a medical student, McMaster University, Hamilton, Ontario, Canada
| | - Nicole N Woods
- N.N. Woods is associate professor, Department of Family and Community Medicine, University of Toronto, and director, Institute for Education Research, UHN, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-2976-1108
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23
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Ipingbemi AE, Erhun WO, Adisa R. Pharmacist-led intervention in treatment non-adherence and associated direct costs of management among ambulatory patients with type 2 diabetes in southwestern Nigeria. BMC Health Serv Res 2021; 21:1000. [PMID: 34551779 PMCID: PMC8459556 DOI: 10.1186/s12913-021-06979-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/01/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Non-adherence to recommended therapy remains a challenge to achieving optimal clinical outcome with resultant economic implications. OBJECTIVE To evaluate the effect of a pharmacist-led intervention on treatment non-adherence and direct costs of management among patients with type 2 diabetes (T2D). METHOD A quasi-experimental study among 201-patients with T2D recruited from two-tertiary healthcare facilities in southwestern Nigeria using semi-structured interview. Patients were assigned into control (HbA1c < 7%, n = 95) and intervention (HbA1c ≥ 7%, n = 106) groups. Baseline questionnaire comprised modified 4-item Medication Adherence Questions (MAQ), Perceived Dietary Adherence Questionnaire (PDAQ) and International Physical Activity Questionnaire, to assess participants' adherence to medications, diet and physical activity, respectively. Post-baseline, participants were followed-up for 6-month with patient-specific educational intervention provided to resolve adherence discrepancies in the intervention group only, while control group continued to receive usual care. Subsequently, direct costs of management for 6-month pre-baseline and 6-month post-baseline were estimated for both groups. Data were summarized using descriptive statistics. Chi-square, McNemar and paired t-test were used to evaluate categorical and continuous variables at p < 0.05. RESULTS Mean age was 62.9 ± 11.6 years, and 160(79.6%) were females. Glycated haemoglobin (HbA1c) was 6.1 ± 0.6% (baseline) and 6.1 ± 0.8% at 6-month post-baseline (p = 0.094) for control group, and 8.7 ± 1.5% (baseline) versus 7.8 ± 2.0% (6-month), p < 0.001, for the intervention. Post-baseline, response to MAQ items 1 (p = 0.017) and 2 (p < 0.001) improved significantly for the intervention. PDAQ score increased significantly from 51.8 ± 8.8 at baseline to 56.5 ± 3.9 at 6-month (p < 0.001) for intervention, and from 56.3 ± 4.0 to 56.5 ± 3.9 (p = 0.094) for the control group. Physical activity increased from 775.2 ± 700.5 Metabolic Equivalent Task (MET) to 829.3 ± 695.5MET(p < 0.001) and from 901.4 ± 743.5MET to 911.7 ± 752.6MET (p = 0.327) for intervention and control groups, respectively. Direct costs of management per patient increased from USD 327.3 ± 114.4 to USD 333.0 ± 118.4 (p = 0.449) for the intervention, while it decreased from USD 290.1 ± 116.97 to USD289.1 ± 120.0 (p = 0.89) for control group, at baseline and 6-month post-baseline, respectively. CONCLUSION Pharmacist-led intervention enhanced adherence to recommended medications, diet and physical activity among the intervention patients, with a corresponding significant improvement in glycaemic outcome and an insignificant increase in direct costs of management. There is a need for active engagement of pharmacists in management of patients with diabetes in clinical practice. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04712916 . Retrospectively-registered.
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Affiliation(s)
- Aduke E Ipingbemi
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Oyo state, Nigeria.
| | - Wilson O Erhun
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Osun state, Nigeria
| | - Rasaq Adisa
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Oyo state, Nigeria
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24
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Martin GP, Chew S, Dixon-Woods M. Why do systems for responding to concerns and complaints so often fail patients, families and healthcare staff? A qualitative study. Soc Sci Med 2021; 287:114375. [PMID: 34507217 DOI: 10.1016/j.socscimed.2021.114375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/06/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
Healthcare organisations' responses to concerns and complaints often fall short of the expectations of patients and staff who raise them, and substandard responses to concerns and complaints have been implicated in organisational failures. Informed by Habermas's systems theory, we offer new insights into the features of organisations' responses to concerns and complaints that give rise to these problems. We draw on a large qualitative dataset, comprising 88 predominantly narrative interviews with people raising and responding to concerns and complaints in six English NHS organisations. In common with past studies, many participants described frustrations with systems and processes that seemed ill-equipped to deal with concerns of the kinds they raised. Departing from existing analyses, we identify the influence of functional rationality, as conceptualised by Habermas, and embodied in procedures, pathways and scripts for response, in producing this dissatisfaction. Functionally rational processes were well equipped to deal with simple, readily categorised concerns and complaints. They were less well placed to respond adequately to concerns and complaints that were complex, cross-cutting, or irreducible to predetermined criteria for redress and resolution. Drawing on empirical examples and on Habermas's theory of communicative action, we offer suggestions for alternative and supplementary approaches to responding to concerns and complaints that might better address both the expectations of complainants and the improvement of services.
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Affiliation(s)
- Graham P Martin
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH, UK.
| | - Sarah Chew
- Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, LE1 7RH, UK
| | - Mary Dixon-Woods
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH, UK
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25
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Stories under construction: Exploring meaning-making on a geriatric ward. J Aging Stud 2021; 58:100940. [DOI: 10.1016/j.jaging.2021.100940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
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26
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Lubis DS, Conn C, Andajani S. Developing HIV prevention online using a habermasian 'lifeworld' approach with young men who have sex with men from Bali. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:749-757. [PMID: 34241581 DOI: 10.1080/19371918.2021.1939830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Internet is a promising medium to strengthen participation in Human Immunodeficiency Virus (HIV) prevention among young men who have sex with men (YMSM). This study engaged YMSM from Bali in codesigning online HIV prevention using a series of participatory action research focus groups. Further, this research utilized Habermasian critical theory of communicative action to interpret the findings. This was framed around the current mismatch between HIV prevention, the "systemworld", and the lived reality, or "lifeworld", of YMSM in Bali. Using a model of intervention called "So Us", YMSM aspired to HIV prevention which reflects their identity, language, and interaction style.
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Affiliation(s)
- Dinar Saurmauli Lubis
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Cath Conn
- School of Public Health & Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Sari Andajani
- School of Public Health & Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
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27
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Thompson T, Grove L, Brown J, Buchan J, Kerry AL, Burge S. COGConnect: A new visual resource for teaching and learning effective consulting. PATIENT EDUCATION AND COUNSELING 2021; 104:2126-2132. [PMID: 33422369 DOI: 10.1016/j.pec.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 11/22/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Consultation skills are essential to clinical practice and, when effective, can facilitate diagnoses and improve patient satisfaction. Various models exist to facilitate consultation teaching. These can be prescriptive, a challenge to apply in clinical settings and are often designed for primary care. In redesigning our entire curriculum, we sought to create a new visual, digital, resource for consultation teaching, aligned with statements from the UK Council for Clinical Communication (UKCCC), and suitable for the evolving expectations of patients, clinicians and the UK NHS, in 21st century medicine. METHODS We conducted a literature review encompassing teaching methods, NHS Priorities, patients' priorities, lifestyle interventions and practitioner resilience. COGConnect was designed iteratively through consultation with a graphic designer, health psychologists, a range of clinicians, and a consultation expert, and has evolved through extensive use in our new "effective consulting" course in primary and secondary care. RESULTS COGConnect is deliberately visual, iterative, bi-directional and multi-phasic. The central image of COGConnect is two persons in connection; the floating cogs suggesting an encounter of different agents who must adapt their cog-connection in terms of speed, direction and dimension. Around this image we place five core values. The consultation phases are represented by ten colourful cogs, with important additions including 'formulating', 'activating' and 'integrating'. CONCLUSION COGConnect builds on the strengths of existing frameworks and provides a strong visual resource suitable for digital learning. It offers greater emphasis on explicit clinical reasoning, activation of patient self-care and learning from the interaction. Having become the de facto resource for consultation skills training across primary and secondary care in our institution, the next phase is to develop the COGConnect.info website and a programme of formal evaluation.
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Affiliation(s)
- Trevor Thompson
- Centre for Academic Primary Care, School of Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK.
| | - Lizzie Grove
- Centre for Academic Primary Care, School of Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Juliet Brown
- Centre for Academic Primary Care, School of Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Jess Buchan
- Centre for Academic Primary Care, School of Population Health Sciences, University of Bristol, Bristol, BS8 2PS, UK
| | - Anthony L Kerry
- Department of Respiratory Medicine, Western Hospital NHS Foundation Trust, Swindon, SN3 6BB, UK
| | - Sarah Burge
- Bristol Medical School, University of Bristol, 69 St Michael's Hill, Bristol, BS2 8DZ, UK
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Watermeyer J, Thwala Z, Beukes J. Medical Terminology in Intercultural Health Interactions. HEALTH COMMUNICATION 2021; 36:1115-1124. [PMID: 32202159 DOI: 10.1080/10410236.2020.1735700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The terminology and jargon used in medical interactions can pose particular challenges to understanding for patients, healthcare providers, and mediators in cases where a language barrier is present. Common medical words used in the interactional space may mean different things to each party present. This study focuses on 79 mediated and nonmediated South African and Italian recorded healthcare interactions in which a language barrier was present. Using a hybrid sociolinguistic approach, we examined how patients, mediators, and healthcare providers orient to the use of medical terminology and how both parties demonstrate understanding of terminology used in the interactional space. Talk-extrinsic data in the form of interviews with South African patients revealed a frequent lack of understanding of key terminology, yet we found few displays of a lack of understanding in the interactional data nor explicit requests by patients for clarification of terminology not understood. In both data sets, patients made use of medical terminology infrequently and usually when describing their symptoms. Healthcare providers used medical terminology quite regularly. We found limited evidence of explicit verification of patients' understanding of medical terminology by healthcare providers or mediators. Given the additional communication complexities inherent in health interactions where a language barrier is present and patients' tendency not to request clarification, the healthcare provider has a special responsibility to ensure that all parties understand the terminology brought into the interactional space. Direct checks of patient understanding of terminology can provide an effective and efficient way of revealing comprehension and establishing shared membership.
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Affiliation(s)
- Jennifer Watermeyer
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand
| | - Zamokuhle Thwala
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand
| | - Johanna Beukes
- Health Communication Research Unit, School of Human and Community Development, University of the Witwatersrand
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Arreskov AB, Lindell JF, Davidsen AS. General practitioner responses to concerns in chronic care consultations for patients with a history of cancer. J Health Psychol 2021; 27:2261-2275. [PMID: 34219544 DOI: 10.1177/13591053211025593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We investigated general practitioners' (GPs') responses to patients' concerns in chronic care consultations. Video recordings of 14 consultations were analyzed with conversation analysis. We found two categories of responses: exiting and exploring the patient's concerns. Most GPs exited the concern by interrupting the patient, acknowledging the concern but then referring back to the progression of the consultation, or affiliating with the concern without exploring it. Only a few raised concerns were explored, and then most often the somatic rather than the emotional aspects of them. The findings point to the risk of missing patients' voiced concerns in consultations with a fixed agenda.
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30
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Dowrick A, Feder G, Kelly M. Boundary-Work and the Distribution of Care for Survivors of Domestic Violence and Abuse in Primary Care Settings: Perspectives From U.K. Clinicians. QUALITATIVE HEALTH RESEARCH 2021; 31:1697-1709. [PMID: 33749389 PMCID: PMC8438775 DOI: 10.1177/1049732321998299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health care encounters are opportunities for primary care practitioners to identify women experiencing domestic violence and abuse (DVA). Increasing DVA support in primary care is a global policy priority but discussion about DVA during consultations remains rare. This article explores how primary care teams in the United Kingdom negotiate the boundaries of their responsibilities for providing DVA support. In-depth interviews were undertaken with 13 general practitioners (GPs) in two urban areas of the United Kingdom. Interviews were analyzed thematically. Analysis focused on the boundary practices participants undertook to establish their professional remit regarding abuse. GPs maintained permeable boundaries with specialist DVA support services. This enabled ongoing negotiation of the role played by clinicians in identifying DVA. This permeability was achieved by limiting the boundaries of the GP role in the care of patients with DVA to identification, with the work of providing support distributed to local specialist DVA agencies.
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Affiliation(s)
- Anna Dowrick
- Queen Mary University of London, London, United Kingdom
| | - Gene Feder
- University of Bristol, Bristol, United Kingdom
| | - Moira Kelly
- Queen Mary University of London, London, United Kingdom
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31
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Gremyr I, Elg M, Eriksson E, Halldórsson Á, Smith F, Gustavsson S. Exploring power shifts as an enabler for a strengthened patient role in quality improvements: a Swedish survey study. BMJ Open Qual 2021; 10:bmjoq-2020-001185. [PMID: 33648954 PMCID: PMC7925245 DOI: 10.1136/bmjoq-2020-001185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives This study examined the relationship between professionals’ perceptions of a strengthened role for the patient and of patient involvement in quality improvement (QI) and whether professionals’ experiences in improvement science were a moderator on such a relationship. Design From a predominantly close-ended, 44-item questionnaire, 4 questions specifically concerning professionals′ perception on patient involvement in QI were analysed. Setting Three Swedish regions. Participants 155 healthcare professionals who had previously participated in courses in improvement science. Results The covariate patient involvement was significantly related to a perceived strengthened patient role. There was also a significant interaction effect between degree of patient involvement and professionals’ experience in the area of improvement science on a strengthened patient role. The result shows that there is a relationship between the perceived level of patient involvement in improvements and professionals’ perceptions of a strengthened patient role. In this study, the covariate, perceived patient involvement, was significantly related to experiences of more equal relationships between patients and healthcare professionals. There was also a significant interaction effect between the degree of patient involvement and professionals’ experience in the area of improvement science, for a more equal relationship between patients and healthcare professionals. Conclusion Increased patient involvement in QI is a means of strengthening the patient role and supporting a more equal relation between patients and healthcare professionals. Furthermore, empirical evidence shows that the healthcare professionals’ experiences in the area of improvement science support a strengthened patient role and a more equal power relationship, but for this to happen, the mindset of professionals is key. Future research is needed to capture and investigate the experiences from patients and relatives about being involved in QI in healthcare, and to study the effects on quality in care processes.
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Affiliation(s)
- Ida Gremyr
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
| | - Mattias Elg
- Department of Management and Engineering, Linköpings Universitet, Linkoping, Sweden
| | - Erik Eriksson
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
| | - Árni Halldórsson
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden
| | - Frida Smith
- Department of Technology Management and Economics, Chalmers University of Technology, Goteborg, Sweden.,Department of Care Development, Regional Cancer Centre West, Goteborg, Sweden
| | - Susanne Gustavsson
- Hospital Administration Management, Skaraborg Hospital Skövde, Skovde, Sweden
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32
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Ravn Jakobsen P, Hermann AP, Søendergaard J, Kock Wiil U, Myhre Jensen C, Clemensen J. The gap between women's needs when diagnosed with asymptomatic osteoporosis and what is provided by the healthcare system: A qualitative study. Chronic Illn 2021; 17:3-16. [PMID: 30525980 DOI: 10.1177/1742395318815958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Women diagnosed with asymptomatic osteoporosis need better support to understand the implications of the condition and how to practice self-management in their daily lives. In contrast, physicians report that asymptomatic osteoporosis is not a serious chronic condition and do not pay much attention to the condition compared to other chronic conditions. Therefore, the aim of this study was to investigate the gap between women's needs, when diagnosed with asymptomatic osteoporosis, and what is provided by the healthcare system. METHODS A secondary analysis of semi-structured interviews with 17 women newly diagnosed with asymptomatic osteoporosis was conducted and combined with semi-structured interviews with six physicians. Giorgi's descriptive phenomenological method was used in the analysis. RESULTS Two overall themes were identified: different perceptions of asymptomatic osteoporosis and discrepancies in the osteoporosis consultation. Habermas was used as a theoretical approach to discuss the findings. DISCUSSION We discuss that physicians pay too much attention to the objective world and highlight that there is a need for better inclusion of women's subjective and social worlds, to enable mutual understanding and communicative action in the osteoporosis consultation. This would lead to treatment decisions based on women's needs and support women in their self-management of osteoporosis.
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Affiliation(s)
- Pernille Ravn Jakobsen
- University College South Denmark, Haderslev, Denmark.,Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark
| | | | - Jens Søendergaard
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Uffe Kock Wiil
- Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark.,SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Charlotte Myhre Jensen
- Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Jane Clemensen
- Centre for Innovative Medical Technology, University of Southern Denmark & Odense University Hospital, Odense, Denmark.,HC Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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Savander EÈ, Hintikka J, Wuolio M, Peräkylä A. The Patients' Practises Disclosing Subjective Experiences in the Psychiatric Intake Interview. Front Psychiatry 2021; 12:605760. [PMID: 34040547 PMCID: PMC8141629 DOI: 10.3389/fpsyt.2021.605760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/17/2021] [Indexed: 12/02/2022] Open
Abstract
In psychiatric diagnostic interviews, a clinician's question designed to elicit a specific symptom description is sometimes met with the patient's self-disclosure of their subjective experience. In shifting the topical focus to their subjective experiences, the patients do something more or something other than just answering the question. Using conversation analysis, we examined such sequences in diagnostic interviews in an outpatient clinic in Finland. From 10 audio-recorded diagnostic interviews, we found 45 segments where medical questions were met with patients' self-disclosures. We show four sequential trajectories that enable this shift of topic and action. There are four possible trajectories: (1) the patient first answers the medical question and the clinician acknowledges this answer, whereupon the patient shifts to a self-disclosure of their subjective experience; (2) the patient first gives the medical answer but shifts to self-disclosure without the clinician's acknowledgement of that answer; (3) the patient produces an extensive answer to the medical question and, in the course of producing this, shifts into the self-disclosure; (4) the patient does not offer a medical answer but designs the self-disclosure as if it were the answer to the medical question. We argue that in the shifts to the self-disclosure of their subjective negative experience, the patients take local control of the interaction. These shifts also embody a clash between the interactional projects of the participants. At the end of the paper, we discuss the clinical relevance of our results regarding the patient's agency and the goals of the psychiatric assessment.
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Affiliation(s)
| | - Jukka Hintikka
- Department of Psychiatry, Päijät-Häme Central Hospital, Lahti, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mariel Wuolio
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Anssi Peräkylä
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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Naldemirci Ö, Britten N, Lloyd H, Wolf A. Epistemic injustices in clinical communication: the example of narrative elicitation in person-centred care. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:186-200. [PMID: 33112448 PMCID: PMC7894328 DOI: 10.1111/1467-9566.13209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
The increasing popularity of the term 'person-centred' in the healthcare literature and a wide range of ideals and practices it implies point to the need for a more inclusive and holistic healthcare provision. A framework developed in a Swedish context suggested narrative elicitation as a key practice in transition to person-centred care. Initiating clinical communication by inviting people to tell their stories makes persistent yet often subtle problems in clinical communication visible. By drawing upon an observational study on narrative elicitation and vignette-based focus group interviews with nurses, our aim is to trace 'credibility deficits' (Fricker 2007. Epistemic Injustice. Power and the Ethics of Knowing. Oxford: Oxford University Press) and 'credibility excesses' (Medina 2011, Social Epistemology, 25, 1, 15-35, 2013, The Epistemology of Resistance: Gender and Racial Oppression, Epistemic Injustice, and the Social Imagination. Oxford: Oxford University Press) in narrative elicitation. We argue that narrative elicitation may be one way to tackle epistemic injustices by giving voice to previously silenced groups, yet it is not enough to erase the effects of 'credibility deficits' in clinical communication. Rather than judging individual professionals' success or failure in eliciting narratives, we underline some extrinsic problems of narrative elicitation, namely structural and positional inequalities reflecting on narrative elicitation and the credibility of patients. 'Credibility excesses' can be useful and indicative to better understand where they are missing.
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Affiliation(s)
| | - Nicky Britten
- University of Exeter Medical SchoolExeterUK
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Helen Lloyd
- School of PsychologyUniversity of PlymouthPlymouthUK
| | - Axel Wolf
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
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35
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Role of patients' organizations in Health Technology Assessment: a Habermasian system and lifeworld perspective. Int J Technol Assess Health Care 2020; 37:e6. [PMID: 33317647 DOI: 10.1017/s0266462320002147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Patient and public involvement in Health Technology Assessment (HTA) is gaining increased interest among research and policy communities. Patients' organizations represent an important link between individual patients and the health system. Social theories are increasingly being used to explain doctor-patient-system interactions, expanding understanding beyond the mere clinical perspective. In this sense, patient involvement in HTA can also be considered through the Habermas's theory of communicative action. From a Habermasian perspective, HTA as part of the instrumental rationality contributes to an increased efficiency of resource use within the system; however, such rationalization threatens to colonize the lifeworld by making it "increasingly state administered with attenuated possibilities for communicative action as a result of the commercialization and rationalization in terms of immediate returns." Using Habermasian system/lifeworld framework, this paper explores opportunities and obstacles to patient involvement in HTA, whereby trying to understand current and possible roles of patients' organizations as a mediating force between HTA as a function of the system and the lifeworld represented by patients.
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36
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Mitchell G, Porter S, Manias E. Enabling sustained communication with patients for safe and effective management of oral chemotherapy: A longitudinal ethnography. J Adv Nurs 2020; 77:899-909. [PMID: 33210337 DOI: 10.1111/jan.14634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 09/09/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023]
Abstract
AIMS To examine how patients received, understood, and acted on healthcare professional communication about their oral chemotherapeutic regimen throughout their treatment. DESIGN A longitudinal ethnographic study. METHODS Over 60 hr of observational data were recorded, in the form of field notes and audio-recordings from interactions among nine oncology doctors, six oncology nurses, eight patients, and 11 family members over a period of 6 months in outpatient departments in one hospital in Northern Ireland. Sixteen semi-structured interviews with patients and three focus groups with healthcare professionals were also carried out. This study took place from October 2013-June 2016. Data were thematically analysed. RESULTS Three themes where identified from the data. These were initiating concordance through first communication about oral chemotherapy; which focused on initial communication during oncology consultations about oral chemotherapy, sustained communication of managing chemotherapy side effects; which was about how communication processes supported timely and effective side effect management and un-sustained communication of oral chemotherapy medication-taking practice; when patients and healthcare professionals failed to communicate effectively about chemotherapy medication-taking. CONCLUSION The two most important factors in ensuring the optimal management of oral chemotherapeutic medicines are early recognition and appropriate response to side effects and the maintenance of safe and effective medication administration. This study found that oncology doctors and nurses engaged in sustained communication about the side effects of chemotherapy but did not focus their communication on safe administration after the first consultation. IMPACT Based on this evidence, we recommend that healthcare professionals who provide oral chemotherapy for home administration should review their processes and procedures. Healthcare professionals need to ensure that they embed frequent communication for the duration of treatment between themselves and patients, including open discussion and advice, about side effects and medication administration.
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Affiliation(s)
- Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Sam Porter
- Department of Social Sciences & Social Work, Bournemouth University, Poole, UK
| | - Elizabeth Manias
- School of Nursing & Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Vic., Australia
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Hammond R, Stenner R, Palmer S. What matters most: a qualitative study of person-centered physiotherapy practice in community rehabilitation. Physiother Theory Pract 2020; 38:1207-1218. [PMID: 33044879 DOI: 10.1080/09593985.2020.1825577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Person-centered approaches to care require physiotherapists to engage in trying to understand the full range of biomedical, psychological, and social factors that people bring to the consultation, along with the client's individual responses to those factors. If, however, the main issues of importance to people are not openly declared and discussed they cannot be addressed. This is likely to result in people receiving interventions that clinicians think they need, rather than care based on their expressed needs and preferences. OBJECTIVE To understand people's abilities to express the issues of importance to them within a consultation and clinicians' abilities to acknowledge and address those issues. DESIGN A qualitative study using an interpretive phenomenological approach. METHODS Eight clients were interviewed before they met their physiotherapist, the initial consultation with their physiotherapist was recorded, and both were interviewed separately afterward. ANALYSIS The clients frequently do not raise their emotions or feelings as issues of importance, and physiotherapists generally struggle to elicit, or identify as important, such matters. How these were presented to the clinician and subsequently addressed varied. We formulated three themes: 1) managing complex situations; 2) establishing a person-centered agenda; and 3) addressing emotional issues. CONCLUSIONS Community physiotherapists may aim for a more person-centered approach; however, their habits, practices and behaviors remain within a culturally entrenched, clinician-centric, biomedical model.
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Affiliation(s)
- Ralph Hammond
- Somerset Partnership NHS Foundation Trust, Williton Hospital, Williton, Somerset, UK
| | - Robert Stenner
- Somerset Partnership NHS Foundation Trust - Orthopaedic Assessment Service, Taunton, UK
| | - Shea Palmer
- Department of Allied Health Professions, University of the West of England Bristol, Bristol, UK
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Dahlberg H, Berg M. The lived experiences of healthcare during pregnancy, birth, and three months after in women with type 1 diabetes mellitus. Int J Qual Stud Health Well-being 2020; 15:1698496. [PMID: 31825747 PMCID: PMC6922046 DOI: 10.1080/17482631.2019.1698496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Being pregnant, giving birth, and becoming a mother the first months after birth, is for women with type 1 diabetes mellitus (T1DM) a period of difficult challenges. In order to identify their need of support from healthcare, the aim of this study was to describe healthcare during pregnancy, labour, birth, and up to 12 weeks after birth as experienced by Swedish women with T1DM. We used a phenomenological reflective lifeworld research approach, and made 1-2 individual interviews with ten women in late pregnancy and/or 2-3 months after. Transcribed interviews were analysed through focusing on the meanings of the study phenomenon. The results revealed how the diabetes disease, as well as the risks and responsibility that comes with it, become more visible during the period in question, due to a constant monitoring, performed by the woman herself as well as by the healthcare professionals. The essential meaning of the phenomenon is a need to share the burden of risks and responsibilities with healthcare professionals. The complex situation that these women are in, both as experts on their illness and care and in need of care, requires a care that make women feel capable and responsible, but at the same time offers support and relieve them of their responsibility when needed.
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Affiliation(s)
- Helena Dahlberg
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Centre for Person-centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothenburg Centre for Person-centred Care, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ahlsen B, Engebretsen E, Nicholls D, Mengshoel AM. The singular patient in patient-centred care: physiotherapists' accounts of treatment of patients with chronic muscle pain. MEDICAL HUMANITIES 2020; 46:226-233. [PMID: 30918108 DOI: 10.1136/medhum-2018-011603] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/18/2019] [Accepted: 02/28/2019] [Indexed: 06/09/2023]
Abstract
A patient-centred approach has gained increasing interest in medicine and other health sciences. Whereas there are discussions about the meaning of a patient-centred approach and what the concept entails, little is known about how the patient as a person is understood in patient-centred care. This article investigates understandings of the patient as a self in patient-centred care through physiotherapy of patients with chronic muscle pain. The material consists of interviews with five Norwegian physiotherapists working in a rehabilitation clinic. Drawing on Kristeva's discussion of subjectivity in medical discourse, the study highlights two different treatment storylines that were closely entwined. One storyline focuses on open singular healing processes in which the treatment was based on openness to a search for meaning and sharing. In this storyline, the "person" at the centre of care was not essentialised in terms of biological mechanisms, but rather considered as a vulnerable, irrational and moving self. By contrast, the second storyline focused on goal-oriented interventions aimed at restoring the patient to health. Here, the person in the centre of the treatment was shaped according to model narratives about "the successful patient"; the empowered, rational, choosing and self-managing individual. As such, the findings revealed two conflicting concepts of the individual patient inherent in patient-centred care. On the one hand, the patient is seen as being a person in constant movement, and on the other, they are captured by more standardised terms designed to focus on a more stable notion of outcome of illness. Therefore, our study suggests that the therapists' will to recognise the individual in patient-centred care had a counterpart involving a marginalisation of the singular.
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Affiliation(s)
- Birgitte Ahlsen
- Physiotherapy, OsloMet - Oslo Metropolitan University Faculty of Health Sciences, Oslo, Norway
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Eivind Engebretsen
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
| | - David Nicholls
- School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Anne Marit Mengshoel
- Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway
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Agarwal V. Patient Communication of Chronic Pain in the Complementary and Alternative Medicine Therapeutic Relationship. J Patient Exp 2020; 7:238-244. [PMID: 32851146 PMCID: PMC7427370 DOI: 10.1177/2374373519826137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Patient descriptions of pain shape the pain experience, yet there is insufficient understanding of how patient communication can help providers lessen pain’s psychological and physical impact. Objective: To examine how individuals communicate their pain experience in the complementary and alternative medicine (CAM) provider-patient relationship. Method: Qualitative thematic framing examining semistructured interviews of a purposive and snowball sample of CAM patients (N = 13; 850 double-spaced pages) recruited from the mid-Atlantic region of the United States. Results: Complementary and alternative medicine patients communicate the pain experience through an awareness of their interdependence with: (a) relational spaces as attention to the self, the healing practices, and the provider; (b) physical spaces as openness to surroundings and the spatiality and temporality of self; and (c) physiological spaces as breathing and neurological and immune system functioning. Conclusion: A therapeutic relationship cultivating interdependence through awareness of relational, physical, and physiological spaces supports patients’ ability to open up to, know, and accept their body. The CAM provider’s work connects their practice with patient awareness of control over their environment, relationships, and physiology to redefine their pain experience.
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Affiliation(s)
- Vinita Agarwal
- Department of Communication Arts, Fulton School of Liberal Arts, Salisbury University, Salisbury, MD, USA
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Farrell C, Chan EA, Siouta E, Walshe C, Molassiotis A. Communication patterns in nurse-led chemotherapy clinics: A mixed-method study. PATIENT EDUCATION AND COUNSELING 2020; 103:1538-1545. [PMID: 32127234 DOI: 10.1016/j.pec.2020.02.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine patterns of nurse-patient communication in fulfilling patients' informational/psychosocial needs, effects of longer consultation/operational aspects on person-centred care experiences. METHODS Mixed-method design; secondary analysis of transcripts of nurse-patient communication within nurse-led chemotherapy clinics in UK [3]. Purposive sampling (13 nurses); non-participant observations (61 consultations). Qualitative content analysis of audio-recorded transcripts. Quantitative analysis using the Medical Interview Aural Rating Scale [14] to compare mean differences in the number of cues and level of responding using one-way ANOVA, and correlational analyses of discursive spaces. RESULTS Nurses responded positively to informational cues, but not psychosocial cues. Longer consultations associated with more informational and psychosocial cues (p < .0001), but not nurses' cue-responding behaviours. Four main themes emerged: challenges/opportunities for person-centred communication in biomedical contexts; patients' "life world" versus the "medical world"; three-way communication: nurse, patient and family; implications of continuity of care. CONCLUSIONS The challenges/opportunities for cue-responding in nurse-led chemotherapy clinics were evident for informational and psychosocial support of patients. Shifting from a biomedical to biopsychosocial focus is difficult. PRACTICE IMPLICATIONS Further evaluation is needed to integrate biopsychosocial elements into communication education/training. Careful planning is required to ensure continuity and effective use of time for person-centred care.
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Affiliation(s)
| | - E Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region
| | - Eleni Siouta
- Nursing Department, Sophiahemmet University College, Sweden
| | | | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region
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Exploring Pictorial Health Education Tools for Long-Term Home Care: A Qualitative Perspective. Healthcare (Basel) 2020; 8:healthcare8030205. [PMID: 32659998 PMCID: PMC7551951 DOI: 10.3390/healthcare8030205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 11/27/2022] Open
Abstract
Regarding long-term home care needs, nurses need to communicate effectively and reasonably when teaching home caregivers. Designers can assist medical staff and develop pictorial tools to enhance communication. The purpose of this study is to explore a theoretical basis from the perspective of designers, patients’ home caregivers, and medical staff to construct a theoretical framework that can jointly develop pictorial health education tools and healthcare system. The qualitative methods, including in-depth interview and observation, are applied to this study; ground theory sets out to construct a framework from the verbatim transcript of the interviews. Based on interview results, six axial codes were extracted: (1) the method of interdisciplinary cooperation; (2) medical research ethics; (3) communication methods; (4) forms of health education tools; (5) development of health education tools; (6) home care intubation procedure. Eight groups of home caregivers offered suggestions from their experiences. The designers need to assist medical staff to solve real problems, pay attention to professional norms, and forms of cooperation. Health education tools need to meet the needs of medical staff and home caregivers and designers should pay attention to the processes of communication. This study can also assist in interdisciplinary cooperation to explore the theoretical basis of pictorial health education tools for nurses in the context of long-term care at home.
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Morden A, Ong BN, Jinks C, Healey E, Finney A, Dziedzic KS. Resistance or appropriation? : Uptake of exercise after a nurse-led intervention to promote self-management for osteoarthritis. Health (London) 2020; 26:221-243. [PMID: 32486866 PMCID: PMC8928233 DOI: 10.1177/1363459320925879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The philosophical underpinning of trials of complex interventions is critiqued for not taking into account causal mechanisms that influence potential outcomes. In this article, we draw from in-depth interviews (with practice nurses and patients) and observations of practice meetings and consultations to investigate the outcomes of a complex intervention to promote self-management (in particular exercise) for osteoarthritis in primary care settings. We argue that nurses interpreted the intervention as underpinned by the need to educate rather than work with patients, and, drawing from Habermasian theory, we argue that expert medicalised knowledge (system) clashed with lay ‘lifeworld’ prerogatives in an uneven communicative arena (the consultation). In turn, the advice and instructions given to patients were not always commensurate with their ‘lifeworld’. Consequently, patients struggled to embed exercise routines into their daily lives for reasons of unsuitable locality, sense-making that ‘home’ was an inappropriate place to exercise and using embodied knowledge to test the efficacy of exercise on pain. We conclude by arguing that using Habermasian theory helped to understand reasons why the trial failed to increase exercise levels. Our findings suggest that communication styles influence the outcomes of self-management interventions, reinforce the utility of theoretically informed qualitative research embedded within trials to improve conduct and outcomes and indicate incorporating perspectives from human geography can enhance Habermas-informed research and theorising.
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Murdoch J, Salter C, Ford J, Lenaghan E, Shiner A, Steel N. The "unknown territory" of goal-setting: Negotiating a novel interactional activity within primary care doctor-patient consultations for patients with multiple chronic conditions. Soc Sci Med 2020; 256:113040. [PMID: 32473530 PMCID: PMC7306159 DOI: 10.1016/j.socscimed.2020.113040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/01/2020] [Accepted: 05/07/2020] [Indexed: 12/30/2022]
Abstract
Goal-setting is widely recommended for supporting patients with multiple long-term conditions. It involves a proactive approach to a clinical consultation, requiring doctors and patients to work together to identify patient's priorities, values and desired outcomes as a basis for setting goals for the patient to work towards. Importantly it comprises a set of activities that, for many doctors and patients, represents a distinct departure from a conventional consultation, including goal elicitation, goal-setting and action planning. This indicates that goal-setting is an uncertain interactional space subject to inequalities in understanding and expectations about what type of conversation is taking place, the roles of patient and doctor, and how patient priorities may be configured as goals. Analysing such spaces therefore has the potential for revealing how the principles of goal-setting are realised in practice. In this paper, we draw on Goffman's concept of ‘frames’ to present an examination of how doctors' and patients' sense making of goal-setting was consequential for the interactions that followed. Informed by Interactional Sociolinguistics, we used conversation analysis methods to analyse 22 video-recorded goal-setting consultations with patients with multiple long-term conditions. Data were collected between 2016 and 2018 in three UK general practices as part of a feasibility study. We analysed verbal and non-verbal actions for evidence of GP and patient framings of consultation activities and how this was consequential for setting goals. We identified three interactional patterns: GPs checking and reframing patients' understanding of the goal-setting consultation, GPs actively aligning with patients' framing of their goal, and patients passively and actively resisting GP framing of the patient goals. These reframing practices provided “telling cases” of goal-setting interactions, where doctors and patients need to negotiate each other's perspectives but also conflicting discourses of patient-centredness, population-based evidence for treating different chronic illnesses and conventional doctor-patient relations. First study of GP goal-setting interactions for patients with multiple conditions. Goal-setting involves novel activities in an uncertain interactional space. GPs and patients may need to negotiate different framings of patient's priorities. GPs may actively align with patient's goal, patients may resist GP framing of goal. Negotiation of frames reveal conflicting discourses invoked at interactional level.
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Affiliation(s)
- Jamie Murdoch
- School of Health Sciences & Norwich Medical School, Faculty of Medicine and Health Sciences University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Charlotte Salter
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - John Ford
- Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK.
| | - Elizabeth Lenaghan
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Alice Shiner
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Nicholas Steel
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
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Bradby H, Lindenmeyer A, Phillimore J, Padilla B, Brand T. 'If there were doctors who could understand our problems, I would already be better': dissatisfactory health care and marginalisation in superdiverse neighbourhoods. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:739-757. [PMID: 32020646 PMCID: PMC7318273 DOI: 10.1111/1467-9566.13061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
How people in community settings describe their experience of disappointing health care, and their responses to such dissatisfaction, sheds light on the role of marginalisation and underlines the need for radically responsive service provision. Making the case for studying unprompted accounts of dissatisfaction with healthcare provision, this is an original analysis of 71 semi-structured interviews with healthcare users in superdiverse neighbourhoods in four European cities. Healthcare users spontaneously express disappointment with services that dismiss their concerns and fail to attend to their priorities. Analysing characteristics of these healthcare users show that no single aspect of marginalisation shapes the expression of disappointment. In response to disappointing health care, users sought out alternative services and to persuade reluctant service providers, and they withdrew from services, in order to access more suitable health care and to achieve personal vindication. Promoting normative quality standards for diverse and diversifying populations that access care from a range of public and private service providers is in tension with prioritising services that are responsive to individual priorities. Without an effort towards radically responsive service provision, the ideal of universal access on the basis of need gives way to normative service provision.
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Affiliation(s)
| | | | - Jenny Phillimore
- Institute for Research into Superdiversity (IRiS)School of Social PolicyUniversity of BirminghamBirminghamUK
| | - Beatriz Padilla
- Department of SociologyUniversity of South FloridaTampaUSA
- Instituto Universitario de Lisboa (ISCTE‐IUL)LisbonPortugal
| | - Tilman Brand
- Department Prevention and EvaluationLeibniz Institute for Prevention Research and Epidemiology – BIPSBremenGermany
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Abstract
AbstractThis article examines how older adults make decisions about their medications through interconnected axes of trust that operate across social networks. Trust is negotiated by older adults enrolled in a deprescribing programme which guides them through the process of reducing medications to mitigate risks associated with polypharmacy. Habermas’ work on the significance of communicative action in negotiating trust within social relationships informs our analysis, specifically in-depth semi-structured interviews with older adults about their medication use and the role of social networks in managing their health. Participants were age 70+ and experiencing polypharmacy. Our analysis discusses the social nature of medication practices and the importance of social networks for older adults’ decision-making. Their perspective reflects the critique of late-modern society put forward by Habermas. Negotiating trust in pharmaceutical decision-making requires navigating tensions across and between system networks (health-care professionals) and life-world networks (family and friends). This study contributes to our knowledge of how distinct forms of trust operate in different social spheres, setting the context for the way health-care decisions are made across social networks. Our analysis reinforces the need for older adults to engage meaningfully in health-care decision-making such that a convergence between system-world and life-world structures is encouraged. This would improve deprescribing programmes’ efficacy as older adults optimise their medication use and improve overall quality of life.
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Cooley L, Hudson J, Potter E, Raymond KF, George C, Georgiopoulos AM. Clinical communication preferences in cystic fibrosis and strategies to optimize care. Pediatr Pulmonol 2020; 55:948-958. [PMID: 31977168 DOI: 10.1002/ppul.24655] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The importance of optimizing communication between clinicians and individuals and families living with cystic fibrosis (CF) about daily care, adherence, and related psychosocial concerns is well documented. The purpose of this study was to gain an understanding of interpersonal communication experiences and preferences among individuals and families living with CF as they engage with the clinical team. The study also aimed to reveal opportunities for enhancing future interpersonal communication practices. METHODS Five U.S. CF care centers participated in the following activities: (a) On-site observation of clinic interactions during outpatient visits; (b) On-site 1:1 interviews with individuals living with CF, their family members, and CF clinicians; (d) Focus groups conducted in person with CF care team members; (d) Focus groups conducted virtually with adults and family members with CF. Content analysis of transcripts and constant comparative methods were used to identify emergent themes. RESULTS Four themes related to participants' needs and preferences for clinic interactions emerged during analysis: (a) eliciting psychosocial concerns, (b) addressing childhood development and transitions, (c) negotiating agendas and sharing decisions, and (d) educating to enhance CF conversations. CONCLUSION CF clinicians and individuals and families living with CF expressed the need for resources and training to engage in better conversations with each other. Participants identified areas of high priority, including working together around social, psychological, and economic challenges, preparation for transition to adulthood, and sustaining daily care. Findings point to the value of developing advanced communication skills that foster trust-building, negotiating agendas, active listening, and collaborative goal-setting.
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Affiliation(s)
- Laura Cooley
- Division of Education and Outreach, Academy of Communication in Healthcare, Lexington, Kentucky
| | - Janella Hudson
- Division of Education and Outreach, Academy of Communication in Healthcare, Lexington, Kentucky
| | - Eileen Potter
- Department of Pulmonary and Sleep Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Katherine F Raymond
- Partnerships for Sustaining Daily Care, The Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Cynthia George
- Partnerships for Sustaining Daily Care, The Cystic Fibrosis Foundation, Bethesda, Maryland
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Artioli G, Foà C, Cosentino C, Taffurelli C, Sarli L. The Patient's Narrative Agenda as an assessment tool: the story of Robert, suffering from osteosarcoma. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:7-15. [PMID: 32168307 PMCID: PMC7944659 DOI: 10.23750/abm.v91i2-s.9371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Indexed: 12/04/2022]
Abstract
Background and aim of the work. To activate the participation of the person in his/her care path, the literature highlights the impact of the professional’s ability to show a genuine interest in the problems brought by the patient and to recognize him/her as ‘competent’. In this sense the narrative patient’s agenda could be a useful relational tool, because is focused on the perception of patient experiences of his/her illness. Thus this study aims to analyze the usefulness of patient’s narrative agenda during the assessment phase. Method. A semi-structured interview has been adopted to explore the agenda of Robert, 21 years old, suffering from osteosarcoma. A first level analysis identified the four functional areas of the agenda: ideas and beliefs; expectations and desires and context in which he lives and interacts. A second level analysis assessed the main Robert’s problems. Results. The narrative agenda has highlighted many central problems of Robert (e.g. therapeutic adherence, quality of life, mood, body image, existential problems related to experiences, hopes and expectations). Of course these results could be integrated with other tools: qualitative, to Understand difficulties and to formulate hypotheses, and quantitative, to measure the level of severity of problems reported. Discussion and conclusion. The narrative agenda has not only proved to be a valid instrument of assessment, allowing an adequate insight on the patient’s problems, as we exemplified, but it can be also used for monitoring the dynamic situation of the person’s history, lending itself to the re-exploration of its functional areas over time.
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Affiliation(s)
| | - Chiara Foà
- Department of Medicine and Surgery, University of Parma, Italy.
| | | | | | - Leopoldo Sarli
- Department of Medicine and Surgery, University of Parma, Italy.
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“You don’t like to tell them their job but it’s your foot at the end of the day”: theorising and negotiating ‘resistance’ in clinical encounters. SOCIAL THEORY & HEALTH 2020. [DOI: 10.1057/s41285-020-00134-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gentles SJ, Nicholas DB, Jack SM, McKibbon KA, Szatmari P. Coming to understand the child has autism: A process illustrating parents' evolving readiness for engaging in care. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:470-483. [PMID: 31508991 PMCID: PMC6985991 DOI: 10.1177/1362361319874647] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
LAY ABSTRACT What is already known about the topic? Parents of children with autism often learn about their child's autism before diagnosis and can spend long periods seeking care (including assessment) before receiving a diagnosis. Meanwhile, parents' readiness to engage in care at this early stage can vary from parent to parent. What this paper adds? This study revealed how parents come to understand their child has autism-on their own terms, rather than from just talking to professionals. It also explained how parents' growing awareness of their child's autism leads them to feel more motivated to engage in care by seeking information and pursuing services. Four "optional steps" described how parents' growing readiness to engage in care at this early stage can vary, depending on their personal process. Implications for practice, research, or policy The results suggest ways that professionals can be more sensitive (a) to parents' varying awareness of autism and (b) to their varying readiness for being involved in early care. They also suggest ways to tailor parent supports to their individual situation and design care that is more family centered. Not all parents want high levels of involvement. Depending on their personal process, some parents may need care and support that is directed at them before feeling ready for professionals to engage them in care directed at the child.
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