The practice orientations of physicians and patients: the effect of doctor-patient congruence on satisfaction

Associations of clinical personnel characteristics and telemedicine practices

CONTEXT

The use of telemedicine strategies has been increasing in the United States for more than a decade, with physicians taking advantage of this new tool to reach more patients. Determining the specific demographics of physicians utilizing telemedicine most in their practice can inform recommendations for expanded telemedicine use among all physicians and aid in mitigating the need for local physicians in urban and rural populations.

OBJECTIVES

This study aims to assess the use of telemedicine by physicians in 2021, based on four demographics utilizing the National Electronic Health Record Survey (NEHRS): physician age, sex, specialty, and training.

METHODS

We performed a cross-sectional study of the 2021 NEHRS to determine the relationship between physician characteristics and telemedicine practices. Differences between groups were measured through design-based chi-square tests.

RESULTS

Compared to male physicians, female physicians were more likely to utilize telemedicine services (X 2=8.0; p=0.005). Compared to younger physicians, those over the age of 50 were less likely to utilize telemedicine services (X 2=4.1; p=0.04). Compared to primary care physicians, medical and surgical specialty physicians were less likely to utilize telemedicine services, with surgical specialty physicians being the least likely overall (X 2=11.5; p<0.001). We found no significant differences in telemedicine use based on degree (Osteopathic and Allopathic).

CONCLUSIONS

Our results showed a statistically significant difference between physician's age, sex, and specialty on telemedicine use in practice during 2021. Efforts to increase telemedicine use among physicians may be needed to provide more accessible care to patients. Thus, by increasing physician education on the importance of telemedicine for modern patients, more physicians may decide to utilize telemedicine services in practice.

Oral Health-Related Quality of Life in a Paediatric Population in the Dominican Republic

Introduction: During the summer of 2019 and within the framework of a social dentistry program carried out in the low-income town of San Francisco de Macorís (Dominican Republic), a descriptive study was carried out on oral health-related quality of life (OHRQoL), aiming to find out the oral health status of a population of children in the aforementioned Dominican city. Objective: The aim of this study was to describe the oral health status of a child population and its relationship with the quality of life perceived by these children in the aforementioned population of San Francisco de Macorís in order to develop an specific oral health program taking into account not only the existing oral health status but also the perceptions and feelings of the child population in this regard. Method: A descriptive cross-sectional study was carried out on a representative sample of children who were examined on their oral health status, following WHO guidelines, by professionals from the University of Seville (Spain) together with professionals from private practice (USA) and students from the Universidad Católica Nordestana (UCNE, Dominican Republic). Likewise, the children's parents voluntarily completed the Oral Quality of Life questionnaire COHIP-19 in its culturally adapted Spanish version. Results: For this purpose, 94 children with a mean age of 10.34 (SD 3.38) were observed in our study following WHO recommendations for oral health studies and evaluating OHQoL using the specific questionnaire validated in Spanish COHIP-19 in its short format (SF). The results show a state of oral health with a significant prevalence of caries (80.9%) and a DMFT of 1.70 (SD 1.90). The OHQoL perceived by these children shows that pain, bad breath or feeling sad because of the condition of their teeth were the factors with the worst evaluation score. Conclusions: The conclusion that mainly emerges from this study is that caries continues to be the main problem to be solved (more than other variables studied, such as malocclusion or fluorosis), and this ailment also causes pain, dysfunction, and bad breath and is therefore perceived as a problem to be solved in the children of this Dominican city.

Effects of a shared decision-making implementation programme on patient-centred communication in oncology-Secondary analysis of a randomised controlled trial

BACKGROUND

There is a need for better implementation of patient-centred (PC) communication and shared decision-making (SDM) in routine cancer care.

OBJECTIVE

The aim of this study was to assess whether a programme to implement SDM in oncology had effects on PC communication in clinical encounters.

DESIGN

This study constitutes a secondary analysis of data derived from an implementation trial applying a stepped wedge design that, among other strategies, incorporated training and coaching to enhance the PC communication skills of physicians.

SETTING AND PARTICIPANTS

We analysed audio recordings of clinical encounters collected in three departments of a comprehensive cancer centre in Germany before and after rolling out the implementation programme.

MAIN VARIABLES STUDIED

We assessed the PC communication skills of physicians.

MAIN OUTCOME MEASURES

Each recording was rated by two researchers using the German version of the Four Habits Coding Scheme (4HCS), an observer-based measure of PC communication. Interrater reliability of the outcome measure was acceptable but moderate. Demographic data of patients participating in audio recordings were analysed.

METHODS

Data were analysed using descriptive statistics and linear mixed-effects models.

RESULTS

In total, 146 encounters, 74 before and 72 after implementation, were evaluated. The mean age of patients was 57.1 years (SD = 13.8), 70.3% were female, the largest portion of patients had medium formal education (32.4%) and were (self-) employed (37.8%). No statistically significant effect of the implementation programme on the physicians' PC communication skills was found.

DISCUSSION

The results indicate that the investigated programme to implement SDM in oncology, including training and coaching, had no effects on PC communication in clinical encounters. These results are in contrast to other studies that report the effects of specific training or coaching on PC communication. Reasons for the lack of effect include the short duration of our training compared to other studies, limited reliability and moderate interrater reliability of the 4HCS scale, limited reach of the intervention programme as well as the inclusion of physicians regardless of their exposure to the interventions.

CONCLUSION

Further research is needed to develop implementation strategies that improve physicians' PC communication skills.

PATIENT CONTRIBUTION

Data on patients and clinical encounters with patients and physicians were analysed. There was no other patient or public involvement.

Medical students' attitude toward patient-centeredness: A longitudinal study

OBJECTIVES

This study explored the trajectories of patient-centered orientation in a sample of Italian medical students throughout medical school.

METHODS

Four consecutive student cohorts were longitudinally assessed at the second (T0) and fifth year (T1) of medical school. Students completed a questionnaire including demographics and the Italian validated version of the Patient-Practitioner Orientation Scale.

RESULTS

352 students completed both administrations. Students became more patient-centered in terms of Sharing along the course of their clinical curriculum, whereas there were no significant changes in Caring. Groups with distinct developmental trajectory patterns of both Caring and Sharing were identified. Students high in patient-centeredness at T0 reported significantly lower scores at T1 while students with lower scores at T0 significantly increased from the first to the last measurement. Female students significantly outscored their male colleagues on Caring and Sharing in both administrations.

CONCLUSIONS

Findings call for innovative education strategies to sustain patient-centeredness attitudes in medical students entering hospital-based clinical medicine. Further research is needed to identify characteristics of the medical curriculum that are primarily involved in fostering students' patient-centeredness.

PRACTICE IMPLICATIONS

Including the assessment and monitoring of patient-centeredness throughout the medical school can inform tailored education aiming to foster this dimension.

Beyond satisfaction in person-centered pharmacy services

Patient self-reported satisfaction is commonly used as an assessment of service experience and quality for community pharmacy services. This commentary discusses alternative foundational approaches to evaluating service experience and quality in patient-centered care. It describes historical and recent literature pertaining to the development and use of satisfaction measures for service design and patient experience assessment. It then highlights potential limitations of patient satisfaction as an assessment tool for patient-centeredness and patient experience identified in the pharmacy literature, which include criticisms that use of patient satisfaction may compromise accuracy in measuring quality due to factors such as patients having poor knowledge of and low expectations for quality and having a predisposition toward rating satisfaction highly when experiencing no-cost and/or unfamiliar services. Moreover, satisfaction measurements may change based on service exposure, with patient preferences for service offerings changing with increased service exposure and variation in patient-specific and environmental factors. After discussing limitations and criticism of patient self-reported satisfaction, we introduce alternative assessments methods which may facilitate more accurate assessments of patient experience and patient-centered pharmacy services such as patient-reported outcomes measures (PROMs), patient-reported experience measures (PREMs), and human-centered design techniques such as journey mapping, prototyping, and user testing to design and assess patient-centered pharmacy services. These alternative assessments are rooted in, or related to preferred implementation science approaches to establishing, evaluating, and sustaining pharmacy services.

Piloting a shared decision-making clinician training intervention in maternity care in Australia: A mixed methods study

PROBLEM

Implementation of woman-centred care in evidence-based maternity practice requires clinicians to be skilled in shared decision-making, yet there is limited training or research into such interventions.

BACKGROUND

Shared decision-making enables women to make informed decisions in partnership with clinicians where there are varied clinical options in relation to indications for and timing of planned birth.

AIM

We aimed to develop a shared decision-making training intervention and evaluate its feasibility and acceptability to midwives and obstetricians.

METHODS

The intervention was co-designed by midwifery and medical clinician-researchers, and a consumer representative. Online training and demonstration videos were distributed to midwives and obstetricians in three Sydney hospitals, followed by two online workshops in 2021 and 2022 where participants practised shared decision-making in roleplaying scenarios tailored to timing of birth. Training was evaluated using post-workshop and post-training surveys and semi-structured qualitative interviews.

FINDINGS

The training workshop format, duration and content were well received. Barriers to the uptake of shared decision-making were time, paternalistic practices and fear of repercussions of centring women in the decision-making process.

DISCUSSION

The intervention enabled midwifery and medical colleagues to learn communication repertoires from each other in woman-centred discussions around timing of birth. Roleplay scenarios enabled participants to observe and provide feedback on their colleagues' shared decision-making practices, while providing a space for collective reflection on ways to promote, and mitigate barriers to, its implementation in practice.

CONCLUSION

Shared decision-making training supports maternity clinicians in developing skills that implement woman-centred care in the timing of planned birth.

Hospitalisation outcomes for patients with severe mental illness treated by female vs. male psychiatry residents

OBJECTIVE

Recent literature suggests that female physicians provide higher quality of care compared to their male counterparts across a variety of physical medical conditions. We examine whether a similar phenomenon is observed for psychiatry residents treating hospitalised psychiatric patients.

METHODS

We analysed 300 hospitalised patient records from Shalvata Mental Healthcare Centre (Hod Hasharon, Israel). Resident-patient sex matchings were compared.

RESULTS

No significant differences were observed in terms of residents' age and patients' age, medical condition and hospitalisation history. Male and female patients treated by female residents presented shorter hospitalisations (58 and 54 days compared to 67 and 66 days, respectively, p < .05), longer time to next hospitalisation (269 and 179 days compared to 179 and 123 days, respectively, p < .01), lower 30-day readmission rate (37% and 35% compared to 10% and 19%, respectively, p < .05), higher levels of family involvement during hospitalisation (2.6 and 2.7 points compared to 2.1 and 1.9 points, respectively, p < .01) and higher chances of obtaining rehabilitation services (39% and 34% vs. 23% and 17%, respectively, p < .05).

CONCLUSIONS

Hospitalised patients treated by female psychiatry residents are associated with better hospitalisation outcomes compared to those cared for by male residents. KEY POINTSBoth male and female patients treated by female residents presented better hospitalisation outcomes.These hospitalisation outcomes include shorter hospitalisation periods, longer time to next hospitalisation, lower 30-day remission rate, significantly higher levels of family involvement and higher chances of obtaining rehabilitation services.Further work is needed in order to investigate the sources and reasons for the identified differences.

Patient-Perceived Patient-Centeredness During Pregnancy

OBJECTIVES

Although patient-centeredness is a pinnacle in high-quality healthcare, there is a lack of research measuring patient-centeredness from the perspective of the patient in the context of perinatal care. Therefore, the objectives of this study were to (1) measure patient-perceived patient-centeredness from pregnant people receiving prenatal care in Nova Scotia, and (2) explore potential correlates of patient-perceived patient-centeredness.

METHODS

Participants completed an e-survey through REDCap software. Questions comprised of the Patient-Perceived Patient-Centeredness (Revised) (PPPC-R) questionnaire and demographic questions. The PPPC-R total score was calculated. Descriptive statistics were calculated to describe the sample, and inferential statistics were conducted. Linear regression analysis was used to determine how the independent variables predicted the PPPC-R total score.

RESULTS

A total of 98 patients participated in the survey to completion. The mean PPPC-R total score was 62.2 (SD 10.5), equivalent to a score of 3.45/4. No significant correlates of the PPPC-R total score were identified; however, trends were observed related to age, parity, Body mass index, race/ethnicity, and education.

CONCLUSIONS

Participants in our study rated their clinicians' patient-centeredness very highly. There was no significant difference in PPPC-R score among pregnant people based on the independent variables we collected.

Attitudes toward Patient-Centred Care, Empathy, and Assertiveness among Students in Rehabilitation Areas: A Longitudinal Study

This study assessed attitudes toward patient-centred care, empathy, assertiveness, and subjective perception of communication skills and technical knowledge among Portuguese undergraduate students in healthcare. These students may develop rehabilitation activities with patients in their person-oriented or technique-oriented professions. Portuguese nursing and allied health students from two public higher education schools completed questionnaires in the first and third academic years: Patient-Practitioner Orientation Scale, Jefferson Scale of Physician Empathy, Scale for Interpersonal Behaviour, and a subjective perception of technical knowledge and communication skills. A total of 183 students completed the surveys. In the first year, students showed moderate to high scores on patient-centredness attitudes, empathy, and assertiveness and perceived themselves as having good communication skills. Students from person-oriented programmes significantly improved their Total and shared patient-centred attitudes in the third year compared with students attending technique-oriented professions. Significant differences in empathy were found between groups in the third year. Distress associated with assertive behaviours increased significantly across time in students from technique-oriented programmes compared with their peers in person-oriented programmes. The results suggest that the health profession's orientation and the programmes' specific curriculum might have a role in how some dimensions evolved in the two groups of students. The increasing assertiveness-related discomfort highlighted the importance of assessing and monitoring students' emotional wellbeing during their initial interactions with patients.

Gender Differences in Premenstrual Syndrome and Premenstrual Dysphoric Disorder Diagnosis and Treatment among Japanese Obstetricians and Gynecologists: A Cross-Sectional Study

Premenstrual symptoms are characterized by unpleasant psychophysical symptoms that appear during the luteal phase before menstruation and interfere with a woman's quality of life. Premenstrual syndrome (PMS) is a pathological condition with premenstrual symptoms, of which premenstrual dysphoric disorder (PMDD) is a particularly severe psychological symptom. This study aimed to examine the gender differences in the diagnosis and treatment of PMS and PMDD among obstetricians and gynecologists (OB/GYNs) in Japan. Data were obtained from the survey conducted by the Japanese Society of Obstetrics and Gynecology. We used data from 1,257 of the 1,265 OB/GYNs who are engaged in PMS/PMDD practice and reported their gender. Multivariate regression analysis adjusted for propensity scores was performed. Female OB/GYNs were more frequently engaged in treating patients with PMS/PMDD than males [odds ratio (OR) 1.74; 95% confidence interval (CI) 1.36-2.21]. With regard to the diagnostic methods, more female OB/GYNs selected the two-cycle symptom diary than males (OR 2.88; 95% CI 1.80-4.60). Regarding treatment, fewer female OB/GYNs selected selective serotonin reuptake inhibitors as their first-line drug (OR 0.39; 95% CI 0.17-0.89). Gender differences were found in the selection of PMS/PMDD diagnosis and treatment methods among Japanese OB/GYNs.

Patient-centered care - evidence in the context of professional health practice

OBJECTIVES

to analyze patient-centered attitudes in care and sharing practices of nursing, speech therapy, dentistry and medicine professionals.

METHODS

cross-sectional research was used with 411 professionals, and the Patient-Practitioner Orientation Scale instrument was applied as a measure of outcome.

RESULTS

physicians presented higher mean scores, reflecting a patient-centered orientation, shared control, and focus on the person, with statistical difference for all domains (p<0.02). Dentists were the professionals who presented lower scores, especially in the sharing domain, with statistical difference in relation to nurses, speech therapists, and physicians (p<0.05).

CONCLUSIONS

finally, the attitudes of professionals in the health areas studied indicated self-reported preference for centrality in patients. In this context, patient-centered care can be an important resource in health care when committed to overcoming the object man.

An Evaluation of the Relationship between Training of Health Practitioners in a Person-Centred Care Model and their Person-Centred Attitudes

Introduction

The Esther Network (EN) person-centred care (PCC) advocacy training aims to promote person-centred attitudes among health practitioners in Singapore. This study aimed to assess the relationship between the training and practitioners' PCC attributes over a 3-month period, and to explore power sharing by examining the PCC dimensions of "caring about the service user as a whole person" and the "sharing of power, control and information".

Methods

A repeated-measure study design utilising the Patient-Practitioner Orientation Scale (PPOS), was administered to 437 training participants at three time points - before training (T1), immediately after (T2) and three months after training (T3). A five-statement questionnaire captured knowledge of person-centred care at T1 and T2. An Overall score, Caring and Sharing sub-scores were derived from the PPOS. Scores were ranked and divided into three groups (high, medium and low). Ordinal Generalised Estimating Equation (GEE) model analysed changes in PPOS scores over time.

Results

A single, short-term training appeared to result in measurable improvements in person-centredness of health practitioners, with slight attenuation at T3. There was greater tendency to "care" than to "share power" with service users across all three time points, but the degree of improvement was larger for sharing after training. The change in overall person-centred scores varied by sex and profession (females score higher than males, allied health showed a smaller attenuation at T3).

Conclusion

Training as a specific intervention, appeared to have potential to increase health practitioners' person-centredness but the aspect of equalising power was harder to achieve within a hierarchical structure and clinician-centric culture. An ongoing network to build relationships, and a supportive system to facilitate individual and organisational reflexivity can reinforce learning.

Factors Influencing Patient Satisfaction and Loyalty as Perceived by Dentists and Their Patients

OBJECTIVE

This study aimed to identify the key aspects of patients' dental care experience that influenced their self-perceived satisfaction and loyalty. Also examined was the agreement between patients and dentists regarding these factors.

METHODS

Questionnaires were administered to 1121 patients and 77 dentists, focusing on demographic information and 15 selected items related to the patients' last dental visit. Descriptive and linear regression analyses were conducted.

RESULTS

The study included participants from 41 practices. Factors significantly influencing satisfaction and loyalty included location convenience, treatment quality, trust in dentists' decisions, visit frequency satisfaction, clear treatment explanations, dentist's interest in symptoms, patient-dental personnel attachment, and dentist's knowledge of the patient and their medical records. While overall agreement between patients and dentists was high, some areas exhibited notable disagreement.

CONCLUSIONS

The findings mostly align with existing literature, underscoring the importance of communication, trust, and a personal patient-dentist relationship in promoting satisfaction and loyalty. However, they also show that local, generally not reported factors might be at play, which necessitates dentists' awareness and consideration of the local context for optimal outcomes.

Attitudes of medical students in Khartoum, Sudan towards the doctor-patient relationship: a cross-sectional study

Background/Objectives

The doctor-patient relationship is essential to the delivery of high-quality medical care. A strong doctor-patient relationship that improves patient outcomes and satisfaction depends on effective communication. The purpose of this study was to assess medical students' attitudes toward the doctor-patient relationship during their clinical years at the University of Khartoum. We also looked at how gender and study year affected patient-centeredness.

Participants/Setting

The study was conducted on medical students in their clinical years from December 2020 to March 2021. Students were selected from years 3 to 6. A total of 353 medical students constituted the study sample.

Design

The cross-sectional study utilized the Patient Practitioner Orientation Scale (PPOS) for the measurement of student attitudes towards the doctor-patient relationship. PPOS scores are calculated as a mean score that ranges from 1 (indicating doctor or disease-centered inclinations) to 6 (indicating patient-centered or egalitarian inclinations). Medical students' demographic data was collected, including their gender, age and study year.

Results

A total of 313 students completed the survey (response rate: 89%). The average total PPOS score and the scores for the caring and sharing subscales for the entire cohort were 4.08 ± 0.53, 4.43 ± 0.58, and 3.72 ± 0.72, respectively. Female gender was significantly associated with more patient-centered attitudes (p < 0.001). When compared to the start of their clinical curriculum, students' attitudes were significantly more patient-centered by the conclusion of their studies (p < 0.001).

Conclusion

A satisfactory level of patient-centeredness was demonstrated by medical students at the University of Khartoum, and gender had an impact on this quality. Additional consideration should be given to the finding that students' orientations were more patient-centered in the caring dimension and less so in the sharing one. Once addressed, improvements in that area could create an environment that enhances attitudes among students in the sharing domain, with great potential gains to patients.

Self-awareness, empathy, and patient-centered care among critical care nurses in Jordan

Self-awareness, empathy, and patient-centered care are essential components for nurses for improving nurse-patient relationship and providing high-quality care for the patients. There is limited research regarding these components among critical care nurses in Arab countries, including Jordan. Thus, this study purposed to evaluate the self-awareness, empathy, and patient-centered care among critical care nurses in Jordan. A cross-sectional, descriptive correlational design was applied. Data were collected from 140 registered nurses from six hospitals in different health sectors. Findings showed that the mean scores for self-awareness, empathy and patient-centered care were as follows: 1.92 (SD = 0.27), 4.87 (SD = 0.88), and 3.71 (SD = 0.80), respectively. These results indicate that nurses had a high level of self-awareness and empathy and a low level of patient-centered care. There was no relationship between self-awareness and socio-demographic variables, perceived stress, and social support. Also, there was a positive relationship between empathy and social support (r = 0.310, p < 0.001). Patient-centered care had a positive relationship with social support (r = 0.202, p < 0.05) and perceived stress (r = 0.175, p < 0.05), also, male nurses had higher patient-centered care than female encounters. Social support was a predictor of empathy, while social support and perceived stress were the main predictors for patient-centered care. The results of the study reflect the need for educational programs to promote self-awareness and empathy to enhance patient-centered care and achieve high-quality patient care. Additionally, correlating factors with PCC (social support and perceived stress) should be taken into consideration upon implementing any interventional programs.

Person-centered care: preferences and predictors in speech-language pathology and audiology practitioners

Introduction

Increasingly person-centered care (PCC) is being recognized as an important aspect of speech-language pathology and audiology (SLP/A) service delivery. This study aimed to (i) identify preferences toward PCC; (ii) determine predictors of these preferences; and (iii) describe the understanding and views of PCC among SLP/A in South Africa.

Methods

A mixed-method design was followed utilizing an online survey and four focus group discussions. The survey included demographic questions, the modified Patient-Practitioner Orientation Scale (mPPOS), the Ten-Item-Personality-Inventory (TIPI) and an open-ended question. The focus group discussions included prompting questions which facilitated an open-ended discussion.

Results

A total of 91 practitioners (39.6% speech-language pathologists) completed the online survey, with nine (44.4% audiologists) participating in the focus group discussions. A high preference toward PCC was noted, with a total mean mPPOS score of 4.6 (0.6 SD). Quantile regression analysis revealed four predictors (age, home language, sector, and personality trait openness) associated with PCC preferences. Three main categories emerged from the open-ended question and focus group discussions: (i) Positive experiences with PCC; (ii) restrictions toward PCC, and (iii) PCC exposure.

Discussion

Positive (age and personality trait openness) and negative (home language and sector of employment) predictors toward PCC exist among speech-language pathologists and audiologists, with an overall general preference toward PCC. Practitioners experience facilitators and barriers toward implementing PCC including the extent of personal experiences, available resources and tools as well as workplace culture. These aspects require further investigation.

Factors affecting physicians' attitudes towards patient-centred care: a cross-sectional survey in Beijing

OBJECTIVES

Patient-centred care has been raised as an important component in providing high-quality healthcare services. This research aims to measure physicians' attitudes towards patient-centred care in Chinese healthcare settings and to identify the sociodemographic predictors of their attitudes using an exploratory research design.

DESIGN

A cross-sectional survey.

SETTING

Twelve hospitals in Beijing, China.

PARTICIPANTS

1290 physicians from 12 hospitals in Beijing were invited to take part in the survey using snowball sampling methods. There was a response rate of 84% (n=1084), of which 1053 responses (82%) were valid and included in this research.

METHODS

This research used a survey containing a previously validated 6-point Likert scale called 'Chinese-revised Patient-Practitioner Orientation Scale' (CR-PPOS). Descriptive statistics and multivariable logistic regression analyses were performed to measure participants' attitudes and to identify the sociodemographic predictors of Chinese physicians' attitudes towards patient-centred care.

RESULTS

Gender, professional title (ie, seniority) and hospital type influence Chinese physicians' attitudes towards patient-centred care. Female physicians, physicians with intermediate titles and those who work in tertiary (ie, top-level) hospitals tend to have higher patient-centred attitudes (OR=1.532, 95% CI 1.160 to 2.022; OR=2.089, 95% CI 1.206 to 3.618; OR=2.198, 95% CI 1.465 to 3.297) than male physicians with other titles, and than those who work in first, secondary or private hospitals. Physicians working in non-surgical departments, those who have received training in doctor-patient communication, and those who are satisfied with their income obtained high patient-centred scores, both on the overall CR-PPOS and its two subscales.

CONCLUSIONS

This research identified sociodemographic predictors of Chinese physicians' attitudes towards patient-centred care. The findings contribute to knowledge of factors to be considered in reforming medical education and the Chinese healthcare system to improve physician-patient relationships and provide high-quality healthcare to patients. However, these findings are exploratory in nature and require further investigation to establish their validity and generalisability.

Factors Associated With Changes in Patient-Centered Care in Undergraduate Nursing Students

AIM

The purpose of this study was to examine active listening, self-awareness, and empathy and how they relate to changes in patient-centered care (PCC) in undergraduate nursing students.

BACKGROUND

PCC is associated with better patient outcomes, but the level of PCC has been found to be low in nursing students.

METHOD

This secondary analysis used baseline and follow-up data at two time points from 50 undergraduate nursing students.

RESULTS

Changes in self-awareness were associated with changes in PCC directly (Follow-Up 1) or directly and indirectly through the effects on changes in empathy (Follow-Up 2), controlling for age, experience, and intervention. Changes in active listening were associated with changes in PCC only indirectly through the effect on changes in empathy only at Follow-Up 2.

CONCLUSION

Changes in self-awareness and active listening need to be the first targets of interventions to improve PCC in undergraduate nursing students.

Patients' perspectives about doctor-patient communication regarding transvaginal mesh implant surgery

OBJECTIVES

Many women experience pelvic floor disorders which may require medical intervention such as transvaginal mesh implant surgeries (TVM; the abdominal or vaginal insertion of woven netting to support pelvic tissue). We examined women's perceptions of communication with their health professionals concerning TVM.

DESIGN

We analysed 153 women's written submissions to an Australian Government Inquiry regarding their experiences of transvaginal mesh surgery to explore their perceptions of TVM-related doctor-patient communication. Data were analysed using deductive and inductive reflexive thematic analysis.

RESULTS

Women expressed several challenges in their communication with their health professionals. Three themes regarding communication were generated: Insufficient information was abundant; Normalisation and minimisation of the procedure and risks; and, Desired communication interactions.

CONCLUSIONS

According to women's accounts, doctor-patient communication was poor. Health professionals must be knowledgeable about medical procedures and their potential complications and provide their patients with adequate, accurate information to make informed choices about their health. Health professionals should also document informed consent.

PRACTICE IMPLICATIONS

Health professionals should be well-informed about TVM, including best-practice treatments for pelvic floor disorders, indications for TVM, the risks, outcomes and potential complications from various forms of TVM, and ways to adequately communicate sufficient information to women.

Experiences and perspectives on patient-centered education of medical students in Korea

PURPOSE

This study analyzed the current status of and correlations between Korean medical students' experiences and perspectives surrounding patient-centered medical education (PCME).

METHODS

A structured PCME questionnaire composed of three categories, understanding patients within social and cultural contexts, understanding patients' individual health contexts through communication, and placement of patients at the center of medical education, was used. The students were stratified into pre-medical (Pre-med), medical (Med), and policlinic (PK) groups because of curriculum differences by grade. The χ2 test was applied to analyze the association between students' experiences with and perspectives on PCME. A Cramer's V of 0.200 was considered a large effect size for any association between experiences with and perspectives on PCME.

RESULTS

Among the respondents, 50.6% answered that they did not know about patient-centered medicine before the survey. With increasing school years went up from Pre-med to PK, fewer students agreed that PCME should be added to pre-clinical medicine curricula (p&lt;0.001), that patients should be in the center throughout medical education (p=0.011), and that patients' personal histories, values, and objectives are important PCME (p=0.001). Students who said they learned PCME for each category were more likely to consider PCME important (Cramer's V was 0.219 and 0.271 for "with," and "for the patients" respectively, p&lt;0.001 for "about/with/for the patients"). Students in all groups chose clinical practice as the best method for PCME (p=0.021). Med group chose the lectures as the most effective tool to learn about the importance of communication (p&lt;0.001).

CONCLUSION

Students who experienced PCME were likely to perceive PCME as important and it showed that experiences of PCME had positive effects on PCME perceptions. Despite students' preferences for clinical practice as the best method for PCME, PK reported that they did not learn PCME, and regarded PCME as less important compared to students at earlier stages of their medical education. Therefore, more intensive and holistic PCME curricula rather than only clinical practice exposure may be necessary.

A 4-factor perspective of the patient-practitioner orientation scale (PPOS): a deeper understanding of patient-centredness

BACKGROUND

Although patient-centred medical services are widely recognized and accepted, how to define and evaluate them remains a controversial topic.

OBJECTIVES

This study attempts to evaluate the underlying structure of the Patient-Practitioner Orientation Scale (PPOS) with a homogenous population and clarify the connotation of patient-centredness.

METHODS

In this cross-sectional study, 279 7th year Chinese medical students in were selected to examine the internal structure of the PPOS by means of internal consistency, exploratory, and confirmatory factor analyses.

RESULTS

Both the two-factor model and the four-factor model showed acceptable internal consistency and structural validity. The four-factor model that endorsed the implicit attitude towards the doctor-patient relationship outperformed the two-factor model in terms of adaptability.

CONCLUSIONS

The PPOS has good psychometric attributes, as evaluated by Chinese medical students. This article attempts to explore patient-centredness from the perspective of implicit attitudes that affect the doctor-patient relationship and resummarizes the four factors. These four dimensions may suggest a deeper attitude towards the doctor-patient relationship, while "sharing information" or "caring about" the "patient" is the behaviour and preference expressed on the basis of these four attitudes, which is the result rather than the cause.

PRACTICE IMPLICATIONS

Understanding the underlying attitudes towards the doctor-patient relationship can help to construct a patient-centred medical service concept and improve the doctor-patient relationship in medical education courses and the system design of medical activities.

Decision-making styles of patients and general population in health care: A scoping review

OBJECTIVE

Decision-making styles form the backbone of effective decision-making and show promise as an important construct that warrants further attention. We investigated what is known about decision-making styles among patients and the general population in a health care setting.

METHODS

We used Arksey and O'Malley's framework and searched PubMed and CINAHL databases using relevant combinations of keywords and subject headings. Articles were limited to those published in English up to February 2020.

RESULTS

Sixteen articles met the inclusion criteria. We found that decision-making styles were described as role preferences or personality, psychological, and cognitive factors that influence decision-making. In the identified studies, the evidence was scarce regarding decision-making styles as the foundation for effective decision-making. Moreover, most studies were vague in the description of decision-making styles, offered little explanation of the concept, and varied substantially in the terminology, numbers, and types of decision-making styles and measurement methods.

CONCLUSIONS

Decision-making styles, as a dynamic process, have received little attention in health care and are rarely addressed in health communication research or investigations of decision-making support. Other frameworks that are not directly related to decision-making styles were used in most analyzed studies.

PRACTICE IMPLICATIONS

Decision-making styles in health care should be reinterpreted as a dynamic process that can be developed or changed.

Female representation in radiology subspecialty interest groups in Australia and New Zealand

INTRODUCTION

Women comprise 31% of the Australian and New Zealand radiology workforce, and 35% of radiology trainees. To date, there has been no study of female representation within clinical radiology subspecialties in Australia and New Zealand. This study aims to quantify female representation among the clinical radiology subspecialty interest groups (SIGs) in Australia and New Zealand.

METHODS

A list of SIGs was compiled using the Royal Australian and New Zealand College of Radiologists (RANZCR) website. The executive of each SIG or the RANZCR Standards committee was contacted with a request to provide the number of female versus male members for each subspecialty group and their executive.

RESULTS

Six out of 10 SIGs reported a low proportion of female members; this was most pronounced for IRSA (interventional radiology; 7% women), AMSIG (musculoskeletal imaging; 13% women) and CCINR (interventional neuroradiology; 13% women). Female radiologists accounted for >50% of membership in four SIGs: OGSIG (obstetrics/gynaecology imaging; 87% women), BIG (breast imaging; 73% women), ARGANZ (abdominal imaging; 69% women) and ANZSTR (thoracic imaging; 69% women). Female executive representation ranged from 0% (IRSA (interventional radiology) and ANZSNR (neuroradiology)) to 100% (OGSIG (obstetrics/gynaecology imaging)).

CONCLUSION

Female representation within the membership and representative leadership of some SIGs is well below parity and active initiatives to improve female representation should be considered.

Perceived Barriers to Professional Equality Among Women in Gastroenterology

Although significant progress relating to professional equality among men and women in medicine has been made over the past few decades, evidence derived from the medical literature suggests that inequity persists with respect to income, attainment of leadership positions, and professional advancement. These inequities have been observed to be more pronounced in gastroenterology. Literature relating to gender-specific barriers to professional equity in gastroenterology is limited. This qualitative study explored perceived barriers to professional equality among women in gastroenterology in Canada through focus groups using a World Café Approach. Several perceived barriers to professional equality were identified. Identification of barriers to professional equality is an important first step to creating meaningful interventions that address the root causes of gender-related inequity in gastroenterology.

How do dental students perceive the role of dental professionals?

OBJECTIVES

To explore dental students' perceptions of the role of dental professionals as healthcare providers and/or businesspersons.

METHODS

A cross-sectional online survey collected information from undergraduate dental students at the Faculty of Dentistry, University of Toronto (N = 430). PPR was assessed through a visual analog scale (VAS) question, with the two ends labeled as "Healthcare Provider" (0) and "Business Person" (100), which asked respondents to point where they perceived dental professionals to be. Association of students' PPR with environmental, institutional and student-related factors was investigated using Chi-square and Spearman's correlation tests and logistic regression. Additionally, information on students' professional attitudes was gathered using: (i) the same VAS question, which asked students what they themselves aspired to be; and (ii) level of agreement with two sets of Likert-type questions highlighting healthcare provider and businessperson attitudes.

RESULTS

The survey yielded a response rate of 51.4% (n = 221). The majority of respondents perceived dental professionals as healthcare providers and aspired to be healthcare providers themselves. Results of multivariable logistic regression suggested that perceiving dental professionals as businesspersons was significantly associated with perceiving future patients as consumers. Those who strongly agreed with healthcare provider statements had lesser odds of perceiving dental professionals as businesspersons.

CONCLUSION

In this sample of students, perceptions of professionalism appear to be congruent with the normative role of dental professionals as healthcare providers. Dental education should prepare graduates who strongly identify with this role even in the presence of dental care market pressures.

Healthcare students' attitudes towards patient centred care: a systematic review with meta-analysis

BACKGROUND

Patient centred care is commonly recommended in clinical practice guidelines to improve patient outcomes and reduce healthcare costs. Identifying measurement tools used to assess healthcare students' attitudes towards patient centered care and determining their attitudes is the first step to ensuring patient centred care is provided in the future. The primary aim of this review was to describe the measurement tools used to assess healthcare students' attitudes towards patient centred care. The secondary aim was to quantify healthcare students' attitudes towards patient centred care.

METHODS

An electronic database search was conducted in MEDLINE, EMBASE, CINAHL from inception until March 1, 2021, with combined terms relating to 'patient centred care', 'attitudes', and 'healthcare students'. Studies that quantitatively assessed healthcare students' attitudes towards patient centred care were included. Measurement tools used in the included studies were qualitatively described. Meta-analysis was conducted to quantify healthcare students' attitudes towards patient centred care and assess the respective influence of gender, profession, and study geographical location on healthcare students' attitudes towards patient centred care.

RESULTS

The electronic search identified 3948 total studies. One hundred twenty-nine full texts were screened, and 49 studies were included. There were 16 measurement tools used to assess healthcare students' attitudes towards patient centered care. Most studies (53%, n = 26) used the Patient-Practitioner Orientation Scale (PPOS) to assess patient centered care. Meta-analyses of 20 studies with 26 total groups resulted in a pooled mean PPOS score of 4.16 on a 0-6 scale (95% Confidence Interval [CI]: 3.95, 4.37), indicating low attitudes towards patient centered care. Additional analyses found that women have significantly higher attitudes towards patients centred care than men (pooled effect 0.14 [95% CI: 0.05, 0.23], n = 8 studies) and mean PPOS scores appear similar among sub-groups of only medical students (pooled mean 4.13, 95% CI: 3.85, 4.42, n = 13 studies) and only American healthcare students (pooled mean 4.49, 95% CI: 4.35, 4.64, n = 5 studies).

CONCLUSIONS

Several different measurement tools have been used to assess healthcare students' attitudes towards patient centred care, but the most commonly used is the PPOS. Our results indicate that healthcare students have low attitudes towards patient centred care. Future studies should evaluate if attitudes towards patient centred care can be improved during healthcare education.

Use of telemedicine in the outpatient sector during the COVID-19 pandemic: a cross-sectional survey of German physicians

BACKGROUND

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, administrative barriers to the use of telemedicine have been reduced in Germany. The study focused on the analysis of use and assessment of telemedicine by physicians working in the outpatient sector, considering the perspective of different disciplines during the COVID-19 pandemic in Germany.

METHODS

The anonymous cross-sectional online survey within the study COVID-GAMS was conducted from 16 November 2020 to 1 January 2021. General practitioners; cardiologists; gastroenterologists; paediatricians; gynaecologists; ear, nose, and throat (ENT) specialists were randomly selected and invited to participate in the survey. At the same time, open recruitment to the online survey was conducted via the professional societies. Descriptive and regression analyses were performed based on the data of 1521 outpatient responding physicians.

RESULTS

The use of telephone and video consultation increased during the pandemic. Regarding the frequency of use, physicians already using telephone/video consultations in March/April 2020 report an increase in such services. General medicine was associated with an increased use of telephone and video consultations than cardiology, gynaecology or ENT, and in the case of telephone consultations also compared to paediatrics. General practitioners assessed the subjective usefulness higher than gynaecology and ENT. And the self-reported proportion of patients receiving telemedical care was higher correlated with general medicine than all other disciplines. The location of the practice (rural vs. urban), type of practice (individual vs. group) and gender (male vs. female) were also shown to be significant influencing factors on the variables mentioned above. Barriers reported by physicians not using telemedicine were the lack of equivalence to face-to-face contact and perceived low demand from patients.

CONCLUSION

The COVID-19 pandemic has led to a significant increase in the use of telemedicine, to varying degrees in the different specialities. Individual and structural factors lead to a reduced use of telemedicine and there are physician's and patient's barriers that have prevented telephone and video consultations from gaining acceptance by physicians. All these factors must be addressed if telemedicine procedures are to be implemented widely.

Assessing attitudes of patient-centered care among chiropractic students at a South African university

OBJECTIVE

Patient-centered care (PCC) is acknowledged globally as a foundation of quality patient care and key to doctor-patient rapport. Student attitudes toward PCC have been assessed in some health professions and some international chiropractic institutions but is lacking in the South African chiropractic student context. This study explores this concept and compares these attitudes to other student groups.

METHODS

A cross-sectional survey was conducted on chiropractic students (years 1, 3, 5, and 6) at a South African institution. The 18-item Patient-Practitioner Orientation Scale (PPOS), with scoring 1-6 on a Likert scale, was used to evaluate the attitude toward PCC by students. Higher scores were representative of more patient-centeredness. Variables were analyzed to assess for associations between variables. Mean PPOS scores were calculated, and reliability and validity were tested using Cronbach α and factor analysis.

RESULTS

There were 100 respondents (68% response rate). The PPOS showed unsatisfactory reliability in our sample. The mean scores for the overall PPOS were 3.64 (SD = 0.46), the sharing subscale was 2.99 (SD = 0.61), and the caring subscale was 4.29 (SD = 0.58). There were small but suggestive trends noticed in PPOS scores based on age, sex, and year of study.

CONCLUSIONS

Chiropractic students from our university showed a general positive tendency toward PCC with no association between age and year of study. Sex showed some suggestive descriptive trends contrary to findings in other studies. The PPOS showed poor reliability in this study, warranting consideration with its use in similar contexts.

Evaluating Teaching Effectiveness of Medical Humanities in an Integrated Clerkship Program by a Novel Prospective Propensity Score Matching Framework

Background: This study aims to rigorously compare the effectiveness of the educational programs of a new integrated clinical clerkship in medicine (3 months) and surgery (3 months) at a cancer center with the conventional subspecialty-based rotations at a tertiary teaching hospital, by this prospective, pre-post comparative method. Methods: Between 2013–2016, we compared 69 students who had selected the integrated clerkship that emphasized clinical competency and medical humanities training with 138 matched peers who had completed conventional clerkships during the same period. Outcome measures for medical humanities included empathy, patient-centeredness, and other values and skills related to holistic health care professionalism by introducing prospective propensity score matching (PSM). Results: At baseline, no significant between-group differences existed. At the completion of the core clerkships, students receiving the integrative clerkship had significantly higher scores on the Patient–Practitioner Orientation Scale (PPOS) and the Professionalism Climate in Clinical Teaching Environment (PCI), and similar Jefferson Scale of Physician Empathy Student Version (JSPE) scores, as compared with the comparison group. We also found that the students in this program did not perform worse than those in the traditional internship group in the comprehensive and formative OSCE medical clinical skills test. Conclusions: Our study develops an empirical basis for rigorous evaluation to design medical education to improve the medical humanities values and skills of interns. Features of the new integrated clerkship program that we developed include substantial participation by the students in patient-centered in-hospital culture, as well as reflection, discussion, and feedback on actual clinical cases.

Attitudes of medical professionals towards patient-centredness: a cross-sectional study in H City, China

OBJECTIVES

Patient-centred communication improves patient experiences and patient care outcomes. This study aimed to assess the preference of medical professionals in China towards patient-centred communication under the context of the deteriorating doctor-patient relationship.

METHODS

A cross-sectional survey of medical professionals was conducted in January and February 2018 in H City of Heilongjiang province, the northeast of China. The Chinese-Revised Patient-Practitioner Orientation Scale (CR-PPOS) was adopted to measure the individual preference of respondents towards patient-centredness in clinical communication. Multivariate logistic regression models were established to identify the sociodemographic (gender, age, marital status and educational attainment) and work experience (years of working, seniority, satisfaction with income, daily workload and perceived doctor-patient relationship) predictors of the preference towards patient-centredness.

PATIENT AND PUBLIC INVOLVEMENT

Not applicable.

RESULTS

A total of 618 valid questionnaires were returned. The CR-PPOS demonstrated acceptable reliability and validity. Overall, a low level of preference towards patient-centredness in clinical communication was found. Relatively higher scores on 'caring for patients' (20.42±4.42) was found compared with those on 'information/responsibility sharing' (15.26±4.21). Younger age, higher educational attainment, lower daily workload and a perception of harmonious doctor-patient relationship were associated with a higher preference towards patient-centredness in clinical communication.

CONCLUSIONS

A low level of preference towards patient-centredness in clinical communication was found in medical professionals in the northeast of China, which may further jeopardise the efforts to improve doctor-patient relationship.

A short scale for measuring attitudes towards the doctor-patient relationship: psychometric properties and measurement invariance of the German Patient-Practitioner-Orientation Scale (PPOS-D6)

Background

The Patient-Practitioner Orientation Scale (PPOS) was originally developed to compare doctor’s and patient’s consensus regarding patient centeredness. Research assumed PPOS measurements to be comparable across different groups of participants, however, without assessing the actual validity of this assumption. In this study, we investigate the psychometric properties and measurement invariance of a short version of the German translation of the PPOS.

Methods

Based on a cross-sectional survey of N = 332 medical students, we present a short version of the German Patient-Practitioner-Orientation Scale (PPOS-D6) and examine its psychometric properties as well as measurement invariance across participants with varying levels of medical experience and gender using multigroup confirmatory factor analyses.

Results

Results indicate that PPOS-D6 provides valid and reliable measurements of patient-centeredness that are invariant across participants with different medical experience. Preliminary results also suggest invariance across gender.

Conclusion

PPOS-D6 is a suitable and efficient measure to compare group-specific attitudes towards the doctor-patient interaction. Additional research on convergent and discriminant validity and divergent study samples is advised.

Medical Students' Perceptions of Patient-Doctor Relationship in South Korea: Concept Mapping Analysis

Introduction: The patient-doctor relationship has evolved from early paternalism to a consumerism and partnership model that emphasizes cooperation. Patient-doctor relationships might vary with the socio-cultural environment, because the medical environment affects such relationships.

Method: We investigated the patient-doctor relationship among medical students through concept mapping analysis. Twenty-six fourth-grade Korean medical students wrote a reflection journal and participated in the concept classification and the importance evaluation of the derived concept. ALSCAL multidimensional scaling and Ward hierarchical cluster analysis were performed. Also, the 5-point Likert scale was used to evaluate the importance of the concept.

Results: Sixty-six statements about the patient-doctor relationship were extracted and grouped into six clusters. The x-axis is the dimension of “Information-Respect,” and the y-axis is “Changeability-Persistence.” Six patient-doctor concepts were derived and students evaluated “Patient-centered” as the most important.

Conclusions: Medical students express various concepts of the patient-doctor relationship. Considering that they may encounter various medical conditions and patients, it is necessary that they understand deeply the complex patient-doctor relationship.

Preference for patient-centered communication among the citizens of the Visegrad countries

OBJECTIVES

The aim of the study was to investigate and compare the preferences that citizens of four Visegrad countries hold concerning the communication between patient and provider.

METHODS

The patient-practitioner orientation scale was used on a general population in our research, which consists of the Sharing and Caring subscales and assesses patient-centered or doctor-centered orientation toward communication. The statistical analysis included 4000 respondents of citizens from the Czech Republic, Slovakia, Poland and Hungary. When comparing the various demographic data and the four countries with each other univariate and multivariate logistic regressions were performed.

RESULTS

Being female, middle aged, having a higher education and a poor health status were associated with significantly higher Sharing and Caring scores. Also, Hungarian citizens had a significantly higher Caring score compared to the other three countries.

CONCLUSIONS

Key demographic variables were identified that affect how citizens perceive the communication between patient and provider. With the exception of Caring among Hungarian citizens, no differences were observed among the Visegrad countries.

PRACTICE IMPLICATIONS

These findings have potential implications for understanding the preferences of the citizens and thus better promote a more patient-centered communication.

Patient-centered care: Dietitians' perspectives and experiences

OBJECTIVE

To (1) explore RDNs' descriptions of patient-centered care (PCC), (2) measure Registered Dietitian Nutritionists' (RDNs) preferences for PCC and (3) identify factors that affect RDNs' PCC preferences.

METHODS

A survey instrument including two open-ended items exploring RDN descriptions of and experiences with PCC, the Patient-Practitioner Orientation Scale (PPOS), and various factors that could influence PCC (e.g., work intensification, work engagement, and work/demographic characteristics) was expert reviewed, pilot tested, and distributed electronically to 4697 RDNs. A regression analysis was conducted, and two open-ended items were qualitatively analyzed.

RESULTS

Three themes emerged when RDNs described PCC (n = 375): dietitian/patient relationship (95.7%), organizational influence (64.4%), and interprofessional teams (26.3%). RDNs (n = 318) scored 4.60/6 on the PPOS. Higher levels of work engagement were predictive of higher PPOS scores, and heavier workloads were predictive of lower PPOS scores (p < 0.05). Primary work position also influenced PPOS scores (p<0.05).

CONCLUSION

RDNs have varying personal definitions of and experiences with PCC, however there are common themes. RDNs generally prefer PCC and score moderately high on the PPOS.

PRACTICE IMPLICATIONS

To strengthen preferences for PCC, managers should create manageable workloads and prioritize work engagement. Continued emphasis on interprofessional collaboration with and organizational promotion of RDNs could improve PCC.

Can You Hear Me Now? Effects of Patient-Centered Communication With Young Adults Aged 26 to 39

Patient-centered communication (PCC) is critical to the delivery of quality health care services. Although numerous health outcomes have been connected to patient–provider communication, there is limited research that has explored the processes and pathways between communication and health. Research among young adults (ages 26-39 years) is even more scarce, despite findings that health communication does vary with age. This cross-sectional study used data from the 2014 Health Interview National Trends Survey to explore the relationship between PCC, patient trust, patient satisfaction, social support, self-care skills, and emotional well-being among young adults aged 26 to 39 years. Our results showed that income, history of depression diagnosis, PCC, patient trust, social support, and patient self-efficacy (self-care skills) were all significantly related to emotional well-being. These findings suggest the need to explore the means through which communication can impact emotional well-being, specifically among young adults who are in poor health or have a history of depression. Future research should also include longitudinal studies, in order to determine causality and directionality among constructs.

Linking doctor-patient relationship to medical residents' work engagement: The influences of role overload and conflict avoidance

Background

Chinese residents’ practical work experiences are different from those described in Western studies. To explore potential mechanisms underlying the effects of doctor-patient relationships on medical residents’ work engagement, verifying a posited mediating effect of role overload, and moderating effect of conflict avoidance, in the Chinese context.

Methods

Based on the conservation of resources theory, a composite model was constructed. This study’s data were collected from four different Chinese tertiary hospitals; 195 residents undergoing regularization training took this survey. Hierarchical moderated and mediated regression analyses were utilized.

Results

Doctor-patient relationship were found to be positively related to residents’ work engagement (β=0.31, p≤0.001). Role overload partially mediated the effect of these relationships on work engagement, and the moderating role of conflict avoidance in the relationship between doctor-patient relationship and conflict avoidance was negative.

Conclusion

Maintaining good doctor-patient relationship can prompt residents to increase their engagement in work in order to meet their patients’ needs. Furthermore, role overload has a particular influence in early career stages. Not only is it necessary for residents to gain a sense of recognition and support while they carry out their job responsibilities, especially while dealing with complex doctor-patient relationship, but it is also important to create work environments that can help residents shape their professional competency.

The development of incorpoRATE: A measure of physicians' willingness to incorporate shared decision making into practice

OBJECTIVES

To develop 'incorpoRATE', a brief and broadly applicable measure of physicians' willingness to incorporate shared decision making (SDM) into practice.

METHODS

incorpoRATE was developed across three phases: 1) A review of relevant literature to inform candidate domain and item development, 2) Cognitive interviews with US physicians to iteratively refine the measure, and 3) Pilot testing of the measure across a larger sample of US physicians to explore item and measure performance.

RESULTS

The final measure consists of seven items that assess physician perspectives on various components of SDM use that may present as barriers in practice. During pilot testing, the majority of physicians expressed positive opinions about the overall concept of SDM, yet were less comfortable acting on informed patient choices when there was known incongruence with their own recommendations.

CONCLUSIONS

incorpoRATE is a novel physician-reported measure that assesses physicians' willingness to incorporate SDM in practice.

PRACTICE IMPLICATIONS

incorpoRATE has the potential to help us further understand the limited adoption of SDM and areas of focus for improving the use of SDM in the future. We recommend that incorpoRATE be subject to further psychometric, real-world testing, in order to explore its performance across different samples of physicians and organizations.

The effect of physician self-disclosure on patient self-disclosure and patient perceptions of the physician

OBJECTIVES

Physician self-disclosure is typically seen as patient-centered communication because it creates rapport and is seen as an expression of empathy. Given that many physician behaviors affect patients differently depending on whether they are shown by a female or male physician, we set out to test whether physician self-disclosure affects patients' intentions to self-disclose and patients' perceptions of their physicians depending on physicians' gender.

METHOD

Two hundred and forty-four participants were recruited and randomly assigned to read one of 4 vignettes as if they were the patient in the dialogue (analogue patient design). They were then asked to report how they would react to the physician and how they perceived the him or her.

RESULTS

Physicians who self-disclosed were perceived as more empathic than physicians who did not, regardless of physician and patient gender. Physician self-disclosure had an effect on the behavioral intentions of the analogue patients, and this was moderated by physician gender. Analogue patients indicated to be more willing to self-disclose to female than to male physicians who self-disclosed.

CONCLUSION

It is important to consider physician gender when training physicians in patient-centered communication because the same behavior can have different effects on patients depending on whether it originates from a female or a male physician.

PRACTICAL IMPLICATIONS

Physicians can use self-disclosure to express empathy. When female physicians do so, they might obtain more personal information from patients, which can positively affect diagnosis and treatment.

Patient Navigator and Community Health Worker Attitudes Toward End-of-Life Care

Background: There are racial/ethnic disparities in hospice use and end-of-life (EOL) care outcomes in the United States. Although the use of community health workers (CHWs) and patient navigators (PNs) has been suggested as a means of reducing them, CHW/PNs' attitudes toward a palliative care philosophy remain unknown. The purpose of this study was to examine how personal attributes affect a CHW/PN's attitude toward EOL care. Methods: CHWs/PNs were recruited from two state-wide organizations and invited to complete an online survey. We collected information on demographics, attitudes toward the palliative care philosophy, and comfort with caring for patients at the EOL. Results: Of the 70 CHWs/PNs who responded to the survey, 82.5% identified as female, 56.4% identified as black, and 56.2% had a four-year college degree or higher. The mean score on a validated scale to assess attitudes toward EOL care was 33.5 (SD = 4.9; possible range, 8-40). Eighty percent strongly agreed or agreed with being open to discussing death with a dying patient. Higher self-efficacy scores were associated with more favorable attitudes toward hospice (r = 0.306, p = 0.016). Conclusions: CHWs/PNs have an overall favorable attitude toward the palliative care philosophy and may be inclined to providing EOL care.

The Antibiotic Treatment of Calf Diarrhea in Four European Countries: A Survey

Neonatal calves are commonly affected by diarrhea caused by different pathogens, but not always bacteria. Yet, antibiotics are routinely used as a treatment to an unknown extent. It was our goal to survey antibiotic use for the treatment of neonatal calf diarrhea in different countries and to identify influencing factors. A total of 873 farmers and veterinarians in Austria, Belgium, Portugal, and Scotland participated in a voluntary online survey. The data were analyzed using classification and regression tree analyses and chi² tests. Overall, 52.5% of the participants stated that they use antibiotics when treating neonatal calf diarrhea. Of those, 27% use them always, and 45% use highest priority critically important antibiotics. The most important factor differentiating antibiotic use practices was the country the participants were from, which could be due to regulatory differences between the countries. All antibiotic products stated were licensed for use in cattle, but several were not licensed for the treatment of diarrhea in calves. Our study shows that there is an urgent need for more scientific evidence to define best practices for the treatment of neonatal calf diarrhea. Furthermore, consensual criteria for antibiotic therapy must be defined, and targeted training for farmers and veterinarians must be provided.

Experience and knowledge of Lyme disease: A scoping review of patient-provider communication

There has been limited research on patient-provider communication dynamics regarding Lyme disease (LD) diagnosis and treatment. Evidence suggests communication in the clinical encounter improves when both patient and healthcare provider (HCP) have concordant orientations (or beliefs) on discussed topics, resulting in higher patient satisfaction and care outcomes. The purpose of this scoping review was to characterize and summarize current research findings on patient and provider knowledge and experiences regarding LD - two factors that may influence the orientation of both patients and providers toward LD in the clinical setting. None of the articles included in the review specifically addressed patient-provider interaction and relationships as the main objective. However, the existing literature indicates notable HCP uncertainty regarding LD diagnosis, treatment, and applied practice patterns. Current research also describes limited knowledge of LD among patient populations and a high prevalence of negative perceptions of care received in mainstream healthcare settings among individuals with persistent symptoms. We identified a critical gap in research that seeks to understand the dynamic of patients and HCPs communicating on the topic of LD in the clinical setting. Future research may identify opportunities where the patient-provider communication dynamic can be improved.

Factors Influencing Patient-Centeredness among Korean Nursing Students: Empathy and Communication Self-Efficacy

In recent years, there is a growing tendency in the extent to which patients wish to be actively involved in processes related to their healthcare and relevant decision-making. This was a cross sectional study. We examined undergraduate nursing students’ patient-centeredness and investigated its associated factors including empathy and communication self-efficacy using a structured questionnaire. A total of 201 undergraduate nursing students who provided written consent to participate in the study completed measures on patient-centeredness (sharing and caring), empathy (fantasy, perspective taking, personal distress, and empathic concern), and communication self-efficacy. The factors affecting patient-centeredness were analyzed using multiple regression. Communication self-efficacy affected patient-centered sharing, while age, empathy (fantasy, personal distress, empathic concern), and communication self-efficacy affected patient-centered caring. Empathy and communication self-efficacy positively affected patient-centeredness. Therefore, strategies that promote empathy and communication self-efficacy are needed to increase patient-centered care competency.