Clinician–patient relationships after two decades of a paradigm of patient-centered care

Communication Tapestry: Health Literacy Mediates Public Trust in Physician Health Information in Pakistani Public Hospitals

BACKGROUND/OBJECTIVES

This study explores the multifaceted factors influencing public trust in healthcare services provided by doctors in public hospitals in Pakistan. The objective is to examine the relationships between various determinants such as doctors' reputation and expertise, patient participation in decision-making, communication clarity, health literacy levels, and trust in prescribed medications to provide actionable insights for improving healthcare trust.

METHODS

A total of 550 patients from public hospitals were surveyed, and data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). This approach enabled the identification of intricate relationships between the key factors influencing trust in healthcare services.

RESULTS

The findings indicate that patient participation in decision-making and transparent communication significantly enhance trust in prescribed medications. Additionally, health literacy emerged as a crucial factor, with higher levels of understanding leading to greater confidence in healthcare services.

CONCLUSIONS

The study highlights the importance of patient-centered care, clear communication strategies, and health literacy initiatives in strengthening public trust in healthcare systems. Practical recommendations are provided for policymakers, healthcare professionals, and researchers to collaboratively improve healthcare service delivery and foster public confidence.

Patient empowerment: a critical evaluation and prescription for a foundational definition

Introduction

The evolution of healthcare continues to display an incongruence between delivery and outcomes. Current healthcare paradigms for patient empowerment warrants analysis. A lacking operational application for and agree upon assessment of patient empowerment contributes to healthcare's incongruence. Interchangeable psychosocial concepts and specific patient contextual factors associated with health-related behavioral change have escaped an applicable definition of empowerment. The aim of this theoretical perspective review is to support a comprehensive and contextual understanding of patient empowerment that frames a definition for future consensus research.

Methods and mechanisms

A theoretical perspective review of patient empowerment including interchangeable concepts and patient contextual factors such as personal suffering and resilience; self-determined meaning and purpose; and autonomy, competence, and self-efficacy are critically analyzed. This analysis builds on adjacent concepts including therapeutic alliance, communication, motivation, and trust. The inclusion of specific patient contextual factors that relate to behavioral change elevate the need to reinforce coping and self-management skills as mechanism for patient empowerment. Practice gaps for those experiencing chronic disease, pain, and mental health disorders in rehabilitation setting are specific populations who benefit from healthcare providers unifying the variables associated with patient empowerment.

Results and discussion

The review of associated concepts synthesized an actionable definition of patient empowerment that serves as a foundation for future research. Behavior related changes occur through the evolution in one's identity, perceptions, and abilities. Interventions that inspire autonomy, competence, and relatedness with a renewed sense of purpose establish resilience and self-efficacy. The totality of this inspired self-determined plan of care establishes the mechanisms required for behavioral change and sustainable transformation. The cumulative experience becomes patient empowerment.

What if you have a humanoid AI robot doctor?: An investigation of public trust in South Korea

BACKGROUND

Humanoid robots with artificial intelligence have been implemented in many healthcare facilities including hospitals, nursing homes, and many others. Due to the development of technology and the increasing use of humanoid robots, it is expected that more advanced humanoid robots will be developed and implemented in healthcare facilities for better healthcare services. Based on this anticipation, this study proactively examined the public trust in humanoid AI robot (HAIR) doctors that we might have in the near future.

METHODS

This study employed two scales that have been predominantly used to measure patient-doctor trust through an extensive search across different scholarships. For data collection, online surveys were administered by posting a weblink to the online survey through social media, mostly Facebook, Twitter, and KakaoTalk, in South Korea.

RESULTS

Data analysis of 424 valid surveys found that the level of public trust in HAIR doctors as primary doctors was slightly higher than human doctors. For the data analysis using demographic variables, a series of t-test and ANOVA revealed that males showed a higher trust in HAIR doctors than females, while maintaining indifference in other demographic variables.

CONCLUSION

Based on the rapid development of AI and robot technology, the implementation of HAIR doctors for our healthcare service would be a reality in the near future as the public also becomes more familiar with interacting with humanoid robots. Therefore, a proactive preparation for the future is urgently needed for effective use of future technology as well as patients' satisfaction.

Person-centred care in primary care: What works for whom, how and in what circumstances?

This rapid realist review aims to explain how and why person-centred care (PCC) in primary care works (or not) among others for people with low health literacy skills and for people with a diverse ethnic and socioeconomic background, and to construct a middle-range programme theory (PT). Peered reviewed- and non-peer-reviewed literature (Jan 2013-Feb 2021) reporting on PCC in primary care was included. Selection and appraisal of documents were based on relevance and rigour according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) criteria. Data on context, mechanisms and outcomes (CMO) were extracted. Based on the extracted data, CMO configurations were identified per source publication. Configurations containing all three constructs (CMO) were included in the PT. The middle-range PT demonstrates that healthcare professionals (HCPs) should be trained and equipped with the knowledge and skills to communicate effectively (i.e. in easy-to-understand words, emphatically, checking whether the patient understands everything, listening attentively) tailored to the wishes, needs and possibilities of the patient, which may lead to higher satisfaction. This way the patient will be more involved in the care process and in the shared decision-making process, which may result in improved concordance, and an improved treatment approach. A respectful and empathic attitude of the HCP plays an important role in establishing a strong therapeutic relationship and improved health (system) outcomes. Together with a good accessibility of care for patients, setting up a personalised care plan with all involved parties may positively affect the self-management skills of patients. Good collaboration within the team and between different domains is desirable to ensure good care coordination. The coherence of items related to PCC in primary care should be considered to better understand its effectiveness.

'Poorly relaxed women': A situational analysis of pelvic examination learning materials for medical students

BACKGROUND

Certain clinical pelvic examination (PE) teaching methods have been critiqued for prioritising student learning over patient autonomy and for not accurately representing diverse patient communities. As such, patient-centred and culturally competent approaches to the PE may need further emphasis in the medical curriculum-in particular, in content delivered to students before patient interaction. Classroom materials serve as students' first exposure to the sensitive procedure. This research explores how patients are represented in these materials.

METHODS

A situational analysis was conducted on 10 purposively sampled PE learning materials for the 2019/20 academic year from five undergraduate medical schools in Canada. Situational analysis focuses on analysing discourse but is epistemically aligned with post-structuralism (most notably Foucault's theories involving discursive power) and allows for specific consideration of 'silences' in the data. Collected data were analysed using cartographic approaches according to this methodology, with particular attention paid to the tenets and frameworks of patient-centred and culturally competent care.

RESULTS

Overall, content in these materials misrepresented and under-represented patients. Materials contained both outdated and unnecessarily sexualised language, in addition to a lack of patient diversity. Clinical authority was often centred over patient agency, and several updated PE techniques known to improve patient experience were absent. Patient-centred and culturally competent approaches were therefore inadequately highlighted in most of the materials.

CONCLUSIONS

Depictions contained in these materials may be perpetuating stereotypes and biases in medicine and may be working to maintain teaching practices that cause harm to patients (standardised and regular) who students interact with in both clinical and educational settings. Efforts may be needed to improve classroom materials on the PE so that they more adequately centre patients and provide opportunities to discuss culturally competent approaches to the procedure that (i) may not be covered in other parts of the PE curriculum and (ii) can reduce known health disparities.