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Vandecasteele R, Robijn L, Stevens PAJ, Willems S, De Maesschalck S. "Trying to write a story together": general practitioners' perspectives on culturally sensitive care. Int J Equity Health 2024; 23:118. [PMID: 38844971 PMCID: PMC11154983 DOI: 10.1186/s12939-024-02200-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Culturally sensitive care is integral to effective and equitable healthcare delivery, necessitating an understanding and acknowledgment of patients' cultural needs, preferences, and expectations. This study investigates the perceptions of cultural sensitivity among general practitioners (GPs), focusing on their intentions, willingness and perceived responsibilities in providing care tailored to cultural needs. METHODS In-depth interviews were conducted with 21 Flemish GPs to explore their perspectives on culturally sensitive care. Data analysis followed a conventional qualitative content analysis approach within a constructivist framework. A coding scheme was developed to identify recurring themes and patterns in the GPs' responses. RESULTS Findings reveal that culturally sensitive care provision is perceived as a multifaceted process, initiated by an exploration phase where GPs inquire about patients' cultural needs and preferences. Two pivotal factors shaping culturally sensitive care emerged: patients' specific cultural expectations and GPs' perceived responsibilities. These factors guided the process of culturally sensitive care towards three distinct outcomes, ranging from complete adaptation to patients' cultural requirements driven by a high sense of responsibility, through negotiation and compromise, to a paternalistic approach where GPs expect patients to conform to GPs' values and expectations. Three typologies of GPs in providing culturally sensitive care were identified: genuinely culturally sensitive, surface-level culturally sensitive, and those perceiving diversity as a threat. Stereotyping and othering persist in healthcare, underscoring the importance of critical consciousness and cultural reflexivity in providing patient-centered and equitable care. CONCLUSIONS This study emphasizes the significance of empathy and underscores the necessity for GPs to embrace the exploration and acknowledgement of patients' preferences and cultural needs as integral aspects of their professional role. It highlights the importance of shared decision-making, critical consciousness, cultural desire and empathy. Understanding these nuances is essential for enhancing culturally sensitive care and mitigating healthcare disparities.
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Affiliation(s)
- Robin Vandecasteele
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium.
| | - Lenzo Robijn
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Peter A J Stevens
- Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Sint-Pietersnieuwstraat 41, Ghent, 9000, Belgium
| | - Sara Willems
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Quality & Safety Ghent, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
- Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2, Ghent, 9000, Belgium
| | - Stéphanie De Maesschalck
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, Ghent University, University Hospital Campus, C. Heymanslaan 10, Ghent, 9000, Belgium
- Centre for the Social Study of Migration and Refugees, Ghent University, H. Dunantlaan 2, Ghent, 9000, Belgium
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Pressimone C, Indralingam R, Metz CD, Levine AS. The Patient-Physician Relationship: Medical Students' Perceptions in a Novel Course. J Gen Intern Med 2024:10.1007/s11606-024-08759-x. [PMID: 38600399 DOI: 10.1007/s11606-024-08759-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
The patient-physician relationship, especially in the case of severely ill patients, is often fraught with anxiety, grief, and guilt in the physician who may come to feel that he or she has failed the patient and thereby becomes a "second victim." This notion was first explored in a 1973 publication (Artiss and Levine N Engl J Med 288(23):1210-4, 1973) that described a novel interactive seminar series for oncology fellows that had been designed to address and possibly remedy the frequent disquiet experienced by young physicians in this setting. Fifty years later, the medical student co-authors of this Perspective enrolled in an elective course that comprised a similar series of interactive seminars, now addressing the contemporary patient-physician relationship. The earlier paper was employed as a historical background, and the framework of the course then broadened such that the students considered the current environmental changes in medical practice (social, cultural, financial, legal, policy) that may be linked to the character of individual patient-physician relationships. This essay reports on the students' perception of such relationships, and on the environmental elements that may be helpful or harmful to the well-being of both patients and physicians.
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Affiliation(s)
| | | | | | - Arthur S Levine
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Dunn LK, Pham E, Kabil E, Kleiman AM, Hilton EJ, Lyons GR, Ma JZ, Nemergut EC, Forkin KT. The Impact of Physician Race and Sex on Patient Ranking of Physician Competence and Perception of Leadership Ability. Cureus 2023; 15:e34778. [PMID: 36909083 PMCID: PMC10005834 DOI: 10.7759/cureus.34778] [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: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Background Biases affect patient perceptions of their physician and influence the physician-patient relationship. While racial disparities in care and inequities in the healthcare workforce are well-documented, the impact of physician race on patient perceptions remains unclear. We aimed to investigate the association of physician race and sex on patient perceptions during simulated preoperative encounters. Methods Three hundred patients recruited consecutively in the Preanesthesia Evaluation and Testing Center viewed pictures of 4 anesthesiologists (black male, white male, black female, white female) in random order while listening to a set of paired audio recordings describing general anesthesia. Participants ranked each anesthesiologist on confidence, intelligence, and likelihood of choosing the anesthesiologist to care for their family member, and chose the one anesthesiologist most like a leader. Results Compared to white anesthesiologists, black anesthesiologists had greater odds of being ranked more confident (OR, 1.45; 95% CI, 1.10 to 1.89; P=0.008) and being considered a leader (OR, 2.06; 95% CI, 1.50 to 2.84; P<0.0001). Among white participants, black anesthesiologists had greater odds of being ranked more intelligent (OR, 2.08; 95% CI, 1.54 to 2.81; P<0.0001) and were more likely to be chosen to care for a family member (OR, 2.26; 95% CI, 1.66 to 3.08; P<0.0001). Female anesthesiologists had greater odds of being ranked more intelligent (OR, 1.36; 95% CI, 1.08 to 1.71; P=0.009) and were more likely to be chosen to care for a family member (OR, 1.58; 95% CI, 1.27 to 1.97; P<0.001) compared with male anesthesiologists. Conclusions Contrary to our hypothesis, patients ranked black physicians more highly on multiple competence and leadership quality metrics. Our data likely highlight the role social desirability bias may play in studies of racial disparities within medicine.
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Affiliation(s)
- Lauren K Dunn
- Anesthesiology, University of Virginia School of Medicine, Charlottesville, USA
| | - Elizabeth Pham
- Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Emmad Kabil
- Anesthesiology, University of Virginia School of Medicine, Charlottesville, USA
| | - Amanda M Kleiman
- Anesthesiology, University of Virginia School of Medicine, Charlottesville, USA
| | - Ebony J Hilton
- Anesthesiology, University of Virginia School of Medicine, Charlottesville, USA
| | - Genevieve R Lyons
- Public Health Sciences, University of Virginia School of Medicine, Charlottesville, USA
| | - Jennie Z Ma
- Public Health Sciences, University of Virginia School of Medicine, Charlottesville, USA
| | - Edward C Nemergut
- Anesthesiology, West Virginia University School of Medicine, Morgantown, USA
| | - Katherine T Forkin
- Anesthesiology, University of Virginia School of Medicine, Charlottesville, USA
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Dawadi A, Lucas T, Drolet CE, Thompson HS, Key K, Dailey R, Blessman J. Healthcare provider cultural competency and receptivity to colorectal cancer screening among African Americans. PSYCHOL HEALTH MED 2022; 27:2073-2084. [PMID: 34154479 PMCID: PMC8692480 DOI: 10.1080/13548506.2021.1939073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 05/26/2021] [Indexed: 12/16/2022]
Abstract
African Americans suffer disproportionately from colorectal cancer (CRC), due in part to disparities in CRC screening. Better understanding culturally relevant psychosocial factors that impact CRC screening is therefore critical. This study examined how African Americans' perceived cultural competency of their physician is associated with receptivity to take-home stool-based CRC screening. CRC screening deficient African Americans (N = 457) completed a patient-focused measure of perceived cultural competency and watched a brief video about CRC risks, prevention, and screening. Receptivity to stool-based CRC screening was measured using Theory of Planned Behavior (TPB) constructs . Participants were also given an opportunity to receive a no-cost at-home Fecal Immunochemical Test (FIT) kit, and we measured acceptance of this offer as a behavioral outcome (yes-no). Results showed that perceived cultural competency was associated with higher receptive attitudes, more favorable norms, greater perceived behavioral control towards stool-based screening, and also greater intentions to engage in FIT Kit screening (p < 0.001). We also found significant indirect effects of perceived cultural competency on FIT kit uptake through intention-mediated pathways. This study provides crucial evidence that participants' perceived cultural competency may play an important role in preventive health behavior among racial minorities, including CRC screening uptake among African Americans.
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Affiliation(s)
- Anurag Dawadi
- Division of Public Health, College of Human Medicine, Michigan State University
| | - Todd Lucas
- Division of Public Health, College of Human Medicine, Michigan State University
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University
| | - Caroline E. Drolet
- Division of Public Health, College of Human Medicine, Michigan State University
| | - Hayley S. Thompson
- Department of Community Outreach and Engagement, Karmanos Cancer Institute, Wayne State University School of Medicine
| | - Kent Key
- Division of Public Health, College of Human Medicine, Michigan State University
| | - Rhonda Dailey
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | - James Blessman
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
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Vella E, White VM, Livingston P. Does cultural competence training for health professionals impact culturally and linguistically diverse patient outcomes? A systematic review of the literature. NURSE EDUCATION TODAY 2022; 118:105500. [PMID: 35964378 DOI: 10.1016/j.nedt.2022.105500] [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: 11/13/2021] [Revised: 06/02/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the impact of cultural competence training for health professionals on patient outcomes. METHOD A systematic review of cultural competence training interventions for healthcare workers including papers published January 2010 to January 2021, identified through MEDLINE, CINAHL, ERIC and APA PsychINFO. Health conditions were not specified, however, only studies reporting patient outcomes were included. Training frameworks and delivery, measures of health professional cultural competence, and patient outcomes were reviewed. RESULTS Of 7879 unique studies identified, five met inclusion criteria including two randomised control trials, two mixed method and one multi-method pre/post study. Professionals reported the training was beneficial, and some improvements in patient perceptions of health providers' cultural competence were found. However, patient health outcomes did not improve significantly in any study. CONCLUSION Cultural competence training is promoted to improve outcomes of patients from culturally diverse backgrounds; however, few studies assess outcomes when examining training impact. Inconsistencies in theoretical frameworks and training makes it difficult to assess the efficacy of training on patient outcomes. RESULTS Of 7879 unique studies identified, five met inclusion criteria including two randomised control trials, two mixed method and one multi-method pre/post study. Professionals reported the training was beneficial, and some improvements in patient perceptions of health providers' cultural competence were found. However, patient health outcomes did not improve significantly in any study. CONCLUSION Cultural competence training is promoted to improve outcomes of patients from culturally diverse backgrounds; however, few studies assess outcomes when examining training impact. Inconsistencies in theoretical frameworks and training makes it difficult to assess the efficacy of training on patient outcomes. PRACTICE IMPLICATIONS To ascertain the benefits of health professional cultural competence training on patient outcomes, research needs to address the issues of definition, theoretical frameworks and implementation approaches to training.
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Affiliation(s)
| | - Victoria M White
- School of Psychology, Faculty of Health, Deakin University, Burwood 3125, Australia
| | - Patricia Livingston
- School of Psychology, Faculty of Health, Deakin University, Burwood 3125, Australia
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Bouchard KL, Grigsby-Toussaint DS, Fox K, Amin S, Vadiveloo M, Greaney ML, Tovar A. Maternal Experiences with Discussing Complementary Feeding in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12061. [PMID: 36231363 PMCID: PMC9566633 DOI: 10.3390/ijerph191912061] [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: 08/03/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Complementary feeding practices promote healthy eating habits and food preferences later in life. Little is known about how US pediatricians communicate infant feeding practices to caregivers or how caregivers respond to this information. The purpose of this study is to explore mothers' experiences and perceptions of the complementary feeding recommendations they receive in primary care settings. English- and Spanish-speaking mothers of infants were recruited from Special Supplemental Nutrition for Women, Infants, and Children offices in Rhode Island, US, and snowball sampling. Semi-structured telephone interviews were conducted to investigate mothers' discussions with pediatricians about complementary feeding and their overall impressions of wellness visits. Thematic analysis was informed by the Fundamentals of Care theoretical framework. The mean age of the sample (n = 13) was 30.5 years and 62% self-identified as Latina. Four themes emerged from the analysis: (1) wellness visits are mostly positive experiences, (2) not all infant feeding recommendations are easy to follow, (3) alternative sources of infant feeding recommendations can be just as helpful, and (4) there is room for improvement at wellness visits. Improving the content, delivery, and cultural relevance of infant feeding recommendations in primary care settings with more specific and tailored information may promote adherence to evidence-based practices.
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Affiliation(s)
- Kelly Lynn Bouchard
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Diana S. Grigsby-Toussaint
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
| | - Katelyn Fox
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Sarah Amin
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Maya Vadiveloo
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
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Massett HA, Mitchell AK, Alley L, Simoneau E, Burke P, Han SH, Gallop-Goodman G, McGowan M. Facilitators, Challenges, and Messaging Strategies for Hispanic/Latino Populations Participating in Alzheimer's Disease and Related Dementias Clinical Research: A Literature Review. J Alzheimers Dis 2021; 82:107-127. [PMID: 33998537 DOI: 10.3233/jad-201463] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) disproportionally affect Hispanic and Latino populations, yet Hispanics/Latinos are substantially underrepresented in AD/ADRD clinical research. Diverse inclusion in trials is an ethical and scientific imperative, as underrepresentation reduces the ability to generalize study findings and treatments across populations most affected by a disease. This paper presents findings from a narrative literature review (N = 210) of the current landscape of Hispanic/Latino participation in clinical research, including the challenges, facilitators, and communication channels to conduct culturally appropriate outreach efforts to increase awareness and participation of Hispanics/Latinos in AD/ADRD clinical research studies. Many challenges identified were systemic in nature: lack of culturally relevant resources; staffing that does not represent participants' cultures/language; eligibility criteria that disproportionately excludes Hispanics/Latinos; and too few studies available in Hispanic/Latino communities. The paper also details facilitators and messaging strategies to improve engagement and interest among Hispanics/Latinos in AD/ADRD research, starting with approaches that recognize and address the heterogeneity of the Hispanic/Latino ethnicity, and then, tailor outreach activities and programs to address their diverse needs and circumstances. The needs identified in this article represent longstanding failures to improve engagement and interest among Hispanics/Latinos in AD/ADRD research; we discuss how the field can move forward learning from the experiences of the COVID-19 pandemic.
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Affiliation(s)
- Holly A Massett
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | - Sae H Han
- Kelly Government, Kelly Services, Inc., Rockville, MD, USA
| | - Gerda Gallop-Goodman
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Melissa McGowan
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
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Sasegbon A, Vasant DH. Understanding racial disparities in the care of patients with irritable bowel syndrome: The need for a unified approach. Neurogastroenterol Motil 2021; 33:e14152. [PMID: 33835634 DOI: 10.1111/nmo.14152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/23/2021] [Indexed: 12/14/2022]
Abstract
Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut-brain interaction, which significantly erodes the quality of life of those it affects. Recent studies have confirmed that its prevalence varies quite markedly between countries, implying that it is affected by cultural and socioeconomic factors. In an important study, Silvernale at al. have recently reported racial disparities including potential referral biases, with reduced opportunities to access specialist care and differing patterns of healthcare utilization affecting ethnic minority populations with IBS. Similar disparities have also been reported for other gastrointestinal disorders. In this paper, we, therefore, discuss the potential implications of such disparities and how they can impact clinical outcomes, and discuss ways in which this problem could be addressed, and highlighting areas for future research.
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Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - Dipesh H Vasant
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK.,Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Forkin KT, Dunn LK, Kotha NC, Bechtel AJ, Kleiman AM, Huffmyer JL, Collins SR, Lyons GR, Ma JZ, Nemergut EC. Anesthesiologist Age and Sex Influence Patient Perceptions of Physician Competence. Anesthesiology 2021; 134:103-110. [PMID: 33108442 PMCID: PMC7725924 DOI: 10.1097/aln.0000000000003595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uncovering patients' biases toward characteristics of anesthesiologists may inform ways to improve the patient-anesthesiologist relationship. The authors previously demonstrated that patients prefer anesthesiologists displaying confident body language, but did not detect a sex bias. The effect of anesthesiologists' age on patient perceptions has not been studied. In this follow-up study, it was hypothesized that patients would prefer older-appearing anesthesiologists over younger-appearing anesthesiologists and male over female anesthesiologists. METHODS Three hundred adult, English-speaking patients were recruited in the Preanesthesia Evaluation and Testing Center. Patients were randomized (150 per group) to view a set of four videos in random order. Each 90-s video featured an older female, older male, younger female, or younger male anesthesiologist reciting the same script describing general anesthesia. Patients ranked each anesthesiologist on confidence, intelligence, and likelihood of choosing the anesthesiologist to care for their family member. Patients also chose the one anesthesiologist who seemed most like a leader. RESULTS Three hundred patients watched the videos and completed the questionnaire. Among patients younger than age 65 yr, the older anesthesiologists had greater odds of being ranked more confident (odds ratio, 1.92; 95% CI, 1.41 to 2.64; P < 0.001) and more intelligent (odds ratio, 2.24; 95% CI, 1.62 to 3.11; P < 0.001), and had greater odds of being considered a leader (odds ratio, 2.62; 95% CI, 1.72 to 4.00; P < 0.001) when compared with younger anesthesiologists. The preference for older anesthesiologists was not observed in patients age 65 and older. Female anesthesiologists had greater odds of being ranked more confident (odds ratio, 1.46; 95% CI, 1.13 to 1.87; P = 0.003) and more likely to be chosen to care for one's family member (odds ratio, 1.80; 95% CI, 1.40 to 2.31; P < 0.001) compared with male anesthesiologists. The ranking preference for female anesthesiologists on these two measures was observed among white patients and not among nonwhite patients. CONCLUSIONS Patients preferred older anesthesiologists on the measures of confidence, intelligence, and leadership. Patients also preferred female anesthesiologists on the measures of confidence and likelihood of choosing the anesthesiologist to care for one's family member. EDITOR’S PERSPECTIVE
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Affiliation(s)
| | - Lauren K. Dunn
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | - Naveen C. Kotha
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | - Allison J. Bechtel
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | - Amanda M. Kleiman
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | - Julie L. Huffmyer
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | - Stephen R. Collins
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
| | - Genevieve R. Lyons
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Jennie Z. Ma
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Edward C. Nemergut
- Department of Anesthesiology, University of Virginia, Charlottesville, VA
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
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Thakur A, Adhikari S, Anderson D, Feinn R. Health Care Access and Utilization by Nepalese Adults in Connecticut. Cureus 2019; 11:e4543. [PMID: 31263650 PMCID: PMC6592465 DOI: 10.7759/cureus.4543] [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] [Indexed: 12/04/2022] Open
Abstract
Introduction Access to healthcare and the utilization of health services at both the state and national levels are frequent areas of study, specifically in major ethnic populations such as White, Black, and Hispanic/Latino. However, there are few studies assessing healthcare access and utilization in the Nepalese communities in the United States (U.S.), despite the rapidly growing population of Nepalese immigrants. Methods To explore this issue, we conducted a questionnaire-based survey of Nepalese adults in Connecticut (CT). Results When compared to the reporting of the general CT population, a greater percentage of this survey’s respondents report having trouble accessing necessary care (21.1% vs 11.0% in CT). Despite this, more Nepalese adults report satisfaction with the provider in terms of time spent during the visit (81.8% vs 76.0% in CT) and a consideration of values and beliefs during treatment (86.2% vs 70.0% in CT). In comparison with previous national reporting of the general U.S. population, Nepalese adults in the survey tend to have fewer total health care visits annually (87.1% reporting between zero and three visits vs. 64.7% in the U.S.). They also reported fewer dental visits (60.6% vs 71.0% in the U.S.). Conclusion While this novel study is one of the few examining health in the Nepalese population in the U.S., it serves as a foundation for future research in this area. Additionally, the results of the study highlight important disparities that local Nepalese organizations can use to design initiatives to improve this population’s health.
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Affiliation(s)
- Abhishek Thakur
- Internal Medicine, Frank H. Netter MD School of Medicine, North Haven, USA
| | - Srijan Adhikari
- Neurosurgery, Frank H. Netter MD School of Medicine, North Haven, USA
| | - Daren Anderson
- Epidemiology and Public Health, Community Health Center, Weitzman Institute, Middletown, USA
| | - Richard Feinn
- Statistics, Frank H. Netter MD School of Medicine, North Haven, USA
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Smothers ZPW, Tu JY, Grochowski C, Koenig HG. Efficacy of an educational intervention on students' attitudes regarding spirituality in healthcare: a cohort study in the USA. BMJ Open 2019; 9:e026358. [PMID: 30948601 PMCID: PMC6500197 DOI: 10.1136/bmjopen-2018-026358] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine if an educational intervention focused on the role of spirituality in healthcare positively affects medical students' attitudes and perceptions relating to this topic. DESIGN A pre-post cohort study. SETTING An undergraduate medical institution affiliated with an academic medical center in the USA. PARTICIPANTS A total of 110 medical students currently on their clinical rotations received the educational intervention, of whom 71 (65%) completed both the presurvey and postsurvey. Demographic variables did not significantly differ from the national average of medical students, or from a comparison group. All students who attended the intervention were given the opportunity to participate in the survey. INTERVENTIONS The educational intervention consisted of a 60-minute lecture focusing on religion/spirituality (R/S) in healthcare, followed by a 90-minute case discussion in a small group setting. PRIMARY AND SECONDARY OUTCOME MEASURES Assessment consisted of 18-item preintervention and postintervention survey quantifying student's attitudes towards, comfort with, and perceptions of R/S in healthcare. RESULTS Attitudes towards, comfort with, and perceptions of R/S in healthcare were generally positive preintervention. Following the intervention, students expressed an increased willingness to include R/S competency in their future practice (p=0.001), were more comfortable sharing their own R/S beliefs with a patient when appropriate (p=0.02), and were more willing to approach a patient with R/S concern (p=0.04). The other surveyed attitudes demonstrated positive, but non-significant improvement. CONCLUSION An educational intervention focusing on approaching patients with R/S concerns has the ability to improve the attitudes and comfort of medical students. By incorporating a total of 150 minutes of education about R/S, medical schools can help develop this particular area of cultural competence, preparing a generation of physicians to professionally approach R/S concerns of patients. Future research should move beyond quantifying attitudes and strive to understand changes in knowledge and student behaviour.
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Affiliation(s)
| | - Jennifer Young Tu
- Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - Colleen Grochowski
- Office of Curricular Affairs, Duke University School of Medicine, Durham, North Carolina, USA
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Broom A, Parker RB, Kirby E, Kokanović R, Woodland L, Lwin Z, Koh ES. A qualitative study of cancer care professionals' experiences of working with migrant patients from diverse cultural backgrounds. BMJ Open 2019; 9:e025956. [PMID: 30904870 PMCID: PMC6475197 DOI: 10.1136/bmjopen-2018-025956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To improve the experiences of people from diverse cultural backgrounds, there has been an increased emphasis on strengthening cultural awareness and competence in healthcare contexts. The aim of this focus-group based study was to explore how professionals in cancer care experience their encounters with migrant cancer patients with a focus on how they work with cultural diversity in their everyday practice, and the personal, interpersonal and institutional dimensions therein. DESIGN This paper draws on qualitative data from eight focus groups held in three local health districts in major metropolitan areas of Australia. Participants were health professionals (n=57) working with migrants in cancer care, including multicultural community workers, allied health workers, doctors and nurses. Focus group discussions were audio recorded and transcribed in full. Data were analysed using the framework approach and supported by NVivo V.11 qualitative data analysis software. RESULTS Four findings were derived from the analysis: (1) culture as merely one aspect of complex personhood; (2) managing culture at the intersection of institutional, professional and personal values; (3) balancing professional values with patient values and beliefs, and building trust and respect; and (4) the importance of time and everyday relations for generating understanding and intimacy, and for achieving culturally competent care. CONCLUSIONS The findings reveal: how culture is often misconstrued as manageable in isolation; the importance of a renewed emphasis on culture as interpersonal and institutional in character; and the importance of prioritising the development of quality relationships requiring additional time and resource investments in migrant patients for enacting effective intercultural care.
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Affiliation(s)
- Alex Broom
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Rhiannon Bree Parker
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Emma Kirby
- Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Renata Kokanović
- Social and Global Studies Centre, RMIT University, Melbourne, Victoria, Australia
- Monash Centre for Health Research and Innovation, Monash University, Melbourne, Victoria, Australia
| | - Lisa Woodland
- Multicultural Health Service, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Zarnie Lwin
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Medical Oncology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Department of Radiation Oncology, Liverpool Hospital, Sydney, New South Wales, Australia
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Shepherd SM, Willis-Esqueda C, Newton D, Sivasubramaniam D, Paradies Y. The challenge of cultural competence in the workplace: perspectives of healthcare providers. BMC Health Serv Res 2019; 19:135. [PMID: 30808355 PMCID: PMC6390600 DOI: 10.1186/s12913-019-3959-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background Cross-cultural educational initiatives for professionals are now commonplace across a variety of sectors including health care. A growing number of studies have attempted to explore the utility of such initiatives on workplace behaviors and client outcomes. Yet few studies have explored how professionals perceive cross-cultural educational models (e.g., cultural awareness, cultural competence) and the extent to which they (and their organizations) execute the principles in practice. In response, this study aimed to explore the general perspectives of health care professionals on culturally competent care, their experiences working with multi-cultural patients, their own levels of cultural competence and the extent to which they believe their workplaces address cross-cultural challenges. Methods The perspectives and experiences of a sample of 56 health care professionals across several health care systems from a Mid-Western state in the United States were sourced via a 19-item questionnaire. The questionnaire comprised both open-ended questions and multiple choice items. Percentages across participant responses were calculated for multiple choice items. A thematic analysis of open-ended responses was undertaken to identify dominant themes. Results Participants largely expressed confidence in their ability to meet the needs of multi-cultural clientele despite almost half the sample not having undergone formal cross-cultural training. The majority of the sample appeared to view cross-cultural education from a ‘cultural awareness’ perspective - effective cross-cultural care was often defined in terms of possessing useful cultural knowledge (e.g., norms and customs) and facilitating communication (the use of interpreters); in other words, from an immediate practical standpoint. The principles of systemic cross-cultural approaches (e.g., cultural competence, cultural safety) such as a recognition of racism, power imbalances, entrenched majority culture biases and the need for self-reflexivity (awareness of one’s own prejudices) were scarcely acknowledged by study participants. Conclusions Findings indicate a need for interventions that acknowledge the value of cultural awareness-based approaches, while also exploring the utility of more comprehensive cultural competence and safety approaches.
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Affiliation(s)
- Stephane M Shepherd
- Centre for Forensic Behavioural Science, Swinburne University of Technology, 1/582 Heidelberg Rd, Alphington, Melbourne, Victoria, Australia.
| | - Cynthia Willis-Esqueda
- Department of Psychology, University of Nebraska-Lincoln, Burnett Hall, Lincoln, NE, USA
| | - Danielle Newton
- School of Social & Political Sciences, The University of Melbourne, Gratton Street, Melbourne, Victoria, Australia
| | - Diane Sivasubramaniam
- School of Psychological Sciences, Swinburne University of Technology, John St, Hawthorn, Melbourne, Victoria, Australia
| | - Yin Paradies
- Alfred Deakin Research Institute for Citizenship and Globalisation, Deakin University, Burwood, Melbourne, Victoria, Australia
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Abstract
Abstract
Editor’s Perspective
What We Know about This Topic
What This Article Tells Us That Is New
Background
Patient perception of physician competence is important. The role of body language and physician sex on patient perceptions has not been investigated. The authors hypothesized that patients perceive anesthesiologists displaying confident body language as more competent and that patients would prefer male anesthesiologists.
Methods
Two hundred adult patients presenting to the Preanesthesia Evaluation and Testing Center at the University of Virginia Health System were recruited to participate using consecutive sampling. Patients viewed four 90-s videos in random order. Each video featured a male or female actor displaying confident, high-power poses or unconfident, low-power poses. Each actor recited the same script describing general anesthesia. Patients were randomized (100 per group) to view one of two sets of videos to account for any actor preferences. Participants ranked each actor anesthesiologist on perceived confidence, intelligence, and likelihood of choosing that anesthesiologist to care for their family member. Participants also chose the one actor anesthesiologist who seemed most like a leader.
Results
Two hundred patients watched the videos and completed the questionnaire. Actor anesthesiologists displaying confident, high-power body language had greater odds of being ranked as more confident (odds ratio, 2.27; 95% CI, 1.76 to 2.92; P < 0.0001), more intelligent (odds ratio, 1.69; 95% CI, 1.13 to 2.18; P < 0.0001), more likely chosen to care for one’s family member (odds ratio, 2.34; 95% CI, 1.82 to 3.02; P < 0.0001), and more likely to be considered a leader (odds ratio, 2.60; 95% CI, 1.86 to 3.65; P < 0.0001). Actor anesthesiologist sex was not associated with ranking for any response measures.
Conclusions
Patients perceive anesthesiologists displaying confident body language as more confident, more intelligent, more like a leader, and are more likely to choose that anesthesiologist to care for their family member. Differences in patient perceptions based on sex of the anesthesiologist were not detected.
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Dai Z, MacDorman KF. The doctor's digital double: how warmth, competence, and animation promote adherence intention. PeerJ Comput Sci 2018; 4:e168. [PMID: 33816821 PMCID: PMC7924424 DOI: 10.7717/peerj-cs.168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/30/2018] [Indexed: 06/12/2023]
Abstract
BACKGROUND Each year, patient nonadherence to treatment advice costs the US healthcare system more than $300 billion and results in 250,000 deaths. Developing virtual consultations to promote adherence could improve public health while cutting healthcare costs and usage. However, inconsistencies in the realism of computer-animated humans may cause them to appear eerie, a phenomenon termed the uncanny valley. Eeriness could reduce a virtual doctor's credibility and patients' adherence. METHODS In a 2 × 2 × 2 between-groups posttest-only experiment, 738 participants played the role of a patient in a hypothetical virtual consultation with a doctor. The consultation varied in the doctor's Character (good or poor bedside manner), Outcome (received a fellowship or sued for malpractice), and Depiction (a recorded video of a real human actor or of his 3D computer-animated double). Character, Outcome, and Depiction were designed to manipulate the doctor's level of warmth, competence, and realism, respectively. RESULTS Warmth and competence increased adherence intention and consultation enjoyment, but realism did not. On the contrary, the computer-animated doctor increased adherence intention and consultation enjoyment significantly more than the doctor portrayed by a human actor. We propose that enjoyment of the animated consultation caused the doctor to appear warmer and more real, compensating for his realism inconsistency. Expressed as a path model, this explanation fit the data. DISCUSSION The acceptance and effectiveness of the animation should encourage the development of virtual consultations, which have advantages over creating content with human actors including ease of scenario revision, internationalization, localization, personalization, and web distribution.
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Tang C, Tian B, Zhang X, Zhang K, Xiao X, Simoni JM, Wang H. The influence of cultural competence of nurses on patient satisfaction and the mediating effect of patient trust. J Adv Nurs 2018; 75:749-759. [DOI: 10.1111/jan.13854] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/22/2018] [Accepted: 08/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Chulei Tang
- Xiangya School of Nursing Central South University ChangshaChina
| | | | - Xiaoxia Zhang
- Xiangya School of Nursing Central South University ChangshaChina
- Nursing Faculty Henan Medical College ZhengzhouChina
| | - Kaili Zhang
- Xiangya School of Nursing Central South University ChangshaChina
| | - Xueling Xiao
- Xiangya School of Nursing Central South University ChangshaChina
| | - Jane M. Simoni
- Department of Psychology University of Washington Seattle Washington
| | - Honghong Wang
- Xiangya School of Nursing Central South University ChangshaChina
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Does Having a Culturally Competent Health Care Provider Affect the Patients' Experience or Satisfaction? A Critically Appraised Topic. J Sport Rehabil 2018; 27:284-288. [PMID: 28095168 DOI: 10.1123/jsr.2016-0123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: The level of cultural competence of health care providers has been studied. However, limited scholarship has examined whether the cultural competence of the health care provider affects patient satisfaction. Focused Clinical Question: Does cultural competence of health care providers influence patient satisfaction with their experience with their provider? Summary of Key Findings: Having a culturally competent health care provider, or one who a patient perceives as culturally competent, does increase patient satisfaction. Clinical Bottom Line: Cultural competence in health care plays an important role in patients being satisfied with their providers, as well as patients willingly and actively participating in their treatment. Strength of Recommendation: Questions 1 to 5 and 9 of the critical appraisal skills program were answered "yes" for all studies in the critically appraised topic. Thus, the authors strongly support the findings.
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Grønhaug G. Addressing the elephant in the room: a possible new way to increase patient adherence to medical advice. Patient Prefer Adherence 2017; 11:1083-1089. [PMID: 28721021 PMCID: PMC5499786 DOI: 10.2147/ppa.s138716] [Citation(s) in RCA: 2] [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: 11/30/2022] Open
Abstract
Lack of patient adherence to medical advice (PAMA) is recognized as an area of interest. None of the previous initiatives to improve PAMA, such as patient centered care and shared decision making, have proved to be successful in terms of improving patient adherence. The aim of the present study is to assess beliefs about priorities in public health care, and adherence to medical advice, to establish a novel approach to increase PAMA. The present study is based on responses to two questions in an experimental survey from the Norwegian Citizen Panel, addressing people's attitudes to priorities in public health care and adherence to medical advice. The questions on priorities in the health care sector are organized into six groups. The questions on adherence are organized into three groups. All questions are answered on a 7-point Likert scale. This study is the first to use experimental surveys to assess PAMA. The results indicate that if health care providers refer to national expertise and patient organizations' recommendations on a given treatment, PAMA could improve. Although technical and methodological interventions in health care have, to some extent, improved PAMA, medical adherence is still low. In the present study, it is shown that integrating either national expertise or collaborated messages with other health professions and patient organizations' recommendations in everyday care may help improve patients adherence to medical advice. A minor change in how treatment suggestions are presented could improve PAMA.
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Affiliation(s)
- Gudmund Grønhaug
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Correspondence: Gudmund Grønhaug, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, Trondheim, N-7491, Norway, Tel +47 9596 1450, Email
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