Use of humour in primary care: different perceptions among patients and physicians

Effects of Laughter Therapy on Improving Negative Emotions Associated with Cancer: A Systematic Review and Meta-Analysis

INTRODUCTION

With aging and growth of the population, the risk of cancer incidence and mortality is rapidly increasing. However, psychosocial treatment has been seriously neglected in many healthcare settings. Laughter therapy is a therapeutic program to improve emotional wellbeing and health which has been applied as a complementary treatment. We aim to explore effects of laughter therapy for patients with cancer on their negative emotions such as depression, anxiety, stress, pain, and fatigue.

METHODS

We searched the Cochrane Library, Embase, PubMed, Scopus, Web of Science, WANFANG data, Weipu (VIP), Chinese National Knowledge Infrastructure (CNKI) and independently rated the risk of bias in every article using the Cochrane Collaboration's Risk of Bias Assessment Tool. Review Manager and STATA software were used to pool the individually included studies.

RESULTS

Seven studies were found eligible to be included in the present review. Overall, study quality was relatively high. Our findings suggest that laughter therapy might have a positive effect on improving emotional response in cancer patients. Arguably, laughter therapy, whether humor or laughter, has a positive effect on anxiety, stress, pain feeling, fatigue, and depression in cancer patients.

CONCLUSIONS

Laughter therapy is a convenient, multi-modality, flexible-duration therapy to improve negative emotions in cancer patients, regardless of their gender, age, and type of cancer.

Laughs and Jokes in Assisted Reproductive Technologies: Quantitative and Qualitative Analysis of Video-Recorded Doctor-Couple Visits

Purpose: To explore the characteristics of the use of laughs and jokes during doctor-couple assisted reproductive technology (ART) visits.

Methods: 75 videotaped doctor-couple ART visits were analyzed and transcribed in order to: (1) quantify laugh and jokes, describing the contribution of doctors and couples and identifying the timing of appearance; (2) explore the topic of laughs and jokes with qualitative thematic analysis.

Results: On average, each visit contained 17.1 utterances of laughs and jokes. Patients contributed for 64.7% of utterances recorded. Doctor (40.6%) and women (40%) introduced the majority of laughs and jokes. Visits with female physicians had significantly more laughs and jokes than visits with male doctors; no differences were found considering physicians’ age and years of experience, cause of infertility, and prognosis. Laughs and jokes were mainly recorded during history taking and information giving. Four core themes were identified, regarding the topic of laughs and jokes: health status, infertility treatment, organizational aspects, and doctor-patient interaction.

Conclusion: Laughs and jokes are common in doctor-couple ART visits and are frequently used during the dialogue, covering a wide range of topics. Results seem to show that laughs and jokes are related to doctor’s personal characteristics (like gender), while are not associated with infertility aspects. Given the complexity of this communicative category, further studies are needed to explore the functions and the effects of laugh and jokes.

The importance of humour in oncology: a survey of patients undergoing radiotherapy

Background

Humour has long been considered an important coping tool for patients with cancer, but published quantitative data about its significance are limited. The purpose of our study was to survey patients with cancer undergoing radiotherapy regarding their opinions about the use of humour in their care.

Methods

An anonymous 35-item questionnaire evaluating the patient experience, including the value of humour, was developed by an interdisciplinary team of health care providers (hcps) working within the Radiation Medicine program. This anonymous, voluntary, paper-based survey for self-completion required approximately 10 minutes to finish and was administered during the fall of 2018 and the spring of 2019.

Results

For the 199 patients who completed the survey [108 women, 89 men (2 respondents did not specify)], median age was 68 years. That group represents approximately 30%-35% of the patients on treatment during the study period. Almost all respondents (86%) indicated that, during their visits to the cancer centre, it was "somewhat important" or "very important" for health care providers (hcps) to use appropriate humour, and 61% of respondents indicated using humour "frequently" or "always" when dealing with their individual cancers. Most respondents (79%) said that humour decreased anxiety, and 86% indicated that laughing was considered "somewhat important" or "very important." Approximately 4% of respondents even listed "sense of humour" as being the most important quality that they looked for in their interactions with their hcps.

Conclusions

Cancer patients undergoing radiotherapy clearly view humour as being important for coping and dealing with their disease, and oncology hcps should routinely consider incorporating the use of appropriate humour into the care that they provide.

Humor and sympathy in medical practice

Medical professionals seem to interpret their uses of humor very differently from those outside the medical profession. Nurses and physicians argue that humor is necessary for them to do their jobs well. Many (potential) patients are horrified that they could one day be the butt of their physician's jokes. The purpose of this paper is to encourage the respectful use of humor in clinical prac-tice, so as to support its importance in medical practice, while simultaneously protecting against its potential abuse. I begin by examining two extremes of supporting or chastising the use of medical humor. I look at these views through the lenses of popular theories of humor to help explain their theoretical bases. In this second section, I explain the emotional aspect of humor as an embodied and embedded transformation of the world. This clarifies the role that humor plays in our daily lives, as well as why the ethical or unethical nature of its use is dependent on context. Third, I address the potential problems in the relationship between humor and clinical sympathy, and how this further affects the relationship between medical professionals and their patients. I conclude by arguing that humor can conflict with clinical sympathy, but this need not be the case. If medical professionals actively engage with clinical sympathy and focus on using humor in a way that is respectful towards their patients, then humor can continue to be a positive force in their lives while still providing the best care for their patients.

Resonance and dissonance asymmetry in effective physician-patient relationships

This paper examines the proposed asymmetry that should occur between resonance and dissonance in physician-patient relationships in favour of resonance to facilitate an effective relationship. Resonance is represented by the positive emotional attractor, which comprises patients' conscious preferred future or ideal self, and dissonance is expressed by the negative emotional attractor and consists of the gaps between patients' ideal and real self or their fears, problems, and shortfalls. Intentional change theory is reviewed to optimise the physician-patient relationship. Concepts from complexity theory and recent research on emotions are used to explain positive and negative emotional attractors. The role of resonance and dissonance in physician-patient relationships is discussed along with how behaviour can be changed with positive and negative emotional attractors. This paper focuses on the quality and effectiveness of physician-patient relationships for physicians who create high versus low positive emotional attractor/negative emotional attractor ratios. Two theoretical propositions are offered and the research and practice implications are explained.

[Ethical aspects of teaching of nervous diseases]

Ethical aspects of training of physicians are considered. The author highlights the importance of teaching the basic disciplines during the training of the neurologist. An analysis of most frequent mistakes that arise in practical activity as a consequence of overestimation of paraclinical methods of investigation, underestimation of a role of treatment that the patient receives due to other indications is presented. The formation of life attitude of the physician is the extremely important component of teaching process. One should not forget the lessons of history shown examples of physicians that gave their lives to save patients. Also, there are examples of physicians who had violated the fundamental humanitarian principles.

What do people appreciate in physicians' communication? An international study with focus groups using videotaped medical consultations

BACKGROUND

The literature shows that the quality of communication is usually determined from a professional perspective. Patients or lay people are seldom involved in the development of quality indicators or communication.

OBJECTIVE

To give voice to the lay people perspective on what constitutes 'good communication' by evoking their reactions to variations in physician communication.

DESIGN

Lay people from four different countries watched the same videotaped standardized medical encounters and discussed their preferences in gender-specific focus groups who were balanced in age groups.

SETTING AND PARTICIPANTS

Two hundred and fifty-nine lay people (64 NL, 72 IT, 75 UK and 48 BE) distributed over 35 focus groups of 6-8 persons each.

MAIN VARIABLES STUDIED

Comments on doctors' behaviours were classified by the GULiVer framework in terms of contents and preferences.

RESULTS

Participants prevalently discussed 'task-oriented expressions' (39%: competency, self-confident, providing solutions), 'affective oriented/emotional expressions' (25%: empathy, listening, reassuring) and 'process-oriented expressions' (23%: flexibility, summarizing, verifying). 'Showing an affective attitude' was most appreciated (positive percentage within category: 93%, particularly facilitations and inviting attitude), followed by 'providing solution' (85%). Among disfavoured behaviour, repetitions (88%), 'writing and reading' (54%) and asking permission (42%) were found.

CONCLUSIONS

Although an affective attitude is appreciated by nearly everybody, people may vary widely in their communication needs and preferences: what is 'good communication' for one person may be disliked or even a source of irritation for another. A physician should be flexible and capable of adapting the consultation to the different needs of different patients. This challenges the idea of general communication guidelines.

Humor

Humor has not been taken as seriously as it should be. Humor has many positive effects in the daily lives of patients and clinicians need to take advantage of these. Many indices of stress are attenuated and this serves to improve the therapeutic alliance. Freudian, rational emotive therapy, and kleinian views are presented, as well as examples of how to use playful therapy. In addition, advice on how to develop humor is given.

Humour in health-care interactions: a risk worth taking

BACKGROUND

Humour is a complex, dynamic phenomenon that mainly occurs in social situations between two or more people. Most humour research reviews rehearsed as opposed to spontaneous humour and rarely review the patients' perspective.

AIM

We explore patients' perspectives on the use of humour in health care. We discuss the asymmetrical and divergent humour use between patients and clinical nurse specialists and posit nurses' approaches to risk as a contributing factor.

DESIGN

A constructivist grounded theory collated researcher-provoked (interviews, observation, field notes, pre-and post-interaction audio diaries) and non-researcher-provoked data (naturally occurring interactions) over 18 months. This paper is based upon four patient focus groups. A constant comparison approach to data collection and analyses was applied using interpretative and illustrative frameworks that balanced what was 'known' and 'unknown' about humour.

SETTING AND PARTICIPANTS

Patients were recruited from four patient-peer groups. Three audio-taped (n = 20) and one observed focus group interactions (n = 12) were undertaken at the groups' regular meeting places.

RESULTS

Patients hold a broad appreciation of humour and recognize it as being evident in subtle and nuanced forms. Patients wish health-care staff to initiate and reciprocate humour.

CONCLUSION

A chasm exists between what patients apparently want with regard to humour use in health-care interactions and what actually transpires. Initiating humour involves risk, and risk-taking requires a degree of self-esteem and confidence. Nurses are, arguably, risk-averse and have low self-esteem. Future research could review confidence and self-esteem markers with observed humour use in nurses and their interactions across a range of specialities.

Laughter and positive therapies: modern approach and practical use in medicine

The exploration of the possible strategies centered in positive emotions is a suggestion to investigate and probably useful to raise the efficiency of therapeutic interventions. Laughter and humor have been classified as part of the 24 personal strengths and are considered as one of the activities that encourage personal well-being, savoring, and promoting flow states. Laughter therapy, classified within alternative or complementary therapies in medicine, includes a group of techniques and therapeutic interventions aimed to achieve laughter experiences which result in health-related outcomes, both physiological and psychological. Recent advent of positive psychology has developed high interest and expectations in the benefits of adding positive techniques to laughter therapy (and to other mind-body therapies). Consequently with this modern approach positive laughter therapy was born, as add-on to conventional laughter therapy and positive psychology, with its contributions and limitations. Health professionals can exert an important role in order to disseminate overall benefits of "positive therapies" while applying them in real-world clinical settings, for both patients and themselves.

Medical clowning: even adults deserve a dream

The article examines the significance of the integration of medical clowns as an intervention strategy with adult outpatients suffering from chronic illnesses. The study is based on content analysis of the documentation of the work of two medical clowns over two years. The dominant theme involves the definition of the clown's role and includes perspectives on his integration into the hospital's multidisciplinary medical staff and his impact on the staff and on patients and their families. The finding is discussed in light of the dual role of the medical social worker as coordinator and as a case manager, and the challenge of integrating medical clowns in treatment of adult patients. There is room for further exploration of the contribution of medical clowns to assisting and improving the quality of life for patients and hospital staff.

Development and Validation of the Physician—Patient Humor Rating Scale

The purpose of this study was the development of a rating instrument to assess the use of humor in physician— patient interactions, and to compare humor use as a function of patients’ socioeconomic status. The 46-item Physician—Patient Humor Rating Scale (PPHRS) was used to rate 246 audiotaped primary care interactions. Four subscales were reliable and valid, demonstrating correlations with patient satisfaction and reports of physician humor, with physician satisfaction and with separate affective communication ratings. There was a significant difference in use of humor as a function of patient socioeconomic status, such that there was greater mutual trust between physicians and high versus low income patients.

From critical care to comfort care: the sustaining value of humour

AIMS AND OBJECTIVES

To identify commonalities in the findings of two research studies on humour in diverse settings to illustrate the value of humour in team work and patient care, despite differing contexts. Background. Humour research in health care commonly identifies the value of humour for enabling communication, fostering relationships, easing tension and managing emotions. Other studies identify situations involving serious discussion, life-threatening circumstances and high anxiety as places where humour may not be appropriate. Our research demonstrates that humour is significant even where such circumstances are common place.

METHOD

Clinical ethnography was the method for both studies. Each researcher conducted observational fieldwork in the cultural context of a healthcare setting, writing extensive fieldnotes after each period of observation. Additional data sources were informal conversations with patients and families and semi-structured interviews with members of the healthcare team. Data analysis involved line-by-line analysis of transcripts and fieldnotes with identification of codes and eventual collapse into categories and overarching themes.

RESULTS

Common themes from both studies included the value of humour for team work, emotion management and maintaining human connections. Humour served to enable co-operation, relieve tensions, develop emotional flexibility and to 'humanise' the healthcare experience for both caregivers and recipients of care.

CONCLUSIONS

Humour is often considered trivial or unprofessional; this research verifies that it is neither. The value of humour resides, not in its capacity to alter physical reality, but in its capacity for affective or psychological change which enhances the humanity of an experience, for both care providers and recipients of care. Relevance to clinical practice. In the present era which emphasises technology, efficiency and outcomes, humour is crucial for promoting team relationships and for maintaining the human dimension of health care. Nurses should not be reluctant to use humour as a part of compassionate and personalised care, even in critical situations.

The purpose and function of humour in health, health care and nursing: a narrative review

AIM

This paper is a report of a review conducted to identify, critically analyse and synthesize the humour literature across a number of fields related to health, health care and nursing.

BACKGROUND

The humour-health hypothesis suggests that there is a positive link between humour and health. Humour has been a focus of much contention and deliberation for centuries, with three theories dominating the field: the superiority or tendentious theory, the incongruity theory and the relief theory.

DATA SOURCES

A comprehensive literature search was carried out in January 2007 using a number of databases, keywords, manual recursive searching and journal alerts (January 1980-2007) cross-referenced with the bibliographic databases of the International Society of Humor Studies. An inclusion and exclusion criterion was identified.

REVIEW METHODS

A narrative review of evidence- and non-evidence-based papers was conducted, using a relevant methodological framework with additional scrutiny of secondary data sources in the latter. Humour theories, incorporating definition, process and impact constituted a significant part of the appraisal process.

RESULTS

A total of 1630 papers were identified, with 220 fully sourced and 88 included in the final review. There is a dearth of humour research within nursing yet, ironically, an abundance of non-evidence-based opinion citing prerequisites and exclusion zones. Examination of physician-patient interaction and the humour-health hypothesis demonstrates that use of humour by patients is both challenging and revealing, particularly with regard to self-deprecating humour.

CONCLUSION

Nurses and nursing should adopt a circumspect and evidenced-based approach to humour use in their work.