1
|
Yasmina K, Valérie SDDA. The content of patients' emotional expressions during follow-up consultations for chronic diseases. Chronic Illn 2024:17423953241241758. [PMID: 38528745 DOI: 10.1177/17423953241241758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVES In this article, we seek to extract the themes that patients share when they express negative emotions in the context of follow-up consultation of chronic illness. We are mainly interested in patients with chronic illnesses, as these pathologies have a significant emotional overload leading to a significant deterioration of the patient's quality of life. METHODS Our corpus included audio recordings of 12 chronic disease follow-up consultations conducted by physicians practicing in neurology, nutrition, internal medicine and infectiology. The 12 patients participating suffer from various chronic diseases: Parkinson's, HIV, diabetes, etc. We performed thematic content analyses on the emotional sequences in order to extract the themes underlying these emotional expressions. RESULTS The 10 themes we have extracted are related to physical aspects, psychological aspects, the healthcare system and/or the healthcare provider, prognostic elements, social life, family life, aspects of professional life, issues of daily life, treatments and finally, aspects related to objectives and disease progress. DISCUSSION/CONCLUSION Our results show that follow-up consultations for chronic illnesses are consultations during which patients express emotions for different purposes. These emotional expressions concern particular themes that are not found in other forms of medical consultations. We will compare these results in the discussion part of this article.
Collapse
Affiliation(s)
- Kebir Yasmina
- 2LPN (Psychology and Neuroscience Lab, UR7489), Université de Lorraine, Nancy, France
| | | |
Collapse
|
2
|
Physician eye contact in telemedicine video consultations: A cross-cultural experiment. Int J Med Inform 2022; 165:104825. [DOI: 10.1016/j.ijmedinf.2022.104825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 11/15/2022]
|
3
|
Muraya T, Akagawa Y, Andoh H, Chiang C, Hirakawa Y. Improving person-centered advance care planning conversation with older people: a qualitative study of core components perceived by healthcare professionals. J Rural Med 2021; 16:222-228. [PMID: 34707731 PMCID: PMC8527630 DOI: 10.2185/jrm.2021-022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/17/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: The non-medical needs of patients, such as values and personal
preferences, are likely to be omitted from advance care planning (ACP) discussions because
of a lack of readiness and awareness on the part of healthcare professionals. The aim of
the present study was to identify core components perceived by multidisciplinary
healthcare professionals to improve person-centered ACP conversations with older
people. Methods: The study participants were healthcare professionals (physicians,
nurses, and care managers) working in different cities. This qualitative study was
performed online using eight individual in-depth interviews and one subsequent focus group
composed of eight healthcare professionals. The interviews and focus group discussion were
audio-recorded online and transcribed verbatim. The aim of the analysis of the individual
in-depth interviews was to summarize the transcribed results, create a conceptual
framework for person-centered ACP conversation, and provide meaningful interpretations of
the focus group participant discourse. The qualitative data were then analyzed by
inductive manual coding using a qualitative content analysis approach. Results: Five themes capturing the core components for successful
person-centered ACP were extracted from the ideas voiced by participants: Placing highest
value on patient autonomy and human life; uncovering patient’s true feelings and desires;
sharing collected information on patients’ end-of-life wishes with other team members;
relaying patients’ wishes to the physician; and handling conflicts among patients,
relatives, and healthcare professionals. Conclusion: The results provide guidelines for the future development of
novel, value-based, person-centered ACP practice for multidisciplinary healthcare
professionals.
Collapse
Affiliation(s)
| | - Yuko Akagawa
- Department of Clinical Nursing, Akita University Graduate School of Health Science, Japan
| | - Hideaki Andoh
- Department of Clinical Nursing, Akita University Graduate School of Health Science, Japan
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Japan
| |
Collapse
|
4
|
Abstract
Cultural factors have influenced the presentation, diagnoses, and treatment of anxiety disorders in India for several centuries. This review covers the antecedents, prevalence, phenomenology, and treatment modalities of anxiety disorders in the Indian cultural context. It covers the history of the depiction of anxiety in India and the concept of culture in the classification of anxiety disorders, and examines the cultural factors influencing anxiety disorders in India. We review the prevalence and phenomenology of various disorders, such as generalized anxiety disorder, panic disorder, social anxiety, and phobic disorder, as well as culture-specific syndromes such as dhat and koro in India. Finally, the review examines the wide range of therapeutic modalities practiced in India, such as faith healing, psychotherapy, ayurveda, psychopharmacology, Unani medicine, homeopathy, yoga, meditation, and mindfulness. We conclude by emphasizing the significance of cultural factors in making relevant diagnoses and offering effective and holistic treatments to individuals with anxiety disorders.
Collapse
Affiliation(s)
- Maherra Khambaty
- Department of Psychiatry, Jaslok Hospital and Research Center, Mumbai, India
| | - Rajesh M Parikh
- Department of Psychiatry, Jaslok Hospital and Research Center, Mumbai, India
| |
Collapse
|
5
|
Ragsdale JW, Van Deusen R, Rubio D, Spagnoletti C. Recognizing Patients' Emotions: Teaching Health Care Providers to Interpret Facial Expressions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1270-1275. [PMID: 26983074 DOI: 10.1097/acm.0000000000001163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Facial expressions are an important clue to a patient's emotions. The authors developed a 90-minute workshop in May 2011 to teach physicians and physicians-in-training to interpret facial expressions and to use that skill in the context of patient care. METHOD The workshop included a didactic presentation in which facial expression features were taught using progressively more difficult examples, followed by three interactive exercises. The authors presented the workshop at six separate venues in the United States in 2011 and 2012. To test the effectiveness of this workshop, the authors designed a comprehensive pre- and postworkshop evaluation which assessed participants' skill, knowledge, attitude (toward importance), and confidence. RESULTS A total of 156 health care providers participated in the workshop and completed pre- and postworkshop evaluations. Participants showed substantial improvement in skill and knowledge (fact- and case-based) scores, as well as modest improvement in importance and confidence ratings. Faculty and medical students demonstrated similar baseline measures of skill, knowledge, and importance, though faculty reported a slightly higher confidence in their skills. No correlation was found between baseline ratings of confidence in abilities and any baseline measure of performance. CONCLUSIONS Given the similar baseline performance of faculty and medical students, the ability to interpret facial expressions does not appear to be learned through routine clinical practice, highlighting the need for dedicated facial expression training. The authors were able to demonstrate that physicians and physicians-in-training could effectively learn to recognize emotion by interpreting facial expressions through a short workshop.
Collapse
Affiliation(s)
- John W Ragsdale
- J.W. Ragsdale is assistant professor, Division of Hospital Medicine, Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky. R. Van Deusen is assistant professor of medicine, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. D. Rubio is professor of medicine, biostatistics, nursing, and clinical and translational science, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. C. Spagnoletti is associate professor of medicine, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | | |
Collapse
|
6
|
MacDonald K. Patient-Clinician Eye Contact: Social Neuroscience and Art of Clinical Engagement. Postgrad Med 2015; 121:136-44. [DOI: 10.3810/pgm.2009.07.2039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
7
|
Boerebach BC, Scheepers RA, van der Leeuw RM, Heineman MJ, Arah OA, Lombarts KM. The impact of clinicians' personality and their interpersonal behaviors on the quality of patient care: a systematic review. Int J Qual Health Care 2014; 26:426-81. [DOI: 10.1093/intqhc/mzu055] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
8
|
Cherry MG, Fletcher I, O'Sullivan H, Shaw N. What impact do structured educational sessions to increase emotional intelligence have on medical students? BEME Guide No. 17. MEDICAL TEACHER 2012; 34:11-9. [PMID: 22250672 DOI: 10.3109/0142159x.2011.614293] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Emotional intelligence (EI) is a type of social intelligence that involves monitoring, discriminating between and using emotions to guide thinking and actions. EI is related to interpersonal and communication skills, and is important in the assessment and training of medical undergraduates. AIM This review aimed to determine the impact of structured educational interventions on the EI of medical students. METHODS We systematically searched 14 electronic databases and hand searched high yield journals. We looked at changes in EI and related behaviour of medical students, assessed using Kirkpatrick's hierarchy, provided they could be directly related to the content of the educational intervention. RESULTS A total of 1947 articles were reviewed, of which 14 articles met the inclusion criteria. CONCLUSIONS The use of simulated patients is beneficial in improving EI when introduced in interventions later rather than earlier in undergraduate medical education. Regardless of duration of intervention, interventions have the best effects when delivered: (1) over a short space of time; (2) to students later in their undergraduate education and; (3) to female students. This should be taken into account when designing and delivering interventions. Emphasising the importance of empathetic qualities, such as empathetic communication style should be made explicit during teaching.
Collapse
|
9
|
Meunier J, Libert Y, Merckaert I, Delvaux N, Etienne AM, Liénard A, Marchal S, Reynaert C, Slachmuylder JL, Razavi D. How much is residents' distress detection performance during a clinical round related to their characteristics? PATIENT EDUCATION AND COUNSELING 2011; 85:180-187. [PMID: 21131159 DOI: 10.1016/j.pec.2010.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 09/09/2010] [Accepted: 09/25/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim of this study was to investigate residents' characteristics associated with their performance in detecting patients' distress (detection performance). METHODS Residents' detection performance was assessed in a clinical round. A mean detection performance score was calculated for each resident by comparing residents' rating of patients' distress (VAS) with patients' reported distress (HADS). Residents' characteristics include general (socio-demographic, professional and psychological), detection (self-efficacy, attitudes and outcome expectancies) and performance characteristics (communication skills (LaComm), psychological arousal (STAI) and physiological arousal (heart rate and blood pressure) in a highly emotional and complex simulated interview task). RESULTS Ninety-four residents and 442 inpatients were included. 30% of the variance in residents' detection performance was related to residents' performance characteristics: anxiety level (p=.040) and mean arterial blood pressure (p=.019) before the task; empathy (p=.027) and mean heart rate (p=.043) during the task; mean arterial blood pressure changes (p=.012) during the assessment procedure. CONCLUSION Residents' detection performance is partly related to their performance characteristics. Psychological and physiological arousals are key characteristics--beside empathic skills--that need to be considered in models designed to determine detection performance. PRACTICE IMPLICATIONS Future interventions designed to improve residents' detection performance should focus notably on their performance characteristics.
Collapse
Affiliation(s)
- Julie Meunier
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
D'Agostino TA, Bylund CL. The Nonverbal Accommodation Analysis System (NAAS): initial application and evaluation. PATIENT EDUCATION AND COUNSELING 2011; 85:33-39. [PMID: 20851559 PMCID: PMC4801112 DOI: 10.1016/j.pec.2010.07.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 07/21/2010] [Accepted: 07/29/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To describe the development, initial application, and evaluation of the Nonverbal Accommodation Analysis System (NAAS). Grounded in Communication Accommodation Theory, this coding system provides a method for analyzing physician and patient nonverbal accommodation behaviors within medical consultations. METHODS Video recordings of 45 new visit consultations at a comprehensive cancer center were coded using the NAAS. Inter-rater and intra-rater reliability were assessed. For validation purposes, two independent coders rated all consultations for theoretically related constructs. RESULTS The NAAS demonstrated high levels of reliability. Statistically significant correlations were observed across all 10 behavior categories for both inter-rater and intra-rater reliability. Evidence of content and construct validity was also observed. CONCLUSION The current study presents the initial application and evaluation of a coding system meant for analysis of the nonverbal behavior of physicians and patients within medical consultations. The results of this initial trial and psychometric evaluation provide evidence of the NAAS as a valid and reliable nonverbal accommodation coding system. PRACTICE IMPLICATIONS The NAAS enables researchers to investigate the way in which physicians and patients manage social distance through nonverbal behavior within medical interactions from a theoretically-informed perspective. Such efforts can aid in the development of communication skill interventions.
Collapse
|
11
|
Hsu MY, McCormack B. Using narrative inquiry with older people to inform practice and service developments. J Clin Nurs 2011; 21:841-9. [DOI: 10.1111/j.1365-2702.2011.03851.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
12
|
Abstract
BACKGROUND Evidence suggests that older people hold lower expectations of healthcare, which restricts their involvement. Narrative research provides an option to explore personal experiences beyond the boundaries of a questionnaire, providing insights into decisions involving treatment, screening, and various health practices that can help guide the development and provision of effective healthcare services. PURPOSE The purposes of this article were to develop and to implement a narrative research approach in a rehabilitation unit for older people to inform service development. METHODS This study applied a narrative research approach. Participants in this study were at least 65 years of age and were patients in the target rehabilitation center. They were cognitively and physically able to communicate and give informed consent to participate. Patients were interviewed toward the end of their stay at the rehabilitation center. A total of 28 patients were invited for the interview. Narrative interviewing skills were developed and used in data collection. Literature review and comparative method were used to analyze data. RESULTS Findings revealed researcher characteristics, including respect, understanding, and acceptance, as key attributes of success in conducting narrative work with the older people. Narrative interview skills were essential to sustain such characteristics when collecting participant stories. It was found that participants who had been already assigned a discharge date were more likely to participate in the narrative interview. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Narrative approaches aim to provide an environment in which service users can experience the development of services through their service utilization experience. The narrative research approach and the narrative interview skills may help practitioners facilitate and cultivate person-centered nursing practice.
Collapse
|
13
|
Mitchell AJ, Vahabzadeh A, Magruder K. Screening for distress and depression in cancer settings: 10 lessons from 40 years of primary-care research. Psychooncology 2011; 20:572-84. [PMID: 21442689 DOI: 10.1002/pon.1943] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 01/10/2011] [Accepted: 01/25/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE There has been at least 40 years of active research on screening for depression and distress in primary care. Both successes and failures have been documented. The purpose of this focussed narrative review was to summarise this research and present the key lessons for clinicians and researchers working in psychosocial oncology. METHODS We searched for studies assessing the utility of screening in primary care in seven electronic bibliographic databases (CENTRAL, CINAHL, Embase, HMIC, Medline, PsycINFO, Web of Knowledge) from inception to December 2010. Results were reviewed and summarised into key areas. RESULTS We found that research could be distilled into the following key learning points. (1) Primary care is an important partner in psychosocial care. (2) Both over and under detection are problematic. (3) Barriers to identification involve patient and clinician factors. (4) Acceptability of screening is critical to implementation. (5) Underserved groups need special attention in screening. (6) Patient-clinician trust is an important modifiable variable. (7) Greater contact influences detection. (8) Clinician confidence/skills influence screening success and subsequent action. (9) Training may improve confidence but effects upon long-term outcomes are modest. (10) Screening is generally ineffective without aftercare. CONCLUSIONS Primary care has shown largely what does not work in relation to screening. Namely relying on clinicians' unassisted judgement without infrastructural support, using over-complex scales with low acceptability, looking for depression alone, using screening without linked treatment, treating in the absence of follow-up and failing to engage patients in their own care. These pitfalls can and should be avoided in psychosocial oncology.
Collapse
|
14
|
Crane J, Crane FG. Optimal nonverbal communications strategies physicians should engage in to promote positive clinical outcomes. Health Mark Q 2010; 27:262-274. [PMID: 20706894 DOI: 10.1080/07359683.2010.495300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This article discusses the importance of physician management of their nonverbal communication behavior during physician-patient interactions. This management is important because certain nonverbal behaviors are associated with clinical outcomes. The article outlines research findings involving various physicians' nonverbal behaviors, such as gaze orientation, head nodding, facial expressiveness, body orientation, proxemics, and paralinguistics. It also highlights the need to train physicians in nonverbal communications skills and provides a taxonomy of best practices or optimal nonverbal communications strategies that a physician should engage while interacting with patients.
Collapse
|
15
|
Zantinge EM, Verhaak PFM, de Bakker DH, van der Meer K, Bensing JM. Does burnout among doctors affect their involvement in patients' mental health problems? A study of videotaped consultations. BMC FAMILY PRACTICE 2009; 10:60. [PMID: 19706200 PMCID: PMC2754435 DOI: 10.1186/1471-2296-10-60] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 08/26/2009] [Indexed: 11/11/2022]
Abstract
Background General practitioners' (GPs') feelings of burnout or dissatisfaction may affect their patient care negatively, but it is unknown if these negative feelings also affect their mental health care. GPs' available time, together with specific communication tools, are important conditions for providing mental health care. We investigated if GPs who feel burnt out or dissatisfied with the time available for their patients, are less inclined to encourage their patients to disclose their distress, and have shorter consultations, in order to gain time and energy. This may result in less psychological evaluations of patients' complaints. Methods We used 1890 videotaped consultations from a nationally representative sample of 126 Dutch GPs to analyse GPs' communication and the duration of their consultations. Burnout was subdivided into emotional exhaustion, depersonalisation and reduced accomplishment. Multilevel regression analyses were used to investigate which subgroups of GPs differed significantly. Results GPs with feelings of exhaustion or dissatisfaction with the available time have longer consultations compared to GPs without these feelings. Exhausted GPs, and GPs with feelings of depersonalisation, talk more about psychological or social topics in their consultations. GPs with feelings of reduced accomplishment are an exception: they communicate less affectively, are less patient-centred and have less eye contact with their patients compared to GPs without reduced accomplishment. We found no relationship between GPs' feelings of burnout or dissatisfaction with the available time and their psychological evaluations of patients' problems. Conclusion GPs' feelings of burnout or dissatisfaction with the time available for their patients do not obstruct their diagnosis and awareness of patients' psychological problems. On the contrary, GPs with high levels of exhaustion or depersonalisation, and GPs who are dissatisfied with the available time, sometimes provide more opportunities to discuss mental health problems. This increases the chance that appropriate care will be found for patients with mental health problems. On the other hand, these GPs are themselves more likely to retire, or risk burnout, because of their dissatisfaction. Therefore these GPs may benefit from training or personal coaching to decrease the chance that the process of burnout will get out of hand.
Collapse
Affiliation(s)
- Else M Zantinge
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
| | | | | | | | | |
Collapse
|
16
|
Chahl P. Ten steps to better communication. Br J Hosp Med (Lond) 2008; 69:M141-3. [PMID: 18819301 DOI: 10.12968/hmed.2008.69.sup9.31062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Good communication skills are the foundations on which a good doctor–patient relationship is established. They have a significant influence on patient satisfaction and are likely to lead to a more satisfying career in medicine. This article is aimed at medical students and trainees in the early stage of their career, and it focuses on the key ingredients of good communication (Table 1).
Collapse
Affiliation(s)
- Pavan Chahl
- Queen Elizabeth Psychiatric Hospital, Birmingham B14 2QZ
| |
Collapse
|
17
|
Themessl-Huber M, Humphris G, Dowell J, Macgillivray S, Rushmer R, Williams B. Audio-visual recording of patient-GP consultations for research purposes: a literature review on recruiting rates and strategies. PATIENT EDUCATION AND COUNSELING 2008; 71:157-168. [PMID: 18356003 DOI: 10.1016/j.pec.2008.01.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 01/16/2008] [Accepted: 01/17/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To identify ethical processes and recruitment strategies, participation rates of studies using audio or video recording of primary health care consultations for research purposes, and the effect of recording on the behaviour, attitudes and feelings of participants. METHODS A structured literature review using Medline, Embase, Cochrane Library, and Psychinfo. This was followed by extensive hand search. RESULTS Recording consultations were regarded as ethically acceptable with some additional safeguards recommended. A range of sampling and recruitment strategies were identified although specific detail was often lacking. Non-participation rates in audio-recording studies ranged from 3 to 83% for patients and 7 to 84% for GPs; in video-recording studies they ranged from 0 to 83% for patients and 0 to 93% for GPs. There was little evidence to suggest that recording significantly affects patient or practitioner behaviour. CONCLUSIONS Research involving audio or video recording of consultations is both feasible and acceptable. More detailed reporting of the methodical characteristics of recruitment in the published literature is needed. PRACTICE IMPLICATIONS Researchers should consider the impact of diverse sampling and recruitment strategies on participation levels. Participants should be informed that there is little evidence that recording consultations negatively affects their content or the decisions made. Researchers should increase reporting of ethical and recruitment processes in order to facilitate future reviews and meta-analyses.
Collapse
Affiliation(s)
- Markus Themessl-Huber
- School of Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee DD1 4HJ, UK.
| | | | | | | | | | | |
Collapse
|
18
|
Perry CD. Does treating maternal depression improve child health management? The case of pediatric asthma. JOURNAL OF HEALTH ECONOMICS 2008; 27:157-73. [PMID: 17498828 DOI: 10.1016/j.jhealeco.2007.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 02/06/2007] [Accepted: 03/15/2007] [Indexed: 05/15/2023]
Abstract
Past studies have demonstrated an association between maternal depression and poor management of pediatric asthma. Using an instrumental variables strategy to address the endogeneity of depression treatment, I build on this literature to answer the question of whether treating maternal depression leads to an improvement in pediatric asthma management. I show that treatment of mother's depression improves management of child's asthma, resulting in a reduction in asthma costs in the 6-month period following diagnosis of $798 per asthmatic child whose mother is treated for depression.
Collapse
|
19
|
Okuyama T, Nakane Y, Endo C, Seto T, Kato M, Seki N, Akechi T, Furukawa TA, Eguchi K, Hosaka T. Mental health literacy in Japanese cancer patients: ability to recognize depression and preferences of treatments-comparison with Japanese lay public. Psychooncology 2007; 16:834-42. [PMID: 17120276 DOI: 10.1002/pon.1119] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Insufficient knowledge about mental illness and its treatment has been shown to constitute a major barrier to its adequate care for mental illness in the lay public (LP). We therefore examined Japanese cancer patients' (CP) ability to recognize depression and their preferences of its treatments. PARTICIPANTS AND METHOD One hundred lung CP and 300 LP were selected at random to participate in the study. Structured interviews using a vignette of a person with both cancer and depression were conducted with CP, and those using a vignette of a person with depression were carried out with LP, respectively. RESULTS Only 11% of CP recognized the presence of depression in the vignette, while 25% of LP did (p<0.001). There were few significant differences in the preference for standard psychiatric treatments between CP and LP: standard treatments such as antidepressants (CP: 39%, LP: 36%) were less often rated as helpful, whereas non-standard treatments such as physical activity (CP: 85%, LP: 66%) were most often rated as helpful. CONCLUSIONS The results indicated that cancer patients' knowledge about mental illness and its treatment were insufficient. Psychological education may reduce patient-related barriers to seek and to utilize optimal mental health care in cancer patients.
Collapse
Affiliation(s)
- Toru Okuyama
- Department of Psychiatry and Cognitive-behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Zantinge EM, Verhaak PFM, de Bakker DH, Kerssens JJ, van der Meer K, Bensing JM. The workload of general practitioners does not affect their awareness of patients' psychological problems. PATIENT EDUCATION AND COUNSELING 2007; 67:93-9. [PMID: 17382508 DOI: 10.1016/j.pec.2007.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 02/09/2007] [Accepted: 02/10/2007] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To investigate if general practitioners (GPs) with a higher workload are less inclined to encourage their patients to disclose psychological problems, and are less aware of their patients' psychological problems. METHODS Data from 2095 videotaped consultations from a representative selection of 142 Dutch GPs were used. Multilevel regression analyses were performed with the GPs' awareness of the patient's psychological problems and their communication as outcome measures, the GPs' workload as a predictor, and GP and patient characteristics as confounders. RESULTS GPs' workload is not related to their awareness of psychological problems and hardly related to their communication, except for the finding that a GP with a subjective experience of a lack of time is less patient-centred. Showing eye contact or empathy and asking questions about psychological or social topics are associated with more awareness of patients' psychological problems. CONCLUSION Patients' feelings of distress are more important for GPs' communication and their awareness of patients' psychological problems than a long patient list or busy moment of the day. GPs who encourage the patient to disclose their psychological problems are more aware of psychological problems. PRACTICE IMPLICATIONS We recommend that attention is given to all the communication skills required to discuss psychological problems, both in the consulting room and in GPs' training. Additionally, attention for gender differences and stress management is recommended in GPs' training.
Collapse
Affiliation(s)
- Else M Zantinge
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
21
|
Suzuki T, Murase S, Kitano A, Nagase H, Momoi S, Nakamaki M. Eye Contact in Medical Examinations Using Videophones. Telemed J E Health 2006; 12:535-41. [PMID: 17042706 DOI: 10.1089/tmj.2006.12.535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
In Japan, approximately 12,000,000 cellular phones with a videophone function have been distributed and are becoming an important part of the telemedicine infrastructure. By eye movement analysis, we investigated the effectiveness of eye contact using cellular videophones during medical interviews. Three male volunteers acted as first-time patients and were filmed using a high-resolution camera. The video of each of these volunteers was converted into pictures of three different sizes-70 cm x 40 cm (large picture), 26 cm x 20 cm (medium picture), and 14 cm x 12 cm (small picture)-and viewed on a 32-inch video monitor. The large, medium, and small pictures were considered to represent an actual medical interview, an interview via a television conference system, and an interview via a cellular videophone, respectively. Nine doctors watched these pictures, and their eye movements were recorded with a gaze-point recorder. After watching the videos, the doctors evaluated quality of three size pictures. Standard deviation values of the gaze point coordinates decreased with the picture size. However, a very low decrease was observed in the time ratio, during which the gaze point was on the face (eye contact rate); the rate was 92.2% (large picture), 91.8% (medium picture), and 85.1% (small picture). No statistical difference was observed between the values of the medium and small pictures. Subjective evaluations yielded low scores in the small pictures. The relatively high rate of eye contact rate in the small pictures suggests that a cellular videophone will be a good tool for telemedicine, although the usage by which the subjective evaluations can be improved should be determined by doctors.
Collapse
Affiliation(s)
- Toshiro Suzuki
- Division of Medical Informatics, Shinshu University Hospital, Matsumoto, Japan
| | | | | | | | | | | |
Collapse
|
22
|
Braddock CH, Snyder L. The doctor will see you shortly. The ethical significance of time for the patient-physician relationship. J Gen Intern Med 2005; 20:1057-62. [PMID: 16307634 PMCID: PMC1490262 DOI: 10.1111/j.1525-1497.2005.00217.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2005] [Indexed: 11/26/2022]
Abstract
Many physicians and health care leaders express concern about the amount of time available for clinical practice. While debates rage on about how much time is truly available, the perception that time is inadequate is now pervasive. This perception has ethical significance, because it may cause clinicians to forego activities and behaviors that promote important aspects of the patient-physician relationship, to shortcut shared decision making, and to fall short of obligations to act as patient advocates. Furthermore, perceived time constraints can hinder the just distribution of physician time. Although creating more time in the clinical encounter would certainly address these ethical concerns, specific strategies-many of which do not take significantly more time-can effectively change the perception that time is inadequate. These approaches are critical for clinicians and health systems to maintain their ethical commitments and simultaneously deal with the realities of time.
Collapse
Affiliation(s)
- Clarence H Braddock
- Department of Medicine, Stanford University School of Medicine, Stanford, Calif 94305, USA.
| | | |
Collapse
|
23
|
Ryan H, Schofield P, Cockburn J, Butow P, Tattersall M, Turner J, Girgis A, Bandaranayake D, Bowman D. How to recognize and manage psychological distress in cancer patients. Eur J Cancer Care (Engl) 2005; 14:7-15. [PMID: 15698382 DOI: 10.1111/j.1365-2354.2005.00482.x] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Psychological distress is common in cancer patients, however, it is often unrecognized and untreated. We aimed to identify barriers to cancer patients expressing their psychological concerns, and to recommend strategies to assist oncologists to elicit, recognize, and manage psychological distress in their patients. Medline, Psychlit, and the Cochrane databases were searched for articles relating to the detection of emotional distress in patients. Patients can provide verbal and non-verbal information about their emotional state. However, many patients may not reveal emotional issues as they believe it is not a doctor's role to help with their emotional concerns. Moreover, patients may normalize or somatize their feelings. Anxiety and depression can mimic physical symptoms of cancer or treatments, and consequently emotional distress may not be detected. Techniques such as active listening, using open questions and emotional words, responding appropriately to patients' emotional cues, and a patient-centred consulting style can assist in detection. Screening tools for psychological distress and patient question prompt sheets administered prior to the consultation can also be useful. In conclusion, the application of basic communication techniques enhances detection of patients' emotional concerns. Training oncologists in these techniques should improve the psychosocial care of cancer patients.
Collapse
Affiliation(s)
- H Ryan
- Centre for Health Research & Psycho-oncology, University of Newcastle, Newcastle, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Deveugele M, Derese A, De Bacquer D, van den Brink-Muinen A, Bensing J, De Maeseneer J. Is the communicative behavior of GPs during the consultation related to the diagnosis? A cross-sectional study in six European countries. PATIENT EDUCATION AND COUNSELING 2004; 54:283-289. [PMID: 15324979 DOI: 10.1016/j.pec.2004.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Revised: 01/29/2004] [Accepted: 02/07/2004] [Indexed: 05/24/2023]
Abstract
This study explores the relation between the diagnosis made by the general practitioner (GP) and his or her communicative behavior within a consultation, by means of the analysis of 2095 videotaped consultations of 168 GPs from six countries participating in the Eurocommunication study. The doctors' diagnoses were coded into ICPC chapters and merged into seven clinically relevant diagnostic clusters. The communicative behavior was gauged by means of the Roter interaction analysis system (RIAS). We found the most important differences for consultations about psychosocial problems as compared to all other diagnostic categories. In these consultations, doctors show more affective behavior, are more concerned about having a good relationship with their patients, ask more questions and give less information than in other consultations. The percentages of utterances in the other diagnostic categories were pretty similar. The communicative behavior of doctors reflects a global pattern in every consultation. This pattern is the most stable for affective behavior (social talk, agreement, rapport building and facilitation). Within instrumental behavior (the other categories), the directions and the information the doctor gives are adapted to the problems presented.
Collapse
Affiliation(s)
- Myriam Deveugele
- Department of General Practice and Primary Health Care, Ghent University, UZ 1K3 De Pintelaan 185, B 9000 Gent, Belgium.
| | | | | | | | | | | |
Collapse
|
25
|
Scardovi A, Rucci P, Gask L, Berardi D, Leggieri G, Ceroni GB, Ferrari G. Improving psychiatric interview skills of established GPs: evaluation of a group training course in Italy. Fam Pract 2003; 20:363-9. [PMID: 12876103 DOI: 10.1093/fampra/cmg404] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A number of studies have shown that the communication style of GPs has a significant impact on their ability to recognize and manage psychiatric disorders. Italian training programmes do exist, but none have been evaluated for effectiveness. METHODS Nine established GPs participated in a training programme consisting of twelve 3-h education sessions. Each session consisted of group discussion of videotaped patient interviews selected by GPs. Case discussion followed Lesser's "problem-based approach" criteria. Efficacy of training was assessed by measuring the pre-post change in accuracy in detecting psychiatric illness and changes in the interview skills of the GPs. RESULTS Accuracy in detection of psychiatric illness increased significantly after training. Changes were seen in the interview style after training, such as use of open-ended questions and appropriate counselling in relation to problems presented by the patient. Physicians also improved their management skills by using a more negotiatory style and providing patients with supportive feedback. The way in which physicians gave advice and information to the patients improved significantly despite the fact that GPs were not instructed about how to give information to their patients. CONCLUSIONS Group training in problem-based interviewing utilizing video feedback is a robust, culturally transferrable model for improving the skills of established physicians. Our results suggest that training produces indirect effects that are the result of the teaching method rather than of explicit instructions. Further research is required to assess how to optimize the effect of educational interventions to ensure sustainability and maximal impact on measurable outcomes of care.
Collapse
Affiliation(s)
- Andrea Scardovi
- Istituto di Psichiatria, Università di Bologna, Viale Pepoli 5, 40123 Bologna, Italy.
| | | | | | | | | | | | | |
Collapse
|
26
|
Speer DC, Schneider MG. Mental health needs of older adults and primary care: Opportunity for interdisciplinary geriatric team practice. ACTA ACUST UNITED AC 2003. [DOI: 10.1093/clipsy.10.1.85] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
27
|
Brownhill S, Wilhelm K, Barclay L, Parker G. Detecting Depression in Men: A Matter of Guesswork. ACTA ACUST UNITED AC 2002. [DOI: 10.3149/jmh.0103.259] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
28
|
O'Hara BS, Saywell RM, Smidley JA, Burba JL, Thakker N, Bogdewic SP, Zollinger TW. Medical students' experience with psychiatric diagnoses in a family medicine clerkship. TEACHING AND LEARNING IN MEDICINE 2001; 13:167-175. [PMID: 11475660 DOI: 10.1207/s15328015tlm1303_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Many medical schools require a family medicine clerkship, yet little is known about the quantity and diversity of the diagnoses encountered by the students. PURPOSE This study examines patients encountered with psychiatric diagnoses using quantitative data collected by students in a family practice clerkship. METHODS Over a 2-year period, 445 students completed 3,320 patient encounter forms for patients with a psychiatric diagnosis, noting their comfort level and responsibilities. RESULTS The patients' diagnoses reflect those seen in a typical family practice. Of the 71,869 presenting diagnoses, 3,548 were for a psychiatric condition, most commonly depression (37.1%) and neuroses (28.0%). Students reported a high level of comfort in diagnosing and treating patients with a psychiatric disorder. The students routinely discussed these cases with their preceptors. CONCLUSIONS By using a relatively simple computerized database, many curricular issues can be identified. For example, analysis of the database shows that the clerkship provides students with substantial practice in taking patient histories and performing initial patient examinations in patients presenting with a psychiatric problem. However, students infrequently provided patient education and counseling to patients with psychiatric disorders. Specific psychiatric diagnoses reflecting limited experience and lower levels of perceived competence include attention deficit disorder and senile and presenile organic psychotic disorders.
Collapse
Affiliation(s)
- B S O'Hara
- Department of Family Medicine and Bowen Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
Studies concluding that St. John's wort (Hypericum perforatum) is an effective antidepressant can be challenged due to questionable methodology. We attempt to correct this by a meta-analysis utilizing only well-defined clinical trials. Controlled, double-blind studies using strictly defined depression criteria were analyzed by the rate of change of depression and by the number of "treatment responders." Rates of side effects and dropouts were also analyzed. Hypericum was 1.5 times more likely to result in an antidepressant response than placebo and was equivalent to tricyclic antidepressants (TCAs). The meta-analysis also showed that there was a higher dropout rate in the TCA group and that the TCAs were nearly twice as likely to cause side effects, including those more severe than hypericum. Hypericum perforatum was more effective than placebo and similar in effectiveness to low-dose TCAs in the short-term treatment of mild to moderately severe depression. However, design problems in existing studies prevent definitively concluding that St. John's wort is an effective antidepressant.
Collapse
Affiliation(s)
- H L Kim
- Department of Psychiatry, University of Hawaii, John A. Burns School of Medicine, Honolulu 96813, USA
| | | | | |
Collapse
|
30
|
Herran A, Vazquez-Barquero JL. Recognition and treatment of mental disorders in primary health care. Ann Saudi Med 1999; 19:383-4. [PMID: 17277551 DOI: 10.5144/0256-4947.1999.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Herran
- Clinical and Social Psychiatry Research Unit, Department of Psychiatry, University Hospital "Marques de Valdecilla", Santander, Spain
| | | |
Collapse
|