1
|
Richards HL, Fortune DG, Lyons L, Curtin Y, Hennessey DB. Patients' Emotional Talk During Surveillance Cystoscopy for Non-muscle Invasive Bladder Cancer: Opportunities for Improving Communication. Urology 2024; 185:1-7. [PMID: 38160762 DOI: 10.1016/j.urology.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To examine the emotional communication that takes place between patients and health care providers during surveillance cystoscopy for non-muscle invasive bladder cancer (NMIBC). METHODS Participants were 57 patients with a diagnosis of NMIBC attending for surveillance cystoscopy and 10 health care professionals (HCPs). Cystoscopy procedures were audio-recorded and transcribed verbatim. Two approaches to analysis of transcriptions were undertaken: (1) a template analysis and (2) Verona Coding Definitions of Emotional Sequences. RESULTS Communication during cystoscopy generally comprised of "social/small talk," "results of the cystoscopy," and "providing instructions to the patient." Emotional talk was present in 41/57 consultations, with 129 emotional cues and concerns expressed by patients. Typically patients used hints to their emotions rather than stating explicit concerns. The majority (86%) of HCPs responses to the patient did not explicitly mention the patient's emotional concern or cue. Urology trainees were less likely than other HCPs to provide space for patients to explore their emotional concerns (t = -1.78, P <.05). CONCLUSION Emotional communication was expressed by the majority of patients during cystoscopy. While all HCPs responded to patients' emotional communication, there were a number of missed opportunities to "pick-up" on patients' emotional cues and improve communication. Urologists need to be aware of the nuances of patients' emotional communication. Learning to identify and respond appropriately to emotional cues may improve communication with patients.
Collapse
Affiliation(s)
- H L Richards
- Department of Clinical Health Psychology, Mercy University Hospital, Cork, Ireland; Department of Urology, Mercy University Hospital, Cork, Ireland; Department of Psychology, University of Limerick, Limerick, Ireland.
| | - D G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - L Lyons
- Department of Urology, Mercy University Hospital, Cork, Ireland
| | - Y Curtin
- Department of Clinical Health Psychology, Mercy University Hospital, Cork, Ireland
| | - D B Hennessey
- Department of Urology, Mercy University Hospital, Cork, Ireland
| |
Collapse
|
2
|
Obama K, Fujimori M, Okamura M, Kadowaki M, Ueno T, Boku N, Mori M, Akechi T, Yamaguchi T, Oyamada S, Okizaki A, Miyaji T, Sakurai N, Uchitomi Y. Effectiveness of a facilitation programme using a mobile application for initiating advance care planning discussions between patients with advanced cancer and healthcare providers: protocol for a randomised controlled trial (J-SUPPORT 2104). BMJ Open 2023; 13:e069557. [PMID: 36977536 PMCID: PMC10069562 DOI: 10.1136/bmjopen-2022-069557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION Timely implementation of the discussion process of advance care planning (ACP) is recommended. The communication attitude of healthcare providers is critical in ACP facilitation; thus, improving their communication attitudes may reduce patient distress and unnecessary aggressive treatment while enhancing care satisfaction. Digital mobile devices are being developed for behavioural interventions owing to their low space and time restrictions and ease of information sharing. This study aims to evaluate the effectiveness of an intervention programme using an application intended to facilitate patient questioning behaviour on improving communication related to ACP between patients with advanced cancer and healthcare providers. METHODS AND ANALYSIS This study uses a parallel-group, evaluator-blind, randomised controlled trial design. We plan to recruit 264 adult patients with incurable advanced cancer at the National Cancer Centre in Tokyo, Japan. Intervention group participants use a mobile application ACP programme and undergo a 30 min interview with a trained intervention provider for discussions with the oncologist at the next patient visit, while control group participants continue their usual treatment. The primary outcome is the oncologist's communication behaviour score assessed using audiorecordings of the consultation. Secondary outcomes include communication between patients and oncologists and the patients' distress, quality of life, care goals and preferences, and medical care utilisation. We will use a full analysis set including the registered participant population who receive at least a part of the intervention. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by the Scientific Advisory Board of the Japan Supportive, Palliative and Psychosocial Oncology Group (Registration No. 2104) and the Institutional Review Board of the National Cancer Centre Hospital (registration No. 2020-500). Written informed consent is obtained from the patients. The results of the trial will be published in peer-reviewed scientific journals and presented at scientific meetings. TRIAL REGISTRATION NUMBERS UMIN000045305, NCT05045040.
Collapse
Affiliation(s)
- Kyoko Obama
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Maiko Fujimori
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Masako Okamura
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Midori Kadowaki
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | | | - Narikazu Boku
- Department of Oncology and General Medicine, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Ayumi Okizaki
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Tempei Miyaji
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
| | - Naomi Sakurai
- Cancer Survivors Recruiting Project, General Incorporated Association, Tokyo, Japan
| | - Yosuke Uchitomi
- Institute for Cancer Control, National Cancer Center Japan, Tokyo, Japan
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Chuo-ku, Japan
| |
Collapse
|
3
|
Bregio C, Finik J, Baird M, Ortega P, Roter D, Karliner L, Diamond LC. Exploring the Impact of Language Concordance on Cancer Communication. JCO Oncol Pract 2022; 18:e1885-e1898. [PMID: 36112970 PMCID: PMC9653203 DOI: 10.1200/op.22.00040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/13/2022] [Accepted: 07/24/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Patients with cancer who have limited English proficiency are more likely to experience inequities in cancer knowledge, timely care, and access to clinical trials. Matching patients with language-concordant clinicians and working with professional interpreters can effectively reduce language-related disparities, but little data are available regarding the impact of language-concordant interactions in oncology care. This study aimed to assess the use of the Roter Interaction Analysis System (RIAS) in language-concordant and -discordant interactions for patients with non-English language preference presenting for an initial oncology visit at four New York City hospitals. METHODS We used the RIAS, a validated tool for qualitative coding and quantitative analysis, to evaluate interactions between 34 patients and 16 clinicians. The pairings were stratified into dyads: English language-concordant (n = 12); professionally interpreted (n = 11); partially language-concordant (n = 4, partially bilingual clinicians who communicated in Spanish and/or used ad hoc interpreters); and Spanish language-concordant (n = 7). A trained Spanish-speaking coder analyzed the recordings using established RIAS codes. RESULTS Spanish language-concordant clinicians had almost two-fold greater number of statements about biomedical information than English language-concordant clinicians. Spanish language-concordant patients had a higher tendency to engage in positive talk such as expressing agreement. The number of partnership/facilitation-related statements was equivalent for English and Spanish language-concordant groups but lower in professionally interpreted and partially language-concordant dyads. CONCLUSION Language concordance may facilitate more effective biomedical counseling and therapeutic relationships between oncology clinicians and patients. Future research should further explore the impact of language concordance on cancer-specific health outcomes.
Collapse
Affiliation(s)
- Celyn Bregio
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Jackie Finik
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Morgan Baird
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pilar Ortega
- Department of Medical Education, University of Illinois College of Medicine, Chicago, IL
- Department of Emergency Medicine, University of Illinois College of Medicine, Chicago, IL
| | - Debra Roter
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Leah Karliner
- Center for Aging in Diverse Communities, University of California, San Francisco, CA
- Multiethnic Health Equity Research Center, University of California, San Francisco, CA
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA
| | - Lisa C. Diamond
- Hospital Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| |
Collapse
|
4
|
Siebinga VY, Driever EM, Stiggelbout AM, Brand PLP. Shared decision making, patient-centered communication and patient satisfaction - A cross-sectional analysis. Patient Educ Couns 2022; 105:2145-2150. [PMID: 35337712 DOI: 10.1016/j.pec.2022.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The integration of shared decision making (SDM) and patient-centered communication (PCC) is needed to actively involve patients in decision making. This study examined the relationship between shared decision making and patient-centered communication. METHODS In 82 videotaped hospital outpatient consultations by 41 medical specialists from 18 disciplines, we assessed the extent of shared decision making by the OPTION5 score and patient-centered communication by the Four Habits Coding Scheme (4HCS), and analyzed the occurrence of a high versus low degree (above or below median) of SDM and/or PCC, and its relation to patient satisfaction scores. RESULTS In comparison to earlier studies, we observed comparable 4HCS scores and relatively low OPTION5 scores. The correlation between the two was weak (r = 0.29, p = 0.009). In 38% of consultations, we observed a combination of high SDM and low PCC scores or vice versa. The combination of a high SDM and high PCC, which was observed in 23% of consultations, was associated with significantly higher patient satisfaction scores. CONCLUSION Shared decision making and patient-centered communication are not synonymous and do not always co-exist. PRACTICE IMPLICATIONS The value of integrated training of shared decision making and patient-centered communication should be further explored.
Collapse
Affiliation(s)
- Veerle Y Siebinga
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands.
| | - Ellen M Driever
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands
| | - Anne M Stiggelbout
- Department of Medical Decision Making/ Quality of Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul L P Brand
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands; UMCG Postgraduate School of Medicine, University Medical Center, University of Groningen, The Netherlands
| |
Collapse
|
5
|
Guo A, Wang P. The Current State of Doctors' Communication Skills in Mainland China from the Perspective of Doctors' Self-evaluation and Patients' Evaluation: A Cross-Sectional Study. Patient Educ Couns 2021; 104:1674-1680. [PMID: 33384190 DOI: 10.1016/j.pec.2020.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess doctors' communication skills in mainland China using the SEGUE Framework. METHODS A survey on doctors' communication skills with doctors (n = 1361) and patients (n = 1757) from 14 provinces in eastern, central and western China was conducted. RESULTS The doctors' self-evaluation scores were higher than patients' evaluations (p < .001). The scores of female doctors were higher than males (p = .022). Both doctors' self-evaluations and patients' evaluations indicated that the scores of doctors in tertiary hospitals were higher than those in primary hospitals. CONCLUSION Doctors' communication skills don't match patients' needs. Female doctors are more empathetic and patient than male doctors and consequently have better communication skills. Doctors in tertiary hospitals have better communication skills because tertiary hospitals provide more training opportunities in communication skills and have better medical services and management. PRACTICE IMPLICATIONS This study confirms the applicability of the SEGUE Framework to doctors and patients in mainland China. The effectiveness of cultivating doctors' communication skills should be evaluated through feedback from the perspective of both doctors and patients. Medical institutes need to prioritize patients' needs and provide training in doctors' communication skills to address the discrepancy in the perceptions of doctors and patients.
Collapse
Affiliation(s)
- Ai Guo
- Shanghai Normal University, Department of Psychology, Shanghai, China; School of Psychiatry, Wenzhou Medical University, Wenzhou, China
| | - Pei Wang
- School of Psychiatry, Wenzhou Medical University, Wenzhou, China; East China Normal University, Faculty of Education, Shanghai, China.
| |
Collapse
|
6
|
Schachner T, Gross C, Hasl A, V Wangenheim F, Kowatsch T. Deliberative and Paternalistic Interaction Styles for Conversational Agents in Digital Health: Procedure and Validation Through a Web-Based Experiment. J Med Internet Res 2021; 23:e22919. [PMID: 33512328 PMCID: PMC7880814 DOI: 10.2196/22919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/11/2020] [Accepted: 12/07/2020] [Indexed: 01/26/2023] Open
Abstract
Background Recent years have witnessed a constant increase in the number of people with chronic conditions requiring ongoing medical support in their everyday lives. However, global health systems are not adequately equipped for this extraordinarily time-consuming and cost-intensive development. Here, conversational agents (CAs) can offer easily scalable and ubiquitous support. Moreover, different aspects of CAs have not yet been sufficiently investigated to fully exploit their potential. One such trait is the interaction style between patients and CAs. In human-to-human settings, the interaction style is an imperative part of the interaction between patients and physicians. Patient-physician interaction is recognized as a critical success factor for patient satisfaction, treatment adherence, and subsequent treatment outcomes. However, so far, it remains effectively unknown how different interaction styles can be implemented into CA interactions and whether these styles are recognizable by users. Objective The objective of this study was to develop an approach to reproducibly induce 2 specific interaction styles into CA-patient dialogs and subsequently test and validate them in a chronic health care context. Methods On the basis of the Roter Interaction Analysis System and iterative evaluations by scientific experts and medical health care professionals, we identified 10 communication components that characterize the 2 developed interaction styles: deliberative and paternalistic interaction styles. These communication components were used to develop 2 CA variations, each representing one of the 2 interaction styles. We assessed them in a web-based between-subject experiment. The participants were asked to put themselves in the position of a patient with chronic obstructive pulmonary disease. These participants were randomly assigned to interact with one of the 2 CAs and subsequently asked to identify the respective interaction style. Chi-square test was used to assess the correct identification of the CA-patient interaction style. Results A total of 88 individuals (42/88, 48% female; mean age 31.5 years, SD 10.1 years) fulfilled the inclusion criteria and participated in the web-based experiment. The participants in both the paternalistic and deliberative conditions correctly identified the underlying interaction styles of the CAs in more than 80% of the assessments (X21,88=38.2; P<.001; phi coefficient rφ=0.68). The validation of the procedure was hence successful. Conclusions We developed an approach that is tailored for a medical context to induce a paternalistic and deliberative interaction style into a written interaction between a patient and a CA. We successfully tested and validated the procedure in a web-based experiment involving 88 participants. Future research should implement and test this approach among actual patients with chronic diseases and compare the results in different medical conditions. This approach can further be used as a starting point to develop dynamic CAs that adapt their interaction styles to their users.
Collapse
Affiliation(s)
- Theresa Schachner
- Department of Management, Technology, and Economics, Centre for Digital Health Interventions, ETH Zurich, Zurich, Switzerland
| | - Christoph Gross
- Department of Management, Technology, and Economics, Centre for Digital Health Interventions, ETH Zurich, Zurich, Switzerland
| | - Andrea Hasl
- Department of Educational Sciences, University of Potsdam, Potsdam, Germany.,International Max Planck Research School on the Life Course (LIFE), Berlin, Germany
| | - Florian V Wangenheim
- Department of Management, Technology, and Economics, Centre for Digital Health Interventions, ETH Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- Department of Management, Technology, and Economics, Centre for Digital Health Interventions, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St. Gallen, Switzerland
| |
Collapse
|
7
|
Lambert K, Lau TK, Davison S, Mitchell H, Harman A, Carrie M. Does a renal diet question prompt sheet increase the patient centeredness of renal dietitian outpatient consultations? Patient Educ Couns 2020; 103:1645-1649. [PMID: 32199691 DOI: 10.1016/j.pec.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 02/29/2020] [Accepted: 03/03/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Effective communication is fundamental to helping patients change behaviour. Few studies have operationalised how to quantify and improve the patient centeredness of communication during the dietitian outpatient consultation. We sought to evaluate the impact of a renal diet question prompt sheet (QPS) on patient centeredness (PC) in dietitian outpatient clinics and describe the impact of a renal diet QPS on the volume and pattern of communication between dietitians (n = 4) and patients/carers (n = 24, n = 11). METHODS The Roter Interaction Analysis System was used to compute a PC index, the volume communication (number of questions and utterances) and categorise dietitian communication. RESULTS The QPS was associated with significant improvements in the PC of communication (p = 0.004 and p = 0.001), without increasing the volume of communication. The QPS was also associated with an increase in the total number of questions asked (p < 0.0001) especially from patients (p = 0.0009); and an increase in the volume of communication devoted to education and counselling (p < 0.0001). CONCLUSIONS This study describes a promising intervention to increase the patient centeredness of dietetic consultations in an outpatient setting. PRACTICE IMPLICATIONS Whilst simple in design, the use of a QPS had a large effect on how patients and carers interact with the dietitian in the outpatient setting.
Collapse
Affiliation(s)
- Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, 2522, Australia.
| | - Tsz Kwan Lau
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, 2522, Australia.
| | - Sarah Davison
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, 2500, Australia.
| | - Holly Mitchell
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, 2500, Australia.
| | - Alex Harman
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, 2500, Australia.
| | - Mandy Carrie
- Department of Clinical Nutrition, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, 2500, Australia.
| |
Collapse
|
8
|
du Pon E, van Dooren A, Kleefstra N, van Dulmen S. Effects of a Proactive Interdisciplinary Self-Management Program on Patient Self-Efficacy and Participation During Practice Nurse Consultations: A Randomized Controlled Trial in Type 2 Diabetes. J Clin Med Res 2020; 12:79-89. [PMID: 32095177 PMCID: PMC7011933 DOI: 10.14740/jocmr3965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/12/2019] [Indexed: 11/26/2022] Open
Abstract
Background Nowadays, patients with chronic conditions such as type 2 diabetes mellitus (T2DM) need and want to be more active participants in their health care. This study aimed to investigate the effects of the Proactive Interdisciplinary Self-Management (PRISMA) training program on participation during consultations with practice nurses and self-efficacy of patients with T2DM in general practice. Methods Within a randomized controlled trial, patients were followed for 6 months. They received either PRISMA in addition to usual care or usual care only. Self-efficacy was assessed using the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale. Consultations were video-recorded and analyzed using the Roter interaction analysis system. Multilevel analysis was carried out. Results No differences in the PEPPI-5 were found between the intervention (n = 101) and control groups (n = 102) (U = 1,737.5, z = -0.2, P = 0.8). In addition, the groups did not differ in patient participation. However, patients who attended the PRISMA program expressed more counselling utterances (B = 0.22; standard error (SE) = 0.09). Conclusions PRISMA did not result in higher self-efficacy or patient participation during the consultation with practice nurses at 6 months. Possibly, two training sessions are insufficient and a more powerful intervention might be needed. However, the study showed indications that patients counselled themselves more frequently during the consultation. Practice nurses could stimulate patients who are already engaged in self-counselling by further specifying their goals of behavior change.
Collapse
Affiliation(s)
- Esther du Pon
- Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, Utrecht, the Netherlands.,Diabetes Centre, Isala, Zwolle, the Netherlands
| | - Ad van Dooren
- Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, Utrecht, the Netherlands
| | - Nanne Kleefstra
- Medical Research Group, Langerhans, Ommen, the Netherlands.,High & Intensive Care, GGZ Drenthe Mental Health Institute, Assen, the Netherlands.,Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Sandra van Dulmen
- Netherlands institute for health services research (Nivel), Utrecht, the Netherlands.,Department of Primary and Community Care, Radboud university medical center, Nijmegen, the Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| |
Collapse
|
9
|
Abstract
Communication is a core component of effective healthcare that impacts many patient and doctor outcomes, yet is complex and challenging to both analyse and teach. Human-based coding and audit systems are time-intensive and costly; thus, there is considerable interest in the application of artificial intelligence to this topic, through machine learning using both supervised and unsupervised learning algorithms. In this article we introduce health communication, its importance for patient and health professional outcomes, and the need for rigorous empirical data to support this field. We then discuss historical interaction coding systems and recent developments in applying artificial intelligence (AI) to automate such coding in the health setting. Finally, we discuss available evidence for the reliability and validity of AI coding, application of AI in training and audit of communication, as well as limitations and future directions in this field. In summary, recent advances in machine learning have allowed accurate textual transcription, and analysis of prosody, pauses, energy, intonation, emotion and communication style. Studies have established moderate to good reliability of machine learning algorithms, comparable with human coding (or better), and have identified some expected and unexpected associations between communication variables and patient satisfaction. Finally, application of artificial intelligence to communication skills training has been attempted, to provide audit and feedback, and through the use of avatars. This looks promising to provide confidential and easily accessible training, but may be best used as an adjunct to human-based training. Artificial intelligence (AI) applied to health professional-patient communication enables efficient audit and feedback. Very recent advances have increased the ability of AI to encode the complexity in human interaction. AI can now encode words as well as a person does, as well as emotion and non-verbal aspects of communication. AI coding has been shown to be moderately to substantially reliable. Translation into the real world has yet to be demonstrated.
Collapse
Affiliation(s)
- Phyllis Butow
- University of Sydney, School of Psychology, Centre for Medical Psychology and Evidence-Based Medicine (CeMPED), Sydney, Australia.
| | - Ehsan Hoque
- University of Rochester, Rochester Human-Computer Interaction Group, Rochester, New York, USA
| |
Collapse
|
10
|
Howe LC, Leibowitz KA, Crum AJ. When Your Doctor "Gets It" and "Gets You": The Critical Role of Competence and Warmth in the Patient-Provider Interaction. Front Psychiatry 2019; 10:475. [PMID: 31333518 PMCID: PMC6619399 DOI: 10.3389/fpsyt.2019.00475] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 06/14/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Research demonstrates that the placebo effect can influence the effectiveness of medical treatments and accounts for a significant proportion of healing in many conditions. However, providers may differ in the degree to which they consciously or unconsciously leverage the forces that produce placebo effects in clinical practice. Some studies suggest that the manner in which providers interact with patients shapes the magnitude of placebo effects, but this research has yet to distill the specific dimensions of patient-provider interactions that are most likely to influence placebo response and the mechanisms through which aspects of patient-provider interactions impact placebo response. Methods: We offer a simplifying and unifying framework in which interactions that boost placebo response can be dissected into two key dimensions: patients' perceptions of competence, or whether a doctor "gets it" (i.e., displays of efficiency, knowledge, and skill), and patients' perceptions of warmth, or whether a doctor "gets me" (i.e., displays of personal engagement, connection, and care for the patient). Results: First, we discuss how this framework builds on past research in psychology on social perception of competence and warmth and in medical literature on models of effective medical care, patient satisfaction, and patient-provider interactions. Then we consider possible mechanisms through which competence and warmth may affect the placebo response in healthcare. Finally, we share original data from patients and providers highlighting how this framework applies to healthcare. Both patient and provider data illustrate actionable ways providers can demonstrate competence and warmth to patients. Discussion: We conclude with recommendations for how researchers and practitioners alike can more systematically consider the role of provider competence and warmth in patient-provider interactions to deepen our understanding of placebo effects and, ultimately, enable providers to boost placebo effects alongside active medications (i.e., with known medical ingredients) and treatment in clinical care.
Collapse
Affiliation(s)
- Lauren C Howe
- Department of Business Administration, University of Zurich, Zurich, Switzerland
| | - Kari A Leibowitz
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, CA, United States
| |
Collapse
|
11
|
Burro R, Savardi U, Annunziata MA, De Paoli P, Bianchi I. The perceived severity of a disease and the impact of the vocabulary used to convey information: using Rasch scaling in a simulated oncological scenario. Patient Prefer Adherence 2018; 12:2553-2573. [PMID: 30573952 PMCID: PMC6292238 DOI: 10.2147/ppa.s175957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Healthcare staff should be aware of the importance that patients may attach to the words that are used to convey information. This is relevant in terms of the patients' understanding. Modeling how people understand the information conveyed in a medical context may help health practitioners to better appreciate the patients' approach. PURPOSE 1) Analyze the participants' self-reported perception of the type of information provided in an oncological scenario in terms of three dimensions: impairment to their health, risks associated with the disease itself and commitment required to undergo the treatment; and 2) show the benefits of using Rasch scaling for the analysis of the data. Starting from a survey, Rasch scaling produces a unidimensional logit-interval scale relating to the extent to which each item conveys a latent dimension. These were related to structure, in particular concerning communication by means of opposite vs. unipolar language. SUBJECTS AND METHODS The participants rated 82 items of information in a questionnaire regarding their perception of impairment to their health (H) and the risks (R) and commitment relating to the treatment prescribed (T). RESULTS The scaling produced an item bank for healthcare staff to consult in order to estimate the importance the recipient would be likely to attach to the vocabulary used and the likely impact of the information in terms of the patient's condition. Furthermore, the use of opposites was generally associated with a clearer impression of whether the information given was generally only very negative or slightly negative, whereas 'neutral' information was often perceived as being very negative. ACTUAL FINDINGS Is possible to estimate people's understanding more precisely (in terms of H, R and T) which can help healthcare practitioners to modulate the way they convey information. LIMITATIONS The participants in the study were healthy volunteers and the context was simulated.
Collapse
Affiliation(s)
- Roberto Burro
- Department of Human Sciences, University of Verona, 37129 Verona, Italy,
| | - Ugo Savardi
- Department of Human Sciences, University of Verona, 37129 Verona, Italy,
| | | | - Paolo De Paoli
- National Cancer Institute IRCCS "Centro di Riferimento Oncologico" (CRO), 33080 Aviano (PN), Italy
| | - Ivana Bianchi
- Department of Humanities (section Philosophy and Human Sciences), University of Macerata, 62100 Macerata, Italy
| |
Collapse
|
12
|
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
Collapse
Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
| | | |
Collapse
|
13
|
Hlubocky FJ, Kass NE, Roter D, Larson S, Wroblewski KE, Sugarman J, Daugherty CK. Investigator Disclosure and Advanced Cancer Patient Understanding of Informed Consent and Prognosis in Phase I Clinical Trials. J Oncol Pract 2018; 14:e357-e367. [PMID: 29787333 DOI: 10.1200/jop.18.00028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Advanced cancer patients (ACPs) who participate in phase I clinical trials often report a less-than-ideal understanding of the required elements of informed consent (IC) and unrealistic expectations for anticancer benefit and prognosis. We examined phase I clinical trial enrollment discussions and their associations with subsequent ACP understanding. METHODS Clinical encounters about enrollment in phase I trials between 101 ACPs and 29 oncologists (principal investigators [PIs] and fellows) at three US academic medical institutions were recorded. The Roter Interaction Analysis System was used for analysis. ACPs completed follow-up questionnaires to assess IC recall. RESULTS PIs disclosed the following phase I IC elements to ACPs in encounters: trial purpose in 40%; specific physical risks in 60%; potential specific medical benefits gained by trial participation (eg, disease stabilization) in 48.2%; and alternatives to phase I trial participation in 47.1%, with 1.1% of encounters containing palliative and 2.3% hospice information. PIs provided ACP-specific prognoses in 29.0% of encounters but used precise terms of death in only 4.7% and terminal in 1.2%. A significant association existed between PI disclosure of the trial purpose as dosage/toxicity, and ACPs subsequently correctly recalled trial purpose versus PIs who did not disclose it (85% v 13%; P < .05). CONCLUSION Many oncologists provide incomplete disclosures about phase I trials to ACPs. When disclosure of certain elements of IC occurs, it seems to be associated with better recall, especially with regard to the research purpose of phase I trials.
Collapse
Affiliation(s)
- Fay J Hlubocky
- University of Chicago, Chicago, IL; and Johns Hopkins University, Baltimore, MD
| | - Nancy E Kass
- University of Chicago, Chicago, IL; and Johns Hopkins University, Baltimore, MD
| | - Debra Roter
- University of Chicago, Chicago, IL; and Johns Hopkins University, Baltimore, MD
| | - Susan Larson
- University of Chicago, Chicago, IL; and Johns Hopkins University, Baltimore, MD
| | | | - Jeremy Sugarman
- University of Chicago, Chicago, IL; and Johns Hopkins University, Baltimore, MD
| | | |
Collapse
|
14
|
Oberink R, Boom SM, van Dijk N, Visser MRM. Assessment of motivational interviewing: a qualitative study of response process validity, content validity and feasibility of the motivational interviewing target scheme (MITS) in general practice. BMC Med Educ 2017; 17:224. [PMID: 29162090 PMCID: PMC5698949 DOI: 10.1186/s12909-017-1052-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/02/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The Motivational Interviewing target Scheme (MITS) is an instrument to assess competency in Motivational Interviewing (MI) and can be used to assess MI in long and brief consultations. In this qualitative study we examined two sources of the Unified Model of Validity, the current standard of assessment validation, in the context of General Practice. We collected evidence concerning response process validity and content validity of the MITS in general practice. Furthermore, we investigated its feasibility. METHODS Assessing consultations of General Practitioners and GP-trainees (GPs), the assessors systematically noted down their considerations concerning the scoring process and the content of the MITS in a semi-structured questionnaire. Sampling of the GPs was based on maximum variation and data saturation was used as a stopping criterion. An inductive approach was used to analyse the data. In response to scoring problems the score options were adjusted and all consultations were assessed using the original and the adjusted score options. RESULTS Twenty seven assessments were needed to reach data saturation. In most consultations, the health behaviour was not the reason for encounter but was discussed on top of discussing physical problems. The topic that was most discussed in the consultations was smoking cigarettes. The adjusted score options increased the response process validity; they were more in agreement with theoretical constructs and the observed quality of MI in the consultations. Concerning content validity, we found that the MITS represents the broad spectrum and the current understanding of MI. Furthermore, the MITS proved to be feasible to assess MI in brief consultations in general practice. CONCLUSIONS Based on the collected evidence the MITS seems a promising instrument to measure MI interviewing in brief consultations. The evidence gathered in this study lays the foundation for research into other aspects of validation.
Collapse
Affiliation(s)
- Riëtta Oberink
- Department of General Practice/Family Medicine, Academic Medical Centre–University of Amsterdam, meibergdreef 15, 1105 Amsterdam, The Netherlands
| | - Saskia M. Boom
- Department of General Practice/Family Medicine, Academic Medical Centre–University of Amsterdam, meibergdreef 15, 1105 Amsterdam, The Netherlands
| | - Nynke van Dijk
- Department of General Practice/Family Medicine, Academic Medical Centre–University of Amsterdam, meibergdreef 15, 1105 Amsterdam, The Netherlands
| | - Mechteld R. M. Visser
- Department of General Practice/Family Medicine, Academic Medical Centre–University of Amsterdam, meibergdreef 15, 1105 Amsterdam, The Netherlands
| |
Collapse
|
15
|
Lanier C, Dominicé Dao M, Hudelson P, Cerutti B, Junod Perron N. Learning to use electronic health records: can we stay patient-centered? A pre-post intervention study with family medicine residents. BMC Fam Pract 2017; 18:69. [PMID: 28549460 PMCID: PMC5446676 DOI: 10.1186/s12875-017-0640-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/16/2017] [Indexed: 11/16/2022]
Abstract
Background The Electronic Health Record (EHR) is now widely used in clinical encounters. Because its use can negatively impact the physician-patient relationship, several recommendations on the “patient-centered” use of the EHR have been published. However, the impact of training to improve EHR use during clinical encounters is not well known. The aim of this study was to assess the impact of training on residents’ EHR-related communication skills and explore whether they varied according to the content of the consultation. Methods We conducted a pre-post intervention study at the Primary Care Division of the Geneva University Hospitals, Switzerland. Residents were invited to attend a 3-month training course that included 2 large group sessions and 2–4 individualized coaching sessions based on videotaped encounters. Outcomes were: 1) residents’ perceptions regarding the use of EHR, measured through a self-administered questionnaire and 2) objective use of the EHR during the first 10 min of patient encounters. Changes in practice were measured pre and post intervention using the Roter interaction analysis system (RIAS) and EHR specific items. Results Seventeen out of 27 residents took part in the study. Participants used EHR in about 30% of consultations. After training, they were less likely to consider EHR to be a barrier to the physician-patient relationship, and felt more comfortable using the EHR. After training, participants increased the use of signposting when using the EHR (pre: 0.77, SD 1.69; post: 1.80, SD3.35; p 0.035) and decreased EHR use when psychosocial issues appeared (pre: 24.5% and post: 9.76%, p < 0.001). Conclusions This study suggests that training can improve residents’ EHR-related communication skills, especially in situations where patients bring up sensitive psychosocial issues. Future research should focus on patients’ perceptions of the relevance and usefulness of such skills.
Collapse
Affiliation(s)
- Cédric Lanier
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, rue Gabrielle Perret-Gentil, CH-1211, Geneva, Switzerland. .,Primary care unit, University of Geneva, Centre Médical Universitaire de Genève, Geneva, Switzerland.
| | - Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, rue Gabrielle Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, rue Gabrielle Perret-Gentil, CH-1211, Geneva, Switzerland
| | - Bernard Cerutti
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Noëlle Junod Perron
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, rue Gabrielle Perret-Gentil, CH-1211, Geneva, Switzerland
| |
Collapse
|
16
|
Gibon AS, Durieux JF, Merckaert I, Delvaux N, Farvacques C, Libert Y, Marchal S, Moucheux A, Slachmuylder JL, Razavi D. Development of the LaComm 1.0, A French medical communication analysis software: A study assessing its sensitivity to change. Patient Educ Couns 2017; 100:297-304. [PMID: 27593086 DOI: 10.1016/j.pec.2016.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To test and compare the sensitivity to change of a communication analysis software, the LaComm 1.0, to the CRCWEM's using data from a randomized study assessing the efficacy of a communication skills training program designed for nurses. METHODS The program assessment included the recording of two-person simulated interviews at baseline and after training or 3 months later. Interview transcripts were analyzed using the CRCWEM and the LaComm 1.0 tools. RESULTS One hundred and nine oncology nurses (mainly graduated or certified) were included in the study. The CRCWEM detected 5 changes out of 13 expected changes (38%) (e.g., more open directive questions after training) and the LaComm 1.0, 4 changes out of 7 expected changes (57%) (e.g., more empathic statements after training). For open directive question, the effect sizes of the group-by-time changes were slightly different between tools (CRCWEM: Cohen's d=0.97; LaComm 1.0: Cohen's d=0.67). CONCLUSIONS This study shows that the LaComm 1.0 is sensitive to change. PRACTICE IMPLICATIONS The LaComm 1.0 is a valid method to assess training effectiveness in French. The use of the Lacomm 1.0 in future French communication skills training programs will allow comparisons of studies.
Collapse
Affiliation(s)
- Anne-Sophie Gibon
- Institut Jules Bordet, Brussels, Belgium; Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium
| | | | - Isabelle Merckaert
- Institut Jules Bordet, Brussels, Belgium; Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium
| | - Nicole Delvaux
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Hôpital Universitaire Erasme, Service de Psychologie, Brussels, Belgium
| | | | - Yves Libert
- Institut Jules Bordet, Brussels, Belgium; Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium
| | | | | | | | - Darius Razavi
- Institut Jules Bordet, Brussels, Belgium; Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium.
| |
Collapse
|
17
|
Radziej K, Loechner J, Engerer C, Niglio de Figueiredo M, Freund J, Sattel H, Bachmann C, Berberat PO, Dinkel A, Wuensch A. How to assess communication skills? Development of the rating scale ComOn Check. Med Educ Online 2017; 22:1392823. [PMID: 29141516 PMCID: PMC7011842 DOI: 10.1080/10872981.2017.1392823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/09/2017] [Indexed: 05/30/2023]
Abstract
BACKGROUND Good communication is a core competency for all physicians. Thus, medical students require adequate preparation in communication skills. For research purposes, as well as for evaluation in teaching, there is a clear need for reliable assessment tools. We analyzed the shortcomings of existing instruments and saw a need for a new rating scale. The aim of this publication is to describe the development process for, and evaluation of, a new rating scale. METHODS First, we developed the rating scale in 10 steps. Then, two raters evaluated the newly developed rating scale by rating 135 videotaped consultations of medical students with standardized patients. Additionally, standardized patients evaluated students' performance, which was used as an outside criterion to validate ratings. RESULTS Our rating scale comprises six domains with 13 specific items evaluated on a five-point Likert scale: initiating conversation, patient's perception, structure of conversation, patient's emotions, end of conversation, and general communication skills. Item-total correlation coefficients between the checklist items ranged from 0.15 to 0.78. Subscale consistency was calculated for domains comprised of more than one item and Cronbach's α ≥ 0.77, indicating acceptable consistency. Standardized patients' global evaluation correlated moderately with overall expert ratings (Spearman's ρ = .40, p < .001). CONCLUSION Our rating scale is a reliable and applicable assessment tool. The rating scale focuses on the evaluation of general communication skills and can be applied in research as well as in evaluations, such as objective structured clinical examinations (OSCE). ABBREVIATIONS CST: Communication skills training; ICC: Intra-class correlation coefficient; OSCE: Objective structured clinical examination; SP: Standardized patients; SD: Standard deviation; M: Mean.
Collapse
Affiliation(s)
- K. Radziej
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - J. Loechner
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Ludwig-Maximilians-Universität, Munich, Germany
| | - C. Engerer
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - M. Niglio de Figueiredo
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Clinic of Dermatology and Venereology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J. Freund
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H. Sattel
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C. Bachmann
- Institute of Medical Education, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - P. O. Berberat
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A. Dinkel
- Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A. Wuensch
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
18
|
Maclachlan EW, Shepard-Perry MG, Ingo P, Uusiku J, Mushimba R, Simwanza R, Likoro J, Brandt LJ, Thomas KK, Kasonka C, Hamunime N, O'Malley G. Evaluating the effectiveness of patient education and empowerment to improve patient-provider interactions in antiretroviral therapy clinics in Namibia. AIDS Care 2015; 28:620-7. [PMID: 26695005 PMCID: PMC4841015 DOI: 10.1080/09540121.2015.1124975] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/23/2015] [Indexed: 11/04/2022]
Abstract
In order to increase patient active engagement during patient-provider interactions, we developed and implemented patient training sessions in four antiretroviral therapy (ART) clinics in Namibia using a "Patient Empowerment" training curriculum. We examined the impact of these trainings on patient-provider interactions after the intervention. We tested the effectiveness of the intervention using a randomized parallel group design, with half of the 589 enrolled patients randomly assigned to receive the training immediately and the remaining randomized to receive the training 6 months later. The effects of the training on patient engagement during medical consultations were measured at each clinic visit for at least 8 months of follow-up. Each consultation was audiotaped and then coded using the Roter Interaction Analysis System (RIAS). RIAS outcomes were compared between study groups at 6 months. Using intention-to-treat analysis, consultations in the intervention group had significantly higher RIAS scores in doctor facilitation and patient activation (adjusted difference in score 1.19, p = .004), doctor information gathering (adjusted difference in score 2.96, p = .000), patient question asking (adjusted difference in score .48, p = .012), and patient positive affect (adjusted difference in score 2.08, p = .002). Other measures were higher in the intervention group but did not reach statistical significance. We have evidence that increased engagement of patients in clinical consultation can be achieved via a targeted training program, although outcome data were not available on all patients. The patient training program was successfully integrated into ART clinics so that the trainings complemented other services being provided.
Collapse
Affiliation(s)
- Ellen W Maclachlan
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Mark G Shepard-Perry
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| | - Paulina Ingo
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - James Uusiku
- b International Training and Education Center for Health (I-TECH) , Ondangwa , Namibia
| | - Ruusa Mushimba
- c International Organization for Migration (IOM) , Windhoek , Namibia
| | - Ricky Simwanza
- d Ministry of Health and Social Services (MoHSS) , Katima Mulilo , Namibia
| | - Joseph Likoro
- e The Global Fund to Fight AIDS, Tuberculosis and Malaria , Windhoek , Namibia
| | - Laura J Brandt
- f International Training and Education Center for Health (I-TECH), University of Washington Department of Global Health , Windhoek , Namibia
| | - Katherine K Thomas
- g International Clinical Research Center (ICRC), University of Washington Department of Global Health , Seattle , WA , USA
| | - Claude Kasonka
- h Monitoring and Evaluation Unit , Millennium Challenge Account , Lusaka , Zambia
| | - Ndapewa Hamunime
- i Namibia Ministry of Health and Social Services , Directorate of Special Programs (MoHSS/DSP, Windhoek, Namibia)
| | - Gabrielle O'Malley
- a Department of Global Health, International Training and Education Center for Health (I-TECH) , University of Washington , Seattle , WA , USA
| |
Collapse
|
19
|
Finkelstein A, Carmel S, Bachner Y. Physicians' communication styles as correlates of elderly cancer patients' satisfaction with their doctors. Eur J Cancer Care (Engl) 2015; 26. [DOI: 10.1111/ecc.12399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2015] [Indexed: 12/01/2022]
Affiliation(s)
- A. Finkelstein
- Department of Public Health; Ben-Gurion University of the Negev; Beer-Sheva Israel
- Faculty of Life and Health Sciences; Tal Campus; Lev Academic Center; Jerusalem Israel
| | - S. Carmel
- The Center for Multidisciplinary Research in Aging; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Y.G. Bachner
- Department of Public Health; Ben-Gurion University of the Negev; Beer-Sheva Israel
| |
Collapse
|
20
|
Abstract
New cancer patients frequently raise concerns about fears, uncertainties, and hopes during oncology interviews. This study sought to understand when and how patients raise their concerns, how doctors responded to these patient-initiated actions, and implications for communication satisfaction. A subsampling of video recorded and transcribed encounters was investigated involving 44 new patients and 14 oncologists. Patients completed pre/post self-report measures about fears, uncertainties, and hopes as well as postevaluations of interview satisfaction. Conversation analysis was used to initially identify pairs of patient-initiated and doctor-responsive actions. A coding scheme was subsequently developed, and two independent coding teams, comprised of two coders each, reliably identified patient-initiated and doctor-responsive social actions. Interactional findings reveal that new cancer patients initiate actions much more frequently than previous research had identified, concerns are usually raised indirectly, and with minimal emotion. Doctors tend to respond to these concerns immediately, but with even less affect, and rarely partner with patients. From pre/post results, it was determined that the higher patients' reported fears, the higher their postvisit fears and lower their satisfaction. Patients with high uncertainty were highly proactive (e.g., asked more questions), yet reported even greater uncertainties after encounters. Hopeful patients also exited interviews with high hopes. Overall, new patients were very satisfied: oncology interviews significantly decreased patients' fears and uncertainties, while increasing hopes. Discussion raises key issues for improving communication and managing quality cancer care.
Collapse
Affiliation(s)
- Wayne A. Beach
- Professor, School of Communication, San Diego State University, San Diego, CA 92182-4561, Phone: (619) 594-4948, FAX: (619) 594-0704, Adjunct Professor, Department of Surgery, Member, Moores Cancer Center, University of California, San Diego
| | - David M. Dozier
- Professor, Public Relations Emphasis, School of Journalism & Media Studies, San Diego State University, San Diego, CA 92182-4561
| |
Collapse
|
21
|
Zill JM, Christalle E, Müller E, Härter M, Dirmaier J, Scholl I. Measurement of physician-patient communication--a systematic review. PLoS One 2014; 9:e112637. [PMID: 25532118 PMCID: PMC4273948 DOI: 10.1371/journal.pone.0112637] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/09/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Effective communication with health care providers has been found as relevant for physical and psychological health outcomes as well as the patients' adherence. However, the validity of the findings depends on the quality of the applied measures. This study aimed to provide an overview of measures of physician-patient communication and to evaluate the methodological quality of psychometric studies and the quality of psychometric properties of the identified measures. METHODS A systematic review was performed to identify psychometrically tested instruments which measure physician-patient communication. The search strategy included three databases (EMBASE, PsycINFO, PubMed), reference and citation tracking and personal knowledge. Studies that report the psychometric properties of physician-patient communication measures were included. Two independent raters assessed the methodological quality of the selected studies with the COSMIN (COnsensus based Standards for the selection of health status Measurement INtruments) checklist. The quality of psychometric properties was evaluated with the quality criteria of Terwee and colleagues. RESULTS Data of 25 studies on 20 measures of physician-patient communication were extracted, mainly from primary care samples in Europe and the USA. Included studies reported a median of 3 out of the nine COSMIN criteria. Scores for internal consistency and content validity were mainly fair or poor. Reliability and structural validity were rated mainly of fair quality. Hypothesis testing scored mostly poor. The quality of psychometric properties of measures evaluated with Terwee et al.'s criteria was rated mainly intermediate or positive. DISCUSSION This systematic review identified a number of measures of physician-patient communication. However, further psychometric evaluation of the measures is strongly recommended. The application of quality criteria like the COSMIN checklist could improve the methodological quality of psychometric property studies as well as the comparability of the studies' results.
Collapse
Affiliation(s)
- Jördis M. Zill
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Eva Christalle
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
22
|
Salsbury SA, DeVocht JW, Hondras MA, Seidman MB, Stanford CM, Goertz CM. Chiropractor interaction and treatment equivalence in a pilot randomized controlled trial: an observational analysis of clinical encounter video-recordings. Chiropr Man Therap 2014; 22:42. [PMID: 25478142 PMCID: PMC4255952 DOI: 10.1186/s12998-014-0042-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/03/2014] [Indexed: 01/31/2023] Open
Abstract
Background Chiropractic care is a complex health intervention composed of both treatment effects and non-specific, or placebo, effects. While doctor-patient interactions are a component of the non-specific effects of chiropractic, these effects are not evaluated in most clinical trials. This study aimed to: 1) develop an instrument to assess practitioner-patient interactions; 2) determine the equivalence of a chiropractor’s verbal interactions and treatment delivery for participants allocated to active or sham chiropractic groups; and 3) describe the perceptions of a treatment-masked evaluator and study participants regarding treatment group assignment. Methods We conducted an observational analysis of digital video-recordings derived from study visits conducted during a pilot randomized trial of conservative therapies for temporomandibular pain. A theory-based, iterative process developed the 13-item Chiropractor Interaction and Treatment Equivalence Instrument. A trained evaluator masked to treatment assignment coded video-recordings of clinical encounters between one chiropractor and multiple visits of 26 participants allocated to active or sham chiropractic treatment groups. Non-parametric statistics were calculated. Results The trial ran from January 2010 to October 2011. We analyzed 111 complete video-recordings (54 active, 57 sham). Chiropractor interactions differed between the treatment groups in 7 categories. Active participants received more interactions with clinical information (8 vs. 4) or explanations (3.5 vs. 1) than sham participants within the therapeutic domain. Active participants received more directions (63 vs. 58) and adjusting instrument thrusts (41.5 vs. 23) in the procedural domain and more optimistic (2.5 vs. 0) or neutral (7.5 vs. 5) outcome statements in the treatment effectiveness domain. Active participants recorded longer visit durations (13.5 vs. 10 minutes). The evaluator correctly identified 61% of active care video-recordings as active treatments but categorized only 31% of the sham treatments correctly. Following the first treatment, 82% of active and 11% of sham participants correctly identified their treatment group. At 2-months, 93% of active and 42% of sham participants correctly identified their group assignment. Conclusions Our findings show the feasibility of evaluating doctor-patient interactions in chiropractic clinical trials using video-recordings and standardized instrumentation. Clinical trial design and clinician training protocols should improve and assess the equivalence of doctor-patient interactions between treatment groups. Trial registration This trial was registered in ClinicalTrials.gov as NCT01021306 on 24 November 2009.
Collapse
Affiliation(s)
- Stacie A Salsbury
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA
| | - James W DeVocht
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA
| | - Maria A Hondras
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Michael B Seidman
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA
| | - Clark M Stanford
- The University of Illinois, 801 South Paulina Street, 102c (MC621), Chicago, IL 60612 USA
| | - Christine M Goertz
- Palmer College of Chiropractic, Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803 USA
| |
Collapse
|
23
|
Slort W, Blankenstein AH, Schweitzer BPM, Deliens L, van der Horst HE. Effectiveness of the 'availability, current issues and anticipation' (ACA) training programme for general practice trainees on communication with palliative care patients: a controlled trial. Patient Educ Couns 2014; 95:83-90. [PMID: 24412094 DOI: 10.1016/j.pec.2013.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 11/27/2013] [Accepted: 12/10/2013] [Indexed: 05/17/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of a new palliative care 'availability, current issues and anticipation' (ACA) training programme to improve communication skills of general practice trainees (GPTs). METHODS In a controlled trial among third-year GPTs, we videotaped one 20-min consultation between each GPT and a simulated palliative care patient at baseline and at six months follow-up. We measured the number of issues discussed and the quality of communication skills and analysed between-group differences using linear mixed models and logistic regression. RESULTS Fifty-four GPTs were assigned to the intervention and 64 to the control group. We found no effect of the programme on the number of issues discussed or on the quality of GPT communicative behaviour. GPTs infrequently addressed 'spiritual/existential issues' and 'unfinished business'. In a selection of the consultations, simulated patients brought up more issues than the GPTs did. CONCLUSION The ACA training programme was not effective in the way it was carried out and evaluated in this trial. PRACTICE IMPLICATIONS The ACA programme should focus on the issues that scored low in this trial. Future research on GPT-patient communication in palliative care should consider using real patients in a series of consultations to evaluate effectiveness.
Collapse
Affiliation(s)
- Willemjan Slort
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Annette H Blankenstein
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bart P M Schweitzer
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Luc Deliens
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Henriëtte E van der Horst
- Department of General Practice & Elderly Care Medicine, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
24
|
Shaw J, Young J, Butow P, Chambers S, O'Brien L, Solomon M. Delivery of telephone-based supportive care to people with cancer: An analysis of cancer helpline operator and cancer nurse communication. Patient Educ Couns 2013; 93:444-450. [PMID: 23910248 DOI: 10.1016/j.pec.2013.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 05/13/2013] [Accepted: 07/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Telephone-based supportive care presents a potentially highly accessible means of addressing unmet supportive care needs for people with cancer. Identification of behaviours that facilitate communication is essential for development of training for telephone-based supportive care. The aim of this study was to describe communication behaviours within supportive care telephone calls in two contexts (1) a telephone outreach intervention and (2) cancer helpline calls, to identify potential areas for further training. METHODS 50 recorded calls were analysed using two standardised coding systems: the RIAS and Verona-CoDES-C. RESULTS Mean call length was 21 min (304 utterances) for nurse-outreach calls and 23 min (355 utterances) for helpline calls. Closed questioning, verbal attentiveness and giving information/counselling were the most common communication behaviours identified. Emotional cues were most commonly responded to through non-explicit back-channelling, exploration of content or provision of reassurance or advice. CONCLUSIONS This study confirmed the need to address the manner in which questions are framed to maximise patient disclosure. Responding to patent emotional cues was highlighted as an area for future training focus. PRACTICE IMPLICATIONS Communication skills training that addresses each of these tasks is likely to improve the effectiveness of telephone-based delivery of supportive care.
Collapse
Affiliation(s)
- Joanne Shaw
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Australia; University of Sydney, Australia.
| | | | | | | | | | | |
Collapse
|
25
|
Kimball BC, James KM, Yost KJ, Fernandez CA, Kumbamu A, Leppin AL, Robinson ME, Geller G, Roter DL, Larson SM, Lenz HJ, Garcia AA, Braddock CH, Jatoi A, de Nuncio MLZ, Montori VM, Koenig BA, Tilburt JC. Listening in on difficult conversations: an observational, multi-center investigation of real-time conversations in medical oncology. BMC Cancer 2013; 13:455. [PMID: 24093624 PMCID: PMC3850997 DOI: 10.1186/1471-2407-13-455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The quality of communication in medical care has been shown to influence health outcomes. Cancer patients, a highly diverse population, communicate with their clinical care team in diverse ways over the course of their care trajectory. Whether that communication happens and how effective it is may relate to a variety of factors including the type of cancer and the patient's position on the cancer care continuum. Yet, many of the routine needs of cancer patients after initial cancer treatment are often not addressed adequately. Our goal is to identify areas of strength and areas for improvement in cancer communication by investigating real-time cancer consultations in a cross section of patient-clinician interactions at diverse study sites. METHODS/DESIGN In this paper we describe the rationale and approach for an ongoing observational study involving three institutions that will utilize quantitative and qualitative methods and employ a short-term longitudinal, prospective follow-up component to investigate decision-making, key topics, and clinician-patient-companion communication dynamics in clinical oncology. DISCUSSION Through a comprehensive, real-time approach, we hope to provide the fundamental groundwork from which to promote improved patient-centered communication in cancer care.
Collapse
|
26
|
Slort W, Blankenstein AH, Schweitzer BPM, Knol DL, Deliens L, Aaronson NK, van der Horst HE. Effectiveness of the ACA (Availability, Current issues and Anticipation) training programme on GP-patient communication in palliative care; a controlled trial. BMC Fam Pract 2013; 14:93. [PMID: 23819723 PMCID: PMC3734100 DOI: 10.1186/1471-2296-14-93] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 05/07/2013] [Indexed: 01/28/2023]
Abstract
Background Communicating effectively with palliative care patients has been acknowledged to be somewhat difficult, but little is known about the effect that training general practitioners (GPs) in specific elements of communication in palliative care might have. We hypothesized that GPs exposed to a new training programme in GP-patient communication in palliative care focusing on availability of the GP for the patient, current issues the GP should discuss with the patient and anticipation by the GP of various scenarios (ACA), would discuss more issues and become more skilled in their communication with palliative care patients. Methods In this controlled trial among GPs who attended a two-year Palliative Care Peer Group Training Course in the Netherlands only intervention GPs received the ACA training programme. To evaluate the effect of the programme a content analysis (Roter Interaction Analysis System) was performed of one videotaped 15-minute consultation of each GP with a simulated palliative care patient conducted at baseline, and one at 12 months follow-up. Both how the GP communicated with the patient (‘availability’) and the number of current and anticipated issues the GP discussed with the patient were measured quantitatively. We used linear mixed models and logistic regression models to evaluate between-group differences over time. Results Sixty-two GPs were assigned to the intervention and 64 to the control group. We found no effect of the ACA training programme on how the GPs communicated with the patient or on the number of issues discussed by GPs with the patient. The total number of issues discussed by the GPs was eight out of 13 before and after the training in both groups. Conclusion The ACA training programme did not influence how the GPs communicated with the simulated palliative care patient or the number of issues discussed by the GPs in this trial. Further research should evaluate whether this training programme is effective for GPs who do not have a special interest in palliative care and whether studies using outcomes at patient level can provide more insight into the effectiveness of the ACA training programme. Trial registration Current Controlled Trials ISRCTN56722368
Collapse
Affiliation(s)
- Willemjan Slort
- Department of General Practice & Elderly Care Medicine, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
BACKGROUND This is an updated version of a review that was originally published in the Cochrane Database of Systematic Reviews in 2004, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses have been proposed and are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether CST is effective in improving the communication skills of HCPs involved in cancer care, and in improving patient health status and satisfaction. SEARCH METHODS We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2012, MEDLINE, EMBASE, PsycInfo and CINAHL to February 2012. The original search was conducted in November 2001. In addition, we handsearched the reference lists of relevant articles and relevant conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In this updated version, we limited our criteria to RCTs evaluating 'CST' compared with 'no CST' or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real and/or simulated patients with cancer, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects model and, for continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 15 RCTs (42 records), conducted mainly in outpatient settings. Eleven studies compared CST with no CST intervention, three studies compared the effect of a follow-up CST intervention after initial CST training, and one study compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists (six studies), residents (one study) other doctors (one study), nurses (six studies) and a mixed team of HCPs (one study). Overall, 1147 HCPs participated (536 doctors, 522 nurses and 80 mixed HCPs).Ten studies contributed data to the meta-analyses. HCPs in the CST group were statistically significantly more likely to use open questions in the post-intervention interviews than the control group (five studies, 679 participant interviews; P = 0.04, I² = 65%) and more likely to show empathy towards patients (six studies, 727 participant interviews; P = 0.004, I² = 0%); we considered this evidence to be of moderate and high quality, respectively. Doctors and nurses did not perform statistically significantly differently for any HCP outcomes.There were no statistically significant differences in the other HCP communication skills except for the subgroup of participant interviews with simulated patients, where the intervention group was significantly less likely to present 'facts only' compared with the control group (four studies, 344 participant interviews; P = 0.01, I² = 70%).There were no significant differences between the groups with regard to outcomes assessing HCP 'burnout', patient satisfaction or patient perception of the HCPs communication skills. Patients in the control group experienced a greater reduction in mean anxiety scores in a meta-analyses of two studies (169 participant interviews; P = 0.02; I² = 8%); we considered this evidence to be of a very low quality. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving some types of HCP communication skills related to information gathering and supportive skills. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', patients' mental or physical health, and patient satisfaction.
Collapse
Affiliation(s)
- Philippa M Moore
- Family Medicine, P. Universidad Catolica de Chile, Lira 44, Santiago, Chile.
| | | | | | | |
Collapse
|
28
|
Smets EMA, Hillen MA, Douma KFL, Stalpers LJA, Koning CCE, de Haes HCJM. Does being informed and feeling informed affect patients' trust in their radiation oncologist? Patient Educ Couns 2013; 90:330-7. [PMID: 22694893 DOI: 10.1016/j.pec.2012.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 05/01/2012] [Accepted: 05/02/2012] [Indexed: 05/22/2023]
Abstract
OBJECTIVE We investigated whether the content of information provided by radiation oncologists and their information giving performance increase patients' trust in them. METHODS Questionnaires were used to assess radiotherapy patients (n=111) characteristics before their first consultation, perception of information giving after the first consultation and trust before the follow-up consultation. Videotaped consultations were scored for the content of the information provided and information giving performance. RESULTS Patients mean trust score was 4.5 (sd=0.77). The more anxious patients were, the less they tended to fully trust their radiation oncologist (p=0.03). Patients' age, gender, educational attainment and anxious disposition together explained 7%; radiation oncologists' information giving (content and performance) explained 3%, and patients' perception of radiation oncologists' information-giving explained an additional 4% of the variance in trust scores. CONCLUSION It can be questioned whether trust is a sensitive patient reported outcome of quality of communication in highly vulnerable patients. PRACTICE IMPLICATIONS It is important to note that trust may not be a good patient reported outcome of quality of care. Concerning radiation oncologists' information giving performance, our data suggest that they can particularly improve their assessments of patients' understanding.
Collapse
Affiliation(s)
- Ellen M A Smets
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
29
|
Meystre C, Bourquin C, Despland JN, Stiefel F, de Roten Y. Working alliance in communication skills training for oncology clinicians: a controlled trial. Patient Educ Couns 2013; 90:233-238. [PMID: 23158787 DOI: 10.1016/j.pec.2012.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 10/16/2012] [Accepted: 10/19/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of communication skills training (CST) on working alliance and to identify specific communicational elements related to working alliance. METHODS Pre- and post-training simulated patient interviews (6-month interval) of oncology physicians and nurses (N=56) who benefited from CST were compared to two simulated patient interviews with a 6-month interval of oncology physicians and nurses (N=57) who did not benefit from CST. The patient-clinician interaction was analyzed by means of the Roter Interaction Analysis System (RIAS). Alliance was measured by the Working Alliance Inventory - Short Revised Form. RESULTS While working alliance did not improve with CST, generalized linear mixed effect models demonstrated that the quality of verbal communication was related to alliance. Positive talk and psychosocial counseling fostered alliance whereas negative talk, biomedical information and patient's questions diminished alliance. CONCLUSION Patient-clinician alliance is related to specific verbal communication behaviors. PRACTICE IMPLICATIONS Working alliance is a key element of patient-physician communication which deserves further investigation as a new marker and efficacy criterion of CST outcome.
Collapse
Affiliation(s)
- Claudia Meystre
- Department of Psychiatry, Lausanne University Hospital, CH-1011 CHUV-Lausanne, Switzerland
| | | | | | | | | |
Collapse
|
30
|
Fagerlind H, Kettis A, Bergström I, Glimelius B, Ring L. Different perspectives on communication quality and emotional functioning during routine oncology consultations. Patient Educ Couns 2012; 88:16-22. [PMID: 22261005 DOI: 10.1016/j.pec.2011.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 12/08/2011] [Accepted: 12/10/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine quality of communication in routine oncology consultations from patient, physician, and observer perspectives, and to determine agreement of emotional function content in consultations from these three perspectives. METHODS In total, 69 consultations were included. Perceived quality of communication and whether or not emotional functioning had been discussed was evaluated with patient- and physician-reported questionnaires. Observer perspective was evaluated by content analysis of audio records of the consultations. Agreement between perspectives was analyzed and means compared using linear mixed models. RESULTS The patients' ratings of communication quality differed significantly from those of both the physician and observer. Observer and physician scores did not differ significantly. Physicians rated emotional functioning as discussed more often than was reported from patient and observer perspectives. CONCLUSION The patients' view of the quality of communication differed from that of the physician and observer. Whether emotional functioning was discussed or not was also perceived differently by patients, physicians, and observer. PRACTICE IMPLICATIONS The underpinnings and implications of these results need to be further explored regarding how to move toward a higher degree of shared understanding, where different perspectives are more in alignment, and how to develop more valid methods for evaluating communication.
Collapse
Affiliation(s)
- Hanna Fagerlind
- Department of Pharmacy, Uppsala University, Uppsala, Sweden.
| | | | | | | | | |
Collapse
|
31
|
Nicklasson M, Elfström ML, Olofson J, Bergman B. The impact of individual quality of life assessment on psychosocial attention in patients with chest malignancies: a randomized study. Support Care Cancer 2013; 21:87-95. [DOI: 10.1007/s00520-012-1496-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 05/09/2012] [Indexed: 11/12/2022]
|
32
|
Stubenrauch S, Schneid EM, Wünsch A, Helmes A, Bertz H, Fritzsche K, Wirsching M, Gölz T. Development and evaluation of a checklist assessing communication skills of oncologists: the COM-ON-Checklist. J Eval Clin Pract 2012; 18:225-30. [PMID: 21029271 DOI: 10.1111/j.1365-2753.2010.01556.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Communication skills training (CST) has to be proven effective, and therefore reliable instruments to evaluate CST are required. Most instruments assessing medical consultations do not take individual aspects of CST into consideration. Such assessment tools should naturally also be closely associated with the communication skills taught to the participants. Thus, we developed a new instrument which evaluates the effects of specific CST. DEVELOPMENT Based on a literature review, we developed a checklist with questions ('items') which assess the behaviour of a doctor in a special doctor-patient consultation (The COM-ON-Checklist, COM-ON = communication in oncology). First, we developed items for general communication skills that are a requirement of every doctor-patient consultation, and in addition to this, we developed items for specific situations which present a particular challenge for doctors in terms of communication skills, namely: the situation in which the doctor is required to discuss the shift from curative to palliative care, and the disclosure of information about clinical trials. For assessment, a 5-point rating scale with anchor points was used. EVALUATION Blinded raters were trained to use the COM-ON-Checklist. The intra-class correlation (ICC) was used to calculate the agreement between raters. RESULTS The COM-ON-Checklist consists of two parts: the first part evaluates general communication skills; the second part evaluates content-specific aspects of the consultation. The ICC ranged from 0.5 to 0.8, which demonstrates moderate to very good results of inter-rater reliability. DISCUSSION The COM-ON-Checklist can be used to evaluate specific CST. It is also a feedback source for clinicians because it assesses their personal communication skills in different settings. In conclusion, the COM-ON-Checklist provides a reliable, structured method for assessing communication skills in oncological settings.
Collapse
Affiliation(s)
- Sara Stubenrauch
- University Hospital Freiburg, Department of Internal Medicine I, Freiburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Lelorain S, Brédart A, Dolbeault S, Sultan S. A systematic review of the associations between empathy measures and patient outcomes in cancer care. Psychooncology 2012; 21:1255-64. [PMID: 22238060 DOI: 10.1002/pon.2115] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Despite a call for empathy in medical settings, little is known about the effects of the empathy of health care professionals on patient outcomes. This review investigates the links between physicians' or nurses' empathy and patient outcomes in oncology. METHOD With the use of multiple databases, a systematic search was performed using a combination of terms and subject headings of empathy or perspective taking or clinician-patient communication, oncology or end-of-life setting and physicians or nurses. Among the 394 hits returned, 39 studies met the inclusion criteria of a quantitative measure of empathy or empathy-related constructs linked to patient outcomes. RESULTS Empathy was mainly evaluated using patient self-reports and verbal interaction coding. Investigated outcomes were mainly proximal patient satisfaction and psychological adjustment. Clinicians' empathy was related to higher patient satisfaction and lower distress in retrospective studies and when the measure was patient-reported. Coding systems yielded divergent conclusions. Empathy was not related to patient empowerment (e.g. medical knowledge, coping). CONCLUSION Overall, clinicians' empathy has beneficial effects according to patient perceptions. However, in order to disentangle components of the benefits of empathy and provide professionals with concrete advice, future research should apply different empathy assessment approaches simultaneously, including a perspective-taking task on patients' expectations and needs at precise moments. Indeed, clinicians' understanding of patients' perspectives is the core component of medical empathy, but it is often assessed only from the patient's point of view. Clinicians' evaluations of patients' perspectives should be studied and compared with patients' reports so that problematic gaps between the two perspectives can be addressed.
Collapse
Affiliation(s)
- Sophie Lelorain
- Laboratoire de Psychopathologie et Processus de Santé (LPPS EA 4057), IUPDP, Université Paris Descartes, Boulogne-Billancourt, France.
| | | | | | | |
Collapse
|
34
|
Hunziker S, Schläpfer M, Langewitz W, Kaufmann G, Nüesch R, Battegay E, Zimmerli LU. Open and hidden agendas of "asymptomatic" patients who request check-up exams. BMC Fam Pract 2011; 12:22. [PMID: 21504617 PMCID: PMC3094231 DOI: 10.1186/1471-2296-12-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 04/19/2011] [Indexed: 01/28/2023]
Abstract
Background Current guidelines for a check-up recommend routine screening not triggered by specific symptoms for some known risk factors and diseases in the general population. Patients' perceptions and expectations regarding a check-up exam may differ from these principles. However, quantitative and qualitative data about the discrepancy between patient- and provider expectations for this type of clinic consultation is lacking. Methods For a year, we prospectively enrolled 66 patients who explicitly requested a "check-up" at our medical outpatient division. All patients actively denied upon prompting having any symptoms or specific health concerns at the time they made their appointment. All consultations were videotaped and analysed for information about spontaneously mentioned symptoms and reasons for the clinic consultation ("open agendas") and for cues to hidden patient agendas using the Roter interaction analysis system (RIAS). Results All patients initially declared to be asymptomatic but this was ultimately the case in only 7 out of 66 patients. The remaining 59 patients spontaneously mentioned a mean of 4.2 ± 3.3 symptoms during their first consultation. In 23 patients a total of 31 hidden agendas were revealed. The primary categories for hidden agendas were health concerns, psychosocial concerns and the patient's concept of disease. Conclusions The majority of patients requesting a general check-up tend to be motivated by specific symptoms and health concerns and are not "asymptomatic" patients who primarily come for preventive issues. Furthermore, physicians must be alert for possible hidden agendas, as one in three patients have one or more hidden reasons for requesting a check-up.
Collapse
Affiliation(s)
- Sabina Hunziker
- Medical Outpatient Division/Ambulatory Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | | | | | | | | | | | | |
Collapse
|
35
|
Trinkaus HL, Gaisser AE. SACA: Software Assisted Call Analysis--an interactive tool supporting content exploration, online guidance and quality improvement of counseling dialogues. Patient Educ Couns 2010; 80:410-416. [PMID: 20688458 DOI: 10.1016/j.pec.2010.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Nearly 30,000 individual inquiries are answered annually by the telephone cancer information service (CIS, KID) of the German Cancer Research Center (DKFZ). The aim was to develop a tool for evaluating these calls, and to support the complete counseling process interactively. METHODS A novel software tool is introduced, based on a structure similar to a music score. Treating the interaction as a "duet", guided by the CIS counselor, the essential contents of the dialogue are extracted automatically. For this, "trained speech recognition" is applied to the (known) counselor's part, and "keyword spotting" is used on the (unknown) client's part to pick out specific items from the "word streams". The outcomes fill an abstract score representing the dialogue. RESULTS Pilot tests performed on a prototype of SACA (Software Assisted Call Analysis) resulted in a basic proof of concept: Demographic data as well as information regarding the situation of the caller could be identified. CONCLUSION The study encourages following up on the vision of an integrated SACA tool for supporting calls online and performing statistics on its knowledge database offline. PRACTICE IMPLICATIONS Further research perspectives are to check SACA's potential in comparison with established interaction analysis systems like RIAS.
Collapse
Affiliation(s)
- Hans L Trinkaus
- Fraunhofer Institute for Industrial Mathematics, Department of System Analysis, Prognosis and Control, Kaiserslautern, Germany.
| | | |
Collapse
|
36
|
Cloud-Buckner J, Gallimore JJ, Scott R. Theoretical Discussion of CAMOCS and RIAS Communication Models to Support Healthcare Information Technology Development. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/154193121005400505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increasing use of healthcare information technology has a direct, sometimes negative, effect on communication between physicians and patients. Many studies have evaluated how patient-provider interactions are affected by the implementation of an already developed technology. Instead, we propose that research in understanding and modeling communication should inform healthcare IT design so that systems can support the communication that needs to exist. This paper briefly describes two communication models (one based in healthcare and one based in business organizational communication), their similarities and differences, and research outcomes related to their use when evaluating communication in the healthcare domain. We then describe how these models might be combined and used as an underlying model to inform and validate design for healthcare IT.
Collapse
Affiliation(s)
- Jennifer Cloud-Buckner
- Ohio Center of Excellence for Human-Centered Innovation
- Department of Biomedical, Industrial, and Human Factors Engineering
| | - Jennie J. Gallimore
- Ohio Center of Excellence for Human-Centered Innovation
- Department of Biomedical, Industrial, and Human Factors Engineering
- Boonshoft School of Medicine Wright State University, Dayton, OH, USA
| | - Rosalyn Scott
- Ohio Center of Excellence for Human-Centered Innovation
- Boonshoft School of Medicine Wright State University, Dayton, OH, USA
| |
Collapse
|
37
|
Fagerlind H, Bergström I, Lindblad ÅK, Velikova G, Glimelius B, Ring L. Communication analysis in oncology care. Performance of a combination of a content analysis system and a global scale. Psychooncology 2010; 20:992-1000. [DOI: 10.1002/pon.1808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 04/16/2010] [Accepted: 06/14/2010] [Indexed: 11/12/2022]
|
38
|
Bensing JM, Verheul W, Jansen J, Langewitz WA. Looking for Trouble: The Added Value of Sequence Analysis in Finding Evidence for the Role of Physicians in Patients' Disclosure of Cues and Concerns. Med Care 2010; 48:583-8. [DOI: 10.1097/mlr.0b013e3181d567a5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
Abstract
AIMS The purpose of this pilot study was to assess the feasibility of a quantitative approach to study occupational therapist-client interactions. Role plays were videotaped in which 10 therapists met three client-actors. A questionnaire assessed the occupational therapists' and the patient-actors' opinion of the role-play experience. A modified version of the Roter Interaction Analysis System (RIAS), OT-RIAS, was used to analyse data. MAJOR FINDINGS Occupational therapists considered the role play experience to be "highly realistic" (mean score 5.4 on a 1-6 Likert scale). The actors' comfort role playing clients was also high (mean = 4.0; range 1-5). Inter-coder reliability for the OT-RIAS was highly significant (r = 0.919; p = 0.000). The modified version of this system fits well in an occupational therapy context. PRINCIPAL CONCLUSION The quantitative approach used in this study to explore the therapist-client relationship appears to be effective. The role plays and RIAS may be useful in research exploring correlation between the OT communication style and outcome measures such as client satisfaction or comprehension, or in order to assess and offer feedback in teaching communication skills programmes.
Collapse
Affiliation(s)
- Elena Vegni
- Medical Psychology Department, School of Medicine, University of Milan, Milan, Italy.
| | | | | | | |
Collapse
|
40
|
Brazil K, Sussman J, Bainbridge D, Whelan T. Who is responsible? The role of family physicians in the provision of supportive cancer care. J Oncol Pract 2009; 6:19-24. [PMID: 20539726 DOI: 10.1200/jop.091060] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2009] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients living with cancer identify family physicians (FPs; ie, primary care physicians) as a preferred resource for supportive cancer care (SCC), either through direct provision or referral. However, little research exists on the specific role FPs play in addressing these needs. METHODS A mailed survey was sent to all FPs in a health care region in Ontario, Canada, to determine their current and preferred roles in the specific provision of SCC to patients with cancer who have been newly diagnosed or are at the end of life. RESULTS Completed surveys were received from 84 (64%) of 183 eligible FPs. Most practitioners reported providing for their patients' various SCC needs. However, clear gaps were demonstrated in psychosocial and nutritional counseling and in providing information about SCC services. FPs were satisfied with their current role reported in SCC coordination, although the type of role varied; FPs who were asked about their end-of-life patients tended to see themselves as part of coordinating teams, whereas FPs asked about their recently diagnosed patients were more likely to defer this responsibly to a third party. CONCLUSION This study identified gaps in the provision of psychosocial and informational care to patients with cancer that may result in unmet needs. In general, FPs do not see themselves as primarily responsible for coordinating patients' SCC and do not wish to assume this role. Accordingly, models that involve FPs as team members in SCC coordination are more feasible for reducing patient need.
Collapse
Affiliation(s)
- Kevin Brazil
- St Joseph's Health System Research Network; the Supportive Care Research Unit, Juravinski Cancer Centre; and the Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | | | | |
Collapse
|
41
|
Venetis MK, Robinson JD, Turkiewicz KL, Allen M. An evidence base for patient-centered cancer care: a meta-analysis of studies of observed communication between cancer specialists and their patients. Patient Educ Couns 2009; 77:379-383. [PMID: 19836920 DOI: 10.1016/j.pec.2009.09.015] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 03/31/2009] [Accepted: 09/11/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE In the context of patients visiting cancer specialists, the objective is to test the association between both patient-centered communication (including Affective Behavior and Participation Behavior) and Instrumental Behavior and patients' post-visit satisfaction with a variety of visit phenomena. METHODS Meta-analysis of 25 articles representing 10 distinct data sets. RESULTS Both patient-centered- and instrumental behavior are significantly, positively associated with satisfaction, with patient-centered communication having a relatively stronger association. CONCLUSION There is an evidence base for the efficacy of patient-centered care. PRACTICE IMPLICATIONS Cancer specialists need to train to improve their patient-centered communication.
Collapse
Affiliation(s)
- Maria K Venetis
- Department of Communication, Rutgers University, 4 Huntington Street, New Brunswick, NJ 08901, USA.
| | | | | | | |
Collapse
|
42
|
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 Fam Pract 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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
43
|
Fagerlind H, Lindblad ÅK, Bergström I, Nilsson M, Nauclér G, Glimelius B, Ring L. Patient-physician communication during oncology consultations. Psychooncology 2008; 17:975-85. [DOI: 10.1002/pon.1410] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
44
|
|
45
|
Bensing JM, Tromp F, van Dulmen S, van den Brink-Muinen A, Verheul W, Schellevis F. De zakelijke huisarts en de niet-mondige patiënt: veranderingen in communicatie. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/bf03086628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
46
|
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 Educ Couns 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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
47
|
Abstract
BACKGROUND AND PURPOSE Communication is the most important aspect of practice that health care professionals have to master. The purpose of this study was to measure the content and prevalence of verbal and nonverbal communications between physical therapists and patients with back pain. SUBJECTS Seven physical therapists and 21 patients with back pain participated in this study. METHODS The first interaction following the initial assessment was recorded with a video camera. The outcome measures were the Medical Communications Behavior System (verbal communication) and frequencies of nonverbal behaviors (affirmative head nodding, smiling, eye gaze, forward leaning, and touch). Semistructured interviews were undertaken with the physical therapists to determine the perceived influence of the video camera. RESULTS A total of 2,055 verbal statements were made. Physical therapists spent approximately twice as much time talking as patients, with content behaviors (such as taking history and giving advice) comprising 52% of verbal communications. The most prevalent nonverbal behaviors were touch by physical therapists (54%) and eye gaze by patients (84%). DISCUSSION AND CONCLUSION The prevalence and content of communication can be measured with video analysis and validated tools. Communication is an extremely important but underexplored dimension of the patient-therapist relationship, and the methods described here could provide a useful model for further research and reflective practice.
Collapse
Affiliation(s)
- Lisa Roberts
- Physiotherapy Department, Southampton University Hospitals NHS Trust, Southampton, Hampshire, United Kingdom
| | | |
Collapse
|
48
|
Timmermans LM, van der Maazen RWM, Leer JWH, Kraaimaat FW. Palliative or curative treatment intent affects communication in radiation therapy consultations. Psychooncology 2007; 15:713-25. [PMID: 16308906 DOI: 10.1002/pon.1008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess whether communication in radiotherapy consultations is affected by palliative or curative treatment intent. SUBJECTS AND METHODS The study involved 160 patients and 8 radiation oncologists. Eighty patients visited the radiation oncologist (RO) for palliative treatment and 80 for curative treatment. The consultation prior to radiation treatment was analyzed with the Roter Interaction Analysis System (RIAS). Within three days, patients completed a quality of life questionnaire (EORTC-QLQ-C30). RESULTS In palliative radiotherapy (PRT) consultations, ROs asked more (closed-ended) biomedical and psychosocial questions and provided more information on prognosis than in consultations for curative radiotherapy (CRT). Patients in both groups provided a great deal of psychosocial information but asked few questions. The ROs expressed more concerns in the PRT consultations, while patients did not. PRT patients received fewer supportive remarks than CRT patients. In both groups, explicit decision-making received little attention. Proxies who accompanied the patients took a more active role in PRT than in CRT consultations. CONCLUSION Communication in radiotherapy is affected by treatment intent with respect to the main contents of the consultation.
Collapse
Affiliation(s)
- Liesbeth M Timmermans
- Department of Medical Psychology, University Medical Centre Nijmegen, The Netherlands.
| | | | | | | |
Collapse
|
49
|
Carpiac-Claver ML, Levy-Storms L. In a manner of speaking: communication between nurse aides and older adults in long-term care settings. Health Commun 2007; 22:59-67. [PMID: 17617014 DOI: 10.1080/10410230701310307] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Older adults in long-term care facilities have few opportunities for emotionally meaningful social interactions with noninstitutional social ties; yet having such relationships is a basic human need that affects well-being. Among institutional social ties, affective communication can enhance relationships between residents and nurse aides, who provide most of their care. This naturalistic study identifies types and examples of nurse aide-initiated communication with long-term care residents during mealtime assistance in the context of residents' responses. Verbal and nonverbal communication from videos of nurse aides and residents in two skilled nursing facilities (n = 17) and an assisted living facility (n = 6) were transcribed. The transcripts were coded and the data were organized into categories using grounded theory methods. Although substantial content emphasized instrumental communication (i.e., prompts to eat and/or drink), 4 types of affective communication initiated by nurse aides emerged: "personal conversation," "addressing the resident," "checking in," and "emotional support/praise." These results suggest that affective verbal communication needs further development in terms of scope and depth to optimize residents' well-being. The specific examples of nurse aides' affective verbal communication with residents from these findings can be incorporated and expanded on in nurse aide training programs to improve the way nurse aides relate to residents during care provision.
Collapse
|
50
|
Bensing JM, Tromp F, van Dulmen S, van den Brink-Muinen A, Verheul W, Schellevis FG. Shifts in doctor-patient communication between 1986 and 2002: a study of videotaped general practice consultations with hypertension patients. BMC Fam Pract 2006; 7:62. [PMID: 17064407 PMCID: PMC1630692 DOI: 10.1186/1471-2296-7-62] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 10/25/2006] [Indexed: 12/30/2022]
Abstract
Background Departing from the hypotheses that over the past decades patients have become more active participants and physicians have become more task-oriented, this study tries to identify shifts in GP and patient communication patterns between 1986 and 2002. Methods A repeated cross-sectional observation study was carried out in 1986 and 2002, using the same methodology. From two existing datasets of videotaped routine General Practice consultations, a selection was made of consultations with hypertension patients (102 in 1986; 108 in 2002). GP and patient communication was coded with RIAS (Roter Interaction Analysis System). The data were analysed, using multilevel techniques. Results No gender or age differences were found between the patient groups in either study period. Contrary to expectations, patients were less active in recent consultations, talking less, asking fewer questions and showing less concerns or worries. GPs provided more medical information, but expressed also less often their concern about the patients' medical conditions. In addition, they were less involved in process-oriented behaviour and partnership building. Overall, these results suggest that consultations in 2002 were more task-oriented and businesslike than sixteen years earlier. Conclusion The existence of a more equal relationship in General Practice, with patients as active and critical consumers, is not reflected in this sample of hypertension patients. The most important shift that could be observed over the years was a shift towards a more businesslike, task-oriented GP communication pattern, reflecting the recent emphasis on evidence-based medicine and protocolized care. The entrance of the computer in the consultation room could play a role. Some concerns may be raised about the effectiveness of modern medicine in helping patients to voice their worries.
Collapse
Affiliation(s)
- Jozien M Bensing
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
- Utrecht University, Department of Health Psychology, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Fred Tromp
- Utrecht Medical Center St. Radboud, Department of Postgraduate Training for General Practice, PO Box 9120, 6500 HB Nijmegen, The Netherlands
| | - Sandra van Dulmen
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Atie van den Brink-Muinen
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
| | - William Verheul
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
| | - François G Schellevis
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
- VU, University Medical Centre, Department of General Practice, Van der Boechorststraat 7 1081 BT Amsterdam, The Netherlands
| |
Collapse
|