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King A, Piccinini-Vallis H. Patient-Perceived Patient-Centeredness During Pregnancy. J Obstet Gynaecol Can 2023; 45:102194. [PMID: 37625642 DOI: 10.1016/j.jogc.2023.102194] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES Although patient-centeredness is a pinnacle in high-quality healthcare, there is a lack of research measuring patient-centeredness from the perspective of the patient in the context of perinatal care. Therefore, the objectives of this study were to (1) measure patient-perceived patient-centeredness from pregnant people receiving prenatal care in Nova Scotia, and (2) explore potential correlates of patient-perceived patient-centeredness. METHODS Participants completed an e-survey through REDCap software. Questions comprised of the Patient-Perceived Patient-Centeredness (Revised) (PPPC-R) questionnaire and demographic questions. The PPPC-R total score was calculated. Descriptive statistics were calculated to describe the sample, and inferential statistics were conducted. Linear regression analysis was used to determine how the independent variables predicted the PPPC-R total score. RESULTS A total of 98 patients participated in the survey to completion. The mean PPPC-R total score was 62.2 (SD 10.5), equivalent to a score of 3.45/4. No significant correlates of the PPPC-R total score were identified; however, trends were observed related to age, parity, Body mass index, race/ethnicity, and education. CONCLUSIONS Participants in our study rated their clinicians' patient-centeredness very highly. There was no significant difference in PPPC-R score among pregnant people based on the independent variables we collected.
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Sardessai-Nadkarni AA, Street RL. Understanding the pathways linking patient-centered communication to cancer survivors' emotional health: examining the mediating roles of self-efficacy and cognitive reappraisal. J Cancer Surviv 2023; 17:1266-1275. [PMID: 35167049 DOI: 10.1007/s11764-022-01170-7] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Many cancer survivors commonly face psychological health issues upon cancer diagnosis, both during and after treatment. Patient-centered communication can play an important role in improving health outcomes among cancer survivors across the cancer continuum. The current study examined the influence of patient-centered communication on self-efficacy in managing health, cognitive reappraisal, and emotional distress among cancer survivors. METHODS The analysis was conducted on a subsample of 809 cancer survivors acquired from a nationally representative 2019 Health Information National Trends Survey 5 (Cycle 3). Multivariate regression analysis was conducted to explore the pathways through which patient-centered communication can be associated with cancer survivors' emotional distress, mediated by self-efficacy and cognitive reappraisal. RESULTS The results indicated that effective patient-centered provider communication led to higher self-efficacy in managing health, greater involvement in cognitive reappraisal, and decreased emotional distress among cancer survivors. Additionally, the results revealed that the effect of patient-centered communication that led to decreased emotional distress was fully mediated through self-efficacy and cognitive reappraisal. CONCLUSIONS Although patient-centered communication positively relates to various emotional health outcomes among cancer survivors, it does not affect their emotional health directly. Self-efficacy and cognitive reappraisal play a crucial role in explaining the underlying mechanisms of such effects. IMPLICATIONS FOR CANCER SURVIVORS Future interventions to promote patient-centered communication in cancer care should give more emphasis to managing patients' emotions. Providers should not only recognize, elicit, and respond to patient's emotions, but also develop emotional regulation skills among patients, and improve their ability to cope with emotional distress.
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Affiliation(s)
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Henick D, Italiano T, Person H, Keefer L. Medical students' knowledge and perception of irritable bowel syndrome in comparison to inflammatory bowel disease. Neurogastroenterol Motil 2023; 35:e14576. [PMID: 37018414 DOI: 10.1111/nmo.14576] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 02/25/2023] [Accepted: 03/14/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Gastroenterologists may hold less positive attitudes toward disorders of gut-brain interaction (DGBI) like irritable bowel syndrome (IBS) compared with organic GI disorders like inflammatory bowel disease (IBD). This contributes to worse health outcomes in patients with DGBI and decreased patient satisfaction. Medical student knowledge and perception of these two disorders have not been directly studied. METHODS A cohort of medical students (n = 106) completed a survey where they read clinical vignettes about patients with IBS and IBD and answered questions regarding their knowledge of and attitudes toward these two diseases. KEY RESULTS IBS was perceived as a less real and a more exaggerated disorder when compared to IBD, and patients with IBS were seen as more difficult to treat. With more clinical exposure across 4 years of training, students were more likely to perceive IBS as a "less real" illness, though they held fewer negative attitudes toward patients with IBS. Greater familiarity with both IBS and IBD was associated with fewer negative attitudes. CONCLUSIONS & INFERENCES Biases observed in gastroenterologists toward patients with IBS originate as early as the beginning of medical school, including seeing IBS as a "less real" disease and more difficult to treat. Earlier educational interventions may be helpful in identifying and addressing these biases.
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Affiliation(s)
- Daniel Henick
- Department of Medical Education, Yale School of Medicine, New Haven, CT, USA
| | - Tyler Italiano
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannibal Person
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Laurie Keefer
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Araja D, Krumina A, Nora-Krukle Z, Schneider ME, Berkis U, Murovska M. Coaching to strengthen critical success factors in integrative care for chronic fatigue patients: the Patient Needs-Resources Model. Front Neurosci 2023; 17:1202930. [PMID: 37547141 PMCID: PMC10400772 DOI: 10.3389/fnins.2023.1202930] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Theoretical and empirical studies discover that an integrative approach is particularly important in chronic disorders and multiple long-term conditions, such as chronic fatigue. Chronic fatigue syndrome (CFS) is a classic example of a potentially severe, multisystemic illness with a wide diversity of symptoms and the corresponding diagnostic complexity. The prevalence of CFS-like syndromes expanded in the context of the COVID-19 pandemic, increasing the disorder and treatment burden. Thus, this article aimed to draw attention to the possibilities to strengthen the integrative approach to diagnosing and treating chronic disorders and multiple long-term conditions. The main critical success factors identified for integrative approaches were: a holistic approach, that provides a more comprehensive diagnostic and personalized treatment strategy, a multidisciplinary team, and patient engagement. The strengths and weaknesses of these factors were explored and coaching was identified as a potential unifying and reinforcing element. Coaching has a wide spectrum of manifestations clearly representing a holistic approach, that has been successfully used in multidisciplinary team building. Moreover, coaching exposes support addressing the patient engagement issues identified by the Patient Needs-Resources Model (PN-R Model) such as low levels of self-efficacy, optimism, and subjective well-being. Coaching may assist patients to identify and prioritize their goals, becoming aware of their personal resources, developing strategies for managing symptoms, and building skills to increase their self-efficacy and active engagement in the treatment process. Therefore, the authors emphasize coaching as a perspective element of optimization of patient care, that requires additional theoretical and long-term empirical research.
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Affiliation(s)
- Diana Araja
- Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia
| | - Angelika Krumina
- Department of Infectology, Riga Stradins University, Riga, Latvia
| | - Zaiga Nora-Krukle
- Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia
| | | | - Uldis Berkis
- Development and Project Department, Riga Stradins University, Riga, Latvia
| | - Modra Murovska
- Institute of Microbiology and Virology, Riga Stradins University, Riga, Latvia
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Grant N, Buchanan H, Brennan ML. Factors within A Veterinarian-Cattle Farmer Relationship That May Impact on Biosecurity Being Carried out on Farms: An Exploratory Study. Vet Sci 2023; 10:410. [PMID: 37505816 PMCID: PMC10383729 DOI: 10.3390/vetsci10070410] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/19/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
Veterinarians (vets) appear to be one of the main gateways to biosecurity information for cattle farmers, and therefore are likely to affect the implementation of these measures. The aim of this study was to explore factors within the vet-farmer relationship that may impact on biosecurity being carried out on cattle farms in England. Interviews were conducted with cattle farmers and large-animal vets, with a focus on individuals deemed to implement good levels of biosecurity or those working with said individuals. The questions explored how each stakeholder felt the communication occurred between the groups and the perceived consequential influence each had on the other. Inductive Thematic analysis was used to explore participants' experience of vet-farmer interactions with a focus on areas of reciprocity between the two groups. Five primary themes were identified. Factors within the vet-cattle farmer relationship, such as trust and familiarity, which were interconnected with time spent with each other, appeared to influence the uptake of biosecurity measures on cattle farms. These factors purportedly impacted the ability of vet-farmer pairs to have cooperative discussions and enter into shared decision-making. In order to enhance animal and human health and welfare, these relationship factors might be key to the development of sustainable optimisation frameworks.
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Affiliation(s)
- Nikisha Grant
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Heather Buchanan
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Marnie L Brennan
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK
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Hill JN, Krüger K, Boczor S, Kloppe T, von dem Knesebeck O, Scherer M. Patient-centredness in primary care walk-in clinics for refugees in Hamburg. BMC Prim Care 2023; 24:112. [PMID: 37149641 PMCID: PMC10163696 DOI: 10.1186/s12875-023-02060-2] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 04/12/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND The huge increase of refugees to Germany caused a great challenge to the health system. We aimed to examine the level of patient-centredness in medical consultations with refugee patients, aided by video interpreters in primary care walk-in clinics (PCWC) in Hamburg. METHODS Videotaped consultations (N = 92) of 83 patients from 2017 to 2018 were analysed. Two raters used the Measure of Patient-Centered Communication (MPCC) and the International Classification of primary care (ICPC-2). MPCC scores with regard to patients' reason for seeking medical care and the procedures taken were explored using variance analyses adjusted for age, gender, and the duration of the consultation. The duration was further explored by Pearson correlations. RESULTS Patient-centredness of all consultations on average was 64% (95% CI 60-67) according to MPCC, with health-related issues affecting the results. The highest level of patient-centredness was achieved in psychological health issues with 79% (65-94), the lowest in respiratory ones with 55% (49-61). Longer consultations resulted in higher MPCC scores. CONCLUSIONS The level of patient-centredness varied in the addressed health issues as well as in the duration of the consultation. Despite the variation, video interpreting in consultations supports a solid patient-centredness. PRACTICE IMPLICATIONS We recommend the use of remote video interpreting services for outpatient healthcare to support patient-centred communication and to fill the gap of underrepresentation of qualified interpreters on site, regarding a high diversity of spoken languages.
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Affiliation(s)
- Josephine Nana Hill
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Katarina Krüger
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrid Boczor
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Kloppe
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Piccinini-Vallis H, Zed J, Easley J. Comparison of patients' perceptions of family physicians' patient-centeredness between virtual and in-person clinical encounters: A cross-sectional study. J Family Med Prim Care 2023; 12:517-522. [PMID: 37122655 PMCID: PMC10131964 DOI: 10.4103/jfmpc.jfmpc_1511_22] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/31/2022] [Accepted: 11/29/2022] [Indexed: 05/02/2023] Open
Abstract
Introduction A clinician's patient-centeredness is a core construct of quality healthcare and is associated with several positive patient outcomes. This study aimed to compare patient-perceived patient centeredness between in-person and virtual clinical encounters during the coronavirus pandemic. Materials and Methods Participants completed an online anonymous questionnaire pertaining to a recent clinical encounter. Patients of an academic family medicine teaching clinic scheduled for either an in-person or a virtual clinical encounter were recruited by phone over a two-month period. Using the patient-centered clinical method as a conceptual framework, patient-perceived patient centeredness was measured by the Patient-Perceived Patient-Centeredness Questionnaire-Revised (PPPC-R), consisting of 18 items that reflect three factors (healthcare process, context and relationship, and roles). Results The sample consisted of 72 participants. There was no difference in the PPPC-R scores between participants who received in-person and those who received virtual care. However, the mean ranks for the PPPC-R total score and for all three factors were higher for participants who saw a family physician compared to participants who saw a family medicine learner. Conclusion Family physicians provided similar quality healthcare, measured through a patient-perceived patient-centeredness lens, via both virtual and in-person appointments. These results support sustaining virtual care when deemed appropriate by both patient and clinician.
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Affiliation(s)
- Helena Piccinini-Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Canada
- Address for correspondence: Dr. Helena Piccinini-Vallis, Department of Family Medicine, Dalhousie University, 6960 Mumford Road, Suite 0265, Halifax, Nova Scotia, Canada B3L4P1. E-mail:
| | - Joanna Zed
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Julie Easley
- Department of Family Medicine, Dalhousie University, Fredericton, Canada
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Golembiewski EH, Espinoza Suarez NR, Maraboto Escarria AP, Yang AX, Kunneman M, Hassett LC, Montori VM. Video-based observation research: A systematic review of studies in outpatient health care settings. Patient Educ Couns 2023; 106:42-67. [PMID: 36207219 DOI: 10.1016/j.pec.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/10/2021] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine the use of video-based observation research in outpatient health care encounter research. METHODS We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics. RESULTS 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies. CONCLUSION Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement. PRACTICE IMPLICATIONS Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
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Affiliation(s)
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Family Medicine and Emergency Medicine Laval University Quebec, Canada.
| | - Andrea P Maraboto Escarria
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Obstetrics and Gynecology Hospital Angeles Lomas Mexico City, Mexico.
| | - Andrew X Yang
- Mayo Clinic Alix School of Medicine Rochester, MN, USA.
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences Leiden University Medical Center Leiden, the Netherlands.
| | - Leslie C Hassett
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Medicine Mayo Clinic, Rochester, MN, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Mayo Clinic Libraries Mayo Clinic, Rochester, MN, USA.
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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.
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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
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Kang J, Lee M, Cho YS, Jeong JH, Choi SA, Hong J. The relationship between person-centred care and the intensive care unit experience of critically ill patients: A multicentre cross-sectional survey. Aust Crit Care 2021; 35:623-629. [PMID: 34844837 DOI: 10.1016/j.aucc.2021.10.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/30/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Person-centred care has the potential to improve the patient experience in the intensive care unit (ICU). However, the relationship between person-centred care perceived by critically ill patients and their ICU experience has yet to be determined. OBJECTIVES The aim of this study was to investigate the relationship between person-centred care and the ICU experience of critically ill patients. METHODS This study was a multicentre, cross-sectional survey involving 19 ICUs of four university hospitals in Busan, Korea. The survey was conducted from June 2019 to July 2020, and 787 patients who had been admitted to the ICU for more than 24 hours participated. We measured person-centred care using the Person-Centered Critical Care Nursing perceived by Patient Questionnaire. Participants' ICU experience was measured by the Korean version of the Intensive Care Experience Questionnaire that consists of four subscales. We analysed the relationship between person-centred care and each area of the ICU experience using multivariate linear regression. RESULTS Person-centred care was associated with 'awareness of surroundings' (β = 0.29, p < .001), 'frightening experiences' (β = -0.31, p < .001), and 'satisfaction with care' (β = 0.54, p < .001). However, there was no significant association between person-centred care and 'recall of experience'. CONCLUSIONS We observed that person-centred care was positively related to most of the ICU experiences of critically ill patients except for recall of experience. Further studies on developing person-centred nursing interventions are needed.
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Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, 32, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea
| | - Minju Lee
- Department of Nursing, Youngsan University, 288, Junam-ro, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Young Shin Cho
- Department of Nursing, Youngsan University, 288, Junam-ro, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Jin-Heon Jeong
- Department of Intensive Care Medicine & Neurology, Dong-A University Hospital, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea
| | - Sol A Choi
- Medical Intensive Care Unit, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, Republic of Korea
| | - Jiwon Hong
- College of Nursing, Dong-A University, 32, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea.
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Bylund CL, Taylor G, Mroz E, Wilkie DJ, Yao Y, Emanuel L, Fitchett G, Handzo G, Chochinov HM, Bluck S. Empathic communication in dignity therapy: Feasibility of measurement and descriptive findings. Palliat Support Care. [DOI: 10.1017/s1478951521001188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract
Objective
Dignity therapy (DT) is a guided process conducted by a health professional for reviewing one's life to promote dignity through the illness process. Empathic communication has been shown to be important in clinical interactions but has yet to be examined in the DT interview session. The Empathic Communication Coding System (ECCS) is a validated, reliable coding system used in clinical interactions. The aims of this study were (1) to assess the feasibility of the ECCS in DT sessions and (2) to describe the process of empathic communication during DT sessions.
Methods
We conducted a secondary analysis of 25 transcripts of DT sessions with older cancer patients. These DT sessions were collected as part of larger randomized controlled trial. We revised the ECCS and then coded the transcripts using the new ECCS-DT. Two coders achieved inter-rater reliability (κ = 0.84) on 20% of the transcripts and then independently coded the remaining transcripts.
Results
Participants were individuals with cancer between the ages of 55 and 75. We developed the ECCS-DT with four empathic response categories: acknowledgment, reflection, validation, and shared experience. We found that of the 235 idea units, 198 had at least one of the four empathic responses present. Of the total 25 DT sessions, 17 had at least one empathic response present in all idea units.
Significance of results
This feasibility study is an essential first step in our larger program of research to understand how empathic communication may play a role in DT outcomes. We aim to replicate findings in a larger sample and also investigate the linkage empathic communication may have in the DT session to positive patient outcomes. These findings, in turn, may lead to further refinement of training for dignity therapists, development of research into empathy as a mediator of outcomes, and generation of new interventions.
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Clayton MF, Utz R, Iacob E, Towsley GL, Eaton J, Fuhrmann HJ, Dassel K, Caserta M, Supiano K. Live hospice discharge: Experiences of families, and hospice staff. Patient Educ Couns 2021; 104:2054-2059. [PMID: 33454147 PMCID: PMC8726000 DOI: 10.1016/j.pec.2021.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 12/29/2020] [Accepted: 01/02/2021] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To examine live hospice discharge prevalence and experiences of families and hospice staff. Hospice eligibility is based on a cancer model where decline and death are predicable. Decline is less predictable for diagnoses such as dementia, frequently resulting in involuntary live hospice discharge. METHODS A mixed-method integration of hospice 2013-17 admission/discharge data, 5 family interviews, hospice discipline-specific focus groups (3 aides, 2 nurses, 1 administrator interview) and a discipline-combined focus group (all 6 staff; each staff participant engaged in two data collection experiences). RESULTS 5648 hospice admissions occurred between 2013-17; 795 patients experienced live discharge. The most prevalent admitting diagnosis was cancer, the most prevalent live discharge diagnosis was dementia. Family caregiver themes were Attitude and experience with hospice, Discharge experience, and Continued need/desire for hospice following discharge. Staff themes were Discharge circumstances, Regulatory guidelines, and Changing practice to meet regulatory guidelines. CONCLUSION Involuntary live hospice discharge precludes patient-centered care due to policy constraints, especially for those with noncancer diagnoses. Families and staff noted the paradox of beneficial hospice care, yet this care resulted in ineligibility for continued hospice services. PRACTICE IMPLICATIONS Transparent, patient-family-staff communication (including CNAs) facilitates hospice live discharge planning. Hospice service eligibility policy changes are needed.
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Affiliation(s)
- Margaret F Clayton
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA.
| | - Rebecca Utz
- Department of Sociology, University of Utah, 390 1530 E #301 Salt Lake City, UT, 84112, USA
| | - Eli Iacob
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Gail L Towsley
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Jacqueline Eaton
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Hollie J Fuhrmann
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Kara Dassel
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Michael Caserta
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Katherine Supiano
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
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Stark S, Worm L, Kluge M, Roos M, Burggraf L. The patient satisfaction in primary care consultation-Questionnaire (PiC): An instrument to assess the impact of patient-centred communication on patient satisfaction. PLoS One 2021; 16:e0254644. [PMID: 34270615 PMCID: PMC8284638 DOI: 10.1371/journal.pone.0254644] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/30/2021] [Indexed: 11/27/2022] Open
Abstract
Background Primary care consultation is significantly influenced by communication between the General Practitioner (GP) and their patients. Hypothesising that patient satisfaction can be tested based on an expectation-experience comparison, the aim of this article is to discuss the influence of communication on patient satisfaction. Methods A standardised questionnaire was developed striving for a universal primary care survey tool that focuses on patient satisfaction in the context of patient-centred-communication. The sample consisted of 14 German GPs with 80 patients each (n = 1120). Due to the inclusion in an overarching cluster-randomised-study (CRT), the medical practices to be examined were divided into intervention and control groups. The intervention was developed as a reflective training on patient-centred communication. Results The results in the present sample show no correlation between patient-centred-communication and patient satisfaction. There are also no significant differences between the intervention and control group. Discussion The results raise the question to what extent patient satisfaction can be shaped significantly through patient-centred-communication. The presented project represents part of the basic research in general medical care research and contributes to the transparent processing of theoretical assumptions. With the results described here, communication models with a focus on patient centredness can be evaluated with regard to their practical relevance and transferability.
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Affiliation(s)
- Stefanie Stark
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
- * E-mail:
| | - Lukas Worm
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marie Kluge
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marco Roos
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Larissa Burggraf
- Institute of General Practice, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Bachmann C, Kropf R, Biller S, Schnabel KP, Junod Perron N, Monti M, Berendonk C, Huwendiek S, Breckwoldt J. Development and national consensus finding on patient-centred high stakes communication skills assessments for the Swiss Federal Licensing Examination in Medicine. Patient Educ Couns 2021; 104:1765-1772. [PMID: 33358770 DOI: 10.1016/j.pec.2020.12.003] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 10/30/2020] [Accepted: 12/05/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe and evaluate a consensus finding and expert validation process for the development of patient-centred communication assessments for a national Licensing Exam in Medicine. METHODS A multi-professional team of clinicians and experts in communication, assessment and role-play developed communication assessments for the Swiss Federal Licensing Examination. The six-month process, informed by a preceding national needs-assessment, an expert symposium and a critical literature review covered the application of patient-centred communication frameworks, the development of assessment guides, concrete assessments and pilot-tests. The participants evaluated the process. RESULTS The multiple-step consensus process, based on expert validation of the medical and communication content, led to six high-stakes patient-centred communication OSCE-assessments. The process evaluation revealed areas of challenge such as calibrating rating-scales and case difficulty to the graduates' competencies and integrating differing opinions. Main success factors were attributed to the outcome-oriented process and the multi-professional exchange of expertise. A model for developing high stakes patient-centred communication OSCE-assessments was derived. CONCLUSIONS Consensus finding was facilitated by using well-established communication frameworks, by ensuring outcome-orientated knowledge exchange among multi-professional experts, and collaborative validation of content through experts. PRACTICE IMPLICATIONS We propose developing high-stakes communication assessments in a multi-professional expert consensus and provide a conceptual model.
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Affiliation(s)
- C Bachmann
- Institute for Medical Education, University of Bern, Switzerland; Office of Educational Affairs, Faculty of Medicine, University of Rostock, Ernst-Heydemann-Str. 8, 18057, Rostock, Germany.
| | - R Kropf
- Office of the Dean, Faculty of Medicine, University of Zurich, Switzerland
| | - S Biller
- Office of Student Affairs, Faculty of Medicine, University of Basel, Switzerland
| | - K P Schnabel
- Institute for Medical Education, University of Bern, Switzerland
| | - N Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Switzerland
| | - M Monti
- Medical Education Unit, Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - C Berendonk
- Institute for Medical Education, University of Bern, Switzerland
| | - S Huwendiek
- Institute for Medical Education, University of Bern, Switzerland
| | - J Breckwoldt
- Office of the Dean, Faculty of Medicine, University of Zurich, Switzerland; Institute of Anaesthesiology University Hospital Zurich, Zurich, Switzerland
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Park KY, Park HK, Hwang HS, Yoo SH, Ryu JS, Kim JH. Improved detection of patient centeredness in objective structured clinical examinations through authentic scenario design. Patient Educ Couns 2021; 104:1094-1099. [PMID: 33097361 DOI: 10.1016/j.pec.2020.10.016] [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: 10/22/2019] [Revised: 07/30/2020] [Accepted: 10/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In current objective structured clinical examinations (OSCEs), simulated encounters lacking realism reduce authenticity of assessment as students can take the OSCEs with a search-and-scan approach and trained empathy. Accordingly, patient-centeredness, the fundamental goal of OSCE, is not well assessed. This study evaluated the effect of a change in the OSCE scenario and checklist with respect to detecting students' patient-centeredness. METHODS A scenario script for valid representation of a real clinical encounter was developed and defined as authenticated scenario. The OSCE scores and the measure of patient-centered communication (MPCC) scores of 79 medical students were compared between the two OSCE stations, one using the traditional scenario and another using the authenticated scenario. RESULTS The MPCC total score was higher in the OSCE station using the authenticated scenario than that of the traditional scenario (p < 0.001). For the OSCE scores, the patient satisfaction score and the patient-physician interaction score were higher in the station using the authenticated scenario than the traditional one (p < 0.001). CONCLUSION The OSCE station using the authenticated scenario better detected medical student level of patient-centeredness. PRACTICE IMPLICATIONS Strengthening the authenticity of the OSCE scenario is critical for detecting the medical students' levels of patient-centeredness.
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Affiliation(s)
- Kye-Yeung Park
- Deptartment of Family Medicine, Hanyang University Medical Centre, Seoul, Republic of Korea.
| | - Hoon-Ki Park
- Deptartment of Family Medicine, Hanyang University Medical Centre, Seoul, Republic of Korea.
| | - Hwan-Sik Hwang
- Deptartment of Family Medicine, Hanyang University Medical Centre, Seoul, Republic of Korea.
| | - Sang-Ho Yoo
- Department of Medical Humanities and Ethics, Hanyang University Medical College, Seoul, Republic of Korea.
| | - Jae-Sook Ryu
- Deptartment of Environmental Biology and Medical Parasitology, Hanyang University Medical College, Seoul, Republic of Korea.
| | - Jong-Hoon Kim
- Department of Anaesthesiology and Pain Medicine, Inha University Medical College, Incheon, Republic of Korea.
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Asan O, Yu Z, Crotty BH. How clinician-patient communication affects trust in health information sources: Temporal trends from a national cross-sectional survey. PLoS One 2021; 16:e0247583. [PMID: 33630952 PMCID: PMC7906335 DOI: 10.1371/journal.pone.0247583] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 07/23/2020] [Accepted: 02/09/2021] [Indexed: 01/17/2023] Open
Abstract
Background Understanding patients’ trust in health information sources is critical to designing work systems in healthcare. Patient-centered communication during the visit might be a major factor in shaping patients’ trust in information sources. Objective The purpose of this paper is to explore relationships between patient ratings of clinician communication during the visit and patient trust in health information sources. Methodology We conducted a secondary analysis of the nationally-representative Health Information National Trends Surveys; HINTS4 Cycle1 (2011), HINTS4 Cycle4 (2014), and HINTS5 Cycle1 (2017), and HINTS5 Cycle2 (2018). We created a composite score of patient-centered communication from five questions and dichotomized at the median. We created multivariable logistic regression models to see how patient-centered communication influenced trust in different information sources across cycles. Consecutively, we used hierarchical analysis for aggregated data. Results We analyzed data from 14,425 individuals. In the adjusted logistic models for each cycle and the hierarchical model, clinicians’ perceived patient-centered communication skills were significantly associated with increased trust in the clinicians as an information source. Conclusion Clinicians still represent an essential source of trustworthy information reinforced by patient-centered communication skills. Given that trust helps build healing relationships that lead to better healthcare outcomes, communication sets an essential foundation to establish necessary trust. Interpreting information from the internet sources for patients is likely to remain a vital clinician function.
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Affiliation(s)
- Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey, United States of America
- * E-mail:
| | - Zhongyuan Yu
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, New Jersey, United States of America
| | - Bradley H. Crotty
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
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Nugent BD, McCall MK, Connolly M, Mazanec SR, Sereika SM, Bender CM, Rosenzweig MQ. Protocol for Symptom Experience, Management, Outcomes, and Adherence in Women Receiving Breast Cancer Chemotherapy. Nurs Res 2020; 69:404-411. [PMID: 32520763 PMCID: PMC7483966 DOI: 10.1097/nnr.0000000000000450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The 5-year survival for Black women with breast cancer in the United States is lower than White women for stage-matched disease. Our past and ongoing work and that of others suggest that symptom incidence, cancer-related distress, and ineffective communication contribute to racial disparity in dose reduction and early therapy termination. Although race is perhaps the most studied social determinant of health, it is clear that race alone does not account for all disparities. OBJECTIVES The aim of the study was to present a study protocol of Black and White women prescribed breast cancer chemotherapy. The aims are to (1) examine and compare chemotherapy received/prescribed over time and in total; (2a) examine and compare symptom incidence, distress, and management and clinical encounter, including patient-centeredness of care and management experience over time and (2b) correlate symptom incidence, distress, and management experience to Aim 1; and (3) explore the effects of social determinants of health, including age, income, education, zip code, and lifetime stress exposure, on Aims 1, 2a, and 2b. METHODS A longitudinal, repeated-measures (up to 18 time points), comparative, mixed-methods design is employed with 179 White and 179 Black women from 10 sites in Western Pennsylvania and Northeast Ohio over the course of chemotherapy and for 2 years following completion of therapy. RESULTS The study began in January 2018, with estimated complete data collection by late 2023. DISCUSSION This study is among the first to explore the mechanistic process for racial disparity in dosage and delay across the breast cancer chemotherapy course. It will be an important contribution to the explanatory model for breast cancer treatment disparity and may advance potential mitigation strategies for racial survival disparity.
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Affiliation(s)
- Bethany D Nugent
- Bethany D. Nugent, PhD, RN, is Research Associate, School of Nursing, University of Pittsburgh, Pennsylvania. Maura K. McCall, MSN, RN, is Graduate Student Researcher, School of Nursing, University of Pittsburgh, Pennsylvania. Mary Connolly, BSN, RN, is Project Director, School of Nursing, University of Pittsburgh, Pennsylvania. Susan M. Sereika, PhD, is Professor, School of Nursing, University of Pittsburgh, Pennsylvania. Catherine M. Bender, PhD, RN, FAAN, is Professor, School of Nursing, University of Pittsburgh, Pennsylvania. Margaret Q. Rosenzweig, PhD, CRNP-C, AOCNP, FAAN, is Professor, School of Nursing, University of Pittsburgh, Pennsylvania. Susan R. Mazanec, PhD, RN, AOCN, is Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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Ekman N, Taft C, Moons P, Mäkitalo Å, Boström E, Fors A. A state-of-the-art review of direct observation tools for assessing competency in person-centred care. Int J Nurs Stud 2020; 109:103634. [PMID: 32531569 DOI: 10.1016/j.ijnurstu.2020.103634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/21/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Direct observation is a common assessment strategy in health education and training, in which trainees are observed and assessed while undertaking authentic patient care and clinical activities. A variety of direct observation tools have been developed for assessing competency in delivering person-centred care (PCC), yet to our knowledge no review of such tools exists. OBJECTIVE To review and evaluate direct observation tools developed to assess health professionals' competency in delivering PCC. DESIGN State-of-the-art review DATA SOURCES: Electronic literature searches were conducted in PubMed, ERIC, CINAHL, and Web of Science for English-language articles describing the development and testing of direct observation tools for assessing PCC published until March 2017. REVIEW METHODS Three authors independently assessed the records for eligibility. Duplicates were removed and articles were excluded that were irrelevant based on title and/or abstract. All remaining articles were read in full text. A data extraction form was developed to cover and extract information about the tools. The articles were examined for any conceptual or theoretical frameworks underlying tool development and coverage of recognized PCC dimensions was evaluated against a standard framework. The psychometric performance of the tools was obtained directly from the original articles. RESULT 16 tools were identified: five assessed PCC holistically and 11 assessed PCC within specific skill domains. Conceptual/theoretical underpinnings of the tools were generally unclear. Coverage of PCC domains varied markedly between tools. Most tools reported assessments of inter-rater reliability, internal consistency reliability and concurrent validity; however, intra-rater reliability, content and construct validity were rarely reported. Predictive and discriminant validity were not assessed. CONCLUSION Differences in scope, coverage and content of the tools likely reflect the complexity of PCC and lack of consensus in defining this concept. Although all may serve formative purposes, evidence supporting their use in summative evaluations is limited. Patients were not involved in the development of any tool, which seems intrinsically paradoxical given the aims of PCC. The tools may be useful for providing trainee feedback; however, rigorously tested and patient-derived tools are needed for high-stakes use.
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Affiliation(s)
- Nina Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Academic Centre for Nursing and Midwifery, Faculty of Medicine, KU Leuven, Leuven, Belgium.
| | - Charles Taft
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Academic Centre for Nursing and Midwifery, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Åsa Mäkitalo
- Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden
| | - Eva Boström
- Department of Nursing, University of Umeå, Umeå, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
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Bellier A, Chaffanjon P, Krupat E, Francois P, Labarère J. Cross-cultural adaptation of the 4-Habits Coding Scheme into French to assess physician communication skills. PLoS One 2020; 15:e0230672. [PMID: 32298278 PMCID: PMC7161987 DOI: 10.1371/journal.pone.0230672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/04/2019] [Accepted: 03/05/2020] [Indexed: 11/19/2022] Open
Abstract
Background The Four Habits Coding Scheme (4-HCS) is a standardized instrument designed to assess physicians’ communication skills from an external rater’s perspective, based on video-recorded consultations. Objective To perform the cross-cultural adaptation of the 4-HCS into French and to assess its psychometric properties. Methods The 4-HCS was cross-culturally adapted by conducting forward and backward translations with independent translators, following international guidelines. Four raters rated 200 video-recorded medical student consultations with standardized patients, using the French version of the 4-HCS. We examined the internal consistency, factor structure, construct validity, and reliability of the 4-HCS. Results The mean overall 4-HCS score was 76.44 (standard deviation, 12.34), with no floor or ceiling effects across subscales. The median rating duration of rating was 8 min (range, 4–19). Cronbach’s alpha was 0.94 for the overall 4-HCS, ranging from 0.72 to 0.88 across subscales. In confirmatory factor analysis, goodness-of-fit statistics did not corroborate the hypothesized 4-habit structure. Exploratory factor analysis resulted in two dimensions, with the merging of three conceptually related habits into a single dimension and substantial cross-loading for 15 out of 23 items. Median average absolute-agreement intra-class correlation coefficient estimates were 0.74 (range, 0.68–0.84) and 0.85 (range, 0.76–0.91) for inter- and intra-rater reliability of habit subscales, respectively. Conclusion The French version of the 4-HCS demonstrates satisfactory internal consistency but requires the use of two independent raters to achieve acceptable reliability. The underlying factor structure of the original US version and cross-cultural adaptations of the 4-HCS deserve further investigation.
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Affiliation(s)
- Alexandre Bellier
- Quality of Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- School of Medicine, Grenoble Alpes University, Grenoble, France
- Computational and Mathematical Biology Team, TIMC-IMAG, UMR 5525, CNRS, Grenoble Alpes University, Grenoble, France
- CIC 1406, INSERM, Grenoble Alpes University, Grenoble, France
- * E-mail:
| | | | - Edward Krupat
- Center for Evaluation, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Patrice Francois
- Quality of Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - José Labarère
- Quality of Care Unit, Grenoble Alpes University Hospital, Grenoble, France
- School of Medicine, Grenoble Alpes University, Grenoble, France
- Computational and Mathematical Biology Team, TIMC-IMAG, UMR 5525, CNRS, Grenoble Alpes University, Grenoble, France
- CIC 1406, INSERM, Grenoble Alpes University, Grenoble, France
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Pascual López JA, Gil Pérez T, Sánchez Sánchez JA, Menárguez Puche JF. [Questionnaires of person centered care in primary care. A systematic review]. Aten Primaria 2019; 52:738-749. [PMID: 31883783 PMCID: PMC8054285 DOI: 10.1016/j.aprim.2019.11.004] [Citation(s) in RCA: 2] [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: 03/31/2019] [Revised: 10/11/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022] Open
Abstract
Objetivo Pese a la importancia de la «atención centrada en la persona» (ACP), hay evidentes limitaciones para valorarla y medirla, debidas probablemente a la dificultad para definirla. El objetivo del estudio fue identificar herramientas validadas que midiesen la ACP o algunos de sus aspectos en el ámbito de la atención primaria. Diseño Revisión sistemática. Fuentes de datos MEDLINE, Embase, Cochrane, PSYCinfo, IME-Biomedicina, LILACS y TESEO hasta del 31 de mayo de 2018. Selección de estudios Los criterios de inclusión fueron: a) estudios de validación de cuestionarios, revisiones sistemáticas sobre estudios de validación u otros estudios descriptivos, b) realizados todos ellos en el ámbito de la atención primaria y c) que midieran aspectos de la ACP en profesionales y/o pacientes. Dos investigadores revisaron de forma independiente los artículos y sus discrepancias fueron resueltas por un tercer investigador. Extracción de datos Se recogieron datos sobre los aspectos de la ACP medidos, población a la que se dirige, tipo de cuestionario, y datos sobre validez y fiabilidad. Resultados Se localizaron 1.415 artículos a los que se añadieron 54 referencias adicionales identificadas a través de referencias de los artículos de la revisión sistemática. Tras una depuración finalmente fueron 75 los artículos que cumplieron todos los criterios y 39 las herramientas identificadas y clasificadas según las dimensiones analizadas. Conclusiones Debido a la dificultad de medir la ACP en su conjunto, la mayor parte de los artículos hacen referencia solo a alguno de sus aspectos o dimensiones, predominando la perspectiva del paciente frente a la del profesional. Estas herramientas son, no obstante, un importante punto de partida para futuros cuestionarios que intenten valorar de forma integral la ACP.
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Affiliation(s)
| | - Trinidad Gil Pérez
- Centro de Salud docente Mariano Yago, Servicio Murciano de Salud, Yecla, Murcia, España
| | - Juan Antonio Sánchez Sánchez
- Grupo de Trabajo de Medicina Basada en la Evidencia, Sociedad Murciana de Medicina de Familia y Comunitaria (SMUMFyC), Murcia, España
| | - Juan Francisco Menárguez Puche
- Grupo de Trabajo de Medicina Basada en la Evidencia, Sociedad Murciana de Medicina de Familia y Comunitaria (SMUMFyC), Murcia, España; Centro de Salud docente Profesor Jesús Marín, Molina de Segura, Murcia, España
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Piccinini-Vallis H, Vallis M. Curbing excess gestational weight gain in primary care: using a point-of-care tool based on behavior change theory. Int J Womens Health 2018; 10:609-615. [PMID: 30349404 PMCID: PMC6187976 DOI: 10.2147/ijwh.s172346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Excess gestational weight gain (GWG) is a risk factor for several adverse outcomes for mothers and their offspring. In Nova Scotia, Canada, approximately 60% of women experience excess GWG. Outside the pregnancy arena, a patient-centered approach has been shown to promote increased patient adherence to clinician recommendations, and increased intentions for, and attempts at, behavior change. The 5As of Healthy Pregnancy Weight Gain is a tool that assists clinicians to have patient-centered discussions about GWG. This feasibility trial examined the association between training in the use of this tool and women’s self-efficacy to manage GWG, readiness to adhere to GWG guidelines, perception of their clinicians’ patient-centeredness when discussing GWG, and guideline concordance of total GWG. Method Participants were 11 family physicians who provide prenatal care and 24 of their patients who were pregnant. Physicians were randomly assigned to a single 60-minute training session in the use of the tool or usual care. Consenting patients completed measures of social support, stress, patient-perceived patient-centeredness, self-efficacy, and motivation. At the end of each woman’s pregnancy, data pertaining to guideline concordance of GWG were collected. Results Comparison of patient participants with prenatal care providers in the trained and untrained groups showed no significant difference in patient-perceived physician patient-centeredness when discussing GWG, self-efficacy to manage GWG, readiness to adhere to GWG guidelines, or GWG congruence with the guidelines. Conclusion This feasibility study required very little time commitment and entailed minimal disruption to clinicians’ practices. Nonetheless, it was very difficult to recruit clinicians for the study. Although recent theory-driven work showed that prenatal care providers have, overall, high perceived self-efficacy in discussing GWG with their patients, most studies have demonstrated that these providers do not often discuss GWG with their patients; so, there is clearly a mismatch in their perceived self-efficacy and what actually transpires.
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Affiliation(s)
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada,
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Robertson-Jones TA, Tissue MM, Connolly M, Gallups SF, Bender CM, Rosenzweig MQ. Exploring Racial Differences in Patient Centeredness of Care (PCC) During Breast Cancer (BC) Chemotherapy Clinical Visits. J Racial Ethn Health Disparities 2018; 6:94-100. [PMID: 29971577 DOI: 10.1007/s40615-018-0503-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The communication patterns between clinician and patient, described as the patient centeredness of care (PCC), may be a critically important etiology of breast cancer (BC) racial disparity. The purpose of this prospective, comparative pilot study was to qualitatively explore and code for PCC during the clinical visit of women undergoing BC chemotherapy and compare by race. METHODS Age-matched Black and White women were recruited. Audio recordings of clinical visits conducted prior to any cycle (except first) chemotherapy infusion were obtained and transcribed. Transcripts were blindly reviewed by three independent coders assigning PCC scores, ranging from 1 to 5, with lower scores indicating better PCC. Consensus was reached among reviewers via discussion. RESULTS Dyads consisted of five Black (mean age 47) and five White (mean age 45) women undergoing BC chemotherapy. Twenty-four recordings were analyzed, 13 White and 11 Black. For all 22 PCC items, the mean scores were worse for Black women with significant differences (compared by chi-square analysis) noted for 6/22 items (27%). CONCLUSIONS Qualitatively exploring clinician and patient communication patterns during the chemotherapy clinical visits informs the understanding of racial differences for symptom assessment, reporting, and management. These pilot findings inform future research exploring racial disparity in cancer treatment dose intensity.
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Affiliation(s)
- Tinnikkar Angel Robertson-Jones
- Hampton University School of Nursing, E. Tyler St. & Emancipation Drive, William Freeman Hall, Room 110, Hampton, VA, 23668, USA
| | - Madison M Tissue
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Mary Connolly
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Sarah Frazier Gallups
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Catherine M Bender
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA
| | - Margaret Quinn Rosenzweig
- University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15261, USA. .,Acute and Tertiary Care Department, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA, 15216, USA.
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Ellington L, Cloyes KG, Xu J, Bellury L, Berry PH, Reblin M, Clayton MF. Supporting home hospice family caregivers: Insights from different perspectives. Palliat Support Care 2018; 16:209-219. [PMID: 28464961 PMCID: PMC5670030 DOI: 10.1017/s1478951517000219] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Our intention was to describe and compare the perspectives of national hospice thought leaders, hospice nurses, and former family caregivers on factors that promote or threaten family caregiver perceptions of support. METHOD Nationally recognized hospice thought leaders (n = 11), hospice nurses (n = 13), and former family caregivers (n = 14) participated. Interviews and focus groups were audiotaped and transcribed. Data were coded inductively, and codes were hierarchically grouped by topic. Emergent categories were summarized descriptively and compared across groups. RESULTS Four categories linked responses from the three participant groups (95%, 366/384 codes): (1) essentials of skilled communication (30.6%), (2) importance of building authentic relationships (28%), (3) value of expert teaching (22.4%), and (4) critical role of teamwork (18.3%). The thought leaders emphasized communication (44.6%), caregivers stressed expert teaching (51%), and nurses highlighted teamwork (35.8%). Nurses discussed teamwork significantly more than caregivers (z = 2.2786), thought leaders discussed communication more than caregivers (z = 2.8551), and caregivers discussed expert teaching more than thought leaders (z = 2.1693) and nurses (z = 2.4718; all values of p < 0.05). SIGNIFICANCE OF RESULTS Our findings suggest differences in priorities for caregiver support across family caregivers, hospice nurses, and thought leaders. Hospice teams may benefit from further education and training to help cross the schism of family-centered hospice care as a clinical ideal to one where hospice team members can fully support and empower family caregivers as a hospice team member.
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Affiliation(s)
- Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | - Jiayun Xu
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Lanell Bellury
- Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia, USA
| | - Patricia H. Berry
- Hartford Center of Gerontological Excellence, Oregon Health & Science University, Portland, Oregon, USA
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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Delany C, Richards A, Stewart H, Kosta L. Five challenges to ethical communication for interprofessional paediatric practice: A social work perspective. J Interprof Care 2017; 31:505-511. [PMID: 28287850 DOI: 10.1080/13561820.2017.1296419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In paediatric clinical care, what is said to a parent or carer as well as when, where, and how it is said, directly advances or diminishes parents' capacities to understand available options and to contribute to decisions about treatment for their child. This makes interprofessional and patient communication an ethical endeavour. Social workers are uniquely situated to observe, participate in, and provide an active link in the communication between families and other health team members. This article reports phenomenological research exploring ethical issues encountered by social workers in their everyday practice communicating with families and other health professionals in a paediatric hospital context in Australia. Data were collected via semi-structured interviews with nine social workers and analysed thematically. Participants described two main communication-based roles: to support families through information provision and to contribute collaboratively to the interprofessional team involved in caring for a child and family. We grouped participants' descriptions of conflict between these roles into five main "communication challenges": (1) holding troublesome knowledge; (2) the need for diplomacy; (3) conciliation; (4) every man and his dog in family meetings; and (5) systems and processes presenting a brick wall. The five communication challenges provide empirically derived examples of how communication occurring within interprofessional health teams and between individual clinicians and parents can act to diminish or enhance parents' experience of care for their hospitalised child. Identifying these challenges may help to inform how communication within interprofessional teams and between clinicians and patients can benefit children and their parents.
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Affiliation(s)
- Clare Delany
- a Children's Bioethics Centre , Royal Children's Hospital , Melbourne , Victoria , Australia.,b Medical School , The University of Melbourne , Melbourne , Victoria , Australia
| | - Angela Richards
- c Social Work , Royal Children's Hospital , Melbourne , Victoria , Australia
| | - Helen Stewart
- c Social Work , Royal Children's Hospital , Melbourne , Victoria , Australia
| | - Lauren Kosta
- d Department of Social Work , The University of Melbourne , Melbourne , Victoria , Australia
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Song L, Tyler C, Clayton MF, Rodgiriguez-Rassi E, Hill L, Bai J, Pruthi R, Bailey DE. Patient and family communication during consultation visits: The effects of a decision aid for treatment decision-making for localized prostate cancer. Patient Educ Couns 2017; 100:267-275. [PMID: 27692491 PMCID: PMC5318208 DOI: 10.1016/j.pec.2016.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/15/2016] [Accepted: 09/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To analyze the effects of a decision aid on improving patients' and family members' information giving and question asking during consultations for prostate cancer treatment decision-making. METHODS This study is a secondary analysis of archived audio-recorded real-time consultation visits with participants from a randomized clinical trial. Participants were randomly assigned into three groups: TD-intervention targeted patient-only; TS-intervention targeted patients and family members; and control-a handout on staying healthy during treatment. We conducted content analysis using a researcher-developed communication coding system. Using SAS 9.3, we conducted Chi-square/Fisher's exact test to examine whether information giving and question asking among patients and family members varied by groups when discussing different content/topics. RESULTS Compared with those in the TS and control groups, significantly higher percentages of participants in the TD group demonstrated information giving in discussing topics about diagnosis, treatment options, risks and benefits, and preferences; and engaged in question asking when discussing diagnosis, watchful waiting/active surveillance, risks and benefits, and preferences for treatment impacts. CONCLUSION Information support and communication skills training for patients were effective in improving communication during treatment decision-making consultations. PRACTICE IMPLICATIONS Providing information about prostate cancer and communication skills training empower patients and their family members.
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Affiliation(s)
- Lixin Song
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC, USA.
| | - Christina Tyler
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, USA; Office of Human Research Ethics (OHRE), UNC, Chapel Hill, NC, USA
| | | | | | - Latorya Hill
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Jinbing Bai
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Raj Pruthi
- School of Medicine Department of Urology, UNC, Chapel Hill, NC, USA
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van Dongen JJJ, Habets IGJ, Beurskens A, van Bokhoven MA. Successful participation of patients in interprofessional team meetings: A qualitative study. Health Expect 2016; 20:724-733. [PMID: 27714904 PMCID: PMC5513000 DOI: 10.1111/hex.12511] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Accepted: 09/20/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The number of people with multiple chronic conditions increases as a result of ageing. To deal with the complex health-care needs of these patients, it is important that health-care professionals collaborate in interprofessional teams. To deliver patient-centred care, it is often recommended to include the patient as a member of the team. OBJECTIVE To gain more insight into how health-care professionals and patients, who are used to participate in interprofessional team meetings, experience and organize patient participation in the team meetings. METHODS A qualitative study including observations of meetings (n=8), followed by semi-structured interviews with participating health-care professionals (n=8), patients and/or relatives (n=11). Professionals and patients were asked about their experiences of patient participation immediately after the team meetings. Results from both observations and interviews were analysed using content analysis. RESULTS The findings show a variety of influencing factors related to patient participation that can be divided into five categories: (i) structure and task distribution, (ii) group composition, (iii) relationship between professionals and patients or relatives, (iv) patients' characteristics and (v) the purpose of the meeting. CONCLUSION Patient participation during team meetings was appreciated by professionals and patients. A tailored approach to patient involvement during team meetings is preferable. When considering the presence of patients in team meetings, it is recommended to pay attention to patients' willingness and ability to participate, and the necessary information shared before the meeting. Participating patients seem to appreciate support and preparation for the meeting.
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Affiliation(s)
- Jerôme Jean Jacques van Dongen
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, Zuyd University of Applied Sciences, Heerlen, the Netherlands.,Department of Family Medicine, CAPHRI School for Public health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | | | - Anna Beurskens
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, Zuyd University of Applied Sciences, Heerlen, the Netherlands.,Department of Family Medicine, CAPHRI School for Public health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Marloes Amantia van Bokhoven
- Department of Family Medicine, CAPHRI School for Public health and Primary Care, Maastricht University, Maastricht, the Netherlands
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Asan O, Tyszka J, Fletcher KE. Capturing the patients' voices: Planning for patient-centered electronic health record use. Int J Med Inform 2016; 95:1-7. [PMID: 27697228 DOI: 10.1016/j.ijmedinf.2016.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To understand (1) the perceptions of patients regarding use of EHR during clinic visits, (2) the impact of the presence of EHR on patient interactions with physicians, and (3) the ways in which EHR usage might increase patient engagement. METHODS We conducted semi-structured interviews of a convenience sample of patients of internal medicine resident doctors from three primary care clinics. Interviews were audio-recorded and transcribed verbatim. We used thematic analysis to identify themes from the transcripts. Informed consent was obtained from each participant. RESULTS We interviewed 32 patients; 37.5% male. Our analysis revealed three primary themes: (1) the views and beliefs of patients on the use of EHR in clinics, (2) patients' perception of the communication skills of residents, and (3) patients' perceptions about information sharing, patient engagement, and health education related to the EHR. An invitation to patients to view the screen as the physician interprets its content increases patient satisfaction and understanding. Residents' possessed skills in communication is not impeded when using EHR. CONCLUSION Patients generally express a positive or neutral perception of EHR use during clinic visits. Using information voiced by patients, we can teach health providers EHR strategies that are likely to engage patients in the visit and engender their trust.
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Affiliation(s)
- Onur Asan
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States.
| | - Jeanne Tyszka
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States
| | - Kathlyn E Fletcher
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States; Clement J. Zablocki VA Medical Center, 5000 West National Avenue, Milwaukee, WI 83295, United States
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Abstract
Patient-centered care involves the provision of treatments that are responsive to patients' preferences. This study aimed to examine the psychometric properties of the Treatment Perception and Preferences measure. Participants ( n = 128) completed the measure relative to pharmacological, educational, and behavioral treatments for the management of insomnia. For each treatment, the measure presents a description of its goal, activities, mode and dose of delivery, and nine items to rate its perceived acceptability. All items measuring perception of treatment were internally consistent (α > .85) and loaded on one factor, except the item assessing severity of side effects. Differences in the measure's scores between groups of participants provided evidence of validity: participants with a preference for a particular treatment rated it more favorably than alternative treatments. The measure provides a systematic and efficient method for eliciting well-informed treatment preferences. Its use in practice should be investigated.
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Affiliation(s)
| | - Dana R Epstein
- 2 Phoenix VA Health Care System, Arizona State University, Phoenix, USA
| | - Mary Fox
- 3 York University, Toronto, Ontario, Canada
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Phillips NM, Street M, Haesler E. A systematic review of reliable and valid tools for the measurement of patient participation in healthcare. BMJ Qual Saf 2015; 25:110-7. [PMID: 26415751 DOI: 10.1136/bmjqs-2015-004357] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 08/31/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Patient participation in healthcare is recognised internationally as essential for consumer-centric, high-quality healthcare delivery. Its measurement as part of continuous quality improvement requires development of agreed standards and measurable indicators. AIM This systematic review sought to identify strategies to measure patient participation in healthcare and to report their reliability and validity. In the context of this review, patient participation was constructed as shared decision-making, acknowledging the patient as having critical knowledge regarding their own health and care needs and promoting self-care/autonomy. METHODS Following a comprehensive search, studies reporting reliability or validity of an instrument used in a healthcare setting to measure patient participation, published in English between January 2004 and March 2014 were eligible for inclusion. RESULTS From an initial search, which identified 1582 studies, 156 studies were retrieved and screened against inclusion criteria. Thirty-three studies reporting 24 patient participation measurement tools met inclusion criteria, and were critically appraised. The majority of studies were descriptive psychometric studies using prospective, cross-sectional designs. Almost all the tools completed by patients, family caregivers, observers or more than one stakeholder focused on aspects of patient-professional communication. Few tools designed for completion by patients or family caregivers provided valid and reliable measures of patient participation. There was low correlation between many of the tools and other measures of patient satisfaction. CONCLUSION Few reliable and valid tools for measurement of patient participation in healthcare have been recently developed. Of those reported in this review, the dyadic Observing Patient Involvement in Decision Making (dyadic-OPTION) tool presents the most promise for measuring core components of patient participation. There remains a need for further study into valid, reliable and feasible strategies for measuring patient participation as part of continuous quality improvement.
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Affiliation(s)
- Nicole Margaret Phillips
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia Deakin University Centre for Quality and Patient Safety Research, Burwood, Victoria, Australia
| | - Maryann Street
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia Deakin University Centre for Quality and Patient Safety Research, Burwood, Victoria, Australia
| | - Emily Haesler
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
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Asan O, Young HN, Chewning B, Montague E. How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care. Patient Educ Couns 2015; 98:310-6. [PMID: 25534022 PMCID: PMC4319541 DOI: 10.1016/j.pec.2014.11.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/21/2014] [Accepted: 11/30/2014] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Use of electronic health records (EHRs) in primary-care exam rooms changes the dynamics of patient-physician interaction. This study examines and compares doctor-patient non-verbal communication (eye-gaze patterns) during primary care encounters for three different screen/information sharing groups: (1) active information sharing, (2) passive information sharing, and (3) technology withdrawal. METHODS Researchers video recorded 100 primary-care visits and coded the direction and duration of doctor and patient gaze. Descriptive statistics compared the length of gaze patterns as a percentage of visit length. Lag sequential analysis determined whether physician eye-gaze influenced patient eye gaze, and vice versa, and examined variations across groups. RESULTS Significant differences were found in duration of gaze across groups. Lag sequential analysis found significant associations between several gaze patterns. Some, such as DGP-PGD ("doctor gaze patient" followed by "patient gaze doctor") were significant for all groups. Others, such DGT-PGU ("doctor gaze technology" followed by "patient gaze unknown") were unique to one group. CONCLUSION Some technology use styles (active information sharing) seem to create more patient engagement, while others (passive information sharing) lead to patient disengagement. PRACTICE IMPLICATIONS Doctors can engage patients in communication by using EHRs in the visits. EHR training and design should facilitate this.
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Affiliation(s)
- Onur Asan
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.
| | - Henry N Young
- College of Pharmacy, University of Georgia, Athens, USA
| | - Betty Chewning
- School of Pharmacy, University of Wisconsin-Madison, Madison, USA
| | - Enid Montague
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Sidani S, Collins L, Harbman P, MacMillan K, Reeves S, Hurlock-Chorostecki C, Donald F, Staples P, van Soeren M. Development of a Measure to Assess Healthcare Providers’ Implementation of Patient-Centered Care. Worldviews Evid Based Nurs 2014; 11:248-57. [DOI: 10.1111/wvn.12047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Souraya Sidani
- Professor and Canada Research Chair, Daphne Cockwell School of Nursing; Ryerson University; Toronto ON Canada
| | - Laura Collins
- Project Coordinator, Daphne Cockwell School of Nursing; Ryerson University; Toronto ON Canada
| | - Patti Harbman
- Nurse Scientist, Trillium Health Partners, Postdoctoral Fellow, Health Interventions Research Centre; Ryerson University, and Assistant Clinical Professor, Canadian Centre for Advanced Practice Nursing Research, McMaster University; Toronto ON Canada
| | | | - Scott Reeves
- Director, Center for Innovation in Interprofessional Healthcare Education and Professor, Department of Social and Behavioral Sciences; University of California, San Francisco; San Francisco CA USA
| | | | - Faith Donald
- Associate Professor, Daphne Cockwell School of Nursing, Ryerson University, and Affiliate Faculty, Canadian Centre for Advanced Practice Nursing Research; McMaster University; Toronto ON Canada
| | - Patti Staples
- Nurse Practitioner, Hotel Dieu Hospital; Kingston ON Canada
| | - Mary van Soeren
- Associate Professor and Associate Director Undergraduate Programs; School of Nursing, Dalhousie University; Halifax NS Canada
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Brom L, Hopmans W, Pasman HRW, Timmermans DRM, Widdershoven GAM, Onwuteaka-Philipsen BD. Congruence between patients' preferred and perceived participation in medical decision-making: a review of the literature. BMC Med Inform Decis Mak 2014; 14:25. [PMID: 24708833 PMCID: PMC3992143 DOI: 10.1186/1472-6947-14-25] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 03/27/2014] [Indexed: 11/30/2022] Open
Abstract
Background Patients are increasingly expected and asked to be involved in health care decisions. In this decision-making process, preferences for participation are important. In this systematic review we aim to provide an overview the literature related to the congruence between patients’ preferences and their perceived participation in medical decision-making. We also explore the direction of mismatched and outline factors associated with congruence. Methods A systematic review was performed on patient participation in medical decision-making. Medline, PsycINFO, CINAHL, EMBASE and the Cochrane Library databases up to September 2012, were searched and all studies were rigorously critically appraised. In total 44 papers were included, they sampled contained 52 different patient samples. Results Mean of congruence between preference for and perceived participation in decision-making was 60% (49 and 70 representing 25th and 75th percentiles). If no congruence was found, of 36 patient samples most patients preferred more involvement and of 9 patient samples most patients preferred less involvement. Factors associated with preferences the most investigated were age and educational level. Younger patients preferred more often an active or shared role as did higher educated patients. Conclusion This review suggests that a similar approach to all patients is not likely to meet patients’ wishes, since preferences for participation vary among patients. Health care professionals should be sensitive to patients individual preferences and communicate about patients’ participation wishes on a regular basis during their illness trajectory.
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Affiliation(s)
- Linda Brom
- Department of Public and Occupational Health, EMGO Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 Amsterdam, BT, The Netherlands.
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Munro ML, Martyn KK, Fava NM, Helman A. Inter-Rater Reliability of the Measure of Patient-Centered Communication in Health Promotion Clinic Visits with Youth. Int J Commun Health 2014; 3:34-42. [PMID: 25705720 PMCID: PMC4332588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Patient-centered communication during clinic visits is critical for a patient and provider to establish a relationship that explores the patient's needs and desires and tailors health care accordingly. However, there are currently limitations to measuring patient-centered communication within the clinic visit. This study will examine the inter-rater reliability of a modified version of the Measure of Patient-Centered Communication (MPCC) for use with youth in health promotion clinic visits. Transcripts from actual patient-provider interactions (n=11) with 17-23 year old participants and providers (n=6; NPs and MDs) were analyzed for inter-rater reliability of a modified version of the MPCC. The MPCC demonstrated satisfactory inter-rater reliability among the five components of patient-centered communication (kappa=0.78) and good mean inter-rater reliability among the five provider responses (percent agreement=87.5%). Measuring patient-centered communication presents challenges. This study demonstrated that the MPCC could be a potential tool in this endeavor; however, adjustments are needed for it to be a reliable measure of patient-centered communication during clinic visits with youth. In order to provide patient-centered communication and care we must be able to accurately measure the communication and techniques being implemented in all patient visits.
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Affiliation(s)
- Michelle L. Munro
- University of Michigan, School of Nursing, 400 North Ingalls Building, Room 3188, Ann Arbor, MI 48109-5482, Telephone: 734-647-0154, Fax: 734-647-0351
| | | | - Nicole M. Fava
- Wayne State University, Merrill Palmer Skillman Institute
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Abstract
Patient-centered care (PCC) has been described as a vague concept, which yields an inconsistent operationalization and implementation of this approach to care. This integrative review of the literature, guided by the conceptualization of PCC as a complex intervention, aimed to identify the specific elements of PCC. Conceptual, empirical and clinical literature in different health professions (n = 178 articles) was critically analyzed. Comparing and contrasting the definitions and descriptions of PCC revealed three specific elements that were represented in these components: holistic, collaborative and responsive care. Activities that constitute each component were specified. The implementation of PCC components is facilitated by a non-specific element: the therapeutic relationship. The results inform the development of protocols that can be used to promote the fidelity with which PCC is delivered by different professionals in a variety of healthcare settings.
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Affiliation(s)
- Souraya Sidani
- School of Nursing, Ryerson University , Toronto, ON , Canada and
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Abstract
Background: Ethics-of-care theories contain important notions regarding the quality of care; however, until now, concrete translations of the insights into instruments are lacking. This may be a result of the completely different type of epistemology, theories and concepts used in the field of quality of care research. Objectives: Both the fields of ‘ethics of care’ and ‘quality of care’ aim for improvement of care; therefore; insights could possibly meet by focusing on the following question: How could ethics-of-care theories contribute to better quality in care at a measurement level? This study reviews existing instruments with the aim of bridging this gap and examines the evidence of their psychometric properties, feasibility and responsiveness. Research design: A systematic search of the literature was undertaken using multiple electronic databases covering January 1990 through May 2012. Method and findings: Of the 3427 unique references identified, 55 studies describing 40 instruments were selected. Using a conceptual framework, an attempt was made to distinguish between related concepts and to group available instruments measuring different types of concepts. A total of 13 instruments that reflect essential aspects of ethics-of-care theory were studied in greater detail, and a quality assessment was conducted. Conclusion: Three promising qualitative instruments were found, which follow the logic of the patient and take their specific context into account.
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Affiliation(s)
| | - Gijs Hesselink
- Radboud University Nijmegen Medical Centre, The Netherlands
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Speer SA, McPhillips R. Patients' perspectives on psychiatric consultations in the Gender Identity Clinic: implications for patient-centered communication. Patient Educ Couns 2013; 91:385-391. [PMID: 23369376 DOI: 10.1016/j.pec.2012.12.009] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/13/2012] [Accepted: 12/21/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To explore transsexual patients' perceptions of communication with psychiatrists in a Gender Identity Clinic and advance understanding of patient centered communication (PCC) in psychiatric, 'gatekeeping' settings. METHODS 21 qualitative interviews with a convenience sample of clinic patients. Interviews were coded at a semantic level and subject to an inductive thematic analysis. RESULTS Patients' perceptions clustered into three themes: (1) aspects of communication that patients described liking; (2) aspects of communication that patients described disliking; and (3) aspects of communication that patients deemed challenging but necessary or useful. CONCLUSION Patients described liking or disliking aspects of communication that reflect existing understandings of PCC. However, a striking feature of their accounts was how they were able to rationalize and reflect pragmatically on their negative communication experiences, welcoming doctors' challenges as an opportunity to consider their life-changing decision to transition from their natal gender. PRACTICE IMPLICATIONS In certain clinical settings, current operationalizations of PCC may not apply. Patients' perceptions of communication may be enhanced if an analysis of their experiences formed part of the professional training of doctors, who could be invited to consider the functional specificity of communication across settings and the consequences (both immediate and post hoc) of their communication practices.
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Affiliation(s)
- Susan A Speer
- School of Psychological Sciences, The University of Manchester, Manchester, UK.
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Wrede-Sach J, Voigt I, Diederichs-Egidi H, Hummers-Pradier E, Dierks ML, Junius-Walker U. Decision-making of older patients in context of the doctor-patient relationship: a typology ranging from "self-determined" to "doctor-trusting" patients. Int J Family Med 2013; 2013:478498. [PMID: 23691317 PMCID: PMC3652207 DOI: 10.1155/2013/478498] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 06/02/2023]
Abstract
Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.
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Affiliation(s)
- Jennifer Wrede-Sach
- Hannover Medical School, Institute for General Practice, Carl-Neuberg Street 1, 30625 Hannover, Germany
- University Medical Center Hamburg-Eppendorf, Department of Primary Medical Care, Martinistr. 52, 20246 Hamburg, Germany
| | - Isabel Voigt
- Hannover Medical School, Institute for General Practice, Carl-Neuberg Street 1, 30625 Hannover, Germany
| | - Heike Diederichs-Egidi
- Hannover Medical School, Institute for General Practice, Carl-Neuberg Street 1, 30625 Hannover, Germany
| | - Eva Hummers-Pradier
- Hannover Medical School, Institute for General Practice, Carl-Neuberg Street 1, 30625 Hannover, Germany
- University Medical Centre Göttingen, Department of General Practice, Humboldtallee 38, 37073 Göttingen, Germany
| | - Marie-Luise Dierks
- Hannover Medical School, Institute for Epidemiology, Public Medicine and Healthcare Systems Research, Carl-Neuberg Street 1, 30625 Hannover, Germany
| | - Ulrike Junius-Walker
- Hannover Medical School, Institute for General Practice, Carl-Neuberg Street 1, 30625 Hannover, Germany
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Wrede J, Voigt I, Bleidorn J, Hummers-Pradier E, Dierks ML, Junius-Walker U. Complex health care decisions with older patients in general practice: patient-centeredness and prioritization in consultations following a geriatric assessment. Patient Educ Couns 2013; 90:54-60. [PMID: 22884411 DOI: 10.1016/j.pec.2012.07.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 05/18/2012] [Accepted: 07/20/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To examine to what extent general practitioners in consultations after a geriatric assessment set shared health priorities with older patients experiencing multimorbidity and to what extent this was facilitated through patient-centered behavior. METHODS Observation of consultations embedded in a cluster randomized controlled trial,(1) in which 317 patients from 41 general practices received the STEP assessment followed by a care planning consultation with their GPs. GPs in the intervention group used a structured procedure for setting health (care) priorities in contrast to control GPs. A sample of 43 consultations (24 intervention; 19 control) were recorded, transcribed and analyzed with regard to priority setting and patient-centeredness. RESULTS Patient-centeredness was only moderately apparent in consultations dealing with complex care plans for older patients with multimorbidity. The shared determination of health priorities seemed unusual for both doctors and patients and was rarely practiced, albeit more frequently in intervention consultations. CONCLUSION Setting health care priorities with patients experiencing multimorbidity is ethically desirable and medically appropriate. Yet a short structured guide for doctors cannot easily achieve this. PRACTICE IMPLICATIONS More research is needed in regard to handling complex health needs of older patients. It requires a professional approach and training in patient-centered holistic care planning.
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Affiliation(s)
- Jennifer Wrede
- Institute for General Practice, Hannover Medical School, Hannover, Germany.
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Wouda JC, van de Wiel HBM. Education in patient-physician communication: how to improve effectiveness? Patient Educ Couns 2013; 90:46-53. [PMID: 23068910 DOI: 10.1016/j.pec.2012.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 08/30/2012] [Accepted: 09/16/2012] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Despite educational efforts expertise in communication as required by the CanMEDS competency framework is not achieved by medical students and residents. Several factors complicate the learning of professional communication. METHODS We adapted the reflective-impulsive model of social behaviour to explain the complexities of learning professional communication behaviour. We formulated recommendations for the learning objectives and teaching methods of communication education. Our recommendations are based on the reflective-impulsive model and on the model of deliberate practice which complements the reflective-impulsive model. Our recommendations are substantiated by those we found in the literature. RESULTS The reflective-impulsive model explains why the results of communication education fall below expectations and how expertise in communication can be attained by deliberate practice. The model of deliberate practice specifies learning conditions which are insufficiently fulfilled in current communication programmes. CONCLUSION The implementation of our recommendations would require a great deal of effort. Therefore we doubt whether expertise in professional communication can be fully attained during medical training. PRACTICE IMPLICATIONS We propose that the CanMEDS communication competencies not be regarded as endpoints in medical education but as guidelines to improve communication competency through deliberate practice throughout a professional career.
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Affiliation(s)
- Jan C Wouda
- Wenckebach Institute, University of Groningen, University Medical Center, Groningen, The Netherlands.
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Zimmermann C, de Haes H, Visser A. Enhancing the patient position in the world of health care: contributions from the EACH conference 2010 in Verona. Patient Educ Couns 2011; 84:283-286. [PMID: 21854990 DOI: 10.1016/s0738-3991(11)00393-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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