1
|
Rodenbach RA, Thordardottir T, Brauer M, Hall AC, Ward E, Smith CB, Campbell TC. Balancing risks and rewards: How hematologists discuss uncertainty in allogeneic hematopoietic cell transplantation outcomes. Patient Educ Couns 2024; 123:108177. [PMID: 38341898 PMCID: PMC10997451 DOI: 10.1016/j.pec.2024.108177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Allogeneic hematopoietic cell transplant (alloHCT) offers many patients with blood cancers a chance of cure but carries risks. We characterized how hematologists discuss the high-risk, high-reward concept of alloHCT. METHODS Qualitative analysis of video-recorded virtual encounters of hematologists who routinely perform alloHCT with actors portraying an older man recently diagnosed with high-risk myelodysplastic syndrome. RESULTS Hematologists (n = 37) were a median age of 44 years, 65% male, and 68% white. They frequently used "teeter-totter" language that juxtaposed alloHCT's risks and rewards in a dynamic, quickly alternating fashion and communicated uncertainty in transplant outcomes. This dialogue oscillated between encouragement about alloHCT's potential for cure and caution about its risks and occurred within single speech turns and in exchanges between hematologist and patient. Fewer hematologists outlined their big-picture stance on transplant's risks and benefits early in the conversation. Meanwhile, hematologists varied in how they counseled patients to manage transplant-related uncertainty and consider treatment decision making. CONCLUSION Hematologists use "teeter-totter" language to express hope and concern, confidence and uncertainty, and encouragement and caution about the high-risk, high-reward nature of alloHCT. PRACTICE IMPLICATIONS Teeter-totter language may help frame big-picture content about alloHCT's risks and benefits that is essential for patient education and decision making.
Collapse
Affiliation(s)
| | | | - Markus Brauer
- University of Wisconsin Department of Psychology, Madison, WI, USA
| | - Aric C Hall
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Earlise Ward
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA
| | | | - Toby C Campbell
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| |
Collapse
|
2
|
Kleinstäuber M, Diefenbach MA, Rief W. "It is not just in your mind" - Improving physician-patient communication in individuals with persistent somatic symptoms. J Psychosom Res 2023:111580. [PMID: 38176986 DOI: 10.1016/j.jpsychores.2023.111580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Maria Kleinstäuber
- Department of Psychology, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, USA.
| | - Michael A Diefenbach
- Institute of Health System Science at the Feinstein Institutes for Medical Research, Northwell Health, 600 Community Dr, Manhasset, NY 11030, USA
| | - Winfried Rief
- Dept. of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| |
Collapse
|
3
|
Schuch A, Walther P, Timm L, Steinbach K, Haneklaus L, Münzel T, Prochaska JH, Wild PS. [Utilization of video consultation in cardiovascular lipid treatment]. Herz 2023:10.1007/s00059-023-05211-4. [PMID: 37855873 DOI: 10.1007/s00059-023-05211-4] [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: 08/31/2022] [Revised: 07/04/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Video consultation is a possibility for physician-patient communication independent of the location; however, only limited information is available for the possibility of sole use since 2018. METHODS After the implementation of video consultation (Viomedi) in lipid consultations at the Medical University Mainz, the patients in the first quarter of 2022 were assessed depending on the possibility, suitability and readiness to participate. Included were patients under lipid management and long COVID patients. After treatment an online survey was carried out on the utilization and appraisal. RESULTS Of the 134 patients 29.1% were inclusively treated (3 refusals). All subjects (16 replies) reported having managed (very) well. Advantages were seen in counselling and follow-up. Problems were feared with respect to technology and possible disorders. Data protection aspects played a subordinate role. In comparison to telephone calls, a significant improvement in the physician-patient relationship (p-value = 0.00027), the quality of treatment and information (p-value both = 0.00044), the access to care (p-value = 0.0053) and the communication (p-value = 0.021) was assumed. An improvement in access to care (p-value = 0.021) and the quality of information (p-value = 0.034) was seen in comparison to personal contact. The main problems were a lack of experience, technical requirements, technical problems and unpunctuality of the practitioner. The flexibility, low effort and the pleasant consultation were all praised. All subjects wanted to use the video consultation again. CONCLUSION Video consultation can represent a supplement to treatment of patients under lipid management. The correct use requires exact planning and further research.
Collapse
Affiliation(s)
- A Schuch
- Zentrum für Kardiologie, Kardiologie I, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Rhein-Main, 55131, Mainz, Deutschland
| | - P Walther
- Hochschule Fresenius, Hochschule für Angewandte Wissenschaften, 20095, Hamburg, Deutschland.
| | - L Timm
- Hochschule Fresenius, Hochschule für Angewandte Wissenschaften, 20095, Hamburg, Deutschland
| | - K Steinbach
- Zentrum für Kardiologie, Kardiologie I, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Rhein-Main, 55131, Mainz, Deutschland
| | - L Haneklaus
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Rhein-Main, 55131, Mainz, Deutschland
| | - T Münzel
- Zentrum für Kardiologie, Kardiologie I, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
- Präventive Kardiologie und Medizinische Prävention, Zentrum für Kardiologie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
- Klinische Epidemiologie und Systemmedizin, Centrum für Thrombose und Hämostase, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, 55131, Mainz, Deutschland
| | - J H Prochaska
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Rhein-Main, 55131, Mainz, Deutschland
- Forschungszentrum Translationale Vaskuläre Biologie (CTVB), Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
- Präventive Kardiologie und Medizinische Prävention, Zentrum für Kardiologie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
- Klinische Epidemiologie und Systemmedizin, Centrum für Thrombose und Hämostase, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, 55131, Mainz, Deutschland
| | - P S Wild
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Rhein-Main, 55131, Mainz, Deutschland
- Forschungszentrum Translationale Vaskuläre Biologie (CTVB), Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
- Präventive Kardiologie und Medizinische Prävention, Zentrum für Kardiologie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
- Klinische Epidemiologie und Systemmedizin, Centrum für Thrombose und Hämostase, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, 55131, Mainz, Deutschland
| |
Collapse
|
4
|
Mistry NA, Sweis J, Ofori B, McKoy JM, Langford A, Psutka SP, Perazza E, Raman JD, Murphy AB. Engaging disparities in prostate cancer: Piloting an interactive, virtual workshop to educate providers on shared decision-making for underserved populations. Urol Oncol 2023; 41:430.e1-430.e7. [PMID: 37453812 DOI: 10.1016/j.urolonc.2023.06.021] [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: 04/12/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is an approach to patient-centered care that is strongly recommended when counseling patients for screening and treatment of prostate cancer. However, providers report lack of comfort with SDM and particularly in disparate populations. We report our experience designing and piloting an online workshop to educate practicing urologists on SDM in diverse populations. Our objective was to create a valued interactive SDM workshop to help urologists learn to lead SDM discussions with men form underserved populations. Therefore, we tested the hypothesis that urologists would agree or strongly agree that we met our learning objectives on postcourse survey. MATERIALS AND METHODS With the support of the American Urologic Association, we developed a case-based workshop with interactive role-playing to demonstrate and teach integration of SDM into clinical care. Cases were centered around screening and treatment decisions for localized prostate cancer in diverse patients. Brief surveys were used to track success with learning objectives and urologists' satisfaction with the workshop. RESULTS The session included 14 participants from 6 countries. A postworkshop survey indicated that 100% of respondents (8 of 8) "strongly agreed" that the activity met learning objectives, and 100% rated the session as "good" (1), "very good" (1), or "excellent" (6). Participants' knowledge also improved on shared decision-making concepts and the knowledge was maintained one month after the workshop. CONCLUSION We successfully created and piloted an interactive online workshop to improve urologists' comfort using shared decision-making in caring for diverse patient populations. The course met its objectives and participant feedback for the course was positive. Sharing this process and framework for development of this intervention may inform future workshops that can be applied to medical students, residents, and providers.
Collapse
Affiliation(s)
- Neil A Mistry
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jamila Sweis
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bernice Ofori
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - June M McKoy
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Aisha Langford
- Department of Population Health, NYU Langone Health, New York, NY
| | - Sarah P Psutka
- Department of Urology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
| | - Elizabeth Perazza
- Department of Surgery, Urology Service, Veterans Administration Caribbean Healthcare System, San Juan, PR
| | - Jay D Raman
- Department of Urology, Penn State Health, Hershey, PA
| | - Adam B Murphy
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL; Robert H. Lurie Comprehensive Cancer Center, Chicago, IL.
| |
Collapse
|
5
|
Fryer K, Sanders T, Greco M, Mooney C, Deary V, Burton C. Recognition, explanation, action, learning: Teaching and delivery of a consultation model for persistent physical symptoms. Patient Educ Couns 2023; 115:107870. [PMID: 37441925 DOI: 10.1016/j.pec.2023.107870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/08/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To describe the teaching and delivery of an extended consultation model designed for clinicians to use with patients with persistent physical symptoms and functional disorders. The model is underpinned by current scientific knowledge about persistent physical symptoms and the communication problems that arise in dealing with them. METHODS Process evaluation of training and delivery of the Recognition, Explanation, Action, Learning (REAL) model within the Multiple Symptoms Study 3: a randomised controlled trial of an extended-role GP "Symptoms Clinic". Evaluation used clinician and patient interviews and consultation transcripts. RESULTS 7 GPs were trained in the intervention and 6 of them went on to deliver the REAL model in Symptoms Clinics either face-to-face or online. The Symptoms Clinic provided a set of 4 extended consultations to approximately 170 patients. Evaluation of training indicated that there was a considerable load in terms of new knowledge and skills. Evaluation of delivery found clinicians could adapt the model to individual patients while maintaining a high level of fidelity to its core components. CONCLUSION REAL is a teachable consultation model addressing specific clinical communication issues for people with persistent physical symptoms. PRACTICE IMPLICATIONS REAL enables clinicians to explain persistent physical symptoms in a beneficial way.
Collapse
Affiliation(s)
- Kate Fryer
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Tom Sanders
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Monica Greco
- Department of Sociology, Goldsmiths, University of London, London, UK
| | - Cara Mooney
- School for Health & Related Research, University of Sheffield, Sheffield, UK
| | - Vincent Deary
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Christopher Burton
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK.
| |
Collapse
|
6
|
Feldman DB, Corn BW. Hope and cancer. Curr Opin Psychol 2023; 49:101506. [PMID: 36493525 DOI: 10.1016/j.copsyc.2022.101506] [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: 09/24/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
Two models of hope have predominated in the literature pertaining to cancer-Snyder's "Hope Theory" and Herth's hope model-both of which have produced brief self-report measures. Growing evidence demonstrates that hope, as operationalized in these models, is associated with a number of psychological variables in individuals with cancer, including depression, distress, coping, symptom burden, and posttraumatic growth. Emerging evidence also suggests that hope may predict probability of survival in advanced cancer. Surveys show that patients and families generally prefer healthcare communication that authentically conveys prognosis; such communication is not associated with decreased hope, but may actually foster hope. Finally, several interventions have been developed to enhance hope in people with cancer, which generally demonstrate medium effects.
Collapse
|
7
|
Fisher KA, Nguyen N, Fouayzi H, Singh S, Crawford S, Mazor KM. Impact of a physician recommendation on COVID-19 vaccination intent among vaccine hesitant individuals. Patient Educ Couns 2023; 106:107-112. [PMID: 36244947 PMCID: PMC9523946 DOI: 10.1016/j.pec.2022.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 07/26/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To test the impact of varied physician recommendations on COVID-19 vaccine hesitancy. METHODS We conducted a vignette-based experimental survey on Prolific, an online research platform. COVID-19 vaccine hesitant, adult panel members were assigned to one of five messages that varied by recommendation style (participatory vs explicit) and strategy (acknowledgement of concerns; comparison to the flu shot; statement that millions of people have already received it; emphasis on protecting others). Vaccine hesitancy was re-assessed with the question, "Would you get vaccinated at this visit?". RESULTS Of the 752 participants, 60.1% were female, 43.4% Black, 23.6% Latino, and 33.0% White; mean age was 35.6 years. Overall, 33.1% of the initially "not sure" and 13.1% of the initially "no" participants became less hesitant following any recommendation. Among the "not sure" participants, 20.3% of those who received a participatory recommendation became less hesitant compared with 34.3%- 39.5% for the explicit recommendations. The "protect others" message was most effective among initially "no" participants; 19.8% become less hesitant, compared to 8.7% for the participatory recommendation. CONCLUSION A physician recommendation may reduce COVID-19 vaccine hesitancy. PRACTICE IMPLICATIONS An explicit recommendation and "protect others" message appear to be important elements of a physician recommendation for COVID-19 vaccination.
Collapse
Affiliation(s)
- Kimberly A Fisher
- Department of Medicine, Division of Health Systems Science, UMass Chan Medical School, Worcester, MA, USA.
| | - Ngoc Nguyen
- Department of Medicine, Division of Health Systems Science, UMass Chan Medical School, Worcester, MA, USA
| | - Hassan Fouayzi
- Department of Medicine, Division of Health Systems Science, UMass Chan Medical School, Worcester, MA, USA
| | - Sonal Singh
- Department of Medicine, Division of Health Systems Science, UMass Chan Medical School, Worcester, MA, USA; Department of Family and Community Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Sybil Crawford
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA, USA
| | - Kathleen M Mazor
- Department of Medicine, Division of Health Systems Science, UMass Chan Medical School, Worcester, MA, USA
| |
Collapse
|
8
|
Kojima L, Han AY, French JC, Lipman JM. The Patient's Voice in Assessing Resident Communication Skills. J Surg Educ 2022; 79:e220-e224. [PMID: 36075805 DOI: 10.1016/j.jsurg.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/02/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To generate validity evidence for using patient-reported satisfaction ratings of residents' communication skills to determine progress along the Interpersonal and Communication Skills (ICS) Milestones. DESIGN A single-institution, retrospective study analyzed a CAHPS Clinician and Group Survey (CG-CAHPS) database which collects inpatients' ratings of residents' communication skills using 6 questions on a scale of 1 (very poor) to 5 (very good). CG-CAHPS results for each resident were averaged for each question as well as across the 6 questions. The averaged ratings were compared between low and high performer groups. SETTING A large, academic, mid-western General Surgery residency program. PARTICIPANTS General Surgery residents with 3 or more survey responses from July 2020 to June 2021 were included. Residents were dichotomized into low or high performer groups based on their end-of-year ICS1 sub-competency milestone within their post-graduate year (PGY) cohort. RESULTS 543 CG-CAHPS responses across 44 residents were analyzed with a median of 9 (Interquartile range 6, 17) responses per resident. When residents were compared based on PGY, ratings for the question "resident's knowledge about your medical care of condition" demonstrated statistically significant differences with PGY5s receiving the lowest score (p = 0.05). PGY5s received the lowest averaged ratings across all questions (p = 0.08, η2 = 0.10). When residents were dichotomized into low (n = 21) and high performer groups (n = 23) based on ICS1 milestones, statistically significant differences were noted in ratings for the questions "concern the resident showed for your questions or worries" (4.81 vs. 5, p = 0.047) and "courtesy and respect of the resident" (4.75 vs. 5, p = 0.046). CONCLUSIONS Analysis of patient ratings of surgery residents' communication skills demonstrated concordant findings between ICS1 milestone and 2 domains of CG-CAHPS responses. When low and high performer groups were compared, CG-CAHPS responses demonstrated a similar pattern. These findings provide validity evidence for CG-CAHPS data as a source of information for ICS1 sub-competency assessment.
Collapse
Affiliation(s)
- Lisa Kojima
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
| | - Amy Y Han
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Judith C French
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy M Lipman
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
9
|
Aziz T, Gobioff S, Flink-Bochacki R. Effect of a family planning program on documented emotional support and reproductive goals counseling after previable pregnancy loss. Patient Educ Couns 2022; 105:3071-3077. [PMID: 35738964 DOI: 10.1016/j.pec.2022.06.010] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To evaluate the effect of the Ryan Program for family planning training on patient counseling surrounding previable pregnancy loss. METHODS We conducted a retrospective cohort study of patients with first- and second-trimester miscarriages, therapeutic abortions, ectopic and molar pregnancies, from years before and after establishing a Ryan Program. We compared documentation of coping and future reproductive goals by patient factors, using chi square testing and logistic regression. RESULTS We included 285 pregnancies: 138 pre-Ryan, 147 post-Ryan. Documentation of coping and future goals was greater post-Ryan than pre-Ryan (57.8% vs. 26.8% for coping, 72.8% vs. 50.7% for goals; both p < 0.001). Coping was less likely to be documented for adolescents (aOR 0.02), patients of Asian race (aOR 0.08), those diagnosed in the emergency department (aOR 0.22), and those with ectopic or molar pregnancy (aOR 0.14) (all p < 0.005). Coping documentation increased with second-trimester loss (aOR 6.19) and outpatient follow-up (aOR 3.41) (all p < 0.005). CONCLUSIONS Establishment of a Ryan Program was associated with greater attention to patient coping and goals after previable pregnancy loss. Patients experiencing medically-dangerous pregnancy losses receive less attention to their coping. PRACTICE IMPLICATIONS Comprehensive family planning training and outpatient access may improve patient-centeredness of care for previable pregnancy loss.
Collapse
Affiliation(s)
- Tania Aziz
- Albany Medical Center, Department of Obstetrics and Gynecology, 43 New Scotland Ave. MC-74, Albany, NY 12208, USA.
| | - Samantha Gobioff
- Albany Medical College, 47 New Scotland Ave. MC-74, Albany, NY 12208, USA.
| | - Rachel Flink-Bochacki
- Albany Medical Center, Department of Obstetrics and Gynecology, 43 New Scotland Ave. MC-74, Albany, NY 12208, USA.
| |
Collapse
|
10
|
Timmerman A, Oerlemans M, van der Vleuten C, Pawlikowska T, Ram P, Muris J. Exploring typologies of consultation performance using authentic clinical experiences to support learning and assessment in postgraduate medical training. Patient Educ Couns 2022; 105:2276-2284. [PMID: 34810057 DOI: 10.1016/j.pec.2021.10.035] [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: 02/27/2020] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To validate and refine typologies of consultation performance from previous research to identify learning needs associated with each typology. METHODS We performed a qualitative study in a General Practice Specialty Training programme, using a two-stage design. First, we selected four exemplars from 80 videotaped consultations of 7 first-year and 6 third-year trainees that reflected the four typologies. We subsequently held individual interviews with clinical supervisors (N = 20) who observed these consultations to identify recurrent trainee behaviours. RESULTS The 'doctor-patient interaction' dimension from previous research was specified to encompass relationship-building, exploring, structuring, and shared decision-making competencies. Medical expertise was a moderating factor. The attitude and consultation behaviours included in the typologies were validated and we formulated directions for learning based on learning needs identified per typology. CONCLUSION Supervisors have a shared frame of reference for the behaviours reflecting proficient consultation performance. Serving as a developmental road map, all learning needs emphasised contextual adaptation, calling for an improved balance between patient-centred relationship building and application of medical expertise. PRACTICE IMPLICATIONS By providing rich and tailored feedback on consultation performance, the refined typologies - albeit subject to additional refinement in future research - may promote the monitoring of individual competence development over time.
Collapse
Affiliation(s)
- Angelique Timmerman
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands.
| | - Marjolein Oerlemans
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Cees van der Vleuten
- Maastricht University, Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Teresa Pawlikowska
- RCSI University of Medicine and Health Sciences, Health Professions Education Centre, Dublin, Ireland
| | - Paul Ram
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| | - Jean Muris
- Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
| |
Collapse
|
11
|
Briedé S, van Charldorp TC, Kaasjager KAH. Discussing care decisions at the internal medicine outpatient clinic: A conversation analysis. Patient Educ Couns 2022; 105:2045-2052. [PMID: 34961652 DOI: 10.1016/j.pec.2021.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/12/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Explore how often, when and how care decisions are discussed during consultations at an internal medicine outpatient clinic, and what we can learn from these observations. METHODS Qualitative analysis of 150 video-taped consultations. Consultations involving a discussion of care decisions were analyzed using conversation analysis. RESULTS 1) Only 21 of the 150 consultations involved a discussion of care decisions; 2) As there is no destined phase for the introduction of the topic of care decisions, the topic is most often introduced at the end of the phase 'treatment and course of the disease'; 3) A lot of interactional effort is needed to create common ground and make relevance clear with extensive justification. Hesitation markers, repairs and hypothetical talk show the precariousness of the topic. CONCLUSIONS Three dilemma's need to be addressed: 1) a slot has to be created to introduce the topic of care decisions; 2) common ground has to be created, possibly over time; 3) the paradox of framing the topic as relevant 'in the future' but 'needs to be discussed now' needs to be attended to. PRACTICE IMPLICATIONS We recommend that physician training should address the three dilemmas. Future research should focus on how to do so.
Collapse
Affiliation(s)
- Saskia Briedé
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Tessa C van Charldorp
- Department of Languages, Literature and Communication, Faculty of Humanities, Utrecht University, Utrecht, The Netherlands.
| | - Karin A H Kaasjager
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
12
|
Cripe LD, Vater LB, Lilly JA, Larimer A, Hoffmann ML, Frankel RM. Goals of care communication and higher-value care for patients with advanced-stage cancer: A systematic review of the evidence. Patient Educ Couns 2022; 105:1138-1151. [PMID: 34489147 DOI: 10.1016/j.pec.2021.08.016] [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: 04/26/2021] [Revised: 07/23/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Goals-of-care communication (GOCC) is recommended to increase the value of cancer care near the end of life (EOL). OBJECTIVES Conduct a systematic review of the evidence that GOCC is associated with higher-value care. METHODS We searched PubMed, Scopus, Ovid MEDLINE, EMBASE, EMB Reviews, CINAHL, and PsycInfo from inception to July 2019. We analyzed the population,design, and results and the authors' definitions of GOCC. Risk of bias was assessed. RESULTS Thirty-two articles were selected. Ten articles reported results from 8 interventions; 17 characterized participants' perspectives; and 5 were retrospective The topics, behaviors, timing, and anticipated outcomes of GOCC varied significantly and were indistinguishable from practices such as advance care planning. GOCC typically focused on treatment outcomes rather than patients' goals. Four of 5 interventions increased evidence of GOCC after clinician training. Only one reported improved patient outcomes. CONCLUSION No consensus exists about what GOCC entails. There is limited evidence that GOCC increases the value of EOL care. PRACTICE IMPLICATIONS Future studies should focus on how to engage patients in conversations about their personal goals and integrate their goals into care planning. Clinicians can encourage GOCC by explaining how patients' goals influence decisions especially as treatment options become limited.
Collapse
Affiliation(s)
- Larry D Cripe
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Simon Cancer Center, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Laura B Vater
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Simon Cancer Center, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Jason A Lilly
- Indiana University Health, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Medical Library, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Angeline Larimer
- Indiana University Purdue University at Indianapolis (IUPUI), 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Mary Lynn Hoffmann
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Richard M Frankel
- Indiana University School of Medicine, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Simon Cancer Center, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Regenstrief Institute, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Purdue University at Indianapolis (IUPUI), 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Health, 473 Barnhill Drive, Indianapolis, IN 46202, USA; Indiana University Medical Library, 473 Barnhill Drive, Indianapolis, IN 46202, USA.
| |
Collapse
|
13
|
Baldt B. ["He does not know it yet"-Triadic communication and its pitfalls exemplified by an oncological ward round consultation]. Wien Med Wochenschr 2022:10.1007/s10354-022-00924-3. [PMID: 35386061 DOI: 10.1007/s10354-022-00924-3] [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: 07/12/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
Medical communication is an effective instrument for the medical practice. Due to the low status that medical communication still has within medicine and medical education, many physicians do not know how to use this instrument professionally. Using medical communication in a way that patients are well informed and involved is a prerequisite for them to make self-determined decisions. In this paper I analyze a consultation in an oncology ward to show the pitfalls of medical communication, especially in triadic communication, based on a case study to work out suggestions for optimization from the transcript. Mistakes in conducting conversations, which can be recognized as such in theory, unfortunately still happen in practice, which is why this case study is intended as an invitation to critically reflect on one's own conduct of conversations. The conclusion contains suggestions for the preparation as well as the conduct of the consultation during medical rounds.
Collapse
Affiliation(s)
- Bettina Baldt
- Institut für Systematische Theologie und Ethik, Universität Wien, Schenkenstr. 8-10, 1010, Wien, Österreich.
| |
Collapse
|
14
|
Fisher KA, Kennedy K, Bloomstone S, Fukunaga MI, Bell SK, Mazor KM. Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD. Patient Educ Couns 2022; 105:726-733. [PMID: 34175167 PMCID: PMC8651798 DOI: 10.1016/j.pec.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/31/2020] [Revised: 05/20/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To understand the impact of sharing clinic notes on communication and self-management among patients with COPD and to develop recommendations for writing patient-centered notes. METHODS Thirty patients with COPD participated in 'think-aloud' interviews in which they reviewed their COPD-specific clinic note. Interviews were coded using conventional content analysis, organized by the six-function communication framework. RESULTS Participants were predominantly White (93.3%), with a mean age of 65.5 years. More than half had a high school degree or less, half reported difficulty understanding spoken information, and nearly half sometimes need help reading medical materials. Patients indicated notes provided an opportunity to learn details of their condition and facilitated information sharing - strengthening information exchange. Reading notes enabled self-management through motivation, prompting information seeking, and reminding them of action steps. Patients reacted positively to statements suggesting the provider listened to them, saw them as a person, and was attentive to details, which fostered the relationship. Most patients reacted negatively to medical terminology, incorrect information, and wording that was perceived as disparaging. CONCLUSIONS Sharing clinic notes with patients can promote information exchange, enable self-management, and strengthen the patient-provider relationship. PRACTICE IMPLICATIONS Incorporating patients' recommendations for writing notes could strengthen the benefits of sharing notes.
Collapse
Affiliation(s)
- Kimberly A Fisher
- Department of Medicine, University of Massachusetts Medical School, Worcester, USA; Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA.
| | - Kara Kennedy
- University of Massachusetts Medical School, Worcester, USA.
| | - Sarah Bloomstone
- Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA.
| | - Mayuko Ito Fukunaga
- Department of Medicine, University of Massachusetts Medical School, Worcester, USA; Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA; Department of Population and Quantitative Health Sciences University of Massachusetts Medical School, Worcester, USA.
| | | | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Medical School, Worcester, USA; Meyers Primary Care Institute, A Joint Endeavor of the University of Massachusetts Medical School, Reliant Medical Group and Fallon Health, Worcester, USA.
| |
Collapse
|
15
|
Chang DS, Chen WL, Wang R. Impact of the bidirectional relationship between communication and cognitive efficacy on orthopedic patient adherence behavior. BMC Health Serv Res 2022; 22:199. [PMID: 35164761 PMCID: PMC8845262 DOI: 10.1186/s12913-022-07575-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/21/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
Background There is growing interest in patient autonomy, and communication between physicians and patients has become the essential cornerstone for improving the quality of healthcare services. Previous research has concentrated on the direct effect of physician-patient communication on service outcomes. In the present study, we examined the influence among constructs in the service process and the impact on healthcare outcomes. The present study used behavioral theory to expand the process aspect of the Donabedian healthcare service quality structure-process-outcome model to examine the impact of cognitive changes and communication feedback on patients’ adherence behavior. In addition, the moderating effect of hospital facility levels is examined. Methods A conceptual model was developed and tested using a questionnaire administered to patients in eight hospitals. A total of 397 respondents returned usable surveys, with a response rate of 92.11%. Structural equation modeling was used to analyze the data in two steps that involved a measurement model and a structural model. The former was applied to estimate the Cronbach’s alphas, intercorrelations of factors, and descriptive statistics; the latter was used to test the hypothesized relationships of the constructs. Results The results identified three mediators of the healthcare process within the healthcare services framework: physician-patient communication, cognitive efficacy, and adherence behavior. Physician-patient communication influenced cognitive efficacy (β = 0.16, p < 0.001), and cognitive efficacy influenced physician-patient communication (β = 0.18, p < 0.001). The effect of this bidirectional relationship on adherence behavior was positive (β = 0.38, p < 0.001). The healthcare structure influenced healthcare outcomes via these three healthcare process constructs. The adherence behavior of patients who were treated in the medical center has greater influences by the structure and physician-patient communication than it was treated in the regional hospitals. Conclusions This study revealed a complex pattern in relationships among process constructs for healthcare services. The findings of this study acknowledge the important potential interrelationships among the healthcare service constructs to improve the quality of healthcare outcomes. Trial registration CRREC104107. Date: 22/01/2016. Prospectively Registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07575-5.
Collapse
Affiliation(s)
- Dong-Shang Chang
- Department of Business Administration, National Central University, Taoyuan, Taiwan
| | - Wil-Lie Chen
- School of Nursing, China Medical University, Taichung, Taiwan.
| | - Rouwen Wang
- Department of Business Administration, National Central University, Taoyuan, Taiwan
| |
Collapse
|
16
|
Bányai G, Dombrádi V, Katona C, Boruzs K, Dezső G, Nagy A, Bíró K. Preference for patient-centered communication among the citizens of the Visegrad countries. Patient Educ Couns 2021; 104:3086-3092. [PMID: 33958254 DOI: 10.1016/j.pec.2021.04.005] [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: 07/30/2020] [Revised: 03/31/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The aim of the study was to investigate and compare the preferences that citizens of four Visegrad countries hold concerning the communication between patient and provider. METHODS The patient-practitioner orientation scale was used on a general population in our research, which consists of the Sharing and Caring subscales and assesses patient-centered or doctor-centered orientation toward communication. The statistical analysis included 4000 respondents of citizens from the Czech Republic, Slovakia, Poland and Hungary. When comparing the various demographic data and the four countries with each other univariate and multivariate logistic regressions were performed. RESULTS Being female, middle aged, having a higher education and a poor health status were associated with significantly higher Sharing and Caring scores. Also, Hungarian citizens had a significantly higher Caring score compared to the other three countries. CONCLUSIONS Key demographic variables were identified that affect how citizens perceive the communication between patient and provider. With the exception of Caring among Hungarian citizens, no differences were observed among the Visegrad countries. PRACTICE IMPLICATIONS These findings have potential implications for understanding the preferences of the citizens and thus better promote a more patient-centered communication.
Collapse
Affiliation(s)
- Gábor Bányai
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Viktor Dombrádi
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Cintia Katona
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Hungary
| | - Klára Boruzs
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Gréta Dezső
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Hungary
| | - Attila Nagy
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Klára Bíró
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
| |
Collapse
|
17
|
Younas A, Khan RA, Yasmin R. Entrustment in physician-patient communication: a modified Delphi study using the EPA approach. BMC Med Educ 2021; 21:497. [PMID: 34544394 PMCID: PMC8454034 DOI: 10.1186/s12909-021-02931-1] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Competency based curricula across the globe stress on the importance of effective physician patient communication. A variety of courses have been used to train physicians for this purpose. However, few of them link competencies with practice resulting in confusions in implementation and assessment. This issue can be resolved by treating certain specific patient communication related tasks as acts of entrustment or entrustable professional activities (EPAs). In this study, we aimed to define a competency-based framework for assessing patient physician communication using the language of EPAs. METHODS A modified Delphi study was conducted in three stages. The first stage was an extensive literature review to identify and elaborate communication related tasks which could be treated as EPAs. The second stage was content validation by medical education experts for clarity and representativeness. The third stage was three iterative rounds of modified Delphi with predefined consensus levels. The McNemar test was used to check response stability in the Delphi Rounds. RESULTS Expert consensus resulted in development of 4 specific EPAs focused on physician-patient communication with their competencies and respective assessment strategies all aiming for level 5 of unsupervised practice. These include Providing information to the patient or their family about diagnosis or prognosis; Breaking Bad news to the patient or their family; Counseling a patient regarding their disease or illness; Resolving conflicts with patients or their families. CONCLUSIONS The EPAs for Physician-patient communication are a step toward an integrative, all-inclusive competency-based assessment framework for patient-centered care. They are meant to improve the quality of physician patient interaction by standardizing communication as a decision of entrustment. The EPAs can be linked to competency frameworks around the world and provide a useful assessment framework for effective training in patient communication. They can be integrated into any post graduate curriculum and can also serve as a self-assessment tool for postgraduate training programs across the globe to improve their patient communication curricula.
Collapse
Affiliation(s)
- Ayesha Younas
- Department of Medical and Dental Education, Shifa College of Dentistry, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
| | - Rehan Ahmed Khan
- Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
| | - Raheela Yasmin
- RARE Department, Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
| |
Collapse
|
18
|
Mazor KM, King AM, Hoppe RB, D'Addario A, Musselman TG, Tallia AF, Gallagher TH. Using crowdsourced analog patients to provide feedback on physician communication skills. Patient Educ Couns 2021; 104:2297-2303. [PMID: 33715944 DOI: 10.1016/j.pec.2021.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 02/12/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Effective physician-patient communication is important, but physicians who are seeking to improve have few opportunities for practice or receive actionable feedback. The Video-based Communication Assessment (VCA) provides both. Using the VCA, physicians respond to communication dilemmas depicted in brief video vignettes; crowdsourced analog patients rate responses and offer comments. We characterized analog patients' comments and generated actionable recommendations for improving communication. METHODS Physicians and residents completed the VCA; analog patients rated responses and answered:"What would you want the provider to say in this situation?" We used qualitative analysis to identify themes. RESULTS Forty-three participants completed the VCA; 556 analog patients provided 1035 comments. We identified overarching themes (e.g., caring, empathy, respect) and generated actionable recommendations, incorporating analog patient quotes. CONCLUSION While analog patients' comments could be provided directly to users, conducting a thematic analysis and developing recommendations for physician-patient communication reduced the burden on users, and allowed for focused feedback. Research is needed into physicians' reactions to the recommendations and the impact on communication. PRACTICE IMPLICATIONS Physicians seeking to improve communication skills may benefit from practice and feedback. The VCA was designed to provide both, incorporating the patient voice on how best to communicate in clinical situations.
Collapse
Affiliation(s)
- Kathleen M Mazor
- Meyers Primary Care Institute, United States; University of Massachusetts Medical School, United States.
| | - Ann M King
- National Board of Medical Examiners, United States
| | - Ruth B Hoppe
- College of Human Medicine, Michigan State University, United States
| | | | | | - Alfred F Tallia
- Department of Family Medicine, Rutgers, Robert Wood Johnson Medical School, United States
| | | |
Collapse
|
19
|
Manuel B, Valcke M, Keygnaert I, Roelens K. Improving medical students' communication competencies to deal with intimate partner violence using clinical simulations in Mozambique. BMC Med Educ 2021; 21:126. [PMID: 33622300 PMCID: PMC7901116 DOI: 10.1186/s12909-021-02560-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND During their medical training, medical students aim to master communication skills and professionalism competencies to foster the best possible patient-physician relationship. This is especially evident when dealing with sensitive topics. This study describes and analyses the outcomes of a simulation-based training module on clinical communication competency through interacting with simulated intimate partner violence (IPV) survivors. The training was set up as part of a broader IPV module within a Gynaecology and Obstetrics Bachelor of Medicine and Bachelor of Surgery of Medicine (MBBS). METHODS In total, 34 (59%) of all fourth-year medical students from one medical school in Mozambique were involved. A mixed-method approach was adopted. First, a quasi-experimental pre-test/post-test design was adopted to study the impact of the intervention to tackle critical IPV knowledge, skills, and attitudes, underlying a patient communication script. Second, a qualitative analysis of student perceptions was carried out. RESULTS The results of the paired sample t-tests point at a significant and positive change in post-test values when looking at the general IPV self-efficacy (IPV SE) score and the subscales mainly in attitudes. Participants expressed a desire for additional IPV communication competency and suggested enhancements to the module. CONCLUSION We conclude that due to IPV being a sensitive issue, simulation activities are a good method to be used in a safe environment to develop clinical skills. The results of this study are a good complement of the analysis of the competencies learned by the medical students in Mozambique with the current curriculum.
Collapse
Affiliation(s)
- B Manuel
- Department of Community Health, Faculty of Medicine, University Eduardo Mondlane, Av. Salvador Allende, nr 702, Maputo, Mozambique.
| | - M Valcke
- Department of Educational Studies, Ghent University, Ghent, Belgium
| | - I Keygnaert
- Department of Public Health and Primary Care, International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - K Roelens
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
20
|
Hood-Medland EA, White AEC, Kravitz RL, Henry SG. Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain. BMC Fam Pract 2021; 22:4. [PMID: 33397299 PMCID: PMC7780618 DOI: 10.1186/s12875-020-01317-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/15/2020] [Indexed: 01/19/2023]
Abstract
Background Agenda setting is associated with more efficient care and better patient experience. This study develops a taxonomy of visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience. Methods This observational study analyzed 83 video recorded US primary care visits at a single academic medical center in California involving family medicine and internal medicine resident physicians (n = 49) and patients (n = 83) with chronic pain on opioids. Using conversation analysis, we developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discussed. Exploratory quantitative analyses were conducted to assess the relationship of agenda setting and visit opening styles with post-visit measures of both patient experience and physician perception of visit difficulty. Results We identified 2 visit opening styles representing agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda setting opening styles (open-ended question, patient launch, physician launch). Agenda setting was only performed in 11% of visits and was associated with fewer surprise patient topics than visits without agenda setting (mean (SD) 2.67 (1.66) versus 4.28 (3.23), p = 0.03). Conclusions In this study of patients with chronic pain, resident physicians rarely performed agenda setting, whether defined in terms of “agenda eliciting” or “agenda re-framing.” Agenda setting was associated with fewer surprise topics. Understanding the communication context and outcomes of agenda setting may inform better use of this communication tool in primary care practice.
Collapse
Affiliation(s)
- Eve Angeline Hood-Medland
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA.,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA
| | - Anne E C White
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA. .,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA.
| | - Richard L Kravitz
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA.,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA
| | - Stephen G Henry
- Department of Internal Medicine, University of California Davis, 4150 V Street Suite 2400, Sacramento, CA, 95817, USA.,University of California Davis Center for Healthcare Policy and Research, Sacramento, CA, USA
| |
Collapse
|
21
|
Lu X, Zhang R. Impact of patient information behaviours in online health communities on patient compliance and the mediating role of patients' perceived empathy. Patient Educ Couns 2021; 104:186-193. [PMID: 32665071 DOI: 10.1016/j.pec.2020.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patient health information seeking and physician-patient communication in OHCs proved to have impacts on patient compliance, but related studies from psychological perspectives are limited. This study aims to investigate the impact of patient health information seeking and physician-patient communication in OHCs on patient compliance. METHODS This study established a research model and proposed six hypotheses. An anonymous investigation was conducted using Chinese OHCs. Confirmatory factor analysis, partial least squares, and structural equation modelling were used to test the hypotheses. RESULTS We received 371 responses, and 316 of them were valid. Patient health information seeking and physician-patient communication frequency in OHCs had positive impacts on patients' perceived affective and cognitive empathies, which positively impacted patient compliance. CONCLUSIONS Patient compliance can be improved by patient health information seeking and physician-patient communication in OHCs and affective and cognitive empathies. Patients' perceived affective empathy is the preferred perspective to improve patient compliance. PRACTICE IMPLICATIONS Physicians should encourage patients to seek health information and communicate with them through OHCs, be concerned about patients' experiences, feelings, and attitudes, understand patients' demands and mental states, and show their patients that they can feel patients' pain. Increasing physician-patient communication frequency in OHCs can help improve patient compliance.
Collapse
Affiliation(s)
- Xinyi Lu
- School of Economics and Management, Beijing Jiaotong University, Beijing, China
| | - Runtong Zhang
- School of Economics and Management, Beijing Jiaotong University, Beijing, China.
| |
Collapse
|
22
|
van Eenennaam RM, Kruithof WJ, van Es MA, Kruitwagen-van Reenen ET, Westeneng HJ, Visser-Meily JMA, van den Berg LH, Beelen A. Discussing personalized prognosis in amyotrophic lateral sclerosis: development of a communication guide. BMC Neurol 2020; 20:446. [PMID: 33308184 PMCID: PMC7734773 DOI: 10.1186/s12883-020-02004-8] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Personalized ENCALS survival prediction model reliably estimates the personalized prognosis of patients with amyotrophic lateral sclerosis. Concerns were raised on discussing personalized prognosis without causing anxiety and destroying hope. Tailoring communication to patient readiness and patient needs mediates the impact of prognostic disclosure. We developed a communication guide to support physicians in discussing personalized prognosis tailored to individual needs and preferences of people with ALS and their families. METHODS A multidisciplinary working group of neurologists, rehabilitation physicians, and healthcare researchers A) identified relevant topics for guidance, B) conducted a systematic review on needs of patients regarding prognostic discussion in life-limiting disease, C) drafted recommendations based on evidence and expert opinion, and refined and finalized these recommendations in consensus rounds, based on feedback of an expert advisory panel (patients, family member, ethicist, and spiritual counsellor). RESULTS A) Topics identified for guidance were 1) filling in the ENCALS survival model, and interpreting outcomes and uncertainty, and 2) tailoring discussion to individual needs and preferences of patients (information needs, role and needs of family, severe cognitive impairment or frontotemporal dementia, and non-western patients). B) 17 studies were included in the systematic review. C) Consensus procedures on drafted recommendations focused on selection of outcomes, uncertainty about estimated survival, culturally sensitive communication, and lack of decisional capacity. Recommendations for discussing the prognosis include the following: discuss prognosis based on the prognostic groups and their median survival, or, if more precise information is desired, on the interquartile range of the survival probability. Investigate needs and preferences of the patients and their families for prognostic disclosure, regardless of cultural background. If the patient does not want to know their prognosis, with patient permission discuss the prognosis with their family. If the patient is judged to lack decisional capacity, ask the family if they want to discuss the prognosis. Tailor prognostic disclosure step by step, discuss it in terms of time range, and emphasize uncertainty of individual survival time. CONCLUSION This communication guide supports physicians in tailoring discussion of personalized prognosis to the individual needs and preferences of people with ALS and their families.
Collapse
Affiliation(s)
- Remko M van Eenennaam
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Willeke J Kruithof
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Michael A van Es
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Esther T Kruitwagen-van Reenen
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Henk-Jan Westeneng
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anita Beelen
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands. .,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
| |
Collapse
|
23
|
Ahmed M, Im HB, Hwang JH, Han D. Disclosure of herbal medicine use to health care providers among pregnant women in Nepal: a cross-sectional study. BMC Complement Med Ther 2020; 20:339. [PMID: 33172473 PMCID: PMC7654584 DOI: 10.1186/s12906-020-03142-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/31/2020] [Indexed: 12/30/2022] Open
Abstract
Background Pregnant women’s disclosure of herbal medicine (HM) use to their health care providers during pregnancy is crucial, as misuse of HM can have a detrimental effect on both pregnant woman and the fetus. However, the lack of disclosure of HM use to physicians remains a public health concern in developing countries such as Nepal. Methods A cross-sectional study was conducted among 400 postpartum women admitted at Maternity and Women’s Hospital located in Kathmandu, Nepal. The survey instrument included 30 questions on the use of HM during pregnancy, sociodemographic and health characteristics, and pregnancy outcomes. Chi-square test and logistic regression were conducted for data analysis using SPSS ver. 21.0., and a p-value of less than 0.05 was considered statistically significant for all analyses. Results 60.3% of respondents used at least one herbal remedy during their previous pregnancy, and the overall disclosure rate of HM use to healthcare providers was 54.6%. Women with secondary education level and four or more antenatal care visits were more likely to disclose their HM use to healthcare providers. Conclusions This study highlights that despite the popular use of HM among pregnant women in Nepal, most women obtained HM-related information from informal sources and did not disclose their HM use to physicians. To ensure the safe use of HM, physicians should integrate questions regarding patients’ HM use into their routine patient assessments to facilitate active communication and improve the quality of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-020-03142-9.
Collapse
Affiliation(s)
- Mansoor Ahmed
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan.,Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea
| | - Hyea Bin Im
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Jung Hye Hwang
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea.,Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, South Korea
| | - Dongwoon Han
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea. .,Institute of Health Services Management, Hanyang University, Seoul, South Korea. .,Department of Preventive Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 133-791, South Korea.
| |
Collapse
|
24
|
Matta P, El Mouallem R, Akel M, Hallit S, Fadous Khalife MC. Parents' knowledge, attitude and practice towards children's vaccination in Lebanon: role of the parent-physician communication. BMC Public Health 2020; 20:1439. [PMID: 32962689 PMCID: PMC7510257 DOI: 10.1186/s12889-020-09526-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/27/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background One of the most effective public health interventions in the world is immunization. However, some parents doubt its usefulness and safety. Many factors influence their decision to vaccinate, including their sociodemographic characteristics, their trust in the public health system, the parent-physician relationship, their level of knowledge and their attitudes towards vaccination. Our objective was to determine the factors, especially the parent-physician communication, associated with parental knowledge, attitudes and practices of their children’s vaccination. Methods Three thousand five hundred parents (father, mother or both) of children aged between 1 month and 15 years were approached by a trained personnel who performed the data collection through personal interviews (February–April 2019). Results The response rate was 79.5%. The results of the multivariable analysis showed that a better patient-physician communication was significantly associated with higher knowledge, better attitude and practice. Better knowledge was significantly associated with better attitude, whereas better knowledge and attitude were significantly associated with better practice. Conclusion Our study shows the importance of good physician-patient communication in improving knowledge, attitude and practice of parents towards their children’s vaccination.
Collapse
Affiliation(s)
- Perla Matta
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Pediatrics and Neonatology Department, Notre Dame Des Secours University Hospital, Byblos, Lebanon
| | - Rayane El Mouallem
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Marwan Akel
- INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.,School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon. .,INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.
| | - Marie-Claude Fadous Khalife
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon. .,Pediatrics and Neonatology Department, Notre Dame Des Secours University Hospital, Byblos, Lebanon.
| |
Collapse
|
25
|
van der Velden NCA, Meijers MC, Han PKJ, van Laarhoven HWM, Smets EMA, Henselmans I. The Effect of Prognostic Communication on Patient Outcomes in Palliative Cancer Care: a Systematic Review. Curr Treat Options Oncol 2020; 21:40. [PMID: 32328821 DOI: 10.1007/s11864-020-00742-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND While prognostic information is considered important for treatment decision-making, physicians struggle to communicate prognosis to advanced cancer patients. This systematic review aimed to offer up-to-date, evidence-based guidance on prognostic communication in palliative oncology. METHODS PubMed and PsycInfo were searched until September 2019 for literature on the association between prognostic disclosure (strategies) and patient outcomes in palliative cancer care, and its moderators. Methodological quality was reported. RESULTS Eighteen studies were included. Concerning prognostic disclosure, results revealed a positive association with patients' prognostic awareness. Findings showed no or positive associations between prognostic disclosure and the physician-patient relationship or the discussion of care preferences. Evidence for an association with the documentation of care preferences or physical outcomes was lacking. Findings on the emotional consequences of prognostic disclosure were multifaceted. Concerning disclosure strategies, affective communication seemingly reduced patients' physiological arousal and improved perceived physician's support. Affective and explicit communication showed no or beneficial effects on patients' psychological well-being and satisfaction. Communicating multiple survival scenarios improved prognostic understanding. Physicians displaying expertise, positivity and collaboration fostered hope. Evidence on demographic, clinical and personality factors moderating the effect of prognostic communication was weak. CONCLUSION If preferred by patients, physicians could disclose prognosis using sensible strategies. The combination of explicit and affective communication, multiple survival scenarios and expert, positive, collaborative behaviour likely benefits most patients. Still, more evidence is needed, and tailoring communication to individual patients is warranted. IMPLICATIONS Future research should examine the effect of prognostic communication on psychological well-being over time and treatment decision-making, and focus on individualising care.
Collapse
|
26
|
Denton CP, Laird B, Moros L, Flores JLL. Challenges in physician-patient communication for optimal management of systemic sclerosis-associated interstitial lung disease: a discourse analysis. Clin Rheumatol 2020; 39:2989-2998. [PMID: 32285258 PMCID: PMC7497349 DOI: 10.1007/s10067-020-05063-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/20/2019] [Revised: 03/13/2020] [Accepted: 03/23/2020] [Indexed: 11/22/2022]
Abstract
Introduction Systemic sclerosis (SSc) is a rare, potentially life-threatening condition. The prognosis is difficult to predict, and treatment is complex. This can be difficult to understand or explain, posing challenges for effective physician-patient communication. Our study assessed communication between physicians and patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) to identify information gaps and needs. Methods Twenty-three 20-min consultations between physicians (rheumatologists, pulmonologists) and patients (19 real, 4 actors) with diagnosed SSc-ILD across 6 countries were observed and recorded. Interactional sociolinguistic discourse analysis was used to understand the pattern and meaning of communication, whether the needs of both participants were met, and the level of understanding between participants. Results In most consultations, patients were given little opportunity to explain their concerns or ask questions. Physicians used plain language but would revert to medical terminology for complex issues. Patients would also use medical terminology, despite not fully understanding the terms, which led to some physicians mistakenly believing that patients had a better understanding than they did. Differences in cognitive models between physicians and patients were often responsible for misunderstandings. However, during effective consultations, patients were invited to tell their story, and physicians used techniques to check and demonstrate understanding, express empathy and build rapport. Conclusions Communication challenges between physicians and patients limit joint understanding of SSc-ILD and may result in both parties misunderstanding important information and patients being less aware of self-help management approaches. Strategies should be developed with physicians to facilitate effective communication and increase patient understanding and support.
Collapse
Affiliation(s)
- Christopher P Denton
- Division of Medicine, Department of Inflammation, Centre for Rheumatology and Connective Tissue Diseases, Royal Free and University College Medical School, University College London, London, UK.
| | | | - Lizette Moros
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | |
Collapse
|
27
|
Reisch LM, Prouty CD, Elmore JG, Gallagher TH. Communicating with patients about diagnostic errors in breast cancer care: Providers' attitudes, experiences, and advice. Patient Educ Couns 2020; 103:833-838. [PMID: 31813712 DOI: 10.1016/j.pec.2019.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/24/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To gain understanding of breast cancer care providers' attitudes regarding communicating with patients about diagnostic errors, to inform interventions to improve patient- provider discussions. METHODS Focus groups were held in three U.S. states involving 41 breast cancer care providers from a variety of specialties. Discussions focused on providers' experiences with potential errors in breast cancer diagnosis, communication with patients following three hypothetical diagnostic vignettes, and suggestions for how and why diagnostic errors in breast cancer care should be communicated. Transcripts were qualitatively analyzed. RESULTS Providers were more willing to inform breast cancer patients of a diagnostic error when they felt it would be helpful, when they felt responsible for the error, when they were less concerned about litigation, and when the patient asked directly. CONCLUSIONS Breast cancer care providers experience several challenges when considering whether to inform a patient about diagnostic errors. A better understanding of patients' preferences for open communication, combined with customized tools and training, could increase clinicians' comfort with these difficult discussions. PRACTICE IMPLICATIONS Providers gave suggestions to facilitate discussions about diagnostic errors when these events occur, including themes of education, honesty, and optimism.
Collapse
Affiliation(s)
- Lisa M Reisch
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Joann G Elmore
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | | |
Collapse
|
28
|
Wali RM, Alqahtani RM, Alharazi SK, Bukhari SA, Quqandi SM. Patient satisfaction with the implementation of electronic medical Records in the Western Region, Saudi Arabia, 2018. BMC Fam Pract 2020; 21:37. [PMID: 32061265 PMCID: PMC7024550 DOI: 10.1186/s12875-020-1099-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The implementation of the Electronic Medical Record (EMR) system initiated a significant transition in the healthcare system from traditional paper-based medical records to a digital version. Though EMR offers several benefits compared to Paper Medical Records (PMR), patient satisfaction with the EMR has been an area of concern. The objective of this study is to explore patient satisfaction with the EMR compared to the PMR of patients attending five Primary Healthcare Centers in the Western Region of Saudi Arabia. METHODS A cross-sectional survey was conducted with patients who attended five Primary Health Care centers (PHCs) in the Western Region during 2018. A sample of 377 participants was invited to complete a self-developed structured questionnaire with multiple choice and Likert Scale questions. The questionnaire was distributed to participants in the PHC waiting areas. RESULTS The sample size realized as (n = 377) participants, the majority (65.0%) were female. The overall patient satisfaction was 3.708. Patient satisfaction with the EMR was statistically significant compared to the PMR (3.7241 vs. 3.6919, p < 0.001). Several factors provided evidence of the overall satisfaction with the implementation of the EMR, including an increase in physician attention during the clinical consultation (82.3%), increased explanation of tests and medication (85.8%), increased time spent with the patient during the consultation (80.4%) and increased active listening by the physician (77.3%). Besides, the patients felt confident to ask the physician question related to health during clinical consultation (84.0%). CONCLUSION Patient satisfaction during the clinical consultation and overall satisfaction with various PHC services improved with the implementation of EMR.
Collapse
Affiliation(s)
- R M Wali
- Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia. .,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia. .,King Saud Bin Abdulaziz University of Health Sciences, Jeddah, Saudi Arabia.
| | - R M Alqahtani
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,King Saud Bin Abdulaziz University of Health Sciences, Jeddah, Saudi Arabia
| | - S K Alharazi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,King Saud Bin Abdulaziz University of Health Sciences, Jeddah, Saudi Arabia
| | - S A Bukhari
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,King Saud Bin Abdulaziz University of Health Sciences, Jeddah, Saudi Arabia
| | - S M Quqandi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,King Saud Bin Abdulaziz University of Health Sciences, Jeddah, Saudi Arabia
| |
Collapse
|
29
|
Romero-Rodríguez E, Pérula de Torres LÁ, Fernández García JÁ, Roldán Villalobos A, Ruiz Moral R, Parras Rejano JM. Impact of a primary care training program on the prevention and management of unhealthy alcohol use: A quasi-experimental study. Patient Educ Couns 2019; 102:2060-2067. [PMID: 31178165 DOI: 10.1016/j.pec.2019.05.019] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the impact of a training program targeted to Primary Care (PC) professionalson the acquisition of communication skills, attitudes, and knowledge about the prevention and management of unhealthy alcohol use. METHODS A quasi-experimental, pre- and post-intervention study was performed in PC centers of Cordoba (Spain). Family doctors, residents and nurses participated in the study. The intervention was based on a motivational interviewing training program, which consisted in a workshop on learning skills, attitudes and knowledge about the alcohol management. PC providers were videotaped with a standardized patient in order to check the clinical and communication competencies acquired. A descriptive, bivariate and multivariate analysis was carried out (p < 0.05). RESULTS PC providers' communication skills and attitudes showed significant improvements in the variables studied (p < 0.001), as well as in the clinical interview evaluation parameters. CONCLUSION The present study reveals the impact of a training program targeted to PC professionals on communication skills, attitudes, and knowledge about the prevention and management of patients with unhealthy alcohol use. PRACTICE IMPLICATIONS Training activities targeted to PC providers represent a valuable strategy to improve communication skills, attitudes and knowledge of these professionals in their clinical practice.
Collapse
Affiliation(s)
- Esperanza Romero-Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain.
| | - Luis Ángel Pérula de Torres
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Teaching Unit of Family and Community Medicine, Health District of Cordoba and Guadalquivir, Cordoba, Spain; Program of Preventive Activities and Health Promotion -PAPPS- (semFYC). Barcelona, Spain
| | - José Ángel Fernández García
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Villarrubia Health Center, Andalusian Health Service, Cordoba, Spain
| | - Ana Roldán Villalobos
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Teaching Unit of Family and Community Medicine, Health District of Cordoba and Guadalquivir, Cordoba, Spain; Carlos Castilla Del Pino Health Center, Andalusian Health Service, Cordoba, Spain
| | - Roger Ruiz Moral
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Francisco de Vitoria University, Madrid, Spain
| | - Juan Manuel Parras Rejano
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; Villanueva del Rey Health Center, Andalusian Health Service, Cordoba, Spain
| |
Collapse
|
30
|
Abstract
An increase in general health literacy and a targeted patient information are important prerequisites for coping with the chronic disease in people with inflammatory rheumatic diseases. The education programs of the Working Group of Regional Cooperative Rheumatism Centers in the German Society for Rheumatology (AGRZ), such as StruPI, the offers of the German Rheumatism League (Deutsche Rheuma-Liga) and other elements provide a framework for those affected and their relatives, in which a participative decision-making (PEF) on equal terms can be possible. The physician-patient communication changes in the sense of a PEF and hopefully leads to a sustainably better patient compliance. Non-medicinal treatment, comorbidities and changes in life style are important issues in such cases. The StruPI is an established format for information and education of patients, particularly in outpatient rheumatism patients. In the midterm patient education (outpatient and inpatient) and self-management courses will be offered and honored nationwide, analogue to other chronic diseases, e.g. asthma and diabetes. Patients can influence the course of the disease by life style changes. The treatment of chronic diseases can only function in the long term in a consensual partnership.
Collapse
Affiliation(s)
- K Cattelaens
- Deutsche Rheuma-Liga Bundesverband e. V., Maximilianstr. 14, 53111, Bonn, Deutschland.
| | - S Schewe
- Deutsche Rheuma-Liga Bundesverband e. V., Maximilianstr. 14, 53111, Bonn, Deutschland.,Rheumatologie, Sonnen-Gesundheitszentrum, München, Deutschland
| | - F Schuch
- Praxisgemeinschaft Rheumatologie Nephrologie, Erlangen, Deutschland
| |
Collapse
|
31
|
Nordfalk JM, Gulbrandsen P, Gerwing J, Nylenna M, Menichetti J. Development of a measurement system for complex oral information transfer in medical consultations. BMC Med Res Methodol 2019; 19:139. [PMID: 31272386 PMCID: PMC6610985 DOI: 10.1186/s12874-019-0788-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 10/30/2018] [Accepted: 06/26/2019] [Indexed: 11/18/2022] Open
Abstract
Background Information exchange between physician and patient is crucial to achieve patient involvement, shared decision making and treatment adherence. No reliable method exists for measuring how much information physicians provide in a complex, unscripted medical conversation, nor how much of this information patients recall. This study aims to fill this gap by developing a measurement system designed to compare complex orally provided information to patient recall. Methods The development of the complex information transfer measurement system required nine methodological steps. Core activities were data collection, definition of information units and the first draft of a codebook, refinement through independent coding and consensus, and reliability testing. Videotapes of physician-patient consultations based on a standardized scenario and post-consultation interviews with patients constituted the data. The codebook was developed from verbatim transcriptions of the videotapes. Inter-rater reliability was calculated using a random selection of 10% of the statements in the transcriptions. Results Thirtyfour transcriptions of visits and interviews were collected. We developed a set of rules for defining a single unit of information, defined detailed criteria for exclusion and inclusion of relevant units of information, and outlined systematic counting procedures. In the refinement phase, we established a system for comparing the information provided by the physician with what the patient recalled. While linguistic and conceptual issues arose during the process, coders still achieved good inter-rater reliability, with intra-class correlation for patient recall: 0.723, and for doctors: 0.761. A full codebook is available as an appendix. Conclusions A measurement system specifically aimed at quantifying complex unscripted information exchange may be a useful addition to the tools for evaluating the results of health communication training and randomized controlled trials. Electronic supplementary material The online version of this article (10.1186/s12874-019-0788-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- J M Nordfalk
- Health Services Research Unit HØKH, Akershus University Hospital, Mail Drawer 1000, 1478, Lørenskog, Norway.
| | - P Gulbrandsen
- Health Services Research Unit HØKH, Akershus University Hospital, Mail Drawer 1000, 1478, Lørenskog, Norway
| | - J Gerwing
- Health Services Research Unit HØKH, Akershus University Hospital, Mail Drawer 1000, 1478, Lørenskog, Norway
| | - M Nylenna
- Institute of Health and Society, University of Oslo; Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway
| | - J Menichetti
- Institute of Clinical Medicine, University of Oslo, Akershus University Hospital, Mail Drawer 1000, 1478, Lørenskog, Norway
| |
Collapse
|
32
|
Vandenberg AE, Bowling CB, Adisa O, Sahlie A, Nadel L, Lea J, Plantinga LC. Shared patient and provider values in end-stage renal disease decision making: Identifying the tensions. Patient Educ Couns 2019; 102:1280-1287. [PMID: 30803904 DOI: 10.1016/j.pec.2019.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/06/2018] [Accepted: 02/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine concordance and tensions in values among stakeholder groups across the shared decision making process for end-stage renal disease patients treated with hemodialysis. METHODS A thematic analysis of transcripts from three stakeholder groups: hemodialysis patients (2 groups, n = 17), nephrologists (1 group, n = 9), and non-physician providers (dietitians, social workers, and registered nurses) (1 group, n = 8). A framework of decision-making components (communication, information, decision, behavior, and outcome) guided analysis of values within and across groups. RESULTS Shared values included communication that informed patients and involved family; information about function, trajectory, life context, and patient experience; behavior to manage diet; and outcomes of function, safety, and survival. Identified thematic tensions in patient-provider values were: personalized vs. routinized communication; shared vs. separate information; managed vs. adherent behavior; and participating vs. protected outcome. Patient behavior emerged as a contested area of control. CONCLUSION Emphasizing shared values and bridging values conflicts may ease tensions surrounding self-care behavior by facilitating discussions about diet, medications, and consistent dialyzing. PRACTICE IMPLICATIONS More individualized information needs to be delivered to patients in a personalized communication approach that can still be achieved within a busy dialysis clinic setting.
Collapse
Affiliation(s)
- Ann E Vandenberg
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - C Barrett Bowling
- Durham Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Olufunmilola Adisa
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Abyalew Sahlie
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Leigh Nadel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Janice Lea
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Laura C Plantinga
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
33
|
Abstract
OBJECTIVE Physicians are trained on how to best solicit additional concerns from patients. What has not yet been studied is when and how physicians initiate additional concerns. This analysis focuses on when and how general surgeons share their noticings of medical problems unrelated to the upcoming (or recent) procedures that patients are being seen for. METHODS 281 video-recorded medical encounters with 95 patients from a rural Texas (USA) general surgery private practice were reviewed for surgeon noticings of additional concerns. In addition to analyzing the videos using Conversation Analysis, the author conducted 9 months of ethnographic research to gain understanding of the local setting. RESULTS 22 cases of surgeon noticings were found in 17 visits and were typically detected during the physical examination. Surgeons shared noticings adjacent to their discovery and predominantly framed noticings as bad news tellings. This framing helped mitigate 4 dilemmas surgeons encountered: unknown patient awareness of concern, surgeons' rights to assess areas unrelated to upcoming (or recent) procedures, not meeting the desired health optimization outcome & putting additional burden on patients, and other contextual factors specific to the visit that make sharing a noticing difficult. In addition to alerting patients and potentially activating earlier treatment, sharing noticings can also function to help build physician-patient relationships across time and curtail future patient worry. IMPLICATIONS Each surgeon noticing is potentially a concern that may have otherwise remained undetected and untreated, and speaks to the importance of physicians taking time to conduct thorough physical examinations.
Collapse
|
34
|
Schoenborn NL, Boyd CM, Lee SJ, Cayea D, Pollack CE. Communicating About Stopping Cancer Screening: Comparing Clinicians' and Older Adults' Perspectives. Gerontologist 2019; 59:S67-S76. [PMID: 31100135 PMCID: PMC6524758 DOI: 10.1093/geront/gny172] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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] [Received: 05/16/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Older adults with limited life expectancy frequently receive cancer screening. We sought to compare the perspectives of clinicians and older adults on how to communicate about stopping cancer screening. RESEARCH DESIGN AND METHODS We used data from two studies involving semistructured in-person individual interviews, in which we asked about perspectives on communication about stopping cancer screening, with 28 primary care clinicians and 40 community-dwelling older adults, respectively. RESULTS We identified three major themes: (a) Consensus among primary care clinicians and older adults regarding communication around stopping cancer screening. Both groups considered discussing the benefits/risks of cancer screening and involving patients in the decision as important and mentioned framing screening cessation as shift in health priorities. (b) Differences in perceived reactions to stopping cancer screening. Primary care clinicians were concerned about patient reaction to stopping cancer screening, whereas older adults reported no negative reactions in the context of a trusting relationship. (c) Differences in views around whether to discuss life expectancy in the context of stopping cancer screening. Clinicians rarely discussed life expectancy in this context, whereas older adults were divided on whether life expectancy should be discussed. DISCUSSION AND IMPLICATIONS Given the heterogeneity in older adults' preferences, it is important to assess whether patients want to discuss life expectancy when discussing stopping cancer screening, though use of the specific term "life expectancy" may not be necessary. Instead, focusing discussion on the benefits/risks of cancer screening and mentioning shift in health priorities are acceptable communication strategies for both clinicians and older adults.
Collapse
Affiliation(s)
- Nancy L Schoenborn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia M Boyd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sei J Lee
- Department of Medicine, University of California, San Francisco
| | - Danelle Cayea
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland
| |
Collapse
|
35
|
Down S, Alzaid A, Polonsky WH, Belton A, Edelman S, Gamerman V, Nagel F, Lee J, Emmerson J, Capehorn M. Physician experiences when discussing the need for additional oral medication with type 2 diabetes patients: Insights from the cross-national IntroDia® study. Diabetes Res Clin Pract 2019; 148:179-188. [PMID: 30641173 DOI: 10.1016/j.diabres.2019.01.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/05/2018] [Accepted: 01/04/2019] [Indexed: 12/30/2022]
Abstract
AIMS Physician-patient communication when discussing the need for additional oral medication for type 2 diabetes (add-on) may affect the self-care of people with this condition. We aimed to investigate physicians' recalled experiences of the add-on consultation. METHODS We conducted a cross-sectional survey of physicians treating people with type 2 diabetes in 26 countries, as part of a large cross-national study of physician-patient communication during early treatment of type 2 diabetes (IntroDia®). The survey battery included novel questions about physician experiences at add-on and the Jefferson Scale of Physician Empathy. RESULTS Of 9247 eligible physicians, 6753 responded (73.0% response rate). Most (82%) agreed that physician-patient discussions at add-on strongly influence patients' disease acceptance and treatment adherence. Half the physicians reported ≥1 challenge in most or all add-on conversations, with a significant inverse relationship between frequency of challenges and Jefferson Scale of Physician Empathy score (standardised β coefficient: -0.313; p < 0.001). Physicians estimated that only around half their patients with type 2 diabetes follow their self-care advice. Exploratory factor analysis of physician beliefs about why their patients did not follow recommendations yielded two distinct dimensions: psychosocial barriers (e.g. depressed mood) and personal failings of the patient (e.g. not enough willpower) (r = 0.37, p < 0.001). CONCLUSIONS Physicians' empathy and beliefs about their patients may play a significant role in their success with the add-on conversation and, consequently, promotion of patient engagement and self-care. Although the study was limited by its retrospective, cross-sectional nature, the findings from IntroDia® may inform efforts to improve diabetes care.
Collapse
Affiliation(s)
- Susan Down
- Somerset Partnership NHS Foundation Trust, Parkgate House, East Reach, Taunton, Somerset TA1 3ES, United Kingdom.
| | - Aus Alzaid
- Prince Sultan Military Medical City, PO Box 7897, Riyadh 11159, Saudi Arabia.
| | - William H Polonsky
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Behavioral Diabetes Institute, 5405 Oberlin Drive, Suite 100, San Diego, CA 92121, USA.
| | - Anne Belton
- The Michener Institute of Education at UHN, 222 St. Patrick Street, Toronto, Ontario M5T 1V4, Canada.
| | - Steven Edelman
- Division of Endocrinology and Metabolism, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.
| | - Victoria Gamerman
- Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road, PO Box 368, Ridgefield, CT 06877, USA.
| | - Friederike Nagel
- Boehringer Ingelheim GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany.
| | - Jisoo Lee
- Boehringer Ingelheim International GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany.
| | - James Emmerson
- Boehringer Ingelheim International GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany.
| | - Matthew Capehorn
- Rotherham Institute for Obesity, and Clifton Medical Centre, Doncaster Gate, Rotherham, South Yorkshire S65 1DA, United Kingdom.
| |
Collapse
|
36
|
Abstract
The diagnoses and prognoses that medical professionals have to communicate in cases of cancer come with special problems. Of all fatal diseases, cancer possibly causes most psychological impact on the patient. Although, by nature, medical professionals are aware of this negative impact and take care to be as prudent and human as possible, recent studies have shown that the "psychological factors of the patient" are of direct relevance to the medical factors in cancer, over and above their importance on quality of life during the course of the disease. This direct relevance needs replies that go beyond purely medical knowledge, as well as a specific training as to their application. Interdisciplinary medical-psychological cooperation is probably required. Studies indicate that compliance with both requisites may bring an improvement to clinical results. In Europe, although less than in the United States of America, the necessary inclusion has been the recognition of psychological training in academic pre- and postgraduate training in communicating these cases.
Collapse
Affiliation(s)
- D M Campagne
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, España.
| |
Collapse
|
37
|
Anderson A, Taylor Z, Georges R, Carlson-Cosentino M, Nguyen L, Salas M, Vice A, Bernal N, Bhaloo T. Primary Care Physicians' Role in Parental Decision to Vaccinate with HPV Vaccine: Learnings from a South Texas Hispanic Patient Population. J Immigr Minor Health 2019; 20:1236-1242. [PMID: 28825172 DOI: 10.1007/s10903-017-0646-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 11/28/2022]
Abstract
Hispanic populations have low HPV vaccination rates, although the vaccine is safe and efficacious. We surveyed a low-income Hispanic population to characterize knowledge gaps about the HPV vaccine and understand factors associated with the decision to vaccinate a child to determine how physicians can enhance vaccination rates. Surveys in English and Spanish were distributed to parents of children under age 18. Statistical analysis included logistic regression. Knowledge that the vaccine can prevent invasive cervical cancer most impacted intent to vaccinate. Physician recommendation to vaccinate was far more influential in a parent's decision compared to TV and other sources. Girls are more likely to receive the HPV vaccine over boys. While physician recommendation is critical, they have minimal time for education. Our results suggest that physicians should focus on the vaccine's link to cancer prevention, leaving other knowledge areas for the interdisciplinary care team.
Collapse
Affiliation(s)
- Ashley Anderson
- Faculty at the CHRISTUS Santa Rosa Family Medicine Program, San Antonio, TX, USA
| | - Zachary Taylor
- Faculty at the CHRISTUS Santa Rosa Family Medicine Program, San Antonio, TX, USA
| | - Rebekah Georges
- Faculty at the CHRISTUS Santa Rosa Family Medicine Program, San Antonio, TX, USA
| | | | | | | | - Andrea Vice
- Central Carolina Physicians, Sanford, NC, USA
| | | | - Tajudaullah Bhaloo
- School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler, Houston, TX, 77030, USA.
| |
Collapse
|
38
|
Siegrist V, Langewitz W, Mata R, Maiori D, Hertwig R, Bingisser R. The influence of information structuring and health literacy on recall and satisfaction in a simulated discharge communication. Patient Educ Couns 2018; 101:2090-2096. [PMID: 30131266 DOI: 10.1016/j.pec.2018.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/30/2018] [Accepted: 08/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We investigated the effects of information structuring and its potential interaction with pre-existing medical knowledge on recall in a simulated discharge communication. METHODS 127 proxy-patients (i.e. students) were randomly assigned to one of four conditions. Video vignettes provided identical information, differing in means of information structuring only: The natural conversation (NC) condition was not explicitly structured whereas the structure (S) condition presented information organised by chapter headings. The book metaphor (BM) and the post organizer (PO) conditions also presented structured information but in addition included a synopsis, either at the beginning or at the end of discharge communication, respectively. Proxy-patients' recall, perception of quality and pre-existing medical knowledge were assessed. RESULTS Information structuring (conditions: S, BM, PO) did not increase recall in comparison to NC, but pre-existing medical knowledge improved recall (p < .01). An interaction between medical knowledge and recall in the BM condition was found (p = .02). In comparison to the NC, proxy-patients in all information structuring conditions more strongly recommended the physician (p < .001). CONCLUSIONS Structured discharge communication complemented by the BM is beneficial in individuals with lower pre-existing medical knowledge. PRACTICE IMPLICATIONS The lower pre-existing medical knowledge, the more recipients will profit from information structuring with the BM.
Collapse
Affiliation(s)
- Victoria Siegrist
- Emergency Department, University Hospital Basel, Basel, Switzerland; Center for Cognitive and Decision Sciences, University of Basel, Basel, Switzerland
| | - Wolf Langewitz
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
| | - Rui Mata
- Center for Cognitive and Decision Sciences, University of Basel, Basel, Switzerland
| | - Dominik Maiori
- Center for Cognitive and Decision Sciences, University of Basel, Basel, Switzerland; Department of Digital Film Production, SAE Institute Zurich, Zurich, Switzerland
| | - Ralph Hertwig
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
39
|
Kijima T, Akai K, Matsushita A, Hamano T, Onoda K, Yano S, Nabika T, Ishibashi Y, Kumakura S. Development of the Japanese version of the general practice assessment questionnaire: measurement of patient experience and testing of data quality. BMC Fam Pract 2018; 19:181. [PMID: 30486790 PMCID: PMC6264598 DOI: 10.1186/s12875-018-0873-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/16/2018] [Indexed: 11/18/2022]
Abstract
Background Physicians’ interpersonal performance is critical in medical practice, especially primary care practice. The General Practice Assessment Questionnaire (GPAQ) was developed in the United Kingdom to evaluate the quality of primary care from the viewpoint of patients. This questionnaire highlights the evaluation of interpersonal skills and interactions between physicians and patients. Though several other tools also exist to evaluate primary care quality, the GPAQ has several distinctive evaluation items, covering receptionists, access to primary care, and enablement (patients’ understanding of self-care and of their own health after consultation). Our purpose was to develop and validate a Japanese version of the GPAQ. Methods This cross-sectional study tested the validity and reliability of the Japanese version of the questionnaire. We translated the original GPAQ into Japanese and assessed its reliability and validity among patients aged ≥20 years at five rural primary care centres located in Shimane and Okayama prefectures, Japan. We also examined its internal reliability using Cronbach’s alpha coefficient and construct validity—including item-scale correlations, item-other scale correlations, and inter-scale correlations. Moreover, we examined correlations between each score and overall satisfaction using Spearman’s correlation coefficient for criterion-related validity. Results The translated version of the GPAQ was administered, and we received 252 responses (mean age: 68 ± 12.3 years, male: 42.9%); all data were analysed. The translated questionnaire showed good reliability and validity, with Cronbach’s alphas ranging from 0.79–0.92 for all scales, and satisfactory item-scale, item-other scale, and inter-scale correlations. Correlations with overall satisfaction were strong (Spearman’s correlation coefficients: 0.31–0.38) for all scales except ‘continuity of care’. Conclusions The Japanese version of the GPAQ was acceptable, reliable, and valid. This could be a useful instrument to evaluate key areas of primary care performance in Japan, particularly physicians’ communication skills. Further work is required to evaluate its utility in urban areas. Electronic supplementary material The online version of this article (10.1186/s12875-018-0873-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tsunetaka Kijima
- Department of General Medicine, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan.
| | - Kenju Akai
- Centre for Community-based Healthcare Research and Education, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Akira Matsushita
- Nagi Family Clinic, Tsuyama Family Clinic, Yunogou Family Clinic, Family Practice Centre of Okayama, 292-1, Toyosawa, Nagi-cho, Katsuta-gun, Okayama, 708-1323, Japan
| | - Tsuyoshi Hamano
- Department of Sports Sociology and Health Sciences, Faculty of Sociology, Kyoto Sangyo University, Kamigamomotoyama, Kita-ku, Kyoto-shi, Kyoto, 603-8555, Japan
| | - Keiichi Onoda
- Department of Neurology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Shozo Yano
- Department of Laboratory Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Toru Nabika
- Department of Functional Pathology, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Yutaka Ishibashi
- Department of General Medicine, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| | - Shunichi Kumakura
- Department of Medical Education and Research, Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo-shi, Shimane, 693-8501, Japan
| |
Collapse
|
40
|
Wild D, Nawaz H, Ullah S, Via C, Vance W, Petraro P. Teaching residents to put patients first: creation and evaluation of a comprehensive curriculum in patient-centered communication. BMC Med Educ 2018; 18:266. [PMID: 30453937 PMCID: PMC6245928 DOI: 10.1186/s12909-018-1371-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/31/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND Patient-centered communication is essential for successful patient encounters and positive patient outcomes. Therefore, training residents how to communicate well is one of the key responsibilities of residency programs. However, many residents, especially international medical graduates, continue to struggle with communication barriers. METHODS All residents and faculty from a small community teaching hospital participated in a three-year, multidimensional patient-centered communication curriculum including communication training with lectures, experiential learning, communication skills practice, and reflection in the areas of linguistics, physician-patient communication, cultural & linguistically appropriate care, and professionalism. We evaluated the program through a multipronged outcomes assessment, including self-assessment, scores on the Calgary-Cambridge Scale during Objective Structured Clinical Examination (OSCE), a survey to measure the hidden curriculum, English Communication Assessment Profile (E-CAP),, the Maslach Burnout-Inventory (MBI), and residents' evaluation of faculty communication. RESULTS Sixty-two residents and ten faculty members completed the three-year curriculum. We saw no significant changes in the MBI or hidden curriculum survey. Communication skills as measured by Calgary Cambridge Score, E-CAP, and resident communication improved significantly (average Calgary-Cambridge Scale scores from 70% at baseline to 78% at follow-up (p-value < 0.001), paired t-test score from 68% at baseline to 81% at follow-up (p-value < 0.004), average E-CAP score from 73 to 77% (p-value < 0.001)). Faculty communication and teaching as rated by residents also showed significant improvement in four out of six domains (learning climate (p < 0.001), patient-centered care (p = 0.01), evaluation (p = 0.03), and self-directed learning (p = 0.03)). CONCLUSION Implementing a multidimensional curriculum in patient-centered communication led to modest improvements in patient-centered communication, improved language skills, and improved communication skills among residents and faculty.
Collapse
Affiliation(s)
- Dorothea Wild
- Preventive Medicine Residency Program, Griffin Hospital, Derby, USA
| | - Haq Nawaz
- Combined Internal Medicine/Preventive Medicine Residency Program, Griffin Hospital, Derby, United States
| | - Saif Ullah
- Department of Medical Education, Griffin Hospital, 130 Division Street, Derby, CT 06484 USA
| | - Christina Via
- Department of Medical Education, Griffin Hospital, 130 Division Street, Derby, CT 06484 USA
| | | | - Paul Petraro
- Department of Medical Education, Griffin Hospital, 130 Division Street, Derby, CT 06484 USA
| |
Collapse
|
41
|
Gulbrandsen P. The possible impact of vulnerability on clinical communication: Some reflections and a call for empirical studies. Patient Educ Couns 2018; 101:1990-1994. [PMID: 30087020 DOI: 10.1016/j.pec.2018.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To direct attention to the concept of vulnerability, how it affects interactions in subtle ways and is difficult to detect in studies of clinical dialogues. METHODS A reflection on three everyday examples of what seems like insignificant details in physician-patient interaction, enlightened by readings with an emphasis on unacknowledged shame, illness and social bonds, and the physician's role. RESULTS Physicians are aware of patients' vulnerability as risk and susceptibility to harm under certain circumstances, but often miss the vulnerability related to perceived or anticipated loss of social bonds. The latter may elicit unacknowledged shame, which leads to subtle behavioral changes that are easy to overlook. Typical reactions are silence or lack of relevant response to questions. Physicians are rarely aware of their own vulnerability. Slight behavioral changes from a clinician may reduce or increase a patient's ability to partake actively in problem solving and decision-making. CONCLUSION When physicians or patients are touching upon unacknowledged shame as part of being vulnerable, subtle changes in the interaction may hamper efficient communication. PRACTICE IMPLICATIONS We need studies that add participants' unprompted and prompted reflections on encounter videos, with an emphasis on micro-events and their explanation and impact on the interaction.
Collapse
Affiliation(s)
- Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway.
| |
Collapse
|
42
|
Karnieli-Miller O, Michael K, Eidelman S, Meitar D. What you "see" is how you communicate: Medical students' meaning making of a patient's vignette. Patient Educ Couns 2018; 101:1645-1653. [PMID: 29691110 DOI: 10.1016/j.pec.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/08/2017] [Revised: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To examine how medical students notice issues in a vignette and construct their meaning, and how this construction influences their plan to communicate with the patient. METHODS Following a breaking bad news course for 112 senior medical students, we qualitatively analyzed the participants' written descriptions of the issues they noticed as requiring special attention, using an Immersion/Crystallization iterative consensus process. RESULTS Different students noticed different issues, but no-one noticed all 19 planted issues (Mean of issues noticed by students = 6.77; SD = 2.29). The students wrote about the issues in 46 different ways, representing the diverse meanings they ascribed, ranging from identifying, through inferring, to interpreting while jumping to conclusions. Moreover, for some issues, some students focused on the patient whereas others focused on the physician or the physician-patient relationship. Noticing issues led to preparing for communication with the patient. CONCLUSIONS Noticing the issues and the subsequent meaning-making process facilitated the preparation to address them in the envisioned encounter. PRACTICE IMPLICATIONS When teaching communication skills, it would be helpful to focus on increasing students' awareness of the issues they notice or fail to notice and their personal meaning-making process. This might reduce bias and enhance their preparation for effective patient-centered communication.
Collapse
Affiliation(s)
| | - Keren Michael
- Department of Human Services, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Shmuel Eidelman
- Technion Faculty of Medicine, Rambam Health Campus, Haifa, Israel
| | - Dafna Meitar
- Department of Medical Education, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
43
|
Lown BA, Setnik GS. Utilizing compassion and collaboration to reduce violence in healthcare settings. Isr J Health Policy Res 2018; 7:39. [PMID: 30016994 PMCID: PMC6048890 DOI: 10.1186/s13584-018-0234-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022] Open
Abstract
Violence in healthcare settings is a global problem and violent acts are more likely to occur in emergency departments (EDs). Significant barriers to reporting workplace violence persist among healthcare workers. This, and lack of shared definitions and metrics, increase the difficulty of assessing its prevalence, understanding its causes, and comparing the impact of interventions to reduce its frequency. While risk factors for violence in EDs have been articulated, less is known about how the perspectives of patients and accompanying persons, and their interactions with ED staff may contribute to violence. We discuss the nature and social context of ED violence and some approaches used to address this problem in the U.S. We argue that perpetrators of violence as well as healthcare staff who experience ED violence suffer when it occurs. While securing safety is paramount, compassionate practices to address this suffering and the social context from which it emerges should be developed and provided for all involved. Collaboration among stakeholders, including patients and family members, may lead to effective approaches to address this problem.
Collapse
Affiliation(s)
- Beth A Lown
- The Schwartz Center for Compassionate Healthcare, 100 Cambridge Street, Suite 2100, Boston, MA, 02114, USA. .,Harvard Medical School, Mount Auburn Hospital Department of Medicine, 330 Mount Auburn Street, Cambridge, MA, 02138, USA.
| | - Gary S Setnik
- Harvard Medical School, Mount Auburn Hospital Department of Medicine, 330 Mount Auburn Street, Cambridge, MA, 02138, USA
| |
Collapse
|
44
|
Abstract
Nearly fifteen years have passed since this author's publication which examined the depth of education and training for medical students and practicing physicians specific to clinical competence in the care of lesbian and gay patients in the United States. Since then, there has been an explosion of research gains which have shed a steady light on the needs and disparities of lesbian and gay healthcare. This rich literature base has expanded to include bisexual and transgender (LGBT) healthcare in peer-reviewed journals. Despite these research gains underscoring a call for action, there continues to be a dearth of cultural competency education and training for healthcare professionals focused on clinical assessment and treatment of LGBT patients. This article will focus exclusively on the current status of medical and nursing education and training specific to clinical competence for LGBT healthcare. We are long overdue in closing the clinical competency gap in medical and nursing education to reduce the healthcare disparities within the LGBT community.
Collapse
Affiliation(s)
- Kathleen A Bonvicini
- Institute for Healthcare Communication, 171 Orange Street, 2nd floor, New Haven, CT 06510-3153, United States.
| |
Collapse
|
45
|
Gerwing J, Gulbrandsen P. The perils of information giving: What an accidental incident taught us about messages and roles. Patient Educ Couns 2017; 100:2109-2115. [PMID: 28601263 DOI: 10.1016/j.pec.2017.05.009] [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] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Occasionally mishaps in an investigation lead to new understandings. We report how a videotaped emotional discussion among a family after they had received information about their relative's state gave us insight into the minute sources of uncertainty that fueled their confusion. METHODS Based on the themes of the family's discussion, we used a forensic approach to locate distinct sequences of interest in the video and transcript. Microanalysis of face-to-face dialogue was performed to understand the most critical sequence. The analysis was supported by questionnaire data. RESULTS The family's disagreement about the patient's prognosis could be traced to minor differences in how the surgeon and the anesthesiologist had framed the information. In attempting to resolve apparent contradictions, the family realized they were uncertain about the physicians' roles, which amplified the emotional expressions in the discussions. Role confusion could be traced to subtle details in the surgeon's presentation of himself and the surgery. CONCLUSION Minor discrepancies in how health care professionals frame information combined with not exploring relatives' emotions may lead to major differences in relatives' perceptions. Doubt about health providers' roles decontextualizes information and reassurance, magnifying uncertainty. PRACTICE IMPLICATIONS Health providers should present themselves clearly without haste. If more than one provider is involved, joint preparation of the main messages may be necessary.
Collapse
Affiliation(s)
| | - Pål Gulbrandsen
- HØKH Research Centre, Akershus University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| |
Collapse
|
46
|
Abstract
OBJECTIVE To critically examine different approaches to the measurement of patient-centered communication. METHODS Provides a critique of 7 different measures of patient-centered communication with respect to differences in their assumptions about what constitutes patient-centeredness and in their approaches to measurement. RESULTS The measures differed significantly with regard to whether the measure captured behavior (what the interactants did) or judgment (how well the behavior was performed), focused on the individual clinician or on the interaction as a whole, and on who makes the assessment (participant or observer). A multidimensional framework for developing patient-centered communication measures is presented that encompasses the patient's perspective and participation, the biopsychosocial context of the patient's health, the clinician-patient relationship, quality of information-exchange, shared understanding, and shared, evidence-based decision-making. CONCLUSIONS The state of measurement of the patient-centered communication construct lacks coherence, in part because current measures were developed either void of a conceptual framework or from very different theoretical perspectives. PRACTICE IMPLICATIONS Assessment of patients' experiences with quality of communication in medical encounters should drill down into specific domains of patient-centeredness.
Collapse
Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, United States; Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Houston VA Center for Innovations in Quality, Effectiveness and Safety, United States.
| |
Collapse
|
47
|
Yang LY, Manhas DS, Howard AF, Olson RA. Patient-reported outcome use in oncology: a systematic review of the impact on patient-clinician communication. Support Care Cancer 2018; 26:41-60. [PMID: 28849277 DOI: 10.1007/s00520-017-3865-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are an increasingly popular tool to optimize care and bridge the gap between patient experience and clinician understanding. The aim of this review was to identify mechanisms through which PROs facilitate patient-clinician communication in the adult oncology population. METHODS We conducted a systematic review of the published literature using the following data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, Cab Direct, and CDSR. Studies included in this review reported on the outcomes of PRO use, used PROs as an intervention and not as a study outcome measurement tool, included cancer patients or survivors as study participants, and analyzed patient-clinician communication. RESULTS We identified 610 unique records, of which 43 publications met the inclusion and exclusion criteria. Synthesis of the reviewed studies provided evidence of the usefulness of PROs in facilitating patient-clinician communication on a variety of topics. We identified mechanisms though which PROs influenced patient-clinician communication to include increasing symptom awareness, prompting discussion, streamlining consultations, and facilitating inter-professional communication. Barriers to PRO use in communication improvement include technical problems impeding its administration and completion, compliance issues due to lack of incentive or forgetfulness, and use of PROs that do not appropriately assess issues relevant to the patient. Facilitators include increased education on PRO use, using PRO tools that patients find more acceptable, and providing patient data summaries in an easily accessible format for clinicians. CONCLUSIONS Our review suggests that PROs facilitate patient-clinician communication through various mechanisms that could perhaps contribute to improvements in symptom management and survival. The impact of PROs on clinical outcomes, however, remains poorly studied.
Collapse
|
48
|
Medendorp NM, Visser LNC, Hillen MA, de Haes JCJM, Smets EMA. How oncologists' communication improves (analogue) patients' recall of information. A randomized video-vignettes study. Patient Educ Couns 2017; 100:1338-1344. [PMID: 28233585 DOI: 10.1016/j.pec.2017.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Cancer patients need information provision to cope with their disease. However, only 20-60% of information provided during consultations is remembered. This study aimed to investigate whether oncologists' use of trust-conveying communication, characterized by communicating competence, honesty and caring, enhances patients' memory. Moreover, we aimed to investigate if this hypothetical relationship is mediated by a reduction in psychophysiological arousal during the consultation. METHODS An experimental design was used, allowing for conclusion about causality. Two versions of a scripted video-taped consultation were used in which the oncologist adopted either a standard or a trust-conveying communication style. 97 cancer-naive individuals acted as analogue patients and were randomly assigned to watch one of the consultations. RESULTS Free recall, assessed 24-28h after viewing, was higher (p=0.039) in the trust-conveying condition (65.3% versus 59.5%). Recognition did not differ (p=0.502). Psychophysiological assessment during watching showed a smaller heart rate response in the trust-conveying condition (p=0.037). No mediation effect nor an effect on electrodermal activity was found. CONCLUSION These results suggest that oncologists' use of trust-conveying communication could increase patients' free recall of information and diminish their cardiovascular response. PRACTICE IMPLICATIONS The underlying mechanisms by which oncologists' communication influences information recall warrants further investigation.
Collapse
Affiliation(s)
- N M Medendorp
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - L N C Visser
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
| | - M A Hillen
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - J C J M de Haes
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
49
|
Blumenthal-Barby JS. 'That's the doctor's job': Overcoming patient reluctance to be involved in medical decision making. Patient Educ Couns 2017; 100:14-17. [PMID: 27423179 DOI: 10.1016/j.pec.2016.07.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To review the barriers to patient engagement and techniques to increase patients' engagement in their medical decision-making and care. DISCUSSION Barriers exist to patient involvement in their decision-making and care. Individual barriers include education, language, and culture/attitudes (e.g., deference to physicians). Contextual barriers include time (lack of) and timing (e.g., lag between test results being available and patient encounter). Clinicians should gauge patients' interest in being involved and their level of current knowledge about their condition and options. Framing information in multiple ways and modalities can enhance understanding, which can empower patients to become more engaged. Tools such as decision aids or audio recording of conversations can help patients remember important information, a requirement for meaningful engagement. Clinicians and researchers should work to create social norms and prompts around patients asking questions and expressing their values. Telehealth and electronic platforms are promising modalities for allowing patients to ask questions on in a non-intimidating atmosphere. CONCLUSION Researchers and clinicians should be motivated to find ways to engage patients on the ethical imperative that many patients prefer to be more engaged in some way, shape, or form; patients have better experiences when they are engaged, and engagement improves health outcomes.
Collapse
Affiliation(s)
- J S Blumenthal-Barby
- Baylor College of Medicine, Center for Medical Ethics & Health Policy, One Baylor Plaza, MS: BCM 420, Houston, TX, USA.
| |
Collapse
|
50
|
Asan O. Providers' perceived facilitators and barriers to EHR screen sharing in outpatient settings. Appl Ergon 2017; 58:301-307. [PMID: 27633226 DOI: 10.1016/j.apergo.2016.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 06/06/2023]
Abstract
As health care becomes more patient-centered, some scholars and policy makers propose shifting use of electronic health records (EHRs) to a tool to educate and engage patients. Physician-patient screen sharing may provide a way to achieve this. However, the barriers and facilitators that physicians experience with screen sharing are unknown. In this study, we explored providers' facilitators and barriers to using EHR as a primary care communication tool. We conducted an interview study with 14 primary care providers to discover their views on screen sharing. We used the work system model as a conceptual framework to classify emergent factors. Content analysis yielded 28 facilitators and 56 barriers to patient-centered screen sharing in primary care. We linked these to work system elements. We outline suggestions for more patient-centered EHR systems, and for provider communication training. Finally, we consider the role screen sharing might play in the development of physician-patient situation awareness.
Collapse
Affiliation(s)
- Onur Asan
- Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| |
Collapse
|