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Jawad N, Hakeem FF, Sabbah W. Exploring health advice by dental professionals in USA: A secondary data analysis of NHANES (2015-2018). Patient Educ Couns 2024; 119:108038. [PMID: 37951164 DOI: 10.1016/j.pec.2023.108038] [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: 08/05/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVES To examine socioeconomic and ethnic variations in the provision of health advice by dental professionals. METHODS Data were from the National Health and Examination Survey (NHANES) (2015-2018). Socioeconomic position (Poverty-income ratio and education) and ethnicity were the main exposures. The outcome variable of interest was whether participants received health advice regarding the "benefits of quitting cigarettes," "benefits of monitoring blood sugar levels," and "importance of oral cancer screening". Logistic regression analysis was used to examine the relationship between socioeconomic factors/ethnicity, and health advice after adjusting for covariates. RESULTS The analysis included a total of 5524 people aged eighteen and above who had complete data. Black and Hispanic individuals had higher odds of receiving advice on smoking (OR = 1.49, 95% CI: 1.04-2.12 and OR = 1.48, 95% CI: 1.05-2.07, respectively) and glucose monitoring (OR = 3.00, 95% CI: 2.03-4.43 and OR = 3.14, 95% CI: 2.04-4.82, respectively), but no significant difference for cancer screening advice.Higher poverty-income ratios (PIR) were associated with lower odds of receiving smoking advice (OR = 0.91, 95% CI: 0.84-0.98), but no significant associations were observed for glucose monitoring or cancer screening advice. The study's findings reveal a social gradient in the provision of cancer advice, with individuals having higher education levels, particularly university education (OR = 1.69, 95% CI: 1.24-2.31), showing significantly higher odds of receiving cancer screening advice CONCLUSION: The study highlights significant variations in health advice provision in dental settings, with education level, ethnicity, and smoking status playing prominent roles, emphasizing the need for targeted interventions to promote equity and cultural competence in delivering health advice in dental settings. PRACTICE IMPLICATION The results emphasize the importance of strong policies and ongoing education for dental professionals to ensure optimal treatment and prevention.
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Affiliation(s)
- Noora Jawad
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Faisal F Hakeem
- College of Dentistry, Department of Preventive Dental Sciences, Taibah University Dental College & Hospital, Madinah, Saudi Arabia.
| | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
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Jenstad LM, Howe T, Breau G, Abel J, Colozzo P, Halas G, Mason G, Rieger C, Simon L, Strachan S. Communication between healthcare providers and communicatively-vulnerable patients with associated health outcomes: A scoping review of knowledge syntheses. Patient Educ Couns 2024; 119:108040. [PMID: 37951163 DOI: 10.1016/j.pec.2023.108040] [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: 05/30/2023] [Revised: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE Summarize literature on provider-patient communication linked to health outcomes in communicatively-vulnerable patient populations. METHODS Scoping review of reviews: systematically searched six databases. INCLUSION CRITERIA systematic searches and syntheses of literature; one or more providers and communicatively-vulnerable patients; synchronous in-person communication; intermediate or health outcome linked to communication. RESULTS The search yielded 14,615 citations; 47 reviews - with wide range of providers, communication vulnerabilities, communication practices, and health outcomes - met inclusion criteria. Methodology included qualitative, quantitative, and mixed approaches. Quality ranged from very low to high. Six categories of communication practices linked to health outcomes were identified: 1) motivation-based; 2) accommodation of language, culture, gender, sexual identity, and other concordance with the patient; 3) cultural adaptations of interventions; 4) use of interpreters; 5) other provider-patient communication practices; 6) patient communication practices. CONCLUSION Communication practices were studied in a wide range of providers, with common themes regarding best practices. A unique finding is the role of the patient's communication practices. The specificity of communication practices studied is heterogeneous, with many reviews providing insufficient details. PRACTICE IMPLICATIONS Motivation-based practices and culturally- and linguistically-appropriate care have impacts on patient outcomes across a range of settings with different professions and communicatively-vulnerable groups.
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Affiliation(s)
- Lorienne M Jenstad
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Tami Howe
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Genevieve Breau
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, London SE10 9LS, UK.
| | - Jennifer Abel
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Paola Colozzo
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Gayle Halas
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Glenda Mason
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Caroline Rieger
- Department of Central, Eastern and Northern European Studies, University of British Columbia, Vancouver, Canada
| | - Leora Simon
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Shaelyn Strachan
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
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Fortini C, Daeppen JB. How do hospital providers perceive and experience the information-delivery process? A qualitative exploratory study. PEC Innov 2023; 3:100222. [PMID: 37842173 PMCID: PMC10570693 DOI: 10.1016/j.pecinn.2023.100222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/21/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023]
Abstract
Objective To explore how professionals deal with informing their patients and how they experience the process per se, in order to deepen understanding of the issues involved and to identify areas of focus for improvement. Methods Semi-structured qualitative interviews were conducted with 13 hospital professionals at Lausanne University Hospital, Switzerland. Results Information includes feedback, practical information, patient condition, treatment/process of care, and educational material. Information-delivery is a process that involves informing the patient then checking patient reception of the information. The main expected outcome is patient action. Providers can feel trapped, guilty, inadequate, powerless, disenchanted when the process fails to achieve its expected purpose. Conclusions Informing and checking strategies are not implemented optimally, and providers could benefit from guidance in order to decrease discomfort and become more proficient at delivering information. Innovation Addressing the information-delivery process per se provides us with a novel insight into the complexity of the process and contributes to identifying essential ingredients of future innovative training programs for providers at large.
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Affiliation(s)
- Cristiana Fortini
- Addiction Medicine, Lausanne University Hospital CHUV, 23A rue du Bugnon, Lausanne 1011, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Lausanne University Hospital CHUV, 23A rue du Bugnon, Lausanne 1011, Switzerland
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Roumen C, Offermann C, Eekers DB, Spreeuwenberg MD, Fijten R. Difficult medical encounters in oncology: What physicians need. An exploratory study. PEC Innov 2023; 3:100202. [PMID: 37705725 PMCID: PMC10495654 DOI: 10.1016/j.pecinn.2023.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
Objective The objective of this study was to assess how often-medical oncology professionals encounter difficult consultations and if they desire support in the form of training. Methods In February 2022, a survey on difficult medical encounters in oncology, training and demographics was set up. The survey was sent to 390 medical oncology professionals part of the OncoZON network of the Southeast region of the Netherlands. Results Medical oncology professionals perceive a medical encounter as difficult when there is a dominant family member (n = 27), insufficient time (n = 24), or no agreement between medical professional and patient (n = 22). Patients involved in these encounters are most often characterized with low health literacy (n = 12) or aggressive behavior (n = 10). The inability to comprehend difficult medical information or perceived difficult behavior complicates encounters. Of the medical oncology professionals, 27-44% preferred a training as a physical group meeting (24%) or an individual virtual meeting (19%). Conclusion Medical oncology professionals consider dominant or aggressive behavior and the inability to comprehend medical information by patients during consultations as difficult encounters for which they would appreciate support. Innovation Our results highlight concrete medical encounters in need of specific education programs within daily oncology practice.
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Affiliation(s)
- Cheryl Roumen
- Department of Health Services Research, Maastricht University, Maastricht, the Netherlands
| | - Claudia Offermann
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Daniëlle B.P. Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Rianne Fijten
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
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Wollney EN, Vasquez TS, Fisher CL, Armstrong MJ, Paige SR, Alpert J, Bylund CL. A systematic scoping review of patient and caregiver self-report measures of satisfaction with clinicians' communication. Patient Educ Couns 2023; 117:107976. [PMID: 37738791 DOI: 10.1016/j.pec.2023.107976] [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: 04/13/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE We conducted a systematic scoping review of self-report tools used to measure patient and/or caregiver satisfaction with clinician communication. Aims included identifying: 1) instruments that have been used to measure communication satisfaction, and 2) content of the communication items on measures. METHODS Two databases (PubMed and CINAHL) were searched for relevant studies. Eligibility included patient or caregiver self-report tools assessing satisfaction with clinicians' communication in a biomedical healthcare setting; and the stated purpose for using the measurement involved evaluating communication satisfaction and measures included more than one question about this. All data were charted in a form created by the authors. RESULTS Our search yielded a total of 4531 results screened as title and abstracts; 228 studies were screened in full text and 85 studies were included in the review. We found 53 different tools used to measure communication satisfaction among those 85 studies, including 29 previously used measures (e.g., FS-ICU-24, CAHPS), and 24 original measures developed by authors. Content of communication satisfaction items included satisfaction with content-specific communication, interpersonal communication skills of clinicians, communicating to set the right environment, and global communication satisfaction items. CONCLUSION There was high variability in the number of items and types of content on measures. Communication satisfaction should be better conceptualized to improve measurement, and more robust measures should be created to capture complex factors of communication satisfaction. PRACTICE IMPLICATIONS Creating a rigorous evaluation of satisfaction with clinician communication may help strengthen communication research and the assessment of communication interventions.
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Affiliation(s)
- Easton N Wollney
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Taylor S Vasquez
- College of Journalism & Communications, University of Florida, Gainesville, FL, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Control and Population Sciences Program (CCPS), UF Health Cancer Center, Gainesville, FL, USA
| | - Melissa J Armstrong
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA; Norman Fixel Institute for Neurological Diseases, UF Health, Gainesville, FL, USA
| | - Samantha R Paige
- Health & Wellness Solutions, Johnson & Johnson, Inc., New Brunswick, NJ, USA
| | - Jordan Alpert
- Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, OH, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Control and Population Sciences Program (CCPS), UF Health Cancer Center, Gainesville, FL, USA
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Briedé S, de Winter MA, van Charldorp TC, Kaasjager KAH. The effect of physician training and patient education on the discussion of care decisions at the internal medicine outpatient clinic. BMC Health Serv Res 2022; 22:1569. [PMID: 36550522 PMCID: PMC9773541 DOI: 10.1186/s12913-022-08901-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Care decision discussions are intended to align treatment with the patient's wishes, goals and values. To overcome the numerous barriers to such discussions, physicians as well as patients need tailored support. We evaluate the effect of a physicians' training and a conversation aid for patients about care decisions on patient and physician outcomes. METHODS At the internal medicine outpatient clinic of the University Medical Centre Utrecht, a 1:1 randomized, parallel-group study (patient conversation aid) was combined with a pre-post intervention (physicians' training) design. Primary outcome was patient satisfaction, secondary outcomes were patient-doctor relationship, shared-decision-making, doctor preparedness and patient appreciation of the conversation aid. RESULTS Between October 2018 and February 2020 11 physicians (36% residents, 73% female) and 185 patients (median age 58 years (interquartile range (IQR) 50-68), 60% male) participated. Only 28% of the patients reported a care decision discussion during the consultation. We found no effect of the interventions on patient satisfaction (effect sizes -0.14 (95% confidence interval (CI) -0.56-0.27) for conversation aid; 0.04 (95% CI -0.40-0.48) for physician's training), nor on the patient-doctor relationship or shared-decision-making. However, physicians felt more prepared to discuss care decisions after training (median 3 (IQR 1-4) vs 1 (IQR 0-3), p = 0.015). Patients assessed the conversation aid informative and gave an overall mark of median 7 (IQR 7-8). CONCLUSIONS First steps towards fruitful discussions about care decisions were made: patients considered the conversation aid informative and physicians felt better prepared to discuss care decisions after training. The low number of care decision conversations patients reported shows exactly how important it is to focus on interventions that facilitate these discussions, for both the patient and physician. Further work needs to be done to establish the best way to empower patients and physicians. TRIAL REGISTRATION Dutch trial register, trial 6998 (NTR 7188), registered 04/05/2018, https://www.trialregister.nl/trial/6998 .
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Affiliation(s)
- Saskia Briedé
- grid.7692.a0000000090126352Department of Internal Medicine and Dermatology, University Medical Centre Utrecht, 85500, 3508 GA Utrecht, Utrecht, The Netherlands
| | - Maria A. de Winter
- grid.7692.a0000000090126352Department of Internal Medicine and Dermatology, University Medical Centre Utrecht, 85500, 3508 GA Utrecht, Utrecht, The Netherlands
| | - Tessa C. van Charldorp
- grid.5477.10000000120346234Department of Languages, Literature and Communication, Faculty of Humanities, Utrecht University, Trans 10, 3512 JK Utrecht, Utrecht, the Netherlands
| | - Karin A. H. Kaasjager
- grid.7692.a0000000090126352Department of Internal Medicine and Dermatology, University Medical Centre Utrecht, 85500, 3508 GA Utrecht, Utrecht, The Netherlands
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Halpin SN, Konomos M, Roulston K. Using conversation analysis to appraise how novel educational videos impact patient medical education. Patient Educ Couns 2022; 105:2027-2032. [PMID: 34887157 DOI: 10.1016/j.pec.2021.11.012] [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: 02/26/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine in what ways, if any, do patients, caregivers, and nurses make videos relevant during in-person education. METHODS We applied conversation analysis to analyze interaction in 12 nurse-led education visits (1011 min of audio) in which speakers referred to a supplemental education video. RESULTS Patients initiated talk about the video in about half of the clinic visits analyzed, while nurses initiated talk about the video across all clinic visits analyzed. Interactions showed that patients demonstrated knowledge of video content and clarified information concerning their treatment plans by asking questions of nurses. Nurses referenced the video prior to repeating information that they recognized patients had viewed. In all instances analyzed, nurses made references to the videos in ways that re-oriented conversations back toward the content of the informal scripts that they used to deliver patient education. CONCLUSION Patients referenced the video in ways that demonstrated that they had viewed it and had gained knowledge concerning treatment plans, and to ask specific questions about these. Nurses referred to the videos by acknowledging patients' prior knowledge of upcoming information. PRACTICE IMPLICATIONS Understanding how pre-delivered supplemental videos impact patient involvement in in-person education contributes understanding to how video-based instruction supports patient-centered care.
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Affiliation(s)
- Sean N Halpin
- College of Education, University of Georgia, 308 River's Crossing, 850 College Station Road, Athens, GA 30602, United States.
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Bylund CL, Michaels M, Weiss ES, Patel S, D'Agostino TA, Binz-Scharf MC, McKee D. The Impact of an Online Training Program About Cancer Clinical Trials on Primary Care Physicians' Knowledge, Attitudes and Beliefs, and Behavior. J Cancer Educ 2021; 36:1039-1044. [PMID: 32157570 PMCID: PMC7483356 DOI: 10.1007/s13187-020-01731-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Participation in cancer clinical trials (CCTs) is critical to improving cancer treatments and quality of care. However, rates of patient participation remain low. Research has shown that a trusted physician recommendation is an important influence on patients' decisions to enroll in a CCT. Improving primary care providers' (PCPs') knowledge, attitudes, and beliefs about CCTs is a promising potential path for improving CCT participation. The aim of this pilot study was to test the effect of an online educational course for PCPs about clinical trials on primary care providers' knowledge, attitudes and beliefs, and behavior. Forty-one PCPs in the New York City area participated in a 1-h online training session on cancer clinical trials. These PCPs had self-selected to complete the training in a previous survey. The objectives of the training module were to (1) educate the PCPs about clinical trials, with a focus on overcoming misconceptions; and (2) discuss roles of PCPs in partnering with oncologists to help patients gain access to clinical trials. The training module included didactics, audio excerpts, and case descriptions. Participants completed a pre-test immediately before taking the course, a post-test immediately after taking the course, and a 3-month post-course survey. All three assessments included a general T/F knowledge test, a 7-item attitude/belief scale, and a knowledge test focused specifically on local resources and access for clinical trials. Forty-one PCPs completed the module and the pre-post course surveys. Eighty percent (33/41) also completed the 3-month post-course survey. General knowledge and local knowledge increased significantly (p < .05) from pre- to post-course. At 3 months post-training, both general and local knowledge scores remained significantly increased from baseline. For those who completed the 3-month post-course survey, attitudes and beliefs increased significantly from pre- to post-course, but this change was not sustained at 3 months post-training. At 3 months post-training, 52% of the PCPs who had an interaction with a recently diagnosed cancer patient reported speaking with patients about CCTs as a result of the training. A brief online course showed significant and sustained improvement in PCPs' general and local knowledge about cancer clinical trials, which translated into self-reported behavior change. Future dissemination of the course and further research into its impact are important next steps.
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Affiliation(s)
- Carma L Bylund
- Memorial Sloan-Kettering Cancer Center, New York, USA.
- University of Florida, Gainesville, USA.
| | - Margo Michaels
- Education Network to Advance Cancer Clinical Trials, Bethesda, USA
- Health Access and Action Consulting Newton, Massachusetts, USA
| | - Elisa S Weiss
- Albert Einstein College of Medicine, Bronx, USA
- The Leukemia & Lymphoma Society, Rye Brook, NY, USA
| | - Shilpa Patel
- Albert Einstein College of Medicine, Bronx, USA
- The Center for Health Care Strategies, Hamilton, USA
| | - Thomas A D'Agostino
- Memorial Sloan-Kettering Cancer Center, New York, USA
- Albany Stratton VA Medical Center, Albany, USA
| | | | - Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, USA
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, USA
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Jenkinson B, Kearney L, Kynn M, Reed R, Nugent R, Toohill J, Bogossian F. Validating a scale to measure respectful maternity care in Australia: Challenges and recommendations. Midwifery 2021; 103:103090. [PMID: 34332313 DOI: 10.1016/j.midw.2021.103090] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/27/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Respectful maternity care is a pervasive human rights issue, but little is known about its realisation in Australia. Two scales, developed in North America, measure key aspects of respectful maternity care: the Mothers on Respect Index and Mothers Autonomy in Decision Making scale. This study aimed to validate these two scales in Queensland, Australia, and to determine the extent to which women currently experience respectful maternity care and autonomy in decision making. DESIGN A sequential two-phase study. A focus group reviewed the scales, made adaptations to scale items and completed a Content Validation Survey. The Respectful Maternity Care in Queensland survey, comprising the validated Australian scales and demographic questions was distributed online in early 2020. SETTING Queensland, Australia. PARTICIPANTS Focus group involved women (n=10) who were aged over 18, English-speaking, and had given birth during the preceding two years. All women who had birthed in Queensland between September 2019 and February 2020, were eligible to participate in the cross-sectional survey. 161 women participated in the survey. MEASUREMENTS AND FINDINGS Item content validity (>0.78) was established for all but one item. Scale content validity was established for both scales (0.92 and 0.99 respectively). Survey participants (n= 161) were mostly married/partnered (95%), heterosexual (93%), tertiary educated (47%), Caucasian (88%), and had experienced a range of maternity models of care. Median scores on each scale (74 and 26 respectively) indicated that participants felt well respected and highly autonomous. Free-text comments highlighted the importance of relationship-based care. KEY CONCLUSIONS Both scales appear valid for use in Australia. Although most participants reported high levels of respect and autonomy, the proportion of participants who had experienced continuity of midwifery care was also high. IMPLICATIONS FOR PRACTICE Both scales could be routinely deployed as patient reported experience measures in Australia, broadening the data that informs maternity service planning and delivery.
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Affiliation(s)
- Bec Jenkinson
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia; The University of Queensland, Australia
| | - Lauren Kearney
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia; Sunshine Coast Health Institute, Australia.
| | - Mary Kynn
- University of Aberdeen, United Kingdom
| | - Rachel Reed
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Rachael Nugent
- Sunshine Coast Health Institute, Australia; The Sunshine Coast University Hospital, Queensland, Australia
| | - Jocelyn Toohill
- Office of the Chief Nursing and Midwifery Officer, Department of Health, Queensland, Australia
| | - Fiona Bogossian
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia; The University of Queensland, Australia; Sunshine Coast Health Institute, Australia
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Abstract
Health disparities research often focuses on the social patterning of health outcomes. Increasingly, there has been an emphasis on understanding the mechanisms perpetuating disparities, even after issues of patient access to health services are addressed. The following study utilizes a novel dataset of electronic medical records (EMR), radiology records, and U.S. Census data to investigate the racial/ethnic patterning of provider-patient communication among patients diagnosed with incidental medical findings requiring follow-up. My results indicate that racial/ethnic disparities in follow-up adherence stem from initial disparities in provider-patient communication. These communication disparities persist even after accounting for multiple socioeconomic, health, and provider characteristics, indicating a bias in medicine, whereby providers are less likely to communicate information about incidental medical findings to patients of color relative to White patients. This paper has important clinical implications, as it sheds new light on why we might see low adherence to medical advice among patients of color. Findings also have social, political, and policy relevance, as they suggest an important mechanism through which health inequalities persist. To finally eliminate racial/ethnic health inequalities in the United States, racial bias and discrimination within medical and public health infrastructures must be eliminated.
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Affiliation(s)
- Rebecca A Schut
- Population Studies Center, University of Pennsylvania, 239 McNeil Building, 3718 Locust Walk, Philadelphia, PA, 19104, USA.
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Mirabal-Beltran R, Anderson J, Dariotis JK, Finocchario-Kessler S. A Checklist to Assess Childbearing Intentions and Promote Referral to Preconception Care or Contraception: A Multi-Site Study. Matern Child Health J 2021; 25:786-795. [PMID: 33389454 DOI: 10.1007/s10995-020-03051-w] [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] [Accepted: 11/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study assesses HIV provider views on the value of a checklist designed to assess patients' preconception care (PCC) needs and guide implementation of PCC. METHODS Ninety-two HIV providers in seven U.S. cities provided perspectives via an in-depth phone interview regarding a checklist to facilitate communication and referrals for PCC. A sub-sample of 27 providers shared feedback on a checklist designed for this purpose. Interview audio files were transcribed and uploaded to a web-based program supporting coding and analysis of qualitative data. Content analysis was utilized to identify key themes within the larger, a priori themes of interest. Feedback regarding the checklist was analyzed using a grounded theory approach to examine patterns and emergent themes across transcripts. RESULTS Providers averaged 11.5 years of HIV treatment experience; over 80 percent were physicians (MD) or nurse practitioners (NP) and 76 percent were HIV/infectious disease specialists. The majority of providers were female (70%) and Caucasian (72%). Checklist benefits identified included standardization of care, assisting new/inexperienced providers, educational resource for patients, and aid in normalizing childbearing. Concerns included over-protocolizing care, interfering with patient-provider communication, or requiring providers address non-priority issues during visits. Providers suggested checklists be simple, incorporated into the electronic medical record, and accompanied with appropriate referral systems. DISCUSSION Findings support a need for a checklist tool to assist in conversations about reproductive intentions/desires. Additional referral or innovative consultative services will be needed as more persons living with HIV/AIDS are engaged on the topic of childbearing.
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Affiliation(s)
- Roxanne Mirabal-Beltran
- Department of Professional Nursing Practice, Georgetown University School of Nursing & Health Studies, Washington, DC, USA.
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jean Anderson
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Gynecology and Obstetrics, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jacinda K Dariotis
- Department of Population, Family, and Reproductive Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Human Development & Family Studies, The Family Resiliency Center, The University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Konerding U, Bowen T, Elkhuizen SG, Faubel R, Forte P, Karampli E, Malmström T, Pavi E, Torkki P. The impact of accessibility and service quality on the frequency of patient visits to the primary diabetes care provider: results from a cross-sectional survey performed in six European countries. BMC Health Serv Res 2020; 20:800. [PMID: 32847573 PMCID: PMC7449065 DOI: 10.1186/s12913-020-05421-0] [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: 03/08/2019] [Accepted: 06/10/2020] [Indexed: 12/02/2022] Open
Abstract
Background Visits to the primary diabetes care provider play a central role in diabetes care. Therefore, patients should attend their primary diabetes care providers whenever a visit is necessary. Parameters that might affect whether this condition is fulfilled include accessibility (in terms of travel distance and travel time to the practice), as well as aspects of service quality (for example in-practice waiting time and quality of the provider’s communication with the patient). The relationships of these variables with the frequency of visits to the primary diabetes care provider are investigated. Methods The investigation is performed with questionnaire data of 1086 type 2 diabetes patients from study regions in England (213), Finland (135), Germany (218), Greece (153), the Netherlands (296) and Spain (71). Data were collected between October 2011 and March 2012. Data were analysed using log-linear Poisson regression models with self-reported numbers of visits in a year to the primary diabetes care provider as the criterion variable. Predictor variables of the core model were: country; gender; age; education; stage of diabetes; heart problems; previous stroke; problems with lower extremities; problems with sight; kidney problems; travel distance and travel time; in-practice waiting time; and quality of communication. To test region-specific characteristics, the interaction between the latter four predictor variables and study region was also investigated. Results When study regions are merged, travel distance and in-practice waiting time have a negative effect, travel time no effect and quality of communication a positive effect on visit frequency (with the latter effect being by far largest). When region specific effects are considered, there are strong interaction effects shown for travel distance, in-practice waiting time and quality of communication. For travel distance, as well as for in-practice waiting time, there are region-specific effects in opposite directions. For quality of communication, there are only differences in the strength with which visit frequency increases with this variable. Conclusions The impact of quality of communication on visit frequency is the largest and is stable across all study regions. Hence, increasing quality of communication seems to be the best approach for increasing visit frequency.
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Affiliation(s)
- Uwe Konerding
- Trimberg Research Academy, University of Bamberg, 96045, Bamberg, Germany. .,Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - Tom Bowen
- The Balance of Care Group, Camden Cottage, Bennett's Lane, Bath, BA1 5JX, UK
| | - Sylvia G Elkhuizen
- Institute of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000, Rotterdam, DR, The Netherlands
| | - Raquel Faubel
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Joint Research Unit in Biomedical Engineering (IIS La Fe- Universitat Politècnica de València), Valencia, Spain
| | - Paul Forte
- The Balance of Care Group, Camden Cottage, Bennett's Lane, Bath, BA1 5JX, UK
| | - Eleftheria Karampli
- Department of Health Economics, National School of Public Health, 196 Alexandras Ave, 115 21, Athens, Greece
| | - Tomi Malmström
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland, PO Box 15500, 00076, Aalto, Finland
| | - Elpida Pavi
- Department of Health Economics, National School of Public Health, 196 Alexandras Ave, 115 21, Athens, Greece
| | - Paulus Torkki
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland, PO Box 15500, 00076, Aalto, Finland.,Present address: Department of Public Health, Faculty of Medicine, University of Helsinki, P.O. BOX 00020, 00014, Helsingin yliopisto, Finland
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Presciutti A, Shaffer JA, Newman M, Perman SM. Modifiable provider-patient relationship factors and illness perceptions are associated with quality of life in survivors of cardiac arrest with good neurologic recovery. Resusc Plus 2020; 3:100008. [PMID: 34223295 PMCID: PMC8244500 DOI: 10.1016/j.resplu.2020.100008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
Aim To evaluate associations between provider-patient communication, readiness for discharge, and patients' illness perceptions with post-arrest quality of life (QoL). Methods We distributed an online survey to survivors of cardiac arrest who were members of the Sudden Cardiac Arrest Foundation. Survivors completed the Questionnaire for the Quality of Provider-Patient Interactions (QQPPI), Readiness for Hospital Discharge Scale (RHDS), and the Brief Illness Perception Questionnaire (B-IPQ). When completing the QQPPI and RHDS, survivors were asked to think back to their hospitalization and discharge. QoL domains (physical, psychological, social) were measured via the WHO-QOL BREF. Three multiple regression models examined associations between QQPPI, RHDS, and B-IPQ scores with QoL domains, adjusted for age, sex, months since arrest, self-reported understanding of cardiac arrest and potential post-arrest symptoms at discharge, self-reported memory at discharge, and functional status as defined by the Lawton Instrumental Activities of Daily Living scale. Results A total of 163 survivors (mean age: 50.1 years, 50.3% women, 95.5% white, mean time since arrest: 63.9 months) provided complete survey data. More threatening illness perceptions (β: -0.45, p < 0.001) and lower readiness for discharge (β: 0.21, p = 0.01) were associated with worse physical QoL. More threatening illness perceptions (β: -0.47, p < 0.001) was associated with worse psychological QoL. More threatening illness perceptions (β: -0.28, p = 0.001) and poor provider-patient communication (β: 0.35, p < 0.001) were associated with worse social QoL. Conclusions Modifiable provider-patient relationship factors and illness perceptions were associated with quality of life in survivors of cardiac arrest with good neurologic recovery.
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Affiliation(s)
- Alex Presciutti
- Department of Psychology, University of Colorado Denver, USA
| | | | | | - Sarah M Perman
- Department of Emergency Medicine, University of Colorado Anschutz, USA
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14
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Schouten BC, Cox A, Duran G, Kerremans K, Banning LK, Lahdidioui A, van den Muijsenbergh M, Schinkel S, Sungur H, Suurmond J, Zendedel R, Krystallidou D. Mitigating language and cultural barriers in healthcare communication: Toward a holistic approach. Patient Educ Couns 2020; 103:S0738-3991(20)30242-1. [PMID: 32423835 DOI: 10.1016/j.pec.2020.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
Due to ongoing globalization and migration waves, healthcare providers are increasingly caring for patients from diverse cultural and/or ethnic minority backgrounds. Adequate health communication with migrants and ethnic minorities is often more difficult to establish compared to people belonging to the majority groups of a given society, because of a combination of language and cultural barriers. To address this topic, in December 2018 a symposium was organized-under the auspices of the Amsterdam Center for Health Communication-during which speakers from both academia and professional practice discussed the current state-of-the-art and brought forward innovative solutions to improve intercultural communication in healthcare. Main questions that were discussed during this symposium included: "How can language barriers in intercultural health communication be mitigated?" and "Which innovations can contribute to improving intercultural health communication?" In this paper, we discuss some answers to these questions and propose that in order to enhance intercultural communication and healthcare for migrant and ethnic minority patients, a more holistic approach to studying when, how, and for what purposes (a combination of) communication strategies should be utilized in mitigating both language and cultural barriers to decrease health disparities and improve health care for migrant and ethnic minority patients.
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Affiliation(s)
- Barbara C Schouten
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Antoon Cox
- Interpreting Studies, Antwerp Campus, KU, Leuven, Belgium.
| | - Gözde Duran
- Expertise Centre Dementia for Professionals, University College Windesheim, the Netherlands.
| | - Koen Kerremans
- Department of Linguistics & Literary Studies, Free University Brussels, Belgium.
| | | | - Ali Lahdidioui
- Dutch Association Moroccan Physicians [AMAN], the Netherlands.
| | - Maria van den Muijsenbergh
- Radboud University Medical Centre, Department of Primary and Community Care Health Disparities Group, Nijmegen, the Netherlands; Pharos, Centre of Expertise on Health Disparities, Utrecht, the Netherlands.
| | - Sanne Schinkel
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Hande Sungur
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Jeanine Suurmond
- Department of Social Medicine, Amsterdam University Medical Centre, the Netherlands.
| | - Rena Zendedel
- Department of Languages, Literature and Communication, Utrecht University, the Netherlands.
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15
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Becker KL. Tell me your dreams and goals: Structuring communication exchanges to improve patient-centered care with chronic pain patients. Appl Nurs Res 2020; 53:151248. [PMID: 32451006 DOI: 10.1016/j.apnr.2020.151248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Communicating pain is a difficult endeavor due to the lack of observable pathology, the immeasurable nature of pain, and the presence of comorbid symptoms. While research has shown the value of cure-centered and care-centered communication, it is unclear how chronic pain patients would like to structure pain communication with their providers so that it produces pain disclosure and emotional support. Aim This study examines communication preferences of chronic pain patients including types of questions asked and information received to allow a holistic portrayal of the experience of living with chronic pain. DESIGN The research used a quantitative survey that was disseminated via online chronic pain devoted support groups. PARTICIPANTS 192 respondents took the survey, with women respondents outnumbering men at a 4:1 ratio. Respondents came from 38 states and represented eight countries. RESULTS For providers to better understand patients' chronic pain, results indicate they would like providers to inquire about how pain impacts their daily activities, relationships, work responsibilities, and goals and dreams using open-ended questions. These low-stake questions can facilitate emotional disclosure, increase feelings of support, and allow for co-morbid linkages. CONCLUSION These inquiries prioritize patients' own subjective knowledge, can deepen the communication exchange between provider and patient, and facilitate pain disclosure. The findings help to deliver patient-centered care, promote rapport, and foster trust between providers and their patients.
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Affiliation(s)
- Karin L Becker
- United States Air Force Academy, United States of America.
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16
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Miller LR, Peck BM. A Prospective Examination of Racial Microaggressions in the Medical Encounter. J Racial Ethn Health Disparities 2020; 7:519-27. [PMID: 31845288 DOI: 10.1007/s40615-019-00680-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/16/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
Disparities in healthcare and health outcomes between whites and non-whites continue to plague the US healthcare system. A large literature suggests that people of color face obstacles at various points in the healthcare system. This article examines one such obstacle: whether patients of color experience microaggressions from physicians during primary care medical visits. A majority of microaggression studies are qualitative and retrospective in nature. In the current study, we use a prospective approach to broaden how microaggressions are measured, as well as understand differential treatment of racial minorities within healthcare. Using data derived from audio recordings of medical visits (n = 224), we utilize a quantitative measure to examine microaggressions in the medical encounter. We find that when race status differences are present between patient and physician, patients of color are more likely to experience microaggressions from their physician. The results suggest that medical encounters differ depending on characteristics of the parties involved. These differences may not only perpetuate the differential treatment of people of color but also contribute to health disparities for people of color.
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17
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Hannawa AF. When facing our fallibility constitutes "safe practice": Further evidence for the Medical Error Disclosure Competence (MEDC) guidelines. Patient Educ Couns 2019; 102:1840-1846. [PMID: 31064681 DOI: 10.1016/j.pec.2019.04.024] [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: 11/29/2018] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study pursues further empirical validation of the "Medical Error Disclosure Competence (MEDC)" guidelines. The following research questions are addressed: (1) What communicative skills predict patients' perceived disclosure adequacy? (2) To what extent do patients' adequacy perceptions predict disclosure effectiveness? (3) Are there any significant sex differences in the MEDC constructs? METHODS A sample of 193 respondents completed an online survey about a medical error they experienced in the past 5 years, and about the subsequent disclosure of that error to them. RESULTS One in four patients had experienced a medical error, only a third of them received a disclosure. Only interpersonal adaptability influenced disclosure adequacy, with a large effect size. Adequacy, in turn, predicted both patients' relational distancing and approach behaviors. Nonverbally skillful disclosures significantly decreased the likelihood of patient trauma. Expressions of remorse significantly increased patient resilience. Nonverbal skills (-) and a full account (+) predicted patients' tendency to harm themselves. Males were more reactive to disclosures than female patients. CONCLUSION MEDC guidelines-adherent disclosure communication maintains the provider-patient relationship, increase patient resilience, and decreases patient trauma after a medical error. PRACTICE IMPLICATIONS Given the results of this study, adherence to the MEDC-guidelines must be considered "safe practice."
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18
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Rubinelli S, Silverman J, Aelbrecht K, Deveugele M, Finset A, Humphris G, Martin P, Rosenbaum M, van Dulmen S, van Weel-Baumgarten E. Developing the International Association for Communication in Healthcare (EACH) to address current challenges of health communication. Patient Educ Couns 2019; 102:1217-1221. [PMID: 30661729 DOI: 10.1016/j.pec.2019.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 12/30/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
In 2017, EACH celebrated its change of name from European Association for Communication in Healthcare to EACH: International Association for Communication in Healthcare. This paper aims to present the developments and achievements of EACH over the past five years with a focus on its mission in promoting and advancing the field of communication in healthcare. Specifically, the paper focuses on how EACH, first, promotes research in the field of health communication, second, provides support, resources and sharing for healthcare communication teachers and, third, aims at influencing policy through dissemination of evidence. This paper also explores future challenges and directions for EACH to further strengthen its impact by designing activities in knowledge transfer and knowledge dissemination, engaging with patients and truly benefitting from their expertise, fostering active participation and networking among its members, targeting interventions to the needs of different countries around the world and refining knowledge-sharing and cooperation both within the membership of EACH and outside the association to as wide an audience as possible. Scholars, educators and practitioners active in the field of healthcare communication are invited to comment on this paper and to actively contribute towards the goals of EACH.
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Affiliation(s)
- Sara Rubinelli
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Frohburgstrasse 3, P.O. Box 4466, 6002 Lucerne, Switzerland; Swiss Paraplegic Research, Guido Zäch Institute, Guido Zäch Strasse 4a, 6207 Nottwil, Switzerland.
| | - Jonathan Silverman
- School of Medicine, Deakin University, Australia; School of Clinical Medicine, University of Cambridge, UK.
| | - Karolien Aelbrecht
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - Myriam Deveugele
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, De Pintelaan 185, B-9000 Ghent, Belgium.
| | - Arnstein Finset
- University of Oslo, Institute of Basic Medical Sciences, Department of Behavioural Sciences in Medicine, 1111, Blindern, N-0317 Oslo, Norway.
| | - Gerry Humphris
- University of St Andrews, Medical School, North Haugh, St Andrews, Fife, KY16 9TF, UK.
| | - Peter Martin
- Faculty of Health, Deakin University, Burwood, Victoria, Australia.
| | - Marcy Rosenbaum
- University of Iowa Carver College of Medicine, Iowa City, IA, US.
| | - Sandra van Dulmen
- Rodboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; NIVEL (Netherlands Institute for health services research), Utrecht, the Netherlands; Faculty of Health Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Evelyn van Weel-Baumgarten
- Rodboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands.
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Nazione S, Perrault EK, Keating DM. Finding Common Ground: Can Provider-Patient Race Concordance and Self-disclosure Bolster Patient Trust, Perceptions, and Intentions? J Racial Ethn Health Disparities 2019; 6:962-972. [PMID: 31119610 DOI: 10.1007/s40615-019-00597-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 02/12/2019] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Improvements in provider-patient relationships may help alleviate health disparities. Provider-patient race concordance and provider self-disclosure are variables that may help improve this relationship. PURPOSE This study sought to answer if provider-patient race concordance and provider self-disclosure may improve patient trust, rapport, similarity, likeability, intention to disclose, satisfaction, behavioral intention to keep a provider, and intention to recommend a provider, while using empathy as a covariate. METHODS Using 882 White or Black participants, the current research used a 2 × 2 online experimental design. Participants were asked to read a vignette in which they were told they had borderline high cholesterol and needed to eat a healthier diet, by either a Black or White male physician, who either self-disclosed or did not self-disclose regarding their own struggle to eat a healthy diet. After reading this vignette, participants were surveyed regarding the dependent variables of interest. RESULTS Participants in a Black concordant dyad reported higher levels of similarity than those in any other dyad. Provider self-disclosure led to higher levels of trust, rapport, similarity, likeability, intention to disclose, satisfaction, behavioral intention to continue using the provider, and intention to recommend the provider. No interaction effects were found. CONCLUSION While it is possible, based on past research, that race-concordant pairings may lead to trust via similarity, provider self-disclosure directly increased perceptions of trust as well as providing numerous other benefits. This study supports the importance of trainings for providers on health-related self-disclosure to benefit both parties in provider-patient dyads.
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Affiliation(s)
- Samantha Nazione
- Communication Department, Berry College, Box 299 Berry College, Mount Berry, GA, 30149, USA.
| | - Evan K Perrault
- Brian Lamb School of Communication, Purdue University, 100 N. University Street, West Lafayette, IN, 47907, USA
| | - David M Keating
- California State University, Northridge, Communication Studies, MZ 351, 18111 Nordhoff Street, Northridge, CA, 91330, USA
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Chamberlain AT, Limaye RJ, O'Leary ST, Frew PM, Brewer SE, Spina CI, Ellingson MK, Dudley MZ, Orenstein WA, Donnelly MA, Riley LE, Ault KA, Salmon DA, Omer SB. Development and acceptability of a video-based vaccine promotion tutorial for obstetric care providers. Vaccine 2019; 37:2532-2536. [PMID: 30962093 DOI: 10.1016/j.vaccine.2019.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 12/17/2022]
Abstract
A prenatal care provider's recommendation for maternal vaccines is one of the strongest predictors of vaccine acceptance during pregnancy. Aside from basic talking points, few resources exist to help obstetric care providers effectively navigate conversations with vaccine hesitant patients. This paper describes the development and acceptability of "VaxChat," an hour-long, evidence-based video tutorial aimed at improving obstetric care providers' ability to promote maternal vaccines. Between June and November 2017, 62 obstetric care providers registered to receive continuing medical education credit for viewing VaxChat. Of the post-tutorial responses received, over 90% said VaxChat increased their knowledge of what to say to vaccine hesitant patients, increased their confidence in addressing vaccinations with their pregnant patients, and will help them improve their practice culture regarding maternal vaccine promotion. Eighty percent intend to change how they approach vaccine conversations. These data suggest VaxChat may be a welcome complement to existing provider-to-patient talking points.
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Affiliation(s)
- A T Chamberlain
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States.
| | - R J Limaye
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - S T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO 80045, United States
| | - P M Frew
- School of Community Health Sciences, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154, United States
| | - S E Brewer
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, United States
| | - C I Spina
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital, 13199 E Montview Blvd, Suite 300, Aurora, CO 80045, United States
| | - M K Ellingson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States
| | - M Z Dudley
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - W A Orenstein
- Department of Pediatrics, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA 30322, United States; Emory Vaccine Center, Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
| | - M A Donnelly
- Department of Obstetrics and Gynecology, School of Medicine, University of Colorado, 12631 E. 17th Avenue, Academic Office 1, Room 4010, Aurora, CO 80045, United States; Denver Health Hospital Authority, 777 Bannock St, Denver, CO 80204, United States
| | - L E Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, Cornell University, 156 William St 7th Floor, New York, NY 10038, United States
| | - K A Ault
- Department of Obstetrics and Gynecology, School of Medicine, University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS 66160, United States
| | - D A Salmon
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - S B Omer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States; Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322, United States; Department of Pediatrics, School of Medicine, Emory University, 2015 Uppergate Dr, Atlanta, GA 30322, United States; Emory Vaccine Center, Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States
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21
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Lowenstein LM, Volk RJ, Street R, Flannery M, Magnuson A, Epstein R, Mohile SG. Communication about geriatric assessment domains in advanced cancer settings: "Missed opportunities". J Geriatr Oncol 2018; 10:68-73. [PMID: 29884597 DOI: 10.1016/j.jgo.2018.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/12/2018] [Revised: 04/04/2018] [Accepted: 05/20/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Older patients with advanced cancer often have age-related health issues (e.g., memory impairment) that influence their cancer treatment decisions. Communication about these age-related concerns can potentially lead to further assessment and subsequent clinical interventions to improve treatment decision-making and patients' quality of life. Yet, little is known about the communication of age-related concerns between oncologists, patients, and caregivers. MATERIALS AND METHODS This study is a secondary analysis of data from the Values and Options in Cancer Care (VOICE) study. Audio-recorded and transcribed outpatient clinical oncology encounters with 37 patients with advanced cancer ≥60 years of age were content-analyzed. Two trained coders used a structured coding scheme based on pre-specified geriatric assessment (GA) domains to examine the transcripts for the frequency and quality of communication about age-related concerns. Atlas.ti version 6 was used for all analyses. RESULTS The median age of the patients was 66 years (range = 60-90 years); patients were mostly female (26/37), married (22/37), and White (36/37). Out of 37 audio-recorded visits, 31 had at least one mention of an age-related concern with a total of 70 mentions. Oncologists initiated communication about age-related concerns half of the time (53%). When age-related concerns were mentioned, half of the time (50%) the oncologist did not implement further evidence-based interventions to address the age-related concern (e.g., conduct a cognitive screen for a memory concern). CONCLUSION Interventions are needed to improve the frequency and quality of the communication about age-related concerns to improve the care of older adults with cancer.
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Affiliation(s)
- Lisa M Lowenstein
- Department of Medicine, Hematology/Oncology, Wilmot Cancer Center, University of Rochester. 601 Elmwood Avenue, Box, 704, Rochester, NY, USA.
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center. 1400 Pressler St., Unit 1444, Houston, TX, 77030, USA
| | - Richard Street
- Department of Communication, Texas A&M University. College Station, TX, 77843, USA
| | - Marie Flannery
- School of Nursing, University of Rochester. 255 Crittenden Blvd. Box SON, Rochester, NY 14642, USA
| | - Allison Magnuson
- Department of Medicine, Hematology/Oncology, Wilmot Cancer Center, University of Rochester. 601 Elmwood Avenue, Box, 704, Rochester, NY, USA
| | - Ronald Epstein
- Department of Family Medicine, University of Rochester. 1381 South Avenue, Rochester, NY 14620, USA
| | - Supriya G Mohile
- Department of Medicine, Hematology/Oncology, Wilmot Cancer Center, University of Rochester. 601 Elmwood Avenue, Box, 704, Rochester, NY, USA
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Abstract
BACKGROUND Infertility patients generally see provider-patient communication and relationships as important, but as often insufficient, raising critical questions regarding why these gaps persist, and how they might best be addressed. METHODS Semi-structured interviews of approximately one hour each were conducted with 37 ART providers and patients (17 physicians, 10 other health providers, and 10 patients) and were thematically analyzed. RESULTS Patients see clinicians' interactions as ranging widely from good to bad, related to several specific barriers and factors. Patients and providers may differ in their physical and emotional experiences, expectations concerning treatment outcomes and uncertainties, and time frames and finances, generating dynamic processes and tensions. Characteristics of particular providers, clinics and patients can also vary. Infertility patients tend to find only one outcome acceptable - a "take home baby" - rather than partial success, as is the case with many other diseases. Yet most IVF cycles fail. Many patients must pay considerable out-of-pocket expenses for infertility treatment, exacerbating disappointments and frustrations. Providers often work in competitive, entrepreneurial markets, and "hype" their potential success. After treatment failures, providers may feel guilty and withdraw from patients. Yet these behaviors can antagonize patients more than physicians realize, aggravating patient stresses. Several providers described how they understood patients' needs and perceptions more fully only after becoming infertility patients themselves. Interactions with not only physicians, but other providers (e.g., nurses and staff) can play key roles. Patients may be willing to understand these impediments, but providers often communicate these obstacles and reasons poorly or not at all, furthering tensions. CONCLUSIONS These data, the first to examine several critical aspects of challenges that infertility providers and patients face in communication and relationships, suggest that several key dynamic processes and factors may be involved, and need to be addressed. While prior research has shown that infertility patients value, but often feel disappointed in relationships with clinicians, the present data highlight several specific impediments, and thus have critical implications for future practice, research, guidelines and education.
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Affiliation(s)
- Robert Klitzman
- Columbia University, 1051 Riverside Drive #15, New York, NY, 10032, USA.
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Reich CM, Hack SM, Klingaman EA, Brown CH, Fang LJ, Dixon LB, Jahn DR, Kreyenbuhl JA. Consumer satisfaction with antipsychotic medication-monitoring appointments: the role of consumer-prescriber communication patterns. Int J Psychiatry Clin Pract 2018; 22:89-94. [PMID: 28920491 PMCID: PMC5909968 DOI: 10.1080/13651501.2017.1375530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The study was designed to explore patterns of prescriber communication behaviors as they relate to consumer satisfaction among a serious mental illness sample. METHODS Recordings from 175 antipsychotic medication-monitoring appointments between veterans with psychiatric disorders and their prescribers were coded using the Roter Interaction Analysis System (RIAS) for communication behavioral patterns. RESULTS The frequency of prescriber communication behaviors (i.e., facilitation, rapport, procedural, psychosocial, biomedical, and total utterances) did not reliably predict consumer satisfaction. The ratio of prescriber to consumer utterances did predict consumer satisfaction. CONCLUSIONS Consistent with client-centered care theory, antipsychotic medication consumers were more satisfied with their encounters when their prescriber did not dominate the conversation. PRACTICE IMPLICATIONS Therefore, one potential recommendation from these findings could be for medication prescribers to spend more of their time listening to, rather than speaking with, their SMI consumers.
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Affiliation(s)
- Catherine M Reich
- a Department of Psychology , University of Minnesota Duluth , Duluth , MN , USA
| | - Samantha M Hack
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Elizabeth A Klingaman
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Clayton H Brown
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Li Juan Fang
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Lisa B Dixon
- d New York State Psychiatric Institute , New York , NY , USA.,e Department of Psychiatry , Columbia University , New York , NY , USA
| | | | - Julie A Kreyenbuhl
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
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Cranley NM, Curbow B, George TJ Jr, Christie J. Influential factors on treatment decision making among patients with colorectal cancer: A scoping review. Support Care Cancer 2017; 25:2943-51. [PMID: 28589309 DOI: 10.1007/s00520-017-3763-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE In recent years, a greater emphasis has been placed on shared decision-making (SDM) techniques between providers and patients with the goal of helping patients make informed decisions about their care and subsequently to improve patient health outcomes. Previous research has shown variability in treatment decision-making among patients with colorectal cancer (CRC), and there is little comprehensive information available to help explain this variability. Thus, the purpose of this study was to evaluate the current state of the literature on factors that are influential in treatment decision-making among patients with CRC. METHOD A priori search terms using Boolean connectors were used to examine PubMed, PsycINFO, Web of Science, CINAHL, and MEDLINE for relevant studies. Eligibility criteria for inclusion in the study included patients with CRC and examination of influences on CRC treatment decision-making. All relevant data were extracted including, author, title and year, study methodology, and study results. RESULTS Findings (n = 13) yielded influences in four areas: informational, patient treatment goals, patient role preferences, and relationship with provider. Quality of life and trust in physician were rated a high priority among patients when making decisions between different therapeutic options. Several studies found that patients wanted to be informed and involved but did not necessarily want to make autonomous treatment choices, with many preferring a more passive role. CONCLUSIONS Providers who initiate a dialog to better understand their patients' treatment goals can establish rapport, increase patient understanding of treatment options, and help patients assume their desired role in their decision-making. Overall, there were a small number of studies that met all inclusion criteria with most used a cross-sectional design.
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Guo F, Norton AR, Fuchs EL, Hirth JM, Garcia-Blanco MA, Berenson AB. Provider-patient communication about Zika during prenatal visits. Prev Med Rep 2017; 7:26-29. [PMID: 28593119 PMCID: PMC5447381 DOI: 10.1016/j.pmedr.2017.05.003] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 05/03/2017] [Accepted: 05/15/2017] [Indexed: 12/23/2022] Open
Abstract
Zika virus transmission within and between the Americas is of global concern. This study assessed knowledge about the Zika virus among pregnant women in the United States, their travel plans to endemic areas, and whether their health care providers discussed Zika with them. This cross-sectional study used data from 492 pregnant women (18-50 years) from an online survey conducted from April 8 to July 27, 2016. Pregnant women were recruited online through Facebook, Twitter, Craigslist, and Reddit. Almost all (97.8%) participants had heard of the Zika virus, of which 71% first learned about it from the internet. Over one third of these pregnant women reported that their health providers discussed transmission of the Zika virus with them. Most respondents reported that their providers had discussed risks related to travelling to areas with Zika outbreaks. Half of the survey respondents reported that their providers gave them information about avoiding mosquito bites. Pregnant women were not concerned about Zika affecting their own health, but 34% were very or extremely concerned about it affecting their babies' health. Almost no pregnant women currently had travel plans to areas with ongoing Zika transmissions, and of the 14% who previously had plans, most (85%) cancelled their travel due to concerns about Zika. Overall, pregnant women in our sample were highly knowledgeable about Zika virus. Over one third of women received suggestions regarding prevention of Zika from their healthcare providers.
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Affiliation(s)
- Fangjian Guo
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, TX, United States.,Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, United States
| | - Alexander R Norton
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, TX, United States.,Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, United States
| | - Erika L Fuchs
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, TX, United States.,Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, United States
| | - Jacqueline M Hirth
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, TX, United States.,Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, United States
| | - Mariano A Garcia-Blanco
- Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, TX, United States.,Programme in Emerging Infectious Diseases, Duke Medical School, Singapore
| | - Abbey B Berenson
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, TX, United States.,Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch, Galveston, TX, United States
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26
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Stub T, Quandt SA, Arcury TA, Sandberg JC, Kristoffersen AE, Musial F, Salamonsen A. Perception of risk and communication among conventional and complementary health care providers involving cancer patients' use of complementary therapies: a literature review. BMC Complement Altern Med 2016; 16:353. [PMID: 27609097 PMCID: PMC5016861 DOI: 10.1186/s12906-016-1326-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/25/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Communication between different health care providers (conventional and complementary) and cancer patients about their use of complementary therapies affects the health and safety of the patients. The aim of this study was to examine the qualitative research literature on the perception of and communication about the risk of complementary therapies between different health care providers and cancer patients. METHODS Systematic searches in six medical databases covering literature from 2000 to 2015 were performed. The studies were accessed according to the level of evidence and summarized into different risk situations. Qualitative content analysis was used to analyze the text data, and the codes were defined before and during the data analysis. RESULTS Twenty-nine papers were included in the primary analysis and five main themes were identified and discussed. The main risk situations identified were 1. Differences in treatment concepts and philosophical values among complementary and conventional health care providers. 2. Adverse effects from complementary products and herbs due to their contamination/toxicity and interactions with conventional cancer treatment. 3. Health care physicians and oncologists find it difficult to recommend many complementary modalities due to the lack of scientific evidence for their effect. 4. Lack of knowledge and information about complementary and conventional cancer treatments among different health care providers. CONCLUSION The risk of consuming herbs and products containing high level of toxins is a considerable threat to patient safety (direct risk). At the same time, the lack of scientific evidence of effect for many complementary therapies and differences in treatment philosophy among complementary and conventional health care providers potentially hinder effective communication about these threats with mutual patients (indirect risk). As such, indirect risk may pose an additional risk to patients who want to combine complementary therapies with conventional treatment in cancer care. Health care providers who care for cancer patients should be aware of these risks.
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Affiliation(s)
- Trine Stub
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Division of Public Health Sciences, Winston-Salem, NC 27157 USA
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
- Present address: Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Sara A. Quandt
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Division of Public Health Sciences, Winston-Salem, NC 27157 USA
| | - Thomas A. Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Joanne C. Sandberg
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157 USA
| | - Agnete E. Kristoffersen
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Frauke Musial
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
| | - Anita Salamonsen
- Department of Community Medicine, The National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway
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Gremigni P, Casu G, Sommaruga M. Dealing with patients in healthcare: A self-assessment tool. Patient Educ Couns 2016; 99:1046-1053. [PMID: 26851160 DOI: 10.1016/j.pec.2016.01.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 09/02/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study aimed to investigate how healthcare personnel self-evaluate their ability to relate to patients in day-to-day practice from a patient-centered perspective, and to test the psychometric properties of a questionnaire developed to assess it. METHODS A sample of 600 healthcare personnel, recruited among eight hospitals in various parts of Italy, completed the 16-item Provider-Patient Relationship Questionnaire (PPRQ). A sample of 50 nurses answered the PPRQ twice, at a four-week interval. The PPRQ validity, reliability and susceptibility to social desirability were tested. RESULTS PPRQ showed good reliability and structural validity, with four first-order factors: effective communication, interest in the patient's agenda, empathy, and patient involvement in care. Correlation with social desirability was negligible. Participants rated themselves as highly competent in communicating with patients, but less interested in involving the patient in care and in the patient's agenda. Differences in PPRQ dimensions were found between groups based on job type and geographic area. CONCLUSION PPRQ is a brief self-report measure of the provider-patient relationship with promising psychometric properties in this sample. PRACTICE IMPLICATIONS PPRQ has potential value in promoting a self-reflecting learning environment, whether through training or day-to-day practice.
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Affiliation(s)
- Paola Gremigni
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - Giulia Casu
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - Marinella Sommaruga
- Clinical Psychology and Social Support Unit, Salvatore Maugeri Foundation, Care and Research Institute, Milan, Italy.
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Hannawa AF, Shigemoto Y, Little TD. Medical errors: Disclosure styles, interpersonal forgiveness, and outcomes. Soc Sci Med 2016; 156:29-38. [PMID: 27017088 DOI: 10.1016/j.socscimed.2016.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 10/13/2015] [Revised: 03/11/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
RATIONALE This study investigates the intrapersonal and interpersonal factors and processes that are associated with patient forgiveness of a provider in the aftermath of a harmful medical error. OBJECTIVE This study aims to examine what antecedents are most predictive of patient forgiveness and non-forgiveness, and the extent to which social-cognitive factors (i.e., fault attributions, empathy, rumination) influence the forgiveness process. Furthermore, the study evaluates the role of different disclosure styles in two different forgiveness models, and measures their respective causal outcomes. METHODS In January 2011, 318 outpatients at Wake Forest Baptist Medical Center in the United States were randomly assigned to three hypothetical error disclosure vignettes that operationalized verbally effective disclosures with different nonverbal disclosure styles (i.e., high nonverbal involvement, low nonverbal involvement, written disclosure vignette without nonverbal information). All patients responded to the same forgiveness-related self-report measures after having been exposed to one of the vignettes. RESULTS The results favored the proximity model of interpersonal forgiveness, which implies that factors more proximal in time to the act of forgiving (i.e., patient rumination and empathy for the offender) are more predictive of forgiveness and non-forgiveness than less proximal factors (e.g., relationship variables and offense-related factors such as the presence or absence of an apology). Patients' fault attributions had no effect on their forgiveness across conditions. The results evidenced sizeable effects of physician nonverbal involvement-patients in the low nonverbal involvement condition perceived the error as more severe, experienced the physician's apology as less sincere, were more likely to blame the physician, felt less empathy, ruminated more about the error, were less likely to forgive and more likely to avoid the physician, reported less closeness, trust, and satisfaction but higher distress, were more likely to change doctors, less compliant, and more likely to seek legal advice. CONCLUSION The findings of this study imply that physician nonverbal involvement during error disclosures stimulates a healing mechanism for patients and the physician-patient relationship. Physicians who disclose a medical error in a nonverbally uninvolved way, on the other hand, carry a higher malpractice risk and are less likely to promote healthy, reconciliatory outcomes.
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Affiliation(s)
- Annegret F Hannawa
- Center for the Advancement of Healthcare Quality and Patient Safety, Faculty of Communication Sciences, Università della Svizzera italiana (USI Lugano), Via G. Buffi 13, 6900 Lugano, Switzerland.
| | - Yuki Shigemoto
- Psychology Department, Texas Tech University, Lubbock, TX 79409-2051, USA.
| | - Todd D Little
- Institute for Measurement, Methodology, Analysis and Policy (IMMAP), Texas Tech University, Lubbock, TX 79409-2051, USA.
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Zickmund SL, Burkitt KH, Gao S, Stone RA, Rodriguez KL, Switzer GE, Shea JA, Bayliss NK, Meiksin R, Walsh MB, Fine MJ. Racial Differences in Satisfaction with VA Health Care: A Mixed Methods Pilot Study. J Racial Ethn Health Disparities 2015; 2:317-29. [PMID: 26863462 DOI: 10.1007/s40615-014-0075-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/24/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION As satisfied patients are more adherent and play a more active role in their own care, a better understanding of factors associated with patient satisfaction is important. PURPOSE In response to a United States Veterans Administration (VA) Hospital Report Card that revealed lower levels of satisfaction with health care for African Americans compared to Whites, we conducted a mixed methods pilot study to obtain preliminary qualitative and quantitative information about possible underlying reasons for these racial differences. METHODS We conducted telephone interviews with 30 African American and 31 White veterans with recent inpatient and/or outpatient health care visits at three urban VA Medical Centers. We coded the qualitative interviews in terms of identified themes within defined domains. We summarized racial differences using ordinal logistic regression for Likert scale outcomes and used random effects logistic regression to assess racial differences at the domain level. RESULTS Compared to Whites, African Americans were younger (p < 0.001) and better educated (p = 0.04). Qualitatively, African Americans reported less satisfaction with trust/confidence in their VA providers and healthcare system and less satisfaction with patient-provider communication. Quantitatively, African Americans reported less satisfaction with outpatient care (odds ratio = 0.28; 95 % confidence interval (CI) 0.10-0.82), but not inpatient care. At the domain level, African Americans were significantly less likely than Whites to express satisfaction themes in the domain of trust/confidence (odds ratio = 0.36; 95 % CI 0.18-0.73). CONCLUSION The current pilot study demonstrates racial differences in satisfaction with outpatient care and identifies some specific sources of dissatisfaction. Future research will include a large national cohort, including Hispanic veterans, in order to gain further insight into the sources of racial and ethnic differences in satisfaction with VA care and inform future interventions.
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Affiliation(s)
- Susan L Zickmund
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA. .,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA.
| | - Kelly H Burkitt
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA
| | - Shasha Gao
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA
| | - Roslyn A Stone
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.,Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, 15261, USA
| | - Keri L Rodriguez
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
| | - Galen E Switzer
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Judy A Shea
- Philadelphia VA Medical Center, Center for Health Equity Research and Promotion, Philadelphia, PA, 19104, USA
| | - Nichole K Bayliss
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.,Department of Psychology, Chatham University, Pittsburgh, PA, 15232, USA
| | - Rebecca Meiksin
- Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, London, England
| | - Mary B Walsh
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
| | - Michael J Fine
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
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Turkiewicz KL, Allen M, Venetis MK, Robinson JD. Observed communication between oncologists and patients: A causal model of communication competence. World J Meta-Anal 2014; 2:186-193. [DOI: 10.13105/wjma.v2.i4.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/16/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate and test a causal model derived from previous meta-analytic data of health provider behaviors and patient satisfaction.
METHODS: A literature search was conducted for relevant manuscripts that met the following criteria: Reported an analysis of provider-patient interaction in the context of an oncology interview; the study had to measure at least two of the variables of interest to the model (provider activity, provider patient-centered communication, provider facilitative communication, patient activity, patient involvement, and patient satisfaction or reduced anxiety); and the information had to be reported in a manner that permitted the calculation of a zero-order correlation between at least two of the variables under consideration. Data were transformed into correlation coefficients and compiled to produce the correlation matrix used for data analysis. The test of the causal model is a comparison of the expected correlation matrix generated using an Ordinary Least Squares method of estimation. The expected matrix is compared to the actual matrix of zero order correlation coefficients. A model is considered a possible fit if the level of deviation is less than expected due to random sampling error as measured by a chi-square statistic. The significance of the path coefficients was tested using a z test. Lastly, the Sobel test provides a test of the level of mediation provided by a variable and provides an estimate of the level of mediation for each connection. Such a test is warranted in models with multiple paths.
RESULTS: A test of the original model indicated a lack of fit with the summary data. The largest discrepancy in the model was between the patient satisfaction and the provider patient-centered utterances. The observed correlation was far larger than expected given a mediated relationship. The test of a modified model was undertaken to determine possible fit. The corrected model provides a fit to within tolerance as evaluated by the test statistic, χ2 (8, average n = 342) = 10.22. Each of the path coefficients for the model reveals that each one can be considered significant, P < 0.05. The Sobel test examining the impact of the mediating variables demonstrated that patient involvement is a significant mediator in the model, Sobel statistic = 3.56, P < 0.05. Patient active was also demonstrated to be a significant mediator in the model, Sobel statistic = 4.21, P < 0.05. The statistics indicate that patient behavior mediates the relationship between provider behavior and patient satisfaction with the interaction.
CONCLUSION: The results demonstrate empirical support for the importance of patient-centered care and satisfy the need for empirical casual support of provider-patient behaviors on health outcomes.
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Hall JA, Ship AN, Ruben MA, Curtin EM, Roter DL, Clever SL, Smith CC, Pounds K. The Test of Accurate Perception of Patients' Affect (TAPPA): an ecologically valid tool for assessing interpersonal perception accuracy in clinicians. Patient Educ Couns 2014; 94:218-223. [PMID: 24184040 DOI: 10.1016/j.pec.2013.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 06/29/2013] [Revised: 09/27/2013] [Accepted: 10/05/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE A clinician's ability to infer patients' thoughts and feelings is a critical component of high quality care. The goal of this article is to present a new test to measure this ability in clinicians, called the Test of Accurate Perception of Patients' Affect (TAPPA). METHODS Audiovisual clips were taken from patients' actual medical visits. The patients reviewed the videotape after the visit to identify their thoughts and feelings during the visit. This information was used to extract short audiovisual clips for which the correct answer was the patient's report of the thought or feeling associated with that clip. The TAPPA contains 48 audiovisual clips, each responded to in a multiple choice format. RESULTS The TAPPA showed good psychometric properties (optimal mean and good variance, adequate internal consistency, and strong re-test reliability) and convergent validity with other tests of emotion recognition. In addition, the test showed predicted better performance by female than male participants. CONCLUSION The TAPPA promises to be a valuable tool for research and education on provider-patient relationships and quality of care. PRACTICE IMPLICATIONS A tool for testing clinicians' understanding of patients' thoughts and feelings may contribute to better quality of care and to improved selection and training.
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Affiliation(s)
- Judith A Hall
- Department of Psychology, Northeastern University, Boston, USA.
| | - Amy N Ship
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Mollie A Ruben
- Department of Psychology, Northeastern University, Boston, USA
| | | | - Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Sarah L Clever
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - C Christopher Smith
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Karen Pounds
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, USA
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Saleem JJ, Flanagan ME, Russ AL, McMullen CK, Elli L, Russell SA, Bennett KJ, Matthias MS, Rehman SU, Schwartz MD, Frankel RM. You and me and the computer makes three: variations in exam room use of the electronic health record. J Am Med Inform Assoc 2013; 21:e147-51. [PMID: 24001517 DOI: 10.1136/amiajnl-2013-002189] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [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: 11/03/2022] Open
Abstract
Challenges persist on how to effectively integrate the electronic health record (EHR) into patient visits and clinical workflow, while maintaining patient-centered care. Our goal was to identify variations in, barriers to, and facilitators of the use of the US Department of Veterans Affairs (VA) EHR in ambulatory care workflow in order better to understand how to integrate the EHR into clinical work. We observed and interviewed 20 ambulatory care providers across three geographically distinct VA medical centers. Analysis revealed several variations in, associated barriers to, and facilitators of EHR use corresponding to different units of analysis: computer interface, team coordination/workflow, and organizational. We discuss our findings in the context of different units of analysis and connect variations in EHR use to various barriers and facilitators. Findings from this study may help inform the design of the next generation of EHRs for the VA and other healthcare systems.
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Affiliation(s)
- Jason J Saleem
- Human Factors, Office of Informatics and Analytics, Veterans Health Administration, Indianapolis, Indiana, USA
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