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Wallace CL, Coccia K, Khoo YM, Bullock K. Meaning of Hospice Care: Perceptions of Patients and Families. Am J Hosp Palliat Care 2023; 40:1132-1140. [PMID: 36594567 DOI: 10.1177/10499091221149702] [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] [Indexed: 01/04/2023] Open
Abstract
Background: About half of hospice-eligible adults die without hospice each year. Misconceptions about hospice are frequently identified as barriers to utilization, but hospice perceptions are not well documented. Objectives and Setting/Subjects: To examine perceptions of hospice (initial and post-enrollment) among 90 U.S. patients/families actively enrolled in a large, metropolitan hospice in Texas, and to identify factors associated with participant perceptions. Design and Measurement: Concurrent mixed methods and cross-sectional design collecting data via research questionnaire with Likert scales and open-ended questions. Wilcoxon signed-rank test determined differences between recall of initial hospice perceptions at time of referral and perceptions while actively receiving services; Fisher's exact and Kruskal-Wallis tests were used to examine bivariate relationships between perceptions of hospice and satisfaction with physician communication and demographic variables. Qualitative statements were analyzed using an inductive, content analysis approach. Results: There was a significant difference between participants' perceptions of hospice recalled from initial conversations compared with current perceptions following hospice enrollment (z = -6.44, P < .01). Initial perceptions of hospice were significantly related to satisfaction with physician communication (P = .011) and diagnosis (P = .019). Qualitative themes range from negative (ie hospice = death) to positive (ie comfort, support, loving staff) with 65.6% of participants demonstrating positive increases in understanding. Conclusion: Participants' perceptions of hospice were positively associated with satisfaction with physician communication prior to hospice enrollment, and potentially impacted by the experience of care itself. During hospice discussions, clinicians should elicit patient and family perceptions in addition to providing descriptions of eligibility and services.
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Affiliation(s)
- Cara L Wallace
- School of Social Work, Saint Louis University, Saint Louis, MO, USA
| | - Kathryn Coccia
- School of Social Work, Saint Louis University, Saint Louis, MO, USA
| | - Yit Mui Khoo
- School of Social Work, Saint Louis University, Saint Louis, MO, USA
| | - Karen Bullock
- Boston College School of Social Work, Chestnut Hill, MA, USA
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2
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Licciardone JC, Patel S, Kandukuri P, Beeton G, Nyalakonda R, Aryal S. Patient Satisfaction With Medical Care for Chronic Low Back Pain: A Pain Research Registry Study. Ann Fam Med 2023; 21:125-131. [PMID: 36973050 PMCID: PMC10042573 DOI: 10.1370/afm.2949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 03/29/2023] Open
Abstract
PURPOSE The process and outcomes of delivering medical care for chronic low back pain might affect patient satisfaction. We aimed to determine the associations of process and outcomes with patient satisfaction. METHODS We conducted a cross-sectional study of patient satisfaction among adult participants with chronic low back pain in a national pain research registry using self-reported measures of physician communication, physician empathy, current physician opioid prescribing for low back pain, and outcomes pertaining to pain intensity, physical function, and health-related quality of life. We used simple and multiple linear regression models to measure factors associated with patient satisfaction, including a subgroup of participants having both chronic low back pain and the same treating physician for >5 years. RESULTS Among 1,352 participants, only physician empathy (standardized β, 0.638; 95% CI, 0.588-0.688; t = 25.14; P < .001) and physician communication (standardized β, 0.182; 95% CI, 0.133-0.232; t = 7.22; P < .001) were associated with patient satisfaction in the multivariable analysis that controlled for potential confounders. Similarly, in the subgroup of 355 participants, physician empathy (standardized β, 0.633; 95% CI, 0.529-0.737; t = 11.95; P < .001) and physician communication (standardized β, 0.208; 95% CI, 0.105-0.311; t = 3.96; P < .001) remained associated with patient satisfaction in the multivariable analysis. CONCLUSIONS Process measures, notably physician empathy and physician communication, were strongly associated with patient satisfaction with medical care for chronic low back pain. Our findings support the view that patients with chronic pain highly value physicians who are empathic and who make efforts to more clearly communicate treatment plans and expectations.
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Affiliation(s)
| | - Salman Patel
- University of North Texas Health Science Center, Fort Worth, Texas
| | | | - George Beeton
- University of North Texas Health Science Center, Fort Worth, Texas
| | | | - Subhash Aryal
- University of Pennsylvania, Philadelphia, Pennsylvania
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3
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White AA, King AM, D'Addario AE, Brigham KB, Dintzis S, Fay EE, Gallagher TH, Mazor KM. Effects of Practicing With and Obtaining Crowdsourced Feedback From the Video-Based Communication Assessment App on Resident Physicians' Adverse Event Communication Skills: Pre-post Trial. JMIR Med Educ 2022; 8:e40758. [PMID: 36190751 PMCID: PMC9577713 DOI: 10.2196/40758] [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] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND US residents require practice and feedback to meet Accreditation Council for Graduate Medical Education mandates and patient expectations for effective communication after harmful errors. Current instructional approaches rely heavily on lectures, rarely provide individualized feedback to residents about communication skills, and may not assure that residents acquire the skills desired by patients. The Video-based Communication Assessment (VCA) app is a novel tool for simulating communication scenarios for practice and obtaining crowdsourced assessments and feedback on physicians' communication skills. We previously established that crowdsourced laypeople can reliably assess residents' error disclosure skills with the VCA app. However, its efficacy for error disclosure training has not been tested. OBJECTIVE We aimed to evaluate the efficacy of using VCA practice and feedback as a stand-alone intervention for the development of residents' error disclosure skills. METHODS We conducted a pre-post study in 2020 with pathology, obstetrics and gynecology, and internal medicine residents at an academic medical center in the United States. At baseline, residents each completed 2 specialty-specific VCA cases depicting medical errors. Audio responses were rated by at least 8 crowdsourced laypeople using 6 items on a 5-point scale. At 4 weeks, residents received numerical and written feedback derived from layperson ratings and then completed 2 additional cases. Residents were randomly assigned cases at baseline and after feedback assessments to avoid ordinal effects. Ratings were aggregated to create overall assessment scores for each resident at baseline and after feedback. Residents completed a survey of demographic characteristics. We used a 2×3 split-plot ANOVA to test the effects of time (pre-post) and specialty on communication ratings. RESULTS In total, 48 residents completed 2 cases at time 1, received a feedback report at 4 weeks, and completed 2 more cases. The mean ratings of residents' communication were higher at time 2 versus time 1 (3.75 vs 3.53; P<.001). Residents with prior error disclosure experience performed better at time 1 compared to those without such experience (ratings: mean 3.63 vs mean 3.46; P=.02). No differences in communication ratings based on specialty or years in training were detected. Residents' communication was rated higher for angry cases versus sad cases (mean 3.69 vs mean 3.58; P=.01). Less than half of all residents (27/62, 44%) reported prior experience with disclosing medical harm to patients; experience differed significantly among specialties (P<.001) and was lowest for pathology (1/17, 6%). CONCLUSIONS Residents at all training levels can potentially improve error disclosure skills with VCA practice and feedback. Error disclosure curricula should prepare residents for responding to various patient affects. Simulated error disclosure may particularly benefit trainees in diagnostic specialties, such as pathology, with infrequent real-life error disclosure practice opportunities. Future research should examine the effectiveness, feasibility, and acceptability of VCA within a longitudinal error disclosure curriculum.
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Affiliation(s)
- Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Ann M King
- National Board of Medical Examiners, Philadelphia, PA, United States
| | | | - Karen Berg Brigham
- Collaborative for Accountability and Improvement, University of Washington, Seattle, WA, United States
| | - Suzanne Dintzis
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, United States
| | - Emily E Fay
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States
| | - Thomas H Gallagher
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, United States
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4
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Tensen E, van Sinderen F, Bekkenk MW, Jaspers MW, Peute LW. To Refer or Not to Refer in Teledermoscopy: Retrospective Study. JMIR Dermatol 2022; 5:e40888. [PMID: 37632902 PMCID: PMC10334922 DOI: 10.2196/40888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/03/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Challenges remain for general practitioners (GPs) in diagnosing (pre)malignant and benign skin lesions. Teledermoscopy (TDsc) supports GPs in diagnosing these skin lesions guided by teledermatologists' (TDs) diagnosis and advice and prevents unnecessary referrals to dermatology care. However, the impact of the availability of TDsc on GPs' self-reported referral decisions to dermatology care before and after the TDsc consultation is unknown. OBJECTIVE The objective of this study is to assess and compare the initial self-reported referral decisions of GPs before TDsc versus their final self-reported referral decisions after TDsc for skin lesions diagnosed by the TD as (pre)malignant or benign. METHODS TDsc consultations requested by GPs in daily practice between July 2015 and June 2020 with a TD assessment and diagnosis were extracted from a nationwide Dutch telemedicine database. Based on GP self-administered questions, the GPs' referral decisions before and their final referral decision after TDsc consultation were assessed for (pre)malignant and benign TD diagnoses. RESULTS GP self-administered questions and TD diagnoses were evaluated for 6364 TDsc consultations (9.3% malignant, 8.8% premalignant, and 81.9% benign skin lesions). In half of the TDsc consultations, GPs adjusted their initial referral decision after TD advice and TD diagnosis. Initially, GPs did not have the intention to refer 67 (56.8%) of 118 patients with a malignant TD diagnosis and 26 (16.0%) of 162 patients with a premalignant TD diagnosis but then decided to refer these patients after the TDsc consultation. Furthermore, GPs adjusted their decision from referral to nonreferral for 2534 (74.9%) benign skin lesions (including 676 seborrheic keratosis and 131 vascular lesions). CONCLUSIONS GPs adjusted their referral decision in 52% (n=3306) of the TDsc consultations after the TD assessment. The availability of TDsc is thus of added value and assists GPs in their (non)referral for patients with skin lesions to dermatology care. TDsc resulted in referrals of patients with (pre)malignant skin lesions that GPs would not have referred directly to the dermatologist. TDsc also led to a reduction of unnecessary referrals of patients with low complex benign skin lesions (eg, seborrheic keratosis and vascular lesions).
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Affiliation(s)
- Esmée Tensen
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
- Ksyos Health Management Research, Amsterdam, Netherlands
| | - Femke van Sinderen
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
- Ksyos Health Management Research, Amsterdam, Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Monique W Jaspers
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
| | - Linda W Peute
- Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, Netherlands
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5
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Timmins L, Kern LM, O'Malley AS, Urato C, Ghosh A, Rich E. Communication Gaps Persist Between Primary Care and Specialist Physicians. Ann Fam Med 2022; 20:343-347. [PMID: 35879085 PMCID: PMC9328695 DOI: 10.1370/afm.2781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022] Open
Abstract
A survey conducted with data from 2008 found that physicians often do not communicate with each other at the time of referral or after consultation. Communication between physicians might have improved since then, with the dissemination of electronic health records (EHRs), but this is not known. We used 2019 survey data to measure primary care physicians' perceptions of communication at the time of referral and after consultation. We found that large gaps in communication persist. The similarity between these survey results suggests that despite the dissemination of EHRs, physicians still do not consistently communicate with each other about the patients they share.
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6
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Wharton B, Beeler DM, Cooper S. The "Day Zero Talk": the Initial Communication of a Pediatric Oncology Diagnosis by Primary Care Physicians and Other Primary Care Providers. J Cancer Educ 2022; 37:728-738. [PMID: 32946047 PMCID: PMC9199113 DOI: 10.1007/s13187-020-01874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 06/03/2023]
Abstract
While much is known about the initial communication of a definitive pediatric cancer diagnosis by the child's pediatric oncologist, little is known about the discussions leading up to this formal conversation, which are often had with nononcologists. We sought to describe these initial conversations regarding the possibility of a child's oncologic diagnosis, from the perspective of both the patient/family as well as the provider. Semistructured interviews were performed with individuals involved with a child with recently diagnosed cancer at a quaternary care institution in an urban, mid-Atlantic city. Interviews were recorded, transcribed, and analyzed using qualitative thematic analysis. In total, 71 people were interviewed, representing the experiences of 29 unique pediatric patients. Patient and caregiver themes included recognition of the urgency of the situation and variety of terms used to indicate the potential of cancer. Physician themes included the impact of health literacy on the discussion and varying opinions on how direct to be regarding the possibility of a cancer diagnosis. The initial discussions of the possibility of a pediatric cancer diagnosis often occur with nononcologists, and this day zero talk is critical in laying the groundwork for future communication with providers.
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Affiliation(s)
- Bernadette Wharton
- Johns Hopkins University School of Medicine, 733 North Broadway, Suite 137, Baltimore, MD, 21205, USA.
- Johns Hopkins University School of Medicine, BLM 11375, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Dori Michelle Beeler
- Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 904, Baltimore, MD, 21205, USA
| | - Stacy Cooper
- Johns Hopkins University School of Medicine, BLM 11375, 1800 Orleans Street, Baltimore, MD, 21287, USA
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7
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Graves CE, Goyal N, Levin A, Nuño MA, Kim J, Campbell MJ, Shen WT, Gosnell JE, Roman SA, Sosa JA, Duh QY, Suh I. ANXIETY DURING THE COVID-19 PANDEMIC: A WEB-BASED SURVEY OF THYROID CANCER SURVIVORS. Endocr Pract 2022; 28:405-413. [PMID: 35032648 PMCID: PMC8754453 DOI: 10.1016/j.eprac.2022.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/02/2022] [Accepted: 01/07/2022] [Indexed: 12/25/2022]
Abstract
Objective Cancer patients and survivors may be disproportionately affected by COVID-19. We sought to determine the effects of the pandemic on thyroid cancer survivors’ health care interactions and quality of life. Methods An anonymous survey including questions about COVID-19 and the Patient-Reported Outcomes Measurement Information System profile (PROMIS-29, version 2.0) was hosted on the Thyroid Cancer Survivors’ Association, Inc website. PROMIS scores were compared to previously published data. Factors associated with greater anxiety were evaluated with univariable and multivariable logistic regression. Results From May 6, 2020, to October 8, 2020, 413 participants consented to take the survey; 378 (92%) met the inclusion criteria: diagnosed with thyroid cancer or noninvasive follicular neoplasm with papillary-like nuclear features, located within the United States, and completed all sections of the survey. The mean age was 53 years, 89% were women, and 74% had papillary thyroid cancer. Most respondents agreed/strongly agreed (83%) that their lives were very different during the COVID-19 pandemic, as were their interactions with doctors (79%). A minority (43%) were satisfied with the information from their doctor regarding COVID-19 changes. Compared to pre-COVID-19, PROMIS scores were higher for anxiety (57.8 vs 56.5; P < .05) and lower for the ability to participate in social activities (46.2 vs 48.1; P < .01), fatigue (55.8 vs 57.9; P < .01), and sleep disturbance (54.7 vs 56.1; P < .01). After adjusting for confounders, higher anxiety was associated with younger age (P < .01) and change in treatment plan (P = .04). Conclusion During the COVID-19 pandemic, thyroid cancer survivors reported increased anxiety compared to a pre-COVID cohort. To deliver comprehensive care, providers must better understand patient concerns and improve communication about potential changes to treatment plans.
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Affiliation(s)
- Claire E Graves
- Department of Surgery, University of California Davis, Sacramento, California.
| | - Neha Goyal
- Psycho-Oncology Program, University of California San Francisco Cancer Center, San Francisco, California
| | - Anna Levin
- Psycho-Oncology Program, University of California San Francisco Cancer Center, San Francisco, California
| | - Miriam A Nuño
- Department of Surgery, University of California Davis, Sacramento, California
| | - Jina Kim
- Department of Surgery, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Michael J Campbell
- Department of Surgery, University of California Davis, Sacramento, California
| | - Wen T Shen
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Jessica E Gosnell
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Sanziana A Roman
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Julie A Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Quan-Yang Duh
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Insoo Suh
- Department of Surgery, NYU Langone Health, New York, New York
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Payne TH, Keller C, Arora P, Brusati A, Levin J, Salgaonkar M, Li X, Zech J, Lees AF. Writing Practices Associated With Electronic Progress Notes and the Preferences of Those Who Read Them: Descriptive Study. J Med Internet Res 2021; 23:e30165. [PMID: 34612825 PMCID: PMC8529482 DOI: 10.2196/30165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/13/2021] [Accepted: 07/27/2021] [Indexed: 11/26/2022] Open
Abstract
Background Hospital progress notes can serve as an important communication tool. However, they are criticized for their length, preserved content, and for the time physicians spend writing them. Objective We aimed to describe hospital progress note content, writing and reading practices, and the preferences of those who create and read them prior to the implementation of a new electronic health record system. Methods Using a sample of hospital progress notes from 1000 randomly selected admissions, we measured note length, similarity of content in successive daily notes for the same patient, the time notes were signed and read, and who read them. We conducted focus group sessions with note writers, readers, and clinical leaders to understand their preferences. Results We analyzed 4938 inpatient progress notes from 418 authors. The average length was 886 words, and most were in the Assessment & Plan note section. A total of 29% of notes (n=1432) were signed after 4 PM. Notes signed later in the day were read less often. Notes were highly similar from one day to the next, and 26% (23/88) had clinical risk associated with the preserved content. Note content of the highest value varied according to the reader’s professional role. Conclusions Progress note length varied widely. Notes were often signed late in the day when they were read less often and were highly similar to the note from the previous day. Measuring note length, signing time, when and by whom notes are read, and the amount and safety of preserved content will be useful metrics for measuring how the new electronic health record system is used, and can aid improvements.
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Affiliation(s)
- Thomas H Payne
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Carolyn Keller
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Pallavi Arora
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Allison Brusati
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Jesse Levin
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Monica Salgaonkar
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Xi Li
- University of Southern California, Los Angeles, CA, United States
| | | | - A Fischer Lees
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
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Harper DM, Tariq M, Alhawli A, Syed N, Patel M, Resnicow K. Cancer risk perception and physician communication behaviors on cervical cancer and colorectal cancer screening. eLife 2021; 10:e70003. [PMID: 34427182 PMCID: PMC8384416 DOI: 10.7554/elife.70003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background Women 50-65 years of age have the lowest cervical and colorectal cancer (CRC) screening rates among ages recommended for screening. The primary aim of this work is to determine how cancer risk perceptions and provider communication behaviors, in addition to known demographic factors, influence the uptake of both cervical and CRC screening or a single screen among women in southeast Michigan. Methods Fourteen health services and communication behavior questions were adapted from the Health Information National Trends Survey (HINTS) and administered to a multiethnic sample of adults in southeast Michigan. The outcome variable was self-reported up-to-date cervical cancer and/or CRC screening as defined by the United States Preventive Services Task Force (USPSTF). Demographic and cancer risk/communication behavior responses of the four screening populations (both tests, one test, no tests) were analyzed with multinomial regression for all comparisons. Results Of the 394 respondents, 54% were up to date for both cervical and CRC screening, 21% were up to date with only cervical cancer screening and 12% were up to date for only CRC screening. Of the 14 risk perception and communication behavior questions, only 'Did your primary care physician (PCP) involve you in the decisions about your health care as much as you wanted?' was significantly associated with women having both screens compared to only cervical cancer screening (aOR 1.67; 95% CI: 1.08, 2.57). The multivariate model showed age, and Middle East and North African (MENA) ethnicity and Black race, in addition to PCP-patient dyad decision-making to be associated with the cancer screenings women completed. Conclusions Optimizing PCP-patient decision-making in health care may increase opportunities for both cervical cancer and CRC screening either in the office or by self-sampling. Understanding the effects of age and the different interventional strategies needed for MENA women compared to Black women will inform future intervention trials aimed to increase both cancer screenings. Funding This work was supported by NIH through the Michigan Institute for Clinical and Health Research UL1TR002240 and by NCI through The University of Michigan Rogel Cancer Center P30CA046592-29-S4 grants.
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Affiliation(s)
- Diane M Harper
- Department of Family Medicine, University of Michigan School of MedicineAnn ArborUnited States
- Department of Obstetrics & Gynecology, University of Michigan School of MedicineAnn ArborUnited States
- Department of Women’s Studies, University of Michigan, College of Literature, Science and the ArtsAnn ArborUnited States
| | - Madiha Tariq
- Arab Community Center for Economic and Social Services (ACCESS)DearbornUnited States
| | - Asraa Alhawli
- Arab Community Center for Economic and Social Services (ACCESS)DearbornUnited States
| | - Nadia Syed
- Arab Community Center for Economic and Social Services (ACCESS)DearbornUnited States
| | - Minal Patel
- Department of Health Behavior & Health Education, University of Michigan School of PublicAnn ArborUnited States
- Outreach and Health Disparities Research, University of Michigan Rogel Cancer CenterAnn ArborUnited States
| | - Ken Resnicow
- Outreach and Health Disparities Research, University of Michigan Rogel Cancer CenterAnn ArborUnited States
- Center for Health Communications Research, University of Michigan, School of Public HealthAnn ArborUnited States
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10
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Malhotra C, Chaudhry I, Ozdemir S, Teo I, Kanesvaran R. Experiences with health care practitioners among advanced cancer patients and their family caregivers: A longitudinal dyadic study. Cancer 2021; 127:3002-3009. [PMID: 33878215 DOI: 10.1002/cncr.33592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Assessing patient and caregiver experiences with care is central to improving care quality. The authors assessed variations in the experiences of advanced cancer patients and their caregivers with physician communication and care coordination by patient and caregiver factors. METHODS The authors surveyed 600 patients with a stage IV solid malignancy and 346 caregivers every 3 months for more than 2 years. Patients entered the cohort any time during their stage IV trajectory. The analytic sample was restricted to patient-caregiver dyads (n = 299). Each survey assessed patients' experiences with physician communication and care coordination; patients' symptom burden; caregivers' quality of life; and patients' and caregivers' anxiety, financial difficulties, and perceptions of treatment goals. An actor-partner interdependence framework was used for analysis. RESULTS Patients reported better physician communication (average marginal effect [AME], 6.04; 95% confidence interval [CI], 3.82 to 8.26) and care coordination (AME, 8.96; 95% CI, 6.94 to 10.97) than their caregivers. Patients reported worse care coordination when they (AME, -0.56; 95% CI, -1.07 to -0.05) or their caregivers (AME, -0.58; 95% CI, -0.97 to -0.19) were more anxious. Caregivers reported worse care coordination when they were anxious (AME, -1.62; 95% CI, -2.02 to -1.23) and experienced financial difficulties (AME, -2.31; 95% CI, -3.77 to -0.86). Correct understanding of the treatment goal (vs being uncertain) was associated with caregivers reporting physician communication as better (AME, 3.67; 95% CI, 0.49 to 6.86) but with patients reporting it as worse (AME, -3.29; 95% CI, -6.45 to -0.14). CONCLUSIONS Patients' and caregivers' reports of physician communication and care coordination vary with aspects of their own and each other's well-being and with their perceptions of treatment goals. These findings may have implications for improving patients' and caregivers' reported experiences with health care practitioners.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.,Health Services and System Research, Duke-NUS Medical School, Singapore, Singapore
| | - Isha Chaudhry
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.,Health Services and System Research, Duke-NUS Medical School, Singapore, Singapore
| | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.,Health Services and System Research, Duke-NUS Medical School, Singapore, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.,Health Services and System Research, Duke-NUS Medical School, Singapore, Singapore.,National Cancer Centre, Singapore, Singapore
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11
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Elias RM, Fischer KM, Siddiqui MA, Coons T, Meyerhofer CA, Pretzman HJ, Greig HE, Stevens SK, Burton MC. A Taxonomic Review of Patient Complaints in Adult Hospital Medicine. J Patient Exp 2021; 8:23743735211007351. [PMID: 34179414 PMCID: PMC8205411 DOI: 10.1177/23743735211007351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Previous studies show that patient complaints can identify gaps in quality of care, but it is difficult to identify trends without categorization. We conducted a review of complaints relating to admissions on hospital internal medicine (HIM) services over a 26-month period. Data were collected on person characteristics and key features of the complaint. The complaints were also categorized into a previously published taxonomy. Seventy-six unsolicited complaints were identified, (3.5 per 1000 hospital admissions). Complaints were more likely on resident services. The mean duration between encounter and complaint was 18 days, and it took an average of 12 days to resolve the complaint. Most patients (59%) had a complaint in the Relationship domain. Thirty-nine percent of complaints mentioned a specific clinician. When a clinician was mentioned, complaints regarding communication and humaneness predominated (68%). The results indicate that the efforts to reduce patient complaints in HIM should focus on the Relationships domain.
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Affiliation(s)
- Richard M Elias
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karen M Fischer
- Health Sciences Research Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Mustaqeem A Siddiqui
- Division of Hematology, Department of Hematology and Oncology, Mayo Clinic, Rochester, MN, USA.,Office of Patient Experience, Mayo Clinic, Rochester, MN, USA
| | - Trevor Coons
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Holly J Pretzman
- Informatics and Quality Management Services, Mayo Clinic, Rochester, MN, USA
| | - Hope E Greig
- Office of Patient Experience, Mayo Clinic, Rochester, MN, USA
| | | | - M Caroline Burton
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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12
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Rabah NM, Khan HA, Winkelman RD, Levin JM, Mroz TE, Steinmetz MP. Key drivers of patient satisfaction with spine surgeons in the outpatient setting. J Neurosurg Spine 2021:1-8. [PMID: 33740767 DOI: 10.3171/2020.9.spine201292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS) was developed as a result of the value-based purchasing initiative by the Center for Medicare & Medicaid Services. It allows patients to rate their experience with their provider in the outpatient setting. These ratings are then reported in aggregate and made publicly available, allowing patients to make informed choices during physician selection. In this study, the authors sought to elucidate the primary drivers of patient satisfaction in the office-based spine surgery setting as represented by the CG-CAHPS. METHODS All patients who underwent lumbar spine surgery between 2009 and 2017 and completed a patient experience survey were studied. The satisfied group comprised patients who selected a top-box score (9 or 10) for overall provider rating (OPR) on the CG-CAHPS, while the unsatisfied group comprised the remaining patients. Demographic and surgical characteristics were compared using the chi-square test for categorical variables and the Student t-test for continuous variables. A multivariable logistic regression model was developed to analyze the association of patient and surgeon characteristics with OPR. Survey items were then added to the baseline model individually, adjusting for covariates. RESULTS The study population included 647 patients who had undergone lumbar spine surgery. Of these patients, 564 (87%) selected an OPR of 9 or 10 on the CG-CAHPS and were included in the satisfied group. Patient characteristics were similar between the two groups. The two groups did not differ significantly regarding patient-reported health status measures. After adjusting for potential confounders, the following survey items were associated with the greatest odds of selecting a top-box OPR: did this provider show respect for what you had to say? (OR 21.26, 95% CI 9.98-48.10); and did this provider seem to know the important information about your medical history? (OR 20.93, 95% CI 11.96-45.50). CONCLUSIONS The present study sought to identify the key drivers of patient satisfaction in the postoperative office-based spine surgery setting and found several important associations. After adjusting for potential confounders, several items relating to physician communication were found to be the strongest predictors of patient satisfaction. This highlights the importance of effective communication in the patient-provider interaction and elucidates avenues for quality improvement efforts in the spine care setting.
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Affiliation(s)
- Nicholas M Rabah
- 1Center for Spine Health, Cleveland Clinic.,2Case Western Reserve University School of Medicine.,3Department of Neurosurgery, Cleveland Clinic.,4Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio; and
| | - Hammad A Khan
- 1Center for Spine Health, Cleveland Clinic.,2Case Western Reserve University School of Medicine.,3Department of Neurosurgery, Cleveland Clinic.,4Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio; and
| | - Robert D Winkelman
- 1Center for Spine Health, Cleveland Clinic.,3Department of Neurosurgery, Cleveland Clinic
| | - Jay M Levin
- 5Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thomas E Mroz
- 1Center for Spine Health, Cleveland Clinic.,4Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio; and
| | - Michael P Steinmetz
- 1Center for Spine Health, Cleveland Clinic.,3Department of Neurosurgery, Cleveland Clinic
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13
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Johnson KM. Towards better metainterpretation: improving the clinician's interpretation of the radiology report. Diagnosis (Berl) 2020; 8:dx-2020-0081. [PMID: 32683334 DOI: 10.1515/dx-2020-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 02/28/2024]
Abstract
How the clinician interprets the radiology report has a major impact on the patient's care. It is a crucial cognitive task, and can also be a significant source of error. Because the clinician must secondarily interpret the radiologist's interpretation of the images, this step can be referred to as a "metainterpretation". Some considerations for that task are offered from the perspective of a radiologist. A revival of the tradition of discussing cases with the radiologist is encouraged.
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Affiliation(s)
- Kevin M Johnson
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
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14
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Cataldi JR, O'Leary ST, Lindley MC, Hurley LP, Allison MA, Brtnikova M, Beaty BL, Crane LA, Kempe A. Survey of Adult Influenza Vaccination Practices and Perspectives Among US Primary Care Providers (2016-2017 Influenza Season). J Gen Intern Med 2019; 34:2167-75. [PMID: 31325130 DOI: 10.1007/s11606-019-05164-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/30/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Seasonal influenza vaccination is recommended for all adults; however, little is known about how primary care physicians can communicate effectively with patients about influenza vaccination. OBJECTIVE To assess among general internal medicine (GIM) and family physicians (FP) regarding adult influenza vaccination: (1) recommendation and administration practices, (2) barriers to discussing and perceived reasons for patient refusal, and (3) factors associated with physician self-efficacy in convincing patients to be vaccinated. DESIGN Email and mail survey conducted in February-March 2017 PARTICIPANTS: Nationally representative sample of GIM and FP MAIN MEASURES: Factor analysis was used to group similar items for multivariable analysis of barriers and strategies associated with high physician self-efficacy about convincing patients to be vaccinated (defined as disagreeing that they could do nothing to change resistant patients' minds). KEY RESULTS Response rate was 67% (620/930). Ninety-eight percent always/almost always recommended influenza vaccine to adults ≥ 65 years, 90% for adults 50-64 years, and 75% for adults 19-49 years. Standing orders (76%) and electronic alerts (64%) were the most commonly used practice-based immunization strategies. Frequently reported barriers to discussing vaccination were other health issues taking precedence (41%), time (29%), and feeling they were unlikely to change patients' minds (24%). Fifty-eight percent of physicians reported high self-efficacy about convincing patients to be vaccinated; these providers reported fewer patient belief barriers contributing to vaccine refusal (RR = 0.93 per item; 95% CI (0.89-0.98); Cronbach's α = 0.70), were more likely to report using both fact- (1.08/item; (1.03-1.14); 0.66) and personal experience-based (1.07/item; (1.003-1.15); 0.65) communication strategies, and were more likely to work in practices using patient reminders for influenza vaccine (1.32; (1.16-1.50)). CONCLUSIONS Physicians identified barriers to successfully communicating about adult influenza vaccination but few effective strategies to counter them. Interventions to promote self-efficacy in communication and under-utilized practice-based immunization strategies are needed.
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Abstract
Given that many consumers do not understand any licensed physician can perform cosmetic surgery, cosmetic procedure advertising regulation is lacking and differs by state; and consumers often search for providers online and rely on the site's information. Cosmetic surgery websites have the potential to be a threat to consumers' safety and health. This study asked what types of physician information do cosmetic surgery websites supply. A content analysis was conducted with 873 physicians' information provided on cosmetic surgery websites in the top 10 cosmetic surgery cities, finding members of plastic surgery associations and core providers were more likely to list medical qualifications. All physicians were unlikely to list experience. Two-thirds stated their specific board certification, and 15% to 30% in each city failed to follow their state's regulations for disclosing board certification. The study concludes by suggesting national ethical guidelines.
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16
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Trudeau MS, Madden RF, Parnell JA, Gibbard WB, Shearer J. Dietary and Supplement-Based Complementary and Alternative Medicine Use in Pediatric Autism Spectrum Disorder. Nutrients 2019; 11:E1783. [PMID: 31375014 DOI: 10.3390/nu11081783] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 12/26/2022] Open
Abstract
Previous literature has shown that complementary and alternative medicine (CAM) is steadily increasing in autism spectrum disorder (ASD). However, little data is currently available regarding its use, safety, and efficacy in children with ASD. Thus, the purpose of this study is to describe the use of supplement-based CAM therapies in children between the ages of 4 to 17 years with ASD. This population-based, cross-sectional study evaluated children with ASD regarding supplement use. A total of 210 participants were recruited from a variety of sources including educational and physical activity programs, and social media to complete a questionnaire. Primary caregivers provided information on current supplement based CAM use. Data evaluated the proportion of children that used supplement therapies, the types of supplements used, reasons for use, perceived safety, and demographic factors associated with use (e.g., income, parental education, severity of disorder). Seventy-five percent of children with ASD consumed supplements with multivitamins (77.8%), vitamin D (44.9%), omega 3 (42.5%), probiotics (36.5%), and magnesium (28.1%) as the most prevalent. Several supplements, such as adrenal cortex extract, where product safety has not yet been demonstrated, were also reported. A gluten free diet was the most common specialty diet followed amongst those with restrictions (14.8%). Health care professionals were the most frequent information source regarding supplements; however, 33% of parents reported not disclosing all their child’s supplements to their physician. In conclusion, the use of supplement therapies in children with ASD is endemic and highlights the need for further research concerning public health education surrounding safety and efficacy.
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17
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Peng PH, Laditka SB, Lin HS, Lin HC, Probst JC. Factors associated with retinal screening among patients with diabetes in Taiwan. Taiwan J Ophthalmol 2019; 9:185-193. [PMID: 31572656 PMCID: PMC6759549 DOI: 10.4103/tjo.tjo_30_18] [Citation(s) in RCA: 4] [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: 03/19/2018] [Accepted: 07/18/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study is to explore the factors associated with having a diabetic retinopathy exam (DRE) during the past 2 years among patients with diabetes. METHODS Patients visiting the eye clinic at Shin-Kong Memorial Hospital in Taipei were enrolled in this study from January to June 2009. A total of 313 patients participated in this study. Excluding patients with missing responses for more than three questions (38) yielded a final sample of 275 participants. Chi-square and Mann-Whitney U-tests were used for bivariate analysis. Multivariable logistic regression examined factors associated with having a DRE controlling for demographic and health factors. RESULTS Although 83% of participants said that their physician suggested DRE, only 60% were screened during the past 2 years. In response to the question about why patients did not seek a DRE exam, 43.2% reported that they did not know having this exam was necessary. In adjusted results, receiving information about the relationship between diabetes and retinopathy from medical staff and believing that diabetes could damage the vision were associated with having a DRE in the past 2 years (both P < 0.05). CONCLUSIONS Although most patients indicated that their physician suggested the need for eye care, a substantial percentage of patients with diabetes were not aware of the need for a regular DRE. Information about the relationship between diabetes and retinopathy and concerns about damage to vision were associated with greater likelihood of seeking a DRE. These factors should be considered to promote DR screening.
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Affiliation(s)
- Pai-Huei Peng
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Sarah B. Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, USA
| | - Huey-Shyan Lin
- Department of Health-Business Administration, School of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Hui-Chen Lin
- Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Janice C. Probst
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, USA
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18
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Rippé CB, Dubinsky AJ. Trust me, I'm a physician using sales skills: Enhancing physician-patient communication through the personal selling process. Health Mark Q 2019; 35:245-265. [PMID: 30757976 DOI: 10.1080/07359683.2018.1524594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Given the challenges in patient non-adherence and the lack of training in healthcare providers' communication and in application of bedside manners, this manuscript suggests an innovative approach for physicians working with patients by applying the marketing literature's seven-step sales process. This article explores ways to apply the sales process to healthcare providers' interactions with patients. This approach views the healthcare interaction with patients as a sales scenario and is shared by connecting existing marketing literature that delineates specific selling tactics to examples of those tactics in the healthcare environment. Practical examples are provided through the framework for easy implementation.
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Affiliation(s)
- Cindy B Rippé
- a Department of Business Administration , Flagler College , St. Augustine , Florida , USA
| | - Alan J Dubinsky
- b Department of Consumer Science , Purdue University, Matthews Hall , West Lafayette , Indiana , USA
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19
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Prater LC, Wickizer T, Bose-Brill S. Examining Age Inequalities in Operationalized Components of Advance Care Planning: Truncation of the ACP Process With Age. J Pain Symptom Manage 2019; 57:731-737. [PMID: 30610891 DOI: 10.1016/j.jpainsymman.2018.12.338] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 12/21/2018] [Accepted: 12/25/2018] [Indexed: 12/21/2022]
Abstract
CONTEXT Opportunities for patients to receive unnecessary, costly, and potentially harmful care near the end of life abound. Advance care planning (ACP) can help to make this vulnerable period better for patients, caregivers, and providers. OBJECTIVE The objective of this study was to determine whether older age predicted the presence of certain forms of retrievable ACP documentation in the electronic health record (EHR) in a large sample of hospice-referred patients. METHODS This was a retrospective analysis of medical-record data on 3595 patients referred to hospice between January 1, 2013 and December 31, 2015. EHR documentation of an ACP note in the problem list, presence of a scanned advance directive, and the presence of a verified do-not-resuscitate order were the outcome measures. Logistic regression was used to assess the effect of age, education, race, gender, cancer diagnosis, dementia diagnosis, palliative encounter, and death on the outcome variables. RESULTS Our results suggest that when we control for prognosis, patients over age 70 years may experience gaps in ACP communication. We found that as patients age, the odds of having documentation of a conversation (odds ratio [OR] = 0.56; P < 0.001) or scanned advance directive decreased (OR = 0.63; P < 0.001), while the odds of having a verified do-not-resuscitate order increased (OR = 1.42; P < 0.001). CONCLUSION The results of this study may imply some degree of unilateral and physician-driven decision making for end-of-life care among older adults. Collaborative efforts between an interdisciplinary medical team should focus on developing policies to address this potential disparity between younger and older adults at the end of life.
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Affiliation(s)
- Laura C Prater
- Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Thomas Wickizer
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Seuli Bose-Brill
- Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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20
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Vassy JL, Davis JK, Kirby C, Richardson IJ, Green RC, McGuire AL, Ubel PA. How Primary Care Providers Talk to Patients about Genome Sequencing Results: Risk, Rationale, and Recommendation. J Gen Intern Med 2018; 33:877-885. [PMID: 29374360 PMCID: PMC5975138 DOI: 10.1007/s11606-017-4295-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/14/2017] [Accepted: 12/20/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Genomics will play an increasingly prominent role in clinical medicine. OBJECTIVE To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. DESIGN Qualitative analysis. PARTICIPANTS PCPs and their generally healthy patients undergoing genome sequencing. APPROACH Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients' office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. KEY RESULTS For each genomic result discussed in 48 PCP-patient visits, we identified a "take-home" message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. CONCLUSIONS PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results.
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Affiliation(s)
- Jason L Vassy
- Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA.
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - J Kelly Davis
- Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Christine Kirby
- Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Ian J Richardson
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert C Green
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Genetics, Brigham and Women's Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Peter A Ubel
- Margolis Center for Health Policy, Duke University, Durham, NC, USA
- Fuqua School of Business, Sanford School of Public Policy, School of Medicine, Duke University, Durham, NC, USA
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21
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Rash AH, Sheldon R, Donald M, Eronmwon C, Kuriachan VP. Valued Components of a Consultant Letter from Referring Physicians' Perspective: a Systematic Literature Synthesis. J Gen Intern Med 2018; 33:948-954. [PMID: 29508258 PMCID: PMC5975156 DOI: 10.1007/s11606-018-4356-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/10/2018] [Accepted: 02/05/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Effective communication between the consultants and physicians form an integral foundation of effective and expert patient care. A broad review of the literature has not been undertaken to determine the components of a consultant's letter of most value to the referring physician. We aimed to identify the components of a consultant's letter preferred by referring physicians. METHODS We searched Embase and MEDLINE (OVID) Medicine (EBM) Reviews and Cochrane Database of Systematic Reviews for English articles with no restriction on initial date to January 6, 2017. Articles containing letters from specialists to referring physicians regarding outpatient assessments with either an observational or experimental design were included. Studies were excluded if they pertained to communications from referring physicians to consultant specialists, or pertained to allied health professionals, inpatient documents, or opinion articles. We enumerated the frequencies with which three common themes were addressed, and the positive or negative nature of the comments. The three themes were the structure of consultant letters, their contents, and whether referring physicians and consultants shared a common opinion about the items. RESULTS Eighteen articles were included in our synthesis. In 11 reports, 91% of respondents preferred structured formats. Other preferred structural features were problem lists and brevity (four reports each). The most preferred contents were oriented to insight: diagnosis, prognosis, and management plan (16/21 mentions in the top tertile). Data items such as history, physical examination, and medication lists were less important (1/23 mentions in the top tertile). Reports varied as to whether referring physicians and consultants shared common opinions about letter features. CONCLUSIONS Referring physicians prefer brief, structured letters from consultants that feature diagnostic and prognostic opinions and management plans over unstructured letters that emphasize data elements such as detailed histories and medication lists. Whether these features improve outcomes is unknown.
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Affiliation(s)
- Arjun H Rash
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Robert Sheldon
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
| | - Maoliosa Donald
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Cindy Eronmwon
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Vikas P Kuriachan
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Flower KB, Skinner AC, Yin HS, Rothman RL, Sanders LM, Delamater A, Perrin EM. Satisfaction With Communication in Primary Care for Spanish-Speaking and English-Speaking Parents. Acad Pediatr 2017; 17:416-423. [PMID: 28104488 PMCID: PMC5524514 DOI: 10.1016/j.acap.2017.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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] [Received: 09/13/2016] [Revised: 01/01/2017] [Accepted: 01/07/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Effective communication with primary care physicians is important yet incompletely understood for Spanish-speaking parents. We predicted lower satisfaction among Spanish-speaking compared to English-speaking Latino and non-Latino parents. METHODS Cross-sectional analysis at 2-month well visits within the Greenlight study at 4 pediatric resident clinics. Parents reported satisfaction with 14 physician communication items using the validated Communication Assessment Tool (CAT). High satisfaction was defined as "excellent" on each CAT item. Mean estimations compared satisfaction for communication items among Spanish- and English-speaking Latinos and non-Latinos. We used generalized linear regression modeling, adjusted for parent age, education, income, and clinic site. Among Spanish-speaking parents, we compared visits conducted in Spanish with and without an interpreter, and in English. RESULTS Compared to English-speaking Latino (n = 127) and non-Latino parents (n = 432), fewer Spanish-speaking parents (n = 303) reported satisfaction with 14 communication items. No significant differences were found between English-speaking Latinos and non-Latinos. Greatest differences were found in the use of a greeting that made the parent comfortable (59.4% of Spanish-speaking Latinos endorsing "excellent" vs 77.5% English-speaking Latinos, P < .01) and discussing follow-up (62.5% of Spanish-speaking Latinos vs 79.8% English-speaking Latinos, P < .01). After adjusting for parent age, education, income, and study site, Spanish-speaking Latinos were still less likely to report high satisfaction with these communication items. Satisfaction was not different among Spanish-speaking parents when the physician spoke Spanish versus used an interpreter. CONCLUSIONS Satisfaction with physician communication was associated with language but not ethnicity. Spanish-speaking parents less frequently report satisfaction with communication, and innovative solutions to enhance communication quality are needed.
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Affiliation(s)
- Kori B. Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599
| | - Asheley C. Skinner
- Duke University, Duke Clinical Research Institute, 2400 Pratt Street, Room 0311 Terrace Level, Durham, NC 27705
| | - H. Shonna Yin
- Department of Pediatrics, School of Medicine/Bellevue Hospital Center, New York University, 550 First Avenue, New York, NY 10016
| | - Russell L. Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, 6103 Medical Center East, Nashville, TN 37232
| | - Lee M. Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, 117 Encina Commons, Stanford, CA 94305
| | - Alan Delamater
- Department of Pediatrics, University of Miami School of Medicine, 1601 NW 12 Avenue, #4046, Miami, FL 33136
| | - Eliana M. Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599
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Mazzi MA, Rimondini M, Deveugele M, Zimmermann C, Moretti F, van Vliet L, Deledda G, Fletcher I, Bensing J. What do people appreciate in physicians' communication? An international study with focus groups using videotaped medical consultations. Health Expect 2015; 18:1215-26. [PMID: 23796047 PMCID: PMC5060825 DOI: 10.1111/hex.12097] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 05/22/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The literature shows that the quality of communication is usually determined from a professional perspective. Patients or lay people are seldom involved in the development of quality indicators or communication. OBJECTIVE To give voice to the lay people perspective on what constitutes 'good communication' by evoking their reactions to variations in physician communication. DESIGN Lay people from four different countries watched the same videotaped standardized medical encounters and discussed their preferences in gender-specific focus groups who were balanced in age groups. SETTING AND PARTICIPANTS Two hundred and fifty-nine lay people (64 NL, 72 IT, 75 UK and 48 BE) distributed over 35 focus groups of 6-8 persons each. MAIN VARIABLES STUDIED Comments on doctors' behaviours were classified by the GULiVer framework in terms of contents and preferences. RESULTS Participants prevalently discussed 'task-oriented expressions' (39%: competency, self-confident, providing solutions), 'affective oriented/emotional expressions' (25%: empathy, listening, reassuring) and 'process-oriented expressions' (23%: flexibility, summarizing, verifying). 'Showing an affective attitude' was most appreciated (positive percentage within category: 93%, particularly facilitations and inviting attitude), followed by 'providing solution' (85%). Among disfavoured behaviour, repetitions (88%), 'writing and reading' (54%) and asking permission (42%) were found. CONCLUSIONS Although an affective attitude is appreciated by nearly everybody, people may vary widely in their communication needs and preferences: what is 'good communication' for one person may be disliked or even a source of irritation for another. A physician should be flexible and capable of adapting the consultation to the different needs of different patients. This challenges the idea of general communication guidelines.
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Affiliation(s)
- Maria A. Mazzi
- Department of Public Health and Community MedicineUniversity of VeronaVeronaItaly
| | - Michela Rimondini
- Department of Public Health and Community MedicineUniversity of VeronaVeronaItaly
| | - Myriam Deveugele
- Department of General Practice and Primary Health CareUniversity of GhentGhentBelgium
| | - Christa Zimmermann
- Department of Public Health and Community MedicineUniversity of VeronaVeronaItaly
| | - Francesca Moretti
- Department of Public Health and Community MedicineUniversity of VeronaVeronaItaly
| | - Liesbeth van Vliet
- NIVELNetherlands Institute for Health Services ResearchUtrecht UniversityUtrechtThe Netherlands
| | - Giuseppe Deledda
- Department of Public Health and Community MedicineUniversity of VeronaVeronaItaly
| | - Ian Fletcher
- Division of Health ResearchLancaster UniversityLancasterUK
| | - Jozien Bensing
- NIVELNetherlands Institute for Health Services ResearchUtrecht UniversityUtrechtThe Netherlands
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Johnson LM, Leek AC, Drotar D, Noll RB, Rheingold SR, Kodish ED, Baker JN. Practical communication guidance to improve phase 1 informed consent conversations and decision-making in pediatric oncology. Cancer 2015; 121:2439-48. [PMID: 25873253 DOI: 10.1002/cncr.29354] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/06/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND It can be difficult to explain pediatric phase 1 oncology trials to families of children with refractory cancer. Parents may misunderstand the information presented to them, and physicians may assume that certain topics are covered in the informed consent document and need not be discussed. Communication models can help to ensure effective discussions. METHODS Suggestions for improving the informed consent process were first solicited from phase 1 study clinicians via questionnaire. Eight parents who had enrolled their child on a phase 1 pediatric oncology trial were recruited for an advisory group designed to assess the clinicians' suggestions and make additional recommendations for improving informed consent for pediatric phase 1 trials. RESULTS A phase 1 communication model was designed to incorporate the suggestions of clinicians and families. It focused on educating parents/families about phase 1 trials at specific time points during a child's illness, but specifically at the point of disease recurrence. An informative phase 1 fact sheet that can be distributed to families was also presented. CONCLUSIONS Families who will be offered information regarding phase 1 clinical trials can first receive a standardized fact sheet explaining the general purpose of these early-phase clinical trials. Parental understanding may be enhanced further when oncologists address key themes, beginning at the time of diagnosis and continuing through important decision points during the child's illness. This model should be prospectively evaluated.
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Affiliation(s)
- Liza-Marie Johnson
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Angela C Leek
- Department of Bioethics, Cleveland Clinic, Cleveland, Ohio
| | - Dennis Drotar
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Robert B Noll
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan R Rheingold
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Eric D Kodish
- Center for Ethics, Humanities, and Spiritual Care, Cleveland Clinic, Cleveland, Ohio
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Mishori R, Singh LO, Levy B, Newport C. Mapping physician Twitter networks: describing how they work as a first step in understanding connectivity, information flow, and message diffusion. J Med Internet Res 2014; 16:e107. [PMID: 24733146 PMCID: PMC4004136 DOI: 10.2196/jmir.3006] [Citation(s) in RCA: 39] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/03/2014] [Accepted: 02/20/2014] [Indexed: 11/13/2022] Open
Abstract
Background Twitter is becoming an important tool in medicine, but there is little information on Twitter metrics. In order to recommend best practices for information dissemination and diffusion, it is important to first study and analyze the networks. Objective This study describes the characteristics of four medical networks, analyzes their theoretical dissemination potential, their actual dissemination, and the propagation and distribution of tweets. Methods Open Twitter data was used to characterize four networks: the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the American College of Physicians (ACP). Data were collected between July 2012 and September 2012. Visualization was used to understand the follower overlap between the groups. Actual flow of the tweets for each group was assessed. Tweets were examined using Topsy, a Twitter data aggregator. Results The theoretical information dissemination potential for the groups is large. A collective community is emerging, where large percentages of individuals are following more than one of the groups. The overlap across groups is small, indicating a limited amount of community cohesion and cross-fertilization. The AMA followers’ network is not as active as the other networks. The AMA posted the largest number of tweets while the AAP posted the fewest. The number of retweets for each organization was low indicating dissemination that is far below its potential. Conclusions To increase the dissemination potential, medical groups should develop a more cohesive community of shared followers. Tweet content must be engaging to provide a hook for retweeting and reaching potential audience. Next steps call for content analysis, assessment of the behavior and actions of the messengers and the recipients, and a larger-scale study that considers other medical groups using Twitter.
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Affiliation(s)
- Ranit Mishori
- Department of Family Medicine's Center for Health Communication, Media and Primary Care, Georgetown University School of Medicine, Washington, DC, United States.
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McDaniel SH, Morse DS, Reis S, Edwardsen EA, Gurnsey MG, Taupin A, Griggs JJ, Shields CG. Physicians criticizing physicians to patients. J Gen Intern Med 2013; 28:1405-9. [PMID: 23715689 PMCID: PMC3797330 DOI: 10.1007/s11606-013-2499-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/25/2013] [Accepted: 05/07/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Teamwork is critical to providing excellent healthcare, and effective communication is essential for teamwork. Physicians often discuss patient referrals from other physicians, including referrals from outside their primary institution. Sharing conflicting information or negative judgments of other physicians to patients may be unprofessional. Poor teamwork within healthcare systems has been associated with patient mortality and lower staff well-being. OBJECTIVE This analysis explored how physicians talk to patients with advanced cancer about care rendered by other physicians. DESIGN Standardized patients (SPs) portraying advanced lung cancer attended covertly recorded visits with consenting oncologists and family physicians. PARTICIPANTS Twenty community-based oncologists and 19 family physicians had encounters with SPs. APPROACH Physician comments about care by other physicians were extracted from transcriptions and analyzed qualitatively. These comments were categorized as Supportive or Critical. We also examined whether there were differences between physicians who provide supportive comments and those who provided critical comments. KEY RESULTS Fourteen of the 34 encounters (41 %) included in this analysis contained a total of 42 comments about the patient's previous care. Twelve of 42 comments (29 %) were coded as Supportive, twenty-eight (67 %) as Critical, and two (4 %) as Neutral. Supportive comments attributed positive qualities to another physician or their care. Critical comments included one specialty criticizing another and general lack of trust in physicians. CONCLUSION This study described comments by physicians criticizing other physicians to patients. This behavior may affect patient satisfaction and quality of care. Healthcare system policies and training should discourage this behavior.
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Affiliation(s)
- Susan H McDaniel
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA,
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Parikh AR, Kaplan CP, Burke NJ, Livaudais-Toman J, Hwang ES, Karliner LS. Ductal carcinoma in situ: knowledge of associated risks and prognosis among Latina and non-Latina white women. Breast Cancer Res Treat 2013; 141:261-8. [PMID: 23996141 PMCID: PMC4520413 DOI: 10.1007/s10549-013-2676-x] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/19/2013] [Indexed: 01/07/2023]
Abstract
While not itself life-threatening, ductal carcinoma in situ (DCIS) can progress to invasive disease if untreated, and confers an increased risk of future breast cancer. We investigated knowledge of DCIS among a cohort of English- and Spanish-speaking Latina and English-speaking non-Latina white women previously treated for DCIS. We examined knowledge of DCIS with four true/false statements about risk of invasive disease, breast cancer recurrence, and prognosis. For each knowledge statement, we modeled the odds of a correct answer by language-ethnicity (English-speaking Latinas, Spanish-speaking Latinas, and English-speaking whites) adjusting for demographics, health history, and treatment factors. Of 710 participants, 52 % were English-speaking whites, 21 % English-speaking Latinas, and 27 % Spanish-speaking Latinas. Less than half (41 %) of participants were aware that DCIS is not life-threatening and only 32 % knew that surgical treatment choice does not impact mortality; whereas two-thirds (67 %) understood that DCIS confers increased risk of future breast cancer, and almost all (92 %) knew that DCIS, if untreated, could become invasive. Only three Spanish-speakers used professional interpreters during discussions with their physicians. In adjusted analyses, compared to English-speaking whites, both English- and Spanish-speaking Latinas had significantly lower odds of knowing that DCIS was not life-threatening (OR, 95 % CI 0.6, 0.4-0.9 and 0.5, 0.3-0.9, respectively). In contrast, Spanish-speaking Latinas had a twofold higher odds of knowing that DCIS increases risk of future breast cancer (OR, 95 % CI 2.6, 1.6-4.4), but English-speaking Latinas were no different from English-speaking whites. Our data suggest that physicians are more successful at conveying the risks conferred by DCIS than the nuances of DCIS as a non-life-threatening diagnosis. This uneven communication is most marked for Spanish-speaking Latinas. In addition to the use of professional interpreters, efforts to create culturally and linguistically standardized information could improve knowledge and engagement in informed decision making for all DCIS patients.
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Affiliation(s)
- Aparna R. Parikh
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA. Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Celia Patricia Kaplan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA. Medical Effectiveness Research Center for Diverse Populations, University of California San Francisco, San Francisco, CA, USA. Division of General Internal Medicine, Department of Medicine, University of California San Francisco, 1545, Divisadero, San Francisco, CA 94143-0320, USA
| | - Nancy J. Burke
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA. Department of Anthropology, History and Social Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Livaudais-Toman
- Medical Effectiveness Research Center for Diverse Populations, University of California San Francisco, San Francisco, CA, USA. Division of General Internal Medicine, Department of Medicine, University of California San Francisco, 1545, Divisadero, San Francisco, CA 94143-0320, USA
| | - E. Shelley Hwang
- Division of Surgical Oncology, Department of Surgery, Duke University, Durham, NC, USA
| | - Leah S. Karliner
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA. Medical Effectiveness Research Center for Diverse Populations, University of California San Francisco, San Francisco, CA, USA. Division of General Internal Medicine, Department of Medicine, University of California San Francisco, 1545, Divisadero, San Francisco, CA 94143-0320, USA
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Hyde YM, Germino B, Mishel M, Street RL, Campbell L, Brashers D, Mccoy TP. Healthcare Provider Communication Patterns during Consultations about Treating Localized Prostate Cancer. J Best Pract Health Prof Divers 2013; 6:876-890. [PMID: 34708223 PMCID: PMC8547618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Disparities in mortality in prostate cancer may reflect differences in healthcare providers' communication. OBJECTIVE This study examined physicians' communication with African American and Caucasian men when making decisions about treatment for localized prostate cancer to determine whether information-giving and partnership-building behaviors varied by the age, education level, and race of the patient. METHODS The study was a secondary analysis of data from a larger study examining decisionmaking among men with prostate cancer. Verbatim transcripts of physician communication with 13 African American and 32 Caucasian patients were coded using a well-established scheme. RESULTS Physicians tended to use information-giving and partnership-building behaviors more often with patients who were Caucasian, but this practice was tempered by the patient's age or education level. CONCLUSION Information-giving and partnership-building behaviors should be studied relative to patient outcomes, such as treatment adherence and satisfaction. Communication is a two-way interaction, and patients' perceptions should be included in future studies. PRACTICE IMPLICATIONS Biases, assumptions, and differential behavior toward patients who are older, minorities, or less educated must be addressed during all healthcare providers' socialization and education. All will benefit from their education in communication and partnership-building with patients.
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Affiliation(s)
- Yolanda M. Hyde
- School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Barbara Germino
- School of Nursing, University of North Carolina at Chapel-Hill, Chapel-Hill, North Carolina
| | - Merle Mishel
- School of Nursing, University of North Carolina at Chapel-Hill, Chapel-Hill, North Carolina
| | | | - Lenora Campbell
- School of Health Sciences, Division of Nursing, Winston-Salem State University, Winston-Salem, North Carolina
| | - Dale Brashers
- College of Nursing, University of Illinois at Urbana-Champaign, Chicago, Illinois
| | - Thomas P. Mccoy
- School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina
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Abstract
OBJECTIVE The objective of the study was to assess whether a targeted intervention improved the satisfaction of neonatal parents with primary medical provider communication. STUDY DESIGN The study design was a survey assessment of parents in a neonatal intensive care unit regarding their satisfaction with physician and nurse practitioner communication. Serial cohorts were surveyed before and after an intervention, including educating providers about family communication, distributing contact cards to families and showing a poster of providers in the unit. RESULT More subjects in the post-intervention cohort (n=33) were satisfied (95%) with provider communication than in the pre-intervention cohort (n=50, 74%; P<0.01). Parents who reported talking with a provider in the previous 7 days were more satisfied than parents who did not (P<0.001). After the intervention, fewer families (36 versus 65%) reported a desire for more frequent provider contact (P<0.01). CONCLUSION A targeted intervention improved parent satisfaction with provider communication. Improving the quality and quantity of parent-provider communication increased parent satisfaction with communication with their baby's medical providers.
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Bell CM, Schnipper JL, Auerbach AD, Kaboli PJ, Wetterneck TB, Gonzales DV, Arora VM, Zhang JX, Meltzer DO. Association of communication between hospital-based physicians and primary care providers with patient outcomes. J Gen Intern Med 2009; 24:381-6. [PMID: 19101774 PMCID: PMC2642573 DOI: 10.1007/s11606-008-0882-8] [Citation(s) in RCA: 94] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 10/27/2008] [Accepted: 11/10/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients admitted to general medicine inpatient services are increasingly cared for by hospital-based physicians rather than their primary care providers (PCPs). This separation of hospital and ambulatory care may result in important care discontinuities after discharge. We sought to determine whether communication between hospital-based physicians and PCPs influences patient outcomes. METHODS We approached consecutive patients admitted to general medicine services at six US academic centers from July 2001 to June 2003. A random sample of the PCPs for consented patients was contacted 2 weeks after patient discharge and surveyed about communication with the hospital medical team. Responses were linked with the 30-day composite patient outcomes of mortality, hospital readmission, and emergency department (ED) visits obtained through follow-up telephone survey and National Death Index search. We used hierarchical multi-variable logistic regression to model whether communication with the patient's PCP was associated with the 30-day composite outcome. RESULTS A total of 1,772 PCPs for 2,336 patients were surveyed with 908 PCPs responses and complete patient follow-up available for 1,078 patients. The PCPs for 834 patients (77%) were aware that their patient had been admitted to the hospital. Of these, direct communication between PCPs and inpatient physicians took place for 194 patients (23%), and a discharge summary was available within 2 weeks of discharge for 347 patients (42%). Within 30 days of discharge, 233 (22%) patients died, were readmitted to the hospital, or visited an ED. In adjusted analyses, no relationship was seen between the composite outcome and direct physician communication (adjusted odds ratio 0.87, 95% confidence interval 0.56 - 1.34), the presence of a discharge summary (0.84, 95% CI 0.57-1.22), or PCP awareness of the index hospitalization (1.08, 95% CI 0.73-1.59). CONCLUSION Analysis of communication between PCPs and inpatient medical teams revealed much room for improvement. Although communication during handoffs of care is important, we were not able to find a relationship between several aspects of communication and associated adverse clinical outcomes in this multi-center patient sample.
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Affiliation(s)
- Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Abstract
INTRODUCTION Deficient physician communication skills can lead to complaints by patients and colleagues. While there are many communication training courses for physicians, there are few descriptions of programs that address their deficiencies. AIM This report describes the use of a coaching model developed by the author to remediate inadequate communication skills. PROGRAM DESCRIPTION The coaching model consists of a discrete set of communication skills that are gradually integrated into professional activities while debriefing that process in a supportive relationship. PROGRAM EVALUATION Outcomes are provided for the first 13 physicians coached after the approach was standardized. On a Likert scale (range, 1-7), with 7 expressing "high satisfaction," all participants rated the consultation in the 5-7 range (mean, 6.3), and all supervisors rated the consultation in the 6-7 range (mean, 6.7). DISCUSSION A coaching model is effective in improving communication skills deemed inadequate by physicians' patients and colleagues. Future work should evaluate the impact of integrating coaching into health care organizations and on developing new tools to augment coaching.
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Affiliation(s)
- Barry Egener
- The Foundation for Medical Excellence, 1639 SW Skyline Blvd., Portland, OR 97221, USA.
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Patwardhan M, Coeytaux RR, Deshmukh R, Samsa G. What is the impact of physician communication and patient understanding in the management of headache? Neuropsychiatr Dis Treat 2007; 3:893-7. [PMID: 19300624 PMCID: PMC2656331 DOI: 10.2147/ndt.s493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Migraine is a common and debilitating condition. Despite the burden of disease and increasing availability of effective treatment, migraine management is unsatisfactory. Evidence in other chronic conditions indicates that effective physician communication results in better patient understanding and health outcomes.The current literature review was intended to evaluate evidence regarding the relationship of effective physician-provider communication to health outcomes and patient satisfaction among patients with migraine. The authors searched MEDLINE((R)) (1966-June 2007) and the Cochrane Database of Systematic Reviews for relevant publications. The search strategy combined the concepts of "headache disorders" and "physician-patient relations". 912 abstracts were identified, and 80 (9%) of them were included for data abstraction.There were no studies that met our eligibility criteria. Therefore we revised the eligibility criteria to allow for the inclusion of non-migraine primary headache disorders or the role of non-physician health care providers. Twelve published papers met the revised criteria. The findings from the limited evidence available suggests, but does not prove, that improvements in physician-patient communication could result in a significant decrease in the burden of suffering and health care resource utilization associated with migraine. More research is needed to assess the explicit role of physician-patient communication in the management of migraine.
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Affiliation(s)
- Meenal Patwardhan
- Department of Medicine, Duke University Medical Center, Durham, NC, USA.
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