Families and Friends of Homicide Victims' Experiences With the Healthcare System: A Trauma-Informed Perspective

INTRODUCTION

Families and friends of homicide victims (FFHV) interact with healthcare systems almost immediately after the traumatic event. Their interactions with healthcare providers can either facilitate healing, have a neutral effect, or compound an already painful experience. When trauma victims are admitted to the hospital, resources are necessarily diverted on their behalf with less consistent attention paid to their families and friends. The interactions surrounding the immediate circumstance as well as experiences in the weeks to months after can have significant long-term impact. This study explores the needs and experiences of FFHV when interacting with the healthcare system to inform physicians' and providers' interactions and provision of services.

METHODS

This study of 3 focus groups sought to understand these experiences with the healthcare system to better inform physicians' and providers' interactions and provision of services.

RESULTS

Using the framework approach, the study ultimately built upon the existing trauma-informed care (TIC) framework to include several emergent themes. Participants discussed the need for death notification sensitivity, benefits of coordinated care, barriers to accessing care, the need for physician empathy and attention, the lack of trauma screening, and hastily prescribing medications.

CONCLUSION

This TIC approach can inform future healthcare interactions with the FFHV as it grounds the patients' experience in their historical reality and may improve future provider-patient relationship.

Racial/ethnic differences in treatment recommendations: lifestyle changes and medication prescriptions for high cholesterol

Objective: High cholesterol is a common condition in the United States, affecting nearly one third of adults, and is a leading precursor to coronary heart disease. This study investigates race/ethnic differences in treatment recommendations for patients with high cholesterol, including prescription medication and lifestyle changes such as eating less fat, losing weight, or exercising more.Design: Data were obtained from the 2005 to 2010 National Health and Nutrition Examination Survey (N = 4846), a representative sample of adults in the United States, and the 2005-2010 National Ambulatory Medical Care Survey (N = 12,113), a representative sample of patient visits in the United States. Logistic regression analyses were used to assess whether health professionals recommended lifestyle changes or medication prescriptions differently by patient race/ethnicity and age. Models adjusted for demographic characteristics, socioeconomic status, health behaviors, health care access/utilization, and comorbidities.Results: Non-Hispanic Black and Hispanic patients with high cholesterol were significantly and substantially more likely to receive recommendations for lifestyle changes compared to non-Hispanic White patients. These differences were exacerbated at younger ages and largely diminished for adults over the age of 65. These patterns were reflected in both datasets. However, non-Hispanic Black patients from the NHANES analysis were less likely than non-Hispanic White patients to receive medication prescriptions for high cholesterol, particularly at younger ages. There were no race/ethnic differences in odds of medication prescriptions for Hispanic patients compared to White patients.Conclusions: Results suggest widespread and pervasive race/ethnic differences in recommending lifestyle changes for patients with high cholesterol. Although lifestyle changes may lower cholesterol they are often less effective than prescription medication. Because differences in lifestyle recommendations were not reflected in prescription practices, results may indicate a form of discrimination within physician-patient interactions that could be addressed by increased provider education about most effective treatment practices.

Having and being a personal physician: vision of the Pisacano scholars

Having a strong relationship with a personal physician can improve patient health outcomes. Yet achieving and sustaining this type of patient-physician relationship is often not possible in the current American health care system. Pisacano scholars and alumni, a group of young physician leaders supported by the American Board of Family Medicine, gathered for a 2-day symposium in June 2010 to explore the meaning of personal doctoring and its importance to our work as family physicians. Using the techniques of appreciative inquiry, the group discussed three questions: What is it like to have a personal physician? What is it like to be a personal physician? and, What are some feasible next steps toward making this possible? Symposium participants concluded that achieving the ideal patient-physician relationship for all patients and physicians would involve extensive alterations to the current health care system beyond what is outlined in the 2010 Patient Protection and Affordable Care Act. However, in the context of current health reform efforts, individual physicians, researchers, and policy makers must not lose sight of the importance of the patient-physician relationship and should continue to take concrete steps on an individual and system level to move us closer to this ideal.

The influence of patient expectations regarding cure on treatment decisions

OBJECTIVE

To test whether cancer patients' expectations for cure prior to interacting with their oncologist influence their decisions to follow treatment recommendations. Further, to test whether patients' expectations for cure are affected by the strength of the oncologist-patient alliance or the extent to which companions (if present) share patients' expectations for cure.

METHODS

Interactions of 101 patients (and 114 companions) with oncologists about treatment were coded for the strength of the oncologist-patient alliance. Prior to the interaction, patients and companions reported expectations about whether the patient would be cured of cancer. After the interaction, patients reported whether they intended to follow the recommended treatment.

RESULTS

Patients who expected a cure were more likely to report an intention to follow oncologists' treatment recommendation when the strength of their alliance with their oncologist was weaker (B=-0.51, p<.05). Patients whose expectations for cure matched their companions' expectations were less likely to report intentions to follow treatment recommendations (B=-0.28, p<.05).

CONCLUSION

Patients who have an expectation of being cured of cancer prior to meeting with their oncologist are more likely to intend to follow recommended treatment when their alliance with the oncologist is weaker and their companions do not believe they will be cured.

PRACTICE IMPLICATIONS

To better understand patient treatment decisions and improve overall cancer care, oncologists should be aware of the complex ways that patients' expectations about cure influence treatment choices.