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Mandhana DM, Jacome CS, Ballard DI, Tesfai Y, Johnson SB, Gionfriddo MR, Espinoza Suarez NR, Perneth SA, Su L, Montori VM. Developing and validating the Unhurried Conversations Assessment Tool (UCAT). Patient Educ Couns 2024; 123:108237. [PMID: 38461793 DOI: 10.1016/j.pec.2024.108237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/29/2024] [Accepted: 02/29/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Given the importance of unhurried conversations for providing careful and kind care, we sought to create, test, and validate the Unhurried Conversations Assessment Tool (UCAT) for assessing the unhurriedness of patient-clinician consultations. METHODS In the first two phases, the unhurried conversation dimensions were identified and transformed into an assessment tool. In the third phase, two independent raters used UCAT to evaluate the unhurriedness of 100 randomly selected consultations from 184 videos recorded for a large research trial. UCAT's psychometric properties were evaluated using this data. RESULTS UCAT demonstrates content validity based on the literature and expert review. EFA and reliability analyses confirm its construct validity and internal consistency. The seven formative dimensions account for 89.93% of the variance in unhurriedness, each displaying excellent internal consistency (α > 0.90). Inter-rater agreement for the overall assessment item was fair (ICC = 0.59), with individual dimension ICCs ranging from 0.26 (poor) to 0.95 (excellent). CONCLUSION UCAT components comprehensively assess the unhurriedness of consultations. The tool exhibits content and construct validity and can be used reliably. PRACTICE IMPLICATIONS UCAT's design and psychometric properties make it a practical and efficient tool. Clinicians can use it for self-evaluations and training to foster unhurried conversations.
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Affiliation(s)
- Dron M Mandhana
- Department of Communication, Villanova University, Villanova, PA, USA; Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Cristian Soto Jacome
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Norwalk Hospital, Department of Internal Medicine, Nuvance Health, Norwalk, CT, USA
| | - Dawna I Ballard
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
| | - Yohanna Tesfai
- Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
| | - Sarah B Johnson
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Michael R Gionfriddo
- Division of Pharmaceutical, Administrative, and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
| | - Nataly R Espinoza Suarez
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Centre for Sustainable Health Research, Integrated University Health and Social Services Center of Capitale-Nationale, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Sandra Algarin Perneth
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Lillian Su
- Division of Cardiovascular Intensive Care Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Victor M Montori
- Knowledge & Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA.
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Khaleghzadegan S, Rosen M, Links A, Ahmad A, Kilcullen M, Boss E, Beach MC, Saha S. Validating computer-generated measures of linguistic style matching and accommodation in patient-clinician communication. Patient Educ Couns 2024; 119:108074. [PMID: 38070297 DOI: 10.1016/j.pec.2023.108074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To explore the validity of computer-analyzed linguistic style matching (LSM) in patient-clinician communication. METHODS Using 330 transcribed HIV patient encounters, we quantified word use with Linguistic Inquiry and Word Count (LIWC), a dictionary-based text analysis software. We measured LSM by calculating the degree to which clinicians matched patients in the use of LIWC "function words" (e.g., articles, pronouns). We tested associations of different LSM metrics with patients' perceptions that their clinicians spoke similiarly to them. RESULTS We developed 3 measures of LSM: 1) at the whole-visit level; (2) at the turn-by-turn level; and (3) using a "rolling-window" approach, measuring matching between clusters of 8 turns per conversant. None of these measures was associated with patient-rated speech similarity. However, we found that increasing trajectories of LSM, from beginning to end of the visit, were associated with higher patient-rated speech similarity (β 0.35, CI 0.06, 0.64), compared to unchanging trajectories. CONCLUSIONS Our findings point to the potential value of clinicians' adapting their communication style to match their patients, over the course of the visit. PRACTICE IMPLICATIONS With further validation, computer-based linguistic analyses may prove an efficient tool for generating data on communication patterns and providing feedback to clinicians in real time.
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Affiliation(s)
- Salar Khaleghzadegan
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
| | - Michael Rosen
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alya Ahmad
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Molly Kilcullen
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Boss
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Catherine Beach
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Somnath Saha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, USA
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Anderson JN, Paladino AJ, Blue R, Dangerfield DT, Eggly S, Martin MY, Schwartzberg LS, Vidal GA, Graetz I. Silent suffering: the impact of sexual health challenges on patient-clinician communication and adherence to adjuvant endocrine therapy among Black women with early-stage breast cancer. J Cancer Surviv 2023:10.1007/s11764-023-01511-0. [PMID: 38114711 DOI: 10.1007/s11764-023-01511-0] [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: 05/08/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Adjuvant endocrine therapy (AET) increases sexual health challenges for women with early-stage breast cancer. Black women are more likely than women of other racial/ethnic groups to report adverse symptoms and least likely to initiate and maintain AET. Little is known about how sexual health challenges influence patient-clinician communication and treatment adherence. This study explores facilitators of and barriers to patient-clinician communication about sexual health and how those factors might affect AET adherence among Black women with early-stage breast cancer. METHODS We conducted 32 semi-structured, in-depth interviews among Black women with early-stage breast cancer in the U.S. Mid-South region. Participants completed an online questionnaire prior to interviews. Data were analyzed using thematic analysis. RESULTS Participants' median age was 59 (range 40-78 years, SD = 9.0). Adverse sexual symptoms hindered participants' AET adherence. Facilitators of patient-clinician communication about sexual health included female clinicians and peer support. Barriers included perceptions of male oncologists' disinterest in Black women's sexual health, perceptions of male oncologists' biased beliefs about sexual activity among older Black women, cultural norms of sexual silence among Southern Black women, and medical mistrust. CONCLUSIONS Adverse sexual symptoms and poor patient-clinician communication about sexual health contribute to lower AET adherence among Black women with early-stage breast cancer. New interventions using peer support models and female clinicians trained to discuss sexual health could ameliorate communication barriers and improve treatment adherence. IMPLICATIONS FOR CANCER SURVIVORS Black women with early-stage breast cancer in the U.S. Mid-South may require additional resources to address sociocultural and psychosocial implications of cancer survivorship to enable candid discussions with oncologists.
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Affiliation(s)
- Janeane N Anderson
- College of Nursing, University of Tennessee Health Science Center, 874 Union Avenue, Memphis, TN, 38163, USA.
| | - Andrew J Paladino
- College of Medicine, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38103, USA
| | - Ryan Blue
- College of Nursing, University of Tennessee Health Science Center, 874 Union Avenue, Memphis, TN, 38163, USA
| | - Derek T Dangerfield
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave. NW #308, Washington, D.C, 20037, USA
| | - Susan Eggly
- Department of Oncology, School of Medicine, Wayne State University, 87 E. Canfield, Detroit, MI, 48201, USA
| | - Michelle Y Martin
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, 66 N. Pauline Street, Memphis, TN, 38163, USA
| | | | - Gregory A Vidal
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN, 38138, USA
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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McDarby M, Silverstein HI, Rosa WE, Parker PA, Carpenter BD. Patient and caregiver questions and clinician responses during initial outpatient neuropalliative care appointments. PEC Innov 2023; 3:100207. [PMID: 37700766 PMCID: PMC10494256 DOI: 10.1016/j.pecinn.2023.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
Objective Open communication during appointments exemplifies person-centered care. The current study characterized questions asked by persons with neurologic illnesses and their caregivers-and clinicians' responses to those questions-during initial outpatient palliative care appointments. Methods We coded type (direct or indirect) and topic of questions stated by patients and their caregivers in audio recordings from 38 initial outpatient palliative care appointments. We also coded the completeness and quality features of clinicians' responses. Results Patients and caregivers stated 556 total questions; most were direct questions (79.7%) and primarily about symptoms, treatment, and lifestyle issues. Clinicians responded to more than 90% of all questions. Responses to both question types were similar in completeness and quality, but clinicians more frequently offered support in response to direct questions and gave recommendations in response to indirect questions. Conclusion Persons with neurologic illnesses and their caregivers use different question types to obtain information about symptoms and treatment during initial palliative care appointments. Results may guide clinician training and patient education for optimizing information exchange in palliative care. Innovation This study is the first to explore patient and caregiver use of indirect questions in neuropalliative care appointments and the quality of clinicians' responses to those questions.
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Affiliation(s)
- Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Hannah I. Silverstein
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, United States of America
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Patricia A. Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Brian D. Carpenter
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, United States of America
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5
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Raisa A, Alpert JM, Bylund CL, Jarad-Fodeh S. Identifying the mechanisms of patient-centred communication in secure messages between clinicians and cancer patients. PEC Innov 2023; 2:100161. [PMID: 37384151 PMCID: PMC10294087 DOI: 10.1016/j.pecinn.2023.100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/18/2023] [Accepted: 04/11/2023] [Indexed: 06/30/2023]
Abstract
Objective Identify how patients and clinicians incorporate patient-centered communication (PCC) within secure messaging. Methods A random sample of 199 secure messages from patient portal communication between patients and clinicians were collected and analyzed. Via manual annotation, the task of tagging target words/phrases in text, we identified five components of PCC: information giving, information seeking, emotional support, partnership, and shared decision-making. Textual analysis was also performed to understand the context of PCC expressions within messages. Results Information-giving was the predominant (n = 346, 68.1%) PCC category used in secure messaging, more than double of the other four PCC codes, information-seeking (n = 82, 16.1%), emotional support (n = 52, 10.2%), shared decision making (n = 5, 1.0%), combined. The textual analysis revealed that clinicians informed patients about appointment reminders and new protocols while patients reminded clinicians about upcoming procedures and outcomes of test results conducted by other clinicians. Although less common, patients expressed statements of concern, uncertainty, and fear; enabling clinicians to provide support. Conclusion Secure messaging is mainly used for exchanging information, but other aspects of PCC emerge using this channel of communication. Innovation Meaningful discussions can occur via secure messaging, and clinicians should be mindful of incorporating PCC when communicating with patients through secure messaging.
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Affiliation(s)
- Aantaki Raisa
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Jordan M. Alpert
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Carma L. Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Samah Jarad-Fodeh
- Department of Emergency Medicine, Yale School of Public Health – Biostatistics, Yale Center for Medical Informatics, Yale University, New Haven, CT, USA
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Wollney EN, Vasquez TS, Stalvey C, Close J, Markham MJ, Meyer LE, Cooper LA, Bylund CL. Are evaluations in simulated medical encounters reliable among rater types? A comparison between standardized patient and outside observer ratings of OSCEs. PEC Innov 2023; 2:100125. [PMID: 37214504 PMCID: PMC10194306 DOI: 10.1016/j.pecinn.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/20/2022] [Accepted: 01/20/2023] [Indexed: 05/24/2023]
Abstract
Objective By analyzing Objective Structured Clinical Examination (OSCE) evaluations of first-year interns' communication with standardized patients (SP), our study aimed to examine the differences between ratings of SPs and a set of outside observers with training in healthcare communication. Methods Immediately following completion of OSCEs, SPs evaluated interns' communication skills using 30 items. Later, two observers independently coded video recordings using the same items. We conducted two-tailed t-tests to examine differences between SP and observers' ratings. Results Rater scores differed significantly on 21 items (p < .05), with 20 of the 21 differences due to higher SP in-person evaluation scores. Items most divergent between SPs and observers included items related to empathic communication and nonverbal communication. Conclusion Differences between SP and observer ratings should be further investigated to determine if additional rater training is needed or if a revised evaluation measure is needed. Educators may benefit from adjusting evaluation criteria to decrease the number of items raters must complete and may do so by encompassing more global questions regarding various criteria. Furthermore, evaluation measures may be strengthened by undergoing reliability and validity testing. Innovation This study highlights the strengths and limitations to rater types (observers or SPs), as well as evaluation methods (recorded or in-person).
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Affiliation(s)
- Easton N. Wollney
- Dept. of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Taylor S. Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Carolyn Stalvey
- Dept. of Internal Medicine, College of Medicine, University of Florida, Gainesville, FL USA
| | - Julia Close
- Dept. of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Merry Jennifer Markham
- Dept. of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lynne E. Meyer
- Graduate Medical Education, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lou Ann Cooper
- Dept. of Medical Education, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Carma L. Bylund
- Dept. of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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Huynh K, Brito JP, Bylund CL, Prokop LJ, Ospina NS. Understanding diagnostic conversations in clinical practice: A systematic review. Patient Educ Couns 2023; 116:107949. [PMID: 37660463 PMCID: PMC11002943 DOI: 10.1016/j.pec.2023.107949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/15/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Summarize frameworks to understand diagnostic conversations and assessments of diagnostic conversations in practice. METHODS We systematically searched MEDLINE, Scopus, Cochrane, and other databases from inception to July 2022 for reports of diagnostic conversations. Two authors independently reviewed studies for eligibility, assessed methodological quality with the mixed methods appraisal tool and extracted information related to study characteristics, frameworks and components evaluated in assessments of diagnostic conversations and results. RESULTS Eight studies were included. One study reported an empiric framework of diagnostic conversations that included the following components: identifying the problem that requires diagnosis, obtaining information, and delivering the diagnosis and treatment plan. Thematic analyses highlighted communication between patients and clinicians as central in diagnostic conversations as it allows a) patient's presentation of their symptoms which guide subsequent diagnostic steps, b) negotiation of the significance of the patient's symptoms through conversation and c) introducing and resolving diagnostic uncertainty. CONCLUSION Despite the importance of diagnostic conversation only one empiric framework described its components. Additionally, limited available evidence suggests patients can have an important role in the diagnostic process that expands beyond patients as an information source. PRACTICE IMPLICATIONS Patients should be included as active partners in co-development of diagnostic plans of care.
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Affiliation(s)
- Ky Huynh
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Juan P Brito
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | | | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA.
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Allgood S, Park J, Soleiman K, Saha S, Han D, McArthur A, Moore RD, Beach MC. Taxonomy and effectiveness of clinician agenda-setting questions in routine ambulatory encounters: A mixed method study. Patient Educ Couns 2023; 115:107889. [PMID: 37480792 DOI: 10.1016/j.pec.2023.107889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES Despite decades of communication training, studies repeatedly demonstrate that clinicians fail to elicit patients' agendas. Our goal was to provide clinicians with actionable guidance about the effectiveness of agenda-soliciting questions. METHODS We coded clinician agenda-soliciting questions and patient responses in audio-recorded ambulatory encounters at an urban academic hospital. To evaluate the association between question type and odds of the patient raising a concern, we performed mixed-effects logistic regression. RESULTS We identified 346 agenda-soliciting questions within 138 visits (mean 2.51/visit; range 0-9). Agenda-soliciting questions were categorized as personal state inquiries (37%, "How are you?"), feeling-focused (5% "How're you feeling?"), problem-focused (12%; "Are you having any problems"), direct solicitations (3%; "Anything you want to discuss today?"), "what else" (3%), "anything else" (14%), leading (16%; "Nothing else today?"), and space-reducing (11% "Anything else? Smoking?"). Patients raised a concern in response to 107 clinician questions (27%). Patients were more likely to raise a concern to direct solicitation (OR 22.95, 95% CI 2.62-200.70) or "what else" (OR 4.68, 95% CI 1.05-20.77) questions. CONCLUSIONS The most effective agenda-soliciting questions are used least frequently by clinicians. PRACTICE IMPLICATIONS Clinicians should elicit patient agendas by using direct language, and solicit additional concerns using "what else" vs. "anything else" questions.
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Affiliation(s)
| | - Jenny Park
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Dingfen Han
- Johns Hopkins University, Baltimore, MD, USA
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Eliacin J, Matthias MS, Cameron KA, Burgess DJ. Veterans' views of PARTNER-MH, a peer-led patient navigation intervention, to improve patient engagement in care and patient-clinician communication: A qualitative study. Patient Educ Couns 2023; 114:107847. [PMID: 37331280 DOI: 10.1016/j.pec.2023.107847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE In this study, we report on participants' experiences of PARTNER-MH, a peer-led, patient-navigation intervention for racially and ethnically minoritized patients in Veterans Health Administration mental health services aimed at improving patient engagement in care and patient-clinician communication. Participants described their views of PARTNER-MH, barriers and facilitators to the intervention's implementation, and their application of varied intervention concepts to improve engagement in care and communication with their mental health clinicians. METHODS This is a qualitative analysis of the PARTNER-MH pilot randomized controlled trial. Participants participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Rapid data analysis approach was used to analyze the data. RESULTS Participants (n = 13) perceived PARTNER-MH as an acceptable intervention, and viewed use of peers as interventionists, long-term outreach and engagement efforts, and navigation services favorably. Barriers to implementation included limited flexibility in peers' schedules and lack of peer/participant gender concordance, as well as limited options for program delivery modality. Three main themes summarized participants' views and perceived benefits of PARTNER-MH that contributed to improved patient-clinician communication: 1) increased patient engagement, 2) improved patient-clinician relationship, and 3) enhanced communication self-efficacy. CONCLUSIONS Participants viewed PARTNER-MH as beneficial and identified several intervention components that contributed to improved engagement in care, communication self-efficacy, and patient-clinician communication. PRACTICE IMPLICATION Some patients, especially minoritized patients and those who have been disenfranchised from healthcare systems may benefit from peer-led interventions that facilitate engagement in care and communication self-efficacy to improve patient-clinician communication and healthcare outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04515771.
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Affiliation(s)
- Johanne Eliacin
- National Center for PTSD, VA Boston Healthcare System, Boston, USA; HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA; Regenstrief Institute, Indianapolis, USA; Indiana University School of Medicine, Department of General Internal Medicine and Geriatrics, Indianapolis, USA.
| | - Marianne S Matthias
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA; Regenstrief Institute, Indianapolis, USA; Indiana University School of Medicine, Department of General Internal Medicine and Geriatrics, Indianapolis, USA
| | - Kenzie A Cameron
- Northwestern University, Feinberg School of Medicine, Division of General Internal Medicine, Chicago, USA
| | - Diana J Burgess
- Minneapolis VA Healthcare System, Center for Care Delivery and Outcomes Research, Minneapolis, USA; University of Minnesota, Department of Medicine, Minneapolis, USA
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Brooks JV, Zegers C, Sinclair CT, Wulff-Burchfield E, Thimmesch AR, English D, Nelson-Brantley HV. Understanding the Cures Act Information Blocking Rule in cancer care: a mixed methods exploration of patient and clinician perspectives and recommendations for policy makers. BMC Health Serv Res 2023; 23:216. [PMID: 36879318 PMCID: PMC9990332 DOI: 10.1186/s12913-023-09230-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The 21st Century Cures Act Interoperability and Information Blocking Rule was created to increase patient access to health information. This federally mandated policy has been met with praise and concern. However, little is known about patient and clinician opinions of this policy within cancer care. METHODS We conducted a convergent parallel mixed methods study to understand patient and clinician reactions to the Information Blocking Rule in cancer care and what they would like policy makers to consider. Twenty-nine patients and 29 clinicians completed interviews and surveys. Inductive thematic analysis was used to analyze the interviews. Interview and survey data were analyzed separately, then linked to generate a full interpretation of the results. RESULTS Overall, patients felt more positive about the policy than clinicians. Patients wanted policy makers to understand that patients are unique, and they want to individualize their preferences for receiving health information with their clinicians. Clinicians highlighted the uniqueness of cancer care, due to the highly sensitive information that is shared. Both patients and clinicians were concerned about the impact on clinician workload and stress. Both expressed an urgent need for tailoring implementation of the policy to avoid unintended harm and distress for patients. CONCLUSIONS Our findings provide suggestions for optimizing the implementation of this policy in cancer care. Dissemination strategies to better inform the public about the policy and improve clinician understanding and support are recommended. Patients who have serious illness or diagnoses such as cancer and their clinicians should be included when developing and enacting policies that could have a significant impact on their well-being. Patients with cancer and their cancer care teams want the ability to tailor information release based on individual preferences and goals. Understanding how to tailor implementation of the Information Blocking Rule is essential for retaining its benefits and minimizing unintended harm for patients with cancer.
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Affiliation(s)
- Joanna Veazey Brooks
- University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Carli Zegers
- University of Kansas School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Christian T Sinclair
- University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | | | - Amanda R Thimmesch
- University of Kansas School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Daniel English
- University of Kansas School of Nursing, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
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Golembiewski EH, Espinoza Suarez NR, Maraboto Escarria AP, Yang AX, Kunneman M, Hassett LC, Montori VM. Video-based observation research: A systematic review of studies in outpatient health care settings. Patient Educ Couns 2023; 106:42-67. [PMID: 36207219 DOI: 10.1016/j.pec.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine the use of video-based observation research in outpatient health care encounter research. METHODS We conducted a systematic search of MEDLINE, Scopus, Cochrane and other databases from database inception to October 2020 for reports of studies that used video recording to investigate ambulatory patient-clinician interactions. Two authors independently reviewed all studies for eligibility and extracted information related to study setting and purpose, participant recruitment and consent processes, data collection procedures, method of analysis, and participant sample characteristics. RESULTS 175 articles were included. Most studies (65%) took place in a primary care or family practice setting. Study objectives were overwhelmingly focused on patient-clinician communication (81%). Reporting of key study elements was inconsistent across included studies. CONCLUSION Video recording has been used as a research method in outpatient health care in a limited number and scope of clinical contexts and research domains. In addition, reporting of study design, methodological characteristics, and ethical considerations needs improvement. PRACTICE IMPLICATIONS Video recording as a method has been relatively underutilized within many clinical and research contexts. This review will serve as a practical resource for health care researchers as they plan and execute future video-based studies.
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Affiliation(s)
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Family Medicine and Emergency Medicine Laval University Quebec, Canada.
| | - Andrea P Maraboto Escarria
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Department of Obstetrics and Gynecology Hospital Angeles Lomas Mexico City, Mexico.
| | - Andrew X Yang
- Mayo Clinic Alix School of Medicine Rochester, MN, USA.
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences Leiden University Medical Center Leiden, the Netherlands.
| | - Leslie C Hassett
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Medicine Mayo Clinic, Rochester, MN, USA.
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit Mayo Clinic Rochester, MN, USA; Mayo Clinic Libraries Mayo Clinic, Rochester, MN, USA.
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12
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Dwyer LA, Epstein RM, Feeney BC, Blair IV, Bolger N, Ferrer RA. Responsive social support serves important functions in clinical communication: Translating perspectives from relationship science to improve cancer clinical interactions. Soc Sci Med 2022; 315:115521. [PMID: 36384086 PMCID: PMC9722606 DOI: 10.1016/j.socscimed.2022.115521] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/26/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
Patient-clinician interactions are critical to patient-centered care, including in cancer care contexts which are often defined by multiple patient-clinician interactions over an extended period. Research on these dyadic interactions has been guided by perspectives in clinical communication science, but the study of clinical communication has not been fully integrated with perspectives on interpersonal interactions from relationship science research. An overlapping concept in both fields is the concept of responsive socialsupport. In this article, we discuss responsiveness as a concept that offers opportunities for connections between these two disciplines. Next, we focus on how relationship science can be applied to research in clinical settings. We discuss how three areas of relationship science define responsiveness and have potential for extension to clinical communication: (1) (in)visibility of social support, (2) attachment orientations, and (3) shared meaning systems. We also discuss how social biases can impede responsiveness and suggest research avenues to develop ideas and understand potential challenges in connecting these two fields. Many opportunities exist for interdisciplinary theory development that can generate momentum in understanding interpersonal processes in cancer care.
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Affiliation(s)
| | - Ronald M Epstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Brooke C Feeney
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Irene V Blair
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Niall Bolger
- Department of Psychology, Columbia University, New York, NY, USA
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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13
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Espinoza Suarez NR, LaVecchia CM, Morrow AS, Fischer KM, Kamath C, Boehmer KR, Brito JP. ABLE to support patient financial capacity: A qualitative analysis of cost conversations in clinical encounters. Patient Educ Couns 2022; 105:3249-3258. [PMID: 35918230 DOI: 10.1016/j.pec.2022.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore how costs of care are discussed in real clinical encounters and what humanistic elements support them. METHODS A qualitative thematic analysis of 41 purposively selected transcripts of video-recorded clinical encounters from trials run between 2007 and 2015. Videos were obtained from a corpus of 220 randomly selected videos from 8 practice-based randomized trials and 1 pre-post prospective study comparing care with and without shared decision making (SDM) tools. RESULTS Our qualitative analysis identified two major themes: the first, Space Needed for Cost Conversations, describes patients' needs regarding their financial capacity. The second, Caring Responses, describes humanistic elements that patients and clinicians can bring to clinical encounters to include good quality cost conversations. CONCLUSION Our findings suggest that strengthening patient-clinician human connections, focusing on imbalances between patient resources and burdens, and providing space to allow potentially unexpected cost discussions to emerge may best support high quality cost conversations and tailored care plans. PRACTICE IMPLICATIONS We recommend clinicians consider 4 aspects of communication, represented by the mnemonic ABLE: Ask questions, Be kind and acknowledge emotions, Listen for indirect signals and (discuss with) Every patient. Future research should evaluate the practicality of these recommendations, along with system-level improvements to support implementation of our recommendations.
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Affiliation(s)
- Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Centre for Sustainable Health Research, Laval University, Quebec, QC, Canada
| | | | - Allison S Morrow
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - Karen M Fischer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, MN, USA
| | - Celia Kamath
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Juan P Brito
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, MN, USA.
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14
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Nugent SM, Golden SE, Sullivan DR, Thomas CR, Wisnivesky J, Saha S, Slatore CG. Patient-clinician communication and patient-centered outcomes among patients with suspected stage I non-small cell lung cancer: a prospective cohort study. Med Oncol 2022; 39:203. [PMID: 36175802 DOI: 10.1007/s12032-022-01776-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/15/2022] [Indexed: 10/14/2022]
Abstract
Among patients with suspected early-stage non-small cell lung cancer (NSCLC), we sought to evaluate the association of patient-clinician communication (PCC) with patient-centered outcomes (PCOs). We conducted a multicenter, prospective cohort study examining PCOs at five time points, up to 12-months post-treatment. We used generalized estimating equation (GEE) models adjusted for sociodemographic and clinical variables to examine the relationship between PCC (dichotomized as high- or low-quality) and decisional conflict, treatment self-efficacy, and anxiety. The cohort included 165 patients who were 62% male with a mean age of 70.7 ± SD 8.1 years. Adjusted GEE analysis including 810 observations revealed high-quality PCC was associated with no decisional conflict (adjusted odds ratio [aOR] = 0.14, 95% CI = 0.07 to 0.27) and higher self-efficacy (β = -0.26, 95% CI = -0.37 to -0.14). High-quality PCC was not associated with moderately severe anxiety (aOR = 0.68, 95% CI = 0.41 to 1.09), though was associated with decreased anxiety scores (β = -3.91, 95% CI = -6.48 to -1.35). Among individuals with suspected early-stage NSCLC, high-quality PCC is associated with less decisional conflict and higher self-efficacy; the relationship with anxiety is unclear. Clinicians should prioritize enhanced treatment-related communication at critical and vulnerable periods in the cancer care trajectory to improve PCOs.
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Affiliation(s)
- Shannon M Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA. .,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA. .,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth University, Lebanon, NH, USA
| | - Juan Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth University, Lebanon, NH, USA.,Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, USA
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15
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Flickinger TE, Waselewski M, Tabackman A, Huynh J, Hodges J, Otero K, Schorling K, Ingersoll K, Tiouririne NAD, Dillingham R. Communication between patients, peers, and care providers through a mobile health intervention supporting medication-assisted treatment for opioid use disorder. Patient Educ Couns 2022; 105:2110-2115. [PMID: 35260260 PMCID: PMC10112280 DOI: 10.1016/j.pec.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 05/02/2023]
Abstract
INTRODUCTION Our team developed the HOPE app as a clinic-based platform to support patients receiving medication assisted treatment (MAT) for opioid use disorder. We investigated the app's two communication features: an anonymous community message board (CMB) and secure messaging between patients and their clinic team. METHODS The HOPE (Heal Overcome Persist Endure) app was piloted with patients and MAT providers. Text from the CMB and messaging were downloaded and de-identified. Content analysis was performed using iteratively developed codebooks with team consensus. RESULTS The pilot study enrolled 28 participants; 25 were "members" (patients) and 3 were providers (physician, nurse, social worker). Of member-generated CMB posts, 45% described the poster's state of mind, including positive and negative emotions, 47% conveyed support and 8% asked for support. Members' secure messages to the team included 52% medical, 45% app-related, and 8% social topics. Provider's messages contained information exchange (90%) and relationship-building (36%). DISCUSSION Through the CMB, members shared emotions and social support with their peers. Through secure messaging, members addressed medical and social needs with their care team, used primarily for information exchange but also relationship-building. PRACTICE IMPLICATIONS The HOPE app addresses communication needs for patients in MAT and can support them in recovery.
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Affiliation(s)
- Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Marika Waselewski
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alexa Tabackman
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Jacqueline Hodges
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kori Otero
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kelly Schorling
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Nassima Ait-Daoud Tiouririne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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16
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Freytag J, Chu J, Hysong SJ, Street RL, Markham CM, Giordano TP, Westbrook RA, Njue-Marendes S, Johnson SR, Dang BN. Acceptability and feasibility of video-based coaching to enhance clinicians' communication skills with patients. BMC Med Educ 2022; 22:85. [PMID: 35135521 PMCID: PMC8822679 DOI: 10.1186/s12909-021-02976-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 09/08/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Despite a growing call to train clinicians in interpersonal communication skills, communication training is either not offered or is minimally effective, if at all. A critical need exists to develop new ways of teaching communication skills that are effective and mindful of clinician time pressures. We propose a program that includes real-time observation and video-based coaching to teach clinician communication skills. In this study, we assess acceptability and feasibility of the program using clinician interviews and surveys. METHODS The video-based coaching intervention targets five patient-centered communication behaviors. It uses trained communication coaches and live feed technology to provide coaching that is brief (less than 15 min), timely (same day) and theory-informed. Two coaches were trained to set up webcams and observe live video feeds of clinician visits in rooms nearby. As coaches watched and recorded the visit, they time stamped illustrative clips in real time. Video clips were a critical element of the program. During feedback sessions, coaches used video clips to promote discussion and self-reflection. They also used role play and guided practice techniques to enforce new tips. Clinicians included residents (n = 15), fellows (n = 4), attending physicians (n = 3), and a nurse practitioner (n = 1) at two primary care clinics in Houston, Texas. We administered surveys to clinicians participating in the program. The survey included questions on quality and delivery of feedback, and credibility of the coaches. We also interviewed clinicians following the intervention. We used rapid analysis to identify themes within the interviews. RESULTS Survey measures showed high feasibility and acceptability ratings from clinicians, with mean item scores ranging from 6.4 to 6.8 out of 7 points. Qualitative analysis revealed that clinicians found that 1) coaches were credible and supportive, 2) feedback was useful, 3) video-clips allowed for self-reflection, 4) getting feedback on the same day was useful, and 5) use of real patients preferred over standardized patients. CONCLUSIONS Video-based coaching can help clinicians learn new communication skills in a way that is clinician-centered, brief and timely. Our study demonstrates that real-time coaching using live feed and video technology is an acceptable and feasible way of teaching communication skills.
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Affiliation(s)
- Jennifer Freytag
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
| | - Jinna Chu
- Baylor College of Medicine, Houston, USA
| | - Sylvia J Hysong
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
| | - Richard L Street
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Baylor College of Medicine, Houston, USA
- Texas A&M University, College Station, USA
| | | | - Thomas P Giordano
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
| | - Robert A Westbrook
- Jesse H. Jones Graduate School of Business, Rice University, Houston, USA.
| | - Sarah Njue-Marendes
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
| | - Syundai R Johnson
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
| | - Bich N Dang
- VA Center for Innovations in Quality, Effectiveness, and Safety, Houston, USA
- Michael E. DeBakey VA Medical Center, Houston, USA
- Baylor College of Medicine, Houston, USA
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17
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Evers AWM, Colloca L, Blease C, Gaab J, Jensen KB, Atlas LY, Beedie CJ, Benedetti F, Bingel U, Büchel C, Bussemaker J, Colagiuri B, Crum AJ, Finniss DG, Geers AL, Howick J, Klinger R, Meeuwis SH, Meissner K, Napadow V, Petrie KJ, Rief W, Smeets I, Wager TD, Wanigasekera V, Vase L, Kelley JM, Kirsch I. What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus. Psychother Psychosom 2021; 90:49-56. [PMID: 33075796 DOI: 10.1159/000510738] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. OBJECTIVE There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information. METHODS Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients. RESULTS There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities. CONCLUSIONS The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients' needs, and on developing standardized disclosure training modules for clinicians.
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Affiliation(s)
- Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands, .,Erasmus University Rotterdam & Delft University of Technology, Rotterdam/Delft, The Netherlands,
| | - Luana Colloca
- Departments of Pain Translational Symptoms Science and Anesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jens Gaab
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin B Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institute of Mental Health, and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Chris J Beedie
- School of Psychology, University of Kent, Canterbury, United Kingdom
| | - Fabrizio Benedetti
- Physiology and Neuroscience, University of Turin Medical School, Turin, Italy
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jet Bussemaker
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ben Colagiuri
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, California, USA
| | | | - Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Jeremy Howick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Regine Klinger
- Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie H Meeuwis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Karin Meissner
- Division of Health Promotion, University of Applied Sciences, Coburg, Germany
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Ionica Smeets
- Science Communication and Society, Institute of Biology, Leiden University, Leiden, The Netherlands
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - John M Kelley
- Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA
| | - Irving Kirsch
- Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA
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18
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Kennedy DL, Olsen MK, Yang H, Gao X, Alkon A, Prose NS, Dunbar K, Jackson LR, Pollak KI. Communication Coaching in Cardiology (CCC): A study protocol and methodological challenges and solutions of a randomized controlled trial in outpatient cardiology clinics. Contemp Clin Trials 2021; 105:106389. [PMID: 33798730 DOI: 10.1016/j.cct.2021.106389] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/19/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
Given the role of effective communication in improving patient adherence and satisfaction, high quality patient-clinician communication is critical. Building on previous communication interventions in oncology and pediatrics, we developed a tailored communication coaching intervention to improve empathic communication quality and patient-centered care. In this randomized controlled trial, cardiologists record their patient encounters for review by a communication coach who provides tailored feedback. We are recruiting 40 cardiologists and 400 patients, or 4 patients per cardiologist in the Pre-intervention phase and 6 patients per cardiologists in the Post-intervention phase, from outpatient cardiology clinics within the Duke Health System. The primary goal of the trial is to determine the efficacy of the clinician communication coaching versus usual care in the post-intervention phase (240 patient encounters). In this paper, we describe the development of the communication coaching intervention. We also describe the details of the methods and outcomes of the ongoing trial. Finally, we discuss the challenges, solutions, and lessons learned during the start-up phase of the study.
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Affiliation(s)
- Danielle L Kennedy
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC 27710, United States of America.
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, United States of America; Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC 27705, United States of America
| | - Hongqiu Yang
- Duke Cancer Research Institute, Durham, NC 27710, United States of America
| | - Xiaomei Gao
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC 27710, United States of America
| | - Aviel Alkon
- Department of General Internal Medicine, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Neil S Prose
- Department of Dermatology and Pediatrics, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Kayla Dunbar
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Larry R Jackson
- Department of Cardiology, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Kathryn I Pollak
- Cancer Prevention and Control, Duke Cancer Institute, Durham, NC 27710, United States of America; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, United States of America
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19
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Josfeld L, Keinki C, Pammer C, Zomorodbakhsch B, Hübner J. Cancer patients' perspective on shared decision-making and decision aids in oncology. J Cancer Res Clin Oncol 2021; 147:1725-1732. [PMID: 33682014 PMCID: PMC8076112 DOI: 10.1007/s00432-021-03579-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/20/2021] [Indexed: 12/26/2022]
Abstract
Purpose Shared Decision-Making (SDM) enhances patients’ satisfaction with a decision, which in turn increases compliance with and adherence to cancer treatment. SDM requires a good patient-clinician relationship and communication, patients need information matching their individual needs, and clinicians need support on how to best involve the individual patient in the decision-making process. This survey assessed oncological patients’ information needs and satisfaction, their preferred information in patient decision aids (PDAs), and their preferred way of making decisions regarding their treatment. Methods Questionnaires were distributed among attendees of a lecture program on complementary and alternative medicine in oncology of which 220 oncological patients participated. Results Participants reported a generally high need for information—correlating with level of education—but also felt overwhelmed by the amount. The latter proved particularly important during consultation. Use of PDAs increased satisfaction with given information but occurred in less than a third of the cases. Most requested contents for PDAs were pros and cons of treatment options and lists of questions to ask. The vast majority of patients preferred SDM to deciding alone. None wanted their physician to decide for them. Conclusions There is a high demand for SDM but a lack of conclusive evidence on the specific information needs of different types of patients. Conversation between patients and clinicians needs encouragement and support. PDAs are designed for this purpose and have the potential to increase patient satisfaction. Their scarce use in consultations calls for easier access to and better information on PDAs for clinicians.
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Affiliation(s)
- Lena Josfeld
- Klinik für Innere Medizin II Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Christian Keinki
- Klinik für Innere Medizin II Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Carolina Pammer
- Klinik für Innere Medizin II Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Bijan Zomorodbakhsch
- üBAG/MVZ Onkologische Kooperation Harz GbR, Kösliner Str. 14, 38642, Goslar, Germany
| | - Jutta Hübner
- Klinik für Innere Medizin II Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
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20
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O'Neill SC, Vadaparampil ST, Street RL, Moore TF, Isaacs C, Han HS, Augusto B, Garcia J, Lopez K, Brilleman M, Jayasekera J, Eggly S. Characterizing patient-oncologist communication in genomic tumor testing: The 21-gene recurrence score as an exemplar. Patient Educ Couns 2021; 104:250-256. [PMID: 32900604 PMCID: PMC7854933 DOI: 10.1016/j.pec.2020.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/19/2020] [Accepted: 08/26/2020] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Women with early-stage, ER + breast cancer are recommend to receive genomic profiling tests, such as the 21-gene Recurrence Score (RS) test, to guide treatment decisions. We examined test- and treatment-related information discussed and the associations between RS categories and aspects of communication during patient-oncologist clinical encounters. METHODS As part of a larger trial, clinical encounters (N = 46) were audiorecorded and coded for 1) RS- and treatment-related information, 2) shared decision making, 3) patient active participation, and 4) oncologist patient-centered communication. We examined differences by RS category using mixed models, adjusting for nesting within oncologist. RESULTS Patients with a high RS were more likely to receive a chemotherapy recommendation (p < .01), hear about the risks/side effects of chemotherapy (p < .01), and offer their preferences (p = .02) than those with intermediate or low RS. Elements of shared decision making increased with RS. Oncologist patient-centered communication (M = 4.09/5, SD = .25) and patient active participation (M = 3.5/4, SD = 1.0) were high across RS. CONCLUSION Findings suggest that disease severity, rather than clinical uncertainty, impact treatment recommendations and shared decision making. PRACTICE IMPLICATIONS Oncologists adjust test- and treatment-related information and shared decision making by disease severity. This information provides a framework to inform decision making in complex cancer and genomics settings.
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Affiliation(s)
| | | | | | - Tanina Foster Moore
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
| | - Claudine Isaacs
- Department of Oncology, Georgetown University, Washintgon DC, USA
| | - Hyo S Han
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Bianca Augusto
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Jennifer Garcia
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA
| | - Katherine Lopez
- Department of Oncology, Georgetown University, Washintgon DC, USA
| | | | | | - Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, MI, USA
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21
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Keller MS, Jusufagic A, Spiegel BMR. Patient and provider differences in the treatment of opioid-induced constipation: a qualitative study. BMC Gastroenterol 2019; 19:182. [PMID: 31718543 PMCID: PMC6852732 DOI: 10.1186/s12876-019-1097-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/23/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Patients using opioids to treat chronic non-cancer pain often experience side effects that may affect health-related quality of life (HRQOL). These side effects include opioid-induced constipation (OIC), sedation, dizziness, and nausea. OIC can significantly affect HRQOL for patients on a daily basis. However, it is not well understood whether patients and clinicians view OIC management similarly. AIMS In this study, we sought to elucidate the decision-making process around managing OIC by assessing patient and provider treatment preferences, experiences, and communication regarding this condition. METHODS We conducted semi-structured interviews with 33 clinicians, and held three focus groups with patients who were currently using or had used opioids for chronic non-cancer pain. We then analyzed transcribed interviews using descriptive qualitative methods based on grounded theory methodology. RESULTS Clinicians recognized OIC as a concern but prioritized pain management over constipation. They focused on medication-based treatments for OIC, but also recommended lifestyle changes (e.g., diet) and reducing opioids to relieve symptoms. Patients reported using over-the-counter treatments, but the majority focused on diet-related constipation management. Patients reported not receiving adequate information from clinicians about OIC and relevant treatments. Cost of treatment was a major concern for both patients and clinicians. CONCLUSIONS Assessing experiences with and preferences for OIC treatment, including cost, ease of access, and side effects, could improve patient-provider communication and HRQOL. Quality improvement efforts can target uncovered misalignments between patients and clinicians to improve communication about opioid medication adverse effects and relevant treatment options, which may help improve quality of life for patients with chronic pain.
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Affiliation(s)
- Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA. .,Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Dr. S., 31-269 CHS, Box 951772, Los Angeles, CA, 90095, USA.
| | - Alma Jusufagic
- Penn State University College of Medicine, Hershey, PA, USA
| | - Brennan M R Spiegel
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Dr. S., 31-269 CHS, Box 951772, Los Angeles, CA, 90095, USA.,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), 116 N Robertson Blvd, Suite 800, Los Angeles, CA, 90048, USA
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22
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Pilote L, Côté L, Chipenda Dansokho S, Brouillard É, Giguère AMC, Légaré F, Grad R, Witteman HO. Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational study. BMC Med Inform Decis Mak 2019; 19:84. [PMID: 30975132 PMCID: PMC6460774 DOI: 10.1186/s12911-019-0800-5] [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: 10/06/2017] [Accepted: 03/18/2019] [Indexed: 01/31/2023] Open
Abstract
Background Shared decision making is associated with improved patient outcomes in radiation oncology. Our study aimed to capture how shared decision-making practices–namely, communicating potential harms and benefits and discussing what matters to patients–occur in usual care. Methods We invited a convenience sample of clinicians and patients in a radiation oncology clinic to participate in a mixed methods study. Prior to consultations, clinicians and patients completed self-administered questionnaires. We audio-recorded consultations and conducted qualitative content analysis. Patients completed a questionnaire immediately post-consultation about their recall and perceptions. Results 11 radiation oncologists, 4 residents, 14 nurses, and 40 patients (55% men; mean age 64, standard deviation or SD 9) participated. Patients had a variety of cancers; 30% had been referred for palliative radiotherapy. During consultations (mean length 45 min, SD 16), clinicians presented a median of 8 potential harms (interquartile range 6–11), using quantitative estimates 17% of the time. Patients recalled significantly fewer harms (median recall 2, interquartile range 0–3, t(38) = 9.3, p < .001). Better recall was associated with discussing potential harms with a nurse after seeing the physician (odds ratio 7.5, 95% confidence interval 1.3–67.0, p = .04.) Clinicians initiated 63% of discussions of harms and benefits while patients and families initiated 69% of discussions about values and preferences (Chi-squared(1) = 37.8, p < .001). 56% of patients reported their clinician asked what mattered to them. Conclusions Radiation oncology clinics may wish to use interprofessional care and initiate more discussions about what matters to patients to heed Jain’s (2014) reminder that, “a patient isn’t a disease with a body attached but a life into which a disease has intruded.”
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Affiliation(s)
- Laurie Pilote
- Division of Radiation Oncology, Department of Medicine, CHU de Québec, 11, Côte du Palais, Quebec City, QC, G1R 0A2, Canada
| | - Luc Côté
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Population Health and Optimal Health Practices Research, 10 rue de l'Espinay, Hôpital Saint François d'Assise D6, Quebec City, QC, G1L 3L5, Canada
| | - Selma Chipenda Dansokho
- Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Émilie Brouillard
- Division of Radiation Oncology, Department of Medicine, CHU de Québec, 11, Côte du Palais, Quebec City, QC, G1R 0A2, Canada
| | - Anik M C Giguère
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Quebec Excellence Centre on Aging, Research Centre of the CHU de Quebec, St-Sacrement Hospital, Local L2-08, 1050 chemin Sainte-Foy, Quebec City, QC, G1S 4L8, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL) CERSSPL-UL, 880, rue Père-Marquette, 3e étage, Québec, QC, G1S 2A4, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Population Health and Optimal Health Practices Research, 10 rue de l'Espinay, Hôpital Saint François d'Assise D6, Quebec City, QC, G1L 3L5, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL) CERSSPL-UL, 880, rue Père-Marquette, 3e étage, Québec, QC, G1S 2A4, Canada
| | - Roland Grad
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858, chemin de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada.,Herzl Family Practice Centre, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, E-740, Montreal, QC, H3T 1E2, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Population Health and Optimal Health Practices Research, 10 rue de l'Espinay, Hôpital Saint François d'Assise D6, Quebec City, QC, G1L 3L5, Canada. .,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL) CERSSPL-UL, 880, rue Père-Marquette, 3e étage, Québec, QC, G1S 2A4, Canada.
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23
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Pérez-Stable EJ, El-Toukhy S. Communicating with diverse patients: How patient and clinician factors affect disparities. Patient Educ Couns 2018; 101:2186-2194. [PMID: 30146407 PMCID: PMC6417094 DOI: 10.1016/j.pec.2018.08.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Patient-clinician communication (PCC) may generate or reduce healthcare disparities. This paper is based on the 2017 International Conference on Communication in Healthcare keynote address and reviews PCC literature as a research area for the National Institute on Minority Health and Health Disparities (NIMHD). METHODS A narrative review of selected evidence on disparities in PCC experienced by race and ethnic minorities, associations between PCC and poor health outcomes, and patient and clinician factors related to PCC. RESULTS Factors associated with poor quality PCC on the patient level include being a member of racial/ethnic minority, having limited English proficiency, and low health and digital literacy; on the clinician level, being less culturally competent, lacking communication skills to facilitate shared decision-making, and holding unconscious biases. Recommendations include offering patient- and/or clinician-targeted interventions to guard against unconscious biases and improve PCC, screening patients for health literacy and English proficiency, integrating PCC in performance processes, and leveraging health information technologies to address unconscious biases. CONCLUSION EffectivePCC is a pathway to decrease health disparities and promote health equity. PRACTICE IMPLICATIONS Standardized collection of social determinants of health in the Electronic Health Record is an importantfirst step in promoting more effective PCC.
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Affiliation(s)
- Eliseo J Pérez-Stable
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, USA.
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24
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Evers AW, Colloca L, Blease C, Annoni M, Atlas LY, Benedetti F, Bingel U, Büchel C, Carvalho C, Colagiuri B, Crum AJ, Enck P, Gaab J, Geers AL, Howick J, Jensen KB, Kirsch I, Meissner K, Napadow V, Peerdeman KJ, Raz A, Rief W, Vase L, Wager TD, Wampold BE, Weimer K, Wiech K, Kaptchuk TJ, Klinger R, Kelley JM. Implications of Placebo and Nocebo Effects for Clinical Practice: Expert Consensus. Psychother Psychosom 2018; 87:204-210. [PMID: 29895014 PMCID: PMC6191882 DOI: 10.1159/000490354] [Citation(s) in RCA: 268] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/22/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Placebo and nocebo effects occur in clinical or laboratory medical contexts after administration of an inert treatment or as part of active treatments and are due to psychobiological mechanisms such as expectancies of the patient. Placebo and nocebo studies have evolved from predominantly methodological research into a far-reaching interdisciplinary field that is unravelling the neurobiological, behavioural and clinical underpinnings of these phenomena in a broad variety of medical conditions. As a consequence, there is an increasing demand from health professionals to develop expert recommendations about evidence-based and ethical use of placebo and nocebo effects for clinical practice. METHODS A survey and interdisciplinary expert meeting by invitation was organized as part of the 1st Society for Interdisciplinary Placebo Studies (SIPS) conference in 2017. Twenty-nine internationally recognized placebo researchers participated. RESULTS There was consensus that maximizing placebo effects and minimizing nocebo effects should lead to better treatment outcomes with fewer side effects. Experts particularly agreed on the importance of informing patients about placebo and nocebo effects and training health professionals in patient-clinician communication to maximize placebo and minimize nocebo effects. CONCLUSIONS The current paper forms a first step towards developing evidence-based and ethical recommendations about the implications of placebo and nocebo research for medical practice, based on the current state of evidence and the consensus of experts. Future research might focus on how to implement these recommendations, including how to optimize conditions for educating patients about placebo and nocebo effects and providing training for the implementation in clinical practice.
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Affiliation(s)
- Andrea W.M. Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands,*Andrea W.M. Evers, Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, PO Box 9555, NL–2300 RB Leiden (The Netherlands), E-Mail
| | - Luana Colloca
- Department of Pain Translational Symptoms Science and Anaesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Charlotte Blease
- Department of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Marco Annoni
- Department of Institute of Biomedical Technologies, National Research Council, Rome, Italy
| | - Lauren Y. Atlas
- Department of Section on Affective Neuroscience and Pain, NIH, Bethesda, Massachusetts, USA
| | - Fabrizio Benedetti
- Department of Physiology and Neuroscience, University of Turin Medical School, Turin, Italy
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Carvalho
- Department of Clinical and Health Psychology, Instituto Universitário de Ciências Psicológicas, Lisbon, Portugal
| | - Ben Colagiuri
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Alia J. Crum
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Jens Gaab
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Andrew L. Geers
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Jeremy Howick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Karin B. Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Irving Kirsch
- Beth Israel Deaconess Medical Center, Program in Placebo Studies, Boston, Massachusetts, USA
| | - Karin Meissner
- Division of Health Promotion, University of Applied Sciences, Coburg, Germany
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Kaya J. Peerdeman
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Amir Raz
- Departments of Psychiatry, Neurology and Neurosurgery, McGill University, Montreal, Québec, Canada
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Tor D. Wager
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA
| | - Bruce E. Wampold
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA,Modum Bad Psychiatric Center, Vikersund, Norway
| | - Katja Weimer
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Katja Wiech
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Ted J. Kaptchuk
- Beth Israel Deaconess Medical Center, Program in Placebo Studies, Boston, Massachusetts, USA
| | - Regine Klinger
- Department of Pain Translational Symptoms Science and Anaesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - John M. Kelley
- Beth Israel Deaconess Medical Center, Program in Placebo Studies, Boston, Massachusetts, USA
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25
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Duberstein PR, Chen M, Chapman BP, Hoerger M, Saeed F, Guancial E, Mack JW. Fatalism and educational disparities in beliefs about the curability of advanced cancer. Patient Educ Couns 2018; 101:113-118. [PMID: 28716485 PMCID: PMC5732080 DOI: 10.1016/j.pec.2017.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 07/05/2017] [Accepted: 07/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Understanding socioeconomic disparities in the care of patients with incurable cancer is a high priority. We hypothesized that patients without a high school education are more likely to believe that they could be cured and we explored the role of fatalism. METHODS We studied 977 patients with advanced, incurable cancer. Two logistic regression analyses were conducted. Model One examined the effect of education on beliefs about curability. Model Two added fatalism. RESULTS The significant association between having less than a high school education and the belief that advanced cancer can be cured (OR=2.55; 95% CI: 1.09-5.96) in Model One was attenuated by 39% and rendered nonsignificant in Model Two. Fatalism was associated with the belief that advanced cancer can be cured. Whites were less likely to believe they could be cured than Blacks and Asians/Pacific Islanders. Beliefs about curability were not associated with income or insurance status. CONCLUSIONS People who do not complete high school are more likely to believe that their advanced cancer is curable, in part because they are more likely to hold fatalistic worldviews. PRACTICE IMPLICATIONS Interventions to help oncologists care for patients with fatalistic beliefs could mitigate socioeconomic disparities in end-of-life care.
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Affiliation(s)
- Paul R Duberstein
- Departments of Psychiatry, Medicine, and Family Medicine, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY, 14642, USA.
| | - Michael Chen
- Department of Public Health Sciences, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY, 14642, USA.
| | - Benjamin P Chapman
- Departments of Psychiatry and Public Health Sciences, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY, 14642, USA.
| | - Michael Hoerger
- Departments of Psychiatry, Medicine, and Psychology, Tulane University, 2007 Percival Stern Hall, New Orleans, LA, 70118, USA.
| | - Fahad Saeed
- Department of Medicine, Divisions of Nephrology and Palliative Care, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA.
| | - Elizabeth Guancial
- Department of Medicine and Wilmot Cancer Institute, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA.
| | - Jennifer W Mack
- Department of Pediatric Oncology and Division of Population Sciences, Dana Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA; 25 Shattuck Street, Boston, MA 02115, USA
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26
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Beach MC, Laws MB, Rose G, Roter D, Lee Y, Chander G, Woodson T, Moore RD, Rogers W, Wilson IB. Effects of Minimal Versus Intensive Intervention to Enhance Motivational Interviewing in HIV Care. AIDS Behav 2018; 22:276-286. [PMID: 28578544 PMCID: PMC5712480 DOI: 10.1007/s10461-017-1794-6] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We conducted a randomized trial comparing the effect of two different levels of motivational interviewing training on clinician communication behaviors and patient experiences. We enrolled 12 HIV clinicians who attended a one-day MI workshop focusing on behavior change counseling skills. We then randomized clinicians to receive (or not) 3-5 rounds of personalized feedback from the MI trainer. We compared outcomes before and after the interventions and between the intervention groups. We tested time-by-study arm interactions to determine if one group improved more than the other. For all analyses, we used generalized estimating equations to account for clustering of patients within clinicians, with Gaussian or negative binomial distributions as appropriate. Patients of clinicians in both intervention groups rated their visits as more MI consistent (6.86 vs. 6.65, p = 0.005) and audio-recording analysis revealed that visits were more patient-centered (1.34 vs. 0.96, p = 0.003) with a more positive patient affect (22.36 vs. 20.84, p < 0.001) after versus before the intervention, without differences between intervention arms. Several specific clinician behaviors such as empathic statements, asking patient opinions and open-ended questions improved more in the workshop+feedback versus the workshop-only intervention arm. A few specific communication behaviors increased (total and complex reflections) after versus before the intervention, without differences between intervention arms. The workshop alone was as effective as the workshop plus feedback in improving patient experiences and overall communication measures. Certain communication behaviors improved more with the more intensive intervention, but these additional benefits may not warrant the extra financial and logistical resources required.
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Affiliation(s)
| | | | - Gary Rose
- William James College, Boston, MA, USA
| | - Debra Roter
- Johns Hopkins University, Baltimore, MD, USA
| | - Yoojin Lee
- Brown School of Public Health, Providence, RI, USA
| | | | | | | | - William Rogers
- Institute for Health Care and Clinical Policy Studies, Tufts Medical Center, Boston, USA
| | - Ira B Wilson
- Brown School of Public Health, Providence, RI, USA
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27
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Nugent SM, Golden SE, Thomas CR Jr, Deffebach ME, Sukumar MS, Schipper PH, Tieu BH, Moghanaki D, Wisnivesky J, Slatore C. Patient-clinician communication among patients with stage I lung cancer. Support Care Cancer 2018; 26:1625-33. [PMID: 29209835 DOI: 10.1007/s00520-017-3992-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/20/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Limited data exist about patient-centered communication (PCC) and patient-centered outcomes among patients who undergo surgery or stereotactic body radiation therapy (SBRT) for stage I non-small cell lung cancer (NSCLC). We aimed to examine the relationship between PCC and decision-making processes among NSCLC patients, using baseline data from a prospective, multicenter study. METHODS Patients with stage 1 NSCLC completed a survey prior to treatment initiation. The survey assessed sociodemographic characteristics, treatment decision variables, and patient psychosocial outcomes: health-related quality of life (HRQOL), treatment self-efficacy, decisional conflict, and PCC. RESULTS Fifty-two percent (n = 85) of 165 individuals planned to receive SBRT. There were no baseline differences detected on patient psychosocial outcomes between those who planned to receive SBRT or surgery. All participants reported high HRQOL (M = 72.5, SD = 21.3) out of 100, where higher scores indicate better functioning; high self-efficacy (M = 1.5, SD = 0.5) out of 6, where lower numbers indicate higher self-efficacy; minimal decisional conflict (M = 15.2, SD = 12.7) out of 100, where higher scores indicate higher decisional conflict; and high levels of patient-centered communication (M = 2.4, SD = 0.8) out of 7 where higher scores indicate worse communication. Linear regression analyses adjusting for sociodemographic and clinical variables showed that higher quality PCC was associated with higher self-efficacy (β = 0.17, p = 0.03) and lower decisional conflict (β = 0.42, p < 0.001). CONCLUSIONS Higher quality PCC was associated with higher self-efficacy and lower decisional conflict. Self-efficacy and decisional conflict may influence subsequent health outcomes. Therefore, our findings may inform future research and clinical programs that focus on communication strategies to improve these outcomes.
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28
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Trujols J, González-Saiz F, Manresa MJ, Alcaraz S, Batlle F, Duran-Sindreu S, Pérez de Los Cobos J. Patient perception of methadone dose adequacy in methadone maintenance treatment: The role of perceived participation in dosage decisions. Patient Educ Couns 2017; 100:981-986. [PMID: 27988071 DOI: 10.1016/j.pec.2016.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/13/2016] [Accepted: 12/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In clinical practice, methadone maintenance treatment (MMT) entails tailoring the methadone dose to the patient's specific needs, thereby individualizing treatment. The aim of this study was to identify the independent factors that may significantly explain methadone dose adequacy from the patient's perspective. METHOD Secondary analysis of data collected in a treatment satisfaction survey carried out among a representative sample of MMT patients (n=122) from the region of La Rioja (Spain). As part of the original study protocol, participants completed a comprehensive battery to assess satisfaction with MMT, psychological distress, opinion of methadone as a medication, participation in dosage decisions, and perception of dose adequacy. RESULTS Multivariate binary logistic regression showed that the only variable independently associated with the likelihood of a patient perceiving methadone dose as inadequate was the variable perceived-participation in methadone dosage decisions (OR=0.538, 95% CI=0.349-0.828). CONCLUSION Patient participation in methadone dosage decisions was predictive of perceived adequacy of methadone dose beyond the contribution of other socio-demographic, clinical, and MMT variables. PRACTICE IMPLICATIONS Patient participation in methadone dosage decision-making is valuable for developing a genuinely patient-centred MMT.
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Affiliation(s)
- Joan Trujols
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Biomedical Research Networking Center on Mental Health (CIBERSAM), Barcelona, Spain.
| | - Francisco González-Saiz
- Community Mental Health Unit of Villamartín, Mental Health Clinical Management Unit of Hospital de Jerez de la Frontera, Northern Area Health Management of Cádiz, Andalusian Health Service, Spain; Addictive Disorders Network (RTA), Granada, Spain
| | - María José Manresa
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Saul Alcaraz
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Francesca Batlle
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain
| | - Santiago Duran-Sindreu
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Biomedical Research Networking Center on Mental Health (CIBERSAM), Barcelona, Spain
| | - José Pérez de Los Cobos
- Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Biomedical Research Networking Center on Mental Health (CIBERSAM), Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Spain
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Steel E, Robbins A, Jenkins M, Flander L, Gaff C, Keogh L. How does genetic risk information for Lynch syndrome translate to risk management behaviours? Hered Cancer Clin Pract 2017; 15:1. [PMID: 28070225 PMCID: PMC5217251 DOI: 10.1186/s13053-016-0061-6] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/09/2016] [Indexed: 01/16/2023] Open
Abstract
Background There is limited research on why some individuals who have undergone predictive genetic testing for Lynch syndrome do not adhere to screening recommendations. This study aimed to explore qualitatively how Lynch syndrome non-carriers and carriers translate genetic risk information and advice to decisions about risk managment behaviours in the Australian healthcare system. Methods Participants of the Australasian Colorectal Cancer Family Registry who had undergone predictive genetic testing for Lynch syndrome were interviewed on their risk management behaviours. Transcripts were analysed thematically using a comparative coding analysis. Results Thirty-three people were interviewed. Of the non-carriers (n = 16), 2 reported having apparently unnecessary colonoscopies, and 6 were unsure about what population-based colorectal cancer screening entails. Of the carriers (n = 17), 2 reported they had not had regular colonoscopies, and spoke about their discomfort with the screening process and a lack of faith in the procedure’s ability to reduce their risk of developing colorectal cancer. Of the female carriers (n = 9), 2 could not recall being informed about the associated risk of gynaecological cancers. Conclusion Non-carriers and female carriers of Lynch syndrome could benefit from further clarity and advice about appropriate risk management options. For those carriers who did not adhere to colonoscopy screening, a lack of faith in both genetic test results and screening were evident. It is essential that consistent advice is offered to both carriers and non-carriers of Lynch syndrome.
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Affiliation(s)
- Emma Steel
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
| | - Andrew Robbins
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Louisa Flander
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Clara Gaff
- Walter and Eliza Hall Institute, Melbourne, Australia
| | - Louise Keogh
- Centre for Health Equity, The University of Melbourne, Melbourne, Australia
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Pollak KI, Nagy P, Bigger J, Bilheimer A, Lyna P, Gao X, Lancaster M, Watkins RC, Johnson F, Batish S, Skelton JA, Armstrong S. Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices. Patient Educ Couns 2016; 99:300-303. [PMID: 26320822 DOI: 10.1016/j.pec.2015.08.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Studies indicate needed improvement in clinician communication and patient satisfaction. Motivational interviewing (MI) helps promote patient behavior change and improves satisfaction. In this pilot study, we tested a coaching intervention to teach MI to all clinic staff to improve clinician and patient satisfaction. METHODS We included four clinics (n=29 staff members). In the intervention clinics (one primary care and one pediatric obesity-focused), we trained all clinic staff in MI through meetings as a group seven times, directly observing clinicians in practice 4-10 times, and providing real-time feedback on MI techniques. In all clinics, we assessed patient satisfaction via anonymous surveys and also assessed clinician burnout and self-rated MI skills. RESULTS Clinicians in the intervention clinics reported improvements in burnout scores, self-rated MI skills, and perceived cohesion whereas clinicians in the control clinic reported worse scores. Patient satisfaction improved in the intervention clinics more than in the control clinics. CONCLUSION This is the first study to find some benefit of training an entire clinic staff in MI via a coaching model. PRACTICE IMPLICATIONS It might help to train staff in MI to improve clinician satisfaction, team cohesion, perceived skills, and patient satisfaction.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA; Department of Community and Family Medicine, Duke School of Medicine, Durham, USA.
| | - Paul Nagy
- Department of Psychiatry, Duke School of Medicine, Durham, USA
| | | | - Alicia Bilheimer
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA
| | - Pauline Lyna
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA
| | - Xiaomei Gao
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA
| | | | | | - Fred Johnson
- Division of Community Health, Department of Community and Family Medicine, Duke School of Medicine, Durham, USA
| | | | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, USA
| | - Sarah Armstrong
- Department of Pediatrics, Duke School of Medicine, Durham, USA
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Appel L, Abrams H, Morra D, Wu RC. Put a face to a name: a randomized controlled trial evaluating the impact of providing clinician photographs on inpatients' recall. Am J Med 2015; 128:82-9. [PMID: 25261009 DOI: 10.1016/j.amjmed.2014.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 06/11/2014] [Revised: 07/30/2014] [Accepted: 08/10/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Inpatients are visited by many health care providers daily; many cannot remember the name of even one member of their clinical care team. We provided inpatients with photographs of their clinicians and evaluated the impact on patient recall and communication with their health care providers. METHODS A concealed allocation, randomized controlled trial (ClinicalTrials.gov NCT01658644) was conducted between September 2012 and April 2013 in the general internal medicine wards of a large teaching hospital in Toronto, Canada. Consenting patients were randomized into 3 groups: the control group received the current standard of care; the second group received handouts with the names and roles of their clinical care team; and the third group received handouts with the names, roles, and photographs of their clinical care team. Before discharge, patients completed a survey on their ability to recall their clinicians and were asked to rate the quality of communication with their care team. RESULTS Of the 186 patients (mean age 61 years, female = 44%) who completed surveys (control n = 60; names n = 65; photos n = 61), those receiving photos in the handout correctly identified significantly more clinicians by photograph (P = .001) and recalled more names (P = .002) than patients assigned to the control group. Regarding the perceived quality of communication, the results did not show differences between the control and intervention groups. CONCLUSION In this era of patient-centered care, providing patients with more information about who is directly involved with their health care appears to be warranted.
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Affiliation(s)
- Lora Appel
- School of Communication and Information, Rutgers University, New Brunswick, NJ; Centre for Innovation Complex Care, Toronto, Ont, Canada.
| | - Howard Abrams
- Centre for Innovation Complex Care, Toronto, Ont, Canada; Division of General Internal Medicine, University Health Network, Toronto, Ont, Canada
| | - Dante Morra
- Department of Medicine, University of Toronto, Ont, Canada; Trillium Health Partners, Mississauga, Ont, Canada
| | - Robert C Wu
- Centre for Innovation Complex Care, Toronto, Ont, Canada; Division of General Internal Medicine, University Health Network, Toronto, Ont, Canada
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Henry SG, Feng B, Franks P, Bell RA, Tancredi DJ, Gottfeld D, Kravitz RL. Methods for assessing patient-clinician communication about depression in primary care: what you see depends on how you look. Health Serv Res 2014; 49:1684-700. [PMID: 24837881 DOI: 10.1111/1475-6773.12187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To advance research on depression communication and treatment by comparing assessments of communication about depression from patient report, clinician report, and chart review to assessments from transcripts. DATA One hundred sixty-four primary care visits from seven health care systems (2010-2011). STUDY DESIGN Presence or absence of discussion about depressive symptoms, treatment recommendations, and follow-up was measured using patient and clinician postvisit questionnaires, chart review, and coding of audio transcripts. Sensitivity and specificity of indirect measures compared to transcripts were calculated. PRINCIPAL FINDINGS Patient report was sensitive for mood (83 percent) and sleep (83 percent) but not suicide (55 percent). Patient report was specific for suicide (86 percent) but not for other symptoms (44-75 percent). Clinician report was sensitive for all symptoms (83-98 percent) and specific for sleep, memory, and suicide (80-87 percent), but not for other symptoms (45-48 percent). Chart review was not sensitive for symptoms (50-73 percent), but it was specific for sleep, memory, and suicide (88-96 percent). All indirect measures had low sensitivity for treatment recommendations (patient report: 24-42 percent, clinician report 38-50 percent, chart review 49-67 percent) but high specificity (89-96 percent). For definite follow-up plans, all three indirect measures were sensitive (82-96 percent) but not specific (40-57 percent). CONCLUSIONS Clinician report and chart review generally had the most favorable sensitivity and specificity for measuring discussion of depressive symptoms and treatment recommendations, respectively.
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Affiliation(s)
- Stephen G Henry
- Division of General Medicine, Geriatrics, and Bioethics, Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA
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