Patient-Partners as Educators: Vulnerability Related to Sharing of Lived Experience

Patient-partners are invaluable in health professions' education. Sharing their lived experiences with prospective and current healthcare providers can provide an opportunity for these participants to hone their patient-centric skills. However, sharing stories publicly is a vulnerable role and may feel emotionally risky for patient-partners. Using reflective dialogue, this manuscript outlines recommendations through the Sender-Receiver Model of Communication for Patient-Partners encounters when working with patient-partners in health professions' education. These recommendations include recognizing that: Patient-partners need to consider if they are ready to share their story. Some stories are wounds requiring further healing; other stories are scars fully processed by patient-partners and ready to be shared publicly.The audience should differentiate between questions that can promote critical thinking versus feel like a "personal attack." Audiences should recognize vulnerability patient-partners may experience in sharing their stories and engage accordingly.Pre-session and post-session debriefs are important. Shared stories may elicit intense emotions from patient-partners and audiences. Both groups should be given an opportunity to process and work through emotions.

What Do You Want Us to Know?: Learning From Life Stories to Improve Veterans' Healthcare Experiences

My Life My Story (MLMS) is a national Veterans Health Administration (VA) life story interview program that aims to provide more humanistic care for veterans by focusing on the patient as a person. Our project took place at the Pittsburgh VA Healthcare System and had 3 main goals: (1) describe themes that emerge in MLMS interviews from the prompting question, what do you want your healthcare provider to know about you?; (2) identify topics of importance to veterans and suggest ways for healthcare providers to explore them; and (3) foster a culture at the Pittsburgh VA that places not only the health but also the personal triumphs, hardships, and aspirations of veterans at the center. Veterans provided verbal consent to have their previously recorded stories used in this study. Stories were coded and then analyzed for patterns and themes. A total of 17 veterans participated in our study. Themes that emerged from the stories include (1) Early Hardships; (2) Economic Disadvantage; (3) Polaroid Snapshots; (4) Around the World; (5) Haunted by Combat; (6) Life-altering Moments; (7) Homecoming; (8) Romantic Beginnings & Obstacles; (9) Inequity across Gender & Race; and (10) Facing Mortality. This study's findings underscore the need to address the traumas associated with military service, as well as the challenges faced with re-integration into civilian life, when working with veterans. The MLMS interviews explored in this study can help clinicians identify topics of importance to veterans, strengthen their relationships with their patients, and improve the care that veterans receive.

Reimagining Relationship-Based Health Care in a Post-COVID World

The US health care system has a long history of discouraging the creation and maintenance of meaningful relationships between patients and providers. Fee-for-service payment models, the 1-directional, paternalistic approach of care providers, electronic health records, anddocumentation requirements, all present barriers to the development of meaningful relationships in clinic visits. As patients and providers adopt and experiment with telemedicine and other systems changes to accommodate the impact of Coronavirus disease 2019, there is an opportunity to reimagine visits entirely—both office-based and virtual—and leverage technology to transform a unidirectional model into one that values relationships as critical facilitators of health and well-being for both patients and providers.

Hearing the Voice of a Shadow Child: Healthy Siblings Experience of Cystic Fibrosis and Other Life-Threatening Conditions

Cystic fibrosis (CF) is a chronic, life-threatening disease, similar to other chronic life-disrupting pediatric conditions, and this creates physical and psychosocial problems for parents and the healthy sibling/s of the sick child, who often become sibling carers. It is feared that, despite good intentions, professionals fail to hear the authentic voice of those intimately involved, especially these sibling carers, who can feel they became a “shadow child.” This study is a partnership between an academic and a former CF sibling carer, who wrote a “fairy story” for his children about the Uncle they never knew. It is an effort to hear the “voice of shadow children” who can feel left behind and unseen as families and professionals focus upon their ill sibling.

Philosophical Hermeneutics and Teaching Through Behandlung: The Treatment and Handling of Patients With Care

The purpose of this Feature article is to share a teaching approach for academic researchers and clinicians about the treatment of patients beyond their biomedical needs. To achieve this objective, we will delve into the writings of H-G Gadamer which offer a relational approach to the healing process through the exploration of how the German word Behandlung applies to medical and dental education. Through conversational philosophical hermeneutics, Gadamer endeavors to unite the consciousness of one subject with that of the others and refers to the process as appropriation whereby the researcher/clinician is working toward understanding the experience of the individual within the context of a community of patient experiences.

High Civic-Mindedness Reduces Compassion Fatigue in the First 3 Years of Professional Physical Therapist Practice: A Pilot Study

Introduction

Clinicians with compassion fatigue (CF) experience behavioral, cognitive, and emotional changes due to repeated exposure to second-hand trauma from the clients with whom they are working. A civic-minded professional possesses the core value of social responsibility. Physical therapy (PT) education programs must balance a focus on developing social responsibility and compassion against the risk of CF.

Objective

The objectives of this study were to (1) describe the prevalence of CF in a sample of physical therapists in the early years of practice and (2) to determine whether higher civic-mindedness leads to the development of CF in physical therapists.

Method

Three cohorts of recent graduates were administered the Professional Quality of Life (Pro-QOL) survey to measure CF. Thirty-five of 127 surveys sent (27.6% response rate) were completed.

Results

A Mann-Whitney U was run to determine differences in the Pro-QOL survey between those scoring high or low in civic-mindedness at graduation. Higher civic-mindedness scores exhibited significantly lower burnout and higher compassion satisfaction.

Conclusion

Higher levels of civic-mindedness appear to have a protective effect against developing CF.

Why Companion Animals Are Beneficial During COVID-19 Pandemic

Companion animals and pets can be helpful during the novel coronavirus-19 pandemic. Interactions with them and positive physical contact lead to a variety of physiological and psychological benefits. It also releases biochemicals which can further boost the immune system and enhance health and well-being. This perspective discusses the benefits of these interactions, the modes of interactions and the activities that can be used. It also highlights the individuals that should avoid this approach and the status of the animal’s health before engaging with them.

"Won't You Be My Doctor?": Four Keys to a Satisfying Relationship in an Increasingly Virtual World

Despite rapid technological advances in healthcare, medicine is still largely practiced in a doctor’s office one conversation at a time. This reality is changing rapidly during the COVID-19 pandemic as face-to-face conversations with primary care practitioners are being replaced by virtual visits conducted by phone or video conferencing. Communication challenges in patient-practitioner relationships exist in face-to-face visits and they are accentuated in virtual ones. Absent a physical examination and other sensory data, conversation is the primary means by which safe, satisfying care depends. We present 4 steps to help patients and practitioners work together to obtain optimal results from virtual or face-to-face visits, summarized by the acronym PREP: Prepare, Rehearse, Engage, and Persist. Based on 80 years of combined clinical practice and research, we recommend strategies to help bridge the gap between what patients want and deserve in their medical visits and practitioners’ understanding of their patients’ concerns.

Development of a Communications Program to Support Care of Critically Ill Coronavirus Disease 2019 (COVID-19) Patients

A significant role of intensive care unit (ICU) workforce is ongoing communication with and support for families of critically ill patients. The COVID-19 pandemic has created unanticipated challenges to this essential function. Restrictions on visitors to hospitals and unprecedented clinical demands hamper traditional communication between ICU staff and patient families. In response to this challenge, we created a dedicated communications service to provide comprehensive support to families of COVID-19 patients, and to create capacity for our ICU teams to focus on patient care. In this brief report, we describe the development, implementation, and preliminary experience with the service.

Exploring Dimensions of Empowerment from the Patients' Perspective in One Specialist Epilepsy Service in Ireland

Empowerment is integral to patient-centered practice, particularly as this relates to people with chronic conditions, though operationally it is poorly understood in this context. Empowerment, therefore, as experienced by patients with a chronic condition needs exploration. This article reports the experience of empowerment by patients in one specialist epilepsy service in Ireland as an exemplar of broader issues affecting empowerment of patients with chronic conditions. A Frameworks Approach was used to analyze in-depth interviews with patients (n = 10) in one Irish epilepsy service. Analysis was further informed by nonparticipatory observation of service delivery. Results indicate that patients' negative experiences of empowerment appear to be derived from traditional social norms relating to clinician patient power dimensions and social stigma internalized by clinicians at an unconscious level. With this in mind, educational approaches based upon critical social theory may provide a framework and guide to enable services to engage with these issues and embrace empowerment of patients with chronic conditions within therapeutic engagement.

Creating Virtual Presence During a Pandemic

This article describes ways in which telemedicine has reshaped the doctor-patient relationship, and how we may face the challenge of maintaining a clinician's presence in the virtual environment.

An Insider View of the Cancer Radiation Experience Through the Eyes of a Cancer Patient

While oncology providers see and treat thousands of cancer patients every year, few have had cancer themselves, or know what’s it like to be in the shoes of a cancer patient days in and days out. This article written by a cancer survivor, writer, and experience design consultant lifts the lid on the cancer patient experience, for the benefit of noncancer patients. Through visual imageries, the author helps oncology providers and caregivers visualize and realize the vulnerability of the cancer experience and discover the treatment experience through new eyes. The article reveals emotional, mental, and somatic stressors, which add stress and/or trauma to the treatment experience and have been largely overlooked by health-care providers.

Patient Experience in Health Professions Curriculum Development

To enhance student learning, many health profession programs are embracing involvement of patients in their curricula, yet little is known about the impact of such an experience on patients.

OBJECTIVE

To understand the experiences of patients who contributed to the creation of a Verbatim Reader's Theater used in health professions curriculum.

METHODS

A semi-structured interview was conducted with a focus group of 3 patients who participated in curriculum development. The interview was recorded, transcribed verbatim, and analyzed for themes using van Manen approach to hermeneutic phenomenology.

RESULTS

Five themes emerged: (1) contextualizing contribution, (2) addressing expectations, (3) changing health-care service delivery, (4) sharing common experiences, and (5) coordinating participation.

CONCLUSION

Patients had a positive experience contributing to curriculum development and found meaning in sharing their lived experience to shape the values of future clinicians. Strategies to promote continued success in partnership between patients and health professional curriculum developers include clear communication about the project's direction and early discussion of patient role and expectations.

Codesigning a Measure of Person-Centred Coordinated Care to Capture the Experience of the Patient: The Development of the P3CEQ

BACKGROUND

Person-centred coordinated care (P3C) is a priority for stakeholders (ie, patients, carers, professionals, policy makers). As a part of the development of an evaluation framework for P3C, we set out to identify patient-reported experience measures (PREMs) suitable for routine measurement and feedback during the development of services.

METHODS

A rapid review of the literature was undertaken to identity existing PREMs suitable for the probing person-centred and/or coordinated care. Of 74 measures identified, 7 met our inclusion criteria. We critically examined these against core domains and subdomains of P3C. Measures were then presented to stakeholders in codesign workshops to explore acceptability, utility, and their strengths/weaknesses.

RESULTS

The Long-Term Condition 6 questionnaire was preferred for its short length, utility, and tone. However, it lacked key questions in each core domain, and in response to requests from our codesign group, new questions were added to cover consideration as a whole person, coordination, care plans, carer involvement, and a single coordinator. Cognitive interviews, on-going codesign, and mapping to core P3C domains resulted in the refinement of the questionnaire to 11 items with 1 trigger question. The 11-item modified version was renamed the P3C Experiences Questionnaire.

CONCLUSIONS

Due to a dearth of brief measures available to capture people's experience of P3C for routine practice, an existing measure was modified using an iterative process of adaption and validation through codesign workshops. Next steps include psychometric validation and modification for people with dementia and learning difficulties.

Changing Roles, Changing Perspectives-Vulnerability as a Patient

As an assistant professor of nursing and nurse in an emergency department, I offer my perspective on being a patient with cancer and the element of feeling vulnerable associated with an "insiders" viewpoint of the health-care system.

Now and at the Hour of Death

With Alzheimer disease, the challenge of death can be unique to each who experience it: the caretaker, the family, the health-care professional, and the victim himself. Death of personality, of memory, and of physical skills wears away the fabric of relationships, leaving little hope of any return to normalcy. To some, this reflection exhibits how faith sustains hope and comforts those afflicted, despite the odds of inevitable loss. To others it reflects upon the poignant complexities associated with palliative care and the demand for individualized attention to the beliefs, norms, and values of each situation, no matter the culture, religion, age, or race. No two cases are ever the same in the face of death, yet for those who experience it, all must appreciate how difficult, unique, personal, and memorable such moments can be.

Patient-Centered Communication Behaviors That Correlate With Higher Patient Satisfaction Scores

Background:

With increased emphasis on improving the patient experience, clinicians are being asked to improve their patient-centered communication behaviors to improve patient satisfaction (PS) scores.

Local Problem:

The relationship between clinician communication behaviors and PS is poorly studied in the emergency department (ED) setting. The purpose of this study was to identify whether specific communication behaviors correlate with higher PS scores in the ED setting.

Methods:

During a quality improvement project, we performed 191 bedside observations of ED clinicians during their initial interaction with patients and recorded the frequency of 8 positive communication behaviors as defined by the PatientSET tool.

Interventions:

The frequency of use of the PatientSET communication behaviors was compared between known high performers in Press Ganey PS scores versus low performers.

Results:

Being a high Press Ganey performer was associated with a significantly higher frequency of performance in 6 of the 8 PatientSET communication behaviors.

Conclusions:

Positive communication behaviors such as those in the PatientSET tool occurred more frequently in ED clinicians with higher PS scores.