Co-occurrence of positive staff interactions and positive affect in memory-care residents: An observational study

OBJECTIVES

With high numbers of persons with dementia living in residential care, it is vital to maximize psychosocial well-being for this population in this setting. The current study observed whether proportions of positive affect in residents differed based on co-occurring staff (typically certified nurse assistants) interaction types.

METHODS

A trained research team observed staff/resident interactions and affect in residents with dementia in common areas of a residential memory care unit (n = 22; observations over one year, or 6999 minutes total).

RESULTS

The most observed resident affect type was neutral (53.1% of all minutes observed), followed by positive affect (44.5%). The most common staff interaction type was neutral/no interaction (81.1% of all minutes observed), followed by positive staff interactions (18.1%). There was very little resident negative affect (2.4%) and staff negative interactions (.8%) observed. When staff had neutral/no/negative interactions, residents were positive 36% of the time, whereas when staff had positive interactions with them, residents were positive 81% of the time (z = 28.84, p < .001). A qualitative review of field notes identified themes and subthemes providing a more thorough understanding and context for the resident affect and staff interactions. While quantitative analyses suggested low rates of negative staff interaction, field notes highlight that neutral or no interactions with residents sometimes comprised missed opportunities, as well as more problematic lack of interaction (ignoring).

CONCLUSIONS

Not just avoiding negative interactions, but eliciting positive social interactions between staff and residents is important in promoting positive affect and overall wellbeing in persons with dementia.

'Take 10 to talk about it': Use of a scripted, post-event debriefing tool in a neonatal intensive care unit

AIM

This study assessed the impact of a scripted, post-event debriefing tool in identifying logistical, procedural, personnel and performance obstacles and successes in a clinical setting. It was predicted that the debriefing tool would highlight the importance of routine debriefing following challenging clinical events.

METHODS

The study was conducted in a 22-bed neonatal intensive care unit at a tertiary hospital and involved all staff members in the perinatal service. The debriefing tool, a two-page form providing a structured, scripted approach, was used at the earliest opportunity after acute clinical deteriorations, emergency caesarean sections and any other critical events as decided by the neonatal team. Sessions were facilitated by either a nursing or medical member of the neonatal team. Following a 2-month trial, impact was measured via the comparison of before and after survey questions as well as review of a database of issues raised, subsequent actions and outcomes.

RESULTS

Significant, positive changes were observed for survey questions specific to the frequency of debriefing, team communication, provision of learning opportunities and identification of logistical, equipment and procedural issues. In addition, the database highlighted the significant positive impact in day-to-day practice as a result of changes initiated by the debriefing tool. All participants requested the unit to continue using the tool.

CONCLUSION

Scripted, post-event debriefing is achievable and valuable in the clinical setting. It encourages a supportive workplace culture and empowers team members to initiate practical change in their organisations.

Concealing an HIV-Positive Status in Medical Settings: Discussions in Russian Online Forums

Concealment of diagnosis is one of the most important manifestations of HIV-related stigma, which is a major barrier to addressing the growing HIV epidemic in Russia. The purpose of our research was to understand how and why people living with HIV (PLHIV) conceal their HIV status in medical settings. We analyzed data collected through two major Russian online forums for PLHIV. We found that concealing HIV status in medical settings is connected to worries about breach of confidentiality, denial of quality medical care, and judgment from health care providers. PLHIV discuss the dilemmas between risks of disclosing and potential legal or health-related consequences of concealment. We identified strategies that PLHIV use to conceal their status including falsifying medical records, hiding test results, and offering payments to doctors. Understanding status concealment is important for building more effective interactions between health care providers and PLHIV, at both the individual and the institutional levels.

Design and Preliminary Testing of the Caregiver-Centered Communication Questionnaire (CCCQ)

The study objective was to develop and test a new survey instrument that measures caregiver-centered communication. We developed a questionnaire inspired by the National Cancer Institute framework on patient-centered communication, focusing on family caregiver communication for this tool. The questionnaire includes 5 subscales: exchange of information, relationship with team, emotions, managing care, and decision-making. The initial questionnaire was reviewed by domain experts for face validity and edited further to include 30 items. We administered the modified questionnaire to 115 family caregivers of patients with serious illness in various settings. Cronbach α for the entire scale was 0.97 and ranged from 0.82 to 0.93 for the 5 subscales. Participants found that the survey addressed important concepts and that items were in most cases easy to understand. This instrument provides a structured way to assess caregiver-centered communication, addressing a pressing need for tools that measure the extent to which communication is responsive to the needs and preferences of family caregivers. Further testing and refinement are needed to improve the ease of use and examine the reliability and validity of this measure.

Perspectives on the Future of Epidemiology: A Framework for Training

Over the past century, the field of epidemiology has evolved and adapted to changing public health needs. Challenges include newly emerging public health concerns across broad and diverse content areas, new methods, and vast data sources. We recognize the need to engage and educate the next generation of epidemiologists and prepare them to tackle these issues of the 21st century. In this commentary, we suggest a skeleton framework upon which departments of epidemiology should build their curriculum. We propose domains that include applied epidemiology, biological and social determinants of health, communication, creativity and ability to collaborate and lead, statistical methods, and study design. We believe all students should gain skills across these domains to tackle the challenges posed to us. The aim is to train smart thinkers, not technicians, to embrace challenges and move the expanding field of epidemiology forward.

The effects of dispositional restrictiveness on physiological markers of challenge and threat during a hypothetical transitional period in romantic relationships

Restrictiveness, a component of relationship dominance associated with monitoring and regulating partners' behavior, is a risk factor and accelerant of Intimate Partner Violence (IPV). Few studies, however, have examined in vivo physiological responses associated with restrictiveness. Toward this end, 105 romantic couples (N = 210) completed measures of restrictiveness and had their physiological responses recorded in anticipation of and during a dyadic interaction in which they discussed a hypothetical transitional period in which one person (the discloser) revealed to their partner (the responder) that they had just gotten into their dream school or was offered their dream job. Individuals high (vs. low) in restrictiveness exhibited physiological responses indicative of greater psychological challenge (e.g., elevated cardiac output and lower peripheral resistance) in anticipation of and during the conversation. In contrast, their partners exhibited greater physiological indicators of psychological threat in anticipation of (but not during) the conversation, particularly when assigned to the discloser role. Exploratory analyses of communication behaviors corroborated the physiological data. This research integrates the biopsychosocial model of challenge and threat with theories of relationship power and dominance to demonstrate the physiological manifestations of a well-known risk factor for IPV in romantic relationships and interpersonal restrictiveness.

Improving social participation of children with autism spectrum disorder: Pilot testing of an early animal-assisted intervention in Spain

Children with autism spectrum disorder (ASD) experience moderate to profound challenges in relation to the skills required for social participation. Animal-assisted intervention (AAI) is increasingly used within early community care. However, the results of its early application in this population group are not known. This pilot study aimed to explore the feasibility of an early intervention based on the use of therapy dogs and to examine their impact on communication and social interaction skills. A within-subject quasi-experimental longitudinal design was used. The instruments for measuring results were the Assessment of Communication and Interaction Skills (ACIS) and Animal-assisted Therapy Flow Sheet, both based on observation. A total of 19 children with confirmed or probable ASD (with mean age of 46.2 months), cared for in a Spanish therapeutic unit, participated in a median of nine AAI sessions, with a mean duration of 19.9 min per session. The total ACIS score increased significantly between the initial and final assessments of the study, with communication and social interaction skills improving with a large effect size. In the Animal-assisted Therapy Flow Sheet instrument, statistically significant improvements were found in most of the items that evaluate the frequency of child-dog social relationships (look at the dog, touch it, talk to it and get involved in an activity with the animal) and child-therapist relationships (look at the therapist and talk to him/her); the effect sizes ranged from medium to large. In conclusion, the early application of an AAI is feasible and seems to improve communication and social interaction skills, both essential elements for social participation. The results suggest that this intervention may be a beneficial non-pharmacological therapy as a complementary approach within community care for children with ASD in the early years of their life.

Applying Palliative Care Principles to Communicate With Children About COVID-19

Children are seeing rapid changes to their routines and facing an unpredictable future. Palliative care teams may consider expanding their communication training and skill sets to help families consider caring ways to communicate with their children and grandchildren about the coronavirus. Palliative care teams are wise to encourage families to ground their communication with children on key values: honesty and trust, self-compassion, safety, sensitivity, connection, preparedness, community building, recognition of death as a part of the life cycle, and legacy.

[Ageing and the elderly, stereotypes and their implications]

Older people are often victims of stereotypes that have detrimental consequences, ageism with its negative and discriminatory attitudes based on age alone. It is therefore essential to be able to communicate accurately, respectfully and sympathetically with older people. The words used are important components of the care relationship. Society as a whole must act on itself and its language in order to fight against ageism and become more inclusive.

What are the psychological effects of mesothelioma on patients and their carers? A scoping review

OBJECTIVE

Despite recent advances in research, malignant mesothelioma remains an incurable and devastating disease, typically bringing shock and emotional distress to patients and carers. Little research has addressed the psychological impact on either group. This scoping review examines the current state of evidence on the psychological effects of mesothelioma on patients and carers, and identifies areas for further research.

METHODS

We searched PubMed, PsychINFO, CINAHL, the Cochrane Library and Web of Science for English-language peer-reviewed research articles published 1981 to 2019 reporting studies focussing on the psychological effects of mesothelioma on patients and carers. Following data extraction and quality appraisal, reflexive thematic analysis was used to identify themes.

RESULTS

Seventeen articles met the inclusion criteria. Carers' experiences were generally amalgamated with patients'. Three themes were developed. The Passing of Time included the importance of timing of interventions; delays in the medical journey; awareness of different time-phases in mesothelioma; and uncertainty/certainty. Dealing with Difficult Feelings reflected ubiquitous negative emotions, feelings about identity and states of being and associated coping strategies. Craving Good Communication covered issues related to sharing of information and to positive/negative aspects of communication.

CONCLUSIONS

Though limited, the evidence indicates that mesothelioma, with its high symptom-burden, incurability, rarity and asbestos-related causation, leads to complex and inter-relating psychological effects on patients and carers. These effects are both negative and positive. The sparse literature gives a partial picture and demonstrates an urgent need for more nuanced research. Studies exploring the experiences of specific groups are recommended, with particular attention required to carers.

Sexual and reproductive health communication between parents and high school adolescents in Vientiane Prefecture, Lao PDR

BACKGROUND

Adolescent health has become a priority on the global health agenda. Parent-adolescent communication regarding sexual and reproductive health (SRH) issues can help to reduce adolescent risk-taking sexual behaviours.

OBJECTIVE

This study was to describe the situation of SRH communication, and to determine the factors associated with SRH communication between high school students and their parents in Vientiane Capital prefecture, Lao PDR.

METHODS

A multistage sampling technique was applied. A self-administered questionnaire was implemented among a sample of 384 high school students aged 14-17 in Vientiane. SRH communication in this study was recorded as the frequency with which adolescents discussed with their parents at least four topics on SRH issues during a six-month period prior to the interview. Data were entered and analysed using Epi Data software version 6.0 and STATA software version 14.2.

RESULTS

Slightly more than one-fifth of the students (21.3%) communicated with parents on SRH issues. The multivariate logistic regression model showed that being a male adolescent (AOR = 2.1; 95% CI 1.2 to 3.5), urban school locations (AOR = 0.2; 95% CI 0.1 to 0.5), a mature father (AOR = 1.7; 95% CI 1.0 to 2.9), positive attitudes towards general communication with parents (AOR = 2.2; 95% CI 1.1 to 4.2) and accessibility to multiple SRH information sources (AOR = 5.2; 95% CI 2.4 to 11.4) were significantly associated with adolescent-parent communication on SRH issues.

CONCLUSION

This study showed that student-parent communication on SRH issues was low, so policymakers should develop programs to improve SRH communication skills in all schools and encourage open discussion among family members, especially with respect to the participation of adolescent girls. The positive attitudes of students and multiple sources of SRH information were also important factors in improving SRH communication.

A randomized controlled trial examining an exam room poster to prompt communication about weight

BACKGROUND

Recognition of childhood weight status is important to the adoption of healthy lifestyle behaviours.

OBJECTIVES

We assessed whether an exam room educational poster addressing weight and healthy lifestyle behaviours was acceptable to parents, prompted parent-provider communication or improved parental weight perception accuracy.

METHODS

In this multi-site randomized controlled trial, exam rooms were randomized to display the posters (English and Spanish) or not. Children ages 3 to 8 years (N = 965) attending well visits were weighed and roomed per usual clinic protocol. After the visit, parents completed a questionnaire assessing demographics, child weight status perceptions and whether they discussed weight status with provider or were shown growth charts. We used separate logistic regression analyses to examine associations between intervention status and: asking provider about child weight, being shown growth charts, and accuracy of weight perception, adjusting for covariates and clustering by exam room.

RESULTS

Of the parents who saw the poster, 97% liked seeing it and reported greater understanding of weight status visualization (96%) and healthy lifestyle behaviours (94%). Parents who saw the poster were more likely to report being shown a growth chart (OR 1.87, 95% 1.06, 3.30) but were not more likely to ask about their child's weight status nor accurately report their child's weight status.

CONCLUSIONS

An educational exam room poster about healthy weight was well-received by parents and prompted providers to show the child's growth chart but did not prompt parent-initiated conversations about weight status nor improve parental weight perception accuracy.

Teaching Death Disclosure: A Mixed-Method Comparison of Resident Self-Assessment and Standardized Patient Assessment

OBJECTIVE

To characterize how pediatric resident self-evaluation compares to standardized patient evaluations in simulated child death disclosure scenarios.

METHODS

This was a prospective, observational, mixed-methods study in which 18 second-year pediatric residents delivered the news of a death of a child to a trained standardized patient (SP) couple. The SPs evaluated residents via a quantitative global rating (1-3 scale) and via qualitative comments. Following the training, the residents completed self-assessments consisting of a global rating, qualitative comments, and their confidence related to 5 death disclosure skills.

RESULTS

Agreement between SPs and resident ratings was poor; resident scores were compared to each of their 2 SP evaluators yielding Kappa coefficients of -0.23 (95% confidence interval = -0.60 to -0.07) and -0.30 (95% confidence interval = -0.70 to -0.04). Residents uniformly rated themselves as less capable in their communication skills than SPs did. Residents reported significant increases in their confidence in discussing autopsy and organ donation. Major themes determined from the qualitative comments from SPs included nonverbal communication, verbal communication, attunement to parents, and management of next steps. Residents' comments mirrored these themes with the exception of the absence of nonverbal communication.

CONCLUSIONS

Pediatric residents underestimated their abilities in a self-assessment of their performance in a SP death disclosure scenario, demonstrating the importance of external feedback, particularly from SPs themselves. Based on SP feedback, future death disclosure trainings should emphasize nonverbal communication skills and specific behaviors that convey effective attunement to families.

To treat or not to treat, that is the question. Health Psychol Open 2020;7:2055102920943025. [PMID: 32742714 PMCID: PMC7375721 DOI: 10.1177/2055102920943025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Following a diagnosis and surgical treatment for localized breast cancer, medical oncologists present patients with adjuvant systemic therapeutic options that have been shown to reduce the risk of subsequent cancer recurrence. In this commentary, I present the challenge that resulted from my discussions with a patient and family who asked that I not only discuss options and make recommendations but also decide the choice of therapy on her behalf.

Interprofessional education and transitions of care: a case-based educational pilot experience

Interprofessional education is becoming a requirement for accreditation of most health profession programs, therefore it is necessary to share innovative experiences so all can learn from the successes and barriers of implementation. Faculty members from five health profession programs (medicine, nursing, occupational therapy, pharmacy, and physical therapy) were tasked with developing a pilot interprofessional education experience focused on transitions of care. The result was a three-phase experience in which students individually completed online virtual cases, then came together for small- and large-group discussions, and concluded by working through a simulated patient discharge. Objectives centered on recognizing the individual's professional role during transitions of care, identifying barriers to transitions of care, and evaluating strategies to improve safety during a transition. Outcomes were measured using an anonymous pre and post-experience survey. Twenty-three students completed the experience and identified key themes related to their profession's role in, and barriers to a transition of care. The majority of students strongly agreed that this experience has made them more aware of the importance of interprofessional communication, and that they would recommend this pilot experience to a colleague.

Managing Uncertainty During the Communication of Diagnostic Test Information Between Patients and Clinicians in Australian Emergency Care

We sought (a) an inductive understanding of patient and clinician perspectives and experiences of the communication of diagnostic test information and (b) a normative understanding of the management of uncertainty that occurs during the clinical encounter in emergency care. Between 2016 and 2018, 58 interviews were conducted with patients and nursing, medical, and managerial staff. Interview data were sequentially analyzed through an inductive thematic analysis, then a normative theory of uncertainty management. Themes of "Ideals," "Service Efficiency," and "Managing Uncertainty" were inductively identified as influencing the communication of diagnostic test information. A normative theory of uncertainty management highlighted (a) how these themes reflected the interaction's sociocultural context, encapsulated various criteria by which clinicians and patients evaluated the appropriateness and effectiveness of their communication, and represented competing goals during the clinical encounter, and (b) how systemic tensions between themes accounted for when diagnostic test information communication occurred, was deferred or avoided.

Biomimicry of Cellular Motility and Communication Based on Synthetic Soft-Architectures

Cells, sophisticated membrane-bound units that contain the fundamental molecules of life, provide a precious library for inspiration and motivation for both society and academia. Scientists from various disciplines have made great endeavors toward the understanding of the cellular evolution by engineering artificial counterparts (protocells) that mimic or initiate structural or functional cellular aspects. In this regard, several works have discussed possible building blocks, designs, functions, or dynamics that can be applied to achieve this goal. Although great progress has been made, fundamental-yet complex-behaviors such as cellular communication, responsiveness to environmental cues, and motility remain a challenge, yet to be resolved. Herein, recent efforts toward utilizing soft systems for cellular mimicry are summarized-following the main outline of cellular evolution, from basic compartmentalization, and biological reactions for energy production, to motility and communicative behaviors between artificial cell communities or between artificial and natural cell communities. Finally, the current challenges and future perspectives in the field are discussed, hoping to inspire more future research and to help the further advancement of this field.

Spatial Influences on Team Awareness and Communication in Two Outpatient Clinics: a Multiple Methods Study

BACKGROUND

Healthcare organizations are moving their primary care teams out of private offices into shared workspaces for many reasons, including teamwork improvement and cost reduction.

OBJECTIVE

Identify the specific aspects of layout and design that enable two fundamental processes of high-functioning teams: communication and situation awareness.

DESIGN

This was a multi-method study employing qualitative interviews, floor plan analysis, observations, behavior mapping, and surveys.

PARTICIPANTS

Two primary care clinics in a large, integrated healthcare system in the upper Midwest, with Clinic S in a suburban location and Clinic A in a rural setting. In the two clinics, a total of 36 staff members were interviewed, 57 (66% response rate) staff members were surveyed, and 2013 individual-points were recorded during 63 behavior mapping observations.

MAIN MEASURES

Communication encounters, team members' perception of the environment and teamwork, visibility, distance, functional pathways, and self-reported mode and frequency of staff communication.

KEY RESULTS

Observations, interviews, and surveys identified environmental factors that predict staff awareness and communication patterns. Visibility impacts situation awareness. Frequency of face-to-face communication increases with visibility and proximity between workstations (e.g., Clinic A nurses' intra-role communication without workstation proximity vs inter-role communication with workstation proximity: 22.6% [11.4, 33.9] vs 77.4% [66.1, 88.6], p = 0.001) and with staff members' functional paths. Visual exposure to patients predicts staff's concerns about their communication (Clinic S: 2.29 ± 0.81 vs Clinic A: 3.20 ± 0.84, p < 0.001).

CONCLUSIONS

Design and layout of team spaces have important influences on the way that team members work together. The organizational goals of the healthcare system, particularly which staff members need to work together most frequently, should drive the specific design solution.

Flattening the Curve: Minimizing the Impact of COVID-19 on a Pulmonary and Critical Care Medicine Fellowship Training Program

A pandemic threatens to disrupt many aspects of a fellowship training program. The University of Washington pulmonary and critical care fellowship program was the first in the United States to encounter coronavirus disease (COVID-19), and it has had the luxury of having adequate staffing and resources to date. In response to questions and concerns from our fellows about the pandemic, our program prioritized patient care, effective communication, and efforts to support fellow well-being. Additional considerations for programs during a health crisis include impacts on clinical care, scheduling, training, and formal education programs. Although we continue to adapt to the needs of our fellows, these early lessons learned may be helpful to those who are just beginning to experience the repercussions of COVID-19.

It Has Always Been About Relationships

Since the beginning of my nursing career in South Africa, for me, it has always been about relationships. I was three years older than my classmates in nursing school and was married before I graduated, so my social life was separate, but I made friends and enjoyed listening to their dating successes and woes. One of my instructors lived down the road from me, and we spent many an evening talking about nursing. She had worked in Canada's North, and I remember her telling me that it was so cold that her contact lenses froze. Little did I anticipate that, one day, I too would move to Canada (the cold certainly has been a persistent issue for me). In many ways, she was a mentor-although I didn't realize it at the time-and she was certainly an inspiration.

Evaluation of a Novel Educational Intervention to Improve Conversations About Implantable Cardioverter-Defibrillators Management in Patients with Advanced Heart Failure

Background: Implantable cardioverter-defibrillators (ICDs) reduce the incidence of sudden cardiac death for high-risk patients with heart failure (HF), but shocks from these devices can also cause pain and anxiety at the end of life. Although professional society recommendations encourage proactive discussions about ICD deactivation, clinicians lack training in conducting these conversations, and they occur infrequently. Methods: As part of a six-center randomized controlled trial, we evaluated the educational component of a multicomponent intervention shown to increase conversations about ICD deactivation by clinicians who care for a subset of patients with advanced HF. This consisted of a 90-minute training workshop designed to improve the quality and frequency of conversations about ICD management. To characterize its utility as an isolated intervention, we compared HF clinicians' pre- and postworkshop scores (on a 5-point Likert scale) assessing self-reported confidence and skills in specific practices of advance care planning, ICD deactivation discussions, and empathic communication. Results: Forty intervention-group HF clinicians completed both pre- and postworkshop surveys. Preworkshop scores showed high baseline levels of confidence (4.36, standard deviation [SD] = 0.70) and skill (4.08, SD = 0.72), whereas comparisons of pre- and postworkshop scores showed nonsignificant decreases in confidence (-1.16, p = 0.252) and skill (-0.20, p = 0.843) after the training session. Conclusions: Our findings showed no significant changes in self-assessment ratings immediately after the educational intervention. However, our data did demonstrate that HF clinicians had high baseline self-perceptions of their skills in advance care planning conversations and appear to be well-primed for further professional development to improve communication in the setting of advanced HF.

Exploring Family Caregiver Communication Difficulties and Caregiver Quality of Life and Anxiety

BACKGROUND

When family caregivers are involved in patient care, both patients and caregivers experience better clinical outcomes. However, caregivers experience communication difficulties as they navigate a complex health care system and interact with health care providers. Research indicates that caregivers experience a communication burden that can result in topic avoidance and distress; however, little is known about how burden stemming from communication difficulties with health care providers relates to caregiving outcomes.

OBJECTIVES

To investigate how family caregiver communication difficulties with health care providers influence caregiver quality of life and anxiety.

METHODS

Data were collected in a cross-sectional online survey of 220 caregivers with communication difficulties resulting from caregiver avoidance of caregiving-related topics, inadequate reading and question-asking health literacy, and low communication self-efficacy.

RESULTS

Caregiver outcomes were not affected by reading health literacy level but did differ based on question-asking health literacy level. Adequate question-asking health literacy was associated with lower anxiety and a higher quality of life. Caregivers who avoided discussing caregiving topics reported higher anxiety and lower quality of life and caregivers with increased communication self-efficacy reported a higher quality of life.

CONCLUSION

Involvement of family caregivers in care is likely to require tailored approaches that address caregiver communication and health literacy skills. Findings from this study suggest that hospice and palliative care providers should identify and provide support for caregiver communication difficulties in order to positively influence caregiver quality of life and anxiety.

Return to Normalcy? Principles on Resuming Surgical Services in the COVID-19 Era

The rapidly changing health care climate related to coronavirus disease 2019 (COVID-19) has resulted in numerous changes to health care systems and in practices that protect both the public and the workers who serve in hospitals around the country. As a result, these past few months have seen a drastic reduction in outpatient visits and surgical volumes. With phased reopening and appropriate guidance, health care systems are attempting to return to normal. Our institution has had the unique opportunity to already return operations back to full capacity. The experiences and lessons learned are described, and we provide guiding principles to allow for a safe and effective return to patient care.

Patient and Caregiver Perspectives on Terms Used to Describe Kidney Health

BACKGROUND AND OBJECTIVES

The language used to communicate important aspects of kidney health is inconsistent and may be conceptualized differently by patients and health professionals. These problems may impair the quality of communication, care, and patient outcomes. We aimed to describe the perspectives of patients on terms used to describe kidney health.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Patients with CKD (n=54) and caregivers (n=13) from the United States, United Kingdom, and Australia participated in ten focus groups to discuss terms for kidney health (including kidney, renal, CKD, ESKD, kidney failure, and descriptors for kidney function). We analyzed the data using thematic analysis.

RESULTS

We identified four themes: provoking and exacerbating undue trauma (fear of the unknown, denoting impending death, despair in having incurable or untreatable disease, premature labeling and assumptions, judgment, stigma, and failure of self); frustrated by ambiguity (confused by medicalized language, lacking personal relevance, baffled by imprecision in meaning, and/or opposed to obsolete terms); making sense of the prognostic enigma (conceptualizing level of kidney function, correlating with symptoms and effect on life, predicting progression, and need for intervention); and mobilizing self-management (confronting reality, enabling planning and preparation, taking ownership for change, learning medical terms for self-advocacy, and educating others).

CONCLUSIONS

The obscurity and imprecision of terms in CKD can be unduly distressing and traumatizing for patients, which can impair decision making and self-management. Consistent and meaningful patient-centered terminology may improve patient autonomy, satisfaction, and outcomes.

How COVID-19 Is Testing and Evolving Our Communication Skills

The COVID-19 pandemic forced us, as health care professionals and members of the general public, to adapt. Simple things we take for granted have become more difficult. As pressures increased for health care professionals, conversations and decisions have become tougher. This brought the need to adapt working practices and find ways to continue providing compassionate patient-centred care remotely. In UK radiotherapy departments, radiation therapist (review radiographer)–led clinics moved to telephone-based clinics to reduce the time spent by patients in a hospital environment. This required setting up a “virtual” clinic room with patients by removing distractions and setting boundaries for the conversation. We have had to adapt our communication skills quickly as picking up on nonverbal cues is not possible through the phone. It can be challenging to understand feelings through the tone of a patient's voice and empathise accordingly. The pandemic has forced patients to slow down and really focus on themselves which has led to picking up physical and mental health changes earlier. This is one of the many positive outcomes that can be drawn from the pandemic. Although we have changed how we work, ultimately we are still here to help our patients.