Spelling Errors and Shouting Capitalization Lead to Additive Penalties to Trustworthiness of Online Health Information: Randomized Experiment With Laypersons

BACKGROUND

The written format and literacy competence of screen-based texts can interfere with the perceived trustworthiness of health information in online forums, independent of the semantic content. Unlike in professional content, the format in unmoderated forums can regularly hint at incivility, perceived as deliberate rudeness or casual disregard toward the reader, for example, through spelling errors and unnecessary emphatic capitalization of whole words (online shouting).

OBJECTIVE

This study aimed to quantify the comparative effects of spelling errors and inappropriate capitalization on ratings of trustworthiness independently of lay insight and to determine whether these changes act synergistically or additively on the ratings.

METHODS

In web-based experiments, 301 UK-recruited participants rated 36 randomized short stimulus excerpts (in the format of information from an unmoderated health forum about multiple sclerosis) for trustworthiness using a semantic differential slider. A total of 9 control excerpts were compared with matching error-containing excerpts. Each matching error-containing excerpt included 5 instances of misspelling, or 5 instances of inappropriate capitalization (shouting), or a combination of 5 misspelling plus 5 inappropriate capitalization errors. Data were analyzed in a linear mixed effects model.

RESULTS

The mean trustworthiness ratings of the control excerpts ranged from 32.59 to 62.31 (rating scale 0-100). Compared with the control excerpts, excerpts containing only misspellings were rated as being 8.86 points less trustworthy, those containing inappropriate capitalization were rated as 6.41 points less trustworthy, and those containing the combination of misspelling and capitalization were rated as 14.33 points less trustworthy (P<.001 for all). Misspelling and inappropriate capitalization show an additive effect.

CONCLUSIONS

Distinct indicators of incivility independently and additively penalize the perceived trustworthiness of online text independently of lay insight, eliciting a medium effect size.

Turkish Adaptation of the Frommelt Attitude Toward Care of the Dying Scale

The aim of the research was to conduct the Turkish validity and reliability study of the Frommelt Attitude toward Care of the Dying Scale. The study used a cross-sectional research design. The sample of the study consists of 236 intensive care nurses. The data were analyzed using SPSS 22.0 and SPSS AMOS 22.0 programs. Descriptive statistical methods, reliability analysis, exploratory and confirmatory factor analyses were used in the analysis of the data. According to the findings of the exploratory factor analysis, the scale was divided into six factors as in its original. According to results of the confirmatory factor analysis showed that the goodness of fit of the scale was acceptable level. Cronbach's alpha coefficients of the Frommelt Attitude toward Care of the Dying and subdimensions were found to be between 0.606 and 0.800. These results showed that the Turkish form of scale was valid and reliable and it had the necessary conditions for using Turkish form.

Medical Ethics and the Biopsychosocial Model for Patient Care: A Case Analysis for Improved Communication, Clinical Time, and Error Avoidance

The practice of interdisciplinary medicine is one of the most effective and cooperative forms of medical management, which optimizes clinical care and outcomes for a patient. This model of care affords the patient the benefit of receiving the best available therapeutic options from specialists who are experts in their respective disciplines, which would otherwise be limited when compared with the clinical expertise from a single provider managing multiple co-morbidities. However, poor communication between each specialized team managing a patient's care can result in redundancies and superfluous treatment that can have deleterious clinical outcomes that impede the physician-patient relationship and question the bioethical principles of clinical practice. Having a medical provider like an internist who is the primary medical provider for a patient anchors reinforces the physician-patient relationship through familiarity and continuous involvement in the gross clinical course of a patient. Specialty care provides a very focused and limiting scope of practice. However, whether practicing specialty care or being a generalist, utilizing clinical tools, such as the biopsychosocial model and routinely using bioethical principles during clinical encounters, not only help extract pertinent information from the patient's medical history but also furthers the continuity of clinical care by understanding the global context of the patient's medical history. This is a case analysis that exemplifies sub-optimal outcomes in patient care due to undermining the critical role of an internist in patient care and clinical management in addition to challenging several bioethical principles of clinical care. It also highlights the importance of how using the biopsychosocial model of care can avoid clinical errors, improve interdisciplinary and patient communication, and, ultimately, optimize the patient-physician relationship and clinical care.

Olfaction scaffolds the developing human from neonate to adolescent and beyond

The impact of the olfactory sense is regularly apparent across development. The fetus is bathed in amniotic fluid (AF) that conveys the mother's chemical ecology. Transnatal olfactory continuity between the odours of AF and milk assists in the transition to nursing. At the same time, odours emanating from the mammary areas provoke appetitive responses in newborns. Odours experienced from the mother's diet during breastfeeding, and from practices such as pre-mastication, may assist in the dietary transition at weaning. In parallel, infants are attracted to and recognize their mother's odours; later, children are able to recognize other kin and peers based on their odours. Familiar odours, such as those of the mother, regulate the child's emotions, and scaffold perception and learning through non-olfactory senses. During juvenility and adolescence, individuals become more sensitive to some bodily odours, while the timing of adolescence itself has been speculated to draw from the chemical ecology of the family unit. Odours learnt early in life and within the family niche continue to influence preferences as mate choice becomes relevant. Olfaction thus appears significant in turning on, sustaining and, in cases when mother odour is altered, disturbing adaptive reciprocity between offspring and carer during the multiple transitions of development between birth and adolescence. This article is part of the Theo Murphy meeting issue 'Olfactory communication in humans'.

Feasibility of an Online, Interactive Body Mass Index Parental Notification Letter (e-BMI)

School-based body mass index (BMI) screening is required in 50% of states with parent notification letters distributed among 11 of those states. Additional research is needed to effectively communicate screening results to parents. We conducted a pilot investigation of parent acceptability of an electronic, interactive BMI parental notification letter (e-BMI) along with the feasibility of implementing an e-BMI letter in the school setting. In addition, we assessed parental attitudes and practices regarding their child's weight-related behaviors. Electronic letter distribution and parent receipt were consistent with traditional paper letter mailings; however, we did not observe any significant behavioral impacts with either letter format. Parents reported interest in wellness programming offered by the school, a potential opportunity for schools to engage families in healthful practices. Additional research is needed to understand the impact of e-BMI letters and accompanying web-based resources specifically for parents of students with overweight or obesity.

Implementing changes to cervical screening: A qualitative study with health professionals

BACKGROUND

Profound changes were made to the Australian National Cervical Screening Program in December 2017, which included a reduction in the frequency of screening and a new cervical screening test.

AIM

To explore the attitudes and experiences of health professionals practising in Australia since implementation of these changes.

MATERIALS AND METHODS

Thirty-one semi-structured interviews were conducted with general practitioners, obstetricians and gynaecologists, pathologists and nurses involved in cervical screening Australia-wide. Data were analysed using Framework Analysis.

RESULTS

Overall, health professionals had positive attitudes toward the changes but described many challenges associated with their implementation. Participants discussed practical system challenges, communication and education, finding ways around the guidelines and other perceived 'collateral'. Practical system challenges included increased colposcopy referrals, limited access to the National Cancer Screening Register, a complex primary screening approach, and issues with self-collection. In terms of communication and education, limited public education was recognised, in addition to challenges with particular age groups of women. Finding ways around the guidelines were described, for example over-referring women for co-testing by stating symptoms, which could lead to overtreatment. Other perceived collateral were demonstrated through reduced opportunistic screening opportunities due to less frequent primary care presentations, and concern over the potential for further underscreening in already under-screened populations.

CONCLUSIONS

These findings provide insight into the challenges health professionals face with renewing programs, in terms of practical issues and unexpected downstream effects which need to be addressed to ensure future implementation of the program is streamlined.

Advance care planning in the community: factors of influence

OBJECTIVES

This study aims to identify factors among British community-based adults associated with advance care planning engagement. Factors are then compared among six domains of wishes: medical care, spiritual and religious needs, privacy and peace, dignified care, place of death and pain relief.

METHODS

Cross-sectional data were analysed from a stratified random sample of adults across Great Britain (England, Scotland and Wales) who were interviewed on their attitudes towards death and dying. Weighted multivariable logistic regression tested for associations with expressing any end-of-life wishes and then for each separate domain.

RESULTS

Analysis of 2042 respondents (response rate: 53.5%) revealed those less likely to have discussed their wishes were: male, younger, born in the UK, owned their residence, had no experience working in health or social care, had no chronic conditions or disabilities, had not experienced the death of a close person in the last 5 years and feel neither comfortable nor uncomfortable or uncomfortable talking about death. Additional factors among the six domains associated with having not discussed wishes include: having less and more formal education, no religious beliefs, lower household income and living with at least one other person.

CONCLUSIONS

This study is the first to be conducted among a sample of community-dwelling British adults and the first of its kind to compare domains of end-of-life wishes. Our findings provide an understanding of social determinants which can inform a public health approach to end-of-life care that promotes advance care planning among compassionate communities.

The Role of Palliative Care in Caring for the Families of Patients With COVID-19

In palliative care, we strive to provide care to the whole patient. When we think about the whole patient, we include the people who are important in our patients' lives. Our New York City-based palliative care team has found that caring for patients' loved ones has proven to be an even more important aspect of the care we have provided during the COVID epidemic. In this article, we describe the multicomponenet interdisciplinary interventions we have implemented to enhance our ability to create a therapeutic alliance with family members and facilitate the provision of goal concordant care to patients with COVID during this extremely difficult time.

Communication, Collaboration and Care Coordination: The Three-Point Guide to Cancer Care Provision for Aboriginal and Torres Strait Islander Australians

Aim:

To explore health professionals’ perspectives on communication, continuity and between-service coordination for improving cancer care for Indigenous people in Queensland.

Methods:

Semi-structured interviews were conducted in a purposive sample of primary health care (PHC) services in Queensland with Indigenous and non-Indigenous health professionals who had experience caring for Indigenous cancer patients in the PHC and hospital setting. The World Health Organisation integrated people-centred health services framework was used to analyse the interview data.

Results:

Seventeen health staff from six Aboriginal Community Controlled Services and nine health professionals from one tertiary hospital participated in this study. PHC sites were in urban, regional and rural settings and the hospital was in a major city. Analysis of the data suggests that timely communication and information exchange, collaborative approaches, streamlined processes, flexible care delivery, and patient-centred care and support were crucial in improving the continuity and coordination of care between the PHC service and the treating hospital.

Conclusion:

Communication, collaboration and care coordination are integral in the provision of quality cancer care for Indigenous Australians. It is recommended that health policy and funding be designed to incorporate these aspects across services and settings as a strategy to improve cancer outcomes for Indigenous people in Queensland.

Study protocol of OncoTolk: an observational study on communication problems in language-mediated consultations with migrant oncology patients in Flanders (Belgium)

INTRODUCTION

Effective doctor-patient communication in oncology settings can be challenging due to the complexity of the cancer disease trajectory. The challenges can become greater when doctors and patients do not share a common language and need to rely on language mediators. The aim of this study is to provide evidence-based recommendations for healthcare professionals, patients and language mediators on how to interact with each other during language-mediated consultations in oncology settings.

METHODS AND ANALYSIS

A systematic review of the literature on communication problems in monolingual and multilingual oncology settings will be conducted. Thirty language-mediated consultations with Turkish-speaking or Arabic-speaking cancer patients, language mediators and Dutch-speaking oncologists/haematologists will be video-recorded in three urban hospitals in Flanders, Belgium. All participants will be interviewed immediately after the consultation and 2 weeks after it by means of video-stimulated recall. Multimodal interaction analysis will be combined with qualitative content analysis to allow for the identification of communication practices when communication problems occur.

ETHICS AND DISSEMINATION

The study has been approved by the following ethics committees: Ghent University Hospital, Antwerp University Hospital, Antwerp Hospitals Network (ZNA). Results will be published via (inter)national peer-reviewed journals and the findings of the study will be communicated using a comprehensive dissemination strategy aimed at healthcare professionals, patients and language mediators.

Enabling Access to Rehabilitation in Acute Care: Exploring Physiotherapists' and Occupational Therapists' Perspectives on Patient Care When Assistants Become the Primary Therapy Providers

Purpose: The aim of this study was to explore physiotherapists' and occupational therapists' perspectives on how the implementation of a new model of care in the acute medicine setting has affected their practice and patient care outcomes. Method: A qualitative case study was used to gain an in-depth understanding of therapists' experiences. Semi-structured, in-person interviews (45-60 min long) were conducted with eight clinicians (four occupational therapists and four physiotherapists). We used an iterative process of discussion and questioning to interpret the themes emerging from the data. Results: The findings are grouped into four categories - change in the therapist-patient relationship, change in therapists' access to first-hand patient information, developing processes to enhance information exchange, and developing processes to support patient care delivery - and two themes - therapists' expectations of patient care outcomes and redefining the value of the occupational therapists' and physiotherapists' role in contributing to patient care. Conclusions: Participants described the process of adapting their professional skills and behaviours as they evolved into the role of manager of therapy care. Occupational therapists and physiotherapists recognized the potential for occupational therapist assistants (OTAs) and physiotherapist assistants (PTAs) to provide more frequent and consistent care. The therapists highlighted the necessity of ensuring that effective working processes and interactions between the therapist and the OTAs and PTAs were in place to ensure high-quality patient care.

Challenging the Concept of Smartphone Addiction: An Empirical Pilot Study of Smartphone Usage Patterns and Psychological Well-Being

Smartphone use is ubiquitous, however, scholarly debate regarding the addictive nature of smartphones abounds. In this context, it is integral to distinguish between the content that users experience and the medium that facilitates access to the former, as users may experience addictive-like responses to the specific activities they engage in through the context experienced rather than the device that facilitates access to these activities. The present study aimed to explore conceptualizations of smartphone addiction by (a) investigating user preferences for specific smartphone functionalities, (b) examining behavioral changes associated with limited access to preferred functionalities, and (c) exploring links between aspects of smartphone use and self-reported psychological well-being. A total of 471 participants completed an online survey, providing data on sociodemographics, actual and hypothetical smartphone usage, and psychological well-being (depression, anxiety, and stress symptoms). The results showed that communication functionalities were most frequently cited as being preferred among smartphone users. Notably, participants reported that they would check their smartphones significantly fewer times if their top-three functionalities were inaccessible. This suggests that smartphone users are likely to become addicted to the functionalities they access on their smartphones (content) and not the smartphones themselves (medium), rendering unviable the notion of smartphone addiction as a construct. Further analyses suggested negligible to small correlations between aspects of smartphone use and psychological well-being variables. The findings imply that rather than focusing on frequency of smartphone use, it is recommended that future research examines the type and quality of specific smartphone usages and their effects on user well-being.

Spirituality and religiosity in a palliative medicine population: mixed-methods study

BACKGROUND

Spiritual care allows palliative care patients to gain a sense of purpose, meaning and connectedness to the sacred or important while experiencing a serious illness. This study examined how Australian patients conceptualise their spirituality/religiosity, the associations between diagnosis and spiritual/religious activities, and views on the amount of spiritual support received.

METHODS

This mixed-methods study used anonymous semistructured questionnaires, which included the Functional Assessment of Chronic Illness Therapy-Spiritual Scale-12 (FACIT-SP-12) and adapted and developed questions examining religion/spirituality's role and support.

RESULTS

Participants numbered 261, with a 50.9% response rate. Sixty-two per cent were affiliated with Christianity and 24.2% with no religion. The mean total FACIT-SP-12 score was 31.9 (SD 8.6). Patients with Christian affiliation reported a higher total FACIT-SP-12 score compared with no religious affiliation (p=0.003). Those with Christian and Buddhist affiliations had higher faith subscale scores compared with those with no religious affiliation (p<0.001). Spirituality was very important to 39.9% and religiosity to 31.7% of patients, and unimportant to 30.6% and 39.5%, respectively. Following diagnosis, patients prayed (p<0.001) and meditated (p<0.001) more, seeking more time, strength and acceptance. Attendance at religious services decreased with frailty (p<0.001), while engagement in other religious activities increased (p=0.017). Patients who received some level of spiritual/religious support from external religious/faith communities and moderate to complete spiritual/religious needs met by the hospitals reported greater total FACIT-SP-12 spirituality scores (p<0.001).

CONCLUSION

Respectful inquiry into patients spiritual/religious needs in hospitals allows for an attuned approach to addressing such care needs while considerately accommodating those disinterested in such support.

Responsible Job Design Based on the Internal Social Responsibility of Local Governments

Sustainability needs the socially responsible orientation of public institutions, but not only externally. How civil servants and municipal employees consider what local governments do in relation to their internal social responsibility is the main question of this study. Through structural equation modelling and a sample of 294 employees in local governments in a Spanish region (Extremadura), it is demonstrated that responsible job position design, as well as good communication and team building, both have positive and significant effects on the personal identification of employees with the city council. That has been interpreted as the essence of internal social responsibility and the first step for building external social responsibility at the municipal level. Practical implications and future directions are discussed.

Social networks for health communication in rural Uganda: A mixed-method analysis of Dekabusa Trading Centre, Luwero County

To reach the most vulnerable individuals in under-resourced countries, health communication interventions increasingly move towards the community level. However, little is known about how health information spreads through local social networks. This paper maps the health information network of a rural trading centre in Uganda. As part of a five-year ethnographic study of sustainable community health resources, ego networks were obtained for 231 village residents in March 2014. Using both ethnographic and social network data, we analyze how the village social network is structured, and how this structure may influence the transmission of health information. Results show a network with low average proximity, with a small number of individuals, notably key administrative officials, much closer connected to many other community members than average. However, because of social partitioning in the village network, a number of people are outside the social clusters in which the top influencers are located.

Protocol for a systematic review of reviews evaluating effectiveness of mass media interventions for prevention and control of non-communicable diseases

INTRODUCTION

Timely interventions are required in order to change unhealthy lifestyles because if continued for a prolonged period of time, these become risk factors for non-communicable diseases (NCDs). Education through mass media is an important factor in bringing out the behavioural change which may get missed in community-based interventions due to their limited reach. Many countries engage in mass media interventions, however, the nature of interventions and their effectiveness differs. We, therefore, describe the protocol of a systematic review to evaluate the effectiveness of the mass media interventions to reduce the risk of NCDs in the general population and compare the differences in effectiveness estimates across low/middle-income countries and developed countries.

METHODS AND ANALYSIS

We will search The Cochrane Library, Database of Abstracts of Reviews of Effectiveness, PubMed, Excerpta Medica Database limited to publications since 2000 to October 2019. Specific terms for the search strategy will be piloted as database-controlled vocabulary in the databases searched. The searches will include variations of the following terms: mass media, mass communication, campaign, publicity and terms for types of media, that is, print media, mobile, digital media, social media and broadcast. Study designs to be included will be systematic reviews followed by grey literature and other good quality reviews identified. The primary outcome of effectiveness will be the percentage change in population having different behavioural risk factors. In addition, mean overall change in levels of several physical or biochemical parameters will be studied as secondary outcomes.

ETHICS AND DISSEMINATION

The review is being done under the doctoral research which has been approved by the Institute Ethics Committee of the Post Graduate Institute of Medical Education and Research Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will present the results at relevant conferences and meetings.

PROSPERO REGISTRATION NUMBER

CRD42016048013.

A Guiding Principles Checklist for Otolaryngologic Surgery in the COVID-19 Era

The COVID-19 pandemic has had a dramatic impact on surgical workflows. There is an abundance of ever-changing information, and protocols are reflexively modified on a daily basis. As many otolaryngologic procedures are shown to have higher risk of viral transmission-so-called aerosol-generating procedures-it is imperative that multidisciplinary care teams be provided updated, timely, and consistent information. A single-page Guiding Principles surgical checklist was developed to discuss 7 key factors: patient information, staff wellness, risk minimization, prioritization, resource utilization, key society criteria, and communication. This was completed for every patient requiring otolaryngologic surgery and was distributed to the care teams involved. It provided the most information for those on the frontline and allowed for cogent pre-, intra-, and postoperative planning.

Back to the Future: Principles on Resuming Outpatient 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. With phased reopening and appropriate guidance, health care systems are attempting to return to normal. The experiences and lessons learned are described, and we provide guiding principles to allow for a safe and effective return to outpatient care.

Improving the quality of discharge summaries through a direct feedback system

INTRODUCTION

There is a recognised need to improve the quality of discharge documentation to facilitate the safe and effective ongoing care of patients once they leave hospital. Previous studies have focused on individual interventions, such as teaching or feedback. Our continuous quality improvement project aims to improve the quality of discharge documentation at our hospital by providing a comprehensive overhaul of the education and feedback around discharge documentation.

METHODS

We designed a comprehensive data analysis tool to analyse the performance of our discharge summaries. We presented at clinical governance sessions and arranged numerous teaching sessions for junior doctors. We developed a live-feedback system based on the content of a sample set of the previous month's summaries, which included poster-based feedback and group teaching.

RESULTS

Our interventions have significantly improved the quality of our discharge documentation across a broad range of categories, including the summary of the stay, actions for general practitioners and information given to patients in lay terminology.

CONCLUSION

Our comprehensive quality improvement project has improved the quality of our discharge documentation. Further work aims to expand this project into a regional setting, as well as designing a strategy to maintain engagement of key stakeholders to ensure continued progress.

Reinventing How Pharmacy Educators Connect as a Community

The onset of the novel coronavirus (COVID-19) pandemic has added a new layer of complexity to an already difficult period for academic pharmacy. The need to follow social-distancing guidelines has resulted in rapid adoption of technology-enabled communication strategies. While these technologies provide unprecedented ways in which we can connect as an academic community, we must consider their effectiveness in not only promoting exchange of information, but also creating inspiration within the community and supporting the level of interdependence required to tackle the difficult challenges that lie ahead. As the connecting body within the community of pharmacy education, it is incumbent on the American Association of Colleges of Pharmacy (AACP) to consider how we will adapt during this period of disruption. We must adopt new strategies that will allow our members to connect in new, meaningful ways, ways that stimulate ideas, new partnerships, and an overall sense of hope for our future.

Clinical research nursing and factors influencing success: a qualitative study describing the interplay between individual and organisational leadership influences and their impact on the delivery of clinical research in healthcare

BACKGROUND

Clinical research delivery is a term increasingly used to describe the work undertaken to implement studies which explore and test prevention, diagnosis and treatment in healthcare. Such studies range from multi-site clinical trials to single site observational projects. Whilst widely acknowledged as fundamental to effective healthcare, clinical research is complex to deliver and is met with challenges in the busy clinical environment. The perceptions and experiences of Clinical Research Nurses, whose work is central to this agenda, have emerged as important, yet frequently overlooked insights in relation to the potential success of research delivery. Increased understanding of these insights is essential to address the barriers and maximise facilitators to success in clinical research.

AIM

To better understand how the perceptions and experiences of Clinical Research Nurses relate to potential for success in research delivery.

METHODS

Seven focus groups and two one-to-one interviews (27 participants) were conducted in a large tertiary North East England National Health Service Foundation Trust between March and June 2017.

RESULTS

Clinical Research Nurses' described perceptions and experiences of working to co-ordinate and deliver a range of research as individuals, within their teams, throughout the wider organisation, and beyond. Two key elements situated within an overarching theme of leadership emerged as likely to impact on how successfully they were able to practise:• the individual (self-leadership).• the organisation (leadership culture).

CONCLUSIONS

The framework emerging from this study illustrates a complex interplay between personal attributes and organisational culture, mediated by national strategies and targets associated with the clinical research agenda. When situated within the concept of leadership, it broadens the potential for understanding the underlying issues and increases the range of possible support mechanisms to improve experiences for Clinical Research Nurses. Framing the challenges in this way contributes new knowledge to the dialogue surrounding clinical research delivery.

Impact of Age on Patients' Communication and Technology Preferences in the Era of Meaningful Use: Mixed Methods Study

BACKGROUND

Identifying effective means of communication between patients and their health care providers has a positive impact on patients' satisfaction, adherence, and health-related outcomes.

OBJECTIVE

This study aimed to identify the impact of patients' age on their communication and technology preferences when managing their health. We hypothesize that a patient's age affects their communication and technology preferences when interacting with clinicians and managing their health.

METHODS

A mixed methods study was conducted to identify the preferences of patients with cardiovascular diseases. Results were analyzed based on the patients' age. Grounded theory was used to analyze the qualitative data. Patients were recruited based on age, gender, ethnicity, and zip code.

RESULTS

A total of 104 patients were recruited: 34 young adults (19-39 years), 33 middle aged (40-64), and 37 senior citizens (>65). Young adults (mean 8.29, SD 1.66) reported higher computer self-efficacy than middle-aged participants (mean 5.56, SD 3.43; P<.05) and senior citizens (mean 47.55, SD 31.23; P<.05). Qualitative analysis identified the following three themes: (1) patient engagement (young adults favored mobile technologies and text messaging, middle-aged patients preferred phone calls, and senior citizens preferred direct interactions with the health care provider); (2) patient safety (young adults preferred electronic after-visit summaries [AVS] and medication reconciliation over the internet; middle-aged patients preferred paper-based or emailed AVS and medication reconciliation in person; senior citizens preferred paper-based summaries and in-person medication reconciliation); (3) technology (young adults preferred smartphones and middle-aged patients and senior citizens preferred tablets or PCs). Middle-aged patients were more concerned about computer security than any other group. A unique finding among senior citizens was the desire for caregivers to have access to their personal health record (PHR).

CONCLUSIONS

Patients of different ages have different communication and technology preferences and different preferences with respect to how they would like information presented to them and how they wish to interact with their provider. The PHR is one approach to improving patient engagement, but nontechnological options need to be sustained to support all patients.

Clinicians' perceptions of rounding processes and effectiveness of clinical communication

RATIONALE, AIMS, AND OBJECTIVES

Ward rounds present opportunities for medical officers, nurses, allied health clinicians, and patients to interact and plan patient care. A recent literature review found eight types of rounding processes. Different purposes, varying levels of representation from clinical professions, and understanding of each others' roles revealed a complex activity. A shared understanding of rounding processes facilitates positive teamwork and improves patient care. We examined how clinicians perceive the nature of rounding processes they undertake within their practice, multidisciplinary team attendance at rounds, and the effectiveness of team communication.

METHODS

We surveyed frontline professionals in two acute care and two rehabilitation wards from a metropolitan teaching hospital. There were 77 participants representing medical officers, nurses, and allied health clinicians. Participants selected the type of rounding processes undertaken on their ward from a list of six defined types, then answered questions about who participated in the rounds and their perceptions of the effectiveness of multidisciplinary communication. Survey findings were analysed using descriptive statistics and comparison.

RESULTS

Overall, professionals were inconsistent in the identification of number and types of rounds. Participants nominated processes more consistently within individual clinical disciplines than by clinical speciality. Medical officers identified rounds most consistently, while some nurses were unable to identify any rounding processes undertaken. The perceptions clinicians had of their own attendance at rounds differed from that of their colleagues. Despite variation in perceptions about rounds, professionals reported effective multidisciplinary communication patterns overall.

CONCLUSION

Rounds are a common yet complex activity. Rounds are revealed to be a taken-for-granted organizational activity with diversity in function, attendance, and participation, yet rounding processes are perceived and experienced differently between health professions. These differences impact on multidisciplinary attendance at rounds amongst peers. Making and communicating explicit round expectations and roles for clinicians supports coordinated teamwork and care planning.

Influence of Provider Communication on Emerging Adults' Medication Cognitions and Provider Satisfaction

OBJECTIVE

This study examined how the content of medical provider communication related to medication prescriptions influenced emerging adults' (EA) medication-related cognitions and satisfaction with care.

METHODS

In total, 257 EA (ages 18-25) were randomized to one of three audio vignettes depicting a medical appointment in which the EA imagined him/herself as the recipient of an oral antibiotic prescription. Provider communication content varied by vignette as follows: the positive outcome expectancy (POE) vignette focused on enhancing patient POE related to antibiotic use; the negative outcome expectancy (NOE) vignette focused on reducing patient NOE; and the standard care vignette focused on providing factual medication information. Following the vignette, participants self-reported on demographics, select medication-related cognitions, and provider satisfaction from vignette.

RESULTS

Those in the NOE vignette condition reported higher provider satisfaction, perceived the provider to have given more information, and evidenced lower NOE and higher POE about the antibiotic compared with those in the other conditions. Intent to adhere did not vary by vignette condition.

CONCLUSIONS

Brief, provider-initiated communication focused on reducing patient NOE may have unique value in altering EA's medication-related cognitions. Given that medication-related beliefs are known correlates of adherence, future research should replicate and expand these findings in the context of real-world medical encounters and through the utilization of objective indices of medication adherence to more fully understand the potential significance of provider language emphasizing reduction of NOE on medication adherence.