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Lapin BR, Honomichl RD, Thompson NR, Rose S, Sugano D, Udeh B, Katzan IL. Association Between Patient Experience With Patient-Reported Outcome Measurements and Overall Satisfaction With Care in Neurology. Value Health 2019; 22:555-563. [PMID: 31104734 DOI: 10.1016/j.jval.2019.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/14/2019] [Accepted: 02/21/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There has been increasing focus on both patient-reported outcome measurement (PROM) collection and patient satisfaction ratings; nevertheless, little is known about their relationship. OBJECTIVES To determine the association between patient experience with PROM collection and visit satisfaction and to identify characteristics of better ratings for each. METHODS This cross-sectional observational study included all patients seen in 15 neurological clinics who completed PROMs as well as 6 questions on the patient experience with PROMs at least once from October 1, 2015 to December 31, 2016. Visit satisfaction was evaluated using a composite measure of physician communication, overall physician rating, and the likelihood of recommending that physician as indicated on the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey. Predictors of PROM experience and satisfaction were identified using proportional odds and logistic regression models, respectively. RESULTS There were 6454 patients (average age 58 ± 15 years, 59% women) who completed PROMs and responded to the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey. There were significant positive associations between each PROM experience question and visit satisfaction (r = 0.11-0.19; P<.010), although factors predicting visit satisfaction differed from those predicting PROM experience. A differential effect of PROMs on visit satisfaction was identified for patients who were nonwhite, had lower income, and had more comorbidities. CONCLUSIONS Although there was a significant association between better PROM experience and higher visit satisfaction, relationships with clinical characteristics differed, providing insights into how PROMs may be associated with patients' visit satisfaction. Further research is necessary to confirm whether PROMs can be used to improve visit satisfaction, particularly in patients who historically have reported lower quality of care.
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Affiliation(s)
- Brittany R Lapin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
| | - Ryan D Honomichl
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Susannah Rose
- Office of Patient Experience, Cleveland Clinic, Cleveland, OH, USA
| | - David Sugano
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Belinda Udeh
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Irene L Katzan
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
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102
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Chanfreau-Coffinier C, Washington DL, Chuang E, Brunner J, Darling JE, Canelo I, Yano EM. Exploring the association of care fragmentation and patient ratings of care quality: A mediation analysis of women Veterans' experience with VA care. Health Serv Res 2019; 54:816-826. [PMID: 30989651 DOI: 10.1111/1475-6773.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To examine the relationship between care fragmentation and patient ratings of care quality and identify potentially actionable mediators. DATA SOURCES/STUDY SETTING 2015 telephone survey of 1395 women Veterans with three or more visits in primary care and/or women's health care in the prior year at 12 Veterans Affairs (VA) medical centers. STUDY DESIGN Cross-sectional analysis. DATA COLLECTION/EXTRACTION METHODS We operationalized lower care fragmentation as receiving VA-only care versus dual use of VA/non-VA care. Participants rated VA care quality (overall care, women's health care (WH), and primary care (PC)) and three aspects of their patient experience (ease of access to services, provider communication, and gender sensitivity of VA environments). We examined associations between care fragmentation and care ratings and applied the Karlson-Holm-Breen decomposition method to test for mediation by aspects of patients' experience. PRINCIPAL FINDINGS Lower care fragmentation was associated with higher ratings of care quality (odds ratios [95% CI] for overall care: 1.57 [1.14;2.17]; WH: 1.65 [1.20;2.27]; PC: 1.41 [1.10;1.82]). Relationships were mediated by patient-rated provider communication and gender sensitivity (26-54 percent and 14-15 percent of total effects, respectively). Ease of access was associated with higher care ratings (odds ratios [95% CI] for overall care: 2.93 [2.25;3.81]; WH: 2.81 [2.15;3.68]; PC: 2.33 [1.63;3.33], in models with the three types of patient care experiences included), but did not mediate the association of care fragmentation and care ratings. CONCLUSIONS Potential negative effects of care fragmentation on care quality ratings could be mitigated by attention to quality of patient-provider communication and gender sensitivity of VA environments.
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Affiliation(s)
- Catherine Chanfreau-Coffinier
- Veterans Affairs (VA) Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Donna L Washington
- Veterans Affairs (VA) Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Medicine, University of California Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, California
| | - Emmeline Chuang
- Veterans Affairs (VA) Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, California
| | - Julian Brunner
- Veterans Affairs (VA) Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, California
| | - Jill E Darling
- Veterans Affairs (VA) Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ismelda Canelo
- Veterans Affairs (VA) Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M Yano
- Veterans Affairs (VA) Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.,Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, California
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103
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Davis SA, Carpenter D, Lee C, Garcia N, Reuland DS, Tudor G, Loughlin CE, Sleath B. Effect of an Asthma Question Prompt List and Video Intervention on Adolescents' Medication Adherence 12 Months Later. Ann Pharmacother 2019; 53:683-689. [PMID: 30758220 DOI: 10.1177/1060028019831259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Many adolescents do not obtain the maximum benefit from their asthma medications. Improving patient-provider communication may improve adolescents' asthma knowledge, adherence, and clinical outcomes. OBJECTIVE To determine how a question prompt list and educational video intervention affect youth- and caregiver-reported medication adherence and self-reported medication problems. METHODS Adolescents with persistent asthma (n = 359; 56.4% with moderate to severe asthma) and their caregivers were enrolled in a randomized controlled trial at 4 pediatric clinics. Intervention group families received a question prompt list and watched a short video before seeing the provider; control families received usual care. Youth- and caregiver-reported medication adherence was measured with a Visual Analog Scale, ranging from 0 to 100. Generalized estimating equations were used to determine how the intervention and covariates were associated with medication adherence and reported problems at 12 months. RESULTS The intervention was not a significant predictor of medication adherence at 12 months. Higher caregiver education was associated with higher youth-reported adherence (β = 1.1; 95% CI = 0.1, 2.1; P = 0.036) and caregiver-reported adherence (β = 1.2; 95% CI = 0.3, 2.0; P = 0.006). The intervention was associated with fewer caregiver-reported problems at 12 months (β = -0.32; 95% CI = -0.48, -0.16; P < 0.001). CONCLUSIONS AND RELEVANCE A question prompt list and educational video decreased the number of caregiver-reported medication problems, but did not significantly affect medication adherence. Further research is needed to develop more effective interventions to improve medication adherence and outcomes.
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Affiliation(s)
- Scott A Davis
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Nacire Garcia
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S Reuland
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Ceila E Loughlin
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Betsy Sleath
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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104
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Uy MJA, Pereira MA, Berge JM, Loth KA. How Should We Approach and Discuss Children's Weight With Parents? A Qualitative Analysis of Recommendations From Parents of Preschool-Aged Children to Physicians. Clin Pediatr (Phila) 2019; 58:226-237. [PMID: 30428705 PMCID: PMC6461358 DOI: 10.1177/0009922818812489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The primary objective of this study was to describe parents' preference for how physicians should approach diet and weight-related advice for their child. Semi-structured interviews were conducted with parents (n = 40) of preschoolers, transcribed verbatim, and double-coded using an inductive thematic analysis approach. Parents identified recommendations for how physicians should approach conversations about weight. Themes included (1) Tone and Approach are Important, (2) Avoid Judgment, (3) Have Regard for Parental Expertise, (4) Consider the Timing of the Discussion with Parents, and (5) Equip Parents with Concrete and Individualized Recommendations. Future research should focus on developing brief, effective communication tools to guide discussions with parents about child nutrition and weight. Opportunities to learn about and practice the use of these brief interventions should be incorporated into medical education with the goal of providing clinicians the learning opportunities, skills/tools, and resources needed to adequately and respectfully discuss weight and diet with parents and children.
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105
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Reno JE, Thomas J, Pyrzanowski J, Lockhart S, O'Leary ST, Campagna EJ, Dempsey AF. Examining strategies for improving healthcare providers' communication about adolescent HPV vaccination: evaluation of secondary outcomes in a randomized controlled trial. Hum Vaccin Immunother 2019; 15:1592-1598. [PMID: 30433845 DOI: 10.1080/21645515.2018.1547607] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
There is a critical need for campaigns and interventions to increase rates of human papillomavirus (HPV) vaccination among U.S. adolescents. Healthcare providers are key stakeholders in parents' HPV vaccine decision-making. The current study presents the evaluation of secondary outcomes in a multi-component communication-based intervention to improve healthcare providers' communication about HPV vaccination. Evaluation was conducted via surveys of providers participating in a 12-month randomized controlled trial. Findings suggest use of communication components (combined use of the presumptive approach [PA] with all patients, and motivational interviewing and a fact sheet with vaccine hesitant parents) contributed to providers in the intervention group reporting higher perceived levels of parental HPV vaccine acceptance than control providers, as well as increased vaccination rates in the intervention arm in the main RCT.
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Affiliation(s)
- Jenna E Reno
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Jacob Thomas
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Jennifer Pyrzanowski
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Steven Lockhart
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Sean T O'Leary
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Elizabeth J Campagna
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
| | - Amanda F Dempsey
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver , Aurora , CO , USA
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106
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Reno JE, O'Leary ST, Pyrzanowski J, Lockhart S, Thomas J, Dempsey AF. Evaluation of the Implementation of a Multicomponent Intervention to Improve Health Care Provider Communication About Human Papillomavirus Vaccination. Acad Pediatr 2018; 18:882-888. [PMID: 30107236 DOI: 10.1016/j.acap.2018.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the relative use, usefulness, and facilitators and barriers to use as perceived by providers of 5 different components in a human papillomavirus vaccine communication intervention-which was found to be effective at improving human papillomavirus vaccination rates. METHODS Four serial surveys of 108 providers (doctor of medicine, nurse practitioner, or doctor of osteopathic medicine) from intervention clinics involved in the study assessed the use and usefulness of the 5 communication intervention components during a 12-month period. RESULTS Survey response rates were 79% to 86%. The fact sheet (64%-77%) and motivational interviewing techniques (MI; 86%) were the most used components-use was sustained during the 12-month period. These components also were perceived as somewhat or very useful by most providers, and this perceived usefulness increased over time (very or somewhat useful at end of study, 97% fact sheet, 98% MI, respectively). Although fewer providers reported using the Web site (15%-42%), or disease images (6%-17%), when these were used, most providers (67%-87%) felt they were somewhat or very useful. The decision aid was not used frequently (17%-41% of providers), and 43% of providers felt it was not very or not at all useful. Facilitators and barriers were identified for each component. The fact sheet and MI were perceived as the easiest to integrate into the clinic workflow. CONCLUSIONS The fact sheet and MI were the most used and most useful intervention components. Both were easy to integrate into clinic workflow, and their use was sustained over time. Dissemination of similar interventions in the future should focus on these 2 specific components.
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Affiliation(s)
- Jenna E Reno
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado Denver, Aurora.
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado Denver, Aurora
| | - Jennifer Pyrzanowski
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado Denver, Aurora
| | - Steven Lockhart
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado Denver, Aurora
| | - Jacob Thomas
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado Denver, Aurora
| | - Amanda F Dempsey
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado Denver, Aurora
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107
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Ryan C, Kushalnagar P. Towards Health Equity: Deaf Adults' Engagement in Social e-Health Activities and e-Communication with Health Care Providers. J Health Commun 2018; 23:836-841. [PMID: 30281000 PMCID: PMC6290250 DOI: 10.1080/10810730.2018.1527875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Deaf people face significant barriers with accessing health information, health care services, and communication with their health care provider and as a result, show poorer health outcomes compared to the general population. Studies on the general population found that those who use social network sites (SNS) for health-related activities were more likely to communicate with their health care provider via the Internet or email. For deaf individuals who use American Sign Language (ASL), using eHealth platforms to communicate with health care providers has the potential to navigate around communication barriers and create greater opportunity to discuss screening and treatment plans. Using national data from the HINTS-ASL survey, we explored whether engagement in social eHealth activities on SNS is linked to electronic communication with health care providers after controlling for deaf patient characteristics. Our sample for this study consisted of 515 deaf participants who reported using (social media/SNS) to read and share health information. Controlling for sociodemographic variables, participants who engaged in social eHealth activity were threefold more likely to communicate with their healthcare provider electronically. Using eHealth platforms for social health engagement demonstrates potential to reduce health inequality among deaf people.
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Affiliation(s)
- Claire Ryan
- a Department of Educational Psychology , The University of Texas at Austin , Austin , TX , USA
| | - Poorna Kushalnagar
- b Department of Psychology , Gallaudet University , Washington , DC , USA
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108
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Reading M, Baik D, Beauchemin M, Hickey KT, Merrill JA. Factors Influencing Sustained Engagement with ECG Self-Monitoring: Perspectives from Patients and Health Care Providers. Appl Clin Inform 2018; 9:772-781. [PMID: 30304745 PMCID: PMC6179719 DOI: 10.1055/s-0038-1672138] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/19/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patient-generated health data (PGHD) collected digitally with mobile health (mHealth) technology has garnered recent excitement for its potential to improve precision management of chronic conditions such as atrial fibrillation (AF), a common cardiac arrhythmia. However, sustained engagement is a major barrier to collection of PGHD. Little is known about barriers to sustained engagement or strategies to intervene upon engagement through application design. OBJECTIVE This article investigates individual patient differences in sustained engagement among individuals with a history of AF who are self-monitoring using mHealth technology. METHODS This qualitative study involved patients, health care providers, and research coordinators previously involved in a randomized, controlled trial involving electrocardiogram (ECG) self-monitoring of AF. Patients were adults with a history of AF randomized to the intervention arm of this trial who self-monitored using ECG mHealth technology for 6 months. Semistructured interviews and focus groups were conducted separately with health care providers and research coordinators, engaged patients, and unengaged patients. A validated model of sustained engagement, an adapted unified theory of acceptance and use of technology (UTAUT), guided data collection, and analysis through directed content analysis. RESULTS We interviewed 13 patients (7 engaged, 6 unengaged), 6 providers, and 2 research coordinators. In addition to finding differences between engaged and unengaged patients within each predictor in the adapted UTAUT model (perceived ease of use, perceived usefulness, facilitating conditions), four additional factors were identified as being related to sustained engagement in this population. These are: (1) internal motivation to manage health, (2) relationship with health care provider, (3) supportive environments, and (4) feedback and guidance. CONCLUSION Although it required some modification, the adapted UTAUT model was useful in understanding of the parameters of sustained engagement. The findings of this study provide initial requirement specifications for the design of applications that engage patients in this unique population of adults with AF.
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Affiliation(s)
- Meghan Reading
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, United States
| | - Dawon Baik
- School of Nursing, Columbia University, New York, New York, United States
| | - Melissa Beauchemin
- School of Nursing, Columbia University, New York, New York, United States
| | - Kathleen T. Hickey
- School of Nursing, Columbia University, New York, New York, United States
| | - Jacqueline A. Merrill
- School of Nursing, Columbia University, New York, New York, United States
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
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109
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Jagsi R, Ward KC, Abrahamse P, Wallner LP, Kurian AW, Hamilton AS, Katz SJ, Hawley ST. Unmet need for clinician engagement regarding financial toxicity after diagnosis of breast cancer. Cancer 2018; 124:3668-3676. [PMID: 30033631 PMCID: PMC6553459 DOI: 10.1002/cncr.31532] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Little is known regarding whether growing awareness of the financial toxicity of a cancer diagnosis and its treatment has increased clinician engagement or changed the needs of current patients. METHODS The authors surveyed patients with early-stage breast cancer who were identified through population-based sampling from 2 Surveillance, Epidemiology, and End Results (SEER) regions and their physicians. The authors described responses from approximately 73% of surgeons (370 surgeons), 61% of medical oncologists (306 medical oncologists), 67% of radiation oncologists (169 radiation oncologists), and 68% of patients (2502 patients). RESULTS Approximately one-half (50.9%) of responding medical oncologists reported that someone in their practice often or always discusses financial burden with patients, as did 15.6% of surgeons and 43.2% of radiation oncologists. Patients indicated that financial toxicity remains common: 21.5% of white patients and 22.5% of Asian patients had to cut down spending on food, as did 45.2% of black and 35.8% of Latina patients. Many patients desired to talk to providers about the financial impact of cancer (15.2% of whites, 31.1% of blacks, 30.3% of Latinas, and 25.4% of Asians). Unmet patient needs for engagement with physicians about financial concerns were common. Of 945 women who worried about finances, 679 (72.8%) indicated that physicians and their staff did not help. Of 523 women who desired to talk to providers regarding the impact of breast cancer on employment or finances, 283 (55.4%) reported no relevant discussion. CONCLUSIONS Many patients report inadequate clinician engagement in the management of financial toxicity, even though many providers believe that they make services available. Clinician assessment and communication regarding financial toxicity must improve; cure at the cost of financial ruin is unacceptable. Cancer 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Reshma Jagsi
- University of Michigan, Department of Radiation Oncology, Center for Bioethics and Social Science in Medicine
| | - Kevin C. Ward
- Emory University, Rollins School of Public Health, Department of Epidemiology
| | | | - Lauren P. Wallner
- University of Michigan, Department of Internal Medicine
- University of Michigan, Department of Epidemiology
| | | | - Ann S. Hamilton
- Keck School of Medicine, University of Southern California, Department of Preventive Medicine
| | - Steven J. Katz
- University of Michigan, Department of Internal Medicine
- University of Michigan, Department of Health Management and Policy
| | - Sarah T. Hawley
- University of Michigan, Department of Internal Medicine
- University of Michigan, Department of Health Management and Policy
- Ann Arbor VA Center of Excellence in Health Services Research & Development
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110
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Perez S, Lambert SD, Lee V, Loiselle CG, Chan P, Gupta A, Lo K, Rosberger Z, Zelkowitz P. A fertility needs assessment survey of male cancer patients. Psychooncology 2018; 27:2747-2753. [PMID: 30176700 DOI: 10.1002/pon.4874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To describe fertility-related informational needs and practices, and to examine if demographic characteristics are related to these needs and practices. METHODS A needs assessment survey was conducted at three Canadian cancer centres. RESULTS 192 male cancer patients (Mage = 33.6) completed the survey. Most patients (70%) recalled having had a discussion with a health care provider regarding their fertility and 44% banked their sperm. Patients reported not getting all the information that they wanted, eg, the risk that a future child may have the same type of cancer (78%), and what was covered by insurance plans (71%). Barriers to sperm preservation were urgency to begin cancer treatment (49%), not planning to have a child in the future (47%) and worries that cancer could be passed on to future children (38%). Participants' age and being the parent of a child were significantly associated with having had a discussion about fertility. Participants' age, province, being the parent of a child and the desire for future children were significantly associated with fertility preservation. CONCLUSIONS Discussions with health care providers were more frequent, and fertility preservation rates were higher than in past studies, but still not all patients' questions were answered. Misconceptions about passing on cancer to one's child, and that sperm preservation will delay treatment, should be dispelled. Health care providers can ask patients if they have any desire to have children in the future as a way to initiate a discussion of fertility preservation. Key information gaps and psychosocial resource needs are suggested to fully meet male cancer patients' fertility-related concerns.
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Affiliation(s)
- Samara Perez
- Department of Psychiatry Montreal, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research Montreal, Montreal, QC, Canada
| | - Sylvie D Lambert
- School of Nursing Montreal, McGill University Ingram School of Nursing Montreal, Montreal, QC, Canada.,St. Mary's Research Centre Montreal, Montreal, QC, Canada
| | - Virginia Lee
- McGill University Health Centre, Montreal, QC, Canada
| | - Carmen G Loiselle
- School of Nursing Montreal, McGill University Ingram School of Nursing Montreal, Montreal, QC, Canada.,Segal Cancer Center Montreal, Jewish General Hospital, Montreal, QC, Canada
| | - Peter Chan
- McGill University Health Centre, Montreal, QC, Canada
| | - Abha Gupta
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Kirk Lo
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Zeev Rosberger
- Department of Psychiatry Montreal, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research Montreal, Montreal, QC, Canada.,Segal Cancer Center Montreal, Jewish General Hospital, Montreal, QC, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry Montreal, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research Montreal, Montreal, QC, Canada.,Department of Psychiatry Montreal, Jewish General Hospital, Montreal, QC, Canada
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111
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Puhl RM, Himmelstein MS. Adolescent preferences for weight terminology used by health care providers. Pediatr Obes 2018; 13:533-540. [PMID: 29573233 DOI: 10.1111/ijpo.12275] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In light of high rates of obesity and weight stigma in youth, the American Academy of Paediatrics recommends that paediatric health care professionals use appropriate, sensitive and non-stigmatizing language in communication about weight with youth. For these efforts to be effective, there is a need to identify weight-based language preferences among youth with overweight and obesity, as research in this area is scarce. OBJECTIVES The present study provides a systematic assessment of youth perspectives of weight-based language used by providers. METHODS Adolescents (ages 13-18 years; N = 148) enrolled in a national weight loss camp were surveyed about their preferences for words that health providers use to refer to their body weight. Adolescents completed an online survey and responded to a list of 16 words describing excess body weight, as well as questions assessing demographics, body mass index, and experienced as well as internalized weight stigma. RESULTS Adolescents assigned low ratings to words like 'fat', 'large', 'obese' and 'extremely obese', indicating that they would not want providers to use these words when discussing their body weight. In contrast, words like 'weight problem', 'BMI' and 'plus size' were rated among the most preferred words for providers to use. Word preferences varied across gender, body mass index and extent of internalized weight stigma. CONCLUSIONS These findings underscore the importance of acknowledging different word preferences among youth, and to avoid making assumptions about what words youth will feel most comfortable using in discussions about their body weight.
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Affiliation(s)
- R M Puhl
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA.,Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - M S Himmelstein
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
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112
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Newnham H, Barker A, Ritchie E, Hitchcock K, Gibbs H, Holton S. Discharge communication practices and healthcare provider and patient preferences, satisfaction and comprehension: A systematic review. Int J Qual Health Care 2018; 29:752-768. [PMID: 29025093 DOI: 10.1093/intqhc/mzx121] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/22/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose To systematically review the available evidence about hospital discharge communication practices and identify which practices were preferred by patients and healthcare providers, improved patient and provider satisfaction, and increased patients' understanding of their medical condition. Data sources OVID Medline, Web of Science, ProQuest, PubMed and CINAHL plus. Study selection Databases were searched for peer-reviewed, English-language papers, published to August 2016, of empirical research using quantitative or qualitative methods. Reference lists in the papers meeting inclusion criteria were searched to identify further papers. Data extraction Of the 3489 articles identified, 30 met inclusion criteria and were reviewed. Results of data synthesis Much research to date has focused on the use of printed material and person-based discharge communication methods including verbal instructions (either in person or via telephone calls). Several studies have examined the use of information technology (IT) such as computer-generated and video-based discharge communication practices. Utilizing technology to deliver discharge information is preferred by healthcare providers and patients, and improves patients' understanding of their medical condition and discharge instructions. Conclusion Well-designed IT solutions may improve communication, coordination and retention of information, and lead to improved outcomes for patients, their families, caregivers and primary healthcare providers as well as expediting the task for hospital staff.
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Affiliation(s)
- Harvey Newnham
- Department of Medicine, Monash University, Level 5, 99 Commercial Road, Melbourne, Victoria 3004, Australia.,General Medicine, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Anna Barker
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St. Kilda Road, Melbourne, Victoria 3004, Australia
| | - Edward Ritchie
- General Medicine, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Karen Hitchcock
- General Medicine, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Harry Gibbs
- Department of Medicine, Monash University, Level 5, 99 Commercial Road, Melbourne, Victoria 3004, Australia.,General Medicine, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Sara Holton
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St. Kilda Road, Melbourne, Victoria 3004, Australia
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113
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Correa JB, Brandon KO, Meltzer LR, Hoehn HJ, Piñeiro B, Brandon TH, Simmons VN. Electronic cigarette use among patients with cancer: Reasons for use, beliefs, and patient-provider communication. Psychooncology 2018; 27:1757-1764. [PMID: 29671928 DOI: 10.1002/pon.4721] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/26/2018] [Accepted: 03/24/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Smoking tobacco cigarettes after a cancer diagnosis increases risk for several serious adverse outcomes. Thus, patients can significantly benefit from quitting smoking. Electronic cigarettes are an increasingly popular cessation method. Providers routinely ask about combustible cigarette use, yet little is known about use and communication surrounding e-cigarettes among patients with cancer. This study aims to describe patterns, beliefs, and communication with oncology providers about e-cigarette use of patients with cancer. METHODS Patients with cancer (N = 121) who currently used e-cigarettes were surveyed in a cross-sectional study about their patterns and reasons for use, beliefs, and perceptions of risk for e-cigarettes, combustible cigarettes, and nicotine replacement therapies. Patient perspectives on provider communication regarding e-cigarettes were also assessed. RESULTS Most participants identified smoking cessation as the reason for initiating (81%) and continuing (60%) e-cigarette use. However, 51% of patients reported current dual use of combustible cigarettes and e-cigarettes, and most patients reported never having discussed their use of e-cigarettes with their oncology provider (72%). Patients characterized e-cigarettes as less addictive, less expensive, less stigmatizing, and less likely to impact cancer treatment than combustible cigarettes (Ps < .05), and more satisfying, more useful for quitting smoking, and more effective at reducing cancer-related stress than nicotine replacement therapies (Ps < .05). CONCLUSIONS Patients with cancer who use e-cigarettes have positive attitudes toward these devices and use them to aid in smoking cessation. This study also highlights the need for improved patient-provider communication on the safety and efficacy of e-cigarettes for smoking cessation.
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Affiliation(s)
- John B Correa
- Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Karen O Brandon
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Lauren R Meltzer
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Hannah J Hoehn
- Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Bárbara Piñeiro
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Thomas H Brandon
- Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Vani N Simmons
- Department of Psychology, University of South Florida, Tampa, FL, USA.,Department of Health Outcomes & Behavior, H. Lee Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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114
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Stans SEA, Dalemans RJP, Roentgen UR, Smeets HWH, Beurskens AJHM. Who said dialogue conversations are easy? The communication between communication vulnerable people and health-care professionals: A qualitative study. Health Expect 2018; 21:848-857. [PMID: 29671920 PMCID: PMC6186534 DOI: 10.1111/hex.12679] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To gain insight into how communication vulnerable people and health‐care professionals experience the communication in dialogue conversations, and how they adjust their conversation using augmentative and alternative communication (AAC) or other communication strategies. Methods Communication vulnerable clients and health‐care professionals in a long‐term care institution were observed during a dialogue conversation (n = 11) and subsequently interviewed (n = 22) about their experiences with the conversation. The clients had various communication difficulties due to different underlying aetiologies, such as acquired brain injury or learning disorder. Results from the observations and interviews were analysed using conventional content analysis. Results Seven key themes emerged regarding the experiences of clients and professionals: clients blame themselves for miscommunications; the relevance of both parties preparing the conversation; a quiet and familiar environment benefitting communication; giving clients enough time; the importance and complexity of nonverbal communication; the need to tailor communication to the client; prejudices and inexperience regarding AAC. The observations showed that some professionals had difficulties using appropriate communication strategies and all professionals relied mostly on verbal or nonverbal communication strategies. Conclusion Professionals were aware of the importance of preparation, sufficient time, a suitable environment and considering nonverbal communication in dialogue conversations. However, they struggled with adequate use of communication strategies, such as verbal communication and AAC. There is a lack of knowledge about AAC, and professionals and clients need to be informed about the potential of AAC and how this can help them achieve equal participation in dialogue conversations in addition to other communication strategies.
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Affiliation(s)
- Steffy E A Stans
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Ruth J P Dalemans
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Uta R Roentgen
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Hester W H Smeets
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Anna J H M Beurskens
- Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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115
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Cubaka VK, Schriver M, Kayitare JB, Cotton P, Maindal HT, Nyirazinyoye L, Kallestrup P. 'He should feel your pain': Patient insights on patient-provider communication in Rwanda. Afr J Prim Health Care Fam Med 2018; 10:e1-e11. [PMID: 29781688 PMCID: PMC5913761 DOI: 10.4102/phcfm.v10i1.1514] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/02/2017] [Accepted: 11/09/2017] [Indexed: 12/30/2022] Open
Abstract
Background Patient–provider communication is an interpersonal interaction between a patient and a health care provider. Objective This study explored patients’ communication preferences and perceptions on what factors influence the patient–provider communication in primary health care settings in Rwanda. Methods In-depth semi-structured interviews with 15 individuals including 8 with limited literacy. A thematic inductive analysis was used. Results Patients valued communication with providers and expressed the need for interacting with caring, empathic providers who can share all the information they want and involve them in their own care. Health literacy and power issues were factors that may influence patient–provider communication. Patients with limited literacy appeared to rely highly on health care providers for making decisions about and managing their health care. Conclusion The expressed preferences, including those of patients with limited literacy, aligned well with the patient-centred care model. There were indications of a power imbalance weighing on the provider’s side. Although patients with limited literacy were reliant on providers for decision-making, they were ready to be more involved in the care, suggesting a potential for improved patient involvement even for patients with paternalistic care preferences. These patients’ insights can impact policies and curricula to optimise clinical practice. Generated knowledge will contribute to the indispensable yet underdeveloped field of health communication in sub-Saharan Africa. Practice implications Findings call for more inclusion of patient perspectives in the patient–provider encounter. This could require more training of professionals and research on the topic, both in Rwanda and in other regions.
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Affiliation(s)
- Vincent K Cubaka
- School of Medicine and Pharmacy, University of Rwanda, Rwanda; Department of Public Health, Aarhus University.
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Ahmed S, Almario CV, Chey WD, Robbins LA, Chang B, Ahn J, Ko J, Gu P, Siu A, Spiegel BMR. Electronic patient agenda forms: comparing agreement between the reason for specialty consultation reported by referring providers and patients. Inform Health Soc Care 2018; 44:105-113. [PMID: 29509054 DOI: 10.1080/17538157.2018.1437041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Little is known about the agreement between referring providers' reason for specialty evaluation and patients' understanding of why they are referred for consultation. Here, we compared the reason for consult (RFC) documented by referring providers during usual care vs. the perceived RFC independently reported by patients through an e-portal just prior to the specialist visit. METHODS We performed an observational study among patients referred for gastrointestinal (GI) evaluation. Patients referred to the specialty clinic submitted their self-reported RFC using an online patient agenda form prior to their visit. Therefore, each participant had a referring provider- and patient-documented RFC. Blinded physicians reviewed the RFCs in random order using a priori coding criteria. We then compared whether the provider and patient RFC pairs were concordant (i.e., ≥1 clinical topic[s] in the RFCs matched). RESULTS Sixty patients completed the e-portal prior to their visit, leading to 60 provider-patient RFC pairs. The RFC pairs were concordant in only 52% of cases. CONCLUSIONS There is poor agreement between referring providers' reason for GI referral and patients' understanding of why they are visiting the clinic. Future research examining whether electronic patient agenda forms impact diagnostic and management precision, patient satisfaction, and healthcare utilization is warranted.
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Affiliation(s)
- Shahzad Ahmed
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Christopher V Almario
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,c Division of Health Services Research , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,d Division of Informatics , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,e Cedars-Sinai Center for Outcomes Research and Education (CS-CORE) , Los Angeles , CA , USA
| | - William D Chey
- f Division of Gastroenterology , University of Michigan , Ann Arbor , MI , USA
| | - Lori A Robbins
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Bianca Chang
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Joseph Ahn
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Jeffrey Ko
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Phillip Gu
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Alvin Siu
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Brennan M R Spiegel
- a Department of Medicine , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,b Division of Digestive and Liver Diseases , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,c Division of Health Services Research , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,d Division of Informatics , Cedars-Sinai Medical Center , Los Angeles , CA , USA.,e Cedars-Sinai Center for Outcomes Research and Education (CS-CORE) , Los Angeles , CA , USA
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Moreno PI, Ramirez AG, San Miguel-Majors SL, Fox RS, Castillo L, Gallion KJ, Munoz E, Estabrook R, Perez A, Lad T, Hollowell C, Penedo FJ. Satisfaction with cancer care, self-efficacy, and health-related quality of life in Latino cancer survivors. Cancer 2018; 124:1770-1779. [PMID: 29390165 DOI: 10.1002/cncr.31263] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of the current study was to examine how modifiable factors such as satisfaction with cancer care and self-efficacy impact health-related quality of life (HRQOL) among Latino cancer survivors. METHODS Latinos previously diagnosed with breast, prostate, or colorectal cancer (N = 288) completed questionnaires (Patient Satisfaction with Cancer Care Scale, Stanford Chronic Disease Self-Management Measures, Functional Assessment of Cancer Therapy-General, and Short Acculturation Scale for Hispanics) within 2 years after receiving primary cancer treatment. RESULTS Path model analyses demonstrated that satisfaction with cancer care was associated with greater HRQOL and that this relationship was explained by several facets of self-efficacy (ie, confidence in managing psychological distress [z = 3.81; P<.001], social support from close others [z = 2.46; P = .014], social/recreational activities [z = 3.30; P = .001], and patient-provider communication [z = -3.72; P<.001]). Importantly, foreign-born, less acculturated, and monolingual Spanish-speaking survivors reported lower self-efficacy in patient-provider communication; however, adjusting for acculturation, language, nativity, and other covariates did not alter these results. CONCLUSIONS Factors that contribute to disparities in HRQOL among Latino cancer survivors compared with non-Latino whites, such as low income, less education, and a lack of health insurance, can be difficult to address. The findings of the current study emphasize the importance of self-efficacy within the context of patient-centered cancer care practices (eg, patient inclusion in care decisions, sufficient time with provider, ready access to medical advice) and suggest that improving satisfaction with care may increase patients' confidence in managing important aspects of their cancer experience and, in turn, improve HRQOL among Latino cancer survivors. Cancer 2018. © 2018 American Cancer Society. Cancer 2018;124:1770-9. © 2018 American Cancer Society.
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Affiliation(s)
- Patricia I Moreno
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amelie G Ramirez
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, Texas
| | | | - Rina S Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leopoldo Castillo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kipling J Gallion
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, Texas
| | - Edgar Munoz
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, Texas
| | - Ryne Estabrook
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Arely Perez
- Institute for Health Promotion Research, UT Health San Antonio, San Antonio, Texas
| | - Thomas Lad
- Department of Oncology, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Courtney Hollowell
- Department of Urologic Surgery, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Frank J Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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118
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Walker RE, Kusch J, Fink JT, Nelson DA, Morris G, Skalla J, Cisler RA. Facilitating Factors and Barriers to Weight Management in Women: Physician Perspectives. J Patient Cent Res Rev 2018. [PMID: 31413993 DOI: 10.17294/2330-0698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
PURPOSE The complexity of addressing overweight and obesity in women has been an ongoing public health and health care challenge. While the mechanism for addressing overweight and obesity in women remains unclear, it has been speculated that disparities in overweight and obesity by race and gender contribute to the complexity. The purpose of the present study was to examine perceptions of primary care physicians when discussing weight management with their patients. METHODS We conducted focus group discussions exploring facilitators and barriers to discussing weight management and weight loss among women patients. Participants included 18 family medicine and internal medicine physicians who were recruited using a snowball sampling technique from two large urban institutions. Focus group discussions were transcribed verbatim. Responses were then codified and analyzed in frequency of occurrence using specialized computer software. RESULTS Nine themes emerged from group discussions. These recurring themes reflected three overarching critical points: 1) potential utility of the primary care setting to address weight management; 2) the importance of positive patient-provider communication in supporting weight loss efforts; and 3) acknowledgement of motivation as intrinsic or extrinsic, and its role in obesity treatment. CONCLUSIONS Physician perceptions of their own lack of education or training and their inability to influence patient behaviors play crucial roles in discussing weight management with patients.
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Affiliation(s)
- Renee E Walker
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
| | - Jennifer Kusch
- Center for Urban Population Health, Milwaukee, WI.,Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI.,School of Health Sciences, Milwaukee Area Technical College, Milwaukee, WI
| | - Jennifer T Fink
- Center for Urban Population Health, Milwaukee, WI.,Department of Health Informatics & Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - David A Nelson
- Center for Urban Population Health, Milwaukee, WI.,Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - George Morris
- Center for Urban Population Health, Milwaukee, WI.,Columbia St. Mary's, Milwaukee, WI
| | - Jessica Skalla
- Center for Urban Population Health, Milwaukee, WI.,Department of Health Informatics & Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Ron A Cisler
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI.,Department of Health Informatics & Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI.,Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
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119
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Walker RE, Kusch J, Fink JT, Nelson DA, Morris G, Skalla J, Cisler RA. Facilitating Factors and Barriers to Weight Management in Women: Physician Perspectives. J Patient Cent Res Rev 2018; 5:18-27. [PMID: 31413993 PMCID: PMC6664340 DOI: 10.17294/2330-0698.1495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The complexity of addressing overweight and obesity in women has been an ongoing public health and health care challenge. While the mechanism for addressing overweight and obesity in women remains unclear, it has been speculated that disparities in overweight and obesity by race and gender contribute to the complexity. The purpose of the present study was to examine perceptions of primary care physicians when discussing weight management with their patients. METHODS We conducted focus group discussions exploring facilitators and barriers to discussing weight management and weight loss among women patients. Participants included 18 family medicine and internal medicine physicians who were recruited using a snowball sampling technique from two large urban institutions. Focus group discussions were transcribed verbatim. Responses were then codified and analyzed in frequency of occurrence using specialized computer software. RESULTS Nine themes emerged from group discussions. These recurring themes reflected three overarching critical points: 1) potential utility of the primary care setting to address weight management; 2) the importance of positive patient-provider communication in supporting weight loss efforts; and 3) acknowledgement of motivation as intrinsic or extrinsic, and its role in obesity treatment. CONCLUSIONS Physician perceptions of their own lack of education or training and their inability to influence patient behaviors play crucial roles in discussing weight management with patients.
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Affiliation(s)
- Renee E Walker
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
| | - Jennifer Kusch
- Center for Urban Population Health, Milwaukee, WI
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
- School of Health Sciences, Milwaukee Area Technical College, Milwaukee, WI
| | - Jennifer T Fink
- Center for Urban Population Health, Milwaukee, WI
- Department of Health Informatics & Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - David A Nelson
- Center for Urban Population Health, Milwaukee, WI
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - George Morris
- Center for Urban Population Health, Milwaukee, WI
- Columbia St. Mary's, Milwaukee, WI
| | - Jessica Skalla
- Center for Urban Population Health, Milwaukee, WI
- Department of Health Informatics & Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Ron A Cisler
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
- Center for Urban Population Health, Milwaukee, WI
- Department of Health Informatics & Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
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120
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Chen NNT, Moran MB, Frank LB, Ball-Rokeach SJ, Murphy ST. Understanding Cervical Cancer Screening among Latinas through the Lens of Structure, Culture, Psychology and Communication. J Health Commun 2018; 23:661-669. [PMID: 30058946 PMCID: PMC6326179 DOI: 10.1080/10810730.2018.1500661] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This study explored how structural and cultural forces work together with psychological and communication factors in influencing Pap test compliance among Latinas in Los Angeles County, a group who face health disparities related to cervical cancer screening, incidence and mortality. By adopting a multilevel approach to obtain a grounded understanding of this issue, this work revealed that structural barriers, fatalism, religious service attendance, perceived susceptibility, perceived costs, and cues to action from health care providers are all associated with Pap test compliance. Financial barriers also influence compliance, with underinsurance having a stronger negative impact compared to no insurance at all. These findings provide insights into how communication efforts can be strategically designed to address both individual- and system-level barriers to promote health-seeking behaviors among Latinas, and potentially among other population groups experiencing health disparities due to similar reasons.
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Affiliation(s)
| | - Meghan B. Moran
- School of Public Health, Johns Hopkins University, Baltimore, MD, USA;
| | - Lauren B. Frank
- Department of Communication, Portland State University, Portland, OR, USA;
| | - Sandra J. Ball-Rokeach
- Annenberg School for Communication, University of Southern California, Los Angeles, CA, USA;
| | - Sheila T. Murphy
- Annenberg School for Communication, University of Southern California, Los Angeles, CA, USA;
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Donevant SB, Messias DKH, Estrada RD. Utilization of Mobile Applications in Collaborative Patient-Provider Monitoring of Chronic Health Conditions: An Examination of Three Theoretical Frameworks to Guide Practice. J Inform Nurs 2018; 3:6-11. [PMID: 31179417 PMCID: PMC6555616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mobile health (mHealth) applications may improve chronic disease management through enhanced patient-provider communication and collaboration. The aim of this review was to compare and critique the application of three theoretical frameworks to guide mHealth research and practice in patient-provider interactions.
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122
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Drainoni ML, Biancarelli DL, Leech AA, Sullivan M, Bazzi AR. Implementing a Pre-Exposure Prophylaxis Intervention for Safer Conception among HIV Serodiscordant Couples: Recommendations for Health Care Providers. J Health Dispar Res Pract 2018; 11:19-33. [PMID: 30467527 PMCID: PMC6241314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Couples in HIV serodiscordant relationships frequently desire children. Although partners who are virally suppressed pose almost no risk of transmitting HIV to their partners, partners who are inconsistently on therapy may transmit HIV to their partners when attempting to conceive. Pre-exposure prophylaxis (PrEP) is an available safer conception strategy for these couples but is not consistently offered. We sought to better understand barriers to PrEP implementation for couples seeking conception and patient perceptions on what providers could do to encourage use. We conducted in-depth, qualitative interviews with 11 participants representing six couples taking PrEP for safer conception in a safety-net hospital in New England. Semi-structured qualitative interviews assessed the following: Relationship nature and contextual factors; attitudes and perceptions regarding PrEP for safer conception; experience within health care systems related to HIV and PrEP; and facilitators, barriers, and other experiences using PrEP for safer conception. Four key themes have important implications for implementation of PrEP for safer conception: Knowledge and understanding gaps regarding HIV and PrEP among both members of the couple, role of insurance and financing in decision-making, learning to manage and adhere to a treatment plan, and the need for providers to enhance knowledge and offer further support. Addressing barriers to safer conception strategies at multiple levels is needed to prevent HIV transmission within serodiscordant couples who desire children. Providers can play an important role in lowering these barriers through the use of multiple strategies.
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Toledo P, Pumarino J, Grobman WA, Wong CA, Holl JL, Hasnain-Wynia R. Patients' preferences for labor analgesic counseling: A qualitative analysis. Birth 2017; 44:345-351. [PMID: 28474356 DOI: 10.1111/birt.12292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The decision to use, or not use, neuraxial labor analgesia is complex, with both maternal and fetal considerations. Fears and concerns about neuraxial analgesia may influence analgesic decision-making. Little is known about patients' preferences for analgesic counseling. Therefore, the objectives of this qualitative study were to evaluate the sources of information used by patients, the timing and content of antepartum counseling about labor analgesia, and patients' preferences for such counseling. METHODS A semi-structured interview guide was developed. Survey domains included the sources of information used by patients, the timing and content of antenatal counseling, patients' perceptions of intrapartum analgesic counseling, and their preferences for analgesic counseling. Interviews occured on postpartum day 1. Interview transcripts were analyzed using content analysis. RESULTS The interviews of 45 women were analyzed. The Internet was the most frequently mentioned source of information (44%). The majority of women (78%) discussed analgesic options with their obstetric providers before delivery. All women were counseled intrapartum by an anesthesiologist, but several women commented on the difficulty of concentrating while laboring. Seventy-three percent of women stated that they would want counseling on analgesic options from their obstetric provider during the second or third trimester. CONCLUSIONS Women prefer to be counseled about labor analgesia by their obstetric providers, as they have an established relationship. Patients would prefer the counseling to occur during pregnancy, before the onset of labor. However, given the frequent use of the Internet, the content and quality of online materials should also be evaluated.
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Affiliation(s)
- Paloma Toledo
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Javiera Pumarino
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William A Grobman
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Obstetrics and Gynecology Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cynthia A Wong
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jane L Holl
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Romana Hasnain-Wynia
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Office of Research, Denver Health and Hospital Authority, Denver, CO, USA
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Jacques-Tiura AJ, Carcone AI, Naar S, Brogan Hartlieb K, Albrecht TL, Barton E. Building Motivation in African American Caregivers of Adolescents With Obesity: Application of Sequential Analysis. J Pediatr Psychol 2017; 42:131-141. [PMID: 27246865 DOI: 10.1093/jpepsy/jsw044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 04/26/2016] [Indexed: 11/13/2022] Open
Abstract
Objective We sought to examine communication between counselors and caregivers of adolescents with obesity to determine what types of counselor behaviors increased caregivers' motivational statements regarding supporting their child's weight loss. Methods We coded 20-min Motivational Interviewing sessions with 37 caregivers of African American 12-16-year-olds using the Minority Youth Sequential Coding for Observing Process Exchanges. We used sequential analysis to determine which counselor communication codes predicted caregiver motivational statements. Results Counselors' questions to elicit motivational statements and emphasis on autonomy increased the likelihood of both caregiver change talk and commitment language statements. Counselors' reflections of change talk predicted further change talk, and reflections of commitment language predicted more commitment language. Conclusions When working to increase motivation among caregivers of adolescents with overweight or obesity, providers should strive to reflect motivational statements, ask questions to elicit motivational statements, and emphasize caregivers' autonomy.
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Affiliation(s)
- Angela J Jacques-Tiura
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, MI, USA
| | - April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, MI, USA
| | - Sylvie Naar
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, MI, USA
| | - Kathryn Brogan Hartlieb
- Department of Dietetics and Nutrition, Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Terrance L Albrecht
- Karmanos Cancer Institute, School of Medicine, Wayne State University, MI, USA
| | - Ellen Barton
- Linguistics Program, Department of English, Wayne State University, MI, USA
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Frimenko KM, Murdoch-Kinch CA, Inglehart MR. Educating Dental Students About Eating Disorders: Perceptions and Practice of Interprofessional Care. J Dent Educ 2017; 81:1327-1337. [PMID: 29093146 DOI: 10.21815/jde.017.090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/30/2017] [Indexed: 11/20/2022]
Abstract
Providing care for patients with eating disorders (EDs) requires an interprofessional care (IPC) approach. The aims of this study were to assess dental students' ED- and IPC-related educational experiences, perceptions of preparedness for ED-related communication with patients and providers, and attitudes related to an IPC approach to ED. Relationships among perceptions of education, preparedness, attitudes, and characteristics (e.g., year in program and family members in other health care fields) were also explored. Of the 440 University of Michigan students invited to participate, 339 completed the survey (77% response rate). A total of 257 students from another 21 dental schools completed the web-based survey, but their response rates could not be computed because it is unknown how many academic deans at the other 65 schools forwarded the recruitment email to their students. In the combined results, the students did not evaluate their ED- and IPC-related clinical education positively (mean=1.33 on scale from 1=least to 3=most education), with first-year students (D1) reporting the least and fourth-year students (D4) the most educational experiences (D1: 1.08, D2: 1.16, D3: 1.42, D4: 1.59; p<0.001). While the students did not perceive themselves well prepared to talk with patients about mental health/ED, they reported feeling better prepared for IPC-related communication: on scale from 1=least to 5=most prepared, mean (patient)=2.94 vs. mean (IPC/provider)=3.61; p<0.001. All the students had mean positive attitudes towards dental professionals' ED-related responsibilities and related IPC considerations. The more education these students reported, the more prepared they perceived being and the more positive their attitudes. The more family members in health professions the students had, the better prepared they reported feeling to communicate with patients and providers from other disciplines about EDs. However, the finding that even the fourth-year students did not evaluate their ED- and IPC-related clinical education positively deserves attention. Educating students about EDs with an IPC approach could ensure better professional preparedness in this context.
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Affiliation(s)
- Katherine M Frimenko
- Dr. Frimenko is a General Practice Resident, The Ohio State University; Dr. Murdoch-Kinch is the Dr. Walter H. Swartz Professor of Integrated Special Care Dentistry, Associate Dean for Academic Affairs, and Clinical Professor of Dentistry, Department of Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan School of Dentistry; and Dr. Inglehart is Professor, Department of Periodontics and Oral Medicine, School of Dentistry and Adjunct Professor, Department of Psychology, College of Literature, Science & Arts, University of Michigan
| | - Carol Anne Murdoch-Kinch
- Dr. Frimenko is a General Practice Resident, The Ohio State University; Dr. Murdoch-Kinch is the Dr. Walter H. Swartz Professor of Integrated Special Care Dentistry, Associate Dean for Academic Affairs, and Clinical Professor of Dentistry, Department of Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan School of Dentistry; and Dr. Inglehart is Professor, Department of Periodontics and Oral Medicine, School of Dentistry and Adjunct Professor, Department of Psychology, College of Literature, Science & Arts, University of Michigan.
| | - Marita R Inglehart
- Dr. Frimenko is a General Practice Resident, The Ohio State University; Dr. Murdoch-Kinch is the Dr. Walter H. Swartz Professor of Integrated Special Care Dentistry, Associate Dean for Academic Affairs, and Clinical Professor of Dentistry, Department of Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan School of Dentistry; and Dr. Inglehart is Professor, Department of Periodontics and Oral Medicine, School of Dentistry and Adjunct Professor, Department of Psychology, College of Literature, Science & Arts, University of Michigan
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Chou WS, Hamel LM, Thai CL, Debono D, Chapman RA, Albrecht TL, Penner LA, Eggly S. Discussing prognosis and treatment goals with patients with advanced cancer: A qualitative analysis of oncologists' language. Health Expect 2017; 20:1073-1080. [PMID: 28261901 PMCID: PMC5600249 DOI: 10.1111/hex.12549] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The National Academy of Medicine recommends that cancer patients be knowledgeable of their prognosis to enable them to make informed treatment decisions, but research suggests few patients receive this information. OBJECTIVE This qualitative study describes oncologists' language during discussions of prognosis and treatment goals in clinical interactions with African American patients diagnosed with cancer. DESIGN We analysed transcripts from video recordings of clinical interactions between patients with Stage III or IV cancer (n=26) and their oncologists (n=9). In-depth discourse analysis was conducted to describe and interpret oncologists' communication behaviours and common linguistic features in the interactions. SETTING AND PARTICIPANTS Data were from a larger study of patient-provider communication between African Americans and oncologists at two cancer hospitals in Detroit. RESULTS Prognosis was discussed in 73.1% (n=19) of the interactions; treatment goals were discussed in 92.3% (n=24). However, analysis revealed that oncologists' description of prognosis was vague (e.g. "prognosis is a bit worse in your case") and rarely included a survival estimate. Oncologists often used ambiguous terminology, including euphemisms and jargon, and emphasized uncertainty (e.g. "lesions are suspicious for the disease"). Conversation about prognosis was frequently brief, moving quickly to the urgency and details of treatment. DISCUSSION This study demonstrates how oncologists' language may obscure discussion of prognosis and treatment goals. The identified behaviours may lead to missed opportunities in eliciting and discussing patients' knowledge about and preferences for their care. Patient-, provider- and system-oriented interventions are needed to improve clinical communication, especially among minority patients with advanced cancer.
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Affiliation(s)
| | - Lauren M. Hamel
- Wayne State University/Karmanos Cancer InstituteDetroitMIUSA
| | | | - David Debono
- Wayne State University/Karmanos Cancer InstituteDetroitMIUSA
| | | | | | - Louis A. Penner
- Wayne State University/Karmanos Cancer InstituteDetroitMIUSA
| | - Susan Eggly
- Wayne State University/Karmanos Cancer InstituteDetroitMIUSA
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Katapodi MC, Viassolo V, Caiata-Zufferey M, Nikolaidis C, Bührer-Landolt R, Buerki N, Graffeo R, Horváth HC, Kurzeder C, Rabaglio M, Scharfe M, Urech C, Erlanger TE, Probst-Hensch N, Heinimann K, Heinzelmann-Schwarz V, Pagani O, Chappuis PO. Cancer Predisposition Cascade Screening for Hereditary Breast/Ovarian Cancer and Lynch Syndromes in Switzerland: Study Protocol. JMIR Res Protoc 2017; 6:e184. [PMID: 28931501 PMCID: PMC5628286 DOI: 10.2196/resprot.8138] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/15/2017] [Accepted: 07/15/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Breast, colorectal, ovarian, and endometrial cancers constitute approximately 30% of newly diagnosed cancer cases in Switzerland, affecting more than 12,000 individuals annually. Hundreds of these patients are likely to carry germline pathogenic variants associated with hereditary breast ovarian cancer (HBOC) or Lynch syndrome (LS). Genetic services (counseling and testing) for hereditary susceptibility to cancer can prevent many cancer diagnoses and deaths through early identification and risk management. OBJECTIVE Cascade screening is the systematic identification and testing of relatives of a known mutation carrier. It determines whether asymptomatic relatives also carry the known variant, needing management options to reduce future harmful outcomes. Specific aims of the CASCADE study are to (1) survey index cases with HBOC or LS from clinic-based genetic testing records and determine their current cancer status and surveillance practices, needs for coordination of medical care, psychosocial needs, patient-provider and patient-family communication, quality of life, and willingness to serve as advocates for cancer genetic services to blood relatives, (2) survey first- and second-degree relatives and first-cousins identified from pedigrees or family history records of HBOC and LS index cases and determine their current cancer and mutation status, cancer surveillance practices, needs for coordination of medical care, barriers and facilitators to using cancer genetic services, psychosocial needs, patient-provider and patient-family communication, quality of life, and willingness to participate in a study designed to increase use of cancer genetic services, and (3) explore the influence of patient-provider communication about genetic cancer risk on patient-family communication and the acceptability of a family-based communication, coping, and decision support intervention with focus group(s) of mutation carriers and relatives. METHODS CASCADE is a longitudinal study using surveys (online or paper/pencil) and focus groups, designed to elicit factors that enhance cascade genetic testing for HBOC and LS in Switzerland. Repeated observations are the optimal way for assessing these outcomes. Focus groups will examine barriers in patient-provider and patient-family communication, and the acceptability of a family-based communication, coping, and decision-support intervention. The survey will be developed in English, translated into three languages (German, French, and Italian), and back-translated into English, except for scales with validated versions in these languages. RESULTS Descriptive analyses will include calculating means, standard deviations, frequencies, and percentages of variables and participant descriptors. Bivariate analyses (Pearson correlations, chi-square test for differences in proportions, and t test for differences in means) will assess associations between demographics and clinical characteristics. Regression analyses will incorporate generalized estimating equations for pairing index cases with their relatives and explore whether predictors are in direct, mediating, or moderating relationship to an outcome. Focus group data will be transcribed verbatim and analyzed for common themes. CONCLUSIONS Robust evidence from basic science and descriptive population-based studies in Switzerland support the necessity of cascade screening for genetic predisposition to HBOC and LS. CASCADE is designed to address translation of this knowledge into public health interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03124212; https://clinicaltrials.gov/ct2/show/NCT03124212 (Archived by WebCite at http://www.webcitation.org/6tKZnNDBt).
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Affiliation(s)
- Maria C Katapodi
- Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.,University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Valeria Viassolo
- Unit of Oncogenetics and Cancer Prevention, Division of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Christos Nikolaidis
- Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Nicole Buerki
- Women's Clinic and Gynecological Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rossella Graffeo
- Institute of Oncology (IOSI) and Breast Unit (CSSI) of Southern Switzerland, Bellinzona, Switzerland
| | - Henrik Csaba Horváth
- University Clinic for Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland
| | - Christian Kurzeder
- Women's Clinic and Gynecological Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuela Rabaglio
- University Clinic for Medical Oncology, Inselspital Bern, Bern, Switzerland
| | - Michael Scharfe
- Clinical Trials Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Corinne Urech
- Women's Clinic and Gynecological Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias E Erlanger
- Clinical Trials Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Karl Heinimann
- Medical Genetics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Viola Heinzelmann-Schwarz
- Women's Clinic and Gynecological Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Olivia Pagani
- Institute of Oncology (IOSI) and Breast Unit (CSSI) of Southern Switzerland, Bellinzona, Switzerland
| | - Pierre O Chappuis
- Unit of Oncogenetics and Cancer Prevention, Division of Oncology, Geneva University Hospitals, Geneva, Switzerland.,Division of Genetic Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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Lee BS, Klein JW, Oster NV, Elmore JG. Generalist physicians' challenges in understanding specialists' clinic notes. Postgrad Med J 2017; 94:122-123. [PMID: 28899990 DOI: 10.1136/postgradmedj-2017-135218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Bryan S Lee
- Altos Eye Physicians, Los Altos, California, USA.,Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Jared W Klein
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Natalia V Oster
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Joann G Elmore
- Department of Medicine, University of Washington, Seattle, Washington, USA
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Morris A, Herrmann T, Liles C, Roskell C. A qualitative examination of patients experiences of dietitians ' consultation engagement styles within nephrology. J Hum Nutr Diet 2017; 31:12-22. [PMID: 28836298 DOI: 10.1111/jhn.12504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dietitians provide individuals with tailored, practical nutritional advice. For this reason, skills in effective interpersonal communication are essential. In the case of chronic kidney disease, the specifics of dietary advice may change according to renal function. The conveyance of accurate dietary advice and compliance is critical and requires full engagement with the service. The effect of communication styles on patients ' engagement experiences with renal dietetics is unknown. Accordingly, the present study aimed to explore patients ' engagement experiences with renal dietitians. METHODS A qualitative phenomenology study using semi-structured in-depth interviews was undertaken with 20 adult renal service users who had engaged with renal dietitians to receive dietary advice. Interpretive phenomenological analysis was used to analyse data. RESULTS Two main themes emerged from consultation experiences: helpful and unhelpful engagement styles. Individuals reporting helpful engagement styles experienced dietitians ' communication as empathetic, demonstrating positive regard for their lifestyles. However, individuals who reported experiences of unhelpful engagement styles found dietetic care indifferent and communication styles paternalistic. These individuals continued to engage reluctantly despite unhelpful engagement experiences, but felt disempowered. These diverse experiences of engagement can be interpreted by means of 'ego states' within the theoretical model of transactional analysis (TA). Adult ego states may underpin a helpful engagement style whilst a dietitians ' parental ego state was more likely to precipitate an unhelpful engagement style. CONCLUSIONS Ego states, in the context of TA theory, can help to explain the way in which patients engage with renal dietitians. Attention should be given to the employment of a humanistic approach within dietetic consultations. Dietitans need to ensure that they can demonstrate expertise and confidence in the specific communication skills required for patient-centred care.
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Affiliation(s)
- A Morris
- Dietetics Department, University Hospital, Coventry, UK
| | | | - C Liles
- University of Birmingham, Birmingham, UK
| | - C Roskell
- University of Birmingham, Birmingham, UK
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130
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Matthias MS, Johnson NL, Shields CG, Bair MJ, MacKie P, Huffman M, Alexander SC. "I'm Not Gonna Pull the Rug out From Under You": Patient-Provider Communication About Opioid Tapering. J Pain 2017; 18:1365-1373. [PMID: 28690000 DOI: 10.1016/j.jpain.2017.06.008] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/21/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
In response to increases in harms associated with prescription opioids, opioid prescribing has come under greater scrutiny, leading many health care organizations and providers to consider or mandate opioid dose reductions (tapering) for patients with chronic pain. Communicating about tapering can be difficult, particularly for patients receiving long-term opioids who perceive benefits and are using their medications as prescribed. Because of the importance of effective patient-provider communication for pain management and recent health system-level initiatives and provider practices to taper opioids, this study used qualitative methods to understand communication processes related to opioid tapering, to identify best practices and opportunities for improvement. Up to 3 clinic visits per patient were audio-recorded, and individual interviews were conducted with patients and their providers. Four major themes emerged: 1) explaining-patients needed to understand individualized reasons for tapering, beyond general, population-level concerns such as addiction potential, 2) negotiating-patients needed to have input, even if it was simply the rate of tapering, 3) managing difficult conversations-when patients and providers did not reach a shared understanding, difficulties and misunderstandings arose, and 4) nonabandonment-patients needed to know that their providers would not abandon them throughout the tapering process. PERSPECTIVE Although opioid tapering can be challenging, helping patients to understand individualized reasons for tapering, encouraging patients to have input into the process, and assuring patients they would not be abandoned all appear to facilitate optimal communication about tapering.
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Affiliation(s)
- Marianne S Matthias
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute, Inc, Indianapolis, Indiana; Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana; Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.
| | - Nicole L Johnson
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Cleveland G Shields
- Department of Human Development & Family Studies, Regenstrief Center for Healthcare Engineering, Purdue Center for Cancer Research, Purdue University, West Lafayette, Indiana
| | - Matthew J Bair
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute, Inc, Indianapolis, Indiana; Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Palmer MacKie
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Sieck CJ, Hefner JL, Schnierle J, Florian H, Agarwal A, Rundell K, McAlearney AS. The Rules of Engagement: Perspectives on Secure Messaging From Experienced Ambulatory Patient Portal Users. JMIR Med Inform 2017; 5:e13. [PMID: 28676467 PMCID: PMC5516097 DOI: 10.2196/medinform.7516] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/28/2017] [Accepted: 04/14/2017] [Indexed: 11/23/2022] Open
Abstract
Background Patient portals have shown promise in engaging individuals in self-management of chronic conditions by allowing patients to input and track health information and exchange secure electronic messages with their providers. Past studies have identified patient barriers to portal use including usability issues, low health literacy, and concerns about loss of personal contact as well as provider concerns such as increased time spent responding to messages. However, to date, studies of both patient and provider perspectives on portal use have focused on the pre-implementation or initial implementation phases and do not consider how these issues may change as patients and providers gain greater experience with portals. Objective Our study examined the following research question: Within primary care offices with high rates of patient-portal use, what do experienced physician and patient users of the ambulatory portal perceive as the benefits and challenges of portal use in general and secure messaging in particular? Methods This qualitative study involved 42 interviews with experienced physician and patient users of an ambulatory patient portal, Epic’s MyChart. Participants were recruited from the Department of Family Medicine at a large Academic Medical Center (AMC) and included providers and their patients, who had been diagnosed with at least one chronic condition. A total of 29 patients and 13 primary care physicians participated in the interviews. All interviews were conducted by telephone and followed a semistructured interview guide. Interviews were transcribed verbatim to permit rigorous qualitative analysis. Both inductive and deductive methods were used to code and analyze the data iteratively, paying particular attention to themes involving secure messaging. Results Experienced portal users discussed several emergent themes related to a need for greater clarity on when and how to use the secure messaging feature. Patient concerns included worry about imposing on their physician’s time, the lack of provider compensation for responding to secure messages, and uncertainty about when to use secure messaging to communicate with their providers. Similarly, providers articulated a lack of clarity as to the appropriate way to communicate via MyChart and suggested that additional training for both patients and providers might be important. Patient training could include orienting patients to the “rules of engagement” at portal sign-up, either in the office or through an online tutorial. Conclusions As secure messaging through patient portals is increasingly being used as a method of physician-patient communication, both patients and providers are looking for guidance on how to appropriately engage with each other using this tool. Patients worry about whether their use is appropriate, and providers are concerned about the content of messages, which allow them to effectively manage patient questions. Our findings suggest that additional training may help address the concerns of both patients and providers, by providing “rules of engagement” for communication via patient portals.
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Affiliation(s)
- Cynthia J Sieck
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jennifer L Hefner
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jeanette Schnierle
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Hannah Florian
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Aradhna Agarwal
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Kristen Rundell
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Ann Scheck McAlearney
- The Ohio State University College of Medicine, Columbus, OH, United States.,The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, United States
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Hurley EA, Harvey SA, Keita M, Kennedy CE, Roter D, Dao S, Doumbia S, Winch PJ. Patient-provider communication styles in HIV treatment programs in Bamako, Mali: A mixed-methods study to define dimensions and measure patient preferences. SSM Popul Health 2017; 3:539-48. [PMID: 29270460 DOI: 10.1016/j.ssmph.2017.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Effective patient-provider communication (PPC) promotes patient adherence and retention in long-term care. Sub-Saharan Africa faces unprecedented demand for chronic care for HIV patients on antiretroviral therapy (ART), yet adherence and retention remain challenging. In high-income countries, research describing patient preferences for different PPC styles has guided interventions to improve PPC and patient outcomes. However, research on PPC preferences in sub-Saharan Africa is limited. We sought to define PPC dimensions relevant to ART programs in Bamako, Mali through recordings of clinical interactions, in-depth interviews and focus-group discussions with 69 patients and 17 providers. To assess preferences toward contrasting PPC styles within dimensions, we conducted a vignette-based survey with 141 patients across five ART facilities. Qualitative analysis revealed two PPC dimensions similar to those described in the literature on patient-centered communication (level of psychosocial regard, balance of power), and one unique dimension that emerged from the data (guiding patient behavior: easy/tough/sharp). Significantly more survey participants chose the vignette demonstrating high psychosocial regard (52.2%) compared to a biomedical style (22.5%) (p<0.001). Within balance of power, a statistically similar proportion of participants chose the vignette demonstrating shared power (40.2%) compared to a provider-dominated style (35.8%). In guiding patient behavior, a similar proportion of participants preferred the vignette depicting the “easy” (38.4%) and/or “tough” style (40.6%), but significantly fewer preferred the “sharp” style (14.5%) (p<0.001). Highly educated participants chose biomedical and shared power styles more frequently, while less educated participants more frequently indicated “no preference”. Working to understand, develop, and tailor PPC styles to patients in chronic care may help support patient retention and ultimately, clinical outcomes. Emphasis on developing skills in psychosocial regard and on adapting styles of power balance and behavioral guidance to individual patients is likely to yield positive results and should be considered a high priority for ART providers. Examines patient preferences among culturally-relevant PPC styles. Most patients preferred the “high psychosocial regard” over the “biomedical” style. Patients were split in preference for “shared power” versus “provider-dominant”. Preferences were split between “easy” versus “tough” style of recommending behavior change. Patients with lower education were more likely to indicate “no preference” among PPC styles.
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Berry ABL, Lim C, Hartzler AL, Hirsch T, Ludman E, Wagner EH, Ralston JD. Creating Conditions for Patients' Values to Emerge in Clinical Conversations: Perspectives of Health Care Team Members. DIS (Des Interact Syst Conf) 2017; 2017:1165-1174. [PMID: 28890950 PMCID: PMC5589444 DOI: 10.1145/3064663.3064669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Eliciting, understanding, and honoring patients' values- the things most important to them in daily life-is a cornerstone of patient-centered care. However, this rarely occurs explicitly as a routine part of clinical practice. This is particularly problematic for individuals with multiple chronic conditions (MCC) because they face difficult choices about how to balance competing demands for self-care in accordance with their values. In this study, we sought to inform the design of interventions to support conversations about patient values between patients with MCC and their health care providers. We conducted a field study that included observations of 21 clinic visits for patients who have MCC, and interviews with 16 care team members involved in those visits. This paper contributes a practice-based account of ways in which providers engage with patient values, and discusses how future work in interactive systems design might extend and enrich these engagements.
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Affiliation(s)
| | - Catherine Lim
- Kaiser Permanente Washington Health, Research Institute, Seattle, WA USA
| | - Andrea L Hartzler
- Kaiser Permanente Washington Health, Research Institute, Seattle, WA USA
| | - Tad Hirsch
- University of Washington, Seattle, WA USA
| | - Evette Ludman
- Kaiser Permanente Washington Health, Research Institute, Seattle, WA USA
| | - Edward H Wagner
- Kaiser Permanente Washington Health, Research Institute, Seattle, WA USA
| | - James D Ralston
- Kaiser Permanente Washington Health, Research Institute, Seattle, WA USA
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134
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Abstract
Despite published guidelines on the need to provide comprehensive care to lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) youth, there has been limited research related to the deliverance of primary health care to this population. The goals of this study were to learn about LGBTQ youth's experiences with their primary care physicians and to identify areas for improvement. Youth attending 1 of 5 community-based programs completed a written questionnaire and participated in a focus group discussion regarding experiences at primary care visits, including topics discussed, counselling received, and physician communication. Most of the youth did not feel their health care needs were well met. The majority acknowledged poor patient-provider communication, disrespect, and lack of discussions about important topics such as sexual and emotional health. Participants cited concerns about confidentiality and inappropriate comments as barriers to care. Youth expressed a strong desire to have physicians be more aware of their needs and concerns.
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Affiliation(s)
- Barbara K Snyder
- 1 Community Health Programs Health Center, Great Barrington, MA, USA
| | - Gail D Burack
- 2 RutgersRobert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anna Petrova
- 2 RutgersRobert Wood Johnson Medical School, New Brunswick, NJ, USA
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135
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Anderson MO, Jackson SL, Oster NV, Peacock S, Walker JD, Chen GY, Elmore JG. Patients Typing Their Own Visit Agendas Into an Electronic Medical Record: Pilot in a Safety-Net Clinic. Ann Fam Med 2017; 15:158-161. [PMID: 28289116 PMCID: PMC5348234 DOI: 10.1370/afm.2036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/28/2016] [Accepted: 10/10/2016] [Indexed: 11/09/2022] Open
Abstract
Collaborative visit agenda setting between patient and doctor is recommended. We assessed the feasibility, acceptability, and utility of patients attending a large primary care safety-net clinic typing their agendas into the electronic visit note before seeing their clinicians. One hundred and one patients and their 28 clinicians completed post-visit surveys. Patients and clinicians agreed that the agendas improved patient-clinician communication (patients 79%, clinician 74%), and wanted to continue having patients type agendas in the future (73%, 82%). Enabling patients to type visit agendas may enhance care by engaging patients and giving clinicians an efficient way to prioritize patients' concerns.
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Affiliation(s)
- McHale O Anderson
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Sara L Jackson
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Natalia V Oster
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Sue Peacock
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Janice D Walker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Galen Y Chen
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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136
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Levin-Zamir D, Leung AYM, Dodson S, Rowlands G. Health Literacy in Selected Populations: Individuals, Families, and Communities from the International and Cultural Perspective. Stud Health Technol Inform 2017. [PMID: 28972530 DOI: 10.3233/978-1-61499-790-0-392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
International and cultural perspectives of health literacy help deepen the understanding of the global context within which health literacy plays an important role. Throughout this chapter, we explore the significance of health literacy initiatives, interventions, practices, and research for addressing health challenges on a variety of levels in the international and global context. More specifically, in this chapter, the notion of health literacy as a dynamic construct is introduced, after which we examine health literacy throughout the life course, emphasizing the impact of health literacy among children and the elderly in their families and in the community. Cultural norms and family interpersonal relations, and values influence health literacy and need to be considered when closing the health literacy disparities. Global trends of migration and immigration bring to the forefront the need for unravelling the complexity of health systems, for which health literacy plays a central role; health literacy initiatives address cultural differences between providers and patients to help narrow the communication gap. The importance of cultural competency among health care providers exemplifies how capacity building in health literacy is critical for maximizing the benefits to the public of the health care system. Health literacy provides a conceptual foundation for community participatory research, involving members of the public to take part in the planning, execution and evaluation of health education interventions. Throughout the chapter, selected case studies and picture boxes from around the globe, exemplify aforementioned topics of interest, showcased in the chapter. Practical recommendations for policy makers, practitioners and research are offered based on the studies conducted in the international context.
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Affiliation(s)
| | - Angela Yee Man Leung
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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137
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Abstract
Side effects from hormonal therapy (HT) for breast cancer treatment occur frequently and are associated with worse quality of life and HT non-adherence. Whether improved patient-physician communication is associated with patients' reporting of side effects is unknown. We undertook this study to assess factors associated with women's reports of HT side effects. Between December 2012 and April 2013, we conducted a cross-sectional survey of breast cancer patients undergoing HT in an urban medical center. Descriptive statistics, univariate analyses, and multivariate analyses were used to evaluate associations. Of the 100 participants, 67% reported having HT side effects. However, when prompted, an additional 9% reported experiencing specific HT-related symptoms. Despite very high communication scores, one-third of participants reported they had not discussed side effects with providers. Multivariate analysis showed that after controlling for age, education, race, and medication beliefs, women who had difficulty asking providers for more information were more likely to report side effects (odds ratio 8.27, 95% confidence interval 1.01-69.88). Although HT side effects often occur and are bothersome, patient-provider discussions about side effects remain suboptimal. Providers should actively ask patients about medication side effects so that they can be addressed to improve quality of life and potentially, medication adherence.
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Affiliation(s)
- Jenny J Lin
- a Division of General Internal Medicine, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Jennifer Chao
- a Division of General Internal Medicine, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Nina A Bickell
- a Division of General Internal Medicine, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA.,b Department of Population Health and Policy , Icahn School of Medicine at Mount Sinai , New York , New York , USA
| | - Juan P Wisnivesky
- a Division of General Internal Medicine, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , New York , USA
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Grande SW, Castaldo MG, Carpenter-Song E, Griesemer I, Elwyn G. A digital advocate? Reactions of rural people who experience homelessness to the idea of recording clinical encounters. Health Expect 2016; 20:618-625. [PMID: 27604687 PMCID: PMC5513013 DOI: 10.1111/hex.12492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 11/30/2022] Open
Abstract
Background Are the benefits of recording clinical encounters shared across different groups, or do they vary based on social position? Studies show that educated patients record their clinical visits to enhance their experience, but very little is known about recording benefits among “hard‐to‐reach” populations. Objective To examine the reactions of homeless people to the idea of using a smartphone to record their own clinical encounter, either covertly or with permission from their physician. Method We conducted semi‐structured interviews with individuals at a temporary housing shelter in Northern New England. A thematic analysis identified themes that were iteratively refined into representative groups. Results Eighteen (18) interviews were conducted, 12 with women and six with men. Initial reactions to clinical recordings were positive (11 of 18). A majority (17 of 18) were willing to use recordings in future visits. A thematic analysis characterized data in two ways: (i) by providing reliable evidence for review, they functioned as an advocacy measure for patients; (ii) by promoting transparency and levelling social distance, this technology modified clinical relationships. Discussion Recordings permitted the sharing of data with others, providing tangible proof of behaviour and refuting misconceptions. Asking permission to record appeared to modify relationships and level perceived social distance with clinicians. Conclusions We found that while many rural, disadvantaged individuals felt marginalized by the wide social distance between themselves and their clinicians, recording technology may serve as an advocate by holding both patients and doctors accountable and by permitting the burden of clinical proof to be shared.
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Affiliation(s)
- Stuart W Grande
- The Preference Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Mary Ganger Castaldo
- The Preference Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | | | - Ida Griesemer
- The Dartmouth Psychiatric Research Center, Lebanon, NH, USA
| | - Glyn Elwyn
- The Preference Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
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139
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Lee LK, Mulvaney-Day N, Berger AM, Bhaumik U, Nguyen HT, Ward VL. The Patient Passport Program: An Intervention to Improve Patient-Provider Communication for Hospitalized Minority Children and Their Families. Acad Pediatr 2016; 16:460-467. [PMID: 26724179 DOI: 10.1016/j.acap.2015.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/23/2015] [Accepted: 12/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Effective patient-provider communication is essential to improve health care delivery and satisfaction and to minimize disparities in care for minorities. The objective of our study was to evaluate the impact of a patient-provider communication program, the Patient Passport Program, to improve communication and satisfaction for hospitalized minority children. METHODS This was a qualitative evaluation of a communication project for families with hospitalized children. Families were assigned to either the Patient Passport Program or to usual care. The Passport Program consisted of a personalized Passport book and additional medical rounds with medical providers. Semistructured interviews at the time of patient discharge were conducted with all participants to measure communication quality and patient/family satisfaction. Inductive qualitative methods were used to identify common themes. RESULTS Of the 40 children enrolled in the Passport Program, 60% were boys; the mean age was 9.7 years (range, 0.16-19 years). The most common themes in the qualitative analysis of the interviews were: 1) organization of medical care; 2) emotional expressions about the hospitalization experience; and 3) overall understanding of the process of care. Spanish- and English-speaking families had similar patient satisfaction experiences, but the Passport families reported improved quality of communication with the medical care team. CONCLUSIONS The Patient Passport Program enhanced the quality of communication among minority families of hospitalized children with some common themes around the medical care expressed in the Passport book.
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Affiliation(s)
- Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Mass.
| | | | | | - Urmi Bhaumik
- Division of Adolescent Medicine, Boston Children's Hospital, Boston, Mass
| | - Hiep T Nguyen
- Division of Pediatric Urology, Cardon Children's Hospital, Mesa, Ariz
| | - Valerie L Ward
- Department of Radiology, Boston Children's Hospital, Boston, Mass
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140
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Archiopoli A, Ginossar T, Wilcox B, Avila M, Hill R, Oetzel J. Factors of interpersonal communication and behavioral health on medication self-efficacy and medication adherence. AIDS Care 2016; 28:1607-1614. [PMID: 27320778 DOI: 10.1080/09540121.2016.1192577] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite devastating effects on health outcomes and disease progression, many people living with HIV (PLWH) are non-adherent to their medications. Medication self-efficacy is a pivotal factor in medication adherence, yet its formation and relationship with other factors are understudied. This study examines a model that considers the role of three communicative factors (patient-provider communication, social support, and social undermining) and two behavioral health factors (depression and alcohol abuse) and medication self-efficacy impacting medication adherence. Methods included a cross-sectional design using a survey questionnaire of 344 PLWH. Findings indicated that 25% of variance in medication adherence can be explained by a mediation model where depression (B = -.18) and provider-patient communication (B = .21) affect medication self-efficacy, which in turn impacts medication adherence (B = .64). Other variables, including demographics, did not add any explanatory power. These findings demonstrate the complex nature of medication adherence and the formation of medication self-efficacy.
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Affiliation(s)
- Ashley Archiopoli
- a Department of Arts & Humanities , University of Houston-Downtown , Houston , TX , USA
| | - Tamar Ginossar
- b Department of Communication & Journalism , The University of New Mexico , Albuquerque , NM , USA
| | - Bryan Wilcox
- c Department of Political Science , University of California , Los Angeles , CA , USA
| | - Magdalena Avila
- d Department of Health, Exercise and Sports Science , The University of New Mexico , Albuquerque , NM , USA
| | - Ricky Hill
- e Department of Medicine , University of Chicago , Chicago , IL , USA
| | - John Oetzel
- f Department of Management Communication , University of Waikato , Hamilton , New Zealand
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141
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Gakumo CA, Raper JL, Cerice DK, Stand-Gravois MJ, Mugavero MJ. A Qualitative Study on Health Numeracy and Patient-Provider Communication of Laboratory Numbers in Older African Americans with HIV. J Assoc Nurses AIDS Care 2016; 27:826-834. [PMID: 27522144 DOI: 10.1016/j.jana.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 06/04/2016] [Indexed: 10/21/2022]
Abstract
Health numeracy plays a vital role in the successful management of HIV because much HIV-related health information is expressed in quantitative terms. The purpose of our study was to explore what older African Americans with HIV (N = 20) understood about their HIV laboratory numbers and to examine communication of the numbers between patients and providers during clinic visits. The following four themes emerged: (a) HIV laboratory numbers are important to understand health status; (b) the numbers can often be confusing; (c) mutual communication between patient and provider is essential to understand the numbers; and (d) when communicating numbers, use less detail. Implications for future interventions to address health numeracy deficits in this population are discussed.
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142
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Lim C, Berry ABL, Hirsch T, Hartzler AL, Wagner EH, Ludman E, Ralston JD. "It just seems outside my health": How Patients with Chronic Conditions Perceive Communication Boundaries with Providers. DIS (Des Interact Syst Conf) 2016; 2016:1172-1184. [PMID: 28804790 DOI: 10.1145/2901790.2901866] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To improve care for the growing number of older adults with multiple chronic conditions, physicians and other healthcare providers need to better understand what is most important in the lives of these patients. In a qualitative study of home visits with patients and family caregivers, we found that patients withhold information from providers when communicating about what they deem important to their health and well-being. We examine the various motivations and factors that explain communication boundaries between patients and their healthcare providers. Patients' disclosures reflected perceptions of what was pertinent to share, assumptions about the consequences of sharing, and the influence of interpersonal relationships with providers. Our findings revealed limitations of existing approaches to support patient-provider communication and identified challenges for the design of systems that honor patient needs and preferences.
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Affiliation(s)
| | | | - Tad Hirsch
- University of Washington, Seattle, WA USA
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143
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Abstract
Background. Complementary and alternative medicine (CAM) use is common among cancer patients, but the majority of CAM studies do not specify the time periods in relation to cancer diagnoses. We sought to define CAM use by cancer patients and investigate factors that might influence changes in CAM use in relation to cancer diagnoses. Methods. We conducted a cross-sectional survey of adults diagnosed with breast, prostate, lung, or colorectal cancer between 2010 and 2012 at the Lineberger Comprehensive Cancer Center. Questionnaires were sent to 1794 patients. Phone calls were made to nonrespondents. Log binomial/Poisson regressions were used to investigate the association between cancer-related changes in CAM use and conversations about CAM use with oncology providers. Results. We received 603 (33.6 %) completed questionnaires. The mean age (SD) was 64 (11) years; 62% were female; 79% were white; and 98% were non-Hispanic. Respondents reported the following cancer types: breast (47%), prostate (27%), colorectal (14%), lung (11%). Eighty-nine percent reported lifetime CAM use. Eighty-five percent reported CAM use during or after initial cancer treatment, with category-specific use as follows: mind-body medicine 39%, dietary supplements 73%, body-based therapies 30%, and energy medicine 49%. During treatment CAM use decreased for all categories except energy medicine. After treatment CAM use returned to pretreatment levels for most CAMs except chiropractic. Initiation of CAM use after cancer diagnosis was positively associated with a patient having a conversation about CAM use with their oncology provider, mainly driven by patient-initiated conversations. Conclusions. Consistent with previous studies, CAM use was common among our study population. Conversations about CAM use with oncology providers appeared to influence cessation of mind-body medicine use after cancer diagnosis.
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Affiliation(s)
- Qianlai Luo
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gary N Asher
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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144
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Aarts JWM, van Oers AM, Faber MJ, Cohlen BJ, Nelen WLDM, Kremer JAM, van Dulmen AM. Communication at an online infertility expert forum: provider responses to patients' emotional and informational cues. J Psychosom Obstet Gynaecol 2016; 36:66-74. [PMID: 25777750 DOI: 10.3109/0167482x.2015.1009033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Online patient-provider communication has become increasingly popular in fertility care. However, it is not known to what extent patients express cues or concerns and how providers respond. In this study, we investigated cues and responses that occur in online patient-provider communication at an infertility-specific expert forum. We extracted 106 threads from the multidisciplinary expert forum of two Dutch IVF clinics. We performed the following analyses: (1) thematic analysis of patients' questions; and (2) rating patients' emotional and informational cues and subsequent professionals' responses using an adaptation of the validated Medical Interview Aural Rating Scale. Frequencies of themes, frequencies of cues and responses, and sequences (what cue is followed by what response) were extracted. Sixty-five infertile patients and 19 providers participated. The most common themes included medication and lifestyle. Patients gave more informational than emotional cues (106 versus 64). Responses to informational cues were mostly adequate (61%). The most common response to emotional cues was empathic acknowledgment (72%). Results indicate that an online expert forum could have a positive effect on patient outcomes, which should guide future research. Offering infertile patients an expert forum to communicate with providers can be a promising supplement to usual care in both providing information and addressing patients' concerns.
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Affiliation(s)
- J W M Aarts
- Department of Obstetrics and Gynecology, Radboud University Medical Center , Nijmegen , The Netherlands
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145
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Ferrante JM, Seaman K, Bator A, Ohman-Strickland P, Gundersen D, Clemow L, Puhl R. Impact of Perceived Weight Stigma among Underserved Women on Doctor-Patient Relationships. Obes Sci Pract 2016; 2:128-135. [PMID: 27293804 PMCID: PMC4902272 DOI: 10.1002/osp4.40] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective The aim of this study was to evaluate how perception of weight stigma among underserved women with obesity impacts doctor–patient relationships. Methods This study consisted of an interviewer‐administered survey of 149 women with obesity (body mass index (BMI) > 30 kg m−2) immediately after their physician visit at four Federally Qualified Health Centers. Perceptions of weight stigma and physician empathy were measured using the Stigma Situations in Health Care instrument and Consultation and Relational Empathy (CARE) measure, respectively. Associations of CARE and Stigma scores with BMI and patient characteristics were analysed using Mantel–Haenszel chi‐squared test and ordinal logistic regression. Results The mean CARE score was 42.1 (standard deviation 8.4; range 11.0–50.0), and mean stigma score was 4.6 (standard deviation 7.6; range 0–43.0). Each increase in BMI category was associated with almost twofold increased odds of higher perception of stigma (odds ratio, 1.90, 95% confidence interval 1.30–2.78, P = 0.001). BMI was not associated with CARE. However, for each increase in stigma category, the odds of lower CARE score doubled (odds ratio, 0.52, 95% confidence interval 0.36–0.75, P = 0.0005). Conclusions While BMI was not associated with perception of physician empathy, higher frequency of weight stigmatizing situations was negatively associated with perception of physician empathy. Reducing weight stigma in primary care could improve doctor–patient relationships and quality of care in patients with obesity.
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Affiliation(s)
- Jeanne M Ferrante
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - KelliAnn Seaman
- Preliminary Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alicja Bator
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pamela Ohman-Strickland
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA; Department of Biostatistics, Rutgers-School of Public Health, Piscataway, New Jersey, USA
| | - Daniel Gundersen
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Rutgers-Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Lynn Clemow
- Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rebecca Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, USA
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146
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Abstract
BACKGROUND Over 25 million people in the USA have limited English proficiency (LEP). Interpreters are often used to facilitate communication with health care providers. Little is currently known about interpreter quality. OBJECTIVE To explore the quality of telephone interpretation during medication consultations between Hmong clients and their pharmacists. METHODS This descriptive study analyzed transcripts from videos of consultations between six triads of Hmong patients, pharmacy students and interpreters. Analysis was divided into two segments: (1) pharmacy: communication from student pharmacist the interpreter to patient and (2) patient: communication from patient to interpreter to student pharmacist. Researchers coded transcripts separately then compared codes. KEY FINDINGS The six encounters yielded 496 communications with 275 discrepancies including omissions, additions, and word substitutions. Pharmacy to patient communications included, 45% (118/262) of omissions, 27.5% (72/262) of substitutions, and 15.6% (41/262) of additions. The patient to provider communications included, 8.1% (19/234) of omissions, 6.0% (14/234) of substitutions, and 4.2% (10/234) of word additions. Some omissions, additions, and substitutions in the pharmacy to patient communications were classified as potentially clinically relevant. Significantly, substantial discrepancies between the student pharmacists' comments and the interpretation to patients had potential for hindering relationship building between patients and their providers. CONCLUSIONS Pharmacists may assume that the presence of an interpreter ensures accurate communication from pharmacist to patient and from patient to pharmacist. This study confirms that those assumptions may not be valid. These findings highlight the need to improve pharmacy education and interventions to improve pharmacist communication with LEP patients.
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Affiliation(s)
- Maichou Lor
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Betty Chewning
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
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147
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Moss JL, Gilkey MB, Rimer BK, Brewer NT. Disparities in collaborative patient-provider communication about human papillomavirus (HPV) vaccination. Hum Vaccin Immunother 2016; 12:1476-83. [PMID: 26786888 DOI: 10.1080/21645515.2015.1128601] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Healthcare providers may vary their communications with different patients, which could give rise to differences in vaccination coverage. We examined demographic disparities in parental report of collaborative provider communication and implications for human papillomavirus (HPV) vaccination. METHODS Participants were 4,124 parents who completed the National Immunization Survey-Teen about daughters ages 13-17. We analyzed disparities in collaborative communication (mutual information exchange, deliberation, and decision) and whether they mediated the relationship between demographic characteristics and HPV vaccine initiation. RESULTS Half of parents (53%) in the survey reported collaborative communication. Poor, less educated, Spanish-speaking, Southern, and rural parents, and parents of non-privately insured and Hispanic adolescents, were least likely to report collaborative communication (all p<.05). These disparities in communication accounted for geographic variation in HPV vaccination, specifically, the higher rates of uptake in the Northeast versus the South (mediation z=2.31, p<.01) and in urban/suburban vs. rural areas (mediation z=2.87, p<.01). These disparities were also associated with vaccination among subgroups with relatively high coverage, minimizing what could have been even higher uptake among Hispanic compared to non-Hispanic white adolescents (mediation z=-3.04, p<.01) and non-privately versus privately insured adolescents (mediation z=-3.67, p<.001). Controlling for provider recommendation attenuated some of these associations (but all p<.10). CONCLUSIONS Collaborative communication showed widespread disparities, being least common among underserved groups. Collaborative communication helped account for differences-and lack of differences-in HPV vaccination among some subgroups of adolescent girls. Leveraging patient-provider communication, especially for underserved demographic groups, could improve HPV vaccination coverage.
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Affiliation(s)
- Jennifer L Moss
- a Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.,b Cancer Prevention Fellowship, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute , Bethesda , MD , USA
| | - Melissa B Gilkey
- c Harvard Medical School & Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - Barbara K Rimer
- a Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.,d Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC
| | - Noel T Brewer
- a Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina , Chapel Hill , NC , USA.,d Lineberger Comprehensive Cancer Center, University of North Carolina , Chapel Hill , NC
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148
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Abstract
OBJECTIVES This review is intended to 1) describe the construct of immediacy by analyzing how immediacy is used in social relational research and 2) discuss how immediacy behaviors can be incorporated into patient-provider interventions aimed at supporting patients' medication management. METHODS A literature search was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, OVID, PubMed, and Education Resource Information Center (ERIC) EBSCO with the keyword "immediacy". The literature was reviewed and used to describe historical conceptualizations, identify attributes, examine boundaries, and identify antecedents and consequences of immediacy. RESULTS In total, 149 articles were reviewed, and six attributes of immediacy were identified. Immediacy is 1) reciprocal in nature and 2) reflected in the communicator's attitude toward the receiver and the message, 3) conveys approachability, 4) respectfulness, 5) and connectedness between communicators, and 6) promotes receiver engagement. Immediacy is associated with affective learning, cognitive learning, greater recall, enhanced relationships, satisfaction, motivation, sharing, and perceptions of mutual value in social relationships. CONCLUSION Immediacy should be further investigated as an intervention component of patient-provider relationships and shared decision making in medication management. PRACTICE IMPLICATIONS In behavioral interventions involving relational interactions between interveners and participants, such as in medication management, the effects of communication behaviors and immediacy during intervention delivery should be investigated as an intervention component.
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Affiliation(s)
- Rebecca J Bartlett Ellis
- Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
- Correspondence: Rebecca J Bartlett Ellis, Science of Nursing Care Department, Indiana University School of Nursing, 1111 Middle Drive, E423, Indianapolis, IN 46202, USA, Tel +1 317 274 0047, Fax +1 317 278 2021, Email
| | - Anna F Carmon
- Communication Studies, Indiana University Purdue University Columbus, Columbus, IN, USA
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149
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Bolge SC, Goren A, Brown D, Ginsberg S, Allen I. Openness to and preference for attributes of biologic therapy prior to initiation among patients with rheumatoid arthritis: patient and rheumatologist perspectives and implications for decision making. Patient Prefer Adherence 2016; 10:1079-90. [PMID: 27390518 PMCID: PMC4913989 DOI: 10.2147/ppa.s107790] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Despite American College of Rheumatology recommendations, appropriate and timely initiation of biologic therapies does not always occur. This study examined openness to and preference for attributes of biologic therapies among patients with rheumatoid arthritis (RA), differences in patients' and rheumatologists' perceptions, and discussions around biologic therapy initiation. PATIENTS AND METHODS A self-administered online survey was completed by 243 adult patients with RA in the US who were taking disease-modifying antirheumatic drugs (DMARDs) and had never taken, but had discussed biologic therapy with a rheumatologist. Patients were recruited from a consumer panel (n=142) and patient advocacy organization (n=101). A separate survey was completed by 103 rheumatologists who treated at least 25 patients with RA per month with biologic therapy. Descriptive and bivariate analyses were conducted separately for patients and rheumatologists. Attributes of biologic therapy included route of administration (intravenous infusion or subcutaneous injection), frequency of injections/infusions, and duration of infusion. RESULTS Over half of patients (53.1%) were open to both intravenous infusion and subcutaneous injection, whereas rheumatologists reported 40.7% of patients would be open to both. Only 26.3% of patients strongly preferred subcutaneous injection, whereas rheumatologists reported 35.2%. Discrepancies were even more pronounced among specific patient types (eg, older vs younger patients and Medicare recipients). Among patients, 23% reported initiating discussion about biologics and 54% reported their rheumatologist initiated the discussion. A majority of rheumatologists reported discussing in detail several key aspects of biologics, whereas a minority of patients reported the same. CONCLUSION Preferences differed among patients with RA from rheumatologists' perceptions of these preferences for biologic therapy, including greater openness to intravenous infusion among patients than assumed by rheumatologists and relative lack of discussion about key aspects of biologic therapy perceived by patients. There is a need for more open communication about treatment options, which may encourage more appropriate, timely transition to biologic therapy.
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Affiliation(s)
- Susan C Bolge
- Health Economics & Outcomes Research, Janssen Scientific Affairs, LLC, Raritan, NJ, USA
| | - Amir Goren
- Health Outcomes Practice, Kantar Health, New York, USA
- Correspondence: Amir Goren, Health Outcomes Practice, Kantar Health, 11 Madison Ave, Floor 12, New York, NY 10010, USA, Tel +1 212 706 3909, Fax +1 212 647 7659, Email
| | - Duncan Brown
- Health Outcomes Practice, Kantar Health, New York, USA
| | - Seth Ginsberg
- Global Healthy Living Foundation, Upper Nyack, NY, USA
| | - Isabel Allen
- Department of Biostatistics & Epidemiology, University of California San Francisco, San Francisco, CA, USA
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150
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Koster ES, Blom L, Overbeeke MR, Philbert D, Vervloet M, Koopman L, van Dijk L. Quality of pharmaceutical care at the pharmacy counter: patients' experiences versus video observation. Patient Prefer Adherence 2016; 10:363-9. [PMID: 27042025 PMCID: PMC4809339 DOI: 10.2147/ppa.s102032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Consumer Quality Index questionnaires are used to assess quality of care from patients' experiences. OBJECTIVE To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. METHODS Pharmaceutical encounters in four pharmacies were video-recorded. Patients completed a questionnaire based upon the Consumer Quality Index Pharmaceutical Care after the encounter containing questions about patients' experiences regarding information provision, medication counseling, and pharmacy staff's communication style. An observation protocol was used to code the recorded encounters. Agreement between video observation and patients' experiences was calculated. RESULTS In total, 109 encounters were included for analysis. For the domains "medication counseling" and "communication style", agreement between patients' experiences and observations was very high (>90%). Less agreement (45%) was found for "information provision", which was rated more positive by patients compared to the observations, especially for the topic, encouragement of patients' questioning behavior. CONCLUSION A questionnaire is useful to assess the quality of medication counseling and pharmacy staff's communication style, but might be less suitable to evaluate information provision and pharmacy staff's encouragement of patients' questioning behavior. Although patients may believe that they have received all necessary information to use their new medicine, some information on specific instructions was not addressed during the encounter. When using questionnaires to get insight into information provision, observations of encounters are very informative to validate the patient questionnaires and make necessary adjustments.
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Affiliation(s)
- Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
- Correspondence: Ellen S Koster, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, PO Box 80082, 3508 TB Utrecht, the Netherlands, Tel +31 30 253 7324, Fax +31 30 253 9166, Email
| | - Lyda Blom
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Marloes R Overbeeke
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Daphne Philbert
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands
| | - Marcia Vervloet
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Laura Koopman
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, the Netherlands
- National Health Care Institute, Diemen, the Netherlands
| | - Liset van Dijk
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, the Netherlands
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