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Houchens N, Saint S, Kuhn L, Ratz D, Engle JM, Meddings J. Patient Preferences for Telemedicine Video Backgrounds. JAMA Netw Open 2024; 7:e2411512. [PMID: 38748425 PMCID: PMC11096986 DOI: 10.1001/jamanetworkopen.2024.11512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/12/2024] [Indexed: 05/18/2024] Open
Abstract
This cross-sectional study assesses patient preferences for various visual backgrounds during telemedicine video visits.
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Affiliation(s)
- Nathan Houchens
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Sanjay Saint
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Latoya Kuhn
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Jason M. Engle
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Jennifer Meddings
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor
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Wythe H, Attavar R, Jones J, Kelly J, Palmer C, Jenkins L, Dekker R, Fearns D, Watkins S, Hunt A, Pattison N. Evaluating the usefulness of a wordless picture book for adults with intellectual disabilities about the COVID-19 vaccination programme using co-production: The CAREVIS study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13203. [PMID: 38369311 DOI: 10.1111/jar.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/06/2023] [Accepted: 01/12/2024] [Indexed: 02/20/2024]
Abstract
AIM To explore the usefulness of a co-designed wordless book showing processes of receiving COVID-19 vaccines designed by, and for, adults with intellectual disabilities. METHODS A qualitative evaluation of the resource using mixed methods. Semi-structured interviews were conducted with people with intellectual disabilities, carers and health professionals about resource content, and use. This was analysed thematically. A survey was circulated to intellectual disabilities networks to understand resource need, use, sharing and content. RESULTS Understanding the COVID-19 vaccine was a process, not a single event using one resource. A visual resource had a place in facilitating conversations about vaccines between people with intellectual disabilities and carers. Differing perspectives were expressed regarding personal needs, existing awareness of vaccine programmes and communication preferences. Changes were suggested to improve the suggested storyline and relevance around COVID-19 restrictions changing. CONCLUSION A visual resource may help conversations about the COVID-19 vaccine for people with intellectual disabilities.
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Affiliation(s)
- Helena Wythe
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Raj Attavar
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
| | - Julia Jones
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Jackie Kelly
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | | | | | | | - Debra Fearns
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Scott Watkins
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Anne Hunt
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
- East and North Hertfordshire NHS Trust, Hertfordshire, UK
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Rudinsky SL, Weissbrod E, Cole R. The Impact of the Patient Role on Medical Student Learning During Peer Simulation: A Qualitative Phenomenological Study. Simul Healthc 2024; 19:11-20. [PMID: 36730921 DOI: 10.1097/sih.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Simulation-based learning is an effective approach to teaching and assessing medical students. However, there is a lack of research regarding how playing the patient role during peer simulation impacts medical student learning. This study, therefore, examines the experiences of first-year medical students in the patient role during a high-fidelity, multiday peer simulation. METHODS Using a phenomenological approach to qualitative data analysis, we analyzed 175 student reflection papers assigned to the students at the conclusion of the peer simulation. Our research team individually coded each paper and then came to a consensus on themes and patterns within the data. RESULTS We discovered the following 4 themes within the data: (1) communication, (2) empathy, (3) stress, and (4) professional identity. Through observation and peer simulation students learned the importance of team, patient, and nonverbal communication, especially during transitions of care. Next, the students recognized the importance of quality patient care and prioritizing the humanity of their future patients. The students also connected stress and mistakes, teaching them the importance of stress management. Finally, inspired by their peers and looking to their future selves, the students expressed a commitment to continued professional development. CONCLUSIONS The patient role during peer simulation is an impactful learning experience for first-year medical students. Our study holds important implications for ways in which medical educators can maximize the benefits of simulation-based education for junior medical student learning.
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Affiliation(s)
- Sherri L Rudinsky
- From the Department of Military and Emergency Medicine (S.L.R., R.C.), Uniformed Services University of the Health Sciences, Bethesda; and The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, Rockville, MD (E.W.)
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Rivedal DD, Cichocki M, Chung KC. Dealing with Difficult People and Why It Matters. Plast Reconstr Surg 2023; 152:923-928. [PMID: 37871024 DOI: 10.1097/prs.0000000000010790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Affiliation(s)
- David D Rivedal
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
| | - Meghan Cichocki
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
| | - Kevin C Chung
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
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Van Ingen Schenau ISA, Niemeijer AS, Zuiker JK, Scholten SMHJ, Lamberts KF, Van Baar ME, Nieuwenhuis MK. Improvement of burn care by video interaction guidance. Burns 2023; 49:1698-1705. [PMID: 36914440 DOI: 10.1016/j.burns.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
AIMS To evaluate the effect of video interaction guidance on improving the nurse-child relationship during the wound care procedures. Additionally, determine whether the interactional behavior of nurses is related to pain and distress experienced by children. METHODS The interactional skills of seven nurses receiving video interaction guidance were compared with those of ten other nurses. The nurse-child interactions were video-taped during wound care procedures. Of the nurses receiving video interaction guidance, three wound dressing changes were videotaped before they received video interaction guidance and three after. The interaction between nurse and child was scored with the Nurse-child interaction taxonomy by two experienced raters. The COMFORT-B behavior scale was used to assess pain, and distress. All raters were blinded regarding video interaction guidance allocation and the sequence of tapes RESULTS: Five nurses in the intervention group (71 %) showed clinically relevant progress on the taxonomy while only four nurses (40 %) showed similar progress in the control group [p = .10]. A weak association was found between the nurses' interactions and the children's pain and distress [r = -.30, p = .002]. CONCLUSIONS This is the first study to show that video interaction guidance can be used as a tool to train nurses to become more effective during patient encounters. Furthermore, nurses' interactional skills are positively associated with a child's pain and distress level.
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Affiliation(s)
- Ina S A Van Ingen Schenau
- Burn Center Martini Hospital, Groningen, the Netherlands; Association of Dutch Burn Centers, Burn Center Martini Hospital, Groningen, the Netherlands.
| | - Anuschka S Niemeijer
- Association of Dutch Burn Centers, Burn Center Martini Hospital, Groningen, the Netherlands; Science Institute Martini Hospital, Groningen, the Netherlands
| | | | | | - Kirsten F Lamberts
- Burn Center Martini Hospital, Groningen, the Netherlands; Dept. Medical Psychology, Martini Hospital, the Netherlands
| | - Margriet E Van Baar
- Association of Dutch Burn Centres, Burn Center Maasstad Hospital, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marianne K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Center Martini Hospital, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, the Netherlands
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Daniali H, Ruben MA, Flaten MA. Systematic manipulation of experimenters' non-verbal behaviors for the investigation of pain reports and placebo effects. Front Psychol 2023; 14:1248127. [PMID: 38023052 PMCID: PMC10644817 DOI: 10.3389/fpsyg.2023.1248127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/01/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Non-verbal behaviors (NBs) of caregivers affect pain reports and placebo effects. However, little experimental research has systematically examined the caregivers' NBs. This study protocol and preparatory study report a systematic manipulation of experimenters' NBs to investigate pain report and placebo effects. Methods We propose an experiment in which videotaped experimenters (VEs) conduct a pain stimulation and a placebo treatment study. The VEs express one positively enhanced NB and keep the other NBs neutral. Participants will be randomized to either the positive facial expressions (+FE), tone of voice (+TV), body movement (+BM), or neutral NBs (i.e., neutral condition; NC) of the VEs. As a preparatory study for proof of concept, two groups of NB coders from Norway and the USA separately rated the degree of NBs (eye contact, body postures and movements, and tone of voice), and impressions of dominance and being in charge, positivity, and expressivity from each NB video. The NB videos had construct validity and reliability. The +BM and +FE were rated as more dominant and in charge than the +TV and the NC. The +FE and +BM were rated as the most positive and expressive NBs, respectively. Expected results +FE will have the largest placebo effects on pain and stress levels. However, transmitting the NBs to patients by VEs is challenging. Moreover, controlling for the effects of research assistants present in the testing room is challenging. Discussion We propose that caregivers' NBs affect pain reports and placebo effects. Moreover, different NBs elicit different impressions, and a better understanding of the role of caregiver NBs requires more rigorous investigations. Lastly, aiming to investigate the caregiver NBs, the varying degrees of micro-NBs and their effects on the formation of impressions should be considered.
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Affiliation(s)
- Hojjat Daniali
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mollie A. Ruben
- Department of Psychology, University of Rhode Island, Kingston, RI, United States
| | - Magne Arve Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Hamroun A, Glowacki F, Frimat L. Comprehensive conservative care: what doctors say, what patients hear. Nephrol Dial Transplant 2023; 38:2428-2443. [PMID: 37156527 DOI: 10.1093/ndt/gfad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Indexed: 05/10/2023] Open
Abstract
The demographic evolution of patients with advanced chronic kidney disease (CKD) has led to the advent of an alternative treatment option to kidney replacement therapy in the past couple of decades. The KDIGO controversies on Kidney Supportive Care called this approach "comprehensive conservative care" (CCC) and defined it as planned holistic patient-centered care for patients with CKD stage 5 that does not include dialysis. Although the benefit of this treatment option is now well-recognized, especially for the elderly, and comorbid and frail patients, its development remains limited in practice. While shared decision-making and advance care planning represent the cornerstones of the CCC approach, one of the main barriers in its development is the perfectible communication between nephrologists and patients, but also between all healthcare professionals involved in the care of advanced CKD patients. As a result, a significant gap has opened up between what doctors say and what patients hear. Indeed, although CCC is reported by nephrologists to be widely available in their facilities, few of their patients say that they have actually heard of it. The objectives of this review are to explore discrepancies between what doctors say and what patients hear, to identify the factors underlying this gap, and to formulate practical proposals for narrowing this gap in practice.
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Affiliation(s)
- Aghiles Hamroun
- Lille University, Lille University Hospital Center of Lille, Department of Nephrology, Dialysis, Kidney Transplantation, and Apheresis, Lille, France
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR1167 RID-AGE, F-59000 Lille, France
| | - François Glowacki
- Lille University, Lille University Hospital Center of Lille, Department of Nephrology, Dialysis, Kidney Transplantation, and Apheresis, Lille, France
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | - Luc Frimat
- Department of Nephrology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- Inserm, CIC-1433 Clinical Epidemiology, University Hospital of Nancy, Université de Lorraine, Vandœuvre-Lès-Nancy, France
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Holmes SM. Learning Language, Un/Learning Empathy in Medical School. Cult Med Psychiatry 2023:10.1007/s11013-023-09830-8. [PMID: 37725219 DOI: 10.1007/s11013-023-09830-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/21/2023]
Abstract
This article considers the ways in which empathy for patients and related solidarity with communities may be trained out of medical students during medical school. The article focuses especially on the pre-clinical years of medical school, those that begin with orientation and initiation events such as the White Coat Ceremony. The ethnographic data for the article come from field notes and recordings from my own medical training as well as hundreds of hours of observant participation and interviews with medical students over the past several years. Exploring the framework of language socialization, I argue that learning the verbal, textual and bodily language of medical practice contributes to the increasing experience of separation between physicians and patients. Further considering the ethnographic data, I argue that we also learn a form of empathy limited to performance that short circuits clinical care and the possibility for solidarity for health equity. The article concludes with implications for medical education and the medical social sciences and humanities.
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Affiliation(s)
- Seth M Holmes
- University of California, Berkeley, 50 University Hall, MC 7360, Berkeley, CA, 94720, USA.
- University of Barcelona, Barcelona, Spain.
- ICREA Catalan Institution for Research and Advanced Study, Barcelona, Spain.
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De Coninck S, Emmers E. "Online, the counselor can't see me cry": a systematic literature review on emotion and computer-mediated care. Front Digit Health 2023; 5:1216268. [PMID: 37720162 PMCID: PMC10504663 DOI: 10.3389/fdgth.2023.1216268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Computer-mediated care is becoming increasingly popular, but little research has been done on it and its effects on emotion-related outcomes. This systematic literature review aims to create an overview that addresses the research question: "Is there a relationship between computer-mediated care and emotional expression, perception, and emotional and (long-term) emotion outcomes?" Method This systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and used five eligibility criteria, namely, (1) participants: adults seeking support; (2) intervention: eHealth; (3) diagnostic criteria: transdiagnostic concept of difficulty identifying, expressing, and/or regulating emotions (e.g., alexithymia); (4) comparator: either face-to-face care or no comparator; and (5) study design: quantitative studies or qualitative studies. Quality was assessed using the QualSyst tool. Results The analysis includes 25 research papers. Self-paced interventions appear to have a positive effect on emotion regulation. Videoconferencing interventions improved emotion regulation from before to after treatment but worsened emotion regulation compared with face-to-face treatment. Discussion The lack of variation in the modalities studied and the emotion measurements used make it difficult to draw responsible conclusions. Future research should examine how different modalities affect the real-time communication of emotions and how non-verbal cues influence this.
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Affiliation(s)
- Sarah De Coninck
- Research Unit Inclusive Society, University College Leuven Limburg, Leuven, Belgium
- Research Units Sustainable Resources and Smart Organizations, University College Leuven Limburg, Diepenbeek, Belgium
- Brain and Cognition, KU Leuven, Leuven, Belgium
| | - Elke Emmers
- School of Educational Studies, UHasselt, Hasselt, Belgium
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B J, Kesavadev J, Shrivastava A, Saboo B, Makkar BM. Evolving Scope of Clinical Empathy in the Current Era of Medical Practice. Cureus 2023; 15:e40041. [PMID: 37425530 PMCID: PMC10324523 DOI: 10.7759/cureus.40041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Clinical empathy is one of the most essential tools of medical practice, and it is an act of correctly acknowledging the emotional state of another without experiencing that state oneself. Empathy comprises four components. Mounting evidence exists to support the use of clinical empathy as a tactic for effective health care. Resolving the multi-fold barriers of clinical empathy is important. Clinical empathy is very important in the current era, and a trust-based relationship in patient care is a way to optimal clinical outcomes that can be achieved through better communication and treatment-compliance plans between health care professionals and patients.
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Affiliation(s)
- Jayakrishnan B
- Department of Medicine, Educare Institute of Dental Sciences, Malappuram, IND
| | - Jothydev Kesavadev
- Department of Diabetes and Endocrinology, Jothydev's Diabetes and Research Center, Trivandrum, IND
| | | | - Banshi Saboo
- Department of Endocrinology, Dia Care, Diabetes Care and Hormone Clinic, Ahmedabad, IND
| | - Brij Mohan Makkar
- Department of Endocrinology, Dr. Makkar's Diabetes & Obesity Centre, New Delhi, IND
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Eichbaum Q, Barbeau-Meunier CA, White M, Ravi R, Grant E, Riess H, Bleakley A. Empathy across cultures - one size does not fit all: from the ego-logical to the eco-logical of relational empathy. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:643-657. [PMID: 36129550 PMCID: PMC9491267 DOI: 10.1007/s10459-022-10158-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/16/2022] [Indexed: 05/11/2023]
Abstract
Empathy is extolled in Western healthcare and medical education as an exemplary quality to cultivate in trainees and providers. Yet it remains an elusive and inadequately understood attribute. It posits a "one size fits all" unidimensional attribute applicable across contexts with scant attention given to its multifaceted dimensions in intercultural contexts. In this article, we uncloak the shortcomings of this conventional empathy in intercultural settings, and instead propound an expanded "relational empathy".
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Affiliation(s)
- Quentin Eichbaum
- Department of Pathology, Microbiology and Immunology, Division of Medical Education and Administration, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, TVC 4511C, 1301 Medical Center Drive, TN37232, Nashville, TN, USA.
| | | | - Mary White
- Boonshoft School of Medicine, Wright State University, Fairborn, OH, USA
| | - Revathi Ravi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Helen Riess
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan Bleakley
- Plymouth University Peninsula School of Medicine, Plymouth, UK
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Huang CW, Wu BCY, Nguyen PA, Wang HH, Kao CC, Lee PC, Rahmanti AR, Hsu JC, Yang HC, Li YCJ. Emotion recognition in doctor-patient interactions from real-world clinical video database: Initial development of artificial empathy. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107480. [PMID: 36965299 DOI: 10.1016/j.cmpb.2023.107480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE The promising use of artificial intelligence (AI) to emulate human empathy may help a physician engage with a more empathic doctor-patient relationship. This study demonstrates the application of artificial empathy based on facial emotion recognition to evaluate doctor-patient relationships in clinical practice. METHODS A prospective study used recorded video data of doctor-patient clinical encounters in dermatology outpatient clinics, Taipei Municipal Wanfang Hospital, and Taipei Medical University Hospital collected from March to December 2019. Two cameras recorded the facial expressions of four doctors and 348 adult patients during regular clinical practice. Facial emotion recognition was used to analyze the basic emotions of doctors and patients with a temporal resolution of 1 second. In addition, a physician-patient satisfaction questionnaire was administered after each clinical session, and two standard patients gave impartial feedback to avoid bias. RESULTS Data from 326 clinical session videos showed that (1) Doctors expressed more emotions than patients (t [326] > = 2.998, p < = 0.003), including anger, happiness, disgust, and sadness; the only emotion that patients showed more than doctors was surprise (t [326] = -4.428, p < .001) (p < .001). (2) Patients felt happier during the latter half of the session (t [326] = -2.860, p = .005), indicating a good doctor-patient relationship. CONCLUSIONS Artificial empathy can offer objective observations on how doctors' and patients' emotions change. With the ability to detect emotions in 3/4 view and profile images, artificial empathy could be an accessible evaluation tool to study doctor-patient relationships in practical clinical settings.
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Affiliation(s)
- Chih-Wei Huang
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Taipei Medical University Ringgold standard institution - Center for Simulation in Medical Education, Taipei 116, Taiwan
| | - Bethany C Y Wu
- National Taiwan University Children and Family Research Center Sponsored by CTBC Charity Foundation, Taipei, Taiwan
| | - Phung Anh Nguyen
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan; Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Han Wang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Wanfang Hospital, Taipei Medical University, Taiwan; Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Pei-Chen Lee
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | - Annisa Ristya Rahmanti
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jason C Hsu
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan; International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan; Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Hsuan-Chia Yang
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Yu-Chuan Jack Li
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, TMU Da'an Campus 15 F, No. 172-1, Kee lung Road, Section 2, Da-an District, Taipei, Taiwan; Research Center of Big Data and Meta-analysis, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Wanfang Hospital, Taipei Medical University, Taiwan.
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Olszewski AE, Bogetz J, Mercer A, Bradford MC, Scott M, Fields B, Williams K, Rosenberg AR, Trowbridge A. Empathy Expression in Interpreted and Noninterpreted Care Conferences of Seriously Ill Children. Pediatrics 2023; 151:e2022059447. [PMID: 36785992 PMCID: PMC9986854 DOI: 10.1542/peds.2022-059447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Clinician empathy is associated with improved communication and clinical outcomes. We hypothesized that, when clinicians express empathy, families are more likely to deepen discussions, and that clinicians express less empathy in care conferences with language interpretation. METHODS Prospective, mixed methods cohort study of English and interpreted audio-recorded transcripts of care conferences for pediatric patients with serious illness hospitalized at a single urban, quaternary medical institution between January 2018 and January 2021. Directed content analysis identified empathic opportunities, clinician empathetic statements or missed opportunities, and family responses. Clinician empathic statements were "buried" if immediately followed by more clinician medical talk. Descriptive analyses summarized demographics and codes. χ2 analyses summarized differences among language interpretation and family responses. RESULTS Twenty-nine patient-family dyads participated. Twenty-two (81%) family members were female. Eleven (39%) used language interpretation (8 Spanish, 2 Vietnamese, 1 Somali). Families created 210 empathic opportunities. Clinicians responded with unburied empathy 80 times (38%, no differences for English versus interpreted care conferences, P = .88). When clinicians buried empathy or missed empathic opportunities, families responded with alliance (agreement, gratitude, or emotional deepening) 14% and 15% of the time, respectively. When clinicians responded with unburied empathy, families responded with alliance 83% of the time (P < .01). CONCLUSIONS Our study suggests that clinician empathic expression does not differ when language interpretation is used in pediatric care conferences. Clinicians often miss opportunities to express empathy, or they bury it by medical talk. Although unburied empathy created opportunities for relationship-building and family-sharing, buried empathy negatively impacted these domains similarly to no empathic expression.
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Affiliation(s)
- Aleksandra E. Olszewski
- Divisions of Bioethics and Palliative Care
- Division of Critical Care Medicine, Department of Pediatrics, Lurie Children’s Hospital and Northwestern University, Chicago, Illinois
| | - Jori Bogetz
- Divisions of Bioethics and Palliative Care
- Palliative Care and Resilience Program
| | | | - Miranda C. Bradford
- Palliative Care and Resilience Program
- Core for Biostatistics, Epidemiology and Analytics in Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Maya Scott
- Divisions of Bioethics and Palliative Care
- Center for Diversity and Health Equity
| | | | - Kelli Williams
- Parent Advisory Council, Seattle Children’s Hospital, Seattle, Washington
| | - Abby R. Rosenberg
- Hematology and Oncology, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington
- Palliative Care and Resilience Program
| | - Amy Trowbridge
- Divisions of Bioethics and Palliative Care
- Palliative Care and Resilience Program
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Wang Y, Wang P, Wu Q, Wang Y, Lin B, Long J, Qing X, Wang P. Doctors' and Patients' Perceptions of Impacts of Doctors' Communication and Empathy Skills on Doctor-Patient Relationships During COVID-19. J Gen Intern Med 2023; 38:428-433. [PMID: 36253633 PMCID: PMC9575631 DOI: 10.1007/s11606-022-07784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/06/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, the performance of Chinese doctors may have led to improved doctor-patient relationships (DPRs). However, it is unclear how doctors and patients perceived the impact of doctors' communication and empathy skills on DPRs during the COVID-19 pandemic. OBJECTIVE To examine the perceptions of doctors and patients on how doctors' communication skills and empathy skills influence DPRs during COVID-19. MAIN MEASURES Doctors' and patients' perceptions of doctors' communication skills were measured using the Chinese version of the SEGUE Framework. To measure empathy skills and DPRs, the Jefferson Scale of Empathy and Difficult Doctor-Patient Relationship Questionnaire were administered to doctors, and the Consultation and Relational Empathy Measure and Patient-Doctor Relationship Questionnaire were administered to patients. RESULTS A total of 902 doctors and 1432 patients in China were recruited during the pandemic via online or offline surveys (overall response rate of 69.8%). Both doctors and patients rated doctors' empathy skills as more impactful on DPRs than communication skills. Doctors believed that only their empathy skills influenced DPRs. But patients believed that there was a significant bi-directional relationship between doctors' communication and empathy skills and these two skills interacted to directly and indirectly influence DPRs, and doctors' empathy had a greater mediating effect than their communication. CONCLUSIONS During COVID-19, there were both similarities and differences between Chinese doctors' and patients' views on how doctors' communication and empathy skills influenced DPRs. The greater effect of doctors' empathy skills suggests that both doctors and patients attach more importance to doctors' empathy in doctor-patient interactions. The bi-directional effect on patient outcomes suggests that both doctors' communication and empathy skills are important to patients' perceptions of DPRs.
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Affiliation(s)
- Yanjiao Wang
- Faculty of Education, East China Normal University, Shanghai, China
- School of Teacher Education, Honghe University, Mengzi, China
| | - Peijuan Wang
- School of Foreign Languages, Tongji University, Shanghai, China
| | - Qing Wu
- College of Education, Lanzhou City University, Lanzhou, China
| | - Yao Wang
- Faculty of Education, East China Normal University, Shanghai, China
| | - BingJun Lin
- Psychological Counseling Center, Fujian Vocational College of Art, Fuzhou, China
| | - Jia Long
- Faculty of Education, East China Normal University, Shanghai, China
| | - Xiong Qing
- The Fourth People's Hospital of Huaihua, Huaihua, China
| | - Pei Wang
- Faculty of Education, East China Normal University, Shanghai, China.
- School of Teacher Education, Honghe University, Mengzi, China.
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15
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Anishchuk S, Kubacki A, Howell Y, van Harten MT, Yarascavitch C, MacGiolla Phadraig C. Can a virtual learning module foster empathy in dental undergraduate students? EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:118-125. [PMID: 35114039 PMCID: PMC10078759 DOI: 10.1111/eje.12783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/20/2021] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Empathy is an essential part of patient-centred health care, which positively benefits both patients and clinicians. There is little agreement regarding how best to design and deliver training for healthcare trainees to impart the skills and behaviours of clinical empathy. The study aimed to inform the field by sharing an educational intervention where we aimed to improve empathy amongst dental undergraduate students in Trinity College Dublin using a virtual learning module. METHODS Adopting pre-post-repeat pre-experimental design, dental professional students completed the Jefferson Scale of Empathy (JSE) for Health Professional Students immediately prior to and after a three-week virtual programme designed to increase clinical empathy. Using a three-factor model described for the JSE in the literature, scores were evaluated for internal consistency and paired tests were performed on scores appropriate to their distributions. Seven-point Likert scales were scored to record student experience of training and technology, which are reported descriptively. RESULTS Most of the 37 participants were female (76%) and represented dental science (N = 27) and dental hygiene roles (N = 7). Results revealed a mean JSE-HPS scale score rise from 110.0 (SD = 10.4) to 116.4 (SD = 11.1), which represented a rise of 5.8% (t (36) = 3.6, p = 0.001). The three factors associated with cognitive empathy, namely perspective-taking (T(36) = 3.931, p < 0.001; walking in the patient's shoes T(36) = 2.093, p = 0.043); and compassionate care (Z = 2.469, p = 0.014) were all found to have increased after the intervention. Students reported a positive experience of discipline-specific and generic videos as part of the module. CONCLUSION The study demonstrated that a virtual educational module was associated with an increase in empathy amongst dental undergraduate students. The design of a blended module incorporating the Massive Open Online Course (MOOC) and virtual learning are beneficial and have a promising future.
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Affiliation(s)
- Sviatlana Anishchuk
- Trinity College DublinUniversity of DublinDublin Dental University HospitalDublinIreland
| | - Angela Kubacki
- Trinity College DublinUniversity of DublinDublin Dental University HospitalDublinIreland
- Institute of Medical and Biomedical EducationSt George'sUniversity of LondonLondonIreland
| | - Yvonne Howell
- Trinity College DublinUniversity of DublinDublin Dental University HospitalDublinIreland
| | - Maria T. van Harten
- Trinity College DublinUniversity of DublinDublin Dental University HospitalDublinIreland
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16
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Vanhooren S, Conrado Veiga Bosquetti Y, Frediani G. The Development of the Existential Empathy Questionnaire. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221144599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Therapist empathy toward existential concerns might be a critical component of clinical practice. This study aims to explore the psychometric properties of the Existential Empathy Questionnaire (EEQ), a self-report instrument developed to measure levels of existential empathy among mental health professionals. The EEQ was completed by a sample of 393 therapists recruited in Belgium, along with measures of general empathy, experiential avoidance, and existential avoidance. To assess the test–retest reliability, 353 participants of the same sample completed the EEQ a second time 2 weeks later. Clinical experience and therapeutic theoretical background were assessed to inform professional characteristics. The results support the use of the EEQ as a unidimensional measure of existential empathy. It demonstrates good internal reliability and temporal stability. A principal components analysis indicates three components with small to moderate intercorrelations, labeled as “Communication,” “Avoidance and Overwhelming Feelings,” and “Resonance and Presence.” EEQ total scores show a moderate positive association with general empathy and a moderate negative association with experiential and existential avoidance. Furthermore, the EEQ significantly uniquely predicts experiential and existential avoidance after controlling for general empathy. Years of clinical practice and a humanistic-oriented therapeutic approach correlated moderately with high EEQ scores.
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17
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Xu H, Cheng X, Wang T, Wu S, Xiong Y. Mapping Neuroscience in the Field of Education through a Bibliometric Analysis. Brain Sci 2022; 12:1454. [PMID: 36358380 PMCID: PMC9688185 DOI: 10.3390/brainsci12111454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/02/2023] Open
Abstract
This study aimed to explore the core knowledge topics and future research trends in neuroscience in the field of education (NIE). In this study, we have explored the diffusion of neuroscience and different neuroscience methods (e.g., electroencephalography, functional magnetic resonance imaging, eye tracking) through and within education fields. A total of 549 existing scholarly articles and 25,886 references on neuroscience in the field of education (NIE) from the Web of Science Core Collection databases were examined during the following two periods: 1995-2013 and 2014-2022. The science mapping software Vosviewer and Bibliometrix were employed for data analysis and visualization of relevant literature. Furthermore, performance analysis, collaboration network analysis, co-citation network analysis, and strategic diagram analysis were conducted to systematically sort out the core knowledge in NIE. The results showed that children and cognitive neuroscience, students and medical education, emotion and empathy, and education and brain are the core intellectual themes of current research in NIE. Curriculum reform and children's skill development have remained central research issues in NIE, and several topics on pediatric research are emerging. The core intellectual themes of NIE revealed in this study can help scholars to better understand NIE, save research time, and explore a new research question. To the best of our knowledge, this study is one of the earliest documents to outline the NIE core intellectual themes and identify the research opportunities emerging in the field.
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Affiliation(s)
- Hanqing Xu
- College of Science and Technology, Ningbo University, Cixi 315211, China
| | - Xinyan Cheng
- Department of Sociology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Ting Wang
- College of Science and Technology, Ningbo University, Cixi 315211, China
| | - Shufen Wu
- Ningbo Childhood Education College, Ningbo 315336, China
| | - Yongqi Xiong
- College of Science and Technology, Ningbo University, Cixi 315211, China
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18
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Maximiano-Barreto MA, Bomfim AJDL, Borges MM, de Moura AB, Luchesi BM, Chagas MHN. Recognition of Facial Expressions of Emotion and Depressive Symptoms among Caregivers with Different Levels of Empathy. Clin Gerontol 2022; 45:1245-1252. [PMID: 34219607 DOI: 10.1080/07317115.2021.1937426] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess differences in the recognition of facial expressions of emotion among caregivers of older people with different levels of empathy. METHODS A cross-sectional study was conducted with 158 caregivers of older adults who provided care in family residences or nursing homes. The caregivers were divided into three groups based on the score of the multidimensional Interpersonal Reactivity Index: "lower empathy", "intermediate empathy", and "higher empathy". Data collection involved the administration of a sociodemographic questionnaire, the Emotion Recognition Test, and the Patient Health Questionnaire. RESULTS No significant differences were found among the groups in terms of sociodemographic variables. Regarding clinical characteristics, the "higher empathy" group had more depressive symptoms than the other groups (p = .001). Moreover, the "higher empathy" group exhibited greater accuracy at recognizing the expression of sadness than the "lower empathy" group (p = .033). The recognition of sadness remained significant in the analysis of variance adjusted for depressive symptoms (p < .05). CONCLUSIONS Caregivers with higher levels of empathy showed greater accuracy at recognizing sadness emotion compared to caregivers with lower levels of empathy. Additionally, caregivers with greater empathy have more depressive symptoms. CLINICAL IMPLICATIONS The recognition of facial expressions of sadness may give caregivers a skill to infer possible needs in older care recipients. However, a higher level of empathy may exert a negative psychological impact on caregivers of older people, which could have repercussions regarding the quality of care provided.
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Affiliation(s)
- Madson Alan Maximiano-Barreto
- Department of Psychology, Federal University of São Carlos, São Carlos, Brazil.,Research Group on Mental Health, Cognition, and Aging, Federal University of São Carlos, São Carlos, Brazil
| | - Ana Julia de Lima Bomfim
- Research Group on Mental Health, Cognition, and Aging, Federal University of São Carlos, São Carlos, Brazil.,Department of Neurocience and Behavior, University of São Paulo, Ribeirão Preto, Brazil
| | - Marina Miranda Borges
- Research Group on Mental Health, Cognition, and Aging, Federal University of São Carlos, São Carlos, Brazil
| | - Amanda Barros de Moura
- Research Group on Mental Health, Cognition, and Aging, Federal University of São Carlos, São Carlos, Brazil
| | - Bruna Moretti Luchesi
- Research Group on Mental Health, Cognition, and Aging, Federal University of São Carlos, São Carlos, Brazil.,Undergraduate Course in Medicine and Postgraduate Program in Nursing, Federal University of Mato Grosso do Sul, Três Lagoas, Brazil
| | - Marcos Hortes Nisihara Chagas
- Department of Psychology, Federal University of São Carlos, São Carlos, Brazil.,Research Group on Mental Health, Cognition, and Aging, Federal University of São Carlos, São Carlos, Brazil.,Department of Neurocience and Behavior, University of São Paulo, Ribeirão Preto, Brazil.,Bairral Psychiatry Institute, Itapira, Brazil
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19
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Festl-Wietek T, Kern N, Erschens R, Griewatz J, Zipfel S, Herrmann-Werner A. Online student tutorials for effective peer teaching in digital times: a longitudinal quantitative study. BMC MEDICAL EDUCATION 2022; 22:681. [PMID: 36114526 PMCID: PMC9479236 DOI: 10.1186/s12909-022-03741-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/07/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Peer-assisted learning represents a favoured method of teaching in universities. The COVID-19 pandemic has necessitated transferring medical education to digital formats, and subsequently, the question has arisen of whether online tutorials might be effective. This study, thus, investigated the efficacy of online tutorials in a communication course by assessing the interaction, verbal communication, and nonverbal communication of tutors and students. METHODS Second-year medical students were invited to participate in this longitudinal quantitative study. Validated and self-developed questionnaires (e.g., Jefferson Empathy Scale) including 39 questions (rated on a 7- or 5-point Likert scale) were used to assess the different variables including interaction, verbal and nonverbal communication and students' learning success. RESULTS Out of 165 medical students, 128 took part in the study. The students as well as tutors reported that they found each other likeable (Mstudents = 4.60±0.71; Mtutors = 4.38±0.53; p > .05). Learning success increased throughout the communication course (Cohen's d = 0.36-0.74). The nonverbal and verbal communication in the simulated patient (SP) encounter was also rated as high by all three groups (Mnonverbal = 3.90±0.83; Mverbal = 4.88±0.35). CONCLUSIONS Interaction as well as nonverbal and verbal communication occurred in the online format, indicating that online tutorials can be effective. The implementation of SPs increases the efficiency of synchronous online learning as it enhances the simulation of a real patient-physician encounter. Thus, online tutorials are a valuable amendment to medical education.
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Affiliation(s)
- Teresa Festl-Wietek
- TIME - Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
| | - Nils Kern
- Deanery of Students' Affairs, University of Tuebingen, Tuebingen, Germany
| | - Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Jan Griewatz
- TIME - Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany.
| | - Stephan Zipfel
- Deanery of Students' Affairs, University of Tuebingen, Tuebingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Anne Herrmann-Werner
- TIME - Tübingen Institute for Medical Education, University of Tuebingen, Tuebingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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20
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Brunelli A. European Society of Thoracic Surgeons Presidential Address 2022 Sawubona: Bridging Emotional and Cognitive Gaps Through Empathy and Perspective Taking. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 62:6687157. [PMID: 36053284 DOI: 10.1093/ejcts/ezac412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 07/28/2022] [Indexed: 11/12/2022]
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21
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Stinson J, Wolfe R, Spaulding W. Social Connectedness in Schizotypy: The Role of Cognitive and Affective Empathy. Behav Sci (Basel) 2022; 12:bs12080253. [PMID: 35892353 PMCID: PMC9394355 DOI: 10.3390/bs12080253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 12/30/2022] Open
Abstract
Social connectedness is increasingly understood to be a resilience factor that moderates vulnerability to poor physical and mental health. This study examines cognitive and affective processes that support normal socialization and social connectedness, and the impact of schizotypy, in well-functioning college students. In this study, a total of 824 college students completed a series of self-report questionnaires, and structural equation modeling was then employed to identify relationships between cognitive and affective empathy, alexithymia, distress tolerance, social connectedness, and schizotypy. Schizotypy is a trait-like condition, presumed to be genetic in origin, associated with the risk for schizophrenia. Like schizophrenia, schizotypy is thought to have three distinct dimensions or categories, termed positive, negative, and disorganized. Results indicate that the respective dimensions of schizotypy have different pathways to social connectedness, through both direct and indirect effects. Positive schizotypy exerts a counterintuitive positive influence on social connectedness, mediated by positive effects on cognitive empathy, but this is obscured by the high correlations between the schizotypal dimensions and the strong negative influences on empathy and social connectedness of the negative and disorganized dimensions, unless all those intercorrelations are taken into account. Overall, the pathways identified by structural equation modeling strongly support the role of empathy in mediating the impact of schizotypy on social connectedness. Implications for the etiology of social impairments in schizotypy, and for interventions to enhance social connectedness to improve quality of life and reduce health disparities in people at risk for severe mental illness, are discussed.
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Affiliation(s)
- Jessica Stinson
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
- South Texas Veterans Healthcare System, San Antonio, TX 78229, USA
- Correspondence:
| | - Rebecca Wolfe
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
| | - Will Spaulding
- Department of Psychology, College of Arts and Sciences, University of Nebraska–Lincoln, Lincoln, NE 68588, USA; (R.W.); (W.S.)
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22
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Talking Points: Enhancing Communication Between Radiologists and Patients. Acad Radiol 2022; 29:888-896. [PMID: 33846062 DOI: 10.1016/j.acra.2021.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 11/23/2022]
Abstract
Radiologists communicate along multiple pathways, using written, verbal, and non-verbal means. Radiology trainees must gain skills in all forms of communication, with attention to developing effective professional communication in all forms. This manuscript reviews evidence-based strategies for enhancing effective communication between radiologists and patients through direct communication, written means and enhanced reporting. We highlight patient-centered communication efforts, available evidence, and opportunities to engage learners and enhance training and simulation efforts that improve communication with patients at all levels of clinical care.
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23
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[Comprehensive conservative care of stage 5-CKD: A practical guide]. Nephrol Ther 2022; 18:155-171. [PMID: 35732405 DOI: 10.1016/j.nephro.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/20/2022] [Indexed: 10/17/2022]
Abstract
In French-speaking countries, the anglicism "traitement conservateur" is commonly used in clinical practice for CKD 5 patients, meaning comprehensive conservative care. In 2015, the publication of KDIGO controversies put forward this "new" therapeutic option at the same level as dialysis or transplantation. However, its detailed contents remain heterogeneous due to cultural and ethical considerations, varying with regional or national health systems. This is the reason why the French-speaking society of Nephrology, Dialysis, Transplantation (SFNDT) set up an international debate to publish clinical guidelines in French.
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Leuchtenberg S, Gromer D, Käthner I. Videoconferencing versus
face‐to‐face
psychotherapy: Insights from patients and psychotherapists about comparability of therapeutic alliance, empathy and treatment characteristics. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sophie Leuchtenberg
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy University of Würzburg Würzburg Germany
| | - Daniel Gromer
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy University of Würzburg Würzburg Germany
| | - Ivo Käthner
- Department of Psychology I, Biological Psychology, Clinical Psychology and Psychotherapy University of Würzburg Würzburg Germany
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25
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White AA, King AM, D'Addario AE, Brigham KB, Dintzis S, Fay EE, Gallagher TH, Mazor KM. Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory. JMIR MEDICAL EDUCATION 2022; 8:e30988. [PMID: 35486423 PMCID: PMC9107044 DOI: 10.2196/30988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 02/19/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Residents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios. OBJECTIVE We aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app. METHODS Internal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents' error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople. RESULTS Internal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates' and crowdsourced laypeople's ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75. CONCLUSIONS Crowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills.
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Affiliation(s)
- Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Ann M King
- National Board of Medical Examiners, Philadelphia, PA, United States
| | | | - Karen Berg Brigham
- Collaborative for Accountability and Improvement, University of Washington, Seattle, WA, United States
| | - Suzanne Dintzis
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, United States
| | - Emily E Fay
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, United States
| | - Thomas H Gallagher
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, United States
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, United States
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26
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Newton BW. Having Heart: Affective and Cognitive Empathy Scores vs. Residency Specialty Match at an Osteopathic Medical School. MEDICAL SCIENCE EDUCATOR 2022; 32:423-436. [PMID: 35528289 PMCID: PMC9054984 DOI: 10.1007/s40670-022-01526-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Past studies examining the cognitive empathy of medical school graduates grouped the various residency selections vs. parsing them out. This study examines both affective and cognitive empathy scores of osteopathic medical school graduates entering eleven different residency specialties. METHODS Participants from the Campbell University Jerry M. Wallace School of Osteopathic Medicine (CUSOM) classes of 2017-2019 completed the Balanced Emotional Empathy Scale (BEES; measuring affective empathy) and the Jefferson Scale of Empathy, Student version (JSE-S; measuring cognitive empathy). Empathy scores were compared to residency choice upon graduation. The specialty choices were broken into two groups: Core specialties (i.e., people-oriented) that include Family Medicine, Internal Medicine, Obstetrics and Gynecology (OB/Gyn), Pediatrics, and Psychiatry. The remaining specialties are considered Non-Core specialties (i.e., technical/procedure-oriented) and included Anesthesiology, Diagnostic Radiology, Emergency Medicine, General Surgery, Neurology, and Orthopedics. Results are compared to data from the nationwide Project in Osteopathic Medical Education and Empathy (POMEE). RESULTS Women graduates tended to have larger BEES and JSE-S scores than men. Affective empathy scores were the largest for students selecting Core specialties. Four of these Core specialties were in the top four positions out of the eleven specialties selected by eight or more graduates. None of the eleven specialties was ranked higher than the 50th percentile compared to BEES score norms. Cognitive empathy scores were also the largest for students selecting Core specialties. All five of the Core specialties were in the top six positions out of the eleven specialties. None of the eleven specialties ranked greater than the 39th percentile when compared to OMS-III and OMS-IV POMEE data. Only women entering Psychiatry had a JSE-S score that was greater than the 50th percentile. CONCLUSIONS Osteopathic graduates selecting the five Core specialties have BEES and JSE-S scores that are, usually, larger than students entering Non-Core specialties. For either survey instrument, both Pediatrics and Family Medicine were first and second out of a possible 11 positions, respectively. Most CUSOM graduates had JSE-S scores lower than their peers in other osteopathic medical schools that participated in the POMEE study. When the CUSOM data are compared to allopathic data, there is no clear evidence that osteopathic students have substantially higher affective or cognitive empathy scores than their allopathic peers. Therefore, it appears that medical students who select osteopathy for its tenant of a more holistic approach to patient care are no more empathetic than students studying allopathic medicine. Several suggestions are made on how to potentially increase student empathy during undergraduate medical education.
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Affiliation(s)
- Bruce W. Newton
- Department of Anatomy, Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546 USA
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Myronuk L. Effect of telemedicine via videoconference on provider fatigue and empathy: Implications for the Quadruple Aim. Healthc Manage Forum 2022; 35:174-178. [PMID: 35289218 DOI: 10.1177/08404704211059944] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Telemedicine via videoconferencing rapidly deployed during the COVID-19 pandemic reduces contact and opportunity for virus transmission, with Quadruple Aim benefits of improved population health and associated cost avoidance of COVID-related illness. Patient experience of telemedicine has generally been positive, but widespread use of videoconferencing outside of healthcare has brought growing recognition of associated mental fatigue. Experience in telepsychiatry shows attending to non-verbal communication and maintaining empathic rapport requires increased mental effort, making provider experience more sensitive to cumulative fatigue effects. Since empathy and therapeutic alliance are foundational to all physician-patient relationships, these telepsychiatry findings have implications for telehealth generally. Health leaders and providers planning for sustainable incorporation of videoconferencing into ongoing healthcare delivery should consider the potential for unintended negative effects on provider experience and burnout.
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Affiliation(s)
- Lonn Myronuk
- 8204Vancouver Island Health Authority, Nanaimo, British Columbia, Canada
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Desmond J. Medicine, Value, and Knowledge in the Veterinary Clinic: Questions for and From Medical Anthropology and the Medical Humanities. Front Vet Sci 2022; 9:780482. [PMID: 35359687 PMCID: PMC8964002 DOI: 10.3389/fvets.2022.780482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/28/2022] [Indexed: 11/28/2022] Open
Abstract
The welcome development of the veterinary humanities, and veterinary anthropology specifically, raises the question of its potential relationship with the now well-established field(s) of the medical humanities, and of medical anthropology. Although there are national variations, the term “medical humanities” generally refers to either the tapping of the humanities to improve medical education by developing, through engagement with the humanities like literature and visual art, skills in empathy, visualization and expressivity, or alternatively, it refers to the application of humanities approaches of cultural critique to the presumptions, practices and institutions of the human medical world to denaturalize the ideologies of knowledge that contemporary human medicine professions depend upon. This article reflects on the potential impact that the development of a veterinary medical humanities could have on the field of (human) medical humanities and vice versa. Could such a development force a re-conception of notions of agency, of consent, and of the position of “patient” when the (human based) medical humanities is expanded to include both human and veterinary medicine? What would the potential usefulness, or limitations, both in conceptual and in applied terms, be of constructing a multi-species notion of “medical humanities?” What can such a comparative approach offer to veterinary medicine, in practice and in terms of the curricula of veterinary training? To reflect on these questions, this article draws on my multiple years of fieldwork in veterinary clinics and classrooms to first lay out the constituent components of the formal practice of contemporary veterinary medicine (at least in the U.S.) in terms of the roles that species specificity and relations to humans play in the delivery of care, and then seeks to center the animal in these practices to ask questions about consent, resistance, veterinary obligation, and the role of finance in comparison with human medicine. These similarities and differences will form the basis for a consideration of the effects of enlarging the medical humanities to encompass more than one species.
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Bußenius L, Kadmon M, Berberat PO, Harendza S. Evaluating the Global Rating scale's psychometric properties to assess communication skills of undergraduate medical students in video-recorded simulated patient encounters. PATIENT EDUCATION AND COUNSELING 2022; 105:750-755. [PMID: 34112546 DOI: 10.1016/j.pec.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate the psychometric properties of the Global Rating scale (GR) as an observer-based tool to assess communication skills of undergraduate medical students in video-recorded patient encounters. METHODS Seventy advanced undergraduate medical students participated in a simulation-based assessment including patient consultations. Simulated patients rated these encounters with the Consultation and Relational Empathy (CARE) scale. Two independent, blinded raters assessed the videos of the encounters with the GR and another blinded rater with the Clinical Reasoning Indicators Scale (CRI-HT-S). To assess the GR's psychometric properties, we analysed reliability by means of a G-study, interrater reliability by ICC, convergent validity (correlation of GR and CARE), and divergent validity (correlation of GR and CRI-HT-S). RESULTS We analysed 325 videos of 65 students (56.9% female, mean age 26.1 ± 2.2 years). The G-coefficient was.90. Interrater reliability of the GR was ICC = .95, 95% CI [.91,.97]. CARE and GR correlated moderately (ρ = .47, 95% CI [.25,.65]). GR and CRI-HT-S did not correlate (ρ = .09, 95% CI [-.16,.34]). CONCLUSIONS With excellent reliability and adequate validity, the quality of the GR as assessment instrument for communication skills could be demonstrated. PRACTICE IMPLICATIONS The GR is a suitable instrument for video-based rating of communication skills.
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Affiliation(s)
- Lisa Bußenius
- Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Kadmon
- Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Pascal O Berberat
- TUM Medical Education Center, Technical University of Munich, Munich, Germany
| | - Sigrid Harendza
- III. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Abstract
Empathy is an integral aspect of communication with older people and is central to person-centred care. As part of the provision of person-centred care, empathy supports effective communication, producing positive effects such as increased emotional well-being, increased adherence to treatment plans, reduced pain levels and improved wound healing. Empathy involves attempting to understand the other person's perspective and feelings and communicate that understanding back to them. Empathic communication can help older people feel that they are being listened to and valued as partners in healthcare relationships. This article focuses on why it is important to demonstrate empathy when communicating with older people and how this can be achieved. It explains the origin of the concept of empathy in nursing and provides different ways of characterising empathy. It explores barriers to empathic communication in older people nursing and identifies verbal and non-verbal communication skills that nurses can use to enhance their empathy. Finally, it explains the importance for nurses to develop self-awareness and undertake self-care to preserve their capacity to demonstrate empathy towards older people.
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Affiliation(s)
- Kirsten Jack
- Manchester Metropolitan University, Manchester, England
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Abstract
BACKGROUND AND OBJECTIVES Health care organizations track patient experience data, identify areas of improvement, monitor provider performance, and assist providers in improving their interactions with patients. Some practices use one-on-one provider counseling ("shadow coaching") to identify and modify provider behaviors. A recent evaluation of a large shadow coaching program found statistically significant improvements in coached providers' patient experience scores immediately after being coached. This study aimed to examine the content of the recommendations given to those providers aimed at improving provider-patient interactions, characterize these recommendations, and examine their actionability. METHODS Providers at a large, urban federally qualified health center were selected for coaching based on Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) patient experience scores (92 of 320 providers), shadowed by a trained peer coach for a half to full day and received recommendations on how to improve interactions with their patients. We coded 1082 recommendations found in the 92 coaching reports. RESULTS Reports contained an average of 12 recommendations. About half encouraged consistency of existing behaviors and half encouraged new behaviors. Most recommendations related to behaviors of the provider rather than support staff and targeted actions within the examination room rather than other spaces (eg, waiting room). The most common recommendations mapped to behavioral aspects of provider communication. Most recommendations targeted verbal rather than nonverbal communication behaviors. Most recommendations were actionable (ie, specific, descriptive), with recommendations that encouraged new behaviors being more actionable than those that encouraged existing actions. CONCLUSIONS Patient experience surveys are effective at identifying where improvement is needed but are not always informative enough to instruct providers on how to modify and improve their interactions with patients. Analyzing the feedback given to coached providers as part of an effective shadow-coaching program provides details about implementation on shadow-coaching feedback. Recommendations to providers aimed at improving their interactions with patients need to not only suggest the exact behaviors defined within patient experience survey items but also include recommended behaviors indirectly associated with those measured behaviors. Attention needs to be paid to supplementing patient experience data with explicit, tangible, and descriptive (ie, actionable) recommendations associated with the targeted, measured behaviors. Research is needed to understand how recommendations are put into practice by providers and what motivates and supports them to sustain changed behaviors.
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Hernandez‐Nino J, Thomas M, Alexander AB, Ott MA, Kline JA. Communication at diagnosis of venous thromboembolism: Lasting impact of verbal and nonverbal provider communication on patients. Res Pract Thromb Haemost 2022; 6:e12647. [PMID: 35071970 PMCID: PMC8760606 DOI: 10.1002/rth2.12647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/27/2021] [Accepted: 11/24/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Establishing trust and effective communication can be challenging in the emergency department, where a prior relationship between patient and provider is lacking and decisions have to be made rapidly. Venous thromboembolism (VTE) represents an emergent condition that requires immediate decision making. OBJECTIVE The aim of this paper was to document the experiences, perceptions, and the overall impact of health care provider communication on patients during the diagnosis of VTE in the emergency department. METHODS This was a qualitative method study using semistructured interviews to increase understanding of the patient experience during the diagnosis of VTE and impact of the health care provider communication on subsequent patient perceptions. RESULTS A total of 24 interviews were conducted. Content analysis revealed that certain aspects of health care providers' communication-namely, word choice, incomplete information, imbalance between fear over reassurance and nonverbal behavior-used to deliver and explain VTE diagnosis, treatment, and prognosis increases patients' fears. CONCLUSION These interviews elucidate areas for improvement of communication in the emergency care setting for acute VTE.
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Affiliation(s)
| | - Mary Thomas
- Indiana University School of MedicineIndianapolisIndianaUSA
| | - Andreia B. Alexander
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Mary A. Ott
- Department of PediatricsIndiana University School of MedicineIndianaIndianapolisUSA
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Derksen FAWM, Olde Hartman TC, Lagro-Janssen ALM, Kramer AWM. Clinical empathy in GP-training: Experiences and needs among Dutch GP-trainees. "Empathy as an element of personal growth". PATIENT EDUCATION AND COUNSELING 2021; 104:3016-3022. [PMID: 33863583 DOI: 10.1016/j.pec.2021.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Clinical empathy has been described as a key component of effective person-centeredness in patient-physician communication. Yet little is known about general practitioner (GP) trainees' experiences and opinions regarding clinical empathy, empathy-education and the development of empathic skills. This study aimed to explore trainees' experiences with clinical empathy during GP training. METHODS This study used focus group interviews. GP trainees at two Dutch universities were approached by e-mail. Focus groups were conducted between April and November 2018. Six focus groups were conducted: two with starting trainees, two with trainees at the end of their first year and two with trainees at the end of their 3 years' training. Two experienced qualitative researchers analyzed the focus groups. During the thematic analysis the differences and similarities between the various stages of education were taken into account and a framework for the identified themes and subthemes was developed. RESULTS Thirty-five GP trainees took part. Four main themes could be identified. Starting trainees experienced frictions regarding the influence of personal affective reactions on their medical competencies. Trainees at the end of their first year indicated that they reached a balance between empathic involvement and their responsibility to carry out relevant medical tasks, such as following GP guidelines. Trainees at the end of their three years' training recognized the mutual relationship between the development of the behavioral part of clinical empathy and personal growth. All trainees stated that their needs concerning education changed during their GP training and proposed changes to the curriculum. CONCLUSIONS GP trainees face various obstacles in developing empathic skills and behavior. Particularly they mention handling personal affective reactions. Trainees express a clear wish for clinical empathy, in its theoretical as well as its skill and emotional aspects, to play a central role in the curriculum. PRACTICE IMPLICATIONS More explicit attention to be paid to empathy by embedding theoretical education, explicit attention to skill training and assessment of empathic behavior by patients and supervisors.
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Affiliation(s)
- F A W M Derksen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - T C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A L M Lagro-Janssen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Sloan M, Lever E, Harwood R, Gordon C, Wincup C, Blane M, Brimicombe J, Lanyon P, Howard P, Sutton S, D'Cruz D, Naughton F. Telemedicine in rheumatology: A mixed methods study exploring acceptability, preferences and experiences among patients and clinicians. Rheumatology (Oxford) 2021; 61:2262-2274. [PMID: 34698822 PMCID: PMC8689882 DOI: 10.1093/rheumatology/keab796] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/20/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The Covid-19 pandemic necessitated a rapid global transition towards telemedicine; yet much remains unknown about telemedicine's acceptability and safety in rheumatology. To help address this gap and inform practice, this study investigated rheumatology patient and clinician experiences and views of telemedicine. METHODS Sequential mixed methodology combined analysis of surveys and in-depth interviews. Between and within-group differences in views of telemedicine were examined for patients and clinicians using t-tests. RESULTS Surveys (Patients n = 1,340, Clinicians n = 111) and interviews (Patients n = 31, Clinicians n = 29) were completed between April 2021 and July 2021. The majority of patients were from the UK (96%) and had inflammatory arthritis (32%) or lupus (32%). Patients and clinicians rated telemedicine as worse than face-to-face consultations in almost all categories, although >60% found it more convenient. Building trusting medical relationships and assessment accuracy were great concerns (93% of clinicians and 86% of patients rated telemedicine as worse than face-to-face for assessment accuracy). Telemedicine was perceived to have increased misdiagnoses, inequalities and barriers to accessing care. Participants reported highly disparate telemedicine delivery and responsiveness from primary and secondary care. Although rheumatology clinicians highlighted the importance of a quick response to flaring patients, only 55% of patients were confident that their rheumatology department would respond within 48 hours. CONCLUSION Findings indicate a preference for face-to-face consultations. Some negative experiences may be due to the pandemic rather than telemedicine specifically, although the risk of greater diagnostic inaccuracies using telemedicine is unlikely to be fully resolved. Training, choice, careful patient selection, and further consultation with clinicians and patients is required to increase telemedicine's acceptability and safety.
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Affiliation(s)
- Melanie Sloan
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK
| | - Elliott Lever
- Rheumatology department, Northwick Park Hospital, UK
| | - Rupert Harwood
- Patient and Public Involvement in lupus Research Group, Institute of Public Health, University of Cambridge, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of inflammation and ageing, College of Medical and Dental Science, University of Birmingham, UK
| | - Chris Wincup
- Department of Rheumatology, University College London, UK
| | - Moira Blane
- Patient and Public Involvement in lupus Research Group, Institute of Public Health, University of Cambridge, UK
| | - James Brimicombe
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK
| | - Peter Lanyon
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, UK
| | - Paul Howard
- LUPUS UK, St James' House, Romford, Essex, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK
| | - David D'Cruz
- The Louise Coote Lupus unit, Guy's and St Thomas', NHS foundation Trust, UK
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, UK
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Li J, Clouser JM, Brock J, Davis T, Jack B, Levine C, Mays GP, Mittman B, Nguyen H, Sorra J, Stromberg A, Du G, Dai C, Adu A, Vundi N, Williams MV. Effects of Different Transitional Care Strategies on Outcomes after Hospital Discharge-Trust Matters, Too. Jt Comm J Qual Patient Saf 2021; 48:40-52. [PMID: 34764025 DOI: 10.1016/j.jcjq.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND As health systems shift toward value-based care, strategies to reduce readmissions and improve patient outcomes become increasingly important. Despite extensive research, the combinations of transitional care (TC) strategies associated with best patient-centered outcomes remain uncertain. METHODS Using an observational, prospective cohort study design, Project ACHIEVE sought to determine the association of different combinations of TC strategies with patient-reported and postdischarge health care utilization outcomes. Using purposive sampling, the research team recruited a diverse sample of short-term acute care and critical access hospitals in the United States (N = 42) and analyzed data on eligible Medicare beneficiaries (N = 7,939) discharged from their medical/surgical units. Using both hospital- and patient-reported TC strategy exposure data, the project compared patients "exposed" to each of five overlapping groups of TC strategies to their "control" counterparts. Primary outcomes included 30-day hospital readmissions, 7-day postdischarge emergency department (ED) visits and patient-reported physical and mental health, pain, and participation in daily activities. RESULTS Participants averaged 72.3 years old (standard deviation =10.1), 53.4% were female, and most were White (78.9%). Patients exposed to one TC group (Hospital-Based Trust, Plain Language, and Coordination) were less likely to have 30-day readmissions (risk ratio [RR], 0.72; 95% confidence interval [CI] = 0.57-0.92, p < 0.001) or 7-day ED visits (RR, 0.72; 95% CI, 0.55-0.93, p < 0.001) and more likely to report excellent physical and mental health, greater participation in daily activities, and less pain (RR ranged from 1.11 to 1.15, p < 0.01). CONCLUSION In concert with care coordination activities that bridge the transition from hospital to home, hospitals' clear communication and fostering of trust with patients were associated with better patient-reported outcomes and reduced health care utilization.
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Bukhari M, Robinson S, Adebajo A, Heslop P, Walker D. Empathic communication during a pandemic: How can we minimize the deficit? Rheumatology (Oxford) 2021; 60:SI1-SI2. [PMID: 33989389 DOI: 10.1093/rheumatology/keab415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marwan Bukhari
- Department of Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust Royal Lancaster Infirmary, Lancaster, UK
| | - Sandra Robinson
- Department of Rheumatology, Northumbria Healthcare NHS Foundation Trust Unit 7/8, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Ade Adebajo
- Department of Rheumatology, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Peta Heslop
- Department of Rheumatology, Northumbria Healthcare NHS Foundation Trust Unit 7/8, Newcastle Upon Tyne, Tyne and Wear, UK
| | - David Walker
- Department of Rheumatology, Northumbria Healthcare NHS Foundation Trust Unit 7/8, Newcastle Upon Tyne, Tyne and Wear, UK
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Saeed F, Shah AY, Allen RJ, Epstein RM, Fiscella KA. Communication principles and practices for making shared decisions about renal replacement therapy: a review of the literature. Curr Opin Nephrol Hypertens 2021; 30:507-515. [PMID: 34148978 PMCID: PMC8373782 DOI: 10.1097/mnh.0000000000000731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the skill set required for communication and person-centered decision making for renal replacement therapy (RRT) choices, especially conservative kidney management (CKM). RECENT FINDINGS Research on communication and decision-making skills for shared RRT decision making is still in infancy. We adapt literature from other fields such as primary care and oncology for effective RRT decision making. SUMMARY We review seven key skills: (1) Announcing the need for decision making (2) Agenda Setting (3) Educating patients about RRT options (4) Discussing prognoses (5) Eliciting patient preferences (6) Responding to emotions and showing empathy, and (7) Investing in the end. We also provide example sentences to frame the conversations around RRT choices including CKM.
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Affiliation(s)
- Fahad Saeed
- Departments of Medicine and Public Health, Division of Nephrology
- Division of Palliative Care
- University of Rochester School of Medicine, National University of Medical Sciences
| | - Amna Yousaf Shah
- Rawalpindi, Pakistan; CITE Center, Department of Behavioral and Natural Sciences
| | | | - Ronald M Epstein
- Division of Palliative Care
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kevin A Fiscella
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Zhao Y, Fuller L, Daugherty KK. Evaluating pharmacy faculty perceptions of empathy in education: A qualitative study. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:975-981. [PMID: 34294263 DOI: 10.1016/j.cptl.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/02/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Empathy is critical in building teacher-student relationships. Little research is available evaluating the empathetic capacity of faculty who teach in healthcare professional programs. This study's objectives were to describe how faculty define empathy, describe faculty perspectives on the role of empathy in pharmacy education, and discuss the potential barriers to demonstrating empathy to students. METHODS A qualitative research approach was utilized for this study. Semi-structured interviews were conducted with faculty members randomly selected from an accelerated doctor of pharmacy program. All interviews were transcribed, and an interpretive phenomenological approach was used to describe, code, and analyze the experiences. RESULTS Results showed that faculty naturally define empathy more from an emotional aspect rather than a cognitive one. Faculty have a consensus on the role of empathy in education and believe it essential for building relationships with students and fostering positive learning environments. Further, most faculty think that empathy is an innate ability, but that empathy can be developed through life experiences and training. Significant challenges of being empathetic in educational environments are associated with the instructor, learner, and learning itself, including demanding time and energy, establishing boundaries, maintaining standards, and handling challenging students. CONCLUSIONS Faculty perceptions of empathy in education revealed empathetic teaching plays an essential role in building teacher-student relationships and positively impacting students' learning. Empathy is a critical skill and characteristic for healthcare profession educators to possess. The development of empathy training modules may be helpful to improve faculty's empathy.
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Affiliation(s)
- Yuan Zhao
- Sam Houston State University College of Osteopathic Medicine, Department of Molecular and Cellular Biology, 925 City Central Avenue, Conroe, TX 77304, United States.
| | - Lynn Fuller
- Sullivan University College of Pharmacy and Health Sciences, Department of Pharmaceutical Sciences, 2100 Gardiner Lane, Louisville, KY 40205, United States.
| | - Kimberley K Daugherty
- Sullivan University College of Pharmacy and Health Sciences, Department of Clinical and Administrative Sciences, 2100 Gardiner Lane, Louisville, KY 40205, United States.
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Langewitz WA. The lived body (Der Leib) as a diagnostic and therapeutic instrument in general practice. Wien Klin Wochenschr 2021; 134:561-568. [PMID: 34297201 PMCID: PMC9418073 DOI: 10.1007/s00508-021-01911-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
Based on vignettes from clinical cases, supervision and Balint groups this article presents a neo-phenomenological perspective on the lived experience of healthcare professionals in interactions with patients and relatives. Specifically, the familiar phenomenon of "something in the air" between two persons will be analyzed.Constellations and situations are presented as fundamental and generic (ontological) categories that can be differentiated to understand the details and the whole (die Gestalt) of an interaction.The term atmosphere is introduced to investigate the material carrier of something that "colors the air" between healthcare provider and patient.The neo-phenomenological taxonomy of the lived body (der Leib) is used to describe the recipient structure of atmospheric mood.Finally, the potential of these concepts for a more comprehensive diagnosis and for therapeutic use in general practice will be elucidated.
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Affiliation(s)
- Wolf Axel Langewitz
- Dept. Psychosomatic Medicine, Communication in Medicine (Head: Prof. Sabina Hunziker, MD), University Hospital and University Basel, Hebelstrasse 2, 4031, Basel, Switzerland.
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Pant S, Elias MA, Woolfall K, Morales MM, Lincy B, Jahan I, Sumanasena SP, Ramji S, Shankaran S, Thayyil S. Parental and professional perceptions of informed consent and participation in a time-critical neonatal trial: a mixed-methods study in India, Sri Lanka and Bangladesh. BMJ Glob Health 2021; 6:bmjgh-2021-005757. [PMID: 34020995 PMCID: PMC8144040 DOI: 10.1136/bmjgh-2021-005757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Time-critical neonatal trials in low-and-middle-income countries (LMICs) raise several ethical issues. Using a qualitative-dominant mixed-methods design, we explored informed consent process in Hypothermia for encephalopathy in low and middle-income countries (HELIX) trial conducted in India, Sri Lanka and Bangladesh. Methods Term infants with neonatal encephalopathy, aged less than 6 hours, were randomly allocated to cooling therapy or usual care, following informed parental consent. The consenting process was audio-video (A-V) recorded in all cases. We analysed A-V records of the consent process using a 5-point Likert scale on three parameters—empathy, information and autonomy. In addition, we used exploratory observation method to capture relevant aspects of consent process and discussions between parents and professionals. Finally, we conducted in-depth interviews with a subgroup of 20 parents and 15 healthcare professionals. A thematic analysis was performed on the observations of A-V records and on the interview transcripts. Results A total of 294 A-V records of the HELIX trial were analysed. Median (IQR) score for empathy, information and autonomy was 5 (0), 5 (1) and 5 (1), respectively. However, thematic analysis suggested that the consenting was a ceremonial process; and parental decision to participate was based on unreserved trust in the treating doctors, therapeutic misconception and access to an expensive treatment free of cost. Most parents did not understand the concept of a clinical trial nor the nature of the intervention. Professionals showed a strong bias towards cooling therapy and reported time constraints and explaining to multiple family members as key challenges. Conclusion Despite rigorous research governance and consent process, parental decisions were heavily influenced by situational incapacity and a trust in doctors to make the right decision on their behalf. Further research is required to identify culturally and context-appropriate strategies for informed trial participation.
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Affiliation(s)
- Stuti Pant
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | | | - Kerry Woolfall
- Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
| | | | | | - Ismat Jahan
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Dhaka District, Bangladesh
| | | | - Siddarth Ramji
- Pediatrics, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Seetha Shankaran
- Neonatal- Perinatal Medicine, Wayne State University, Detroit, Michigan, USA
| | - Sudhin Thayyil
- Centre for Perinatal Neuroscience, Imperial College London, London, UK
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Hall JA, Schwartz R, Duong F, Niu Y, Dubey M, DeSteno D, Sanders JJ. What is clinical empathy? Perspectives of community members, university students, cancer patients, and physicians. PATIENT EDUCATION AND COUNSELING 2021; 104:1237-1245. [PMID: 33234440 DOI: 10.1016/j.pec.2020.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/06/2020] [Accepted: 11/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore what undergraduates, community members, oncology patients, and physicians consider empathic behavior in a physician. METHODS 150 undergraduates, 152 community members, 95 physicians, and 89 oncology patients rated 49 hypothetical physician behaviors for how well they fit their personal definition of physician empathy. Dimensions of empathy were explored and compared across groups. RESULTS Three dimensions of empathy were Conscientious and Reassuring, Relationship Oriented, and Emotionally Involved. Relationship Oriented was the most strongly endorsed, followed by Emotionally Involved, with Conscientious and Reassuring coming in last. There were no group differences for Conscientious and Reassuring, but the Relationship Oriented factor was more endorsed by the clinical groups (physicians and patients) than the non-clinical groups. The Emotionally Involved factor was endorsed by physicians notably more than by patients. CONCLUSION What is considered clinical empathy is not the same across individuals and stakeholder groups. PRACTICE IMPLICATIONS Physicians and patients differ in how much they include the physicians' emotionality and emotion-related actions in their definition of empathy. Communication training for physicians that emphasizes behaviors associated with empathy (listening, understanding a person's feelings and perspectives, and showing interest in and concern for the whole person) may enhance patients' perception of clinical empathy.
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Affiliation(s)
- Judith A Hall
- Department of Psychology, Northeastern University, Boston, MA, USA.
| | | | - Fred Duong
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Yuan Niu
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Manisha Dubey
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - David DeSteno
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Justin J Sanders
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Riess H. Institutional Resilience: The Foundation for Individual Resilience, Especially During COVID-19. Glob Adv Health Med 2021; 10:21649561211006728. [PMID: 33889440 PMCID: PMC8040559 DOI: 10.1177/21649561211006728] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/13/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022] Open
Abstract
In the protracted healthcare crisis that the COVID-19 pandemic has become, healthcare professional wellness and resilience are a national concern. Physicians, nurses and medical staff have been profoundly negatively affected due to the inability of institutions to prepare for this pandemic. Institutional fixed point standards such as Eudaemonics, Inherent Value, and Amplifying Assumptions are essential to make it possible to steer an organizational course during a crisis. Fixed point standards must be embedded in hospitals and systems so they are positioned to do the most good. Employees must feel safe, valued and cared for always, so they can be resilient when crises strike. The best way to do that is by viewing the healthcare professionals through the lens of empathy. Institutional values of safety, access to accurate and caring information, human connection, and emphasis on mental health, are hallmarks of resilient organizations and will result in resilient individuals.
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Affiliation(s)
- Helen Riess
- Massachusetts General Hospital, Wang Ambulatory Care Center, Harvard Medical School, Boston, Massachusetts
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Matsuhisa T, Takahashi N, Takahashi K, Yoshikawa Y, Aomatsu M, Sato J, Mercer SW, Ban N. Effect of physician attire on patient perceptions of empathy in Japan: a quasi-randomized controlled trial in primary care. BMC FAMILY PRACTICE 2021; 22:59. [PMID: 33789572 PMCID: PMC8011374 DOI: 10.1186/s12875-021-01416-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/16/2021] [Indexed: 12/30/2022]
Abstract
Background There is limited quantitative research on the effect of physician attire on patient–physician relationships. This study aimed to measure the influence of Japanese family physicians’ attire on the “human” aspects of medical care in terms of patient-perceived relational empathy. Methods This was a multicenter, prospective, controlled trial conducted in primary clinics in Japan. We explored the effects of family physician attire (white coat vs. casual attire) on patient-perceived empathy. Family physicians were allocated to alternate weeks of wearing a white coat or casual attire during consultations. Patients’ perceptions of physician empathy were evaluated using the self-rated Japanese Consultation and Relational Empathy (CARE) Measure. We used a linear mixed model to analyze the CARE Measure scores, adjusting for cluster effects of patients nested within doctor, age, and sex of patients, and doctors’ sex and years of clinical experience. We used the same method with Bonferroni adjustment to analyze patient sex differences in perceived empathy. Results A total of 632 patients of seven family physicians were allocated to white coat-wearing consultations (n = 328), and casual attire-wearing consultations (n = 304). There was no difference in CARE Measure scores between white coat and casual primary care consultations overall (p = 0.162). Subgroup analysis of patient sex showed that CARE Measure scores of male patients were significantly higher in the Casual group than in the White coat group (adjusted p-value = 0.044). There was no difference in female patient scores between White coat and Casual groups (adjusted p-value = 1.000). Conclusions This study demonstrated that physician attire (white coat or casual attire) in a primary care setting did not affect patient-perceived relational empathy overall. However, male patients of physicians wearing casual attire reported higher physician empathy. Although empathy cannot be reduced to simple variables such as attire, white coats may have a negative effect on patients, depending on the context. Family physicians should choose their attire carefully. Trial registration Japanese University Hospital Medical Information Network (UMIN-ICDR). Clinical Trial identifier number UMIN000037687 (Registered August 14, 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042749). The study was prospectively registered.
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Affiliation(s)
- Takaharu Matsuhisa
- Department of General Medicine/Family & Community Medicine, Nagoya University Hospital, Tsurumai-cho 65, Showa-ku, Nagoya, 466-8560, Japan.
| | - Noriyuki Takahashi
- Department of Education for Community-Oriented Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Kunihiko Takahashi
- M&D Data Science Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Yuki Yoshikawa
- Department of General Medicine/Family & Community Medicine, Nagoya University Hospital, Tsurumai-cho 65, Showa-ku, Nagoya, 466-8560, Japan
| | - Muneyoshi Aomatsu
- Department of Medical Education, Saku Central Hospital, 197 Usuda, Saku, 385-0051, Japan
| | - Juichi Sato
- Department of General Medicine/Family & Community Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, Scotland
| | - Nobutaro Ban
- Medical Education Center, Aichi Medical University School of Medicine, 1-1 Yazakokarimata, Nagakute, 480-1195, Japan
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Goldstein P, Losin EAR, Anderson SR, Schelkun VR, Wager TD. Clinician-Patient Movement Synchrony Mediates Social Group Effects on Interpersonal Trust and Perceived Pain. THE JOURNAL OF PAIN 2020; 21:1160-1174. [PMID: 32544602 PMCID: PMC7722052 DOI: 10.1016/j.jpain.2020.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/24/2020] [Accepted: 03/22/2020] [Indexed: 12/19/2022]
Abstract
Pain is an unfortunate consequence of many medical procedures, which in some patients becomes chronic and debilitating. Among the factors affecting medical pain, clinician-patient (C-P) similarity and nonverbal communication are particularly important for pain diagnosis and treatment. Participants (N = 66) were randomly assigned to clinician and patient roles and were grouped into C-P dyads. Clinicians administered painful stimuli to patients as an analogue of a painful medical procedure. We manipulated the perceived C-P similarity of each dyad using groups ostensibly based on shared beliefs and values, and each patient was tested twice: Once with a same group clinician (concordant, CC) and once with a clinician from the other group (discordant, DC). Movement synchrony was calculated as a marker of nonverbal communication. We tested whether movement synchrony mediated the effects of group concordance on patients' pain and trust in the clinician. Movement synchrony was higher in CC than DC dyads. Higher movement synchrony predicted reduced pain and increased trust in the clinician. Movement synchrony also formally mediated the group concordance effects on pain and trust. These findings increase our understanding of the role of nonverbal C-P communication on pain and related outcomes. Interpersonal synchrony may be associated with better pain outcomes, independent of the specific treatment provided. PERSPECTIVE: This article demonstrates that movement synchrony in C-P interactions is an unobtrusive measure related to their relationship quality, trust toward the clinician, and pain. These findings suggest that interpersonal synchrony may be associated with better patient outcomes, independent of the specific treatment provided.
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Affiliation(s)
- Pavel Goldstein
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado; The School of Public Health, University of Haifa, Israel
| | | | | | - Victoria R Schelkun
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire; Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado.
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Turner RE, Archer E. Patient-centred care: The patients' perspective - A mixed-methods pilot study. Afr J Prim Health Care Fam Med 2020; 12:e1-e8. [PMID: 33054274 PMCID: PMC7564840 DOI: 10.4102/phcfm.v12i1.2390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background Patient centredness is a broad concept, a moral philosophy. Patient-centred care can be viewed as the actions of patient-centredness. One of the most pertinent actions that a healthcare practitioner can utilise to deliver patient-centred care is empathic communication. Whilst many medical programmes include empathetic communication skills as part of their curricula, the recipients of this care are not asked about the relevance of this teaching. Aim We attempted to determine whether the Western constructs of empathy were relevant in our context and also establish whether there were any parts of the medical interview which participants felt were especially important to be communicated to in their home language. Setting Two urban communities within the City of Cape Town, Western Cape Province, South Africa. Methods This was a mixed-methods pilot study using an explanatory sequential design. Participants who would typically make use of public health care facilities and whose first language was Afrikaans or isiXhosa were conveniently sampled. A subgroup of participants was invited to take part in a follow-up focus group discussion to add clarity to the survey responses. Results and Conclusion Western constructs for empathy appeared to be relevant within our multicultural context. Patients wanted to communicate with their doctors and understand the cause of their problems as well as the management plan. Finally, whilst the numbers in this pilot study were too small to be generalisable, it was evident that patient-centred care was not perceived to be implemented in some public healthcare facilities attended by the participants, which resulted in them feeling unseen and disrespected.
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Affiliation(s)
- Roseanne E Turner
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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They Just Don't Get Me: A Qualitative Analysis of Transgender Women's Health Care Experiences and Clinician Interactions. J Assoc Nurses AIDS Care 2020; 30:e82-e95. [PMID: 31461741 PMCID: PMC6738627 DOI: 10.1097/jnc.0000000000000023] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transgender individuals face many barriers when accessing health care, including having to teach clinicians how to care for them to receive appropriate care. We conducted a secondary analysis of qualitative data collected via semistructured interviews with 18 transgender women ranging in age from 21 to 60 years and living with HIV. Data were analyzed using conventional content analysis. Participants encountered two clinician types: Those who get me and Those who don't get me. Clinicians who get me provided gender-affirming care, fostered patient engagement, performed appropriate health screenings, and were willing to learn about transgender health. Clinicians who don't get me were aloof, uninterested, and unwilling to provide care. Clinicians who don't get me and system-level factors such as fragmented care, lack of insurance, and a low volume of transgender-competent clinicians contributed to transgender women's unmet health and education needs. Recommendations for improving transgender health care are provided.
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Rahman RJ, Keenan JR, Hudson J. Exploring rural palliative care patients’ experiences of accessing psychosocial support through telehealth: A longitudinal approach. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2020. [DOI: 10.4081/qrmh.2020.8821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this research, we explore the experiences of rural palliative care patients receiving psychosocial support through telehealth. A longitudinal approach considered how experiences vary over time. Three patients with a terminal cancer diagnosis were given a laptop to access psychosocial support via telehealth over three months. Semi-structured interviews were conducted at monthly intervals. Interpretative phenomenological analysis identified four themes: Deepening understanding through unburdened and continuous connections; the ever-present paradox of visible and invisible telehealth; insight into the holistic self: from barrier to facilitator; and, the immediate change from unnecessary distraction to mindful engagement. Findings challenge previous conclusions regarding the inability of telehealth to support meaningful relationships, and instead provide novel insights to explain why enabling rural palliative care patients to access support from home is supportive for their wellbeing and the quality of healthcare relationships. Our conclusions question whether the indirect benefits of telehealth could also offer a valuable way of accessing health services beyond a palliative care setting.
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Pelaccia T, Messman AM, Kline JA. Misdiagnosis and failure to diagnose in emergency care: Causes and empathy as a solution. PATIENT EDUCATION AND COUNSELING 2020; 103:1650-1656. [PMID: 32169322 DOI: 10.1016/j.pec.2020.02.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/06/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
Diagnostic error is the most frequent cause of allegations of negligence in emergency care in the United States and is estimated to contribute to the death of hundreds of thousands of patients worldwide each year. In this special contribution, we elucidate the cognitive mechanisms that emergency physicians use to make decisions and identify how these mechanisms can become sources of diagnostic error. The discussion centers on the appraisal of proposed methods to reduce the risk of diagnostic error, including debiasing strategies and a brief discussion of the theoretical basis for interventions to improve clinician empathy.
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Affiliation(s)
- Thierry Pelaccia
- Center for Training and Research in Health Sciences Education (CFRPS), University of Strasbourg, 67085 Strasbourg, France; Prehospital Emergency Care Service (SAMU 67), Strasbourg University Hospital, France.
| | - Anne M Messman
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
| | - Jeffrey A Kline
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Abstract
Emergency department (ED) patient experience is a growing area of focus for leaders in the ED and throughout health care. While many factors intrinsic to the ED care environment add to the challenge of providing patients with an excellent experience, doing so holds many benefits, including improved patient compliance and health outcomes, improved workplace satisfaction and reduced provider and staff burnout, decreased malpractice risk, and increased revenue. Although wait time is a major driver of patient experience, provider and staff communication are critically important and excellent communication and perceived empathy may mitigate long waits, overcrowded environments, and other challenges.
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Affiliation(s)
- Jonathan D Sonis
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 850, Boston, MA 02114, USA.
| | - Benjamin A White
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Founders 850, Boston, MA 02114, USA
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50
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Kelly M, Svrcek C, King N, Scherpbier A, Dornan T. Embodying empathy: A phenomenological study of physician touch. MEDICAL EDUCATION 2020; 54:400-407. [PMID: 31793673 DOI: 10.1111/medu.14040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Empathic physician behaviour is associated with improved patient outcomes. One way to demonstrate empathy is through the use of non-verbal communication (NVC) including touch. To date, research on NVC, and specifically touch, has been relatively limited in medicine, which is surprising given the central role it plays in conveying affective and empathic messages. To inform curriculum development on NVC, this study aimed to examine physicians' experiences of communicating by touch. METHODS We conducted an interpretative phenomenological study. A total of 15 physicians (seven women and eight men) from different specialties, including both recent graduates and experienced doctors, described in detail specific instances of touch drawn from their clinical practices. Interview prompts encouraged participants to recall exact details such as the context, their relationship with the patient they touched and their physical experience of touching. Interviews (45-100 minutes) were analysed with template analysis, followed by a process of dialectic questioning, moving back and forth between the data and researchers' personal reflections on them, drawing on phenomenological literature to synthesise a final interpretation. RESULTS Participants described two dimensions of the experience of touch: 'choosing and inviting touch' and 'expressing empathy.' Touch was a personal and fragile process. Participants interpreted non-verbal patient cues in order to determine whether or not touch was appropriate. They interpreted facial expressions and body language in the present to make meaning of patients' experiences. They used touch to share emotions, and to demonstrate empathy and presence. Participants' experiences of touch framed it as a form of embodied empathic communication. CONCLUSIONS Touch is a powerful form of NVC that can establish human connection. Phenomenological accounts of empathy, which emphasise its embodied intersubjective nature, can be used to theoretically enrich pedagogical approaches to touch in medical education and to deepen our understanding of empathy.
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Affiliation(s)
- Martina Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Clark Svrcek
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nigel King
- Department of Applied Psychology, University of Huddersfield, Huddersfield, UK
| | - Albert Scherpbier
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
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