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Rimondini M, Mazzi MA, Busch IM, Bensing J. You only have one chance for a first impression! Impact of Patients' First Impression on the Global Quality Assessment of Doctors' Communication Approach. HEALTH COMMUNICATION 2019; 34:1413-1422. [PMID: 29995443 DOI: 10.1080/10410236.2018.1495159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patients' first impressions obtained during early contacts with doctors represent the basis for relationship building processes. Aim of this study was to verify how patients' first impression of doctors' communication approach influences patients' global assessment of doctors' performance. This cross-sectional study was part of a larger, multicenter observational study aiming to assess lay-people's preferences regarding patient-doctor communication. All participants (N = 136) were equally distributed over two selected Italian and Dutch recruitment centers as well as for gender and age. In each center, panels of 6-9 persons each watched the same set of eight videotaped Objective Structured Clinical Examination consultations. Participants performed different tasks as to pick up salient communication elements while watching the videos and to rate doctors' global communicative performances on a 10-point Likert scale. We performed a mediation analysis to assess direct and indirect effects of participants' first impression on participants' global assessment. Among the 439 collected first impressions, 284(65%) were positive. When the first impression was positive, the mean value of the global assessment of doctors' performance was significantly higher (M = 7.4, SD = 1.5) than when the first impression was negative (M = 6.0, SD = 1.6); t(437) = 9.0 p < .001. According to the mediation analysis, this difference was due to a direct (c' = 0.53) and an indirect effect (ab = 0.86) deriving from the total effect of first impressions on the global assessment of doctors' performances (c = 1.39). In conclusion, the first impression has a strong impact on positive and negative judgments on doctors' communication approach and may facilitate or inhibit all further interactions.
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Affiliation(s)
- Michela Rimondini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona
| | - Maria Angela Mazzi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona
| | - Isolde Martina Busch
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona
| | - Jozien Bensing
- Department of Health Psychology, Netherlands Institute for Health Services Research (NIVEL)
- Faculty of Social Sciences, Utrecht University
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Michael K, Dror MG, Karnieli-Miller O. Students' patient-centered-care attitudes: The contribution of self-efficacy, communication, and empathy. PATIENT EDUCATION AND COUNSELING 2019; 102:2031-2037. [PMID: 31257098 DOI: 10.1016/j.pec.2019.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 05/10/2019] [Accepted: 06/07/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Patient-centered-care (PCC) attitudes are important to enhance PCC behavior, but research on perceptions and attitudes that contribute to PCC attitudes is limited. We tested a new model, assessing whether the association between self-efficacy and PCC attitudes is mediated by communication and empathy attitudes. Furthermore, we assessed medical-school-stage and gender differences in these variables. METHODS Medical/dentistry students (N = 653) completed self-reported questionnaires. Analyses were performed using Pearson's-correlations, PROCESS macro, and independent samples t-tests. RESULTS The association between communication self-efficacy and PCC attitudes was completely mediated by communication and empathy attitudes. Students in clinical years had more positive attitudes toward PCC and empathy, and higher communication self-efficacy. Females had more positive attitudes toward PCC, communication, and empathy. CONCLUSIONS The results emphasize the importance of communication self-efficacy and the mediating role of communication and empathy attitudes in enhancing PCC attitudes. This highlights the need to focus on learners' affective matter (what they feel/think) about their competencies and attitudes. PRACTICE IMPLICATIONS Educational interventions should improve understanding of the benefits of applying good communication skills, of learning the importance of empathy and its relevance to patient care, and strengthening students' confidence in applying these skills. Attention to these is important for enhancing students' PCC attitudes.
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Affiliation(s)
- Keren Michael
- Department of Human Services, The Max Stern Yezreel Valley Academic College, Yezreel Valley, Israel.
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Beidelschies M, Alejandro-Rodriguez M, Ji X, Lapin B, Hanaway P, Rothberg MB. Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes. JAMA Netw Open 2019; 2:e1914017. [PMID: 31651966 PMCID: PMC6822085 DOI: 10.1001/jamanetworkopen.2019.14017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE The incidence of chronic disease is increasing along with health care-related costs. The functional medicine model of care provides a unique operating system to reverse illness, promote health, and optimize function. The association between this model of care and patient's health-related quality of life (HRQoL) is unknown. OBJECTIVE To assess the association between functional medicine and patient-reported HRQoL using Patient-Reported Outcome Measurement Information System (PROMIS) global health measures. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was performed to compare 7252 patients aged 18 years or older treated in a functional medicine setting with propensity score (PS)-matched patients in a primary care setting. Sensitivity analyses assessed improvement limited to patients seen at both 6 and 12 months. The study included patients who visited the Cleveland Clinic Center for Functional Medicine or a Cleveland Clinic family health center between April 1, 2015, and March 1, 2017. MAIN OUTCOMES AND MEASURES The primary outcome was change in PROMIS Global Physical Health (GPH) at 6 months. Secondary outcomes included PROMIS Global Mental Health (GMH) at 6 months and PROMIS GPH and GMH at 12 months. The PROMIS GPH and GMH scores were transformed to a T-score from 0 to 100 with a mean of 50. Higher scores indicate a better health-related quality of life. RESULTS Of the 7252 patients (functional medicine center: 1595; family health center: 5657), 4780 (65.9%) were women; mean (SD) age was 54.1 (16.0) years. At 6 months, functional medicine patients exhibited significantly larger improvements in PROMIS GPH T-score points than were seen in patients treated at a family health center (mean [SD] change, functional medicine center: 1.59 [6.29] vs family health center: 0.33 [6.09], P = .004 in 398 PS-matched pairs). At 12 months, functional medicine patients showed improvement similar to that observed at 6 months; however, comparisons with patients seen at the family health center were not significant. Patients in the functional medicine center with data at both 6 and 12 months demonstrated improvements in PROMIS GPH (mean [SD], 2.61 [6.53]) that were significantly larger compared with patients seen at a family health center (mean [SD], 0.25 [6.54]) (P = .02 in 91 PS-matched pairs). CONCLUSIONS AND RELEVANCE In this study, the functional medicine model of care demonstrated beneficial and sustainable associations with patient-reported HRQoL. Prospective studies are warranted to confirm these findings.
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Affiliation(s)
| | | | - Xinge Ji
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Brittany Lapin
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
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Venetis MK, Staples S, Robinson JD, Kearney T. Provider Information Provision and Breast Cancer Patient Well-Being. HEALTH COMMUNICATION 2019; 34:1032-1042. [PMID: 29583022 DOI: 10.1080/10410236.2018.1454254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Research continues to delineate and clarify specific communication behaviors associated with improved patient outcomes. In the context of breast cancer surgery, this exploratory study examined the effect of breast surgeon information provision on the immediate post-visit outcomes of patients' anxious preoccupation, intention to adhere to treatment recommendations, and treatment plan satisfaction. Participants included 51 newly diagnosed breast cancer patients receiving care from one breast surgeon at a National Cancer Institute-designated cancer center in the northeastern United States. Participants completed pre- and post-visit questionnaires. Medical interactions were recorded, transcribed, and analyzed via multidimensional analysis, a method of linguistic analysis that uses exploratory factor analysis to identify how specific types of words are patterned and work to accomplish communicative goals (Biber, 1988). The multidimensional analysis identified constellations of language used by providers and patients. Although five linguistic dimensions emerged, one dimension, impersonal information provision, is of unique interest in understanding how providers communicate with patients. Impersonal information provision encompasses the ways in which the provider, using an impersonal tone, discussed the logistics, details, and implications of treatment options. Increased impersonal information provision was associated with patients' decreased anxious preoccupation (β = -.22, t = -2.82, p = .007), increased treatment plan satisfaction (β = .36, t = 2.54, p = .012), and increased intention to adhere to treatment recommendations (β = .34, t = 2.45, p = .018). Findings suggest that specific provider behavior and types of information provided have unique and important effects on patients' health outcomes.
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Affiliation(s)
| | | | | | - Thomas Kearney
- d Division of Surgical Oncology , Rutgers Cancer Institute of New Jersey
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55
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Nevin PE, Blas M, Bayer A, Gutierrez MAC, Rao D, Molina Y. Positive cancer care in Peru: Patient and provider perspectives. Health Care Women Int 2019; 41:510-523. [PMID: 31090496 DOI: 10.1080/07399332.2019.1608206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Peruvian women experience high mortality from reproductive cancers, partially due to suboptimal cancer care utilization and experiences. In this qualitative study, we examined factors contributing to positive cancer care experiences. Our sample included 11 cancer patients and 27 cancer providers who attended the First International Cancer Symposium survivorship conference in Lima, Peru in 2015. We conducted thematic analysis. Emergent themes revealed that, for patients, individualized empathic care by providers was an important facilitator to positive cancer care experiences. For providers, the ability to provide such care depended on provider norms and facility infrastructure to support such patient-centered practices.
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Affiliation(s)
- Paul E Nevin
- University of Washington, Seattle, Washington, USA
| | - Magaly Blas
- University of Washington, Seattle, Washington, USA.,Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angela Bayer
- Univeristy of California Los Angeles, Los Angeles, California, USA
| | | | - Deepa Rao
- University of Washington, Seattle, Washington, USA
| | - Yamilé Molina
- University of Illinois at Chicago, Chicago, Illinois, USA
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Selby P, Popescu R, Lawler M, Butcher H, Costa A. The Value and Future Developments of Multidisciplinary Team Cancer Care. Am Soc Clin Oncol Educ Book 2019; 39:332-340. [PMID: 31099640 DOI: 10.1200/edbk_236857] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Multidisciplinary teams (MDTs) have been recommended as a key part of best cancer care for 25 years. Here, we set out the functions and approaches of MDTs and review their impact. Although the literature is patchy in quality, MDTs contribute to improving cancer care and outcomes. They must be well organized, efficient, and well led; work with sound and timely information; and communicate well within the team and with their patients. Patients need carefully prepared information to help them share in the decision-making process. MDTs will be improved by a series of ongoing innovative developments. Increasing information from molecular pathology will increase the precision of their decisions, although the technologies remain expensive and may not be accessible in all countries for some time. New point-of-care testing technologies will improve the quality and timeliness of testing. Good informatics is essential to deliver the information to patients and the MDT. MDTs should be research active, delivering clinical trials, and this should improve outcomes for all of their patients. Patient engagement and empowerment in MDTs should improve patient satisfaction and outcomes. Patient-reported outcome measures will improve MDTs' insights into their patients' problems and symptoms and can improve patient outcomes.
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Affiliation(s)
- Peter Selby
- 1 Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | | | - Mark Lawler
- 3 Centre for Cancer Research and Cell Biology, Queen's University, Belfast, United Kingdom
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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Dehghan H, Keshtkaran A, Ahmadloo N, Bagheri Z, Hatam N. Patient Involvement in Care and Breast Cancer Patients’ Quality of Life- a Structural Equation Modeling (SEM)
Approach. Asian Pac J Cancer Prev 2018; 19:2511-2517. [PMID: 30256045 PMCID: PMC6249441 DOI: 10.22034/apjcp.2018.19.9.2511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/18/2018] [Indexed: 11/27/2022] Open
Abstract
In cancer patients, improving the quality of life is a basic goal of treatment, with the patient – physician relationship as a major factor. Therefore the aim of this structural equation modeling study was to analyze the influence of patient involvement in care on quality of life in 411 breast cancer patients undergoing outpatient chemotherapy and radiotherapy. Two questionnaires were used: 1-patient-physician questionnaire, 2-EORTC QLQC-30 (to measure QOL). The structural equation model exhibited an excellent data fit (Chi-Square= 31.04 / RMSEA= 0.042), T-values for all paths with the exception of that between patient satisfaction and emotional- cognitive function, were significant. According to the findings, various aspects of the physician-patient relationship are significantly and positively associated with quality of life and increasing patient involvement in care by increasing trust and satisfaction, was associated with marked improvement. The findings of this study emphasized the importance of an effective relationship between doctor and patient as a contributing factor for improving the quality of life. Therefore it is suggested that policymakers and decision-makers active in strategic planning for the health system and physicians responsible for treatment pay more attention to developing and improving relationships with patients as an approach to improving patient outcomes, particularly with reference to quality of life.
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Affiliation(s)
- Hajar Dehghan
- Students Research Committee, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Keshtkaran
- Department of Health Service Administration, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Niloofar Ahmadloo
- Department of Radiotherapy and Oncology, school of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bagheri
- Department of Biostatistics, school of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Hatam
- Department of Health Service Administration, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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García-de-Diego JM, Serrano-Del-Rosal R. [Universalization, parity and evolution of the demand of epidural analgesia in labor in Andalusia (Spain)]. GACETA SANITARIA 2018; 33:427-433. [PMID: 30055810 DOI: 10.1016/j.gaceta.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Assess whether the universalization of epidural analgesia supplied in hospitals of the Andalusia Public Health Service (SSPA) has ended up with the inequalities shown in previous studies regarding to their demand: the percentage of women who rejected epidural analgesia was higher among the users having low educational level, lower income and working as housekeeper. METHOD The data are based on satisfaction surveys conducted by the Institute for Advanced Social Studies amongst of SSPA users. This survey includes a section aimed at women attended in labor (N = 21,300). The hierarchical segmentation analysis shows which variables are the ones that discriminate most in the usage of epidural analgesia. Subsequently, through a model of binary logistic regression we analyze which socio-demographic variables are significant (2012) and how its impact is on the choice of epidural analgesia in childbirth. RESULTS Overall, the socio-demographic variables of the users are statistically significant in the demand or not of epidural analgesia during labor. However, the detailed analysis of the last year (2012) shows that none of the socio-demographic variables introduced in the model has a significant effect on the decision of using epidural analgesia. CONCLUSIONS The process of universalization of epidural anesthesia in childbirth has ended with social inequalities in their use, that is, with those differences that are not due to a real choice but are induced by socio-cultural characteristics of women.
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Affiliation(s)
| | - Rafael Serrano-Del-Rosal
- Instituto de Estudios Sociales Avanzados, Consejo Superior de Investigaciones Científicas (IESA-CSIC), Córdoba, España.
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61
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Patient-clinician communication among patients with stage I lung cancer. Support Care Cancer 2017; 26:1625-1633. [PMID: 29209835 DOI: 10.1007/s00520-017-3992-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/20/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Limited data exist about patient-centered communication (PCC) and patient-centered outcomes among patients who undergo surgery or stereotactic body radiation therapy (SBRT) for stage I non-small cell lung cancer (NSCLC). We aimed to examine the relationship between PCC and decision-making processes among NSCLC patients, using baseline data from a prospective, multicenter study. METHODS Patients with stage 1 NSCLC completed a survey prior to treatment initiation. The survey assessed sociodemographic characteristics, treatment decision variables, and patient psychosocial outcomes: health-related quality of life (HRQOL), treatment self-efficacy, decisional conflict, and PCC. RESULTS Fifty-two percent (n = 85) of 165 individuals planned to receive SBRT. There were no baseline differences detected on patient psychosocial outcomes between those who planned to receive SBRT or surgery. All participants reported high HRQOL (M = 72.5, SD = 21.3) out of 100, where higher scores indicate better functioning; high self-efficacy (M = 1.5, SD = 0.5) out of 6, where lower numbers indicate higher self-efficacy; minimal decisional conflict (M = 15.2, SD = 12.7) out of 100, where higher scores indicate higher decisional conflict; and high levels of patient-centered communication (M = 2.4, SD = 0.8) out of 7 where higher scores indicate worse communication. Linear regression analyses adjusting for sociodemographic and clinical variables showed that higher quality PCC was associated with higher self-efficacy (β = 0.17, p = 0.03) and lower decisional conflict (β = 0.42, p < 0.001). CONCLUSIONS Higher quality PCC was associated with higher self-efficacy and lower decisional conflict. Self-efficacy and decisional conflict may influence subsequent health outcomes. Therefore, our findings may inform future research and clinical programs that focus on communication strategies to improve these outcomes.
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Sheppard VB, Hurtado-de-Mendoza A, Zheng YL, Wang Y, Graves KD, Lobo T, Xu H, Jennings Y, Tolsma D, Trout M, Robinson BE, McKinnon B, Tadesse M. Biospecimen donation among black and white breast cancer survivors: opportunities to promote precision medicine. J Cancer Surviv 2017; 12:74-81. [PMID: 29147853 DOI: 10.1007/s11764-017-0646-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Advances in precision medicine (PM) have potential to reduce and/or eliminate breast cancer disparities in both treatment and survivorship. However, compared to white Americans, black Americans are often underrepresented in genetic research. This report assessed factors that influence receipt of buccal cells via saliva kits. METHODS This prospective study recruited women with confirmed hormonal-positive (HR+) breast cancer (BC). A standardized telephone survey collected sociodemographic, socio-cultural (e.g., religiosity), and healthcare process factors. Clinical information was abstracted from medical records. After the baseline survey, return postage-paid envelopes and mouthwash collection kits were mailed. Univariate and adjusted logistic regression models estimated the probability of biospecimen donation. RESULTS Seventy percent of the sample provided buccal cells which were of good quality. No differences were noted by race or other demographic factors. In the multivariable logistic model, time spent with providers (OR 1.61 per 1-point increase; 95% CI 1.242, 2.088) and religiosity (OR 0.957 per 1-point increase; 95% CI 0.931, 0.984) remained associated with biospecimen provision. Women with lower-stage cancer (vs. higher stage III+) were more likely to donate biospecimens (p < 0.05). CONCLUSIONS Cancer care experiences predicted specimen donation. Understanding the contextual reasons for lower receipt among women with higher religiosity scores and higher stage warrants further examination. IMPLICATIONS FOR CANCER SURVIVORS PM is relevant to cancer survivors because of its potential to inform targeted therapies, understand disease resistance, and aide in prediction of toxicity and/or recurrence. Future efforts to launch precision medicine trials with BC survivors may benefit from engaging medical oncologists and/or leveraging patient-provider encounters for trial participation.
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Affiliation(s)
- Vanessa B Sheppard
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
| | | | - Yun-Ling Zheng
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Ying Wang
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Kristi D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Tania Lobo
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Hanfei Xu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Yvonne Jennings
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Martha Trout
- Southeast Permanente Medical Group, Atlanta, GA, USA
| | | | | | - Mahlet Tadesse
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Alby F, Fatigante M, Zucchermaglio C. Managing risk and patient involvement in choosing treatment for cancer: an analysis of two communication practices. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:1427-1447. [PMID: 28833216 DOI: 10.1111/1467-9566.12598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Drawing on conversation analyses of oncology consultations collected in Italy, the article examines the communication practices used to recommend treatments. We found that the oncologist formulates the treatment recommendation (TR) for high-risk patients in terms of a 'mandatory' choice and for low-risk patients as an 'optional' type of decision. In the first case the doctor presses to reach a decision during the visit while in the second case leaves the decision open-ended. Results show that high-risk patients have less time to decide, are pressured towards choosing an option, but have more opportunities for involvement in TR during the visit. Low-risk patients instead have more time and autonomy to make a choice, but they are also less involved in the decision-making in the visit time. Moreover, we document that TR is organised through sequential activities in which the oncologist informs the patient of alternative therapeutic options while at the same time building a case for the kind of treatment she/he believes to be best for the patient's health. We suggest that in this field risk plays a key role in decision-making which should be better understood with further studies and taken into account in the debate on shared decision-making and patient-centred communication.
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Affiliation(s)
- Francesca Alby
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | - Marilena Fatigante
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
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Bientzle M, Fissler T, Cress U, Kimmerle J. The impact of physicians' communication styles on evaluation of physicians and information processing: A randomized study with simulated video consultations on contraception with an intrauterine device. Health Expect 2017; 20:845-851. [PMID: 27860037 PMCID: PMC5600216 DOI: 10.1111/hex.12521] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed at examining the impact of different types of physicians' communication styles on people's subsequent evaluation of physician attributes as well as on their information processing, attitude and decision making. METHOD In a between-group experiment, 80 participants watched one of three videos in which a gynaecologist displayed a particular communication style in a consultation situation on contraception with an intrauterine device. We compared doctor-centred communication (DCC) vs patient-centred communication (PCC) vs patient-centred communication with need-orientation (PCC-N). RESULTS In the PCC condition, participants perceived the physician to be more empathetic and more competent than in the DCC condition. In the DCC condition, participants showed less attitude change compared to the other conditions. In the PCC-N condition, the physician was perceived as more empathetic and more socially competent than in the other conditions. However, participants acquired less knowledge in the PCC-N condition. CONCLUSION We conclude that appropriate application of particular communication styles depends on specific consultation goals. Our results suggest that patients' needs should be addressed if the main goal is to build a good relationship, whereas a traditional PCC style appears to be more effective in communicating factual information.
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Affiliation(s)
| | - Tim Fissler
- Leibniz‐Institut fuer WissensmedienTuebingenGermany
| | - Ulrike Cress
- Leibniz‐Institut fuer WissensmedienTuebingenGermany
- Department of PsychologyUniversity of TuebingenTuebingenGermany
| | - Joachim Kimmerle
- Leibniz‐Institut fuer WissensmedienTuebingenGermany
- Department of PsychologyUniversity of TuebingenTuebingenGermany
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Gilligan T, Coyle N, Frankel RM, Berry DL, Bohlke K, Epstein RM, Finlay E, Jackson VA, Lathan CS, Loprinzi CL, Nguyen LH, Seigel C, Baile WF. Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline. J Clin Oncol 2017; 35:3618-3632. [PMID: 28892432 DOI: 10.1200/jco.2017.75.2311] [Citation(s) in RCA: 328] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose To provide guidance to oncology clinicians on how to use effective communication to optimize the patient-clinician relationship, patient and clinician well-being, and family well-being. Methods ASCO convened a multidisciplinary panel of medical oncology, psychiatry, nursing, hospice and palliative medicine, communication skills, health disparities, and advocacy experts to produce recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. The systematic review focused on guidelines, systematic reviews and meta-analyses, and randomized controlled trials published from 2006 through October 1, 2016. Results The systematic review included 47 publications. With the exception of clinician training in communication skills, evidence for many of the clinical questions was limited. Draft recommendations underwent two rounds of consensus voting before being finalized. Recommendations In addition to providing guidance regarding core communication skills and tasks that apply across the continuum of cancer care, recommendations address specific topics, such as discussion of goals of care and prognosis, treatment selection, end-of-life care, facilitating family involvement in care, and clinician training in communication skills. Recommendations are accompanied by suggested strategies for implementation. Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Timothy Gilligan
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nessa Coyle
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard M Frankel
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Donna L Berry
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kari Bohlke
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ronald M Epstein
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Esme Finlay
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vicki A Jackson
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher S Lathan
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles L Loprinzi
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lynne H Nguyen
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carole Seigel
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Walter F Baile
- Timothy Gilligan, Cleveland Clinic, Cleveland, OH ; Nessa Coyle, Memorial Sloan Kettering Cancer Center, New York; Ronald M. Epstein, University of Rochester School of Medicine, Rochester, NY; Richard M. Frankel, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN; Donna L. Berry and Christopher S. Lathan, Dana-Farber Cancer Institute, Harvard Medical School; Vicki A. Jackson, Massachusetts General Hospital, Harvard Medical School, Boston; Carole Seigel, Patient/Advocacy Representative, Brookline, MA; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Esme Finlay, University of New Mexico School of Medicine, Albuquerque, NM; Charles L. Loprinzi, Mayo Clinic, Rochester, MN; and Lynne H. Nguyen and Walter F. Baile, The University of Texas MD Anderson Cancer Center, Houston, TX
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Reeve BB, Thissen DM, Bann CM, Mack N, Treiman K, Sanoff HK, Roach N, Magnus BE, He J, Wagner LK, Moultrie R, Jackson KD, Mann C, McCormack LA. Psychometric evaluation and design of patient-centered communication measures for cancer care settings. PATIENT EDUCATION AND COUNSELING 2017; 100:1322-1328. [PMID: 28214167 DOI: 10.1016/j.pec.2017.02.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/01/2017] [Accepted: 02/09/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the psychometric properties of questions that assess patient perceptions of patient-provider communication and design measures of patient-centered communication (PCC). METHODS Participants (adults with colon or rectal cancer living in North Carolina) completed a survey at 2 to 3 months post-diagnosis. The survey included 87 questions in six PCC Functions: Exchanging Information, Fostering Health Relationships, Making Decisions, Responding to Emotions, Enabling Patient Self-Management, and Managing Uncertainty. For each Function we conducted factor analyses, item response theory modeling, and tests for differential item functioning, and assessed reliability and construct validity. RESULTS Participants included 501 respondents; 46% had a high school education or less. Reliability within each Function ranged from 0.90 to 0.96. The PCC-Ca-36 (36-question survey; reliability=0.94) and PCC-Ca-6 (6-question survey; reliability=0.92) measures differentiated between individuals with poor and good health (i.e., known-groups validity) and were highly correlated with the HINTS communication scale (i.e., convergent validity). CONCLUSION This study provides theory-grounded PCC measures found to be reliable and valid in colorectal cancer patients in North Carolina. Future work should evaluate measure validity over time and in other cancer populations. PRACTICE IMPLICATIONS The PCC-Ca-36 and PCC-Ca-6 measures may be used for surveillance, intervention research, and quality improvement initiatives.
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Affiliation(s)
- Bryce B Reeve
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 E. Weaver Street, Suite 220, Carrboro, NC, 27510, USA; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105-B McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, 27599-7411, USA.
| | - David M Thissen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC 27599-3270, USA.
| | - Carla M Bann
- Division of Statistical and Data Sciences, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | - Nicole Mack
- Division of Statistical and Data Sciences, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | - Katherine Treiman
- Center for Communication Science, RTI International, 6110 Executive Blvd, Rockville, MD 20850, USA.
| | - Hanna K Sanoff
- Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Chapel Hill, NC, 27599, USA.
| | - Nancy Roach
- Fight Colorectal Cancer, 1414 Prince Street, Suite 204, Alexandria, VA, 22314, USA.
| | - Brooke E Magnus
- Department of Psychology, Marquette University, 317 Cramer Hall, Milwaukee, WI, 53233, USA.
| | - Jason He
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC 27599-3270, USA.
| | - Laura K Wagner
- Public Health Research Division, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | - Rebecca Moultrie
- Public Health Research Division, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
| | - Kathryn D Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 E. Weaver Street, Suite 220, Carrboro, NC, 27510, USA.
| | - Courtney Mann
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 E. Weaver Street, Suite 220, Carrboro, NC, 27510, USA.
| | - Lauren A McCormack
- Public Health Research Division, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA.
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Henry SG, Penner LA, Eggly S. Associations between thin slice ratings of affect and rapport and perceived patient-centeredness in primary care: Comparison of audio and video recordings. PATIENT EDUCATION AND COUNSELING 2017; 100:1128-1135. [PMID: 28087212 PMCID: PMC5410186 DOI: 10.1016/j.pec.2016.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/02/2016] [Accepted: 12/17/2016] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To investigate associations between ratings of "thin slices" from recorded clinic visits and perceived patient-centeredness; to compare ratings from video recordings (sound and images) versus audio recordings (sound only). METHODS We analyzed 133 video-recorded primary care visits and patient perceptions of patient-centeredness. Observers rated thirty-second thin slices on variables assessing patient affect, physician affect, and patient-physician rapport. Video and audio ratings were collected independently. RESULTS In multivariable analyses, ratings of physician positive affect (but not patient positive affect) were significantly positively associated with perceived patient-centeredness using both video and audio thin slices. Patient-physician rapport was significantly positively associated with perceived patient-centeredness using audio, but not video thin slices. Ratings from video and audio thin slices were highly correlated and had similar underlying factor structures. CONCLUSION Physician (but not patient) positive affect is significantly associated with perceptions of patient-centeredness and can be measured reliably using either video or audio thin slices. Additional studies are needed to determine whether ratings of patient-physician rapport are associated with perceived patient-centeredness. PRACTICE IMPLICATIONS Observer ratings of physician positive affect have a meaningful positive association with patients' perceptions of patient-centeredness. Patients appear to be highly attuned to physician positive affect during patient-physician interactions.
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Affiliation(s)
- Stephen G Henry
- Department of Internal Medicine, University of California Davis, Sacramento, USA.
| | - Louis A Penner
- Department of Oncology, Wayne State University, Karmanos Cancer Institute, Detroit, USA
| | - Susan Eggly
- Department of Oncology, Wayne State University, Karmanos Cancer Institute, Detroit, USA
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Hamasaki T, Kato H, Kumagai T, Hagihara A. Association Between Dentist-Dental Hygienist Communication and Dental Treatment Outcomes. HEALTH COMMUNICATION 2017; 32:288-297. [PMID: 27223581 DOI: 10.1080/10410236.2016.1138376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Communication between physician and patient is critical in all fields of medicine, and various types of communication exist in healthcare settings. Cooperation among healthcare professionals is thought to be essential in providing high-quality services. Dental hygienists are key team members in the provision of dental care, and are known to play an important role in the health of their patients. This study aimed to determine the effect of communication between dentists and hygienists on patient satisfaction. Study subjects were dentists, patients, and dental hygienists, and we examined how dentist-dental hygienist communication affected patient outcome indices. A significant difference was observed only for satisfaction in terms of meeting expectations (p = 0.035). Results for patient satisfaction indicated significant differences in explanatory behavior in dentist-dental hygienist evaluations (p = 0.001). The results showed improved health and reduced fear, indicating significant differences for the dentist-dental hygienist evaluations in explanation behavior (p = 0.016). Our evaluation of the effects of dentist-dental hygienist communication on patient outcomes indicated a significant correlation, suggesting that inter-professional communication in the field of dentistry affects patient satisfaction.
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Affiliation(s)
- Tomoko Hamasaki
- a Department of Nutrition Faculty of Home Economics , Kyushu Women's University , Japan
| | | | | | - Akihito Hagihara
- d Department of Health Services Management and Policy , Kyushu University Graduate School of Medicine
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Eid M, Nahon-Serfaty I. Risk, Activism, and Empowerment. Oncology 2017. [DOI: 10.4018/978-1-5225-0549-5.ch029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The prevalence of breast cancer in Venezuela is particularly alarming, which is attributed to healthcare inequalities, low health literacy, and lagging compliance with prevention methods (i.e., screening and mammography). While the right to health is acknowledged by the Venezuelan constitution, activism beyond governmental confines is required to increase women's breast cancer awareness and decrease mortality rates. Through the development of social support and strategic communicative methods enacted by healthcare providers, it may be possible to empower women with the tools necessary for breast cancer prevention. This paper discusses issues surrounding women's breast cancer, such as awareness of the disease and its risks, self-advocacy, and the roles of activists, healthcare providers, and society. Specifically, it describes a four-year action-oriented research project developed in Venezuela, which was a collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include higher levels of awareness and interest among community members and organizations to learn and seek more information about women's breast cancer, better understandings of the communicated messages, more media coverage and medical consultations, increasing positive patient treatments, expansion of networking of NGOs, as well as a widely supported declaration for a national response against breast cancer in Venezuela.
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Rathert C, Mittler JN, Banerjee S, McDaniel J. Patient-centered communication in the era of electronic health records: What does the evidence say? PATIENT EDUCATION AND COUNSELING 2017; 100:50-64. [PMID: 27477917 DOI: 10.1016/j.pec.2016.07.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Patient-physician communication is essential for patient-centered health care. Physicians are concerned that electronic health records (EHRs) negatively affect communication with patients. This study identified a framework for understanding communication functions that influence patient outcomes. We then conducted a systematic review of the literature and organized it within the framework to better understand what is known. METHOD A comprehensive search of three databases (CINAHL, Medline, PsycINFO) yielded 41 articles for analysis. RESULTS Results indicated that EHR use improves capture and sharing of certain biomedical information. However, it may interfere with collection of psychosocial and emotional information, and therefore may interfere with development of supportive, healing relationships. Patient access to the EHR and messaging functions may improve communication, patient empowerment, engagement, and self-management. CONCLUSION More rigorous examination of EHR impacts on communication functions and their influences on patient outcomes is imperative for achieving patient-centered care. By focusing on the role of communication functions on patient outcomes, future EHRs can be developed to facilitate care. PRACTICE IMPLICATIONS Training alone is likely to be insufficient to address disruptions to communication processes. Processes must be improved, and EHRs must be developed to capture useful data without interfering with physicians' and patients' abilities to effectively communicate.
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Affiliation(s)
- Cheryl Rathert
- Department of Health Administration, 1008 East Clay St. P.O. Box 980203, Virginia Commonwealth University, Richmond, VA 23298-0203, United States.
| | - Jessica N Mittler
- Department of Health Administration, 1008 East Clay St. P.O. Box 980203, Virginia Commonwealth University, Richmond, VA 23298-0203, United States.
| | - Sudeep Banerjee
- Department of Health Administration, 1008 East Clay St. P.O. Box 980203, Virginia Commonwealth University, Richmond, VA 23298-0203, United States.
| | - Jennifer McDaniel
- Tompkins-McCaw Library for the Health Sciences, 509 North 12th Street, P.O. Box 980582, Virginia Commonwealth University, Richmond, VA 23298-0582, United States.
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Seitz T, Turk BR, Löffler-Stastka H. Can we still stop the migration of physicians from Austria? : An evaluation of clinical internships by students of the Medical University of Vienna. Wien Klin Wochenschr 2017; 129:65-69. [PMID: 27761735 PMCID: PMC5247532 DOI: 10.1007/s00508-016-1095-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 09/14/2016] [Indexed: 02/07/2023]
Abstract
The increasing emigration of graduates of the Medical University of Vienna presents a serious problem. This study examined students' evaluation of clinical rotations, their self-rated performance, and where they felt the most deficits exist. Medical students answered an online questionnaire surveying the following aspects: an evaluation of their internship; supervision; integration in the team and improvement of field-specific knowledge; the qualities of taking a patient's medical history by empathy; patient-centeredness; structure; target orientation; and the ability to integrate field-specific knowledge into anamnesis. The data collected indicate that rotations in Austria, especially in Vienna, were evaluated significantly worse than those abroad. Particularly the lack of supervision and integration in the team were criticized. These data stress a dire need for the reform of curricular structures during clinical rotation in the latter years of medical education.
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Affiliation(s)
- Tamara Seitz
- grid.22937.3dMedizinische Universität Wien, Vienna, Austria
| | - Bela R. Turk
- grid.22937.3dUniversitätsklinik für Psychoanalyse und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Vienna, Austria
| | - Henriette Löffler-Stastka
- grid.22937.3dUniversitätsklinik für Psychoanalyse und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Vienna, Austria
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Sikavi D, Weseley AJ. The relationship between psychosocial factors in the patient-oncologist relationship and quality of care: A study of breast cancer patients. J Psychosoc Oncol 2016; 35:32-46. [PMID: 27918875 DOI: 10.1080/07347332.2016.1247406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined the relationship between psychosocial factors in the patient-oncologist relationship and aspects of care among women with breast cancer. Breast cancer patients (N = 118) completed a questionnaire about their relationship with their oncologist, their treatment, and their health. While trust was related to several positive outcomes, physician supportiveness was most strongly related to satisfaction with care, and health care access was most strongly associated with general health. The results suggest that the addition of supportiveness and healthcare access to trust provide a more complete picture of patients' health outcomes.
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Affiliation(s)
- Daniel Sikavi
- a Department of Ecology and Evolutionary Biology , Princeton University , Princeton , NJ , USA
| | - Allyson J Weseley
- b Behavioral Science Program , Roslyn High School , Roslyn Heights , NY , USA
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Castro EM, Van Regenmortel T, Vanhaecht K, Sermeus W, Van Hecke A. Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review. PATIENT EDUCATION AND COUNSELING 2016; 99:1923-1939. [PMID: 27450481 DOI: 10.1016/j.pec.2016.07.026] [Citation(s) in RCA: 468] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/14/2016] [Accepted: 07/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The concepts of patient empowerment, patient participation and patient-centeredness have been introduced as part of the trend towards a more participatory health care and have largely been used interchangeably. Although these concepts have been discussed for a number of years, their exact meaning in hospital care remains somewhat unclear. This absence of theoretical and conceptual clarity has led to (1) poor understanding and communication among researchers, health practitioners and policy makers and (2) problems in measurement and comparison between studies across different hospitals. METHODS This paper examines all three concepts through a concept analysis based on the method of Avant and Walker (2005) [1] and the simultaneous concept analysis of Haase et al. (1992) [2]. RESULTS Through these methods, the antecedents, attributes, consequences and empirical referents of each concept are determined. In addition, similarities and differences between the three concepts are identified and a definition offered for each concept. Furthermore, the interrelatedness between the key concepts is mapped, and definitions are proposed. CONCLUSIONS It can be concluded that patient empowerment is a much broader concept than just patient participation and patient-centeredness. PRACTICE IMPLICATIONS The present study may provide a useful framework that researchers, policy makers and health care providers can use to facilitate patient empowerment.
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Affiliation(s)
| | - Tine Van Regenmortel
- Faculty of Social Sciences - HIVA, University of Leuven, Leuven, Belgium, Belgium; Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo, Tilburg, Netherlands
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, University of Leuven, Leuven, Belgium
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health - University Center for Nursing and Midwifery, Ghent University, Ghent, Belgium
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Street RL, Mazor KM, Arora NK. Assessing Patient-Centered Communication in Cancer Care: Measures for Surveillance of Communication Outcomes. J Oncol Pract 2016; 12:1198-1202. [PMID: 27650836 PMCID: PMC5455589 DOI: 10.1200/jop.2016.013334] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Richard L. Street
- Texas A&M University, College Station; Baylor College of Medicine, Houston, TX; Meyers Primary Care Institute, Worcester, MA; and Patient-Centered Care Research Outcomes Research Branch, Washington, DC
| | - Kathleen M. Mazor
- Texas A&M University, College Station; Baylor College of Medicine, Houston, TX; Meyers Primary Care Institute, Worcester, MA; and Patient-Centered Care Research Outcomes Research Branch, Washington, DC
| | - Neeraj K. Arora
- Texas A&M University, College Station; Baylor College of Medicine, Houston, TX; Meyers Primary Care Institute, Worcester, MA; and Patient-Centered Care Research Outcomes Research Branch, Washington, DC
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Moore DA, Markman ES, McMahon CE, Markman M. Utilization of Behavioral Medicine Services to Refine Medical Diagnostic Formulation in the Face of Uncertain Symptom Presentation. Case Rep Oncol 2016; 9:493-498. [PMID: 27721774 PMCID: PMC5043164 DOI: 10.1159/000447553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 12/05/2022] Open
Abstract
In the ever expanding realm of cancer care, the psychosocial impact of disease and medical treatments has been garnering increased attention. To address these needs, the integration of behavioral medicine services into inpatient and outpatient medical settings has added a unique resource available to oncologists. Psycho-oncologists may assist providers via the provision of psychological assessment and intervention, supplying valuable consultation to members of the medical team and much needed clinical services to patients. The authors present a complex case in which the utilization of behavioral medicine consultation to clarify the diagnostic picture was critical to identifying underlying anatomic disease.
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Affiliation(s)
- David A Moore
- Division of Behavioral Medicine, Department of Medicine, MD Anderson Cancer Center at Cooper University Hospital, Camden, N.J., USA
| | - Elisabeth S Markman
- Division of Behavioral Medicine, Department of Medicine, MD Anderson Cancer Center at Cooper University Hospital, Camden, N.J., USA
| | - Cori E McMahon
- Division of Behavioral Medicine, Department of Medicine, MD Anderson Cancer Center at Cooper University Hospital, Camden, N.J., USA
| | - Maurie Markman
- Division of Medicine and Science, Cancer Treatment Centers of America at Eastern Regional Medical Center, Philadelphia, Pa., USA
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Thomas SJ. Does evidence-based health care have room for the self? J Eval Clin Pract 2016; 22:502-8. [PMID: 27237731 DOI: 10.1111/jep.12563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 11/28/2022]
Abstract
Evidence-based health care (EBHC) has consistently been attacked by opponents for being perniciously reductive. Although these attacks are overwhelmingly framed as critiques of evidence-based medicine, they standardly target the research wing of EBHC upon which evidence-based medicine is dependent, and increasingly extend to adjacent health care disciplines, such as nursing. One of the most persistent forms this line of attack has taken is the allegation that EBHC, with its emphasis on the hierarchy of evidence, grounded in the use of randomized controlled trials, and the clinical guidelines developed on their basis, fails to recognize the patient as the complex self she is, treating her instead as merely a quantifiable, medical-scientific object. By reducing the patient to certain quantifiable dimensions, the patient as self is allegedly 'erased'. In short, the complaint is that an evidence-based approach to health care has no room for the self. Contrary to this persistently held view, it is argued here that EBHC does have room for the self. Review of these critiques suggests they can be categorized into two groups: soft critiques and strong critiques. Soft critiques tend to take a more measured tone grounded in empirical concerns about the dangers of an evidence-based approach to health care, whereas strong critiques tend to make sweeping claims grounded in theoretical commitments to anti-foundationalist philosophical frameworks. While both soft and strong critiques ultimately fail to make the case that EBHC has no room for the self, the empirical concerns of soft critiques nevertheless present a challenge EBHC advocates would do well to take seriously and address.
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Affiliation(s)
- S Joshua Thomas
- Department of Philosophy, St. John's University, New York City, NY, USA.,Center for Medical Humanities, Compassionate Care, and Bioethics, Stony Brook University, Stony Brook, NY, USA
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van Bruinessen IR, van Weel-Baumgarten EM, Gouw H, Zijlstra JM, van Dulmen S. An Integrated Process and Outcome Evaluation of a Web-Based Communication Tool for Patients With Malignant Lymphoma: Randomized Controlled Trial. J Med Internet Res 2016; 18:e206. [PMID: 27473173 PMCID: PMC4982912 DOI: 10.2196/jmir.5877] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/26/2016] [Accepted: 06/21/2016] [Indexed: 12/29/2022] Open
Abstract
Background The complex nature of the medical dialogue and the often emotional context in cancer care present challenges to health care professionals (HCPs) and patients. Patients are increasingly expected to be informed participants and to be able to make conscious decisions, which they often find very difficult. In an attempt to support patients with malignant lymphoma in clinical communication, we developed a stand-alone, Web-based intervention called “PatientTIME.” The development of PatientTIME was based on a participatory intervention mapping framework. Its primary aim is to boost patients’ self-efficacy in patient-professional communication (ie, their confidence when interacting with their HCP). Patients can use this intervention before their hospital visit to prepare for their clinical consultation. PatientTIME is fully automated and use is patient-initiated. Objective The aim of this study was to evaluate if and in what way patients benefit from PatientTIME and if it enhances their confidence in clinical communication. Methods The intervention was evaluated in a closed randomized controlled trial with continuous recruitment (using online and offline methods to reach potential participants) and data collection. In accordance with the Medical Research Council guidance, we started with a process evaluation. Subsequently, an outcome evaluation was performed focusing on the patients’ perceived confidence in communication with their HCP, measured with the validated PEPPI questionnaire at baseline and at 3 months after participation. Process and outcome data were obtained through Web-based questionnaires, log files (automatically generated files mapping the interactions between program and users), and a logbook (comprising a record of actions and interactions kept by the researchers). Participants were not blinded. A total of 146 patients registered online, of whom 97 gave their informed consent and were assigned at random to the control group (N=34) or 1 of the 2 intervention groups (N=63). Ultimately 87/97 (90%) of these patients actually participated in the study, producing 87 datasets for analysis. Results More than half of the intervention group patients reported that the intervention helped them prepare for a clinical consultation; it created awareness about the importance of communication and reinforced their existing communication skills. In the postvisit test, the control group showed a small, nonsignificant improvement in perceived communication efficacy. The intervention group showed a significant improvement in perceived efficacy. However, the interaction effect was not significant, indicating that the improvement solely as a result of the intervention may not be significant. Conclusions A considerable number of patients reported that PatientTIME did provide support. We found a trend indicating that in the long run, patients with access to PatientTIME scored better on the perceived efficacy scale than patients without access. However, at this stage we cannot conclude that PatientTIME improves patients’ confidence when interacting with HCPs. ClinicalTrial Netherlands National Trial Register (NTR): 3779; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3779 (archived by WebCite at http://www.webcitation.org/6iztxJ5Nt)
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Zafar W, Hafeez H, Jamshed A, Shah MA, Quader A, Yusuf MA. Preferences regarding disclosure of prognosis and end-of-life care: A survey of cancer patients with advanced disease in a lower-middle-income country. Palliat Med 2016; 30:661-73. [PMID: 26769733 DOI: 10.1177/0269216315625810] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cancer patients' preferences regarding disclosure of prognosis and end-of-life care remain under-reported from low- and middle-income countries where cancer poses an increasing demand on scarce healthcare resources. A better knowledge of these preferences can help in achievement of shared treatment goals. AIM To survey preferences of adult cancer patients regarding disclosure of prognosis and end-of-life care DESIGN A multidimensional questionnaire was developed to survey consecutively sampled patients. A fifth of the participants completed a repeat survey 3 months later. SETTING/PARTICIPANTS Adult patients at a specialist cancer center in Pakistan. RESULTS In total, 520 patients were surveyed initially (participation rate 98.6%) and 100 completed the repeat survey. Three in five respondents wanted a healthcare provider to give them detailed information about their prognosis and life expectancy. Those who wanted information withheld were significantly more likely to be female, to have a lower socioeconomic status, or to have lung cancer. Only two in five patients agreed that they wanted to die at home and more than 90% wanted all possible care till end-of-life. Yet, a little over half also agreed that they did not wish to be placed on a ventilator. In rank ordering preferences about end-of-life, respondents ranked "religious wellbeing" as the highest and "avoiding inappropriate prolongation of dying" as the lowest of six options. CONCLUSION A majority of adult cancer patients surveyed in this study wanted a truthful disclosure about their disease prognosis and expressed a preference for hospital-based care at end-of-life. Healthcare providers should find ways to tailor prognostic information to patients' expressed information needs.
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Affiliation(s)
- Waleed Zafar
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Haroon Hafeez
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Arif Jamshed
- Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Mazhar Ali Shah
- Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Ainul Quader
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - M Aasim Yusuf
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
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Rodriguez AN, DeWitt P, Fisher J, Broadfoot K, Hurt KJ. Psychometric characterization of the obstetric communication assessment tool for medical education: a pilot study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2016; 7:168-179. [PMID: 27289202 PMCID: PMC4912696 DOI: 10.5116/ijme.5740.4262] [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: 02/15/2016] [Accepted: 05/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To characterize the psychometric properties of a novel Obstetric Communication Assessment Tool (OCAT) in a pilot study of standardized difficult OB communication scenarios appropriate for undergraduate medical evaluation. METHODS We developed and piloted four challenging OB Standardized Patient (SP) scenarios in a sample of twenty-one third year OB/GYN clerkship students: Religious Beliefs (RB), Angry Father (AF), Maternal Smoking (MS), and Intimate Partner Violence (IPV). Five trained Standardized Patient Reviewers (SPRs) independently scored twenty-four randomized video-recorded encounters using the OCAT. Cronbach's alpha and Intraclass Correlation Coefficient-2 (ICC-2) were used to estimate internal consistency (IC) and inter-rater reliability (IRR), respectively. Systematic variation in reviewer scoring was assessed using the Stuart-Maxwell test. RESULTS IC was acceptable to excellent with Cronbach's alpha values (and 95% Confidence Intervals [CI]): RB 0.91 (0.86, 0.95), AF 0.76 (0.62, 0.87), MS 0.91 (0.86, 0.95), and IPV 0.94 (0.91, 0.97). IRR was unacceptable to poor with ICC-2 values: RB 0.46 (0.40, 0.53), AF 0.48 (0.41, 0.54), MS 0.52 (0.45, 0.58), and IPV 0.67 (0.61, 0.72). Stuart-Maxwell analysis indicated systematic differences in reviewer stringency. CONCLUSIONS Our initial characterization of the OCAT demonstrates important issues in communications assessment. We identify scoring inconsistencies due to differences in SPR rigor that require enhanced training to improve assessment reliability. We outline a rational process for initial communication tool validation that may be useful in undergraduate curriculum development, and acknowledge that rigorous validation of OCAT training and implementation is needed to create a valuable OB communication assessment tool.
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Affiliation(s)
- A. Noel Rodriguez
- Department of Obstetrics and Gynecology, Divisions of Maternal Fetal Medicine and Reproductive Sciences, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Peter DeWitt
- Biostatistics and Informatics, Research Consulting Lab, Colorado School of Public Health, Aurora, Colorado, USA
| | - Jennifer Fisher
- Center for Advancing Professional Excellence (CAPE), University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kirsten Broadfoot
- Center for Advancing Professional Excellence (CAPE), University of Colorado School of Medicine, Aurora, Colorado, USA
| | - K. Joseph Hurt
- Department of Obstetrics and Gynecology, Divisions of Maternal Fetal Medicine and Reproductive Sciences, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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Nicolai J, Buchholz A, Seefried N, Reuter K, Härter M, Eich W, Bieber C. When do cancer patients regret their treatment decision? A path analysis of the influence of clinicians' communication styles and the match of decision-making styles on decision regret. PATIENT EDUCATION AND COUNSELING 2016; 99:739-746. [PMID: 26658703 DOI: 10.1016/j.pec.2015.11.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 11/14/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To test the influence of physician empathy (PE), shared decision making (SDM), and the match between patients' preferred and perceived decision-making styles on patients' decision regret. METHODS Patients with breast or colon cancer (n=71) completed questionnaires immediately following (T1) and three months after a consultation (T2). Path analysis was used to examine the relationships among patient demographics, patient reports of PE, SDM, the match between preferred and perceived decision-making styles, and patient decision regret at T2. RESULTS After controlling for clinician clusters, higher PE was directly associated with more SDM (β=0.43, p<0.01) and lower decision regret (β=-0.28, p<0.01). The match between patients' preferred and perceived roles was negatively associated with decision regret (β=-0.33, p<0.01). Patients who participated less than desired reported more decision regret at T2. There was no significant association between SDM and decision regret (β=0.03, p=0.74). CONCLUSION PE and the match between patients' preferred and perceived roles in medical decision making are essential for patient-centered cancer consultations and treatment decisions. PRACTICE IMPLICATIONS Ways to enhance PE and matching the consultation style to patients' expectations should be encouraged.
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Affiliation(s)
- Jennifer Nicolai
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Germany; Psychology III, University of Mannheim, Germany.
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nathalie Seefried
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Germany
| | - Katrin Reuter
- Department of Psychiatry and Psychotherapy, University of Freiburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Germany
| | - Christiane Bieber
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Germany
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Barthakur MS, Sharma MP, Chaturvedi SK, Manjunath SK. Experiences of Breast Cancer Survivors with Oncology Settings in Urban India: Qualitative Findings. Indian J Surg Oncol 2016; 7:392-396. [PMID: 27872525 DOI: 10.1007/s13193-016-0519-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 04/19/2016] [Indexed: 10/21/2022] Open
Abstract
The experience of diagnosis and treatment of cancer leads to significant changes within an individual. In the course of survivorship trajectory, very often cancer survivors are left with the sense, improvements could be done to enhance the quality of cancer care. This article focuses on experiences of breast cancer survivors with oncology setting in urban India. Data was collected from 15 women in South and East India using in-depth interview method. Qualitative interview data was analysed using descriptive phenomenology method. Areas of importance that emerged broadly included informational and emotional categories. Findings reveal quality of cancer care in India can be improved through developing an orientation towards patient-centred style rather than doctor/disease centred approach which has major influence on physical and mental health outcomes. This would require further research and increased emphasis on training of medical as well as paramedical professionals.
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Affiliation(s)
- Michelle S Barthakur
- Manukau Community Mental Health Centre, Counties Manukau District Health Board, Auckland, New Zealand ; Department of Clinical Psychology, NIMHANS, Bangalore, India
| | | | | | - Suraj K Manjunath
- Department of Surgical Oncology, St. Johns Medical College and Hospital, Bangalore, India
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82
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van Bruinessen IR, van der Hout LE, van Weel-Baumgarten EM, Gouw H, Zijlstra JM, van Dulmen S. Communication during haematological consultations; patients' preferences and professionals' performances. Ann Hematol 2016; 95:1177-83. [PMID: 27091348 DOI: 10.1007/s00277-016-2669-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/07/2016] [Indexed: 11/30/2022]
Abstract
Many patients with haematological malignancies experience barriers in clinical communication. Reaching effective communication is of great importance as it has been linked to a range of improved patient outcomes such as satisfaction, compliance to treatment, perceived quality of life and physical and mental health. To get a better understanding how communication in haematological consultations can be improved, the current study focussed on patients' preferences and perceived performances regarding the communicative behaviour of their health care professional. Secondly, the mediation of an online communication tool for patients was analysed. Within a controlled pre- post-test design, 78 datasets of clinical consultations could be analysed. Patients considered both affective and instrumental communication aspects important. The affective communication behaviour of the health care professional met the patients' pre-visit preferences well. In the information exchange, more variability and discrepancies were found. Overall, the online intervention did not seem to influence the patients' perceived communication performance of their health care professional much. To further improve the communication during clinical consultations, health care professionals should inquire about patients' expectations, especially during the exchange of information and advices. At the same time, patients should be supported to express their preferences at the start of the consultation. The study was registered in the Netherlands Trial Register, number 3779.
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Affiliation(s)
- Inge R van Bruinessen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
| | - Lotte E van der Hout
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | | | - Hans Gouw
- Hematon (Dutch Patient Association for Leukaemia, Malignant Lymphoma and Stem Cell Transplantation), Amersfoort, The Netherlands
| | - Josée M Zijlstra
- Department of Haematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
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83
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Atinga RA, Bawole JN, Nang-Beifubah A. 'Some patients are more equal than others': Patient-centred care differential in two-tier inpatient ward hospitals in Ghana. PATIENT EDUCATION AND COUNSELING 2016; 99:370-377. [PMID: 26475729 DOI: 10.1016/j.pec.2015.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine differences in patient-centred care among private and public inpatients in public hospitals and whether satisfaction with patient-centred care differ between the patient groups. METHOD Cross-sectional data collected from inpatients in private wards (n=300) and public wards (n=520) in Ghana, using a structured questionnaire modelled on four dimensions of patient-centred care: respect and dignity, emotional support, interpersonal relations and information sharing. RESULTS Patient-centred care differed significantly among private and public patients (p<0.001), with an effect size ranging from medium to large. Private patients rated patient-centred care higher than public patients in all the items of the four dimensions. Satisfaction with patient-centred care discriminated between the patient groups. Satisfaction was significantly high for private patients who are aged 50+ (p<0.001), had high education (p<0.05) and high income (p<0.001) compared to the same category of public patients. CONCLUSION Physicians behaviour is stereotyping and less favourable to public patients, suggesting inequitable access to patient-centred care for inpatients from high and low socioeconomic backgrounds. PRACTICE IMPLICATIONS Hospitals with private and public wards should be compelled to properly coordinate and regulate the activities of physicians to avoid fragmented care for inpatients.
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Affiliation(s)
- Roger A Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana.
| | - Justice N Bawole
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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84
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Maatouk-Bürmann B, Ringel N, Spang J, Weiss C, Möltner A, Riemann U, Langewitz W, Schultz JH, Jünger J. Improving patient-centered communication: Results of a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2016; 99:117-24. [PMID: 26490488 DOI: 10.1016/j.pec.2015.08.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Patient-centered communication is a key element for improving the quality of care in terms of therapeutic relationship, patient participation, and treatment process. Postgraduate trainings provide an essential way of promoting patient centeredness on the job where learning opportunities are often limited by time, patient volume, and economic pressure. In the present study, changes in patient centeredness during clinical routines of postgraduate physicians (internal medicine) after a three-day communication training were assessed. METHODS A randomized controlled trial was conducted in a primary care clinic. The intervention consisted of a communication training that aimed to enhance patient centeredness in postgraduate physicians. The training was based on a need assessment and the principles of deliberate practice. Workplace-based assessment of physicians' communication behavior was obtained using the Roter Interaction Analysis System. RESULTS Three months after the intervention, trained physicians showed significantly increased patient centeredness (F=5.36, p=.04; d=0.42). CONCLUSION The communication training significantly improved patient centeredness during routine clinical practice. Thus, this training provides a structured and theory-based concept to foster patient centeredness. PRACTICE IMPLICATIONS The results support the implementation of communication trainings as a part of faculty development and medical specialization training.
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Affiliation(s)
- Barbara Maatouk-Bürmann
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany.
| | - Nadja Ringel
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Jochen Spang
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Carmen Weiss
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Möltner
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Urs Riemann
- Department of Internal Medicine I, SLK Clinic Heilbronn, Germany
| | - Wolf Langewitz
- Division of Psychosomatic Medicine, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
| | - Jana Jünger
- Department of General Internal Medicine and Psychosomatic, Heidelberg University Hospital, Heidelberg, Germany
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Berghout M, van Exel J, Leensvaart L, Cramm JM. Healthcare professionals' views on patient-centered care in hospitals. BMC Health Serv Res 2015; 15:385. [PMID: 26373841 PMCID: PMC4572638 DOI: 10.1186/s12913-015-1049-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/07/2015] [Indexed: 12/30/2022] Open
Abstract
Background Patient-centered care (PCC) is a main determinant of care quality. Research has shown that PCC is a multi-dimensional concept, and organizations that provide PCC well report better patient and organizational outcomes. However, little is known about the relative importance of PCC dimensions. The aim of this study was therefore to investigate the relative importance of the eight dimensions of PCC according to hospital-based healthcare professionals, and examine whether their viewpoints are determined by context. Methods Thirty-four healthcare professionals (16 from the geriatrics department, 15 from a surgical intensive care unit, 3 quality employees) working at a large teaching hospital in New York City were interviewed using Q methodology. Participants were asked to rank 35 statements representing eight dimensions of PCC extracted from the literature: patient preferences, physical comfort, coordination of care, emotional support, access to care, continuity and transition, information and education and family and friends. By-person factor analysis was used to reveal patterns of communality in statement rankings, which were interpreted and described as distinct viewpoints. Results Three main viewpoints on elements important for PCC were identified: “treating patients with dignity and respect,” “an interdisciplinary approach” and “equal access and good outcomes.” In these viewpoints, not all dimensions were equally important for PCC. Furthermore, the relative importance of the dimensions differed between departments. Context thus appeared to affect the relative importance of PCC dimensions. Conclusion Healthcare organizations wishing to improve PCC should consider the relative importance of PCC dimensions in their specific context of care provision, which may help to improve levels of patient-centeredness in a more efficient and focused manner. However, as the study sample is not representative and consisted only of professionals (not patients), the results cannot be generalized outside the sample. More research is needed to confirm our study findings.
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Affiliation(s)
- Mathilde Berghout
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Job van Exel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Laszlo Leensvaart
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jane M Cramm
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Zachariae R, O'Connor M, Lassesen B, Olesen M, Kjær LB, Thygesen M, Mørcke AM. The self-efficacy in patient-centeredness questionnaire - a new measure of medical student and physician confidence in exhibiting patient-centered behaviors. BMC MEDICAL EDUCATION 2015; 15:150. [PMID: 26374729 PMCID: PMC4572680 DOI: 10.1186/s12909-015-0427-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 08/24/2015] [Indexed: 05/18/2023]
Abstract
BACKGROUND Patient-centered communication is a core competency in modern health care and associated with higher levels of patient satisfaction, improved patient health outcomes, and lower levels of burnout among physicians. The objective of the present study was to develop a questionnaire assessing medical student and physician self-efficacy in patient-centeredness (SEPCQ) and explore its psychometric properties. METHODS A preliminary 88-item questionnaire (SEPCQ-88) was developed based on a review of the literature and medical student portfolios and completed by 448 medical students from Aarhus University. Exploratory Principal Component analysis resulted in a 27-item version (SEPCQ-27) with three underlying self-efficacy factors: 1) Exploring the patient perspective, 2) Sharing information and power, and 3) Dealing with communicative challenges. The SEPCQ-27 was completed by an independent sample of 291 medical students from 2 medical schools and 101 hospital physicians. RESULTS Internal consistencies of total and subscales were acceptable for both students and physicians (Cronbach's alpha (range): 0.74-0.95). There were no overall indications of gender-related differential item function (DIF), and a Confirmatory Factor Analysis (CFA) indicated good fit (CFI = 0.98; NNFI = 0.98; RMSEA = 0.05; SRMR = 0.07). Responsiveness was indicated by increases in SEPCQ scores after a course in communication and peer-supervision (Cohen's d (range): 0.21 to 0.73; p: 0.053 to 0.001). Furthermore, positive associations were found between increases in SEPCQ-scores and course-related motivation to learn (medical students) and between SEPCQ scores and years of clinical experience (physicians). CONCLUSIONS The final SEPCQ-27 showed satisfactory psychometric properties, and preliminary support was found for its construct validity, indicating that the SEPCQ-27 may be a valuable measure in future patient centered communication training and research.
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Affiliation(s)
- Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology, Aarhus University, Bartholins Allé 9, DK8000, Aarhus, Denmark.
| | - Maja O'Connor
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology, Aarhus University, Bartholins Allé 9, DK8000, Aarhus, Denmark.
| | - Berit Lassesen
- Center for Teaching and Learning, School of Business and Social Science, Aarhus University, Fuglsangs Alle 4, 8210, Aarhus, Denmark.
| | - Martin Olesen
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology, Aarhus University, Bartholins Allé 9, DK8000, Aarhus, Denmark.
| | - Louise Binow Kjær
- Centre for Health Sciences Education, Aarhus University, INCUBA, Palle Juul-Jensens Boulevard 82, bld. B, 8200, Aarhus, Denmark.
| | - Marianne Thygesen
- Faculty of Health, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000, Odense, Denmark.
| | - Anne Mette Mørcke
- Centre for Health Sciences Education, Aarhus University, INCUBA, Palle Juul-Jensens Boulevard 82, bld. B, 8200, Aarhus, Denmark.
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Perceptions of a patient-staff-caregiver group among inpatients in a radiotherapy unit. Palliat Support Care 2015; 13:953-60. [DOI: 10.1017/s1478951514000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Coping with cancer and its treatments has significant psychological implications for patients, and hospitalization can lead to emotional distress. Based on a community meeting (CM), a common therapeutic intervention in psychiatric wards, a unique patient–staff–caregiver group is held weekly on the radiotherapy unit of our hospital. The goals are to strengthen patient coping abilities and prompt open communications. The present study aimed at quantitatively estimating the effect of the community meeting by gauging the perceptions with respect to several therapeutic aspects.Method:A questionnaire was developed for patients who participated in CMs during their hospitalization based on four theoretical factors: illness perception, relations with the main caregiver, relations with other participants, and relations with unit staff.Results:Participants' general satisfaction with the meetings was found to be positive. The most significant aspect of the meetings, as perceived by participants, was relationships with the staff. Patients born in Israel perceived relationships with other participants more positively.Significance of results:Attentive interaction with medical staff and open communications are highly important for patients and contribute to their general satisfaction with the meetings.
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88
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Beach WA, Dozier DM. Fears, Uncertainties, and Hopes: Patient-Initiated Actions and Doctors' Responses During Oncology Interviews. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1243-54. [PMID: 26134261 PMCID: PMC5114848 DOI: 10.1080/10810730.2015.1018644] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
New cancer patients frequently raise concerns about fears, uncertainties, and hopes during oncology interviews. This study sought to understand when and how patients raise their concerns, how doctors responded to these patient-initiated actions, and implications for communication satisfaction. A subsampling of video recorded and transcribed encounters was investigated involving 44 new patients and 14 oncologists. Patients completed pre/post self-report measures about fears, uncertainties, and hopes as well as postevaluations of interview satisfaction. Conversation analysis was used to initially identify pairs of patient-initiated and doctor-responsive actions. A coding scheme was subsequently developed, and two independent coding teams, comprised of two coders each, reliably identified patient-initiated and doctor-responsive social actions. Interactional findings reveal that new cancer patients initiate actions much more frequently than previous research had identified, concerns are usually raised indirectly, and with minimal emotion. Doctors tend to respond to these concerns immediately, but with even less affect, and rarely partner with patients. From pre/post results, it was determined that the higher patients' reported fears, the higher their postvisit fears and lower their satisfaction. Patients with high uncertainty were highly proactive (e.g., asked more questions), yet reported even greater uncertainties after encounters. Hopeful patients also exited interviews with high hopes. Overall, new patients were very satisfied: oncology interviews significantly decreased patients' fears and uncertainties, while increasing hopes. Discussion raises key issues for improving communication and managing quality cancer care.
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Affiliation(s)
- Wayne A. Beach
- Professor, School of Communication, San Diego State University, San Diego, CA 92182-4561, Phone: (619) 594-4948, FAX: (619) 594-0704, Adjunct Professor, Department of Surgery, Member, Moores Cancer Center, University of California, San Diego
| | - David M. Dozier
- Professor, Public Relations Emphasis, School of Journalism & Media Studies, San Diego State University, San Diego, CA 92182-4561
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89
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Jesus TS, Silva IL. Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes. Clin Rehabil 2015; 30:315-28. [DOI: 10.1177/0269215515585133] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 04/12/2015] [Indexed: 12/20/2022]
Abstract
Background: There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) ‘how’ rehabilitation outcomes can be improved by communication; and (b) through ‘which’ elements in particular. This article elaborates on the conceptual developments toward informing further practice and research. Methods: Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review. Results: After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the ‘4 Rehab Communication Elements’ deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing. Discussion: This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the ‘4 Rehab Communication Elements’. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes.
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Affiliation(s)
- Tiago Silva Jesus
- Health Psychology Department, Medical School, Universidad Miguel Hernández, Elche, Spain
- Universidade Fernando Pessoa, Oporto, Portugal
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90
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Sabee CM, Koenig CJ, Wingard L, Foster J, Chivers N, Olsher D, Vandergriff I. The Process of Interactional Sensitivity Coding in Health Care: Conceptually and Operationally Defining Patient-Centered Communication. JOURNAL OF HEALTH COMMUNICATION 2015; 20:773-782. [PMID: 25942355 DOI: 10.1080/10810730.2015.1018567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study aimed to develop a process for measuring sensitivity in provider-patient interactions to better understand patient-centered communication. The authors developed the Process of Interactional Sensitivity Coding in Healthcare (PISCH) by incorporating a multimethod investigation into conversations between physicians and their patients with type 2 diabetes. The PISCH was then applied and assessed for its reliability across the unitization of interactions, the activities that were reflected, and the characteristics of patient-centered interactional sensitivity that were observed within each unit. In most cases, the PISCH resulted in reliable analysis of the interactions, but a few key areas (shared decision making, enabling self-management, and responding to emotion) were not reliably assessed. Implications of the test of this coding scheme include the expansion of the theoretical notion of interactional sensitivity to the health care context, rigorous implementation of a multimethod measurement development that relied on qualitative and quantitative assessments, and important future questions about the role of communication concepts in future interpersonal research.
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Affiliation(s)
- Christina M Sabee
- a Department of Communication Studies , San Francisco State University , San Francisco , California , USA
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91
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Gálvez P, Valencia A, Palomino AM, Cataldo M, Schwingel A. Communicating about eating behaviors. A qualitative study of Chilean women and their health-care providers. Int J Qual Stud Health Well-being 2015; 10:25979. [PMID: 25661846 PMCID: PMC4320207 DOI: 10.3402/qhw.v10.25979] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2015] [Indexed: 11/23/2022] Open
Abstract
Good communication between health care providers (HCPs) and patients is critical in achieving positive health outcomes. The purpose of this article was to compare the perceptions of Chilean woman and their HCPs with respect to determinants of eating behaviors. Semi-structured interviews were conducted with women (n=15) visiting a public health care center in Chile and with their HCPs (n=8) who were in charge of promoting healthy eating behaviors among women. Data from the interviews indicated similarities and inconsistencies in determinants of eating behaviors between the groups. Both mentioned many important factors that influence women's eating behaviors, including food preferences, dietary knowledge, self-control and self-efficacy, family, food cost, and food availability. HCPs appeared to be less aware of the role that personality traits and past experiences play as potential determinants which women mentioned. In contrast, women were less aware of the influence of anxiety and low self-esteem on eating choices, which HCPs noted as key factors. Although it was encouraging to see agreement between women and their HCPs in some areas, it is important to work on increasing understanding among the groups with respect to the important role psychological factors play in influencing eating behavior. We suggest that HCPs should focus on the importance of women's personality traits and past eating behaviors, as well as work on improving women's self-esteem and helping to decrease their anxiety levels. HCPs should be encouraged to develop good communication with each person in order to help them understand the roles that external and internal factors play in eating behaviors.
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Affiliation(s)
- Patricia Gálvez
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, IL, USA;
| | | | - Ana M Palomino
- Nutrition and Dietetic School, University of Chile, Santiago, Chile
| | - Marjorie Cataldo
- Nutrition and Dietetic School, University of Chile, Santiago, Chile
| | - Andiara Schwingel
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, IL, USA
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92
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Eid M, Nahon-Serfaty I. Risk, Activism, and Empowerment: Women's Breast Cancer in Venezuela. INTERNATIONAL JOURNAL OF CIVIC ENGAGEMENT AND SOCIAL CHANGE 2015; 2:43-64. [PMID: 27868080 DOI: 10.4018/ijcesc.2015010104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The prevalence of breast cancer in Venezuela is particularly alarming, which is attributed to healthcare inequalities, low health literacy, and lagging compliance with prevention methods (i.e., screening and mammography). While the right to health is acknowledged by the Venezuelan constitution, activism beyond governmental confines is required to increase women's breast cancer awareness and decrease mortality rates. Through the development of social support and strategic communicative methods enacted by healthcare providers, it may be possible to empower women with the tools necessary for breast cancer prevention. This paper discusses issues surrounding women's breast cancer, such as awareness of the disease and its risks, self-advocacy, and the roles of activists, healthcare providers, and society. Specifically, it describes a four-year action-oriented research project developed in Venezuela, which was a collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include higher levels of awareness and interest among community members and organizations to learn and seek more information about women's breast cancer, better understandings of the communicated messages, more media coverage and medical consultations, increasing positive patient treatments, expansion of networking of NGOs, as well as a widely supported declaration for a national response against breast cancer in Venezuela.
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93
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Song L, Toles MP, Bai J, Nielsen ME, Bailey DE, Sleath B, Mark B. Patient Participation in Communication about Treatment Decision-Making for Localized Prostate Cancer during Consultation Visits. Health (London) 2015; 7:1419-1429. [PMID: 34296220 PMCID: PMC8293682 DOI: 10.4236/health.2015.711156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives: To describe the communication behaviors of patients and physicians and patient participation in communication about treatment decision-making during consultation visits for localized prostate cancer (LPCa). Methods: This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed); “low” (patient listening only); “moderate” (patient providing information or asking questions); and “high” (patient providing information and asking questions). Results: Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories; 2) “low” in discussing survival/mortality; 3) “low and moderate” in discussing treatment options; 4) “none and low” in discussing treatment impacts; and 5) “low” in discussing treatment preferences. Conclusions: Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.
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Affiliation(s)
- Lixin Song
- School of Nursing, University of North Carolina (UNC), Chapel Hill, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina (UNC), Chapel Hill, USA
- Corresponding author.
| | - Mark P. Toles
- School of Nursing, University of North Carolina (UNC), Chapel Hill, USA
| | - Jinbing Bai
- School of Nursing, University of North Carolina (UNC), Chapel Hill, USA
| | - Matthew E. Nielsen
- Lineberger Comprehensive Cancer Center, University of North Carolina (UNC), Chapel Hill, USA
- Department of Urology, School of Medicine, University of North Carolina (UNC), Chapel Hill, USA
| | | | - Betsy Sleath
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA
| | - Barbara Mark
- School of Nursing, University of North Carolina (UNC), Chapel Hill, USA
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94
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Small M, Higgins V, Lees A, Johns N, Mastrangelo A, Nazareth T, Turner SJ. Physician-Patient Concordance in Pharmacological Management of Patients with COPD. COPD 2015; 12:473-83. [PMID: 26244570 PMCID: PMC4776681 DOI: 10.3109/15412555.2014.995287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A retrospective analysis of a cross-sectional, multicenter survey was conducted in United States (US) medical practices to evaluate the concordance between patients with COPD and their physicians on disease-specific characteristics. Associations between patient and disease-related characteristics with monotherapy, dual therapy, or triple therapy prescribed as COPD maintenance regimens were also examined. Eligible physicians completed patient record forms (PRFs) for up to 6 consecutive patients with COPD. Patients for whom a PRF was completed were invited to complete a patient self-completion (PSC) survey consisting of questions similar to those on the PRF, as well as several validated measures to assess the impact of COPD on patients' lives. A total of 469 patients completed a PSC that was matched with the PRF completed by their physician, forming the sample for the concordance analysis. Moderate agreement (kappa (κ) = 0.41-0.60) was observed for 79% of measures, with the lowest concordance rating corresponding to hemoptysis (κ = 0.22). There were few differences in demographic or clinical characteristics between patients prescribed monotherapy and dual therapy. Triple therapy rather than monotherapy or dual therapy was more often prescribed for patients with greater frequency of symptoms, negative impact of COPD on daily life and interpersonal relationships, and respiratory impairment based on the most recent FEV1. Diverse factors influence US physicians' perceptions of disease and treatment choices, including patient symptoms, quality of life, and disease impact. Our results highlight that concordance between physicians and patients regarding symptoms and physical function may contribute to optimal management of COPD.
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Affiliation(s)
- Mark Small
- Adelphi Real World, Adelphi Mill, Bollington, Cheshire, United Kingdom
| | - Victoria Higgins
- Adelphi Real World, Adelphi Mill, Bollington, Cheshire, United Kingdom
| | - Adam Lees
- Adelphi Real World, Adelphi Mill, Bollington, Cheshire, United Kingdom
| | - Nicola Johns
- Adelphi Real World, Adelphi Mill, Bollington, Cheshire, United Kingdom
| | | | - Tara Nazareth
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Stuart J. Turner
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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95
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Zill JM, Christalle E, Müller E, Härter M, Dirmaier J, Scholl I. Measurement of physician-patient communication--a systematic review. PLoS One 2014; 9:e112637. [PMID: 25532118 PMCID: PMC4273948 DOI: 10.1371/journal.pone.0112637] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/09/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Effective communication with health care providers has been found as relevant for physical and psychological health outcomes as well as the patients' adherence. However, the validity of the findings depends on the quality of the applied measures. This study aimed to provide an overview of measures of physician-patient communication and to evaluate the methodological quality of psychometric studies and the quality of psychometric properties of the identified measures. METHODS A systematic review was performed to identify psychometrically tested instruments which measure physician-patient communication. The search strategy included three databases (EMBASE, PsycINFO, PubMed), reference and citation tracking and personal knowledge. Studies that report the psychometric properties of physician-patient communication measures were included. Two independent raters assessed the methodological quality of the selected studies with the COSMIN (COnsensus based Standards for the selection of health status Measurement INtruments) checklist. The quality of psychometric properties was evaluated with the quality criteria of Terwee and colleagues. RESULTS Data of 25 studies on 20 measures of physician-patient communication were extracted, mainly from primary care samples in Europe and the USA. Included studies reported a median of 3 out of the nine COSMIN criteria. Scores for internal consistency and content validity were mainly fair or poor. Reliability and structural validity were rated mainly of fair quality. Hypothesis testing scored mostly poor. The quality of psychometric properties of measures evaluated with Terwee et al.'s criteria was rated mainly intermediate or positive. DISCUSSION This systematic review identified a number of measures of physician-patient communication. However, further psychometric evaluation of the measures is strongly recommended. The application of quality criteria like the COSMIN checklist could improve the methodological quality of psychometric property studies as well as the comparability of the studies' results.
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Affiliation(s)
- Jördis M. Zill
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Eva Christalle
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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96
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Turkiewicz KL, Allen M, Venetis MK, Robinson JD. Observed communication between oncologists and patients: A causal model of communication competence. World J Meta-Anal 2014; 2:186-193. [DOI: 10.13105/wjma.v2.i4.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/16/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate and test a causal model derived from previous meta-analytic data of health provider behaviors and patient satisfaction.
METHODS: A literature search was conducted for relevant manuscripts that met the following criteria: Reported an analysis of provider-patient interaction in the context of an oncology interview; the study had to measure at least two of the variables of interest to the model (provider activity, provider patient-centered communication, provider facilitative communication, patient activity, patient involvement, and patient satisfaction or reduced anxiety); and the information had to be reported in a manner that permitted the calculation of a zero-order correlation between at least two of the variables under consideration. Data were transformed into correlation coefficients and compiled to produce the correlation matrix used for data analysis. The test of the causal model is a comparison of the expected correlation matrix generated using an Ordinary Least Squares method of estimation. The expected matrix is compared to the actual matrix of zero order correlation coefficients. A model is considered a possible fit if the level of deviation is less than expected due to random sampling error as measured by a chi-square statistic. The significance of the path coefficients was tested using a z test. Lastly, the Sobel test provides a test of the level of mediation provided by a variable and provides an estimate of the level of mediation for each connection. Such a test is warranted in models with multiple paths.
RESULTS: A test of the original model indicated a lack of fit with the summary data. The largest discrepancy in the model was between the patient satisfaction and the provider patient-centered utterances. The observed correlation was far larger than expected given a mediated relationship. The test of a modified model was undertaken to determine possible fit. The corrected model provides a fit to within tolerance as evaluated by the test statistic, χ2 (8, average n = 342) = 10.22. Each of the path coefficients for the model reveals that each one can be considered significant, P < 0.05. The Sobel test examining the impact of the mediating variables demonstrated that patient involvement is a significant mediator in the model, Sobel statistic = 3.56, P < 0.05. Patient active was also demonstrated to be a significant mediator in the model, Sobel statistic = 4.21, P < 0.05. The statistics indicate that patient behavior mediates the relationship between provider behavior and patient satisfaction with the interaction.
CONCLUSION: The results demonstrate empirical support for the importance of patient-centered care and satisfy the need for empirical casual support of provider-patient behaviors on health outcomes.
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97
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Venetis MK, Robinson JD, Kearney T. Breast-cancer patients' participation behavior and coping during presurgical consultations: a pilot study. HEALTH COMMUNICATION 2014; 30:19-25. [PMID: 25122519 DOI: 10.1080/10410236.2014.943633] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the context of breast-cancer care, there is extremely little research on the association between observed (i.e., taped and coded) communication behaviors and patients' health outcomes, especially those other than satisfaction. In the context of presurgical consultations between female breast cancer patients and a surgeon, the aim of this exploratory study was to test the association between communication-based participation behaviors and pre-post consultation changes in aspects of patients' mental adjustment to cancer (i.e., coping). Participants included 51 women newly diagnosed with breast cancer and a surgical oncologist from a National Cancer Institute (NCI)-designated cancer center in the northeastern United States. Outcomes were changes in patients' fighting spirit, helplessness/hopelessness, anxious preoccupation, cognitive avoidance, and fatalism (measured immediately before and after consultations via survey), and the main predictors were three communication-based participation behaviors coded from videotapes of consultations: patient question asking, patient assertion of treatment preferences, and surgeon solicitation of patient question/concern/opinion. Patients who more frequently asserted their treatment preferences experienced increases in their fighting spirit (p = .01) and decreases in their anxious preoccupation (p = .02). When companions (e.g., sister, spouse) asked more questions, patients experienced decreases in their anxious preoccupation (p = .05). These findings suggest that, in the present context, there may be specific, trainable communication behaviors, such as patients asserting their treatment preferences and companions asking questions, that may improve patients' psychosocial health outcomes.
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98
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Mossanen M, True LD, Wright JL, Vakar-Lopez F, Lavallee D, Gore JL. Surgical pathology and the patient: a systematic review evaluating the primary audience of pathology reports. Hum Pathol 2014; 45:2192-201. [PMID: 25149550 DOI: 10.1016/j.humpath.2014.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/30/2014] [Accepted: 07/09/2014] [Indexed: 12/11/2022]
Abstract
The pathology report is a critical document that helps guide the management of patients with cancer. More and more patients read their reports, intending to participate in decisions about their care. However, a substantial subset of patients may lack the ability to comprehend this often technical and complex document. We hypothesized that most literature on pathology reports discusses reports from the perspective of other physicians and not from the perspective of patients. An expert panel of physicians developed a list of search criteria, which we used to identify articles on PubMed, MEDLINE, Cochrane Reviews, and Google Scholar databases. Two reviewers independently evaluated all articles to identify for detailed review those that met search criteria. We identified the primary audience of the selected articles and the degree to which these articles addressed clarity of communication of pathology reports with patients. Of 801 articles identified in our search, 25 involved the formatting of pathology reports for clarity of communication. Recurrent themes in proposed improvements in reports included content standardization, variation in terminology, clarity of communication, and quality improvement. No articles discussed patients as their target audience. No study evaluated the health literacy level required of patients to comprehend pathology reports. In summary, there is a scarcity of patient-centered approaches to improve pathology reports. The literature on pathology reports does not include patients as a target audience. Limited resources are available to help patients comprehend their reports. Efforts to improve patient-centered communication are desirable to address this overlooked aspect of patient care.
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Affiliation(s)
- Matthew Mossanen
- Department of Urology, University of Washington, Seattle, WA 98195, USA.
| | - Lawrence D True
- Department of Pathology, University of Washington, Seattle, WA 98195, USA
| | - Jonathan L Wright
- Department of Urology, University of Washington, Seattle, WA 98195, USA
| | - Funda Vakar-Lopez
- Department of Pathology, University of Washington, Seattle, WA 98195, USA
| | - Danielle Lavallee
- Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, WA 98195, USA
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA 98195, USA
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99
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Boerebach BC, Scheepers RA, van der Leeuw RM, Heineman MJ, Arah OA, Lombarts KM. The impact of clinicians' personality and their interpersonal behaviors on the quality of patient care: a systematic review. Int J Qual Health Care 2014; 26:426-81. [DOI: 10.1093/intqhc/mzu055] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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100
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Sep MSC, van Osch M, van Vliet LM, Smets EMA, Bensing JM. The power of clinicians' affective communication: how reassurance about non-abandonment can reduce patients' physiological arousal and increase information recall in bad news consultations. An experimental study using analogue patients. PATIENT EDUCATION AND COUNSELING 2014; 95:45-52. [PMID: 24485947 DOI: 10.1016/j.pec.2013.12.022] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/29/2013] [Accepted: 12/29/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The diagnosis of incurable cancer may evoke physiological arousal in patients. Physiological arousal can negatively impact patients' recall of information provided in the medical consultation. We aim to investigate whether clinicians' affective communication during a bad news consultation will decrease patients' physiological arousal and will improve recall. METHODS Healthy women (N=50), acting as analogue patients, were randomly assigned to watch one out of the two versions of a scripted video-vignette of a bad news consultation in which clinician's communication differed: standard vs. affective communication. Participants' skin conductance levels were obtained during video-watching, and afterwards their recall was assessed. RESULTS While the diagnosis increased skin conductance levels in all analogue patients, skin conductance levels during the remainder of the consultation decreased more in the affective communication condition than in the standard condition. Analogue patients' recall was significantly higher in the affective condition. CONCLUSION Breaking bad news evokes physiological arousal. Affective communication can decrease this evoked physiological arousal and might be partly responsible for analogue patients' enhanced information recall. PRACTICE IMPLICATIONS Although our findings need to be translated to clinical patients, they suggest that clinicians need to deal with patients' emotions before providing additional medical information.
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Affiliation(s)
- Milou S C Sep
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Mara van Osch
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Liesbeth M van Vliet
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Jozien M Bensing
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
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