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Translation and psychometric evaluation of the German version of the IcanSDM measure - a cross-sectional study among healthcare professionals. BMC Health Serv Res 2021; 21:541. [PMID: 34078373 PMCID: PMC8171052 DOI: 10.1186/s12913-021-06430-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Shared decision-making (SDM) between patients and healthcare professionals (HCPs) is a key component of patient-centred care. To implement SDM in clinical practice and to evaluate its effects, it is helpful to know about HCPs’ perception of SDM barriers. The measure IcanSDM was developed in Canada and assesses the perception of SDM barriers. To our knowledge, no equivalent measure exists in German. Therefore, the aim of this study was to translate and adapt the IcanSDM measure to be used by a German speaking population and evaluate its psychometric properties. Methods This is a cross-sectional psychometric study based on a secondary analysis of baseline data from a SDM implementation study. The original 8-item IcanSDM was translated into German using a team translation protocol. We assessed comprehensibility via cognitive interviews with n = 11 HCPs. Based on results of cognitive interviews, the translated IcanSDM version was revised. Two hundred forty-two HCPs filled out the measure. Psychometric analysis included acceptance (completion rate), item characteristics (response distribution, skewness, item difficulties, corrected item-total correlations, inter-item correlations), factorial structure (confirmatory factor analysis (CFA), model fit), and internal consistency (Cronbach’s α). Results We translated and adapted the German IcanSDM successfully except for item 8, which had to be revised after the cognitive interviews. Completion rate was 98%. Skewness of the items ranged between −.797 and 1.25, item difficulties ranged between 21.63 and 70.85, corrected item-total-correlations ranged between .200 and .475, inter-item correlations ranged between .005 and .412. Different models based on CFA results did not provide a valid factorial structure. Cronbach’s α ranged between .563 and .651 for different factor models. Conclusion We provide the first German measure for assessing perception of SDM barriers by HCPs. The German IcanSDM is a brief measure with good acceptance. However, we found unsatisfying psychometric properties, which were comparable to results of the original scale. In a next step, the IcanSDM should be further developed and modified and predictive validity should be evaluated. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06430-3.
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O'Donnell D, Slater P, McCance T, McCormack B, McIlfatrick S. The development and validation of the Person-centred Practice Inventory-Student instrument: A modified Delphi study. NURSE EDUCATION TODAY 2021; 100:104826. [PMID: 33662673 DOI: 10.1016/j.nedt.2021.104826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Global health care policy and regulatory requirements indicate that nursing students must be prepared for person-centred practice. Despite this, there is no evidence of a theoretically derived instrument to measure students' perceptions of person-centred practice. OBJECTIVES To adapt the Person-centred Practice Inventory-Staff instrument for use with healthcare students and to test the adapted instrument. DESIGN This study involved a two-phased, modified Delphi Technique. In Phase 1 students' views about items in the Person-centred Practice Inventory-Staff were explored to gain consensus about items for inclusion in an adapted student version. In Phase 2, the psychometric properties of the adapted instrument were tested. SETTING A UK university. PARTICIPANTS Pre-registration nursing students. METHODS Phase 1 involved an iterative process including three focus groups (n = 13) followed by Delphi surveys (Round 1: n = 382; Round 2: n = 144). Thematic analysis was used to analyse students' comments and consensus percentages were calculated after each Delphi round. Phase 2 involved a survey using the adapted instrument (n = 532). The measurement model was analysed using confirmatory factor analysis. RESULTS The results indicated stability in the measurement model with this sample. Item correlation scores were between 0.22 and 0.74 with no evidence of collinearity and factor loadings ranged from 0.44-0.86. Fit indices indicated goodness of fit between the observed data and the respective domains in the Person-centred Practice Framework (chi-squared to degrees of freedom ratio of <3, root mean square estimations of approximation 0.06 for all domains and between 0.05 and 0.07 at 90% confidence interval. Comparative fit index estimates ranged from 0.90-0.97). CONCLUSION This study provides initial validation of the Person-centred Practice Inventory-Student instrument which is offered as a measure of students' perceptions of their person-centred practice. The instrument has utility in assessing the efficacy of curricula in preparing students as person-centred practitioners.
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Affiliation(s)
- Deirdre O'Donnell
- Faculty of Life and Health Sciences, School of Nursing, Ulster University, Northern Ireland BT48 7JL, UK.
| | - Paul Slater
- Faculty of Life and Health Sciences, School of Nursing, Ulster University, Northern Ireland BT48 7JL, UK
| | - Tanya McCance
- Faculty of Life and Health Sciences, School of Nursing, Ulster University, Northern Ireland BT48 7JL, UK
| | - Brendan McCormack
- School of Health Sciences, Division of Nursing, Queen Margaret University, Musselburgh, East Lothian EH21 6UU, UK
| | - Sonja McIlfatrick
- Faculty of Life and Health Sciences, School of Nursing, Ulster University, Northern Ireland BT48 7JL, UK
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Zeng CH, Lu J, Zhu HD, Teng GJ. Benchmark Status of Women Interventional Radiologists in China. J Vasc Interv Radiol 2021; 32:974-982. [PMID: 33862196 DOI: 10.1016/j.jvir.2021.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the current status of women interventional radiologists in China and discuss possible measures to boost their representation in this male-dominated field for a more diverse workplace environment in the future. MATERIALS AND METHODS The list of Chinese interventional radiologists obtained from the Chinese College of Interventionalists was retrospectively reviewed. Key information was extracted from the database, including sex, chronologic trends of representation of women interventional radiologists, position, education level, geographic distribution, interventional radiology (IR) practice time, departmental affiliation, and hospital classification. RESULTS Of the 13,855 entries, 7,324 (52.9%) were interventional radiologists having valid information. Among them, 684 (9.3%) were identified as women. The number of women interventional radiologists has continued to increase since the first woman registered in 1992. The average age of women interventional radiologists was 39.1 years ± 5.7 (range, 26-50). The majority of them were attending physicians (n = 280; 40.9%) with a bachelor's degree (n = 363; 53.1%). Most women interventional radiologists (n = 215, 31.4%) joined this specialty 5-9 years after becoming physicians, whereas 128 (18.7%) started practicing IR from the very beginning. A total of 42.4% of women interventional radiologists were from the departments of IR and cardiology. CONCLUSIONS Although the total number shows an upward trend, women interventional radiologists are still underrepresented. Education level, geographic areas, and other socioeconomic factors may simultaneously influence the population size of women interventional radiologists in China.
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Affiliation(s)
- Chu-Hui Zeng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jian Lu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hai-Dong Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
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Cantaert GR, Van Hecke A, Smolderen K. Perceptions of physicians, medical and nursing students concerning shared decision-making: a cross-sectional study. Acta Clin Belg 2021; 76:1-9. [PMID: 31272338 DOI: 10.1080/17843286.2019.1637487] [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: 10/26/2022]
Abstract
Objective: The purpose of this study was to evaluate the attitudes of Flemish physicians and medical/nursing trainees regarding shared decision-making (SDM) and to determine possible differences based on sex, age, rank, occupation and specialty. Methods: A cross-sectional study was conducted between June and September 2017 in which the Patient-Practitioner Orientation Scale (PPOS) was translated and administered. Higher scores on the six-point scale indicate a patient-centered respondent. Independent t-tests, One and Two-way ANOVA and multivariate regression analysis with the variables sex, age, occupation and specialty were performed. Results: 266 responses from 93 physicians, 147 medical and 26 nursing students were analyzed. Mean sharing scores were 4,24 ± 0,64; 4,30 ± 0,61; and 4,30 ± 0,67, respectively. In the regression model, female sex (p < 0,10) and employment (p < 0,05) in general practice or internal medicine is predictive for higher sharing among physicians. Bivariate analysis revealed significant differences between specialisms (p < 0,05): pediatricians (4,79 ± 0,69), psychiatrists (4,74 ± 0,47), obstetricians/gynecologists (4,40 ± 0,38) and general practitioners (4,31 ± 0,59) scored higher on the PPOS than surgeons (3,84 ± 0,58). Conclusion: Flemish providers and trainees are disease-centered. Physicians' attitudes vary depending on their specialism, presumably due to prolonged exposure to the specific clinical context. Additionally, academic-trained nurses share the belief that the physician should decide and the patient should rely on his knowledge rather than his own. There is an urgent need for health policy and educational institutions to facilitate an environment in which SDM is supported.
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Affiliation(s)
- Gabriël Rafaël Cantaert
- Department of Public Health and primary care, University Centre for Nursing & Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and primary care, University Centre for Nursing & Midwifery, Ghent University, Ghent, Belgium
- Staff director of Nursing, Nursing Departement, Ghent University Hospital, Ghent, Belgium
| | - Kim Smolderen
- Department of Biomedical & Health Informatics, University of Missouri-Kansas City, Missouri-Kansas, KS, USA
- Saint Luke's Mid America Heart Institute, Missouri-Kansas, KS, USA
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Gender Disparity and Potential Strategies for Improvement in Neurology and Clinical Neurophysiology. J Clin Neurophysiol 2020; 37:446-454. [PMID: 32756266 DOI: 10.1097/wnp.0000000000000712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Discrimination in the workplace when documented is illegal but is seen to still exist in some forms whether based on culture, race, or gender. Each of these disparities warrants further discussion and study because of their significant impacts on hiring decisions, career advancement, and compensation. In this article, the authors have focused their attention on gender disparity in the fields of neurology and clinical neurophysiology and shared the data currently available to them. At a time when the field of clinical neurophysiology has seen enormous growth, gender disparity in leadership and compensation remain. Despite the increasing number of women entering the fields of neurology and clinical neurophysiology, women remain underrepresented in national leadership positions. Many women physicians report experiencing gender discrimination despite increasing efforts by universities and medical centers to improve inclusivity and diversity. Equity and inclusivity are not the same and there is a disconnect between the increased numbers of women and their shared experiences in the workplace. Implicit bias undermines the ability of women to advance in their careers. For neurologists, data indicate that the latest gender pay gap is $56,000 (24%), increased from $37,000 in 2015, and is one of the largest pay gaps in any medical specialty. One third of the top 12 medical schools in the United States require that maternity leave be taken through disability coverage and/or sick benefits, and most family leave policies constrain benefits to the discretion of departmental leadership. The authors recommend strategies to improve gender disparity include institutional training to Identify and overcome biases, changes to professional organizations and national scientific meeting structure, transparency in academic hiring, promotion and compensation, and mentorship and sponsorship programs.
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Lamb CC, Wang Y. PHYSICIAN CHARACTERISTICS THAT INFLUENCE PATIENT PARTICIPATION IN THE TREATMENT OF PRIMARY IMMUNODEFICIENCY. PATIENT EDUCATION AND COUNSELING 2020; 103:2280-2289. [PMID: 32475713 DOI: 10.1016/j.pec.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is recommended to improve healthcare quality. Physicians who use a rational decision-making style and patient-centric approach are more likely to incorporate SDM into clinical practice. This paper explores how certain physician characteristics such as gender, age, race, experience, and specialty explain patient participation. METHODS A multi-group structural equation model tested the relationship between physician decision-making styles, patient-centered care, physician characteristics, and patient participation in clinical treatment decisions. A survey was completed by 330 physicians who treat primary immunodeficiency. Sample group responses were compared between groups across specialty, age, race, experience, or gender. RESULTS A patient-centric approach was the main factor that encouraged SDM independent of physician decision-making style with both treatment protocols and product choices. The positive effect of patient-centrism is stronger for immunologists, more experienced physicians, or male physicians. A rational decision-making style increases participation for non-immunologists, older physicians, white physicians, less-experienced physicians and female physicians. CONCLUSION A patient-centric approach, rational decision-making and certain physician characteristics help explain patient participation in clinical decisions. Practice Implications Future SDM research and policy initiatives should focus on physician adoption of patient-centric approaches to chronic care diseases and the potential bias associated with physician characteristics and decision-making style.
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Affiliation(s)
- Christopher C Lamb
- BioSolutions Services, Englewood Cliffs, New Jersey, United States; Department of Management and Entrepreneurship, Silberman College of Business, Fairleigh Dickinson University, Teaneck, New Jersey, United States; Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Yunmei Wang
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart &Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio 44106, USA
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Kesselheim J, Baker JN, Kersun L, Lee-Miller C, Moerdler S, Snaman JM, Warwick A, Weng S, Zhang Z. Humanism and professionalism training for pediatric hematology-oncology fellows: Results of a multicenter randomized trial. Pediatr Blood Cancer 2020; 67:e28308. [PMID: 32729211 DOI: 10.1002/pbc.28308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Although humanism and professionalism are central tenets to the practice of medicine, few formal curricula exist for medical trainees. Following a national needs assessment among pediatric hematology-oncology (PHO) fellows, we created a novel curriculum entitled "Humanism and Professionalism for Pediatric Hematology-Oncology" (HP-PHO). In this study, we measure outcomes of this curricular intervention. METHOD We cluster-randomized 20 PHO fellowship programs to deliver usual training in humanism and professionalism (UT) or the novel curriculum (intervention) during the 2016-2017 academic year. The primary outcome measure was the Pediatric Hematology-Oncology Self-Assessment in Humanism (PHOSAH). Secondary measures included the Maslach Burnout Inventory, Patient-Provider Orientation Scale, Empowerment at Work Scale, and a 5-point satisfaction scale. Participating fellows completed pre- and posttests at the beginning and end of the academic year, respectively, and we calculated change scores for each study instrument. RESULTS Cluster randomization yielded 59 intervention and 41 UT fellows. The nine intervention sites administered 33 of 36 modules. Change scores on the PHOSAH were not significantly different between the UT and intervention arms. However, fellows on the intervention arm gave significantly higher ratings on several items within the satisfaction scale related to physician burnout, physician depression, balancing professional duties and personal life, and humanism overall. CONCLUSIONS Exposure to the HP-PHO curriculum did not alter fellows' self-assessed humanism and professionalism skills. However, intervention fellows expressed significantly higher levels of satisfaction in their humanism training, indicating the curriculum's potential for positive impact on the fellows' perceived learning environment.
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Affiliation(s)
- Jennifer Kesselheim
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Justin N Baker
- Department of Oncology, Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie Kersun
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cathy Lee-Miller
- Department of Oncology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Scott Moerdler
- Department of Pediatrics, The Children's Hospital at Montefiore, New York City, New York
| | - Jennifer M Snaman
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Ann Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shicheng Weng
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Zilu Zhang
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
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Moerdler S, Li Y, Weng S, Kesselheim J. Burnout in pediatric hematology oncology fellows: Results of a cross-sectional survey. Pediatr Blood Cancer 2020; 67:e28274. [PMID: 32277803 DOI: 10.1002/pbc.28274] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/07/2022]
Abstract
Burnout is a significant problem in the medical community, including among pediatric hematology/oncology (PHO) faculty. However, the prevalence of burnout, its associated risk factors, and outcomes within PHO fellows are unknown. We present the results of a cross-sectional study of PHO fellows from 21 training programs. A total of 45/115 fellows (39.1%) met criteria for high level of burnout. Fellows who met criteria for high burnout also demonstrated poor outcomes including decreased empowerment, increased doctor-centered care, decreased self-assessed humanism, and decreased satisfaction with training. Further longitudinal investigation is needed to better understand burnout and the causative factors affecting PHO fellows.
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Affiliation(s)
- Scott Moerdler
- Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Yunhui Li
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Jennifer Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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Chekijian S, Kinsman J, Taylor RA, Ravi S, Parwani V, Ulrich A, Venkatesh A, Agrawal P. Association between patient-physician gender concordance and patient experience scores. Is there gender bias? Am J Emerg Med 2020; 45:476-482. [PMID: 33069544 DOI: 10.1016/j.ajem.2020.09.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patient satisfaction, a commonly measured indicator of quality of care and patient experience, is often used in physician performance reviews and promotion decisions. Patient satisfaction surveys may introduce gender-related bias. OBJECTIVE Examine the effect of patient and physician gender concordance on patient satisfaction with emergency care. METHODS We performed a cross-sectional analysis of electronic health record and Press Ganey patient satisfaction survey data of adult patients discharged from the emergency department (2015-2018). Logistic regression models were used to examine relationships between physician gender, patient gender, and physician-patient gender dyads. Binary outcomes included: perfect care provider score and perfect overall assessment score. RESULTS Female patients returned surveys more often (n=7 612; 61.55%) and accounted for more visits (n=232 024; 55.26%). Female patients had lower odds of perfect scores for provider score and overall assessment score (OR: 0.852, 95% CI: 0.790, 0.918; OR: 0.782, 95% CI: 0.723, 0.846). Female physicians had 1.102 (95% CI: 1.001, 1.213) times the odds of receiving a perfect provider score. Physician gender did not influence male patients' odds of reporting a perfect care provider score (95% CI: 0.916, 1.158) whereas female patients treated by female physicians had 1.146 times the odds (95% CI: 1.019, 1.289) of a perfect provider score. CONCLUSION Female patients prefer female emergency physicians but were less satisfied with their physician and emergency department visit overall. Over-representation of female patients on patient satisfaction surveys introduces bias. Patient satisfaction surveys should be deemphasized from physician compensation and promotion decisions.
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Affiliation(s)
- Sharon Chekijian
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Jeremiah Kinsman
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shashank Ravi
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Stanford University School of Medicine, USA
| | - Vivek Parwani
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Arjun Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Wang D, Liu C, Zhang X. Do Physicians' Attitudes towards Patient-Centered Communication Promote Physicians' Intention and Behavior of Involving Patients in Medical Decisions? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176393. [PMID: 32887364 PMCID: PMC7503802 DOI: 10.3390/ijerph17176393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/21/2020] [Accepted: 08/29/2020] [Indexed: 12/30/2022]
Abstract
Promoting patient-centered communication among physicians is one core strategy for improving physician–patient relationships and patient outcomes. Our study aims to understand the physicians’ attitudes towards patient-centered communication and its effects on physicians’ intention and behavior of involving patients in medical decisions in primary care in China. One cross-sectional study was conducted in primary facilities in Hubei province, China, from December 2019 to January 2020, where physicians’ attitudes towards patient-centered communication were measured by the Chinese-revised patient–practitioner orientation scale. Multilevel ordinal logistic regression was conducted for estimating the effects of physicians’ attitudes on their intention and behavior of patient involvement in medical decisions. Six hundred and seventeen physicians were investigated for the main study. Physicians had a medium score of patient-centered communication (3.78, SD = 0.56), with relatively high caring subscale score (4.59, SD = 0.64), and low sharing subscale score (3.09, SD = 0.75). After controlling physicians’ covariates, physicians’ attitudes towards patient-centered communication was significantly associated with a higher intention of involving patients in medical decisions (OR > 1, p = 0.020). Physicians’ positive attitudes towards patient-centered communication affected their intention of involving patients in medical decisions, which implies the importance of taking the physicians’ attitudes into account for the accomplishment of patient involvement processes.
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Shah RF, Mertz K, Gil JA, Eppler SL, Amanatullah D, Yao J, Chou L, Steffner R, Safran M, Hu SS, Kamal RN. The Importance of Concordance Between Patients and Their Subspecialists. Orthopedics 2020; 43:315-319. [PMID: 32931591 DOI: 10.3928/01477447-20200818-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/12/2019] [Indexed: 02/03/2023]
Abstract
Concordance, the concept of patients having shared demographic/socioeconomic characteristics with their physicians, has been associated with improved patient satisfaction and outcomes in primary care but has not been studied in subspecialty care. The objective of this study was to investigate whether patients value concordance with their specialty physicians. The authors assessed the importance of concordance in subspecialist care in 2 cohorts of participants. The first cohort consisted of patients seeking care at a multispecialty orthopedic clinic. The second cohort consisted of volunteer participants recruited from an online platform. Each participant completed a survey scored on an ordinal scale which characteristics of their physicians they find important for their primary care physician (PCP) and a specialist. The characteristics included age, sex, ethnicity, sexual orientation, primary language spoken, and religion. The difference in concordance scores for PCPs and specialists were compared with paired t tests with a Bonferroni correction. A total of 118 patients were recruited in clinic, and a total of 982 volunteers were recruited online. In the clinic cohort, the level of importance for patient-physician concordance of age, ethnicity, language, and religion was not significantly different between PCPs and specialists. In the volunteer cohort, the level of importance for concordance of age, sex, national origin, language, and religion was not significantly different between PCPs and specialists. The volunteers recruited online had significantly higher concordance scores than the patients recruited in clinic for most variables. Patients find patient-physician concordance as important in specialty care as they do in primary care. This may have similar effects on patient outcomes in specialty care. [Orthopedics. 2020;43(5):315-319.].
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Howren MB, Vander Weg MW, Christensen AJ, Kaboli PJ. Association of patient preferences on medication discussion in hypertension: Results from a randomized clinical trial. Soc Sci Med 2020; 262:113244. [PMID: 32750626 DOI: 10.1016/j.socscimed.2020.113244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/26/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022]
Abstract
Patient-centered care has received significant attention and is an integral component of high-quality healthcare. While it is often assumed that most prefer a patient-centered role orientation, such preferences exist along a continuum with some patients preferring a more provider-centered role. The present study examines patient preference data from a randomized clinical trial designed to test the efficacy of a patient activation intervention to promote thiazide prescribing for veteran patients with uncontrolled hypertension. Patient preferences for involvement in healthcare were assessed using the 9-item Sharing subscale of the Patient-Practitioner Orientation Scale (PPOS). The primary aim was to examine differences in discussion of thiazide use in the clinical encounter by those scoring high versus low on the PPOS. Five hundred ninety-five veteran patients were randomized to either one of three intervention groups or a usual care control group. The adjusted odds ratios (OR) for the three intervention groups relative to the control group indicated that thiazide discussion increased as a function of intervention intensity across both high and low PPOS groups. ORs for the most intensive intervention group were 3.72 (95% CI = 1.61-8.65, p < .01) for high PPOS patients and 6.71 (95% CI = 2.59-10.67, p < .001) for low PPOS patients. Results suggest that this patient activation intervention is effective for veteran patients representing a range of preferred involvement. Consideration of such preferences may be useful in tailoring future interventions in the healthcare context.
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Affiliation(s)
- M Bryant Howren
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, USA; Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA.
| | - Mark W Vander Weg
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, USA; Division of General Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, IA, USA; Department of Psychological & Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | | | - Peter J Kaboli
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, USA; Division of General Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, IA, USA
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The RICH LIFE Project: A cluster randomized pragmatic trial comparing the effectiveness of health system only vs. health system Plus a collaborative/stepped care intervention to reduce hypertension disparities. Am Heart J 2020; 226:94-113. [PMID: 32526534 DOI: 10.1016/j.ahj.2020.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/04/2020] [Indexed: 01/08/2023]
Abstract
Disparities in the control of hypertension and other cardiovascular disease risk factors are well-documented in the United States, even among patients seen regularly in the healthcare system. Few existing approaches explicitly address disparities in hypertension care and control. This paper describes the RICH LIFE Project (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) design. METHODS RICH LIFE is a two-arm, cluster-randomized trial, comparing the effectiveness of enhanced standard of care, "Standard of Care Plus" (SCP), to a multi-level intervention, "Collaborative Care/Stepped Care" (CC/SC), for improving blood pressure (BP) control and patient activation and reducing disparities in BP control among 1890 adults with uncontrolled hypertension and at least one other cardiovascular disease risk factor treated at 30 primary care practices in Maryland and Pennsylvania. Fifteen practices randomized to the SCP arm receive standardized BP measurement training; race/ethnicity-specific audit and feedback of BP control rates; and quarterly webinars in management practices, quality improvement and disparities reduction. Fifteen practices in the CC/SC arm receive the SCP interventions plus implementation of the collaborative care model with stepped-care components (community health worker referrals and virtual specialist-panel consults). The primary clinical outcome is BP control (<140/90 mm Hg) at 12 months. The primary patient-reported outcome is change from baseline in self-reported patient activation at 12 months. DISCUSSION This study will provide knowledge about the feasibility of leveraging existing resources in routine primary care and potential benefits of adding supportive community-facing roles to improve hypertension care and reduce disparities. TRIAL REGISTRATION Clinicaltrials.govNCT02674464.
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Harris M, Camenzind AL, Fankhauser R, Streit S, Hari R. Does a home-based interview with a chronically ill patient help medical students become more patient-centred? A randomised controlled trial. BMC MEDICAL EDUCATION 2020; 20:217. [PMID: 32652987 PMCID: PMC7353797 DOI: 10.1186/s12909-020-02136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/02/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND While patient-centred care improves patient outcomes, studies have shown that medical students become less patient-centred with time, so it is crucial to devise interventions that prevent this. We sought to determine whether first-year medical students who had a structured home-based interview with a chronically ill patient became more patient-centred than those who had a sham intervention. METHODS This randomised controlled trial assigned first-year students from the University of Bern, Switzerland, to either an interview with a chronically ill patient at the patient's home or to a sham comparator. We used the PPOS-D12 questionnaire to measure students' levels of patient-centredness at baseline, and changes in these levels during their longitudinal primary care clerkship. RESULTS A total of 317 students participated. Patient-centred attitudes increased during the study. A home-based interview with a chronically ill patient had no additional effect. Being female and having been exposed to patients before medical school were associated with being more patient-centred at baseline. Students were less patient-centred than their General Practitioner teachers. CONCLUSIONS A structured, home-based interview with a chronically ill patient did not change students' patient-centred attitudes, so cannot be recommended as a way to influence those attitudes. However, patient-centred attitudes increased during the students' first year of study, possibly because of their longitudinal primary care clerkship. TRIAL REGISTRATION Clinicaltrials.gov reference: NCT03722810 , registered 29th October 2018.
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Affiliation(s)
- Michael Harris
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- College of Medicine & Health, University of Exeter, Exeter, UK
- Gore Cottage, Emborough, Radstock, BA3 4SJ UK
| | - Anna-Lea Camenzind
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Rita Fankhauser
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Roman Hari
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Lordon RJ, Mikles SP, Kneale L, Evans HL, Munson SA, Backonja U, Lober WB. How patient-generated health data and patient-reported outcomes affect patient-clinician relationships: A systematic review. Health Informatics J 2020; 26:2689-2706. [PMID: 32567460 PMCID: PMC8986320 DOI: 10.1177/1460458220928184] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Many patients use mobile devices to track health conditions by recording patient-generated health data. However, patients and clinicians may disagree how to use these data. Objective: To systematically review the literature to identify how patient-generated health data and patient-reported outcomes collected outside of clinical settings can affect patient–clinician relationships within surgery and primary care. Methods: Six research databases were queried for publications documenting the effect of patient-generated health data or patient-reported outcomes on patient–clinician relationships. We conducted thematic synthesis of the results of the included publications. Results: Thirteen of the 3204 identified publications were included for synthesis. Three main themes were identified: patient-generated health data supported patient–clinician communication and health awareness, patients desired for their clinicians to be involved with their patient-generated health data, which clinicians had difficulty accommodating, and patient-generated health data platform features may support or hinder patient–clinician collaboration. Conclusion: Patient-generated health data and patient-reported outcomes may improve patient health awareness and communication with clinicians but may negatively affect patient–clinician relationships.
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Affiliation(s)
| | | | - Laura Kneale
- University of Washington School of Medicine, USA; University of Washington-Bothell, USA
| | | | - Sean A Munson
- University of Washington College of Engineering, USA
| | - Uba Backonja
- University of Washington School of Medicine, USA; University of Washington-Tacoma, USA
| | - William B Lober
- University of Washington School of Medicine, USA; University of Washington, USA
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Abstract
ABSTRACTObjectivesAudit and feedback is widely used to improve physician performance. Many data metrics are being provided to physicians, yet most of these are driven by the regulatory environment. We sought to conduct a needs assessment of audit and feedback metrics that were most useful to clinicians within our health care region.MethodsWe conducted a Web-based survey of five clinical practice sites in our region and asked that physicians rank 49 clinical practice metrics. In addition, we assessed their readiness for audit and feedback and their preferences for data confidentiality. We collected data on duration of training, gender, and site of practice (academic v. community) allowing for comparison between groups.ResultsA total of 104 emergency medicine physicians participated in the survey (52.3% response rate). There was a significant readiness for participation in audit and feedback activities. Top ranked metrics were emergency department return rates and colleague's assessment of collegiality and quality of care, which were common across all sites. Small yet significant differences were noted between genders and academic v. community practitioners.ConclusionThis study represents the first regional analysis of physician preferences for audit and feedback activities and implementation. It demonstrates that physicians are interested in audit and feedback activities and provides a roadmap for the development of a regional audit and feedback structure. It will also be used as a guiding document for regional change management.
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Nguyen TN, Ngangue PA, Ryan BL, Stewart M, Brown JB, Bouhali T, Fortin M. The revised Patient Perception of Patient‐Centeredness Questionnaire: Exploring the factor structure in French‐speaking patients with multimorbidity. Health Expect 2020; 23:904-909. [PMID: 32338814 PMCID: PMC7495072 DOI: 10.1111/hex.13068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/13/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Tu Ngoc Nguyen
- Department of Family Medicine and Emergency Medicine Faculty of Medicine and Health Sciences Université de Sherbrooke Sherbrooke QC Canada
| | - Patrice Alain Ngangue
- Department of Family Medicine and Emergency Medicine Faculty of Medicine and Health Sciences Université de Sherbrooke Sherbrooke QC Canada
| | - Bridget L. Ryan
- Centre for Studies in Family Medicine Department of Family Medicine Schulich School of Medicine & Dentistry Western University London ON Canada
- Department of Epidemiology and Biostatistics Schulich School of Medicine & Dentistry Western University London ON Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine Department of Family Medicine Schulich School of Medicine & Dentistry Western University London ON Canada
- Department of Epidemiology and Biostatistics Schulich School of Medicine & Dentistry Western University London ON Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine Department of Family Medicine Schulich School of Medicine & Dentistry Western University London ON Canada
| | - Tarek Bouhali
- Department of Family Medicine and Emergency Medicine Faculty of Medicine and Health Sciences Université de Sherbrooke Sherbrooke QC Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine Faculty of Medicine and Health Sciences Université de Sherbrooke Sherbrooke QC Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac St-Jean QC Canada
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Women in interventional radiology: insights into Australia's gender gap. Clin Radiol 2020; 75:560.e1-560.e7. [PMID: 32331782 DOI: 10.1016/j.crad.2020.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/18/2020] [Indexed: 11/22/2022]
Abstract
AIM To assess differences in the exposure, teaching, knowledge, appreciation, and interest in interventional radiology (IR) between male and female doctors prior to specialisation and to identify potential predisposing factors to the gender inequality in interventional radiology. MATERIALS AND METHODS A prospective cross-sectional multicentre study was conducted using in-person and web-based distribution of a voluntary, anonymous questionnaire to junior doctors yet to commence specialisation at 11 health services across two Australian states. RESULTS Complete responses were provided by 333 junior doctors (21.9% response rate). Women were significantly less likely than men to consider a career in IR (13.1% versus 29.7%, p < 0.001). No other statistically significant gender disparities were identified, as both men and women reported low levels of prior teaching and exposure to IR, strong belief in the importance of IR, and suboptimal knowledge of IR. CONCLUSIONS The gender gap amongst practising Australian interventional radiologists is perpetuated by a consistent gender gap in upcoming junior doctors' desire to pursue IR. This disparity exists despite junior doctors receiving the same exposure and opportunities in interventional radiology, possibly suggesting that preconceived stereotypes or psychosocial factors deter females from pursuing this procedural, male-dominated subspecialty. Future qualitative studies are required to confirm this hypothesis, in conjunction with prospective, experimental trials to determine whether changes in education, mentorship, and advocacy can promote gender equality.
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Brickley B, Sladdin I, Williams LT, Morgan M, Ross A, Trigger K, Ball L. A new model of patient-centred care for general practitioners: results of an integrative review. Fam Pract 2020; 37:154-172. [PMID: 31670759 DOI: 10.1093/fampra/cmz063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND GPs providing patient-centred care (PCC) is embedded in international health care policies due to its positive impact on patients and potential to lower health care costs. However, what is currently known about GP-delivered PCC is unknown. OBJECTIVE To synthesize literature investigating GP-delivered PCC and address 'what is currently known about GP-delivered PCC?' METHOD A systematic literature search was conducted between June and July 2018. Eligible articles were empirical, full-text studies published in English between January 2003 and July 2018, related to at least three of the four dimensions of PCC described by Hudon et al. (2011), and related to preventative, acute, and/or chronic care by GPs. Following screening, full-text articles were independently assessed for inclusion by two investigators. Data were extracted and quality assessed by two researchers. Findings on PCC were analysed thematically (meta-synthesis). RESULTS Thirty medium- to high-quality studies met the inclusions criteria. Included studies utilized varied designs, with the most frequent being quantitative, cross-sectional. A theoretical model of PCC was synthesized from included studies and contained four major components: (i) understanding the whole person, (ii) finding common ground, (iii) experiencing time and (iv) aiming for positive outcomes. Harms of PCC were rarely reported. CONCLUSIONS Four overarching theoretical components of PCC relate to elements of the consultation and experience of time. These components can be used to inform the development of toolkits to support GPs and general practice organizations in pursuit of PCC as well as tools to measure patient-centredness.
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Affiliation(s)
- Bryce Brickley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ishtar Sladdin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Mark Morgan
- Bond University, Gold Coast, Queensland, Australia
| | - Alyson Ross
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Kellie Trigger
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Abstract
Hospital readmission rates are used as a metric to measure quality patient care. While several tools predict readmissions based on patient-specific characteristics, this study assesses if physician characteristics correlate with hospital readmission rates.In a 5-year retrospective electronic record review at a single institution, 31 internal medicine attending physicians' discharges were tracked for a total of 70 physician years, and 15,933 hospital discharges. Each physician's yearly 7-day, 8 to 30-day, and 30-day readmission rates were compared. Each rate was also correlated with years of post-graduate clinical experience, discharge volume, physician sex, and fiscal year.Individual physicians had significantly different 7-day, 8 to 30-day, and 30-day readmission rates from each other. The rates were not related to sex, years after post-graduate training, or fiscal year. However, physician patient volume correlated with 7-day readmission rates. Physicians who discharged ≤100 patients per year had a higher 7-day readmission rate than physicians who discharged >100 patients per year. This correlation with patient volume did not hold for the 8 to 30-day and 30-day readmission rates.Individual physicians differ in their patient readmission rates in 7-day, 8 to 30-day, and 30-day categories. A critical level of a physician's hospital activity, as reflected by the number of patient discharges per year (>100), results in lower 7-day readmission rates. Sex, post-graduate years of clinical experience, and fiscal year did not play a role. The lack of correlation between each physicians' 7-day and 8 to 30-day readmission rates suggests that different physician factors are involved in these 2 rates.
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Affiliation(s)
- Michael Skolka
- Department of Neurology, Mayo Clinic Hospital, Rochester, Minnesota
| | | | - Muhammad Khalid
- Department of Internal Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Eileen Hennrikus
- Department of Internal Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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Matsen CB, Ray D, Kaphingst KA, Zhang C, Presson AP, Finlayson SRG. Patient Satisfaction With Decision Making Does Not Correlate With Patient Centeredness of Surgeons. J Surg Res 2020; 246:411-418. [PMID: 31635834 DOI: 10.1016/j.jss.2019.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/09/2019] [Accepted: 09/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-quality decision making is important in patient-centered care. Although patient involvement in decision making varies widely, most patients desire to share in decision making. The Press-Ganey Patient Satisfaction survey includes questions that measure patients' perceptions of their providers' efforts to involve them in decision making (PGDM). We hypothesized that higher PGDM scores would correlate with higher scores on a validated measure of patient centeredness. MATERIALS AND METHODS Surgical providers at a university hospital who routinely receive Press-Ganey scores received a survey that included the Patient-Practitioner Orientation Scale (PPOS), a validated tool that measures the provider's orientation toward patient centeredness on a continuous six-point scale: score ≥5 = high, 4.57-5 = moderate, and <4.57 = low and includes nine-item "caring" or "sharing" subscales. We compared PPOS scores to PGDM scores, averaged from April 2015 to January 2016. RESULTS Eighty-six of 112 (75%) of surgical providers responded to the survey. Fifty-two (46%) had PGDM scores available and 26% achieved a perfect score on the PGDM. The overall PPOS scores were low, with a mean of 4.2 (SD = 0.5). The PPOS was not correlated with the PGDM, correlation coefficient (rs) = -0.07 (CI: -0.34-0.21, P = 0.63). Similarly, the two subscales of the PPOS did not correlate with the PGDM with rs = -0.15 (CI: -0.41-0.13, P = 0.29) for "caring" and rs = -0.04 (CI: -0.31-0.23, P = 0.76) for "sharing". CONCLUSIONS Although surgical providers scored low in patient centeredness using the PPOS, over one-quarter (26%) of them rank in the top 1% on the PGDM. No correlation was found between providers' patient centeredness and their patients' perceptions of efforts to include them in decision making.
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Affiliation(s)
- Cindy B Matsen
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | - David Ray
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah College of Humanities, Salt Lake City, Utah
| | - Chong Zhang
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Angela P Presson
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
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Fielding A, Mulquiney K, Canalese R, Tapley A, Holliday E, Ball J, Klein L, Magin P. A general practice workplace-based assessment instrument: Content and construct validity. MEDICAL TEACHER 2020; 42:204-212. [PMID: 31597048 DOI: 10.1080/0142159x.2019.1670336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Introduction: Relatively few general practice (GP) workplace-based assessment instruments have been psychometrically evaluated. This study aims to establish the content validity and internal consistency of the General Practice Registrar Competency Assessment Grid (GPR-CAG).Methods: The GPR-CAG was constructed as a formative assessment instrument for Australian GP registrars (trainees). GPR-CAG items were determined by an iterative literature review, expert opinion and pilot-testing process. Validation data were collected, between 2014 and 2016, during routine clinical teaching visits within registrars' first two general practice training terms (GPT1 and GPT2) for registrars across New South Wales and the Australian Capital Territory. Factor analysis and expert consensus were used to refine items and establish GPR-CAG's internal structure. GPT1 and GPT2 competencies were analysed separately.Results: Data of 555 registrars undertaking GPT1 and 537 registrars undertaking GPT2 were included in analyses. A four-factor, 16-item solution was identified for GPT1 competencies (Cronbach's alpha range: 0.71-0.83) and a seven-factor 27-item solution for GPT2 competencies (Cronbach's alpha: 0.63-0.84). The emergent factor structures were clinically characterisable and resonant with existing medical education competency frameworks.Discussion: This study establishes initial evidence for the content validity and internal consistency of GPR-CAG. GPR-CAG appears to have utility as a formative GP training WBA instrument.
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Affiliation(s)
- Alison Fielding
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Katie Mulquiney
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | | | - Amanda Tapley
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jean Ball
- Clinical Research Design IT and Statistical Support, Hunter Medical Research Institute, New Lambton, Australia
| | - Linda Klein
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Parker Magin
- GP Synergy NSW and ACT Research and Evaluation Unit, Mayfield West, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Takeuchi K, Noguchi Y, Nakai Y, Ojima T, Yamashita Y. Dentist gender-related differences in patients' oral health behaviour. J Oral Sci 2020; 62:32-35. [PMID: 31996520 DOI: 10.2334/josnusd.18-0462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This study aimed at determining whether oral health behavior differs between patients regularly checked by male and female dentists. The analysis was based on a cross-sectional survey of 354 Japanese community residents (median age = 54 years; 145 men and 209 women) conducted in a municipality from January to February 2017. Data on demographic characteristics and factors associated with oral health behavior were obtained through self-administered questionnaires. The association between regular dentist gender and patients' regular dental care check-up and interdental cleaning performance was examined after adjusting for potential confounders. Among respondents, 88.7% and 11.3% reported having male and female regular dentists, respectively. In a multivariate logistic regression model, patients regularly checked by female dentists had an increased likelihood of visiting their dentist for dental care check-up at least once every year (odds ratio [OR] = 2.23, 95% confidence interval [CI] = 1.09-4.55)and using an interdental cleaner (OR = 2.62, 95% CI = 1.03-6.71) compared to those regularly checked by male dentists. Patients regularly checked by female dentists tended to have more preventive oral health behaviors than those regularly checked by male dentists. These findings suggest that dentist gender has important clinical implications for patients' oral health behavior.
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Affiliation(s)
- Kenji Takeuchi
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University.,Department of Preventive Medicine, Nagoya University Graduate School of Medicine
| | - Yuki Noguchi
- Department of Dental Hygiene, University of Shizuoka Junior College
| | - Yukie Nakai
- Department of Dental Hygiene, University of Shizuoka Junior College
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine
| | - Yoshihisa Yamashita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University
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Perspectives of patients and physicians regarding hypertensive management from an online survey for excellence: a subanalysis of the PARADOX study by physician categories. Hypertens Res 2020; 43:431-441. [PMID: 31996814 PMCID: PMC8075984 DOI: 10.1038/s41440-019-0365-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/05/2019] [Accepted: 10/07/2019] [Indexed: 11/26/2022]
Abstract
An existing clinical problem in Japan is the high prevalence of uncontrolled hypertension despite the availability of various effective therapies. Here, we analyzed survey data to gain insight into this paradox from physicians’ perspectives, with results categorized according to specialty (i.e., with or without certification by the Japanese Society of Hypertension [JSH]), institution type, gender, and age. A web-based survey of typical educational activities for patients regarding hypertension management was conducted in Japan between October 19 and 31, 2017. Differences between physician groups were investigated per category. Survey results from 541 physicians were analyzed: 59 JSH certified (i.e., ‘specialist’) vs 482 non-JSH certified (i.e., ‘nonspecialist’) physicians; 192 general practitioners vs 349 hospital physicians; 500 males vs 41 females; and 178 younger (mean age: 40.7 years), 174 middle-aged (52.0 years) or 189 older (61.3 years) physicians. The most statistically significant differences between groups were observed in the category of physician specialty. Compared with nonspecialists, specialist physicians were more conscious of providing education on patient lifestyle modifications, more aware of patient- and physician-derived issues, and understood and followed the treatment guidelines. General practitioners cared more about the patient’s burden than did hospital physicians. Younger physicians identified the need to incorporate the patient’s perspective into their treatment. This analysis shows that the provision and perceptions of education differ between physician categories. Compared with specialist physicians, nonspecialists were less likely to provide adequate guidance on lifestyle modifications, possibly due to their uncertainty in understanding treatment guideline recommendations. Further education of nonspecialists on hypertension management may be warranted.
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Monzani D, Vergani L, Pizzoli SFM, Marton G, Mazzocco K, Bailo L, Messori C, Pancani L, Cattelan M, Pravettoni G. Sexism Interacts with Patient-Physician Gender Concordance in Influencing Patient Control Preferences: Findings from a Vignette Experimental Design. Appl Psychol Health Well Being 2020; 12:471-492. [PMID: 31985173 PMCID: PMC7384069 DOI: 10.1111/aphw.12193] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient preferences regarding their involvement in shared treatments decisions is fundamental in clinical practice. Previous evidences demonstrated a large heterogeneity in these preferences. However, only few studies have analysed the influence of patients' individual differences, contextual and situational qualities, and their complex interaction in explaining this variability. METHODS We assessed the role of the interaction of patient's sociodemographic and psychological factors with a physician's gender. Specifically, we focused on patient gender and attitudes toward male or female physicians. One hundred fifty-three people participated in this randomised controlled study and were randomly assigned to one of two experimental conditions in which they were asked to imagine discussing their treatment with a male and a female doctor. RESULTS Analyses showed an interplay between attitude towards women and the gender of patients and doctors, explaining interindividual variability in patient preferences. CONCLUSIONS In conclusion, patients' attitudes toward the physicians' gender constitutes a relevant characteristic that may influence the degree of control patients want to have and the overall patient-physician relationship.
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Affiliation(s)
- Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Messori
- Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Luca Pancani
- Department of Psychology, University of Milan - Bicocca, Milan, Italy
| | - Manuela Cattelan
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Italy
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Drivenes K, Haaland VØ, Mesel T, Tanum L. Practitioners' positive attitudes promote shared decision-making in mental health care. J Eval Clin Pract 2019; 25:1041-1049. [PMID: 31508872 DOI: 10.1111/jep.13275] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/05/2019] [Accepted: 08/21/2019] [Indexed: 11/27/2022]
Abstract
RATIONALE AND AIMS There is a growing expectation of implementing shared decision making (SDM) in today's health care service, including mental health care. Traditional understanding of SDM may be too narrow to capture the complexity of treatments of mental health problems. Although the patients' contribution to SDM is well described, the contribution from the health care practitioners is less explored. Therefore, our aim was to explore the attitudes of practitioners in mental health care and the associations between practitioners' attitudes and SDM. METHOD We performed a cross-sectional study where practitioners reported their sharing and caring attitudes on the Patient-Practitioner Orientation Scale (PPOS) and age, gender, profession, and clinical working site. The patients reported SDM using the CollaboRate tool. We used a mixed effect model linking the data from each practitioner to one or more patients. We presented the findings and used them as background for a more philosophic reflection. RESULTS We included 312 practitioners with mean age 46.1 years. Of the practitioners, 60 held a medical doctors degree, 97 were psychologists, and 127 held a college degree in nursing, social science, or pedagogy. Female practitioners reported higher sharing (4.79 vs 4.67 [range 1-6], P = .04) and caring scores (4.77 vs 4.65 [range 1-6], P = .02) than males. The regression model contained 206 practitioners and 772 patients. We found a higher probability for the patient to report high SDM score if the practitioner reported higher sharing scores, and lower probability if the practitioner worked in ambulatory care. CONCLUSIONS SDM in mental health care is complex and demands multifaceted preparations from practitioners as well as patients. The practitioners' attitudes are not sufficiently explored using one instrument. The positive association between practitioners' patient-centred attitudes and SDM found in this study implies a relevance of the practitioners' attitudes for accomplishment of SDM processes in mental health care.
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Affiliation(s)
- Karin Drivenes
- Division of Mental Health, Sørlandet Hospital HF, Norway.,South Eastern Norway Hospital Pharmacy Enterprise, Kristiansand, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vegard Øksendal Haaland
- Division of Mental Health, Sørlandet Hospital HF, Norway.,Department of Psychology, Clinical Neuroscience Research Group, University of Oslo, Oslo, Norway
| | - Terje Mesel
- Division of Mental Health, Sørlandet Hospital HF, Norway.,Department of Religion Philosophy and History, University of Agder, Kristiansand, Norway
| | - Lars Tanum
- Research and Development Department Mental Health, Akershus University Hospital, Lorenskog, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Mohamed KG, Hunskaar S, Abdelrahman SH, Malik EM. Impact on core values of family medicine from a 2-year Master's programme in Gezira, Sudan: observational study. BMC FAMILY PRACTICE 2019; 20:145. [PMID: 31660866 PMCID: PMC6816210 DOI: 10.1186/s12875-019-1037-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Training of family physicians should include not only clinical and procedural skills, but also core values as comprehensive care, continuity of care, leadership and patient-centeredness. The Gezira Family Medicine Project (GFMP) is a 2 years Master's programme in family medicine in Sudan. We assessed the impact of GFMP on the candidates' adherence to some core values of family medicine. METHODS This is a prospective study with before-after design based on repeated surveys. We used Patient-Practitioner Orientation Scale (PPOS) to assess physicians' attitude towards patient-centeredness. Practice based data from individual patients' consultations and self-assessment methods were used to assess physicians' adherence to core values. RESULTS At the end of the programme the candidates (N = 110) were significantly more active in community health promotion (p < 0.001), more confident as a team leader (p = 0.008), and showed increased adherence to national guidelines for managing diabetes (p = 0.017) and hypertension (p = 0.003). The responding candidates had more knowledge about patients' medical history (p < 0.001), family history (p < 0.001) and family situation (p < 0.001). There were more planned follow up consultations (p < 0.001) and more referrals (p = 0.040). In contrast, results from PPOS showed slightly less orientation towards patient-centeredness (p = 0.007). CONCLUSIONS The GFMP Master's programme induced a positive change in adherence to several core values of family medicine. The candidates became less patient-centered.
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Affiliation(s)
- Khalid Gaffer Mohamed
- Department of Family and Community Medicine, Faculty of Medicine Medina, University of Taibah, Medina, Saudi Arabia
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Family and Community Medicine, University of Gezira, Medani, Sudan
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | | | - Elfatih Mohamed Malik
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Liu W, Hao Y, Zhao X, Peng T, Song W, Xue Y, Tao S, Kang Z, Ning N, Gao L, Cui Y, Liang L, Wu Q. Gender differences on medical students' attitudes toward patient-centred care: a cross-sectional survey conducted in Heilongjiang, China. PeerJ 2019; 7:e7896. [PMID: 31660273 PMCID: PMC6815647 DOI: 10.7717/peerj.7896] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/16/2019] [Indexed: 12/30/2022] Open
Abstract
Objectives Assessing medical students' attitudes toward patient-centred care is essential to bettering medical education. Based on doctor-patient relationships and the medical system in China, it is important to explore the impact of gender differences and other background factors on patient-centred attitudes and to provide references for medical education reform. Methods A cross-sectional study was conducted on fourth-year medical undergraduate students from November 2017 to March 2018 in Heilongjiang Province, Northeast China. The Chinese-revised Patient-Practitioner Orientation Scale (CR-PPOS), which has been validated in previous research, was used to measure the medical students' attitudes. The medical students' demographic data was collected, including their gender, age, information on whether they have siblings, family residence location, doctor(s) for parents, year in which the student first experienced clinical practice, and student category. Results A total of 513 students (91.12%) completed the survey. The Chinese medical students scored considerably higher for 'Caring' (including patients' preferences into the decision-making process) than for 'Sharing' (sharing information/responsibility with patients). These students tended to have patient-centred attitudes, as measured by an average overall CR-PPOS score of 3.63 (scores higher than 3.5 indicate patient-centred attitudes), which is higher than Malian (3.38) and Pakistani (3.40) medical students but lower than American (4.57) and Brazilian (4.66) students. Female students (P < 0.05) were significantly associated with more patient-centred attitudes and with higher 'Sharing' and 'Caring' subscale scores. Student category (P < 0.05) was associated with 'Sharing' and 'Caring' scores. Clinical hospital students (P < 0.05) were associated with more patient-centred attitudes and with higher 'Sharing' and 'Caring' subscale scores, Students without siblings (p < 0.07) were associated with the higher 'Sharing' subscale scores. Conclusions In China, gender has a significant impact on medical students' patient-centred attitudes, which is similar to findings from other countries. If medical schools want to raise patient-centred attitudes across the board and bridge the gap between male and female patient-centred attitudes, gender, student category, and other factors should be incorporated into medical education.
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Affiliation(s)
- Wei Liu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Yanhua Hao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Xiaowen Zhao
- Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China
| | - Tao Peng
- Department of Sexual Health Education, School of Health Management, Harbin Medical University, Harbin, China
| | - Weijian Song
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China.,Department of Humanities and Social Sciences, Harbin Medical University, Daqing, China
| | - Yuxin Xue
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China.,Chengyang People's Hospital, Qingdao, China
| | - Siyi Tao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Zheng Kang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Ning Ning
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Lijun Gao
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Yu Cui
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Libo Liang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, China
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Yu B, Ghoneim A, Lawrence H, Glogauer M, Quiñonez C. Perceived professional roles and implications for clinical decision‐making. J Public Health Dent 2019; 80:43-50. [DOI: 10.1111/jphd.12346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/12/2019] [Accepted: 09/05/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Bonnie Yu
- Dental Public HealthUniversity of Toronto Faculty of Dentistry Toronto Ontario Canada
| | - Abdulrahman Ghoneim
- Dental Public HealthUniversity of Toronto Faculty of Dentistry Toronto Ontario Canada
| | - Herenia Lawrence
- Dental Public HealthUniversity of Toronto Faculty of Dentistry Toronto Ontario Canada
| | - Michael Glogauer
- PeriodonticsUniversity of Toronto Faculty of Dentistry Toronto Ontario Canada
| | - Carlos Quiñonez
- Dental Public HealthUniversity of Toronto Faculty of Dentistry Toronto Ontario Canada
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Hammerich K, Stuber K, Hogg-Johnson S, Abbas A, Harris M, Lauridsen HH, Lemeunier N, Maiers M, McCarthy P, Morales V, Myburgh C, Petrini V, Pohlman K, Mior S. Assessing attitudes of patient-centred care among students in international chiropractic educational programs: a cross-sectional survey. Chiropr Man Therap 2019; 27:46. [PMID: 31528334 PMCID: PMC6739992 DOI: 10.1186/s12998-019-0263-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/26/2019] [Indexed: 11/15/2022] Open
Abstract
Background Patient-centred care is internationally recognized as a foundation of quality patient care. Attitudes of students towards patient-centred care have been assessed in various health professions. However, little is known how chiropractic students’ attitudes towards patient-centred care compare to those of other health professions or whether they vary internationally, and between academic programs. Objective To assess the association of select variables on student attitude towards patient-centred care among select chiropractic programs worldwide. Methods We conducted a cross-sectional study using the Patient-Practitioner Orientation Scale (PPOS) to assess students’ patient-centred attitudes towards the doctor-patient relationship. Eighteen items were scored on a 1 to 6 Likert scale; higher scores indicating more patient-centredness. All students from seven chiropractic educational programs worldwide were invited to complete an online survey. Results were analyzed descriptively and inferentially for overall, sharing and caring subscales. General linear regression models were used to assess the association of various factors with PPOS scores. Results There were 1858 respondents (48.9% response rate). Student average age was 24.7 (range = 17–58) years and 56.2% were female. The average overall PPOS score was 4.18 (SD = 0.48) and average sharing and caring subscale scores were 3.89 (SD = 0.64) and 4.48 (SD = 0.52), respectively. There were small but significant differences in all PPOS scores by gender, age, and program. Year/semester of study within a program typically was not associated with scores, neither was history of previous chiropractic care nor having family members who are health professionals. Conclusion This is the first international study assessing students’ attitudes of patient-centred care in chiropractic educational programs. We found small but significantly different PPOS scores between chiropractic programs worldwide that did not change across year/semester of study. Scores tended to be lower than those reported among medical students. Observed differences may be related to curricular content, extent of patient exposure and/or regional cultural realities.
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Affiliation(s)
- Karin Hammerich
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Kent Stuber
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Sheilah Hogg-Johnson
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Anser Abbas
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | - Martin Harris
- 2Central Queensland University, Rockhampton, Australia
| | | | | | - Michele Maiers
- 5Northwestern Health Sciences University, Bloomington, USA
| | | | | | | | - Vanessa Petrini
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
| | | | - Silvano Mior
- 1Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
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81
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Rosewilliam S, Indramohan V, Breakwell R, Liew BXW, Skelton J. Patient-centred orientation of students from different healthcare disciplines, their understanding of the concept and factors influencing their development as patient-centred professionals: a mixed methods study. BMC MEDICAL EDUCATION 2019; 19:347. [PMID: 31510999 PMCID: PMC6737623 DOI: 10.1186/s12909-019-1787-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/03/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND A patient-centred approach to care is increasingly the mandate for healthcare delivery. There is a need to explore how health professional students develop patient-centred attributes. This study aims to understand the extent of patient-centred orientations of health professional students, their perceptions and factors influencing their adoption of the approach. METHODS The study used a cross-sectional, parallel mixed methods design combining a survey using the Patient-Practitioner Orientation Scale (PPOS) followed by focus groups with medical, nursing, physiotherapy and speech and language therapy students. Data included students' age, gender, programme, and placements experienced. Pearson's chi squared and the non-parametric equivalent Kruskal-Wallis H test were done to test for differences in demographics for appropriate variables. One-way ANOVA or Welch test was done to explore differences in PPOS scores. Regression analysis was done to test the influence of the demographic variables on PPOS scores. Data from focus groups were coded, categorised and organised under themes appropriate to the research aims. RESULTS Of the 211 complete responses, significant differences were observed between medical and physiotherapy students in total PPOS scores, (MD -8.11 [95% CI -12.02 - 4.20] p = 0.000), Caring component (MD -4.44 [95% CI - 6.69, - 2.19] p = 0.000) and Sharing component (MD -3.67 [95% CI -6.12 -1.22] p = 0.001). The programme in which students were enrolled i.e. Medicine and SALT were the only indicators of higher PPOS total scores (F = 4.6 Df 10,69; p = 7.396e-06) and caring scores (F = 2.164 Df 10, 69 p = 0.022). Focus groups revealed that students perceived patient-centredness as holistic yet individualised care through establishing a partnership with patient. They identified that their student status, placement pressures, placement characteristics especially mentoring influenced their development of patient-centred attributes. CONCLUSION This study highlights the fact that the pressures of training in the National Health Service affects the development of students' patient-centred orientation. There is a need for further work to explore aspects related to mentor training, for the development of patient-centred attributes, in a curricular framework structured on students' needs from this study.
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Affiliation(s)
- Sheeba Rosewilliam
- School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston B15 2TT, Birmingham, UK.
| | - Vivek Indramohan
- Department of Life Sciences, School of Health Sciences, Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | | | - Bernard Xian Wei Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK
| | - John Skelton
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Affiliation(s)
- Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Ryan BL, Brown JB, Tremblay PF, Stewart M. Measuring Patients' Perceptions of Health Care Encounters: Examining the Factor Structure of the Revised Patient Perception of Patient-Centeredness (PPPC-R) Questionnaire. J Patient Cent Res Rev 2019; 6:192-202. [PMID: 31414031 DOI: 10.17294/2330-0698.1696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Given the ongoing desire to make health care more patient-centered and growing evidence supporting the provision of patient-centered care, it is important to have valid tools for measuring patient-centered care. The patient-centered clinical method (PCCM) is a conceptual framework for providing patient-centered care. A revision to the PCCM framework led to a corresponding need to enhance the Patient Perception of Patient-Centeredness (PPPC) questionnaire. The original PPPC was aligned with the components of the PCCM conceptual framework and developed to measure patient-centeredness from the patient's perspective. The purpose of this study was to examine the factor structure of a revised version of the PPPC (ie, PPPC-R). METHODS Eleven new items were added to the original 14 items. The modified questionnaire was administered to patients in primary health care teams in Ontario, Canada. The confirmatory factor analysis was conducted on a subset of 381 patients who had seen a family physician. RESULTS The initial proposed 4-factor model first tested with a confirmatory factor analysis (CFA) did not fit adequately. Exploratory factor analysis was therefore used as a second step to modify the model and to identify weak items. A 3-factor exploratory model with 18 of the original 25 items was converted into a final hypothetical CFA model that had a good fit (χ2 (132)=176.795, P<0.01; CFI=0.991; RMSEA=0.030). The third factor contained only 2 items and so is interpreted with caution. CONCLUSIONS The validity of the PPPC-R is supported by some congruence between the conceptual framework (the PCCM) and the statistical analysis (CFA), but there is not a 1:1 correspondence. The components of the PCCM represent conceptually what is important when teaching, researching, and providing patient-centered care, whereas the PPPC-R represents patient-centered care as it is experienced by the patient.
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84
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Measuring Communication Similarity Between Hospice Nurses and Cancer Caregivers Using Latent Semantic Analysis. Cancer Nurs 2019; 43:506-513. [PMID: 31356461 DOI: 10.1097/ncc.0000000000000729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Optimal end-of-life care requires effective communication between hospice nurses, caregivers, and patients, yet defining and evaluating effective communication are challenging. Latent semantic analysis (LSA) measures the degree of communication similarity (talking about the same topic) without relying on specific word choices or matching of communication behaviors (question-answer), thus more comprehensively evaluating communication interactions. OBJECTIVE Guided by the Communication Accommodation Theory, we evaluated communication similarity, indicating theoretical convergence, between hospice nurses and caregivers of cancer patients, identifying nurse attributes and communication skills that were associated with greater communication similarity. METHODS A descriptive secondary analysis of self-reported nurse data and 31 audio-recorded cancer patient home hospice nursing visits across 2 states and 7 hospices. RESULTS The average LSA score was 0.83 (possible range, 0-1). A nurse preference for greater patient-oriented visits, use of more Nurse Partnering statements, and less Conversation Dominance (ratio of total nurse to total caregiver talk) were associated with higher LSA scores. CONCLUSIONS Effective communication is essential to optimal end-of-life care. Latent semantic analysis is a feasible and promising approach for assessing communication similarity during home hospice care. IMPLICATIONS FOR PRACTICE Hospice nurses are at the forefront of family caregiver communication, playing a vital role in empowering caregivers to assume required patient care tasks. Communication strategies such as the use of partnering statements that increase LSA scores can be taught to hospice nurses and other members of the hospice interdisciplinary team as a way to enrich communication skills and improve communication confidence and can be translated into other oncology nursing contexts.
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85
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Evong Y, Chorney J, Ungar G, Hong P. Perceptions and observations of shared decision making during pediatric otolaryngology surgical consultations. J Otolaryngol Head Neck Surg 2019; 48:28. [PMID: 31208462 PMCID: PMC6580583 DOI: 10.1186/s40463-019-0351-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/10/2019] [Indexed: 02/12/2023] Open
Abstract
Objective Increased parental involvement in the decision-making process when considering elective surgeries for their children, termed shared decision-making (SDM), may lead to positive outcomes. The objective of this study was to describe perceived and observed levels of SDM during pediatric otolaryngology consultations. Methods One hundred and seventeen parents and their children undergoing elective surgical consultations were prospectively enrolled. The visits were videotaped and coded using the Observing Patient Involvement (OPTION) scale. Following the encounter, all participants completed a questionnaire that measured perceived levels of SDM (SDM-Q-9). Surgeons also completed a similar questionnaire (SDM-Q-Doc). Spearman’s correlation coefficient was determined to measure the associations between observed and perceived levels of SDM. Results The overall OPTION scores were low (median score of 14 out of 48) and not significantly correlated with perceived levels of SDM (SDM-Q-9, p = 0.415; SDM-Q-Doc, p = 0.236), surgery type (p = 0.197), or patient demographic factors. The OPTION scores were positively correlated with consultation length (p < 0.001). There was great variability in the level to which each OPTION items were observed during the consultation (not present in any visits to present in 96.6% of the visits). Conclusions Observed levels of SDM were consistently low, but higher levels were observed when the surgeon spent more time during the consultation. Observed levels of SDM did not match perceived levels of SDM, which were consistently rated higher by both caregivers and surgeons.
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Affiliation(s)
- Yolanda Evong
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- IWK Health Centre, 5850/5920 University Avenue, PO Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Gilanders Ungar
- IWK Health Centre, 5850/5920 University Avenue, PO Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Paul Hong
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. .,IWK Health Centre, 5850/5920 University Avenue, PO Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada.
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Peabody MR, Young A, Peterson LE, O'Neill TR, Pei X, Arnhart K, Chaudhry HJ, Puffer JC. The Relationship Between Board Certification and Disciplinary Actions Against Board-Eligible Family Physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:847-852. [PMID: 30768464 DOI: 10.1097/acm.0000000000002650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Lack of specialty board certification has been reported as a significant physician-level predictor of receiving a disciplinary action from a state medical board. This study investigated the association between family physicians receiving a disciplinary action from a state medical board and certification by the American Board of Family Medicine (ABFM). METHOD Three datasets were merged and a series of logistic regressions were conducted examining the relationship between certification status and disciplinary actions when adjusting for covariates. Data were available from 1976 to 2017. Predictor variables were gender, age, medical training degree type, medical school location, and the severity of the action. RESULTS Of the family physicians in this sample, 95% (114,454/120,443) had never received any disciplinary action. Having ever been certified was associated with a reduced likelihood of ever receiving an action (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.30, 0.40; P < .001), and having held a prior but not current certification at the time of the action was associated with an increase in receiving the most severe type of action (OR = 3.71; 95% CI = 2.24, 6.13; P < .001). CONCLUSIONS Disciplinary actions are uncommon events. Family physicians who had ever been ABFM certified were less likely to receive an action. The most severe actions were associated with decreased odds of being board certified at the time of the action. Receiving the most severe action type increased the likelihood of physicians holding a prior but not current certification.
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Affiliation(s)
- Michael R Peabody
- M.R. Peabody is senior psychometrician, American Board of Family Medicine, Lexington, Kentucky. A. Young is assistant vice president, Research and Data Integration, Federation of State Medical Boards, Euless, Texas. L.E. Peterson is vice president of research, American Board of Family Medicine, and assistant professor, Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky. T.R. O'Neill is vice president of psychometric services, American Board of Family Medicine, Lexington, Kentucky. X. Pei is senior research analyst, Federation of State Medical Boards, Euless, Texas. K. Arnhart is senior research analyst, Federation of State Medical Boards, Euless, Texas. H.J. Chaudhry is president and chief executive officer, Federation of State Medical Boards, Euless, Texas. J.C. Puffer is president and chief executive officer emeritus, American Board of Family Medicine, Lexington, Kentucky
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Attitudes Toward Patient-Centered Care in the Mental Care Services in Isfahan, Iran. Community Ment Health J 2019; 55:548-552. [PMID: 30535891 DOI: 10.1007/s10597-018-0357-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
Understanding patient-physician relationships in mental care services is an indispensable element to improve the quality of mental care, yet little is known about it in Iran. This study measured the attitudes of the patients' family and personal caregivers (FPCs) and psychiatrists toward patient-centered care. A sample of 88 FPCs of mental patients and 29 psychiatrists in four teaching hospitals of Isfahan city, Iran, providing mental care, were asked to complete the patient-practitioner orientation scale (PPOS). Results showed mean scores of PPOS, sharing and caring for the psychiatrists were 3.4, 3.8, and 3.1, compared to 3.9, 4.2, and 3.7 for the mental patients' FPCs. There was a significant difference between the PPOS mean scores of the FPC and psychiatrist groups (p < 0.05) indicating that psychiatrists' attitudes were less patient-centered. Developing medical training interventions, establishing communication skills workshops, and increasing patients' awareness are some approaches to address the low level of patient-centered care.
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88
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Bobitt J, Qualls SH, Schuchman M, Wickersham R, Lum HD, Arora K, Milavetz G, Kaskie B. Qualitative Analysis of Cannabis Use Among Older Adults in Colorado. Drugs Aging 2019; 36:655-666. [DOI: 10.1007/s40266-019-00665-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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89
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The Ideals of Facial Beauty Among Chinese Aesthetic Practitioners: Results from a Large National Survey. Aesthetic Plast Surg 2019; 43:102-114. [PMID: 30288564 PMCID: PMC6345732 DOI: 10.1007/s00266-018-1241-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/09/2018] [Indexed: 11/30/2022]
Abstract
Abstract As the demand for cosmetic procedures increases, the importance of patient-centred care in this field becomes more prominent. The aesthetic practitioners’ ideals of beauty, in addition to their knowledge and perception of patients’ ideals of beauty and expectations, are important during doctor–patient communication. These are important in strengthening practices of patient-centred communication and treatment. This study was conducted to investigate ideals of facial beauty among Chinese aesthetic practitioners. A questionnaire with simple sketches of facial features was given to aesthetic practitioners in Chinese cosmetology hospitals and clinics to assess aesthetic practitioners’ ideals of beauty and their preferences for facial shapes, facial profile, nose and lip shape, jaw angle, and chin shape. A total of 596 surveys were completed. This survey revealed that Chinese aesthetic practitioners preferred a heart/inverted triangular facial shape with a reduced lower face height, a straight and small nose, as well as lips that are full medially and taper off laterally with well-defined borders and Cupid’s bow. An obtuse jaw angle for women and a square well-defined jaw angle for men, and a round and pointy chin for both women and men were the most preferred. A majority (66.7%) of the respondents said they would have plastic surgery. However, if given the choice 82.9% indicated they would opt for non-surgical procedures. Finally, a clear majority (90.5%) believed that being beautiful would improve their daily life. The results were then compared to a similar previous study in which the same ideals of beauty were investigated among Chinese laypersons. This information will help the aesthetic professionals to understand their patient’s requests and expectations better and therefore aid in offering and providing treatments that are in line. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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90
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Khan S, Spooner JJ, Spotts HE. United States Physician Preferences Regarding Healthcare Financing Options: A Multistate Survey. PHARMACY 2018; 6:pharmacy6040131. [PMID: 30544848 PMCID: PMC6306909 DOI: 10.3390/pharmacy6040131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Not much is currently known about United States (US) physicians’ opinions about healthcare financing, specifically subsequent to the creation and implementation of the Affordable Care Act (ACA). Objectives: A four state survey of practicing US based physicians’ opinions about healthcare financing following ACA passage and implementation. Methods: Physician leaders practicing in the state of New York, Texas, Colorado and Mississippi were surveyed. Two factor analyses (FA) were conducted to understand the underlying constructs. Results: We determined the final response rate to be 26.7% after adjusting it for a variety of factors. Most physicians favored either a single payer system (43.8%) or individualized insurance coverage using health savings accounts (33.2%). For the single-payer system, FA revealed two underlying constructs: System orientation (how the physicians perceived the impact on the healthcare system or patients) and individual orientation (how the physicians perceived the impact on individual physicians). Subsequently, we found that physicians who were perceived neutral in their attitudes towards physician-patient relationship and patient conflict were also neutral in reference to system orientation and individual orientation. Physicians who were perceived as stronger on the physician-patient relationship were more supportive of a single-payer system. Conclusion: This study brings attention to the paradox of social responsibility (to provide quality healthcare) and professional autonomy (the potential impact of a healthcare financing structure to negatively affect income and workload). Efforts to further reform healthcare financing and delivery in the US may encounter resistance from healthcare providers (physicians, mid-level prescribers, pharmacists, or nurses) if the proposed reform interferes with their professional autonomy.
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Affiliation(s)
- Shamima Khan
- Leon Hess Business School, Monmouth University, 400 Cedar Avenue, West, Long Branch, NJ 07764, USA.
- CRE Services, Inc., 1560 Broadway, Suite 812, New York, NY 10036, USA.
| | - Joshua J Spooner
- College of Pharmacy and Health Sciences, Western New England University, 1215 Wilbraham Road, Springfield, MA 01119, USA.
| | - Harlan E Spotts
- College of Business, Western New England University, 1215 Wilbraham Road, Springfield, MA 01119, USA.
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Kim ES, Wang Y, Kiefer SM. Cross-Level Group Measurement Invariance When Groups Are at Different Levels of Multilevel Data. EDUCATIONAL AND PSYCHOLOGICAL MEASUREMENT 2018; 78:973-997. [PMID: 30559511 PMCID: PMC6293419 DOI: 10.1177/0013164417739062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Studies comparing groups that are at different levels of multilevel data (namely, cross-level groups) using the same measure are not unusual such as student and teacher agreement in education or congruence between patient and physician perceptions in health research. Although establishing measurement invariance (MI) between these groups is important, testing MI is methodologically challenging because the groups compared for MI are at different levels with one group nested within the other group. We propose a multilevel confirmatory factor analysis (CFA) model that allows MI testing between cross-level groups at the between level and demonstrated testing MI between students and teachers using the promoting social interaction scale. Along with the demonstration, some methodological issues in implementing the proposed model (e.g., cluster invariance and reliability) and evaluating the model fit of multilevel CFA (e.g., ΔCFI and level-specific fit indices) and alternative approaches to the proposed model are discussed.
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Affiliation(s)
| | - Yan Wang
- University of South Florida, Tampa, FL,
USA
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92
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Bryce AR, Rossi TA, Tansey C, Murphy RA, Murphy LA, Nakamura RK. Effect of client complaints on small animal veterinary internists. J Small Anim Pract 2018; 60:167-172. [PMID: 30284723 DOI: 10.1111/jsap.12936] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/30/2018] [Accepted: 07/03/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To investigate the effect of client complaints on small animal veterinary internists' welfare, job satisfaction and medical practices. MATERIALS AND METHODS Cross-sectional anonymous survey study. Between February 1 and March 31, 2017, a web-based questionnaire was made available through the American College Veterinary Internal Medicine sub-specialty Small Animal Internal Medicine E-mail List Serve. RESULTS A total of 92 completed surveys were available for review. Fifty-nine (64∙1%) respondents received a client complaint during the previous 6 months with cost of care the most common reason (53∙3%). Eighty-nine (96∙7%) respondents worry about client complaints being made against them with 33 (35∙8%) stating they worry "most of the time" or "all of the time." Thirty-two (34∙8%) reported being verbally assaulted by a client in the previous 6 months and 27 (29∙4%) reported being threatened with litigation during the previous 6 months. Sixty-six (71∙7%) have reported changing the way they practice medicine to avoid a client complaint and 40 (43∙5%) have considered changing their career because of complaints made against them. CLINICAL RELEVANCE Client complaints are a frequent problem among small animal veterinary internists that have detrimental effects on job satisfaction, psychological distress and medical practices.
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Affiliation(s)
- A R Bryce
- Department of Internal Medicine, Southern California Veterinary Specialty Hospital, Irvine, California 92614, USA
| | - T A Rossi
- Department of Internal Medicine, Southern California Veterinary Specialty Hospital, Irvine, California 92614, USA
| | - C Tansey
- Department of Oncology, Inland Valley Veterinary Specialists and Emergency Center, Upland, California 91786, USA
| | - R A Murphy
- Department of Psychiatry, Beamount Hospital, Dublin 9, Ireland
| | - L A Murphy
- Department of Critical Care, Veterinary Specialty Center of Delaware, New Castle, Delaware 19720, USA
| | - R K Nakamura
- Department of Cardiology, IDEXX Laboratories, Westbrook, Maine 04092, USA
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The Impact of Pain Invisibility on Patient-Centered Care and Empathetic Attitude in Chronic Pain Management. Pain Res Manag 2018; 2018:6375713. [PMID: 30344801 PMCID: PMC6174788 DOI: 10.1155/2018/6375713] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/29/2018] [Indexed: 12/30/2022]
Abstract
Objectives The use of interdisciplinary patient-centered care (PCC) and empathetic behaviour seems to be a promising avenue to address chronic pain management, but their use in this context seems to be suboptimal. Several patient factors can influence the use of PCC and empathy, but little is known about the impact of pain visibility on these behaviours. The objective of this study was to investigate the influence of visible physical signs on caregiver's patient-centered and empathetic behaviours in chronic pain context. Methods A convenience sample of 21 nurses and 21 physicians participated in a descriptive study. PCC and empathy were evaluated from self-assessment and observer's assessment using a video of real patients with chronic pain. Results The results show that caregivers have demonstrated an intraindividual variability: PCC and empathetic behaviours of the participants were significantly higher for patients who have visible signs of pain (rheumatoid arthritis and complex regional pain syndrome) than for those who have no visible signs (Ehler–Danlos syndrome and fibromyalgia) (p < 0.001). Participants who show a greater difference in their patient-centered behaviour according to pain visibility have less clinical experience. Discussion The pain visibility in chronic pain patients is an important factor contributing to an increased use of PCC and empathy by nurses and physicians, and clinical experience can influence their behaviours. Thus, pain invisibility can be a barrier to quality of care, and these findings reinforce the relevance to educating caregivers to these unconscious biases on their behaviour toward chronic pain patients.
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94
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Ahmad W, Ashraf H, Talat A, Khan AA, Baig AA, Zia I, Sarfraz Z, Sajid H, Tahir M, Sadiq U, Imtiaz H. Association of burnout with doctor-patient relationship and common stressors among postgraduate trainees and house officers in Lahore-a cross-sectional study. PeerJ 2018; 6:e5519. [PMID: 30221087 PMCID: PMC6136394 DOI: 10.7717/peerj.5519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 08/06/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction Burnout is defined as a prolonged state of physical and psychological exhaustion. Doctors, due to the demanding nature of their job, are susceptible to facing burnout, which has far reaching implications on their productivity and motivation. It affects the quality of care they provide to patients, thus eroding the doctor-patient relationship which embodies patient centeredness and autonomy. The study aims at addressing the stressors leading to burnout and its effect on the doctor-patient relationship. Methods A descriptive, cross-sectional study design with convenience (non-probability) sampling technique was employed in six major hospitals of Lahore, Pakistan. A total of 600 doctors were approached for the study which included house officers or "HOs" (recent graduates doing their 1 year long internship) and post-graduate trainees or "PGRs" (residents for 4-5 years in their specialties). Burnout was measured using the Copenhagen Burnout Inventor (CBI) while attitudes towards the doctor-patient relationship was measured using the Patient Practitioner Orientation Scale (PPOS), which measures two components of the relationship: power sharing and patient caring. Pearson correlation and linear regression analysis were used to analyze the data via SPSS v.21. Results A total of 515 doctors consented to take part in the study (response rate 85.83%). The final sample consisted of 487 doctors. The burnout score was not associated with the total and caring domain scores of PPOS (P > 0.05). However, it was associated with the power sharing sub-scale of PPOS. Multiple linear regression analysis yielded a significant model, by virtue of which CBI scores were positively associated with factors such as female gender, feeling of burn out, scoring high on sharing domain of PPOS and a lack of personal control while CBI scores were negatively associated with private medical college education, having a significant other, accommodation away from home and a sense of never ending competition. Burnout levels varied significantly between house officers and post graduate trainees. Twenty-three percent of the participants (mostly house officers) had high/very high burnout levels on the CBI (Kristenson's burnout scoring). Both groups showed significant differences with respect to working hours, smoking status and income. Conclusion Although burnout showed no significant association with total and caring domain scores of PPOS (scale used to assess doctor-patient relationship), it showed a significant association with the power sharing domain of PPOS suggesting some impact on the overall delivery of patient care. Thus, it necessitates the monitoring of stressors in order to provide an atmosphere where patient autonomy can be practiced.
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Affiliation(s)
- Waqas Ahmad
- CMH Lahore Medical College, Lahore, Pakistan
| | - Huma Ashraf
- CMH Lahore Medical College, Lahore, Pakistan
| | - Afnan Talat
- CMH Lahore Medical College, Lahore, Pakistan
| | | | | | - Iqra Zia
- CMH Lahore Medical College, Lahore, Pakistan
| | | | - Hifsa Sajid
- CMH Lahore Medical College, Lahore, Pakistan
| | | | - Usman Sadiq
- CMH Lahore Medical College, Lahore, Pakistan
| | - Hira Imtiaz
- CMH Lahore Medical College, Lahore, Pakistan
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Cubaka VK, Schriver M, Vedsted P, Makoul G, Kallestrup P. Measuring patient-provider communication skills in Rwanda: Selection, adaptation and assessment of psychometric properties of the Communication Assessment Tool. PATIENT EDUCATION AND COUNSELING 2018; 101:1601-1610. [PMID: 29724432 DOI: 10.1016/j.pec.2018.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 04/17/2018] [Accepted: 04/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To identify, adapt and validate a measure for providers' communication and interpersonal skills in Rwanda. METHODS After selection, translation and piloting of the measure, structural validity, test-retest reliability, and differential item functioning were assessed. RESULTS Identification and adaptation: The 14-item Communication Assessment Tool (CAT) was selected and adapted. VALIDITY AND RELIABILITY TESTING Content validation found all items highly relevant in the local context except two, which were retained upon understanding the reasoning applied by patients. Eleven providers and 291 patients were involved in the field-testing. Confirmatory factor analysis showed a good fit for the original one factor model. Test-retest reliability assessment revealed a mean quadratic weighted Kappa = 0.81 (range: 0.69-0.89, N = 57). The average proportion of excellent scores was 15.7% (SD: 24.7, range: 9.9-21.8%, N = 180). Differential item functioning was not observed except for item 1, which focuses on greetings, for age groups (p = 0.02, N = 180). CONCLUSION The Kinyarwanda version of CAT (K-CAT) is a reliable and valid patient-reported measure of providers' communication and interpersonal skills. K-CAT was validated on nurses and its use on other types of providers may require further validation. PRACTICE IMPLICATION K-CAT is expected to be a valuable feedback tool for providers in practice and in training.
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Affiliation(s)
- Vincent Kalumire Cubaka
- School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda; Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Michael Schriver
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Gregory Makoul
- PatientWisdom, New Haven, CT, United States; University of Connecticut School of Medicine, Farmington, CT, United States
| | - Per Kallestrup
- Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
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96
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Silverman TB, Vanegas A, Marte A, Mata J, Sin M, Ramirez JCR, Tsai WY, Crew KD, Kukafka R. Study protocol: a cluster randomized controlled trial of web-based decision support tools for increasing BRCA1/2 genetic counseling referral in primary care. BMC Health Serv Res 2018; 18:633. [PMID: 30103738 PMCID: PMC6090728 DOI: 10.1186/s12913-018-3442-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND BRCA1 and BRCA2 mutations confer a substantial breast risk of developing breast cancer to those who carry them. For this reason, the United States Preventative Services Task Force (USPSTF) has recommended that all women be screened in the primary care setting for a family history indicative of a mutation, and women with strong family histories of breast or ovarian cancer be referred to genetic counseling. However, few high-risk women are being routinely screened and fewer are referred to genetic counseling. To address this need we have developed two decision support tools that are integrated into clinical care. METHOD This study is a cluster randomized controlled trial of high-risk patients and their health care providers. Patient-provider dyads will be randomized to receive either standard education that is supplemented with the patient-facing decision aid, RealRisks, and the provider-facing Breast Cancer Risk Navigation Toolbox (BNAV) or standard education alone. We will assess these tools' effectiveness in promoting genetic counseling uptake and informed and shared decision making about genetic testing. DISCUSSION If found to be effective, these tools can help integrate genomic risk assessment into primary care and, ultimately, help expand access to risk-appropriate breast cancer prevention options to a broader population of high-risk women. TRIAL REGISTRATION This trial is retrospectively registered with ClinicalTrials.gov Identifier: NCT03470402 : 20 March 2018.
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Affiliation(s)
- Thomas B Silverman
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Alejandro Vanegas
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Awilda Marte
- Department of Medicine, Columbia University, New York, NY, USA
| | - Jennie Mata
- Department of Medicine, Columbia University, New York, NY, USA
| | - Margaret Sin
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | | | - Wei-Yann Tsai
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine, Columbia University, New York, NY, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Rita Kukafka
- Department of Biomedical Informatics, Columbia University, New York, NY, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
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Schoenthaler A, Basile M, West TV, Kalet A. It takes two to tango: A dyadic approach to understanding the medication dialogue in patient-provider relationships. PATIENT EDUCATION AND COUNSELING 2018; 101:1500-1505. [PMID: 29478882 PMCID: PMC6019130 DOI: 10.1016/j.pec.2018.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To describe typologies of dyadic communication exchanges between primary care providers and their hypertensive patients about prescribed antihypertensive medications. METHODS Qualitative analysis of 94 audiotaped patient-provider encounters, using grounded theory methodology. RESULTS Four types of dyadic exchanges were identified: Interactive (53% of interactions), divergent-traditional (24% of interactions), convergent-traditional (17% of interactions) and disconnected (6% of interactions). In the interactive and convergent-traditional types, providers adopted a patient-centered approach and used communication behaviors to engage patients in the relationship. Patients in these interactions adopted either an active role in the visit (interactive), or a passive role (convergent-traditional). The divergent-traditional type was characterized by provider verbal dominance, which inhibited patients' ability to ask questions, seek information, or check understanding of information. In the disconnected types, providers used mainly closed-ended questions and terse directives to gather and convey information, which was often disregarded by patients who instead diverted the conversation to psychosocial issues. CONCLUSIONS This study identified interdependent patient-provider communication styles that can either facilitate or hinder discussions about prescribed medications. PRACTICE IMPLICATIONS Examining the processes that underlie dyadic communication in patient-provider interactions is an essential first step to developing interventions that can improve the patient-provider relationship and patient health behaviors.
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Affiliation(s)
- Antoinette Schoenthaler
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, 227 East 30th Street, NY, 10016, USA.
| | - Melissa Basile
- The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA.
| | - Tessa V West
- Department of Psychology, New York University Graduate School of Arts and Sciences, NY, USA.
| | - Adina Kalet
- Division of General Internal Medicine and Clinical Investigation, Department of Medicine, New York University School of Medicine, NY, USA.
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98
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Speaking Up and Walking Out: Are Vulnerable Patients Less Likely to Disagree With or Change Doctors? Med Care 2018; 56:749-754. [PMID: 29901494 DOI: 10.1097/mlr.0000000000000936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Disparities in clinical process-of-care and patient experiences are well documented for Medicare beneficiaries with ≥1 social risk factors. If such patients are less willing to express disagreement with their doctors or change doctors when dissatisfied, these behaviors may play a role in observed disparities. OBJECTIVE To investigate the association between social risk factors and self-reported likelihood of disagreeing with or changing doctors if dissatisfied among the Medicare fee-for-service population. SUBJECTS Fee-for-service beneficiaries (N=96,317) who responded to the 2014 Medicare Consumer Assessment of Healthcare Providers and Systems survey. Subgroups were defined based on age, education, income, and race/ethnicity. METHODS Respondents reported how likely they would be to express disagreement with their doctors and change doctors if dissatisfied (1=very unlikely to 4=very likely; rescaled to 0-100 points). We fit mixed-effect linear regression models predicting these outcomes from social risk factors, controlling for health status and geographic location. RESULTS Beneficiaries who were older, less educated, and had lower incomes were least inclined to express disagreement or change doctors (P<0.001). Compared with non-Hispanic whites, Asian/Pacific Islander (-9.5) and Hispanic (-3.6) beneficiaries said they would be less likely, and black (+2.8) beneficiaries more likely, to express disagreement. Asian/Pacific Islander (-8.7), Hispanic (-5.9), and American Indian/Alaska Native (-3.8) beneficiaries were less inclined than non-Hispanic whites to change doctors (P<0.01). DISCUSSION Reduction in health care disparities may be achieved if doctors and advocates encourage vulnerable patients to express their concerns and perspectives and if communities and caregivers provide support for changing providers when care is poor.
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100
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Vijn TW, Wollersheim H, Faber MJ, Fluit CRMG, Kremer JAM. Building a patient-centered and interprofessional training program with patients, students and care professionals: study protocol of a participatory design and evaluation study. BMC Health Serv Res 2018; 18:387. [PMID: 29843804 PMCID: PMC5975479 DOI: 10.1186/s12913-018-3200-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background A common approach to enhance patient-centered care is training care professionals. Additional training of patients has been shown to significantly improve patient-centeredness of care. In this participatory design and evaluation study, patient education and medical education will be combined by co-creating a patient-centered and interprofessional training program, wherein patients, students and care professionals learn together to improve patient-centeredness of care. Methods In the design phase, scientific literature regarding interventions and effects of student-run patient education will be synthesized in a scoping review. In addition, focus group studies will be performed on the preferences of patients, students, care professionals and education professionals regarding the structure and content of the training program. Subsequently, an intervention plan of the training program will be constructed by combining these building blocks. In the evaluation phase, patients with a chronic disease, that is rheumatoid arthritis, diabetes and hypertension, and patients with an oncologic condition, that is colonic cancer and breast cancer, will learn together with medical students, nursing students and care professionals in training program cycles of three months. Process and effect evaluation will be performed using the plan-do-study-act (PDSA) method to evaluate and optimize the training program in care practice and medical education. A modified control design will be used in PDSA-cycles to ensure that students who act as control will also benefit from participating in the program. Discussion Our participatory design and evaluation study provides an innovative approach in designing and evaluating an intervention by involving participants in all stages of the design and evaluation process. The approach is expected to enhance the effectiveness of the training program by assessing and meeting participants’ needs and preferences. Moreover, by using fast PDSA cycles and a modified control design in evaluating the training program, the training program is expected to be efficiently and rapidly implemented into and adjusted to care practice and medical education.
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Affiliation(s)
- Thomas W Vijn
- Scientific Center for Quality of Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center, 114, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Hub Wollersheim
- Scientific Center for Quality of Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center, 114, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Marjan J Faber
- Scientific Center for Quality of Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center, 114, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Cornelia R M G Fluit
- Radboudumc Health Academy, Department for Research in Learning and Education, Radboud University Medical Center, 43, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Jan A M Kremer
- Scientific Center for Quality of Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center, 114, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
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