Do patients treated with dignity report higher satisfaction, adherence, and receipt of preventive care?

Predicting Performance of First-Year Residents: Correlations Between Structured Interview, Licensure Exam, and Competency Scores in a Multi-Institutional Study

PURPOSE

To determine whether scores on structured interview (SI) questions designed to measure noncognitive competencies in physicians (1) predict subsequent first-year resident performance on Accreditation Council for Graduate Medical Education (ACGME) milestones and (2) add incremental validity over United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge scores in predicting performance.

METHOD

The authors developed 18 behavioral description questions to measure key noncognitive competencies (e.g., teamwork). In 2013-2015, 14 programs (13 residency, 1 fellowship) from 6 institutions used subsets of these questions in their selection processes. The authors conducted analyses to determine the validity of SI and USMLE scores in predicting first-year resident milestone performance in the ACGME's core competency domains and overall.

RESULTS

SI scores predicted midyear and year-end overall performance (r = 0.18 and 0.19, respectively, P < .05) and year-end performance on patient care, interpersonal and communication skills, and professionalism competencies (r = 0.23, r = 0.22, and r = 0.20, respectively, P < .05). SI scores contributed incremental validity over USMLE scores in predicting year-end performance on patient care (ΔR = 0.05), interpersonal and communication skills (ΔR = 0.09), and professionalism (ΔR = 0.09; all P < .05). USMLE scores contributed incremental validity over SI scores in predicting year-end performance overall and on patient care and medical knowledge.

CONCLUSIONS

SI scores predict first-year resident year-end performance in the interpersonal and communication skills, patient care, and professionalism competency domains. Future research should investigate whether SIs predict a range of clinically relevant outcomes.

Patient and Community Health Worker Perceptions of Community Health Worker Clinical Integration

Traditional community health workers (CHWs) are expanding their role into clinical settings (cCHW) to support patients with care coordination and advocacy services. We investigated the potential to integrate cCHWs, via evaluation of patients' and CHWs' key demographics, needs, and abilities. This mixed-methods study, including adult patients and CHWs, was conducted in the Inland Valley of Southern California, between 2016 and 2017. Survey data, key informant interviews, and focus group discussions were evaluated to compare patient/CHW core demographics, and contrast patient-identified healthcare needs against CHW-identified cCHW service capabilities. Quantitative data were evaluated descriptively and bi-variably using two-sample independent t tests and Pearson's Chi square tests. Qualitative data were coded for emerging themes using a priori and standard grounded theory methods. Patients and CHWs were significantly similar in age, education, and income, but significantly differed in gender, race, United States generation, and marital status. For all healthcare-related services in which patients and CHWs exhibited significant differences, the odds CHWs perceived themselves capable of performing services were greater than patients' stated need of services. Patients and CHWs overlapped regarding their expectations of cCHWs. Although patients and CHWs differed somewhat, they shared many of the same expectations for cCHW integration. This information is critical to further contextualize cCHW training programs and emphasizes the need to education patients about this exciting new form of healthcare delivery. The active role of cCHWs in the clinical care team and the community may expand patient access to preventive healthcare, improve care quality, and minimize health inequities.

Principles for Patient and Family Partnership in Care: An American College of Physicians Position Paper

In this position paper, the American College of Physicians (ACP) examines the rationale for patient and family partnership in care and reviews outcomes associated with this concept, including greater adherence to care plans, improved satisfaction, and lower costs. The paper also explores and acknowledges challenges associated with implementing patient- and family-centered models of care. On the basis of a comprehensive literature review and a multistakeholder vetting process, the ACP's Patient Partnership in Healthcare Committee developed a set of principles that form the foundation for authentic patient and family partnership in care. The principles position patients in their rightful place at the center of care while acknowledging the importance of partnership between the care team and patient in improving health care and reducing harm. The principles state that patients and families should be treated with dignity and respect, be active partners in all aspects of their care, contribute to the development and improvement of health care systems, and be partners in the education of health care professionals. This paper also recommends ways to implement these principles in daily practice.

"They were just waiting to die": Somali Bantu and Karen Experiences with Cancer Screening Pre- and Post-Resettlement in Buffalo, NY

BACKGROUND

Little is known about how pre-resettlement experiences affect refugees' uptake of cancer screenings. The objective of this study was to characterize Somali Bantu and Karen experiences with cancer and cancer screenings prior to and subsequent to resettlement in Buffalo, NY in order to inform engagement by health providers.

METHODS

The study was grounded in a community-based participatory research approach, with data collection and analysis guided by the Health Belief Model and life course framework. Interviews were transcribed, independently coded by two researchers, and analyzed using an immersion-crystallization approach. We conducted 15 semi-structured interviews and six interview-focus group hybrids with Somali Bantu (n = 15) and Karen (n = 15) individuals who were predominantly female (87%).

RESULTS

Cancer awareness was more prevalent among Karen compared to Somali Bantu participants. Prior to resettlement, preventative health care, including cancer screening, and treatment were unavailable or inaccessible to participants and a low priority compared with survival and acute health threats. There, Somali Bantu treated cancer-like diseases with traditional medicine (heated objects, poultices), and Karen reported traditional medicine and even late-stage biomedical treatments were ineffective due to extent of progressed, late-stage ulcerated tumors when care was sought. A fatalistic view of cancer was intertwined with faith (Somali Bantu) and associated with untreated, late-stage cancer (Karen). Karen but not Somali Bantu reported individuals living with cancer were stigmatized pre-resettlement due to the unpleasant manifestations of untreated, ulcerated tumors. Now resettled in the U.S., participants reported obtaining cancer screenings was challenged by transportation and communication barriers and facilitated by having insurance and interpretation services. While Somali Bantu women strongly preferred a female provider for screenings, Karen women felt cancer severity outweighed cultural modesty concerns in terms of provider gender.

SIGNIFICANCE

Our findings suggest the need for culturally-relevant cancer education that incorporates the life course experiences and addresses logistical barriers in linking individuals with screening, to be complemented by trauma-informed care approaches by healthcare providers.

Unlocking the Doors to Patient Satisfaction in Pediatric Orthopaedics

BACKGROUND

Despite efforts to enhance the patient experience, many health care providers continue to struggle to improve patient satisfaction as the identification of tangible quality improvement areas remains difficult. This dilemma is particularly relevant in pediatric settings, where patient satisfaction measures have not been as thoroughly studied in subspecialties such as orthopaedics. We investigate this issue to identify the major drivers of patient satisfaction in pediatric orthopaedics, which has significant financial and professional implications for both hospital administrators and health care providers. Although recent patient experience studies emphasize on improving access to care and nurturing hospitality by facilities upgrades or staff development, we hypothesized that the patient-physician relationship remains the most important factor in patients' assessment of their experiences.

METHODS

Patient satisfaction surveys were collected from outpatient visits to pediatric orthopaedic practices at 5 locations in 3 states. Data were aggregated as monthly percentages of responses on a 5-point Likert scale. Month over month Pearson product-moment correlation coefficients were generated between top responses for "Likelihood of Your Recommending Our Practice to Others" (LTR) and other variables.

RESULTS

In total, 6195 families completed satisfaction surveys. The variables most predictive of likelihood to recommend the practice were "Staff Worked Together" (r=0.82), "Friendliness/Courtesy of Care Provider" (r=0.80), "Cheerfulness of Practice" (r=0.80), "Likelihood of Recommending Care Provider" (r=0.80), and "Care Provider's Information about Medications" (r=0.78).

CONCLUSIONS

Measurements of the patient-physician relationship, along with overall cheerfulness and staff collaboration, have the strongest relationships to LTR. These results suggest that patient satisfaction is influenced by more than just the patient-physician relationship, and may have significance in aiding pediatric orthopaedic clinics in their quality assurance/quality improvement plans of enhancing the patient experience.

LEVEL OF EVIDENCE

Level III-prognostic.

Dissatisfaction with opioid maintenance treatment partly explains reported side effects of medications

BACKGROUND

Drop-out is a core problem in opioid maintenance treatment (OMT), but patients' reactions to and acceptance of the various OMT medications are insufficiently investigated. In Norway, there has been vocal patient resistance to the newest medication, buprenorphine-naloxone (BNX), and complaints have focused on the side effect profile. There has been no comparison of patient satisfaction and side effects of the three most common OMT medications.

AIM

To compare patient satisfaction with OMT and side effects of BNX, buprenorphine monopreparate (BUP), and methadone (MET) as reported by patients.

METHODS

Data were drawn from a national peer-to-peer survey developed by a patient advocacy group. The survey engaged more than 1000 OMT patients, corresponding to one seventh of OMT patients in Norway. The associations between side effects, treatment satisfaction, and patient characteristics were tested in multinomial logistic regressions.

RESULTS

High patient satisfaction with OMT overall was reported despite lower satisfaction with medication itself and widely prevalent side effects. Among each medication group, dissatisfaction with medications or OMT in general along with poor health status increased the relative risk ratio of reporting the heaviest side effect burden. MET users reported the highest side effect burden and BNX users the lightest, but BNX users were more dissatisfied with their medication.

CONCLUSIONS

Side effects are a concern for nearly all OMT patients, and they do not appear to accumulate with age or length of treatment. BNX users' dissatisfaction with their medication is of particular concern, and expectations and preferences of medication may be influencing their dissatisfaction.

Patient-directed self-management of pain (PaDSMaP) compared to treatment as usual following total knee replacement; a randomised controlled trial

Background

Self-administration of medicines by patients whilst in hospital is being increasingly promoted despite little evidence to show the risks and benefits. Pain control after total knee replacement (TKR) is known to be poor.

The aim of the study was to determine if patients operated on with a TKR who self-medicate their oral analgesics in the immediate post-operative period have better pain control than those who receive their pain control by nurse-led drug rounds (Treatment as Usual (TAU)).

Methods

A prospective, parallel design, open-label, randomised controlled trial comparing pain control in patient-directed self-management of pain (PaDSMaP) with nurse control of oral analgesia (TAU) after a TKR. Between July 2011 and March 2013, 144 self-medicating adults were recruited at a secondary care teaching hospital in the UK. TAU patients (n = 71) were given medications by a nurse after their TKR. PaDSMaP patients (n = 73) took oral medications for analgesia and co-morbidities after two 20 min training sessions reinforced with four booklets. Primary outcome was pain (100 mm visual analogue scale (VAS)) at 3 days following TKR surgery or at discharge (whichever came soonest). Seven patients did not undergo surgery for reasons unrelated to the study and were excluded from the intention-to-treat (ITT) analysis.

Results

ITT analysis did not detect any significant differences between the two groups’ pain scores. A per protocol (but underpowered) analysis of the 60% of patients able to self-medicate found reduced pain compared to the TAU group at day 3/discharge, (VAS -9.9 mm, 95% CI -18.7, − 1.1). One patient in the self-medicating group over-medicated but suffered no harm.

Conclusion

Self-medicating patients did not have better (lower) pain scores compared to the nurse-managed patients following TKR. This cohort of patients were elderly with multiple co-morbidities and may not be the ideal target group for self-medication.

Trial Registration

ISRCTN10868989. Registered 22 March 2012, retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3146-2) contains supplementary material, which is available to authorized users.

Factors associated with patient recall of key information in ambulatory specialty care visits: Results of an innovative methodology

While some studies have assessed patient recall of important information from ambulatory care visits, none has done so recently. Furthermore, little is known about features of clinical interactions which are associated with patient understanding and recall, without which shared decision making, a widely shared ideal for patient care, cannot occur. Our objective was to evaluate characteristics of patients and outpatient encounters associated with patient recall of information after one week, along with observation of elements of shared decision making. This was an observational study based on coded transcripts of 189 outpatient encounters, and post-visit interviews with patients 1 week later. Coding used three previously validated systems, adopted for this study. Forty-nine percent of decisions and recommendations were recalled accurately without prompting; 36% recalled with a prompt; 15% recalled erroneously or not at all. Provider behaviors hypothesized to be associated with patient recall, such as open-questioning and “teach back,” were rare. Patients with less than high school education recalled 38% of items freely and accurately, while patients with a college degree recalled 65% (p < .0001). In a multivariate model, the total number of items to be recalled per visit, and percentage of utterances in decision-making processes by the provider (“verbal dominance”), were significant predictors of poorer recall. The item count was associated with poorer recall for lower, but not higher, educated patients.

Psychometric properties of the Patient Dignity Inventory in an acute psychiatric ward: an extension study of the preliminary validation

BACKGROUND

During the last decades, dignity has been an emerging issue in mental health since its ethical and therapeutic implications became known. This study is an extension of the preliminary validation of the Patient Dignity Inventory (PDI) in a psychiatric setting, originally designed for assessing perceived dignity in terminal cancer patients.

METHODS

From October 21, 2015 to December 31, 2016, we administered the Italian PDI to all patients hospitalized in an acute psychiatric ward, who provided their consent and completed it at discharge (n=165). We performed Cronbach's alpha coefficient and principal factor analysis. We administered other scales concomitantly to analyze the concurrent validity of PDI. We applied stepwise multiple linear regression to identify the patients' demographic and clinical variables related to the PDI score.

RESULTS

Our response rate was 93%, with excellent internal consistency (Cronbach's alpha coefficient=0.94). The factorial analysis showed three factors with eigenvalue >1, which explained >80% of total variance: 1) "loss of self-identity and anxiety for the future", 2) "concerns for social dignity and spiritual life", and 3) "loss of personal autonomy". The PDI and the three factor scores were positively and significantly correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Among patients' variables, "suicide risk" and "insufficient social and economic condition" were positively and significantly correlated with the PDI total score.

CONCLUSION

The PDI can be a reliable tool to assess patients' dignity perception in a psychiatric setting, which suggests that both social and clinical severe conditions are closely related to dignity loss.

Theoretical and Pragmatic Adaptation of the 5As Model to Patient-Centered Hypertension Counselling

Patient-centered communication is a means for engaging patients in partnership. However, patient centered communication has not always been grounded in theory or in clinicians' pragmatic needs. The objective of this report is to present a practical approach to hypertension counselling that uses the 5As framework and is grounded in theory and best communication practices.

Patient perspectives of maintaining dignity in Indonesian clinical care settings: A qualitative descriptive study

AIM

To gain an understanding towards the perspectives of hospitalized inpatients in Indonesia regarding maintaining dignity during clinical care.

BACKGROUND

Dignity is a basic human right that is crucial for an individual's well-being. Respect for a person as a valuable human is a concept that is comparable to treating a person with dignity. Maintaining patient's dignity is an ethical goal of nursing care. Nevertheless, the concept is highly dependent on cultural context. This issue has not been well studied in Indonesia.

DESIGN

This study used a qualitative descriptive design.

METHODS

Thirty-five participants were recruited by purposive sampling from medical to surgical wards of six public hospitals in Eastern Java, Indonesia. Data were collected in 2016 through individual face-to-face semi-structured interviews. Inductive content analysis was applied to the data.

FINDINGS

Four major categories which described qualities of nursing care essential for maintaining a patient's dignity in clinical care settings were revealed: (1) responsiveness; (2) respectful nurse-patient relationships; (3) caring characteristics and (4) personalized service.

CONCLUSIONS

Our findings provide a cultural viewpoint of dignity for care recipients in Indonesia. The findings provide empirical support for linking dignified care and person-centred care principles with regards to cultural sensitivity. Nurses must not only be clinically competent but also culturally competent. The ability to provide culturally competent care is important for nurses as a strategy to maintain patient dignity during hospitalized care.

Key drivers of patient experience in ambulatory paediatric cardiology

Patient experience is becoming a central focus of healthcare. A broad range of studies on how to increase patient satisfaction ratings exists; however, they lack the specificity to adequately guide physicians and hospitals on how to improve patient experience. The objective of this study was to define the aspects of patient experience within paediatric cardiologist practices that can serve as predictors of excellent patient satisfaction. From 1 January, 2013 to 28 February, 2015 (26 months), outpatients who visited paediatric cardiologists were asked to complete a 39-question patient satisfaction survey regarding their experience. Surveys were collected over a 26-month period by Press Ganey, an independent provider of patient satisfaction surveys. Participants were asked to rate their experience on a 1-5 Likert-scale: a score of 1 demonstrated a "poor" experience, whereas a score of 5 demonstrated a "very good" experience. This retrospective study of 2468 responses determined that cheerfulness of the practice (r=0.85, p<0.001), a cohesive staff (r=0.83, p<0.001), and a care provider explaining problems and conditions (r=0.81, p<0.001) were key aspects of a paediatric cardiologist's practice that can be used as predictors of overall patient satisfaction. Awareness of how doctors can personalise a patient's experience is vital to achieve greater patient satisfaction and, ultimately, better patient outcomes.

Satisfaction of tuberculosis patients with health services in Ghana

Purpose Within human services, client satisfaction is highly prioritised and considered a mark of responsiveness in service delivery. A large body of research has examined the concept of satisfaction from the perspective of service users. However, not much is known about how service providers construct client satisfaction. The purpose of this paper is to throw light on healthcare professionals' perspectives on patient satisfaction, using tuberculosis (TB) clinics as a case study. Design/methodology/approach In-depth interviews were conducted with 35 TB clinic supervisors purposively sampled from six out of the ten regions of Ghana. An unstructured interview guide was employed. The recorded IDIs were transcribed, edited and entered into QSR NVivo 10.0 and analysed inductively. Findings Respondents defined service satisfaction as involving education/counselling (on drugs, nature of condition, sputum production, caregivers and contacts of patients), patient follow-up, assignment of reliable treatment supporters as well as being attentive and receptive to patients, service availability (e.g. punctuality at work, availability of commodities), positive assurances about disease prognosis and respect for patients. Practical implications Complementing opinions of health service users with those of providers can offer key performance improvement areas for health managers. Originality/value To the best of the authors' knowledge, this is a first study that has examined healthcare providers' views on what makes their clients satisfied with the services they provide.

Are There Racial Disparities in Family-Reported Experiences of Care in Inpatient Pediatrics?

Despite increased emphasis on patient satisfaction as a quality measure in health care, little is known about the influence of race in parent-reported experience of care in pediatrics. This study evaluates the association of race with patient satisfaction scores in an inpatient pediatric tertiary care hospital in one year. Risk-adjusted multivariable logistic regression was performed to evaluate the association of minority race with the likelihood to provide a top-box (=5) satisfaction score for 38 individual questions across 8 domains. Of the 904 participants, 269 (29.8%) identified as belonging to a minority race. Parents of minority children reported 30% to 50% lower satisfaction across questions related to well-established themes of interpersonal communication and cultural competency. Overall, minorities also reported lower satisfaction for the domain of nursing care (odds ratio 0.7, P = .016). These findings suggest a need for training and interventions to improve communication and mitigate disparities in how minority patients and their families perceive pediatric care.

A Direct Observation Checklist to Measure Respect and Dignity in the ICU

OBJECTIVE

Treating patients and family members with respect and dignity is a core objective of health care, yet it is unclear how best to measure this in the ICU setting. Accordingly, we sought to create a direct observation checklist to assess the "respect and dignity status" of an ICU.

DESIGN

A draft checklist based on previous work was iteratively revised to enhance accuracy and feasibility.

SETTING

Seven ICUs within the Johns Hopkins Health System.

SUBJECTS

A total of 351 patient-clinician encounters with 184 different patients.

INTERVENTIONS

Four study team members pilot tested the checklist between January and August 2015.

MEASUREMENTS AND MAIN RESULTS

Standard psychometric analyses were performed. The direct observation checklist exhibits strong content and face validity as well as high reliability and internal consistency. All items load on one factor that supports the unidimensionality of the total index. Furthermore, concurrent validity of the direct observation checklist is demonstrated by statistically significant differences in mean scores between ICUs, between types of clinicians, and between patients' clinical status and mood.

CONCLUSIONS

We rigorously developed, pilot tested, and analyzed a direct observation checklist designed to assess the extent to which patients and families in the ICU setting are treated with respect and dignity. Future research should validate this checklist in other settings and compare its results with other measures. Data gathered about individual items on the direct observation checklist could be used to target areas for training and education; doing so should help facilitate more respectful treatment of patients and their families.

The effectiveness of a nursing discharge programme to improve medication adherence and patient satisfaction in the psychiatric intensive care unit

AIMS AND OBJECTIVES

To observe the extent to which a nursing discharge plan is effective in promoting therapeutic adherence and improving patient satisfaction with their treatment based on information interventions provided by nursing staff, direct hospital medication distribution and follow-up telephone calls.

BACKGROUND

Patient adherence is a fundamental requirement for the treatment of chronic diseases. Among psychiatric patients, adherence to the prescribed course of treatment allows patients to keep the symptoms of their disease under control, allowing for improvements in the management of their condition, minimising the risks of relapse and reducing the number of hospitalisations.

DESIGN

This study uses a prospective correlational design.

METHODS

The Morisky Medication Adherence Scale, the Satisfaction with Information about Medicine Scale and the General Satisfaction Questionnaire were used.

RESULTS

Of the 135 patients enrolled in the study, 57% of the sample was female, and, on average, patients were aged 33 years. About 72.9% were unmarried, and 88.1% were educated at less than high school level. This study showed that patients who received more information on their health status and on what would be done for them after their hospitalisation had a higher adherence to treatment. In addition, patients who were more satisfied with the nursing care provided had a higher rate of adherence to their treatment plan.

CONCLUSIONS

The interpersonal and educational nursing intervention improves adherence to a treatment plan by allowing patients to express themselves not only as individuals who rely on health care but also as protagonists able to effectively manage their disease and to empower themselves by acquiring disease management skills.

RELEVANCE TO CLINICAL PRACTICE

A patient-nurse communication programme could help to analyse the individual patient circumstances that might become barriers to adherence and to apply nursing interventions that promote better patient adherence.

Randomized trial of a question prompt list to increase patient active participation during interactions with black patients and their oncologists

OBJECTIVE

Communication during racially-discordant interactions is often of poor quality and may contribute to racial treatment disparities. We evaluated an intervention designed to increase patient active participation and other communication-related outcomes during interactions between Black patients and non-Black oncologists.

METHODS

Participants were 18 non-Black medical oncologists and 114 Black patients at two cancer hospitals in Detroit, Michigan, USA. Before a clinic visit to discuss treatment, patients were randomly assigned to usual care or to one of two question prompt list (QPL) formats: booklet (QPL-Only), or booklet and communication coach (QPL-plus-Coach). Patient-oncologist interactions were video recorded. Patients reported perceptions of the intervention, oncologist communication, role in treatment decisions, and trust in the oncologist. Observers assessed interaction length, patient active participation, and oncologist communication.

RESULTS

The intervention was viewed positively and did not increase interaction length. The QPL-only format increased patient active participation; the QPL-plus-Coach format decreased patient perceptions of oncologist communication. No other significant effects were found.

CONCLUSION

This QPL booklet is acceptable and increases patient active participation in racially-discordant oncology interactions. Future research should investigate whether adding physician-focused interventions might improve other outcomes.

PRACTICE IMPLICATIONS

This QPL booklet is acceptable and can improve patient active participation in racially-discordant oncology interactions.

How Can Respectfulness in Medical Professionals Be Increased? A Complex But Important Question

Respectfulness is demanded of doctors and predicts more positive patient health-related outcomes, but research is scarce on ways to promote it. This study explores two ways to conceptualize unconditional respect from medical students, defined as respect paid to people on the basis of their humanity, in order to inform strategies to increase it. Unconditional respect conceptualized as an attitude suggests that unconditional respect and conditional respect are additive, whereas unconditional respect conceptualized as a personality trait suggests that people who are high on unconditional respect afford equal respect to all humans regardless of their merits. One hundred and eighty-one medical students completed an unconditional respect measure then read a description of a respect-worthy or a non-respect-worthy man and indicated their respect towards him. The study found a main effect for unconditional respect and a main effect for target respect-worthiness but no interaction between the two when respect paid to the target was assessed, supporting the attitude-based conceptualization. This suggests that unconditional respect can be increased through relevant interventions aimed at increasing the relative salience to doctors of the human worth of individuals. Interventions to increase unconditional respect are discussed.

Patients' Dignity and Its Relationship with Contextual Variables: A Cross-Sectional Study

Introduction: Dignity is considered as fundamental human needs and recognized as one of the central concepts in nursing science. The aim of this study was to assess the extent to which patients’ dignity is respected and to evalutae its relationship with contextual variables.

Methods: This cross-sectional study was conducted on 256 hospitalized patients in the two teaching hospitals affiliated to Zanjan University of medical sciences, Iran. Data were collected by a questionnaire consist of two sections: (a) demographic characteristics, and (b) patient dignity including 32 questions. Data were analyzed by SPSS (ver.13) software using independent t-test, ANOVA and Pearson correlation.

Results: The result showed that the mean (standard deviation) of total score of patient’s dignity was 108.17 (25.28). According to the result, the majority of the respondents (76.2%) were not aware of patient’s rights. There was a significant difference in mean scores of total dignity between single and married persons, living in city or village, and hospitalization in Moosavi and Valiasr hospital.

Conclusion: Health care systems should take the provision of the patients' dignity into account through using a comprehensive educational program for informing of patient, family members, and health professionals about patients’ dignity.

Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia

BACKGROUND

The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic diseases. International evidence suggests that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA.

METHODS

A questionnaire survey was carried out to identify the barriers and enablers to accessing PHCS in rural (n = 5) and urban (n = 5) areas of Riyadh province, selected on the classification of the population density of the governorates. An adapted version of the NHS National Survey Programme was administered that included 50 questions over 11 sections that assessed a wide range of factors related to respondent's access and experience of the PHCS. A total of 935 responses were obtained with 52.9% (n = 495) from urban areas and the remaining 47.1% (n = 440) from rural areas of Riyadh province.

RESULTS

This study highlights that there are high levels of satisfaction among patients among all PHCS. In relation to differences between urban and rural respondents, the findings indicated that there were significant variations in relation to: education level, monthly income, medical investigations, receiving blood tests on time, extra opening hours, distance, cleanliness and health prevention. Core barriers for rural patients related to the distance to reach PHCS, cleanliness of the PHCS, receiving health prevention and promotion services, which should serve to improve health outcomes.

CONCLUSIONS

This study highlighted important differences in access to and utilisation of PHCS between urban and rural populations in Riyadh province in the KSA. These findings have implications for policy and planning of PHCCs and reducing inequalities in health care between rural and urban populations and contributing to a reduction in the chronic disease burden in Riyadh province.

Not all unprofessional behaviors are equal: The creation of a checklist of bad behaviors

INTRODUCTION

Professionalism is a key component of medical education and training. However, there are few tools to aid educators in diagnosing unprofessional behavior at an early stage. The purpose of this study was to employ policy capturing methodology to develop two empirically validated checklists for identifying professionalism issues in early-career physicians.

METHOD

In a series of workshops, a professionalism competency model containing 74 positive and 70 negative professionalism behaviors was developed and validated. Subsequently, 23 subject matter experts indicated their level of concern if each negative behavior occurred 1, 2, 3, 4, or 5 or more times during a six-month period. These ratings were used to create a "brief" and "extended" professionalism checklist for monitoring physician misconduct.

RESULTS

This study confirmed the subjective impression that some unprofessional behaviors are more egregious than others. Fourteen negative behaviors (e.g. displaying obvious signs of substance abuse) were judged to be concerning if they occurred only once, whereas many others (e.g. arriving late for conferences) were judged to be concerning only when they occurred repeatedly.

DISCUSSION

Medical educators can use the professionalism checklists developed in this study to aid in the early identification and subsequent remediation of unprofessional behavior in medical students and residents.

A preliminary study of Patient Dignity Inventory validation among patients hospitalized in an acute psychiatric ward

PURPOSE

To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI), which had been first validated in oncologic field among terminally ill patients.

PATIENTS AND METHODS

After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town), who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for <72 hours. We collected the demographic and clinical variables of our sample (n=135). We statistically analyzed PDI scores, performing Cronbach's alpha coefficient and principal factor analysis, followed by orthogonal and oblique rotation. We concomitantly administered to our sample other scales (Hamilton Rating Scales for Depression and Anxiety, Global Assessment of Functioning and Health of the Nation Outcome Scales) to analyze the PDI concurrent validity.

RESULTS

With a response rate of 93%, we obtained a mean PDI score of 48.27 (±19.59 SD) with excellent internal consistency (Cronbach's alpha coefficient =0.93). The factorial analysis showed the following three factors with eigenvalue >1 (Kaiser's criterion), which explained >80% of total variance with good internal consistency: 1) "Loss of self-identity and social role", 2) "Anxiety and uncertainty for future" and 3) "Loss of personal autonomy". The PDI and the three-factor scores were statistically significantly positively correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores.

CONCLUSION

Our preliminary research suggests that PDI can be a reliable tool to assess patients' dignity perception in a psychiatric setting, until now little investigated, helping professionals to improve quality of care and patients to accept treatments.

Provider and Consumer Behaviors and their Interaction for Measuring Person-Centered Care

BACKGROUND

Current research has found that higher rates of person-centered care (PCC) are associated with greater treatment adherence and positive treatment outcomes. However, the instruments used to access PCC primarily collect data on provider behavior, rather than consumer participation in PCC, despite the necessary co-equal and collaborative nature of PCC interactions.

OBJECTIVES

The objective of the current study was to test the hypotheses that: (1) the Perceived Involvement in Care Scale (PICS) consumer information subscale and the consumer decision making subscale are not correlated with the PPPC subscales and, (2) consumer perceptions of person-centeredness and of consumer involvement in care are significant independent explanatory variables for the theoretically or quantitatively grounded outcomes of therapeutic alliance, treatment adherence, and mental health care system mistrust.

METHODS

Cross-sectional survey data was collected from 82 mental health care consumers receiving services at two Veterans Health Administration (VHA) facilities. Participants completed surveys on perceptions of PCC, consumer involvement in care, therapeutic alliance, medication adherence, and mental health care system mistrust.

RESULTS

Significant correlation between the consumer participation and PCC subscales was mixed. Higher levels of PCC were associated with greater therapeutic alliance, less suspicion of mental health care systems, less perception of lack of support from providers, and less beliefs about group disparities in care. Consumer involvement was only significantly related to suspicion of mental health care systems.

DISCUSSION AND CONCLUSIONS

These findings may be a function of the locus of each outcome variable. When conducting PCC research investigators should consider how the outcomes they are examining inform the method through which they measure patient-centeredness.

The Family Navigator: A Pilot Intervention to Support Intensive Care Unit Family Surrogates

BACKGROUND

Communication problems between family surrogates and intensive care unit (ICU) clinicians have been documented, but few interventions are effective. Nurses have the potential to play an expanded role in ICU communication and decision making.

OBJECTIVES

To conduct a pilot randomized controlled trial of the family navigator (FN), a distinct nursing role to address family members' unmet communication needs early in an ICU stay.

METHODS

An interprofessional team developed the FN protocol. A randomized controlled pilot intervention trial of the FN was performed in a tertiary referral hospital's ICU to test the feasibility and acceptability of the intervention. The intervention addressed informational and emotional communication needs through daily contact by using structured clinical updates, emotional and informational support modules, family meeting support, and follow-up phone calls.

RESULTS

Twenty-six surrogate/patient pairs (13 per study arm) were enrolled. Surrogates randomized to the intervention had contact with the FN on 90% or more of eligible patient days. All surrogates agreed that they would recom mend the FN to other families. Open-ended comments from both surrogates and clinicians were uniformly positive.

CONCLUSIONS

Having a fully integrated nurse empowered to facilitate decision making is a feasible intervention in an ICU and is well-received by ICU families and staff. A larger randomized controlled trial is needed to demonstrate impact on important outcomes, such as surrogates' well-being and decision quality.

Racial Centrality and Health Care Use Among African American Adults With Sickle Cell Disease

The present study examined an exploratory model of the confluence of racial centrality, pain, psychological variables, and health care use in a sample of African American adults with sickle cell disease. Significant path coefficients were observed between pain severity, perceived stress, and psychological symptoms. The model yielded direct effects for paths to health care use from pain frequency and racial centrality—indicating that participants who reported more frequent pain episodes tended to use more health care services and those who endorsed a highly central African American identity utilized fewer health care services. Generally, these findings suggest a need for expanded thinking about determinants of health care use in this population beyond psychological and physiological variables. These findings support a rationale for further exploring the sociocultural context of sickle cell and highlight a specific need for better understanding the complex relationships among multidimensional aspects of racial identity and health care use.

Measuring patient satisfaction in complex continuing care/rehabilitation care

Purpose

To develop a psychometrically validated survey to assess satisfaction in complex continuing care/rehabilitation patients.

Design/methodology/approach

A paper or computer-based survey was administered to 252 complex continuing care/ rehabilitation patients (i.e., post-acute hospital care setting for people who require ongoing care before returning home) across two hospitals in Toronto, Ontario, Canada.

Findings

Using factor analysis, five domains were identified with loadings above 0.4 for all but one item. Behavioral intention and information/communication showed the lowest patient satisfaction, while patient centredness the highest. Each domain correlated positively and significantly predicted overall satisfaction, with quality and safety showing the strongest predictive power and the healing environment the weakest. Gender made a significant contribution to predicting overall satisfaction, but age did not.

Research limitations/implications

Results provide evidence of the survey’s psychometric properties. Owing to a small sample, supplemental testing with a larger patient-group is required to confirm the five-factor structure and to assess test-retest reliability.

Originality/value

Improving the health system requires integrating patient perspectives. The patient experience, however, will vary depending on the population being served. This is the first psychometrically validated survey specific to a smaller speciality patient group receiving care at a complex continuing care/rehabilitation facility in Canada.

Respecting patients is associated with more patient-centered communication behaviors in clinical encounters

OBJECTIVE

Attitudes towards patients may influence how clinicians interact. We investigated whether respect for patients was associated with communication behaviors during HIV care encounters.

METHODS

We analyzed audio-recordings of visits between 413 adult HIV-infected patients and 45 primary HIV care providers. The independent variable was clinician-reported respect for the patient and outcomes were clinician and patient communication behaviors assessed by the Roter Interaction Analysis System (RIAS). We performed negative binomial regressions for counts outcomes and linear regressions for global outcomes.

RESULTS

When clinicians had higher respect for a patient, they engaged in more rapport-building, social chitchat, and positive talk. Patients of clinicians with higher respect for them engaged in more rapport-building, social chitchat, positive talk, and gave more psychosocial information. Encounters between patients and clinicians with higher respect for them had more positive clinician emotional tone [regression coefficient 2.97 (1.92-4.59)], more positive patient emotional tone [2.71 (1.75-4.21)], less clinician verbal dominance [0.81 (0.68-0.96)] and more patient-centeredness [1.28 (1.09-1.51)].

CONCLUSIONS

Respect is associated with positive and patient-centered communication behaviors during encounters.

PRACTICE IMPLICATIONS

Clinicians should be mindful of their respectful attitudes and work to foster positive regard for patients. Educators should consider methods to enhance trainees' respect in communication skills training.

Facilitators and Threats to the Patient Dignity in Hospitalized Patients with Heart Diseases: A Qualitative Study

BACKGROUND

Patient's dignity is an important issue which is highlighted in nursing It is an issue that is highly dependent on context and culture. Heart disease is the most common disease in Iran and the world. Identification of facilitator and threatening patient dignity in heart patients is vital. This study aimed to explore facilitator and threatening patient dignity in hospitalized patients with heart disease.

METHODS

This qualitative content analysis study was performed in 2014 in Kerman, Iran. 20 patients admitted to coronary care units and 5 personnel were selected using purposeful sampling in semi-structured and in depth interviews. Researchers also used documentation and field notes until data saturation. Qualitative data analysis was done constantly and simultaneously with data collection.

RESULTS

Three central themes emerged: a) Care context which includes human environment and physical environment, b) Holistic safe care including meeting the needs of patients both in the hospital and after discharge, c) Creating a sense of security and an effective relationship between patient and nurse, including a respectful relationship and account the family in health team.

CONCLUSION

The results of this study showed that care context is important for patient dignity as well as physical environment and safe holistic care.

Intelligent Emergency Department: Validation of Sociometers to Study Workload

Sociometers are wearable sensors that continuously measure body movements, interactions, and speech. The purpose of this study is to test sociometers in a smart environment in a live clinical setting, to assess their reliability in capturing and quantifying data. The long-term goal of this work is to create an intelligent emergency department that captures real-time human interactions using sociometers to sense current system dynamics, predict future state, and continuously learn to enable the highest levels of emergency care delivery. Ten actors wore the devices during five simulated scenarios in the emergency care wards at a large non-profit medical institution. For each scenario, actors recited prewritten or structured dialogue while independent variables, e.g., distance, angle, obstructions, speech behavior, were independently controlled. Data streams from the sociometers were compared to gold standard video and audio data captured by two ward and hallway cameras. Sociometers distinguished body movement differences in mean angular velocity between individuals sitting, standing, walking intermittently, and walking continuously. Face-to-face (F2F) interactions were not detected when individuals were offset by 30°, 60°, and 180° angles. Under ideal F2F conditions, interactions were detected 50 % of the time (4/8 actor pairs). Proximity between individuals was detected for 13/15 actor pairs. Devices underestimated the mean duration of speech by 30-44 s, but were effective at distinguishing the dominant speaker. The results inform engineers to refine sociometers and provide health system researchers a tool for quantifying the dynamics and behaviors in complex and unpredictable healthcare environments such as emergency care.

Psychometric Properties of the Spanish Adaptation of the Health Care Communication Questionnaire (HCCQ)

This study’s aim is to adapt the Health Care Communication Questionnaire in a Spanish sample, and then test the psychometric properties of the adapted instrument. To do so, the questionnaire was adapted for the Spanish context and then applied in a pilot study as well as a final study. The final sample consisted of 200 patients at Morales Meseguer Hospital in Murcia, Spain. The results show that this adaptation’s psychometric properties were similar to those of the original questionnaire. As for item analysis, all items obtained discriminant indices > .30. Confirmatory factor analysis revealed the same structure as that of the original questionnaire (χ2/df = 1.345; CFI = .983; IFI = .983; TLI = .977; RMSEA = .042), with indices reflecting adequate goodness of fit. Also, results from the analysis of each dimension’s internal consistency had coefficients between .71 and .86. We conclude that the Spanish version of the HCCQ has adequate psychometric properties, is useful, and will serve its purpose in the context in which it will be used.

The Impact of Patient Participation in Health Decisions Within Medical Encounters

Background: Although there are compelling moral arguments for patient participation in medical decisions, the link to health outcomes has not been systematically explored. Objective: Assess the extent to which patient participation in decision making within medical encounters is associated with measured patient outcomes. Methods: We conducted a primary search in PubMed—excluding non-English and animal studies—for articles on decision making in the context of the physician–patient relationship published through the end of February 2015, using the MeSH headings (Physician-Patient Relations [MeSH] OR Patient Participation [MeSH]) and the terms (decision OR decisions OR option OR options OR choice OR choices OR alternative OR alternatives) in the title or abstract. We also conducted a secondary search of references in all articles that met the inclusion criteria. Results: A thorough search process yielded 116 articles for final analysis. There was wide variation in study design, as well as measurement of patient participation and outcomes, among the studies. Eleven of the 116 studies were randomized controlled trials (RCTs). Interventions increased patient involvement in 10 (91%) of the 11 RCTs. At least one positive outcome was detected in 5 (50%) of the 10 RCTs reporting increased participation; the ratio of positive results among all outcome variables measured in these studies was much smaller. Although proportions differed, similar patterns were found across the 105 nonrandomized studies. Conclusions: Very few RCTs in the field have measures of participation in decision making and at least one health outcome. Moreover, extant studies exhibit little consistency in measurement of these variables, and results are mixed. There is a great need for well-designed, reproducible research on clinically relevant outcomes of patient participation in medical decisions.

Patient-centred care in established rheumatoid arthritis

Review of the evidence on patient-centred care (PCC) in rheumatoid arthritis (RA) shows that involving the patient as an individual - with unique needs, concerns and preferences - has a relevant impact on treatment outcomes (safety, effectiveness and costs). This approach empowers patients to take personal responsibility for their treatment. Because clinicians are only able to interact personally with their patients just a few hours per year, patients with a chronic condition such as RA should be actively involved in the management of their disease. To stimulate this active role, five different PCC activities can be distinguished: (1) patient education, (2) patient involvement/shared decision-making, (3) patient empowerment/self-management, (4) involvement of family and friends and (5) physical and emotional support. This article reviews the existing knowledge on these five PCC activities in the context of established RA management, especially focused on opportunities to increase medication adherence in established RA.

Evaluating Intention and Effect

Objective:

This post occupancy evaluation (POE) assessed the impact of architectural design on psychosocial well-being among patients and staff in the context of a new complex continuing care and rehabilitation facility.

Background:

Departing from typical POEs, the hospital design intentions formed the theoretical basis to assess outcomes. Intentions included creating an environment of wellness; enhancing connection to the community, the city, and nature; enhancing opportunities for social interaction; and inspiring activity.

Methods:

A pretest–posttest quasi experiment, including quantitative surveys, assessed the impact of the building design on well-being outcomes across three facilities—the new hospital, the former hospital, and a comparison facility with a similar population.

Results:

With the exception of connection to neighborhood (for patients) and opportunities to visit with others (for staff) and wayfinding (for patients and staff), impressions of the new hospital mirrored the design intentions relative to the former hospital and the comparison facility among patients and staff. Perceptions of improvement in mental health, self-efficacy in mobility, satisfaction, and interprofessional interactions were enhanced at the new hospital relative to the former hospital, whereas optimism, depressive symptoms, general well-being, burnout, and intention to quit did not vary. Interestingly, patients and staff with favorable impressions of the building design fared better on most well-being-related outcomes relative to those with less favorable impressions.

Conclusions:

Beyond the value of assessing the impact of the design intentions on outcomes, the approach used in this study would benefit evaluation strategies across a diversity of health and other public and large-scale buildings.

Preliminary validation of a scale to measure patient perceived similarity to their navigator

Objective

A central premise in deployment of community health workers (CHW) is that CHWs share key characteristics with their patients. We sought to develop a scale to measure this construct called the Perceived Navigator Similarity (PNS) questionnaire.

Methods

We adopted items from a similarly developed scale, patient perceived similarity to their physicians, and examined its psychometric properties among 51 patients who were navigated for cancer care by a CHW.

Results

Principal component analysis revealed two main factors: personal and ethnic. The scale was associated with greater satisfaction with navigation (p < 0.005) and cancer care (p < 0.05).

Conclusion

The PNS shows promise for further validation in larger samples assessing navigator-patient similarity from the patient perspective.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-015-1341-3) contains supplementary material, which is available to authorized users.

Nurses' views of shortcomings in patent care encounters in one hospital in Sweden

AIM AND OBJECTIVE

To describe nurses' views of shortcomings in patient care encounters in one hospital in Sweden.

BACKGROUND

Shortcomings in encounters in healthcare have increased during recent years. Dissatisfaction with encounters in healthcare can affect patients' experiences of dignity, health and well-being.

DESIGN

A qualitative design was used in the study.

METHODS

Three focus group discussions with 15 nurses were conducted. The nurses worked in five different wards. The focus group discussions were subjected to a thematic content analysis.

RESULTS

The results are presented in two themes. The first theme, 'Disregard for the patient's unique nursing needs', describes that information without consideration of the patient's needs, and nurses not being completely present in the meeting with the patient affected healthcare encounters and experiences of quality of care. In the second theme, 'Difficulty managing obstacles', nurses described care situations over which they could not always prevail due to lack of time and/or lack of awareness of the patient's vulnerability.

CONCLUSION

The findings illustrate the importance of nurses and their approaches to patients. The nurse's attitude is important for the patient's experiences of participation, security, dignity, and well-being. The findings also illustrate the importance of routines in the healthcare organisation that support and facilitate positive encounters between patients, their close relatives and the healthcare staff.

RELEVANCE TO CLINICAL PRACTICE

Nurses require understanding, presence and commitment in their relationships to every unique patient, and their goal should be to adopt interventions with regard to positive healthcare encounters based on each patient's experiences of good nursing care.

Psychometric properties of the Health Professionals Communication Skills Scale (HP-CSS)

One of the main features of the relationship between health professionals and their patients is that their effects can be measured. To do this, we need instruments that are well built and that have proven their validity and reliability empirically and experimentally. The objective of this study is to analyse the psychometric properties of the Health Professionals Communication Skills Scale (HP-CSS), which evaluates the communication skills that health professionals use to relate to their patients. The sample consisted of 410 health professionals in the region of Murcia, Spain, and 517 in the province of Alicante, Spain. We obtained descriptive statistics and discrimination indices of the items, the internal structure of the scale using both exploratory and confirmatory factor analysis, the internal consistency, the temporal stability, and the external evidence of validity. The results indicate that the HP-CSS is a valid and reliable instrument and is also useful for the purpose and context in which it will be used.

Effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medication regimen (EMPATHy): study protocol for a randomized controlled trial

Background

Low-income, Mexican-American patients with diabetes exhibit high rates of medication nonadherence, poor blood sugar control and serious complications, and often have difficulty communicating their concerns about the medication regimen to physicians. Interventions led by community health workers, non-professional community members who are trained to work with patients to improve engagement and communication during the medical visit, have had mixed success in improving outcomes. The primary objective of this project is to pilot test a prototype software toolkit called “EMPATHy” that a community health worker can administer to help patients identify the most important barriers to adherence that they face and discuss these barriers with their doctor.

Methods/Design

The EMPATHy toolkit will be piloted in an ongoing intervention (Coached Care) in which community health workers are trained to be “coaches” to meet with patients before the medical visit and help them prepare a list of important questions for the doctor. A total of 190 Mexican-American patients with poorly controlled type 2 diabetes will be recruited from December 2014 through June 2015 and will be randomly assigned to complete either a single Coached Care intervention visit with no software tools or a Coached Care visit incorporating the EMPATHy software toolkit. The primary endpoints are (1) the development of a “contextualized plan of care” (i.e., a plan of care that addresses a barrier to medication adherence in the patient’s daily life) with the doctor, determined from an audio recording of the medical visit, and (2) attainment of a concrete behavioral goal set during the intervention session, assessed in a 2-week follow-up phone call to the patient. The statistical analysis will include logistic regression models and is powered to detect a 50% increase in the primary endpoints.

Discussion

The study will provide evidence regarding the effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medications.

Trial registration

ClinicalTrials.gov NCT02324036 Registered 16 December 2014.

Effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medication regimen (EMPATHy): study protocol for a randomized controlled trial

BACKGROUND

Low-income, Mexican-American patients with diabetes exhibit high rates of medication nonadherence, poor blood sugar control and serious complications, and often have difficulty communicating their concerns about the medication regimen to physicians. Interventions led by community health workers, non-professional community members who are trained to work with patients to improve engagement and communication during the medical visit, have had mixed success in improving outcomes. The primary objective of this project is to pilot test a prototype software toolkit called "EMPATHy" that a community health worker can administer to help patients identify the most important barriers to adherence that they face and discuss these barriers with their doctor.

METHODS/DESIGN

The EMPATHy toolkit will be piloted in an ongoing intervention (Coached Care) in which community health workers are trained to be "coaches" to meet with patients before the medical visit and help them prepare a list of important questions for the doctor. A total of 190 Mexican-American patients with poorly controlled type 2 diabetes will be recruited from December 2014 through June 2015 and will be randomly assigned to complete either a single Coached Care intervention visit with no software tools or a Coached Care visit incorporating the EMPATHy software toolkit. The primary endpoints are (1) the development of a "contextualized plan of care" (i.e., a plan of care that addresses a barrier to medication adherence in the patient's daily life) with the doctor, determined from an audio recording of the medical visit, and (2) attainment of a concrete behavioral goal set during the intervention session, assessed in a 2-week follow-up phone call to the patient. The statistical analysis will include logistic regression models and is powered to detect a 50% increase in the primary endpoints.

DISCUSSION

The study will provide evidence regarding the effectiveness and feasibility of a software tool to help patients communicate with doctors about problems they face with their medications.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02324036 Registered 16 December 2014.

A novel analytical strategy for patient-physician communication research: the one-with-many design

OBJECTIVE

We aimed to demonstrate how a novel analytic strategy - the one-with-many (OWM) design - can provide unique information about patient-physician communication that cannot be obtained using traditional analytic strategies.

METHODS

Using an OWM design we conducted a secondary analysis of behavioral (talk time) and self-reported (perceived teamness) data from a study of patient-physician communication, and examined variance decompositions of these variables.

RESULTS

Talk time was largely relational, suggesting that there is no behavioral consistency on the part of physicians across patients or behavioral similarity among patients who see the same physician. In contrast, there was significant actor variance in perceived teamness, suggesting that some physicians consistently reported higher teamness with their patients than others. However, those physicians' positive perceptions of the communication are not necessarily reciprocated by their patients.

CONCLUSIONS

OWM design provides researchers with the opportunity to take full advantage of rich non-independent data and explore interesting communication patterns (e.g., behavioral continuity, similarity, reciprocity unique to specific dyads) that have been omitted in prior literature.

PRACTICAL IMPLICATIONS

OWM can be used to determine the relative differences in how patients and physicians influence communication patterns and identify which aspects of physician-patient communication are relational and which are not.

Barriers to care and comorbidities along the U.S.-Mexico border

OBJECTIVE

While limited access to care is associated with adverse health conditions, little research has investigated the association between barriers to care and having multiple health conditions (comorbidities). We compared the financial, structural, and cognitive barriers to care between Mexican-American border residents with and without comorbidities.

METHODS

We conducted a stratified, two-stage, randomized, cross-sectional health survey in 2009-2010 among 1,002 Mexican-American households. Measures included demographic characteristics; financial, structural, and cognitive barriers to health care; and prevalence of health conditions.

RESULTS

Comorbidities, most frequently cardiovascular and metabolic conditions, were reported by 37.7% of participants. Controlling for demographics, income, and health insurance, six financial barriers, including direct measures of inability to pay for medical costs, were associated with having comorbidities (odds ratios [ORs] ranged from 1.7 to 4.1, p<0.05). The structural barrier of transportation (OR=3.65, 95% confidence interval [CI] 1.91, 6.97, p<0.001) was also associated with higher odds of comorbidities, as were cognitive barriers of difficulty understanding medical information (OR=1.71, 95% CI 1.10, 2.66, p=0.017), being confused about arrangements (OR=1.82, 95% CI 1.04, 3.21, p=0.037), and not being treated with respect in medical settings (OR=1.63, 95% CI 1.05, 2.53, p=0.028). When restricting analyses to participants with at least one health condition (comparing one condition vs. having ≥ 2 comorbid conditions), associations were maintained for financial and transportation barriers but not for cognitive barriers.

CONCLUSION

A substantial proportion of adults reported comorbidities. Given the greater burden of barriers to medical care among people with comorbidities, interventions addressing these barriers present an important avenue for research and practice among Mexican-American border residents.

Respect in final-year student nurse-patient encounters - an interpretative phenomenological analysis

Very little is known regarding health-care professionals' understanding and experiences of respect towards patients. The study aimed to explore student nurses' understanding and experiences of respect in their encounters with patients. Semi-structured interviews were conducted with eight final-year student nurses with practice placements across different health-care trusts in the UK. Transcripts were analysed using interpretative phenomenological analysis (IPA). Three super-ordinate themes were identified: understanding of what it means to show respect, negotiating role expectations and personal attitudes in practice, and barriers related to the performance of the nursing role. The factors identified should be investigated further and addressed as they are likely to influence patients' experiences of feeling respected in nurse–patient interactions and subsequently their well-being and health-related behaviours.

The relationship between hospital patients' ratings of quality of care and communication

OBJECTIVE

To assess the relationship between hospital patients' quality of care ratings and their experiences with health-related information exchanges and communication during hospitalization.

DESIGN

Cross-sectional multivariate dimensional analysis of data from a quality of care experience questionnaire of hospital patients comparing scores across three levels of reported satisfaction.

SETTING AND PARTICIPANTS

Five thousand nine hundred and fifty-two patients from a Swiss University Hospital responded to the questionnaire at discharge during 2010.

MAIN OUTCOME MEASURES

Survey questions measuring patients' evaluation of quality of care, patient loyalty and overall satisfaction.

RESULTS

Different levels of reported satisfaction are associated with differing experiences of health-related information and communication during a hospital stay.

CONCLUSIONS

Patients who report lower satisfaction appear to attribute to the hospital staff enduring negative dispositions from behaviours that may be due to specific situational contexts. Negative experiences appear to influence scores on most other communication and information domains. Patients who report higher satisfaction, in contrast, appear to differentiate negative experiences and positive experiences and they appear to relativize and compartmentalize negative experiences associated with their hospital stay.