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Evered J, Andersen L, Foxwell A, Iroegbu C, Whitney C. Clinician-Patient Relationships in Virtual Care: A Dimensional Analysis of the Symbolic World of Cancer Care. QUALITATIVE HEALTH RESEARCH 2023; 33:284-296. [PMID: 36718991 DOI: 10.1177/10497323231153793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Rapid uptake of telehealth technologies has shifted clinician-patient relationships, a well-studied topic of sociological inquiry. The purpose of this dimensional analysis study was to understand the symbolic interaction of clinicians and patients within virtual supportive cancer care. Seventeen clinicians, eighteen patients, and three care partners receiving or providing care at a multi-site cancer center in the United States participated in interviews. Our analysis of supportive cancer care experiences reveals a key tension: clinicians need to rely on patients in order to share clinical tasks in a virtual care setting but can be reluctant to do so. We posit that dimming the light on cancer is a process that enables clinicians to overcome their reluctance to engage in clinician-patient task sharing by strengthening the relationship. Taken together, these findings reconceptualize the symbolic interaction of the clinician-patient relationship and highlight opportunities to actualize models of relationship-centered virtual care. We discuss implications for clinical practice, ethical relational care, and the literature on clinician-patient relationships and trust.
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Affiliation(s)
- Jane Evered
- 16142University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- 5228University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Lucy Andersen
- 16142University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Anessa Foxwell
- 16142University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Christin Iroegbu
- 16142University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Clare Whitney
- 16142University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- 16038Stony Brook University School of Nursing, Stony Brook, NY, USA
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Hamid SA, Begum A, Azim MR, Islam MS. Doctor-patient relationship: Evidence from Bangladesh. Health Sci Rep 2021; 4:e394. [PMID: 34622027 PMCID: PMC8485595 DOI: 10.1002/hsr2.394] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS This study analyses the nature and magnitude of the doctor-patient relationship in Bangladesh, intending to trigger policy discussions for improving healthcare quality. The dearth of research on the nature and degree of this relationship in Bangladesh as well as the global context motivates us to conduct this study. METHOD We use primary data from three different surveys conducted during July to October 2018. The study conducts a public perception survey on 701 individuals at various public places in Dhaka City. In addition, we interview 100 exit-patients from two major public hospitals, four for-profit-private hospitals, and one not-for-profit private hospital in Dhaka City. We also interview a total of 62 doctors of different ladders. Each survey uses a structured questionnaire with a set of questions customized in the Bangladesh context. RESULTS The score of the doctor-patient relationship is found quite low from the viewpoint of the public, the patients, and the doctors. However, the score is comparatively high from the doctor's point of view. The results show that lack of optimum time allocation for the patients, not explaining the prescription clearly, and discriminating the patients by their social status are the main factors for a poor relationship with doctors. CONCLUSIONS The doctor-patient relationship is substantially poor from the public, patients, and the doctors' viewpoints. Orienting the doctors to non-therapeutic care (ie, respectful behavior, privacy, dignity, prompt attention, clear communication) in all levels of medical education and training, and improving working conditions of the hospitals are the crucial policy implications.
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Affiliation(s)
- Syed Abdul Hamid
- Research Division Institute of Health Economics, University of Dhaka Dhaka Bangladesh
- Research Division Universal Research Care Ltd Dhaka Bangladesh
| | - Afroza Begum
- Department of Statistics University of Chittagong Chittagong Bangladesh
| | - Md Ragaul Azim
- Research Division Institute of Health Economics, University of Dhaka Dhaka Bangladesh
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Thomas T, Althouse A, Sigler L, Arnold R, Chu E, White DB, Rosenzweig M, Smith K, Smith TJ, Schenker Y. Stronger therapeutic alliance is associated with better quality of life among patients with advanced cancer. Psychooncology 2021; 30:1086-1094. [PMID: 33547717 DOI: 10.1002/pon.5648] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patient-oncologist therapeutic alliance is a foundation of quality cancer care, although there is limited research demonstrating its relationship with patient outcomes. We investigated the relationship between therapeutic alliance and patient quality of life with a secondary goal of determining whether the association varied by patients' baseline level of psychological distress. METHODS Cross-sectional analysis of baseline data from a randomized clinical trial of 672 patients with advanced cancer participating in a primary palliative care intervention trial. Patients completed baseline self-reported measures of therapeutic alliance (The Human Connection Scale, range: 16-64), overall quality of life (Functional Assessment of Cancer Therapy-Palliative Care, range: 0-184), and psychological distress (Hospital Anxiety and Depression Scale, range: 0-42). First, we determined the relationship between therapeutic alliance and quality of life using multivariable regression adjusting for confounders. We then examined if psychological distress was an effect modifier in this relationship by adding interaction effects of depression and anxiety symptoms on therapeutic alliance into the regression model. RESULTS Patients reported high levels of therapeutic alliance (56.4 ± 7.4) and moderate quality of life (130.3 ± 25.5). Stronger therapeutic alliance was associated with better quality of life after adjusting for other confounding factors (β = 3.7, 95% confidence interval = 2.1, 5.3, p < 0.01). The relationship between therapeutic alliance and quality of life was generally consistent regardless of psychological distress. CONCLUSIONS Collaborative, trusting relationships between patients with advanced cancer and their oncologists are associated with better patient quality of life. Future research should investigate the causal, longitudinal nature of these relationships.
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Affiliation(s)
- Teresa Thomas
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew Althouse
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lauren Sigler
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Arnold
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Edward Chu
- Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Douglas B White
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, Program on Ethics and Decision Making in Critical Illness, The CRISMA Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Margaret Rosenzweig
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth Smith
- Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Thomas J Smith
- Department of Medicine Section of General Internal Medicine, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Yael Schenker
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Palmer Kelly E, Meara A, Hyer M, Payne N, Pawlik TM. Characterizing Perceptions Around the Patient-Oncologist Relationship: a Qualitative Focus Group Analysis. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:447-453. [PMID: 30772927 DOI: 10.1007/s13187-019-1481-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of the current study was to characterize the experiences of cancer patients and their caregiver/family members around their relationship with their oncologist, health care team, and the hospital environment. Participants were recruited from The Ohio State University Comprehensive Cancer Center. Participant sociodemographic factors were assessed. Focus groups were moderated and recorded by two members of the research team using a semi-structured interview format. The audio recordings were transcribed and uploaded to NViVO 11 for analyses. Four focus groups were conducted with 25 participants. The mean age of participants was 58.4 years (SD = 15.1, range 26.0-76.0). Participants who were identified as patients (84%) reported different malignancy types including breast (56%), gynecologic (16%), skin (6%) oral (6%), and non-Hodgkin's lymphoma (6%). Three major themes that emerged around the patient-oncologist relationship, include (1) choosing a physician and health care location, (2) relationship with the physician, health care team, and hospital environment; and (3) patient engagement and decision-making. Subthemes highlighted the importance of the flexible communication behaviors and trustworthiness of the oncologist, and the impact of other health care team members. Patients also reported the desire to be engaged in making treatment-related decisions and to include the caregiver/spouse in all stages of cancer care. Understanding the experience of cancer patients in a relationship with their oncologist in the context of the health care team and health care environment will be an important area of future research to provide optimal, tailored patient-centered cancer care.
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Affiliation(s)
| | - Alexa Meara
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicolette Payne
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Palmer Kelly E, Agne JL, Hyer M, Meara A, Olsen G, Pawlik TM. A systematic review of the methods utilised to measure the relationship between cancer patients and oncologists: Implications for future research and practice. Eur J Cancer Care (Engl) 2018; 28:e12981. [PMID: 30561074 DOI: 10.1111/ecc.12981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/13/2018] [Accepted: 11/18/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The patient-physician relationship is a critical component of patient-centred health care. The patient-oncologist relationship is particularly important due to the uncertainties that surround treatment of cancer. The goal of the current review was to summarise current methodological approaches to studying the relationship between cancer patients and oncologists. METHODS A systematic review using PsychInfo, Ebsco, PubMed and Google Scholar was performed using combinations and variations of the MESH terms: "relationship," "doctor-patient," and "oncology." The included studies explicitly measured the "relationship" as an independent or dependent variable. Data were extracted and analysed. RESULTS The 13 studies included in the review were published from 2004 to 2018. There was little agreement between studies on the definition of the patient-oncologist relationship. Trust was most frequently measured, but methods varied. Most studies evaluated the patient perspective (n = 10). The few studies that considered the oncologist perspective did not measure their perception of the relationship. CONCLUSIONS The current review demonstrates that current approaches used to assess the patient-oncologist relationship are inconsistent. These differences may limit our understanding of patient needs in current research and practice. Future research should focus on the use of a relational lens as a theoretical framework to assess the patient-oncologist relationship.
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Affiliation(s)
| | - Julia L Agne
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alexa Meara
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Griffin Olsen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Kugbey N, Oppong Asante K, Meyer-Weitz A. Doctor–patient relationship mediates the effects of shared decision making on health-related quality of life among women living with breast cancer. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1177/0081246318801159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Decreased quality of life is a major challenge among women living with breast cancer due to treatment effects and other psychosocial comorbidities. However, shared decision making and doctor–patient relationship have been linked to improved quality of life, but the mechanism linking shared decision making and quality of life is poorly understood. This study therefore examined both the direct and indirect influences of shared decision making on quality of life through doctor–patient relationship among 205 women living with breast cancer in Ghana with a mean age of 52.49 years. Using a cross-sectional design, participants were administered questionnaires which measured quality of life, doctor–patient relationship, and shared decision making. Results showed that shared decision making had significant indirect influence on overall quality of life via doctor–patient relationships ( b = 4.69, 95% confidence interval = [0.006, 9.555]). Shared decision making had a significant effect on doctor–patient relationships ( b = 7.63, t = 6.76, p < .001) but no significant direct effect on quality of life ( b = 2.72, t = 0.510, p = .61). Findings suggest that shared decision making results in improved doctor–patient relationships which probably lead to better quality of life among women living with breast cancer. These findings underscore the need for increased patient involvement in medical decisions to improve interpersonal relationships and consequently quality of life.
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Affiliation(s)
- Nuworza Kugbey
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ghana
| | - Kwaku Oppong Asante
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa
- Department of Psychology, School of Social Sciences, University of Ghana, Ghana
| | - Anna Meyer-Weitz
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa
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Dehghan H, Keshtkaran A, Ahmadloo N, Bagheri Z, Hatam N. Patient Involvement in Care and Breast Cancer Patients’ Quality of Life- a Structural Equation Modeling (SEM)
Approach. Asian Pac J Cancer Prev 2018; 19:2511-2517. [PMID: 30256045 PMCID: PMC6249441 DOI: 10.22034/apjcp.2018.19.9.2511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/18/2018] [Indexed: 11/27/2022] Open
Abstract
In cancer patients, improving the quality of life is a basic goal of treatment, with the patient – physician relationship as a major factor. Therefore the aim of this structural equation modeling study was to analyze the influence of patient involvement in care on quality of life in 411 breast cancer patients undergoing outpatient chemotherapy and radiotherapy. Two questionnaires were used: 1-patient-physician questionnaire, 2-EORTC QLQC-30 (to measure QOL). The structural equation model exhibited an excellent data fit (Chi-Square= 31.04 / RMSEA= 0.042), T-values for all paths with the exception of that between patient satisfaction and emotional- cognitive function, were significant. According to the findings, various aspects of the physician-patient relationship are significantly and positively associated with quality of life and increasing patient involvement in care by increasing trust and satisfaction, was associated with marked improvement. The findings of this study emphasized the importance of an effective relationship between doctor and patient as a contributing factor for improving the quality of life. Therefore it is suggested that policymakers and decision-makers active in strategic planning for the health system and physicians responsible for treatment pay more attention to developing and improving relationships with patients as an approach to improving patient outcomes, particularly with reference to quality of life.
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Affiliation(s)
- Hajar Dehghan
- Students Research Committee, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Keshtkaran
- Department of Health Service Administration, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Niloofar Ahmadloo
- Department of Radiotherapy and Oncology, school of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bagheri
- Department of Biostatistics, school of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Hatam
- Department of Health Service Administration, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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Ernstmann N, Wirtz M, Nitzsche A, Gross SE, Ansmann L, Gloede TD, Jung J, Pfaff H, Baumann W, Schmitz S, Neumann M. Patients' Trust in Physician, Patient Enablement, and Health-Related Quality of Life During Colon Cancer Treatment. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:571-579. [PMID: 28110419 DOI: 10.1007/s13187-017-1166-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In cancer care, where patients and their families experience significant emotional distress and patients have to deal with complex medical information, patient centeredness is an important aspect of quality of care. The aim of this study is to examine the impact of patients' trust in their oncologists and patients' enablement on changes in health-related quality of life of colon cancer patients during follow-up care. We conducted a prospective study in a representative sample of private practices of German oncologists (N = 44). Patients (N = 131) filled out a standardized questionnaire prior to their first consultation (T0), directly after the first consultation (T1) and after two months (T2). Data were analyzed by structural equation modeling. Significant associations were found between trust in physician and changes in physical functioning between T1 and T2, and between trust in physician and patient enablement. Patient enablement is significantly associated with changes in physical functioning between T1 and T2. The results underline the importance of building a close and trustful patient-physician relationship in the oncology encounter. A central mechanism of the association between the quality of the relationship and health outcomes seems to be patient enablement. To enable patients to cope with their situation by making them understand their diagnosis, treatments, and side effects can impact health-related quality of life in physical domains.
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Affiliation(s)
- Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Markus Wirtz
- Department for Research Methodology, University of Education, Kunzenweg 21, 79117, Freiburg, Germany
| | - Anika Nitzsche
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Sophie E Gross
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Lena Ansmann
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Tristan D Gloede
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Julia Jung
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Eupener Strasse 129, 50933, Cologne, Germany
| | - Walter Baumann
- Scientific Institute of Office-Based Haematologists and Oncologists, WINHO , Vor den Siebenburgen 2, 50676, Cologne, Germany
| | - Stephan Schmitz
- Professional Organization of Office-Based Haematologists and Oncologists e.V. (BNHO), Sachsenring 69, 50677, Cologne, Germany
| | - Melanie Neumann
- Institute for Integrative Medicine, Department for Psychology/Psychotherapy, Department for Medicine, Faculty of Health, Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany
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Arraras JI, Wintner LM, Sztankay M, Tomaszewski KA, Hofmeister D, Costantini A, Bredart A, Young T, Kuljanic K, Tomaszewska IM, Kontogianni M, Chie WC, Kulis D, Greimel E. EORTC QLQ-COMU26: a questionnaire for the assessment of communication between patients and professionals. Phase III of the module development in ten countries. Support Care Cancer 2016; 25:1485-1494. [DOI: 10.1007/s00520-016-3536-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/05/2016] [Indexed: 11/29/2022]
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Brzoska P, Sauzet O, Yilmaz-Aslan Y, Widera T, Razum O. Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study. BMC Health Serv Res 2016; 16:105. [PMID: 27020703 PMCID: PMC4810526 DOI: 10.1186/s12913-016-1348-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/16/2016] [Indexed: 11/11/2022] Open
Abstract
Background In many European countries, foreign nationals experience, on average, less favorable treatment outcomes in rehabilitative care than the respective majority population. In Germany, this for example is reflected in a lower occupational performance and a higher risk of disability retirement after rehabilitation as analyses of routine data show. However, little is known about the perspective of health care users. The aim of the present study was to compare self-rated treatment outcomes between German and non-German nationals undergoing in-patient medical rehabilitation in Germany. Methods We analyzed data from a cross-sectional representative rehabilitation patient survey of 239,811 patients from 642 clinics in Germany who completed about 3 weeks of in-patient rehabilitative treatment. The self-rating of the treatment outcome was based on a dichotomized Likert scale consisting of three items. A multilevel logistic regression analysis adjusted for various demographic, socio-economic, health and other covariates was conducted to examine differences in the self-rated treatment outcome between German and non-German nationals. Results Of the 239,811 respondents 0.9 % were nationals from Turkey, 0.8 % had a nationality from a former Yugoslavian country, 0.9 % held a nationality from the South European countries Portugal, Spain, Italy or Greece and 1.9 % were nationals from other countries. Non-German nationals reported a less favorable self-rated outcome than Germans. Adjusted odds ratios [OR] for reporting a less favorable treatment outcome were 1.24 (95 %-confidence interval [95 %-CI]: 1.12–1.37) for nationals from the South European countries Portugal/Spain/Italy/Greece, 1.62 (95 %-CI: 1.45–1.80) for Turkish nationals and 1.68 (95 %-CI: 1.52–1.85) for nationals from Former Yugoslavia. Conclusions Knowledge on health outcomes from the patients’ point of view is important for the provision of patient-centered health care. Our study showed that non-German nationals report less favorable outcomes of rehabilitative care than Germans. This may be due to cultural and religious needs not sufficiently addressed by health care providers. In order to improve rehabilitative care for non-German nationals, rehabilitative services must become sensitive to the needs of this population group. Diversity management can contribute to this process.
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Affiliation(s)
- P Brzoska
- Department of Epidemiology & International Public Health, Bielefeld University, School of Public Health, Bielefeld, Germany. .,Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Institute of Sociology, Chemnitz, Germany.
| | - O Sauzet
- Department of Epidemiology & International Public Health, Bielefeld University, School of Public Health, Bielefeld, Germany
| | - Y Yilmaz-Aslan
- Department of Epidemiology & International Public Health, Bielefeld University, School of Public Health, Bielefeld, Germany.,Department of Public Health, Giresun University, Faculty of Medicine, Giresun, Turkey
| | - T Widera
- German Statutory Pension Insurance Scheme, Social Medicine and Rehabilitation, Section Rehabilitation Research (Deutsche Rentenversicherung Bund, Geschäftsbereich Sozialmedizin und Rehabilitation, Bereich Reha-Wissenschaften), Berlin, Germany
| | - O Razum
- Department of Epidemiology & International Public Health, Bielefeld University, School of Public Health, Bielefeld, Germany
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Quality of Life and Volume Reduction in Women with Secondary Lymphoedema Related to Breast Cancer. Int J Breast Cancer 2015; 2015:586827. [PMID: 26843988 PMCID: PMC4710936 DOI: 10.1155/2015/586827] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/24/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To assess the quality of life (QOL) as a predictor of volume reduction in women undergoing complex physical therapy (CPT) for lymphoedema following breast cancer. Methods. Clinical trial in 57 women undergoing CPT. Results. At baseline, in measuring quality of life for the EORTC QLQ-C30 questionnaire subscale of functionality, the worst scores for emotional function (55 points) and better social function (89 points) were observed. The symptom scales showed the worst pain averaged (66 points). The overall quality of life showed a low score (40 points). In the BR 23 module, low scores were observed in the field of future perspective (47 points). After treatment of lymphoedema, absolute reduction of excess volume between the upper limbs of 282 mL was observed, representing a reduction of 15%. No association was observed between the domains of quality of life and response to treatment of lymphoedema. Conclusion. This study included 57 women with advanced and chronic lymphoedema in early treatment with CPT and low scores for quality of life. The lymphoedema therapeutic response was not influenced by the QOL at the beginning of treatment.
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12
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Farin E. The reciprocal effect of pain catastrophizing and satisfaction with participation in the multidisciplinary treatment of patients with chronic back pain. Health Qual Life Outcomes 2015; 13:163. [PMID: 26420426 PMCID: PMC4588313 DOI: 10.1186/s12955-015-0359-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/21/2015] [Indexed: 12/15/2022] Open
Abstract
Background The aim of the study was to examine the reciprocity between pain catastrophizing, social participation and quality of life outcomes (pain intensity, pain disability, negative affectivity) in patients with low back pain in a multidisciplinary pain treatment. Methods Patients undergoing inpatient rehabilitation were surveyed at the beginning and two weeks after the end of rehabilitation. N = 262 low back pain patients participated (mean age: 52.2, 62.1 % female). A two-wave cross-lagged design and structural equation modeling were used to analyze data. Results We found evidence of reciprocal relations with regard to several outcomes. For example, pain catastrophizing at the beginning of treatment is associated with negative affectivity after rehabilitation, and the post-treatment value of pain catastrophizing is associated with pain disability and satisfaction with participation at the start of treatment. Pain disability and pain catastrophizing are predictors of lower treatment outcome while pain intensity and negative affectivity are not risk factors. Participation stands in a reciprocal relationship with some of the pain treatment outcomes. The surprising result, namely, that those patients more satisfied with social participation experience less improvement regarding catastrophizing, can be explained by ceiling effects and the Communal Coping Model. Conclusions This study provides evidence of the importance of taking reciprocal relations among pain catastrophizing, social participation and other pain outcomes into account. Providers of multidisciplinary pain treatment need to play attention to patients at risk with high disability and catastrophizing thoughts. Pain treatment would benefit from closer integration of psychosocial measures to foster social participation.
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Affiliation(s)
- Erik Farin
- Institute for Quality Management and Social Medicine, University of Freiburg - Medical Center, Engelbergerstr. 21, D-79106, Freiburg, Germany.
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Lelorain S, Brédart A, Dolbeault S, Cano A, Bonnaud-Antignac A, Cousson-Gélie F, Sultan S. How does a physician's accurate understanding of a cancer patient's unmet needs contribute to patient perception of physician empathy? PATIENT EDUCATION AND COUNSELING 2015; 98:734-741. [PMID: 25817423 DOI: 10.1016/j.pec.2015.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 02/19/2015] [Accepted: 03/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Unmet supportive care needs of patients decrease patient perception of physician empathy (PE). We explored whether the accurate physician understanding of a given patient's unmet needs (AU), could buffer the adverse effect of these unmet needs on PE. METHODS In a cross-sectional design, 28 physicians and 201 metastatic cancer patients independently assessed the unmet supportive care needs of patients. AU was calculated as the sum of items for which physicians correctly rated the level of patient needs. PE and covariates were assessed using self-reported questionnaires. Multilevel analyses were carried out. RESULTS AU did not directly affect PE but acted as a moderator. When patients were highly expressive and when physicians perceived poor rapport with the patient, a high AU moderated the adverse effect of patient unmet needs on PE. CONCLUSION Physician AU has the power to protect the doctor-patient relationship in spite of high patient unmet needs, but only in certain conditions. PRACTICE IMPLICATIONS Physicians should be encouraged toward AU but warned that high rapport and patient low emotional expression may impede an accurate reading of patients. In this latter case, they should request a formal assessment of their patients' needs.
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Affiliation(s)
- Sophie Lelorain
- Univ Lille Nord de France, Department of Psychology, Lille, France; UDL3, SCALab UMR CNRS 9193, Villeneuve d'Ascq, France.
| | - Anne Brédart
- Institut Curie, Psycho-oncology Unit, Paris, France; Paris Descartes University, LPPS EA 4057-IUPDP, Boulogne-Billancourt, France
| | - Sylvie Dolbeault
- Institut Curie, Psycho-oncology Unit, Paris, France; Inserm, U 669, Paris, France; Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France
| | | | - Angélique Bonnaud-Antignac
- University of Nantes, EA4275 SPHERE 'bioStatistics, Pharmacoepidemiology and Human sciEnces Research', Nantes, France
| | - Florence Cousson-Gélie
- University of Montpellier 3, Laboratory Epsylon 'Dynamics of Human Abilities & Health Behaviors', Montpellier, France; ICM, Institut Régional du Cancer de Montpellier, Epidaure Prevention and Education Cancer Center, Montpellier, France
| | - Serge Sultan
- University of Montreal, Sainte Justine University Hospital Research Center, Montreal, Canada
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Predeger EJ, O'Malley M, Hendrix T, Parker NM. Oncology rehabilitation outcomes over time: a mixed-methods approach. Oncol Nurs Forum 2014; 41:E56-63. [PMID: 24578086 DOI: 10.1188/14.onf.e56-e63] [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: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To evaluate an oncology rehabilitation program over time. DESIGN A cross-sectional, retrospective program evaluation using a mixed-methods approach. SETTING An outpatient oncology rehabilitation program housed in an urban, hospital-based comprehensive cancer center in Alaska. SAMPLE 102 cancer survivors who had completed a 10-week oncology rehabilitation program (mean time since completion was 2.5 years). METHODS Participants completed a mailed, 28-item retrospective survey to collect perceived activity level recalled at various points in time as well as program perceptions. Open-ended questions elicited narrative comments about motivators and barriers. The Medical Outcomes Study (MOS) SF-36® was completed before and after the program. MAIN RESEARCH VARIABLES Health-related quality of life, perceived health status, activity level, motivators, barriers, and program perceptions. FINDINGS A small increase in level of activity from precancer to the current time (postrehabilitation) (z = -3.1, p < 0.01) was reported. Most and least helpful motivators emerged from the narrative data, resulting in the shared interpretation of "I have my life back." CONCLUSIONS Program motivators were effective in helping cancer survivors maintain some increased activity and retain positive perceptions well after the completion of the program. IMPLICATIONS FOR NURSING Survivors who complete a rehabilitation program retain a sense of restoration and caring, and some engage in physical activity over time. Adapting the program based on insights into the survivor perspective may assist oncology rehabilitation clinicians to promote optimum physical activity and sustain healthful change.
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Ullrich A, Hauer J, Farin E. Communication preferences in patients with fibromyalgia syndrome: descriptive results and patient characteristics as predictors. Patient Prefer Adherence 2014; 8:135-45. [PMID: 24520192 PMCID: PMC3917950 DOI: 10.2147/ppa.s53474] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Communication with patients with fibromyalgia syndrome (FMS) is often considered difficult. The primary objective of this explorative study was to describe the communication preferences of FMS patients in comparison with other chronic diseases, and the secondary objective was to identify patient-related predictors of those communication preferences. METHODS A total of 256 FMS patients were asked to fill out the KOPRA [(Kommunikationspraeferenzen), communication preferences of patients with chronic illness] questionnaire at the beginning of their rehabilitation, answering questions about their communication preferences. The KOPRA's descriptive parameters were calculated and compared with other diagnosis groups. In order to include as many influencing factors as possible, data on patient-related sociodemographic, medical, pain impact and psychologic variables were gathered. A hierarchical regression analysis with four steps was performed to identify patient-related predictors of patients' communication preferences. RESULTS FMS patients consider an open and patient-centered communication style to be especially important. Emotionally supportive communication and communication about personal circumstances are important for FMS patients, but the preferences of individual patients vary widely. FMS patients reveal higher values in all the subdimensions of communication preferences compared with patients with low back pain or chronic ischemic heart disease. Only a few variables appear to predict patient communication preferences. The explained variance ranged from 3.1% to 9.7%. Psychologic variables have been identified as predictors in conjunction with all communication preferences. CONCLUSION Health care providers who communicate with FMS patients should employ an open and patient-centered communication style, and affective communication components should be adapted to accommodate each patient.
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Affiliation(s)
- Antje Ullrich
- Medical Center, University of Freiburg, Institute for Quality Management and Social Medicine, Freiburg, Germany
- Correspondence: Antje Ullrich, Medical Center, University of Freiburg, Institute for Quality Management and Social Medicine, Engelbergerstr. 21, D-79106 Freiburg, Germany, Tel +49 761 270 74870, Fax +49 761 270 73310, Email
| | - Johannes Hauer
- Medical Center, University of Freiburg, Institute for Quality Management and Social Medicine, Freiburg, Germany
| | - Erik Farin
- Medical Center, University of Freiburg, Institute for Quality Management and Social Medicine, Freiburg, Germany
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Abstract
BACKGROUND Successful treatment of chronic pain patients can be dependent on successful patient-provider communication. Patient-physician communication for patients with chronic back pain (CBP) has rarely been explored. The current study examines two questions: what is important for CBP patients concerning communication with the healthcare provider and are there interindividual differences in communication preferences dependent on sociodemographic characteristics? METHODS Patient preferences were measured using the KOPRA questionnaire (32 items and 4 scales). The mean age of the 701 participating rehabilitants was 51 years (SD ±11.1 years) of which 60% were women. RESULTS An effective and open communication with the healthcare physician was rated as the most important preference for CBP patients. Gender (depending on the scale: p = 0.01-0.82) and age (p = 0.01-0.12) seemed to influence some preferences in patient-provider communication. CONCLUSION By taking into account individual communication preferences of CBP patients, healthcare providers could purposefully be responsive to these, possibly contributing to a more successful treatment.
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