The Relationship Between the Physician-Patient Relationship, Physician Empathy, and Patient Trust

Counseling lifestyle medicine in oncology: A qualitative analysis of interprofessional patient-nurse-physician interactions

OBJECTIVES

Counseling plays a key role in promoting health behaviors, providing evidence-based information, and supporting patients with cancer during and after treatment. This study aimed to evaluate an interprofessional counseling service on Complementary and Integrative Health (CIH) for patients being treated at Comprehensive Cancer Centers (CCCs) in Southern Germany.

METHODS

Patients participating in the CCC-Integrativ study received three CIH counseling sessions within three months in addition to their conventional cancer treatment. Medical and nursing staff participated in a study-specific blended learning training program before conducting the counseling. As part of the process evaluation, 30 audio-recorded counseling sessions were transcribed verbatim and analyzed by conducting a content analysis using MAXQDA 2020.

RESULTS

Throughout the counseling, patients were conceded to address various health issues, which mainly revolved around symptom management interlaced with the areas of nutrition, exercise, and relaxation. The interprofessional teams conducted the counseling in a structured and patient-oriented manner. They worked together to motivate the patients to apply procedures from the CIH field independently, even if patients sometimes experienced difficulties in implementation.

CONCLUSIONS

Interprofessional collaboration improved healthcare quality, as patients received comprehensive and evidence-based advice on their supportive needs and lifestyle issues. Both professions could equally contribute their areas of knowledge and expertise and apply them to the benefit of the patients.

PRACTICE IMPLICATIONS

Providing an integrative counseling service and adequate training on interpersonal communication and CIH for healthcare professionals will improve patient-centered care.

Patient experience and satisfaction with shared decision-making: A cross-sectional study among outpatients

OBJECTIVES

This study aimed to investigate how doctor-patient communication, trust in doctors impacted patients' experience and satisfaction in shared decision-making (SDM).

METHODS

This study is based on the data from a cross-sectional survey (n = 12,401) conducted in 27 public specialist outpatient clinics in Hong Kong.

RESULTS

The multivariable regression models revealed that doctors' better communication skills were associated with lower decision-making involvement (odd ratio, 0.75 [95 % CI, 0.88-0.94], P < .001) but higher satisfaction with involvement (odd ratio, 6.88 [95 % CI, 5.99-7.93], P < .001). Similarly, longer consultation durations were associated with reduced involvement in decision-making (odd ratio, 0.71 [95 % CI, 0.66-0.73], P < .001) but increased satisfaction with involvement (odd ratio, 1.91 [95 % CI, 1.80-2.04], P < .001). Trust in doctors significantly mediated these associations, except for the association between consultation duration and patients' satisfaction with decision-making involvement.

CONCLUSION

Doctors' better communication skills and longer consultations might not necessarily increase patient involvement in SDM but correlated with increased satisfaction with involvement. Trust in doctors emerged as a mediator for participation and satisfaction in decision-making.

PRACTICE IMPLICATIONS

Clinics should consider patients' preferences and capabilities when tailoring communication strategies about decision-making and optimizing patient satisfaction.

Do patients prefer a human doctor, artificial intelligence, or a blend, and is this preference dependent on medical discipline? Empirical evidence and implications for medical practice

Today the doctor-patient relationship typically takes place in a face-to-face setting. However, with the advent of artificial intelligence (AI) systems, two further interaction scenarios are possible: an AI system supports the doctor's decision regarding diagnosis and/or treatment while interacting with the patient, or an AI system could even substitute the doctor and hence a patient interacts with a chatbot (i.e., a machine) alone. Against this background, we report on an online experiment in which we analyzed data from N = 1,183 people. The data was collected in German-speaking countries (Germany, Austria, Switzerland). The participants were asked to imagine they had been suffering from medical conditions of unknown origin for some time and that they were therefore visiting a health center to seek advice from a doctor. We developed descriptions of patient-doctor interactions (referred to as vignettes), thereby manipulating the patient's interaction partner: (i) human doctor, (ii) human doctor with an AI system, and (iii) an AI system only (i.e., chatbot). Furthermore, we manipulated medical discipline: (i) cardiology, (ii) orthopedics, (iii) dermatology, and (iv) psychiatry. Based on this 3 × 4 experimental within-subjects design, our results indicate that people prefer a human doctor, followed by a human doctor with an AI system, and an AI system alone came in last place. Specifically, based on these 12 hypothetical interaction situations, we found a significant main effect of a patient's interaction partner on trust, distrust, perceived privacy invasion, information disclosure, treatment adherence, and satisfaction. Moreover, perceptions of trust, distrust, and privacy invasion predicted information disclosure, treatment adherence, and satisfaction as a function of interaction partner and medical discipline. We found that the situation in psychiatry is different from the other three disciplines. Specifically, the six outcome variables differed strongly between psychiatry and the three other disciplines in the "human doctor with an AI system" condition, while this effect was not that strong in the other conditions (human doctor, chatbot). These findings have important implications for the use of AI in medical care and in the interaction between patients and their doctors.

What Encourages Patients to Recommend Their Doctor After an Online Medical Consultation? The Influence of Patient-Centered Communication, Trust, and Negative Health Information Seeking Experiences

The doctor-patient relationship in China has become increasingly tense, with patients lacking trust in doctors. Meanwhile, online healthcare flourished, accelerated by the COVID-19 pandemic. This study utilized the direct and indirect pathway model of clinician-patient communication to health outcomes and online trust theory to examine the associations between online patient-centered communication (OPCC), benevolence and ability trust in doctors, negative online health information seeking experiences, and willingness to recommend doctors. The findings revealed that benevolence and ability trust mediated the relationship between OPCC and willingness to recommend doctors. Additionally, when participants had a high level of negative online health information seeking experiences, OPCC had a stronger effect on ability trust; meanwhile, the mediation effect of ability trust between the relationship of OPCC and willingness to recommend was stronger. This study also discussed theoretical and practical implications.

The Influence of Doctor-Patient Communication on Patients' Trust: The Role of Patient-Physician Consistency and Perceived Threat of Disease

Purpose

To investigate the influence mechanism of doctor-patient communication on patients' trust, especially the mediating role of patient-physician consistency and the moderating role of perceived threat of disease.

Methods

A total of 699 patients in Guangzhou, China was investigated by questionnaire. The main effect, mediating effect, and moderating effect of the model was verified by SPSS23.0 and LISREL8.71 statistical software.

Results

It was revealed that doctor-patient communication has a significant positive effect on patients' trust. The consistency between patient and physician partially mediates the relationship between doctor-patient communication and patients' trust. Additionally, the perceived threat of the disease moderates the psychological process through which doctor-patient communication affects patients' trust.

Conclusion

Both doctor-patient communication and patient-physician consistency have predictive effects on patients' trust. Doctor-patient communication is not only a direct influence on patient trust but also an indirect influence mediated by patient-physician consistency. Perceived threat of disease moderates the psychological process through which doctor-patient communication affects patients' trust. Specifically, compared to a high level of perceived threat of disease, a low level of perceived threat of disease can enhance the effect of doctor-patient communication on patients' trust. The results of this study underscore the importance of doctor-patient communication and the value of patient-physician consistency for building patients' trust. To foster a harmonious doctor-patient relationship, medical colleges should place great emphasis on cultivating medical students' communication skills. Hospitals should enhance on-the-job training and provide institutional support for doctors, encourage agreements between doctors and patients regarding disease diagnosis and decision-making, and be attentive to patients' perceived threat of disease, particularly for those with high level of perceived threat of disease.

Concordance in the healthcare context: A concept analysis

Background

The concept of concordance and its usage are indicative of patient-centered healthcare, which encourages an equitable collaboration between patients and clinicians. However, there is a lack of clarity in understanding concordance, and an analysis of this concept is warranted.

Objective

This paper seeks to explore the essence of the concordance concept in the healthcare context.

Methods

Walker and Avant's eight-step method of concept analysis was applied. A literature search was conducted using concordance AND concord as keywords on CINAHL, MEDLINE, PubMed, ProQuest, Cochrane database, and ScienceDirect databases, published between 2006 and 2022.

Results

The attributes of concordance include communication process, therapeutic partnership, and agreement on treatment regimens. Antecedents of concordance comprise provider-patient relationship, patients' beliefs, healthcare providers' characteristics, and complexity of treatment plans. Consequences are improved adherence and compliance, improved clinical outcomes, and better quality of life.

Conclusion

This paper offers clarification of concordance by presenting its antecedents, attributes, and consequences. The findings serve as a basis for developing assessments and nursing interventions to promote patient concordance. Nurses can use the findings to encourage concordance by establishing a trusty relationship during health encounters that respects patients' beliefs and effectively communicating to improve patients' understanding in dealing with complex treatment plans.

Initial Validation of a Patient-Reported Compassion Measure in a Mandarin-Speaking Long-Term Care Patient Population

Background and Purpose: Compassion is increasingly considered essential to quality nursing care and is a concept that is strongly embedded across cultures, including Chinese culture. The Patient Compassion Model (PCM) depicts the unique yet overlapping domains of compassion. The Sinclair Compassion Questionnaire (SCQ) was directly developed and validated from this empirical model. In this study, we sought to establish initial validation of a translated SCQ among Mandarin-speaking patients by assessing the transferability of the PCM and the clinical sensibility of the SCQ. Methods: Forward and back-translation of the PCM and SCQ were performed in accordance with World Health Organization guidelines. Qualitative interviews were used to assess the transferability of the PCM with conceptualizations of compassion within a Chinese context. Cognitive interviews were conducted to assess the clarity, readability, wording, questions, and response scales of the Mandarin translation of the SCQ. Qualitative data were analyzed using constant comparative analysis, and cognitive interviews were analyzed using framework analysis. Results: The original categories of the PCM were verified in this Mandarin-speaking patient population. Specifically, participants' understanding of compassion is described as consisting of healthcare provider virtues, emphasizing the importance of a virtuous response that sought to understand the individual and their unique needs, to relationally communicate from a place of shared humanity and to ameliorate suffering. Participants were able to answer, comprehend, and endorse all 15 Mandarin SCQ items, resulting in no modifications to the Mandarin SCQ. Conclusions: This study provides initial validation of the Mandarin SCQ and PCM. Future studies should consider further establishing the validity and reliability of the Mandarin SCQ among a larger Chinese patient population.

The association between empathy and burnout in medical students: a systematic review and meta-analysis

BACKGROUND

Burnout levels in medical students are higher than in other student groups. Empathy is an increasingly desired outcome of medical schools. Empathy is negatively associated with burnout in physicians. Our objective was to quantitatively review the available literature on associations between empathy and burnout in medical students, and to explore associations between specific empathy aspects (cognitive and affective) and burnout sub-dimensions (emotional exhaustion, depersonalization and personal accomplishment).

METHODS

A comprehensive search of the literature published up until January 2024 was undertaken in the PubMed, EMBASE, CINAHL, The Cochrane Library, and PsycINFO databases. Two independent reviewers screened 498 records and quality-rated and extracted data from eligible studies. The effect size correlations (ESr) were pooled using a random-effects model and between-study variation explored with meta-regression. The review was preregistered with PROSPERO (#CRD42023467670) and reported following the PRISMA guidelines.

RESULTS

Twenty-one studies including a total of 27,129 medical students published between 2010 and 2023 were included. Overall, empathy and burnout were negatively and statistically significantly associated (ESr: -0.15, 95%CI [-0.21; -0.10], p < .001). When analyzing sub-dimensions, cognitive empathy was negatively associated with emotional exhaustion (ESr: -0.10, 95%CI [-0.17; -0.03], p = .006) and depersonalization (ESr: -0.15, 95%CI [-0.24; 0.05], p = .003), and positively associated with personal accomplishment (ESr: 0.21, 95%CI [0.12; 0.30], p < .001). Affective empathy was not statistically significantly associated with emotional exhaustion, depersonalization or personal accomplishment. Supplementary Bayesian analysis indicated the strongest evidence for the positive association between cognitive empathy and personal accomplishment. Response rate and gender moderated the relationship so that higher response rates and more male respondents strengthen the negative association between empathy and burnout.

CONCLUSION

Greater empathy, in particular cognitive empathy, is associated with lower burnout levels in medical students. This appears to be primarily driven by cognitive empathy's positive association with personal accomplishment.

PROTOCOL REGISTRATION

#CRD42023467670.

Factors Associated with College Students' Attitudes Toward Telehealth for Primary Care

Introduction: Establishing routine primary care visits helps to prevent serious health issues. College students are less likely than the general population to have a regular primary care provider and engage in routine health visits. Recent research provides evidence that telehealth is a convenient alternative to in-person primary care and that college students are comfortable using this technology, suggesting that telehealth has the potential to mitigate this disparity. As attitudes toward telehealth are one critical precursor to behavioral intention and actual utilization of telehealth, the goal of this study was to investigate which factors predict positive or negative attitudes toward telehealth. Methods: Data for this study were collected from a sample of 621 college students at a large southeastern university between September 19, 2022 and December 19, 2022. Results: The study found that college students who reported more trust in physicians, less medical mistrust, and less discrimination in health care settings reported more positive attitudes toward telehealth. Conclusions: These findings suggest that health care providers' skills in delivering patient-centered culturally informed care and building trust and rapport with patients might promote more positive attitudes toward telehealth and, potentially, greater overall utilization of health care services (including both telehealth and in-person services) among college students. This study lays the foundation for future research to examine psychological mechanisms underlying individuals' utilization of telehealth.

A model of contributors to a trusting patient-physician relationship: a critical review using a systematic search strategy

BACKGROUND

The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model.

METHODS

A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable.

RESULTS

Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services.

DISCUSSION

Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.

Barriers to diverse clinical trial participation in Duchenne muscular dystrophy: Engaging Hispanic/Latina caregivers and health professionals

BACKGROUND

Despite the increasing availability of clinical trials in Duchenne muscular dystrophy, racial/ethnic minorities and other populations facing health disparities remain underrepresented in clinical trials evaluating products for Duchenne. We sought to understand the barriers faced by Hispanic/Latino families specifically and underrepresented groups more generally to clinical trial participation in Duchenne.

METHODS

We engaged two participant groups: Hispanic/Latino caregivers of children with Duchenne in the US, including Puerto Rico, and health professionals within the broader US Duchenne community. Caregiver interviews explored attitudes towards and experiences with clinical trials, while professional interviews explored barriers to clinical trial participation among socio-demographically underrepresented families (e.g., low income, rural, racial/ethnic minority, etc.). Interviews were analyzed aggregately and using a thematic analysis approach. An advisory group was engaged throughout the course of the study to inform design, conduct, and interpretation of findings generated from interviews.

RESULTS

Thirty interviews were conducted, including with 12 Hispanic/Latina caregivers and 18 professionals. We identified barriers to clinical trial participation at various stages of the enrollment process. In the initial identification of patients, barriers included lack of awareness about trials and clinical trial locations at clinics that were less likely to serve diverse patients. In the prescreening process, barriers included ineligibility, anticipated non-compliance in clinical trial protocols, and language discrimination. In screening, barriers included concerns about characteristics of the trial, as well as mistrust/lack of trust. In consent and recruitment, barriers included lack of timely decision support, logistical factors (distance, time, money), and lack of translated study materials.

CONCLUSIONS

Numerous barriers hinder participation in Duchenne clinical trials for Hispanic/Latino families and other populations experiencing health disparities. Addressing these barriers necessitates interventions across multiple stages of the clinical trial enrollment process. Recommendations to enhance participation opportunities include developing clinical trial decision support tools, translating prominent clinical trials educational resources such as ClinicalTrials.gov, fostering trusting family-provider relationships, engaging families in clinical trial design, and establishing ethical guidelines for pre-screening potentially non-compliant patients.

Antecedents of rapport and its mediating role on relational cohesion in patient-physician interaction

Increasing competition in healthcare services, it is imperative that physicians and family-care practitioners seek ways to attract and retain patients. Building relationships with existing patients is one sure way to continued patronage and increased clientele. The purpose of this paper is to examine antecedents of rapport and its influence on perceived relationships in the context of patient-physician interaction. Study using cross-sectional survey method with structured questionnaire was used for data collection. Structural Equation Modeling was used for analyzing the data collected from 326 patients residing in Karnataka, India. The finding suggests that respect, responsibility and understanding have significant influence on relational cohesion with rapport acting as mediating variable. The results add to the empirical validity of the relationship among rapport, respect & relationship, as it is required to understand studied in Indian context. The finding provides new directions for both healthcare professionals and institutions in their endeavor of building relationships with their customers (Patients) by emphasizing the need for developing 'rapport' as an integral part of service interaction. Future research like longitudinal and experimental studies can provide more conclusive evidence regarding the influence of service behaviour on rapport.

Exploring the dynamics of physician-patient relationships: Factors affecting patient satisfaction and complaints

This review identifes the factors influencing the relationship between physicians and patients that can lead to patients' dissatisfaction and medical complaints. Utilizing a systemic approach 92 studies were retrieved which included quantitative, qualitative, and mixed method studies. Through a thematic analysis of the literature, we identified three interrelated main themes that can influence the relationship between physicians and patients, patients' satisfaction, and the decision to file a medico-legal complaint. The main themes include patient and physician characteristics; the interpersonal relationship between physicians and patients; and the health care system and policies, with relevant subthemes. These themes are demonstrated in a descriptive model. The review suggests areas of focus for physicians who may wish to increase their awareness around the potential sources of relational problems with their patients. Identifying these issues may assist in improvements in the therapeutic relationship with patients, can reduce their medico-legal risk, and enhance the quality of their clinical practice. The findings can also be utilized to support andragogical principles for medical learners. The article can serve as a structured framework to identify potential problems and gaps to design and test effective interventions to mitigate these potential relational problems between physician-patient.

A survey on the willingness of outpatients to participate in fundus examination procedures conducted by ophthalmology training residents in China: A cross-sectional study

Background and Aims

The National Standardized Training for Resident Doctors (STRD) in mainland China encounters many challenges in its implementation. To investigate whether outpatients are willing to undergo indirect ophthalmoscopy examination conducted by ophthalmology residents in the ophthalmology STRD program in China.

Methods

This study conducted a cross-sectional survey at the Eye Hospital of Wenzhou Medical University between September 2021 and September 2023. A cohort of 300 initial outpatients requiring indirect ophthalmoscopy examinations were enlisted from the outpatient department. Based on whether the patients are willing to undergo an indirect ophthalmoscopy examination by resident doctors, patients were divided into two groups: Group 1 (willing) and Group 2 (unwilling), and their questionnaire responses were comparatively analyzed.

Results

A total of 261/300 (87%) valid questionnaires were returned in the survey, which included 149 males and 112 females. No notable gender difference (p = 0.400) or disparity in medical expense categories (p = 0.786) was observed between the two groups. However, variables such as outpatient marital status (p = 0.002), the presence of training faculty during fundus examinations with residents and outpatients (p < 0.001), the demeanor of training residents toward patients (p < 0.001), and the quality of doctor-patient communication (p < 0.001) significantly varied between the groups.

Conclusion

The level of outpatients' cooperation with ophthalmology residents during fundus examinations in the Chinese ophthalmology STRD program was observed to be low. Enhancing the presence of training faculty during examinations and enhancing the communication skills of training residents could significantly improve this situation.

Race differences in patient trust and distrust from audio-recorded cardiology encounters

OBJECTIVE

Many have reported racial disparities in self-reported trust in clinicians but have not directly assessed expressions of trust and distrust in physician-patient encounters. We created a codebook to examine racial differences in patient trust and distrust through audio-recorded cardiologist-patient interactions.

METHODS

We analyzed data from a randomized controlled trial of audio-recorded outpatient cardiology encounters (50 White and 51 Black patients). We created a codebook for trust and distrust that was applied to recordings between White cardiologists and White and Black patients. We assessed differences in trust, distrust, and guardedness while adjusting for patient age, sex, and first appointment with the cardiologist.

RESULTS

Compared to White patients, Black patients had significantly lower expressions of trust ([IRR] [95 % CI]: 0.59 [0.41, 0.84]) and a significantly lower mean guarded/open score ([β] [95 % CI] -0.38 [-0.71, -0.04]). There was no statistically significant association between race and odds of at least one distrustful expression (OR [95 % CI] 1.36 [0.37, 4.94]).

CONCLUSION AND PRACTICE IMPLICATIONS

We found that coders can reliably identify patient expressions of trust and distrust rather than relying on problematic self-reported measures. Results suggest that White clinicians can improve their communication with Black patients to increase expressions of trust.

Cross-Cultural Adaptation and Validation of the Perception of the Doctor-Patient Relationship (PREMEPA) Questionnaire in Chronic Multi-Pathological Patients

OBJECTIVE

To conduct a cross-cultural adaptation and validation in Primary Care of the PREMEPA doctor-patient relationship perception questionnaire.

DESIGN

Descriptive, cross-sectional study, using self-administered questionnaires. Qualitative validation: an adapted version of the original questionnaire, was adapted to our culture. The process consisted of the evaluation, cross-cultural adaptation and consensus of a group of experts. The questionnaire was piloted on a sample of 32 patients diagnosed with at least 2 chronic pathologies.

MEASURES

Cognitive piloting, comprehensibility assessment, content validation and internal consistency analysis using Cronbach's alpha coefficient. Quantitative validation: the internal consistency, construct validity and validity of the questionnaire were studied by means of a confirmatory factor analysis developed in a multicenter study, randomly selecting 202 patients with at least 2 chronic pathologies.

RESULTS

Content validity of the new Spanish version was confirmed to be adequate. Comprehensibility and internal consistency (Cronbach's α coefficient = 0.78) were adequate. The confirmatory factor analysis showed good dimensionality, factor relationship and internal consistency, as well as acceptable construct validity. The final result was a 13-item questionnaire consisting of 2 dimensions, which explain 58.5% of the variance: participation in decision-making (accounting for 45.2% of the variance) and person-centered communication (encompassing courtesy, empathy, humanity, and trust).

CONCLUSIONS

This adapted version of the PREMEPA questionnaire can be considered valid for use in the Spanish population with a history of chronic pathology. This version of PREMEPA provides a new instrument to understand and improve chronic patient care, which can improve the doctor-patient relationship, encouraging adherence to treatment and enhancing health outcomes.

Review of Muslim Patient Needs and Its Implications on Healthcare Delivery

BACKGROUND

In the rapidly changing environment of healthcare, striving toward health equity and providing patient-centered care is imperative to the patient's experience. To achieve these goals, a comprehensive understanding of the diverse patient populations seeking these services, their needs, and the multitude of religious, cultural, and structural elements that impact their well-being is required. Muslim patients represent a considerable demographic, both in number and complexity of religious and cultural beliefs and practices. This scoping review examines the intersection of religion and cultural values with healthcare delivery in the context of the Muslim patient experience.

OBJECTIVES

The objective of this review is to identify key concepts and challenges that impact the Muslim patient experience.

SEARCH METHODS

The research databases Cochrane Library, OVID Medline, and PubMED were used to conduct a comprehensive systemic review of original, empirical peer-reviewed publications with the following search terms: "Muslim healthcare," "Muslim patient," and "Muslim experience."

SELECTION CRITERIA

Inclusion and exclusion criteria were used to narrow down articles to those that addressed Muslim patient needs and their healthcare experience.

RESULTS

A total of 21 articles met the criteria of this scoping review. Five central topics were identified during thematic analysis: Ramadan and Fasting, Barriers in the Patient-Physician Relationship, Trauma and Perceived Discrimination, Mental Health Awareness and Stigma, and Awareness of Advanced Care Planning.

CONCLUSION

This scoping review demonstrates that in order to provide patient-centered care addressing the unique needs of Muslim patients, religious and cultural values need to be explored under the frameworks of cultural humility and structural competency.

Acceptability and use of an online health priorities self-identification tool for older adults: A qualitative investigation

Objective

To examine the use of a web-based, self-directed health priorities identification tool for older adults with multiple chronic conditions (MCCs).

Methods

We recruited a gender- and racially-diverse, highly educated sample of older adults with MCCs to engage with our My Health Priorities tool, then complete a semi-structured interview. Thematic analysis was used to examine interview transcripts.

Results

Twenty-one participants shared perspectives on the acceptability and use of the tool. Three themes (with eleven subthemes) were generated to describe: website user experience feedback, the content of the health priorities identification process, and the tool's capacity to empower communication and decision making.

Conclusion

Participants found this tool acceptable and easy to use, describing a variety of benefits of the priorities self-identification process and offered suggestions for refinement and broader implementation. Older adults with limited internet navigation abilities or misconceptions about the self-directed process may benefit from clinicians clarifying the purpose of the process or initiating priorities-aligned discussions.

Innovation

This novel tool can help older adults with MCCs define what matters most for their health and healthcare, informing a variety of health decisions. This tool may enable and motivate patients to lead health priorities decision-making discussions with clinicians and care partners.

Trust as a dyadic mechanism of action: a call to explore patient-provider relationships in the twenty-first century

Background: There is general agreement that trust between patients and providers influences patient knowledge, behaviors, and adherence to provider-recommendations--with subsequent impacts on patient health-related outcomes and provider practices. There is less academic agreement on the processes by which trust is formulated and changed over time and how trust with ongoing healthcare providers can influence health-related outcomes over time.Methods: This opinion draws on social constructionism and symbolic interactionism to posit the possibility that trust can emanate through the communication process, during which a patient and provider transmit and attend to words, images, and paralanguage to convey their states of being and to induce responses, usually acknowledgement, suasion, or physical behaviors, from one another.Results: Theoretical bases for this construct are provided as are qualitative, quantitative, and mixed measurement approaches for multiple healthcare settings.Conclusions: A mechanistic approach to understand how trust is established through patient-provider communication and how trust informs patient health-related outcomes can contribute over time to improve communication in healthcare encounters.

Enhancing doctor-patient relationships in community health care institutions: the Patient Oriented Four Habits Model (POFHM) trial-a stepped wedge cluster randomized trial protocol

BACKGROUND

The poor relationship between doctors and patients is a long-standing, global problem. However, current interventions tend to focus on the training of physicians, while patient-targeted interventions still need to be improved. Considering that patients play a significant role in outpatient consultations, we developed a protocol to assess the effectiveness of the Patient Oriented Four Habits Model (POFHM) in improving doctor-patient relationships.

METHODS

A cross-sectional incomplete stepped-wedge cluster randomized trial design will be conducted in 8 primary healthcare institutions (PHCs). Following phase I of "usual care" as control measures for each PHC, either a patient- or doctor-only intervention will be implemented in phase II. In phase III, both patients and doctors will be involved in the intervention. This study will be conducted simultaneously in Nanling County and West Lake District. The primary outcomes will be evaluated after patients complete their visit: (1) patient literacy, (2) sense of control and (3) quality of doctor-patient communication. Finally, a mixed-effects model and subgroup analysis will be used to evaluate the effectiveness of the interventions.

DISCUSSION

Fostering good consultation habits for the patient is a potentially effective strategy to improve the quality of doctor-patient communication. This study evaluates the implementation process and develops a rigorous quality control manual using a theoretical domain framework under the collective culture of China. The results of this trial will provide substantial evidence of the effectiveness of patient-oriented interventions. The POFHM can benefit the PHCs and provide a reference for countries and regions where medical resources are scarce and collectivist cultures dominate.

TRIAL REGISTRATION

AsPredicted #107,282 on Sep 18, 2022; https://aspredicted.org/QST_MHW.

Exploring the Relationship Between Intolerance of Uncertainty and Trust in Physicians from Spousal and Parent-Child Perspectives

Objective

The present study aimed to probe the intergenerational transmission of intolerance of uncertainty (IU) and trust in physicians. Besides, through the actor-partner interdependence model (APIM), the predictive effect of parents' IU on their own and their spouses' trust in physicians was examined. A mediation model was further constructed to probe the mechanisms by which parents' IU affects children's trust in physicians.

Methods

The Intolerance of Uncertainty Scale-12 (IUS-12) and the Wake Forest Physician Trust Scale (WFPTS) were employed to conduct the questionnaire survey among 384 families (each family with a father, mother, and one child).

Results

IU and trust in physicians were found to be intergenerationally transmitted. The results of the APIM analyses showed that fathers' total IUS-12 scores negatively predicted their own (β = -0.419, p < 0.01) and mothers' (β = -0.235, p < 0.01) total WFPTS scores. Mothers' total IUS-12 scores negatively predicted their own (β = -0.353, p < 0.01) and fathers' (β = -0.138, p = 0.017) total WFPTS scores. The results of mediation analyses indicated that parents' total WFPTS scores and children's total IUS-12 scores mediated the effect of parents' total IUS-12 scores on children's total WFPTS scores.

Conclusion

The public's IU is a crucial influencing factor of their trust in physicians. Besides, the IU between couples and between parents and children could be mutually affected. On the one hand, husbands' IU could affect their own and their wives' trust in physicians, and vice versa. On the other hand, parents' IU and trust in physicians could affect their children's IU and trust in physicians, respectively.

The Role of an Exoskeleton Simulation of Senescence in Health Sciences Education

Background

Education in the formation of human capital in health constantly presents challenges. New tools in the emerging contexts may strengthen empathic attitudes. We developed an educational intervention that included a senescence simulator and assessed its impact on perception and attitudes in healthcare students.

Methods

A cross-sectional comparative study was conducted that assessed acquired knowledge and self-perception using a semistructured survey administered before and after the demonstration and intervention using the simulator and reported the experience through the role of the patient and caregiver. The data were analyzed statistically to identify the demographic characteristics and differences between the groups of students. The data were analyzed statistically to identify the demographic characteristics and differences between the groups of students in the responses pre-post intervention, using statistical software (IBM SPSS Statistics 26.0).

Results

Of the 256 participants surveyed before the intervention, 93.8% described cognitive deterioration as a significant disability and 53.1% considered the health system to be inadequate in meeting the needs of older individuals. Only 59.8% stated that the current academic training meets the educational requirements for the care of the elderly. In total, 98.9% of the participants reported that the simulator changed their perception by increasing their empathy. In total, 76.2% showed greater sensitivity to older adults and 79.3% reported that the experiential learning consolidated their professionalizing perspective. Among the younger participants (aged 18-20 years), sensitivity and reorientation toward pursuing an associated graduate degree were higher after the intervention (p=0.01).

Conclusions

Educational strategies, such as the senescence simulator, offer an experiential intervention that strengthens the knowledge and attitudes toward older individuals. During the pandemic emergency, it proved to be a useful educational strategy in consolidating caring behavior as a hybrid educational tactic. The senescence simulation enabled the participants to widen their educational and professional schemes to encompass the care of the older population.

Doctor Attributes That Patients Desire during Consultation: The Perspectives of Doctors and Patients in Primary Health Care in Botswana

Doctor attributes contribute significantly to the quality of the doctor–patient relationship, consultation, patient satisfaction, and treatment outcomes. However, there is a paucity of research on this topic in many settings in developing countries, including Botswana, where accessibility and availability of care itself are a challenge. The study examined doctor attributes that patients in Botswana desire from the perspectives of doctors and patients in selected public clinics located in four health districts of Botswana. We used a qualitative design and conducted face-to-face interviews with 32 adult patients and 17 doctors selected through the purposive sampling technique. Interviews were audio-recorded and transcribed. Data analysis followed the six steps of qualitative thematic data analysis. We found both discordance and congruence between the doctors and patients on key attributes that patients desire in a doctor during consultation. Both agreed that effective communication and listening skills were key desirable doctor attributes that improve the doctor–patient relationship. Conducting the consultation in the language of the patients enhances effective communication. Doctors cited clinical expertise and competence as key desirable doctor attributes, whereas patients cited interpersonal and social attributes including kindness, empathy, and respect as key doctor attributes that increase trust in the doctor. However, patients expected the doctor to have clinical knowledge, which they perceived as essential to improve doctor–patient interaction and health outcomes. The findings highlight a need to enhance the interpersonal and communication skills of doctors to improve the quality of doctor–patient interactions. To optimise and enhance the consultation, continuing professional development should be adopted as a strategy to improve the communication and interpersonal skills of doctors.

Doctors' and Patients' Perceptions of Impacts of Doctors' Communication and Empathy Skills on Doctor-Patient Relationships During COVID-19

BACKGROUND

During the COVID-19 pandemic, the performance of Chinese doctors may have led to improved doctor-patient relationships (DPRs). However, it is unclear how doctors and patients perceived the impact of doctors' communication and empathy skills on DPRs during the COVID-19 pandemic.

OBJECTIVE

To examine the perceptions of doctors and patients on how doctors' communication skills and empathy skills influence DPRs during COVID-19.

MAIN MEASURES

Doctors' and patients' perceptions of doctors' communication skills were measured using the Chinese version of the SEGUE Framework. To measure empathy skills and DPRs, the Jefferson Scale of Empathy and Difficult Doctor-Patient Relationship Questionnaire were administered to doctors, and the Consultation and Relational Empathy Measure and Patient-Doctor Relationship Questionnaire were administered to patients.

RESULTS

A total of 902 doctors and 1432 patients in China were recruited during the pandemic via online or offline surveys (overall response rate of 69.8%). Both doctors and patients rated doctors' empathy skills as more impactful on DPRs than communication skills. Doctors believed that only their empathy skills influenced DPRs. But patients believed that there was a significant bi-directional relationship between doctors' communication and empathy skills and these two skills interacted to directly and indirectly influence DPRs, and doctors' empathy had a greater mediating effect than their communication.

CONCLUSIONS

During COVID-19, there were both similarities and differences between Chinese doctors' and patients' views on how doctors' communication and empathy skills influenced DPRs. The greater effect of doctors' empathy skills suggests that both doctors and patients attach more importance to doctors' empathy in doctor-patient interactions. The bi-directional effect on patient outcomes suggests that both doctors' communication and empathy skills are important to patients' perceptions of DPRs.

Relationship between self-care compliance, trust, and satisfaction among hypertensive patients in China

Introduction

Hypertension is a growing public health concern worldwide. It is a leading risk factor for all-cause mortality and may lead to complications such as cardiovascular disease, stroke, and kidney failure. Poor compliance of hypertensive patients is one of the major barriers to controlling high blood pressure. Compliance is not ideal among Chinese patients, and increasing patient self-care compliance with hypertension is necessary.

Methods

This article analyzes the status of self-care compliance, trust, and satisfaction among Chinese hypertensive patients using cross-sectional data from Zhejiang Province. We use a multi-group structural equation model (MGSEM) to compare the interrelationships across genders.

Results

The study's findings show that the average trust, satisfaction, and compliance scores are 3.92 ± 0.55, 3.98 ± 0.61, and 3.33 ± 0.41, respectively. Female patients exhibit higher average total scores for trust and compliance than male patients. The SEM results indicate that trust has a direct positive association with compliance [β = 0.242, 95% CI: (0.068, 0.402)] and satisfaction [β = 0.260, 95% CI: (0.145, 0.367)], while their satisfaction is not directly associated with compliance. The results of MGSEM show that trust has an indirect effect on compliance in the male group through satisfaction [β = 0.051, P < 0.05, 95% CI: (0.012, 0.116)]. In the female group, trust has a direct effect on satisfaction [β = 0.235, P < 0.05, 95% CI: (0.041, 0.406)] and compliance [β = 0.319, P < 0.01, 95% CI: (0.086, 0.574)].

Discussion

This study reveals the mechanisms of self-care compliance, trust, and satisfaction among Chinese hypertensive patients. Its findings may serve as a reference for guiding primary healthcare providers to improve hypertension patients' compliance and implement gender-targeted health interventions.

Patient Trust in Physicians Matters-Understanding the Role of a Mobile Patient Education System and Patient-Physician Communication in Improving Patient Adherence Behavior: Field Study

BACKGROUND

The ultimate goal of any prescribed medical therapy is to achieve desired outcomes of patient care. However, patient nonadherence has long been a major problem detrimental to patient health and, thus, is a concern for all health care providers. Moreover, nonadherence is extremely costly for global medical systems because of unnecessary complications and expenses. Traditional patient education programs often serve as an intervention tool to increase patients' self-care awareness, disease knowledge, and motivation to change patient behaviors for better adherence. Patient trust in physicians, patient-physician relationships, and quality of communication have also been identified as critical factors influencing patient adherence. However, little is known about how mobile patient education technologies help foster patient adherence.

OBJECTIVE

This study aimed to empirically investigate whether and how a mobile patient education system (MPES) juxtaposed with patient trust can increase patient adherence to prescribed medical therapies.

METHODS

This study was conducted based on a field survey of 125 patients in multiple states in the United States who have used an innovative mobile health care system for their health care education and information seeking. Partial least squares techniques were used to analyze the collected data.

RESULTS

The results revealed that patient-physician communication and the use of an MPES significantly increase patients' trust in their physicians. Furthermore, patient trust has a prominent effect on patient attitude toward treatment adherence, which in turn influences patients' behavioral intention and actual adherence behavior. Based on the theory of planned behavior, the results also indicated that behavioral intention, response efficacy, and self-efficacy positively influenced patients' actual treatment adherence behavior, whereas descriptive norms and subjective norms do not play a role in this process.

CONCLUSIONS

Our study is one of the first that examines the relationship between patients who actively use an MPES and their trust in their physicians. This study contributes to this context by enriching the trust literature, addressing the call to identify key patient-centered technology determinants of trust, advancing the understanding of patient adherence mechanisms, adding a new explanation of the influence of education mechanisms delivered via mobile devices on patient adherence, and confirming that the theory of planned behavior holds in this patient adherence context.

Understanding of empathetic communication in acute hospital settings: a scoping review

OBJECTIVE

Empathy and empathy education have been reviewed a number of times through systematic reviews and meta-analyses; however, the topic of 'empathetic communication' remains poorly understood when considering engaging in hospital-based research. Therefore, this scoping review aimed to explore the existing literature concerning empathetic communication in hospital settings and to evaluate the definitions presented.

DESIGN

Scoping review.

DATA SOURCES

Systematic searches of the PubMed, CINAHL, Cochrane, PsycINFO, and PsycArticles databases were conducted.

STUDY SELECTION

All English studies in which empathetic communication in hospital settings were explored. The search terms used included empathy, communication, hospital settings, providers, and consumers.

DATA EXTRACTION

Data were assessed through the use of a pre-set analysis tool.

RESULTS

After conducting the searches, 419 articles were identified, of which 26 were included in this review. No single article specifically defined the term 'empathetic communication'; however, 33 unique definitions of 'empathy' were identified, of which 23 considered communication to be a component of empathy. There was a considerable lack of consistency between the empathy definitions, with some classifying communication in empathy as an ability and others classifying it as a dynamic process.

CONCLUSION

Future and contextually focused research is needed to develop a consistent and clear definition of empathetic communication and empathy within a hospital setting to better build positive healthcare cultures.

PRACTICE IMPLICATIONS

Inconsistencies between definitions of empathy in empathetic communication research could reduce the efficacy of future research gains and impact the translation of research findings into clinical practice.

Patient Toward Physician Occupational Stigma Scale: Development of the Chinese Version

Background/Objective

Physicians’ occupational stigma could eradicate physician-patient trust, threatening physicians’ social status and occupational reputation. Hitherto, there has been no scale obtaining good psychometric properties to assess patients’ stigma toward physicians. The present study aimed to develop the Patient toward Physician Occupational Stigma Scale (PPOSS) and examine its reliability and validity.

Methods

The questionnaire comprising sociodemographic information and the PPOSS were employed to survey 645 Chinese patients in two phases. In Sample 2, the Wake Forest Physician Trust Scale (WFOTS), the Intolerance of Uncertainty Scale-12 (IUS-12), and the Brief Illness Perception Questionnaire (BIPQ) were tested.

Results

The PPOSS includes 19 items subsumed into three dimensions of stereotype, discrimination, and prejudice. According to the results of confirmatory factor analysis (CFA), the three-factor model fitted well (χ²/df=2.065, RMSEA=0.057, SRMR=0.045, RFI=0.904, CFI=0.956, IFI=0.956, PNFI=0.779, PCFI=0.811). The PPOSS was significantly negatively correlated with the WFOTS, and significantly positively correlated with the IUS-12 and the BIPQ. The Cronbach’s alpha coefficients for the total scale and each dimension were between 0.87 and 0.94, and the split-half reliability coefficients were between 0.84 and 0.93. Besides, the PPOSS had the measurement invariance across gender.

Conclusion

With its satisfactory psychometric properties, the PPOSS can be used as an effective instrument to assess patients’ stigma toward physicians.

Effect of patient-provider communication on patient risk awareness: The moderating role of trust based on scenario experiment

Good patient-provider communication and high level of trust can decrease patients' risk perception and promote their acceptability of medical risks.The extent to which communication can be effective may be distinguished by different levels of trust. The present study examined the effect of patient-provider communication and treatment outcome on patients' risk awareness, and explored the moderating effect of trust. This research adopted a paper-based scenario experiment with a 2 (communication: good vs. poor) × 2 (treatment outcome: good vs. poor) between-subjects design. Three hundred sixteen college students were enrolled. They were randomly assigned to four groups and instructed to read more information about the two independent variables. Finally, all participants finished the manipulation check (eight items), affect- and cognition-based trust scales (10 items), and risk awareness scales (eight items) by questionnaire. The results showed the positive interaction effects between communication and treatment outcome on patients' acceptance of uncertainties. Affect- and cognition-based trust had similar moderating mechanisms on the interaction effect of communication and treatment outcome on uncertainty acceptability, and different moderating mechanisms on patient risk perception. In clinical work, we should develop the strategy to improve patien-provider communication and trust to improve patients' acceptability of uncertainty.