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Narayan AK, Miles RC, Milton A, Salazar G, Spalluto LB, Babagbemi K, Stowell JT, Flores EJ, Dako F, Weissman IA. Fostering Patient-Centered Equitable Care in Radiology: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:711-719. [PMID: 37255040 DOI: 10.2214/ajr.23.29261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Patient-centered care (PCC) and equity are two of the six core domains of quality health care, according to the Institute of Medicine. Exceptional imaging care requires radiology practices to provide patient-centered (i.e., respectful and responsive to individual patient preferences, needs, and values) and equitable (i.e., does not vary in quality on the basis of gender, ethnicity, geographic location, or socioeconomic status) care. Specific barriers that prevent the delivery of patient-centered equitable care include information gaps, breaches of trust, organizational medical culture, and financial incentives. Information gaps limit practitioners in understanding the lived experience of patients. Breaches of trust prevent patients from seeking needed medical care. Organizational medical cultures may not be centered around patient experiences. Financial incentives can impede practitioners' ability to spend the time and resources required to meet patient goals and needs. Intentional approaches that integrate core principles in both PCC and health equity are required to deliver high-quality patient-centered imaging care for diverse patient populations. The purpose of this AJR Expert Panel Narrative Review is to review the origins of the PCC movement in radiology, characterize connections between the PCC and health equity movements, and describe concrete examples of ways to foster patient-centered equitable care in radiology.
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Affiliation(s)
- Anand K Narayan
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, F6/178C, Madison, WI 53792-3252
| | | | - Arissa Milton
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, F6/178C, Madison, WI 53792-3252
| | - Gloria Salazar
- Department of Radiology, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Lucy B Spalluto
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
- Department of Radiology, Vanderbilt-Ingram Cancer Center, Nashville, TN
- Department of Radiology, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, TN
| | - Kemi Babagbemi
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | | | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Farouk Dako
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ian A Weissman
- Department of Radiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Baalmann M, Müller L, Afat S, Molwitz I, Palm V, Rischen R. [Patient-centered vs. employee-centered radiology : Does this pose a conflict?]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:650-656. [PMID: 37566129 DOI: 10.1007/s00117-023-01195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Patient-centered radiology and employee-centered radiology are being increasingly discussed as an extension of the established structure- and process-oriented management perspective. Concerning potential conflicts, it is unclear if and how these approaches should best be implemented in a radiology department. OBJECTIVE The aim of this narrative review is to identify and critically correlate underlying characteristics of patient-centered and employee-centered approaches including their similarities, conflicts, and synergies as applicable to the radiological work environment. MATERIALS AND METHODS Based on a literature search using PubMed, Scopus, Web of Science, and Google Scholar, the current body of knowledge regarding patient- and employee-centered radiology is presented. RESULTS Patient- and employee-centered radiology focus on the individual needs of patients and employees, respectively, and promise to improve patient satisfaction, healthcare outcomes, and organizational performance. Conflicts result from an increased organizational complexity and the concurrent utilization of limited resources, such as time, money, and staff. Overall, however, synergies outweigh the potential conflicts. CONCLUSIONS Successful implementation of patient- and employee-centered approaches in radiology requires a human-centered leadership approach and an overarching strategy with the execution of specific interventions in the processes. We provide specific recommendations to this effect.
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Affiliation(s)
- Markus Baalmann
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Lukas Müller
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Saif Afat
- Abteilung für diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Isabel Molwitz
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Viktoria Palm
- Klinik für diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Robert Rischen
- Klinik für Radiologie, Universitätsklinikum Münster, Münster, Deutschland
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Engel L, Bryan S, Whitehurst DGT. Conceptualising 'Benefits Beyond Health' in the Context of the Quality-Adjusted Life-Year: A Critical Interpretive Synthesis. PHARMACOECONOMICS 2021; 39:1383-1395. [PMID: 34423386 DOI: 10.1007/s40273-021-01074-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 06/13/2023]
Abstract
There is growing interest in extending the evaluative space of the quality-adjusted life-year framework beyond health. Using a critical interpretive synthesis approach, the objective was to review peer-reviewed literature that has discussed non-health outcomes within the context of quality-adjusted life-years and synthesise information into a thematic framework. Papers were identified through searches conducted in Web of Science, using forward citation searching. A critical interpretive synthesis allows for the development of interpretations (synthetic constructs) that go beyond those offered in the original sources. The final output of a critical interpretive synthesis is the synthesising argument, which integrates evidence from across studies into a coherent thematic framework. A concept map was developed to show the relationships between different types of non-health benefits. The critical interpretive synthesis was based on 99 papers. The thematic framework was constructed around four themes: (1) benefits affecting well-being (subjective well-being, psychological well-being, capability and empowerment); (2) benefits derived from the process of healthcare delivery; (3) benefits beyond the recipient of care (spillover effects, externalities, option value and distributional benefits); and (4) benefits beyond the healthcare sector. There is a wealth of research concerning non-health benefits and the evaluative space of the quality-adjusted life-year. Further dialogue and debate are necessary to address conceptual and normative challenges, to explore the societal willingness to sacrifice health for benefits beyond health and to consider the equity implications of different courses of action.
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Affiliation(s)
- Lidia Engel
- Faculty of Health, Deakin University, Burwood, VIC, Australia.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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Zigman Suchsland M, Cruz MJ, Hardy V, Jarvik J, McMillan G, Brittain A, Thompson M. Qualitative study to explore radiologist and radiologic technologist perceptions of outcomes patients experience during imaging in the USA. BMJ Open 2020; 10:e033961. [PMID: 32690729 PMCID: PMC7375501 DOI: 10.1136/bmjopen-2019-033961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE We aimed to explore the patient-centred outcomes (PCOs) radiologists and radiologic technologists perceive to be important to patients undergoing imaging procedures. DESIGN We conducted a qualitative study of individual semi-structured interviews. PARTICIPANTS We recruited multiple types of radiologists including general, musculoskeletal neuroradiology, body and breast imagers as well as X-ray, ultrasound, CT or MRI radiologic technologists from Washington and Idaho. OUTCOME Thematic analysis was conducted to identify themes and subthemes related to PCOs of imaging procedures. RESULTS Ten radiologists and six radiology technologists participated. Four main domains of PCOs were identified: emotions, physical factors, knowledge and patient burden. In addition to these outcomes, we also identified patient and provider factors that can potentially moderate these outcomes. CONCLUSIONS Radiologists and technologists perceived outcomes related to the effect of imaging procedures on patients' emotions, physical well-being, knowledge and burden from financial and opportunity costs to be important to patients undergoing imaging procedures. There are opportunities for the radiology community to measure and use these PCOs in comparisons of imaging procedures and potentially identify areas where these outcomes can be leveraged to drive a more patient-centred approach to radiology.
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Affiliation(s)
| | - Maria Jessica Cruz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Victoria Hardy
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Jeffrey Jarvik
- Departments of Radiology, Neurological Surgery and Health Services, and the Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington, USA
| | - Gianna McMillan
- Bioethics Institute, Loyola Marymount University, Los Angeles, California, USA
| | - Anne Brittain
- Quality Improvement and Outcomes Department, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Herr KD, Hanna TN. Doctorhood in Radiology: What Makes a Radiologist a Physician? Curr Probl Diagn Radiol 2020; 50:454-456. [PMID: 32553671 DOI: 10.1067/j.cpradiol.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/22/2022]
Abstract
Because image interpretation occurs out of public view, the lay public does not always know what a radiologist is, or that a radiologist is even a physician. Despite the reality that many radiologists have little to no patient contact, all have considerable impact on patient care. As viewed through the lens of patient impact and in the context of the social contract that physicians enter, radiologists lay equal claim to the title "doctor" as any other physician. With titles come responsibilities: as physicians, radiologists are obligated through the social contract to provide humanistic and virtuous care, irrespective of time spent in close proximity with patients. This paper touches on ways in which radiologists can honor the social contract, providing care through a commitment to empathy, compassion, generosity, honesty and collaboration with nonradiologist colleagues. This invitation for introspection assumes special meaning for a profession that is undergoing an identity change at the behest of AI, serving as a reminder that radiologists ought to pay as much heed to maintaining virtuous physician character as they do to the fine points of image interpretation.
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Affiliation(s)
- Keith D Herr
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 550 Peachtree Street, Atlanta, GA.
| | - Tarek N Hanna
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 550 Peachtree Street, Atlanta, GA
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Patient-centered Radiology for the Thoracic Imager. J Thorac Imaging 2020; 35:71-72. [DOI: 10.1097/rti.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patient Complaints in Image-Guided Interventions: Evaluation of Multifactorial Issues Using a Coding Taxonomy. AJR Am J Roentgenol 2018; 210:1288-1291. [PMID: 29547056 DOI: 10.2214/ajr.17.19104] [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] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to classify complaints from patients undergoing image-guided interventions using a coding taxonomy and to test whether single-coded complaints were resolved satisfactorily compared with multifactorial (multiple codes) complaints. MATERIALS AND METHODS In this retrospective study, patients' complaint narratives between April 1999 and December 2012 were reviewed and categorized according to a three-level taxonomy into domains and codes. Resolutions were categorized as satisfactory or unsatisfactory to the patient and were classified as follows: clarification, apology, manager notification, change of provider, reimbursement, and quality review. Complaints were classified as single coded (only one code identified in the patients' description) and multifactorial (multiple codes identified). Statistical analysis was performed with the Fisher test, with the significance level set at 0.05. A run chart with the distribution of complaints by domains (relationships, management, and clinical) by year was performed. RESULTS A total of 146 codes were extracted from 71 narratives (2.06 codes/complaint) and were classified into the following domains: clinical (52%; n = 76), management (24%; n = 35), and relationships (24%; n = 35). The most common codes included quality of care, safety, and communication breakdown issues. A run chart found a decline in absolute numbers of complaints over the years in the domains studied. The frequency of satisfactory resolution was 86% for multifactorial versus 81% for single-coded complaints with no statistically significant differences observed (p = 0.72). Over 50% of complaints were resolved by providing clarification to patients (n = 36). CONCLUSION There were no statistically significant differences between multifactorial and single-coded complaints. Clinical codes and communication breakdown were the most common reasons for patient-reported complaint, with most complaints successfully resolved with clarification.
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Abstract
OBJECTIVE The purposes of this article are to detail the experience of a single-center academic institution in applying the patient-centered approach to a lung cancer screening program and to examine how this approach can expand to other aspects of follow-up imaging of lung nodules. CONCLUSION As the practice of patient-centered radiology gains attention, diagnostic radiologists are findings new ways to become more involved in patient care. A lung cancer screening program is one opportunity for radiologists to consult with and educate patients.
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Weldon CB, Friedewald SM, Kulkarni SA, Simon MA, Carlos RC, Strauss JB, Bunce MM, Small A, Trosman JR. Radiology as the Point of Cancer Patient and Care Team Engagement: Applying the 4R Model at a Patient's Breast Cancer Care Initiation. J Am Coll Radiol 2017; 13:1579-1589. [PMID: 27888945 DOI: 10.1016/j.jacr.2016.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 12/11/2022]
Abstract
Radiologists aspire to improve patient experience and engagement, as part of the Triple Aim of health reform. Patient engagement requires active partnerships among health providers and patients, and rigorous teamwork provides a mechanism for this. Patient and care team engagement are crucial at the time of cancer diagnosis and care initiation but are complicated by the necessity to orchestrate many interdependent consultations and care events in a short time. Radiology often serves as the patient entry point into the cancer care system, especially for breast cancer. It is uniquely positioned to play the value-adding role of facilitating patient and team engagement during cancer care initiation. The 4R approach (Right Information and Right Care to the Right Patient at the Right Time), previously proposed for optimizing teamwork and care delivery during cancer treatment, could be applied at the time of diagnosis. The 4R approach considers care for every patient with cancer as a project, using project management to plan and manage care interdependencies, assign clear responsibilities, and designate a quarterback function. The authors propose that radiology assume the quarterback function during breast cancer care initiation, developing the care initiation sequence, as a project care plan for newly diagnosed patients, and engaging patients and their care teams in timely, coordinated activities. After initial consultations and treatment plan development, the quarterback function is transitioned to surgery or medical oncology. This model provides radiologists with opportunities to offer value-added services and solidifies radiology's relevance in the evolving health care environment. To implement 4R at cancer care initiation, it will be necessary to change the radiology practice model to incorporate patient interaction and teamwork, develop 4R content and local adaption approaches, and enrich radiology training with relevant clinical knowledge, patient interaction competence, and teamwork skill set.
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Affiliation(s)
- Christine B Weldon
- Center for Business Models in Healthcare, Glencoe, Illinois; Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Sarah M Friedewald
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Lynn Sage Comprehensive Breast Center, Northwestern University, Chicago, Illinois
| | - Swati A Kulkarni
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Lynn Sage Comprehensive Breast Center, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Melissa A Simon
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Ruth C Carlos
- University of Michigan Health System, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Jonathan B Strauss
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois; Department of Radiation Oncology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Mikele M Bunce
- Quality of Care and Outcomes Research, Genentech, South San Francisco, California
| | - Art Small
- Quality of Care and Outcomes Research, Genentech, South San Francisco, California
| | - Julia R Trosman
- Center for Business Models in Healthcare, Glencoe, Illinois; Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Kemp JL, Mahoney MC, Mathews VP, Wintermark M, Yee J, Brown SD. Patient-centered Radiology: Where Are We, Where Do We Want to Be, and How Do We Get There? Radiology 2017. [PMID: 28631981 DOI: 10.1148/radiol.2017162056] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose The objectives of the Radiological Society of North America (RSNA) Patient-Centered Radiology Steering Committee survey were to (a) assess RSNA members' general attitudes and experiences concerning patient-centered radiology, with specific attention paid to radiologist-to-patient communication; (b) examine the members' barriers to communicating more directly with patients; and (c) explore their perceptions of how such barriers can be overcome. Materials and Methods A total of 5999 radiologists were invited by e-mail to complete an anonymous electronic survey developed by the Steering Committee and the RSNA Department of Research. Participants were asked to identify aspects of patient-centered care important to their practice, report on their interactions with patients, and share their opinions on radiologist-patient communication. Statistical analyses were performed by using the χ2 test and analysis of variance. Results The response rate was 12% (n = 694, 109 invitations were undeliverable). Most respondents (89%, 611 of 684) agreed that promoting awareness of the role of radiology in patients' overall health care is important to how they practice. The majority (73%, 421 of 575) reported that time or workload frequently prevented them from communicating directly with patients. The majority (74%, 423 of 572) reported that a personal sense of satisfaction was likely to motivate them to communicate more directly with patients, but many commented that changes to reimbursement and compensation would help them communicate with patients more directly. Conclusion Many radiologists support the concept of communicating more directly with patients but report they are constrained by time or workload. Changes to reimbursement schemes may help mitigate these barriers to one crucial aspect of patient-centered care. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Jennifer L Kemp
- From Diversified Radiology of Colorado, 1746 Cole Blvd, #150, Lakewood, CO 80401 (J.L.K.); Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (M.C.M.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (V.P.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.W.); Department of Radiology, VA Medical Center, University of California, San Francisco, San Francisco, Calif. (J.Y.); and Department of Radiology, Boston Children's Hospital, Boston, Mass (S.D.B.)
| | - Mary C Mahoney
- From Diversified Radiology of Colorado, 1746 Cole Blvd, #150, Lakewood, CO 80401 (J.L.K.); Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (M.C.M.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (V.P.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.W.); Department of Radiology, VA Medical Center, University of California, San Francisco, San Francisco, Calif. (J.Y.); and Department of Radiology, Boston Children's Hospital, Boston, Mass (S.D.B.)
| | - Vincent P Mathews
- From Diversified Radiology of Colorado, 1746 Cole Blvd, #150, Lakewood, CO 80401 (J.L.K.); Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (M.C.M.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (V.P.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.W.); Department of Radiology, VA Medical Center, University of California, San Francisco, San Francisco, Calif. (J.Y.); and Department of Radiology, Boston Children's Hospital, Boston, Mass (S.D.B.)
| | - Max Wintermark
- From Diversified Radiology of Colorado, 1746 Cole Blvd, #150, Lakewood, CO 80401 (J.L.K.); Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (M.C.M.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (V.P.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.W.); Department of Radiology, VA Medical Center, University of California, San Francisco, San Francisco, Calif. (J.Y.); and Department of Radiology, Boston Children's Hospital, Boston, Mass (S.D.B.)
| | - Judy Yee
- From Diversified Radiology of Colorado, 1746 Cole Blvd, #150, Lakewood, CO 80401 (J.L.K.); Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (M.C.M.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (V.P.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.W.); Department of Radiology, VA Medical Center, University of California, San Francisco, San Francisco, Calif. (J.Y.); and Department of Radiology, Boston Children's Hospital, Boston, Mass (S.D.B.)
| | - Stephen D Brown
- From Diversified Radiology of Colorado, 1746 Cole Blvd, #150, Lakewood, CO 80401 (J.L.K.); Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (M.C.M.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (V.P.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (M.W.); Department of Radiology, VA Medical Center, University of California, San Francisco, San Francisco, Calif. (J.Y.); and Department of Radiology, Boston Children's Hospital, Boston, Mass (S.D.B.)
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Meyer EC, Lamiani G, Luff D, Brown SD. Voices emerging from the shadows: Radiologic practitioners' experiences of challenging conversations. PATIENT EDUCATION AND COUNSELING 2017; 100:133-138. [PMID: 27639514 DOI: 10.1016/j.pec.2016.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Traditionally, radiologists have practiced their profession behind the scenes. Today, radiologic practitioners face mounting expectations to communicate more directly with patients. However, their experiences with patient communication are not well understood. The aim of this study was to describe the challenges of radiologic practitioners when communicating with patients. METHODS Twelve day-long interprofessional communication skills workshops for radiologic clinicians were held at Boston Children's Hospital. Prior to each workshop, participants were asked to write narratives describing experiences with difficult radiologic conversations that they found particularly challenging or satisfying. The narratives were transcribed and analyzed through thematic content analysis by two researchers. RESULTS Radiologists, radiology trainees, technologists, nurses, and medical interpreters completed 92 narratives. The most challenging aspects of healthcare conversations included: Conveying Serious News (n=44/92; 48%); Expanded Scope of Radiologic Practice (n=37/92; 40%); Inexperience and Gaps in Education (n=15/92; 16%); Clinical Uncertainty (n=14/92; 15%); and Interprofessional Teamwork (n=9/92; 10%). CONCLUSION Radiologic clinicians face substantial communicative challenges focused on conveying serious, unexpected and uncertain diagnoses amid practical challenges and limited educational opportunities. PRACTICE IMPLICATIONS Innovative educational curricula that address these challenges may enhance radiologic practitioners' success in adopting patient-centered communication.
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Affiliation(s)
- Elaine C Meyer
- Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, USA.
| | - Giulia Lamiani
- Department of Health Sciences, Università degli Studi di Milano, San Paolo University Hospital, Via Di Rudinì 8, Milan, Italy.
| | - Donna Luff
- Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, USA.
| | - Stephen D Brown
- Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA, USA.
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Swan JS, Furtado VF, Keller LA, Lotti JB, Saltalamacchia CA, Lennes IT, Salazar GM. Pilot Study of a Patient-Centered Radiology Process Model. J Am Coll Radiol 2016; 14:274-281. [PMID: 27927589 DOI: 10.1016/j.jacr.2016.08.024] [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: 06/10/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The Radiology Process Model (RPM) was previously described in terms of its conceptual basis and proposed survey items. The current study describes the first pilot application of the RPM in the field and the results of initial psychometric analysis. METHODS We used an Institutional Review Board-approved pilot RPM survey in 100 patients having outpatient interventional radiology procedures. The 24 survey items had 4 or 5 levels of severity. We assessed for missing data, items that patients found confusing, any suggestions by patients for additional items and clarity of items from patient feedback. Factor analysis was performed and internal consistency measured. Construct validity was assessed by correlation of patient responses to the items as a summated scale with a visual analog scale (VAS) they completed indicating their interventional radiology experience. RESULTS The visual analog scale and the RPM summated scale were strongly correlated (r = 0.7). Factor analysis showed four factors: interactions with facility and doctors/staff, time-sensitive aspects, pain, and anxiety. The items showed high internal consistency (alpha: 0.86) as a group and approximately 0.7 to 0.9 by the factors. Analysis shows that two items could be deleted (cost and communication between radiologist and referrers). Revision of two items and potential addition of others are discussed. CONCLUSIONS The RPM shows initial evidence of psychometric validity and internal consistency reliability. Minor changes are anticipated before wider use.
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Affiliation(s)
- J Shannon Swan
- Massachusetts General Hospital (MGH) Institute for Technology Assessment, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | | | - Lisa A Keller
- Department of Educational Policy, Research & Administration, University of Massachusetts, Amherst, Massachusetts
| | | | | | - Inga T Lennes
- Harvard Medical School, Boston, Massachusetts; MGH Cancer Center, Boston, Massachusetts
| | - Gloria M Salazar
- Harvard Medical School, Boston, Massachusetts; MGH Imaging, Boston, Massachusetts
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