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Vigier M, Thorson KR, Andritsch E, Schwerdtfeger AR. An Investigation of Patients' and Doctors' Autonomic Nervous System Responses Throughout News-Focused Medical Consultations. HEALTH COMMUNICATION 2024; 39:2256-2266. [PMID: 37753620 DOI: 10.1080/10410236.2023.2261714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Although it is clear that people experience physiological arousal in anticipation of news-focused medical consultations, our knowledge of people's experiences during and throughout these consultations is scarce. We examine interbeat interval responses (IBI) of patients and doctors during real-life medical consultations to understand how the experiences of both parties change throughout these encounters and whether they differ from each other. We also examine how the type of news delivered affects responses. We measured the IBI responses of patients and their oncologists throughout 102 consultations in which providers delivered news (classified as good, bad, or status quo) to patients about a recent computerized tomography scan. We observed two distinct phases of consultations: an initial "news" delivery phase and a subsequent "information" phase. During the news phase, on average, patients' IBI responses rapidly increased-indicating less autonomic arousal over time - whereas doctors' responses did not change over time. In contrast, throughout the information phase, on average, both patients' and doctors' responses remained steady. During the information phase, responses differed based on news type: on average, status quo consultations involved an increase in autonomic arousal, whereas good and bad news consultations involved no changes. Lastly, we observed significant variability in patients' responses during both phases. In sum, on average, patients (but not doctors) experience decreases in autonomic arousal while news is being delivered, suggesting that anticipatory distress regarding these consultations wanes quickly. However, our results also indicate that patients' experiences vary from one another, and future research should focus on factors explaining this variability.
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Affiliation(s)
- Marta Vigier
- Department of Psychology, University of Graz
- Department of Neurobiology, Linköping University
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Walker L, Sivell S. Breaking bad news in a cross-language context: A qualitative study to develop a set of culturally and linguistically appropriate phrases and techniques with Zulu speaking cancer patients. PATIENT EDUCATION AND COUNSELING 2022; 105:2081-2088. [PMID: 35193783 DOI: 10.1016/j.pec.2022.01.007] [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] [Received: 12/19/2020] [Revised: 12/15/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Breaking bad news (BBN) in healthcare is common. Guidelines abound but little is documented in an African context. We wanted to describe Zulu speaking patients' BBN experience and assess their opinions of internationally recommended techniques. METHODS BBN techniques were highlighted from the literature using systematic review methods. Semi-structured focus group interviews with Zulu speaking cancer patients were conducted. Data were analysed using Framework Analysis. RESULTS Language concordance was central - regardless of whether this necessitated a nurse acting as translator. While non-abandonment, empathy and maintenance of hope was valued by participants, an oft-expressed belief in positive outcomes accounted for mixed responses to phrases implying ambiguity. In contrast, "I wish" phrases were appreciated. Silence received mixed responses with a strong dislike for silence as a front for non-disclosure. CONCLUSION Language-related concerns dictated the bulk of participants BBN perspectives. While cultural and linguistic differences exist, good communication skills, empathy and the maintenance of hope remain central. PRACTICE IMPLICATIONS BBN in a language in which the patient is fluent, whether mediated or not, should be the standard of care. Cultural and linguistic variance must be born in mind and clinicians should become familiar with the preferences of the communities they serve.
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Affiliation(s)
- Louise Walker
- Cardiff University, Wales, UK; Greys Hospital, Private Bag 9001, Pietermaritzburg 3200, KwaZulu Natal, South Africa.
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK
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McDaniel SH, Morse DS, Edwardsen EA, Taupin A, Gurnsey MG, Griggs JJ, Shields CG, Reis S. Empathy and boundary turbulence in cancer communication. PATIENT EDUCATION AND COUNSELING 2021; 104:2944-2951. [PMID: 33947581 PMCID: PMC8517043 DOI: 10.1016/j.pec.2021.04.002] [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] [Received: 09/08/2020] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To describe and deepen our understanding of patient-centeredness, empathy, and boundary management in challenging conversations. Previous studies show frequent physician self-disclosure, while empathy and boundary management are infrequent. METHODS Three standardized patients (SPs) portrayed cancer patients consulting a new community-based physician, resulting in 39 audio-recorded SP visits to 19 family physicians and 20 medical oncologists. Transcripts underwent qualitative iterative thematic analysis, informed by grounded theory, followed by directed content analysis. We further defined the identified communicative categories with descriptive and correlational calculations. RESULTS We identified patient-centered physician response categories--empathy, affirmation, and acknowledgement; and physician-centered categories-transparency, self-disclosure, and projection. Acknowledgement and affirmation responses were frequent and empathy rare. Physician transparency and self-disclosure were common. Useful and not useful self-disclosures were highly correlated; empathy, useful and not useful transparency, and projection were moderately correlated. Most physicians used self-disclosure but few of these were judged patient-centered. CONCLUSIONS Physicians expressing empathy and patient-centered transparency were also more likely to use projection and physician-centered transparency, thus engaging in communication "boundary turbulence." Patients may benefit from physicians' improved use of empathy and boundary management.
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Affiliation(s)
- Susan H McDaniel
- Dr. Laurie Sands Distinguished Professor of Families & Health, Departments of Psychiatry & Family Medicine, University of Rochester School of Medicine, Rochester, NY, USA.
| | - Diane S Morse
- Associate Professor of Psychiatry and Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Elizabeth A Edwardsen
- Associate Professor of Emergency Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Adam Taupin
- Equilibria Psychological and Consultation Services, Philadelphia, PA, USA
| | | | - Jennifer J Griggs
- Professor of Internal Medicine, Hematology & Oncology Division, University of Michigan, Ann Arbor, MI, USA
| | - Cleveland G Shields
- Professor of Marriage & Family Therapy, Purdue University, West Lafayette, IN, USA
| | - Shmuel Reis
- Professor of Medical Education, Faculty of Medicine, Hebrew University/Hadassah, Jerusalem, Israel
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'Difficult Conversations with Patients'-A Modified Group Objective Structured Clinical Experience for Medical Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115772. [PMID: 34072179 PMCID: PMC8197999 DOI: 10.3390/ijerph18115772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/30/2022]
Abstract
This study presents a modified Group Objective Structured Clinical Experience (GOSCE) focused on difficult conversations, in which, due to limited time and financial resources, only some students could actively participate in scenarios. We aimed to evaluate the intervention, including differences between them and observers. The intervention was organized for sixth-year medical students at a Polish medical university. The study protocol assumed a pre-post analysis of students' attitudes and self-efficacy of communication skills and their opinions about the intervention. Complete questionnaire pairs were returned by 126 students. The pre-post analysis revealed a significant improvement in their self-efficacy levels of almost all skills as well as their affective attitudes and belief in outcomes of communication learning. The improvement was significant among both the active participants and observers. It also showed a decrease in the motivation score, significant only in females. Regardless of their roles, students had positive opinions about the course and its particular aspects. The modified GOSCE may be an enjoyable and effective learning experience for students, especially in the light of limited resources. However, changes in their motivation score suggest the necessity to increase the importance of communication learning in the curriculum.
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Canary HE, Wilkins V. Beyond Hospital Discharge Mechanics: Managing the Discharge Paradox and Bridging the Care Chasm. QUALITATIVE HEALTH RESEARCH 2017; 27:1225-1235. [PMID: 28682741 DOI: 10.1177/1049732316679811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hospital discharge processes are complex and confusing, and can detrimentally affect patients, families, and providers. This qualitative study investigated pediatric hospital discharge experiences from the perspectives of parents of children with acute and chronic health conditions, primary care providers, and hospitalists. Focus groups and interviews with parents, primary care providers, and hospitalists were used to explore discharge experiences and ideas for improvement offered by participants. Using an iterative approach to analyze data resulted in five major themes for discharge experiences: (a) discharge problems, (b) teamwork, (c) ideal discharge, (d) care chasm, and (e) discharge paradox. The first three themes concern practical issues, whereas the last two themes reflect negative emotional experiences as well as practical problems encountered in the discharge process. Improvements in communication were viewed as a primary strategy for improving the discharge process for better outcomes for patients, their families, and providers.
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Shaw J, Brown R, Dunn S. The impact of delivery style on doctors' experience of stress during simulated bad news consultations. PATIENT EDUCATION AND COUNSELING 2015; 98:1255-1259. [PMID: 26320824 DOI: 10.1016/j.pec.2015.08.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between doctors' bad news delivery style and their experience of physiological stress during simulated bad news consultations. METHODS 31 doctors participated in two simulated breaking bad news (BBN) consultations. Delivery style was categorized as either blunt, forecasting or stalling (i.e. avoidant), based on the time to deliver the bad news and qualitative analysis of the interaction content and doctor's language style. Doctors' heart rate (HR) and skin conductance (SC) were recorded in consecutive 30s epochs. RESULTS Doctors experienced a significant decrease in HR (F(1,36)=44.9, p<.0001) and SC (F(1,48)=5.6, p<.001) between the pre- and post-news delivery phases of the consultation. Between-group comparisons for the three delivery styles did not identify any significant differences in HR (F(2,36)=2.2, p>.05) or SC (F(2,48)=.66, p>.05). CONCLUSION AND PRACTICE IMPLICATIONS Doctors experience heightened stress in the pre-news delivery phase of breaking bad news interactions. Delaying the delivery of bad news exposes doctors to a longer period of increased stress.This suggests that medical students and doctors should be taught to deliver bad news without delay, to help mitigate their response to this stressful encounter.
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Affiliation(s)
- Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney Australia.
| | - Rhonda Brown
- Research School of Psychology, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra Australia
| | - Stewart Dunn
- Pam McLean Centre, Sydney Medical School, The University of Sydney, Sydney Australia
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De Wolf R, Pierson J. Who’s my audience again? Understanding audience management strategies for designing privacy management technologies. TELEMATICS AND INFORMATICS 2014. [DOI: 10.1016/j.tele.2013.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Renkema E, Broekhuis MH, Ahaus K. Explaining the unexplainable - the impact of physicians' attitude towards litigation on their incident disclosure behaviour. J Eval Clin Pract 2014; 20:649-56. [PMID: 24903087 DOI: 10.1111/jep.12194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2014] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES This study aims to provide in-depth insight into the emotions and thoughts of physicians towards malpractice litigation, and how these relate to their incident disclosure behaviour. METHODS Thirty-one Dutch physicians were interviewed and completed short questionnaires regarding malpractice litigation. We used hierarchical cluster analysis to identify physician clusters. Additional qualitative data were analysed. RESULTS Physicians vary largely in their attitude towards malpractice litigation, and their attitude is not straightforward related to their disclosure behaviour. Based on their responses physicians could be divided into two clusters: one with a positive and one with a negative attitude. Physicians with a negative attitude showed often, but also 6 out of 15 not, a reluctance to disclose, whereas the majority in the positive attitude cluster (12 out of 16) showed no reluctance. If, what and how physicians disclose incidents depends on a complex interplay of their emotions and thoughts regarding litigation, and not only on their fear of litigation as many studies assume. CONCLUSIONS Due to the variation among physicians in their litigation attitude and behaviour in terms of incident disclosure the oft-heard call for 'openness' about medical incidents will not be easy to achieve. A coaching system in which physicians can share and discuss their differing attitudes and disclosure principles, teaching medical students and junior physicians about disclosure, and explaining how to organize emotional and legal support for oneself in case of litigation could decrease stress feelings and support open disclosure behaviour.
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Affiliation(s)
- Erik Renkema
- Faculty of Economics and Business, Operations Department, University of Groningen, Groningen, The Netherlands
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Bute JJ, Petronio S, Torke AM. Surrogate decision makers and proxy ownership: challenges of privacy management in health care decision making. HEALTH COMMUNICATION 2014; 30:799-809. [PMID: 25175060 PMCID: PMC5003017 DOI: 10.1080/10410236.2014.900528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study explored the communicative experiences of surrogates who served as decision makers for patients who were unable to convey health information and choices about treatment options. Drawing on assumptions from communication privacy management theory (Petronio, 2002), 35 surrogates were interviewed to explore how they navigated the role of guardian of patients' private health information while the patient was hospitalized. This research determined that not only are surrogates guardians and thereby co-owners of the patients' private health information, they actually served in a "proxy ownership" role. Surrogates described obstacles to both obtaining and sharing private health information about the patient, suggesting that their rights as legitimate co-owners of the patients' information were not fully acknowledged by the medical teams. Surrogates also described challenges in performing the proxy ownership role when they were not fully aware of the patient's wishes. Theoretical and practical implications of these challenges are discussed.
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Affiliation(s)
- Jennifer J. Bute
- Department of Communication Studies, IU School of Liberal Arts, Indiana University-Purdue University Indianapolis, Cavanaugh Hall 307J, 425 University Blvd, Indianapolis, IN 46202, 317-274-2090
| | - Sandra Petronio
- IU School of Liberal Arts, Department of Communication Studies, IU School of Medicine, Campus of Indiana University-Purdue University, Indianapolis (IUPUI)
- Charles Warren Fairbanks Center for Medical Ethics, IU Health,
| | - Alexia M. Torke
- Indiana University, Indiana University Center for Aging Research, Regenstrief Institute, Inc., Fairbanks Center for Medical Ethics, HITS Building Suite 2000, 410 W. 10th St., Indianapolis, IN 46202, 317-423-5649,
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Layat Burn C, Hurst SA, Ummel M, Cerutti B, Baroffio A. Telling the truth: medical students' progress with an ethical skill. MEDICAL TEACHER 2014; 36:251-259. [PMID: 24499052 DOI: 10.3109/0142159x.2013.853118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Truth-telling is a complex task requiring multiple skills in communication, understanding, and empathy. Its application in the context of breaking bad news (BBN) is distressing and problematic if conducted with insufficient skills. PURPOSE We investigated the long-term influence of a simulated patient-based teaching intervention integrating the learning of communication skills within an ethical reflection on students' ethical attitudes towards truth-telling, perceived competence and comfort in BBN. METHODS We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). We analysed their ethical attitudes and level of comfort and competence in BBN before, after the intervention, and during clinical rotations. RESULTS Students' ethical attitudes towards truth-telling remained stable. Students feeling uncomfortable or incompetent improved their level of perceived comfort or competence after the intervention, but those feeling comfortable or competent became more aware of the difficulty of the situation, and consequently decreased their level of comfort and competence. CONCLUSIONS Confronting students with a realistic situation and integrating the practice of communication skills within an ethical reflection may be effective in maintaining ethical attitudes towards truth-telling, in developing new skills and increasing awareness about the difficulty and challenges of a BBN situation.
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Petronio S, Torke A, Bosslet G, Isenberg S, Wocial L, Helft PR. Disclosing medical mistakes: a communication management plan for physicians. Perm J 2013; 17:73-9. [PMID: 23704848 DOI: 10.7812/tpp/12-106] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians' own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. METHODS This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. RESULTS The steps are 1) physician preparation, such as talking about the physician's emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. CONCLUSION This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.
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Affiliation(s)
- Sandra Petronio
- Department of Communication Studies at Indiana University School of Liberal Arts at Indiana University-Purdue University Indianapolis, USA.
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Petronio S, Helft PR, Child JT. A case of error disclosure: a communication privacy management analysis. J Public Health Res 2013; 2:e30. [PMID: 25170501 PMCID: PMC4147749 DOI: 10.4081/jphr.2013.e30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/23/2022] Open
Abstract
To better understand the process of disclosing medical errors to patients, this research offers a case analysis using Petronios’s theoretical frame of Communication Privacy Management (CPM). Given the resistance clinicians often feel about error disclosure, insights into the way choices are made by the clinicians in telling patients about the mistake has the potential to address reasons for resistance. Applying the evidenced-based CPM theory, developed over the last 35 years and dedicated to studying disclosure phenomenon, to disclosing medical mistakes potentially has the ability to reshape thinking about the error disclosure process. Using a composite case representing a surgical mistake, analysis based on CPM theory is offered to gain insights into conversational routines and disclosure management choices of revealing a medical error. The results of this analysis show that an underlying assumption of health information ownership by the patient and family can be at odds with the way the clinician tends to control disclosure about the error. In addition, the case analysis illustrates that there are embedded patterns of disclosure that emerge out of conversations the clinician has with the patient and the patient’s family members. These patterns unfold privacy management decisions on the part of the clinician that impact how the patient is told about the error and the way that patients interpret the meaning of the disclosure. These findings suggest the need for a better understanding of how patients manage their private health information in relationship to their expectations for the way they see the clinician caring for or controlling their health information about errors. Significance for public health Much of the mission central to public health sits squarely on the ability to communicate effectively. This case analysis offers an in-depth assessment of how error disclosure is complicated by misunderstandings, assuming ownership and control over information, unwittingly following conversational scripts that convey misleading messages, and the difficulty in regulating privacy boundaries in the stressful circumstances that occur with error disclosures. As a consequence, the potential contribution to public health is the ability to more clearly see the significance of the disclosure process that has implications for many public health issues.
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Affiliation(s)
- Sandra Petronio
- Department of Communication Studies, Indiana School of Liberal Arts and Indiana School of Medicine, Indiana University-Purdue University , Indianapolis, IN, USA ; Charles Warren Fairbanks Centre for Medical Ethics , Indianapolis, IN, USA
| | - Paul R Helft
- Charles Warren Fairbanks Centre for Medical Ethics , Indianapolis, IN, USA ; Division of Hematology/Oncology, Indiana University School of Medicine , Indianapolis, IN, USA
| | - Jeffrey T Child
- School of Communication Studies, Kent State University , OH, USA
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van Vliet L, Francke A, Tomson S, Plum N, van der Wall E, Bensing J. When cure is no option: how explicit and hopeful can information be given? A qualitative study in breast cancer. PATIENT EDUCATION AND COUNSELING 2013; 90:315-322. [PMID: 21555199 DOI: 10.1016/j.pec.2011.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/27/2011] [Accepted: 03/29/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To investigate how oncologists can balance explicit with general and realistic with hopeful information when discussing various topics at the transition from curative to palliative care in breast cancer. METHODS Qualitative analysis of focus groups consisting of female breast cancer survivors and healthy women. RESULTS Perceptions of survivors and healthy women largely overlapped. Participants thought that oncologists can help patients regain a future perspective during this consultation. To achieve this, four themes seemed important: honest medical information, availability of continued support, hope has many faces, and space to choose. Moreover, participants stressed they would need time to let the message sink in before any further information was provided. CONCLUSION Participants thought that when confronted with this type of consultation they would need - more or less explicit - medical information and information regarding support. In order to maintain hope, knowledge about (treatment) possibilities is important, but also the certainty not to be abandoned by the hospital at a later stage of the disease and the confidence to remain able to make one's own decisions. PRACTICE IMPLICATIONS A life-limiting diagnosis may shatter patients' future perspective; however, this study provides suggestions for oncologists to create a new perspective.
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Affiliation(s)
- Liesbeth van Vliet
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
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When clinicians telling the truth is de facto discouraged, what is the family’s attitude towards disclosing to a relative their cancer diagnosis? Support Care Cancer 2012; 21:1089-95. [DOI: 10.1007/s00520-012-1629-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/14/2012] [Indexed: 10/27/2022]
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Bylund CL, Peterson EB, Cameron KA. A practitioner's guide to interpersonal communication theory: an overview and exploration of selected theories. PATIENT EDUCATION AND COUNSELING 2012; 87:261-7. [PMID: 22112396 PMCID: PMC3297682 DOI: 10.1016/j.pec.2011.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/16/2011] [Accepted: 10/22/2011] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To provide a brief overview of selected interpersonal theories and models, and to present examples of their use in healthcare communication research. RESULTS Nine interpersonal communication theories and their application to healthcare communication are discussed. CONCLUSION As healthcare communication interactions often occur at an interpersonal level, familiarity with theories of interpersonal communication may reinforce existing best practices and lead to the development of novel communication approaches with patients. PRACTICE IMPLICATIONS This article serves as an introductory primer to theories of interpersonal communication that have been or could be applied to healthcare communication research. Understanding key constructs and general formulations of these theories may provide practitioners with additional theoretical frameworks to use when interacting with patients.
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Affiliation(s)
- Carma L Bylund
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York City, USA.
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Shaw J, Dunn S, Heinrich P. Managing the delivery of bad news: an in-depth analysis of doctors' delivery style. PATIENT EDUCATION AND COUNSELING 2012; 87:186-192. [PMID: 21917397 DOI: 10.1016/j.pec.2011.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 07/19/2011] [Accepted: 08/11/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The purpose of this study was to identify and describe the delivery styles doctors typically use when breaking bad news (BBN). METHODS Thirty one doctors were recruited to participate in two standardised BBN consultations involving a sudden death. Delivery styles were determined using time to deliver the bad news as a standardised differentiation as well as qualitative analysis of interaction content and language style. Communication performance was also assessed. RESULTS Analysis of BBN interactions revealed three typical delivery styles. A blunt style characterised by doctors delivering news within the first 30 s of the interaction; Forecasting, a staged delivery of the news within the first 2 min and a stalling approach, delaying news delivery for more than 2 min. This latter avoidant style relies on the news recipient reaching a conclusion about event outcome without the doctor explicitly conveying the news. CONCLUSION Three typical bad news delivery styles used by doctors when BBN were confirmed both semantically and operationally in the study. The relationship between delivery style and the overall quality of BBN interactions was also investigated. PRACTICE IMPLICATIONS This research provides a new template for approaching BBN training and provides evidence for a need for greater flexibility when communicating bad news.
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Affiliation(s)
- Joanne Shaw
- Surgical Outcomes Research Centre (SOuRCe), School of Public Health, University of Sydney, Australia.
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Torke AM, Petronio S, Sachs GA, Helft PR, Purnell C. A conceptual model of the role of communication in surrogate decision making for hospitalized adults. PATIENT EDUCATION AND COUNSELING 2012; 87:54-61. [PMID: 21889865 PMCID: PMC3246097 DOI: 10.1016/j.pec.2011.07.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 07/13/2011] [Accepted: 07/31/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To build a conceptual model of the role of communication in decision making, based on literature from medicine, communication studies and medical ethics. METHODS We proposed a model and described each construct in detail. We review what is known about interpersonal and patient-physician communication, described literature about surrogate-clinician communication, and discussed implications for our developing model. RESULTS The communication literature proposes two major elements of interpersonal communication: information processing and relationship building. These elements are composed of constructs such as information disclosure and emotional support that are likely to be relevant to decision making. We propose these elements of communication impact decision making, which in turn affects outcomes for both patients and surrogates. Decision making quality may also mediate the relationship between communication and outcomes. CONCLUSION Although many elements of the model have been studied in relation to patient-clinician communication, there is limited data about surrogate decision making. There is evidence of high surrogate distress associated with decision making that may be alleviated by communication-focused interventions. More research is needed to test the relationships proposed in the model. PRACTICE IMPLICATIONS Good communication with surrogates may improve both the quality of medical decisions and outcomes for the patient and surrogate.
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Affiliation(s)
- Alexia M Torke
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, IN 46202, USA.
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Abstract
Excellence as a surgeon requires not only the technical and intellectual ability to effectively take care of surgical disease but also an ability to respond to the needs and questions of patients. This article provides an overview of the importance of communication skills in optimal surgical palliation and offers suggestions for a multidisciplinary team approach, using the palliative triangle as the ideal model of communication and interpersonal skills. This article also discusses guidelines for advanced surgical decision making and outlines methods to improve communication skills.
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Affiliation(s)
- Thomas J Miner
- Department of Surgery, The Alpert Medical School of Brown University, Rhode Island Hospital, Providence, 02903, USA.
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Hulsman RL, Smets EMA, Karemaker JM, de Haes HJCJM. The psychophysiology of medical communication. Linking two worlds of research. PATIENT EDUCATION AND COUNSELING 2011; 84:420-427. [PMID: 21676575 DOI: 10.1016/j.pec.2011.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Medical communication is goal oriented behavior. As such, it can be modeled as a chain of decisions, resulting from cognitive and emotional processes each potentially associated with psychophysiological reactions. Psychophysiological may be helpful to detect small changes in affect or arousal in the course of a consultation that would be difficult to detect by other evaluations of the process, like self-reports. The question is how psychophysiological communication research should be modeled for unraveling in more detail the cognitive, emotional and interpersonal processes which underlie physician and patient behavior. METHODS In the world of medical communication research the six-function model of medical communication reveals a number of fundamental perceptual, cognitive and emotional processes which may evoke psychophysiological responses. The world of psychophysiological research encompasses domains of perception, mental imagery, anticipation and action which all have close connections with fundamental tasks in communication. CONCLUSION This paper discusses ten methodological issues in linking continuous psychophysiological data to verbal and nonverbal events in a medical consultation observed with the Verona coding system. PRACTICE IMPLICATIONS When linking the two worlds of research, the methodological challenges discussed need to be solved to obtain a valid and reliable application of psychophysiological measures in medical communication research.
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Affiliation(s)
- Robert L Hulsman
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Veysman BD. Breaking Bad Nuisance. Acad Emerg Med 2011. [DOI: 10.1111/j.1553-2712.2011.01139.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Miner TJ. Communication skills in palliative surgery: skill and effort are key. Surg Clin North Am 2011; 91:355-66, ix. [PMID: 21419258 DOI: 10.1016/j.suc.2010.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Excellence as a surgeon requires not only the technical and intellectual ability to effectively take care of surgical disease but also an ability to respond to the needs and questions of patients. This article provides an overview of the importance of communication skills in optimal surgical palliation and offers suggestions for a multidisciplinary team approach, using the palliative triangle as the ideal model of communication and interpersonal skills. This article also discusses guidelines for advanced surgical decision making and outlines methods to improve communication skills.
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Affiliation(s)
- Thomas J Miner
- Department of Surgery, The Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA.
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Petronio S, Sargent J. Disclosure predicaments arising during the course of patient care: nurses' privacy management. HEALTH COMMUNICATION 2011; 26:255-266. [PMID: 21347936 DOI: 10.1080/10410236.2010.549812] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
At times, nurses receive patient disclosures that have the potential to create challenges resulting in needs for strategies to manage patient information and expectations. This study examines disclosure predicaments nurses experience in critical care and emergency units at a large urban hospital. Utilizing the constant comparative method to identify disclosure themes guided by the principles of communication privacy management (CPM), the findings show that nurses regulate patient privacy in the role of stakeholder confidants. Second, disclosure predicaments occur in three different contexts: during the course of nurses' professional routine; when the nurses created safe terminals or havens for patients to talk; and when family matters became an inseparable part of caring for the patient. Third, the results indicate that there are several specific strategies that nurses use to manage disclosure predicaments they encounter. The lens of CPM is used to interpret these findings and offers a context in which to better understand the needs of nurses concerning patient disclosive behavior and privacy issues for nurses.
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Affiliation(s)
- Sandra Petronio
- Department of Communication Studies and Indiana University School of Medicine, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46228, USA.
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Murray GF. "Though medicine can be learned, it cannot be taught"-the first 100 years: flexnerian competency 2010. Ann Thorac Surg 2010; 90:1-10. [PMID: 20609738 DOI: 10.1016/j.athoracsur.2010.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 03/12/2010] [Accepted: 03/16/2010] [Indexed: 12/31/2022]
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How stressful is doctor–patient communication? Physiological and psychological stress of medical students in simulated history taking and bad-news consultations. Int J Psychophysiol 2010; 77:26-34. [DOI: 10.1016/j.ijpsycho.2010.04.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Revised: 03/06/2010] [Accepted: 04/08/2010] [Indexed: 11/18/2022]
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Cleary M, Hunt GE, Escott P, Walter G. Receiving Difficult News: Views of Patients in an Inpatient Setting. J Psychosoc Nurs Ment Health Serv 2010; 48:40-8. [DOI: 10.3928/02793695-20100504-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 02/16/2010] [Indexed: 11/20/2022]
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Hulsman RL. Shifting goals in medical communication. Determinants of goal detection and response formation. PATIENT EDUCATION AND COUNSELING 2009; 74:302-8. [PMID: 19135823 DOI: 10.1016/j.pec.2008.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 12/03/2008] [Accepted: 12/03/2008] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Research and education of medical communication different perspective, making the extraction of clear recommendations from research that can be applied in education not always possible. In education, medical communication is encountered from a goal-oriented perspective, which is often lacking in quantitative research where the relationship between process variables and the content of medical practice is often ignored. The aim of this paper is to bring the worlds of research and education together by presenting a comprehensive model of determinants explaining the behavior of physicians in daily practice. A basic notion in this model is that medical communication is goal-oriented, problem-solving behavior. Goals in communication are not fixed, but permanently changing over time. Hence, communication abilities do not rely on behavioral skills only but also on perceptual skills in identifying goals. A number of determinants affect the cognitive processes of goal appraisal and response formation: knowledge, attitudes, social norms, self-efficacy, stressors and interfering goals. CONCLUSION Modeling medical communication as goal-oriented problem-solving behavior, and recognizing the complexity of goal appraisal and other key determinants of response formation may provide a common focus for both research and education in measuring, explaining and improving the HCP's behavior. PRACTICE IMPLICATIONS In education not only skill practicing but also reflection on the process and outcomes is important to understand how one acts in practice situations and should act in future situations. In research measurements should be expanded to take contextual and goal-oriented dimensions of the process of communication into account to make findings more relevant for education and practice.
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Affiliation(s)
- Robert L Hulsman
- Academic Medical Centre Amsterdam, Dept. of Medical Psychology, J3, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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Rousseau PC. Recent Literature. J Palliat Med 2008. [DOI: 10.1089/jpm.2008.9966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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